Frequently Asked Questions



Q: What is BPH and why does it cause a problem with urination?
A: BPH places pressure on the urethra and stops your bladder from emptying completely. The symptoms include; nighttime urination, a slow stream, dripping or dribbling of urine, incomplete bladder emptying, the need to urinate quickly and suddenly, and needing to wait several seconds before urine starts to come out.

Q: At what age do BPH symptoms occur?
A: Statistics show that the risk of BPH increases every year after age 40. BPH is present in 20% of men in their fifties, 60% of men in their sixties, and 70% of men by age 70. It is important that men know that BPH is not prostate cancer, and having BPH doesn’t mean a man is more or less likely to get prostate cancer. BPH is treatable!

Q: I see the commercials for treating BPH with medications. Are there other treatments?
A: Many doctors treat the symptoms of BPH with medications. These medications are costly, have side effects and often are not very effective in treating the annoying symptoms of BPH. There are alternatives to medication. These newer minimally invasive therapies include microwave and radiofrequency wave therapy to heat the prostate and gently shrink the enlarged tissues. These remarkable therapies are an in office 30 minute procedure which results in improved urination in almost everyone. They are twice as effective as medication and you can be back to normal activities the next day!


Q: What is andropause?
A: Low T or andropause, is increasingly recognized as a significant health issue for men. By age 40, 15% of men are deficient in testosterone. Many men describe a variety of symptoms including:

  • Lack of energy – feeling tired at the start of each day or as your day progresses
  • Mood swings, depression, forgetfulness, inability to concentrate or multi task
  • Low libido (sex drive)
  • Weight gain – inability to lose abdominal fat or weight in general
  • Loss of strength and muscle mass

Q: Are there any significant health risks associated with low testosterone (Low T)?
A: There are significant health issues associated with “Low T” levels. These include:
Increase in the metabolic syndrome (including diabetes)
Coronary artery disease

Q: Is there a blood test for Low T?
A: Yes, there are blood test to check a man’s level of total and free testosterone levels. Your baseline levels should be done beginning at age 25!


Q: What is a “less-guess prostate test?
A: The test often referred to as a “less-guess” prostate test is the Oncotype Dx Prostate Cancer Assay test. The Oncotype Dx test looks at cancer from a molecular level. This new medical field is called genomics. By analyzing DNA sequences in prostate cancer specimens, it has the potential to give us far more precise information about an individual patient’s cancer than a traditional pathologist can do using slides and a microscope. It may become extremely valuable in helping to determine which prostate cancers need treatment and what type of treatment should be provided. We’ve been evaluating and using tests like this for the past several years. We made the switch to the Oncotype Dx test because it seems to provide better information than tests promoted by other companies.

Q: Can the Oncotype Dx Prostate Cancer Assay test replace annual digital rectal exam (DRE) and PSA blood test? Can it replace prostate biopsies?
A: The answer to both questions is “definitely not.” Screening for prostate cancer remains the only way to determine if a patient may have it.


Q: Is a vasectomy a viable form of birth control?
A: Yes, a vasectomy is considered as a viable form of birth control for couples that have completed their family.

Q: Is a vasectomy a permanent form of birth control?
A: Yes, a vasectomy is a permanent type of birth control for a man. A vasectomy is considered as a male sterilization procedure. While a vasectomy can be reversed with microsurgery, in many cases, a man should only have a vasectomy if he is certain that he does not want a child or additional children.

Q: How is a No Needle No Scalpel Vasectomy different from a “regular” vasectomy?
A: At Pacific Coast Urology Medical Center, Dr. Pugach vasectomy technique does NOT involve a needle or a scalpel. This procedure is less invasive. Instead of using a scalpel, a special instrument is used to make a single small skin opening through which we can perform the entire procedure! It heals faster and causes less discomfort.

Q: Is a No Needle No Scalpel Vasectomy a painful procedure?
A: Instead of feeling discomfort from a needle to inject a local anesthetic, Dr. Pugach uses the “No-Needle Anesthetic”. This latest innovation passes Novocain with a “jet” injector that never penetrates a patient’s skin. It provides the maximum in patient comfort. Most pains report no pain to minimal discomfort.

Q: When can I have sex after my vasectomy?
A: Patients can engage in sexual activity as soon as any swelling has gone down and they are comfortable. This typically is in 3 to 5 days. CAUTION: You must continue to use some form of birth control until you return to the office with your semen analysis so we can determine if there are NO sperm present in the sample. .

Q: Does a vasectomy can negatively affect a man’s sex life?
A: A vasectomy does NOT interfere with erections. A vasectomy interrupts the passage of sperm during an orgasm, but hormone levels, blood flow and your ability to get erections is not changed. Couples can experience an improvement in their sexual relations because there is no concern about pregnancy.

Q: Why is it easier and safer for a man to have a vasectomy or for a woman to have her tubes tied?
A: It is easier and safer for a man to have a vasectomy. With the No Needle No Scalpel Vasectomy the procedure is done in the office and is completed in 15 minutes. With this technique there is no scalpel incision and no needle ever penetrates your skin. Whereas, a tubal ligation requires a general anesthetic and penetration of the abdominal wall and it must be done in an operating room.

For your vasectomy choose wisely…Dr. Robert Pugach is certified by Vasectomy Quality Council.


Q: How many men undergo a vasectomy each year?
A: Approximately 40,000 men each year change their minds and decide to have their vasectomy reversed.

Q: Why is a vasectomy reversal more complicated than a vasectomy?
A: 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 and surgical procedure. The procedure is a 3 to 4 hour delicate surgical procedure that uses precise microsurgical techniques with a special operating room microscope. An exact alignment is needed for a successful operation. 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.


Women’s Bladder Control

Q: What is the most effective treatment for bladder control problems?
A: There is no ONE treatment for bladder control problems as a precise diagnosis of the type of bladder control problem is needed. There are four main categories of bladder control problems:

  • Stress incontinence – leaking urine when you cough, sneeze, laugh or exercise.
  • Urge incontinence – leaking urine after a sudden and strong urge to urinate.
  • Overactive bladder – the need to urinate frequently during the day and/or getting up to urinate during the night. With this condition you may also have urge incontinence.
  • Mixed incontinence – a combination of stress and urge incontinence.

Testing for an accurate diagnosis is needed for an effective treatment recommendation.

Q: I’m only 30 years old and have a bladder control problem. Is this common?
A: Bladder control problems affect 50 million Americans and are one of the most common health problems that women face. While many think that the condition only affects older women, the truth is that women of all ages may have urine leakage (incontinence) or other bladder control issues. Some of the reasons younger women may be affected by bladder control symptoms include, pregnancies, recurrent bladder infections, back injuries, side effects from medications, and poor pelvic muscle tone.

Q: Are there treatment to treat my bladder control problem that doesn’t involve taking medications?
A: Yes, there are advanced treatment methods available ranging from biofeedback exercises, acupuncture (PTNS), BOTOX®, hormone replacement and Interstim® bladder therapy. See more information about Urinary Incontinence treatments .