How Do I Know If I Have a Kidney Stone

Kidney stones is the common term for the medical condition of renal lithiasis or nephrolithiasis. The stones are made up of salts and minerals that form into hard deposits inside your kidneys.

Kidney stones can be caused by many different factors and can show up in different sections of your urinary tract. They may travel from the kidneys to your bladder, and from the bladder to the ureter. Sometimes kidney stones occur when the urine is too concentrated, which allows minerals to coalesce and crystallize. Heeding early signs like painful urination and an irregular urge to pee can help you seek medical help earlier and get treatment.

Pain from Kidney Stones

How can you be sure that kidney stones are causing your pain?
Because there are other maladies that have similar symptoms to kidney stones, a visit to your urologist may save you from uneccesary grief. Some symptoms of kidney stones include:

  • Acute pain below the ribs on the side of your body or in your back. The pain may intensify or shift to various locations as the stones travel along the urinary tract.
  • Pain located in the lower abdomen or groin
  • Pain that fluctuates in severity
  • Painful urination
  • Cloudy or discolored urine (pink, red or brown)
  • Foul-smelling urine
  • Persistent need to urinate or urinating more than usual
  • Urinating in small amounts
  • Nausea and consequent vomiting
  • Chills and fever due to associated infection

You could have just one of these symptoms or several. If you are experiencing severe discomfort along with nausea or blood in your urine, you should seek medical help.

Kidney stones do not usually cause any permanent damage if treated early and correctly. You may be able to drink plentiful amounts of water, take a pain medication, and be able to pass the stone on your own. However, if the stones get lodged in the urinary tract or cause a urinary infection, more aggressive treatment may be in order.

Tests for Kidney Stones

There are several ways your doctor can test for kidney stones that will also reveal their size and precise location. These tests include:

  • Imaging tests: The imaging technology to determine if you have kidney stones includes X-rays, CT scans and ultrasounds.
    CT scans are more thorough than X-rays and result in lucid composite images of kidney stones. Ultrasound is also used to create images of the affected area.
  • Blood tests: Your doctor can determine if your have too much uric acid or calcium in the blood, which can cause kidney stones to form.
  • Urine tests: These lab tests can detect minerals that cause kidney stones in your urine. They can also reveal if you lack elements that prevent stones from forming.

Treatment for Kidney Stones

Your doctor can determine if sound-wave therapy can resolve the problem or if surgery is indicated due to stones being too large to pass, causing infection or other damage. If you are able to pass the stone on your own, saving it for your urologist to examine can help your doctor determine what causes your stones and what can be done to prevent additional ones from forming.

If you would like more information about kidney stones and their treatment, schedule a consultation at the Advanced Urology Institute location nearest you or visit the website.

What are the benefits of da Vinci Robotic Surgery According to Dr. Rolando Rivera

KEY TAKEAWAYS:

  • The da Vinci® robotic surgery technology has revolutionized the field of minimally invasive surgery, offering consistent and superior outcomes and enabling patients to recover faster.
  • The benefits of da Vinci robotic surgery for patients include reduced pain, less blood loss, reduced risk of infection or complications, less scarring, shorter hospital stays, and faster recovery.
  • The da Vinci system offers surgical professionals advantages such as improved dexterity, a wider range of motion, enhanced visualization, improved access to hard-to-reach areas, and improved outcomes that spare healthy tissue.

If you are facing surgery, you want the most effective and least invasive approach to the operation. You can rest easy when you hear that your procedure will be done with the da Vinci® robotic surgery technology.

The da Vinci approach has transformed minimally invasive surgery, enabling patients to get back to what matters sooner. Over the past 20 years, da Vinci platforms have offered consistent and superior outcomes, pioneering new capabilities in the operating room. The da Vinci robotic surgery has virtually revolutionized the field of minimally invasive surgery.

