Dr. Amar Raval’s Recommendations: Surgery or Radiation for Prostate Cancer?

KEY TAKEAWAYS:

  • Surgery and radiation therapy are two common treatment options for prostate cancer, each with its own set of benefits and drawbacks.
  • Dr. Raval often recommends radiation therapy for older patients or those with medical comorbidities that may limit their ability to undergo surgery successfully.
  • Dr. Amar J. Raval, MD, is a urologist in Tampa, FL, and a member of the Advanced Urology Institute, the largest urology practice in Florida.

Dr. Amar J. Raval and the Decision-Making Process for Prostate Cancer Treatment

Amar J. Raval, MD, is a urologist in Tampa, FL, specializing in the diagnosis and treatment of prostate cancer. With a range of treatment options available, deciding between surgery and radiation can be a challenging process for patients. In this article, we explore Dr. Raval’s insights and recommendations for making this important decision.

Surgery vs. Radiation: Weighing the Options

When it comes to treating prostate cancer, surgery and radiation are two of the most common treatment options. Each method has its own set of benefits and drawbacks, making it crucial for patients to carefully consider their individual needs and circumstances before making a decision.

Surgery: The Benefits and Drawbacks

Surgery, specifically radical prostatectomy, involves the complete removal of the prostate gland and surrounding tissues. While surgery can be an effective option for treating prostate cancer, it is an invasive procedure that carries its own set of potential complications. These may include infection, bleeding, and urinary incontinence, among others.

Dr. Raval emphasizes that surgery is not without risks, and patients should be aware of these when weighing their options. However, for some patients, surgery can offer the best chance for long-term cancer control.

Radiation: A Suitable Option for Older Patients or Those with Medical Comorbidities

Radiation therapy, on the other hand, involves the use of high-energy X-rays or particles to kill cancer cells within the prostate. Dr. Raval often recommends radiation therapy for older patients or those with other medical conditions that may limit their ability to undergo surgery successfully.

Although radiation therapy can be a less invasive alternative to surgery, it is not without potential side effects, such as urinary and bowel issues or erectile dysfunction. However, for some patients, radiation therapy may provide a more suitable option given their overall health and age.

The Importance of Patient Autonomy in Treatment Decisions

While Dr. Raval provides his expert opinion and guidance during the decision-making process, he ultimately leaves the choice of treatment up to the patient. Each individual’s unique circumstances, preferences, and values must be taken into account when determining the best course of action for treating prostate cancer.

Dr. Amar Raval at Advanced Urology Institute

Dr. Amar J. Raval is a skilled urologist in Tampa, FL, who is dedicated to providing the best possible care for his patients. As a member of the Advanced Urology Institute, the largest urology practice in Florida, Dr. Raval works alongside a team of experienced urologists who share his commitment to excellence in patient care.

By offering comprehensive treatment options and personalized guidance for patients with prostate cancer, the Advanced Urology Institute ensures that their patients receive the most advanced and effective treatments available in the field of urology.

TRANSCRIPTION:

My name is Amar J. Raval and I’m with Advanced Urology Institute. You know surgery is surgery at the end of the day and it does have its own complications and you’re you know making incisions. With radiation I like to give it to patients who are older who want treatment and also have medical comorbidities or different things that may limit them from being successful from a surgical outcome. But I think it’s again it’s a big conversation to have and ultimately I you know give my thoughts but I leave it up to patients to decide what they want to do.

REFERENCES:

What Is Screening for Prostate Cancer?

My name is Brian Hale, I’m a board certified urologist working with Advanced Urology Institute.

Certainly any man over the age of 50 should be screened for prostate cancer, it is the #2 cause of cancer death in men. There’s a lot of controversy about the PSA because of its lack of specificity: a lot of men who have elevated PSA do not have prostate cancer, but unfortunately we don’t have a better task. We have a rectal exam but that misses more cancer than the PSA, so to stop screening for prostate cancer was a mistake and they actually only reversed that recommendation on screening for prostate cancer based on what was happening. We were seeing a lot of men with Metastatic disease.

Dr Brian Hale: Urologist in Tampa, FLI started private practice in 1995, and from 1995 until the last five (5) years or so, I didn’t have any metastatic prostate cancer patients in my practice, and now I have a lot, and a lot of it was from a lack of screening. I have patients that were trying to do everything right: watching their weight, exercising and they stopped screening for prostate cancer because of the recommendations. They would have symptoms like blockage from their prostate or blood in their urine. We would check a PSA and we would find it to be extremely high and later find they have metastatic disease because of lack of screening. I have several patients I know on the top of my head that have had that problem, unfortunately. So I would definitely recommend that they continue screening for prostate cancer. [While] it is true, we need a better test than PSA, but just because we don’t have a better test doesn’t mean we should stop screening and I think the government is coming back around to that because the treatment of metastatic prostate cancer is a lot more expensive than the treatment of early prostate cancer.

What are the Symptoms & Treatment Options for Low Testosterone, According to Dr. Amar Raval?

