Talking With Your Doctor About Erectile Dysfunction

Do you struggle to have an erection when you want it most? Does your penis fail to get stiff enough for satisfactory sexual intercourse? Or does it get rigid only for a short while and then lose rigidity leaving you humiliated and apprehensive? You don’t need to worry too much if you have experienced this only occasionally. After all, almost every man has failed to achieve or maintain a good, rigid erection at some point in his life, particularly when stressed, tired, anxious or drunk. But if you have had frequent, frustrating and distressing failures to have or maintain an erection, then you may have a problem and need some sensible and sympathetic advice from a urologist.

Why Talk To a Urologist

Erectile dysfunction is a tough experience, but discussing it is even tougher and more embarrassing. You are likely to feel hesitant or scared to talk about ED with a doctor. But even with all the awkwardness you may feel in trying to open up and speak honestly about your erection troubles, talking to a urologist is probably the best step you can possibly make. A urologist is used to dealing with ED, perhaps attending to more than a half dozen cases every week. Your case would be just a routine matter to the urologist. More importantly, your erectile dysfunction may be the first sign of a very serious medical problem. A timely chat with a urologist can enable early diagnosis and treatment of a life-threatening condition.

Honest Useful Conversation

When you visit a urologist, you will meet a listening and caring professional dedicated to helping men have normal sex lives. The doctor will help you to explore the symptoms from when you first noticed changes in your erections to any medications you might be taking that could be causing your problem, your lifestyle habits and the severity of your symptoms. During this chat, being brutally honest and open with the urologist will ensure that the cause of your problem is figured out quickly and accurately. The physician also will conduct a physical exam focused on the health of your heart, nervous system, blood vessels and genitals, followed by appropriate urine and blood tests. The doctor then will be in a position to know the cause of your erectile dysfunction and to recommend the right treatment for you.

Exploring Treatment Options

Urologists are skilled in treating underlying medical conditions such as high blood pressure, atherosclerosis, heart disease, chronic kidney disease, diabetes, Peyronie’s disease or multiple sclerosis. In most cases, erectile dysfunction quickly resolves once the underlying cause is treated. Your urologist also may suggest lifestyle modifications such as reducing alcohol intake, losing some weight, stopping cigarette smoking and increasing physical activity to boost your recovery. But if these interventions do not work, the urologist may explore other treatment options, such as oral medications (like tadalafil, vardenafil or sildenafil), injectable medicines (like alprostadil), and vacuum pumps, and penile implants (bendable or inflatable). As a last resort, surgical repair (penile revascularization) of the veins or arteries of the penis may be considered.

No Longer a Secret

In the past, men didn’t have open and frank discussions about their erectile problems because sexual intercourse was often shrouded in mystery and secrecy. But with the availability of effective treatments for ED, that now seems imprudent. With the availability of innovative and highly effective treatments for erectile dysfunction, it is important to talk to your doctor about your problem and to know your options.

Are you having problems getting or maintaining an erection? Why not make a bold decision today to see a urologist? At Advanced Urology Institute, we offer cordial and compassionate consultations for men having erectile problems. Our skilled and experienced urologists will listen to you, do a thorough physical examination, run appropriate tests and diagnose your condition accurately. We have the necessary diagnostic tools to determine any kind of underlying medical conditions that may be causing your erectile dysfunction. Make an appointment now at AUI, have a candid chat with a urologist and have your problem fixed. For more information on the treatment of erectile dysfunction, visit the “Advanced Urology Institute” site.

The Effectiveness of Erectile Dysfunction Treatments

Worried about your inability to get or maintain an erection? Stop worrying and visit your doctor for an open and honest chat. A urologist can help you find safe and effective treatment of erectile dysfunction that will enable you to approach any future dates with your partner with confidence. Urologists are experts in treating erectile dysfunction and other genitourinary issues, so do not be anxious about such a visit. In fact, you will be surprised to find that your doctor is probably seeing up to a half dozen men with ED every week.

Oral ED Medications

The first choice of treatment for ED is usually oral medications called phosphodiesterase inhibitors type 5 (PDEi-5). These drugs include the first-generation agents such as sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis), together with second-generation agents like mirodenafil (Mvix), iodenafil (Helleva), udenafil (Zydena) and avanafil (Stendra). With the drugs providing a normal, natural erection in 80-95 percent of men as long as there is sexual stimulation, they are the best option for many men with ED. They also deliver high efficacy rates and favorable safety levels.

Transurethral and Intracavernosal Injections

If you are unresponsive to oral drugs, your doctor will review your treatment and consider other options. The urologist may consider a transurethral injection with a drug called alprostadil. The doctor may go for this option if your penile nerves have been compromised and you need to bypass the neurological pathways responsible for an erection. Another option may be an intracavernous injection of papaverine, phentolamine, PGE1 or vasoactive intestinal peptide (VIP). The injections are a good treatment choice with 91-96 percent success rates and proven safety. These drugs may be combined for better efficacy.

Vacuum Constriction Devices

Vacuum erection devices also may be considered. But these are commonly offered to elderly patients who may only want occasional sexual intercourse. Younger men do not like these devices because of the unnatural feeling of the erections and the mechanical procedure necessary to produce the erections. You should discuss this option with your doctor and find out if the devices are ideal for you.

Surgical Therapies

When medical therapies fail, your urologist may recommend surgery. Surgical procedures are often the last option because of the cost, non-reversibility and invasiveness involved. There are two kinds of surgery for men with ED: penile prosthesis and penile revascularization. In penile prosthesis, the urologist inserts an inflatable or semi-rigid implant into the penis tissue. The success rate of penile prosthesis is 97 percent, but the implant must be replaced every 8-15 years. Penile revascularization is a surgical procedure to repair either venous ligation or arterial stenosis. Explore surgery with your doctor if the other options fail to work for you, but be sure to understand what is involved before you make a decision.