Dr. Rolando RiveraSurgical Approach with da Vinci Robotic Surgery

  1. Surgeons and operating room staff who use the da Vinci system are given comprehensive training by the manufacturer. Their professional education includes simulation for skills and procedures, along with practice and peer guidance.
  2. The da Vinci robotic surgical system offers a minimally invasive alternative to laparoscopy and also to open surgery. (Laparoscopy surgery is a procedure that uses fiber-optic instruments inserted through the abdominal wall to see and repair internal organs.)
  3. Because robotic surgery offers greater precision and control for the surgeon, and is performed by just a few tiny incisions, patients generally recover sooner.

Benefits of da Vinci Robotic Surgery for Patients

Patients will be thankful for the many benefits of robotic surgery using the da Vinci approach:

  • Reduced pain
  • Less blood loss
  • Reduced risk of infection or complications
  • Less scarring because of smaller incisions and fewer sutures
  • Briefer hospital stays/faster recovery
  • More rapid return to normal activities, including urinary continence, sexual function, and more.

Benefits of da Vinci Robotic Surgery for Surgical Professionals

To understand more about the benefits of the da Vinci system, consider these advantages. Aided by the da Vinci system’s ergonomic design, your surgeon is able to get a magnified 3-D view with high-definition while operating from a comfortably seated position. Your surgeon can operate precisely with these advantages:

  • Improved dexterity
  • Wider range of motion
  • Enhanced visualization including areas that are not visible by the naked eye
  • Improved access to otherwise almost inaccessible areas
  • Improved outcomes, sparing healthy tissue not impacted by cancer

The superior results with a da Vinci robotic surgery procedure are ideally suited for urologic conditions. At the Advanced Urology Institute, urologists such as Dr. Rolando Rivera perform minimally invasive robotic surgeries for prostate cancer, vasectomies and more complex surgeries such as reconstruction. For more information, visit the Advanced Urology Institute website.

TRANSCRIPTION: 

I’m Rolando Rivera and I’m board certified in Urology and Female Public Medicine and Reconstructed Surgery with Advanced Urology Institute.

Yes, the DaVinci machine, which is a trademark platform in general robotic surgery, is designed to improve the ability of the surgeon to get the tissues and see the structures through small incisions via laparoscopy, it’s based on laparoscopic principles.

You can get to the different organs and use 10 times magnification in a three-dimensional array, so you can see things very close and very magnified. And the robotic platform allows you to have more precision, takes away the surgeon’s tremor because the instruments do all the movement that you guide in a console, so it allows you to do more refined treatments and surgical techniques. Well, because you’re not opening big incisions and you’re creating less trauma, less trauma leads to less inflammation, then pain is less of an issue. And whenever you have small incisions, less trauma, less inflammation, you’ll have quicker recovery.

REFERENCES: 

What Causes Kidney Stones by Dr. Howard Epstein

What causes kidney stones? This is a question that Dr. Howard Epstein hears often when he meets patients suffering from the symptoms, pain and problems caused by this common urological condition.

It is important to first know what the kidneys are and what is their normal function. The kidneys are often described as fist-sized, bean-shaped organs. They are located below the ribs, behind the stomach. Their main function is to filter the blood and maintain the proper balance of necessary salt, water and various minerals in the blood. Excess salt and minerals and other wastes are removed and sent to the bladder as urine. The filtered blood is sent to the heart, where it can carry oxygen and necessary nutrition to the rest of the body. Because the kidneys essentially make sure the blood is clean and healthy, they are critical for life.

Dr. Howard EpsteinFor a normal person, the kidneys will filter around 200 quarts of blood each day, and they will remove about two quarts of liquid each day in the form of urine. Since a healthy person of around 160 pounds has only five quarts of blood, that means the blood will flow through the kidneys around 40 times per day.

Of all the various ailments a person can have, kidney stones can be among the most painful. The stones are formed when the kidneys filter out an excessive amount of minerals, such as salt or calcium, and those minerals remain in the kidney long enough to start crystallization. It’s the same kind of process that can create rock candies. Over time, the crystals become larger, forming kidney stones. If they are small, they can often be flushed out (passed out) of the kidneys and the body without creating any problems. But if at any stage they get stuck in the body, they will continue to grow in that spot. The most common spot is in the kidneys, where they first start growing. As they grow, they hinder normal kidney function, reducing the flow of blood and reducing the kidney’s ability to produce and pass urine. A kidney stone can move and completely stop the flow of urine, which is really bad news.

