Advanced Urology Institute offers a wide range of outpatient urology procedures in every new surgery facility. Whenever possible, there is a preference for treating patients in outpatient settings where primary, less complicated interventions are provided by board-certified urologists and other skilled medical professionals. Patients have the same quality of care they would get at a hospital setting at a lower cost. And with increased availability of advanced medical technology for outpatient care, new surgical centers have ensured redistribution of procedures and improved the efficiency of delivery of services.
Large number of procedures
At AUI, new surgery centers are used for a large number of procedures, including simple reconstructive operations, stone disease, scrotoplasty, meatoplasty, orchiopexy, pelvic prolapse, prostate and bladder procedures. For instance, urologists at new surgery centers treat incontinence, hematuria, kidney stones, urethritis, inguinal hernia, hydrocele, prostatitis, BPH, urinary tract trauma, urethral strictures, inflammatory urinary tract and bladder diseases, and urinary tract infections. And the fact that the centers are found in different locations encourages redistribution of care and access by more patients.
Common procedures performed in new AUI centers include:
Prostate biopsy: Sampling of diagnostic tissue to be used to test for cancer cells.
Bladder biopsy: Removing or sampling of tissue from the lining of the bladder.
Ureteroscopy: Removing kidney stones using thin telescopic instruments
Cystoscopy: Using a tiny camera to examine an affected area in the bladder through the urethra.
Lithotripsy: Using shock waves to break down kidney stones.
Penile prosthesis: Implanting a device in the penis to treat erectile dysfunction.
Circumcision: Removing some or all prepuce (foreskin) from the penis.
Incontinence sling procedure: Implanting an internal support to the urethra to lift it to the normal position and treat incontinence.
Laser vaporization or transurethral resection of prostate: Using a tiny instrument with a laser or electrical loop inserted into the penis to help remove obstructing tissue.
Brachytherapy: Treating prostate cancer by inserting radioactive “seeds” directly into the tissues harboring the cancerous tumor.
Hypospadias: Reconstructing a straight penis, making its urethral opening as close to the penis tip as possible.
InterStim (sacral nerve stimulation): Implanting a tiny pacemaker near the tailbone.
UroLift: Procedure to lift or hold the enlarged prostate tissue out of the way to prevent blockage of the urethra.
Botox injection: Injecting Botox directly into bladder muscles.
For the more complex procedures that require special equipment, patients are usually admitted to the hospital. For example, robotic surgery procedure, pyeloplasty (reconstruction of renal pelvis), nephrectomy, ureteral reimplants and ureteral stent placement are conducted in hospital settings.
At Advanced Urology Institute, we are committed to delivering top-notch urological care to all our patients. Our surgeons are fully-qualified, board-certified, fellowship-trained urologists, who are renowned for their exceptional expertise in treating urological problems. We also have surgical centers that are supplied with the latest medical equipment and technologies to provide the best possible care.
For more information about our urological services, visit the Advanced Urology Institute website.
Prostate cancer recurrence can occur due to cancer cells left behind during treatment or because the cancer was initially diagnosed as less advanced than it actually was.
A rise in Prostate Specific Antigen (PSA) levels and the use of PET/CT imaging scans are effective ways to diagnose recurrent prostate cancer.
Treatment options for recurring prostate cancer depend on the initial treatment and may include radiation therapy, surgical removal of the prostate, cryotherapy, or hormone therapy.
Cancer of the prostate affects a small gland that is situated just in front of the rectum and around the base of the urethra in men. It is the most common type of cancer in men, with those over age 50 facing the greatest risk. The good news is that prostate cancer is treatable. Treatment options include surgical removal of the prostate gland, radiation therapy, hormone therapy and chemotherapy. A combination of various treatment methods may be applied for full effect. Sometimes, however, even after treatment has been administered successfully, the prostate cancer returns. This is called a recurrence and it occurs with other types of cancer too.
Causes of Prostate Cancer Recurrence
Prostate cancer can recur for two main reasons.
1. A small clump of cancer cells left behind during the earlier course of treatment can grow into a larger number.
2. The cancer initially was diagnosed as being less advanced than it actually was. For instance, a patient might be diagnosed with cancer that is limited only to the prostate while in fact, the cancer might have advanced to the surrounding lymph nodes.
Diagnosis of Recurrent Prostate Cancer
A major indicator of recurring prostate cancer is a rise in Prostate Specific Antigen (PSA) levels. PSA is a protein produced by the prostate. A PSA test is always conducted as part of the preliminary work in the diagnosis of prostate cancer, whether initial or recurrent. Ideally, after successful treatment, PSA levels should go down and should stay consistently low. If the level starts to rise again, that is a red light that should be followed up with further testing.
Another test, which doctors agree is very effective in checking for recurrent prostate cancer, is the PET/CT imaging scan. Dr. Jonathan Jay, who has an office in Naples, FL, says the scan is effective because it has the ability to localize the cancer and map out its extent with great accuracy. Treatment of cancer usually depends on being able to tell exactly what part is affected. If this can be done, then it becomes easy to direct treatment at that specific area, which is what a PET/CT imaging scan does.
Treatment of Recurring Prostate Cancer
The form of treatment depends on what was initially administered. The following options are available:
1. If the prostate was surgically removed the first time, radiation therapy may be administered to treat the recurrent cancer;
2. If radiation therapy was administered the first time, a surgical removal of the prostate may be recommended. That decision depends on whether or not the cancer has spread outside of the prostate.
3. Cryotherapy. This treatment involves freezing the cancer cells to kill them.
4. Hormone Therapy. This may be used in combination with other methods. It is also used as a last option when the cancer has spread very far.
The management of recurrent prostate cancer depends on finding the cancer, which most likely would be detected in a post treatment screening. Men who have undergone successful prostate cancer treatment should attend regular screenings after the treatment is finished. Followup screening and checkups are important, and it is important to seek out a comfortable, patient centered treatment center, such as the Advanced Urology Institute. The staff at Advanced Urology Institute is very experienced in working with patients and helping with questions, diagnosis and treatment. They have the knowledge and technology to work with the patient through every step of the process. For more information, visit the Advanced Urology Institute website/
TRANSCRIPTION:
Prostate cancer is one of the most common types of cancer in men, affecting about one in nine. While prostate cancer can be cured in some men, approximately one in three men will experience what is known as recurrent prostate cancer, which is prostate cancer that has come back after initial treatment. Now unfortunately, prostate cancer is the second leading cause of cancer death in men; about one in 41 will die from prostate cancer this year, and that’s according to the American Cancer Society.
