If you are thinking about getting a vasectomy, you are not alone. Each year, more than 500,000 men in the U.S. choose vasectomy as permanent birth control. During vasectomy, each vas deferens (the two tubes that move sperm) are sealed off. This blocks sperm from reaching the semen that is ejaculated from the penis. After a vasectomy, the testicles still make sperm but they are absorbed by the body. A vasectomy prevents pregnancy better than any other method of birth control, except abstinence. Only 1 to 2 women out of 1,000 will get pregnant in the first year after their partners have had a vasectomy.
Your doctor can perform a vasectomy in an office or hospital. Vasectomy is a minor surgery that should take about 20 minutes. One urologist who performs vasectomies tells his patients: “take a long hot shower the morning before with a lot of soap. And make sure you have a bag of frozen peas and a couple of rented movies at home.”
Before the vasectomy, your scrotum will be shaved and cleaned. Usually local anesthesia is used. So you will be awake but should not feel any pain. Some patients may also be given medicine to reduce anxiety. With a standard vasectomy, the urologist makes one or two small cuts in the scrotum. One vas deferens tube is cut and tied or sealed with heat. The tube is replaced inside the scrotum. The procedure is then repeated on the other side. Lastly, the skin is closed with stitches that dissolve and do not have to be removed.
Another popular option is a no-scalpel vasectomy. In this procedure, a small clamp with pointed ends is used to puncture the skin. Then each vas deferens is lifted out, cut, sealed and then put back in place. A no-scalpel vasectomy works just as well as a standard vasectomy. Some benefits of a no-scalpel vasectomy are less bleeding, swelling and pain. There is also a smaller hole in the skin.
Vasectomy is a minor surgery that should take about 20 minutes
About 1-2% of men may have ongoing pain or discomfort after a vasectomy. The pain is most often treated with antiinflammatory drugs, like ibuprofen. Exact causes of pain is not known, but in some cases, additional medical or surgical treatment may be needed.
Otherwise, the risk of bad side effects after a vasectomy is very low, but may include:
- Bleeding under the skin, which may cause swelling or bruising. (Call your doctor if your scrotum swells a lot soon after your surgery.)
- Infection at the site of the cut. It is rare for an infection to occur inside the scrotum.
- A small lump forming because sperm leaks from a vas deferens into nearby tissue. This is usually not painful. If it is painful, it can be treated with rest and pain medicine. Sometimes, surgery may be needed to remove the lump.
- Swelling of the vas deferens
- In rare cases, the vas deferens may grow back together, which would allow the man to have children again.
Older studies suggested a risk of prostate cancer and heart disease years later in men who have had vasectomies. But many years of research since then have found no link between vasectomy and these health problems.
More than 500,000 men have vasectomies in the U.S. each year.
Your scrotum will be numb for one to two hours after a vasectomy. Put cold packs on the area. (The bag of frozen peas mentioned before works well.) Lie on your back as much as you can for the rest of the day. Mild discomfort or pain is normal after a vasectomy, and should be treated with pain relievers. Wearing snug underwear or a jockstrap will help ease discomfort and support the area.
You may have some swelling and minor pain in your scrotum for a few days after the surgery. You may be able to go back to work in one or two days. It depends on how you feel. But you should avoid heavy lifting for a week. You can have sex again as soon as you are comfortable, usually within a week. But keep in mind that the vasectomy is not effective from day one. Sperm may still be in the semen for many months after a vasectomy. It takes about 20 ejaculations or three months to clear the sperm from the tubes. However, results vary for different men. Most often, your urologist will test your sperm count three months later. This is done to make sure your semen is clear of sperm. Until the sperm count is zero or there are very few non-moving sperm, sex without another method of birth control may lead to pregnancy.
After recovering from a vasectomy, a man and his partner should notice no difference during sex. An uncomplicated vasectomy does not cause erection problems. Ejaculation and orgasm should feel the same. The amount of semen does not decrease more than five percent. The only change your partner may be able to feel is a lump at the vasectomy site if one has formed.
THINGS TO THINK ABOUT
The choice to have a vasectomy is a very personal one. Talk with your partner, and think about what is best for you and your family. Be sure to bring up any questions you may have with your health care provider.
Below are some things to keep in mind:
- Vasectomy is safer and cheaper than tubal ligation (blocking the fallopian tubes to prevent pregnancy) in women.
- The one-time cost of a vasectomy may be cheaper over time than the cost of other birth control methods, such as condoms or the pill.