KEY TAKEAWAYS:

  • Low testosterone can cause symptoms such as fatigue, erectile dysfunction, and lack of energy, negatively impacting a person’s daily life and self-esteem.
  • Diagnosing low testosterone involves checking laboratory tests and assessing other hormones that may affect testosterone levels.
  • Treatment options for low testosterone include gels and injectable testosterone, which can have a significant positive impact on patients’ lives.

Dr. Amar J. Raval on Low Testosterone

Amar J. Raval, MD, is a urologist in Tampa, FL, specializing in the diagnosis and treatment of urological conditions, including low testosterone. Low testosterone can have a significant impact on an individual’s daily life and overall well-being. In this article, we will discuss the symptoms and treatment options for low testosterone, as advised by Dr. Raval.

Symptoms of Low Testosterone

Low testosterone, or hypogonadism, can present with a variety of symptoms that may negatively impact an individual’s quality of life. According to Dr. Raval, some of the common symptoms associated with low testosterone include:

  1. Fatigue
  2. Erectile dysfunction
  3. Lack of energy

These symptoms can interfere with a person’s daily activities, relationships, and self-esteem, making it crucial to seek appropriate treatment.

Diagnosing Low Testosterone

Dr. Raval explains that diagnosing low testosterone involves checking certain laboratory tests, including subsequent tests to confirm the low testosterone levels. In addition, other hormones that may affect testosterone levels are also assessed.

Treatment Options for Low Testosterone

Once low testosterone has been confirmed, Dr. Raval discusses various treatment options with patients. These options include:

  1. Gels: Topical testosterone gels are applied directly to the skin and absorbed through the skin’s surface. This method is convenient and relatively easy to administer, although it may cause skin irritation in some cases.
  2. Injectable testosterone: Testosterone injections are another treatment option for individuals with low testosterone. Injections provide a more direct route of administration, and dosing can be more easily controlled compared to gels.

The Impact of Testosterone Treatment on Daily Life

Dr. Raval emphasizes that testosterone treatment can have a dramatic effect on patients’ lives, including their sexual function, energy levels, productivity, and self-esteem. By addressing the underlying hormonal imbalance, patients can experience significant improvements in their overall well-being and quality of life.

Dr. Amar Raval and Advanced Urology Institute

Dr. Amar J. Raval is a urologist in Tampa, FL, who is dedicated to providing the best possible care for his patients. As a member of the Advanced Urology Institute, the largest urology practice in Florida, Dr. Raval works alongside a team of experienced urologists who share his commitment to excellence in patient care.

By offering comprehensive treatment options and personalized guidance for patients with low testosterone, the Advanced Urology Institute ensures that their patients receive the most advanced and effective treatments available in the field of urology.

TRANSCRIPTION:

My name is Amar J. Raval and I’m with Advanced Urology Institute. There’s plenty of patients who have low testosterone and want to know treatment options for that. They have fatigue, erectile dysfunction, lack of energy, and those can plague them in their daily lives. So generally now with the new screening guidelines with the AUA, we check certain labs. We need to show that they have low T on subsequent labs and we also check other hormones that may affect that. And those that are in need or can benefit from therapy, there’s gels as well as injectable testosterone that can be given to help them in that setting. I think it dramatically affects their lives. Their sexual lives, their energy, their being more productive throughout the day can affect relationships and even their self-esteem. So all of these are huge factors for them.

REFERENCES:

Pelvic Organ Prolapse: An Overview

There are awkward conditions, and then there is pelvic organ prolapse. It is uncomfortable, upsetting and embarrassing.

With pelvic organ prolapse (POP), there is a bulge at the opening of your vagina, which occurs because one or more of your pelvic organs has slipped or dropped down from their normal position. The organ can be your womb (uterus), bladder, bowel or the top of your vagina.

How does pelvic organ prolapse occur?

Well, usually, the pelvic organs—the uterus, vagina, bladder, and rectum—are propped and held in place by the muscles and tissues of the pelvic floor. But when these muscles weaken, the pelvic organs drop downwards into or out of the vagina.

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Kidney Stones: Risk Factors and Preventions

The prevalence of kidney stones in the United States has increased over the last decade. As many as 1 in 10 Americans have a kidney stone at some point in their lives, and every year more than half a million Americans go to emergency rooms for kidney stone related complications.

What are kidney stones?

A kidney stone is a small, hard deposit that forms in the kidneys. Stones occur when the urine concentration of crystal-forming substances—such as calcium, oxalate and uric acid—is more than the fluid in the urine can dilute.

They begin as small crystals and grow into larger masses (stones), which then make their way through the urinary tract. Unfortunately, a stone can get stuck on its way out of the urinary system, resulting in an unbearable pain that comes in waves until the stone eventually passes.

What causes kidney stones?

Genetics is one of the risk factors. If you have family members who had kidney stones, you are at a higher risk of having them yourself. Your risk is also higher if you have had kidney stones in the past.

