Benign prostatic hyperplasia (BPH) is the clinical term for an enlarged prostate. An enlarged prostate presses on the urethra which passes through its middle. This causes difficulties with the passing of urine, such as urine retention, weak urine stream or a frequent and sudden urge to urinate. If left untreated, it may lead to urinary tract infections and bladder complications. Benign Prostatic Hyperplasia is not cancerous and it is normal for men over age 40 to start manifesting symptoms. The condition is highly treatable.
Treatment Options for Benign Prostatic Hyperplasia
The treatment is determined by the age and general health of the patient, the size of the patient’s prostate and the severity of the symptoms. After making an evaluation based on those factors, a urologist will recommend either of the following options:
1. Oral Medication
Mild cases of benign prostate hyperplasia respond extremely well to medication. The available medication falls into two categories. There are alpha blockers that relax bladder and prostate muscles, making urination easier. The other choice may be the 5-alpha reductase inhibitors to prevent hormonal changes that cause prostate enlargement. These work to gradually reduce the size of the prostate. In some cases, a doctor may prescribe both alpha blockers and 5-alpha reductase inhibitors.
2. Minimally invasive Procedures
The variety of treatment options that fall under minimally invasive procedures include:
Laser therapy. This is where a high powered laser beam is used to destroy the excess prostatic tissue.
Transurethral incision. With the help of a lighted scope inserted through the urethra, the surgeon makes two incisions on the prostate to ease the passage of urine.
Transurethral resection. This one is administered in the same way as a transurethral incision, except the surgeon removes the inner tissue of the prostate and leaves just the outer parts.
Prostatic Urethral Lift. This is a relatively new procedure. It involves placing small implants that lift and hold the excess prostatic tissue so it no longer presses on the urethra. This procedure is widely recommended because it eliminates the irritation or discomfort that may be caused by the other procedures that involve laser therapy or cutting tissue away.
Open prostatic surgery. This option is used only where the prostate is very large or the symptoms are extremely severe. It is not commonly done.
When symptoms of benign prostate hyperplasia begin to manifest, a patient should consult a urologist immediately so the condition can be managed well from the outset. There are many platforms for obtaining more information and help, such as the Advanced Urology Institute. At Advanced Urology Institute, a team of experts can help with diagnosis and treatment of benign prostate hyperplasia and answer any questions you may have. For more information, visit the Advanced Urology Institute website.
Erectile dysfunction is the inability to have or maintain an erection firm enough for sexual intercourse. Any man may find himself occasionally unable to achieve an erection. That is normal. It is only when this inability becomes a sustained everyday occurrence that he may consider the possibility of erectile dysfunction.
The main factor for erectile dysfunction is aging, starting about the age of 50. Over 50 percent of men over 50 suffer from erectile dysfunction. Other risk factors include cardiovascular disease, high blood sugar, high blood pressure and high cholesterol levels. Emotional and mental conditions such as depression and anxiety also can cause erectile dysfunction.
Treating Erectile Dysfunction
Men who suffer from erectile dysfunction have a number of treatment options. If it is a symptom of an underlying illness, treatment should be focused on the underlying illness. When erectile dysfunction appears with no underlying cause, the following treatment options are available and are highly successful.
1. Oral Medication. These are pills given to increase blood flow to the penis, thus causing an erection. The most common ones are vardenafil or Levitra, Cialis or tadalafil, viagra and avanafil. Oral medication is most successful in patients with mild cases of erectile dysfunction.
2. Penile injections. The most common injectible drug is alprostadil. Using a very fine needle, a patient injects the drug into the base of the penis. The drug increases the size of the arteries that supply blood to the penis. Alprostadil also can be administered by placing a small alprostadil suppository at the opening of the penis, rather than by injection.
3. Vacuum erection device. This is a tube with a hand or battery powered pump. The tube is placed over the penis and the pump is used to draw air out, creating a vacuum. The vacuum thus draws blood into the penis, causing an erection.