- A vasectomy does not protect against sexually transmitted diseases (STDs). Use condoms to protect against STDs.
Lastly, it is important to note vasectomy is a permanent method of birth control. This may be a plus or a minus based on your own situation. You should not have a vasectomy if you may want to father children in the future. While it is possible to have a vasectomy reversed, this is more complex and costly. Also, reversing or “undoing” a vasectomy does not always result in pregnancy. So it is important to think through all your choices carefully before deciding to have a vasectomy.
In English: http://familydoctor.org/familydoctor/en/prevention-wellness/sex-birth-control/birth-control/vasectomy-what-to-expect.html
In Spanish: http://familydoctor.org/familydoctor/es/prevention-wellness/sex-birth-control/birth-control/vasectomy-what-to-expect.html
National Library of Medicine, Medline Plus
In English: http://www.nlm.nih.gov/medlineplus/ency/article/002995.htm
In Spanish: http://www.nlm.nih.gov/medlineplus/spanish/ency/article/002995.htm
Urology Care Foundation
For more facts about testicular cancer and other urologic health problems, please visit the Urology Care Foundation’s website, UrologyHealth.org.
Data from the 2018 Practice Impact Report shows that, over the past decade, 1,653 community oncology clinics and/or practices have closed, been acquired by hospitals, undergone corporate mergers, or reported they are struggling financially.
The mission of Community Oncology Alliance (COA) is to ensure cancer patients receive quality, affordable, and accessible cancer care in their own communities. More than 1.5 million people in the United States are diagnosed with cancer each year, and deaths from the disease have been steadily declining due to earlier detection, diagnosis and treatment.
Dayton Physicians Network (DPN) is the premiere independent cancer treatment clinic in the Miami Valley. It’s not at risk of closing, and that’s due, in large part, to its partnership with COA and the advocacy work being done since the DPN COA Patient Advocacy Network Chapter (CPAN) opened locally three years ago.
As of January 2019, according to the National Cancer Institute, nearly 17 million Americans survived cancer, and the majority of them are being treated in independent treatment centers, said Rose Gerber, director of patient advocacy and education for the Community Oncology Alliance.
With independent treatment centers, patients receive highly personalized care. This isn’t just for the primary care when the patients are receiving cancer treatments, but also for the five-year follow-along period after the completion of treatment. Patients see the same doctors and nurses – even the receptionist is consistent. This is important, because beating cancer is an experience unique to each individual.
“Treating cancer isn’t just physical, it’s emotional,” Gerber said. “The continuity of care in the same setting is very important to patients.”
In a hospital setting, patients are often meeting new care providers each time they receive treatment, Gerber said. In this environment, the continuum of care is difficult to maintain. When you receive your care through independent centers, the doctors and nurses live in the community, might be the coach of a local little league team, and can often be seen in church on Sunday.
“Is that a part of your clinical care? No, but it matters to patients,” Gerber said.
Not only is the care received through an independent cancer treatment centers intimately personal, there are other benefits, as well. Care in independent centers is typically less costly. These centers are highly accessible, with patients parking and walking right in, allowing them to avoid garages and other challenges that come with care providers in larger settings. Independent centers are part of the community, typically featuring multiple locations found throughout the area. Dayton Physicians has 12 locations from Greenville to Middletown.
Federal policies related to reimbursement procedures have a big impact on independent treatment centers. Without proper reimbursement, independent centers can’t stay open. COA provides independent cancer centers, like Dayton Physicians, with resources to advocate for the specific needs of cancer patients and for the support the centers require to remain operational.
Utilizing national and chapter-based events, policymaker meetings, networking opportunities, webinars and articles, COA’s Patient Advocacy Network (CPAN) provides an advocacy outlet for survivors and a voice that allows them to speak on behalf of patients and the need for independent treatment centers.
Recently, Dayton Physicians held a “sit in my chair” congressional meeting, where representatives from Ohio Senator Sherrod Brown’s office were able to experience being a cancer patient. Events like this help raise awareness among policy makers about the importance of maintaining patient access to independent care centers.
During mid-September, Dayton Physicians CEO, Robert Baird, Jr., RN, MSA, CASC, joined the rest of the COA Board of Directors in Washington, D.C., along with other community oncology practices and professionals from across the country. The group came together to tell Congress that patient assistance programs are critically important, need-based lifelines for cancer patients.
If you or someone you love hasn’t experienced cancer, you’re not only lucky, you may not understand the importance of making sure independent community cancer care remains available. COA knows how important independent community cancer treatment centers are and they are dedicated to making keeping doors open and fighting cancer one patient at a time.
