What are the Symptoms & Treatment Options for Low Testosterone, According to Dr. Amar Raval?

KEY TAKEAWAYS:

  • Low testosterone can cause symptoms such as fatigue, erectile dysfunction, and lack of energy, negatively impacting a person’s daily life and self-esteem.
  • Diagnosing low testosterone involves checking laboratory tests and assessing other hormones that may affect testosterone levels.
  • Treatment options for low testosterone include gels and injectable testosterone, which can have a significant positive impact on patients’ lives.

Dr. Amar J. Raval on Low Testosterone

Amar J. Raval, MD, is a urologist in Tampa, FL, specializing in the diagnosis and treatment of urological conditions, including low testosterone. Low testosterone can have a significant impact on an individual’s daily life and overall well-being. In this article, we will discuss the symptoms and treatment options for low testosterone, as advised by Dr. Raval.

Symptoms of Low Testosterone

Low testosterone, or hypogonadism, can present with a variety of symptoms that may negatively impact an individual’s quality of life. According to Dr. Raval, some of the common symptoms associated with low testosterone include:

  1. Fatigue
  2. Erectile dysfunction
  3. Lack of energy

These symptoms can interfere with a person’s daily activities, relationships, and self-esteem, making it crucial to seek appropriate treatment.

Diagnosing Low Testosterone

Dr. Raval explains that diagnosing low testosterone involves checking certain laboratory tests, including subsequent tests to confirm the low testosterone levels. In addition, other hormones that may affect testosterone levels are also assessed.

Treatment Options for Low Testosterone

Once low testosterone has been confirmed, Dr. Raval discusses various treatment options with patients. These options include:

  1. Gels: Topical testosterone gels are applied directly to the skin and absorbed through the skin’s surface. This method is convenient and relatively easy to administer, although it may cause skin irritation in some cases.
  2. Injectable testosterone: Testosterone injections are another treatment option for individuals with low testosterone. Injections provide a more direct route of administration, and dosing can be more easily controlled compared to gels.

The Impact of Testosterone Treatment on Daily Life

Dr. Raval emphasizes that testosterone treatment can have a dramatic effect on patients’ lives, including their sexual function, energy levels, productivity, and self-esteem. By addressing the underlying hormonal imbalance, patients can experience significant improvements in their overall well-being and quality of life.

Dr. Amar Raval and Advanced Urology Institute

Dr. Amar J. Raval is a urologist in Tampa, FL, who is dedicated to providing the best possible care for his patients. As a member of the Advanced Urology Institute, the largest urology practice in Florida, Dr. Raval works alongside a team of experienced urologists who share his commitment to excellence in patient care.

By offering comprehensive treatment options and personalized guidance for patients with low testosterone, the Advanced Urology Institute ensures that their patients receive the most advanced and effective treatments available in the field of urology.

TRANSCRIPTION:

My name is Amar J. Raval and I’m with Advanced Urology Institute. There’s plenty of patients who have low testosterone and want to know treatment options for that. They have fatigue, erectile dysfunction, lack of energy, and those can plague them in their daily lives. So generally now with the new screening guidelines with the AUA, we check certain labs. We need to show that they have low T on subsequent labs and we also check other hormones that may affect that. And those that are in need or can benefit from therapy, there’s gels as well as injectable testosterone that can be given to help them in that setting. I think it dramatically affects their lives. Their sexual lives, their energy, their being more productive throughout the day can affect relationships and even their self-esteem. So all of these are huge factors for them.

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Do You Treat People With ED

Well, yes—every day. At Advanced Urology Institute, we treat men with erectile dysfunction (ED) and achieve great results for our patients. Erectile dysfunction is a big issue for men today, regardless of their age. Up to half of all men experience some form of ED in their lifetime, with roughly 10% of men over 40 suffering severe forms of impotence.

What is erectile dysfunction?

Also called impotence, erectile dysfunction is the inability to regularly get or maintain an erection for satisfying sex. In general, an occasional problem should not be a cause for concern. In fact, it is normal to have trouble getting or keeping an erection for up to 20% of sexual encounters. But frequent trouble getting an erection indicates a medical problem. With ED, successful erections either become the exception more than the rule or they never happen.

