ZSR circumcision is the type of stapler circumcision done by using the innovator stapler called ZSR. It harbours a silicon ring over which the metal staples are present.
How ZSR is different from traditional circumcision?
Traditional circumcision done using stitch involves more pain, long Surgical time, increased bleeding and long recovery. Also the risk of infection is more in patients undergoing traditional circumcision. Also patients have bleeding diasthesis can be better managed with stapler circumcision.
What are long term results of ZSR circumcision?
Long term results of ZSR circumcision are equivalent to stitch circumcision, however the cosmesis appears better with ZSR circumcision.
How much time ZSR circumcision take ?
It takes nearly 5-10 minutes for ZSR circumcision.
Whom to meet for ZSR circumcision?
You can meet your nearby urologist for same. Now stapler circumcision is done in Jalandhar using ZSR technology. You can call and book your appointment for the surgery.About Dr Varinder Attri
Frenulum is the elastic fold of skin that joins the underside of the glans of the penis with the inner surface of the foreskin.
What are risks of having short frenulum ?
A short frenulum (also called frenulum breve) is when the frenulum is so short in length that there is restriction in free and smooth retraction of the foreskin. This often leads to the pain and discomfort during sexual intercouse. Also, it can increase the risk of infections, as it is difficult to clean under the foreskin. Short frenulum can also get torn while sexual activity and hence can lead to bleeding. Read how this condition is different from Phimosis
Short Frenulum/Frenulum breve
What is the treatment for short frenulum ?
It can be managed conservatively if not causing any discomfort or pain. In some cases, steroid creams and stretching exercises can be enough to sufficiently elongate the frenulum. However in majority of cases, surgery is required to alleviate the symptoms. Frenuloplasty (Frenular release) is the mainstay of surgery. Sometimes, the resection of the frenulum (frenulectomy) or circumcision (removal of foreskin) is required. This surgery is done on day care basis with same day discharge of the patient after surgery.
Whom to consult for short frenulum ?
Urologist and Andrologist are the doctors, who look after such problems.
Varicocele is the abnormal dilatation of testicular veins which become tortuous and enlarged. This condition is mostly present on the left side.
How does varicocele develop?
Testis blood return through testicular vein requires a valve mechanism to prevent the backflow of blood. The incompetence of this valvular mechanism leads to the development of varicocele. It is seen commonly on the left side due to anatomical variation. Isolated right side varicocele may represent an underlying right kidney tumor.
What are the symptoms of varicocele?
Varicocele can be asymptomatic or present with
Dull aching/dragging pain or discomfort in groin and scrotum
Scrotal enlargement
Small testis same side
Is having varicocele worrisome?
Varicocele is present in up to 15% of adult men. Not all have symptoms due to their presence. People can have dull aching or dragging pain in the scrotum. Varicocele is the common cause of infertility. Varicocele can affect testis size and semen parameters. Up to 30-40% of patients with primary infertility (never having normal fertility) and 60-70% with secondary infertility (having prior normal fertility) are diagnosed to have varicocele as the cause of infertility. Long-standing varicocele can also affect testosterone production.
How to diagnose this condition?
Diagnosis is generally made examining scrotal contents with the patient in standing position. Ultrasound doppler may be required to look for testis atrophy and early-stage varicoceles. Isolated right-sided varicocele warrant doing an ultrasound of the kidney.
How can I prevent varicocele?
Since the cause of varicocele is largely determined by familial and genetic factors, no preventive measures are beneficial.
Is there any severity grade of varicocele?
Varicocele is graded into 3 grades as the enlargement of veins increases.
Grade 1 – palpable only on Valsalva maneuver (taking a deep breath and holding it while bearing down) or diagnosed on ultrasound
Grade 2 – palpable on clinical examination
Grade 3 – visible veins are seen in the skin of the scrotum
Which patients need treatment?
Not all patients require treatment. They need treatment if having
Persistent pain
Infertility with abnormal semen parameters
Small-sized testis
Infertile patient planning for assisted reproductive techniques
How varicocele causes infertility?
Normal sperm production from testes requires 2-3 degrees less temperature. Varicocele increases intra-scrotal temperature due to the pooling of blood. The most common semen abnormalities seen are oligospermia (decrease sperm count) and asthenospermia (decrease sperm motility).
What are the treatment options for varicocele?
Conservative measures like tight scrotal or a jockstrap may alleviate pain in some patients with low-grade varicocele.
Microsurgical varicocelectomy – This is the most common surgical procedure employed. In this daycare procedure with the patient under spinal anesthesia, a small incision (2-3 cm) is made in the lower groin region to get access to the cord of testis which harbors the enlarged tortuous testicular veins and is then carefully ligated individually under microscopic magnification.
Laparoscopic ligation – In this surgery, the enlarged testicular vein is approached through the abdomen with the patient in general anesthesia.
Embolization – In this non-surgical procedure, the enlarged vein is blocked with small metal coils. The procedure is conducted by passing a small catheter through the groin or the neck. This avoids any surgical incision but the risk of varicocele recurrence is high.
What are the risks of surgery?
Risks with varicocele surgery are its recurrence and hydrocele (fluid collection in the scrotum) formation. Both these risks are lowest with microsurgical varicocelectomy surgery.
What to expect after surgery? If surgery is done for abnormal semen parameters, 60-80% of patients find improvement in their semen analysis. In infertile patients, nearly 40-50 % can impregnate a woman successfully in one year.
Nearly one in six couple unable to conceive after one year of marriage.
Male infertility is as common as female counterpart and contributes nearly 40% as the causes of the infertility in the couple.
Male evaluation must be done at the first visit of the couple to the doctor.
Initial evaluation consists of detailed history, physical examination including genital examination for testes, vas deferens, varicocele, phallus examination.
A simple semen analysis gives a lot of information for future direction of investigation and management.
Management of infertility may include simple smoking cessation, healthy lifestyle, hormone therapy, varicocele surgery, need for IUI, IVF or ICSI.
Many couples with failure to conceive and having male infertility as a cause, can still have their own child with one of other method of assisted reproductive techniques such as IVF and TESA/TESE with ICSI.
Dr Varinder Attri - Urologist, Andrologist and Laparoscopic surgeon 