4. Penile implants. A minor surgical procedure is used to introduce bendable rods at the sides of the penis. These rods give the penis a firmness that allows for intercourse. An alternative of the rods is the insertion of fluid filled cylinders connected to a pump placed in the scrotum. Engaging the pump inflates the cylinders which causes the penis to firm up.
It is advisable for men, especially those approaching age 50, to maintain a healthy relationship with a urologist. An experienced urologist can diagnose and offer advice on the best treatment options. It is also important to stay informed on the causes, signs and symptoms of erectile dysfunction. Many professional sites, such as the one maintained by the Advanced Urology Institute, are very helpful. Advanced Urology Institute also has an experienced team of specialists who can help with consultation, diagnosis and treatment. For more information, visit the Advanced Urology Institute website.
Prostate cancer is cancer of the gland that produces seminal fluid for the nourishment of sperm. Some cases are slow developing and do not affect the patient significantly. These can be managed by watchful waiting and constant monitoring. Others are aggressive and must be addressed immediately. As with most cancers, early diagnosis increases the chances of successful treatment.
Developments in the treatment of prostate cancer
1. Multiparametric MRI (MpMRI) in diagnosis
Determining which cancer is life threatening and which one is not is a critical issue. In order to carry out a more efficient diagnosis, doctors now are using an MRI guided biopsy instead of the more traditional transrectal ultrasound guided biopsy. The MpMRI provides better results determining if the prostate is infected and if the cancer has spread outside the prostate. It can help a doctor decide whether or not a patient should undergo a biopsy. And the MpMRI can be used to monitor the cancer growth, making it a very useful tool when watchful waiting is adopted.
2. Use of immunotherapy in treatment
Until recently, it was thought that immunotherapy was ineffective against prostate cancer. Prostate cancer treatment was primarily limited to surgery, hormone therapy and radiotherapy. In recent years, however, researchers have found that immunotherapy, specifically a drug called pembrolizumab, may be effective in treating aggressive cases of prostate cancer that have advanced beyond the other forms of treatment.
3. Robotic surgery
Like most other areas of surgery, the treatment of prostate cancer has benefited from the use of robotic or the da vinci surgical system that is guided by a surgeon operating from a console. Patients who undergo prostatectomy to remove the prostate may avoid open surgery by opting for robotic surgery. Benefits of robotic surgery include reduced bleeding, reduced pain, low risk of post surgery infections and fast recovery rates.
Medical advancements have improved cancer treatment outcomes and changed lives for the better. At Advanced Urology Institute, the team of specialists uses the latest techniques and technology for treating prostate cancer. They are available to offer consultation, diagnosis and treatment best suited for the individual patient.
For more information, visit the Advanced Urology Institute website.
Erectile dysfunction is the inability to achieve or maintain an erection firm enough for sexual intercourse. It is not incidental to aging, though in reality it occurs mostly in men over the age of 40. The causes of erectile dysfunction are varied, and the first step is to establish whether it is caused by an underlying condition. Whatever the cause, however, there are various options when it comes to the treatment of erectile dysfunction.
1. Oral Medication (Pills)
Like many other medical conditions, erectile dysfunction can be treated effectively by taking medicine. Oral medicines for erectile dysfunction fall under a group called phosphodiesterase 5 (PDE 5) inhibitors. They work by preventing the functioning of the enzyme phosphodiesterase type 5 whose job is to control blood flow to the penile arteries. When the enzyme is not functioning, blood vessels relax, allowing blood to reach the penis, therefore causing an erection. The most common PDE 5 inhibitors are:
a. Sildenafil- commonly referred to as Viagra
b. Avanafil – also known as Stendra
c. Tadalafil – also known as Ciaris; and
d. Varednafil- also known as Levitra
Most of these medications are widely available. It is necessary, however, to consult with a urologist before taking any of them. A trained urologist should be able to assess a patient’s condition and advise whether oral medication is likely to work and if so, which of the available medicines is best suited to the patient’s case.
