Becoming a Urologist with Dr. Rishi Modh

Being a urologist is an opportunity to help people and make a difference in their lives. As a urologist, people come to you with sensitive and often awkward conditions of the genitourinary tract and you assess the problems and provide the most appropriate remedies. The goal of urologists is always to make interventions that ensure patients are able to live fuller lives. And that makes us proud of our work and of our unique place in the medical profession.

Urology — a big world of stuff

Many people think of urology as merely being about urine. But urology is a massive world that covers a wide range of stuff. It’s an amazing and exciting specialty, where you perform surgery, manage problems medically, develop enduring relationships with patients and go home every day feeling satisfied with your work. I like urology because I’m often able to see the results of my work. For example, when patients come with urological cancers — of the prostate or kidney — I am often able to make effective interventions and achieve great outcomes. Actually, almost all my operations usually result in improved quality of life.

Why urology?

Urology was a natural fit for me. I wanted to be involved in diagnosis, medical management and surgical procedures. With most of my cases I have found that wonderful balance of medicine and surgery in urology. I also like listening and talking to people, leading them to open up and share their problems, guiding them to see the bigger picture and helping them to make informed decisions. In urology, I’m able to do this and much more with my patients. Most crucially, I joined urology to have a chance to make a difference in people’s lives. And indeed, I have found the specialty well-rounded, fascinating and exciting, as well as a powerful instrument for improving people’s lives.

Path to urology

I was born and grew up in Tampa, Florida, where my passion for the health and well-being of the people around me and for public health and sanitation made me a volunteer in many causes right from a young age. I soon realized that pursuing medicine would help me to make a better contribution in health care and improve people’s lives. So I joined the University of Miami for my medical education, graduating with AOA honors. Then I went to Shands Hospital, University of Florida for my urology residency. Currently I am happy and proud to be back in Florida where I’m practicing and living the dream of my life — making a difference in people’s lives.

Areas of expertise

As a urologist, I routinely deal with a wide variety of issues, such as urinary tract infections, overactive bladder, urinary incontinence, low testosterone and prostate enlargement. I also offer procedures for kidney transplants, interstitial cystitis, prostatitis, overactive bladder, congenital abnormalities, urinary stones, correcting stress incontinence, operating on adrenal glands and treating bladder, prostate and kidney cancer. I provide vasectomies, vasectomy reversals and treat erectile dysfunction and infertility issues in men.

What makes urology even more interesting is the continuous integration of advanced technology. Today we can access the urethra via the bladder and get into the kidneys without making any incisions. Even operations to remove kidneys or prostates, which previously required open surgery, are now routinely performed robotically or laparoscopically — using tiny, image-guided instruments.

At Advanced Urology Institute where we use the da Vinci surgical system for several operations, a urologist can now just sit at a console, have fingers in sensors and remotely control a multi-armed robotic surgeon, which ensures access to more areas in the body and provides seamless movement during operation in ways that are impossible laparoscopically. Application of such technology guarantees less scarring, less blood loss and quicker recovery for our patients. And for the urologist, it’s always exciting in the operating room working with such technology.

Job satisfaction

It takes long and hard training to become a urologist. The residencies take 5-6 years and typically involve long hours of complex work and limited sleep. Then there are several hours per week spent in the operating room, which may test anyone’s tenacity and patience. However, it helps that urologists are generally professionals with a positive attitude, good bedside manners and vast empathy. So these challenges can hardly diminish our enthusiasm and commitment to urology.

As a urologist, you are always conducting tests and procedures that may be quite uncomfortable for your patients, delivering news about diagnoses that your patients may not want to hear, and facing medical emergencies requiring you to think on your feet and solve issues to the best of your ability. But with skills to communicate well, eyes for detail and unquenchable desire to help people, you’ll always find yourself on top of things.

I really like urology because I’m a hands-on person who enjoys the hours it offers in the operating room. There are many potential conditions to treat, a wide range of procedures to perform and different tools to use —so no two days are the same. From a vasectomy to vasectomy reversal, circumcision to delivering antibiotics for urinary tract infections, laser surgery to robot-assisted procedures, there’s a lot to keep a urologist engaged and involved.

Urologists also are at the forefront of advanced technology, having pioneered laparoscopic approaches that have been adopted by other medical specialties and now leading the way in the use of cutting-edge robotics. The field is ever growing and changing, and we are constantly researching, learning and innovating to perform our duties better.

Most essentially, urology allows you to build lasting relationships and make a difference in people’s lives. I follow my patients over time, getting to know how they are doing and helping them make informed decisions. I enjoy what I do because I’m always involved in improving, prolonging and saving lives.

Why Advanced Urology Institute?

Advanced Urology Institute stands out for its commitment to excellent urological care. By bringing together a huge number of driven, hard-working, experienced and certified professionals, and having them adopt a collaborative, multidisciplinary patient-centered approach to care, AUI not only gives urologists an opportunity to grow, but also offers them a working environment that brings out the best of their knowledge, skills and experiences. I like the fact that all administrative duties have been centralized and we have all the time we need to work with our patients and give our best.

It’s also good that colleagues at AUI are quite laid back, funny and relaxed people. We are serious about our work but we also enjoy jokes with each other and maintain a positive, friendly practice. It’s a fantastic place full of people who love what they do and who handle diverse issues and patients with utmost diligence and thoroughness. And because we love our job, we work harder to get better at it and to achieve great outcomes for our patients. For more information on our urological services, visit the “Advanced Urology Institute” site.

Options for Treating Benign Prostatic Hyperplasia

The prostate is a tiny gland situated between the bladder and the penis. But as men get older, the gland grows larger, putting pressure on the urethra and bladder and causing urinary problems. An enlarged prostate is medically called benign prostatic hyperplasia (or BPH), a condition that’s quite common in older men. In the U.S. around 50 percent of men 51-60 years old have BPH while up to 90 percent of men over age 80 are affected by the condition.

The common symptoms of an enlarged prostate are:

  1. Inability to delay urination.
  2. Urge to urinate more than 8 times a day.
  3. Frequently waking up at night to pass urine.
  4. Dribbling after urinating.
  5. Urinary incontinence (urinating accidentally).
  6. Inability to completely empty the bladder (urinary retention).
  7. Having intermittent or weak urine stream.
  8. Straining to pass urine or difficulty starting urination.

So what are the options for treating BPH?

As urologists, the first thing we do when a patient has symptoms is to rule out other possible problems. We talk with our patients to learn the nature and severity of their symptoms, conduct exams, do ultrasound and relevant tests. Once it’s confirmed that it is BPH, we begin treatment starting with the least invasive procedures. Treatment options for BPH include medication, minimally invasive procedures and surgery, although various lifestyle changes also can improve or prevent symptoms.

1. Medications

The urologist may recommend medication to help control prostatic growth and reduce symptoms. For instance, alpha blockers such as alfuzosin (Uroxatral), silodosin (Rapaflo), doxazosin (Cardura), tamsulosin (Flomax) and terazosin (Hytrin) may be used to relax prostate muscles and make it easier to urinate. They quickly increase urine flow and reduce the need to urinate frequently. Another type of medication that may be prescribed is 5-alpha-reductase inhibitors, such as finasteride (Proscar) and dutasteride (Avodart), which limit the growth of the prostate by blocking hormones that promote growth of the gland. It generally takes 3-6 months for 5-alpha reductase inhibitors to relieve symptoms.

Phosphodiesterase-5 (PDE5) inhibitors such as Sildenafil, (Viagra), Tadalfil (Cialis) and Vardenafil (Levitra) may be given to help relax urinary tract muscles and relieve BPH symptoms. However, in some cases, particularly when either a 5-alpha reductase inhibitor or an alpha blocker isn’t effective on its own, urologists may give a combination therapy. This typically involves a combination of a 5-alpha reductase inhibitor and an alpha blocker and usually results in greater symptom relief.

