Erectile Dysfunction Overview

Erectile dysfunction (male impotence) is a man’s inability to achieve or maintain an erection with enough firmness to have satisfying sex. Occasional erectile dysfunction (ED) is common and many men experience it when undergoing some form of stress. But frequent ED can be a sign of serious health, emotional or relationship problems that require the attention of a professional.

How common is erectile dysfunction?

Roughly 30 million men in the United States have problems achieving or maintaining an erection. The frequency of ED increases with age, affecting only 5-40% of men in their 40’s and up to 50-80% of men over 70 years. However, while the risk of ED increases with age, the condition is not an inevitable consequence of aging. Good health is the key to a lifetime of good sexual function.

Who is at risk of erectile dysfunction?

Dr. James Renehan of Tallahassee, FLApart from occurring frequently among the elderly, ED is often a consequence of poor emotional and physical health. It is common in men with high cholesterol, diabetes, obesity, cardiovascular disease, hypertension, prostate disease, anxiety, damage from surgery or cancer, injuries, stress, depression, performance anxiety, relationship problems, alcohol use, smoking, and drug use. Typically, ED is caused by vascular disease (such as atherosclerosis) that prevents blood supply to the penis, a neurological disorder (like multiple sclerosis) that cuts transmission of nerve impulses to the penis, chronic medical disorders such as Peyronie’s disease, stroke and diabetes, trauma, and operations for bladder, colon and prostate cancer which may affect blood supply to the penis. These risk factors may work singly or in combination.

How is erectile dysfunction treated?

When you visit a urologist, the first step in the diagnosis of the problem is a thorough sexual, medical and psychosocial history. Physical examination with emphasis on the genitourinary, neurologic and vascular systems is performed. From the information gathered, the urologist may request hormone tests (testosterone, luteinizing hormone, and thyroid – stimulating hormone, prolactin and serum hormone-binding globulin), urinalysis, PSA (prostate-specific antigen), lipid profile, and serum chemistry. Functional tests such as prostaglandin E1 injection, formal neurologic testing, nocturnal penile tumescence testing and biothesiometry may be requested, together with imaging studies such as transrectal, testes and penile ultrasonography and angiography.

If erectile dysfunction is diagnosed, the doctor may recommend treatment depending on the cause and severity of the condition. For instance, the urologist may recommend sexual counseling when no organic causes can be established for the problem. Oral medications such as sildenafil, vardenafil, tadalafil or avanafil may be offered to relieve the problem. But for those not responding to oral medicines, the urologist may inject, implant or direct the topical application of drugs such as alprostadil, phentolamine or papaverine. In some cases, an external vacuum or constriction device may be recommended while for other patients hormone replacement therapy may be used to treat severe hypogonadism (lower-than-normal testosterone). Alternatively, the urologist may opt for surgery through procedures such as revascularization, placement of penile implant or surgical correction of venous outflow.

How is erectile dysfunction prevented?

  • Eat a healthy, balanced diet that avoids saturated fats and increases the intake of vegetables, fruits and whole grains.
  • Reduce cholesterol levels through exercise, medication and diet.
  • Maintain a healthy body weight.
  • Exercise regularly.
  • Seek prompt treatment or professional help for conditions such as stress, depression, hypertension, heart disease and diabetes.

At Advanced Urology Institute, we recognize that effective treatment of erectile dysfunction involves a proper determination of the underlying cause and a frank discussion of both medical and non-medical options. This is why we have assembled an accomplished team of physicians, state-of-the-art facilities and a patient-centered system that responds to the unique needs of each patient. If you are experiencing a urological problem, make an appointment today. For more information, visit the Advanced Urology Institute website.

Vasectomy: Easy Safe Effective Birth Control

As a permanent method of birth control, vasectomy has been around for decades with good results. Today it is performed as a routine procedure with over 500,000 operations done in the United States each year.

During the procedure, the vas deferens (the duct that carries sperm from the testicles to the urethra) is cut or blocked to prevent sperm from being released during ejaculation. Sperm must travel from a man’s testicles to the urethra for pregnancy to occur during sexual intercourse, and blocking this passage is what makes vasectomy an effective method of birth control.

How is a vasectomy performed?

Dr. James Renehan of Tallahassee. FLA vasectomy is an outpatient procedure that must be performed in a medical facility or in a doctor’s office. In one technique, the urologist makes two small incisions on either side of the scrotum in order to gain access to the vas deferens. In another technique, the urologist makes one small incision to access both tubes. After accessing the tubes, the doctor cuts and seals them and then adds stitches if necessary. Doctors perform vasectomy under local anesthesia, making it as painless as possible. The procedure takes 10-20 minutes and the patient is free to go home immediately.

Recovery from the operation is easy. Your doctor will give you clear instructions which, if followed, will allow you to get back to normal in a few days. To ensure a quick recovery, you will need to apply cold packs to the area for 12-48 hours and lie on your back as much as possible. Wearing comfortable underwear or a jockstrap will protect the area. It is common to have mild discomfort, bruising and swelling of the scrotum for a few days after a vasectomy. In case of persistent and considerable pain, contact your doctor for advice. Unless your job is strenuous, you can return to work in 1-2 days. However, you must avoid heavy lifting for at least a week to avoid aggravating the wound.