2. Penile implants
For some men, especially those with underlying conditions, oral medication does not work. They may have to resort to other treatment options and the most common of these is the penile implant. This involves a minor surgical procedure and the placing of an implant that causes an erection. There are two choices when it comes to the implant. There is the inflatable implant and the malleable/ semi-rigid implant. Both options have their advantages and disadvantages and the patient will decide based on his circumstances. Overall, however, both implant options report a success rate of over 90 percent.
3. Vascular reconstructive surgery.
Vascular reconstructive surgery involves reconstructing the arteries within the penis to increase blood flow. This last option is neither common nor popular. It is a very difficult, and therefore expensive, procedure. Additionally, it is not always successful and a patient might face the risk of relapse.
It is possible to treat erectile dysfunction. But the right treatment option must be sought for each individual case. It is recommended that anyone experiencing erectile dysfunction should see a urologist. The highly qualified and experienced urologists at Advanced Urology Institute can provide consultation, technology and treatment plans to help patients with erectile dysfunction. Want to find out more about erectile dysfunction? Visit the “Advanced Urology Institute” site.
The da Vinci surgical system is an advanced and effective tool for performing minimally-invasive surgeries. It is a state-of-the-art tool that makes the most of the surgeon’s skill, expertise and experience in conducting urologic procedures. Known as da Vinci because Leonardo da Vinci devised the first robot and used three-dimensional detail and incomparable anatomical accuracy to give life to his masterpieces, the surgical system gives physicians such precision and detail that it effectively simulates an open surgical environment while allowing the use of tiny incisions.
How does the da Vinci system work?
The da Vinci surgery is robot-assisted and minimally-invasive, done via small incisions. The robot’s hands offer a high degree of dexterity, which enables surgeons to operate in the very tight spaces and delicate tissues of the genitourinary tract that otherwise would only be accessed through the longer incisions of open surgery. The da Vinci robot is a self-empowered, computer-controlled device that has been programmed to help in the positioning and maneuvering of surgical instruments. It gives surgeons better precision, flexibility, accuracy and control over surgical procedures.
When using the da Vinci system:
1. The urologist operates from a computer console situated in the operating room, directing and manipulating miniaturized instruments mounted on 3 robotic arms to create small incisions in the patient.
2. During the procedure, the doctor looks through a 3D camera attached to a fourth robotic arm that magnifies the surgical site.
3. The hand, wrist and finger movements of the surgeon are transmitted straight through the computer console and to the instruments attached to the robotic arms, resulting in mimicked movements with the same range of motion as that of the surgeon and allowing maximum control.
4. The robot is supervised by the surgical team at the patient’s bedside.
What are the advantages of the da Vinci surgical system?
1. It ensures that surgeries are more precise by providing better visualization, improved dexterity and greater accuracy.
2. It enables surgeons to conduct complex surgical procedures using tiny incisions.
3. It replicates the surgeon’s technique and movements in real-time, with the surgeon seated just a feet away from the patient viewing an actual image of the operating field while performing the procedure in real-time by manipulating a miniaturized instrument and using tiny incisions.
4. It transmits force feedback sensations from the operating field to the surgeon, which are then used as a substitute for tactile sensations and are augmented by the superior vision offered by the high-resolution 3D view to deliver better visualization, accuracy and precision.
The da Vinci is designed to ensure that both simple and complex procedures are done using incisions of 1-2 cm (also called operating ports), potentially resulting in:
1. Reduced trauma, pain and discomfort to patients
2. Fewer complications
3. Shorter recovery time and quicker return to routine activities
4. Minimal scarring
5. Reduced blood loss and need for transfusions
6. Minimal hospitalization costs
At Advanced Urology Institute, we have incorporated the da Vinci surgical system into our practice. Over the years, we have been able to use the increased range of motion, improved visualization, enhanced dexterity and greater surgical precision offered by the robotic system to deliver improved treatment outcomes to our patients. We are also proud of the skilled and experienced professionals at AUI whose training, fortitude, passion and expertise in the use of advanced technologies have enabled us to provide the best possible care to our patients. For more information on our services, visit the “Advanced Urology Institute” site.