2. Minimally invasive procedures

When medications fail to relieve BPH symptoms, the next step in treatment usually involves minimally invasive interventions. During the procedure, a urologist inserts an instrument into the rectum or urethra to either widen the urethra or destroy excess prostate tissue. For instance, TUMT (Transurethral Microwave Thermotherapy) uses microwaves to heat and destroy excess prostate tissue. TUMT does not cure BPH but makes it easier to pass urine, cuts down urinary frequency and reduces weak flow. Another treatment, TUNA (Transurethral Needle Ablation), uses high-frequency radio waves that are delivered via twin needles to burn a specific area of the prostate. TUNA is an outpatient procedure that relieves BPH symptoms and improves urine flow.

A third minimally invasive option for BPH is water-induced thermotherapy. During the treatment, hot water delivered through a catheter and into a treatment balloon located at the center of the prostate is used to heat up a definite area of the prostate and destroy problematic tissue. Once destroyed, the excess tissue is either reabsorbed in the body or excreted through urine. Another minimally invasive treatment option is the Urolift procedure, which involves inserting small implants into the prostate to retract, hold and lift the enlarged prostate tissue, opening up the passage for urine and relieving bladder blockage. While the Urolift procedure does not involve heating, cutting or removing the excess prostate tissue, it is effective in restoring normal flow of urine and relieving symptoms, and patients usually return home the same day without a catheter.

A revolutionary minimally invasive procedure for treating BPH is the Rezum system. During the treatment, sterile water vapor is injected into the prostate to help destroy overgrown tissue. It takes roughly three months for the body’s healing mechanisms to remove dead prostate cells and shrink the prostate, opening the passage for urine to flow. The Rezum procedure improves urine flow and relieves symptoms without the adverse effect of erectile dysfunction. It’s an ideal option for men who are medically unfit for the other procedures or for those already catheterized.

For prostates that have grown larger than 100 grams, a procedure called aquablation is a good option. It uses a high velocity saline jet to remove the overgrown prostate tissue. After the treatment is planned, the procedure is robotically driven, so its duration and side effects do not depend on prostate size. It does not use heat and postoperative bleeding is prevented by inserting a large catheter and applying a bladder washout (irrigation). The results achieved through aquablation are similar to TURP, except it comes with less dysuria and minimal irritation symptoms because no heat is used.

3. Surgical procedures for treating BPH

If both medication and minimally invasive procedures fail to improve BPH symptoms sufficiently, the urologist may recommend surgery. Surgical interventions also may be necessary if complications develop or symptoms become severe. The most common type of invasive surgery for BPH is TURP (Transurethral Resection of Prostate). In fact, it’s the first surgical option for treating BPH and involves the removal of excess prostate tissue by inserting a resectoscope through the urethra and into the prostate. Or the urologist can opt for TUIP (Transurethral Incision of Prostate) that involves making incisions in the bladder’s neck and into the prostate. The operation is done to widen the urethra and boost urine flow.

In other cases, the urologist may choose to perform laser surgery. This surgical procedure involves inserting a scope into the urethra and using the scope to deliver laser to the prostate tissue. The laser treats enlarged prostate through either enucleation (cutting) or ablation (melting). Both the GreenLight Laser PVP and Holmium laser ablation of prostate (HoLAP) procedures remove the excess prostate tissue by photoselective vaporization while holmium laser enucleation of prostate (HoLEP) uses two instruments, a laser for cutting and removing excess tissue and a morcellator for slicing extra tissue into tiny fragments for removal.

In complicated cases of BPH, such as men with much enlarged prostates or those with bladder damage, urologists may opt for open surgery. During an open simple prostatectomy, the urologist makes an incision just below the navel or numerous small incisions in the abdominal area via laparoscopy. The surgeon then removes the portion of the prostate that’s blocking urine flow.

At Advanced Urology Institute, our choice of treatment usually comes down to patient preferences and their ability to cope with BPH symptoms. We often prefer the least invasive options and give medication in many cases, but other treatment options are considered for patients who aren’t responding well to drugs or who can’t tolerate the adverse effects. As an alternative to TURP and open surgery, we prefer to treat BPH that’s characterized by acute urinary retention, high post-residual volume, recurrent urinary tract infections or bladder stones through the GreenLight Laser PVP or the newer heat treatments like TUNA and microwave. For more information on treatment options for BPH, visit the “Advanced Urology Institute” site.

Becoming a Urologist with Dr. Sean Heron

If I had to do it again, I would still happily choose urology. I really love urology and I’m always excited about the opportunity it offers to listen to people talk about distressing conditions, detect life-threatening conditions and make interventions that improve their lives. For me, the honor of being relied upon to offer advice, the awe of discovering problems in the genitourinary tract, the chance to provide life-improving and life-saving treatments, and the gratitude that comes with helping people through difficult illness — these things just never cease to motivate me. So even in my most stressful work days — when crushed by unbearable time constraints or enormous pressure — I have never felt anything like a drop in my passion for urology.

Why urology?

Ever since I was a child, I wanted to be a doctor. My mother, who was a teacher, realized this early and encouraged me to work hard in school to fulfill my dream. I went to Denison University for my undergraduate studies, then to Ohio State University for my medical degree, graduating in 1989. In medical school, I wasn’t really sure which field of medicine I wanted to specialize. In those days, the first two years of medical school were dedicated to intensive classwork and then in the third year we would go for clinical rotation.

When I went for my rotations, my first area was nephrology, medical care for kidneys. It was quite depressing working with patients with kidney problems and those under dialysis. I couldn’t figure out why patients who were not doing well were discharged to go home only to be back in the hospital the next day. This early experience shaped my attitude toward urology and at this stage, I felt strongly that I would never be a urologist.

We had eight choices as electives, including urology, but I didn’t want to work with kidneys and tried to avoid urology. However, as things turned out, I ended up picking urology. My eureka moment came when I watched from a side view as the prostate was being cut by a urologist. As the procedure went on before my eyes, I immediately changed my mind about urology.

That was my first real experience with urological surgery and it inspired my career choice and my lifelong commitment to the field. I completed a six-year urology and surgery residency at Emory University, Atlanta, Ga., and soon became a certified urologist by American Board of Urology. And even though I heard people say that urology was boring, I have found it fun and fascinating.

Areas of expertise

As a urologist, I offer diagnosis, treatment and follow-up care for a broad range of urological ailments and associated emotional issues. I routinely provide medical and surgical treatments for conditions such as kidney stones, urinary incontinence, erectile dysfunction, male infertility, pelvic pain, urologic cancers and genitourinary tract injuries. But I also perform specialized laparoscopic, laser and robotic procedures for various conditions, such as laser enucleation and laser vaporization for prostatic problems, steam ablation (Rezum) of the prostate, da Vinci robot-assisted surgery for prostate and kidney issues and high-intensity focused ultrasound for prostate cancer. Most importantly, I believe that every patient has unique needs that must be fully understood by the urologist before treatment can commence. So I always make sure to take into account all the needs, concerns and presenting factors of every patient and to provide tailored treatments that meet the specific needs of individual patients.

Job satisfaction

Urologists manage genitourinary tract disorders medically and surgically, taking care of their patients from start to finish. The ability to fix urologic disorders, see the lives of your patients improve, have them enjoy life much better and establish enduring relationships with them is quite satisfying. Likewise, the chance to use some of the latest and most innovative technology, including scopes, lasers and robots for complex urology procedures makes the field continually interesting. Even though urology is a surgical subspecialty, we have far better working hours than in general surgery. There are much fewer urological emergencies and rarely are there painful trauma situations to handle, so urologists have more control over their work schedule and better control over their lives. While urology residency is quite grueling, it isn’t nearly as bad as general surgery residency. With urology you get a good mix of surgery and medicine and enjoy better working conditions and great outcomes, all of which makes it quite fulfilling.

Why Advanced Urology Institute?

When I was choosing urology, there were people around me who thought it was a boring field of medicine. So for me, the inspiration to join the specialty was not enough. I also wanted a practice that would make urology exciting and fun. Luckily I found that in Advanced Urology Institute. I joined AUI’s Pinellas Urology in 1995 and quickly found its collaborative, multidisciplinary and patient-centered approach to care useful in bringing out the best of my skills, knowledge and experiences. And with all administrative work centralized at AUI, there are no bothersome phone calls, electronic documentation, paperwork, quality assurance measures and insurance forms for me to deal with. That makes it easier for me to concentrate on providing the best possible care to my patients. So even if I can’t always guarantee that I’ll make my patients better, I have all the time to work out the best possible remedies for their conditions. For more information on urology and urological services offered by AUI, visit the “Advanced Urology Institute” site.

