Paul Turek
speaker
358 appearances
1 recordings
1 series
first heard Jun 2025
last heard Jun 2025
Paul Turek’s voice in public audio — every appearance, attributed to the second.
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You could be missing a vas deferens. One in 500 men have perfectly normal testicles, but they have a natural vasectomy. It's congenital absence of the vas. They're going to be sterile or infertile.
It's about 10% vasofluid with sperm. It's about 80% seminal vesicle fluid, which is an accessory sex gland in the back of the prostate, and about 10% prostate. So typically during ejaculation, prostatic fluid, which is clear and sticky, will grease the barrel of the urethra pre-cum.
Then during the ejaculation process, the pellet of sperm gets pumped from the vas deferens into a chamber called the ejaculatory duct. And this happens quickly. And then the seminal vesicle, which is like a bladder, contracts, sends it into the prostatic urethra between the bladder and the outer world. There's two valves. One is the bladder neck. It closes.
And one is the urethral sphincter that we pee through. And that opens.
So in 3,000 men I've done vasectomies on in 30 years, two men have said, my volume went down. And I said, really? One of them banked sperm, and he had a semen analysis before and after, and he did go down by 15%. And he noticed it, and I said, good for you. What do you want to do now? So it can be noticeable, but not usually.
And so the color is the same, the opacity is the same, the whole process of liquefaction is the same, viscosity, et cetera.
So my fingers can feel two and a half millimeters The vas deferens is like a piano wire. I mean, it is different than anything else in the cord. I did a study, a third of my men with absent vas were only found out having procedures until I saw them. I usually just do the exam, but it is an expertise thing. Yeah, it's not like the PCP can figure this out.
You have to be doing this all day, every day. Yeah, I think you need to be trained on that. But if you're well-trained, it should be purely a physical exam.
The most common genetic disease in America is cystic fibrosis. So the big implication is these men can't conceive naturally. They have a natural vasectomy. We use sperm retrieval techniques and IVF. but they definitely have the chance of passing on cystic fibrosis to a child. Why is that?
It's a very interesting biology, but men with cystic fibrosis, the most common genetic disease in America, have no vas deferens.
It's a chromosome 7. There's 1,700, 1,800 mutations, maybe 2,000. So they cloned the genes and got the variants in the late 80s. And then they found that there's another group of men who are perfectly healthy, do not have cystic fibrosis, which is a major metabolic disease with a short life expectancy, better now. Those men had absent vas deferens in the absence of disease.
They took the gene sets and looked at them, and they were the same, just not as many. So you have homozygous or heterozygous. So you have a carrier for cystic fibrosis will have an absent vas, but a full-blown CF patient, cystic fibrosis patient, will have no vas deferens too. So it's a form fruit of cystic fibrosis, but it doesn't have all the chemical and metabolic side effects.
Yeah. And then you have to worry if there's a 4% chance in America anyway that a partner might carry it. There are two carriers. You have a one in four chance of having a very affected child. So that's the big concern in my practice. And I'm proud to say in 30 years, we have no CF children. It's all about good engineering and doing it right. So that's the vast difference part.
What else on physical exam are you looking for?
Yeah. So among viruses in the world, There aren't many that get into the testicle like other things. Very little gets into the testicle, similar to the brain. But the mumps virus does it about a third of the time when you're a child with mumps, the parotid gland infection. It's a glandular disease. So it really only matters when you're pubertal and you get mumps. Then it goes to lots of glands.
It goes to your pancreas, cause diabetes. It can go to the salivary glands. It can go to the testicles.
And it will cause viral necrosis and edema of the testis. And similar to a brain, it's in a calvarium, right? The brain is in a fixed space. So when it swells, you got to do something because it can die if it swells too much. Testicle is a fixed cavity with the tunica albiginea. And so if it swells too much, it necrosis, and then you get fibrosis, and then you get sterility.
I've got techniques where I can find sperm in lots of these men, little pockets, but most of it, you're ablating the testis. It's going to scar and die from ischemic necrosis. Zika, Ebola. I mean, the CDC called me when these were coming around. Zika has been transmitted through semen. It causes the anencephaly issues. When these pandemics were occurring, Ebola too.
I got a call that there was an Ebola patient who survived, went to the institute, survived hemorrhagic fever. And then a year later, transmitted Ebola to a partner who transmitted to six other men. And it was another outbreak in South Africa.
Right. We don't know about testes, but we know that mumps will do that to the testes, but Zika is also persistent in the semen.
Showing 81–100 of 358 · page 5 of 18
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