What a Urologist Does: From Kidneys to Prostate

Urologists are specialists in treating conditions of the male and female urinary tracts and the male reproductive organs.  While not every condition of the urinary and reproductive organs requires seeing a urologist, severe or persistent issues call for the intervention of these specialists.

After spending 4 years of study at medical school, a urologist takes at least 5 more years of special training. The doctor may even spend more years of training focused on a more specialized area of care, such as women’s urology, children’s urology, urological cancers, male infertility, kidney stones, sexual health, or reconstructive urology.

Therefore, a practicing urologist should have a deep understanding of the urinary and reproductive organs. The urinary system includes the urethra, ureters, bladder, and kidneys.  While the male reproductive system, including the scrotum, testes, prostate, and penis. 

What problems are commonly associated with these organs?

  1. Kidneys

These are two filtering organs located just below the ribs at each side of the spine. The urinary tract begins at the kidney and runs down to the urethra.  With the kidneys, the condition most frequently tackled by urologists is kidney stones.

  1. Ureters

Urine is made in the kidneys and passed to the bladder via these two tubes. When you have a severe urinary tract infection, it can travel up the ureters, requiring expert intervention by a urologist.

  1. Bladder

This is a pear-shaped organ found behind the pelvis. It is an expandable organ that stores up to 2 cups of urine.  Common bladder conditions diagnosed and treated by a urologist are urinary incontinence and overactive bladder.

  1. Prostate

Found only in men, the prostate is a tiny walnut-sized gland located at the base of the penis.  It increases in size at puberty. 

But it is its slow, steady growth after the age of 25 that often leads to an enlarged prostate and increases the risk of prostate cancer.

  1. Urethra

Urine and semen travel through the urethra before leaving the body. Most urinary tract infections (UTIs) tend to start at the urethra.

  1. Pelvic floor

The pelvic floor is the system of muscles and ligaments in the pelvis. It helps to hold the bladder, uterus and other organs. The weakening of these muscles can result in pelvic floor prolapse.

  1. Penis

This sexual organ in men may be associated with conditions such as erectile dysfunction—failure to have or sustain an erection for sexual intercourse. 

Some men also report the less common condition, Peyronie’s disease, which is characterized by curvature of the penis. Peyronie’s disease can sometimes be painful.

So when should you see a urologist?

While your regular doctor can treat mild urinary and reproductive system problems, you should see a urologist if your symptoms are severe or do not go away.

Urologists generally treat:

  1. Bladder problems
  2. Urinary tract infections
  3. Kidney stones
  4. Kidney blockage
  5. Bladder and kidney cancers
  6. Bedwetting in children

More specifically, in men, urologists treat:

  1. Erectile dysfunction
  2. Enlarged prostate gland
  3. Prostate cancer
  4. Testicular cancer

In women, urologists more specifically treat:

  1. Urinary incontinence after pregnancy
  2. Pelvic organ prolapse

You should see a urologist when:

  1. You have persistent urinary issues

When you have unending urinary problems, seeing a urologist is the most appropriate step.  Generally, it is advisable to visit a urologist when you have:

  1. Trouble starting or stopping a urine stream.
  2. Pain or discomfort during urination.
  3. Abnormal color of urine.
  4. Blood in urine (hematuria)
  5. Urinary incontinence (loss of bladder control)
  6. Pain in your lower back, groin, or stomach, which may mean kidney stones
  7. You are a man older than 40 years

After the age of 40, changes arise in the prostate gland that may necessitate regular check up. For instance, your risk of an enlarged prostate and prostate cancer increases around this time.

Equally, depending on your risk level, you may need regular prostate screenings when you reach the age of 50 years. The risk of bladder cancer also increases after 40 years.

Erectile dysfunction is also a common problem in men after the age of 40 years. And you should not live with it. So if you have trouble having or keeping an erection, see a urologist for help.

  1. You are a man who wants to undergo vasectomy

Vasectomy is a safe and permanent sterilization method. The outpatient procedure can be performed within 30 to 45 minutes by a urologist. And the recovery period is 8-9 days. 

 So if you’re interested in the procedure, visit a urologist to discuss whether the surgery is ideal for you and to schedule your day for getting the snip.

  1. You are a woman after menopause

With childbirth, the pelvic floor muscles weaken and results in increased risk of overactive bladder and incontinence. Should you experience any such conditions after childbirth, then you may need to see a urologist to help you achieve the desired relief.

Also, after menopause, you may experience vaginal atrophy, which may interfere with intimacy.  A urologist can provide the right treatment to help you cope with problems that arise after menopause.

Has your primary care doctor recommended that you see a urologist? Or are you having severe or persistent urinary symptoms that require specialist care?

At Advanced Urology Institute, we will guide you through the many decisions you need to make about protecting your urinary tract health. Our board-certified urologists have the training and experience to help promptly and accurately diagnose and treat urological disorders. 

Our urological procedures are designed to produce the best possible results. And we are proud that we achieve high success and satisfaction rates for our patients. For more information on how urology services can help improve your quality of life, visit the site “Advanced Urology Institute.”

When do you need a PSA test?

The prostate-specific antigen (PSA) test is a blood test performed to screen for prostate cancer. It measures the level of PSA in blood—a protein made only in the prostate gland. After production in the prostate, the PSA finds its way into blood. But the level of PSA in blood depends on age and on the health of the prostate.

What is the normal level of the PSA in blood?