Treating People with Erectile DysfunctionSome of the causes of ED include:

  • Alcohol use, illicit drug use, or smoking
  • Medications, such as for high blood pressure
  • Diabetes
  • High cholesterol
  • Heart disease
  • Obesity
  • Blocked blood vessels
  • Scar tissue inside the penis
  • Sleep disorders
  • Metabolic syndrome
  • Anxiety, stress, or depression
  • Emotional or relationship issues

Risk factors for erectile dysfunction include advanced age, diabetes, obesity, depression, cardiovascular disease, high blood pressure, low testosterone, high cholesterol and smoking.

What does treatment for ED involve?

Erectile dysfunction is a treatable condition. At Advanced Urology Institute, we offer several treatment options, generally beginning with the least invasive approach. We also give lifestyle advice that may help with overcoming the condition.

For instance, if your ED is due to inactivity, obesity, metabolic syndrome, high blood pressure or cardiovascular disease, we may recommend you engage in regular aerobic exercise to help reduce the symptoms. We may also recommend you quit smoking, minimize your alcohol intake and follow a healthy diet.

Treatments for ED include:

1. Phosphodiesterase type-5 (PDE5) inhibitors

PDE-5 medications are typically the first line of treatment we recommend for men with ED. They include Stendra (avanafil), Viagra (sildenafil), Cialis (tadalafil), and Levitra or Staxyn (vardenafil).

These oral medications work in a similar manner to boost the level of cGMP—a natural chemical in the body that promotes the widening of blood vessels following sexual arousal. In turn, more blood reaches the penis.

At the same time, these medicines enhance the relaxation of muscles of the penis in response to stimulation, hence increasing blood flow to the penis and allowing an erection.

2. Creams and injections

Sometimes we prescribe a topical Alprostadil cream as an alternative to the oral medications. The cream comes with a plunger and is applied to the tip of the penis and the surrounding skin 5-30 minutes before having sex.

At other times, we may prescribe penile injections as a treatment for ED. That is, we teach you how to inject a medicine at the base of your penis 5-20 minutes before sexual intercourse. After the injection, there will be increased blood flow to your penis and an erection will develop within 15 minutes.

3. Penis pumps (vacuum devices)

A penis pump (vacuum erection pump) is a tube that fits over the penis. A plastic container is placed over the penis and the pump draws air from the container to create a vacuum. The change in air pressure when the device is used causes blood to be drawn into the penis and triggers an erection.

Once the vacuum creates an erection, the retaining band is slid down the lower end of the penis and the pump is removed. An erection will typically last long enough for intercourse but the penis may be cold to the touch, and the rubber band may restrict ejaculation.

4. Penile implant (surgery)

We generally recommend surgery only when all other treatment options are not successful or not well tolerated. If that is the case, a penile implant (prosthesis) may help in achieving erections.

A penile implant is a medical device surgically placed into a penis to mimic the look and performance of a natural erection. The prosthesis involves an inflatable rod inserted in the middle of the penis, with a pump hidden in the scrotum. The pump is used to inflate the rod, which in turn causes an erection.

Penis pumps are custom-fit to your anatomy in a procedure that is performed carefully to ensure that the sensitivity of the penis and your ability to ejaculate are not adversely affected, allowing you to have a normal orgasm and great sexual encounters.

At Advanced Urology Institute, we recognize that erectile dysfunction is a common but very sensitive issue. That is why we provide a compassionate, patient-friendly approach to ED treatment to help men tackle it as soon as it starts. And because ED may also be a sign of a more serious medical condition, we encourage you to speak with a urologist as soon as possible to help you address the underlying condition and find the best treatment option.

Remember, the sooner you speak with your doctor about ED, the sooner you can go back to enjoying physical intimacy with your significant other. For more information about the diagnosis and treatment of erectile dysfunction, visit the Advanced Urology Institute website.

Are Medications Effective in Treating Erectile Dysfunction – Dr. Yaser Bassel

My name is Yaser Bassel, I am a board-certified urologist with Advanced Urology Institute.

I would say the vast majority of them, especially if they have not tried medications prior to them being seen in our office, probably 70-80 percent of those men will at least have a response to the medication oftentimes enough to basically be satisfactory to the patient or make them pleased with the way the medication is working. So most of them would actually get a good response to the medication.

Are there other treatment options for ED?