If a person consumes too much salt, too many calcium-containing foods, takes certain medications or drinks far too little water, kidney stones can develop. There is evidence that genetics also can can cause stone-making kidney disorders. The end result can be very painful.

Drinking water every day is essential to good health. The citrate in lemon juice can be beneficial in small amounts. Artificially colored sodas and food, as well as too much coffee, can cause problems because of the types of chemicals that enter the body. The body also gets rid of excess water through perspiration, so it is important to drink enough water to urinate at least four times a day, with an average above that.
Anyone experiencing symptoms such as strong pains in the stomach area or on the side down to the groin should immediately see a doctor. There are numerous problems that can cause excessive side or abdominal pain and it is advisable to see a specialist. If you are concerned about the possibility of having kidney stones, schedule a consultation with Dr. Howard Epstein MD or one of the many highly skilled urologists at an Advanced Urology Institute location near you.

Why Urology? with Dr. Bill Vanasupa

Becoming a doctor in any field of medicine requires a great deal of dedication and determination. Students wishing to become physicians put in long hours studying for tests and preparing for classes and internships. After graduating, many new doctors find their profession leaves little time for a personal life with friends and family. Their dedication to patient care can cause a difficult work-life balance.

Dr. Billy VanasupaDr. Bill Vanasupa thought he wanted to be a family practice doctor, seeing and growing with the same patients throughout his career. However, when he was an intern he discovered that although family practice is rewarding in its own way, it was not the right choice for him. When he assisted in surgery as part of his training, he discovered an aspect of medical care that he felt was his calling.

However, Dr. Vanasupa also knew about the challenges of practicing in certain fields of surgery, and he found himself considering where he could best serve patients with both surgical and non-surgical treatments.
As luck would have it, Dr. Vanasupa had a friend in college whose father was a urologist. He spoke to his friend’s father and a career in urology seemed like a good fit for him. Urology would allow him to create lifelong relationships with patients while also performing surgeries and keeping a desired work-life balance. By assisting patients with their urology problems, Dr. Vanasupa has the opportunity to create great patient relationships that last for years.

Today, Dr. Vanasupa is living his dream at Advanced Urology Intstitute by helping people by offering the most advanced medicine and surgical techniques available in the medical field of urology.

How Did Dr. Rolando Rivera Become a Urologist?

KEY TAKEAWAYS:

  • Urology is a challenging and diverse medical specialty, covering a broad range of issues such as urinary incontinence, overactive bladder, vaginal prolapse, kidney stones, and pelvic surgery.
  • Urologists have the opportunity to build long-lasting relationships with their patients and provide patient-specific treatments, creating a primary care type relationship that is rare in specialty medicine.
  • Dr. Rolando Rivera is a dedicated urologist who enjoys the ever-changing field of urology, aiming to improve the quality of life for his patients by providing the best care possible.

Becoming a doctor in any field requires a great deal of dedication and determination. Medical school is known for its years of hard work, difficult tests, internships and endless nights of studying. The product of this hard work is the excellent care provided by dedicated professionals when we are in need of medical assistance.

Dr. Rolando RiveraBecoming a urologist requires a special kind of person. Urology is one of the more challenging specialties a doctor can choose. Urological problems are broad and can encompass issues ranging from urinary incontinence, overactive bladder, vaginal prolapse and kidney stones to the advanced realm of pelvic surgery. Urologists are required to have a large skill set in order to take care of their patients.

Although the extensive field of urology requires a great deal of work, it is also very rewarding. Because of the wide range of issues within this specialization, patients might have to see a urologist many times in their lives. This gives urologists a chance to build relationships with their patients and learn their unique medical needs over time. Urologists have the opportunity to create an almost primary care type relationship with their patients, which is rare in fields of specialty medicine.

