Circumcision

Circumcision is the surgical removal of the skin covering the tip of the penis. Circumcision is fairly common for newborn boys in certain parts of the world, including the United States — making it the most common surgical procedure in newborn males worldwide. Circumcision after the newborn period is a more complicated procedure that may require general anesthesia.
For some families, circumcision is a religious ritual. Circumcision can also be a matter of family tradition, personal hygiene or preventive health care. For others, however, circumcision seems unnecessary or disfiguring. After circumcision, it isn't generally possible to re-create the appearance of an uncircumcised penis.
Circumcision is a religious or cultural ritual for many Jewish and Islamic families, as well as certain aboriginal tribes in Africa and Australia. Circumcision can also be a matter of family tradition, personal hygiene or preventive health care. Sometimes there's a medical need for circumcision, such as when the foreskin is too tight to be retracted over the glans. In other cases, particularly in certain parts of Africa, circumcision is recommended for older boys or men to reduce the risk of certain sexually transmitted infections.
The American Academy of Pediatrics (AAP) policy statement on newborn circumcision says the benefits of circumcision aren't strong enough to recommend routine circumcision for all male newborns. The AAP leaves the circumcision decision up to parents — and supports use of anesthetics for infants who have the procedure.
Circumcision may have various health benefits, including:
 Easier hygiene. Circumcision makes it easier to wash the penis — although washing beneath the foreskin of an uncircumcised penis isn't generally difficult.
 Decreased risk of urinary tract infections. The overall risk of urinary tract infections in males is low, but these infections may be more common in uncircumcised males. Severe infections early in life can lead to kidney problems later on.
 Prevention of penile problems. Occasionally, the foreskin on an uncircumcised penis may be difficult or impossible to retract (phimosis). This can also lead to inflammation of the foreskin or head of the penis.
 Decreased risk of penile cancer. Although cancer of the penis is rare, it's less common in circumcised men. In addition, cervical cancer is less common in the female sexual partners of circumcised men.
 Decreased risk of sexually transmitted infections. Safe sexual practices remain essential, but circumcised men may have a lower risk of certain sexually transmitted infections — including HIV, the virus that causes AIDS.
Circumcision may not be an option if certain blood-clotting disorders or penis abnormalities are present. In addition, circumcision may not be appropriate for premature babies who still require medical care in the hospital nursery.
Circumcision doesn't affect fertility, nor is circumcision generally thought to enhance or detract from sexual pleasure for men or their partners.

Varicocele

A varicocele is a collection of enlarged (dilated) veins (blood vessels) in the scrotum. It occurs next to and above one or both of the testes (testicles).

The affected veins are those that travel in the spermatic cord. The spermatic cord is like a 'tube' that goes from each testis up towards the lower abdomen. You can feel the spermatic cord above each testis in the upper part of the scrotum. The spermatic cord contains the vas deferens (the tube that carries sperm from the testes to the penis), blood vessels, lymphatic vessels, and nerves.

Normally, you cannot see or feel the veins in the spermatic cord that carry the blood from the testes. If you have a varicocele, the veins become bigger (they enlarge or dilate) and this makes them more prominent. It is similar to varicose veins of the legs. The size of a varicocele can vary. A large varicocele is sometimes said to look and feel like 'a bag of worms' in the scrotum.

Who gets a varicocele?

Varicoceles are common. About 1 in 7 men develop a varicocele - usually between the ages of 15 and 25. In about half of cases the varicocele is on the left hand side. In just under half of cases there is one on both sides. In a small number of cases it is just on the right side. The reason why most occur on the left side is because of the different route the left veins take out of the scrotum compared to the right.

What are the symptoms of a varicocele?

Varicoceles are usually painless and usually cause no symptoms. A small number of affected men notice a 'dragging' feeling or slight discomfort from their varicocele. This may only occur at the end of a day, especially if you are on your feet all day. The size of a varicocele varies from case to case. Some cannot be seen, only felt. Some are large and can be easily seen. If you lie down, the blood from the veins drains away and the varicocele may seem to disappear. On standing, gravity will cause the blood to pool again and the varicocele reappears.

Are varicoceles serious?

Usually not. In themselves they are usually harmless. Causes of concern include the following:   

• Possible cause of infertility .Studies have shown that there is a higher rate of infertility in men with a varicocele compared to those who do not have a varicocele. It is thought that the pooled blood causes a slightly higher temperature in the scrotum than normal. This may reduce the number and quality of sperm made by the testis which can reduce fertility. Even if you have a varicocele only on one side, both testes can be warmed by the increased amount of blood pooled in the enlarged veins. However, most men with varicoceles are not infertile. It is just that the chance of being infertile is increased if you have a varicocele.
• Small testis .If a large varicocele develops in a teenager, the testis on the side of the varicocele may not develop as much as would be expected. The testis may end up being smaller than normal. This may contribute to infertility too.
• Sudden onset of a varicocele in an older man
• Rarely, a varicocele quickly develops as a symptom of a blockage of a larger vein in the abdomen (see below). This would normally only occur in men over the age of 40.

