What is a cystoscopy?
Cystoscopy literally means “look into bladder.” There are many reasons why a cystoscopy may be required. One of the most common reasons is detection of blood in urine to look for potential source of blood coming from bladder, such as a bladder tumor or stone. Another reason is to understand the anatomy of the lower urinary tract as it relates to bladder symptoms, such as slowing of urine stream, frequent need to urinate, or urgent need to urinate which cannot be explained by treatable conditions such as a urinary infection. Depending on the preference of the patient, the procedure can be done either in the office, or at the hospital/ambulatory outpatient surgery center. An office cystoscopy is done with a local anesthetic using Lidocaine gel as a lubricant as well as numbing agent, using a flexible instrument to minimize discomfort.

What is a Vasectomy?
Vasectomy is an effective method of permanent sterilization for men. It is the method of contraceptive choice employed by more than 500,000 men each year in the United States. It is easier to access and perform a vasectomy than the female counter part which is called bilateral tubal ligation. While it is potentially a reversible procedure, a vasectomy should be considered permanent sterilization. We ask that a patient be sure that he understands and accepts the permanent nature of vasectomy.

Am I a candidate?
We ask that generally speaking, you come in for a consultation regarding a vasectomy first. This gives you the opportunity to ask any questions you may have. Also, it is important to consider the feasibility of doing such a procedure in the office as there is considerable variability in every man’s anatomy. It is also important to make sure that there are no other abnormalities of the genitalia.

The Procedure
It is important to have all the scrotal hair shaved in preparation for the procedure as well as a clean shower the day of the procedure. The procedure itself typically takes about 15 to 20 minutes in the office. The office procedure is typically done under local anesthesia. If the idea of doing the procedure is too daunting to accept, a vasectomy can certainly be done under sedation or general anesthesia at a surgery center or at an outpatient surgery center. The procedure involves identification, isolation, and ligation of the vas deferens at both the abdominal and testicular end, and removing a small segment of the vas. The procedure creates a blockage of sperm flow. The procedure does not affect other male functions, including production and maintenance of male hormone production, and sexual function including ejaculation. The only difference after a vasectomy is that the semen will not have sperm. However, it is very important to remember that there are already stored up sperm in a man’s internal genital ducts, such as the seminal vesicles. Therefore, other effective contraceptive methods must be employed until the semen can be checked by microscopic inspection to be sure that there is no sperm in the semen.

Fees
Please call our office for information about fees.

Preparation instruction
Please bring briefs/boxer briefs underwear or a clean athletic supporter (jock strap). NO BOXER SHORTS. Please shave the front of your scrotum before you come to the office. The surgery will take approximately 30 minutes. Please call if you have any questions prior to your surgery.

Post-vasectomy instruction
After surgery, you are advised to take it easy for a day or two to avoid swelling. There is no heavy lifting allowed for approximately one week. Also, we routinely advise that you take a prophylactic antibiotic for a week. A prescription will be given to you at the time of the vasectomy.

Circumcision has been practiced since the days of the Egyptian empire and has been part of religious tradition of Jewish and Arabic culture for many years. Circumcision is controversial in terms of its indication. The most current policy statement of the American Academy of Pediatrics on circumcision published in 1999 and reaffirmed in 2005 is as follows: Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. If a decision for circumcision is made, procedural analgesia should be provided.

Is a circumcision necessary?
Circumcision is medically necessary in certain situations, such as tightness of the foreskin interfering with elimination of urine or male sexual function, recurrent infections of the penis, and certain benign and malignant growths affecting the foreskin. However, for the most part, in the United States, a circumcision is a matter of preference and choice by the individual or his parents/family. In Europe, a circumcision is an exception rather than the rule. Commonly, families of certain ethnic backgrounds tend to have strong opinions on the merits of circumcision as well as when such the procedure should be done. These opinions aside, it is still very important to discuss the pros and cons as well as potential risks of surgery and anesthesia before the decision for a circumcision is reached by the patient or his family. A thorough discussion is necessary before an informed consent can be given.

Procedure
An office circumcision can be done under local anesthesia for neonates and infants up to certain weight due to size limitation. Dr. Lim uses the plastibell technique for circumcision done outside of a nursery setting. After early infancy, a circumcision is done under general anesthesia as an outpatient procedure. An adult circumcision can be done under local anesthesia in the office. However, for most adult patients, the preferred way to do a circumcision is under general anesthesia as an outpatient. Pros and cons of different approaches can be discussed fully at the initial consultation.

A prostate biopsy is commonly done to rule out prostate cancer. Prostate cancer is one of the most commonly diagnosed cancer in males, and one in six males in the United States will be diagnosed with prostate cancer at some point in his life time. The widespread use of a blood test called PSA (prostate specific antigen) has lead to early detection of prostate cancer resulting in improved detection and early and effective treatment of prostate cancer. However, the PSA blood test is NOT foolproof. Sometimes, a man can have a “normal” PSA and yet still have prostate cancer detected only by a prostate nodule. Therefore a regular digital examination of the prostate by your physician is a very important part of preventive care of all aging male hosts. Also, a discussion regarding the merits and risks of early prostate cancer screening should take place before the decision is made for or against a prostate biopsy.

Prostate Ultrasound
Also, knowing the size of the prostate can be very helpful in management of prostate disease as it relates to urination symptoms. Studies have shown that a man with a prostate size bigger than40 cc is more likely to have problems of urination that may require a prostate surgery.  While some “educated guess” about the size of the prostate can be made by just a finger examination, the most exact way to know the size of the prostate is a prostate ultrasound. Therefore, a prostate ultrasound can be an extension of physical examination, helping the urologist determine which way to treat an enlarging prostate, whether medically or procedurally.

Often a biopsy is combined with an ultrasound of the prostate. Biopsy of prostate is done transrectally, meaning by going through the rectal lining directly into the prostate gland taking a core of prostate tissue. The biggest risk of a biopsy is infection for obvious reasons. Therefore, it is important to take a prophylactic antibiotic before the biopsy and for 3 days thereafter. Also, it is important to avoid any fecal content in the rectum by evacuation of stool with a Fleets enema. A local anesthetic using Lidocaine is administered at the time of biopsy. The biopsy result can take up to one week to be finalized. It is the practice philosophy of Dr. Lim to go over the result in person. This leaves no room for “guessing” about the result and it is the optimal way to discuss the implication of the biopsy result, whether positive or negative, going forward.

Download prostate biopsy patient instructions