How effective is vasectomy?

Vasectomy boasts of a better success rate than even the most effective forms of female contraception. The chance that a vasectomy fails (and a man impregnates his partner after the operation) is anywhere from 0.3% to 9% in the first six months after surgery. This is usually because it will take a few months for semen to be fully without sperm. Doctors suggest using another method of birth control such as condoms until follow-up analysis of semen shows zero sperm. But after this initial period, the failure risk of vasectomy drops to between 0.04% and 0.08% (about 1 in 2000). In comparison, the failure rate of intra-uterine device (IUD) is 0.2% to 0.8% while that of tubal ligation is nearly 1% during the first year after the procedure. Therefore, vasectomy is not only the best birth control method for men, but also one of the best overall.

Easy, safe and effective birth control

Vasectomy is a safe and low-risk way a man can take on the medical responsibilities of family planning. Whether you want to commit to a child-free life or do not want any more children, vasectomy is a long-term, discreet, 10-20 minute procedure with no danger to your hormonal balance and sex life. It is safer than common forms of contraception for women and recovery is quick and easy. Although this procedure should always be considered a permanent change, the success rate for vasectomy reversals is between 40% to 90% depending on how the original procedure was performed. If you decide that you do not want any more children, this procedure is worth discussing with your doctor. For more information, visit the Advanced Urology Institute website.

Symptoms and Treatment of Low Testosterone

The level of testosterone hormone in the body naturally declines as a man grows older. In fact, up to 40% of all men aged 45 years and older experience the effects of low testosterone. The symptoms of low testosterone may appear even earlier in some men.

Also called hypogonadism or low-T, low testosterone is characterized by a variety of symptoms such as:

  • Low libido (decreased sex drive)
  • Fatigue and lethargy
  • Erectile dysfunction (impotence)
  • Reduced testicle size
  • Breast growth in men (gynecomastia)
  • Loss of body and facial hair
  • Muscle weakness
  • Thinning of bones (osteoporosis)
  • Moodiness, irritability and depression
  • Decreased sense of well-being
  • Increased body fat or reduced muscle mass
  • Difficulties in concentration
  • Memory loss and sleep disturbances
  • Decreased hemoglobin level and mild anemia
  • Skin changes such as fine wrinkles
  • Diagnosis of low testosterone

Dr. Amar Raval of Palm Harbor, FLLow-T is diagnosed by measuring the quantity of testosterone in the blood. To clearly assess the level of testosterone, a urologist will request blood tests for both total testosterone and free testosterone. Often, it takes several measurements to confirm that a man has low-T because the levels tend to change throughout the day, with the highest levels occurring in the morning. Testosterone levels are also affected by body mass index (BMI), alcohol consumption, nutrition, age, illness and certain medications. Additional tests for sex hormones such as follicle stimulating hormone (FSH) and luteinizing hormone (LH) may also be requested by the urologist for a better picture.

Treatment of Low Testosterone

If low-T is diagnosed, the missing hormones may be replaced through hormone replacement therapy, restoring the body’s testosterone levels to normal. In some cases, however, particularly when low-T is diagnosed but no troublesome symptoms are noted, the urologist may not administer any treatment.

For men with bothersome symptoms, the therapy is administered to remove the symptoms and associated sexual problems. Testosterone replacement therapy can be given in different forms and the urologist will discuss options with the patient before deciding on the most appropriate method. After the treatment begins, testosterone levels are monitored to ensure the most effective dose is given.

The different ways of administering testosterone include:

  1. Injections – The urologist gives regular injections deep into a muscle (intramuscular injection) every 2-3 weeks to 3 months depending on the type of injection chosen. When appropriate, the urologist may delegate the task of injecting testosterone to a nurse or teach the patient how to self-inject. When done correctly, the injections are not painful.
  2. Testosterone Implants – Cylindrical pellets are inserted into the abdomen, thigh or buttock by the urologist under local anesthetic, once every 3-6 months.
  3. Testosterone Patches – Used every day and applied on different areas of the body, including arms, back, buttocks and abdomen, the patches work similarly to nicotine patches used by people trying to quit smoking. They deliver testosterone hormone gradually through the skin.
  4. Testosterone Gel – These gels are applied to clean dry skin, usually on the arm, shoulder, back or abdomen. They should be applied after showering to prevent the gel from washing off too quickly.

There are several benefits that can be derived from testosterone replacement therapy. They include:

  • Improved sexual function
  • Enhanced mental sharpness
  • Increased bone density and protection against osteoporosis
  • Increased muscle mass and loss of body fat
  • Greater strength and improved physical performance
  • Enhanced mood and better sense of well-being

Are you experiencing any bothersome symptoms and suspect you could be having low testosterone? Speak with your doctor as soon as possible about the problem. You do not have to live with these symptoms when effective treatment is available. For more information about testosterone replacement therapy, visit the Advanced Urology Institute website.