If you suspect that you have erectile dysfunction, you need to talk to your doctor about it. Then you can work with the doctor to determine the underlying factor or cause of the condition. Actually, ED can only be effectively treated if what is causing it is known. In fact, you may find that your condition improves with only simple lifestyle changes, such as losing weight, quitting smoking or drinking less alcohol. And if it is a medication you’re taking that is causing the problem, your doctor may treat the condition by reducing the dosage or having you try another drug.The treatment options for ED include lifestyle changes, counseling, medications, penile injections, vacuum pumps and surgery.
1. Lifestyle changes
Making lifestyle changes can reduce the severity or improve erectile dysfunction. Some of the changes are:
a. Quitting smoking
b. Stopping or reducing alcohol consumption
c. Increasing physical activity or exercise
d. Cutting down body weight
e. Stopping the use of illegal drugs
2. Seeing a counselor
Your urologist may recommend that you see a counselor if your erectile dysfunction is worsened by psychological or emotional issues. In many cases, counselors require that you go with your partner to the counseling sessions so she can know how best to support you. And as you work on the anxiety and stress issues with your counselor, your urologist will be focused on treating any underlying physical issues. Usually only a handful of sessions with the counselor will be enough for you to overcome ED.
3. Medication
The first treatment that your urologist will offer to treat ED is oral pills. Common oral medications for ED include:
a. Sildenafil (Viagra)
b. Tadalafil (Cialis)
c. Vardenafil (Levitra or Staxyn)
d. Avanafil (Stendra).
These medicines work by relaxing your smooth muscles and increasing blood supply to the penis following sexual stimulation. You’ll be required to take them anywhere from 15 minutes to 36 hours before sex, depending on the particular drug your doctor has prescribed. Vardenafil (Staxyn) dissolves in the mouth, but the other pills are swallowed. However, you aren’t allowed to take any of these drugs more than once per day. The drugs are effective in about 80 percent of men who use them, although if you have an erection that lasts beyond 4 hours, you should seek emergency medical help.
You should not take these medicines as treatment for ED if you are already taking nitrates for a heart disorder. Since nitrates also relax and widen blood vessels, their combination with these drugs leads to a sudden reduction of your blood pressure, which may cause falling, fainting or dizziness and possible injuries. Likewise, if you are already taking drugs to treat enlarged prostate (BPH), inform your doctor about them. A combination of BPH medications called alpha-blockers with ED medicines also may result in sudden reduction of your blood pressure.
In case your erectile dysfunction is due to low testosterone levels, the urologist may prescribe testosterone. However, testosterone therapy won’t work for you if you have nerve or circulatory problems. So you must be very open with your urologist about your other medical problems before you are given any medications.
4. Penile injections
Injecting the penis with a drug called alprostadil can trigger a stronger and firmer erection. While oral medications are able to cause an erection after sexual stimulation, you can’t get an automatic erection with them. That’s why your doctor may at times opt for injecting a drug into the penis to ensure you achieve erection automatically even without sexual stimulation.
5. Vacuum constriction devices (pumps)
Vacuum pumps pull blood into the penis, resulting in an erection. A typical vacuum device is an external pump supplied with a band that you can use to achieve and maintain an erection. According to several studies, up to 50-80 percent of men who have used vacuum erection devices are pleased with the results.
A vacuum device has three components:
a. A plastic tube (cylinder), which you place toward the end of your penis.
b. A pump, which drives out air from the tube in order to create a vacuum.
c. An elastic ring (band), which you place on the cylinder, on the other end applied to your body, and then move it from the tube to the penis in order to maintain erection.
To use the vacuum erection device, you place the pump over your penis and pump out air from the tube (cylinder) to create a vacuum. The vacuum then pulls blood into the penis’ shaft and makes the penis longer and firmer. Once the penis is erect, and with the help of a lubricant, you slide the retaining band downward onto the lower end of your penis. You also remove the pump once you have released the vacuum.
The elastic ring sustains the erection by stopping blood from moving back into the body during intercourse. So you can only attempt intercourse with the elastic ring in place. And the ring can be left in place for about 30 minutes to enable successful intercourse.
