About Us

Through our Male Urologic Health Program, overseen by Drs. Ronald Yap and Thomas Jackson, our urologists provide a comprehensive, multidisciplinary approach to the diagnosis, treatment, and management of male urologic issues and advocate for male health.

Our program concentrates on concerns and issues associated with male urologic health including:

• Sexual Health: Erectile dysfunction, penile curvature (Peyronie's disease) and low testosterone problems;
• Prostate Health: Prostatitis, prostate cancer screening and Benign Prostatic Hyperplasia (BPH);
• Reproductive Health: Vasectomy, vasectomy reversal and infertility.

Frequently Asked Questions
What are some of the common sexual health issues men experience?
When should I contact a physician regarding a sexual health concern?
What is prostatitis?
What causes prostatitis?
What are the symptoms of prostatitis?
How is prostatitis diagnosed and treated?
When and how often should I be screened for prostate cancer?
What is involved in a prostate cancer screening?
Where is the prostate and what does it do?
What is BPH (Benign Prostatic Hyperplasia)?
What problems can occur with BPH?
How will the doctor evaluate my BPH?
What medications exist for BPH?
What surgical options exist for BPH?
What surgical options exist for BPH?
What should I do next?
What is a vasectomy?
How is a vasectomy performed?
Can a vasectomy be reversed?
Can men experience infertility?
What are common causes for male infertility?
How is infertility diagnosed in men?
How is male infertility treated?

Sexual Health

What are some of the common sexual health issues men experience?

• Erectile dysfunction (ED) - ED is defined as the inability to achieve and maintain an erection adequate for sexual activity.
• Ejaculatory dysfunction - There are different types of ejaculatory dysfunction including premature, retrograde and absence of ejaculation. The significance, causes and treatment vary with each specific condition.
• Penile curvature - Penile curvature is most often due to a condition called Peyronie’s Disease. This is a benign condition caused by the formation of scar tissue on the shaft of the penis. There are both medical and surgical treatment options for this issue.
• Low testosterone - This is often seen as part of the aging process and is sometimes referred to as ‘andropause’. It can also be seen in younger men due to hormonal or testicular abnormalities. Signs and symptoms of low testosterone include: decreased libido (sex drive), fatigue, osteoporosis and other problems. Effective testosterone replacement can be achieved with monthly injections or daily topical medication (testosterone gels or patches).

When should I contact a physician regarding a sexual health concern?
Although some sexual problems may improve on their own with time, most patients benefit from early evaluation and treatment. Sometimes changes in sexual function may be the first signs of a more generalized condition such as atherosclerosis. Patients should discuss concerns about their sexual health as soon as they become noticeable to the patient or their partner. A primary care provider can determine which patients will benefit from consultation with a specialist.

What is prostatitis?
Prostatitis is inflammation of the prostate gland.

What causes prostatitis?
The inflammation may be caused by a bacterial infection, nerve or muscle irritation, or be a component of a pelvic pain syndrome.

What are the symptoms of prostatitis?
Symptoms include but are not limited to: pain in the ‘seat area’ or perineum, pelvic pain and or urinary difficulties.

How is prostatitis diagnosed and treated?
Your doctor will do a history and physical exam with digital rectal exam and urinalysis. Further evaluation and treatment is then individually tailored to each patient.

When and how often should I be screened for prostate cancer?
Prostate cancer screening should be discussed with your doctor.

What is involved in a prostate cancer screening?
Prostate cancer screening typically involves a digital rectal exam to assess the prostate for size, symmetry, texture, and nodules as well as a prostate specific antigen (PSA) blood test.

Where is the prostate and what does it do?
The prostate is a male sexual gland that creates semen. It is located between the bladder and penis.

What is BPH (Benign Prostatic Hyperplasia)?
BPH is prostate growth that can diminish the ability for the bladder to send urine through the urethra, or penis tube, during voiding.

