In The News

Robert Pugach, MD featured on KTLA, Channel 5 (Los Angeles, CA) . News segment on the remarkable No Needle No Scalpel Vasectomy. Interview with Health Reporter, Leila Feinstein    

Three-decade old techniques and new ideas combine to create pain-free vasectomies. (November 18, 2009) 

When it comes to permanent birth control, a woman is more than twice as likely as a man to have surgery. But female sterilization is much more complicated and dangerous than the comparable surgery in a man–a vasectomy. But what if a vasectomy was done with no needle, no scalpel, and no pain? It’s happening in southern California.

Dr. Pugach featured on KTLA – Click play to watch.

Orange County urologist
Dr. Robert Pugach says the no-scalpel vasectomy isn’t new; it’s just new in the U.S.

“About 35 years ago the Chinese figured out how to do what’s called a no-scalpel vasectomy,” says Dr. Pugach. “And unfortunately it stayed there, and in a few other parts of the world. It’s taken a long time to come over here.”

During a vasectomy, the tubes that carry sperm to the penis are cut. In the no-scalpel version, instead of an incision to get to the tubes, doctors pull-apart the skin of the scrotum just three-sixteenths of an inch. Why doesn’t it hurt?

“What we added in North America was the no-needle part,” says Dr. Pugach. Instead of a needle filled with numbing agent, a small sprayer has made the difference. “The novacaine is in here and you just prime it and fire it. And that comes out so quickly, that it penetrates the skin. There is literally nothing sharp,” says Dr. Pugach. “If I put this on your skin your skin would go numb in a second.”

As patient David Hiveley waits for the procedure to start, he’s not sure he believes Dr. Pugach’s claims. “I think it’s natural to have some anxiety about things being done down in that area,” says David, a forty-five year old father of two, who with his wife, decided he would be the one to have surgery to prevent future pregnancies.

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There is a flat-screen television on the ceiling above David in the procedure room. But Dr. Pugach says he won’t even get to finish his favorite program, since the procedure will be done before the show ends.

Fifteen minutes to prep the patient, fifteen minutes for the surgery, and we check back in with David, who appears to be in no pain whatsoever.

“It was not painful,” he tells us. “Amazingly enough. I was pleasantly surprised that it was nothing. You have these thoughts in your mind what it could be. I feel great.”

David is told to rest for the next two days, and then he can resume normal activities, including sex. When we checked back in with him a few days later, he said the recovery was uneventful, not painful, and that he has been able to resume all activities, except jogging.

The urologist who performed the no-needle, no-scalpel vasectomy on David, Dr. Robert Pugach, doesn’t just ‘talk the talk’. He’s had a no-scalpel, no-needle vasectomy too, performed by another urologist. If you are considering a vasectomy, make sure you are done having kids. The procedure is reversible in most cases, but it means more surgery.

Besides the pain, Dr. Pugach says many men are concerned a vasectomy will affect their sexual performance. Dr. Pugach says it will only affect performance for the better, since sex can now be more spontaneous.

Copyright © 2009, KTLA-TV, Los Angeles

Dr. Robert Pugach interviewed by California Adventure TV on the No Needle No Scalpel Vasectomy, Meet vasectomy patient Mike.   Learn more about vasectomy and Pacific Coast Urology Medical Center.

Dr. Robert Pugach interviewed by California Adventure TV on the No Needle No Scalpel Vasectomy, Meet vasectomy patient Mike.   Learn more about vasectomy and Pacific Coast Urology Medical Center.

Lara C. Pullen, PhD

Source: Medscape Medical News – NEW GUIDELINES FOR DOCTORS PERFORMING VASECTOMY

Oct 25, 2012

The American Urological Association (AUA) has published new guidelines for physicians who offer vasectomy services, recommending that vasectomy be considered more often as a permanent contraception option.

A supplement to the December issue of the Journal of Urology contains new clinical guidelines for multiple treatments including guidelines for vasectomy. The vasectomy guidelines cover perioperative practice, anesthesia, vas isolation, vas occlusion, and postoperative practice.