Advantages and Disadvantages of Robotic Technology in Urology

Robot-assisted (robotic) surgery uses small instruments attached to a robot’s arm to conduct surgical procedures. A qualified, highly-skilled surgeon controls the robotic arm, using it to enhance surgical precision. In fact, contrary to popular beliefs, it’s the surgeon behind the robot and not the robot itself that performs the procedure. The robot improves surgical outcomes and boosts patient safety by enabling the surgeon to use very tiny incisions and to achieve unmatched precision.

Robotic surgery in urology

Robot-assisted surgery has become very popular in urology, particularly in the United States. In urology centers where it is used, it’s extensively applied in surgery to excise prostate cancer as it enables access to anatomical areas that are difficult to reach. Other urologists use it for kidney cancer surgeries and to some extent in bladder surgeries. Through robot-assisted procedures, urologists are able to use the surgical assistance, enhanced precision, systems networking, dexterity and image-guidance made possible with robots. Urologists are able to easily perform complex procedures that are often difficult to do using conventional laparoscopy.

Pre-operation discussion

While robotics are excellent tools that improve the outcome of surgical procedures, they are not ideal for every situation. The need and value of robot-assisted surgery varies from case to case and it’s important to discuss this with your urologist before undergoing surgery. Being clearly informed of the benefits and risks associated with robotic surgery ensures that you can make an informed decision before the procedure.

Advantages of robot-assisted surgery

Robotic surgery is typically minimally invasive. So the patient suffers less pain, slight blood loss and minimal scarring, and requires only a short recovery time. With the robotic arm eliminating the natural limits of human wrists, surgery can be performed with more delicate, precise and efficient movements. The 3D imaging and endowrist technology of robots ensure surgery is more accurate, nerve bundles are dissected more precisely, erectile function is preserved, and there is a better chance of cure than with non-robotic surgery. The surgeon also enjoys more strength, dexterity, flexibility, control and a better view of the operated area. Robotic surgery allows the surgeon to get more comfortable, perform the procedure with increased concentration and focus, and can undertake complex procedures that are tougher or impossible with other techniques.

Disadvantages of robot-assisted surgery

With robot-assisted surgery, there is not only the risk of human error when operating the robotic system, but also the potential for mechanical failure. For instance, system components such as robotic arms, camera, robotic tower, binocular lenses and instruments can fail. In other cases, the electrical current in the robotic instrument can leave the robotic arm and be misapplied to surrounding tissues, resulting in accidental burn injuries. Likewise, robot-assisted surgery can cause nerve palsies due to extreme body positioning or direct nerve compression that may occur when using robots. It also takes longer to perform robotic surgery than non-robotic surgery in surgical centers with lower robotic volume or by less experienced surgeons.

Ways of improving robot-assisted surgery

It’s important that centers applying robotics follow standardized training, improved reporting and enhanced patient education to reduce errors related to robotic surgery. Robotic surgery should be conducted by urologic surgeons trained in robotics and have extensive robotic and laparoscopic surgical experience. It also must be remembered that adding robots to the surgical equation may create room for error in an already risk-fraught and complex arena. So proper steps must be taken to guarantee safe and effective robot-assisted procedures. Robotic surgery is getting better and better as more advanced robots are developed to overcome existing shortcomings. So patients should expect better outcomes with robot-assisted surgery as advanced machines are applied.

At Advanced Urology Institute, we believe that surgical outcomes are a direct manifestation of the experience and skill of the surgeon, and less about the approach or technology used. That’s why we have assembled a team of qualified, skilled and experienced urologists to offer surgical procedures for different urological disorders. Our urologists perform hundreds of laparoscopic and robotic surgeries every year and have achieved great success rates in terms of efficacy, cure and improved quality of life. Our approach to robotic surgery guarantees that you will get the best possible surgery with remarkable outcomes. For more information, visit the “Advanced Urology Institute” site.

How is Prostate Cancer Diagnosed

About 70 percent of men diagnosed with prostate cancer through PSA screening have low-risk, low-grade disease. Unfortunately, over 90 percent of these men are placed under aggressive treatment soon after diagnosis when in real sense up to 60 percent of them may not need treatment, even in the long-term. Why does this happen? The common screening tests are not able to distinguish between men with prostate cancer that requires treatment and those with clinically insignificant disease. In fact, the PSA test, which is the most frequently used screening test, gives up to 12.5 percent false positive results.

Tackling overdiagnosis and overtreatment

There have been growing concerns over the increased number of prostate cancer cases diagnosed and treated following PSA testing. For instance, overdiagnosis through PSA tests has resulted in more men undergoing biopsy, which comes with adverse effects such as pain, acute urinary retention and urosepsis. Likewise, for men placed immediately under aggressive treatment, there are concerns over psychological distress and adverse effects to treatment such as urinary incontinence, bowel dysfunction and erectile dysfunction, among others, which are typically longstanding and life-altering. So because of the quality-of-life issues and financial costs, attention is shifting to ways of minimizing the harm caused by PSA screening, particularly ways of mitigating the conversion of overdiagnosis to overtreatment.

Risk-based screening

At Advanced Urology Institute, we have designed our screening, diagnosis and treatment processes for prostate cancer to respond to these growing concerns and minimize both overdiagnosis and overtreatment. For instance, we have included a candid patient-urologist discussion of both the PSA and digital rectal exam to make sure our patients are properly informed of their pros and cons. We also perform these screening tests in an individualized manner, based on each patient’s risk factors. As a baseline, we allow men to take their first PSA screening only when in their 40s. This enables us to develop the right screening protocol for each patient.

If a man’s PSA is low during the first test, we generally consider him to have a low lifetime risk of the disease and may not recommend frequent PSA measurements for him. And if we find PSA < 2 for a man in his 60s, we consider him to have a negligible chance of dying from the cancer and recommend that he not undergo any further PSA screening. It’s only for men with higher risk, such as those who have had a first-degree relative with the cancer — which doubles their risk of developing prostate cancer — that we may recommend more frequent screening.

Taking advantage of newer diagnostic tools

Previously, any man with a PSA result that was worrisome, such as one showing a rise over time or has an absolute high value, would automatically be a candidate for biopsy. At Advanced Urology Institute, we have changed this and now may perform other tests before we can recommend a biopsy. For instance, we can use a second test called PCA3 to define a man’s risk level and assess whether or not a biopsy is necessary for him. The PCA3 is a more specific marker for prostate cancer than the PSA and it can be measured in urine, usually after a DRE. Similarly, we can assess the aggressiveness of a tumor through genomic testing and use the results to determine whether immediate treatment or active surveillance is appropriate. So we use such tests to reduce the harm that our patients may suffer from biopsies done due to PSA-based overdiagnosis.

Individualized approach to treatment

To further reduce the chances of treating indolent prostate cancer, we use a combination of PSA and biopsy to assess and classify patients according to degree of aggressiveness of their disease. At AUI, we are committed to minimizing unnecessary, worthless or even harmful treatment after cancer diagnosis. Our most preferred management strategy, particularly for men diagnosed with localized, low-risk prostate cancer, is active surveillance as opposed to immediate treatment. It involves following men with low-grade, low-risk cancer closely and only providing treatment for tumors that exhibit aggressive behavior or are spreading to other areas of the body. Through careful observation, we have realized that a majority of men do not need treatment and therefore are spared the unnecessary aggressive interventions.

During active surveillance, we usually recommend serial PSA testing and biopsy to help monitor the behavior of the tumor. Before we put patients on active surveillance, we inform them that there is a possibility that the cancer may spread to keep them psychologically prepared just in case we detect progress. We also make them aware of the cancer-specific mortality with and without treatment, which is usually less than 10 percent without treatment and reduced by about 50 percent with radiation or surgery. We also inform them of the pros and cons of active surveillance and provide them with all the information they need to make personal treatment decisions.