Dehydration is another major cause of kidney stones, which is why more kidney stones occur in the summer. In fact, kidney stone frequency is known to vary by geographic location, with warmer climates having the highest rates of stone formation.

What you eat and drink makes a huge difference. Drinking enough fluids to make over two liters of urine a day reduces the risk of stone formation. Actually, as a rule, you should always check your urine for signs of dehydration. If your urine is dark or yellow, then you are not drinking enough fluid and run the risk of having stones.

Factors that increase dehydration will contribute to kidney stone formation. For instance, excess salt or sodium in food, such as in processed or fast foods, increase dehydration as the excess salt requires a lot of fluid to excrete. So reducing the sodium in your diet will minimize your risk of stone formation.

Matthew Truesdale, MD of Largo Bardmoor, FL

How do you know that you have kidney stones?

Kidney stones cause pain by getting stuck in the urinary system. Since the kidneys continue to make urine, which in turn can’t get out due to the blockage, the urine builds up, stretches the kidneys and leads to severe pain.

You will know you have kidney stones when you have severe, excruciating pain that comes in waves. The pain typically occurs in the back and does not get better with a change in position. Patients who have had kidney stones and also delivered children report that the stones are more painful than giving birth. In addition to pain, you may have fever, nausea, and even vomiting.

Kidney stones may require a trip to the emergency room if you have severe pain, nausea, vomiting, and a fever greater than 100.3 degrees. These symptoms constitute a urological emergency because they signal both a blockage and an infection. With the blockage preventing antibiotics from getting out via urine, you can get very sick, very quickly; hence the need for emergency care.

Emergency treatment with IV fluids at a hospital may be necessary if you are having nausea and vomiting to the point of dehydration. Emergency care is also appropriate when you have pain that cannot be alleviated by over-the-counter pain medicine.

What is the treatment for kidney stones?

The treatment for kidney stones depends on the size and location of the stone, and on the clinical stability of the patient. The most common approach is medical expulsion therapy—a conservative approach for healthy patients with stones that are small enough to pass on their own and with no fever or other signs of infection.
With medical expulsion, you are encouraged to drink a lot of fluid to help the stone pass on its own. You are also given medications to control the pain and to accelerate passage. If the stone is 5 millimeters or smaller (about half of your thumbnail), there is a 50% chance it will pass on its own and you will avoid surgery.

If you have severe pain, fever, chills and an inability to drink fluids, you may not qualify for medical expulsion therapy. In that case, a surgical procedure may be needed. There are two common surgical options: (1) ureteroscopy or laser lithotripsy, and (2) extracorporeal shockwave lithotripsy.

Ureteroscopy and laser lithotripsy are fancy ways of saying you go to sleep, a camera is inserted through your urethra to the stone, and a laser is used to break the stone into smaller fragments for removal. Extracorporeal shockwave lithotripsy means you go to sleep and sound waves are sent through your skin to fracture the stone into small pieces that can pass on their own in urine.

The advantage of shockwave lithotripsy is that nothing goes into your body, making it less invasive. However, the disadvantage is that the stone fragments still have to pass on their own, a process which can be painful and uncomfortable.

How do you prevent kidney stones?

1. Increase calcium intake

There is a misconception that increasing dietary calcium increases the risk of calcium oxalate stones. This is not true. In fact, eating more calcium rich foods, such as milk or cheese, ensures the oxalate in the diet binds to calcium. When oxalate binds to calcium in the intestines, it is not absorbed in the bloodstream and ends up in stool.

2. Reduce oxalate rich foods

Foods high in oxalate, such as beets, chocolate, tea, coffee, spinach, kale, rhubarb, nuts and beer contribute to stone formation. You may have to eat smaller portions of these foods alongside calcium-rich foods or avoid them altogether.

3. Stay hydrated

Drinking plenty of water will ensure that substances in your urine are diluted and cannot form crystals. As a rule, strive to drink enough water to pass two liters of urine every day—which is drinking roughly eight standard 8-ounce cups per day. It also helps to include some citrus beverages, such as orange juice and lemonade, as the citrate in these beverages helps to block stone formation.

4. Reduce sodium intake

A high salt or sodium diet increases the amount of calcium in your urine and triggers stone formation. Excess salt also wastes the fluid you take as a lot more fluid is necessary for salt-water balance. Make sure to limit your daily sodium intake to 2300mg or less to reduce your risk of kidney stones.

5. Minimize intake of animal protein

Animal protein, such as red meat, eggs, poultry, or seafood, increases the level of uric acid in the body and may cause kidney stones. A high protein diet will also reduce your urinary citrate—the chemical in urine that prevents stones from forming. You can limit animal proteins or replace them with plant-based proteins.

At Advanced Urology Institute, we offer a range of treatments for kidney stones depending on the severity of symptoms and the type, size and location of the stones. We also run tests to find out why they form and give you advice on how to prevent them.

If you or a relative has had kidney stones, consider meeting with one of our urologists for specific ways to reduce your risk. For more information on kidney stone causes, risk factors, diagnosis, treatment and prevention, visit the Advanced Urology Institute website.