What causes varicoceles?

In most cases, the reason why the veins become larger is because the valves of the small veins in the scrotum do not function well. There are one-way valves at intervals along the veins. The valves open to allow blood to flow towards the heart, but close when blood flow slows to stop blood flowing backwards.

If these valves do not work well, blood can flow backwards (due to gravity) and pool in the lower parts of the vein to form a varicocele. (This is similar to how varicose veins form in legs.)

It is not clear why the valves do not work well.

Rarely, a varicocele may develop if there is a blockage of larger veins higher in the abdomen. This puts back-pressure on the smaller veins in the scrotum which then enlarge. This is only likely to occur in men older than 40. For example, if a varicocele suddenly develops in an older man, it may indicate a tumour of the kidney has developed which is pressing on veins.

But it must be stressed, the vast majority of varicoceles develop in teenagers and young men and are not due to a serious condition.

Do I need any tests?

Usually not. Most varicoceles occur in young healthy men. The diagnosis is made by a doctor's examination. A varicocele is associated with some cases of infertility. Therefore, a semen test may be asked for if you are part of a couple that is being investigated for infertility. In the rare situation of a varicocele first developing in a man over 40, then tests to check out a possible underlying cause may be advised. Also, a solitary right-sided varicocele is unusual. If this occurs you may need some tests to rule out any unusual cause.

What is the treatment for varicoceles?

No active treatment is needed in most cases

If a varicocele is causing no symptoms or problems, then it is best left alone. If there is just mild discomfort then supportive underpants (rather than boxer shorts) may help to ease or prevent discomfort. If a varicocele develops in a teenager, then your doctor may wish to monitor the growth of the testes. For example, an annual measurement of the testes may be advised. This may help to clarify if a testis is not growing to its full size.

Treatment may be advised in certain situations

For example, treatment may be a advised if you have persistent discomfort. Also, treatment may be advised if a testis is not growing properly in a teenager with a varicocele.

Treatment involves tying off the veins that are enlarged. Another method of treatment is to use a special substance injected into the veins to block them. Both methods are usually successful. Your surgeon will advise on the pros and cons of the different techniques.

However, after successful treatment, some men have a recurrence of a varicocele months or years later. This is because the veins left behind to do the job of taking the blood from the testes may themselves enlarge or dilate with the extra blood they will now have to carry. A recurrence can be treated in the same way as the first time.

Is treatment for varicocele a possible cure for male infertility?

Probably not. For many years it was thought that treating a varicocele in an infertile man would increase his chance of becoming fertile again. Studies have shown that after treatment, the sperm count may improve. This was assumed to increase the chance of fertility. Some studies did indicate that fertility may be increased with treatment.

However, a recent large analysis (meta-analysis) of studies looking at this issue found that there was no good evidence to say that fertility is increased by treatment. Some experts are critical of this analysis and maintain that more research is needed to clarify whether treating a varicocele improves fertility. If you are infertile, your specialist will advise on current research related to this issue. But remember, most men with a varicocele are not infertile.

  