The amount of PSA in blood is measured in nanograms per milliliter of blood (ng/ml).  For men aged 40 to 50 years, a PSA level above 2.5 nanograms per milliliter is considered abnormal. The normal range for men of this age is usually 0.6 to 0.7 nanograms per milliliter. 

And for men aged 50 to 70 years, a PSA score greater than 4.0 nanograms per milliliter is considered abnormal.  The normal PSA range for men in this age is 1.0 to 1.5 nanograms per milliliter.

Besides, any rapid increase or a continuous rise in PSA level over a period of time is considered abnormal. For instance, a rise of more 0.35 nanograms per milliliter of blood within one year is abnormal. 

Nevertheless, not every increased PSA level is an indicator of prostate cancer. In fact, 3 in 4 men with elevated PSA do not have the cancer. Apart from prostate cancer, an elevated PSA level in your blood may be due to prostatitis, an enlarged prostate, and urinary tract infection.

So when should you get screened for prostate cancer?

The time to begin having PSA tests depends on a number of factors. According to new guidelines, men with no family history or known illness should undergo the PSA test starting from age 54 to 70 years. The reason for this is that it is at this age that they can benefit the most from screening. 

It is from the age of 54 to 70 when:

  1. You are more likely to develop prostate cancer.
  2. Treatment of diagnosed prostate cancer makes most sense—the benefits of treating the cancer outweigh any possible risks of treating side effects.

However, there are some men who may need screening earlier, between the ages of 40 and 54 years. Your doctor may recommend that you get screened this early if you:

  1. Have a positive family history of prostate cancer. That is if you have at least one first-degree relative, like a brother or father, who has had the cancer.
  2. Have at least two extended family members who have had prostate cancer.
  3. Are African-American; an ethnicity that has a higher risk of developing a more aggressive form of prostate cancer. 

But for men who are 70 years or older, taking the PSA test is not usually recommended. That’s because the benefits of treatment may not outweigh the adverse effects. Also, the cancer may not grow or spread to a life-threatening stage in the patient’s lifetime. Though, men above 70 years may undergo the PSA test if they have a life-expectancy greater than 10 years.

Choosing to get the PSA test

As you grow older, your risk of having prostate cancer increases. Hence, you will need to undergo screening to help you detect the cancer early should you have it. For most men, it is recommended that they undergo regular PSA tests after the age of 54 years.

However, you should ask your doctor for advice on when to start having screening tests and how frequently you should be screened. If you are 54 years or older, your doctor may advise that you have a PSA test every 2-3 years. The doctor will also explain to you the harms and benefits of screening for prostate cancer.

What next after an abnormal PSA test?

If your PSA level falls in the abnormal range, your doctor may make the following recommendations:

  1. Repeat the PSA test. If the level is still higher after the repeat, your doctor may recommend monitoring the PSA level over a period of time to see how it changes.
  2. A digital rectal examination to feel for the changes in your prostate gland that may help to detect prostate cancer.
  3. A biopsy, which involves taking small samples from the prostate and checking them for cancer cells.

If it is confirmed that you have prostate cancer, your doctor will want to know whether the cancer is indolent or aggressive. An indolent cancer is slow-growing and has only a minimal chance of spreading to other organs.  With such a cancer, you may not be treated, but may be placed under watchful waiting and active surveillance.

An aggressive cancer grows rapidly and has the potential to spread to other parts of the body. Your doctor will consider your age and other factors when weighing the risks and benefits of treatment.  Eventually, you’ll undergo a personalized treatment that may include radiotherapy and radical prostatectomy.

Do you have fears that you may be at risk for prostate cancer? Would you like to speak with a knowledgeable, experienced urologist to know your risk level and when to begin your prostate cancer screening? Contact Advanced Urology Institute today to book your consultation session with a urologist who will give you the best possible advice. For more information on prostate cancer screening, diagnosis and treatment, visit the site “Advanced Urology institute.”

Can you still have an orgasm after vasectomy?

Rest assured, in virtually every case, you will have normal orgasms after a vasectomy. And you’ll also continue to ejaculate during those orgasms. 

A vasectomy is specifically surgically elected to stop sperm from being part of the ejaculate in order to prevent pregnancy. But in all other respects, it doesn’t change anything about sexual function.  It doesn’t stop you from ejaculating during sexual intercourse or masturbation. Neither does it stop you from achieving orgasms.

How does a vasectomy work?

The vasectomy procedure involves either cutting or blocking off two sperm-carrying tubes called the vas deferens that lead directly from the testicles. This procedure disrupts the flow of sperm to the penis during sexual activity preventing sperm cells from leaving the body. 

But having a vasectomy doesn’t stop your body from working normally. Your testicles will continue to produce sperm as usual. And your prostate gland and seminal vesicles will continue to produce semen. The only difference is that the sperm will no longer mix with the semen.

After a vasectomy, the sperm produced by the testicles doesn’t leave the body. Neither are the cells stored in your body. Instead, the sperm cells are broken down and reabsorbed by your body with no adverse effect on your sexual desire, erections, and performance.

Even without a vasectomy, sperm is usually produced and reabsorbed if they don’t leave the body during sexual intercourse or masturbation. So the process is normal and natural and has no effect on your sexual drive or performance.

No noticeable change in the ejaculate

Since your prostate gland and seminal vesicles will continue to produce the fluid that is predominant in your ejaculate, you’ll still have unaltered orgasms and unchanged ejaculations. The reason for this is that a typical ejaculate before a vasectomy is 95-99 percent semen and only 1-5 percent sperm. 