Listen to the Podcast to learn more about Kidney Stones, Click here

Penile Implants for Erection Problems – Dr. Rishi Modh

My name is Rishi Modh, I am a board-certified urologist with Advanced Urology Institute.

So I think when you go see a urologist about erectile dysfunction, you need to see a urologist who specializes in implants as well. Not all urologists perform penile implants so they may not even offer it as an option for you. A penile implant is an outpatient procedure with a small incision and a fast recovery. It’s a mechanical device that’s placed inside your body that allows you to pump fluid into the penis in order to give you a great erection. Ninety-five percent (95%) of men are extremely happy with their penile implant and ninety-five percent (95) of partners would recommend it to someone else to have a surgery done.

How Does Dr. Amar Raval Diagnose & Treat Kidney Stones?

KEY TAKEAWAYS:

  • Kidney stones are prevalent in Florida, with dehydration and heat as contributing factors.
  • Dr. Amar Raval, a urologist in Tampa, FL, employs imaging tests to diagnose kidney stones and determine the most appropriate treatment.
  • Treatment options for kidney stones include stent placement, ESWL, and laser lithotripsy, all of which are minimally invasive and leverage advanced technology.

Introduction

Kidney stones are a common issue faced by many, especially in Florida, where heat and dehydration contribute to their development. Dr. Amar J. Raval, a reputable urologist in Tampa, FL, at the Advanced Urology Institute, shares his approach to diagnosing and treating kidney stones, leveraging the latest technology and minimally invasive techniques.

Symptoms of Kidney Stones

Patients with kidney stones usually experience a sudden onset of flank pain that doesn’t subside with oral medication, nausea, vomiting, fever, chills, and blood in their urine. These symptoms often prompt them to seek medical attention and undergo imaging tests to identify the presence of kidney stones.

Diagnosis of Kidney Stones

When a patient presents with symptoms indicative of kidney stones, Dr. Raval employs imaging tests, such as X-rays, ultrasounds, or CT scans, to visualize the stones and assess their size, location, and possible obstruction. This information is crucial in determining the best course of treatment for the patient.

Treatment Options for Kidney Stones

Dr. Raval emphasizes that modern technology has significantly advanced kidney stone treatment, offering several minimally invasive approaches:

  • Stent Placement: A temporary stent may be inserted into the ureter to bypass the stone and alleviate pain. This procedure is often performed when the stone is too large to pass naturally or is causing severe symptoms.
  • Extracorporeal Shock Wave Lithotripsy (ESWL): This non-invasive technique uses shock waves to break the kidney stone into smaller pieces, enabling the patient to pass them more easily through the urinary tract.
  • Laser Lithotripsy: In this minimally invasive procedure, a ureteroscope is inserted through the urethra and bladder to reach the stone. A laser is then used to break the stone into tiny fragments, which can be passed naturally or removed using a small basket-like device. A sample of the stone may also be sent for analysis to determine its composition and help prevent future stone formation.

Advanced Urology Institute: Your Partner in Kidney Stone Treatment

At the Advanced Urology Institute, the largest urology practice in Florida, Dr. Amar Raval and his team of skilled professionals are committed to providing the highest quality care for patients with kidney stones. Leveraging cutting-edge technology and innovative treatment options, they ensure that patients can overcome this painful condition with minimal discomfort and a swift recovery.

TRANSCRIPTION:

My name is Amar J. Raval and I’m with Advanced Urology Institute. So kidney disease is very prevalent in Florida because of the heat, lack of hydration being a huge factor. You know, patients generally present with acute onset flank pain that’s, you know, doesn’t resolve with oral medication, nausea, vomiting, fevers, chills, even blood in their urine. Then they ultimately get some sort of imaging that shows that they have a stone that may be obstructing and causing them this discomfort. Approaches are very simple and they’re very endoscopic, don’t require any incisions whether it’s leaving a stent to bypass the stone or if you’re going to treat the stone you can use shock waves from the outside to blast it or a laser to finely fine tune the stone and take a piece of it and send it as a specimen to know what kind of stone it is. So technology is certainly advanced in the realm of kidney stone disease and there’s a lot of minimally invasive approaches to be able to treat that.

REFERENCES:

The Enjoyment of Being a Urologist

Urology is a wonderful specialty, being at the same time a surgical and medical practice. It offers an interesting mix of work in both the office and the operating room.

“For many of us, we enjoy spending time in the operating room—after all, we are surgeons by trade,” says Dr. Scott B. Sellinger, FACS, a board-certified urologist at Advanced Urology Institute. “But for many of us, we also enjoy interactions with our patients in the office. I love to see my folks, especially the ones I’ve been seeing for the past 25 years. They come back every year and we can chat about all kinds of things.”

