What Urology Procedures and Treatment are Performed at AUI?

 

Advanced Urology Institute offers a wide-range of services to prevent, diagnose, treat and care for patients with different urological conditions. Our team of urologists are surgical and medical specialists who treat patients dealing with urinary incontinence, kidney stones, urinary tract infections, sexual dysfunction, premature ejaculation, urethral stones, pelvic floor problems, kidney, prostate and bladder cancer, kidney transplants, vasectomies and traumatic urinary tract injuries. We are involved in the assessment of the structure, function and problems of the prostate, kidney, bladder, testes, penis, urethra and their associated glands.

A typical day at AUI

The consultations each day range from patients with voiding and sexual difficulties to victims of knife and gun violence with injuries to their genitourinary organs. We document and review the medical histories of these patients, order appropriate diagnostic tests, such as the PSA for screening prostate cancer, interpret results of the tests, make accurate diagnosis and develop individualized treatment plans. We typically use a wide range of equipment and instruments, including radiographic (X-ray) machines, MRI scans, CT scans, ultrasounds, fluoroscopes, catheters, cystoscopes, radium emanation tubes, and diathermy machines.

We administer treatment depending on the type of condition, severity of symptoms, area affected and patient preferences. Routinely, we perform brachytherapy, high-intensity focused ultrasound (HIFU), photodynamic therapy, laser-based procedures, extracorporeal shock-wave lithotripsy, robot-assisted surgery and abdominal, pelvic and retroperitoneal surgery. We also may prescribe medication for certain conditions or recommend lifestyle and behavioral changes to improve treatment outcomes.

Treating kidney and urethral stones

For patients who come to our emergency department with excruciating flank pain or stone-related pain, we usually run various tests to diagnose the stone. A CT scan typically is used to confirm the presence, location and size of the stone. For small stones, patients are often discharged with pain medication and guided on fluid intake and what to do to ensure the stone is seamlessly passed. The patients also are given instructions on what to do with the stone once passed. For instance, we direct patients to bring the stones to AUI for analysis of chemical composition and determination of metabolic risk factors. With that information, we are able to recommend appropriate dietary measures for preventing stone recurrence, such as avoiding excess salt and animal protein and increasing fluid intake. For larger stones, we may opt to use more invasive treatments to break down or remove them from the urinary tract. The treatment approach depends on the type, size and location of the stone.

Prostate procedures

In men, the diagnosis and treatment of prostate-related conditions, such as BPH and prostate cancer, require various procedures. At AUI, we frequently administer the PSA (prostate-specific antigen) test to assess if there is a prostate problem in men with urinary symptoms such as pelvic pain, voiding problems and blood in urine. Through PSA screening, we are able to reduce the likelihood of advanced disease and the chances of prostate cancer death. But to maximize the benefits of the test and prevent undue harm, we are always careful to use the test in the right patients and at the right time.

We often use rectal and prostate ultrasound to examine the shape and size of the prostate gland. When a tumor is suspected, we may pass a flexible cystoscope or use CT or MRI scan to assess the nature and extent of the malignancy. To check for abnormal prostate cells or confirm prostate cancer, a prostate biopsy is commonly the go-to procedure. During the procedure, the patient is placed under a local anesthetic. The doctor extracts systematic biopsy cores from the area with the suspicious lesion or growth and sends them to the laboratory for diagnosis. Once BPH or cancer has been confirmed, appropriate treatment such as brachytherapy, TURP (transurethral resection of prostate) or prostatectomy (via laparoscopy or robot-assisted surgery) is set up.

Fertility procedures

At AUI, we see patients with a broad range of fertility issues, including those who want to prevent pregnancy permanently and those who have difficulty becoming pregnant. For men who can’t ejaculate healthy sperm, we offer sperm retrieval procedures like surgical sperm extraction and sperm aspiration to harvest their healthy sperm from the testes. These procedures are usually carefully timed to coincide with in-vitro fertilization (IVF) cycles or with the harvesting of the female partner’s eggs. And for men who can’t ejaculate because of spinal cord injuries and other problems, we offer procedures such as electro-ejaculation or the penile vibratory stimulation. The procedures use electro-stimulation and vibration to prompt ejaculation and enable collection of healthy sperm.

For patients who want to avoid pregnancy, we offer vasectomy and vasectomy reversal procedures. Conducted in the urologist’s office with only a local anesthetic, vasectomy is a quick, safe and effective way in which men can stop getting their partners pregnant. It is generally a permanent sterilization method and offers higher efficacy than tubal ligation performed in women. But for men who change their minds after they have undergone a vasectomy, we offer the reversal procedure as a way to try and restore fertility or to help a smaller fraction of men for whom vasectomy triggers ongoing pain.

Urologic oncology procedures

We have skilled and experienced oncologists at AUI who use a combination of equipment and procedures to diagnose and treat different urologic cancers. At AUI, our medical team offers a comprehensive assessment of all available cancer treatments and their expected outcomes, paving the way for their quick integration in our practice. For that reason, we are often the first cancer center in Florida to adopt the latest innovative cancer treatment and care approaches as soon as they are devised. When making cancer treatment decisions at AUI, urologists typically consider a number of psychological and clinical factors, including type and stage of the cancer, anticipated life expectancy, level of risk, overall health of the patient and personal preferences of the patient.

So whether we are dealing with kidney, prostate or bladder cancer, or with genital and pelvic cancers such as scrotal, penile and urethral malignancies, we ensure that the timing of treatment is just as precise and important as the treatment chosen. In some patients, we may opt for active surveillance (watchful waiting) to delay treatment and avoid related side-effects and risks. But to treat cancer, the options include local topical therapies, genital-preserving surgeries, genital reconstruction surgeries, radiation therapy, chemotherapy or hormone therapy.

Pediatric urology procedures

At AUI, we also offer treatment for a number of childhood conditions, particularly congenital ones. For example, children with undescended testes — where one or both testes haven’t descended into the scrotum — may benefit from our minimally-invasive robotic or laparoscopic procedures to correct the disorder. Surgery is our primary treatment option for most pediatric conditions and the da Vinci robotic surgery and laparoscopic surgery have become the standards of care at AUI. The minimally-invasive approaches are preferred for children because they are generally less painful, come with a shorter hospital stay, and require a shorter recovery time. We also offer circumcision to children in their first few days after birth as an elective procedure to remove the foreskin of the penis.

