Robert G. Pugach MD

My offices have been strangely quiet these past few weeks as we’ve all honored California’s “Shelter in Place” order. As the largest provider of No Needle/No Scalpel Vasectomy services in the western United States, our usual full vasectomy schedule has taken second place to the need for social distancing. That is starting to change. As the COVID-19 pandemic starts to wind down, we are seeing a dramatic increase in scheduled vasectomies starting in May 2020.

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Robert G. Pugach MD

There are two general classes of birth control: reversible and permanent. The principal permanent birth control method for women is called tubal ligation or a “tubal.” Permanent birth control for men is called a vasectomy.

Click on the link below to learn about the differences and advantages of each birth control method.

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West Coast Urology’s Vasovasostomy Guarantee

You will find our guarantee to be unique. When choosing your doctor for a vasectomy reversal procedure,
ask yourself who would you choose – a doctor who guarantees your result or someone who does not?

ARTICLE

“Couples should carefully consider their options”

An interview with Dr. Robert Pugach, Medical Director

of West Coast Urology
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 West Coast Urology, 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.

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 West 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 West Coast Urology is unparalleled.

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.

DR. PUGACH’S COMMENTARY: These findings indicate that there is no association between vasectomy and the risk of prostate cancer.

If you’d like to learn more about vasectomy and prostate cancer, call West Coast Urology at 888-735-4336 for an appointment.

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

Lara C. Pullen, PhD

Source: Medscape Medical News

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.

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.

Meet Evans Tran, Physician Assistant
By Yvette M. Manard, MPH

It’s not every day that you meet a young woman as remarkable as Evans Tran. Evans is a physician assistant working in a busy urology practice. This article is not just about her skill and the caring and compassionate manner with which she treats patients, but a story of her incredible determination to rise above adversity and fulfill her dreams.

As a child of immigrant parents, Evans didn’t have an idyllic Southern California childhood. For many years she lived in a U-haul truck with her family. “My motivation to succeed stems from this childhood experience as I grew up knowing that living in a truck was not what I intended for the rest of my life,” explains Evans.

Evans had high hopes for her future and at a young age she decided to embark on a journey to discover her life’s passion. At the age of 14, she was interested in community service and began volunteering at Long Beach Memorial Medical Center. This experience introduced her to the field of healthcare where she felt great joy in helping people.

Evans enrolled in California State University, Long Beach and earned a BA in Human Development. While in college she gained additional experience in healthcare by completing a Clinical Care Extender Internship Program at St. Mary’s Medical Center in Long Beach. “My commitment to this internship reinforced my passion for medicine,” remarks Evans.

Although this internship provided medical training, she was interested in a more global experience. Taking advantage of the University’s study abroad program, Evans participated in conservation projects with mentally disabled people in New Zealand and worked with HIV children in South Africa.

Upon her return to the United States, Evans was accepted to the Physician Assistant Program at Western University of Health Sciences in Pomona, CA. Her life experiences taught her that, in addition to education and training, one’s ability to provide compassion, understanding and trust can positively influence patients’ health and also inspire them to help others. “Compassion and empathy are what I have learned to provide as a human development major when I understood that cultural, religious, and traditional backgrounds are the backbone of compassionate values.”

Evans received her Master of Science and is a board certified Physician Assistant. She works at West Coast Urology with Dr. Robert Pugach.

West Coast Urology is one of the leading medical practices in the US specializing in the minimally invasive treatment of urological conditions. Visit: www.pacificcoasturology.com and www.advancedvasectomy.com