So when sperm is stopped from being part of the ejaculate, there is no significant reduction in the volume, quality or other characteristics of the ejaculate other than the absence of sperm.  You’ll still produce more or less the same quantity of fluid during orgasm with the same amount and texture of semen.

No effect on testosterone

A vasectomy has no effect on your ability to produce the male sex hormone testosterone. Once testosterone is produced in your testicles the hormone is transported through your body via the bloodstream. Since a vasectomy doesn’t change the flow of blood from your testicles to the rest of the body it won’t affect your testosterone levels.

So the good news is that a vasectomy will not affect your sexual performance. Sex will be the same as before but without the risk of making your partner pregnant. 

After a vasectomy, your sex drive and ability remains intact and there is no change in your erections or on the feeling and sensation you have during ejaculation. In fact, neither you nor your partner will notice a change in the ejaculate and in the orgasms.

No effect on muscle contractions

Orgasms are usually associated with a series of intense muscle contractions. Since a vasectomy does not interfere with the pelvic and sphincter muscles that contract during orgasm, you’ll still reach powerful and pleasurable orgasms. Plus, the procedure doesn’t interfere with the nerve impulses received from the penis.

Safe and secure vasectomy

Are you looking for a safe and permanent form of contraception? At Advanced Urology Institute, we offer vasectomies for men interested in the highest and most reliable form of birth control. 

All vasectomies are completed on an outpatient basis with the procedure taking 20-30 minutes. Afterward, expect to go home and rest for about 48 hours, then engage in lighter activities for the next 7 days followed by going back to your routine after a week.

We are proud that our vasectomy procedure:

  1. Is 99.99 percent effective in helping you prevent pregnancy
  2. Has no long-term effects on your health
  3. Does not affect your hormone levels, sex drive, erections, ejaculations, and orgasms
  4. Does not interfere with sex or the spontaneity of sex
  5. Gives you a simpler, safer and more reliable alternative to female sterilization

We also provide vasectomy reversals. 

For more information on vasectomy and vasectomy reversals, visit the site “Advanced Urology Institute.”

What is the primary symptom of bladder cancer?

Blood in the urine is the primary symptom of bladder cancer.  In fact, 8 in 10 people with bladder cancer will have blood in their urine, a condition doctors call hematuria. 

Generally, if you have visible blood in the urine there is an elevated chance that bladder cancer might be a concern. 

Non-specific sign of bladder cancer

Blood in the urine is the most common but not a very specific sign of bladder cancer. Blood in your urine could suggest common conditions such as urinary tract infection, benign (non-cancerous) tumors, kidney stones, or other benign kidney diseases.

So it’s important you tell your doctor if there is blood in your urine so that other conditions can be ruled out. 

What is the color of urine when there is bladder cancer?

Due to the presence of blood, urine can be rusty or deep red in color. In some cases, the urine may be dark brown. 

However, when the blood in urine is microscopic, it may not be detectable to the naked eyes so a urine test will be essential as a first order diagnostic tool. 

Bladder cancer and its symptoms can be subtle and oftentimes there’s little to no pain initially. 

As your bladder cancer progresses, you may experience the following:

  1. Urinate more often than usual (urinary frequency)
  2. Pain or burning sensation during urination
  3. Uncontrollable urge to urinate (urinary urgency)
  4. Pain in your pelvis or lower back
  5. Difficulty beginning urination (urinary hesitancy)
  6. Getting up several times at night to urinate
  7. Weak urine stream or trouble urinating

These symptoms may also be caused by other conditions, such as bladder stones, urinary tract infection (UTI), an overactive bladder, or an enlarged prostate (in men). You’ll need to have the symptoms checked by your doctor so that the cause can be found and treated.

What are the signs of advanced bladder cancer?

When bladder cancer has grown larger or has spread to other parts of the body, it can cause other more severe symptoms.  

Some of the symptoms include:

  1. Pain in the side or lower back
  2. Being unable to pass urine
  3. Feeling weak or tired
  4. Swelling in the feet
  5. Bone pain
  6. Weight loss
  7. Loss of appetite

Again, many of these symptoms can be caused by other conditions. So it is important that you get checked by your doctor.  If your doctor suspects that you have bladder cancer, the physician will order more specific tests and exams to confirm the cancer. 

At Advanced Urology Institute, we offer diagnostic and treatment services for bladder cancer. 

For more information on the diagnosis and treatment of bladder cancer, visit our website AdvancedUrologyInstitute.com

How long does radiation treatment take?

Key takeaways

  • Radiotherapy is a cancer treatment that uses high doses of radiation to destroy cancerous tumor cells. It can be administered externally or internally, and the length of treatment depends on the type, location, and characteristics of the tumor.
  • External radiotherapy is typically given daily, from Monday to Friday, for five to eight weeks, with breaks on the weekends to allow healthy cells to recover. The length of treatment may vary depending on the specific tumor and the location.
  • External radiotherapy is a painless process that typically takes 30-45 minutes, including set-up time, but the actual treatment only takes 2-5 minutes. The patient lies on a treatment table and is positioned under the radiation machine while special shields or blocks are used to protect healthy tissues.

Radiation therapy delivers controlled, safe and effective doses of radiation to cancerous tumors. The tumor cells are exposed to high doses of radiation that destroy their genetic material and eventually damage or kill them. Hence the cancer can no longer grow, multiply or spread after the treatment. Though the radiation affects all the cells, healthy ones are able to recover fully from the effects of the treatment.

