Kidney Stones Symptoms with Dr. Brian Hale

My name is Brian Hale. I’m a board certified urologist working with Advanced Urology Institute.

So patients who have kidney stones usually complain of flank pain, which is where the pain would be behind the lower ribs and sometimes it wraps around towards the front [and] down towards the groin area. Those are the most common symptoms, [sometimes] they’ll also have blood in the urine on our testing in the office.

Usually we’ll get an ultrasound or CT scan that diagnoses the stone, it’ll tell us the size and location. If the stones are smaller [about] less than 4 millimeters in size, ninety (90) percent of those times it will pass on their own. So on those patients, I give them a chance to try to pass the stone before we operate on them. When they’re bigger, they’ll be more than 6 millimeters in size, the less of a change of passing [the stone], less than ten (10) percent. For those patients, we look at the scheduling surgery for.

Female Pain During Sexual Intercourse

Sexual intercourse shouldn’t be painful. But for some women, it is.
For some, there may be pain during sexual entry or thrusting. For others, there is a burning, aching, or throbbing pain with every penetration, even pain that lasts several hours after intercourse.

What could be the reason for this?

Pain can be experienced before, during, or after vaginal sexual intercourse. Also called dyspareunia, painful intercourse occurs at the top of the vagina and intensifies with thrusting. It is characterized by a tearing, burning, or aching sensation.

Painful Intercourse The condition can happen at any age. It tends to occur in women who are still young, but you may also have the condition during or after menopause due to decreased elasticity of the vaginal walls, narrowing of the vaginal opening, or increased vaginal dryness. You may also experience painful intercourse after surgical menopause — the surgical removal of ovaries.

Learn more about the causes, diagnosis and treatment of Painful Intercourse.

Advantages and Disadvantages of Robotic Technology in Urology – Dr. Shaw Zhou

Shaw Zhou, MD of St Petersburg, FL

My name is Shaw Zhou, I am with Advanced Urology Institute.

Robotic surgery is truly precise, for example, the magnify [goes] up to ten times so the doctor can see better and if your doctor has a hand tremor [it’s still] very steady. You got four arms instead of two arms, so you have two arms to grab for you and so on and so forth. And you have three dimensional [view], you can see much better. The traditional labs got surgical screens which are two dimensional so you don’t have that sense of depth. However the drawback is first of all, the doctor sits 10 feet away, so God forbid if something happened, your doctor will have to go in, wash your hands and you are not by your patient

Also you lose the tactile sensation, cause you don’t feel it no more. When you tie a knot or whatever you know, the tactile sensor feed gives how much force you use now, [before] it’s purely by experience. Although the new robot that we’re talking about that has tactile sensationin other words you can visually see it. They see how much force [is needed] if its red or green. So it’s getting better and better, eventually new robots keep on coming out but in the future I think we can overcome all these shortcomings for robot surgery.

Becoming a Urologist – Dr. Howard Epstein MD

To become a urologist, one must really be committed to both people and study! First, students have to be top high school students. Then they go to a college or university to study the subjects needed before attending a graduate-level medical school.

Medical School

After completing the required subject courses, students take the Medical College Admission Test (MCAT) and complete medical school applications. Applicants then must pass face-to-face interviews with professors who are medical doctors and have just one question: “Would I want this person to be my doctor?”

Once admitted to medical school, the future urologist can look forward to a program that will last at least four years, including grueling residency requirements and more exams. Upon completing exams, the student is a doctor, but merely graduating from medical school does not make a urologist!

Urology Studies

Howard Epstein, MD of St Augustine, FLThere is yet another exam called the American Board of Urology (ABU) Qualifying Examination, Part 1. Then the future urologist must complete five more years of schooling and residency practice. During this time, the new doctor must learn general surgery, surgical critical care, trauma, colorectal surgery, transplantation and plastic/reconstructive surgery. Also during this time, at least four years of clinical urology training are required. After all of that has been completed, the doctor must pass the ABU Certifying Exam (Part II) to become an ABU certified urologist.

There are a few medical programs that can shorten this process of nine years of graduate school, but they are not accepted in every state.

Re-certification as a urologist must occur every ten years. To continue as a licensed medical doctor, one must do a certain amount of continuing education credits each year. The learning never ends.

Urologists must learn how to examine and treat a large number of different disorders. They work with all kinds of diseases and injuries related to the urinary tract. The urinary tract includes the kidneys, ureters, the adrenal glands, the related arteries and veins, the bladder and the urethra. Urology also includes the male reproductive system, which means urologists also treat issues concerning erectile dysfunction.