As far as what we have available to us now and what’s on the forefront, [for] those patients that do not want medication there are some newer technologies that are available that utilize shockwave energy to try and create newer vascularity in order to get a better response for that medication and that is something that’s basically come out over the past couple of years that we are starting to utilize in our practice. For those that do not respond to medication and still want to have treatment, the next step oftentimes [is] performing a test called a Penile Doppler where we will inject the penis with a vasoactive medication which will then initiate an erection so that we can measure blood flow and also measure for a venous leak which are two reasons why patients can have issues with erectile dysfunction.

If you are in need of a consultation or have any questions, visit us at our Tampa, FL office or call us at (813) 749-0820.

Urinary Incontinence in Women

The loss of bladder control known as Urinary Incontinence is a normal problem that is more common in women than men. The effects of urinary incontinence range from barely noticeable to severe. As Dr. Amar Raval from the Advance Urology Institute says, “It is a big issue for women out in public.” Incontinence can cause difficult and embarrassing situations.

There are many causes of urinary incontinence. To understand these causes, it is important to remember that urinary incontinence is a symptom, not a disease. Lifestyle choices that can exacerbate the problem include consuming alcohol, caffeine, spicy foods and certain medications. For women, life events that affect women’s bodies in a way that can cause incontinence include pregnancy, childbirth, menopause and aging. Other causes can be found in weight, family history and health.

Dr. Amar Raval of Palm Harbor, FLThe different types of urinary incontinence can exhibit a variety of symptoms. Stress incontinence is characterized by small leaks of urine due to pressure on the bladder while laughing, coughing, sneezing or exerting oneself. The small leaks of overflow incontinence happen when the bladder has not fully emptied during urination. Urge incontinence is the sudden and intense urge to urinate, sometimes resulting in an involuntary loss of urine. Having to urinate frequently through the night is another symptom experienced by women with urge incontinence. It is also common for women to be affected by more than one of these types of incontinence.

Fortunately, a wide range of treatment options is available. Women can work with their urologist to find the best treatment option for their individual situation. In some cases, treatment can be as easy as making slight lifestyle changes or taking an oral medication. Botox and acupuncture can help relieve stress incontinence. For more advanced cases, urethral slings can ease symptoms by lifting the urethra into a normal position, and robotic surgeries can lift the bladder in cases of incontinence caused by a prolapse.

The loss of bladder control can be a lifestyle limiting problem for women when it affects their ability to leave the house and maintain normal activities. The urologists at the Advance Urology Institute work closely with each patient to ensure they can live with freedom and confidence, and without the worries of incontinence. For more information, visit the Advanced Urology Institute website.

Risk Factors of Prostate Cancer

Prostate cancer is a health challenge that many men will face in their lifetime. What makes prostate cancer unique is the many forms it can take, with each form requiring a different treatment method and affecting men differently. According to board certified urologist Dr. Brian Hale, “Prostate cancer is extremely common and most men with prostate cancer will probably never have a problem from it.”Prostate cancer is so common that up to 80% of men who live to age 80 will have some form of it. Fortunately, for most of these men the illness will not be terminal. However, prostate cancer is still deadly enough to be the second leading cause of death for men in the United States. In other words, prostate cancer is often harmless; but when it isn’t, it can be deadly. This makes a proper and timely prostate cancer diagnosis essential.

Dr. Brian Hale of Palm Harbor, FLFor many men, their prostate cancer will not be aggressive and the symptoms will be manageable. In these cases, urologists rely on active surveillance as the best first treatment option. Rather than risk possibly harmful treatments on a non-aggressive cancer, the urologist will monitor the cancer with routine checkups. Other treatment options will be considered if the cancer becomes more aggressive.

If the prostate cancer is aggressive and immediate treatment is needed, urologists and their patients have a wide range of treatment options to choose from. The treatment option that works best will depend on a number of factors such as the cancer’s size and growth, and the patient’s age and health. Surgery to reduce the size of the cancer is often preferred for slow growing cancers. For more aggressive cancers, urologists may choose chemotherapy or radiation to kill the cancer cells as quickly as possible.

Although there are many possible causes of prostate cancer, there are certain factors that are known to raise the risk of its occurance. The first risk factor is age. As men get older, their likelihood of developing prostate cancer increases. African-American men have a greater genetic risk for developing an aggressive prostate cancer, while family history and obesity are also factors.