Our approach is quite different for patients with high-risk prostate cancer. For them, we usually begin curative treatment as soon as possible, using the tools available to deliver safe, timely and effective treatment. The most common treatments for high-grade, high-risk prostate cancer are radiotherapy, high-intensity frequency ultrasound and robotic prostatectomy. Want to know more about prostate cancer screening, diagnosis and treatment? Visit the “Advanced Urology Institute” site.

Dr Yaser Bassel – Becoming a Urologist

Are you a frank, compassionate and approachable person who likes to help others? If so, then urology may just be the right medical specialty for you. Committed to a lifetime occupation of resolving troubling, embarrassing and depressing conditions of the genitourinary tract, urologists have a wonderful opportunity and privilege of making people’s lives better. They are skilled in tackling issues that most people are shy to speak about, helping patients open up and talk about the most awkward conditions and having the ability to restore a sense of hope and contentment in their lives.

What does a urologist do?

As a urologist, you provide diagnosis, treatment and follow-up care to people with urinary tract disorders, including kidney stones, pelvic pain, urinary incontinence, male sexual dysfunction, urologic cancers, genitourinary tract injuries, Peyronie’s disease, priapism, enlarged prostate and male infertility. You also do urinary tract reconstruction and perform procedures to treat disorders of the urethra, bladder, adrenal glands, ureters and kidneys. While the kind of treatment varies from one patient to another, a typical treatment may include surgery or medication, or both.

Why urology?

Curing people with various medical problems is something I always wanted to do from a very young age. I developed a passion for medicine and yearned for a future where I would be there to help people. But it is the striking prevalence of urological disorders I often encountered, together with my medical school mentors, that sparked my interest in urology. Urology also struck me as the area of medicine where I would thrive and would be needed most — caring for people, developing lasting relationships with patients and making a tangible difference in their lives.

Path to urology

I was born in Egypt but moved with my family to the United States when I was just 3 years old. In the U.S. my family moved around quite a bit and we lived in the Midwest for a period of time before eventually settling in Florida. I went to King High School in the Tampa Bay area, then attended the University of Florida for my undergraduate degree in Microbiology (with a minor in Chemistry). I graduated with honors and achieved a National Merit Scholar, enabling me to go to the University of South Carolina in 2007 for medical school. After getting my medical degree, I joined the Emory University Hospital, Atlanta, for my urology residency.

Going through medical school, I started to explore areas where I could specialize. I wanted to pursue a surgical subspecialty that could help me make the most impact on people’s lives. I also wanted a specialty that would enable me to be directly involved with the patients, establishing lasting relationships with them and seeing their lives improve. And because I was fascinated by the wide range of techniques and procedures in urology and its exciting blend of the best of both worlds of surgery and medicine, I chose urology.

Areas of expertise

As a urologist, I perform both routine and specialized procedures to help patients with urological conditions. I administer antibiotics to patients with recurrent urinary tract infections, hormone therapy for prostate cancer, chemotherapy for urological cancers, and phosphodiesterase-5 (PDE5) inhibitors such as tadalafil or Cialis for men with erectile dysfunction. I also use various surgical techniques like minimally invasive surgery, laparoscopic surgery, robotic surgery, or laser therapy for kidney stones, BPH, cancer, among others. I am frequently involved in surgery to repair the urinary tract after traumatic injury, remove a tumor, remove or break up kidney stones, transplant or remove a kidney, relieve incontinence (like the sling procedure) and relieve urethral strictures caused by scar tissue (a procedure called urethral dilation).

With my skill and experience in minimally invasive surgery, using both laparoscopic techniques and the da Vinci robotic system, I am often called upon to perform complex surgical procedures to treat various genitourinary disorders. Single incision da Vinci robotic surgery provides enhanced 3D, high-definition cameras and complete control robotic arms, ensuring high-precision surgery for removal of a cancerous prostate and treatment of conditions such as prostatitis, enlarged prostate, kidney obstructions, bladder disease and urinary incontinence whenever prescription drugs and other medical therapies fail to help.

Job satisfaction

Like most other medical specialties, urology is a highly demanding field that requires extreme commitment and dedication. Right from intense schooling, continuous medical training, chaotic work schedule, to the hopelessness felt when patients are diagnosed with advanced disease, urology comes with its fair share of frustrations and stresses. But working through these challenges and being able to consistently deliver timely, safe and effective solutions to those in severe need is remarkably satisfying.

Besides, practicing urology is never dull. From the amazing technologies used and the different kinds of people you see each day to the various issues you resolve daily, you are sure to encounter something fun and exciting. You also have the opportunity to interact with your patients, win their trust, and establish enduring relationships. For me, to be able help people overcome devastating and awkward conditions and see their lives improve is what I really find gratifying in urology.

Why Advanced Urology Institute?

I joined Advanced Urology Institute soon after my urology residency and ten years later I still love this place. It’s wonderful with the people you work with at AUI and the systems, technologies and equipment available to use. And with all our administrative work managed through a centralized system, we have all the time to concentrate on delivering the very best care to our patients.

You are not just surrounded by knowledgeable, experienced and certified professionals, you are encouraged to collaborate with them through AUI’s multidisciplinary patient-centered approach to care. This allows you to develop your skills and proficiency, grow quickly in your area of specialization and achieve your career dreams. I couldn’t have found a better place to practice urology than AUI.

Looking for more information on how to become a urologist? Or are you or your loved one in need of urological services? Get more information on urologists and the diagnosis, treatment and care for urological disorders by visiting the “Advanced Urology Institute” site.

How to Properly Treat Kidney Stones

Kidney stone treatment varies from one case to another, depending on stone size, cause and type. While most kidney stones can pass in urine spontaneously, some do not. Medical intervention is usually necessary to remove difficult stones or break them down into smaller pieces that can pass freely. Treatment also may be necessary for relieving the pain and discomfort.

Small, less-bothersome stones

Invasive treatment is not necessary for small kidney stones with minimal symptoms. In fact, by simply drinking plenty of fluid, as much as 2-3 liters a day, these stones are flushed from the urinary system. So unless your urologist says otherwise, you need to drink lots of fluid — mostly water — until your urine is clear or nearly clear.

Since passing even the smallest stones can be accompanied by some discomfort, your doctor may recommend that you use pain relievers such as acetaminophen (Tylenol, others), naproxen sodium (Aleve) or ibuprofen (Motrin IB, Advil, others). Your doctor may prescribe a medication to help you pass the stone faster and with minimal discomfort. For example, an alpha blocker can be given to relax ureter muscles and ensure that kidney stones pass quickly and painlessly.

Large or troublesome kidney stones

Larger stones may too big to pass spontaneously, can cause serious pain and discomfort or obstruction and are likely to lead to kidney damage, urinary tract infections or bleeding. Treatment options for such stones include:

1. Extracorporeal shock-wave lithotripsy (ESWL)

This procedure utilizes sound waves to generate strong vibrations (shock waves), which help break up larger kidney stones into smaller pieces that can more readily pass through the ureters and be removed in urine. ESWL takes 45-60 minutes, but because it can cause mild-to-moderate pain, it’s performed under light anesthesia to minimize discomfort.

2. Ureteroscopy

For stones located in the ureter or kidney, a thin lighted tube (scope) equipped with a camera is passed through the urethra and bladder into the ureter. After the stone is found, special tools are used to snare or break it up into tiny pieces that can pass in urine. The procedure is undertaken under local or general anesthesia, but the urologist also places a stent (small tube) in the ureter to minimize swelling and promote healing.

3. Percutaneous nephrolithotomy (tunnel surgery)

Very large kidney stones can be removed using a small incision made in the back of the patient — a procedure called percutaneous nephrolithotomy. This surgery is ideal for stones that have grown too big to pass, are causing uncontrollable pain, obstruction, infection or damaging the kidneys. The procedure also is recommended in cases where ESWL is unsuccessful. The kidney stone is surgically removed using a small telescope and instruments inserted via the tiny incision in the patient’s back. It’s done under general anesthesia and the patient stays in hospital for 1-2 days to recover.

At Advanced Urology Institute, we see hundreds of patients with kidney stones every year and use some of the best approaches in stone treatment, including advanced imaging technology, dietary recommendations, robotic surgical procedures and medications, to diagnose, treat and prevent the condition. We have the latest shock-wave lithotripsy equipment onsite, which uses state-of-the-art 3D ultrasound technology to reduce radiation exposure. Our urologists and urologic surgeons collaborate with specialists in radiology, nephrology and nutrition to deliver the most comprehensive care possible to our patients. For more information on our services, visit the “Advanced-Urology-Institute” site.