What Female Urology Conditions Can Dr. Jonathan Jay Treat?

KEY TAKEAWAYS:

  • Dr. Jonathan Jay is a board-certified urologist with a fellowship in female urology, voiding dysfunction, and pelvic floor dysfunction, who treats a variety of urinary problems common in aging women, such as incontinence, overactive bladder, pelvic organ prolapse, and pelvic floor dysfunction.
  • A range of treatments is available in urology, with the least invasive options prioritized, including physical and behavioral therapies, nerve therapy, Botox injections, bladder pacemakers, pessaries, and medications; surgery is considered a last resort.
  • Most urinary problems are not life-threatening but significantly impact the quality of life; by resolving them, urologists can restore confidence, meaning, and hope to their patients’ lives, with most patients experiencing good results from minimally invasive procedures.

I am Dr. Jonathan Jay, a board certified urologist with Advanced Urology Institute. While I am board certified in general urology, I also did fellowship in female urology, voiding dysfunction and pelvic floor dysfunction.

Dr. Jonathan Jay of Naples, FLOne of the inevitable consequences of aging in women is urinary problems. With increasing age, the pelvic floor muscles—a group of muscles that support the bladder, vagina and rectum—face the risk of damage. Since these muscles need to relax in order to pass urine well or have smooth bowel movement, their disruption may result in urinary problems, such as incontinence, overactive bladder, pelvic organ prolapse or pelvic floor dysfunction. Tension in these muscles may also lead to pain during sexual intercourse, painful or frequent urination and lower back pain.

Aging and urinary problems

As women age, they may develop and overactive bladder, which means they urinate at all hours and with little warning. Many women suffer from incontinence after childbirth, a condition characterized by unintentional leakage of urine when coughing, sneezing, laughing or jumping. Childbirth may also cause injury to the pelvic floor muscles leading to weak spots in the walls and muscles of the vagina when adjacent organs move from their normal positions resulting in pelvic organ prolapse.

Informed decision-making

Unlike other specialties, such as neurology and oncology, urology offers a range of treatments that deliver great results for these conditions. Actually, most patients do get better after intervention by a urologist.

In fact, one of the reasons I chose this profession is that there are so many ways to help rectify problems and restore normalcy to people’s lives. As a urologist, I get the opportunity to care for patients in their declining years when urologic problems are so common. I care about both their medical and emotional challenges.

As urologists, we have the ability to find your problem when you present with symptoms. Once the problem is identified, we educate you on what you need to do and talk with you about the different treatment options available. I like counseling patients; talking to them about the bigger picture and helping them make informed decisions.

And as we define these problems, educate patients and talk about the different treatment options available, especially the positives and negatives, we help our patients to make choices that they are comfortable with. Still, because we understand that these choices have risks, we ensure that we provide enough information to minimize the risks.

Most urinary problems are not life-threatening, but are quality of life issues. That means that by resolving them, we restore confidence, meaning and hope into our patients’ lives.

What does the treatment involve?

When we make choices for treating urinary problems, we prioritize the least invasive procedures in order to minimize the risks. Typical treatment begins with a physical examination and evaluation followed by a discussion of options such as physical and behavioral therapies–including exercises to build strength in pelvic floor muscles–and reducing water, alcohol and caffeine intake.

As an option for treating overactive bladder, we may recommend nerve therapy, a procedure which involves placing a needle in the ankle to transmit electric stimulation to the nerves that control bladder function. We may also recommend more invasive options for overactive bladder such as Botox injections and an implantable bladder pacemaker.

Depending on the symptoms, we may choose to manage pelvic organ prolapse using silicon or rubber diaphragm called a pessary, which is inserted into the vagina to support the pelvic floor. We may also recommend vaginal medications or muscle injections to help with pelvic floor dysfunction. But if the problem persists or worsens even with these interventions, we may explore surgery as a last resort.

Remarkable outcomes

In urology, we are fortunate that most of the problems are clearly defined, the treatment path is clear, and the results are usually good. At Advanced Urology Institute, we offer everything, from observation, pessaries and medications to surgery. Fortunately, most of our patients do well and get better after we apply minimally invasive procedures.

We understand that many women with urological problems might not know how common and treatable these problems are—a fact that keeps them from seeking proper care. So at AUI, we try to provide information to the public so that people are aware that there are solutions for even the most awkward and uncomfortable urinary problems. For more information on female urology conditions and their treatment, visit the Advanced Urology Institute website.

TRANSCRIPTION: 

I’m Jonathan Jay, I’m a board certified urologist with Advanced Urology Institute.

I’m a board certified general urologist, but I also did a fellowship in female urology and voiding dysfunction and pelvic floor reconstruction.

As women age, one of the advantages of aging is that the parts that allow them to hold urine in place and allow their bladders to be supported within the pelvis are at risk of being damaged. So hysterectomy can damage that support and those mechanisms that allow them to be continent, so can child birthing. So again, some of the advantages of womanhood predispose to some of these problems which makes it a very common problem.

