Is it low T

Is it low T

“Is is low T” is the name of the website and slogan used by Abbott Laboratories to raise awareness regarding low testosterone levels in the aging male.  It is a series of questions related to libido, energy, enjoyment and endurance which may be symptomatic of low testosterone levels.

Is it low T, the question raised in their website is a question pondered by many aging males as the experience andropause and notice decreased energy, libido, sexual function and concentration.  Low testosterone levels can also result in changes in bone and muscle strength.

Is is low T?  Many of our patients are wondering the same thing.  At Urological Consultants of Florida, our Miami urologists David Robbins, MD and Amery Wirtshafter, MD are certified experts in the field of urology including the treatment of male andropause and low testosterone.  We are available to help you answer the question of Is it low T get you on the path to a clear diagnosis and a treatment program resulting in improved quality of life measures.

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Pyeloplasty Surgery Miami

Pyeloplasty surgery is performed to repair a narrowing or stricture at the junction between the kidney and the ureter known as the uretero-pelvic junction or UPJ.  A crossing vessel or stricture at the UPJ causes progressive dilatation of the renal pelvis subsequently leading to swelling (hydronephrosis) and worsening renal function or renal failure.

Miami urologist, David Robbins MD is a board certified urologist and recognized leader in da Vinci robotic surgery and expert in robotic pyeloplasty surgery for both stricture disease and crossing vessel at the UPJ (UPJ obstruction).  Dr. Robbins trained at New York University and learned to perform robotic pyeloplasty procedures from Dr. Michael Stifelman, internationally acclaimed leader in the field of robotic surgery for the kidney and ureter.

Pyeloplasty procedures using the robotic approach are a minimally invasive option for pyeloplasty performed though four keyhole sized incisions as opposed to a long painful  flank incision traditionally used for this surgery.  Robotic pyeloplasty procedures are associated with decreased blood loss, less pain and a shorter hospital stay.  Miami urologist David Robbins, MD is currently performing robotic pyeloplasty surgery at Mount Sinai Medical Center in Miami Beach as well as Aventura Hospital and Medical Center in Aventura.

Miami Beach Office

Miami Beach Office

4302 Alton Road
Suite 920
Miami Beach, FL 33140

Phone: (305) 672-4222
Fax: (305) 672-5461

Office Hours

9:00 am – 5:00 pm


North Miami Beach Office

North Miami Beach Office

1400 N.E. Miami Gardens Drive
Suite 209
North Miami Beach, FL 33179

Phone: (305) 944-0025
Fax: (305) 944-3624

Office Hours

9:00 am – 5:00 pm

Robotic Prostatectomy Surgery Miami

Robotic prostatectomy for the treatment of prostate cancer is considered by many to be the standard of care for the treatment of clinically localized prostate cancer.  Miami urologist, David Robbins, MD is a local expert in the use of the da Vinci robotic system for the treatment of prostate cancer.   Dr. Robbins is performing robotic prostatectomy surgery at two convenient locations in Miami including Mount Sinai Medical Center on Miami Beach and Aventura Hospital in Aventura.  

Robotic prostatectomy provides the advantage of decreased blood loss, decreased post operative pain and a shorter hospital stay.  Outcomes including preservation of erectile function, maintenance of continence and cancer cure are considered a significant improvement over the open technique. 

 

Vasectomy Miami

Urological Consultants of Florida’s board certified urologists, Dr. David Robbins and Dr. Amery Wirtshafter have broad experience performing minimally invasive vasectomy procedures and have helped countless numbers of men to achieve voluntary sterility in Miami, Aventura and the sourrounding region.

