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I am Ketan Kapadia. I’m with Advanced Urology Institute and a board certified urologist.
Obviously the heat is going to play a major role, a lot of it has to do with our diet unfortunately as well. [As with] an American diet, we just don’t eat very well, we’re all a little heavier and that also increases the risk of kidney stones as well.
The interesting thing here in Florida, which isn’t talked about very much and this is sort of the holistic treatment of the patient in urology, which is we get a lot of men who have prostate problems who start cutting back on their fluids because they don’t want to get up at night; And when you start cutting back on fluids and not getting up at night, now you’re at more risk of [getting] stones. We see a lot of older guys who come in with kidney stones for the very first time because they got a prostate problem as well and that hasn’t really been addressed.
Same with women who have overactive bladder. First thing most people do is they start cutting back their fluid so they’re not having to run to the bathroom all the time. Again, you cut back your fluid and now you’re living in Florida in the heat, you’re going to get kidney stones. So a lot of doctors will be more than happy to just get rid of your stone and have the surgery [but] I’m also interested in preventing that next stone. Part of that is getting twenty-four (24) hour urines, seeing why you’re making stones, addressing all the overactive bladder problems and prostate problems because I don’t want you to end up having more stones. I’m happy to operate and take out stones, that’s fun, but it’s my obligation to help prevent [it from happening agan].
My name is Shaw Zhou, I am with Advanced Urology Institute.
Robotic surgery is truly precise, for example, the magnify [goes] up to ten times so the doctor can see better and if your doctor has a hand tremor [it’s still] very steady. You got four arms instead of two arms, so you have two arms to grab for you and so on and so forth. And you have three dimensional [view], you can see much better. The traditional labs got surgical screens which are two dimensional so you don’t have that sense of depth. However the drawback is first of all, the doctor sits 10 feet away, so God forbid if something happened, your doctor will have to go in, wash your hands and you are not by your patient
Also you lose the tactile sensation, cause you don’t feel it no more. When you tie a knot or whatever you know, the tactile sensor feed gives how much force you use now, [before] it’s purely by experience. Although the new robot that we’re talking about that has tactile sensationin other words you can visually see it. They see how much force [is needed] if its red or green. So it’s getting better and better, eventually new robots keep on coming out but in the future I think we can overcome all these shortcomings for robot surgery.
Prostate cancer has a new standard of care in MRI-guided fusion biopsy with transrectal ultrasound. While a prostate biopsy has been the only way to get a definitive diagnosis of prostate cancer, it has only been working if cancer cells are identified in the sample tissue. But in some cases, such as when the tumor occurs at the top surface of the prostate or other unusual locations, a biopsy may not give a correct diagnosis. For instance, the standard TRUS (transrectal ultrasound) guided biopsy in which tissue samples are collected from the prostate in a systematic pattern gives a negative result with tumors located in unusual areas of the prostate. About 15-20 percent of tumor locations can be missed by the biopsy needle.
What makes the MRI-ultrasound fusion biopsy more definitive?
The MRI-ultrasound fusion approach is an improvement on the traditional 12-core TRUS, which involved taking biopsies from twelve prostate areas where the cancer is considered more likely to occur. With the TRUS biopsy, about 70 percent of men who have a negative biopsy result are not essentially free of the cancer. The MRI-ultrasound fusion technology blends the superior imaging capability of the high-definition multi-parametric (mp) MRI with real-time ultrasound imaging. There is better visualization of the suspicious areas of the prostate where the cancer may occur that may not be visible on ultrasound alone. The fusion-guided biopsy detects almost twice as many prostate cancers in all stages as the standard TRUS biopsy.
The ability of MRI-ultrasound fusion-guided biopsy to create a three-dimensional (3D) map of the prostate ensures that doctors are able to see the targeted areas of the prostate better and perform more precise biopsies. The technology uses a machine known as UroNav developed by Invivo, which is supplied with sophisticated software to produce super-detailed MRI images and fuse them with the ultrasound images generated by a transrectal probe administered on the patient in an outpatient setting. The resulting images enable the examining physician to direct biopsy needles with pinpoint accuracy and to easily access any lesions or suspicious areas revealed by MRI. The technology allows the urologist to hit the target spot more accurately and improves cancer detection rate. In fact, it is primarily used for men who have an ongoing suspicion of prostate cancer, such as those with consistently elevated PSA, but whose TRUS biopsy results are repeatedly negative.
Fewer biopsies, more accurate detection
The fusion-guided biopsy is a very targeted approach in which biopsies are performed only in highly suspicious areas of the prostate appearing in the MRI image. As a result, significantly fewer biopsies are done with the MRI-ultrasound fusion than with the traditional TRUS technique, minimizing the adverse effects that often accompany repeat biopsies. Multiple prostate biopsies can lead to complications such as bleeding, infection, urinary retention problems, sepsis or even death.
In spite of fewer biopsies, the MRI fusion approach increases the rate of detection of aggressive prostate cancer. The extensive MRI images obtained before the biopsy helps highlight both high-risk and intermediate-risk cancers often missed by traditional TRUS biopsy. With MRI-ultrasound fusion, the likelihood of detecting cancer increases as the grade of the tumor increases. The use of MRI fusion biopsy helps to avoid metastatic disease by finding cancer before it spreads to other areas of the body.
Improved cancer differentiation
Through MRI fusion, doctors are able to more accurately differentiate cancers that require treatment from the ones that should undergo watchful waiting (active surveillance). Fusion technology is able to show higher-risk cancers and does not highlight the insignificant low-grade tumors, making it less likely for urologic oncologists to over-treat indolent and low-grade cancers. A number of prostate cancers are low-grade, non-aggressive and do not cause problems at all and treating them through chemotherapy, radiotherapy or surgery can impair the quality of life or even cause death. MRI fusion effectively saves patients from the adverse effects of treating low-grade tumors. Fusion technology eliminates up to 50 percent of prostate cancer treatments that are unnecessarily administered on low-grade cancers.