Becoming a Urologist with Dr. Martin Richman

Affable, available and able. That pretty much sums up what we are as urologists. Affable to break down barriers and discuss sensitive, sometimes awkward topics; available to help our patients and colleagues faced with unforeseen situations involving genitourinary organs; and able to deliver outstanding, standard-of-care treatments that guarantee excellent outcomes for our patients. We love our job as it offers an opportunity to provide life-saving treatments to patients. We also recognize that we are in a unique position where we can diagnose life-threatening conditions early, provide timely treatment and give patients a longer life span.

Who is a urologist?

A urologist is a specialist who treats disorders of the urinary tract and the male reproductive organs. As urologists, we look after organs such as the prostate, kidney, bladder, penis, testes, urethra and associated glands. When patients come to us with issues in any of these areas, we discuss the problems, examine the patients, investigate and make accurate diagnoses. We then can recommend medications, plan and undertake surgery, or use various techniques and methodologies to treat the problems. There is a misconception that we treat only men, but in reality we see men, women and children.

What conditions do we treat?

Urologists are experts in the surgical and medical management of urological conditions such as kidney stones, urinary incontinence, overactive bladder, sexual dysfunction, enlarged prostate, recurrent urinary tract infections and urologic cancers. Likewise, we deal with issues like interstitial cystitis, neurogenic bladder, pelvic organ prolapse, pelvic floor problems, Peyronie’s disease, hydrocele, varicocele, vesicoureteral reflux, traumatic injury of the urinary tract, priapism, recurrent urinary tract infections and urologic cancers. In children, we treat conditions like undescended testes, phimosis, hypospadias, epispadias and bladder exstrophy. We also perform kidney transplants and vasectomies.

Why urology?

From a young age, the sciences intrigued me. When I went to college, I was looking for a profession that would fulfill my compassion for people with sensitive and depressing medical conditions while also enabling me to tap into my passion for science to improve people’s quality of life. So after deep soul-searching and self-assessment, I realized that medicine was the right career for me — the profession that was very interesting to me and where I believed it would allow me to live my passion instead of just enduring a routine job.

I completed my undergraduate studies at Indian University in 1994, then joined the University of Toledo, Medical School of Ohio, for my medical degree. Upon graduation, I went to the University Hospitals of Cleveland, Case Medical Center for my urology residency training, which included stints at the Cleveland Clinic Foundation, MetroHealth Medical Center and Cleveland V.A. Hospital. Over this period, I gained in-depth knowledge and skills in urology, learned several technologies and methodologies and attained broad general mastery of medicine. After I was licensed by the Florida Board of Medicine and certified by the American Board of Urology, I soon became a fellow of American College of Surgeons (ACS).

Areas of expertise

As a urologist, I treat a wide range of urological physical ailments, together with emotional problems that accompany them. Each of my patients has unique needs and I make every effort to appreciate that before commencing treatment, taking into account all presenting factors, needs and concerns of the patient. For me, every consultation, treatment and follow-up must be tailored to meet the needs of the individual.

I have a special interest in minimally invasive procedures, including laparoscopic surgery, robotic surgery and laser therapies. That’s why I am frequently involved in procedures such as Holmium laser enucleation for enlarged prostate, Holmium laser vaporization for prostatic problems, Prostiva RF prostate ablation and steam ablation (Rezum) of the prostate. I have performed these procedures since 2012 and was among the first surgeons to offer them in the Southeast. I also am experienced in HIFU (high intensity focused ultrasound) for prostate cancer and the da Vinci robotic surgery for the kidney and prostate, having offered these treatments to patients since 2007.

Job satisfaction

Caring for people with urologic disorders comes with its fair share of challenges. For instance, a sizeable number of patients come to you with later stage and more aggressive disease, whose treatment options are quite limited. This can sometimes make your work seem hopeless. The long work hours and the often stressful situations also may test your patience and tenacity. But the ability to make interventions that improve people’s quality of life will always keep you grounded in your work as a urologist. For there is nothing more satisfying than helping a man who doesn’t sleep every night because of unending urges to visit the bathroom, a child suffering the pain and humiliation of undescended testes, a woman frightened of laughing or sneezing because of urine leakage, or a patient struggling with a symptomatic urologic cancer.

Urology gives me the opportunity to live my dream of assisting those with urologic disorders enjoy their lives a little more. As a urologist, I am able to offer short-term and long-term fixes for various conditions, see the fruits of my work as patients get better, and establish lasting relationships with patients. I absolutely love the wide range of technology applied in urology procedures, such as lasers, scopes and robots used to perform complex surgeries. The use of minimally invasive techniques performed through small incisions is also something that is really exciting. For me, urology offers a great blend of surgical, medical and a variety of minor procedures that I enjoy performing.

Why Advanced Urology Institute?

When still in medical school, I wanted to excel as a doctor. I always looked forward to a practice that would bring out the best of my knowledge, skills and experiences and enable me to succeed. Many years later, I can say with a smile on my face that Advanced Urology Institute is exactly the kind of practice I wanted. AUI brings together a massive pool of skilled, passionate, creative and hard-working medical professionals who are committed to a collaborative, patient-centered approach to care. As a urologist, you can only get better when you are part of such a team. All the administrative work has been centralized and urologists are not burdened by loads of paperwork and tedious tasks as happens in many other practices. As a urologist you only concentrate on delivering the best possible care to your patients. For more information on the urological services provided at AUI, visit the “Advanced-Urology-Institute” site.

Cryotherapy An Alternative Treatment to Radiation Therapy for Prostate Cancer

Cryotherapy means using extremely cold temperatures to freeze and destroy cancer cells. Also called cryoablation or cryosurgery — though not actually a form of surgery — cryotherapy relies on the principle that cancer cells are typically more sensitive to freezing than normal cells. So when an area affected by cancer is exposed to the very low temperatures, cancer cells die while normal cells survive the treatment. While cryotherapy can be used to treat earlier-stage prostate cancer, it isn’t used as the first treatment. It is also a great option for treating prostate tumor that’s resistant or recurs after radiation therapy. However, like brachytherapy, this treatment is not ideal for men with enlarged prostate glands.

How is it performed?

During cryotherapy, the doctor uses a trans-rectal ultrasound (TRUS) to direct several hollow needles (probes) through an incision made on the skin between the scrotum and anus and into the prostate. A very cold (freezing) fluid, such as argon gas or nitrogen liquid, is infused into the prostate via the probes (needles) and used to freeze and kill cancerous prostate cells. To prevent damage to healthy, nearby tissues, the doctor uses the ultrasound to carefully monitor the process and target the tumor with more precision.

Also, to prevent urethral damage, a warm saline solution is circulated via a catheter in the urethra to stop it from freezing. The catheter may be left in place for many weeks afterward to enable the bladder to empty during recovery. Cryotherapy requires epidural (spinal) or general anesthesia. After the procedure, patients may remain in the hospital overnight, although many usually leave on the same day.

How cryotherapy works

Living cells — normal or abnormal — cannot endure extreme cold. That’s why when the prostate gland is infused with liquid nitrogen or argon gas it quickly loses heat, the ice balls or ice crystals swell instantaneously, and the cell membranes rupture, followed by tissue damage and then cell death. After cancer is destroyed, the dead cells and tissues are cleaned up from the body by white blood cells. Also, the body’s immune system is triggered to strike out, attack and destroy any remaining cancer cells.

Cryotherapy provides several advantages over radiation and surgery, particularly in early-stage prostate cancer. It’s a less invasive procedure that can be performed using spinal or epidural anesthesia instead of general anesthesia. This is especially important when treating prostate cancer in older men. It is also beneficial for men with prostate cancer occurring simultaneously with conditions such as lung disease, heart disease or diabetes. Cryotherapy causes less blood loss, pain and swelling, requires shorter hospital stay (1-2 nights) and involves a shorter recovery period. Also, when necessary, cryotherapy can be followed by surgery or radiation therapy.