6. Penile prosthesis (Penile implant surgery)
Another option for treating ED is penile prosthesis in which your urologist performs an operation to implant either a malleable (bendable) device or inflatable device into your penis. A penile implant surgery is preferred when you have an obvious medical condition that is causing the ED and the urologist is sure that your condition won’t resolve naturally or with medications.
Usually, the simplest form of penile prosthesis is surgical implantation of malleable rods inside the erection chambers of your penis. Once implanted, the rods ensure that your penis is maintained in semi-rigid state and just requires lifting or adjusting to erect position for sexual intercourse. Malleable rods are a good option if you’ve had spinal injury or have limited hand strength.
Alternatively, your doctor may go for a hydraulic, inflatable implant. With this prosthesis, you can choose to get an erection when you need to. Inflatable implants increase the size of the penis through a pump that’s located in the scrotum. The advantage of an inflatable implant over malleable rods is that the erection is more natural and easier to conceal than one achieved with malleable rods.
Penile implant surgery takes about one hour to complete and is usually performed in an outpatient setting. Following penile implant surgery, you’ll be able to leave the hospital the same day after surgery and can resume sexual intercourse 4-6 weeks after the procedure.
Artery reconstruction is often a last resort treatment for ED because the procedure is costly, technically difficult and does not usually work. But the aim of the procedure, when recommended, is to boost blood flow in your penis and help you achieve an erection. During the operation, the urologist transfers an artery in another part of your body (usually from a muscle in the belly) to one in your penis, creating a path for blood to move around the blocked (affected) area. The procedure is only rarely considered, but may be an option for men younger than 30 who have ED because of injuries to their penis or the area around it.
Want to find out more about erectile dysfunction? Visit the “Advanced Urology Institute” site.
Dr. Jonathan Jay’s path to urology began with a background in physiology, medicine, residency training, and fellowship training before becoming a board-certified urologist.
A proficient urologist requires not only a deep understanding of medicine but also emotional intelligence, honesty, empathy, and compassion to effectively treat and support patients with a variety of urological conditions.
Dr. Jay chose to practice at Advanced Urology Institute (AUI) due to its centralized administrative tasks, access to cutting-edge surgical and medical equipment, collaborative and multidisciplinary approach to patient care, and friendly working environment.
Urology is a fascinating, stimulating and satisfying field of medicine. As urologists, we treat conditions of the urinary tract in both men and women, together with disorders of the male reproductive system. Being a urologist is an opportunity to care for people with agonizing, embarrassing and life-threatening conditions, such as kidney stones, urinary incontinence, erectile dysfunction, and genitourinary cancers, restoring normalcy in their lives. For those like me who are passionate about saving and improving lives, urology is a worthwhile career. For me, every day spent with my patients is not only an opportunity to serve and help people, but also contribute to saving or extending lives. In turn, the positive outcomes from various interventions bring joy and satisfaction.
Why urology?
Well, mine is a funny story. Growing up in Lansing, Mi., with both my parents having PHDs — my mother working at the Lansing School District and my father being a Michigan University professor — I learned to be inquisitive from a very early age. Being educators, my parents always encouraged me to be curious; to try to understand how various things worked. Eventually I became profoundly curious about how my body works and searched for answers wherever I could find them. As a result, I ended up studying physiology, then medicine, and ultimately specializing in urology.
Path to urology
My curiosity led me to study physiology — the study of how the body works — to learn more about the body. So I attended Michigan State University to pursue a Bachelor of Science degree in physiology. As I was studying physiology, I became interested in medicine. Upon graduation, I went to Ann Arbor, University of Michigan for my medical education. After that, I moved to Henry Ford Hospital for my residency training before going to and completing my fellowship training at the Beth Israel Deaconess Medical Center.
During clinical rotations in medical school I came across urology. I actually did not know anything about urology until my classmates at medical school told me about it. They really took me under their wings like a little brother. And because they liked me and I liked them, we were able to speak freely about our career aspirations and interests. So when they recommended that I study urology, telling me repeatedly that I had to try urology —”stay here and be a urologist’ — I gave it a shot and here I am, a board-certified urologist.