Radiotherapy is generally administered either externally or internally. During external radiation therapy—the most common form of the treatment—a machine is used to direct high-energy rays at the cancer. In contrast, internal radiotherapy (also called brachytherapy) uses a radioactive source that is temporarily or permanently implanted directly into the cancerous area.

So how long does the radiation therapy take?

The exact duration of the treatment depends on the type, characteristics, and location of the tumor.  The length of treatment also depends on the dosage to be delivered, the number of fractions to be given, the treatment plan created by the radiation oncologist, and whether it is external or internal radiotherapy.

For example, if you have a deeper tumor, then you may require a more-focused beam delivered for a shorter period of time. But if you have a larger, shallow tumor, then you may need treatment for a longer period.

Equally, since the radiation must be given in a way that has minimal adverse effects on healthy cells, a shorter length of exposure is necessary if the tumor is located in more delicate organ (like the brain) or is in close proximity to very sensitive body tissues.

Your radiation oncologist will assess your tumor and make the necessary prescription. Then, by working with your radiation oncology team, the oncologist will determine how best to deliver the prescribed dosage, how many treatments are necessary, and how long it should take.

Next, your radiation oncologist will oversee the simulation of treatment to ensure that appropriate dose is given to the right location and that as little as possible reaches normal tissue. The simulation is followed by the testing of the delivery set-up to check the performance and positioning of the equipment to be used to give the treatment. After that, your treatment visits begin with the radiation therapist in charge of administering the daily fractions.

How long does external radiation therapy take?

External radiotherapy is typically delivered daily, from Monday through Friday, for five to eight weeks. Weekend breaks are factored into the treatment schedule to allow healthy cells to recover. Each treatment is offered on an outpatient basis.

But there are exceptions to this schedule.  Some tumors may require treatment for less than five days per week and only need treatment for one to two weeks. Specifically, shorter durations of two or three weeks in length are commonly used in palliative care—the use of radiation to relieve cancer symptoms. Still other tumors, such as certain brain cancers, may require just a single treatment.

External radiation therapy is a painless process and is almost like having a regular x-ray. You’ll be in a room for 30-45 minutes because of the time it takes to set up equipment and place you in the correct position, but the actual treatment takes 2-5 minutes.

Once in the room, you’ll lie on the treatment table. You’ll then be positioned under the radiation machine. Your radiation therapist will place special shields or blocks between the machine and other parts of your body to protect normal tissues. Thereafter, you’re expected to remain still, though you don’t have to hold your breath.

After you’re in the correct position, your radiation therapist will move into a separate, nearby room to turn on the machine and begin the actual treatment. The therapist will watch you on a monitor and you’ll be able to communicate with the therapist through an intercom.

How long does internal radiation therapy take?

Brachytherapy uses radiation implanted inside the body to treat cancer. The radiation implant is placed as close as possible to the tumor in order to concentrate the radiation on the cancer cells and minimize radiation damage on normal tissue around the tumor.  The radioactive material is sealed in a thin wire or hollow tube (catheter) and implanted directly into the cancer affected area on a temporary or permanent basis.

Internal radiation therapy is used when the oncologist decides that the best way to treat the tumor is to expose it to a higher radiation dose. The radioactive implant is closer to the cancerous cells and delivers a higher dose over a shorter period of time. The treatment is ideal for several types of cancers, including breast cancer, brain tumor, gynecological cancer (like ovarian and cervical cancer), lung cancer, and head and neck cancer.

The time taken for brachytherapy and whether it is done on an inpatient or outpatient basis depends on the type of therapy used and the nature of the cancer. In some cases, internal radiotherapy can be completed within three to five outpatient treatments of a few minutes each. But in other cases, the radioactive implant may be left in place for up to a week and there is need for a hospital stay during that period.

Finishing your radiation therapy sessions

It is important to finish all sessions of radiotherapy. And never to miss or delay treatments because this may reduce the effectiveness of the radiation in killing the tumor cells.

You should remember that your doctors are not just bothering you with making several hospital visits. There is need for different sessions because radiation is destructive and should not be delivered all at ago. In fact, if the recommended dosage was to be given once, it would pose a greater risk to healthy tissues and produce more adverse effects.

At Advanced Urology Institute, we spend the necessary time, effort and expertise to design a detailed treatment plan for radiation therapy. We offer the treatment in conjunction with other therapies and with the help of experienced oncologists and a multidisciplinary cancer care team.

We are also committed to reducing the time our patients take in treatment and often implement maximized aggressive treatments when necessary. Contact us today to learn whether radiotherapy is right for you and the various options available for you. For more information, visit the site “Advanced Urology Institute.”

References

What can cause an elevated PSA?

Key takeaways

  • The PSA test measures the quantity of a protein produced by cells of the prostate gland in a blood sample. It is typically used to screen for and monitor prostate cancer in men.
  • Elevated PSA levels can also be caused by non-cancerous conditions such as age, prostatitis, benign prostatic hyperplasia (BPH), and urinary tract infections.
  • To use an elevated PSA as the basis for ordering a prostate biopsy, it is now recommended that the level of PSA is monitored over time and any changes are monitored regularly, with a suspicious lump detected during a DRE being a more accurate basis for suspecting prostate cancer.

Prostate-specific antigen (PSA) is a protein produced by cells of the prostate gland. It is synthesized by both normal and malignant cells and released in blood. The PSA test measures the quantity of this protein in a blood sample, which is then reported in nanograms of PSA per milliliter (ng/mL) of blood. A PSA level of 4.0 ng/mL and below is often considered normal.

