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The vasovasostomy M.D. charge is $950 inclusive of post-operative semen check at 3 months. The hospital charge has been $1500 but this can go down 25% for an immediate payment on a credit card. Non-stop service from most western cities costs about $200. Evanston is 1.25 hours from Salt Lake City airport via I-80.

Penile implants are offered by this practice to persons unresponsive to Viagra and/or Levitra. I have favored the malleable implant because of the lower repeat operation rate and because the patient/partner satisfaction rate is about the same as the inflatable.

Female lack of orgasms can be treated with small amounts of male hormone added to the female hormone typically taken in the post-menopausal periods. Vaginal pain can sometimes be improved by successfull treatment of bladder infections.

Urinary tract stones are a big problem in southwest Wyoming. I have used the ureteroscope primarily to bust the stone under vision but the extracorporeal stone shocker is availabe for the the right patient with a stone that will break easily.

Prostate cancer is a constant worry. My views are anchored on my publication in the British Journal of Urology in 2000. Benign prostatic hypertrophy  (BPH) is, by far, the commonest cause of weak urinary stream and getting up at night. It is, in the absence of a nodule, also the cause of an elevated PSA between 4 and 10. It has probably been undertreated in the last twenty years because of alarm about prostate cancer. It begins, like prostate cancer, in the 3rd and 4rth decade. In these early years, it responds well to pills as well as to lesser surgical procedures like microwave. After age 76, when these benign but troublesome tumors become large, they probably should be resected by somebody who has done a lot of that work.