http://www.nlm.nih.gov/medlineplus/ency/article/002995.htm A vasectomy is surgery to cut the vas deferens, the tubes that carry a man’s sperm from his scrotum to his urethra. The urethra is the tube that carries sperm and urine out of the penis. After a vasectomy, sperm cannot move out of the testes. A man who has had a successful vasectomy cannot make a woman pregnant. Watch this video about: Vasectomy DescriptionVasectomy is usually done in the surgeon’s office using local anesthesia. You will be awake but not feel any pain. After your scrotum is shaved and cleaned, your surgeon will give you a shot of numbing medicine into the area. Your surgeon will then make a small surgical cut in the upper part of your scrotum, and tie off and cut apart the vas deferens. Your surgeon will use stitches or a skin glue to close the wound. You may have a vasectomy without a surgical cut. This is called a no-scalpel vasectomy (NSV). Your surgeon will find the vas deferens by feeling your scrotum and then give you numbing medication. The surgeon will then make a tiny hole in the skin of your scrotum and seal off the vas deferens. The surgeon will usually pull your vas deferens through the tiny hole in order to tie off and cut it apart. You will not need stitches. Why the Procedure is PerformedVasectomy may be recommended for adult men who are sure they want to prevent future pregnancies. A vasectomy makes a man sterile (unable to get a woman pregnant). A vasectomy is not recommended as a short-term form of birth control. The procedure to reverse a vasectomy is a much more complicated operation. Vasectomy may be a good choice for men who: Are in a relationship, and both partners agree they have all the children they want. They do not want to use, or cannot use, other forms of birth control. Are in a relationship, and their partner has health problems that would make pregnancy unsafe for her Are in a relationship, and one or both partners have genetic disorders that they do not want to risk passing on to their children Vasectomy may not be a good choice for men who: Are in a relationship, and one partner is unsure about their desire to have children in the future Are in a relationship that is unstable, going through a stressful phase, or is very difficult in general Are thinking about having the operation just to please their partner Are counting on fathering children later by storing their sperm or by reversing their vasectomy Are young and still have many life changes ahead Are single when they want to have a vasectomy. This includes men who are divorced, widowed, or separated. Do not want, or have a partner who does not want, to be bothered by having to use other forms of birth control during sexual activity RisksThere is no serious risk to vasectomy. Your semen will be tested in the months after the operation to make sure it does not contain sperm. As with any surgical procedure, infection, swelling, or prolonged pain can occur. Careful following of aftercare instructions reduces these risks significantly. Very rarely, the vas deferens can grow back together again. If this happens, sperm can mix with semen. This would make it possible for you to make a woman pregnant. Before the ProcedureTwo weeks before your vasectomy, tell your doctor all of the medicines, even ones you bought without a prescription, vitamins, supplements, and herbs you are taking. You may need to limit or stop taking aspirin, ibuprofen (Advil, Motrin), and other medicines that affect blood clotting for 10 days before your surgery. On the day of your surgery, wear loose, comfortable clothes. Clean your scrotum area well. Take the medicines your doctor told you take. Bring a scrotal support with you to the surgery. After the ProcedureYou should be able to return home as soon as the procedure is done. You can return to work the next day if you do not do heavy physical work. Most men return to work within 2 to 3 days. You should be able to return to your normal physical activities in 3 to 7 days. It is normal to have some swelling and bruising of the scrotum after the procedure. It should go away within 2 weeks. You should wear a scrotal support for 3 to 4 days after the procedure. You can use an ice pack to prevent or reduce swelling. Pain medicine, such as acetaminophen (Tylenol), may help relieve discomfort. You can have sexual intercourse as soon as you feel ready, usually about a week after the surgery. Outlook (Prognosis)Vasectomy does not affect a man’s ability to have an erection or orgasm, or ejaculate semen. A vasectomy does NOT prevent the spread of sexually transmitted diseases (STDs). Your sperm count gradually decreases after a vasectomy. After about 3 months, sperm are no longer present in the semen. You must continue to use birth control to prevent pregnancy until your semen sample is totally free of sperm. Most men are satisfied with vasectomy. Most couples enjoy not having to use birth control. Alternative NamesSterilization surgery male; No-scalpel vasectomy; NSV ReferencesNagler HM, Jung H. Factors predicting successful microsurgical vasectomy reversal. Urol Clin North Am. 2009 Aug;36(3):383-90. Update Date: 3/22/2010Updated by: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Browse the Encyclopedia

Vasectomy Miami, Florida

Vasectomy

Miami urologists David Robbins, MD and Dr. Amery Wirtshafter, MD are proud to offer patients an office based solution to achieve permanent contraception.

  • What is a vasectomy?
  • Is a vasectomy a good choice for you?
  • How is a vasectomy performed?
  • Myths about a vasectomy procedure
  • What are the real risks associated with a vasectomy?
  • How to prepare for your vasectomy
  • What to expect after your vasectomy
  • Follow up instructions

What is a vasectomy?

A vasectomy is a minor surgical procedure performed in the office resulting in permanent sterility by preventing sperm from exiting the penis during ejaculation.  A vasectomy procedure is minimally invasive and highly effective with success rates greater than 99%. A vasectomy procedure is simple to perform and low risk as compared to a tubal ligation in females and for that reason it is the most popular means of birth control when the goal is to achieve permanent sterility.

Is a vasectomy a good choice for you?

A vasectomy procedure is an ideal way to achieve permanent sterility.  However, the decision to undergo a vasectomy procedure should be taken seriously.  A vasectomy procedure is performed for men that have made the decision that they no longer want to father children.  Although a vasectomy reversal procedure is possible, this is a complex surgical procedure performed in the operating room performed under general anesthesia.  It has a low success rate and is typically not covered by insurance.