At Advanced Urology Institute, we offer multidisciplinary, patient-friendly, excellent urology care for our patients. So whether you are interested in seeing a urologist for conditions such as prostatitis, stress incontinence, pelvic organ prolapse, recurrent urinary tract infection or urologic cancer, or for procedures like penile implant surgery, vasectomy and cystoscopy, you can rest assured of having a urologist you can trust at AUI. And we are not only focused on innovative, exceptional and superior treatments, services and outcomes, but also satisfactory patient experiences and sound, long-term patient-physician relationships. With our state-of-the-art facilities, advanced equipment, experienced medical professionals and a responsive, compassionate institutional culture, we guarantee top-notch, exceptional care to our patients in an environment where they feel comfortable and treasured.

For more information urological problems and how to prevent, diagnose and treat them, visit the Advanced Urology Institute website.

How is an enlarged prostate treated

An enlarged prostate, clinically known as a Benign Prostate Hyperplasia (BPH), is a non- cancerous condition associated with aging in men. It is characterized by symptoms such as the frequent and sudden urge to urinate, weak urine flow and urine retention. The treatment of an enlarged prostate can be approached in various ways, depending on the extent of the enlargement and the seriousness of the symptoms.

In a majority of cases, the first approach after an initial diagnosis is that of watchful waiting. A urologist closely monitors the progression of the condition and advises the patient on what lifestyle changes,if any, he should make. Based on the outcome of this monitoring, a urologist may decide to move on to a particular course of treatment. This could be:

1. Medication

Dr. Jonathan Jay of Advanced Urology InstituteA urologist can prescribe medication to reduce the symptoms of an enlarged prostate and also to control the enlargement. The available medications include:

(a) 5- alpha reductase inhibitors. These control prostate enlargement by inhibiting the hormonal changes that encourage prostate enlargement. They include Proscar and Avodart.

(b) Alpha Blockers. These function by relaxing the muscles in the bladder and in the prostate, making it easier to urinate, which eases one of the major symptoms of an enlarged prostate. They include Uroxatral and Rapaflo.

(c) Combination Therapy. In some instances, doctors prescribe a combination of alpha blockers and 5- alpha reductase inhibitors.

(d) Phosphodiesterase 5 Inhibitors. Ordinarily these are prescribed for the treatment of erectile dysfunction. But research indicates they also can be used in treatment of an enlarged prostate, with specific emphasis on the drug Cialis.

2. Minimally Invasive procedures

When medication does not work a urologist might prescribe a minimally invasive procedure. These ordinarily involve the insertion of an instrument such as a lighted scope, to remove or destroy excess prostate tissue. Procedures under this category include the Urolift, where a urologist lifts and staples the prostate to open up the urethra, and laser surgery, where a laser treatment is used to vaporize the excess tissue.

3. Surgery

In extreme cases, a prostatectomy may be done. This is a surgical procedure to remove the prostate gland. It is not recommended for the treatment of an enlarged prostate but it provides a last recourse in cases where the prostate is very large or where a patient has bladder stones.

An experienced urologist should be consulted as soon as the first symptoms of an enlarged prostate manifest. The patient and the urologist can select a suitable course of treatment. Learning about the likely symptoms of the condition is very important.

For more information about BPH and how to diagnose and treat it, visit the “Advanced Urology Institute” website.

Facts About Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia (BPH) is the medical term used to describe a prostate enlarged beyond its expected or normal size. In non-medical terms, BPH is an enlarged prostate. The prostate, in the ordinary development of a male body, is expected to increase in size. For example, the prostate grows up to double its size during the teenage years. But BPH occurs when the prostate enlarges to a point that it starts to affect the normal function of other organs in the urinary system. It is also worth noting that BPH is not cancerous.

Risk Factors for Benign Prostatic Hyperplasia

There is no precise understanding of the causes of BPH. However, it is accepted that the main risk factor for BPH is advanced age. The condition is so common that it is reported that about 50 percent of all men over the age of 50 are likely to have it. Of that 50 percent, however, only about 10 percent are likely to need medical intervention. The prevalence of BPH among older males may be related to an increase in the production of estrogen and the proportionate decrease in testosterone as men grow older. Estrogen promotes the growth of prostatic cells which ultimately leads to an enlarged prostate. Other risk factors include a family history of BPH, heart and circulatory diseases and obesity.

Effects of Benign Prostatic Hyperplasia

The location of the prostate is such that the urethra passes through its middle and the bladder surrounds it. An enlarged prostate presses against the urethra and forms an obstruction to the smooth flow of urine as it comes from the bladder and flows through the urethra. For this reason, BPH is known to contribute to many urinary tract problems in men. These problems are manifested in one or more of the following symptoms:

  1. Sudden urge to urinate;
  2. Frequent need to urinate;
  3. Blood in the urine;
  4. Urine retention
  5. Weak or interrupted urine stream; and
  6. Inability to pass urine.

The symptoms may be mild and can be managed by watchful waiting. However, men experiencing a complete inability to urinate, painful and frequent need to urinate, blood in the urine or pain and great discomfort in the urinary tract area are advised to seek medical attention immediately.

Since the causes of BPH are not very well understood, it is not easy to prevent but it can be managed by frequent monitoring. It is recommended that men nearing 50 should establish and maintain a relationship with a good urologist. The Advanced Urology Institute is a good place to start for people new to this subject. They offer the necessary information and a staff of trained and experienced urologists to help you.

For more information about BPH and how to diagnose and treat it, visit the “Advanced Urology Institute” website.

What is Dr. David Harris’ Journey to Becoming a Urologist?