What causes an elevated PSA level?

The blood PSA level is typically elevated in men with prostate cancer. Therefore, the test is usually ordered in conjunction with the digital rectal exam (DRE) to screen men that are asymptomatic for prostate cancer. It is also recommended for monitoring the progression of prostate cancer in men already diagnosed with the disease, and to test men with prostate symptoms to find out the nature of their problem.

Apart from prostate cancer, there are a number of conditions that may increase the PSA level. For instance, PSA is elevated with age, usually due to enlargement of prostate tissue over the years. Prostatitis (inflammation of the prostate), which is a condition common in men under 50 years due to bacterial infection, tends to result in increased PSA level. Other conditions that lead to increased PSA level include benign prostatic hyperplasia (BPH), urinary tract infections, prostate injury, recent ejaculation, high parathyroid hormone, and surgical procedures.

Normal versus abnormal PSA level

Although a PSA level of 4.0 ng/mL or below is often considered normal, the level of the protein can vary over time in the blood of the same man, making what is usually taken as the normal range less accurate. In fact, studies have indicated that some men with PSA level below 4.0 ng/mL have prostate cancer while many men with levels above 4.0 ng/mL have been found free of the cancer.

Besides, due to the various factors that may cause a fluctuation of PSA level, such as age, prostatitis, BPH, and urinary tract infections, having a fixed normal range for all men is unreliable in some cases. Equally, since PSA test results vary from one laboratory to another and because drugs like Dutasteride (Avodart) and Finasteride (Proscar) that are used to treat BPH tend to lower PSA level, a single elevated PSA may not be very helpful.

Therefore, to use an elevated PSA as the basis for ordering a prostate biopsy to ascertain whether prostate cancer is present, it is now recommended that the level of PSA is monitored over time. A continuous trend of increasing PSA in blood over a prolonged period of time, together with a suspicious lump detected via the DRE, is a more accurate basis for suspecting prostate cancer and ordering for a prostate biopsy.

Elevated PSA in prostate cancer screening

For men without symptoms of prostate cancer, an elevated PSA level may be followed by a repeat PSA test to confirm the original finding. And if the PSA level is still high, the urologist may recommend that more PSA tests and digital rectal exams be done at regular intervals so that any changes can be monitored over time. If the PSA level continues to rise or if a suspicious lump is found during a digital rectal exam, the doctor may now order for confirmatory tests.

For example, a urine test may be requested to establish if the rising PSA level is due to a urinary tract infection. Likewise, imaging tests like cystoscopy, x-rays or transrectal ultrasound may help to show the size and nature of any lump.

And if the tests show there could be prostate cancer, the urologist will recommend a prostate biopsy.  Multiple samples of prostate tissue are collected by inserting hollow needles into the prostate through the wall of the rectum. The samples are examined by a pathologist to confirm whether the cells are cancerous or not.

Elevated PSA in monitoring prostate cancer treatment

After treatment for prostate cancer, the urologist will want to continue to monitor the PSA level to establish whether the disease is recurring or not. An elevated PSA level after treatment is usually the first sign that the cancer is recurring. In fact, an elevated PSA after treatment often happens many months or years before the signs and symptoms of prostate cancer recurrence show.

A single elevated PSA test isn’t enough to conclude that the cancer has recurred. So the urologist will recommend that the test be repeated a number of times, and be done together with other tests, to check for evidence of prostate cancer recurrence. Repeated PSA tests help the doctor to establish a trend over time instead of relying on a single elevated PSA level.

At Advanced Urology Institute, we are committed to the highest standards of urologic care. We make sure to use the right diagnostic and treatment tests, techniques and procedures to deliver the best possible outcomes for our patients. That is why when it comes to the PSA test, we do not rely on a single elevated result to draw conclusions about your prostate health.

It is our practice to monitor elevated PSA for a prolonged period of time and to use the test alongside risks factors (age and family history) and other tests like the digital rectal exam, before we can make conclusions regarding your prostate health. We believe that an elevated PSA level is a valuable tool for early detection of prostate cancer and for successful treatment of the condition if the test is used properly. For more information on prostate cancer diagnosis and treatment, visit the site “Advanced Urology Institute.”

References

What to Expect When Having Radiation Therapy

Key takeaways

  • Radiotherapy is a treatment for cancer that uses high doses of radiation to kill cancer cells. It may be used before, during, or after surgery, and can also be used in conjunction with chemotherapy.
  • A radiation oncology team typically includes a radiation oncologist, radiation oncology nurse, medical radiation physicist, dosimetrist, and radiation therapy technologist, who work together to design and administer the treatment plan.
  • Before radiotherapy treatment begins, a patient will typically be referred to a radiation oncologist, have their medical records reviewed, undergo a physical exam, and have imaging scans to locate the tumor. The patient will then be asked to sign a consent form and a treatment plan will be developed before the first session.

Scheduling your initial radiotherapy session can create concern and anxiety. And of course many are worried and feel overwhelmed. 

At Advanced Urology Institute, we encourage our patients to be partners in the process and to educate themselves about the procedures. We believe that the more you know about radiotherapy before your treatment, the more confident you’ll be to face the treatment and the more likely you’ll play an active role in your recovery.

So what is radiation therapy?

Radiation therapy is the treatment of cancer using focused high doses of radiation to kill cancer cells. During treatment, specific amounts of the radiation are aimed at tumors or parts of the body affected by the cancer.  Once administered, the radiation kills, stops, or slows down the growth of cancer cells.