How is a vasectomy performed?

Vasectomy works by preventing sperm from reaching your penis.

Sperm is made inside of your testicles.   After leaving the testicles, the sperm travels through an organ called the epididymis where it can mature.   At the time of ejaculation, sperm exits the epididymis though a long tube called the vas deferens into the urethra where it is then mixed with fluid from the prostate and semenal vesicles to create semen.   The semen is then forced out of the urethra via rhythmic contractions of the muscles around the penis and perineum during orgasm.

During a vasectomy procedure, the vas deferens are transected thereby preventing sperm from reaching the penis during ejaculation, thus achieving sterility.  Typically we send a small portion of the vas deferens from each side to the laboratory as confirmation that the vasectomy was performed properly.   Additionally, each side is cauterized and tied with a tiny suture to ensure the intended result is achieved.   There are gimmicky devices on the market which clamp the vas without dividing it which claim to be less invasive, however they do not change the time it takes to perform a vasectomy and certainly do not decrease the risk of complications.   These devices introduce a foreign body into the scrotum which can be uncomfortable and potentially cause infection.

before and after vasectomy

Myths about a vasectomy procedure

Many men are concerned about a vasectomy procedure because they have read on the internet or heard from a friend that it may cause erectile dysfunction or they will not ejaculate after the procedure.   A vasectomy procedure certainly does not cause damage to the nerves that cause erections or cause injury to the erectile bodies.   Erectile dysfunction is simply not a known complication of a vasectomy procedure.  Also, a vasectomy procedure does not lead to decreased ejaculatory volume.  Only a minute portion of the volume of semen in the ejaculate is contributed to by sperm from the testicles.   Greater that 99% of the semen volume is from the semenal vesicles and prostate and the path for these fluids is not changed by a vasectomy.  The volume, color and consistency of semen is not altered by a vasectomy procedure.

Additionally, some patients report that they have heard that a vasectomy procedure may increase their risk for developing prostate cancer.  There is no literature making this connection with statistically significant data and recent studies looking at this concern have shown no connection with vasectomy procedure and prostate cancer.

Finally, It is a common misconception that a vasectomy procedure can affect a man’s libido or ability to achieve orgasm and ejaculate normally.  These functions are definitely not altered by a vasectomy procedure.

What are the real risks associated with a vasectomy?

A vasectomy procedure is considered a safe procedure with few risks especially when performed by a urologist with expertise and experience with the procedure such as Dr. Robbins and Dr. Wirtshafter.

Occasionally minor complications may occur and may include:

  • Pain.
  • Bleeding.
  • Bruising.
  • Swelling.

Very infrequently a post vasectomy syndrome may occur which is associated with prolonged scrotal discomfort.  Typically this can be alleviated with anti inflammatory medications such as ibuprofen and the symptoms should resolve with time.

How to prepare for your vasectomy

A vasectomy procedure is typically performed in our North Miami Beach or Miami Beach office under local anesthesia.   The vasectomy procedure takes about 15 minutes to perform and is tolerated very well by our patients.  To add to patient comfort during a vasectomy procedure, we prescribe Valium to be taken 1 hour prior to the procedure.  Additionally, we recommend to patients that they bring an ipod or personal music player with earphones to make their vasectomy experience more relaxing. With the combination of a Valium and music, it is common for patients to fall asleep during the vasectomy procedure.

Before your vasectomy:

  • Clean and shave your scrotal area.
  • Avoid taking anti-inflammatory medicines like ibuprofen or Aspirin.
  • Wear tight-fitting underwear to your vasectomy appointment.
  • Bring someone to drive you home after surgery.

What to expect after your vasectomy

After a vasectomy, it is important to avoid strenuous activities such as exercise heavy lifting or sexual activity for 3-5 days.  It is typical to have mild discomfort that can be relieve with Tylenol or ibuprofen.

Ice should be applied to the area indirectly for 20 minutes every few hours while awake for the first day to reduce swelling and discomfort.

A topical antibacterial such as Neosporin or Bacitracinshould be applied to the wounds 2-3 times per day for several days.

It is important to avoid submerging the wound in water such a in a bath or swimming pool.  These activities can allow bacteria to enter the wound and lead to infection.  It is OK to take a shower even the day of the procedure, but the area should not be washed vigorously or scrubbed with a brush.

Since you will be taking Valium, it is important that someone is there during the procedure and available to drive you home.

Immediately following vasectomy, there is a slight risk of bleeding into your scrotum.  Contact your doctor if you experience:

  • Significant swelling in your scrotum.
  • Intense pain.
  • Fever.
  • Redness in the scrotum.