The urinary tract is one of the most important parts of the body. It regulates which chemicals, vitamins, minerals and gasses go to every part of the body. While the urinary tract does not regulate what goes into the body, it does regulate what comes out, at least as urine, and ensures that blood composition is just right.

Dr. Howard Epstein

Dr. Howard Epstein did not have a traditional course of undergraduate studies for medical school. His first university degrees were a dual-major in electrical engineering and business administration. From friends who were in medical school, he discovered that he was more interested in their work than in the fields for which he had degrees, so he went back to school.

Dr. Epstein has been practicing medicine since 1984. He is a board certified urologist with the American Board of Urology, a fellow of the American College of Surgeons and a member of the American Urological Association. He is also with the Florida Urologic Association. Serving as the chief of urology at the Gainesville Veteran Administration Medical Center increased his awareness of the unique needs of American veterans. He currently practices medicine at the Advanced Urology Institute’s two offices in St Augustine, Florida at the Southpark and Tuscan locations. To contact Dr. Epstein or for more information, visit the Advanced Urology Institute website.

5 Reasons for Women to See a Urologist

A urologist isn’t just a doctor for men. There are many reasons why a woman would need to see a doctor who treats the urinary system. The urinary system is a collection of organs that involved the kidneys and bladder, as well as the organs involved in the reproductive process.

Here are five common reasons why a woman may need to see a urologist

1. Kidney Stones

When minerals in the urine combine, they can sometimes stick together and create kidney stones that get lodged in the urinary tract. These stones vary in size and create a variety of symptoms. The most common symptoms are pain and difficulty urinating. Some women may also experience fever or chills.

Treatment for kidney stones varies depending on patient and stone type, but urologists have plenty of treatment options on hand. In some cases, drinking lots of water can flush the stones out. In other cases, high-intensity focused ultrasounds can break the stones into smaller, more easily passable pieces.

2. Urinary Tract Infection

Commonly referred to as UTI, this a common infection that many women will develop at some point in their lives. It occurs when bacteria enter the urinary tract and cause pain and burning during urination. UTI’s can become serious, so treatment with antibiotics is important.

3. Bladder/Pelvic Prolapse

This painful condition occurs when the bladder begins to drop down into the vagina. There are a few reasons why this may happen. Some women develop this condition after childbirth, but for others it occurs as a part of the aging process. Correcting this problem usually requires surgery performed by a urologist.

4. Bladder Control Problems

Bladder control problems are twice as common for women, and the medical term for these problems is Urinary Incontinence. Urinary incontinence takes many forms. Some women experience dripping when they sneeze, cough or laugh. Some women have an overactive bladder that creates a sudden and urgent need to use the bathroom. No matter what form it takes, women can work with a urologist to find the best treatment, or combination of treatments, to help with their incontinence.

5. Cancer

There are certain cancers for which a woman would be treated by a urologist. These include cancers of the bladder, kidneys or urethra. Lower back pain, pain during urination, and blood in the urine can be signs of one or more of these cancers. Treatment varies depending on the type of cancer, how aggressive it is, and the overall health of the patient.

Women in Florida who need a urologist for treatment of one or more of these problems have many options. The Advance Urology Institute is a team of highly skilled medical professionals who practice at locations throughout the state and with a commitment to achieving the best possible outcomes for their male and female patients. For more information about women’s urological issues, visit the Advance Urology Institute website.

Why Would You Need to See a Urologist

The urinary system is your body’s way of getting rid of urine. If there is something wrong with your urinary system, you may need to see a urologist. A urologist is a doctor trained and certified in treating issues with the many components of the male and female urinary systems and male reproductive organs.

Urologists treat a wide range of urological issues, including problems with the bladder, kidneys or urethra. If you are a man experiencing issues with your reproductive organs—penis, testes, scrotum, and prostate—it is a urologist you will need to see. And for women, issues with the bladder and pelvis are reasons to visit this kind of specialist.

Common bladder problems that send patients to the urologist are kidney blockages, kidney stones, and urinary tract infections (UTIs.) Treatment for these issues vary from patient to patient. For instance, some patients might be able to pass a kidney stone by drinking water and moving around to dislodge it, while others may need a more advanced treatment like a high frequency ultrasound, which is an ultrasound focused on the stone to break it down into smaller, easily passable pieces, similar to sand.

For men’s reproductive health, urologists can treat Erectile Dysfunction (ED). In most cases, this condition is easily treated with oral medication, though in some patients injection therapy may be necessary. Prostate cancer, the most common cancer that affects men, is another reason that men seek out a urologist for treatment. Again, for this issue, treatment varies by diagnosis. While some men’s prostate cancer can be monitored and treated with active surveillance, others may need surgery or chemotherapy depending on the aggressiveness of the cancer.