At Advanced Urology Institute, we have adopted the MRI-ultrasound fusion biopsy and changed the way we screen, evaluate and diagnose prostate cancer. It has become our standard for detecting prostate cancer and we believe in the next few years it will be the gold standard for detecting the cancer. We are proud that it offers a higher detection rate, superior accuracy and reduces the rate of repeat biopsies — making our practice one of the best places for detection and monitoring of the cancer. It helps us deliver the best treatment outcomes for our patients.
If you think you are at high risk of prostate cancer or already have started experiencing some symptoms, let us show you how the precision of our high-definition MRI fusion machine, the expertise of our skilled physicians in MRI fusion biopsy and the know-how of our radiologists proficient in multi-parametric MRI imaging can help you. For more information on the treatment and diagnosis of prostate cancer, visit the “Advanced Urology Institute” site.
A vasectomy is a simple and safe minimally-invasive surgery done by a doctor in a clinic, office or hospital. During the procedure, the small tubes called vas deferens that carry sperm are blocked or cut off to prevent sperm from leaving a man’s body and causing pregnancy. The sperm cells remain in the testicles and are reabsorbed into the body. So after about 3 months following a vasectomy, the semen doesn’t contain any sperm and can’t cause pregnancy. Of course you’ll still produce the same amount of semen as before except that there will be no sperm in them.
Quick and highly-effective
A vasectomy is a quick, 15-to-30-minute procedure and you can return home the same day. Designed to be a permanent form of contraception, a vasectomy is extremely effective in preventing pregnancy — nearly 100 percent. It is one of the most effective methods of birth control you can find. Vasectomy — also called male sterilization — is meant to protect against pregnancy permanently, so it’s super effective once you are past the first three months following surgery when the semen has become sperm-free.
After the procedure, pregnancy is prevented round-the-clock for the rest of your life. Once the doctor confirms that you no longer have sperm in your semen, then you don’t to do anything else to prevent pregnancy.Of course there is a very slim chance of the cut ends of the tubes growing back together after the procedure, making it possible to cause a pregnancy. That, however, very rarely happens.
Types of vasectomy
The vasectomy procedure involves cutting and blocking or partially removing both ends of the vas deferens (the sperm duct). Once that is done, sperm traveling from the testes can no longer reach the semen and form part of the ejaculate. Two types of vasectomies exist: the no-scalpel method and the incision method. The no-scalpel (no-cut) technique has a lower risk of infection and complications and generally requires a shorter recovery time. Because it’s classified as a minor surgical procedure, a vasectomy is often done in the doctor’s office with the patient under local anesthesia. It’s only in a small percentage of men where the procedure is performed in the operating room with general anesthesia or sedation — either due to the results of a doctor’s physical exam or patient preference.
Doesn’t hurt as much as often perceived
Vasectomy is a safer, minimally-invasive birth control method and a more effective procedure compared to tubal ligation. Guys generally tolerate it better than women do with tubal ligation. While you will experience a sharp sensation when the numbing medication is applied with a small needle, there should be no further pain after that. If you experience any further discomfort, inform your doctor so more of the numbing medication may be given or action is taken to alleviate the discomfort. Most men find vasectomy less painful than they anticipated, although a mild swelling and soreness may be experienced after the procedure.
Recovery after a vasectomy
Some mild swelling and discomfort is to be expected for a few days after the procedure, but almost always is gone completely by the end of the first week. It’s recommended that you take 1-2 days off work to reduce your activity level and get ample time to recover — although men with physically strenuous jobs may require a longer break from work. For the first 48 hours after the procedure, keep your activities limited and apply cold packs to your scrotum 3-4 times a day, with each application lasting for about 20 minutes. Wear supportive underwear until the discomfort subsides or for at least a week. Avoid sexual activity and exercise until the discomfort disappears, usually after around one week. Don’t soak in a pool, open water or hot tub for at least 3 weeks to ensure your wound heals quickly — you may just shower and dab dry. Return to normal activity slowly, building up your activity level gradually.
At Advanced Urology Institute, we do vasectomies in the office, using the no-scalpel, no-needle procedure. However, if you’re squeamish about it then you can have the procedure in a surgical room — although for most guys, doing it in the office is alright. The procedure takes about 20 minutes and is not bad in terms of pain. Recovery is also very fast. Most men schedule it on Friday and are back to work on Monday. As long as you don’t engage in strenuous activities such as a heavy lifting kind of a job, you can resume work quickly.
So if you want freedom from the fear of having unwanted children and want to enjoy your sexual relations without worrying about a pregnancy, a vasectomy is the ideal contraception for you. For more information on vasectomy, visit the “Advanced Urology Institute” site.
The prostate gland is a critical component of the male reproductive system. Located just underneath the bladder and in front of the rectum, the tiny walnut-sized gland helps to make semen — the fluid that carries sperm. But as men age, the prostate increases in size, becomes enlarged and begins to cause problems.The most common prostate problems include:
Bacterial infection
Dribbling after urination
Increased need to pass urine (especially at night)
Enlarged prostate, called benign prostatic hyperplasia (BPH)
Prostate cancer
One of the most common cancers
The second most frequent cancer in American men, after skin cancer, prostate cancer typically grows slowly and shows very few early symptoms. So doctors usually recommend that men go for screening to ensure the cancer is spotted early even before symptoms arise and prior to the cancer getting more advanced. During screening tests, doctors perform prostate exams to detect any abnormalities that may indicate an issue, such as cancer. But the exams are not recommended for everyone and are often only necessary when the benefits outweigh the risks.