KEY TAKEAWAYS:

  • Dr. David Harris initially wanted to be a veterinarian, but discovered his passion for urology after realizing veterinary medicine wasn’t the right fit. He completed his medical education at Stritch Medical School, Loyola University, Chicago, and received training in urology at the Lahey Clinic.
  • With over two decades of experience, Dr. Harris has expertise in treating kidney disorders, kidney stones, and prostatic diseases, and has a keen interest in minimally invasive procedures such as laser surgery, laparoscopic surgery, and da Vinci robotic surgery.
  • Dr. Harris finds practicing urology at Advanced Urology Institute (AUI) rewarding because of the warm, collaborative environment, access to the latest medical and surgical equipment, and a focus on compassionate, multidisciplinary patient care

Urology is a constantly intriguing and gratifying specialty. With its many sub-specialties, innovative procedures and generally great outcomes for most patients, it offers the opportunity to improve human life while also genuinely enjoying what you do. As urologists, our job involves diagnosing and treating disorders of the genitourinary tract, including pelvic pain, enlarged prostate, kidney stones, urinary incontinence, male infertility and urologic cancers. It means that most of the time patients come to us feeling embarrassed, humiliated, troubled and hopeless and need not only to be treated but also to be reassured, motivated and encouraged to get back to their normal lives. It is a noble job, one that I really relish.

My path to urology

Growing up, I wanted to be a veterinarian. My dad was a veterinarian so I wanted to follow in his footsteps. However, everything changed when I was in college. I developed a dislike of working with all kinds of animals and quickly realized veterinary medicine wasn’t the field for me. I had to find a career that I was really interested in. Eventually that became medicine, and urology ultimately became the specialty that I preferred.

I completed my undergraduate studies at the University of Illinois, then went to Stritch Medical School, Loyola University, Chicago, for my medical education. I finished my residency training in general surgery by joining the New England Deaconess Hospital, Harvard Surgical Service in Boston for three years. After that, I received my training in urology at the Lahey Clinic. I became a board-certified urologist with the American Board of Urology, a fellow of American College of Surgeons, and a member of Castle Connolly, prominent doctors chosen through peer reviews and physician-led research.

Areas of expertise

I have practiced urology for more than two decades tackling a wide range of issues and amassing a wealth of experience. I routinely see patients with issues such as recurrent urinary tract infections, enlarged prostate, prostatitis, urinary incontinence, urinary stones, urethral strictures, testicular pain, erectile dysfunction and urologic cancers. But I have particular expertise in treating kidney disorders, kidney stones and prostatic diseases. I have a keen interest in minimally invasive procedures (such laser surgery, laparoscopic surgery and the da Vinci robotic surgery) that preserve renal tissue and minimize postoperative pain and recovery time.

Job satisfaction

Urology is really about helping people with distressing and debasing conditions to recover and enjoy normal lives. As a urologist you get to know your patients, address many kinds of patient issues, and establish an ongoing relationship with them. It is deeply satisfying to see patients who have come to you when in their lowest moments and to be able to help them progress and enjoy normal lives again. In fact, there is a unique sense of joy and gratification that comes with procedures that offer immediate relief to patients with agonizing urinary stones, embarrassing urinary incontinence and other uncomfortable conditions.

But you also feel profound satisfaction with every positive outcome realized in treating life-threatening urologic cancers or debilitating genitourinary problems. With urology, you can go home every day feeling happy and contented with the outcomes you’ve achieved for your patients. Besides, I enjoy being a urologist because the specialty is quite flexible and I can choose the extent to which I am busy every day.

Why Advanced Urology Institute?

AUI has just about everything a urologist requires to excel. The place is always warm and buzzing, with colleagues telling jokes or sharing delightful stories. It is such a relaxed and pleasant working environment that brings out the best from every one of us. The administrative duties have been centralized to enable physicians to concentrate on the most important task — delivering the best possible care to patients. We also have access to the latest medical and surgical equipment, regular opportunities to collaborate with other certified, knowledgeable and experienced professionals, and a thriving culture of compassionate, multidisciplinary approach to patient management. In a nutshell, it’s always wonderful practicing urology at AUI. For more information on the services offered at AUI, visit the “Advanced-Urology-Institute” site.

TRANSCRIPTION:

My name is David Harris and I’m a urologist with Advanced Urology Institute in Fort Myers. I’m from suburban Chicago in the Midwest. My father was a veterinarian and I grew up with aspirations of becoming a veterinarian. However, I found out in college as I was actually getting close to applying that I was allergic to many animals and had to have a rethinking of my career plans. So, I’m happy I went into medicine and I think within medicine I found the right niche in urology. 

I went to school through medical school in Chicago and then I trained in Boston in general surgery and urology and met my wife in Boston. We lived in New England for a while and we’ve now been in the south for about 20 years. I went to undergrad at the University of Illinois in Champaign. I did a medical school at Loyola in Chicago. I trained in general surgery at the Deaconess Program at Harvard Medical School and then I trained in urology at the Lahey Clinic in Boston.

REFERENCES:

Advantages of da Vinci Surgical System

The da Vinci Surgical System is a minimally invasive procedure where the operation is performed with the help of robotic instruments inserted through minor incisions. The surgeon sits at a console that offers a three dimensional view of the patient’s anatomy and full control over the surgical instruments.

The da Vinci system provides a suitable alternative to the more traditional open surgery where a surgeon has to make large incisions through skin and muscle to reach the affected organ. It also is an improvement to other minimally invasive procedures, such as laparoscopy. Now a patient has the opportunity to choose robot assisted laparoscopy over conventional laparoscopy.

Advantages of the da Vinci Surgical System

1. Increased precision

The precision with which miniaturized robotic instruments move through the body is comparable to that of a scalpel in a surgeon’s hand. Robotic instruments can access parts of the anatomy that are delicate or hard to reach with no risk of accidental puncture or laceration. The margin of error is very low because precision increases accuracy.

2. Reduced blood loss, pain and scarring

Blood loss, pain and scarring are incidental to any surgical procedure. Blood loss is especially critical and it is a significant contributor to mortality rates in procedures such as hepatic and thoracic surgery. The da Vinci Surgical System requires very little cutting and the incisions made are very small. Advantages of the smaller incisions include less pain, smaller amount of blood loss and a shorter healing period after the surgery. The high definition cameras and the 3D view in the da Vinci Surgical System also offer increased visibility, which reduces the chances of puncturing blood vessels or any other part during the surgery.

3. Faster recovery

Patients who undergo surgery using the da Vinci system report faster recovery. They require less after care and the risk of post surgery complications is remarkably reduced. This is especially the case with post surgery infections, which are a concern in cases of open surgery because of the larger wounds. Patients undergoing this kind of surgery realize the objectives of their treatment quickly and they can return to their normal activities with no problems.

