Uncircumcised men can suffer from a condition known as phimosis, when the foreskin becomes tight and cannot be retracted back over the head of the penis. This can cause discomfort, irritation, difficulty with urination, and pain or even cracking of the skin with erections and intercourse. This can be treated with topical medications or can be definitively treated with a circumcision. The circumcision is performed as a day surgery with the man going home the same day and is typically tolerated very well.
Repair of Incomplete Circumcision in Adults
Some men who have undergone circumcision in the past may have some redundant foreskin left behind which can cause similar problems as listed above under adult circumcision. A circumcision revision can alleviate these problems.
Treatment of Spermatoceles
A spermatocele or epididymal cyst, is a non-cancerous, fluid filled cyst that is an outpocketing from the epididymis (the structure on the testicle where sperm mature connecting to the vas deferens). It is estimated that 30% of all men have spermatoceles. Spermatoceles are typically diagnosed by physical examination and/or by ultrasound. Ultrasound is a relatively inexpensive, painless, reliable test that allows visualization of the spermatocele to confirm that it is indeed a spermatocele. Ultrasounds are performed in a private, comfortable environment in the office at Austin Center for Men’s Health. Over time, spermatoceles will either stay the same size or grow larger. Spermatoceles that grow large or cause pain can be surgically removed, but the timing of doing so should be considered carefully as this treatment may impact the man’s fertility.
Spermatoceles are removed surgically as a day surgery where the patient goes home the same day. Ice packs are recommended for the first 2 days after the procedure to minimize swelling. Oral pain medicine is used to control discomfort after the procedure. Scrotal swelling is typical after surgery and may last for up to 3 weeks after spermatocele surgery.
Spermatoceles do not increase the risk for testicular cancer.
Treatment of Hydroceles
Hydroceles in adults present as swelling of the scrotum caused by excessive fluid secretion by the layer of tissue tightly covering the testicle without adequate reabsorption by the sack surrounding the testicle. Hydroceles will either stay the same size or grow larger. If a hydrocele becomes large enough it can cause discomfort, heaviness, or may be cosmetically unpleasing. In these cases, the hydrocele can be surgically repaired.
Dr. Kavoussi is not only very experienced in such treatments, but has written the textbook chapters describing the surgical techniques for many of the procedures listed above in the textbooks used by urologists around the globe. (Parviz K. Kavoussi, Raymond A. Costabile. Chapter 37, Surgery of the Scrotum and Seminal Vesicles. Campbell-Walsh Urology, 10th edition. Saunders Co. Wein, Kavoussi, Partin, Peters, eds. ; as well as Parviz K. Kavoussi, Raymond A. Costabile. Chapter 23, Disorders of Scrotal Contents: Orchitis, Epididymitis, Testicular Torsion, Torsion of the Appendages, and Fournier’s Gangrene. Practical Urology: Essential Principles and Practice. Springer Co. Chapple, Steers, eds.)
Placement of Testicular Prosthesis
Men who have absence of one or both testicles due to absence from the time of birth, loss of testicle due to torsion (twisting), trauma, or cancer may undergo placement of a saline filled testicular prosthesis. The prosthesis is designed to have the texture, weight, and shape of the natural testis and is sized at the time of surgery to match the natural testis in men having one prosthesis placed.
Anejaculation is the inability to ejaculate semen although it is not uncommon to have normal orgasm. Anejaculation can be a result of spinal cord injuries, nervous system disorders, trauma or severe infection to the pelvis, certain surgical procedures such as those required to remove lymph nodes for testicular cancer, and certain pelvic surgeries. Hormonal factors and psychological stress can be factors as well. Men with anejaculation who want to have children typically still have normal sperm production in the testicles. Techniques can be used to stimulate ejaculation or for surgical sperm retrieval directly from the testicle for use with assisted reproductive technology. There are certain medications that can cause anejaculation and it may be reversed with discontinuation of such medications.
Delayed ejaculation occurs in 1-4% of men. Delayed ejaculation can be due to medications, alcohol, illicit drugs, and nerve damage.
Retrograde ejaculation occurs when semen does not leave the penis during ejaculation, but goes back in the bladder instead. Retrograde ejaculation is not dangerous to a man’s health, but can adversely impact a man’s fertility. Retrograde ejaculation is thought to occur in only 0.3%-2% of subfertile men. Retrograde ejaculation does not impact a man’s ability to have an erection or even to orgasm. Typically a man becomes aware of retrograde ejaculation when there is difficulty conceiving. It is common for a man to notice cloudy appearing urine after ejaculation if retrograde ejaculation is occurring. Retrograde ejaculation can be due to certain surgeries such as specific prostate surgeries, bladder surgeries, or vertebral surgeries low in the spine. Nerve damage from diabetes or multiple sclerosis can result in retrograde ejaculation. Certain medications such as specific ones to treat an enlarged prostate can cause retrograde ejaculation. The diagnosis of retrograde ejaculation is made by locating sperm microscopically in the urine after ejaculation. Retrograde ejaculation is typically only treated for fertility purposes; otherwise, it is not harmful. Some of the causes listed above, such as medications, are reversible. If the cause of retrograde ejaculation is not reversible, some medications can be used to help treat retrograde ejaculation. If the man does not respond to such medicines and the couple is trying to conceive, the sperm from a urine sample after ejaculation can be isolated and used with reproductive techniques.