Interesting surgical techniques

While most urology patients are followed long-term with medical interventions, at least half of them are surgical patients. The subspecialty of urology offers great opportunities to practice the surgical side of the profession, which includes the hands-on application of the latest technology, such as robots and lasers. “I enjoy the surgical side of our profession, and urology offers innovative techniques and technology that makes surgical procedures even more interesting,” says Dr. Sellinger.

Long-term relationships

The opportunity to build lasting doctor-patient relationships makes urology gratifying.

“As a urologist, you get to care for the entire spectrum of age groups of patients, such as children with congenital problems and patients in their declining years, when a lot of urologic problems tend to set in.” says Dr. Sellinger. “I like the fact that I see different patients every day, delve into their emotional problems, and with empathy, provide the support and solutions they need. I also enjoy speaking with the patients I see every year for several years since every time they come in they have something great to share,” he adds.

Tackling embarrassing problems

Urology brings relief to patients with personal and sometimes embarrassing medical problems. Through surgery, medications or both, urologists resolve these issues and improve the quality of life of their patients, which is quite appealing.

“As a urologist, not only do I treat life-threatening conditions like cancer, I also improve the quality of life of patients by freeing them from sexual dysfunction or incontinence,” says Dr. Sellinger.

Great outcomes

Unlike some other specialties, the treatments offered by urologists often provide quick relief and good outcomes. In fact, most patients treated by urologists do well and get better.

“Nowadays, urology is quite advanced, and we have at our disposal medicines, surgery, and the combination of both treatments that render our patients improved soon after they interact with us,” says Dr. Sellinger. “So we feel satisfied and secure in the knowledge that we can solve most, if not all, of the urologic problems,” he adds.

Because of consistently great results, urologists are held in high regard by their patients, who are usually grateful for the care. In turn, this gives a kind of satisfaction to urologists.

“I am happy that I chose urology. I’m always filled with joy every time patients come back to thank me for what I’ve achieved for them,” says Dr. Sellinger. “If I were to start all over again, I would still choose to become a urologist.”

Personalized, compassionate care

Want to have your urological problem treated by an effective urologist? AUI is a medical group with a long history of providing comprehensive, high-quality care. The urologists at AUI find it a joy to work in an environment that brings out the best of their knowledge and experience for the benefit of their patients.

Whether you have kidney, urinary tract, prostate, pelvic or other urological needs, at AUI you will find a urologist who can deliver the right treatment for you. For more information on the diagnosis and treatment of urological conditions, visit the Advanced Urology Institute website.

Why Southerners Have a Higher Risk of Kidney Stone

I am Ketan Kapadia. I’m with Advanced Urology Institute and a board certified urologist.

Dr. Ketan Kapadia of St Petersburg, FLObviously the heat is going to play a major role, a lot of it has to do with our diet unfortunately as well. [As with] an American diet, we just don’t eat very well, we’re all a little heavier and that also increases the risk of kidney stones as well.

The interesting thing here in Florida, which isn’t talked about very much and this is sort of the holistic treatment of the patient in urology, which is we get a lot of men who have prostate problems who start cutting back on their fluids because they don’t want to get up at night; And when you start cutting back on fluids and not getting up at night, now you’re at more risk of [getting] stones. We see a lot of older guys who come in with kidney stones for the very first time because they got a prostate problem as well and that hasn’t really been addressed.

Same with women who have overactive bladder. First thing most people do is they start cutting back their fluid so they’re not having to run to the bathroom all the time. Again, you cut back your fluid and now you’re living in Florida in the heat, you’re going to get kidney stones. So a lot of doctors will be more than happy to just get rid of your stone and have the surgery [but] I’m also interested in preventing that next stone. Part of that is getting twenty-four (24) hour urines, seeing why you’re making stones, addressing all the overactive bladder problems and prostate problems because I don’t want you to end up having more stones. I’m happy to operate and take out stones, that’s fun, but it’s my obligation to help prevent [it from happening agan].

Low Testosterone Treatment Options

Dr. Brian Hale of Palm Harbor, FLMy name is Brian Hale. I’m a board certified urologist working with Advanced Urology Institute.

Men with low testosterone are often treated in our practice, and we have several options in treating it: We have injections that we do every two to three (2-3) weeks, and we also have gels that they can put on their skin every morning to raise their testosterone levels back to normal levels. We even have pellets we put on the skin of some patients that we do every four (4) months. We have different options depending on what the patient wants done.

If you are in need of a consultation or have any questions, visit us at our Tampa, FL office or call us at (813) 749-0820.

Common Urologic Conditions Are Treatable

The urinary system of the human body regulates, manages and eliminates urine waste. The organs in this system are the kidneys, ureters, bladder and urethra. But as with any organ or system of the body, the urinary system can have problems, commonly referred to as urologic diseases or urologic problems.

You can have urologic problems regardless of your age, ethnicity or gender. And when urologic conditions occur, in both men and women they have a direct effect on the urinary tract and how urine is expelled from the body. In men, urologic problems can also affect the reproductive organs.