Women are more likely to see a urologist for bladder problems, often for changes in urination after pregnancy. Pelvic organ prolapse is another potential medical issue for women. Usually caused by age, this is when either the uterus or bladder begins to drop and press into the vagina. A urologist can treat this condition to relieve the discomfort and pain it causes.

Residents of Florida have access to a leading center for the medical specialization of urology with locations throughout the state. The Advanced Urology Institute is an exceptional team of medical professionals who treat their patients’ urological issues with compassion and a commitment to the highest quality care. For more information, visit the Advanced Urology Institute website.

Discussing a Sensitive Topic: Erectile Dysfunction

Erectile Dysfunction, also called ED, is the inability for a man to get or maintain an erection firm enough for sexual activity. It is a very personal and sensitive issue that can be difficult to talk about. Although ED is a common issue that affects many men, it can still cause feelings of embarrassment and shame. This makes open conversations, even with a trusted urologist, difficult in some cases.

Dr. Billy Vanasupa of St Augustine, FLA urologist is a doctor who specializes in the urinary tract and male reproductive system. They are the doctor a patient will most likely to go to about his ED. Urologists see countless cases of ED on a regular basis, and to them it is not a major issue at all. However, good urologists understand that ED can be an embarrassing issue for their patients and they immediately begin their visits by creating a comfortable environment where doctor and patient feel at ease discussing it.

One such urologist who works to create a comfortable environment is Dr. Billy Vanasupa. When talking about his approach with patients who see him for ED, Dr. Vanasupa says, “I always try to make my visits light, make some jokes here and there, and make them feel comfortable.” His goal is to make his patients laugh so they are less nervous and feel they can easily talk to him. Dr. Vanasupa removes the stigma of ED so he and his patient can openly discuss this sensitive topic.

Once everyone is comfortable discussing the topic, the urologist will ask background questions like whether the ED occurred slowly or abruptly. The patient will be asked if he has tried any medications. The doctor’s questions are to help determine root causes for the issue and will include asking about diet, alcohol and drug use, and stress factors. Finding possible causes for ED is an important first step in treating it.

The urologist and patient will discuss best treatment options for ED. In many cases, oral medication, possibly along with some minor lifestyle adjustments, will fix the issue and allow healthy men to return to their normal sexual activity. For some men, oral medication does not help. The urologist may suggest injections. Patients will learn in the office how to administer a very low-pain injection at the base of the penis. There are very few cases where neither the oral or injected medication solves the issue.

Outcomes are best when the patient feels comfortable talking to his urologist about sensitive issues. The Advanced Urology Institute has urologists who can treat erectile dysfunction in a way that puts a patient at ease. 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.

Prostate Cancer Treatment: How to Choose What’s Best for You

Prostate cancer is one of the most common types of cancer that affects men. The prostate is a small gland, similar in shape to a walnut, that produces the seminal fluid that helps transport sperm. Although anyone can get prostate cancer, it becomes more common as men age.

It can be difficult to detect prostate cancer as it has little to no symptoms in its early stages. For this reason, it is important for men to have their prostate routinely checked by their doctor. Only after the cancer advances do symptoms occur like trouble urinating, blood in semen, bone pain, erectile dysfunction and discomfort in the pelvic area.

Advanced Urology Institute Doctor: Dr. David HarrisSome prostate cancers grow slowly and, in some cases, need little to no treatment. Other cancers can be aggressive and spread quickly. It is important to see your urologist often to monitor your cancer, as the best treatment for you will depend on the type of prostate cancer you have and how it reacts to treatment.

Treatments for prostate cancer vary depending on multiple factors. Urologists will look at a patient’s age, health and the type of prostate cancer when deciding on the best treatment. In a healthy young patient, a urologist may recommend robotic surgery or a radical prostatectomy. These are well-tested and invasive treatments that can produce very good outcomes.

For patients who may be a little older and not in the best of health, radiation therapy may be their best option. Having access to quality radiation therapy can be a game changer in prostate cancer treatment and can create excellent outcomes. It also will be easier on a patient with other health issues.

There are also newer advances that can be used to treat prostate cancer. For example, cryotherapy uses extremely cold temperatures to destroy cancerous tissues in the prostate by freezing them. Another example is HIFU therapy. This stands for stands for High Intensity Focused Ultrasound and uses an intense ultrasound, focused on the prostate, to treat the cancer and is minimally invasive.

