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Welcome to Fifth Avenue Urology, the practice of Dr. Yaniv M. Larish. We are located in Manhattan, in New York City’s beautiful Upper East Side. We offer the most advanced state of the art diagnosis and treatment for all problems of the male and female urological and reproductive systems.

Dr. Larish served as the former chief resident of Urology at Lenox Hill Hospital. Drs. Larish is focused on providing exceptional, detail oriented, unrushed, and compassionate urological care to men and women of all ages. At Fifth Avenue Urology, we view the ability to practice medicine as a privilege, not a right. They treat their patients with respect, professionalism and compassion.

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Yaniv M. Larish, M.D.

dr-yaniv-larish-fifth-avenue-urology2 Dr. Larish is a urologist and surgeon treating women and men with a variety of urological conditions. His expertise is in treating complex kidney stones, enlarged prostates (BPH), incontinence, erectile dysfunction, infertility, and urological oncology (prostate, bladder, kidney, and adrenal cancers). He is an expert in general urology and is often consulted for second opinions.

Dr. Larish’s dedication to patients and their families drives his belief in prompt evaluation and care. He treats all his patients like family. As such, same day appointments are available for urgent issues and house calls can be made in select cases.

See our Main Site at www.FifthAvenueUrology.com

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Tag Archives: best doctor for vasectomy in nyc

What Exactly Is A Vasectomy, and What Are Your Options?

A vasectomy is a permanent method of birth control, or sterilization, for men. It is a surgical procedure during which the tubes that runs from the testicular epididymis to the seminal vesicle are cut and tied, or sealed, so that sperm will not enter the ejaculate that is released during orgasm. The vas deferens are the tubes that run from the testicles through the scrotum to the seminal vesicle. Sperm is formed in the testicles and stored in the epididymis where they mature. During ejaculation, sperm flow from the epididymis and are transported through the vas deferens, to the seminal vesicle, where the fluid is diluted before ejaculation.

Although there is a possibility of reversible, it is not always successful, and it is both costly and complex to perform, so if you decide to have a vasectomy, you should think of it as a permanent operation. You should consider the psychological and emotional consequences. Many top urologists recommend that men undergoing a vasectomy preserve some of their sperm through freezing.

vasectomy doctor nyc p02 A vasectomy itself is not a difficult procedure, and is usually performed in a doctor’s office or clinic. There are several methods, and all methods involve sealing at least one side of each vas deferens tube. An experienced urologist, like Dr. Melman, will be able to determine the best treatment option in consultation with each individual patient.

Traditionally, when performing a vasectomy, the urologist will numb the scrotum with a local anesthetic, and make two small incisions on either side, which will allow the urologist to access each vas deferens, which are then cut, separated, and sealed on at least one side by either suturing, electro cauterization, or clamping.

vasectomy doctor nyc no scalpel vasectomy p03 A variation, known as the “no-scalpel” vasectomy or “keyhole” vasectomy, is performed by puncturing the scrotal sac with a sharp hemostat. This results in quicker healing and a smaller chance of infection, as the incision is much smaller.

No-needle vasectomies allow urologists to apply anesthesia painlessly without a needle with a jet-injection device, which forces the anesthetic into the scrotal tissue. This type of anesthesia was devised for men who have a fear of needles. The rest of the procedure is the same, after the scrotum is anesthetized.

An open-ended vasectomy is named because the testicular end of the vas deferens is not sealed, and this sometimes decreases any long-term testicular pain that occasionally results from increased pressure back into the epididymis.

One cause of vasectomy failure is recanalization of the vas deferens. In order to prevent this surgical failure, a method known as fascial interposition was created. Fascia is fibrous tissue that surrounds the vas deferens. In fascial interposition, one end, the prostatic end, of the vas deferens is positioned outside of this fibrous sheath of tissue, decreasing the risk of vasectomy failure.

If you are considering a vasectomy as a method of permanent birth control, you should arrange a consultation with Dr. Melman, one of the top urologists in the United States. He sees patients by appointment in his New York City office. Contact Dr. Melman today to discuss a vasectomy.

What is a vasectomy and who should consider having one?

A vasectomy is a simple, safe, 15 minute procedure done under local anesthesia in the doctor’s office that can prevent unwanted pregnancies and the problems associated with pregnancy. I had a sign in my office that said, “If you had a vasectomy you never have to say, “I’m sorry.” Thousands of vasectomies later it’s still true. No more condoms. No more pills. No worries.

Vasectomy anatomy:

(Click pictures to enlarge) The vas deferentia are tubes that arise from each testis and travel up to the back of the prostate and enter into the prostate along with fluid from the seminal vesicles. That fluid along with secretions from the prostate is called semen. When you “come”, that is, have an orgasm, that is the fluid is ejaculated. Only 1% of the total volume of semen is actually sperm. So after a vasectomy you do not see or feel a difference in your semen volume.

A vasectomy is the snipping and removal of a one inch piece of the vas deferens with interruption of the tubes that carry sperm from their production site in the testes, and to the outside (the outside is your partner’s inside).

You have a vasectomy because you, not your wife, but you, no longer want to father additional children.

The operation is permanent so if you are not absolutely certain that you do not want to father children again don’t do it. I will be writing another blog in the future about vasectomy reversal.

If you are considering banking you semen, “just in case,” don’t have a vasectomy.

But if you have decided that more children are not what you want it is a great operation and you should do it. There is no downside to the operation.

The other function of the testis is to produce the male hormone testosterone. That hormone enters the body through the blood vessels that drain the testes, not through the vas deferens. The bottom line: there is no effect of male hormone production after vasectomy.

Vasectomy, what you have to consider? A few points:

In New York State, by law, there is a mandatory one month waiting period from the time you are counseled and sign your consent, to when you can have the procedure. For other states check with your urologist.
We are really doing a “partial vasectomy”. The vas deferens is about 2 feet long and we are removing an inch, so it’s ‘partial’, not ‘complete’. For this reason, it takes about 13 ejaculations to rid the vas deferens of remaining sperm. You should not consider yourself infertile until your semen is checked under a microscope to look for remaining sperm. If the sample shows no sperm, you are given the good to go sign.
You can return to work the next day after vasectomy surgery.

Frequently asked questions about vasectomy:

Is there a lot of pain after vasectomy?

After vasectomy surgery there tends to be an ache in the groin for a few days until the wounds heal as the testes pull down on the vasectomy site.

Are there possible complications of vasectomy?

All surgeries can have complications of bleeding and infection, but the chance of that happening is only a few percent, but not 0%, so it is possible. If that problem occurs it takes a few weeks longer to feel 100%, but the complication does not affect the vasectomy results, and you will still be sterile.

Does sex feel any different after vasectomy?

Sex feels exactly the same physically after vasectomy. Mentally, sex can actually be more enjoyable because you no longer have to worry whether the condom will break or your wife or girlfriend did not take precautions.

“No-scalpel vasectomy” or “Incisionless vasectomy”

Some doctors claim and market that they do incision-less vasectomy surgery. That is not possible. The vas deferens lies under the skin and although the incision is only a ¼ of an inch, you need to open the skin to reach the vas deferens. The opening is closed with one or two stitches that dissolve so they do not have to be removed.

So, if you are considering having a vasectomy procedure done, call to make an appointment with the most experienced urologist in NYC for vasectomies, Dr. Arnold Melman.