The wide spectrum of needs in urology also works to the advantage of the urologist. There are some fields of medicine that can become routine over years of practice, where patients come in with the same set of issues, needing the same kind of treatment. This does not happen in urology. With a wide range of medical issues, requiring patient-specific treatment, the phyisican enjoys a greater degree of variety at work. And with treatment options ranging from prescriptions to various levels of invasive surgery, urology is consistently an interesting and diverse field of medicine for those who practice it.

One doctor who enjoys this ever changing field of medicine is Dr. Rolando Rivera. After shadowing a urology student and friend in college, Dr. Rivera knew that this was the medical specialty for him. And after graduating with honors from the University of Puerto Rico, he started a rewarding and cutting-edge career. Improving the quality of life for his patients has been the goal that motivates Dr. Rivera to provide the best care possible.

For those who are willing to put in the long hours and hard work required to become a urologist, the reward is a lifetime of making a difference in people’s lives while also never being bored with their profession. For anyone in need of seeing a dedicated urologist like Dr. Rivera, he and many more great doctors can be found at the Advanced Urology Institute. Their team of qualified and experienced specialists can help you with any concerns related to urological conditions. For more information, visit an Advanced Urology Institute location near you.

TRANSCRIPTION: 

I’m Rolando Rivera and I’m board certified in urology and female pelvic medicine and reconstructive surgery with Advanced Urology Institute. 

I actually wanted to be a pilot, but I had glasses and back then pilots didn’t have glasses so my brother is a physician and I got interested in medicine early. I went to the University of Puerto Rico for medical school and I did my residency in the University of Florida in Gainesville.

I actually got exposed to urology fairly early. I think I was a first year medical student and one of my brother’s classmates was a urology resident. I was walking down the hallway one day on a Saturday and he stopped me and said, hey, what are you doing? I said, I’m not doing much and he invited me to see one of his cases and after that everything had to compare to urology. I was hooked, yeah. You know, the most interesting thing about urology is of all the surgical subspecialties or of many of the surgical subspecialties is the one specialty where you can be very broad. I mean, I have relationships with patients that I’ve seen since I came into town 13 years ago so you can follow patients for a long, long time and have almost a primary care type relationship with your patients. 

You can be very obviously invasive and we do a lot of procedures and surgery and it’s open surgery, endoscopic surgery, very broad field and you never get really bored because it’s so diverse.

REFERENCES: 

Becoming a Urologist – Dr. Arash Rafiei

Requirements To Become a Urologist

Like Dr. Arash Rafiei, all urologists are required to complete at least three years of college before they enter medical school. Most students complete four years of college with a Bachelor of Science in Chemistry or Biology. After graduation from medical school, the urologist-in-training will complete a residency at a hospital, usually one with a specialty in urology. The residency is a minimum of five years. Time during residency may be split in some programs as two years in general surgery residency and three years in urology. Board certification takes another two to five years. So, effectively, urologists can expect to spend 13 years in study or residency before board certification.

Selecting Your Urologist

Dr. Arash Rafiei - Orange CIty, FLWhen choosing a urologist, you can specify that you would like a board certified doctor for your urology treatment. Make sure you write down all your questions for the doctor, and seek someone who will take into consideration your individual preferences. Ascertain that the facility and medical staff keep up to date on the latest technologies, such as minimally invasive techniques, as well as proven treatment guidelines.

What does a Urologist do?

Urologists are medical doctors who specialize in the male and female genitourinary tract, including the urinary bladder, urethra, kidneys, adrenal glands and male reproductive organs. They often diagnose and treat male fertility, prostate cancer, and receive ongoing training in other medical and surgical problems related to these organs.
Advanced Urology Institute is a center for excellence in urology with board-certified specialists to treat all areas of this field. If you need an appointment with a urologist in Orange City, Florida, our team specializes in:

  • prostate cancer treatment
  • kidney stones
  • problems with the bladder, including overactive bladder
  • prostatitis
  • erectile dysfunction (ED)
  • urinary tract infections
  • general urology
  • and other urology conditions.