Early detection is the key to a successful treatment. Because prostate cancer is age related, it is recommended to most men that they begin having annual prostate checkups at age 50. African-American men and those with a family history of this cancer should be checked annually starting at age 40. Life saving screenings and successful treatments of prostate cancer happen every day at the Advanced Urology Institute, where trusted urologists like Brian C. Hale, MD guide their patients from diagnosis to recovery.

Should You Be Screened for Prostate Cancer

Prostate cancer is a common cancer that affects the walnut-shaped male prostate gland. As with most cancers, early detection is an important part of any successful treatment. The most common way prostate cancer is detected is through prostate cancer screenings during a patient’s appointment with a urologist. According to Dr. Amar Raval, “Screenings are important, along with a digital rectal exam, because prostate cancer continues to be the number one cancer found in men.”

Should you be screened for prostate cancer? If you can answer yes to one or more of the following conditions, then you may need to be screened:

• If you are between the ages of 55 and 69.
• If there is a history of prostate cancer in your family.
• If you are African-American.
• If you have a pre-existing medical condition that makes treatment difficult.

Dr. Amar Raval of Palm Harbor, FLThese factors are known to increase the risk of developing prostate cancer, and it is recommended that someone who has one or more of these conditions is screened at least once a year.

There are two main types of prostate cancer screening tests that a patient may receive. The most common is a digital rectal examination (DRE). For this exam, the health care provider puts on a glove and inserts a finger into the patient’s rectum to feel for any abnormalities on the prostate that can be attributed to cancer. The other screening is a prostate specific antigen (PSA) blood test. This blood test checks the PSA level in the blood, as someone with prostate cancer will have an elevated PSA level.

If one of these tests leads to a prostate cancer diagnosis, the urologist will want to identify what kind of prostate cancer it is in order to develop the best treatment plan. Non-aggressive cancers may not necessarily need treatment and can be monitored with active surveillance, which means watching the cancer to make sure it doesn’t turn aggressive and spread. In cases where the cancer is of intermediate or high risk, early identification from a screening test can help make sure that the treatment used on the cancer has the best chance for success.

If you believe it is time for you to start being screened for prostate cancer, then you should have a conversation with your urologist. Early detection can be a life saver. For men who are concerned about prostate cancer, the Advance Urology Institute is an excellent place to begin screening.

What are the treatment options for erectile dysfunction?

Erectile dysfunction is a common disorder that affects men of all ages. It is a man’s inability to get and maintain an erection. There are many different causes of ED and in many cases there is more than one underlying cause. All a urologist needs is a physical exam and a few questions answered in order to diagnose erectile dysfunction in a patient.

Dr. Brian Hale - Urologist at Palm Harbor, FLFor urologists like Dr. Brian Hale, treatment for erectile dysfunction begins with trying three different medications. The medications are generally oral and easy to take. The urologist will monitor the results of the oral drugs with the patient. Very often, at least one of the oral drugs prescribed will resolve the issue. For these cases, the urologist will write a prescription for the drug and continue to monitor its effectiveness through routine appointments.

If the urologist and the patient are unable to find an oral medication that works effectively, there are other options to consider. One possibility is injection therapy. Small injections into the shaft of the penis are used to dilate the penile arteries, helping increase blood flow, causing an erection. For most men who do not see results with the oral medication, injection therapy is their next best option.

For many men, injection therapy can seem a bit overwhelming at first, maybe even frightening. But in reality, the injections are easy to administer and are relatively painless. The urologist and the patient will begin the injection therapy with a teaching session at the urologist’s office. The urologist may use an ultrasound to monitor the reaction of the blood vessels to the injection to help determine the right dosage for the patient. The patient is also taught how to administer the injection on his own.

Patients are generally pleased after they start injection therapy. The teaching session at the office helps the patient see that the injections are not painful and can easily be done at home. It is very rare that a patient cannot do the injection therapy himself. For those who did not respond positively to the oral drugs, injection therapy is an ideal treatment to produce the desired results and overcome the erectile dysfunction.

Treating erectile dysfunction is an important part of a patient’s well being, both personally and within his relationships. The urologists of the Advanced Urology Institute offer many options for treatment and remain committed to finding the best one for each patient. For more information, visit the Advanced Urology Institute website.