The PSA (Prostate-Specific Antigen) Test
The prostate-specific antigen test, simply called PSA, is a blood test for detecting prostate cancer and one of the most frequently used screening tests for the cancer. When there is an elevated level of the PSA in the blood, it might indicate that you have cancer. However, it’s not always that straightforward. In fact, there is a raging controversy about the PSA test, with many people questioning whether or not it’s necessary for younger men who are otherwise healthy. For instance, there is the argument that if there is a false positive PSA result, it may cause a lot of unnecessary anxiety and could even cloud a person’s decision regarding future treatment. False positive results are relatively low with the PSA test, but they may still occur.
The biggest argument against the PSA test is that treatment isn’t necessary for many prostate cancers. The cancer tends to grow and spread slowly and rarely causes serious effects during a man’s lifetime. While, in some cases, the cancer can be really aggressive and the PSA test may detect it when it’s still small and easier to treat, the side effects of cancer treatment are monetarily and physically too costly. So a lot of precaution is necessary when deciding who should or should not get treatment — there is no reason for treating a cancer that has little or no chance at all of progressing.
So when should you get your first PSA?
It is important to discuss the benefits, risks and uncertainties of the PSA (prostate-specific antigen) test with your doctor before getting it. If you are a man of average risk, you should get your first PSA at the age of 50. But for men at high-risk of developing prostate cancer, such as African-American men, men of Caribbean descent and men with a first-degree relative (brother, father or son)
who had the cancer before age 60, then the first PSA should be at 45. And for men who are at higher risk, such as those who have more than one first-degree relative who had the cancer at an earlier age (younger than 50), the first PSA test should be at the age of 40.
Establishing the baseline with first PSA
At Advanced Urology Institute, we recommend that men get their first PSA test before the age of 50 so that a baseline can be established and used to make the decision as to whether or not they’ll need further tests. If it’s very low, then your regular PSA tests can be put off. But in cases where the PSA is elevated, we conduct other tests to ensure that it is prostate cancer we’re dealing with and not a prostate infection or an enlarged prostate. Depending on the PSA test result, we may repeat your PSA every 6 months to assess whether the first was a false positive or there is an upward trend.
The main thing with the PSA test is the changes in the level of PSA. Some men can have normal PSA but still have prostate cancer. So monitoring the changes and trends in your PSA is critical for cancer diagnosis. That’s why we encourage people to get their first PSA test early to establish a baseline for monitoring their PSA level. You don’t have to undergo a prostate biopsy just because you have done a PSA. If it’s found that your PSA is where it should be, you’ll not need a biopsy. That’s why we always want to be sure of the trends in your PSA.
Are you at high-risk of prostate cancer? Or are you experiencing symptoms of what could be a prostate problem, such as painful or frequent urination or blood in urine? At Advanced Urology Institute, we exhaustively discuss the pros and cons of the PSA test with our patients before making any decisions. We understand that PSA screening has both benefits and risks and we try to make the best possible decisions for our patients. For more information on the PSA test, prostate exams, diagnosis and treatment of prostate cancer, visit the “Advanced Urology Institute” site.
Kidney stones are a common cause of agonizing and debilitating pain in men and women. In the United States, the stones account for over one million hospital visits and more than 300,000 emergency room visits every year. When patients present with kidney stones, the treatment administered usually depends on the type, size and location of the stone and on the severity of symptoms. Apart from administering treatment, the urologist investigates the underlying cause of the stones and recommends ways of preventing a recurrence.
Spontaneous passage
Kidney stones smaller than 4 mm in diameter are often passed on their own in urine and may be treated at home. While such stones may be painful, the pain often lasts only a few days and usually disappears soon after the stone is passed. So, depending on how bad your symptoms are and how long you’ve had the symptoms, you may not be given any form of treatment and just wait for stones to pass in urine. It usually take up to six weeks to do so.
However, you should only do this if the pain is bearable, there is no sign of infection or kidney blockage and the stone is of a size that can pass on its own. As you wait for it to pass, you’ll need to drink plenty of water and take pain medication to help you manage the discomfort. If you suspect that you have a kidney stone, speak with your doctor to see if you need immediate treatment or if you can wait for it to pass spontaneously.
Medications
There are a number of medications that increase the chance of passing kidney stones. For instance, tamsulosin is commonly given to people with kidney stones to help relax the ureter and make it easier for stones to pass. Apart from medications to boost stone passage, your urologist may prescribe anti-emetic (anti-nausea) medication to reduce nausea and vomiting as you wait for the stone to pass. And if you are in severe pain, your doctor may give you 1-2 pain injections and then prescribe some painkillers and anti-emetics for you to take from home.
Surgical procedures
If the pain is so much that you can’t wait for the stone to pass in the urine, you’ll require a surgical procedure to remove it. Surgery is also necessary if the stone is too big to pass on its own or is hampering kidney function. Kidney stones may be removed surgically if they are causing repeated urinary tract infections or are blocking the normal flow of urine.
Surgical procedures to remove kidney stones include extracorporeal shock-wave lithotripsy (ESWL), ureteroscopy and percutaneous nephrolithotomy (PCNL). These procedures are usually chosen by urologists depending on the size, type and location of the stones.
1. Extracorporeal Shock-Wave Lithotripsy (ESWL)
This procedure is the most frequent way of treating stones that can’t pass spontaneously in urine. High-frequency waves (X-rays or ultrasound) are directed at the stone to break it into smaller pieces that can pass in urine. Often the tiny pieces require a few weeks to pass out in urine. While ESWL is 99 percent effective for kidney stones up to 20 mm in diameter, more than one session is usually necessary for the treatment to be successful.