Signs that you have urinary tract problems:

Urologic conditions are treatable

Urology is a dynamic and advanced field. Urologists know how to treat many urologic diseases, including cancer of the prostate. The first step in any successful treatment is to see a urologist on time. Do not delay. As soon as you experience any problems, visit a urologist for a medical exam.
Mikhail Lezhak, PA-C of Daytona, FL

Common urologic conditions

(1) Urinary Tract Infections (UTIs)

Urinary tract infections (UTIs) are the most frequent type of urologic condition, although they occur more commonly in women than men. Close to 60% of women and 12% of men experience UTIs at some point in their lives. These infections are easily treated with antibiotics, but the treatment should begin as soon as possible to avoid further infection and prevent complications.

(2) Urinary incontinence

Although many people resist seeking help because of embarrassment, urinary incontinence is treatable in most cases. The cause is usually either an overactive bladder (urge incontinence) or stress incontinence. Typically, urge symptoms come from the bladder wall and detrusor muscle and mucosa, while stress symptoms are due to the incompetence of the bladder neck or urethral sphincter.

The diagnosis of urinary incontinence can be reached through a careful patient history, thorough examination and proper tests. You may need bladder retraining, controlled fluid intake, reduction in caffeine intake, or deliberate delayed voiding to treat the symptoms. Your doctor can also recommend medication or perform corrective surgery.

(3) Pelvic Floor Dysfunction

Pelvic floor muscles support the bladder, vagina and rectum. At some point in life, particularly after childbirth, pelvic floor muscles can become irritated or inflamed. Since the pelvic floor has to relax during urination, having pelvic floor dysfunction can cause pain or difficulties. The problem is often treated through pelvic floor exercise, but when the exercises are ineffective, vaginal medications or muscle injections can be used.

(4) Prostatitis

Many urological problems in men are linked to the prostate. Prostatitis is the inflammation or abnormal swelling of the prostate. The most common symptoms of prostatitis are painful urination, fever, chills, abdominal pain, and pain in the lower back or pelvic region. If you are diagnosed with prostatitis, your doctor will recommend antibiotics to reduce the swelling and restore your prostate to normal size.

(5) Bladder and prostate cancer

The PSA test and prostate exam are great ways to check on your prostate health. Should cancer be found in your bladder or prostate, your urologist will offer lifesaving care. Prostate cancer is the second leading cause of cancer-related deaths in men. It results from the abnormal and rapid growth of prostate cells.

Prostate cancer is successfully treated when detected early, which is why men are encouraged to get checked once a year. In fact, the recommended treatment depends on the time of detection, and may include radiation, surgery or regular surveillance. Today, robotic surgery has helped to reduce the hospital stay for kidney, bladder or prostate cancer surgery to just a few days, or just one day.

(6) Prostate enlargement (BPH)

The prostate grows as you age. Over time, you may have to wake up at night to go to the bathroom or you may not be able to produce the stream of urine you once did. When diagnosed with BPH, your urologist will use various techniques to relieve the obstruction caused by the enlarged prostate. These techniques include consistent monitoring, medications, and in some cases surgery.

Your urologist may also recommend the Rezum procedure—which uses heated water vapor to shrink the enlarged prostate tissue—or the green light and thulium laser vaporization techniques, transurethral resection of the prostate, minimally-invasive thermotherapy, or a UroLift. You will likely return home the same day as one of these procedures.

(7) Erectile dysfunction (ED)

This is a common condition as men grow older. When a man in his 40s or 50s notices that his erections are no longer what they used to be, he should talk to a urologist. Erectile dysfunction is the difficulty in achieving or maintaining an erection for sexual intercourse.

Although not fatal, it can cause stress, embarrassment and a strain on your relationship. Urologists will help you determine the underlying conditions and recommend treatments. Your urologist may prescribe medications—such as PDE5 inhibitors Cialis and Tadalafil—penile injections, a penile pump or, as a last resort, penile implant surgery.

(8) Kidney and ureteral stones

Kidney and ureteral stones occur when crystal-like particles in urine develop and grow into larger masses. As the stones pass along the urinary tract, they can get blocked and cause pain. Although most stones are passed naturally, larger stones may require surgery or specific procedures to break them.

One of the most common treatments is the Extracorporeal Shock Wave Lithotripsy (ESWL) technique in which sound waves are used to break up stones into smaller pieces. Also, since kidney stones can recur, patients often need long-term care. Your urologist will advise you on how to prevent kidney stone formation and how to best manage any potentially painful stones that develop.

At Advanced Urology Institute, every day we help people solve problems they may be hesitant to talk about. Since these problems are distressing or awkward to discuss, our goal is to help make you comfortable. We are proud of the long-term relationships we enjoy with our patients. Our knowledgeable urological specialists provide carefully tailored and confidential care. At AUI, patients get a proper diagnosis and the correct treatment, and we are willing to answer any questions you may have about your health.

If you suspect you have a urological problem, we encourage you to make an appointment at one of our many locations. For additional educational resources on urologic conditions, visit the Advanced Urology Institute website.