Dr. Arash Rafiei, MD is board certified and a member of the American Urological Association, the American College of Surgeons, and the Iranian American Medical Association. For more information, call the office of Dr. Rafiei at (386) 774-2121 or call one of our many Advanced Urology Institute locations. Our doctors will answer your questions and deliver the best service and care based on your needs.

Diagnosing Prostate Cancer

Prostate cancer is the most frequently diagnosed cancer for men, with nearly 10 percent of all men getting it in their senior years. About 99 percent of all prostate cancers occur in men over 50 years old, though younger men should not ignore its risk. While it is one of the most common cancers for men, it also has some of the best survival chances, with over 98 percent of all men diagnosed with prostate cancer surviving at least another five years. This is in part because most prostate cancers grow slowly, and also because there are a lot of simple techniques to notice and diagnose its presence. After diagnosis, there are many effective treatments; however, nearly one out of every 41 men will die from prostate cancer.

Just as women should regularly check their breasts for lumps, men also should check their groin areas. However, that is not commonly taught by most doctors to their male patients, so men should ask their doctors how to do self-examinations.

Other signs that men can check could include any one or more of the following:

  1. The need to urinate more frequently
  2. Difficulty in starting to urinate
  3. Having a weak urine flow (it seems to come out too slow)
  4. Needing to sometimes rush to the toilet
  5. Straining to urinate, feeling one’s bladder has not really emptied
  6. Blood in either your urine or semen (which means something serious!)

A patient with any one of these symptoms should discuss them with his doctor. If a man has more than one of the symptoms for a week or more, he should see a doctor as soon as possible to check on possible causes. There are also more potentially treatable physical problems not related to the prostate gland that might cause those problems. A general practitioner through some simple tests should be able to then know if a urologist would be required.

Those uncomfortable “digital” rectal exams (DRE) men are asked to undergo can also detect prostate cancer, as well as another non-cancerous condition that can cause an enlarged prostate (BPH). If a general practitioner detects something unusual from a DRE that seems to be prostate-related, a prostate-specific antigen (PSA) blood test usually will be ordered. PSA is a prostrate-made substance that will tend to increase when men have cancer, inflammation, or even a simple infection of the prostate gland. Medical specialists will know when the PSA counts require specialists like those at the Advanced Urology Institute to further examine the patient.

A urology clinic can do most, if not all the following tests to determine if prostate cancer is the problem. They can use a transrectal ultrasound to get an ultrasound picture of the prostate gland and surrounding tissues. X-rays can detect if a cancer has potentially spread in a visible way. If the urologists determine there clearly are issues with the prostate, they perform a biopsy to discover the grade of the cancer, to discover how potentially aggressive the cancer is. A transrectal magnetic resonance imaging (MRI) may be required since some types of prostate cancer can spread out of the prostate into surrounding tissues and bones. Bone scans also may be utilized. Genetic tests on the biopsied tissues will help determine how aggressive the cancer may be. The clinic may use other types of exams and tests, depending upon medical findings.

After the urologist has completed the medical evaluations, the chances of recovery, the prognosis, can be discussed with the patient as well as the treatment options. The board-certified specialists at various clinics of the Advanced Urology Institute have years of experience working with patients, giving them the best advice for each of their unique situations. For more information, visit the Advanced Urology Institute website.

What does a physician assistant do According to Janelle Bunce?

KEY TAKEAWAYS:

  • Physician assistants work in all areas of medical practice and are trained to perform diagnostic tests, interpret results, and develop treatment plans under the supervision of a physician.
  • In addition to their clinical roles, physician assistants also educate patients on preventative health, collect patient histories, and assist in surgical procedures.
  • The main purpose of a physician assistant’s job is to lighten a physician’s workload, enabling medical facilities to operate more efficiently and effectively.

Physician assistants, as the name suggests, are professionals whose main job is to assist physicians in their work. They work under the supervision of a qualified and registered physician and even when the physician is not physically present, they are expected to report on their activities to their supervising doctor.