And so one of the reasons I chose to be in Naples, Florida after doing that fellowship is that I knew there would be a lot of those problems to be able to rectify and treat here. And so we have the ability again to define the problem for the patient, to educate them on what they have and what their options are. These are not life threatening problems, but they’re quality of life issues and they’re major quality of life issues. And so the choices that the patients make are not one that I make, but it’s one that they make and they’re comfortable with.

For instance, we first define the problem, educate the patient, then we talk about the different options that are available and we talk about the positive and negatives of each of those options and the patient then chooses what they want to do. The outcomes are good. Remember, we’re not doing anything that the patient doesn’t want to assume the risk for.

We offer everything from observation to pessaries, say if you have prolapse, to medications if you have incontinence. We try all the benign things first and then we work our way up to surgical procedures if they have to be bothered enough to want to pursue that.

References:

How Does the Bladder Sphincter Work?

The bladder sphincter is made up of two muscles that control the release of urine from the bladder through the urethra. If the bladder were a reservoir, then the bladder sphincter would be the dam that holds back water and controls when it is released. The bladder sphincter is made up of two muscles, the internal and external sphincter muscles.

  • The internal sphincter muscle is located at the opening of the bladder to the urethra. It is a smooth, involuntary muscle. Because of its location, it is also primary muscle prohibiting the release of urine.
  • The external sphincter muscle surrounds the area of the urethra outside the bladder. It is the secondary muscle in control of urine flow. It is made of skeletal muscle and is a voluntary muscle.

Both muscles function in a similar fashion. When one relaxes the voluntary muscle, the involuntary muscle relaxes as well. When these muscles are relaxed, they open up allowing for urine to flow out of the bladder through the urethra and out the body. When these muscles are contracted, they keep urine in the bladder. Given the functions of the bladder sphincter, it is understandable the important role it plays in urinary continence. Damage or weakening of these muscles can also be a main cause for urinary incontinence.

Urinary IncontinenceUrinary incontinence is the loss of bladder control. It is a common yet embarrassing problem. It can be as mild as releasing a small amount of urine when you laugh or sneeze, or as serious as having the urge to urinate come on so strong and fast that you don’t have time to get to a bathroom. Problems with the bladder sphincters can cause several different forms of incontinence.

One form of urge incontinence occurs when the urethra can’t hold back urine in the bladder and the bladder sphincters relax uncontrollably.

Stress urinary incontinence is another common issue. In this case, stress or damage to the sphincters or surrounding muscles can cause urinary incontinence. This is common in women after childbirth, or in men after prostate surgery or radiation therapy. Neurogenic bladder dysfunction occurs when trauma or disease of the central nervous system causes a person to lose control of their bladder sphincter muscles.

Although issues caused by malfunctioning bladder sphincters can be embarrassing, there are a variety of treatment options available. The option that works best–whether it be lifestyle changes, medication, or surgery–depends on the patient and their overall medical history. Urologists work to understand their patient’s unique needs and develop the best plan to treat their bladder problems. For more information, visit the Advanced Urology Institute website.

Ways to Pass Kidney Stones

Kidney stones can be a painful and difficult experience for the many men and women who get them. These stones are hard deposits of minerals that build up in the body and cause blockages in the urinary tract. The blockages can make it very painful and difficult to urinate. In addition to difficulty urinating, the stones can cause nausea as well as pain in the groin and abdomen. Luckily, there are many ways that urologists can help speed up the process.

Quynh-Dao Tonnu, PA-C: Physician Assistant in DeLand, FLFinding the best way to help a patient to pass a kidney stone depends on several factors. Not all patients are the same, and the size and difficulty of their kidney stones vary as well. If the stones are smaller than 5 millimeters, the urologist will want the patient to try and pass them naturally. This is the least invasive way to pass kidney stones, although it may not always be possible. Drinking lots of liquids for frequent urination is the key for this method. Urologists may also recommend movement like bicycling and jumping jacks to help dislodge the stones naturally.

If passing naturally is not an option, then medication may be the next step. Urologists will use some of the same medications that are used to treat an enlarged prostate. Medication like Flomax helps relieve pressure on the urinary tract by relaxing the muscles in the prostate. This allows for easier urine flow and can help the patient pass the stones.

Another treatment option that makes passing stones easier is called shock wave lithotripsy. This treatment uses a machine pressed up against the patient’s body that targets water waves directly at the kidney stones. With as many as 2,500 waves per treatment, these waves break the kidney stones into small, sand-like particles. The sandy remnant is then easily passed during urination.

In some cases, a more invasive treatment may be needed to remove the stones from the body. A surgeon may use a scope fitted with a medical laser to enter the patient’s urinary tract through the penis. They can then use the laser to break the stones up into smaller fragments for easier passing. This method is sure to help pass the stones, but a urologist may prefer to try more natural methods first.

There is no single method to passing kidney stones. What matters most is making the process as fast, safe and pain-free as possible. For more information about kidney stones, visit the Advance Urology Institute website.