2. Ureteroscopy
For kidney stones that are lodged somewhere in the kidney or ureter, ureteroscopy (also called retrograde intrarenal surgery) may be necessary. The procedure involves directing a long, thin telescope (called ureteroscope) through the urethra, into the bladder, then into the ureter or kidney where the stone is located. If the stone is stuck in the kidney or upper ureter, the urologist uses flexible telescopes for this procedure, but rigid telescopes are ideal for stones stuck in the lower parts of the ureter.
The ureteroscope helps the urologist to reach the stone without making an incision. After reaching the stone, the doctor either can use another instrument to remove it or direct laser energy on it to break it into smaller pieces that can pass naturally in urine. A stent (plastic tube) may be inserted temporarily into the bladder to drain out the stone fragments.
3. Percutaneous nephrolithotomy (PCNL)
For kidney stones that are too large (21-30 mm in diameter), percutaneous lithotripsy is the treatment of choice. During the procedure, a half-inch incision is made in the side or back, just big enough to allow passage of a telescopic instrument (called nephroscope) into the area of the kidney where the stone is located. The nephroscope is used either to pull out the stone or break it up with pneumatic energy (or laser) and suction out the pieces. In fact, it’s the ability to suction out tiny stone pieces that makes this procedure ideal for larger stones.
Kidney stones also can be removed through open surgery, laparoscopic surgery or robotic surgery. But this is only done when the less-invasive procedures fail. Routine surgical procedures for kidney stones require shorter recovery period and you can usually return home the same day after the procedure and resume normal activities in 2-3 days. If the urologist inserts a stent after a procedure, it is removed 4-10 days later. During treatment, you also may be provided with a strainer that you can use to collect stone pieces that pass in urine for laboratory testing and to enable the urologist to recommend appropriate ways of preventing stone recurrence.
At Advanced Urology Institute, we offer shockwave lithotripsy, ureteroscopy and percutaneous nephrolithotomy routinely, and perform robotic and laparoscopic procedures for kidney stones when necessary. We perform blood tests and 24-hour urine analyses for every patient to identify the cause of kidney stones in order to provide the right treatment. We also design prevention strategies tailored to each patient, including personalized dietary recommendations based on results of 24-hour urine analysis. Our aim is to always ensure that our patients properly understand why they have kidney stones and make the necessary lifestyle changes to prevent a recurrence. For more information on kidney stones and how they are managed, visit the “Advanced Urology Institute” site.
Being a urologist is an opportunity to help people and make a difference in their lives. As a urologist, people come to you with sensitive and often awkward conditions of the genitourinary tract and you assess the problems and provide the most appropriate remedies. The goal of urologists is always to make interventions that ensure patients are able to live fuller lives. And that makes us proud of our work and of our unique place in the medical profession.
Urology — a big world of stuff
Many people think of urology as merely being about urine. But urology is a massive world that covers a wide range of stuff. It’s an amazing and exciting specialty, where you perform surgery, manage problems medically, develop enduring relationships with patients and go home every day feeling satisfied with your work. I like urology because I’m often able to see the results of my work. For example, when patients come with urological cancers — of the prostate or kidney — I am often able to make effective interventions and achieve great outcomes. Actually, almost all my operations usually result in improved quality of life.
Why urology?
Urology was a natural fit for me. I wanted to be involved in diagnosis, medical management and surgical procedures. With most of my cases I have found that wonderful balance of medicine and surgery in urology. I also like listening and talking to people, leading them to open up and share their problems, guiding them to see the bigger picture and helping them to make informed decisions. In urology, I’m able to do this and much more with my patients. Most crucially, I joined urology to have a chance to make a difference in people’s lives. And indeed, I have found the specialty well-rounded, fascinating and exciting, as well as a powerful instrument for improving people’s lives.
Path to urology
I was born and grew up in Tampa, Florida, where my passion for the health and well-being of the people around me and for public health and sanitation made me a volunteer in many causes right from a young age. I soon realized that pursuing medicine would help me to make a better contribution in health care and improve people’s lives. So I joined the University of Miami for my medical education, graduating with AOA honors. Then I went to Shands Hospital, University of Florida for my urology residency. Currently I am happy and proud to be back in Florida where I’m practicing and living the dream of my life — making a difference in people’s lives.
Areas of expertise
As a urologist, I routinely deal with a wide variety of issues, such as urinary tract infections, overactive bladder, urinary incontinence, low testosterone and prostate enlargement. I also offer procedures for kidney transplants, interstitial cystitis, prostatitis, overactive bladder, congenital abnormalities, urinary stones, correcting stress incontinence, operating on adrenal glands and treating bladder, prostate and kidney cancer. I provide vasectomies, vasectomy reversals and treat erectile dysfunction and infertility issues in men.
What makes urology even more interesting is the continuous integration of advanced technology. Today we can access the urethra via the bladder and get into the kidneys without making any incisions. Even operations to remove kidneys or prostates, which previously required open surgery, are now routinely performed robotically or laparoscopically — using tiny, image-guided instruments.
At Advanced Urology Institute where we use the da Vinci surgical system for several operations, a urologist can now just sit at a console, have fingers in sensors and remotely control a multi-armed robotic surgeon, which ensures access to more areas in the body and provides seamless movement during operation in ways that are impossible laparoscopically. Application of such technology guarantees less scarring, less blood loss and quicker recovery for our patients. And for the urologist, it’s always exciting in the operating room working with such technology.
Job satisfaction
It takes long and hard training to become a urologist. The residencies take 5-6 years and typically involve long hours of complex work and limited sleep. Then there are several hours per week spent in the operating room, which may test anyone’s tenacity and patience. However, it helps that urologists are generally professionals with a positive attitude, good bedside manners and vast empathy. So these challenges can hardly diminish our enthusiasm and commitment to urology.