What are symptoms of BPH?
The two main classes of symptoms are irritative and obstructive.
Some irritative symptoms include:

• Frequency
• Urgency
• Getting up at night to urinate (nocturia)

What problems can occur with BPH?
Quality of life can be diminished by the frustrating symptoms of BPH. Excessive nighttime urination can also disrupt restful sleep.
Some complications of BPH include:

• Urinary tract infection (UTI)
• Urinary retention
• Bladder stones
• Kidney damage

How will the doctor evaluate my BPH?
First, you will be asked to complete an American Urological Association (AUA) Symptom Score Sheet to further determine your symptoms and bother level. Your doctor will do a thorough interview and male health physical including a prostate examination. Your urine will be examined via urine dipstick and microscope. Prostate Specific Antigen (PSA) tests will be reviewed and/or ordered to screen for prostate cancer. Your doctor will then present treatment options to you.

What medications exist for BPH?
Several classes of drugs are used to treat this condition. Your doctor can prescribe a medication to relax the bladder and prostate muscles, thereby decreasing the obstructive effect of the prostate. Other medications exist which can slowly shrink your prostate or relax bladder tone. Please speak with your doctor further regarding medical management options.

What surgical options exist for BPH?
When medications fail to alleviate urinary bother or when complications arise from BPH, your doctor may discuss surgical treatment.
Options include:

• Transurethral resection of the prostate (TURP)
• Laser ablation of the prostate (HoLAP)
• Needle or microwave treatments to the prostate

What should I do next?
If you wish to be evaluated for your male urinary symptoms, please call our office or request a consultation with us through your primary care provider.

What is a vasectomy?
A vasectomy is a minor surgical procedure that results in permanent sterilization of the male. It is an appropriate form of contraception for couples that have decided to not have any children and/or any additional children. A vasectomy does not impact erections or the ability of the man to enjoy sexual activity.

How is a vasectomy performed?
A vasectomy is performed in a medical office using local anesthesia. A small piece is removed from each vas deferens, the tube that transports sperm from the testicles. The procedure typically takes 15-30 minutes to complete.

Can a vasectomy be reversed?
Although patients are advised to view vasectomy as a method of permanent contraception, the procedure can be reversed in the majority of patients. However, the reversal procedure is considerably more complex and is performed under an operating microscope at a hospital. The cost of the reversal procedure is several times that of the initial vasectomy.

Can men experience infertility?
Approximately 15 percent of couples in the United States experience infertility. A male factor is the primary cause in 20 percent and contributory in another 30 percent. Stated another way, a male factor will be found in up to half of infertile couples. Therefore, it is important to evaluate both partners when a couple presents with concerns regarding their fertility status.

What are common causes for male infertility?
There are several causes of diminished male fertility. Broadly, these are broken down into conditions that reduce sperm production at the level of the testis (e.g. varicocele or varicose veins in the scrotum) and those that impair transport of sperm once they leave the testis (e.g. prior vasectomy, cystic fibrosis). The specific cause of the patient’s infertility determines treatment options available to the couple.

How is infertility diagnosed in men?
The first step in evaluating a man with suspected sub-fertility is to take a careful history (including any family history of fertility problems) and perform a physical examination with particular focus on the genitalia and reproductive organs. A semen analysis is also part of the initial evaluation. This test examines the number of sperm as well as their motility (swimming ability) and shape. Often, it is necessary to perform several semen analyses many weeks apart to establish the patient’s true baseline. Based on the results of the initial evaluation additional tests such as blood work and ultrasound imaging may be recommended.

How is male infertility treated?
Treatment of male infertility depends on the underlying cause. For example, surgical correction of a varicocele, if present, may allow the couple to conceive naturally. Cases of low sperm counts caused by a hormonal insufficiency can often be treated effectively with medication. Other causes of male infertility may require a specialized form of in vitro fertilization (IVF) called intracytoplasmic sperm injection (ICSI). It is common for a couple’s medical providers (urologist and obstetric/gynecologist) to consult on designing a couple’s optimal fertility strategy.

American Society for Reproductive Medicine (ASRM)
UrologyHealth.org
Men's Health Network
Prostate Pal