Types of Prostate Cancer: What You Need to Know

Prostate cancer is a complex disease. It is not easy to predict how any particular prostate tumor will grow, or how rapidly it will spread to areas outside the prostate. After a prostate cancer diagnosis, your urologist will assess various factors to determine the level of risk associated with the disease. Understanding the risk level—low, intermediate or high—will help you and your doctor make decisions to achieve the best survival rate and quality of life.

Types of prostate cancer

While there are many types of prostate cancers, urologists first divide them into two categories—aggressive and indolent—to begin determining the best treatment.

1. Aggressive prostate cancer

Dr. Scott Sellinger of Tallahassee, FLAggressive prostate cancer is the type that grows rapidly, spreads fairly early, quickly and widely, and causes massive body damage. Since it spreads swiftly via secondary deposits, it quickly becomes advanced stage cancer and is very difficult to treat, particularly during the later stages.

For aggressive high-risk prostate cancer, treatment is most effective when it begins while the tumor is still in its early stages. Without early treatment, the cells of the tumor remain highly active, multiplying rapidly. The tumor grows swiftly, spreads rapidly and causes widespread damage.

2. Indolent prostate cancer

Indolent prostate cancer is the type that grows very slowly and is unlikely to spread to areas outside the prostate. Therefore, it is a low-risk, low-volume tumor that can exist in the prostate for several years without causing significant problems. Even if left untreated, it is unlikely to spread outside the prostate; and if it spreads, it only does so slowly and locally.

How are high-risk and low-risk prostate tumors identified?

If you are diagnosed with prostate cancer, your doctor will monitor the disease periodically to see if it is growing and spreading. The primary way for monitoring the growth and spread of the tumor is the prostate-specific antigen (PSA) level in blood. PSA is produced by the prostate and reaches the bloodstream; but larger amounts of PSA in the bloodstream are usually a signal that the prostate is enlarged, infected or malignant.

For instance, the PSA doubling time—the time it takes for a patient’s PSA level to double—predicts how aggressive the cancer is. The faster the PSA level doubles, the more aggressive is the cancer. Likewise, the PSA velocity helps to predict the aggressiveness of a tumor. If the PSA level increases sharply, then the cancer is likely aggressive.

Urologists also use the Gleason score to detect how fast the cancer is growing and spreading. This score is obtained by grading cells in the tumor on the basis of how abnormal or normal the cells look under the microscope. The two most abnormal areas of the tumor are evaluated, each given a score from 1-5, and then the two numbers are added. The higher the score (typically 6 or more), the more aggressive the tumor.

While immediate treatment is called for with aggressive, high-risk tumors, a patient can live with an indolent, low-risk tumor for 20-30 years without the cancer causing any serious effects. For the slow growing tumor, we may recommend observation or a watchful waiting called active surveillance, where we monitor the growth and spread of the tumor without medical intervention.

At Advanced Urology Institute, we offer a wide range of treatment options for prostate cancer, including chemotherapy, hormone therapy, radiotherapy, and surgery. But before we can recommend any treatment, we try to determine the risk of advanced disease. For more information on the diagnosis and treatment of prostate cancer, visit the Advanced Urology Institute website.

Do You Treat People With ED

Well, yes—every day. At Advanced Urology Institute, we treat men with erectile dysfunction (ED) and achieve great results for our patients. Erectile dysfunction is a big issue for men today, regardless of their age. Up to half of all men experience some form of ED in their lifetime, with roughly 10% of men over 40 suffering severe forms of impotence.

What is erectile dysfunction?

Also called impotence, erectile dysfunction is the inability to regularly get or maintain an erection for satisfying sex. In general, an occasional problem should not be a cause for concern. In fact, it is normal to have trouble getting or keeping an erection for up to 20% of sexual encounters. But frequent trouble getting an erection indicates a medical problem. With ED, successful erections either become the exception more than the rule or they never happen.

Treating People with Erectile DysfunctionSome of the causes of ED include:

  • Alcohol use, illicit drug use, or smoking
  • Medications, such as for high blood pressure
  • Diabetes
  • High cholesterol
  • Heart disease
  • Obesity
  • Blocked blood vessels
  • Scar tissue inside the penis
  • Sleep disorders
  • Metabolic syndrome
  • Anxiety, stress, or depression
  • Emotional or relationship issues

Risk factors for erectile dysfunction include advanced age, diabetes, obesity, depression, cardiovascular disease, high blood pressure, low testosterone, high cholesterol and smoking.

What does treatment for ED involve?

Erectile dysfunction is a treatable condition. At Advanced Urology Institute, we offer several treatment options, generally beginning with the least invasive approach. We also give lifestyle advice that may help with overcoming the condition.

For instance, if your ED is due to inactivity, obesity, metabolic syndrome, high blood pressure or cardiovascular disease, we may recommend you engage in regular aerobic exercise to help reduce the symptoms. We may also recommend you quit smoking, minimize your alcohol intake and follow a healthy diet.