Conclusion

The da Vinci Surgery System is available for almost all forms of surgery, including gynecological, kidney and colorectal. Areas such as urology are known to have been at the forefront of adopting this system to urological surgeries and to date, most urologists, including the members of the Advanced Urology Institute, champion the use of the da Vinci Surgery System.

For more information about the da Vinci Surgery System, visit the “Advanced Urology Institute” website.

2 Effective Treatment Options for Prostate Cancer

Prostate cancer can be treated and managed in a number of ways. While the preference of the patient is given priority, it should be tempered with the advice of a trained urologist. A urologist can offer advice on what method is appropriate depending on the age of the patient, the patient’s family history and the natural progression of the disease. The patient also needs to be fully advised of the side effects of any form of treatment before agreeing to undergo the treatment. For any given case of prostate cancer, there are always at least two treatment options available.

1. Surgery

A patient with prostate cancer can choose to have the prostate surgically removed to clear the cancer from the body. The procedure is known as Radical Prostatectomy. It is most appropriate in cases where the cancer is localized and has not spread beyond the prostate. However, even when the cancer is localized, a urologist will determine the progression of the disease before recommending surgery. Low risk localized prostate cancer is unlikely to progress and a radical prostatectomy is unnecessary. On the other hand, when the cancer is aggressive and is likely to result in death if untreated, surgery is definitely the most appropriate choice.

Radical prostatectomy is recommended for patients under the age of 75 , or those with a life expectancy of at least ten years. This is because they are more likely to preserve their sexual and urinary functions after the surgery and they have a stronger chance of outliving any side effects the surgery might have.

2. Radiation Therapy

Radiation therapy, or radiotherapy is the use of radiation in high doses to kill malignant cancer cells or slow their development. Unlike radical prostatectomy, it can be used to treat localized prostate cancer and even advanced prostate cancer. It may be applied in combination with other treatment options such as hormone therapy. It may even be applied if a patient undergoes a radical prostatectomy but the procedure fails to eliminate the cancer fully or if the cancer recurs.

Radiation therapy can be administered externally or internally. When done externally, it is referred to as external beam radiation and is very much like having an X-ray. When administered internally, it is referred to as brachytherapy or internal radiation therapy. In this procedure, a radiation implant is placed inside the body near the affected organ. After a while, the implant ceases to produce radiation. The implant, however, remains in the body.

Both radical prostatectomy and radiation therapy are suitable treatment options and choosing between them may seem a little daunting. The professional opinion of a urologist can help by pointing out the finer points of each choice. The patient also may research the subject by reading up on the various options. There are many sites that offer reliable material on this subject.

For more information about treatment options for prostate cancer, visit the “Advanced Urology Institute” website.

Radical Prostatectomy vs Radiation Therapy


Introduction

Radical prostatectomy and radiation therapy are both cancer treatment methods. Radical prostatectomy is specific to prostate cancer and involves the surgical removal of the prostate, either alone or with other surrounding tissues such as the seminal vesicles and some lymph nodes. There are currently various ways in which a radical prostatectomy can be carried out, including robot assisted laparoscopic prostatectomy, open prostatectomy and laparoscopic prostatectomy.

On the other hand, radiation therapy, also known as radiotherapy, is used in the treatment of almost all cancers, including prostate cancer. It involves the use of high doses of radiation to kill cancer cells or to slow their development by destroying their DNA. For radiation therapy to work effectively, it needs to be applied consistently over a period of time.

Choosing between Radical Prostatectomy and Radiation Therapy

The main advantage of radical prostatectomy is that it is arguably a one time procedure. It takes just a few hours to completely remove the affected prostate and the patient is likely to recover fully, albeit gradually and with the monitoring of a urologist. The main disadvantage is that it is appropriate only where the cancer has not spread to other organs outside the prostate. If it has spread, then removing the prostate and leaving behind other affected organs will have no effect at all. In cases where the cancer has spread, radiation therapy may be the more reasonable choice.

Other factors that urologists and surgeons consider before suggesting either procedure include:

1. Age of the patient — Radical prostatectomy is offered mostly to men under 70 years of age because they are more likely to live longer and be able to survive any long term effects of the disease.

2. The natural progression of the disease — Slow progression of a non-aggressive tumor does not lend itself to surgery. This is a case that can be managed by what is called watchful waiting where the disease is monitored constantly but treatment is deferred for a while.

3. The possibility of cure — The goal of radical prostatectomy is to cure the patient of prostate cancer. If for whatever reason it appears that it is unlikely that this objective will be achieved, then radiation therapy or other forms of treatment should be preferred.

Conclusion

It is important to choose the treatment option that works for your body. In order to make the right choice, make a point of consulting a qualified urologist. Reading material on the subject should also be helpful, and sites such as the one operated by the Advanced Urology Institute should be a good place to start.
For more information, visit the Advanced Urology Institute website.

Robotic Surgery Effective in Partial Nephrectomy


Robotic partial nephrectomy involves using an advanced surgical robot to remove part of the kidney, usually the portion with a tumor. Initially, robotic surgery enjoyed tremendous success with surgical removal of the prostate (prostatectomy), but in recent years its usage in kidney operations also has yielded remarkable results. In fact, robotic partial nephrectomy has become the preferred treatment option for most patients with benign kidney tumors, small renal masses and early-stage cancer. During the procedure, tumors are removed with the least possible disruption of the rest of the kidney — a nephron-sparing approach that maximizes post-operative kidney function.

Why is the da Vinci surgical system suited for partial nephrectomy?

The da Vinci surgical robot provides superior maneuverability that is suited for the delicate slicing, cutting and stitching involved in the removal of a portion of the kidney. The surgical robot offers a three-dimensional view of the targeted area, allowing for a broader range of motion of the surgical devices. Urologists using the robot find it much easier to make the complex maneuvers required during the procedure.

Since it uses smaller incisions and doesn’t involve making cuts through bone or muscle, the da Vinci partial nephrectomy causes less scarring and minimal trauma to patients. The recovery time is typically only 2 weeks compared to the 6-8 weeks recovery time after open kidney surgery. Likewise, blood supply to the kidney is blocked for a shorter duration, leading to less overall blood loss and quicker recovery compared to laparoscopy.