To qualify as a physician assistant, you must obtain a bachelor’s degree with an emphasis on science courses such as anatomy. You need to apply to a Physician Assistant Training Program to obtain a masters degree. The training programs are quite intense, combining theoretical and practical classes in a hospital environment. After completing the training program, the student must pass the Physician Assistant National Certification Examination.

The Role of Physician Assistants.

Janelle Bunce: Physician AssistantPhysician assistants work in all areas of medical practice, from basic primary care to geriatric care, pediatrics, and even emergency medicine. Their roles can be summarized:

1. Studying diagnostic tests and developing basic treatment plans

Physician assistants can perform, order and interpret diagnostic tests. They also are authorized to perform physical tests on patients. Based on the results of the tests, physician assistants can develop a treatment plan but only after consulting with the physician. They are allowed to prescribe medication as part of a treatment plan.

2. Educating patients on preventative health

Physician assistants devote their efforts to educating patients and their families on the steps that can improve disease management and prevent its worsening. They also help by warning and educating people about harmful habits and health hazards.

3. Collecting Patient Histories

When patients go to a facility for the first time, physician assistants interview them to obtain any family history that might have a bearing on the patient’s state of health. Such records are maintained at the hospital and they inform the treatment plan of a patient.

4. Assisting in Surgical Procedures

Some physician assistants focus on being surgical assistants. They perform pre and post surgical roles such as preparing and counseling the patient and monitoring the healing process after surgery.

The essence of a physician assistant’s job is to lighten a physician’s work load. They make sure that the small number of doctors available see as many patients as possible. Physician assistants play a key role that makes them vital to any medical facility’s operation. At the Advanced Urology Institute for instance, every physician is teamed up with one physician assistant to ensure maximum productivity. For more information, visit the Advanced Urology Institute website.

TRANSCRIPTION: 

My name is Janelle Bunce. I’m a physician assistant with Advanced Urology Institute.

There’s a lot of responsibility in the position. We are here to work as a team. I keep telling patients that. I keep reiterating that today. We truly are a team. So if it helps make the physician’s life easier, that’s what we’re here to do. So whether that’s reviewing labs or taking phone calls or rounding at the hospitals in conjunction with them. It’s really to help them be able to have more free time so that they can continue to provide better patient care.

Primarily we work with one physician. So we’re a team of one physician and one advanced practice provider. So we have nurse practitioners and physician assistants. So I work with Dr. Wilkinson. Dr. Wilkinson is a great guy. He is a wonderful physician and we’re able to have a little fun while we work. We spend so much of our time with our work family and he is definitely a fun guy to work with.

REFERENCES: 

What Causes Kidney Stones

Kidneys perform the function of filtering blood to remove waste from it. This waste is mostly water that contains salts such as sodium, calcium and potassium, all collectively referred to as urine. Kidney stones form when these salts are so concentrated in the urine that they crystallize into clumps, that can be as small as a grain of sand or larger.

Ordinarily a kidney stone causes no symptoms until it begins to move in the kidney or to other parts of the urinary system. A small kidney stone can be passed painlessly by urination. Bigger kidney stones, however, can be very painful to pass. But kidney stones are treatable and treatment should help you avoid the painful experience.

Causes of Kidney Stones

Kidney stones result from the clumping together of salts. Most kidney stones are calcium oxalate stones that form from calcium salts and oxalates. Oxalates occur naturally in some fruits, vegetables and nuts. There are also uric acid stones, which form due to lack of fluid in the body or a significant loss of fluid. Risk factors for the formation of kidney stones include:

1. Lack of Water/ Dehydration
This is without a doubt the most common cause of kidney stones. Stones form when urine salts occur in very high amounts in urine. Drinking adequate amounts of water can dilute the urine and reduce the concentration of salts. People in hot areas should take special care to drink a lot of water because they lose a lot of it in perspiration.

Dr. Rolando Rivera 2. High sodium diet
Many kidney stones have an element of calcium. Too much sodium increases the amount of calcium that kidneys have to process, thereby making it more likely for stones to form. Animal proteins such as red meat and shellfish, also have a reputation for making urine acidic, thereby increasing the possibility of having uric acid stones.