As a urologist, you are always conducting tests and procedures that may be quite uncomfortable for your patients, delivering news about diagnoses that your patients may not want to hear, and facing medical emergencies requiring you to think on your feet and solve issues to the best of your ability. But with skills to communicate well, eyes for detail and unquenchable desire to help people, you’ll always find yourself on top of things.
I really like urology because I’m a hands-on person who enjoys the hours it offers in the operating room. There are many potential conditions to treat, a wide range of procedures to perform and different tools to use —so no two days are the same. From a vasectomy to vasectomy reversal, circumcision to delivering antibiotics for urinary tract infections, laser surgery to robot-assisted procedures, there’s a lot to keep a urologist engaged and involved.
Urologists also are at the forefront of advanced technology, having pioneered laparoscopic approaches that have been adopted by other medical specialties and now leading the way in the use of cutting-edge robotics. The field is ever growing and changing, and we are constantly researching, learning and innovating to perform our duties better.
Most essentially, urology allows you to build lasting relationships and make a difference in people’s lives. I follow my patients over time, getting to know how they are doing and helping them make informed decisions. I enjoy what I do because I’m always involved in improving, prolonging and saving lives.
Why Advanced Urology Institute?
Advanced Urology Institute stands out for its commitment to excellent urological care. By bringing together a huge number of driven, hard-working, experienced and certified professionals, and having them adopt a collaborative, multidisciplinary patient-centered approach to care, AUI not only gives urologists an opportunity to grow, but also offers them a working environment that brings out the best of their knowledge, skills and experiences. I like the fact that all administrative duties have been centralized and we have all the time we need to work with our patients and give our best.
It’s also good that colleagues at AUI are quite laid back, funny and relaxed people. We are serious about our work but we also enjoy jokes with each other and maintain a positive, friendly practice. It’s a fantastic place full of people who love what they do and who handle diverse issues and patients with utmost diligence and thoroughness. And because we love our job, we work harder to get better at it and to achieve great outcomes for our patients. For more information on our urological services, visit the “Advanced Urology Institute” site.
The prostate is a tiny gland situated between the bladder and the penis. But as men get older, the gland grows larger, putting pressure on the urethra and bladder and causing urinary problems. An enlarged prostate is medically called benign prostatic hyperplasia (or BPH), a condition that’s quite common in older men. In the U.S. around 50 percent of men 51-60 years old have BPH while up to 90 percent of men over age 80 are affected by the condition.
The common symptoms of an enlarged prostate are:
Inability to delay urination.
Urge to urinate more than 8 times a day.
Frequently waking up at night to pass urine.
Dribbling after urinating.
Urinary incontinence (urinating accidentally).
Inability to completely empty the bladder (urinary retention).
Having intermittent or weak urine stream.
Straining to pass urine or difficulty starting urination.
So what are the options for treating BPH?
As urologists, the first thing we do when a patient has symptoms is to rule out other possible problems. We talk with our patients to learn the nature and severity of their symptoms, conduct exams, do ultrasound and relevant tests. Once it’s confirmed that it is BPH, we begin treatment starting with the least invasive procedures. Treatment options for BPH include medication, minimally invasive procedures and surgery, although various lifestyle changes also can improve or prevent symptoms.
1. Medications
The urologist may recommend medication to help control prostatic growth and reduce symptoms. For instance, alpha blockers such as alfuzosin (Uroxatral), silodosin (Rapaflo), doxazosin (Cardura), tamsulosin (Flomax) and terazosin (Hytrin) may be used to relax prostate muscles and make it easier to urinate. They quickly increase urine flow and reduce the need to urinate frequently. Another type of medication that may be prescribed is 5-alpha-reductase inhibitors, such as finasteride (Proscar) and dutasteride (Avodart), which limit the growth of the prostate by blocking hormones that promote growth of the gland. It generally takes 3-6 months for 5-alpha reductase inhibitors to relieve symptoms.
Phosphodiesterase-5 (PDE5) inhibitors such as Sildenafil, (Viagra), Tadalfil (Cialis) and Vardenafil (Levitra) may be given to help relax urinary tract muscles and relieve BPH symptoms. However, in some cases, particularly when either a 5-alpha reductase inhibitor or an alpha blocker isn’t effective on its own, urologists may give a combination therapy. This typically involves a combination of a 5-alpha reductase inhibitor and an alpha blocker and usually results in greater symptom relief.
2. Minimally invasive procedures
When medications fail to relieve BPH symptoms, the next step in treatment usually involves minimally invasive interventions. During the procedure, a urologist inserts an instrument into the rectum or urethra to either widen the urethra or destroy excess prostate tissue. For instance, TUMT (Transurethral Microwave Thermotherapy) uses microwaves to heat and destroy excess prostate tissue. TUMT does not cure BPH but makes it easier to pass urine, cuts down urinary frequency and reduces weak flow. Another treatment, TUNA (Transurethral Needle Ablation), uses high-frequency radio waves that are delivered via twin needles to burn a specific area of the prostate. TUNA is an outpatient procedure that relieves BPH symptoms and improves urine flow.
A third minimally invasive option for BPH is water-induced thermotherapy. During the treatment, hot water delivered through a catheter and into a treatment balloon located at the center of the prostate is used to heat up a definite area of the prostate and destroy problematic tissue. Once destroyed, the excess tissue is either reabsorbed in the body or excreted through urine. Another minimally invasive treatment option is the Urolift procedure, which involves inserting small implants into the prostate to retract, hold and lift the enlarged prostate tissue, opening up the passage for urine and relieving bladder blockage. While the Urolift procedure does not involve heating, cutting or removing the excess prostate tissue, it is effective in restoring normal flow of urine and relieving symptoms, and patients usually return home the same day without a catheter.