Non-Specific Interventions

Erectile dysfunction treatments may be accompanied by other interventions. For instance, psychotherapy is a noninvasive and highly effective intervention that is often combined with other therapies for a better success rate. Likewise, your urologist may recommend lifestyle modifications, such as increased physical activity, dietary changes, moderate alcohol consumption or a decision to stop smoking in order to improve your ED symptoms and minimize cardiovascular risk. If tests show that you have low testosterone, your doctor may recommend testosterone replacement therapy before you use ED-specific medications. If you are a younger, healthier man, testosterone therapy may just be what you need for enhanced sexual desire and harder erections.

At Advanced Urology Institute, we have established a multidisciplinary, compassionate and patient-centered approach to the treatment of erectile dysfunction. We prioritize the needs and expectations of our patients during treatment, educating them and providing a supportive environment that ensures shared decision-making. We also conduct meticulous follow-ups to identify any changes in the relationships, health and emotional status of our patients to optimize the efficacy of our treatments. If you are experiencing bothersome and embarrassing ED, visit one of our urologists for help. Get more information on the treatment of erectile dysfunction at the “Advanced Urology Institute” site.

Benefits of Testosterone Therapy

Secreted primarily in the testicles, testosterone is a critical hormone responsible for male growth and masculine characteristics. The levels of testosterone increase exponentially in childhood and hit a peak during adolescence, then begin to decline by about 1 percent every year between the ages of 30 and 40 years and older. The gradual decline can be due to either normal aging processes or a condition called hypogonadism. Hypogonadism is a disorder in which the body fails to produce normal quantities of testosterone. It often occurs when there is a problem with the pituitary gland (which controls the testicles) or with the testicles themselves. For men with testosterone levels below the normal range, testosterone replacement therapy can relieve symptoms of low-T and provide many benefits.

Normal Testosterone Levels

For men, the normal range of total testosterone is 300-1,200 ng/dL (nanograms per deciliter). Men with testosterone levels within this range rarely have any problems associated with low testosterone. However, since total testosterone does not usually provide the full picture, doctors often measure and use the levels of free testosterone to assess a man’s vulnerability to low-T symptoms. Free testosterone means the amount of testosterone hormone that is active in the body at any given time. Men with total testosterone levels within the normal range can still suffer from the classic low-T symptoms if their free testosterone levels fall short.

Implications of Low Free Testosterone

The free testosterone level is a clearer indicator of a man’s true testosterone status. In fact, low free-T is almost exclusively associated with sex difficulties. Low testosterone diminishes sex drive in men and results in loss of energy and motivation and poor performance in bed. Men with low testosterone also may suffer from fewer spontaneous erections, slightly lower sperm count, increased body fat, decreased muscle strength and mass, fragile bones, tenderness or swelling of breast tissue, hot flashes, increased fatigue, feelings of depression and sadness, trouble with concentration and memory, lowered self-confidence and motivation, and a degraded overall sense of well-being. These symptoms can be relieved through testosterone replacement therapy.

Benefits of Testosterone Replacement Therapy

There is no doubt that testosterone replacement therapy (TRT) can quickly revive a man’s interest in sex, boost his ability to maintain an erection and recreate the “wow” factor of his orgasms. Treating sexual symptoms is a good enough reason for men to start testosterone therapy. But because testosterone therapy also can improve a man’s health beyond the bedroom, bringing testosterone levels back to normal is a good decision for every man who wants to feel better. Replacement therapy improves bone mineral density, boosts overall bone strength, increases muscle mass and strength, boosts red blood cell production, enhances hemoglobin levels and corrects both iron deficiency anemia and unexplained anemia. Testosterone therapy also improves mood, alleviates depression, irritability and fatigue, relieves disorders linked to testosterone deficiency such as osteoporosis and boosts insulin sensitivity, which can benefit men with diabetes or minimize the risk of diabetes in men with functioning pancreas.

Should You Opt For Testosterone Therapy?

Testosterone replacement therapy is ideal for men with testosterone levels below 300 ng/dL or those experiencing symptoms of low testosterone. Undergoing replacement therapy can help you restore your testosterone levels to normal and improve your libido, cognition, mood, bone density, muscle mass and red blood cell production. However, you should remember that the therapy is only necessary if you have low T. If you are not sure whether the therapy is right for you, speak with your doctor. The doctor will conduct the requisite tests for low-T and guide you accordingly.

At Advanced Urology Institute, we help men recover from their old, tired and depressed selves through safe and effective testosterone replacement therapy. We deliver this therapy after accurate measurements of testosterone levels to ensure that we give testosterone only to the right people. If you have symptoms of low-T or suspect that your levels could be low, speak to one of our urologists. We will ensure to get you back to a more energetic, motivated and happy self. For more information on the diagnosis and treatment for low testosterone, visit the “Advanced Urology Institute” site.

2 Common Types of Incontinence

Urinary incontinence, defined as involuntary and accidental leakage or loss of urine because of defective bladder control, is a common problem in the United States that affects an estimated 25-33 percent of the population. While both men and women can have the condition, more women are at risk of having urinary incontinence because of several factors unique to women. For instance, due to pregnancy, childbirth, different anatomical characteristics in the pelvic region, atrophy (shrinking) of sphincter muscles and menopause, women suffer from urinary incontinence much earlier and more frequently than men do. Urinary incontinence is not a normal consequence of aging, though its prevalence increases with age.

Repercussions beyond Health

Urinary incontinence is not only a health problem, but also poses a variety of psychological, social and emotional difficulties. For instance, women with urinary incontinence may want to avoid certain situations or places for fear of an embarrassing accidental leak. A strong and sudden urge to urinate may cause embarrassment and discomfort, particularly when you are not near a bathroom or toilet. Women also may withdraw from activities they love doing due to the risk of an accidental leak. As a result, urinary incontinence can limit a woman’s activities, diminish her self-confidence and reduce her joy in life. But urinary incontinence is a treatable condition as long as the underlying cause can be identified and addressed.

Two Major Types of Urinary Incontinence

There are two main types of urinary incontinence: stress incontinence and urge incontinence.