3. Personal or family History
A person who comes from a family with a history of having kidney stones is at an increased risk of having them. Similarly, a person who has had kidney stones before is very likely to suffer a recurrence.

4. Digestive illnesses and surgery
Serious inflammations of the digestive system, chronic diarrhea and gastric bypass surgery all can negatively affect the absorption of fluids and calcium by the body. This makes it more likely for the patient to have kidney stones.

Kidney stones are very common despite the fact that they can be prevented by staying hydrated and watching your diet. If you have them, you should consult a doctor immediately so treatment can be administered promptly. The Advanced Urology Institute offers effective treatment for kidney stones. Its staff of specialists are available to help with diagnosis and treatment and can answer any questions about prevention of kidney stones. For more information, visit the Advanced Urology Institute website.

What is the impact of low testosterone on men according to Dr. Samuel Lawindy?

KEY TAKEAWAYS:

  • Low testosterone, or hypogonadism, can lead to reduced sex drive, shrinking testicles, low semen volume, and general fatigue in men.
  • If left untreated, symptoms of low testosterone can increase in severity, potentially causing hair loss, infertility, low bone density, loss of muscle, and weight gain.
  • Regular screening sessions for testosterone levels are important, and men experiencing symptoms should consult a trained urologist for diagnosis and treatment.

Testosterone is the hormone responsible for the development of the male sexual function. Besides being the main force behind a man’s sex drive and production of healthy sperm, testosterone also plays a role in the manufacturing of red blood cells and the distribution of fat in the male body as well as the regulation of muscle mass and bone density.

The production of testosterone drops gradually as men grow older and men over the age of 60 may develop symptoms of low testosterone. There are, however, instances where the production of testosterone slows down and falls below the required levels for reasons other than aging. Such men are said to be suffering from low testosterone. The level of testosterone can be measured through a simple blood test. In a normally functioning male, the level fluctuates between 300 ng/dL to 1000 ng/dL. If the level is below 300 ng/dL, then he may have low testosterone, also called hypogonadism.

Impacts of Low Testosterone on Men

Dr. Samuel Lawindy1. Reduced Sex Drive

A drastic decrease in a man’s urge to have sex may point to low testosterone. Often this will be accompanied by a failure to achieve or maintain an erection, or erectile dysfunction. It is common for men mistakenly to attribute a reduced sex drive to aging. While it is true that the older you are the less interest you may have in sex, this is a gradual process that keeps pace with other bodily changes so when it happens, it is not that much of a surprise. It does not happen abruptly.

2. Shrinking Testicles

Testosterone causes the increase in size of the testicles and the penis during puberty. If the levels go down, it is to be expected that these organs may shrink. The testicles also may feel much softer.

3. Low semen Volume

Testosterone stimulates the production of semen, so low levels of testosterone inhibit the normal production of semen.

4. General Fatigue
Low testosterone levels also may cause a proportionate decrease in energy levels, leading to fatigue. This may be accompanied by a dislike for physical activity and movement.

If left untreated, the symptoms of low testosterone increase in severity and with time may cause hair loss, infertility, low bone density that can develop into osteoporosis, loss of muscle and a marked increase in weight because fat distribution remains unregulated.

The symptoms experienced by patients with low testosterone can mimic symptoms of other conditions. It is therefore necessary for one to undergo diagnostic tests with a trained urologist to determine the cause. Men also should schedule regular screening sessions where their testosterone levels are measured. And it is important to note that hypogonadism is treatable. The Advanced Urology Institute has a highly qualified staff of specialists that can offer a wide variety of treatment options as well as answer any questions. For more information, visit the Advanced Urology Institute website.

TRANSCRIPTION:

So my name is Samuel Lawindy, I’m a board certified urologist at Advanced Urology Institute.
Well low testosterone is a common issue that men may have. It is very important to be evaluated properly for low testosterone. There is a lot of lab values that can be obtained and a lot of information that can be obtained from the proper values and it is important to treat accordingly based on that number.