Radiotherapy may be used before surgery to shrink a tumor to a smaller size. But it may also be used during surgery to target certain cancer cells. In some cases, radiation therapy is used after surgery to destroy the remaining cancer cells.

When paired with chemotherapy, it can help to improve treatment outcomes. And in cancer cases where a cure is not possible, radiation therapy can be used for palliative purposes—to reduce pain, pressure or other side effects of treatment.

While the radiation affects all cells, healthy ones are able to repair themselves and recover their normal cell function after treatment. Alternatively, unhealthy cells, such as cancer cells, aren’t able to repair after radiation.  Hence, the treatment helps to destroy and eliminate unhealthy cells with minimal adverse effects on healthy cells.

What is a radiation oncology team?

Typically, radiotherapy is designed and administered by a team of highly trained medical professionals. The team usually includes a radiation oncologist, radiation oncology nurse, medical radiation physicist, dosimetrist, and radiation therapy technologist.

The radiation oncologist is the doctor who specializes in delivering radiotherapy for treating cancer and who oversees the overall treatment protocols. The doctor works closely with other team members to develop the treatment plan.

The radiation oncology nurse is skilled and experienced in caring for patients receiving radiation therapy. The nurse answers patient questions about the treatment, monitors the patient’s health during the treatment, and helps to manage the side effects.

The medical radiation physicist designs the treatment plan and is an expert in using radiation equipment. To ensure the right doses are administered with accuracy and precision, the radiation physicist is a key member of the team.

And finally, the radiation therapy technologist (radiation therapist) will directly operate the treatment machines such as a linear accelerator during therapy sessions and give the scheduled treatments. Other professionals might include social workers, nutritionists (dietitians), dentists, and rehabilitation therapists, such as physical therapists or speech therapists.

What happens before your treatment?

You’re usually referred to a radiation oncologist when your doctor believes radiotherapy might be an option worth considering. The radiation oncologist will then review your medical records, conduct a physical exam, and order various tests. The doctor then explains your options, speaks with you about the potential benefits and risks of the treatment and answers questions.

If you decide to proceed with radiotherapy, you’ll be asked to grant permission by signing the consent form. Your treatment team will then design the treatment plan before your first session.

Your treatment team will use imaging scans, such as computed tomography (CT), X-ray, and magnetic resonance imaging (MRI) to identify the tumor location. You’ll then receive small marks on your skin to assist the team in targeting the radiation beam at the tumor.

In addition, you may be fitted with immobilization devices such as tapes, foam sponges, headrests, simply molds or plaster casts. These items will help you stay secure and in the same position throughout treatment. If the radiation is targeting your head or neck, you may receive a thermoplastic mask, which is a mesh mask molded to your face and secured to the table. 

Though it is crucial for your body to remain in the same position for each treatment, your oncology treatment team cares about your comfort and would like to hear your suggestions. So speak up about how you’re feeling. Communicate with the team so you can find a comfortable position every time.

What happens during treatment?

Radiotherapy is generally scheduled for five days a week over a six to seven week period although the treatment can last for as little as two to three weeks if the goal is merely palliative. Over the course of treatment, you’ll receive small doses (fractions) of daily radiation instead of large doses. This helps to best target cancer cells and protect healthy cells in the treatment area. Compliance and consistency is key. It is advisable that you complete all your sessions as scheduled and not miss or delay any treatments. 

Before treatment is administered, your radiation therapy technologist will ask you to change into a gown and lie on the movable bed. The marks on your skin are used to position the machine and table—though you may be positioned using molds, boards or special holders. If necessary, special blocks or shields are used to protect your normal organs. You’ll then have to remain still in that position during your treatments breathing normally.

For each treatment session, you’ll be in the room for 10-30 minutes with the radiation administered for 1-2 minutes of that time. As soon as the treatment begins, the radiation therapy technologist will leave you alone in the room with a closed circuit TV and an intercom. The technologist will see and hear you at all times. So if you think you need to move, just notify the therapist and the machine will be turned off and adjusted.

The technologist controls the machine from outside as treatment progresses and monitors the machine at all times.  The treatment is painless and you’ll not see, smell or hear the radiation. In between your treatment sessions, you’ll need to undergo various tests and checks to confirm that the treatment is going on as earlier planned.

For instance, port films will be taken to ensure the positioning remains as it should be. Weekly blood tests may also be run to check your blood cell counts. Plus, your radiation oncologist will meet with you once a week to assess how your body is responding to treatment. Be sure to tell the doctor of any changes or concerns.

Top-notch radiotherapy services

At Advanced Urology Institute we provide cutting-edge treatments for cancer. Our radiotherapy service is tailored to deliver specifically targeted radiation to precisely target and kill cancer cells.

For more information on radiotherapy and other forms of cancer treatment, visit the site “Advanced Urology Institute”.

References:

Advanced Urology Institute Recognized as an Axonics® Center of Excellence

Dr. Carole Gordon is an expert at treating bladder and bowel dysfunction with innovative Axonics Therapy

April 20, 2021

Advanced Urology Institute has been designated an Axonics Center of Excellence by Axonics Modulation Technologies, Inc. The designation recognizes the AUI team and Dr. Carole Gordon for her expertise with Axonics Therapy and sincere commitment to changing the lives of patients suffering from bladder and bowel dysfunction.