Effective alternative to radiation therapy

Even with early intervention and prompt radiotherapy, about 30-40 percent of men still experience a return of prostate cancer. Hence, further treatment is almost always necessary after radiation therapy. Cryotherapy is a great option for preventing cancer recurrence or treating recurrent prostate cancer in cases where the initial radiation therapy fails to kill enough cells. The need to use cryotherapy is determined by conducting follow-up PSA tests after radiotherapy. High PSA levels after radiotherapy implies either radio-resistance or incomplete eradication of cancer cells and cryoprobes can then be used to prevent a recurrence, particularly when the tumor is still localized. When used this way, cryotherapy is very effective — freezing the area and killing cancer cells while sparing normal cells. For more information on safe, effective treatment of prostate cancer, visit the “Advanced Urology Institute” site.

Becoming A Urologist with Dr David DiPiazza

Intriguing, inspiring and interesting, urology is a great profession for a person in love with solving problems, tackling embarrassing situations, saving lives and relating to the stories of humanity. As a urologist, you see people with awkward urine leaks, inability to get an erection, devastating genitourinary cancer and many other depressing and humiliating conditions every day. Fixing these issues and restoring sparkle, enthusiasm and joy to their lives is tremendously rewarding. It’s a unique position that also provides you with the opportunity of continuous learning and satisfaction. It’s an occupation I dreamed of as a child and which I now cherish as a doctor.

Path to Urology

When I completed my undergraduate studies at Cornell University’s prestigious Ivy College, achieving honors of cum laude, I opted to pursue a urology residency to specialize in a field with so many issues to be tackled but so few medical students turning to it.

For a six-year training span that took me to Princeton Medical Center, The Cancer Institute, New Jersey, and Robert Wood Johnson University Hospital, I honed my skills in all aspects of male and female urology, urologic oncology and robotic surgery. With this extensive training and experience I was able to achieve a double certification in 2006 by Female Pelvic Medicine and Reconstructive Surgery and the American Board of Urology. It took me just 5 years of practice to be honored by my peers for excellent work, being elected the Chief of Surgery at the Medical Center of Trinity, originally the Community Hospital.

Areas of Expertise

I routinely tackle the most common urological problems, such as kidney stones, urologic cancers, UTIs, urinary incontinence, enlarged prostate and overactive bladder. As an expert in no-needle, no-scalpel vasectomy, I also perform quite a number of vasectomies in my office. Likewise, because of my skill and experience in advanced laparoscopic technologies and da Vinci robotic I handle several cases of urogynecology and urologic oncology in Florida.

Some of the procedures I perform routinely include sacrocolpopexy (minimally invasive repair of vaginal prolapse), hysterectomy and sling procedures for urinary incontinence, cystectomy (bladder removal) in those with significant bladder cancer, nerve-sparing prostatectomy (prostate removal) for prostate cancer, nephrectomy (kidney removal) to treat kidney cancer, ureter repair and reconstruction in case of obstruction or injury, adrenalectomy (adrenal gland removal) and pyeloplasty (reconstruction of renal pelvis). I am also a robotic surgery instructor and an expert reviewer with C-SATS certification.

Job Satisfaction

As a urologist, the work hours are often long and I usually find myself in situations that are stressful. But to persevere through them and consistently provide safe, timely and effective remedies to those in great need is incredibly satisfying and keeps me going. The challenges just help bring out the best in me and make my job even more fulfilling. Urology is deeply fascinating as I am not just able to tackle embarrassing problems, but also to examine the urinary system and administer treatment with some of the most advanced and innovative technology.

There’s never a dull moment for a urologist as you see different kinds of people and sort out different issues every day, a guarantee that each day will bring some kind of excitement. You also get the opportunity to know these people, earn their trust and build very close, long-term relationships. I find it quite gratifying to care for patients with often devastating and humiliating issues and to see their situations improve.

Why Advanced Urology Institute

During my training years, I looked forward to an ideal workplace — one that would bring out the best of my talents, skills and experiences and empower me to provide the best possible care. And I found it in Advanced Urology Institute. At AUI, I have no administrative work to trouble me, so I spend most of my time caring for my patients and collaborating, innovating and researching for safe and effective solutions to my patients’ problems. And because AUI brings together a huge pool of skilled, creative, passionate and hard-working medical professionals, it makes it easier for me to perform at my best and to take my career to the heights I desire. I couldn’t have found a better workplace than AUI. For more information on the urological services at AUI, visit the “Advanced Urology Institute”site.

What Does the Prostate Gland Do?

The prostate, found only in men, is a tiny, walnut-sized muscular gland in front of the rectum and just below the bladder. It surrounds the urethra, which transports urine to the penis from the bladder, and is essential for the normal functioning of the male genitourinary system. The prostate makes prostatic fluid, which forms a substantial portion of semen. During ejaculation the prostate contracts and closes off the opening between the urethra and bladder, ensuring that prostatic fluid squirts into the urethra and semen is pushed out at speed.

So what does the prostate do?

The prostate is not an essential organ for life, but it’s quite crucial for reproduction. It plays an active part in reproduction by secreting the prostatic fluid, which forms part of healthy semen — the perfect environment for the transit and survival of sperm. Healthy semen includes the enzyme PSA (often measured during screening for prostate cancer), together with other substances secreted in the prostate and seminal vesicles, such as citrate, zinc and fructose, which supply sperm with the energy to travel to the egg. There are also various antibodies in semen to protect sperm and the urinary tract from bacteria and different pathogens.

What are the constituents of prostatic fluid?

The prostate secretes a milky fluid, the prostatic fluid, which makes up about 30 percent of the total fluid that’s ejaculated. The prostatic fluid contains various ingredients, such as enzymes, citric acid and zinc, which keeps sperm alive and protects them and the genetic codes they carry. PSA (prostate-specific antigen) is one of the enzymes in the fluid that, after ejaculation, makes semen runnier and helps sperm travel through semen more easily, which increases the likelihood of successful fertilization of an egg. While prostatic fluid is weakly acidic, the other constituents of semen turn it alkaline overall, which helps to counteract vaginal acidity and prevent damage of sperm.

Growth of the prostate

The prostate grows bigger as men age. Typically the prostate undergoes growth during adolescence driven by the male hormone, testosterone, and the hormone’s byproduct, dihydrotestosterone (DHT). Testosterone hormone is primarily produced in the testes, but smaller quantities also can be secreted in the adrenal glands found just above the kidneys. By the age of 40 the prostate might have grown from a walnut-sized to apricot-sized gland. And by the age of 60 it might have reached the size of a lemon.

Benign prostatic enlargement (BPH)

While the prostate is strategically located to deliver the prostatic fluid and squeeze things along during ejaculation, its position around the urethra makes it a liability when it grows or gets bigger. A swollen prostate will compress the urethra and irritate the walls of the bladder, resulting in interference with normal urine flow. In fact, over 50 percent of all men in their 60s have symptoms of prostate enlargement, a condition called benign prostatic hyperplasia (BPH). And by the age of 70 to 80, a man’s risk of BPH increases to 90 percent, with symptoms such as leaking or dribbling urine, frequent urination, weak or stuttered urine stream.

While the size of your prostate will not always influence how severe the obstruction or symptoms are, BPH can cause serious complications over time, such as urinary tract infections, bladder damage, kidney damage, incontinence and bladder stones, due to bladder strain and urinary retention. So it’s important to see a urologist as soon as you have urinary issues so BPH can be detected early and treated.

Prostate cancer

Another health problem associated with the prostate is prostate cancer, which is the most frequent cancer in men. It occurs in 1 out of 7 men over their lifetime, and more than 200,000 men are diagnosed with the cancer annually. Prostate cancer is frequent in men age 50 and older, but the largest number of cases is found in men 70 to 80 years old. About 3.8 percent of men diagnosed with the cancer die of the disease, while 7 in 10 newly diagnosed patients currently survive past 5 years. As doctors, our role is to screen for the cancer, detect aggressive forms early and prevent any problems that may occur due to obstruction.

So what’s your role?

Tell your doctor about your urinary problems as soon as possible. The symptoms may not only suggest BPH, but also may indicate a more serious condition. With a prompt visit to the doctor, a more serious condition such as prostate cancer can be ruled out.