“Dayton’s Physicians Network isn’t fighting for high-quality, affordable patient care alone – they are part of a national network of CPAN chapters across the country advocating for that care,” Gerber said.
Hospital Again Ranks as Top Hospital in Dayton Area
Congratulations on a great accomplishment to: Premier Health, Miami Valley Hospital, and Dayton Physicians Urology division!
Miami Valley Hospital ranked sixth among all Ohio hospitals in the latest annual rankings released by U.S. News & World Report. The hospital, which is part of Premier Health, again had the best performance among all hospitals in the Dayton metropolitan area.
Miami Valley Hospital with Dayton Physicians Network also ranked 47th in the nation in urology care.
For more information visit: https://health.usnews.com/best-hospitals/rankings/urology/ohio
Lean process workflow. It sounds like something straight off an assembly line – not words you expect to hear in a medical setting – but that’s exactly what’s happening at Dayton Physicians Network urology.
Cutting-edge, lean management and optimizing work flow practices are at the forefront of an innovative approach in collaborative care to treat patients, in light of a shortage of urologists in Dayton and across the United States.
There should be approximately 17,000 urologists based on our population. Currently, there are less than 10,000 active urologists in the United States, and over the next two years, that number will decrease to 8,000, due to retirement.
Not only is retirement decreasing the number of practicing urologists, but as the population ages, urologists are in greater demand – a convergence Dayton Physicians urologist David Key, MD, and his colleagues have been strategizing for the past few years.
The solution came when Key was talking with a friend, who shared how she uses workflow mapping in her business. He recalls their conversation, “I said, ‘Workflow mapping? Show me what you’re talking about.’”
The conversation inspired Key to do more research, eventually following a trail that led him to discover the Virginia Mason Institute in Seattle, Wash., where lean management processes are translated into the healthcare setting, with great success.
“They took the Toyota model of production, looked at efficiencies, and actually applied those practices to the health care industry,” Key said. “They even went over and visited Toyota in Japan. Virginia Mason has perfected the system to the point that Japanese hospitals are now sending their folks to Seattle for training.”
Key and a team from DPN visited the Virginia Mason Institute in 2018 and brought back the methodology. Team members have since been trained, and the new system was launched in July.
Shorter wait times for new patients
Before implementing the new approach to patient care, Key and his Dayton Physicians colleagues together would see an average of 250 new patients a month. “In only two weeks, under this new model, I saw 112 new patients, which extrapolates to over 200 patients for just one doctor over the course of a month,” he said.
Providing fast care for acute needs, the collaborative care model means new patients aren’t waiting five to six weeks to be seen. Instead, patients are being seen within 48 hours of an emergency room visit.
“The problem we were trying to solve for was how to address the needs of our community and allow urologists to take care of patients with the most need, while continuing to serve new patients,” said Dr. Key.
With this as the primary driver, urologists at DPN are now paired with nurse practitioners in a collaborative care model. One doctor is paired with a nurse practitioner and two medical assistants. Nurse practitioners see established patients, under the plan of care laid forth by the urologist. The urologist then is able to focus on surgeries and creating care plans for new patients. The office currently has four nurse practitioners, and Key foresees that number increasing to around eight.
Before being independently involved in patient care, each nurse practitioner participates in a three-month training program. “The training program within our group is pretty strenuous,” Key said. “We are very pleased with our nurse practitioners. They are outstanding.”
What started as a solution to solve the growing shortage of physicians has produced surprising results that are, most importantly, creating better patient care.
“This model allows you to overcome the shortage of physicians, addressing patients needs in shorter time, which increases patient satisfaction and, ultimately, outcomes because you’re treating them in a much quicker fashion,” Key said. “It’s changing the face of how we see patients.”
When it comes to your health, you don’t want to take any chances. You select the best physician, a state-of-the-art facility, and cutting-edge treatments and practices, but don’t stop there. Ensuring that your care provider is working with a medically integrated pharmacy is another box to check when it’s time to make important decisions about your health.
Whether you’re working with a physician for a chronic illness, life-threating condition or one-time injury, pharmaceuticals can be a big part of healing, but managing your medications can become tricky. You want to be sure you’re working with a pharmacist who understands the team approach to your treatment, and the best way to do that is to make sure you’ve selected to work with a medically integrated pharmacy.
A medically integrated pharmacy is a pharmacy that is “in-house” or part of a medical facility or practice. Unlike stand-alone retail pharmacies, medically integrated pharmacies provide many benefits to patient care.