How is the robotic partial nephrectomy performed?

During robotic partial nephrectomy, the surgeon makes a series of tiny incisions in your abdomen. The camera and robotic surgical instruments are inserted through these incisions. To create enough room for manipulation of the surgical instruments and enable easy access to the cancerous tissue, the abdomen is inflated with gas (carbon dioxide gas). The doctor then moves the colon away from the kidney and trims off the fat covering the kidney to expose the kidney surface.

With the kidney exposed, the surgeon halts the blood flow to the kidney temporarily to prevent potential bleeding as the tumor is cut and the remaining portion of the kidney sutured together. At the end of the procedure, the urologist reconstructs the kidney, restores blood flow and then inspects the kidney carefully to make sure there is no bleeding.

Who should undergo robotic partial nephrectomy?

The da Vinci partial nephrectomy is the surgical treatment of choice for patients with smaller kidney tumors, usually not bigger than 4 cm in size. However, even patients with tumors ranging from 4 cm-7 cm also may undergo the procedure if they are to be treated in certain areas. Similarly, robotic partial nephrectomy is appropriate in cases where removing the whole kidney could trigger kidney failure or the need for dialysis.

At Advanced Urology Institute, we perform hundreds of robotic partial nephrectomy every year with amazing results for our patients. The procedure takes a short time, reduces the problems caused by benign or small kidney tumors and is effective in helping patients recover from kidney cancer. The minimally-invasive nature of the procedure guarantees less scarring, minimal trauma and quicker recovery for our patients. But we always ensure that patients are closely monitored for post-operative pain and complications, accomplishing cancer-free and happier lives for our patients. For more information on treatment of kidney cancer and other urological problems, visit our “Advanced Urology Institute” site.

Symptoms of Kidney Stones -Beyond the Basics


Kidney stones occur when hard deposits (minerals and salts) form inside the kidney. They vary in size and may travel to other parts of the urinary tract. While small stones may not produce any symptoms, some people complain of severe pain in different parts of the body. The excruciating pain can be likened to that of childbirth. Here is a quick guide on common symptoms of kidney stones.

1. Urge to urinate or frequent urination

Most people with kidney stones feel the urge to urinate. However, this will depend on where the stone is located. Those that are close to the bladder can irritate the walls and make the patient feel an urgent need to use the bathroom. These contractions may even occur when the bladder is empty. Keep in mind that unless the stone has moved to the urethra, there is no trouble when urinating.

2. Pain in the groin, back or side

Patients who experience pain around the groin or the lower abdomen may need a diagnosis for kidney stones. The pain also can occur under the rib cage or on the back side. It starts as a dull ache that escalates to sharp wincing pain. And it’s very episodic – it can be severe one minute and then completely subsides. The pain may be mild or barely noticeable. The patient may need to seek medical attention if the pain is very intense.

3. Nausea and vomiting

These two symptoms occur when the stones interrupt the flow of urine. It’s worth mentioning that stretching of the kidneys can cause gastrointestinal upset. And the worst part is that this pain does not subside even after making changes in body position. When patients vomit, they get dehydrated so additional fluids are recommended.

4. Blood in the urine

In advanced stages, a kidney stone can cause blood in the urine. The blood is only visible with dipstick testing or when examined with a microscope. People who spot pink or reddish urine should see a urologist immediately. Sometimes the urine may look like tea. This could be an underlying symptom to a more serious condition.

5. Fever

While this is not a common symptom for kidney stones, it occurs when patients have an infection in the problem area. According to experts, fever can occur when the stones block the flow of urine, which could be an emergency situation. And because the antibiotics can’t penetrate to an obstructed kidney, the obstruction must be relieved. Fortunately some stones may pass on their own without treatment.

Need the services of a urologist? Visit Advanced Urology Institute for professional treatment. Here you’ll find Dr. David Burday and other practicing urologists. They will do their best to put you at ease. For more information on treatment of kidney stones and other urological problems, visit our “Advanced Urology Institute” site.

Robotic Assisted Laparoscopic Radical Prostatectomy


Robotic-Assisted Laparoscopic Prostatectomy is a viable option for treating prostate cancer. It is a minimally invasive method for accessing both seminal vesicles and prostate glands during treatment of prostate cancer. Robotic prostatectomy is performed by an experienced surgical team with the help of advanced surgical robotic technology.

What is Robotic-Assisted Radical Prostatectomy?

Robotic prostatectomy involves the use of a laparoscopic system and Robotic Surgery System called da Vinci® Surgical System. This is a sophisticated robotic system designed to enable the surgeons to operate with enhanced vision, precision and control.

With the help of the surgical system, it is possible to pass miniaturized robotic instruments through keyhole incisions and remove the prostate and other nearby tissues with greater accuracy. During a robotic-assisted radical prostatectomy, it is able to create an incision that extends from the belly button to the pubic bone.

In the Robotic-Assisted Laparoscopic Radical-Prostatectomy, an image processing machine and a three-dimensional endoscope are used to achieve a clear and magnified view of structures around the prostate gland. This makes it possible to extract affected parts with optimal preservation of critical body parts such as blood vessels, nerves and muscles.

During the procedure, the surgeon operates the surgical system using a computer console that enables him to control tiny flexible instruments. This makes it possible to achieve higher precision and mobility. The whole process is done without the surgeon’s hand entering the area of the surgery in the patient’s body.

Advantages of Robotic-Assisted Laparoscopic-Radical Prostatectomy:

Robotic prostatectomy has some benefits compared to the traditional open surgical methods. Here are some of the advantages:

  1. Less pain
  2. Less loss of blood during the operation
  3. Shorter stay in the hospital.

Possible risks of Robotic-Assisted Prostatectomy:

The following are possible risks associated with the Robotic Assisted Laparoscopic-Radical Prostatectomy, although they are very unlikely:

  1. Damage to adjacent tissue or organ
  2. Infection of surgical site
  3. Bleeding

Laparoscopic Radical Prostatectomy:

As with all surgical methods, the robotic-assisted radical prostatectomy has a number of potential side effects, which include:

  1. Urinary incontinence or inability to control urine. However, this problem will reduce over time.
  2. Erectile dysfunction or impotence: Depending on the age of the patient, erectile function is likely to be affected.