A revolutionary minimally invasive procedure for treating BPH is the Rezum system. During the treatment, sterile water vapor is injected into the prostate to help destroy overgrown tissue. It takes roughly three months for the body’s healing mechanisms to remove dead prostate cells and shrink the prostate, opening the passage for urine to flow. The Rezum procedure improves urine flow and relieves symptoms without the adverse effect of erectile dysfunction. It’s an ideal option for men who are medically unfit for the other procedures or for those already catheterized.
For prostates that have grown larger than 100 grams, a procedure called aquablation is a good option. It uses a high velocity saline jet to remove the overgrown prostate tissue. After the treatment is planned, the procedure is robotically driven, so its duration and side effects do not depend on prostate size. It does not use heat and postoperative bleeding is prevented by inserting a large catheter and applying a bladder washout (irrigation). The results achieved through aquablation are similar to TURP, except it comes with less dysuria and minimal irritation symptoms because no heat is used.
3. Surgical procedures for treating BPH
If both medication and minimally invasive procedures fail to improve BPH symptoms sufficiently, the urologist may recommend surgery. Surgical interventions also may be necessary if complications develop or symptoms become severe. The most common type of invasive surgery for BPH is TURP (Transurethral Resection of Prostate). In fact, it’s the first surgical option for treating BPH and involves the removal of excess prostate tissue by inserting a resectoscope through the urethra and into the prostate. Or the urologist can opt for TUIP (Transurethral Incision of Prostate) that involves making incisions in the bladder’s neck and into the prostate. The operation is done to widen the urethra and boost urine flow.
In other cases, the urologist may choose to perform laser surgery. This surgical procedure involves inserting a scope into the urethra and using the scope to deliver laser to the prostate tissue. The laser treats enlarged prostate through either enucleation (cutting) or ablation (melting). Both the GreenLight Laser PVP and Holmium laser ablation of prostate (HoLAP) procedures remove the excess prostate tissue by photoselective vaporization while holmium laser enucleation of prostate (HoLEP) uses two instruments, a laser for cutting and removing excess tissue and a morcellator for slicing extra tissue into tiny fragments for removal.
In complicated cases of BPH, such as men with much enlarged prostates or those with bladder damage, urologists may opt for open surgery. During an open simple prostatectomy, the urologist makes an incision just below the navel or numerous small incisions in the abdominal area via laparoscopy. The surgeon then removes the portion of the prostate that’s blocking urine flow.
At Advanced Urology Institute, our choice of treatment usually comes down to patient preferences and their ability to cope with BPH symptoms. We often prefer the least invasive options and give medication in many cases, but other treatment options are considered for patients who aren’t responding well to drugs or who can’t tolerate the adverse effects. As an alternative to TURP and open surgery, we prefer to treat BPH that’s characterized by acute urinary retention, high post-residual volume, recurrent urinary tract infections or bladder stones through the GreenLight Laser PVP or the newer heat treatments like TUNA and microwave. For more information on treatment options for BPH, visit the “Advanced Urology Institute” site.
If I had to do it again, I would still happily choose urology. I really love urology and I’m always excited about the opportunity it offers to listen to people talk about distressing conditions, detect life-threatening conditions and make interventions that improve their lives. For me, the honor of being relied upon to offer advice, the awe of discovering problems in the genitourinary tract, the chance to provide life-improving and life-saving treatments, and the gratitude that comes with helping people through difficult illness — these things just never cease to motivate me. So even in my most stressful work days — when crushed by unbearable time constraints or enormous pressure — I have never felt anything like a drop in my passion for urology.
Why urology?
Ever since I was a child, I wanted to be a doctor. My mother, who was a teacher, realized this early and encouraged me to work hard in school to fulfill my dream. I went to Denison University for my undergraduate studies, then to Ohio State University for my medical degree, graduating in 1989. In medical school, I wasn’t really sure which field of medicine I wanted to specialize. In those days, the first two years of medical school were dedicated to intensive classwork and then in the third year we would go for clinical rotation.
When I went for my rotations, my first area was nephrology, medical care for kidneys. It was quite depressing working with patients with kidney problems and those under dialysis. I couldn’t figure out why patients who were not doing well were discharged to go home only to be back in the hospital the next day. This early experience shaped my attitude toward urology and at this stage, I felt strongly that I would never be a urologist.
We had eight choices as electives, including urology, but I didn’t want to work with kidneys and tried to avoid urology. However, as things turned out, I ended up picking urology. My eureka moment came when I watched from a side view as the prostate was being cut by a urologist. As the procedure went on before my eyes, I immediately changed my mind about urology.
That was my first real experience with urological surgery and it inspired my career choice and my lifelong commitment to the field. I completed a six-year urology and surgery residency at Emory University, Atlanta, Ga., and soon became a certified urologist by American Board of Urology. And even though I heard people say that urology was boring, I have found it fun and fascinating.
Areas of expertise
As a urologist, I offer diagnosis, treatment and follow-up care for a broad range of urological ailments and associated emotional issues. I routinely provide medical and surgical treatments for conditions such as kidney stones, urinary incontinence, erectile dysfunction, male infertility, pelvic pain, urologic cancers and genitourinary tract injuries. But I also perform specialized laparoscopic, laser and robotic procedures for various conditions, such as laser enucleation and laser vaporization for prostatic problems, steam ablation (Rezum) of the prostate, da Vinci robot-assisted surgery for prostate and kidney issues and high-intensity focused ultrasound for prostate cancer. Most importantly, I believe that every patient has unique needs that must be fully understood by the urologist before treatment can commence. So I always make sure to take into account all the needs, concerns and presenting factors of every patient and to provide tailored treatments that meet the specific needs of individual patients.