Surgical Options for Overactive Bladder

If you feel frequent, sudden urges to urinate that you cannot control, you might be suffering from overactive bladder. This condition can lead to feelings of embarrassment or shame, but it’s a common problem and can be treated in a variety of ways. For many people, overactive bladder can be treated with lifestyle changes such as special diet, weight loss, regularly timed trips to the bathroom, and exercises to strengthen the pelvic floor. Dealing with symptoms by using absorbent pads is also an option.

However, for some people, these methods are not enough to ensure they can live a healthy, fulfilling life. In these situations, surgical intervention is an option to correct overactive bladder problems.

Augmentation Cytoplasty

One of the options for treating overactive bladder is called augmentation cytoplasty. This procedure increases the size of the bladder. The surgeon accomplishes this by removing a small part of the intestine and using it to replace parts of the bladder in order to increase its capacity. For some people, this procedure allows them to resume normal bladder function. For others, the use of a catheter may be necessary for the rest of their life.

Urinary Diversion Surgery

Another surgical treatment option for overactive bladder is urinary diversion surgery. This procedure involves diverting urine from the bladder. One option for bypassing the bladder involves linking the ureters, which normally connect the kidneys to the bladder, to an ostomy bag outside of the body. Another option involves the creation of a new bladder inside of the patient’s body, which means they will be able to continue normal urinary function.

Bladder Removal

Bladder removal surgery, or a cystectomy, is the last resort option for patients with overactive bladder for whom no other treatment has been successful. For men, bladder removal surgery also involves the removal of part of the prostate; for women, it involves removal of the uterus, ovaries and part of the vagina. Because this is a risky procedure that involves multiple organs, it is usually only used for more serious urological conditions such as bladder cancer or birth defects. Removal of the bladder necessitates the use of a urinary diversion such as an ostomy bag or a stoma.

An overactive bladder can be a debilitating condition, but there are many options for treatment. If you are dealing with this issue, the physicians at Advanced Urology Institute are here to help you reach a diagnosis and find a treatment to restore your quality of life.

Prostate Cancer Types of Treatment

Prostate cancer is one of the most prevalent types of cancer men face. According to board certified urologist Dr. Arash Rafiei, “One in nine men will have prostate cancer in their lifetime.” Although somewhat common, not all cancers in the walnut-shaped prostate gland are the same. Every case of prostate cancer is different and affects men differently. Urologists work with their patients to find the most effective treatment option based on each patient’s individual needs.

Dr. Arash Rafiei: Urologist in Orange City, FLUrologists will consider their patient’s health, age, and the type cancer when deciding how to proceed. For some cases, the best treatment is none at all. When a patient has slow growing prostate cancer that is not spreading, a urologist may suggest holding off on treatment while monitoring the growth through routine appointments. The cancer needs to be taken seriously and watched closely, but invasive treatment is not always necessary for the patient’s health.

When treatment for the prostate cancer is needed, there are two main options: radiation and surgery. Both options offer the same level of prostate control and urologists will discuss the pros and cons of each with their patients. For surgical options the urologist may suggest a radical prostatectomy or robotic surgery. Both are well-tested invasive options that produce very good patient outcomes.

Radiation therapy is another common cancer treatment option. The radiation is centered on the prostate to kill cancer cells. The radiation will also kill some healthy cells as well, causing side effects. This is a non-invasive option that, like surgery, has its pros and con that a patient and doctor will want to discuss. Follow-up appointments to determine if the cancer responded to the treatment will also be necessary.

In addition to radiation and surgery, there are also some newer options that can be utilized in prostate cancer treatment. For instance, cryotherapy uses very cold temperatures to kill cancerous tissues and cells in the prostate by freezing them. There are also treatments using intense ultrasound waves centered on the prostate to destroy the cancer cells. These procedures are newer and there is less data on when they are the most effective, but they are options to consider.

All cancer is serious and can be a stressful and frightening prospect. Having a dedicated urologist who will listen and suggest the best treatment for each patient is key to success. Whether the best option is observation, radiation, surgery or a newer procedure, the Advance Urology Institute is a team of dedicated urologists with an array of treatment options for their patients.

What is the best treatment for enlarged prostate?

All men can experience difficulties caused by an enlarging prostate. As Board Certified Urologist Dr. Arash Rafiei says, “All men have prostates, and as we age our prostates enlarge, some more than others.” Yet each man’s situation and health is different. The symptoms of an enlarged prostate will differ greatly between individuals and the best treatment option for one may not be the best option for another.

Urologist in DeLand, FL: Dr. Arash RafieiFor most men, the symptoms of an enlarging prostate include the slowing of their urine stream, pushing to urinate, and having to go to the bathroom frequently. Many men also have the feeling of not fully emptying their bladder after urination. In many cases, men will find that they need to wake up multiple times in the night to go to the bathroom.

Because the symptoms of an enlarging prostate differ for everyone, the first thing a urologist will ask is if the symptoms are bothering the patient. For some men, the symptoms, especially in their early stages, are not a problem. Men may notice that they urinate a little more often. It may also take a bit longer for them to urinate when they do. They may have to get up once or twice at night when they did not have to before. A lot of men see these symptoms as inconveniences that they can adapt to and live easily with. In these cases, the urologist and their patient will just want to continue to watch the situation and may not need to take any action.