Kidney Stone Surgery and Removal Procedures

Kidney stones can be stubborn and painful. In many cases, patients rely on a urologist for help removing these painful obstructions. Kidney stones are hard deposits of minerals that form in the body and can cause blockage in the urinary tract. Urologists will decide how to treat the stone based on factors like its size, the patient’s health and the amount of pain it’s causing.

Dr. Brian Hale of Palm Harbor, FLOne cutting-edge and noninvasive method for treating kidney stones is called shock wave lithotripsy. Board-certified urologist Dr. Brian D. Hale describes it as using water waves to break up the stone. A machine is put against the patient’s body and creates small explosions. The water waves from the explosions target the stone. As many as 2,500 water waves are directed at the stone during a single treatment.

These waves break the stone into small pieces similar to sand. The patient will be able to pass these much smaller pieces with greater ease. The whole treatment takes about 25 minutes. The procedure is mostly pain free but does require the patient to go under general anesthesia. In the early 2000s, patients were not required to go under anesthesia for this procedure. However, it was found that natural movements from the patient made it difficult to concentrate the water waves on the stone, so putting patients under anesthesia is now the general practice.

Each case of kidney stones is different, and noninvasive measures are not always an option. An alternative procedure for stone removal is to use a scope to go up the patient’s penis through the urethra to the kidney and then use a medical laser to break up the stone and pull out the fragments. This is the preferred method for some of the smaller stones that cannot be broken up with shock wave lithotripsy.

For larger stones in the kidney, urologists may recommend a more invasive form of surgery called percutaneous nephrolithotomy. In these cases, the urologist will make a small incision in the patient’s back to reach the kidney directly. The urologist then will use a scope and either a laser or ultrasound energy to break up the stone. This procedure also requires general anesthesia and the patient may need to stay in the hospital for one to two days to recover.

There are many options for patients suffering from painful kidney stones. The many urologists of the Advanced Urology Institute have committed to finding the best options to relieve the pain of kidney stones. For more information, visit the Advanced Urology Institute website.

Kidney Stones Pain, Symptoms and Treatment

Kidney stone disease is a common issue that affects men and women alike. There are many factors that can be attributed to developing kidney stones. According to Dr. Amar J. Raval, “Kidney stone disease is very prevalent in Florida because of heat and lack of hydration.” The state’s warm climate helps induce sweating and makes it easier to dehydrate, putting people who live there at a higher risk of developing stones.

In addition to climate, there are several other factors that can increase kidney stone likelihood. Family history is one factor. If someone in your family has a history of developing stones, you are at greater risk of developing them as well. Diets high in protein, salt and sugar also increase the risk. Salt especially is known to increase the amount of calcium your kidneys must filter, raising the chances of stone development. Certain conditions like irritable bowel syndrome and urinary tract infections are also known to increase kidney stone risk.

Urologist Dr. Amar Raval of Palm Harbor, FLThere are numerous symptoms associated with kidney stones and they can vary in seriousness and pain level. Doctors often see patients with acute onset pain in the upper abdomen that does not resolve with medication, nausea, fever, chills, difficulty urinating and even blood in the urine. The symptoms of kidney stones may present themselves differently depending on many different factors. It is important to know when something is not right and when it may be best to see a urologist for help.

Luckily for people suffering from kidney stones, there are many treatments doctors can use to help them. Many of the treatments are endoscopic, not requiring incisions and are minimally invasive. For instance, doctors may insert a stint into the urinary tract to allow the patient to pass the stone. Shock waves also can be used to break large stones into smaller more easily passable pieces. The shock wave treatment also is not invasive. Doctors can use lasers to break off a piece of the stone for a biopsy to determine exactly what kind of stone it is and what the best treatment may be.

Consulting a trusted urologist for diagnosis and treatment options for kidney stones is very important. Like many conditions, kidney stone treatment is easiest when caught early. Urologists like Dr. Amar J. Raval at the Advanced Urology Institute help many patients with kidney stones. They are familiar with kidney stone disease as well as the latest medical technology, and can provide the most advanced treatment options for their patients. For more information, visit the Advanced Urology Institute website.

Becoming a Urologist with Amar Raval, MD

A urologist plays an important role in healthcare. The field of urology encompasses many issues that people face throughout their lives, especially as they start to age. As urologist Dr. Amar Raval notes, urology allows him the opportunity to “provide a service to others.” As a urologist he gets to make a positive impact on his patients’ lives by helping them with many of the common issues that prompt people to seek medical help.