What does it take to be a urologist?
As urologists, we see the whole spectrum of age groups — from newborns to elderly patients. For instance, we can see children with congenital problems and care for geriatric patients with bladder control problems, sexual dysfunction or benign prostatic enlargement. So we delve into deeply emotional problems that require empathy, support and effective solutions.
That is why to be a good urologist, you need not only to understand medicine very well and be able to offer effective treatments, but you also must have emotional intelligence. That is, you need to know what to say, why to say it, when to say it and how to say it, and to treat patients as human beings, handling them in a warm, friendly and respectful manner. Actually, honesty, empathy and compassion are the marks of a proficient urologist.
Areas of expertise
I have practiced urology for several years now, seeing patients for a broad range of issues. Frequently I treat patients with enlarged prostate, urinary stones, urinary incontinence, prostatitis, testicular pain, recurrent urinary tract infections, urologic cancers and erectile dysfunction. But my areas of special interest include voiding dysfunction, pelvic floor reconstruction, urinary incontinence, female urology, urodynamics, and urogenital disorders triggered by neurologic disorders.
Over the years, I have performed pelvic floor reconstruction surgeries in both men and women, neuromodulation, surgery for bladder dysfunction, MonaLisa Touch laser procedure for post-menopausal sexual and urinary symptoms, Botox (botulinum toxin) injections, UroLift System procedure for BPH, and da Vinci robotic treatment for post-menopausal sexual and urinary symptoms. I also keep improving my knowledge and refining my skills through continuous medical education, training and research. I understand that I can only deliver the best to my patients when I have the right skills, tools and methods.
Job satisfaction
Urology is about providing relief to people with troubling and humiliating conditions. Patients come to us when they are at some of the lowest moments of their lives and we are able to address their issues and see them restored to normal lives again. Something unique about urology is that the problems we handle are often clearly defined, which means that almost every time a patient presents with a urological condition, we are able to pinpoint the exact etiology and extent of defect and then provide an effective solution.
Therefore, we are able to achieve great outcomes for almost all our patients. In fact, unlike other specialties such as neurology and oncology, the majority of our patients get better and do well after interacting with us. And with this understanding that we can solve many — if not most — of the urologic issues of our patients, we really feel satisfied with our work. And since we are able to achieve great results for our patients, they are always grateful and hold us in high esteem. So with urology, we are largely contented and happy about the work we do.
Why Advanced Urology Institute?
Urologists need a working environment that can bring out the best of their knowledge, skills and talents. For me, that dream place is Advanced Urology Institute. At AUI, all administrative tasks are centralized to ensure that physicians find enough time to deliver the best possible care. Urologists also have access to cutting-edge surgical and medical equipment and are able to apply the latest methods and techniques as soon as they are available.
Urologists at AUI work under a thriving culture of compassionate, collaborative and multidisciplinary approach to patient care, which enables frequent cooperation with other board-certified, skilled and experienced medical professionals. To crown it all, AUI clinics are always warm, friendly and buzzing with colleagues sharing stories, cracking jokes and interacting freely. It is always a wonderful experience being at AUI and I really feel privileged being part of the team.
Want to know more about AUI and the services we offer? Find out more by visiting the “Advanced Urology Institute” site.
TRANSCRIPTION:
I’m Jonathan Jay, I’m a board-certified urologist with Advanced Urology Institute.
Funny story, I just had a curiosity about how my body worked, so that led me into physiology because that was a study of how your body really works and then with time that just led into medicine.
Lansing Michigan, my family and my parents were educators, both PhDs, my mother working in Lansing School District, my father worked for Michigan State University as a professor.
Interesting enough, education was important in my family. I always had a curiosity about learning and understanding things, so that’s what they gave me, they gave me a curiosity of trying to understand things.
It’s funny, urology came about by a rotation through medical school, all the medical school students said, hey you got to try urology, they let the medical school, medical students close the wounds, that’s a pretty rare thing.
So all the guys were very nice, these guys took me under their wing like a little brother and so with that they said, hey why don’t you, they liked me, I liked them, they said why don’t you stay here and be a urologist.