Pravin Rao, MD, director of reproductive medicine and surgery, Brady Urological Institute, Johns Hopkins University, Baltimore, Maryland, spoke with Medscape Medical News about the new guidelines. Dr. Rao, who did not participate in their development, explained that, “there really has not been a set of well-delineated guidelines for physicians up to this point.”

The AUA recommends an in-person preoperative interactive consultation, which should cover the permanent nature of the surgery, the fact that vasectomy does not produce immediate sterility, and the need for additional contraception until vas occlusion is confirmed. The preoperative consultation does not need to include routine discussion of prostate cancer, coronary heart disease, stroke, hypertension, dementia, or testicular cancer because post vasectomy patients are not at higher risk for these conditions. Prophylactic antimicrobials are not indicated unless the patient is at high risk for infection.

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The guidelines indicate that local anesthesia should be used for the vasectomy, with oral sedation being optional. Vas isolation should be performed using a minimally invasive vasectomy technique such as the no-scalpel technique.

Vas occlusion can be accomplished by extended electrocautery or by 1 of 3 divisional methods:

  • mucosal cautery with fascial interposition and without ligatures or clips applied on the vas,
  • mucosal cautery without fascial interposition and without ligatures or clips applied on the vas, or
  • open-ended vasectomy leaving the testicular end of the vas unoccluded, using mucosal cautery on the abdominal end and fascial interposition.

Surgeons who are able to consistently achieve results by occlusion of the vas with ligatures or clips may use this approach.

According to the guidelines, there is no need for routine histologic examination of the removed vas segments.

Other contraceptive methods should be used until the vasectomy is confirmed successful by post vasectomy semen analysis (PVSA) approximately 8 to 16 weeks after vasectomy. The analysis should be performed on semen within 2 hours after ejaculation. Other contraception may be stopped when the semen sample exhibits a zoospermia, rare non-motile sperm, or 100,000 or fewer non-motile sperm/mL.

If motile sperm are seen on PVSA at 6 months post vasectomy, the vasectomy should be considered a failure. A repeat vasectomy can be performed. Persistence of more than 100,000 non-motile sperm/mL at 6 months post vasectomy should trigger serial PVSAs and clinical judgment to determine whether or not the vasectomy was a failure.

Funding for the committee members was provided by the American Urological Association. Dr. Rao has disclosed no relevant financial relationships. Full conflict-of-interest information is available on the journal’s Web site.


Robert G. Pugach MD… ANSWERS QUESTIONS ABOUT VASECTOMY
Beachcomber – Long Beach,  California 

Many men reach a point in their lives when they consider a vasectomy as a permanent form of birth control.  Whether this decision is for couples who have completed their family, or for men who have decided not to have more children, now there’s a way to have a vasectomy with minimal discomfort and down time – The No Scalpel/No Needle Vasectomy!

At Pacific Coast Urology Medical Center, we perform all of our vasectomies using the remarkable No Needle/No Scalpel technique.  Instead of using a needle, Novocain is sprayed at high speed onto the skin surface, numbing the area in seconds!  Next, a 1/8” skin separation is made with a tiny clamp instead of using a scalpel so stitches aren’t necessary.  The No Scalpel/No Needle vasectomy takes just 15 minutes to complete!

Most men ask what they will feel afterwards.  I reassure my patients that there is usually some minor discomfort or a slight ache for about 24 hours – it’s truly minimal.  I advise my patients to relax and take it easy for the first 24 – 48 hours.  It’s also a good idea to apply some ice to the skin surface on the day after your procedure.

Other common questions include when sexual activity can be resumed and are there any changes in sexual ability?  Sexual activity can usually be resumed 48 – 72 hours after the procedure.  Sexual ability does not change; in fact, many men report an improvement in their sex life because sex can be more spontaneous.  Since the majority of semen in your ejaculate is made from fluid that comes from the seminal vesicles, you should see almost no change in the volume or consistency of your ejaculate after your vasectomy.

One final, important point: it typically takes 6 -10 weeks to clear out all of the sperm from the tubes that are still connected to the ejaculatory ducts in your prostate so it’s important to continue using appropriate protection to prevent a pregnancy.  When you have 2 samples given one month apart that show zero sperm, it is considered safe to have sexual activity without contraception.  