Prostate cancer is a serious and often frightening prospect. Many men will suffer from this cancer, but they are not alone. Along with their urologist, men can combat their cancer in a way that produces the best outcomes. Dedicated urologists, like David S. Harris, MD at Advanced Urology Institute, have an arsenal of treatment options and are ready to help men live healthy lives. For more information, visit the Advanced Urology Institute website.

Why Urology? with Dr. Bill Vanasupa

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

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

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

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

How Did Dr. Rolando Rivera Become a Urologist?

KEY TAKEAWAYS:

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

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

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

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

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

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

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

TRANSCRIPTION: 

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

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

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

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

REFERENCES: 

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.

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.

Diagnosis and Treatment of Urologic Cancer

Urologic cancers are on the rise and here at Advanced Urology Institute we are seeing more and more cases every year. A urologic cancer is one that occurs in any organ of either the urinary system or the male reproductive system. It is a term that encompasses cancers such as adrenal, bladder, kidney, penile, prostate, testicular and ureter cancer. While a diagnosis with urologic cancer can be devastating and traumatic, the good news here at AUI is that with prompt screening and diagnosis, we can catch the cancers early and partner with our patients throughout their treatment and recovery to follow-up care. We always want our patients to understand that we are in it together and we want to work with them and their families to ensure quick recovery and high quality of life throughout their battle with the disease.

Diagnosis of urologic cancers

Diagnosis of urologic cancers usually starts with symptoms, although some patients don’t show symptoms and their tumors are detected during routine imaging. At AUI, our approach to cancer diagnosis includes patients’ symptoms, personal medical history, family medical history, physical examination, screening and diagnostic testing. The symptoms of urologic cancers tend to vary with the type and location of the tumor, but may include abdominal pain, blood in urine, elevated hormone levels, swollen abdomen and enlarged prostate. In terms of diagnostic tests, we often use biopsy, blood tests for hormone levels, digital rectal exam, liver function tests, pelvic exam, renal arteriography, bone scan, ultrasound, urine test, CT scan and MRI scan.

Care after cancer diagnosis

Dr. Chad Hubsher of Advanced Urology InstituteAt Advanced Urology Institute, we understand that diagnosis with urologic cancer is shattering and distressing. So we speak with our patients soon after diagnosis to bring their emotions under control and give them hope. For us the goal is not just to cure cancer but also to prepare and help our patients to face the challenges that may come with the disease. That’s why we work collaboratively with clinicians, researchers, dieticians, nurses, radiotherapists, radiologists and other medical professionals to ensure optimal outcomes are achieved with minimal impact on our patients’ quality of life.

Treatment of urologic cancers

We follow a multidisciplinary approach when treating urologic cancers. That means a wide-range of certified medical experts evaluate a patient’s condition and develop a comprehensive, personalized treatment plan depending on the type, stage and location of the cancer and the patient’s overall health. In a number of cases, surgery may be the primary treatment for urologic cancer and we provide minimally-invasive laparoscopy, robotic surgery, percutaneous cryosurgery and reconstructive procedures that deliver optimal outcomes with reduced scarring, less pain and shorter recovery time. Every patient’s candidacy for surgery is evaluated after diagnosis or during first appointment, but we are always confident of taking on some of the toughest cancer cases and striving to provide the best surgical outcomes and patient experience.

AUI also provides a number of advanced urologic cancer therapies. We offer current and investigational treatments and provide advanced radiation therapies including prostate brachytherapy (radiation seed implants). Treatment options for urologic cancer may include chemotherapy, hormone therapy, immunotherapy and radiation therapy. For instance, we deliver targeted regimens of radiation that are sculpted to the shape and size of the tumor ensuring that their impact is focused on cancer cells while limiting exposure of adjacent normal tissues. Likewise, urinary diversion techniques, fertility-preserving options and drugs with fewer side effects are prioritized. And with our extensive team of survivorship and supportive care experts, who help patients and their caregivers to attain and maintain a better quality of life before, during and after treatment, we often achieve great outcomes for our patients.

Recognized leader in care for urologic cancers

Advanced Urology Institute has a urology oncology team that is a nationally recognized leader in the management of urologic cancer. We have state-of-the-art equipment, leading urologists in their field and imaging and pathology experts who are good at what they do. What that means is that our patients get the best possible care at every stage of their journey with cancer. We manage urologic cancers in an outpatient setting, allowing our patients to go home the same day. And when they go home early from our day cancer center, we monitor them very closely. We are proud that, in most cases, our cancer patients do really well.

At AUI, our goal is not just to cure cancer but also to prevent it from spreading and from coming back. We are also committed to working with the local communities and spreading the word for people to get tested early. For more information on the prevention, diagnosis and treatment of urologic cancers, visit the “Advanced Urology Institute” site.