Want to know more about BPH, prostate cancer and other urological problems? Visit the “Advanced Urology Institute” site.

4 Effective Ways to Treat Kidney Stones

Dreading the agony and pain of kidney stones? You don’t have to because the condition is treatable. And the pain and discomfort disappears as soon as the stones are removed.

The treatment you get depends on the type, size and cause of the stones and on the severity of your symptoms. For instance, if you are having very severe pain, your urologist will give you an injection to relieve the pain. A second injection may be given after 30 minutes if you are still in deep pain. You also may be injected with anti-emetic medication to relieve vomiting and nausea.

Apart from dealing with the symptoms of the kidney stone, your doctor will administer treatment to remove the stone. The 4 effective ways to remove kidney stones include:

1. Spontaneous Passage

If your kidney stones are small (less than 4 mm diameter) and you have minimal symptoms, you won’t require invasive treatment. In fact, once your urologist assesses that you can tolerate the stone, you will be given time so the stone can pass out on its own. In such a case, the urologist will only make the following recommendations:

  • Drrink a lot of water, as much as 1.9-2.3 liters a day, to help you flush out the stone from your urinary tract. In this case, you have to drink enough fluid — until your urine is colorless. So if your urine is still brown or yellow after drinking water, then you know that you aren’t drinking enough fluid.
  • Use pain relievers as you wait for the stone to pass out spontaneously. Since even a very small kidney stone can be really painful, your urologist may recommend pain relievers such as acetaminophen (Tylenol or others), naproxen sodium (Aleve), or ibuprofen (Motrin IB, Advil or others) to relieve the pain. The pain will only last a few days and often disappears soon after the stone is passed.
  • Take medication to help you pass the stone. Such medication, often alpha blockers, help to relax ureter muscles and allow the stone to be flushed out of your urinary system faster and with less pain.

With these recommendations you are expected to wait until the stone passes out and then to collect the stone for analysis by your urologist in order to help determine if there is need for further treatment. To collect the stone, you simply filter your urine through a stocking or gauze as you urinate.

2. Extracorporeal Shock-Wave Lithotripsy (ESWL)

What if your kidney stone is too large to pass out in urine? In that case, your doctor may recommend a procedure called extracorporeal shock-wave lithotripsy. The ESWL procedure uses sound waves to generate strong vibrations (called shock waves), which break the stone into tinier pieces that can easily and less painfully pass through urine.

The high-frequency sound waves (ultrasound) are directed at the stone from a machine for 45-60 minutes. Because this can be a bit uncomfortable, you will undergo the procedure under light anesthesia or sedation to reduce the discomfort. The ESWL procedure is 99 percent effective for kidney stones that are up to 20 mm (0.8inch) in diameter. But you may require one or more ESWL sessions for the kidney stones to be effectively removed.

3. Ureteroscopy

What if the stone is stuck somewhere in your urinary tract, such as the ureter? In that case, your urologist may recommend ureteroscopy, a procedure that’s also called RIRS (retrograde intrarenal surgery). During ureteroscopy your doctor passes a long thin telescope, a ureteroscope, through your urethra, into the bladder and into the ureter, or wherever the stone is stuck.

After locating the stone the urologist uses a special instrument or laser energy to break the stone into tiny pieces that can pass out naturally in urine. The doctor then may place a small plastic tube (stent) temporarily in the ureter to help drain the stone fragments into your bladder, relieve swelling and hasten healing. Ureteroscopy is conducted under general anesthesia, so you shouldn’t operate machinery or drive for up to 48 hours after treatment. It is 50-80 percent effective for kidney stones that are 15 mm (0.6inch) in diameter.

4. Percutaneous Nephrolithotomy (PCNL)

In circumstances where ESWL isn’t appropriate, such as when you are obese, larger stones may require an alternative procedure called percutaneous nephrolithotomy (PCNL). It is a surgical procedure for removing kidney stones using a small thin telescopic instrument known as a nephroscope. The instrument is inserted through a small incision made in your back and guided carefully to your kidney or ureter. Once the stone is located it is either broken into smaller pieces (with pneumatic energy or laser) or pulled out. PCNL has 86 percent efficacy for kidney stones of 21-30 mm in diameter and is performed under general anesthesia.

When should you seek treatment for kidney stones? You need urgent treatment if:

  1. Your pain is sudden, severe or gets worse.
  2. You have a fever of 100.4 F or higher.
  3. You have one or more episodes of shaking or shivering.

At Advanced Urology Institute we have assembled a team of skilled and experienced urologists to help diagnose and treat kidney stones and other urological problems safely and effectively. We offer all 4 effective treatments for kidney stones and have the latest equipment and technology to make the treatment process as painless and comfortable as possible. So don’t try to endure the pain even a day longer before you see us and let us fix it. For more information on kidney stones and other urological disorders, visit the “Advanced Urology Institute’” site.

The Effectiveness of Erectile Dysfunction Treatments

Worried about your inability to get or maintain an erection? Stop worrying and visit your doctor for an open and honest chat. A urologist can help you find safe and effective treatment of erectile dysfunction that will enable you to approach any future dates with your partner with confidence. Urologists are experts in treating erectile dysfunction and other genitourinary issues, so do not be anxious about such a visit. In fact, you will be surprised to find that your doctor is probably seeing up to a half dozen men with ED every week.

Oral ED Medications

The first choice of treatment for ED is usually oral medications called phosphodiesterase inhibitors type 5 (PDEi-5). These drugs include the first-generation agents such as sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis), together with second-generation agents like mirodenafil (Mvix), iodenafil (Helleva), udenafil (Zydena) and avanafil (Stendra). With the drugs providing a normal, natural erection in 80-95 percent of men as long as there is sexual stimulation, they are the best option for many men with ED. They also deliver high efficacy rates and favorable safety levels.

Transurethral and Intracavernosal Injections

If you are unresponsive to oral drugs, your doctor will review your treatment and consider other options. The urologist may consider a transurethral injection with a drug called alprostadil. The doctor may go for this option if your penile nerves have been compromised and you need to bypass the neurological pathways responsible for an erection. Another option may be an intracavernous injection of papaverine, phentolamine, PGE1 or vasoactive intestinal peptide (VIP). The injections are a good treatment choice with 91-96 percent success rates and proven safety. These drugs may be combined for better efficacy.

Vacuum Constriction Devices

Vacuum erection devices also may be considered. But these are commonly offered to elderly patients who may only want occasional sexual intercourse. Younger men do not like these devices because of the unnatural feeling of the erections and the mechanical procedure necessary to produce the erections. You should discuss this option with your doctor and find out if the devices are ideal for you.

Surgical Therapies

When medical therapies fail, your urologist may recommend surgery. Surgical procedures are often the last option because of the cost, non-reversibility and invasiveness involved. There are two kinds of surgery for men with ED: penile prosthesis and penile revascularization. In penile prosthesis, the urologist inserts an inflatable or semi-rigid implant into the penis tissue. The success rate of penile prosthesis is 97 percent, but the implant must be replaced every 8-15 years. Penile revascularization is a surgical procedure to repair either venous ligation or arterial stenosis. Explore surgery with your doctor if the other options fail to work for you, but be sure to understand what is involved before you make a decision.

Non-Specific Interventions

Erectile dysfunction treatments may be accompanied by other interventions. For instance, psychotherapy is a noninvasive and highly effective intervention that is often combined with other therapies for a better success rate. Likewise, your urologist may recommend lifestyle modifications, such as increased physical activity, dietary changes, moderate alcohol consumption or a decision to stop smoking in order to improve your ED symptoms and minimize cardiovascular risk. If tests show that you have low testosterone, your doctor may recommend testosterone replacement therapy before you use ED-specific medications. If you are a younger, healthier man, testosterone therapy may just be what you need for enhanced sexual desire and harder erections.

At Advanced Urology Institute, we have established a multidisciplinary, compassionate and patient-centered approach to the treatment of erectile dysfunction. We prioritize the needs and expectations of our patients during treatment, educating them and providing a supportive environment that ensures shared decision-making. We also conduct meticulous follow-ups to identify any changes in the relationships, health and emotional status of our patients to optimize the efficacy of our treatments. If you are experiencing bothersome and embarrassing ED, visit one of our urologists for help. Get more information on the treatment of erectile dysfunction at the “Advanced Urology Institute” site.