Penis Enlargement Surgery: Everything You Need to Know

Penis enlargement surgery for men without erectile dysfunction has long been the most popular elective surgical procedure performed by the surgical specialists of the Sava Perovic Foundation. But surgery to create larger male genitals and a larger than average penis comprises only about 5% of the 74 complex uro-genital procedures & urologic
However, most international medical tourism to Serbia is for complex, non-elective surgery by the Sava Perovic Foundation Surgical Team, led by Dr Djinovic. About 95% of our urology operations are unrelated to penile enlargement and penis sizes.
Regardless, inquiries about penis girth enlargement using tissue engineering have long dominated all inquiries about penis surgery of any type and consume a disproportionate amount of the case manager's time. This page aims to answer all your questions proactively so the only remaining questions will be:
• are you a suitable candidate?
• when can you get the surgery?
• exactly how much will it cost you?
To be fair to the 95% of our other 20,000+ patients who need complex, life-changing, non-elective surgery, starting in the second quarter of 2010, the case manager will no longer provide by email any penis enlargment surgery information already published here or from any of the pages to which we have provided links here. Peform your due diligence and read the information we have already provided to you before asking any questions.
Dr Djinovic and the Surgical Team of the Sava Perovic Foundation are taking his techniques, procedures and philosophy to the next level. That means they are busier than you can possibly imagine. Many patients came from around the world for Dr Perovic to correct mistakes, failures and bad penis enlargment surgery and the Sava Perovic Foundation Surgical Team continues to provide that service. More than a few guys are waiting for their medical situation to stabilize so Dr Djinovic can undo the damage done by other surgeons attempting girth enhancement using tissue engineering.Other times it’s Alloderm or FFT gone wrong or the unfortunate result of other inadvisable procedures. The Sava Perovic Foundation Surgical Team will fix the penile enhancement problem but do not ask them to comment about the surgery or the surgeon because invariably Dr Djinovic's answer will be: “No comment.”
Perovic penile girth enhancement using autologous tissue engineering with biodegradable scaffolds is very safe with a 100% success rate after more than 300 operations and an average girth increase in both flaccid and erect states of approximately 30% in the initial pilot study done a decade ago
• [mean value flaccid girth gain 3.15 cm (0.42, range 1.9 to 4.1 cm)]
• [mean value erect girth gain 2.47 cm (0.49, range 1.8 to3.0 cm)] 
Substantial but not massive size increase is the trade-off for the safety, success, permanency, and rare, minor complications of tissue engineering such as inflammation that
You can calculate the approximate immediate increase in your girth after tissue engineering surgery using the formulas:
•  [Circumference = π • Diameter] and
• [Diameter = Circumference / π]
• π (pi) = 3.14
… because the scaffolds are exactly 4mm thick which means an instant 8 mm increase in diameter:
•  [(original penile diameter + 8 mm) • 3.14].
How that evolves into penile augmentation over the subsequent months varies from person to person. You can find your current penile diameter using your current circumference.
Penis girth enhancement surgery takes less than 2 hours of surgery, requires 1-2 days hospital stay and 3-4 days in Belgrade total time. A standard schedule:
• Day One: arrive, have consultation and pre-op exam, give blood, check into medical facility & stay night;
• Day Two: surgery, stay night at medical facility;
• Day Three: post-op exam, nursing care, check-out of medical facility, check into hotel (or stay at medical facility for Euros 50 to 60 per night);
• Day Four: physical exam then departure.
A number of men have come back for a second and a third enhancement because the results are cumulative. Penile girth enhancement surgery repeated by the Sava Perovic Foundation Surgical Team a second time costs about 38% less than the first procedure. Girth enhancement by the Team a third time is discounted more than 53%.
Penile lengthening using ligamentolysis (optional) which can provide gains in penile length ranging from ½ cm erect to as much as 4 cm longer flaccid  would cost an addition Euros €1000, if wanted. This procedure is more penile plastic surgery than urology and provides primarily aesthetic benefits
 •  [mean value of flaccid length gain 3.45 cm (0.52, range 2.1 to 4.5 cm) , mean value of erect length gain 0.65 cm (0.32, range 0.5 to 1.0 cm)]
 Pubic area liposuction (optional) at the same time as penis enhancement adds 30 minutes to the entire time in the operating room and an additional Euros €1000 to the total cost.
Gynecomastia and/or nipple reduction (optional) at the same time as penis enlargement surgery cost an additional Euros €1500.
Patients who believe scrotal cell culture for seeding the scaffolds (full tissue culture) may get them better girth gains than blood serum, and who are willing to visit Belgrade twice to do so, are welcome to choose that option. It costs an additional Euros 350 during your first visit for the tissue culture.
During the past four decades, Dr Perovic developed many secret “tips and tricks” while doing surgery on his 20,000 patients. More than 10,000 of those persons needed the most complex uro-genital surgery done anywhere. Those “tips and tricks” used by the Sava Perovic Foundation Surgical Team mean complications are extremely rare and the ones that occur are very minor — and patients get aesthetically pleasing as well as very functional surgical results.
Dr Djinovic puts tremendous importance on attention to detail and that is a big part of their often amazing results.
 We also recommend you take a few minutes to read this article about the risks and complications of any surgery in addition to doing research about the specifics of the procedure you are considering. Get all the answers and information you need to get the surgery abroad you want by doing all of the following:
• 1) inform us of the date you most prefer to have your surgery performed (you will need to arrive in Belgrade the day before);
•  2) submit your medical history (optional but advisable
• 3) send digital photos of your penis from left, right, center, above and below in flaccid and erect states.
• In 2009, Dr Perovic revised post-operative physiotherapy for penile girth enhancement patients, saying: “Regarding postoperative physiotherapy it is best is to start with an ANDROPENIS stretcher (Euros 250) about two weeks post¬
• “Using a vacuum device (Euros 150) is better postponed until about four weeks after surgery with the same protocol as published online.”
Starting 1 May 2010, both the Andronpenis device and the vacuum device are included in surgical package fee. The package price has remained the same since 2007. No increase in price.
[Note: Falling asleep for a long period of time while using an Andropenis device can result in permanent, total loss of tactile and erogenous sensation in the user's penis. Use only as prescribed by your doctor. These are NOT for penis lengthening.] Dr Djinovic does not use fat, lipofilling, Alloderm, silicone or any other substance to create penile girth enhancement in men able to have natural erections unaided. He uses only tissue
engineering and biodegradable scaffolds