Our offices are comfortable and modern and our staff strives to make your visit as pleasant as possible.  During the vasectomy procedure, patients enjoy our large flat screen ceiling mounted TV (Los Alamitos Office) and the services of our wonderful staff at Pacific Coast Urology Medical Center.

We accept most PPO insurance plans, some HMO’s and we  offer a cash price for patients without insurance or for those with high deductibles.  We’re happy to check your benefits for you.

As reported by ABC News, “Vasectomy Increase Reported” 

March 23, 2009 (WLS) — The recession may be causing more people to decide that they don’t want to have children. Doctors around the country are reporting a sharp increase in the number of vasectomies performed since last year. Researchers are concluding that the trend is due to a decreased desire to have children because of the expense involved and more people may be having medical procedures before their jobs and health insurance disappear.

For more information:
http://abclocal.go.com/wls/story?section=news/health&id=6724025

DR. PUGACH’S COMMENTARY: These findings indicate that there is no association between vasectomy and the risk of prostate cancer.
Holt SK, Salinas CA, Stanford JL

Division of Public Health Sciences, Seattle, Washington 98109-1024, USA. Article: J Urol 2008: 180 (December Fred Hutchinson Cancer Research Center,): 2565-2568

Background: The majority of the literature now has shown NO association between vasectomy and prostate cancer. The effect of vasectomy on men with a family history of prostate cancer or on those who underwent a vasectomy at a young age or had an extended period to time since vasectomy.

Objective: To assess the risk of prostate cancer in men by age and length of time to exposure from vasectomy to disease.

PURPOSE: While the weight of evidence shows no association overall between vasectomy and prostate cancer, there has been some suggestion that an association may exist in subgroups, such as men who have a family history of prostate cancer, men who undergo vasectomy at a younger age or when several decades have passed since the procedure. Studies of risk with long latency periods have been hampered by small sample sizes in subgroups since vasectomy only became widely used in the 1960s and generally prostate cancer has a long latency period.

MATERIALS AND METHODS: Data was analyzed from a recent population based case-control study that was designed specifically to address this issue of risk in subgroups. Interviews were completed with 1,001 men diagnosed with prostate cancer from January 1, 2002 through December 31, 2005 in the Seattle-Puget Sound region and in 942 matched control men. Subjects were black and white men between the ages of 35 and 74 years. Data were analyzed using unconditional logistic regression to calculate the OR as an estimate of the relative risk of prostate cancer associated with various vasectomy parameters.

RESULTS: The prevalence of vasectomy was similar in cases and controls (36.2% and 36.1%, respectively, adjusted OR 1.0, 95% CI 0.8-1.2). There were also no associations between prostate cancer and age at vasectomy, years elapsed since vasectomy or calendar year of vasectomy.

If you’d like to learn more about vasectomy and prostate cancer, call Pacific Coast Urology Medical Center at 844-EASY VAS (844-327-9827) for an appointment.

Offices located in Orange and Los Angeles Counties, CA (Huntington Harbour Los Alamitos and Beverly Hills, California).


Undergoing a Delicate Surgery to Become a Father Again (VASECTOMY REVERSAL)
by Yvette M. Manard, MPH

When you read a headline about a “miracle” baby, it’s typically about a woman overcoming infertility and giving birth.  But for men, the circumstances are reversed, as approximately 40,000 men each year change their minds and decide to have their vasectomy reversed.  This was the case for Troy, aged 45, who wanted to become a father again.

In 2002, Troy, a business owner and father of four children, felt that his family was complete and he had a vasectomy. However, like 5% of United States’ men who undergo a vasectomy, Troy’s life circumstances changed.  He fell in love, remarried and as the years passed, Troy and his wife, Jessica, wanted to have a baby.  They began their research to explore options to restore Troy’s fertility.  Their Internet research gave them a basic understanding of the different procedures and the success rates, ranging from vasectomy reversal to assisted reproductive technologies like IVF (In Vitro Fertilization).  “After looking at the statistics, I was concerned that my vasectomy reversal might not be successful because 7 years had passed, and the odds seemed against me that I would be able to father a child again,” Troy explains.