Now urology was something that I never even knew existed, in fact they gave a lecture in the second year of medical school, I said who would want to do that, that is the grossest thing I’ve ever seen, but here I am being a urologist all because of a great experience that people provided me, took me under their wing like a little brother. So for me, I always felt like being a doctor you had to have four qualities. The first quality you had to have is you had to understand medicine. You don’t have to be the valedictorian of the class, but you got to understand medicine fairly well.
The next thing you have to have is stellar social intelligence. You got to be able to talk to a human being like a human being, be able to read social cues, know what to say, when to say and how to say it. Then above all you have to care and have empathy for another human being. You have to have all four of those qualities.
The inability to start or maintain urine flow, causing dribbling or weak urine flow, is called urinary hesitancy. It can occur at any age for all genders, but it is by far most common among aging men. Urinary hesitancy develops gradually but if left untreated, it can lead to a complete inability to pass urine, also known as urine retention. Due to its prevalence among older men, weak urine flow has always been associated with an enlarged prostate gland, a condition very common in older men. This, however, is not the only cause of a weak urine flow.
Causes of a weak Urine Flow
1. Benign Prostate Hyperplasia (BPH)
Benign prostate hyperplasia is the medical term for an enlarged prostate. As a man ages, the prostate grows to a size larger than what is normal. The prostate’s location around the tip of the urethra means that the enlarged prostate presses on the urethra and blocks the passage of urine. This whole or partial obstruction slows down the flow of urine. BPH is the main cause of a weak urine flow in men over the age of 45.
2. Underactive Bladder (UAB)
An underactive bladder is a medical condition characterized by weak urine flow and an inability to empty the bladder completely. The condition is best understood as the opposite of the overactive bladder (OAB) which has received wider attention and is known to cause urinary incontinence, the urgent and frequent urges to urinate. Patients suffering from an underactive bladder have a diminished sense of when their bladder is full and are not able to contract the bladder fully. The condition can occur when there is damage to the bladder peripheral pathways or to the lumbosacral spinal cord. It is also common in patients suffering from diabetes mellitus, neurological diseases, Parkinson’s disease and pelvic fractures.
3. Bladder Outlet Obstruction (BOO)
As the name suggests, this is a condition that occurs when there is a blockage at the neck or the base of the bladder. The blockage completely prevents or reduces urine flow from the bladder. It occurs in both women and men, but is more common in older men. It can be caused by bladder stones, scar tissue in the urethra, bladder cancer or an enlarged prostate.
It is clear that weak urine flow has a variety of causes. It is very important to see a urologist to determine the exact cause of a weak flow. An appropriate plan of treatment can be set up once it has been determined what is creating the problem. It is recommended that you consider seeking out trained, experienced and board approved urologists if you are having problems with weak urine flow.
At AUI, we offer patient-friendly and multidisciplinary urology services for a wide range of problems, including weak urine flow. For more information, visit the “Advanced Urology Institute” site.
For more information, visit the “Advanced Urology Institute” website.
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
A 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.
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.
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.
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 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.
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 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:
The following are possible risks associated with the Robotic Assisted Laparoscopic-Radical Prostatectomy, although they are very unlikely:
Damage to adjacent tissue or organ
Infection of surgical site
Bleeding
Laparoscopic Radical Prostatectomy:
As with all surgical methods, the robotic-assisted radical prostatectomy has a number of potential side effects, which include:
Urinary incontinence or inability to control urine. However, this problem will reduce over time.
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.
My curiosity led me to study physiology — the study of how the body works — to learn more about the body. So I attended Michigan State University to pursue a Bachelor of Science degree in physiology. As I was studying physiology, I became interested in medicine. Upon graduation, I went to Ann Arbor, University of Michigan for my medical education. After that, I moved to Henry Ford Hospital for my residency training before going to and completing my fellowship training at the Beth Israel Deaconess Medical Center.
An 
A urologist can prescribe medication to reduce the symptoms of an enlarged prostate and also to control the enlargement. The available medications include:
