What Urology Procedures and Treatment are Performed at AUI?

 

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

A typical day at AUI

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

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

Treating kidney and urethral stones

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

Prostate procedures

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

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

Fertility procedures

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

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

Urologic oncology procedures

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

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

Pediatric urology procedures

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

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

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

Kidney Stones: Causes, Symptoms, and Treatments

When there is inadequate liquid to dilute salts and waste chemicals found in urine, hard masses called kidney stones may form in the kidneys. The stones can form in one or both kidneys and may vary in size, ranging from a tiny sugar crystal to a large golf ball. While kidney stones are hard to notice, a stone can be large enough to cause blockage or severe pain, particularly when it enters into one of the ureters. Kidney stones are a common condition in the United States, affecting up to 9 percent of the population and sending more than 500,000 people to emergency rooms every year.

What are the symptoms of kidney stones?

While very small kidney stones may just pass through the urinary tract without causing symptoms, a majority of people who seek medical care for the condition do so because of severe pain on the flank, which may extend to the belly, groin or back. The movement of kidney stones through the urinary tract also may cause extreme pain that does not go away, painful urination, blood in urine, chills, fever, nausea and vomiting. When experiencing such symptoms, it is important to see a doctor as soon as possible for prompt medical attention.

Causes of Kidney Stones

Kidney stones occur when there is inadequate liquid to dilute the waste chemicals found in urine, such as oxalate, calcium and phosphorous. When not properly diluted, the waste chemicals get more concentrated and form crystals. The most frequent type of stones is calcium oxalate crystals. While there are many factors that can trigger the formation of kidney stones, including what you drink and eat and chronic medical conditions, the most common cause is dehydration. For instance, people living in hot climates are more likely to lose a lot of water in sweat, resulting in limited amounts of fluid available to dilute urine. The frequently high concentration of urine in such people can trigger kidney stones.

Diagnosing Kidney Stones

Kidney stones are often diagnosed once they have caused obvious symptoms, usually severe pain. The pain is typically so severe that it can send patients to emergency rooms where a range of tests may be conducted to uncover the stones. Apart from the symptoms, kidney stones are diagnosed using tests such as X-rays, CT scan, urinalysis and ultrasound. Blood tests to determine the levels of various minerals involved in stone formation also can unearth kidney stones.

Treatment of Kidney Stones

For small stones, no treatment is necessary. You may only need to take pain medications and wait for the stones to pass out. A stone that is 5mm (1/5 inch) or smaller has a 90 percent chance of passing without intervention while one between 5-10mm has a 50 percent chance of passing. To increase the chance of a stone passing on its own, it is important to drink a lot of fluid every day, such as 8-10 glasses of water daily. A stone that is larger than 10mm may not pass on its own and may require either a non-invasive or invasive treatment to remove it.

Prescription medications may be used to facilitate the passage of some stones that do not pass on their own. For example, alpha-blockers can be used to relax the walls of the ureters and widen the passages to allow the stones to move out easily. Certain medications also may be used to stop the formation of new stones.

Apart from using drugs, the surgeon can pass a special instrument called the ureteroscope through the urinary tract to reach the stone’s location. The surgeon then applies laser energy to break the stone into smaller fragments and remove them through the tube. The procedure is called ureteroscopy and it does not require incisions.

Another commonly used treatment for kidney stones is extracorporeal shock-wave lithotripsy (ESWL). This treatment is ideal for very large stones or for stones that have blocked the urinary tract. During shock wave lithotripsy, the surgeon uses a machine that generates strong vibrations (called shock waves) to break large stones into smaller pieces that can pass out through the urinary tract. However, for kidney stones that are extremely large, the surgeon may need to conduct a surgical operation to remove them.

A lot of technology is currently available to help diagnose, treat and manage kidney stones. The technologies are safe and effective, relieving the symptoms of kidney stones without causing problems to the patients. So if you are experiencing symptoms of kidney stones, visit your doctor as soon as possible to benefit from these latest technologies and get the necessary relief. You do not have to live with a problem whose solution exists. For more information on the diagnosis and treatment of kidney stones, visit the “Advanced Urology Institute” site.