1. Stress Incontinence

Stress incontinence is the accidental loss of urine from the bladder due to weak pelvic muscles. Urine loss occurs during physical activity such as when sneezing, laughing, coughing, exercising or doing an activity that exerts pressure on the pelvic muscles. When you are active, you put pressure on the bladder, which in turn allows urine to escape because the pelvic muscles are weak. Stress incontinence often occurs after pregnancy or childbirth because the pelvic muscles have been stretched and weakened and nerves to the bladder may have been damaged. Obesity or excess weight also can put pressure on the weak pelvic muscles and cause stress incontinence.

2. Urge incontinence

Urge incontinence (known as overactive bladder or OAB) is the sudden, intense and uncontrollable urge to urinate, which occurs when the coordination between the brain and bladder is out of sync. For instance, the brain may send voiding signals to the bladder without warning, or pelvic muscles may become too active and contract frequently even before the bladder is full, resulting in feelings of extreme frequency and urgency. Overactive bladder is the term used to describe any incontinence characterized by uncontrollable urgency, frequency, nocturia and dysuria. Urge incontinence is common in women with an inability to control detrusor contractions, but also may occur in women in menopause (due to inadequate estrogen) or with chronic or acute urinary tract infections, bladder stones, bladder cancer, stroke and multiple sclerosis (due to interference with nerve signals responsible for bladder control).

Sign of Something More Serious

There are many reasons why women may leak urine, from serious neurological conditions like multiple sclerosis, Parkinson’s disease and stroke, traumatic injury of the spinal cord, cardiovascular conditions affecting associated nerves, diuretic medicines, diabetes and obesity, alcohol consumption or recurrent urinary tract infections to inflammation that damages bladder nerves or irritates the bladder. It is therefore advisable to seek medical help as soon as you experience any sign of incontinence. Prompt and timely diagnosis and treatment may uncover a serious underlying problem early. At Advanced Urology Institute, we obtain a full history, conduct a comprehensive physical examination, perform specialized testing and treat urinary incontinence as safely and successfully as possible, making sure to deal effectively with all underlying issues.

A Wide Range of Treatment Options

Treatment of urinary incontinence at AUI depends on the type of incontinence and severity of symptoms. Options may include rehabilitation of pelvic muscles using weighted vaginal cones, electrical stimulation or Kegel’s exercises, sacral nerve neuromodulation, biofeedback and bladder retraining, extracorporeal magnetic innervation, occlusive devices (such as vaginal pessaries or urethral plugs), medications (such as Extended-Release Oxybutynin Chloride like Ditropan XL, tolterodine like Detrol, alpha-adrenergic drugs and estrogens), periurethral injection, and minimally invasive surgery. If you have any symptoms, you should see a urologist as quickly as possible to undergo testing, determine the underlying cause and detect any serious problem you may have.

At Advanced Urology Institute, your health is our foremost priority. We provide the right diagnosis and treatment of urinary incontinence that can quickly restore your confidence and enable you to get out there and do the things you love without worrying about accidental leakages. Do not suffer in silence. For more information on urinary incontinence, visit the “Advanced Urology Institute” site.

Webb McCanse Becoming a Urologist

Are you blessed with a great sense of humor? Do you have the courage to openly talk about sensitive and awkward issues? Or are you just interested in helping very sick people get better? If so, you are just like me and an ideal person to serve as a urologist. People feel uneasy about seeing urologists because the issues we tackle are in an uncomfortable area of the body. But as a urologist, you are always called upon to make patients open up and speak about their problems honestly. It is a challenging task, but one that is very satisfying. Who would not feel gratified and fulfilled after smashing the barriers that make people suffer silently from genitourinary disorders and help them to find relief from embarrassing symptoms?

Becoming a Urologist

The opportunity to work in the Navy was very attractive to me. So I pursued medicine as a path to serving my country. With the United States
Navy taking care of my fees, I completed my medical school training at the University of Kansas and joined the University of Nebraska’s Medical Center for a six-year urology residency. Upon completion, I served in the United States Naval Hospitals of Pensacola and Guam, with sporadic assignments in Cuba and Okinawa, Japan. Following a satisfying naval service, I moved to Advanced Urology Institute.

Areas of Expertise

My extensive training exposed me to a number of advanced technologies and medical procedures. I am an expert in minimally invasive surgical procedures, particularly laparoscopic surgery and robot-assisted surgery for a wide range of genitourinary disorders. At AUI, I see patients with urologic cancers (bladder, penile, urethral and prostate), kidney stones, benign prostatic hyperplasia (BPH), overactive bladder and urinary incontinence, among other conditions. I no longer serve in the Navy, but I am still proud to serve my country by helping its citizens overcome some of the most painful and embarrassing conditions.

Job Satisfaction

Urology is a very interesting profession, with each day presenting new challenges. We educate patients on living healthy lives, achieving their goals and making informed decisions. The level of engagement with patients is just amazing. We get to know our patients, gain their trust and build enduring relationships with them. It is greatly satisfying to just be there for a person who is suffering but feeling embarrassed to discuss his condition. Then to be able to help him open up, discuss the symptoms freely and find relief just brings incredible joy. As a urologist, I am proud of my specialized role and am deeply contented, satisfied and fulfilled as a person.

Why Advanced Urology Institute

Advanced Urology Institute is a pool of like-minded and experienced professionals working through a collaborative, multidisciplinary, patient-centered approach to deliver the best possible care to patients. Our job is not merely to diagnose and treat, but also to help people be proactive and take control of their lives. We consider the different patient needs, offer tailored consultations and treatments, and are always there for our patients. I love working at AUI because it offers the best opportunity for me to serve my country through timely, safe and effective urological care to its citizens. For more information on urological services offered at AUI, visit the “Advanced Urology Institute” site.

How Did Nicole Szell Become a Urologist?