Dr. Amar Raval from Palm Harbor, FLOne common problem is kidney stone disease. Kidney stones form for a variety of different reasons. They are particularly common in warm climates, like Florida. Symptoms can vary, but they include severe abdominal pain, nausea, fever, chills, difficulty urinating or blood in the urine. Kidney stones can be very painful and some people need assistance to pass them. A urologist can assess the stones and determine the best way to remove them. In some cases, experienced urologists can break up the stones using a shock wave treatment that is totally noninvasive.

Urologists also frequently see cases of prostate cancer, one of the most common cancers for men. The disease comes in many different forms, making each case unique. While some need to be treated with surgery, chemotherapy or radiation, other forms are non-aggressive and can be left alone. Urologists also may recommend cutting-edge technologies like HIFU. Whatever the diagnosis, it is important to work with your urologist to monitor your prostate and find the best treatment plan for you.

Urinary incontinence is a common problem that many patients are embarrassed to discuss with their doctor. A urologist deals with many patients experiencing urinary incontinence and is accustomed to having in-depth conversations with their patients about incontinence. They know how to discuss the problem with patients so they feel comfortable while also finding the underlying issue causing the incontinence. Whether it is caused by stress, infection, lifestyle or another issue, a urologist can find the best solution and help a patient maintain a healthy and confident life.

There are countless other issues that bring patients to see a urologist for help. Dr. Amar Raval at the Advanced Urology Institute is one of many dedicated urologists improve their patients’ quality of life. For more information, visit the Advanced Urology Institute website.

Screening for Prostate Cancer – Dr. Brian Hale

Urologist Dr. Brian Hale recommends that men over 50 years old be checked regularly for prostate cancer. It is the second most common cause of cancer deaths in men and it increases in likelihood as men age. Tests such as the PSA can help detect prostate cancer in its early stages when treatment is most effective.

The most common way to screen for prostate cancer is the prostate-specific antigen (PSA) test. The PSA test is simple and works like this: Both cancerous and noncancerous prostate tissues create protein, and small amounts of that protein will enter the bloodstream. Prostate cancer cells produce more proteins than noncancerous ones, so if cancer cells are present there will be an increase in the proteins in the blood. The PSA test works by checking the blood for increased protein levels.

Dr. Brian Hale: Board Certified UrologistThere are pros and cons to PSA screening for prostate cancer. PSA tests can show increases in proteins when cancerous tissue is not actually present. This is called a false positive and can cause a great deal of stress for the patient and lead to more invasive tests that may not be necessary. For these reasons, among others, PSA tests were not recommended to patients for a period of time.

A few years after PSA tests stopped being recommended, Dr. Hale began noticing a troubling trend. He began seeing an increasingly large number of patients with prostate cancers that had metastasized, which is when it spreads to other parts of the body. This happens when prostate cancer goes undetected and has time to grow untreated. Dr. Hale noticed a correlation between the time PSA screening stopped being recommended and the up-tick in cases of fast-growing and metastasized cancers.

Because of this finding, Dr. Hale recommends that men continue PSA screening as part of their preventative care. Although it may not be a perfect test, its pros far outweigh its cons. Prostate cancer, when caught early is far easier to treat, and can often be treated with less extreme methods. Prostate cancers that have metastasized can be trickier and far more expensive to treat. Although some men may not like blood tests, it is better to take a simple blood test and catch an issue early than it is to let prostate cancer spread and turn into a much more serious medical problem.

As you age, it is important to take care of yourself and see the right doctors to discuss what is best for you. Dedicated urologists like Dr. Brian Hale at the Advance Institute of Urology have been discussing these issues with their patients for many years and will continue looking out for them. For more information, visit the Advanced Urology Institute website.

Are Medications Effective in Treating Erectile Dysfunction


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

What ED pills are available?

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

How well do these drugs work?

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

How quickly do the pills work?

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

Which drug works best?

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

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

What are the alternatives to ED drugs?

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

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

Talking With Your Doctor About Enlarged Prostate


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

What is BPH?

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

You should see a urologist when:

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

Why should you see a urologist?

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

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

How should you speak with a urologist?

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

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

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

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

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

How is Prostate Cancer 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.