For men with more severe prostate enlargement the symptoms may be causing issues that are negatively affecting their lives. In these cases, their urologist may recommend medical therapy. Urologists will recommend medication that will help slow the growth of the prostate and relax the muscles around the bladder. This treatment will help make urination easier for men you have been experiencing difficulties. Slowing prostate growth will also give the patient more time before more invasive treatment options become necessary.

For cases where medication does not produce successful outcomes there are plenty of procedures that can help. One common procedure is a transurethral resection of the prostate. For this procedure a resectoscope in inserted through the tip of the penis and into the urethra. The urologist uses this device to trim away excess tissue on the prostate, relieving pressure on the urethra. This is an outpatient procedure and often helps relieve the patient’s urinary problems.

Another procedure that is new and becoming more common for treating enlarged prostates is Urolift. For this cutting-edge treatment, a urologist separates and lifts the prostate from the urethra using a suture, relieving pressure on the urethra and allowing better urine flow. A plus side to Urolift is that, unlike in a transurethral resection, no prostate tissue is removed allowing for quicker recovery. Most patients return home the same day as the procedure.

Having plenty of treatment options is the key to successfully managing prostate enlargement. The urologists at Advance Urology Institute get to know and understand their patients in order to find the best option for each individual. For more information, visit the Advanced Urology Institute website.

What are the treatment options for erectile dysfunction?

Erectile dysfunction is a common disorder that affects men of all ages. It is a man’s inability to get and maintain an erection. There are many different causes of ED and in many cases there is more than one underlying cause. All a urologist needs is a physical exam and a few questions answered in order to diagnose erectile dysfunction in a patient.

Dr. Brian Hale - Urologist at Palm Harbor, FLFor urologists like Dr. Brian Hale, treatment for erectile dysfunction begins with trying three different medications. The medications are generally oral and easy to take. The urologist will monitor the results of the oral drugs with the patient. Very often, at least one of the oral drugs prescribed will resolve the issue. For these cases, the urologist will write a prescription for the drug and continue to monitor its effectiveness through routine appointments.

If the urologist and the patient are unable to find an oral medication that works effectively, there are other options to consider. One possibility is injection therapy. Small injections into the shaft of the penis are used to dilate the penile arteries, helping increase blood flow, causing an erection. For most men who do not see results with the oral medication, injection therapy is their next best option.

For many men, injection therapy can seem a bit overwhelming at first, maybe even frightening. But in reality, the injections are easy to administer and are relatively painless. The urologist and the patient will begin the injection therapy with a teaching session at the urologist’s office. The urologist may use an ultrasound to monitor the reaction of the blood vessels to the injection to help determine the right dosage for the patient. The patient is also taught how to administer the injection on his own.

Patients are generally pleased after they start injection therapy. The teaching session at the office helps the patient see that the injections are not painful and can easily be done at home. It is very rare that a patient cannot do the injection therapy himself. For those who did not respond positively to the oral drugs, injection therapy is an ideal treatment to produce the desired results and overcome the erectile dysfunction.

Treating erectile dysfunction is an important part of a patient’s well being, both personally and within his relationships. The urologists of the Advanced Urology Institute offer many options for treatment and remain committed to finding the best one for each patient. For more information, visit the Advanced Urology Institute website.

Talk With Your Doctor About Erectile Dysfunction

The first step in treating erectile dysfunction is talking to your doctor about it. Unfortunately, for many men this can be difficult as erectile dysfunction is often a sensitive subject for those experiencing it. However, the issue is far more common than most men realize. As Chelsea Ferrell , physician assistant, states, “Fifty percent of men over 50 have some degree of erectile dysfunction, so you do not have to be embarrassed to speak to your doctor about it.” Urologists and PAs discuss erectile dysfunction with patients on a daily basis.

Chelsie Ferrell, Physician Assistant at DeLand, FLUrologists can usually diagnose erectile dysfunction during the appointment by asking a few questions about medical history and having a conversation with the patient. Once diagnosed, urologists try to discuss erectile dysfunction with the patient by reassuring him that even in the most severe cases there are still plenty of treatment options available. Because there are so many options available, the decision really is up to the patient working with his urologist to decide the best treatment for a successful outcome in his case.

There are plenty of different treatments available for erectile dysfunction and, in many cases, if one does not work another will. The most common options are pills like Viagra and Cialis, or generic versions of these pills that offer the same effects at a lower price. Others prefer the vacuum erection device. This is a cylindrical pump that the penis goes into and works like a vacuum to draw blood to the area, with a band that goes around the base of the penis to keep the erection.

Many men respond to at least one of these treatments. However, for those who do not there are still plenty of options. The urologist may want to try injection therapy. Men can give themselves small, relatively pain-free injections of a treatment into the base of the penis that will stimulate an erection. If injection treatment does not help, then the urologist may suggest a penile prosthesis. An implant is surgically inserted into the penis attached to a pump in the scrotum that can be used to give the patient an erection. This treatment will correct the patient’s erectile dysfunction for life.