KEY TAKEAWAYS:

  • Dr. Nicole Szell’s journey to becoming a urologist was driven by her passion for women’s health and her educational background in biology, chemistry, and osteopathic medicine.
  • Urology as a profession is intellectually challenging and rewarding, allowing practitioners to build trust-based relationships with patients and improve their quality of life.
  • Advanced Urology Institute is an ideal place for urologists like Dr. Szell to practice, as it offers a supportive environment with skilled professionals and a patient-centered approach to care.

To be able to dedicate your life to preventing, detecting and intervening in painful and embarrassing situations is an attractive and gratifying undertaking. It may not be for everyone, but for those of us in this profession it just brings incredible joy. As a urologist, you are able to direct your energy and enthusiasm to helping people. You are allowed into the lives of people facing painful conditions and are trusted to inject hope and bring back the joy to living. And as you are diagnosing, treating and educating patients, you make long-term connections and enjoy the thrill of being able to make other people well and happy again. It is a wonderful experience.

My Journey to Urology

Women’s health interested me from a very young age, driving me into many years of service as a volunteer and researcher in various women’s health programs and organizations. So when I went to college, my mind was already made up. I just wanted to pursue female urology and pelvic floor medicine. Being a native of the Midwest and Cleveland, Ohio, I went to Radford University in Radford for my bachelor of science in biology and chemistry. Upon graduation, I joined the College of Osteopathic Medicine, East Lansing, MI, for my medical school degree. Then I went to St. John’s Providence Health System, Detroit, for my urology residency program. I specialized in voiding dysfunction, pelvic floor disorders, sexual dysfunction, urologic reconstruction and pelvic organ prolapse, though I also handle general urology disorders such as kidney stones and bladder cancer.

Job Satisfaction

Urology is a field that challenges the intellect daily. It also inculcates the capacity to develop relationships based on trust. But most importantly, it offers the opportunity to solve women’s health problems, something I have been committed to since I was a young girl. As a urologist, I am able to engage with women in different situations and suffering from various conditions. It is a great privilege to listen to them, help them relax and find hope even in the face of a devastating diagnosis. I love my job because each day offers the chance to relieve discomfort, solve embarrassing conditions and improve the quality of life.

Why Advanced Urology Institute

Advanced Urology Institute is a great place to practice. I call it the urologist’s paradise. You are surrounded by passionate, skilled and talented professionals who are dedicated to a greater purpose. Each member of the pool has an unwavering drive to deliver the best possible care. As a team, we collaborate a lot when handling our patients. Since all administrative work has been centralized, we are left to focus on how to address the issues of our patients. So when patients come, they find us energetic and enthusiastic to serve them. And with our multidisciplinary, compassionate and patient-friendly approach, every patient can be sure of the best possible care. Want to know more about our services? Visit the “Advanced Urology Institute” site.

TRANSCRIPTION: 

Hi, I’m Dr. Nicole Szell. I’m a board certified urologist with Advanced Urology Institute.

I grew up in Cleveland. I am an only child. I moved to Michigan. I did my training at Michigan State for medical school. I did my residency in Detroit, Michigan, and then I went down to Miami for my fellowship in female pelvic medicine and urethral reconstruction. I also did specialized training in chronic pelvic pain, which was in Detroit, and I also did specialized training in female sexual function and dysfunction in San Diego, California, before coming here.

REFERENCES: 

Christopher Sherman Becoming a Urologist

To help a patient overcome an agonizing and upsetting condition brings extraordinary joy. That is the special kind of joy that this profession brings. As a urologist, patients come to you when they are at their worst, trust you with secrets they probably share with no other and put their faith in your ability to find safe and effective solutions for their problems. So whether it is the embarrassing urine leaks, difficulty getting an erection or a devastating genitourinary cancer, you are placed in a position to fix the problem and put a smile on the face of a trusting patient. It is a unique position, but one that brings amazing fulfillment and satisfaction.

The Long Path

Right from childhood, I have had a knack for helping people rise above their limitations. As a native of Florida’s Coral Springs I was often surrounded by people with various medical conditions who had few physicians to attend to them. I made up my mind early that I would pursue medicine to be able to make an impact on these lives. I got my undergraduate degree in health science at the University of Florida, then moved to the College of Medicine, Florida State University, for my medical school degree. After that I took a one-year general surgery training followed by a four-year urology residency at the University of Louisville in Kentucky.

Areas of Expertise

During my training, I became interested in medical technology and in advanced medical procedures. I not only honed my skills in minimally invasive techniques and robot-assisted surgery, but also mastered a number of specialized procedures such as laser surgery for BPH, Botox therapy for overactive bladder, interstim therapy for underactive and overactive bladder, and urethral slings for voiding dysfunction. Through my expertise as a urologist, I have been able to achieve my life’s dream of re-igniting the desire and joy to live in people facing their most uncomfortable, painful or lowest moments. As a urologist, I always feel a sense of peace and fulfillment after making a positive change in the life of a patient.

Job Satisfaction

As urologists, we work for long hours and often face stressful situations. But we take pride in our capacity to persevere and consistently deliver safe, timely and effective treatments. In fact, the challenges just help bring out the best in us and make our job even more interesting. We understand that to have the opportunity to help the sick is very rewarding. We also get to know our patients, win their trust and establish very close relationships. It is so satisfying to take care of patients and be able to make a difference in their lives.

Why Advanced Urology Institute

Every urologist yearns for a workplace that can bring out the best of their skills, talents and experiences and enable them to offer the best possible care. At Advanced Urology Institute, all administrative work has been centralized, allowing physicians to have enough time, tools and drive to collaborate, research, innovate and give the best possible care to their patients. AUI enables us to be in the company of other skilled, passionate, hard-working and creative people, making it easier for us to perform at our best and to take our careers to whatever heights we imagine. At AUI, urologists are living their dreams! For more information, visit the “Advanced Urology Institute” site.