Support for complex medication regimens: As medical treatments advance, pharmaceuticals are becoming more complex. What used to be one pill with breakfast, and maybe another at dinner, can now be doses several times a day, and even different doses on varying days of the week.
“Often, the medications prescribed in oncology care are just as complex as traditional chemotherapy,” said Joshua Cox, Pharm.D., director of pharmacy for Dayton Physicians Network. “Because they are taken in pill form, people assume they are safer, but that’s not always the case.”
Having access to a pharmacist who understands the complexity of the medications you’re taking is an important part of the team of professionals working to help you heal. You need a pharmacist who will do more than just confirm your dose is reasonable and that it won’t interact with other prescriptions.
Access to real-time physician data: When your pharmacist is working in-house with your physicians, he or she has the ability to see to the same data as your doctors. “We can see all the physicians’ notes, lab values, imaging and scans, so we are seeing, in real time, the same information every other health care provider on your team is seeing,” Cox said.
Access to real-time information from a patient’s medical record means the pharmacist can help doctors and nurses make decisions that are the best for the patient.
Ensures better patient outcomes: Medication adherence and education is a large component of the medically integrated pharmacy method. With the team approach, pharmacists work with patients to counsel them about taking medications and what the side effects might be, which can help them monitor whether patients are taking medications correctly.
If side effects or a reaction does occur, the team approach allows these issues to be recognized quickly. With support from the physician, the medication can be safely stopped, if necessary, and side effects can be more effectively managed.
“If you can’t take a medication because of its side effects, it certainly cannot be effective,” Cox said. “With our robust medication adherence program, we can ensure patients are staying on their meds, making the medications more effective and leading to better outcomes.”
Provides cost savings and reduces waste: When it comes to complex medications with serious side effects, such as those administered for cancer treatment, physicians often make changes to help patients feel their best and heal more quickly.
“Doses are frequently changed by physicians, either because it’s intended or because the condition changes in some way,” Cox said. “When that happens, if the prescription is being filled at a pharmacy elsewhere, the delay in communication means the medication could be filled under orders that are no longer current.”
In situations like this with expensive drugs, one incorrectly filled prescription can equate to thousands of dollars thrown away. With a medically integrated pharmacy, pharmacists have access to information the moment the physician makes changes, meaning unnecessary prescriptions are never filled, reducing waste and saving money.
Don’t overlook the benefits of being able to include your pharmacist as a member of your health care team. With the integrated approach, you have the support you need for complex medications, could be better for the health of your body and your budget.
When you hear about a surgeon who also is an outstanding musician, it shouldn’t surprise you. After all, both require a high level of technical skill, complex thinking and persistence to master. Some studies have even found increased grey matter in the brain, which is associated with increased skills, as a result of musical training.
“If I wasn’t a physician, I’d probably be a musician,” he observed. Dr. Yu can play seven instruments, including piano, clarinet, three saxophones, guitar and violin.
While playing an instrument was mandatory, having an actual career in music wasn’t a possibility he felt he could consider. Dr. Yu said he always knew he would become a doctor. His father, his aunts and uncles on his mother’s side, and his grandparents—all of them are physicians.
“For me, it was never really a question,” Dr. Yu said about his career path. He considered a career as a trauma surgeon for a short time before being influenced by two of his uncles to consider urology.
Dr. Yu said urology allows him not only to care for his patients, which is why he enjoys being a doctor, but also to develop lasting relationships with them. Many of the conditions Dr. Yu treats are chronic, allowing him to provide a continuum of care and to work with his patients in developing treatment plans that allow for their input.
From removing kidney stones and helping older patients with enlarged prostates, to treating conditions like diabetes and high blood pressure, Dr. Yu truly enjoys the work he does.
“It gives me a good sense of satisfaction to be able to help people and show them the results of what we do,” Dr. Yu said, who often presents patients with kidney stones removed during their surgeries.
When Dr. Yu is in the operating room, music is still a part of his routine. “I listen to pretty much anything but rap and country music,” he said.
Choosing to practice in Dayton
Dr. Yu performed his undergraduate work at Dartmouth, his medical degree is from NYU, and he completed his residency at Washington University in Saint Louis. He was offered a job at the Cleveland Clinic and chose Dayton Physicians Network instead. Dr. Yu became the first urologist in Dayton to perform robotic pyeloplasty for ureteropelvic junction obstruction, which removes a blockage occurring where the kidney meets the ureter.