Advanced Urology Institute is a patient-centered institute that works to minimize the possible side effects of a procedure. They research and partner with the best board-certified urologists, among them Dr. David Burday, to make sure that patients have a good experience during the operation and heal well afterward. For further information, visit the “Advanced Urology Institute” website.

Treating Erectile Dysfunction


Like every other medical condition, the treatment of erectile dysfunction is safer and more effective when done by a doctor with expertise in treating it — the urologist. Seeing a urologist as soon as you have ED symptoms not only ensures quick relief, but also saves a lot of money. But with so many phony cures being promoted and ED products being advertised, men with ED are often tempted to pursue such options rather than seeing a urologist.

The rush for seemingly convenient cures

Actually a lot of men often rush to vascular clinics to get tests done and undergo procedures, some they do not even need. For many, it is a question of seeking the most convenient or popular remedy rather than the safest and most effective treatment. Likewise, with Viagra now generic and cheaper — available for as low as 30 cents per pill in several outlets — it has become quite easy for ED patients to just buy the drug and try it without seeing a urologist.

Dangers of non-prescribed treatments for ED

While it is safe to say that millions of men find these non-prescribed treatments a convenient way of improving their sex lives, it is never prudent to use a prescription drug such as Viagra when it has not been prescribed by a doctor. These medications come with side effects and risks, and if you have certain medical conditions taking such a drug can lead to severe consequences. For example, if you have heart disease and are taking nitrates, a dangerously low blood pressure may develop if you take Viagra. But when the drug is prescribed by a urologist, the doctor will ensure that you are healthy enough to start using the medication.

So why should you still see a urologist?

Most of the treatments advertised are not only bogus and a waste of money, but also may be harmful. Actually you may try several solutions without relief and eventually find yourself in a worse situation than before you started. So it is wise to just forget about every ED treatment that does not require a prescription. It won’t cure your condition! And when you find products advertised as a “breakthrough” or endorsed by medical organizations, you still need to check them out with your urologists. It is the doctor who should confirm whether or not the product is legitimate, a medical breakthrough or has been endorsed by a reputable medical organization.

Not everyone may take ED medications

ED medications are not for everyone with the condition. The drugs will work for some men, but they may be unsafe or inappropriate for others. You should see a urologist to learn whether your condition requires treatment with ED drugs. A urologist will take your medical history, do a physical exam and order various tests to determine whether you need treatment and which drugs are best for you.

You may have ED due to untreated diabetes, hypertension (high blood pressure), your current medications or another issue. Your ED also may have gotten worse because of stress, depression or anxiety. So it is crucial that you are evaluated by a urologist to determine the underlying cause and provide the right treatment. Remember also that erectile dysfunction may be a sign of another more serious health problem and will not be resolved if the underlying issue is not addressed. So you need to see a urologist to get a comprehensive, effective and safe treatment for your condition.

As urologists, we talk with our patients openly, get to know their medical history, conduct physical exams, and recommend treatment tailored to the individual. In many cases, we recommend erectile medications. But when the drugs fail, we have several alternatives to offer, ranging from penile injections and vacuum devices to penile implants. When you work with a urologist, your condition will be evaluated and the solution offered will not only improve your sexual health, but also boost your long-term health. For more information on the treatment of erectile dysfunction, visit the “Advanced Urology Institute” site.

Are Medications Effective in Treating Erectile Dysfunction


Erectile dysfunction occurs to some degree in about 50 percent of men 40-70 years old. But only 10 percent of men report a total inability to have erections. For 70 percent of men with ED, taking an erectile dysfunction drug can produce an erection sufficient for intercourse. The drugs typically improve the supply of blood to the penis and, together with sexual stimulation, they produce an erection that is hard enough to begin and complete intercourse.

What ED pills are available?

The first ED drug commonly offered is sildenafil (Viagra). It has been on the market for the longest time and its side effects and the foods it interacts with are well known. Other ED drugs available in the U.S. are tadalafil (Cialis), avanafil (Stendra) and vardenafil (Levitra). Another option is Staxyn, the fast-dissolving form of Levitra that is placed under the tongue.

How well do these drugs work?

In those who are otherwise healthy, ED drugs produce an erection sufficient for sexual intercourse in at least 70 percent of men. Although the results vary slightly with each person, 70-80 percent of men will respond well to these medications. In fact, the majority of men with ED are pleased to use these medications. And while there are some who may not have the desired effect from any of these drugs, including men with damaged arteries or nerves after prostate surgery, cardiovascular disease, or diabetes, a larger number will find them quite effective.

How quickly do the pills work?

The pills may not work if they are not used correctly. These drugs are not an on-and-off switch for erections. So they won’t work well if there is no sexual stimulation. After taking the drugs, it is important for a man to be with his sexual partner and have foreplay. Likewise, Viagra and Levitra do not work if taken after a meal and must be taken before eating. But Stendra and Cialis do not interact with food and can be taken after a meal. When used properly, it takes about 15-60 minutes for the pills to start working.

Which drug works best?

There is no specific ED drug that is the best. Studies have shown that all ED pills have similar efficacy and safety. So the best drug depends on the man’s body chemistry, lifestyle and needs. That is why men should consider their and their partners’ preferences and the cost of their preferred medications. For instance, they may consider how spontaneous their partners are when it comes to sexual activity.

Nevertheless, studies have shown that about 52 percent of men with ED prefer tadalafil (Cialis), 28 percent prefer sildenafil (Viagra) and about 20 percent prefer vardenafil (Levitra). Tadalafil is more popular because it offers a 36-hour window of opportunity to have an erection while the other pills offer a much shorter period.

What are the alternatives to ED drugs?

For men not satisfied with the pills or who have conditions that make these drugs ineffective, shockwave lithotripsy is a great alternative to explore. During this treatment, waves are delivered to the penis to create or improve vascularity. Even if shockwave lithotripsy does not work, the urologist may request a test to measure the rate of blood flow to the penis. The test can help the doctor determine if there are underlying issues that ought to be addressed.

Even though ED drugs are generally safe, they should not be taken by men with certain conditions. For example, men with heart disease should not take these drugs. ED patients should always tell their doctors about all their health issues and the medications they are taking during their consultations. With this information, doctors can recommend the right pills or treatment for each patient. For more information on treatment of erectile dysfunction, visit the “Advanced Urology Institute” site.