The good news is that there are newer imaging techniques that can help locate recurrent prostate cancer. Being able to locate the disease in the body can really help doctors personalize care for patients living with recurrent prostate cancer. Here to help us understand more about this is Dr. Jonathan Jay and his patient Peter Irving. Welcome to both of you.
Thank you. Doctor, let me start with you. This is Men’s Health Month, so let’s start with prostate cancer and what it is.
Well, we’ll take a step back and start with what the prostate is because most people don’t understand what the prostate is. The prostate is a male reproductive organ, and one-third of the fluid that a man sees in his ejaculation comes from the prostate. The purpose of this fluid is to nourish and protect sperm until conception.
It’s treatable?
Yes, prostate cancer is treatable. Prostate cancer in its treatable stages is asymptomatic, so it’s very important for men to understand that they need to have an evaluation on a yearly basis starting at age 50, which would entail a rectal examination and a blood test called PSA.
Alright, so let’s bring in Peter. When were you diagnosed? What happened?
In 2008, I was diagnosed with cancer following a needle biopsy in which 12 out of 13 were positive. So you were doing a routine exam, Peter?
Just routine, and the PSA started to spike over a period of months. From what to what?
My normal was 1.5, let’s say, and this kept creeping up, and I think my general practitioner sent me to a urologist when it got to like four or five. But at that time, they still did not believe I had prostate cancer; things just weren’t what they thought they should be. That’s why I went to the urologist, and then I had the needle biopsy.
Which confirmed it?
Which confirmed it, and then I went and had surgery, had it removed, and followed with the same urologist. To be checked?
Yeah.
Alright, doctor, let me bring you in. If you could define PSA for us, please, and inform us of the levels that happened.
PSA stands for prostate-specific antigen; it’s a protein that’s excreted solely by the prostate, so it’s a great way of monitoring whether a patient has prostate cancer, develops prostate cancer, or has a reoccurrence of prostate cancer. The significance of PSA is what the PSA is in an individual. In Peter’s case, his PSA was one and increasing over time; that was indicative that something was changing and something was wrong.
Understood. So, Peter, you have the surgery, you’re living your life, and then you have recurrent prostate cancer?
Well, my PSA started to spike again, you know, in theory, you shouldn’t have any PSA.
Exactly. And I believe it was somewhere again in the ones, and then it kept rebounding and going up and up, and we watched it for four years. In 2016, they decided to do radiation therapy and hormone therapy together, and they concentrated on the spot they found through the new imaging, and today I’m zero.
That’s fantastic. Doctor, since he mentioned the new imaging, it’s a PET CT imaging test. Tell me, what is different about this test as opposed to what is always used, I guess, in a bone scan and CT, right?
Yes. So, what are the differences between what was used then and what he used?
We had to define the location and extent of this disease, so conventionally, how do we do that? CT scan is a test that has the ability to survey the body without making an incision; we can survey the body for soft tissue changes, we can detect enlarged lymph nodes, we can detect masses within the abdominal cavity. Bone scan surveys the bone for reoccurring disease. Now, think of this: with these conventional tests, you have to have a mass—a mass would be hundreds of thousands or millions of cells in one place—to be detected by these conventional studies. This newer CT PET scan has the ability to define the location and extent of prostate cancer, reoccurring prostate cancer, at an earlier stage and at a lower PSA.
And how does that make a difference then for the treatment?
It’s very important because we want to treat the disease; we need to define the extent and location of the disease, as that dictates our treatment options. So, as opposed to, let’s say, affecting other organs in the body, you’re minimizing the effects?
Absolutely. In Peter’s case, we were able to do a CT PET scan, localize reoccurrence to one area within the pelvis, and we were able to treat that, but we treated that with radiation or hormonal therapy. We were able to treat that without affecting any of the other organs around it.
Peter, you’re doing fine now, right? Everything is controlled?
A negative PSA test for two-plus years.
So, for our viewers out there, and we have lots of males, what would you say, what would be your final thoughts, your words of wisdom?
Just have a routine, probably at the age of 45.
45, 50, yes. Start getting your PSAs on a yearly basis, and it’ll make you feel much better. Absolutely. So not worrying about that.
Doctor, any final takeaways?
One of the important things is that prostate cancer is prevalent in our community, yes, but if found early, it’s a treatable medical condition, and all you have to do is a simple rectal examination and a blood test called PSA with your primary care physician. If something were to happen again in the future, would you suggest again this new imaging test to him?
Absolutely. If we saw increasing PSAs, the first thing that I would do is this new CT PET scan.
Alright, thank you so much, gentlemen, both of you for your time. Thank you, and I’m glad you’re doing fantastic.
Advanced Urology Institute (AUI) is an organization that brings together trained, competent and board certified urologists. AUI is well known for its specialization in the treatment of urological disorders in men. Much less known is that urologists at AUI also offer treatment for urological and pelvic disorders in women. Female patients with pelvic organ prolapse can visit any AUI facility where they will find an impressive variety of treatment options. In addition to organ prolapse, AUI also treats kidney problems, bladder complications, urinary tract infections, incontinence, and problems with sexual function.
Treatment Options Available for Pelvic Organ Prolapse
A pelvic organ prolapse involves the drooping of pelvic organs due to a weakness in the muscles of the pelvic floor. When this happens, the bladder, the small intestine, the rectum, the uterus or the upper vaginal wall drops into the vagina. The condition disrupts the urine flow and can affect the reproductive function by making it difficult, uncomfortable or painful to have sexual intercourse.
The condition can be treated by:
1. Physical exercise
Kegel exercises can strengthen pelvic muscles. The exercises involve a woman imagining she has to urinate, then instead of letting it out, she squeezes her muscles to hold it in. It is recommended to repeat the exercises 10 to 15 times a day.
2. A pessary
This is a ring-like device that is inserted into the vagina to hold the affected organ in its proper place.
3. Pelvic Reconstructive Surgery
Reconstructive surgery is a testimony to how much technology has improved the practice of medicine. In cases of pelvic organ prolapse, the surgery is performed to restore the affected organ to its proper place. There are different types of reconstructive surgery, depending on the type of organ prolapse being treated. Whatever the type of reconstructive surgery, however, it is a minimally invasive procedure.