Kidney Stone Causes, Symptoms, and Treatments

There are a lot of kidney stone cases in Florida, thanks to dehydration from the extremely hot weather and diets that include a lot of tea, meat, salt and other highly rich foods associated with the stones. While about 10 percent of Americans may expect to have a kidney stone at some point in their lives, the likelihood rises to 15 percent for people living in the South. Stones are formed when minerals and other substances found in urine crystallize, usually in people who are dehydrated or don’t consume enough fluids.

Symptoms of kidney stones

At Advanced Urology Institute, we see a lot of patients with kidney stones. A contributing factor is our location in Florida, with its massive heat and humidity which leads to dehydration and, unfortunately, to the formation of these painful stones in the kidneys. The stones commonly present with severe, intense pain — like something is stabbing you — and you can barely walk. Kidney stones are characterized by sharp pains in the side or back as they make their way to the bladder. Most of our female patients usually say the stones are more painful than labor pain. Other symptoms of kidney stones include vomiting, nausea, a constant urge to pass urine and blood in urine.

Pain from kidney stones is often sudden in onset, though it may get severe over a period of hours in some cases. The pain may be either intermittent (colicky) or steady and, depending on the stone’s location as it moves through to the bladder, it may begin in the back or flank area and radiate slowly downward to your inguinal ligament, urethra, bladder, testicles or penis. Urinary or bladder symptoms, such as frequency of urination and painful urination, may occur if the stone is located in the portion of your urethra found within the bladder wall. Not all stones cause pain and some of them are often discovered “incidentally” during pelvic or abdominal X-rays. But in patients who experience pain, they usually describe it as the worst pain they have ever experienced.

Diagnosis of kidney stones

Diagnosis of kidney stones is almost entirely based on the history of passing the stones or on occurrence of a stabbing pain in the side or back. We usually place emphasis on the patient’s clinical signs, familial disorders, presence or absence of any previous renal stones, or physical exam findings. We also perform a urinalysis to check the presence of white cells (pyuria) or blood (hematuria) in urine, a culture of urine to exclude infection, and use the presence of crystals in urine (crystalluria) to help identify the stone type. Patients are often required to strain their urine to obtain the stone for crystallographic analysis. Analyzing kidney stones for their mineral composition helps us understand your future risk and to recommend the right dietary habits and restrictions for preventing stones. But we also do a CT or CAT scan of the pelvic and abdominal area to evaluate the size, location, degree of hydronephrosis and density of the stone, all of which are important in determing how we treat and manage the stones.

Treatment

When patients complain of symptoms of kidney stones, we usually do physical exams and run tests to confirm that they actually have stones. But we often begin by getting the pain under control and calming the patients, to enable us to discuss with them available treatment options. The pain due to kidney stones is relieved using pain medication, drinking plenty of fluid to prevent dehydration, and ordering bed rest. In many cases once we have assessed that the stones can pass on their own, we allow about 7 days for them to pass spontaneously. In other instances, however, kidney stones may need to be broken down into tiny pieces or to be removed surgically.

At Advanced Urology Institute, we break up kidney stones using such techniques as percutaneous lithotripsy, cystoscopy or extracorporeal shock-wave lithotripsy. For renal stones less than 2cm in size, we generally treat them using extracorporeal shock-wave lithotripsy. During the procedure, high-intensity ultrasound (shock-waves) are passed through pouches of water placed on the skin and then directed toward the stone. The waves break the kidney stones into tiny pieces that can pass easily through the ureter. For stones located higher in the ureter or in the bladder, we often use cystoscopy to pull them out or break them up with electric energy or laser. During the procedure, the doctor passes a viewing tube with a crushing device into the ureter or bladder to pull the stone out or break it up with electric energy or laser.

For larger stones, percutaneous nephrolithotomy is a safe and reliable technique. For this procedure, you’ll be given medication to sedate you, then a viewing tube will be inserted through an incision made in your side. Once the stone is reached, it’s broken up using electric energy or ultrasound. In cases where this procedure doesn’t work, particularly when the stones are hard to reach or too large, surgery is often the preferred treatment. Surgery to remove kidney stones is performed under general anesthesia with the doctor making an incision into the side and another into the kidney or ureter to remove the stone. After the stone is removed, the incisions are stitched up.

There are many ways of treating kidney stones and the method chosen usually depends on the experience and judgment of the urologist, together with the patient’s preferences. At AUI, we prioritize the comfort of our patients, so we opt for the least invasive procedures before considering surgery. Want to know more about prevention, diagnosis and treatment of kidney stones? Find more information from the “Advanced Urology Institute” site.