Follow-up Instructions

A vasectomy procedure is not immediately effective.  There are still sperm that are left in the vas deferens beyond the point where the tube is divided.  These sperm are viable and capable of causing an unplanned pregnancy. Effective birth control should be resumed after the vasectomy procedure until a negative semen analysis is documented and confirmed by Miami urologist Dr. David Robbins or Dr. Amery Wirtshafter.

A semen analysis should be performed 2 months after the procedure and it is important to have at least 12 ejaculations prior to the analysis to clear the tubes of any remaining sperm.

For the first day or two after vasectomy you may experience mild discomfort in your scrotum or abdomen.  Over-the-counter medications such as Tylenol should help. The doctor may also send you home with narcotic pain medication.

Urological Consultants of Florida vasectomy forms

Miami urologists Dr. David Robbins and Dr. Amery Wirtshafter have provided a pdf copy for download of the vasectomy consent form that you signed at the Miami Beach office or the North Miami Beach office.  You can additionally download the post vasectomy instruction form below.

Vasectomy consent

Vasectomy Discharge Instructions

Please click on the link below to contact Miami urologists Dr. Amery Wirtshafter and Dr. David Robbins for further information or to schedule an appointment.

                            SCHEDULE AN APPOINTMENT

DISCHARGE INSTRUCTIONS FOLLOWING VASECTOMY

LEAVING THE MIAMI BEACH OR NORTH MIAMI BEACH OFFICE:
1. You will need to have someone take you home following the surgery
WHEN YOU GET HOME:
1. Stay off your feet as much as possible for the next 12 hours. This will reduce the chance
of scrotal swelling.
2. Wear cotton, JOCKEY undershorts for increase support and comfort.
3. Avoid heavy lifting or vigorous exercise for seven (7) days after surgery.
4. You can shower the day after surgery. Avoid rubbing the scrotum when drying.
5. Sexual activity can begin one week after your vasectomy when scrotal swelling and
tenderness subside
6. CONTRACEPTIVE PRECAUTIONS ARE ABSOLUTELY NECESSARY UNTIL THE SEMEN
ANALYSIS PRODUCES NEGATIVE RESULTS.
7. Eight to Twelve (8‐12) weeks after your vasectomy, you need to do a Semen Analysis.
8. Please call our office immediately if you have any post op complications including:
a. Infection
b. Bleeding
c. Increasing pain
d. Swelling
e. Temperature of 101
9. If you have any questions, please call the office at (305) 944‐0025.

Androgen Deprivation Treatment for Prostate Cancer

“This article below brings into light new new insights into the cardiovascular risk associated with androgen deprivation therapy for prostate cancer.”  David Robbins

ADT May Not Be Linked To Increased Risk Of Death From Cardiovascular Causes.

The Los Angeles Times (12/7, Roan) “Booster Shots” blog reports that “a prostate cancer treatment called androgen deprivation therapy [ADT] has been somewhat controversial because of fears that the medications involved may raise the risk of death from cardiovascular causes,” but research published in the Journal of the American Medical Association “did not find that association.” Investigators “looked at eight randomized clinical trials on” androgen deprivation therapy.

Bloomberg News (12/7, Flinn) reports that investigators “examined the results of eight trials of 4,141 patients with prostate cancer that had spread beyond the gland.” The researchers found that “eleven percent of patients on the therapy died from heart disease, compared with 11.2 percent in the control group, an insignificant difference, according to the report.” Bloomberg News adds, “In a further analysis of 4,805 patients from 11 trials, about 37.7 percent on the medicines died, compared with 44.4 percent in the untreated group.”

HealthDay (12/7, Reinberg) reports, “‘The use of hormone therapy and radiation is of benefit for patients,’ said Dr. William Kelly, a professor of medical oncology and urology at Thomas Jefferson University’s Kimmel Cancer Center in Philadelphia and co-author of an accompanying journal editorial.” For “this study, the benefits of hormone therapy outweighed the risks, Kelly said.” But, “he noted that these were selected patients in clinical trials, not patients in the general population, in which sicker patients might be at risk for cardiovascular events from hormone therapy.”

WebMD (12/7, Boyles) points out that “just over a year ago the FDA warned that” the “treatments may increase the risk for fatal heart attacks in prostate cancer patients.” And before that “warning, health groups — including the American Heart Association, the American Cancer Society, and the American Urological Association — issued a joint statement designed to alert doctors and patients about the therapy’s potential risks.” Also covering the story were Reuters (12/7, Pittman), the Boston Business Journal (12/7, Donnelly, Subscription Publication), and Medscape (12/7, Nelson).