Even though it is effective, not every patient qualifies for reconstructive surgery. Some factors that must be considered include:
When a woman intends to have children. The surgery may be discouraged because the prolapse may return after the birth.
Age. Younger women may be advised not to have the surgery because of the risk that it may recur and they are more likely to have a child in the future, increasing the risk of a recurrence.
When one has a serious illness, it may be advisable not to have the surgery so as to avoid complications.
The well being of the patient is a top priority at AUI. A female patient with organ prolapse will not only receive the most advanced treatments available, the team also will listen to her questions and work with her on a plan of treatment that is best suited to her needs. AUI makes it a priority to provide information on the topic of pelvic organ prolapse and to be available to discuss any concerns. For more information, visit the Advanced Urology Institute website.
Vasectomy is a minor surgical procedure to cut or block the vas deferens. The vas deferens is a tube that runs from the scrotum which holds the testes in which sperm is manufactured and connects with the seminal vesicles to form the ejaculatory duct. When the vas deferens is cut or blocked during a vasectomy, sperm cannot reach the semen produced in the seminal vesicles. The result is that the semen discharged when a man ejaculates does not have sperm in it. Without sperm, there can be no pregnancy. So a vasectomy is considered one of the most effective methods of birth control.
A vasectomy can be done in two ways:
1. No scalpel Vasectomy. In this procedure, a urologist feels the scrotum and finds the vas deferens. Once the vas deferens can be felt, a clamp is placed on it to hold it in place. A hole is made in the skin and the vas deferens is lifted out. It is cut and the separate ends are tied and put back into place.
2. Conventional Vasectomy. Small incisions are made on each side of the scrotum. The vas deferens is then cut and a small piece of it may be taken out. The separate ends are then tied or seared. This procedure often requires the use of an anesthetic.
The procedure takes about thirty minutes. The outcome, however, takes a while to be realized. Most professionals advise that it takes about three months, or at least 15-20 ejaculations, for semen to become completely sperm free. Before then, it may be advisable to use other forms of birth control. Aftercare usually requires mild pain medication and wearing supportive underwear. Ice packs also can help with the pain. Most men recover within one week.
What to consider before undergoing a Vasectomy
The high success rate of a vasectomy requires absolute certainty on the part of the man that he does not wish to have any more children. In instances in which the man is married, it is necessary for him to discuss the matter with his spouse. A vasectomy is widely considered to be irreversible. When it is reversible, the procedure is sensitive and difficult.
The importance of having the advice of a urologist before, during and after the procedure cannot be understated. Qualified urologists can be found in most hospitals and the search for one can be undertaken online. The Advanced Urology Institute runs a site with very relevant information and this can be a good place to start. For more information on vasectomy, visit the “Advanced Urology Institute” site.
The use of robots in surgery, also called robotic surgery or da Vinci surgery, is an impressive fusion of medicine and engineering that has transformed the medical field. It involves the use of miniaturized robotic instruments inserted into the body through a small incision and guided through the operation by a surgeon sitting at a console. It has brought the following advantages:
1. Increased visibility and precision
The surgeon views the entire anatomy, with specific focus on the surgical site, through a 3D high definition camera. This means even the smallest blood vessels are visible and the surgeon can follow the movement of the instruments with pinpoint accuracy. The surgeon has a clear view of what they are working on and the incidence of human error is cut down dramatically. The smaller instruments also can access tight spots that otherwise would be impossible or extremely difficult for a surgeon to reach.
2. It is a minimally invasive procedure
The incisions made in robotic surgery are only done to accommodate the tiny instruments. There is a world of difference between this procedure and open surgery where a surgeon has to make large incisions on skin and sometimes even cut through muscle to reach the surgical site. The minimally invasive nature of robotic surgery means numerous additional benefits, such as:
a. It causes only a little bleeding;
b. It results in minimal scarring;
c. The patient requires a short recovery period;
d. The patient suffers less pain and physical discomfort, both during and e. after the surgery;
f. There is a very small chance of post-surgery infections;
g. Overall there is less surgical trauma; and
h. There is a rapid return to normal everyday activities.
3. It is less strenuous on surgeons
Most surgeries take two to three hours but complex procedures go on for longer. Surgeons must stay sharp and focused, and in the case of open surgeries, on their feet for as long as the surgery takes. It is only fair to expect that they might suffer from fatigue. In robotic surgery, the surgeon sits can view the anatomy of the patient and control the surgical instruments while sitting at a console. This is definitely easier on the surgeon, who should be able to better maintain better concentration during long surgeries. It also makes it less likely for a mistake to occur.
Robotic surgery is available for almost all surgical procedures. A patient should see a specialist to discuss the applicability of robotic surgery to his or her case. For prostate, kidney and other urinary system problems for instance, the highly specialized urologists and doctors at Advanced Urology Institute can help you with a diagnosis as well as explain the best procedures for you, including robotic surgery. For more information about robotic surgery, visit the “Advanced Urology Institute” site.
There are numerous conditions that affect the urinary system in both men and women. Ordinarily, diseases of the urinary system affect one or more parts of the urinary system, including the kidneys, bladder, urethra, ureters, and in men, the prostate gland.Common urology problems include urinary tract infections, incontinence or urine leakage, pelvic organ prolapse in women, overactive or underactive bladder, enlarged prostate in men and kidney or bladder stones. Most urological conditions can be treated and the patient can return to full health.
Treatment of Common Urology problems
The treatment of a patient will depend on how far the illness has progressed and how severe the symptoms are. The most common treatment methods are:
1. Behavioral modifications and Physical Therapy
Once a specific condition is diagnosed, the first course of treatment focuses on:
a. Changing any of the patient’s behavioral practices that may contribute to the disease; and
b. Introducing practices that strengthen the affected organ or the body in general.
For example, when patients are diagnosed with incontinence, they may be advised to cut down on the intake of fluids such as water and coffee. Similarly, patients with pelvic organ prolapse may be advised to undertake pelvic exercises to strengthen the muscles of the pelvic floor.
2. Medication
Medication can be prescribed for urological conditions in the same way that they are prescribed for other illnesses. Medication works for moderate to severe illnesses that cannot be managed through behavioral modifications alone. Some medications are taken orally while others may be injected. The most common categories of drugs include:
a. Antibiotics. Antibiotics treat simple cases of urinary tract infections successfully.
b. Anticholinergics. These treat an overactive bladder.
c. Alpha-blockers. These are used to treat prostate enlargement in men.