Signs and Symptoms of Low Testosterone

Low testosterone (hypogonadism) is increasingly becoming a serious health concern for men. More men are being diagnosed with the condition, with studies indicating that 4 out of 10 men who are 45 and older have low testosterone (low-T). Likewise, 25 percent of men between 30 and 79 have low-T while about 50 percent of men over 80 have the condition. In fact, low testosterone is so common in men of various ages that numerous TV commercials have been created to make money promoting low-T solutions.

So what is low testosterone?

Also known as Testosterone Deficiency (TD), low-T refers to abnormal blood levels of the male hormone testosterone. The condition is characterized by testosterone levels below 300 ng/dl (nanograms per deciliter) in male patients when the measurement is done correctly. While low-T problems primarily occur in adult males, they are not restricted to male adults. However, when the condition occurs in women and young men, its definition and characterization are slightly different and less clear than for male adults.

Symptoms of low testosterone

Although the symptoms of low-T may differ from one man to another, the most common sexual signs are fewer and weaker erections and reduced sex drive, while non-sexual indicators are depression, low iron levels, increased fat around the waist and lack of energy. Other symptoms of low-T are reduced lean muscle mass, erectile dysfunction, irritability, absent or reduced orgasm, reduction or loss of facial, armpit or pubic hair, sleep disturbances, reduction in strength, sweating or hot flashes, breast enlargement or discomfort, reduction in testes size and memory reduction. Other signs observed only in tests or by doctor examination include osteoporosis, anemia, increased body fat and absent or reduced sperm production.

Treatment of low testosterone

While there are several options for treating low-T, the right treatment for any patient depends on various factors, including the severity of the symptoms, cause of the condition and the patient’s preferences. For instance, if the low-T is caused by lifestyle, a change of habits such as losing weight may be an effective and natural way to boost testosterone levels. Similarly, testosterone levels can be enhanced through supplementation. For men having bothersome or worrisome symptoms such as depression, testosterone replacement therapy (TRT) applied as a skin gel or a regimen of regular injections can improve testosterone levels and alleviate the symptoms.

At Advanced Urology Institute, we recognize that low testosterone is a common burden on many men. We endeavor to provide viable solutions including the safest and most effective testosterone replacement therapy for the needs of all our patients. Driven by the belief that every patient is unique and may suffer from serious complications if treatment is generalized, we deliver a highly personalized replacement therapy to our patients. We also follow our patients very closely and ensure we give testosterone therapy the right way. For more information on safe and effective treatment of low-T, visit the “Advanced Urology Institute” site.

Common Cause of Kidney Stones

Kidney stones are a common condition in the United States affecting about 9 percent of Americans. Every year, roughly 500,000 patients are admitted into emergency rooms because of kidney stones. While the prevalence of the condition has risen over the years, increasing from 1-in-20 people in 1994 to 1-in-11 in 2012, the trend is expected to continue, both in broader geographic coverage and in greater numbers due to extreme temperatures associated with climate change. Higher temperature leads to dehydration, which in turn contributes to increased concentrations of dissolved salts and other substances in urine. When urine is super-saturated, it allows kidney stones to develop.

Low Urine Volume

The risk of kidney stones increases with decrease in urine volume. Caused by poor fluid intake or fluid loss (dehydration) due to hard exercise, living or working in a hot place, low urine volume means there is less fluid available to dissolve salts and other urine constituents. In turn, the urine becomes darker in color, more concentrated and easily forms stones. In fact, a urine volume below 1 liter per day is associated with 10 percent of all recurrent kidney stones while urine volume below 1.5 liters per day is linked with the formation of many recurrent and first-time kidney stones. Low urine volume due to chronic dehydration, defined as a history of prolonged exposure to heat, is the main cause of 20 percent of all incidents of kidney stones.

Effect of Warmer Temperatures

Cases of kidney stones typically increase shortly after episodes of hot weather, hitting a peak within three days of exposure to extreme heat. According to a recent study published in the Environmental Health Perspectives, daily increase in average temperatures leads to increased risk of formation of kidney stones. Another study published in 2008 by the National Academy of Sciences also reported that about 70 percent of Americans are under high risk of kidney stones due to warmer temperatures compared to just 40 percent of Americans at risk in 2000. The number of cases of heat-related kidney stones is projected to increase to up to 2.2 million by 2050.

Hidden Risk

Increase in ambient temperatures results in increased fluid losses through the skin. As more water is lost in sweat and less in urine, salts can build up in urine resulting in stones. Even in cold weather, dehydration occurs in the warm and dry indoor air without being noticed. And since dehydration often occurs without being noticed, it is a bigger factor in kidney stone formation in many patients. For instance, in drier climates, people lose a lot of water through sweat without realizing it and face a greater risk of kidney stone formation.

Are you or your loved one suffering from the symptoms of kidney stones? Would you like to receive world-class, safe, prompt and effective treatment for kidney stones? Or are you looking for the most comprehensive and accurate information on prevention, diagnosis and treatment of kidney stones? Then Advanced Urology Institute is the right place for you. At AUI, we offer patient-friendly and multidisciplinary urology services for a wide range of problems including kidney stones. For more information, visit the “Advanced Urology Institute” site.

Vasectomy: Easy, Safe, and Effective Birth Control

Vasectomy is a common form of birth control. More than 50 million men have undergone the procedure worldwide. In the United States, around 500,000 men get a vasectomy each year. Vasectomy is an easy, safe and effective surgical procedure carried out in a clinic, doctor’s office or hospital. The outpatient procedure takes 10-20 minutes and the patient can go back home on the same day. While it is still the fourth most preferred method of contraception after oral pills, condoms and tubal ligation, it is one of the cheapest, safest and most effective family planning options.

Vasectomy Procedure

During a vasectomy, the small tubes of the scrotum that transport sperm are blocked or cut off to prevent sperm from leaving the body and causing pregnancy. The name vasectomy comes from the vas deferens, the scrotal tubes that are blocked or cut off during the procedure. Vasectomy is intended for permanent sterilization, so while it can be reversed, only those who are sure they no longer want more children should undergo the procedure.