Today, millions of Americans suffer from overactive bladder and fecal incontinence.1 Patients in the Villages, Leesburg, and Ocala areas with chronic and debilitating symptoms related to bladder and bowel dysfunction may seek treatment from the experts at AUI. Axonics Therapy gently stimulates the sacral nerve (sacra neuromodulation), restoring normal communication between the brain and the bladder. Axonics Therapy has been clinically proven to provide rapid and long-lasting relief of symptoms associated with bladder and bowel dysfunction.

In a clinical study, 129 patients with urgency incontinence were treated with Axonics Therapy At 2-years, 93% of patients had successful therapy and 94% of patients were satisfied with theirtherapy.2

The Axonics Center of Excellence program recognizes highly trained and experienced physicians (typically urologists, urogynecologists, and colorectal surgeons) and clinical practices that are committed to patient education and providing exemplary care to achieve optimal clinical outcomes and patient satisfaction.

“AUI is proud to be recognized as a Center of Excellence. This designation is a testament to the dedication of our entire team, and in particular to Dr. Carole Gordon,” said Gina Barnes, Chief Administrative Officer. “We are committed to providing the best care to our patients and are extremely pleased to offer Axonics Therapy.”

About Advanced Urology Institute

As one of the largest full-service urology groups Florida, our 37 locations offer comprehensive urology services, from evaluation and pre-surgical preparation to surgery and rehabilitation. We have evaluated numerous patients and performed thousands of urologic surgical and cancer procedures in the last decade with excellent outcomes. We are dedicated to combining clinical excellence, advanced technology, and patient-centered care.

For more information contact AUI at: 855-977-4888

About Axonics Modulation Technologies, Inc. and Sacral Neuromodulation

Axonics, based in Irvine, Calif., has developed and is commercializing novel implantable SNM devices for patients with urinary and bowel dysfunction. These conditions are caused by a miscommunication between the bladder and the brain and significantly impacts quality of life.

Overactive bladder affects an estimated 87 million adults in the U.S. and Europe. Another estimated 40 million adults are reported to suffer from fecal incontinence/accidental bowel leakage. Axonics SNM therapy, which has been clinically proven to reduce symptoms and restore pelvic floor function, is now being offered at hundreds of medical centers across the U.S. and in dozens of select hospitals in Western Europe. Reimbursement coverage is well established in the U.S. and is a covered service in most European countries. The Axonics System is the first long-lived rechargeable SNM system approved for sale in the world, and the first to gain full-body MRI conditional labeling. For more information, visit www.axonics.com.

References: 1. Irwin DE, Kopp ZS, Agatep B, Milsom I, Abrams P. Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction. BJU Int.  2011;108(7):1132-1138. 2. Pezzella A, McCrery R, Lane F, et al. Two-year outcomes of the ARTISAN-SNM study for the treatment of urinary urgency incontinence using the Axonics rechargeable sacral neuromodulation system [in press]. Neurourol Urodyn. 2021.

What is chronic pelvic pain?

Do you feel pain in the lower part of your torso, just between your hips? It is not a pleasant feeling, and you can’t get a good sleep or engage in quality exercise. At times, you have to miss work. It’s the kind of pain that comes and goes—sometimes dull and sometimes sharp—but never resolves. Next thing you know, six months have gone by and yet the pain is still there.

You might be experiencing chronic pelvic pain.

For this condition, you will need a female pelvic medicine and reconstructive surgery (FPMRS) physician to help you.

At Advanced Urology Institute, we have FPMRS physicians who can help you at our Fort Myers center.

What is chronic pelvic pain?

Chronic pelvic pain (CPP) is a persistent, non-cyclic pain perceived to exist in the pelvis’s structures. Typically, it occurs in the area below the belly button and between the hips. It becomes a medical condition if the pain lasts for at least six months.
Read more about Chronic Pelvic Pain here.

What are the most common bladder issues?

Ladies, do you have bladder problems that keep you from pursuing your goals? Do you want to exercise, work, travel, go out more and not worry about “accidents” happening?

If so, we have the help you need.

Bladder ConditionsAt Advanced Urology Institute, we know that you value your social life and we want you to keep enjoying the things you like doing.

Through our female pelvic medicine and reconstructive surgery (FPMRS) physicians at our Fort Myers office, we provide effective treatment for bladder issues in a compassionate, personalized, and multidisciplinary way, ensuring a high rate of success and uninterrupted social life.

You may not know it, but bladder problems have treatment options that dramatically improve symptoms from these conditions. With treatment, you will never have to reduce your physical activity or remain in isolation. Instead, regain your freedom and enjoy an improved quality of life. That is why you should see a physician with expertise in urogynecology to receive the specialized attention necessary for a quick and complete recovery.

[continue reading more about bladder conditions here]

Pelvic Organ Prolapse: An Overview

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

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

How does pelvic organ prolapse occur?

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

[Continue Reading Here]

5 Reasons for Women to See a Urologist

A urologist isn’t just a doctor for men. There are many reasons why a woman would need to see a doctor who treats the urinary system. The urinary system is a collection of organs that involved the kidneys and bladder, as well as the organs involved in the reproductive process.

Here are five common reasons why a woman may need to see a urologist

1. Kidney Stones

When minerals in the urine combine, they can sometimes stick together and create kidney stones that get lodged in the urinary tract. These stones vary in size and create a variety of symptoms. The most common symptoms are pain and difficulty urinating. Some women may also experience fever or chills.

Treatment for kidney stones varies depending on patient and stone type, but urologists have plenty of treatment options on hand. In some cases, drinking lots of water can flush the stones out. In other cases, high-intensity focused ultrasounds can break the stones into smaller, more easily passable pieces.