“I think Dayton is a very good medical community that is underrecognized nationally,” he said when asked why he settled in the Miami Valley. “I would put us up against Ohio State, Cincinnati and the Cleveland Clinic.”
At the end of a long day, of which there are plenty, Dr. Yu says he enjoys playing the piano, watching movies, hiking and even playing video games from time to time.
“I find myself with less and less free time to spend with my wife and kids,” said Dr. Yu, who recently celebrated his 20-year wedding anniversary and has two boys, ages 15 and 18. “Being involved in medicine isn’t easy…and it’s not really for everybody. You have to be completely committed to it.”
Between paperwork and preparing for his surgeries the next day, Dr. Yu said he often works two to three hours each night after his family goes to bed. With the amount of labor he puts in, he doesn’t see either of his sons carrying on the family tradition of becoming a physician. In fact, one of his sons is also interested in music, and Dr. Yu said he would support whatever direction their lives take them.
“People say, ‘You’re in it for the money,’” Dr. Yu said, “But I really do like what I do. Actually, I love what I do, and I think I’m pretty good at it. I’d like to keep doing it as long as I can.”
If you’d like to make an appointment with Dr. Yu, contact Dayton Physicians Network at 937-293-1622.
The entire United States is experiencing a shortage of Urologists. There should be approximately 17,000 Urologists based on our population. Currently there are less than 10,000 active Urologists in the United States and over the next two years that number will decrease to 8,000 due to retirement. In order to address this shortage and continue to give you and our community the best possible urologic access and care in Southwest Ohio, we have developed collaborative health care provider teams in Urology. These collaborating teams will consist of our physicians and our specialty trained nurse practitioners to provide ongoing care for you.
Our collaborating teams of Physicians and Nurse Practitioners are listed below:
- Dr. David Key and Heather Shoup, CNP
- Dr. Mark Monsour and Rachel Perretta, CNP
- Dr. Blake Anderson and Kelsey Patterson, CNP
- Dr. Michael Yu and Bonnie Loesch, CNP
- Dr. Erik Weise and a soon to be announced Nurse Practitioner
We are excited to offer you this innovative model of Urology Collaborative Care and we look forward to seeing you in the office. As we transition to this new model, you may receive a phone call to change your appointment. We apologize for any inconvenience as we work hard to accommodate as many patients’ needs as possible to provide the best care and access.
For appointments at Dayton Physicians Urology, please contact our call center at (937) 293-1622.
We appreciate the opportunity to care for you.
Dayton Physicians Urology Team
At age 53, Patty* went from a stage three breast cancer diagnosis to complete remission in six months. She’ll tell you it wasn’t an easy road, but with the support of her doctors and Dayton Physicians Network, she is feeling better every day and thinking about the future again.
“I was the first female in my family to be diagnosed with breast cancer,” Patty said. “They say it’s genetic, but that’s not always true.”
When Patty noticed her breasts began to look abnormal, she did a little internet research, only to discover she had all five of the classic signs of breast cancer. She contacted her doctor and was referred to a specialist.
“You feel distraught,” Patty said about her diagnosis. “You feel like your life is finished and wonder if the cancer is going to take over. You wonder how long you have to live. Whether it’s stage zero, one, two or three, it’s very distressing.”
For her treatment, Patty selected Dayton Physicians Network, a multi-specialty network that provides comprehensive cancer care and urologic care services at 12 locations throughout the Miami Valley.
Before treatments begin, patients with DPN are assigned a nurse to thoroughly review the treatment plan and possible side effects. Patty spent over two hours with her nurse, who walked her through the onslaught of new and overwhelming information and terms.
Treatment started almost immediately. In addition to surgery, Patty underwent six cycles of chemo, each lasting between four to six hours, every 21 days, and then endured 28 consecutive days of radiation.
No one wants to go through cancer treatment, but certain things can make the experience more manageable. The Dayton Physicians infusion room located in Miami Valley South is lined with windows and flooded with natural light. Patients are made comfortable in reclining chairs, with options for heated blankets, snacks and beverages.
“A lot of people like it there and request that location,” Patty said. “It’s convenient, with good access from the highway, and parking is great.”
Support system + positive outlook
If you ask Patty what got her through the treatment, she’ll tell you that, in addition to a great support system from her sister, close friends and DPN, she kept a positive attitude.
“I guess I didn’t want the cancer to take over – I wanted to beat it,” Patty said. “I didn’t sit and dwell on the fact that I had cancer. You have to think about things that make you happy.”