Prostate Problem Warning Signs


At Advanced Urology Institute, we frequently see first-time visitors with symptoms of advanced stage prostate problems. For us, that is quite heartbreaking because it means the patients come too late, when only limited treatment options are available for their conditions.

As urologists, we always want the best for our patients. We want to see them leave when they can pee better and are free from the embarrassment of accidental urine leaks. And because early detection and treatment of prostate problems — whether prostate cancer or non-cancerous condition — improve the chances of cure and of long-term survival, we always encourage men to be more mindful of their bodies, especially when it comes to their urinary function and habits. By doing that, they are able to detect warning signs of prostate issues early and can seek treatment.

Warnings signs of prostate problems include:

  1. Frequent urination or frequent urge to pass urine.
  2. Passing urine more often than usual, particularly at night.
  3. Pain, discomfort or burning sensation when passing urine.
  4. Dribbling urine
  5. Weak or interrupted urine streams.
  6. Accidental urine leakage.
  7. Blood in urine or semen
  8. Frequent stiffness or pain in your lower back, rectal area, hips, upper thighs or pelvic area.
  9. Difficulty or inability to urinate
  10. Trouble with starting or stopping your urine stream.
  11. Painful ejaculation
  12. A feeling that you aren’t able to empty your bladder completely.
  13. Swelling of lower extremities.
  14. Paralysis or weakness in lower limbs.
  15. Inability to pass urine while standing up.
  16. Loss of appetite and weight, fatigue, nausea and vomiting.

It is important to see a urologist immediately if:

  1. You find urination difficult, abnormal or painful. The doctor will examine your prostate gland to find out if it is inflamed, enlarged or has a cancer.
  2. You have frequent urination, urinary retention, blood in urine, dribbling or slow flow of urine, problems starting a urine stream, or repeatedly urinate urgently.
  3. You have a chronic pain in your pelvic, lower back, upper thigh or other areas of your lower extremities. While any unexplained ongoing pain in these areas may have various causes and always merits medical attention, seeing a urologist may help detect whether or not you have prostate cancer.
  4. You have swollen legs, weakness in your legs or trouble walking.
  5. You have unexplained weight loss.

As urologists, we have several options for tackling prostate problems, but our interventions normally depend on the severity of the symptoms, type of condition and how it is impacting your overall quality of life. For example, if the prostate condition is not severely affecting your quality of life and you have no complications (such as bleeding, bladder stones or urinary infections), the decision to treat the problem is often optional and left for you to make.

That means if you aren’t bothered enough to undergo a procedure or take medicine for the condition, then you’ll only need frequent follow-up with your urologist to check whether your symptoms remain stable over time and your bladder continues to empty well. But if you already have complications or your bladder is holding increased quantities of residual urine after urination, then we often begin treatment immediately.

To help you pass urine better, we may offer medications such as alpha blockers, 5-alpha reductase inhibitors or a combination of drugs. But minimally invasive surgical procedures such as TUMT (transurethral microwave thermotherapy) and TUNA (transurethral needle ablation), water-induced thermotherapy, PVP (photoselective vaporization of prostate), and HoLAP (holmium laser ablation of prostate) also may be considered. For more information on diagnosis and treatment of prostate problems, visit the “Advanced Urology Institute” site.

Talking With Your Doctor About Enlarged Prostate


You are a man and, like most men, you aren’t that comfortable talking about your health. But if you live long enough or desire to live that long, you’ll have to talk about your health with your doctor. And later in life you are likely to have benign prostatic hyperplasia — about 80 percent of men will have BPH in their lifetime — and will need a urologist to either diagnose or confirm that you have the condition and then treat it.

What is BPH?

BPH means the prostate gland has grown so large that it is causing urinary problems. Often, as the gland enlarges, it presses on the urethra, narrowing or blocking it and making it difficult for urine to pass through the tube. Eventually BPH may cause bothersome and embarrassing urinary symptoms that may require specialized treatment.

You should see a urologist when:

  1. You are finding it problematic to start to urinate.
  2. You frequently have a sudden, uncontrollable urge to urinate.
  3. You have dripping or leaking of urine after you urinate.
  4. You have weak, slow or interrupted urine streams.
  5. You urinate frequently, particularly at night.
  6. You experience pain or discomfort or have to strain or push to urinate.
  7. You can’t empty your bladder completely.

Why should you see a urologist?

BPH should be promptly treated by a urologist because it can have adverse effects on your life. The condition can lead to complications such as urinary tract infections, kidney failure or urinary retention. Likewise, BPH may reach a point where you may have to plan every errand, activity or event you are attending around its proximity to a bathroom.

You also should see a urologist if you have a family history of the condition. The doctor will guide you on the actions to take to prevent or manage the condition, helping you avoid complications and make treatment more cost-effective. And since BPH and prostate cancer may have similar symptoms, speaking with your doctor about your symptoms may help you detect a more serious condition earlier.

How should you speak with a urologist?

Most problems brought to urologists are embarrassing. So rest assured that talking about BPH with the doctor is not a shameful, intimidating act but a courageous, lifesaving step. Don’t be reluctant to open up. Be willing to talk freely since the condition has a great prognosis if treatment begins early. Also there is a lot of value speaking with a urologist when the symptoms are still at their mildest stage because only a simple intervention may be needed. It is important to seek help as soon as symptoms begin to occur.

You should come to your appointment prepared with your complete medical history, medications and all the relevant information about your health and the procedures you have had in the past. You also should bring any information about your condition and a list of questions to ask.

Once you’re at the urologist’s office, make sure you are completely honest about the reasons for your appointment. Be open and say you are visiting because of your urinary problems. Honesty will help to prepare you and the entire urology team that will handle the case. It is also critical to talk about all the changes that you have seen in your health.

While treatment for BPH can be as simple as just avoiding alcohol and caffeine, emptying your bladder as completely as you can, or taking prescribed medication to reduce the symptoms, prevent further growth of the prostate or shrink the prostate, your primary focus should be on achieving an improved quality of life after treatment. Ask the urologist about the possible side effects of the potential treatments, the right treatment for you and how comfortable it will be for you moving forward. Whenever possible, seek non-surgical interventions first before you consider surgery.