Job satisfaction
Urologists manage genitourinary tract disorders medically and surgically, taking care of their patients from start to finish. The ability to fix urologic disorders, see the lives of your patients improve, have them enjoy life much better and establish enduring relationships with them is quite satisfying. Likewise, the chance to use some of the latest and most innovative technology, including scopes, lasers and robots for complex urology procedures makes the field continually interesting. Even though urology is a surgical subspecialty, we have far better working hours than in general surgery. There are much fewer urological emergencies and rarely are there painful trauma situations to handle, so urologists have more control over their work schedule and better control over their lives. While urology residency is quite grueling, it isn’t nearly as bad as general surgery residency. With urology you get a good mix of surgery and medicine and enjoy better working conditions and great outcomes, all of which makes it quite fulfilling.
Why Advanced Urology Institute?
When I was choosing urology, there were people around me who thought it was a boring field of medicine. So for me, the inspiration to join the specialty was not enough. I also wanted a practice that would make urology exciting and fun. Luckily I found that in Advanced Urology Institute. I joined AUI’s Pinellas Urology in 1995 and quickly found its collaborative, multidisciplinary and patient-centered approach to care useful in bringing out the best of my skills, knowledge and experiences. And with all administrative work centralized at AUI, there are no bothersome phone calls, electronic documentation, paperwork, quality assurance measures and insurance forms for me to deal with. That makes it easier for me to concentrate on providing the best possible care to my patients. So even if I can’t always guarantee that I’ll make my patients better, I have all the time to work out the best possible remedies for their conditions. For more information on urology and urological services offered by AUI, visit the “Advanced Urology Institute” site.
Robot-assisted (robotic) surgery uses small instruments attached to a robot’s arm to conduct surgical procedures. A qualified, highly-skilled surgeon controls the robotic arm, using it to enhance surgical precision. In fact, contrary to popular beliefs, it’s the surgeon behind the robot and not the robot itself that performs the procedure. The robot improves surgical outcomes and boosts patient safety by enabling the surgeon to use very tiny incisions and to achieve unmatched precision.
Robotic surgery in urology
Robot-assisted surgery has become very popular in urology, particularly in the United States. In urology centers where it is used, it’s extensively applied in surgery to excise prostate cancer as it enables access to anatomical areas that are difficult to reach. Other urologists use it for kidney cancer surgeries and to some extent in bladder surgeries. Through robot-assisted procedures, urologists are able to use the surgical assistance, enhanced precision, systems networking, dexterity and image-guidance made possible with robots. Urologists are able to easily perform complex procedures that are often difficult to do using conventional laparoscopy.
Pre-operation discussion
While robotics are excellent tools that improve the outcome of surgical procedures, they are not ideal for every situation. The need and value of robot-assisted surgery varies from case to case and it’s important to discuss this with your urologist before undergoing surgery. Being clearly informed of the benefits and risks associated with robotic surgery ensures that you can make an informed decision before the procedure.
Advantages of robot-assisted surgery
Robotic surgery is typically minimally invasive. So the patient suffers less pain, slight blood loss and minimal scarring, and requires only a short recovery time. With the robotic arm eliminating the natural limits of human wrists, surgery can be performed with more delicate, precise and efficient movements. The 3D imaging and endowrist technology of robots ensure surgery is more accurate, nerve bundles are dissected more precisely, erectile function is preserved, and there is a better chance of cure than with non-robotic surgery. The surgeon also enjoys more strength, dexterity, flexibility, control and a better view of the operated area. Robotic surgery allows the surgeon to get more comfortable, perform the procedure with increased concentration and focus, and can undertake complex procedures that are tougher or impossible with other techniques.
Disadvantages of robot-assisted surgery
With robot-assisted surgery, there is not only the risk of human error when operating the robotic system, but also the potential for mechanical failure. For instance, system components such as robotic arms, camera, robotic tower, binocular lenses and instruments can fail. In other cases, the electrical current in the robotic instrument can leave the robotic arm and be misapplied to surrounding tissues, resulting in accidental burn injuries. Likewise, robot-assisted surgery can cause nerve palsies due to extreme body positioning or direct nerve compression that may occur when using robots. It also takes longer to perform robotic surgery than non-robotic surgery in surgical centers with lower robotic volume or by less experienced surgeons.
Ways of improving robot-assisted surgery
It’s important that centers applying robotics follow standardized training, improved reporting and enhanced patient education to reduce errors related to robotic surgery. Robotic surgery should be conducted by urologic surgeons trained in robotics and have extensive robotic and laparoscopic surgical experience. It also must be remembered that adding robots to the surgical equation may create room for error in an already risk-fraught and complex arena. So proper steps must be taken to guarantee safe and effective robot-assisted procedures. Robotic surgery is getting better and better as more advanced robots are developed to overcome existing shortcomings. So patients should expect better outcomes with robot-assisted surgery as advanced machines are applied.
At Advanced Urology Institute, we believe that surgical outcomes are a direct manifestation of the experience and skill of the surgeon, and less about the approach or technology used. That’s why we have assembled a team of qualified, skilled and experienced urologists to offer surgical procedures for different urological disorders. Our urologists perform hundreds of laparoscopic and robotic surgeries every year and have achieved great success rates in terms of efficacy, cure and improved quality of life. Our approach to robotic surgery guarantees that you will get the best possible surgery with remarkable outcomes. For more information, visit the “Advanced Urology Institute” site.