While the couple was doing their Internet research, Troy and Jessica narrowed down the list of urologists they wanted to consult with who specialize in vasectomy reversal.  In October, 2009, the couple selected Dr. Robert Pugach, Medical Director of Pacific Coast Urology Medical Center, and scheduled a consultation.  Even though Troy and Jessica live in Lancaster they didn’t mind the long drive to Dr. Pugach’s Los Alamitos office.

While a vasectomy reversal seems to be a rather straightforward procedure, because it just requires suturing the ends of the vas deferens back together again, it’s far more complex than that.  As Dr. Pugach says, “A vasectomy reversal isn’t as simple as it sounds.”  The procedure is a 3 to 4 hour delicate surgical procedure that uses precise microsurgical techniques with a  special operating room microscope.  During the operation, the urologic surgeon has to carefully stitch together the cut ends of a patient’s vas deferens.   “An exact alignment is needed for a successful operation,” says Dr. Pugach. “This is difficult because the inside of the vas deferens is very tiny – just one-third of a millimeter in diameter.  The best way to envision this is to think of putting the ends of 2 paper clips together.  In that tiny area, up to 24 stitches are required on each side to obtain the most precise alignment possible.”

After discussing it over, Troy and Jessica decided they wanted to try.  “We understood that there is no guarantee in life, but we very much wanted to have a baby,” says Troy.  In November of 2009, Troy underwent the procedure at a local community hospital.  “I was discharged home the same day with minimal pain and advised to take it easy for 72 hours,” continues Troy.

After six months had passed, Troy and Jessica returned to Dr. Pugach for a follow-up semen analysis and were thrilled to be given the good news that Troy’s sperm count was good.  The couple didn’t have to wait long as Jessica’s pregnancy test was positive. Their miracle baby, Jillian, was born January 4, 2011.  “Bringing Jillian home to meet her four siblings, aged 18 to 10 years, was the best New Year’s gift we could ask for,” says Jessica.

But wait! The story doesn’t end here.  With their family now complete, Troy has once again opted for a vasectomy.  This time, Dr. Pugach will be performing a No Needle, No Scalpel vasectomy.  Unlike a vasectomy reversal, the vasectomy will only take 15 minutes while Troy watches a television mounted on the ceiling and surfs through his favorite channels.  Nothing sharp is used for numbing – a jet spray of Novocain numbs the area instantly and no stitches are required!  Dr. Pugach is one of a select group of urologists who perform this remarkable procedure.

Call, 844-EASY VAS (844-327-9827), to schedule a consultation with Dr. Robert Pugach.


Our Miracle Baby Jillian 

Los Angeles and Orange County, May 9, 2011

When you read a headline about a “miracle” baby, it’s typically about a woman overcoming infertility and giving birth. But in this case, the circumstances are reversed and, at the age of 45, I’m a father again!

In 2009, Dr. Robert Pugach performed my vasectomy reversal. I was concerned that my vasectomy reversal might not be successful as I had it done in 2002 by another urologist. I shared my doubts with my wife, Jessica, because 7 years had passed and the odds seemed against me that I would be able to father a child again. Our Internet research gave us a basic understanding of the procedure and the success rates. In fact, that’s how we found out about Pacific Coast Urology and Dr. Robert Pugach. Although we live in Lancaster, we were willing to make the drive to consult with Dr. Pugach.

From our research we knew that a vasectomy reversal requires suturing the ends of my tubes – the vas deferens, back together again. The procedure seemed to be rather straightforward. But, as Dr. Pugach explained to us, a vasectomy reversal isn’t as simple as it sounds. The procedure requires a one to two hour delicate surgical procedure on each side with remarkable precision. Using microsurgical techniques, Dr. Pugach would have to carefully stitch together the cut ends of my vas deferens. As we learned, an exact alignment is needed for a successful operation. Dr. Pugach told us how difficult this is because the inside of the vas deferens is very tiny – just one-third of a millimeter in diameter. Up to 24 stitches must be placed in and around each tube. They are so small that it is difficult to see them without an operating room microscope.

After discussing it with Jessica, we decided that we wanted to try. We understood that there is no guarantee in life but we very much wanted to have a baby. So, in November of 2009, I underwent the procedure at a local community hospital. I was discharged home the same day with minimal pain and advised to take it easy for 72 hours. We returned to Dr. Pugach’s office after six months for our follow up semen analysis and we were thrilled to be given the good news that my sperm count was good.