There are two common vasectomy techniques: the no-cut (no-scalpel) method and the incision method. No-scalpel technique is a lower-risk procedure that minimizes the chance of infection and complications while also taking less time to heal. Nevertheless, whatever method is used, vasectomy is a quick procedure performed with local anesthesia or IV sedation, depending on the patient’s condition and surgeon’s preferences. After numbing, one or two small incisions are used to access the vas deferens so they can be clamped, sealed or cut to disrupt sperm flow. The procedure is performed on both sides.

Recovery from vasectomy

Recovery time after vasectomy varies, but most men are able to return to normal physical activity in 2-3 days. Recovery is quite easy as the patient is able to go home soon after the procedure, rest, apply ice packs for 24-48 hours, watch football over the weekend and be able to resume work the following week. However, it is important to notify your doctor of any severe bruising, swelling, fever, pus or chills. These may indicate internal bleeding or infection and should be dealt with appropriately.

Safety and efficacy

Vasectomy is a highly effective method of preventing pregnancy, guaranteeing almost 100 percent efficacy. It is a safe and low-risk procedure, with just about 1 percent of men reporting side effects such as infection, bleeding and pain. Compared to tubal ligation, vasectomy is faster, less painful and has fewer potential complications. Vasectomy does not significantly change the amount of semen as only sperm will be absent from the ejaculate. It also does not change the way a man ejaculates or feels when having orgasm, so your sex life will remain the same except there will be no worry about pregnancy.

At Advanced Urology Institute, we use the most up-to-date no-scalpel techniques to perform vasectomy and vasectomy reversal quickly, painlessly and effectively. We take great care to review the medical history of every patient, evaluate and counsel our patients, answer all patient questions and ensure that only the right candidates undergo the procedure. We also deliver a safe and effective procedure through a patient-centered, multidisciplinary approach that guarantees the best services for all our patients. At AUI, your health is our number one priority. For more information on vasectomy and vasectomy reversal, visit the “Advanced Urology Institute” site.

Robotic Technology in Urology: Da Vinci Robotic Prostatectomy

Urology has always been one of the leading medical specialties in the adoption and application of the latest cutting-edge technologies. For many decades urology has been one of the areas of medicine that has often readily embraced new technologies and incorporated them into everyday practice for the benefit of patients. Urology was the first medical field to espouse and use scopes for various procedures. And then with the invention of robotic systems, urologists quickly adopted and integrated the da Vinci system in their practices, using it for prostate surgery and making the da Vinci prostatectomy one of the first mainstream
surgical procedures to be performed using robotic technology.

Influence of robotic surgical systems

The introduction of robotic systems in urology has quickly enabled urologists to overcome the limitations of open prostatectomy (traditional laparoscopy) such as limited instrument movement, difficult suturing, complex reconstruction and two-dimensional vision. Likewise, the introduction and quick assimilation of robotic technology has helped to solve the problem of surgeon fatigue in laparoscopic urology. Robotic systems have enabled urologists to perform complex reconstruction and dissection in less than 2 hours delivering excellent outcomes.

Overcoming limitations of open prostatectomy

Before the emergence of robotic surgical systems, men suffering from prostate cancer had very few treatment options. The principal surgical option available was open radical prostatectomy, a procedure that involved large incisions and serious post-operative side effects. For example, when using open prostatectomy, the removal of the entire cancerous prostate resulted in increased risk of post-operative infections, excessive blood loss, considerable pain and longer hospital stays. Open prostatectomy also may lead to loss of sexual function and bladder control due to cutting of the delicate nerve plexus around the prostate. The da Vinci robotic surgery is a minimally invasive procedure that uses smaller incisions, reduces blood loss and ensures a shorter hospital stay, making things better for the patient.

Utmost precision, great outcomes

The intuitive nature of the movement of robotic instruments results in highly precise, accurate, effective and safe prostatectomy. While laparoscopic surgery’s precision is reduced by the fulcrum effect (movement of the instrument tip in the direction opposite to the surgeon’s hands), the da Vinci robotic system has no fulcrum effect, offers three-dimensional visualization, boosts degrees of freedom, eliminates tremor, reduces fatigue and provides motion scaling and ergonomic positioning. Robotic surgery is a remote controlled process in which the surgeon’s movements are precisely translated through sensitive fibers to the instrument’s tip. When applied in prostatectomy, robotic systems have been found to offer several advantages over traditional laparoscopic surgery, including minimal scarring, diminished risk of complications, clinically superior results and quicker recovery.

State-of-the-art prostatectomy at Advanced Urology Institute

Want to be treated by a highly trained and experienced team of surgeons, technicians and nurses? At Advanced Urology Institute, we have urologists who are specialists in robot-assisted surgery for prostate cancer and other urological conditions. We perform dozens of surgical procedures every month using the da Vinci robotic system. This minimally invasive, high-precision robotic technology delivers great results with complex and delicate surgeries such as prostatectomies, where the target site is surrounded and confined by the nerves regulating erectile function and urinary flow. At AUI, we use the robotic system as an exacting tool to avoid damaging these nerves, shorten recovery time and ensure quick return to normal activities.

For more information on exceptional, world-class treatment using robotic technology, visit the “Advanced Urology Institute” site.

Kidney Stones: Causes, Symptoms, and Treatments

When there is inadequate liquid to dilute salts and waste chemicals found in urine, hard masses called kidney stones may form in the kidneys. The stones can form in one or both kidneys and may vary in size, ranging from a tiny sugar crystal to a large golf ball. While kidney stones are hard to notice, a stone can be large enough to cause blockage or severe pain, particularly when it enters into one of the ureters. Kidney stones are a common condition in the United States, affecting up to 9 percent of the population and sending more than 500,000 people to emergency rooms every year.

What are the symptoms of kidney stones?

While very small kidney stones may just pass through the urinary tract without causing symptoms, a majority of people who seek medical care for the condition do so because of severe pain on the flank, which may extend to the belly, groin or back. The movement of kidney stones through the urinary tract also may cause extreme pain that does not go away, painful urination, blood in urine, chills, fever, nausea and vomiting. When experiencing such symptoms, it is important to see a doctor as soon as possible for prompt medical attention.

