Austin Urology Specialty Other Services
Although Dr. Parviz Kavoussi and Dr. G. Luke Machen focus on their subspecialty niche and do not offer general urology services, with their specialty training and skills in microsurgery they do offer other specialty microsurgical services and specific services on the male reproductive tract.
Chronic testicular pain is defined as pain that lasts for at least 3 months. Chronic testicular pain has historically been, and continues to be, a challenging diagnosis and a difficult issue to treat. Conservative treatment is the first line treatment, but surgical intervention may be required for those who fail conservative treatment, and for many men, can be a cure. As many as 100,000 men in the United States are diagnosed with chronic testicular pain annually, due to varying causes. In specific situations, targeted surgical treatments are the mainstay for cure. Varicoceles (abnormally dilated veins around the testicle), which are present in 15% of men, may result in testicular pain, and repairing the varicocele microsurgically offers a high success rate at resolution of pain. (To read more on varicocele repair click here..) In men with retractile testicles, who develop pain due to hyperactive muscles pulling the testicles up during physical activity, some of which even have to milk the testicles back down to the scrotum again for relief after retraction, have a high success rate with a microsurgical cremaster muscle release. This is a minimally invasive procedure that prevents testicular retraction after the procedure.
Men with post-vasectomy pain syndrome, or testicular pain of unknown cause, who respond to a spermatic cord block (numbing injection) in the clinic, are considered good candidates to consider microsurgical spermatic cord denervation. It is believed that nerve fibers running along the spermatic cord (the cord which also contains the vas deferens and blood vessels to and from the testicle) can be triggered to cause this pain. Anatomic studies have shown the nerves that cause such pain actually undergo a micoanatomic structural change, which is known as wallerian degeneration. This process is primarily identified in 3 specific areas that are rich in these nerve branches. In men without a structural abnormality and testicular pain that does not respond to conservative therapy, surgical therapy can be considered. For men in this position who respond to a nerve block in the clinic, approximately 70% will have complete resolution of pain long term, with a specialized minimally invasive microsurgical denervation of the spermatic cord, and another 15% have improvement in pain. Dr. Kavoussi has published a study showing that a targeted approach to microsurgical spermatic cord denervation results in equivalent pain improvement and response rates and faster operative times, keeping patients under anesthesia for shorter periods, and less risk to important anatomic structures running through the spermatic cord. To read his study, click here.
Dr. Kavoussi and Dr. Machen are two of a handful of surgeons who performs microsurgical spermatic cord denervation regularly. As a renowned expert in the procedure, Dr. Kavoussi has been a faculty lecturer teaching the post-graduate course on surgical treatment of chronic testicular pain multiple times at the American Urological Association annual meeting. He has also authored scientific journal articles on chronic testicular pain (https://www.ncbi.nlm.nih.gov/pubmed/23645410, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3649595/, https://www.ncbi.nlm.nih.gov/pubmed/21529899).
He has also written textbook chapters on such topics in reputable urologic textbooks including Campbell’s Textbook of Urology, Practical Urology: Essential Principles and Practice, and Urologic Principles and Practice 2nd edition.
Dr. Kavoussi and Dr. Machen are experts at microsurgery which they implement in all of the above procedures and perform them in a manner that is minimally invasive with minimal recovery after these outpatient day surgeries.
Phimosis is a condition which can impact uncircumcised men. This occurs when the foreskin becomes tight and cannot be retracted back over the head of the penis. This can cause discomfort, irritation, difficulty with urination, and pain or even tearing and bleeding of the foreskin with erections and intercourse. This can be treated with topical steroids or can be treated in a definitive manner with a circumcision. The circumcision is performed as a day surgery with the man going home the same day and is typically tolerated very well.
Repair of Incomplete Circumcisions in Adults
The epididymis, the comma shaped structure attached to the testicle, connecting the sperm producing tubules from the testicle to the vas deferens may form cysts. An epididymal cyst, also known as a spermatocele, is a non-cancerous, fluid filled cyst that is an outpocketing from the epididymis. Spermatoceles are very common, about 30% of all men have spermatoceles. Spermatoceles are typically diagnosed by physical examination and/or by ultrasound when needed. Spermatoceles will do one of two things over time, either stay the same or grow larger in size. Spermatoceles that grow large or cause pain can be surgically removed, but the timing of doing so should be considered carefully as this treatment may impact the man’s fertility, so it is typically deferred until a man is done having children.
Spermatoceles are removed surgically as a day surgery where the patient goes home the same day. Ice packs are recommended for the first 2 days after the procedure to minimize swelling. Oral pain medicine is used to control discomfort after the procedure. Scrotal swelling is typical after surgery and may last for up to 3 weeks after spermatocele surgery. Having a spermatoceles do not increase the risk for testicular cancer.
Adults with hydroceles complain about swelling of the scrotum. This is caused by excessive fluid secretion by the layer of tissue tightly covering the testicle without adequate reabsorption of this fuid by the looser sack surrounding the testicle. Hydroceles will either stay the same size or grow larger. When a hydrocele becomes large enough it can cause discomfort, heaviness, or may be cosmetically bothersome. Surgical repair can be offered for any of these reasons. As a recognized expert in the field, Dr. Kavoussi has written the AUA (American Urological Association) Update Series on the physiology and management of hydroceles.
Dr. Kavoussi is not only very experienced in such treatments, but has written the textbook chapters describing the surgical techniques for many of the procedures listed above in the textbooks used by urologists around the globe. (Parviz K. Kavoussi, Raymond A. Costabile. Chapter 37, Surgery of the Scrotum and Seminal Vesicles. Campbell-Walsh Urology, 10th edition. Saunders Co. Wein, Kavoussi, Partin, Peters, eds. ; as well as Parviz K. Kavoussi, Raymond A. Costabile. Chapter 23, Disorders of Scrotal Contents: Orchitis, Epididymitis, Testicular Torsion, Torsion of the Appendages, and Fournier’s Gangrene. Practical Urology: Essential Principles and Practice. Springer Co. Chapple, Steers, eds.)
Men who have absence of one or both testicles due to absence from the time of birth, loss of testicle due to torsion (twisting), trauma, or testicular cancer may elect to have a saline filled testicular prosthesis placed. The prosthesis is designed to have the texture, weight, and shape similar to that of the natural testis and is sized at the time of surgery to match the natural testis in men having one prosthesis placed.
To schedule a private, personal consultation with the award-winning and widely recognized Dr. Parviz Kavoussi or Dr. G. Luke Machen in any of our specialty Urology Austin and Round Rock clinics (Westlake or South Austin, and Round Rock), please call (512) 444-1414 or contact our office online.
Dr. Parviz Kavoussi contributed the textbook chapter on surgical, radiographic, and endoscopic anatomy of the male reproductive system in the 11th and 12th editions of Campbell’s Walsh Urology textbook, which is considered the “bible of urology” used for training urology residents as well as the primary reference for practicing urologists. A mastery of this anatomy is paramount to optimize outcomes in surgical procedures on the male reproductive system.