Benefits of Testosterone Therapy

Secreted primarily in the testicles, testosterone is a critical hormone responsible for male growth and masculine characteristics. The levels of testosterone increase exponentially in childhood and hit a peak during adolescence, then begin to decline by about 1 percent every year between the ages of 30 and 40 years and older. The gradual decline can be due to either normal aging processes or a condition called hypogonadism. Hypogonadism is a disorder in which the body fails to produce normal quantities of testosterone. It often occurs when there is a problem with the pituitary gland (which controls the testicles) or with the testicles themselves. For men with testosterone levels below the normal range, testosterone replacement therapy can relieve symptoms of low-T and provide many benefits.

Normal Testosterone Levels

For men, the normal range of total testosterone is 300-1,200 ng/dL (nanograms per deciliter). Men with testosterone levels within this range rarely have any problems associated with low testosterone. However, since total testosterone does not usually provide the full picture, doctors often measure and use the levels of free testosterone to assess a man’s vulnerability to low-T symptoms. Free testosterone means the amount of testosterone hormone that is active in the body at any given time. Men with total testosterone levels within the normal range can still suffer from the classic low-T symptoms if their free testosterone levels fall short.

Implications of Low Free Testosterone

The free testosterone level is a clearer indicator of a man’s true testosterone status. In fact, low free-T is almost exclusively associated with sex difficulties. Low testosterone diminishes sex drive in men and results in loss of energy and motivation and poor performance in bed. Men with low testosterone also may suffer from fewer spontaneous erections, slightly lower sperm count, increased body fat, decreased muscle strength and mass, fragile bones, tenderness or swelling of breast tissue, hot flashes, increased fatigue, feelings of depression and sadness, trouble with concentration and memory, lowered self-confidence and motivation, and a degraded overall sense of well-being. These symptoms can be relieved through testosterone replacement therapy.

Benefits of Testosterone Replacement Therapy

There is no doubt that testosterone replacement therapy (TRT) can quickly revive a man’s interest in sex, boost his ability to maintain an erection and recreate the “wow” factor of his orgasms. Treating sexual symptoms is a good enough reason for men to start testosterone therapy. But because testosterone therapy also can improve a man’s health beyond the bedroom, bringing testosterone levels back to normal is a good decision for every man who wants to feel better. Replacement therapy improves bone mineral density, boosts overall bone strength, increases muscle mass and strength, boosts red blood cell production, enhances hemoglobin levels and corrects both iron deficiency anemia and unexplained anemia. Testosterone therapy also improves mood, alleviates depression, irritability and fatigue, relieves disorders linked to testosterone deficiency such as osteoporosis and boosts insulin sensitivity, which can benefit men with diabetes or minimize the risk of diabetes in men with functioning pancreas.

Should You Opt For Testosterone Therapy?

Testosterone replacement therapy is ideal for men with testosterone levels below 300 ng/dL or those experiencing symptoms of low testosterone. Undergoing replacement therapy can help you restore your testosterone levels to normal and improve your libido, cognition, mood, bone density, muscle mass and red blood cell production. However, you should remember that the therapy is only necessary if you have low T. If you are not sure whether the therapy is right for you, speak with your doctor. The doctor will conduct the requisite tests for low-T and guide you accordingly.

At Advanced Urology Institute, we help men recover from their old, tired and depressed selves through safe and effective testosterone replacement therapy. We deliver this therapy after accurate measurements of testosterone levels to ensure that we give testosterone only to the right people. If you have symptoms of low-T or suspect that your levels could be low, speak to one of our urologists. We will ensure to get you back to a more energetic, motivated and happy self. For more information on the diagnosis and treatment for low testosterone, visit the “Advanced Urology Institute” site.

2 Common Types of Incontinence

Urinary incontinence, defined as involuntary and accidental leakage or loss of urine because of defective bladder control, is a common problem in the United States that affects an estimated 25-33 percent of the population. While both men and women can have the condition, more women are at risk of having urinary incontinence because of several factors unique to women. For instance, due to pregnancy, childbirth, different anatomical characteristics in the pelvic region, atrophy (shrinking) of sphincter muscles and menopause, women suffer from urinary incontinence much earlier and more frequently than men do. Urinary incontinence is not a normal consequence of aging, though its prevalence increases with age.

Repercussions beyond Health

Urinary incontinence is not only a health problem, but also poses a variety of psychological, social and emotional difficulties. For instance, women with urinary incontinence may want to avoid certain situations or places for fear of an embarrassing accidental leak. A strong and sudden urge to urinate may cause embarrassment and discomfort, particularly when you are not near a bathroom or toilet. Women also may withdraw from activities they love doing due to the risk of an accidental leak. As a result, urinary incontinence can limit a woman’s activities, diminish her self-confidence and reduce her joy in life. But urinary incontinence is a treatable condition as long as the underlying cause can be identified and addressed.

Two Major Types of Urinary Incontinence

There are two main types of urinary incontinence: stress incontinence and urge incontinence.

1. Stress Incontinence

Stress incontinence is the accidental loss of urine from the bladder due to weak pelvic muscles. Urine loss occurs during physical activity such as when sneezing, laughing, coughing, exercising or doing an activity that exerts pressure on the pelvic muscles. When you are active, you put pressure on the bladder, which in turn allows urine to escape because the pelvic muscles are weak. Stress incontinence often occurs after pregnancy or childbirth because the pelvic muscles have been stretched and weakened and nerves to the bladder may have been damaged. Obesity or excess weight also can put pressure on the weak pelvic muscles and cause stress incontinence.

2. Urge incontinence

Urge incontinence (known as overactive bladder or OAB) is the sudden, intense and uncontrollable urge to urinate, which occurs when the coordination between the brain and bladder is out of sync. For instance, the brain may send voiding signals to the bladder without warning, or pelvic muscles may become too active and contract frequently even before the bladder is full, resulting in feelings of extreme frequency and urgency. Overactive bladder is the term used to describe any incontinence characterized by uncontrollable urgency, frequency, nocturia and dysuria. Urge incontinence is common in women with an inability to control detrusor contractions, but also may occur in women in menopause (due to inadequate estrogen) or with chronic or acute urinary tract infections, bladder stones, bladder cancer, stroke and multiple sclerosis (due to interference with nerve signals responsible for bladder control).

Sign of Something More Serious

There are many reasons why women may leak urine, from serious neurological conditions like multiple sclerosis, Parkinson’s disease and stroke, traumatic injury of the spinal cord, cardiovascular conditions affecting associated nerves, diuretic medicines, diabetes and obesity, alcohol consumption or recurrent urinary tract infections to inflammation that damages bladder nerves or irritates the bladder. It is therefore advisable to seek medical help as soon as you experience any sign of incontinence. Prompt and timely diagnosis and treatment may uncover a serious underlying problem early. At Advanced Urology Institute, we obtain a full history, conduct a comprehensive physical examination, perform specialized testing and treat urinary incontinence as safely and successfully as possible, making sure to deal effectively with all underlying issues.

A Wide Range of Treatment Options

Treatment of urinary incontinence at AUI depends on the type of incontinence and severity of symptoms. Options may include rehabilitation of pelvic muscles using weighted vaginal cones, electrical stimulation or Kegel’s exercises, sacral nerve neuromodulation, biofeedback and bladder retraining, extracorporeal magnetic innervation, occlusive devices (such as vaginal pessaries or urethral plugs), medications (such as Extended-Release Oxybutynin Chloride like Ditropan XL, tolterodine like Detrol, alpha-adrenergic drugs and estrogens), periurethral injection, and minimally invasive surgery. If you have any symptoms, you should see a urologist as quickly as possible to undergo testing, determine the underlying cause and detect any serious problem you may have.

At Advanced Urology Institute, your health is our foremost priority. We provide the right diagnosis and treatment of urinary incontinence that can quickly restore your confidence and enable you to get out there and do the things you love without worrying about accidental leakages. Do not suffer in silence. For more information on urinary incontinence, visit the “Advanced Urology Institute” site.