3. Surgical Procedures
The severity of a problem may require that a patient undergo surgery. Most urological surgeries are minimally invasive. Urologists use technological tools that make the procedure less painful and less traumatic, with the result that a patient recovers very quickly. There are a variety of minimally invasive procedures for treating pelvic organ prolapse, incontinence and an enlarged prostate in men.
The appropriate course of treatment can only be determined after tests are conducted and a diagnosis is made. The available forms of treatment may be used. Our specialists at Advanced Urology Institute can help you find the right tests and work with you on a plan of treatment that is most beneficial to you. They can answer any questions or concerns and help you reach your own decisions on your care. For more information, visit the Advanced Urology Institute website.
Enlarged prostate and urinary problems are quite common in Florida. At Advanced Urology Institute, we see hundreds of men and women with different kinds of urinary problems every month. And for men, the most frequent condition is enlarged prostate — also called prostate gland enlargement or benign prostatic hyperplasia (BPH). It is the most frequent problem for men over age 50; more than 50 percent of men have BPH by age 60. By age 85 and older up to 90 percent of men have the condition.
Normal part of aging
Just like gray hair, BPH is a natural result of getting older. But the trouble is, it is characterized by nightly trips to the bathroom which may become too frequent and eventually disrupt daytime routine. In some cases, an enlarged prostate may make it difficult for you to sit through a plane flight or meeting without getting up. So it can be a really annoying problem.
How does BPH occur?
As men grow older, the prostate gland becomes bigger with cells multiplying gradually and creating an enlargement that exerts pressure on the urethra. Since urine flows from the bladder through the urethra in men, an enlarged prostate blocks urine flow. With increased pressure on the urethra, the bladder is compelled to contract more forcefully to push urine through the body. With time, the bladder muscles become thicker, stronger and overly sensitive, beginning to contract even when only a small amount of urine is inside and triggering the need to pass urine frequently.
Eventually, bladder muscles fail to overcome the effect of a narrowed urethra and cannot empty all the urine. That means some urine is left inside the bladder every time after urination. When the bladder is continuously not emptied completely, there is an increased risk of urinary tract infections. Incomplete emptying also can lead to serious problems over time, including incontinence, blood in urine, bladder stones and acute urinary retention (the inability to urinate). In rare cases, incomplete emptying of the bladder may cause bladder damage or even kidney damage.
Symptoms of BPH include:
Frequent urination
Urgent urination
Nocturia (frequent urination at night)
Trouble starting urination
Weak urine stream
Urine stream that stops and starts
Straining to urinate
Inability to empty bladder completely
Returning to the bathroom to urinate a few minutes after urinating
Dribbling at the end of urination
In rare cases, signs of BPH also may include:
Blood in urine
Inability to urinate
Urinary tract infection
A sudden and complete loss of ability to urinate is a medical emergency so you should see a urologist immediately. But you also should see a doctor whenever you are experiencing urinary symptoms, even if they are not really bothersome. Such visits to the doctor will ensure that the underlying causes of your condition are identified or ruled out. Remember that undiagnosed and untreated urinary problems may cause complete obstruction of the urinary tract, bladder and kidney damage and other serious problems.
At Advanced Urology Institute, we offer several safe and effective treatments for urinary problems. For instance, if you have BPH, we may:
Offer a long course of antibacterial medication to treat bacterial prostatitis.
Provide medication to improve your urine flow and relieve symptoms.
Perform surgical procedures such as:
(a) Transurethral resection of your prostate (TURP).
(b) Transurethral incision of your prostate (TUIP).
(c) PVP (green light laser resection) or HoLEP (holmium laser resection) of prostate.
(d) Open prostatectomy for very large prostates.
(e) Urolift (transurethral insertion of clips to separate prostate lobes).
(f) Aqua-ablation (removal of prostate tissue with water jets).
(g) Rezum therapy (removal of prostate tissue with steam).
So you don’t have to suffer embarrassing urinary symptoms when you have BPH. At AUI, we can fix your condition and enable you to live your life with freedom and confidence. For more information on our treatment options for BPH and other urinary problems, visit the Advanced Urology Institute website.
Benign prostatic hyperplasia (BPH) is the clinical term for an enlarged prostate. An enlarged prostate presses on the urethra which passes through its middle. This causes difficulties with the passing of urine, such as urine retention, weak urine stream or a frequent and sudden urge to urinate. If left untreated, it may lead to urinary tract infections and bladder complications. Benign Prostatic Hyperplasia is not cancerous and it is normal for men over age 40 to start manifesting symptoms. The condition is highly treatable.
Treatment Options for Benign Prostatic Hyperplasia
The treatment is determined by the age and general health of the patient, the size of the patient’s prostate and the severity of the symptoms. After making an evaluation based on those factors, a urologist will recommend either of the following options:
1. Oral Medication
Mild cases of benign prostate hyperplasia respond extremely well to medication. The available medication falls into two categories. There are alpha blockers that relax bladder and prostate muscles, making urination easier. The other choice may be the 5-alpha reductase inhibitors to prevent hormonal changes that cause prostate enlargement. These work to gradually reduce the size of the prostate. In some cases, a doctor may prescribe both alpha blockers and 5-alpha reductase inhibitors.
2. Minimally invasive Procedures
The variety of treatment options that fall under minimally invasive procedures include:
Laser therapy. This is where a high powered laser beam is used to destroy the excess prostatic tissue.
Transurethral incision. With the help of a lighted scope inserted through the urethra, the surgeon makes two incisions on the prostate to ease the passage of urine.
Transurethral resection. This one is administered in the same way as a transurethral incision, except the surgeon removes the inner tissue of the prostate and leaves just the outer parts.
Prostatic Urethral Lift. This is a relatively new procedure. It involves placing small implants that lift and hold the excess prostatic tissue so it no longer presses on the urethra. This procedure is widely recommended because it eliminates the irritation or discomfort that may be caused by the other procedures that involve laser therapy or cutting tissue away.
Open prostatic surgery. This option is used only where the prostate is very large or the symptoms are extremely severe. It is not commonly done.
When symptoms of benign prostate hyperplasia begin to manifest, a patient should consult a urologist immediately so the condition can be managed well from the outset. There are many platforms for obtaining more information and help, such as the Advanced Urology Institute. At Advanced Urology Institute, a team of experts can help with diagnosis and treatment of benign prostate hyperplasia and answer any questions you may have. For more information, visit the Advanced Urology Institute website.
Erectile dysfunction is the inability to have or maintain an erection firm enough for sexual intercourse. Any man may find himself occasionally unable to achieve an erection. That is normal. It is only when this inability becomes a sustained everyday occurrence that he may consider the possibility of erectile dysfunction.
The main factor for erectile dysfunction is aging, starting about the age of 50. Over 50 percent of men over 50 suffer from erectile dysfunction. Other risk factors include cardiovascular disease, high blood sugar, high blood pressure and high cholesterol levels. Emotional and mental conditions such as depression and anxiety also can cause erectile dysfunction.
Treating Erectile Dysfunction
Men who suffer from erectile dysfunction have a number of treatment options. If it is a symptom of an underlying illness, treatment should be focused on the underlying illness. When erectile dysfunction appears with no underlying cause, the following treatment options are available and are highly successful.
1. Oral Medication. These are pills given to increase blood flow to the penis, thus causing an erection. The most common ones are vardenafil or Levitra, Cialis or tadalafil, viagra and avanafil. Oral medication is most successful in patients with mild cases of erectile dysfunction.
2. Penile injections. The most common injectible drug is alprostadil. Using a very fine needle, a patient injects the drug into the base of the penis. The drug increases the size of the arteries that supply blood to the penis. Alprostadil also can be administered by placing a small alprostadil suppository at the opening of the penis, rather than by injection.
3. Vacuum erection device. This is a tube with a hand or battery powered pump. The tube is placed over the penis and the pump is used to draw air out, creating a vacuum. The vacuum thus draws blood into the penis, causing an erection.
4. Penile implants. A minor surgical procedure is used to introduce bendable rods at the sides of the penis. These rods give the penis a firmness that allows for intercourse. An alternative of the rods is the insertion of fluid filled cylinders connected to a pump placed in the scrotum. Engaging the pump inflates the cylinders which causes the penis to firm up.
It is advisable for men, especially those approaching age 50, to maintain a healthy relationship with a urologist. An experienced urologist can diagnose and offer advice on the best treatment options. It is also important to stay informed on the causes, signs and symptoms of erectile dysfunction. Many professional sites, such as the one maintained by the Advanced Urology Institute, are very helpful. Advanced Urology Institute also has an experienced team of specialists who can help with consultation, diagnosis and treatment. For more information, visit the Advanced Urology Institute website.
Prostate cancer is cancer of the gland that produces seminal fluid for the nourishment of sperm. Some cases are slow developing and do not affect the patient significantly. These can be managed by watchful waiting and constant monitoring. Others are aggressive and must be addressed immediately. As with most cancers, early diagnosis increases the chances of successful treatment.
Developments in the treatment of prostate cancer
1. Multiparametric MRI (MpMRI) in diagnosis
Determining which cancer is life threatening and which one is not is a critical issue. In order to carry out a more efficient diagnosis, doctors now are using an MRI guided biopsy instead of the more traditional transrectal ultrasound guided biopsy. The MpMRI provides better results determining if the prostate is infected and if the cancer has spread outside the prostate. It can help a doctor decide whether or not a patient should undergo a biopsy. And the MpMRI can be used to monitor the cancer growth, making it a very useful tool when watchful waiting is adopted.
2. Use of immunotherapy in treatment
Until recently, it was thought that immunotherapy was ineffective against prostate cancer. Prostate cancer treatment was primarily limited to surgery, hormone therapy and radiotherapy. In recent years, however, researchers have found that immunotherapy, specifically a drug called pembrolizumab, may be effective in treating aggressive cases of prostate cancer that have advanced beyond the other forms of treatment.
3. Robotic surgery
Like most other areas of surgery, the treatment of prostate cancer has benefited from the use of robotic or the da vinci surgical system that is guided by a surgeon operating from a console. Patients who undergo prostatectomy to remove the prostate may avoid open surgery by opting for robotic surgery. Benefits of robotic surgery include reduced bleeding, reduced pain, low risk of post surgery infections and fast recovery rates.
Medical advancements have improved cancer treatment outcomes and changed lives for the better. At Advanced Urology Institute, the team of specialists uses the latest techniques and technology for treating prostate cancer. They are available to offer consultation, diagnosis and treatment best suited for the individual patient.
For more information, visit the Advanced Urology Institute website.
Erectile dysfunction is the inability to achieve or maintain an erection firm enough for sexual intercourse. It is not incidental to aging, though in reality it occurs mostly in men over the age of 40. The causes of erectile dysfunction are varied, and the first step is to establish whether it is caused by an underlying condition. Whatever the cause, however, there are various options when it comes to the treatment of erectile dysfunction.
1. Oral Medication (Pills)
Like many other medical conditions, erectile dysfunction can be treated effectively by taking medicine. Oral medicines for erectile dysfunction fall under a group called phosphodiesterase 5 (PDE 5) inhibitors. They work by preventing the functioning of the enzyme phosphodiesterase type 5 whose job is to control blood flow to the penile arteries. When the enzyme is not functioning, blood vessels relax, allowing blood to reach the penis, therefore causing an erection. The most common PDE 5 inhibitors are:
a. Sildenafil- commonly referred to as Viagra
b. Avanafil – also known as Stendra
c. Tadalafil – also known as Ciaris; and
d. Varednafil- also known as Levitra
Most of these medications are widely available. It is necessary, however, to consult with a urologist before taking any of them. A trained urologist should be able to assess a patient’s condition and advise whether oral medication is likely to work and if so, which of the available medicines is best suited to the patient’s case.
2. Penile implants
For some men, especially those with underlying conditions, oral medication does not work. They may have to resort to other treatment options and the most common of these is the penile implant. This involves a minor surgical procedure and the placing of an implant that causes an erection. There are two choices when it comes to the implant. There is the inflatable implant and the malleable/ semi-rigid implant. Both options have their advantages and disadvantages and the patient will decide based on his circumstances. Overall, however, both implant options report a success rate of over 90 percent.
3. Vascular reconstructive surgery.
Vascular reconstructive surgery involves reconstructing the arteries within the penis to increase blood flow. This last option is neither common nor popular. It is a very difficult, and therefore expensive, procedure. Additionally, it is not always successful and a patient might face the risk of relapse.
It is possible to treat erectile dysfunction. But the right treatment option must be sought for each individual case. It is recommended that anyone experiencing erectile dysfunction should see a urologist. The highly qualified and experienced urologists at Advanced Urology Institute can provide consultation, technology and treatment plans to help patients with erectile dysfunction. Want to find out more about erectile dysfunction? Visit the “Advanced Urology Institute” site.
The da Vinci surgical system is an advanced and effective tool for performing minimally-invasive surgeries. It is a state-of-the-art tool that makes the most of the surgeon’s skill, expertise and experience in conducting urologic procedures. Known as da Vinci because Leonardo da Vinci devised the first robot and used three-dimensional detail and incomparable anatomical accuracy to give life to his masterpieces, the surgical system gives physicians such precision and detail that it effectively simulates an open surgical environment while allowing the use of tiny incisions.
How does the da Vinci system work?
The da Vinci surgery is robot-assisted and minimally-invasive, done via small incisions. The robot’s hands offer a high degree of dexterity, which enables surgeons to operate in the very tight spaces and delicate tissues of the genitourinary tract that otherwise would only be accessed through the longer incisions of open surgery. The da Vinci robot is a self-empowered, computer-controlled device that has been programmed to help in the positioning and maneuvering of surgical instruments. It gives surgeons better precision, flexibility, accuracy and control over surgical procedures.
When using the da Vinci system:
1. The urologist operates from a computer console situated in the operating room, directing and manipulating miniaturized instruments mounted on 3 robotic arms to create small incisions in the patient.
2. During the procedure, the doctor looks through a 3D camera attached to a fourth robotic arm that magnifies the surgical site.
3. The hand, wrist and finger movements of the surgeon are transmitted straight through the computer console and to the instruments attached to the robotic arms, resulting in mimicked movements with the same range of motion as that of the surgeon and allowing maximum control.
4. The robot is supervised by the surgical team at the patient’s bedside.
What are the advantages of the da Vinci surgical system?
1. It ensures that surgeries are more precise by providing better visualization, improved dexterity and greater accuracy.
2. It enables surgeons to conduct complex surgical procedures using tiny incisions.
3. It replicates the surgeon’s technique and movements in real-time, with the surgeon seated just a feet away from the patient viewing an actual image of the operating field while performing the procedure in real-time by manipulating a miniaturized instrument and using tiny incisions.
4. It transmits force feedback sensations from the operating field to the surgeon, which are then used as a substitute for tactile sensations and are augmented by the superior vision offered by the high-resolution 3D view to deliver better visualization, accuracy and precision.
The da Vinci is designed to ensure that both simple and complex procedures are done using incisions of 1-2 cm (also called operating ports), potentially resulting in:
1. Reduced trauma, pain and discomfort to patients
2. Fewer complications
3. Shorter recovery time and quicker return to routine activities
4. Minimal scarring
5. Reduced blood loss and need for transfusions
6. Minimal hospitalization costs
At Advanced Urology Institute, we have incorporated the da Vinci surgical system into our practice. Over the years, we have been able to use the increased range of motion, improved visualization, enhanced dexterity and greater surgical precision offered by the robotic system to deliver improved treatment outcomes to our patients. We are also proud of the skilled and experienced professionals at AUI whose training, fortitude, passion and expertise in the use of advanced technologies have enabled us to provide the best possible care to our patients. For more information on our services, visit the “Advanced Urology Institute” site.
If you suspect that you have erectile dysfunction, you need to talk to your doctor about it. Then you can work with the doctor to determine the underlying factor or cause of the condition. Actually, ED can only be effectively treated if what is causing it is known. In fact, you may find that your condition improves with only simple lifestyle changes, such as losing weight, quitting smoking or drinking less alcohol. And if it is a medication you’re taking that is causing the problem, your doctor may treat the condition by reducing the dosage or having you try another drug.The treatment options for ED include lifestyle changes, counseling, medications, penile injections, vacuum pumps and surgery.
1. Lifestyle changes
Making lifestyle changes can reduce the severity or improve erectile dysfunction. Some of the changes are:
a. Quitting smoking
b. Stopping or reducing alcohol consumption
c. Increasing physical activity or exercise
d. Cutting down body weight
e. Stopping the use of illegal drugs
2. Seeing a counselor
Your urologist may recommend that you see a counselor if your erectile dysfunction is worsened by psychological or emotional issues. In many cases, counselors require that you go with your partner to the counseling sessions so she can know how best to support you. And as you work on the anxiety and stress issues with your counselor, your urologist will be focused on treating any underlying physical issues. Usually only a handful of sessions with the counselor will be enough for you to overcome ED.
3. Medication
The first treatment that your urologist will offer to treat ED is oral pills. Common oral medications for ED include:
a. Sildenafil (Viagra)
b. Tadalafil (Cialis)
c. Vardenafil (Levitra or Staxyn)
d. Avanafil (Stendra).
These medicines work by relaxing your smooth muscles and increasing blood supply to the penis following sexual stimulation. You’ll be required to take them anywhere from 15 minutes to 36 hours before sex, depending on the particular drug your doctor has prescribed. Vardenafil (Staxyn) dissolves in the mouth, but the other pills are swallowed. However, you aren’t allowed to take any of these drugs more than once per day. The drugs are effective in about 80 percent of men who use them, although if you have an erection that lasts beyond 4 hours, you should seek emergency medical help.
You should not take these medicines as treatment for ED if you are already taking nitrates for a heart disorder. Since nitrates also relax and widen blood vessels, their combination with these drugs leads to a sudden reduction of your blood pressure, which may cause falling, fainting or dizziness and possible injuries. Likewise, if you are already taking drugs to treat enlarged prostate (BPH), inform your doctor about them. A combination of BPH medications called alpha-blockers with ED medicines also may result in sudden reduction of your blood pressure.
In case your erectile dysfunction is due to low testosterone levels, the urologist may prescribe testosterone. However, testosterone therapy won’t work for you if you have nerve or circulatory problems. So you must be very open with your urologist about your other medical problems before you are given any medications.
4. Penile injections
Injecting the penis with a drug called alprostadil can trigger a stronger and firmer erection. While oral medications are able to cause an erection after sexual stimulation, you can’t get an automatic erection with them. That’s why your doctor may at times opt for injecting a drug into the penis to ensure you achieve erection automatically even without sexual stimulation.
5. Vacuum constriction devices (pumps)
Vacuum pumps pull blood into the penis, resulting in an erection. A typical vacuum device is an external pump supplied with a band that you can use to achieve and maintain an erection. According to several studies, up to 50-80 percent of men who have used vacuum erection devices are pleased with the results.