Talking to your doctor about an issue as common as erectile dysfunction does not have to be an uncomfortable experience. And with the many options available now to treat erectile dysfunction, the right option is just a conversation away. Chelsea Ferrell PA at the Advanced Urology Institute is one of the many friendly and intelligent professionals helping patients find their best treatment option. For more information, visit the Advanced Urology Institute website.

The Two Most Common Female Urology Problems

Although it can feel embarrassing to discuss them with your doctor, problems with your kidneys, bladder and other parts of the urinary system are very common and are usually highly treatable. For women, two of the most common problems are urinary tract infections (UTIs) and urinary incontinence.

Urinary Tract Infection

Chelsie Ferrell, PA of DeLand, FLA urinary tract infection is an infection of a part of the urinary system which includes the bladder, kidneys, ureters and urethra. A UTI can occur when bacteria enters the urinary system, usually via the urethra. Symptoms of a UTI include a strong, constant need to urinate, a burning sensation during urination, and urine that is cloudy or pink or red-tinged and has a strong smell. There also may be pain around the pelvis. Although UTIs are usually not serious, if the infection spreads from the bladder into the kidneys, complications can occur. If you are diagnosed with a UTI, your doctor most likely will prescribe antibiotics to help clear up the infection.

UTIS are more common in women than men because women have shorter urethras. There are easy steps you can take to prevent getting a UTI. Drinking plenty of liquids, wiping from front to back after using the restroom, and urinating soon after sexual intercourse are all important preventative measures you can take to reduce your risk of developing a UTI.

Incontinence

Urinary incontinence, or the involuntary release of urine, is also a common problem for women, especially those who have given birth or have gone through menopause. These life events weaken the pelvic floor, making muscle control around the bladder more difficult. Incontinence also can be caused by weak or overactive bladder muscles or nerve damage.

Incontinence can vary in severity. For some women, this means only a few drops of urine being released when they cough or laugh. Others may experience a sudden urge to urinate and lose control of their bladders before they have time to get to a restroom. This can cause feelings of embarrassment and keep women from participating in activities they enjoy. Thankfully, urinary incontinence is very treatable. If it is becoming a major nuisance in your life, talk to your doctor about specific treatment steps to permanently help deal with the issue rather than addressing the symptoms.

Although problems with the urinary system can feel embarrassing, it is important to remember that you are not alone and that these issues are treatable. The physicians at Advanced Urology Institute are here to help with any urological issues you may be facing. For more information, visit the Advanced Urology Institute website.

Discussing a Sensitive Topic: Erectile Dysfunction

Erectile Dysfunction, also called ED, is the inability for a man to get or maintain an erection firm enough for sexual activity. It is a very personal and sensitive issue that can be difficult to talk about. Although ED is a common issue that affects many men, it can still cause feelings of embarrassment and shame. This makes open conversations, even with a trusted urologist, difficult in some cases.

Dr. Billy Vanasupa of St Augustine, FLA urologist is a doctor who specializes in the urinary tract and male reproductive system. They are the doctor a patient will most likely to go to about his ED. Urologists see countless cases of ED on a regular basis, and to them it is not a major issue at all. However, good urologists understand that ED can be an embarrassing issue for their patients and they immediately begin their visits by creating a comfortable environment where doctor and patient feel at ease discussing it.

One such urologist who works to create a comfortable environment is Dr. Billy Vanasupa. When talking about his approach with patients who see him for ED, Dr. Vanasupa says, “I always try to make my visits light, make some jokes here and there, and make them feel comfortable.” His goal is to make his patients laugh so they are less nervous and feel they can easily talk to him. Dr. Vanasupa removes the stigma of ED so he and his patient can openly discuss this sensitive topic.

Once everyone is comfortable discussing the topic, the urologist will ask background questions like whether the ED occurred slowly or abruptly. The patient will be asked if he has tried any medications. The doctor’s questions are to help determine root causes for the issue and will include asking about diet, alcohol and drug use, and stress factors. Finding possible causes for ED is an important first step in treating it.

The urologist and patient will discuss best treatment options for ED. In many cases, oral medication, possibly along with some minor lifestyle adjustments, will fix the issue and allow healthy men to return to their normal sexual activity. For some men, oral medication does not help. The urologist may suggest injections. Patients will learn in the office how to administer a very low-pain injection at the base of the penis. There are very few cases where neither the oral or injected medication solves the issue.

Outcomes are best when the patient feels comfortable talking to his urologist about sensitive issues. The Advanced Urology Institute has urologists who can treat erectile dysfunction in a way that puts a patient at ease. For more information, visit the Advanced Urology Institute website.

How the Prostate Changes As You Age

For the early part of men’s lives, their prostate is an organ that they never notice. The walnut-shaped reproductive organ located just below the bladder does its job without causing any interruptions in their daily lives. However, this changes as men age. Beginning around age 40, their prostates begin to grow. According to board-certified urologist Dr. Billy Vanasupa, “There’s no rhyme or reason, it just does.”