Not everyone should have testosterone. There are different ways to treat testosterone in regards to treating the hormone that provides testosterone in your body, sometimes blocking the hormone that converts testosterone to estrogen and it’s important to recognize that and treat that accordingly.

Low testosterone symptoms typically include fatigue, low libido, less desire for sex.

You can actually have weight gain, loss of muscle mass and some will actually have decreased outlook in life, somewhat depressed outlook.
Great, they feel wonderful.

If you treat them properly and the testosterone levels come up and they are doing well, tolerating medications well, then they live a normal healthy life.

They just need to be followed again, continually check the testosterone. It’s important to keep checking testosterone and they usually are very happy with the results.

REFERENCES:

Dr. Samuel Lawindy: How Prostate Cancer Is Diagnosed

The prostate gland is the part of the male reproductive system that produces seminal fluid. Prostate cancer is the type of cancer that affects this organ. It is the most common cancer in men, with men over the age of 50 being at the greatest risk. It usually does not manifest symptoms in its initial stages. This is unfortunate because it means prostate cancer may not be detected until it is more advanced. Even when it does present symptoms, they might resemble other conditions such as an enlarged prostate. For this reason, before one concludes that they have prostate cancer, it is necessary that they first undergo the specific tests geared toward detecting it.

Diagnosing Prostate Cancer

There are two preliminary tests for prostate cancer. These are:

1. PSA Test. This tests for an antigen produced by and specific to the prostate. It is normal for the antigen to occur in small quantities. An unusually high level of PSA, however, may indicate the presence of prostate cancer or some other inflammation of the prostate.

Dr. Samuel Lawindy from Daytona Beach, FL2. Digital Rectal Exam. This is very commonly used in prostate screening exercises. The doctor inserts a finger into the rectum and physically examines the prostate. If the doctor detects something unusual in the shape, mass or texture of the prostate, then there may be further tests to determine what the problem is.

The two tests are not conclusive. They simply inform the urologist that something might be wrong and that the patient needs further examination. In order to test for cancer of the prostate specifically, the following procedures may be done after either of the initial tests.

A. A biopsy. A prostate cancer biopsy involves the use of a very fine needle inserted through the rectum to collect tissue from the prostate. The tissue is then tested for cancer.

B. Transrectal ultrasound. The doctor inserts a small probe in the rectum. The probe produces high frequency sounds that bounce off the prostate, producing an image of the prostate that can be projected on a screen and observed in greater detail.

C. MRI Fusion biopsy. This combines an MRI and the transrectal ultrasound to produce a clearer image of the prostate. It gives a better view of the part of the prostate that is affected. If a biopsy is to be performed later, it provides a picture of the precise area where tissue should be tested.

Early detection of prostate cancer improves the chances of successful treatment. It is important for men starting about age 50 to have regular screenings so that any cancer can be detected early. Seek out experienced and certified urologists, such as those on staff at the Advanced Urology Institute, to discuss any concerns and set up screening tests. Such examinations should be a regular part of a man’s health care.
For more information, visit the Advanced Urology Institute website.

Prostate Cancer Recurrence: What Should You Know According to Dr. Jonathan Jay?

KEY TAKEAWAYS:

  • 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

Dr. Jonathan Jay with patientA 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.

REFERENCES: 

Female Pelvic Medicine and Reconstructive Surgery at AUI

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

Dr. Rolando Rivera - Naples, FLReconstructive 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: A Quick and Easy Birth Control

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.

Are Enlarged Prostate and Urinary Problems Common?

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:

  1. Frequent urination
  2. Urgent urination
  3. Nocturia (frequent urination at night)
  4. Trouble starting urination
  5. Weak urine stream
  6. Urine stream that stops and starts
  7. Straining to urinate
  8. Inability to empty bladder completely
  9. Returning to the bathroom to urinate a few minutes after urinating
  10. Dribbling at the end of urination

In rare cases, signs of BPH also may include:

  1. Blood in urine
  2. Inability to urinate
  3. 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:

  1. Offer a long course of antibacterial medication to treat bacterial prostatitis.
  2. Provide medication to improve your urine flow and relieve symptoms.
  3. 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.