If the condition can’t be controlled with medication, such as in severe BPH or when you have complications like bladder stones, urinary tract blockages or kidney problems, your doctor may suggest surgery. Various forms of surgery include laser therapy, transurethral prostatic incision, needle ablation or microwave therapy. It is important to speak with your urologist about the different surgical options before you are treated. For more information on diagnosis and treatment of BPH, visit the “Advanced-Urology-Institute‘” site.

How Is Prostate Cancer Treated

After a diagnosis of prostate cancer, there are several treatment options you may want to consider. However, there is no single option that is right for all men with prostate cancer. Some prostate tumors grow very slowly or don’t grow at all, so you may never even need treatment if you have such a tumor. Then there are tumors that grow rapidly and spread quickly to different areas of the body. Either way, you should work with your doctor to decide what is best for you. As you discuss your treatment with your cancer care team, it is important that you weigh the benefits of every option against the possible side effects and risks.

The factors to consider when choosing treatment for prostate cancer include:

  1.  Stage of your cancer (how far it has spread).
  2. Severity of the tumor (how large in size and how serious the symptoms are).
  3. How quickly the cancer is growing or spreading.
  4. Your age, state of health, lifestyle and expected lifespan.
  5. Any other serious conditions you may have.
  6. What every treatment involves.
  7. Possible side effects of the treatments.
  8. The possibility that the treatment will cure the tumor or help in some way.
  9. How the treatment chosen may affect other treatment options later should the cancer recur or spread.
  10. Your personal feelings about each treatment option.
  11. Practical issues such as nearness to hospital.

The most common treatments for prostate cancer include:

1. Active surveillance

The doctor keeps an eye on the cancer to make sure it can be treated should it begin to spread or grow aggressively. This option is appropriate if you have a small, localized, slow-growing tumor. The doctor will wait until symptoms appear in order to begin treatment. During active surveillance, the progress of the tumor is monitored through regular PSA blood tests, ultrasounds, rectal exams and biopsies. The tests help to check whether the cancer is getting worse so appropriate treatment can be administered as soon as it begins to grow or spread.

2. Radiation therapy

Radiation is aimed at the cancer to destroy the cells and treat the tumor. Image-guided radiotherapy ensures that prostate cancer can be treated with minimal effect on healthy cells. However, radiation therapy is still often considered more ideal for older men and those who have other serious health problems and less so for younger men. You also may undergo radiotherapy after surgery to help get rid of any cancer cells that remain behind or to treat cancer that has reached the bones. There are two forms of radiotherapy: external beam radiotherapy that is applied by a machine placed outside the body and internal radiotherapy (brachytherapy) that involves inserting small radioactive “seeds” into the body either near or into the cancer.

3. Surgery

If you are healthy and have a localized cancer, you may choose to have an operation to remove the prostate gland or to remove the gland and surrounding tissue. But surgery for prostate cancer is often associated with problems getting an erection and controlling urine, so you should speak with your urologist before the procedure to find out if measures are in place to protect your nerves and minimize such effects.

4. Hormone therapy

Prostate cancer cells require the hormone testosterone to keep growing. Hormone therapy, also called androgen deprivation therapy, is when the urologist applies treatment to ensure the cancer cells can’t get the hormone. The treatment either may lower the body levels of testosterone and other male hormones or block the way testosterone works.

5. Chemotherapy

Your urologist may prescribe drugs to kill prostate cancer cells or shrink the prostate. The drugs can be taken orally or may be injected directly into your bloodstream. Generally chemotherapy isn’t given for men with early-stage prostate cancer. But when the cancer is advanced or has spread to other areas of the body, then chemotherapy may be ideal. Apart from using drugs, the urologist may give the prostate cancer vaccine to boost your immune system in order to fight the cancer cells. The vaccine is often given to men who haven’t been successful with hormone therapy and it can help you live longer.

Surgery vs. radiotherapy: Which one is ideal for you?

While some men with low-risk localized prostate cancer and some with medium-risk cancer may find watchful waiting (active surveillance) appropriate, others with localized cancer may want to begin treatment right away. And in that case, either radiation therapy or surgery may be the suitable treatment.
Both radiation therapy and surgery work well for localized prostate tumors, limiting the possibility of the cancer spreading outside the prostate. Both treatments have side effects too, including bowel, bladder and erection problems. With radiation therapy, you are more likely to have bowel problems. But with surgery, you are more likely to have erection problems or leaking of urine. So the choice you make between radiation therapy and surgery should primarily depend on your treatment goals.

For example, if the goal is to treat the cancer by removing the prostate, then surgery is the proper treatment. Of course, there are men who just want to get the cancer out and they wouldn’t mind removal of the prostate too. Then there are some who want to avoid radiation so surgery suits them well. If the goal is treating cancer while also avoiding the risks associated with a major surgery, then radiation therapy is the ideal choice. Having radiation instead of surgery also will help to avoid erection problems and preserve your sexual function.

One form of treatment may be more appropriate for you than the other because of how you feel about it, other health problems you have and your life expectancy. For instance, young men do well after surgery while older men tend to respond well to radiotherapy. That is why you should discuss your options with your doctor before you make a decision.

Treating advanced-stage prostate cancer

For advanced prostate cancer — a cancer that has spread beyond the prostate and into other parts of the body — treatment may not cure the cancer, but will keep it in check and relieve symptoms. The treatment options for advanced prostate cancer include hormone therapy, chemotherapy plus hormone therapy and prostate cancer vaccine. Usually, hormone therapy is given for advanced-stage prostate cancer to help keep the cancer under control. But if after some time the cancer begins to grow again, other treatments may be administered along with the hormone therapy to control the cancer and alleviate the symptoms, though the hormone therapy regime is kept because it ensures that your testosterone level is low.

With prostate cancer, there is no perfect treatment for every patient. All definitive treatments come with side effects, which tend to vary depending on the patient and the actual treatment. As urologists, we are always endeavoring to minimize these effects by picking the appropriate treatment for each patient. We make sure that the treatment can effectively eliminate the cancer while also preserving the patient’s quality of life during and after therapy. For further information on treatment of prostate cancer, visit the “Advanced Urology Institute” site.