As it turned out, almost six months after my vasectomy reversal, Jessica’s pregnancy test was positive. Our miracle baby, Jillian was born January 4, 2011. Bringing Jillian home to meet her four siblings, aged 18 to 10 years, was the best New Year’s gift we could hope for.

Yet, our story doesn’t end here. With our family now complete, I have once again opted for a vasectomy. This time, Dr. Pugach will be performing a No Needle, No Scalpel vasectomy. Unlike a vasectomy reversal, the vasectomy will only take 15 minutes while I watch a television mounted on the ceiling and surf through my favorite channels.

I encourage all men looking to have a vasectomy reversal or a vasectomy to consult with Dr. Pugach. The care and attention you receive from everyone at Pacific Coast Urology is unparalleled.


Couples should carefully consider their options

An interview with Dr. Robert Pugach, Medical Director 

of Pacific Coast Urology Medical Center
by Yvette M.Manard, MPH

Did you know that five to ten percent of the over 600,000 men who annually undergo a vasectomy will choose to have theirs’ reversed at some time? The most often cited reason men decide to have a reversal is that they have undergone life changes, primarily remarriage, and they want to have more children. But why would a man undergo a surgical procedure to father a child with the availability of advanced reproductive technologies (ART)?

According to Dr. Robert Pugach, Medical Director of Pacific Coast Urology Medical Center, this is a very important question he discusses with his patients interested in vasectomy reversal. Dr. Pugach explains the reasons are threefold. “ART procedures are generally more expensive, require a woman to undergo In-Vitro Fertilization (IVF), and, most importantly, the success rate is better with a vasectomy reversal than IVF.” According to the Society for Assisted Reproductive Technology (SART) the national success rate for pregnancies in women under 35 years undergoing IVF is 30 percent, compared to 70 percent success rate for a vasectomy reversal.

Dr. Pugach recently completed an extensive clinical training course in advanced vasectomy reversal (vasovasostomy and vasoepidiymostomy) whereby his Center now offers a money back guarantee on the success of the procedure. “Before the development and refinement of microsurgical techniques, the results of vasectomy reversal were much lower. However, in recent years, with the development of better techniques and in the hands of a skilled microsurgeon to perform the reversal, excellent results can be obtained with a high chance of obtaining a pregnancy,” says Dr. Pugach.

Vasectomy reversal is an extremely delicate surgery because the vas deferens must be repaired microsurgically. During a vasectomy a man’s vas deferens (the tiny tubes that carry sperm) have been cut and, possibly, sealed. The result is that there is vas deferens can no longer carry sperm from the testicles. Repairing the inner channel of the vas deferens, means that each tube, which is approximately 1 millimeter in diameter, (smaller than a pinhead) will be repaired with up 24 stitches with minuscule suturing materials. It is a delicate procedure requiring a powerful microscope and skilled surgical hands.

The success of a vasectomy reversal not only depends on the skill and training of the surgeon but also on a number of other factors. Dr. Pugach’s key consideration is how long ago the vasectomy was performed. “For men who have had their vasectomy less than 10 years ago, the chances of success are better,” explains Dr. Pugach. “The results are best when a vasectomy reversal is performed within 5 years of the original surgery. Once the time goes beyond 10 years, overall results decrease although there can be successful outcomes 15 or even 20 years later.”

Unlike a vasectomy which is performed in an urologist’s office and usually takes less than 30 minutes, a vasectomy reversal is performed in a specially equipped hospital operating room using a general anesthetic. The surgery takes two to four hours to perform. Men can usually return to normal activities within 5 days and mild discomfort is experienced. The cost of the surgery is approximately $8000.

Sperm may not reappear for several months and men will typically return for a semen analysis in one to two months and periodically thereafter. Dr. Pugach has seen his patient’s sperm count and motility (movement) improve within three to six months and pregnancies for couples can occur within this time period.

It should be remembered that a microsurgical vasectomy reversal demands the highest degree of skill and experience to be successful. A couple should be well educated and carefully review their options.