Specializing in urology means a lifelong commitment to serving the sick, particularly those with troubling, embarrassing and sometimes life-threatening conditions. Urologists diagnose, treat and care for people with genitourinary tract disorders, such as pelvic pain, kidney stones, male sexual dysfunction, urinary incontinence, genitourinary tract injuries, enlarged prostate, male infertility and urologic cancers. As a surgical subspecialty, urology involves operating on the kidneys, ureters, bladder, scrotum, urethra and adrenal glands, but treatment varies from patient to patient and may be in the form of surgery, medication or both.
Unique, exciting field
Urology is an amazing and fascinating field of medicine. It’s an opportunity and privilege to improve other people’s lives. As a urologist, you see patients with issues they are often reluctant to discuss. You can help them feel at ease, open up and talk about even the most awkward disorders and then provide treatment to help them overcome these issues. People come to you at their lowest and most vulnerable moments and you work with them to restore hope, meaning and happiness in their lives. For those who love surgery, urology is a delightful and satisfying career as it offers plenty of minimally invasive, laser, laparoscopic and robotic procedures using some of the latest equipment and innovative technologies. But there’s also a lot to enjoy in doing ultrasounds, reading CT scans, performing retrogrades, and much more.
Why I chose urology
I was born and grew up in Shanghai, China, where I completed my medical school education. But for me, pursuing medicine and specializing in urology is something that came quite naturally because serving people and helping those in need was always my passion. Growing up, I always felt a drive to do something to reduce the disease burden in my community, so I routinely participated in activities to help the sick and improve public health. When I went to college, I became convinced that medicine was the right career for me.
I moved to the United States in 1991 and settled in Florida. To advance my medical career, I joined the University of Miami School of Medicine Research, Department of Physiology and Molecular Biology for a research program. During my time in the program, I encountered a lot of urological issues and interacted with quite a number of patients with genitourinary problems. That got me interested in urology. So I went to the University of Pennsylvania for my surgical training, then moved to the University of Nebraska for my urological training.
Areas of expertise
I routinely resolve problems of the male and female urinary tracts, as well as male reproductive health issues. I frequently see men with recurrent urinary tract infections, erectile dysfunction, enlarged prostate and urinary incontinence. But I also perform a lot of surgical procedures and manage issues around the testicles beyond just doing vasectomies. For example, I offer treatment to eliminate testicular pain, laser therapy for urinary stones, sling procedure to relieve incontinence, urethral dilation to relieve urethral strictures and robotic surgery to treat urological cancers. I work closely with my patients on the type of care to give them to ensure the best possible outcomes.
Long-term relationships
As urologists, we have a unique ownership of our patients. For instance, as men’s health doctors, we conduct annual exams, treat erectile dysfunction, and follow those with benign prostatic enlargement and voiding issues. That means we are always helping patients on long-term care, even for more than 10 years. And as we see these patients for that long, operating on them, providing medical management and actually getting to know them so well, we enjoy a wonderful bond and lasting relationship with them. It’s also unique that patients tell us more about themselves than they’ve ever shared with anyone else.
As a urologist, you have to be open and welcoming, and prepared to find a quick common ground with your patients — maybe tell a joke or two to lighten the mood — before they feel comfortable and able to discuss their issues freely with you. Practicing urology means you are always in a position where you can influence the way people talk about and care for their health. For example, many men don’t realize that they may need to have their prostate checked, but talking to them about it ensures they are able to begin annual prostate checks as early as possible. Likewise, for guys worried about their penis size, you have the chance to inform them and make them finally understand that they are fine.
Job satisfaction
Like any other career, urology has challenges. From intense schooling, hectic work schedules and continuous medical education to the desperation and futility of finding your patients with advanced disease, urology is a high-pressure specialty with unique difficulties. But if you love your job and are committed to working through these hardships, you’ll always find it a pleasure going to work every day. I love urology because of the honor it gives me to make other people’s lives better. It’s a unique position to have people trust you with their problems and I can’t stop feeling lucky for it. That makes me even more committed to giving my best for every patient. Urology is also a career that’s intellectually and emotionally
fulfilling. A lot of the procedures and techniques involved in treating urological conditions are innovative and exciting. So despite many years of experience, you continue to learn new things and enjoy new experiences.
Why Advanced Urology Institute?
I joined Advanced Urology Institute in 2002 and soon realized that it was the best thing that ever could have happened to my career. At AUI’s Pinellas Urology where I have worked ever since, I found an already very progressive urology practice with wonderful people and top-notch systems. In fact, soon after joining the center, I was able to start performing laparoscopic and neurostimulation procedures and then to quickly specialize in InterStim therapy for urinary control. The fact that all administrative work has been centralized also means we have all the time to think through and provide the best possible care to our patients.
At AUI, there is a sense that what we do is sacred and that we have to collaborate with other professionals and do it well. So we are always working together with other knowledgeable, experienced and certified specialists to improve our skills and proficiency, grow in our areas of specialization and advance our careers. AUI is a wonderful place to practice urology. For more information on urology, urological conditions and the world-class services provided by AUI, visit the “Advanced Urology Institute” site.
Obviously the heat is going to play a major role, a lot of it has to do with our diet unfortunately as well. [As with] an American diet, we just don’t eat very well, we’re all a little heavier and that also increases the risk of kidney stones as well.
Prostate cancer has a new standard of care in MRI-guided fusion biopsy with transrectal ultrasound. While a prostate biopsy has been the only way to get a definitive diagnosis of prostate cancer, it has only been working if cancer cells are identified in the sample tissue. But in some cases, such as when the tumor occurs at the top surface of the prostate or other unusual locations, a biopsy may not give a correct diagnosis. For instance, the standard TRUS (transrectal ultrasound) guided biopsy in which tissue samples are collected from the prostate in a systematic pattern gives a negative result with tumors located in unusual areas of the prostate. About 15-20 percent of tumor locations can be missed by the biopsy needle.