2. Urinary Tract Infection

Commonly referred to as UTI, this a common infection that many women will develop at some point in their lives. It occurs when bacteria enter the urinary tract and cause pain and burning during urination. UTI’s can become serious, so treatment with antibiotics is important.

3. Bladder/Pelvic Prolapse

This painful condition occurs when the bladder begins to drop down into the vagina. There are a few reasons why this may happen. Some women develop this condition after childbirth, but for others it occurs as a part of the aging process. Correcting this problem usually requires surgery performed by a urologist.

4. Bladder Control Problems

Bladder control problems are twice as common for women, and the medical term for these problems is Urinary Incontinence. Urinary incontinence takes many forms. Some women experience dripping when they sneeze, cough or laugh. Some women have an overactive bladder that creates a sudden and urgent need to use the bathroom. No matter what form it takes, women can work with a urologist to find the best treatment, or combination of treatments, to help with their incontinence.

5. Cancer

There are certain cancers for which a woman would be treated by a urologist. These include cancers of the bladder, kidneys or urethra. Lower back pain, pain during urination, and blood in the urine can be signs of one or more of these cancers. Treatment varies depending on the type of cancer, how aggressive it is, and the overall health of the patient.

Women in Florida who need a urologist for treatment of one or more of these problems have many options. The Advance Urology Institute is a team of highly skilled medical professionals who practice at locations throughout the state and with a commitment to achieving the best possible outcomes for their male and female patients. For more information about women’s urological issues, visit the Advance Urology Institute website.

Why Would You Need to See a Urologist

The urinary system is your body’s way of getting rid of urine. If there is something wrong with your urinary system, you may need to see a urologist. A urologist is a doctor trained and certified in treating issues with the many components of the male and female urinary systems and male reproductive organs.

Urologists treat a wide range of urological issues, including problems with the bladder, kidneys or urethra. If you are a man experiencing issues with your reproductive organs—penis, testes, scrotum, and prostate—it is a urologist you will need to see. And for women, issues with the bladder and pelvis are reasons to visit this kind of specialist.

Common bladder problems that send patients to the urologist are kidney blockages, kidney stones, and urinary tract infections (UTIs.) Treatment for these issues vary from patient to patient. For instance, some patients might be able to pass a kidney stone by drinking water and moving around to dislodge it, while others may need a more advanced treatment like a high frequency ultrasound, which is an ultrasound focused on the stone to break it down into smaller, easily passable pieces, similar to sand.

For men’s reproductive health, urologists can treat Erectile Dysfunction (ED). In most cases, this condition is easily treated with oral medication, though in some patients injection therapy may be necessary. Prostate cancer, the most common cancer that affects men, is another reason that men seek out a urologist for treatment. Again, for this issue, treatment varies by diagnosis. While some men’s prostate cancer can be monitored and treated with active surveillance, others may need surgery or chemotherapy depending on the aggressiveness of the cancer.

Women are more likely to see a urologist for bladder problems, often for changes in urination after pregnancy. Pelvic organ prolapse is another potential medical issue for women. Usually caused by age, this is when either the uterus or bladder begins to drop and press into the vagina. A urologist can treat this condition to relieve the discomfort and pain it causes.

Residents of Florida have access to a leading center for the medical specialization of urology with locations throughout the state. The Advanced Urology Institute is an exceptional team of medical professionals who treat their patients’ urological issues with compassion and a commitment to the highest quality care. For more information, visit the Advanced Urology Institute website.

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.

Becoming a Physician Assistant with Quynh-Dao Tonnu, PA-C

While certified physician assistants (PA-C) are not the same as American Medical Association board-certified medical doctors, they are competent medical professionals. Physician assistants often go into medicine later in life, having already worked in other occupations.

Quynh-Dao Tonnu, PA-CCertified physician assistants go through a rigorous graduate-level training program that takes more than two years to complete. The degree program must be accredited by both the Committee on Allied Health, Education and Accreditation, and the Accreditation Review Commission on Education for the Physician Assistant. After successful completion of the academic portions, the graduates must pass the national Physician Assistant National Certifying Exam. The final stages include formal application with the Florida Board of Medicine and completion of 2,000 hours (about one year) of supervised clinical practice.

Physician assistants are important within medical practices because they relieve the physicians of much of the routine workload. They take medical histories and, because of their medical training and experience, they are able to notice when a patient has a special issue the primary physician should be aware of. They can understand medical histories written by other medical professionals and understand their patients’ backgrounds. For example, some fad diets can seriously affect a person’s digestive system, kidneys, urinary tract and bladder. An experienced PA knows when to ask patients if they have been on such diets.

With a solid understanding of pharmaceutical medicine, physician assistants can prescribe medications or recommend that the physician prescribe certain types of medications. PAs also approve prescription refills according to the physician’s practice and standard medical guidelines. If a patient has questions about how and when to take medications, PAs can give that information.

Quynh-Dao Tonnu, PA-C started her post-secondary education at the University of Florida, where she received her BA in Economics in 2005. Later in 2007, she completed a master’s degree at the University of South Florida in Library and Information Science. After that, she worked in hedge fund accounting, which she found interesting but not very personally fulfilling. In 2014, she changed occupations to become a medical assistant. She realized her most fulfilling job experiences involved working with people, so she went back to school and obtained her Physician Assistant degree in 2017. She has been working in urology for three years and is now fully certified. You can meet this talented PA at the Advanced Urology Institute Oxford office. For more information, visit the Advanced Urology Institute website.