And it worked. On her birthday this year, Patty received the “all-clear” and had a whole new reason to celebrate. A few weeks later, her chemo port was removed.
“No more port means no more treatment,” Patty said of this major milestone in her care. “I’m done.”
Even with the all-clear, Patty will have routine meetings with her oncologist and surgeon. She’ll undergo regular blood checks and work diligently to maintain her health.
Patty’s after-care included her participation in the Dayton Physician Network survivorship program, which is designed to help patients navigate the challenges faced during recovery. Patients are made aware of late and long-term effects of treatment and are supported with after-care options specific to their type of cancer.
As a part of the program, Dayton Physicians screens for a variety of issues including anxiety, depression, distress, changes in cognitive function and memory, hormonal or sexual problems, even financial concerns. A survivorship care plan is created, documenting the patient’s cancer diagnosis and treatment, and the patient and all of their care providers receive copies.
Patty also works with a personal trainer to help her incorporate exercise into her post-treatment lifestyle. Not only does this have health and preventative benefits, but it also helps her overcome some of the muscle weaknesses caused by treatment.
Patty recommends advocating for yourself not only during your care, but also with your employer to be sure work is never a reason to delay or miss a treatment. She also says your attitude is paramount.
“Stay positive and don’t focus on the negative,” Patty said. “There are treatments that work. It takes longer for some than others, but doctors know so much more now than they used to.”
Ironically, Patty says she hasn’t always had such an upbeat outlook.
“Cancer changed that a lot,” she said. “I try to be more positive now. When I see an issue or a problem, I look at everything I’ve been through and think ‘I can handle this—I just beat cancer!’”
For more information about cancer treatment options with Dayton Physicians Network, call us at (937) 293-1622.
* Name changed to protect patient’s identity
Dr. Satheesh Kathula was a representative at a Capitol Hill meeting organized American Association of Physicians from Indian Origin. He met with several US congressmen including Rep. Phil Roe of Tennessee, Rep Joe Wilson of South Carolin, Rp. Ami Bera of California and discussed with them on the following health care issues mainly affecting community oncology care:
- The consequences of pharmacy benefits managers (PBMs) on community oncology care, which are not only more expensive, but have delays in mailing life saving drugs.
- Lowering the Cost of Prescription Drugs: The exorbitant cost of prescription drugs is a critical health care issue, as some life-saving drugs are too expensive for many patients.
- How hospitals get preferential reimbursement over independent practices (340B) which is driving the healthcare cost up.
In mid-April was the Ohio Urologic Society Annual Meeting in Columbus. At this meeting, Dayton Physicians Network’s Blake Anderson, MD took part of a panel about Management of Complex Stone Disease. The moderator for the discussion was Sri Sivalingam and other panelists were Mantu Gupta, MD, Smita De, MD, PhD, Michael Sourial, MD.
Dr. Anderson said “I really enjoyed being on the moderator panel for management of complex stone disease.” In the discussion several cases were presented and the panelists all weighed in on different approaches. One case discussed was, how to treat 10 cm of bladder stones in a man with BPH (enlarged prostate). Also discussed, was a case of a septic woman with recent chemotherapy for breast cancer with bilateral obstructing stones.
All the Panelists noted that there were multiple options for treatment but many factors had to be considered. Below is Dr. Anderson take on the discussion, treatment options, and considerable factors.
“How to treat 10 cm of bladder stones in a man with BPH (enlarged prostate. Options are: shockpulse and laser lithotripsy, then holmium laser enucleation of the prostate.
For the bladder stone cases in general, I am in favor a of combination approach to obstructive prostate tissue under the same anesthetic when feasible as bladder stones typically only form in the setting of obstruction. KUB should be done or can check scout film of CT if that has already been done to see if bladder stones are visible, if not may contain uric acid and preoperative medical therapy with potassium citrate could significantly decrease stone burden.
Kidney stone cases were numerous, incomplete left duplex kidney with large upper pole stone burden, difficult renal access and discussed special techniques to do this and accomplish PCNL.
Another case was of a septic woman with recent chemotherapy for breast cancer with bilateral obstructing stones, discussed ureteral stents or bilateral nephrostomy tubes as options, each with own advantages but both effective in prior studies. This decision involves a lot of patient specific variables, stone size, stone location, anticoagulation status and other anatomic considerations. In patients with low urine pH and low stone Hounsfield units on CT, especially in setting of recent chemotherapy, suspicion for uric acid stones should be high and stone dissolution therapy should be considered (medication, potassium citrate, raises urine pH and can dissolve uric acid stones).”