A vacuum device has three components:
a. A plastic tube (cylinder), which you place toward the end of your penis.
b. A pump, which drives out air from the tube in order to create a vacuum.
c. An elastic ring (band), which you place on the cylinder, on the other end applied to your body, and then move it from the tube to the penis in order to maintain erection.
To use the vacuum erection device, you place the pump over your penis and pump out air from the tube (cylinder) to create a vacuum. The vacuum then pulls blood into the penis’ shaft and makes the penis longer and firmer. Once the penis is erect, and with the help of a lubricant, you slide the retaining band downward onto the lower end of your penis. You also remove the pump once you have released the vacuum.
The elastic ring sustains the erection by stopping blood from moving back into the body during intercourse. So you can only attempt intercourse with the elastic ring in place. And the ring can be left in place for about 30 minutes to enable successful intercourse.
6. Penile prosthesis (Penile implant surgery)
Another option for treating ED is penile prosthesis in which your urologist performs an operation to implant either a malleable (bendable) device or inflatable device into your penis. A penile implant surgery is preferred when you have an obvious medical condition that is causing the ED and the urologist is sure that your condition won’t resolve naturally or with medications.
Usually, the simplest form of penile prosthesis is surgical implantation of malleable rods inside the erection chambers of your penis. Once implanted, the rods ensure that your penis is maintained in semi-rigid state and just requires lifting or adjusting to erect position for sexual intercourse. Malleable rods are a good option if you’ve had spinal injury or have limited hand strength.
Alternatively, your doctor may go for a hydraulic, inflatable implant. With this prosthesis, you can choose to get an erection when you need to. Inflatable implants increase the size of the penis through a pump that’s located in the scrotum. The advantage of an inflatable implant over malleable rods is that the erection is more natural and easier to conceal than one achieved with malleable rods.
Penile implant surgery takes about one hour to complete and is usually performed in an outpatient setting. Following penile implant surgery, you’ll be able to leave the hospital the same day after surgery and can resume sexual intercourse 4-6 weeks after the procedure.
Artery reconstruction is often a last resort treatment for ED because the procedure is costly, technically difficult and does not usually work. But the aim of the procedure, when recommended, is to boost blood flow in your penis and help you achieve an erection. During the operation, the urologist transfers an artery in another part of your body (usually from a muscle in the belly) to one in your penis, creating a path for blood to move around the blocked (affected) area. The procedure is only rarely considered, but may be an option for men younger than 30 who have ED because of injuries to their penis or the area around it.
Want to find out more about erectile dysfunction? Visit the “Advanced Urology Institute” site.
Dr. Jonathan Jay’s path to urology began with a background in physiology, medicine, residency training, and fellowship training before becoming a board-certified urologist.
A proficient urologist requires not only a deep understanding of medicine but also emotional intelligence, honesty, empathy, and compassion to effectively treat and support patients with a variety of urological conditions.
Dr. Jay chose to practice at Advanced Urology Institute (AUI) due to its centralized administrative tasks, access to cutting-edge surgical and medical equipment, collaborative and multidisciplinary approach to patient care, and friendly working environment.
Urology is a fascinating, stimulating and satisfying field of medicine. As urologists, we treat conditions of the urinary tract in both men and women, together with disorders of the male reproductive system. Being a urologist is an opportunity to care for people with agonizing, embarrassing and life-threatening conditions, such as kidney stones, urinary incontinence, erectile dysfunction, and genitourinary cancers, restoring normalcy in their lives. For those like me who are passionate about saving and improving lives, urology is a worthwhile career. For me, every day spent with my patients is not only an opportunity to serve and help people, but also contribute to saving or extending lives. In turn, the positive outcomes from various interventions bring joy and satisfaction.
Why urology?
Well, mine is a funny story. Growing up in Lansing, Mi., with both my parents having PHDs — my mother working at the Lansing School District and my father being a Michigan University professor — I learned to be inquisitive from a very early age. Being educators, my parents always encouraged me to be curious; to try to understand how various things worked. Eventually I became profoundly curious about how my body works and searched for answers wherever I could find them. As a result, I ended up studying physiology, then medicine, and ultimately specializing in urology.
Path to urology
My curiosity led me to study physiology — the study of how the body works — to learn more about the body. So I attended Michigan State University to pursue a Bachelor of Science degree in physiology. As I was studying physiology, I became interested in medicine. Upon graduation, I went to Ann Arbor, University of Michigan for my medical education. After that, I moved to Henry Ford Hospital for my residency training before going to and completing my fellowship training at the Beth Israel Deaconess Medical Center.
During clinical rotations in medical school I came across urology. I actually did not know anything about urology until my classmates at medical school told me about it. They really took me under their wings like a little brother. And because they liked me and I liked them, we were able to speak freely about our career aspirations and interests. So when they recommended that I study urology, telling me repeatedly that I had to try urology —”stay here and be a urologist’ — I gave it a shot and here I am, a board-certified urologist.
What does it take to be a urologist?
As urologists, we see the whole spectrum of age groups — from newborns to elderly patients. For instance, we can see children with congenital problems and care for geriatric patients with bladder control problems, sexual dysfunction or benign prostatic enlargement. So we delve into deeply emotional problems that require empathy, support and effective solutions.
That is why to be a good urologist, you need not only to understand medicine very well and be able to offer effective treatments, but you also must have emotional intelligence. That is, you need to know what to say, why to say it, when to say it and how to say it, and to treat patients as human beings, handling them in a warm, friendly and respectful manner. Actually, honesty, empathy and compassion are the marks of a proficient urologist.
Areas of expertise
I have practiced urology for several years now, seeing patients for a broad range of issues. Frequently I treat patients with enlarged prostate, urinary stones, urinary incontinence, prostatitis, testicular pain, recurrent urinary tract infections, urologic cancers and erectile dysfunction. But my areas of special interest include voiding dysfunction, pelvic floor reconstruction, urinary incontinence, female urology, urodynamics, and urogenital disorders triggered by neurologic disorders.
Over the years, I have performed pelvic floor reconstruction surgeries in both men and women, neuromodulation, surgery for bladder dysfunction, MonaLisa Touch laser procedure for post-menopausal sexual and urinary symptoms, Botox (botulinum toxin) injections, UroLift System procedure for BPH, and da Vinci robotic treatment for post-menopausal sexual and urinary symptoms. I also keep improving my knowledge and refining my skills through continuous medical education, training and research. I understand that I can only deliver the best to my patients when I have the right skills, tools and methods.