Causes of Kidney Stones

Kidney stones occur when there is inadequate liquid to dilute the waste chemicals found in urine, such as oxalate, calcium and phosphorous. When not properly diluted, the waste chemicals get more concentrated and form crystals. The most frequent type of stones is calcium oxalate crystals. While there are many factors that can trigger the formation of kidney stones, including what you drink and eat and chronic medical conditions, the most common cause is dehydration. For instance, people living in hot climates are more likely to lose a lot of water in sweat, resulting in limited amounts of fluid available to dilute urine. The frequently high concentration of urine in such people can trigger kidney stones.

Diagnosing Kidney Stones

Kidney stones are often diagnosed once they have caused obvious symptoms, usually severe pain. The pain is typically so severe that it can send patients to emergency rooms where a range of tests may be conducted to uncover the stones. Apart from the symptoms, kidney stones are diagnosed using tests such as X-rays, CT scan, urinalysis and ultrasound. Blood tests to determine the levels of various minerals involved in stone formation also can unearth kidney stones.

Treatment of Kidney Stones

For small stones, no treatment is necessary. You may only need to take pain medications and wait for the stones to pass out. A stone that is 5mm (1/5 inch) or smaller has a 90 percent chance of passing without intervention while one between 5-10mm has a 50 percent chance of passing. To increase the chance of a stone passing on its own, it is important to drink a lot of fluid every day, such as 8-10 glasses of water daily. A stone that is larger than 10mm may not pass on its own and may require either a non-invasive or invasive treatment to remove it.

Prescription medications may be used to facilitate the passage of some stones that do not pass on their own. For example, alpha-blockers can be used to relax the walls of the ureters and widen the passages to allow the stones to move out easily. Certain medications also may be used to stop the formation of new stones.

Apart from using drugs, the surgeon can pass a special instrument called the ureteroscope through the urinary tract to reach the stone’s location. The surgeon then applies laser energy to break the stone into smaller fragments and remove them through the tube. The procedure is called ureteroscopy and it does not require incisions.

Another commonly used treatment for kidney stones is extracorporeal shock-wave lithotripsy (ESWL). This treatment is ideal for very large stones or for stones that have blocked the urinary tract. During shock wave lithotripsy, the surgeon uses a machine that generates strong vibrations (called shock waves) to break large stones into smaller pieces that can pass out through the urinary tract. However, for kidney stones that are extremely large, the surgeon may need to conduct a surgical operation to remove them.

A lot of technology is currently available to help diagnose, treat and manage kidney stones. The technologies are safe and effective, relieving the symptoms of kidney stones without causing problems to the patients. So if you are experiencing symptoms of kidney stones, visit your doctor as soon as possible to benefit from these latest technologies and get the necessary relief. You do not have to live with a problem whose solution exists. For more information on the diagnosis and treatment of kidney stones, visit the “Advanced Urology Institute” site.

Treating Prostate Cancer

Prostate cancer is one of the most common cancers among American men. In fact, it is the most frequently diagnosed non-skin cancer in men, with over 2 million American men currently living with the cancer. Statistically, a new case arises every 3 minutes, one in six American men has prostate cancer, while an American man dies of it every 19 minutes.

Making treatment decisions

At Advanced Urology Institute, we make every effort to deliver world-class treatment and care for patients with prostate cancer. After a diagnosis, our physicians review various treatment options before picking any treatment for the patient. We also conduct further studies, such as biomarker testing and imaging studies, to ensure that we have correctly established the stage or extent of the disease. We use this information to make the right decisions and give prostate cancer patients the most effective treatments. We choose treatment options depending on the cancer itself (high-risk, intermediate risk or low-risk) and patient factors (personal preferences, age and other health issues).

Prostate cancer treatment options

Advanced Urology Institute offers a wide range of innovative and effective diagnostic and treatment procedures for patients with prostate cancer. At the institute, newly diagnosed patients get the opportunity to meet and discuss their condition with renowned and experienced specialists on the same day.

Our treatment options include:

  1. Active surveillance: For a low-risk prostate cancer that may not harm a patient over the course of his lifetime, urologists at AUI usually recommend close observation. It often comes with secondary chemoprevention.
  2. Prostatectomy: Prostatectomy is a surgical procedure to remove the prostate. For localized prostate cancer, radical prostatectomy may be employed. However, at Advanced Urology Institute, we commonly apply the robot-assisted technique, which is a minimally-invasive, laparoscopic procedure.
  3. Radiation: An external beam of radiation is directed at the prostate in order to kill cancerous cells.
  4. Cryotherapy: Probes are inserted into the prostate gland to allow for the introduction of liquid nitrogen into the gland. Once administered, liquid nitrogen produces an ice ball inside the prostate which destroys cancerous cells.
  5. Brachytherapy: A radioactive seed is implanted in the prostate. The procedure involves inserting and removing the needles that are used to place radioactive seeds inside the prostate.
  6. Hormone therapy: Various medications can be administered to reduce or inhibit the secretion of testosterone hormone. Diminished quantities of testosterone means reduced or no growth of the cancer.
  7. Chemotherapy: Certain drugs may be used to boost the effectiveness of the other treatments, both for metastatic and localized disease.

Multi-disciplinary treatment and care

At Advanced Urology Institute, our goal is to cure prostate cancer while also maximizing the quality of life of our patients. We carefully weigh the benefits of every treatment option against the side effects and develop the most practical individualized treatment programs for all patients. We also believe that effective management of prostate cancer needs extensive collaboration. We have implemented a multidisciplinary approach to treatment that allows our various specialists, such as urologists, radiation oncologists, medical oncologists, radiologists, pathologists and clinical trial nurses to deliberate and get diverse, specialized perspectives before making treatment decisions for any patient. During AUI conferences, detailed discussions among experts help to clarify the benefits and risks of various diagnostic tests and treatment options, resulting in better treatment outcomes for our patients.