The rate of growth is different for everyone. The prostate will grow faster in some men than in others. In some cases, the enlarging prostate can cause problems immediately for a man in his early 40s. In other cases, men may be in their 80s or 90s before they begin to see the effects of a growing prostate. Most commonly though, men in their late 50s and early 60s begin to experience urinary issues that begin slowly and increase in severity.

Some of the most common issues are the slowing of the urine stream, pushing to urinate, having to go back to the bathroom 10-15 minutes after urinating, feeling like the bladder may not be fully emptied, and having to get up frequently at night to go to the bathroom. All the symptoms can be associated with the frequent and sudden urge to use the bathroom.

These symptoms are a sign that it is time for a man to see his urologist. The symptoms will only increase in severity without treatment as the prostate continues to grow. The urologist will begin by helping a patient understand what is causing the issue, using a diagram to show where the prostate is and how it presses on the urethra as it grows. The enlarging prostate makes it difficult for urine to pass through the urethra on its way out of the body.

Treatment begins with medication to help with urination. These medicines help slow the growth of the prostate and relax the muscles around the bladder to make urination easier. A urologist also will do a PSA test to screen for prostate cancer. Not all cases of prostate enlargement are connected to cancer growth, but it is important to screen for the disease as a precaution.

Men’s bodies change in many ways as they age, and the prostate is no exception. Urologists at the Advanced Urology Institute focus on making sure their patients understand how their bodies are changing with age and how they can work with their urologist to stay in the best shape. For more information, visit the Advanced Urology Institute website.

What is the Prevalence of Erectile Dysfunction, According to Dr. Harris?

KEY TAKEAWAYS:

  • Erectile dysfunction (ED) is a common issue that can result from both mental and physical factors, such as depression, anxiety, stress, heart disease, diabetes, high blood pressure, and substance abuse.
  • Certain risk factors, including heart disease, diabetes, tobacco use, drug and alcohol use, and being overweight or obese, increase the likelihood of developing ED.
  • Urologists can diagnose ED through a physical exam and questioning, and treatment options typically start with oral medications, followed by injections if medications prove ineffective.

Erectile dysfunction, also known as ED, is the inability of a man to get or maintain an erection firm enough for intercourse. ED is a very common issue that can negatively affect a man’s self-confidence and his relationship with his partner. Many men see urologists for help with ED when this happens.

Dr. David Harris of Fort Myers, FLThe primary symptom of ED is trouble getting and maintaining an erection, and reduced sexual desire is often associated with it. There are many factors that can cause ED, and they can be divided into two categories: mental and physical. Depression, anxiety and stress are mental factors that can cause ED. There are also physical factors, including heart disease, diabetes, high blood pressure and substance abuse. There are plenty of cases when it is a combination of mental and physical factors that cause ED.

All men are at risk for erectile dysfunction; however, there are some factors that increase the likelihood of developing it. Heart disease and diabetes are key risk factors that increase the likelihood of ED. Tobacco use causes damage to arteries, restricting blood flow and raising the chances of ED. Drug and alcohol use are risk factors as well. Men who are overweight, and especially those who are obese, are also at greater risk of developing erectile dysfunction.

A urologist can diagnose ED by performing a physical exam and asking a few questions. Once diagnosed, urologists can consider a variety of options for treatment, depending on the patient. The first option is usually oral medication. Urologists will try different medications to help patients maintain erections. If none are effective, then the urologist may prescribe injections. Small injections can be made to the shaft of the penis that dilate the blood vessels in the penis, allowing better blood flow and erections. The patient can administer these injections himself as needed.

Erectile dysfunction is not uncommon and as Dr. David Harris says about treating it, “As urologists, we are the leading authority.” Urologists see cases of ED on a daily basis and are accustomed to having conversations about it and finding the best way to solve the issue with their patients. In most cases a patient who is motivated to work with his urologist on finding the best treatment will eventually find a solution that works. The Advanced Urology Institute helps many patients explore their options and treat their ED so they can continue their normal lives and activities. For more information, visit the Advanced Urology Institute website.

TRANSCRIPTION:

My name is David Harris and I’m a urologist with Advanced Urology Institute in Fort Myers. That’s very common. And I think one reason men come into us is I think they understand that as urologists we’re the authority. And we have the literature, we have the established urological associations, understanding and framework from which to address this. And you’ll find ads in the paper, ads on the radio, a lot of quick easy ways to treat this. And patients come to us because they want to know that it’s safe and that they’re going to get an expert to tell them what to do. So yes, we see a lot of patients, it’s a daily thing, and I see in this day and age men much more comfortable coming in the office and saying, you know, Doc, I need a little help. You know, I’m not terrible, but I’m not where I was. Please help me with erections. And I think if you look back 15 years ago, there was less of that. So I think men are much more comfortable coming in and talking about it. And we have a variety of options. Okay. And that’s the same kind of thing. You have to talk to that patient about what their comfort level is, and their health issues, and help define for them the way you want to approach that. I think a fair statement, it doesn’t mean everybody’s got a fix for everything. But I think a guy that is very motivated can find an option to treat ED that will be successful.

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