Job satisfaction
Urology is about providing relief to people with troubling and humiliating conditions. Patients come to us when they are at some of the lowest moments of their lives and we are able to address their issues and see them restored to normal lives again. Something unique about urology is that the problems we handle are often clearly defined, which means that almost every time a patient presents with a urological condition, we are able to pinpoint the exact etiology and extent of defect and then provide an effective solution.
Therefore, we are able to achieve great outcomes for almost all our patients. In fact, unlike other specialties such as neurology and oncology, the majority of our patients get better and do well after interacting with us. And with this understanding that we can solve many — if not most — of the urologic issues of our patients, we really feel satisfied with our work. And since we are able to achieve great results for our patients, they are always grateful and hold us in high esteem. So with urology, we are largely contented and happy about the work we do.
Why Advanced Urology Institute?
Urologists need a working environment that can bring out the best of their knowledge, skills and talents. For me, that dream place is Advanced Urology Institute. At AUI, all administrative tasks are centralized to ensure that physicians find enough time to deliver the best possible care. Urologists also have access to cutting-edge surgical and medical equipment and are able to apply the latest methods and techniques as soon as they are available.
Urologists at AUI work under a thriving culture of compassionate, collaborative and multidisciplinary approach to patient care, which enables frequent cooperation with other board-certified, skilled and experienced medical professionals. To crown it all, AUI clinics are always warm, friendly and buzzing with colleagues sharing stories, cracking jokes and interacting freely. It is always a wonderful experience being at AUI and I really feel privileged being part of the team.
Want to know more about AUI and the services we offer? Find out more by visiting the “Advanced Urology Institute” site.
TRANSCRIPTION:
I’m Jonathan Jay, I’m a board-certified urologist with Advanced Urology Institute.
Funny story, I just had a curiosity about how my body worked, so that led me into physiology because that was a study of how your body really works and then with time that just led into medicine.
Lansing Michigan, my family and my parents were educators, both PhDs, my mother working in Lansing School District, my father worked for Michigan State University as a professor.
Interesting enough, education was important in my family. I always had a curiosity about learning and understanding things, so that’s what they gave me, they gave me a curiosity of trying to understand things.
It’s funny, urology came about by a rotation through medical school, all the medical school students said, hey you got to try urology, they let the medical school, medical students close the wounds, that’s a pretty rare thing.
So all the guys were very nice, these guys took me under their wing like a little brother and so with that they said, hey why don’t you, they liked me, I liked them, they said why don’t you stay here and be a urologist.
Now urology was something that I never even knew existed, in fact they gave a lecture in the second year of medical school, I said who would want to do that, that is the grossest thing I’ve ever seen, but here I am being a urologist all because of a great experience that people provided me, took me under their wing like a little brother. So for me, I always felt like being a doctor you had to have four qualities. The first quality you had to have is you had to understand medicine. You don’t have to be the valedictorian of the class, but you got to understand medicine fairly well.
The next thing you have to have is stellar social intelligence. You got to be able to talk to a human being like a human being, be able to read social cues, know what to say, when to say and how to say it. Then above all you have to care and have empathy for another human being. You have to have all four of those qualities.
The inability to start or maintain urine flow, causing dribbling or weak urine flow, is called urinary hesitancy. It can occur at any age for all genders, but it is by far most common among aging men. Urinary hesitancy develops gradually but if left untreated, it can lead to a complete inability to pass urine, also known as urine retention. Due to its prevalence among older men, weak urine flow has always been associated with an enlarged prostate gland, a condition very common in older men. This, however, is not the only cause of a weak urine flow.
Causes of a weak Urine Flow
1. Benign Prostate Hyperplasia (BPH)
Benign prostate hyperplasia is the medical term for an enlarged prostate. As a man ages, the prostate grows to a size larger than what is normal. The prostate’s location around the tip of the urethra means that the enlarged prostate presses on the urethra and blocks the passage of urine. This whole or partial obstruction slows down the flow of urine. BPH is the main cause of a weak urine flow in men over the age of 45.
2. Underactive Bladder (UAB)
An underactive bladder is a medical condition characterized by weak urine flow and an inability to empty the bladder completely. The condition is best understood as the opposite of the overactive bladder (OAB) which has received wider attention and is known to cause urinary incontinence, the urgent and frequent urges to urinate. Patients suffering from an underactive bladder have a diminished sense of when their bladder is full and are not able to contract the bladder fully. The condition can occur when there is damage to the bladder peripheral pathways or to the lumbosacral spinal cord. It is also common in patients suffering from diabetes mellitus, neurological diseases, Parkinson’s disease and pelvic fractures.
3. Bladder Outlet Obstruction (BOO)
As the name suggests, this is a condition that occurs when there is a blockage at the neck or the base of the bladder. The blockage completely prevents or reduces urine flow from the bladder. It occurs in both women and men, but is more common in older men. It can be caused by bladder stones, scar tissue in the urethra, bladder cancer or an enlarged prostate.
It is clear that weak urine flow has a variety of causes. It is very important to see a urologist to determine the exact cause of a weak flow. An appropriate plan of treatment can be set up once it has been determined what is creating the problem. It is recommended that you consider seeking out trained, experienced and board approved urologists if you are having problems with weak urine flow.
At AUI, we offer patient-friendly and multidisciplinary urology services for a wide range of problems, including weak urine flow. For more information, visit the “Advanced Urology Institute” site.
For more information, visit the “Advanced Urology Institute” website.
Reconstructive surgery is a testimony to how much technology has improved the practice of medicine. In cases of pelvic organ prolapse, the surgery is performed to restore the affected organ to its proper place. There are different types of reconstructive surgery, depending on the type of organ prolapse being treated. Whatever the type of reconstructive surgery, however, it is a minimally invasive procedure.
My curiosity led me to study physiology — the study of how the body works — to learn more about the body. So I attended Michigan State University to pursue a Bachelor of Science degree in physiology. As I was studying physiology, I became interested in medicine. Upon graduation, I went to Ann Arbor, University of Michigan for my medical education. After that, I moved to Henry Ford Hospital for my residency training before going to and completing my fellowship training at the Beth Israel Deaconess Medical Center.
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