Advanced Urology Institute uses image-guided targeting, MRI, ultrasound and fusing 3-D guidance to boost the accuracy and usefulness of prostate biopsies. We also apply minimally-invasive, outpatient procedures in most cases. So, with our comprehensive consultation service and multidisciplinary approach that incorporates the latest technologies, research developments and expertise, all our patients can be sure of the best possible prostate cancer treatment. Want help with prostate cancer? Get more information from our “Advanced Urology Institute” site.

Advanced Urology Institute Working Together For You

Advanced Urology Institute is a leading urology practice that excels in the diagnosis and treatment of disorders of the female and male urinary tracts and problems of the male reproductive system. Designed to be a world-class urology center, AUI brings together a huge group of doctors who are specialists in various areas to offer coordinated, effective and top-notch urology services to their patients. From restoring fertility to curing cancer, addressing incontinence to treating kidney stones, the urology services offered by AUI touch every sphere of life and bring back smiles to the faces of all who come to us for help.

Satisfying patient experience

By centralizing the administration of urology services, the doctors are able to concentrate on delivering the highest quality service to patients from initial consultation to follow-up care. The unique partnership and collaboration of many doctors and several care centers ensures that every physician or center in AUI can broaden the scope of expertise and services provided to patients, resulting in a positive experience to meet the unique needs of our patients wherever they are. At Advanced Urology Institute, we invest our time and effort, skills and experiences to make our services better. We are dedicated to delivering life-saving medical and surgical urology care in a prompt, safe and affordable manner. For us, it is not merely our job. The wellbeing and health of our patients is our number one priority.

Innovative and cutting-edge techniques

Advanced Urology Institute is a pool of urologists from multiple subspecialties. We pride ourselves on expertise and ensure that all members of our team continue to undertake training in the latest specialized surgical and medical techniques. Our experienced urologists work collaboratively to deliver highly complex treatment and care individualized to the needs of our patients. And with our exceptional range of specialist urologists, we are able to deliver more complex and innovative surgical services not available anywhere else. As a group, we are able to pool our resources, enabling all our members to have access to better equipment, instruments and tools for managing urologic disorders. Each member of the team has more experts to seek help from and we frequently send patients to other colleagues among us with more expertise and experience. As a result, we do as good a job and deliver as great results as any other premier urology centers in the country.

Unparalleled range of services

At Advanced Urology Institute, we offer a broad range of life-improving, life-extending and life-saving services to patients of all ages. Those who come to AUI have access to every possible treatment option available. In fact, most of the patients we see usually come with issues that other institutions are not able to diagnose or treat. As a team, we are committed to delivering the right care to every patient the first time they come, guaranteeing the highest rate of treatment success. We also endeavor to provide individualized, comprehensive care for all urologic conditions and diseases, giving every patient the opportunity to tap into our collaborative and team approach to have their issues resolved. At AUI, we ensure that all our hospitals, clinics, health care facilities and physicians serve with integrity and unwavering commitment to excellence. We listen to every concern, tailor every evaluation, apply the right treatment and do what is best for the patient. As a team, we deliver beyond the expectations of our clients.

For more information, visit the “Advanced Urology Institute” site.

What are the Symptoms of Low Testosterone

Produced in the testicles (testes), testosterone is the hormone responsible for masculinity and muscular development. It is the hormone that fuels sex drive, creates a deep voice, boosts muscle mass, regulates mood, controls body and facial hair patterns, and regulates bone strength. Testosterone levels usually decrease as men age, with studies showing that a man loses roughly 10 percent of testosterone each decade after reaching the age of 30.

Symptoms of low testosterone levels

Since the reduction in the level of testosterone is typically gradual, the symptoms take longer to occur. Generally, however, about 30 percent of all men will experience symptoms of low testosterone after the age of 50. Andropause is the term used to describe a decrease in the level of testosterone hormone in men. Men experiencing andropause can suffer various symptoms associated with the condition and may be at risk of having other serious health problems like osteoporosis if proper treatment is not administered.

The symptoms of low testosterone include:

  1. Diminished sexual desire (low libido)
  2. Problems getting erections or weak erections
  3. Fatigue and weakness
  4. Hot flashes
  5. Irritable moods
  6. Depression
  7. Increased body fat
  8. Loss of muscle mass or strength

Low testosterone can cause various complications or even change a man’s body. For instance, it can lead to obesity, hair loss, muscular atrophy (less muscle mass), softer testicles, smaller testicles, cardiovascular problems, larger breasts and brittle bones (osteoporosis).

Causes of low testosterone

Even though aging is the most frequent cause of low levels of testosterone in men, several other factors may be involved. Common causes of low-T include:

  1. Kidney disease
  2. Diabetes
  3. Testicular injuries
  4. Liver disease
  5. COPD (chronic obstructive pulmonary disease)
  6. Radiation therapy
  7. Steroid medications
  8. Pituitary gland disorders
  9. Chemotherapy

Men also may be tested for low-T if they have very low sex drive, erectile dysfunction, low sperm count, hair loss, reduced muscle mass or osteoporosis. And because the symptoms of low testosterone are not specific, a doctor may want to first rule out other conditions with similar symptoms before treatment.

Treatment of low testosterone

Testosterone replacement is the most common treatment for men having low-T. The therapy is administered to relieve symptoms and improve quality of life. The testosterone used in the replacement therapy is usually available in various preparations, including gels, capsules, skin patches and injections. The doctor will decide if testosterone replacement therapy is appropriate for a patient. For instance, the treatment is not appropriate for men with prostate cancer and breast cancer. Men with an enlarged prostate, liver disease, kidney disease or who are using blood thinners may or may not undergo replacement therapy depending on their medical history.

At Advanced Urology Institute, we have a long history of treating low testosterone. We put the interest and health of our patients first and always discuss with our patients in great length their conditions and medical history before we administer treatment. For more information, visit the “Advanced Urology Institute” site.