Treatments for ED include:

1. Phosphodiesterase type-5 (PDE5) inhibitors

PDE-5 medications are typically the first line of treatment we recommend for men with ED. They include Stendra (avanafil), Viagra (sildenafil), Cialis (tadalafil), and Levitra or Staxyn (vardenafil).

These oral medications work in a similar manner to boost the level of cGMP—a natural chemical in the body that promotes the widening of blood vessels following sexual arousal. In turn, more blood reaches the penis.

At the same time, these medicines enhance the relaxation of muscles of the penis in response to stimulation, hence increasing blood flow to the penis and allowing an erection.

2. Creams and injections

Sometimes we prescribe a topical Alprostadil cream as an alternative to the oral medications. The cream comes with a plunger and is applied to the tip of the penis and the surrounding skin 5-30 minutes before having sex.

At other times, we may prescribe penile injections as a treatment for ED. That is, we teach you how to inject a medicine at the base of your penis 5-20 minutes before sexual intercourse. After the injection, there will be increased blood flow to your penis and an erection will develop within 15 minutes.

3. Penis pumps (vacuum devices)

A penis pump (vacuum erection pump) is a tube that fits over the penis. A plastic container is placed over the penis and the pump draws air from the container to create a vacuum. The change in air pressure when the device is used causes blood to be drawn into the penis and triggers an erection.

Once the vacuum creates an erection, the retaining band is slid down the lower end of the penis and the pump is removed. An erection will typically last long enough for intercourse but the penis may be cold to the touch, and the rubber band may restrict ejaculation.

4. Penile implant (surgery)

We generally recommend surgery only when all other treatment options are not successful or not well tolerated. If that is the case, a penile implant (prosthesis) may help in achieving erections.

A penile implant is a medical device surgically placed into a penis to mimic the look and performance of a natural erection. The prosthesis involves an inflatable rod inserted in the middle of the penis, with a pump hidden in the scrotum. The pump is used to inflate the rod, which in turn causes an erection.

Penis pumps are custom-fit to your anatomy in a procedure that is performed carefully to ensure that the sensitivity of the penis and your ability to ejaculate are not adversely affected, allowing you to have a normal orgasm and great sexual encounters.

At Advanced Urology Institute, we recognize that erectile dysfunction is a common but very sensitive issue. That is why we provide a compassionate, patient-friendly approach to ED treatment to help men tackle it as soon as it starts. And because ED may also be a sign of a more serious medical condition, we encourage you to speak with a urologist as soon as possible to help you address the underlying condition and find the best treatment option.

Remember, the sooner you speak with your doctor about ED, the sooner you can go back to enjoying physical intimacy with your significant other. For more information about the diagnosis and treatment of erectile dysfunction, visit the Advanced Urology Institute website.

Advantages and Disadvantages of Robotic Technology in Urology – Dr. Shaw Zhou

Shaw Zhou, MD of St Petersburg, FL

My name is Shaw Zhou, I am with Advanced Urology Institute.

Robotic surgery is truly precise, for example, the magnify [goes] up to ten times so the doctor can see better and if your doctor has a hand tremor [it’s still] very steady. You got four arms instead of two arms, so you have two arms to grab for you and so on and so forth. And you have three dimensional [view], you can see much better. The traditional labs got surgical screens which are two dimensional so you don’t have that sense of depth. However the drawback is first of all, the doctor sits 10 feet away, so God forbid if something happened, your doctor will have to go in, wash your hands and you are not by your patient

Also you lose the tactile sensation, cause you don’t feel it no more. When you tie a knot or whatever you know, the tactile sensor feed gives how much force you use now, [before] it’s purely by experience. Although the new robot that we’re talking about that has tactile sensationin other words you can visually see it. They see how much force [is needed] if its red or green. So it’s getting better and better, eventually new robots keep on coming out but in the future I think we can overcome all these shortcomings for robot surgery.

Are Medications Effective in Treating Erectile Dysfunction – Dr. Yaser Bassel

My name is Yaser Bassel, I am a board-certified urologist with Advanced Urology Institute.

I would say the vast majority of them, especially if they have not tried medications prior to them being seen in our office, probably 70-80 percent of those men will at least have a response to the medication oftentimes enough to basically be satisfactory to the patient or make them pleased with the way the medication is working. So most of them would actually get a good response to the medication.

Are there other treatment options for ED?

As far as what we have available to us now and what’s on the forefront, [for] those patients that do not want medication there are some newer technologies that are available that utilize shockwave energy to try and create newer vascularity in order to get a better response for that medication and that is something that’s basically come out over the past couple of years that we are starting to utilize in our practice. For those that do not respond to medication and still want to have treatment, the next step oftentimes [is] performing a test called a Penile Doppler where we will inject the penis with a vasoactive medication which will then initiate an erection so that we can measure blood flow and also measure for a venous leak which are two reasons why patients can have issues with erectile dysfunction.

If you are in need of a consultation or have any questions, visit us at our Tampa, FL office or call us at (813) 749-0820.