Like Dr. Arash Rafiei, all urologists are required to complete at least three years of college before they enter medical school. Most students complete four years of college with a Bachelor of Science in Chemistry or Biology. After graduation from medical school, the urologist-in-training will complete a residency at a hospital, usually one with a specialty in urology. The residency is a minimum of five years. Time during residency may be split in some programs as two years in general surgery residency and three years in urology. Board certification takes another two to five years. So, effectively, urologists can expect to spend 13 years in study or residency before board certification.
Selecting Your Urologist
When choosing a urologist, you can specify that you would like a board certified doctor for your urology treatment. Make sure you write down all your questions for the doctor, and seek someone who will take into consideration your individual preferences. Ascertain that the facility and medical staff keep up to date on the latest technologies, such as minimally invasive techniques, as well as proven treatment guidelines.
What does a Urologist do?
Urologists are medical doctors who specialize in the male and female genitourinary tract, including the urinary bladder, urethra, kidneys, adrenal glands and male reproductive organs. They often diagnose and treat male fertility, prostate cancer, and receive ongoing training in other medical and surgical problems related to these organs.
Advanced Urology Institute is a center for excellence in urology with board-certified specialists to treat all areas of this field. If you need an appointment with a urologist in Orange City, Florida, our team specializes in:
prostate cancer treatment
kidney stones
problems with the bladder, including overactive bladder
prostatitis
erectile dysfunction (ED)
urinary tract infections
general urology
and other urology conditions.
Dr. Arash Rafiei, MD is board certified and a member of the American Urological Association, the American College of Surgeons, and the Iranian American Medical Association. For more information, call the office of Dr. Rafiei at (386) 774-2121 or call one of our many Advanced Urology Institute locations. Our doctors will answer your questions and deliver the best service and care based on your needs.
Dr. Jonathan Jay’s path to urology began with a background in physiology, medicine, residency training, and fellowship training before becoming a board-certified urologist.
A proficient urologist requires not only a deep understanding of medicine but also emotional intelligence, honesty, empathy, and compassion to effectively treat and support patients with a variety of urological conditions.
Dr. Jay chose to practice at Advanced Urology Institute (AUI) due to its centralized administrative tasks, access to cutting-edge surgical and medical equipment, collaborative and multidisciplinary approach to patient care, and friendly working environment.
Urology is a fascinating, stimulating and satisfying field of medicine. As urologists, we treat conditions of the urinary tract in both men and women, together with disorders of the male reproductive system. Being a urologist is an opportunity to care for people with agonizing, embarrassing and life-threatening conditions, such as kidney stones, urinary incontinence, erectile dysfunction, and genitourinary cancers, restoring normalcy in their lives. For those like me who are passionate about saving and improving lives, urology is a worthwhile career. For me, every day spent with my patients is not only an opportunity to serve and help people, but also contribute to saving or extending lives. In turn, the positive outcomes from various interventions bring joy and satisfaction.
Why urology?
Well, mine is a funny story. Growing up in Lansing, Mi., with both my parents having PHDs — my mother working at the Lansing School District and my father being a Michigan University professor — I learned to be inquisitive from a very early age. Being educators, my parents always encouraged me to be curious; to try to understand how various things worked. Eventually I became profoundly curious about how my body works and searched for answers wherever I could find them. As a result, I ended up studying physiology, then medicine, and ultimately specializing in urology.
Path to urology
My curiosity led me to study physiology — the study of how the body works — to learn more about the body. So I attended Michigan State University to pursue a Bachelor of Science degree in physiology. As I was studying physiology, I became interested in medicine. Upon graduation, I went to Ann Arbor, University of Michigan for my medical education. After that, I moved to Henry Ford Hospital for my residency training before going to and completing my fellowship training at the Beth Israel Deaconess Medical Center.
During clinical rotations in medical school I came across urology. I actually did not know anything about urology until my classmates at medical school told me about it. They really took me under their wings like a little brother. And because they liked me and I liked them, we were able to speak freely about our career aspirations and interests. So when they recommended that I study urology, telling me repeatedly that I had to try urology —”stay here and be a urologist’ — I gave it a shot and here I am, a board-certified urologist.
What does it take to be a urologist?
As urologists, we see the whole spectrum of age groups — from newborns to elderly patients. For instance, we can see children with congenital problems and care for geriatric patients with bladder control problems, sexual dysfunction or benign prostatic enlargement. So we delve into deeply emotional problems that require empathy, support and effective solutions.
That is why to be a good urologist, you need not only to understand medicine very well and be able to offer effective treatments, but you also must have emotional intelligence. That is, you need to know what to say, why to say it, when to say it and how to say it, and to treat patients as human beings, handling them in a warm, friendly and respectful manner. Actually, honesty, empathy and compassion are the marks of a proficient urologist.
Areas of expertise
I have practiced urology for several years now, seeing patients for a broad range of issues. Frequently I treat patients with enlarged prostate, urinary stones, urinary incontinence, prostatitis, testicular pain, recurrent urinary tract infections, urologic cancers and erectile dysfunction. But my areas of special interest include voiding dysfunction, pelvic floor reconstruction, urinary incontinence, female urology, urodynamics, and urogenital disorders triggered by neurologic disorders.
Over the years, I have performed pelvic floor reconstruction surgeries in both men and women, neuromodulation, surgery for bladder dysfunction, MonaLisa Touch laser procedure for post-menopausal sexual and urinary symptoms, Botox (botulinum toxin) injections, UroLift System procedure for BPH, and da Vinci robotic treatment for post-menopausal sexual and urinary symptoms. I also keep improving my knowledge and refining my skills through continuous medical education, training and research. I understand that I can only deliver the best to my patients when I have the right skills, tools and methods.
Job satisfaction
Urology is about providing relief to people with troubling and humiliating conditions. Patients come to us when they are at some of the lowest moments of their lives and we are able to address their issues and see them restored to normal lives again. Something unique about urology is that the problems we handle are often clearly defined, which means that almost every time a patient presents with a urological condition, we are able to pinpoint the exact etiology and extent of defect and then provide an effective solution.
Therefore, we are able to achieve great outcomes for almost all our patients. In fact, unlike other specialties such as neurology and oncology, the majority of our patients get better and do well after interacting with us. And with this understanding that we can solve many — if not most — of the urologic issues of our patients, we really feel satisfied with our work. And since we are able to achieve great results for our patients, they are always grateful and hold us in high esteem. So with urology, we are largely contented and happy about the work we do.
Why Advanced Urology Institute?
Urologists need a working environment that can bring out the best of their knowledge, skills and talents. For me, that dream place is Advanced Urology Institute. At AUI, all administrative tasks are centralized to ensure that physicians find enough time to deliver the best possible care. Urologists also have access to cutting-edge surgical and medical equipment and are able to apply the latest methods and techniques as soon as they are available.
Urologists at AUI work under a thriving culture of compassionate, collaborative and multidisciplinary approach to patient care, which enables frequent cooperation with other board-certified, skilled and experienced medical professionals. To crown it all, AUI clinics are always warm, friendly and buzzing with colleagues sharing stories, cracking jokes and interacting freely. It is always a wonderful experience being at AUI and I really feel privileged being part of the team.
Want to know more about AUI and the services we offer? Find out more by visiting the “Advanced Urology Institute” site.
TRANSCRIPTION:
I’m Jonathan Jay, I’m a board-certified urologist with Advanced Urology Institute.
Funny story, I just had a curiosity about how my body worked, so that led me into physiology because that was a study of how your body really works and then with time that just led into medicine.
Lansing Michigan, my family and my parents were educators, both PhDs, my mother working in Lansing School District, my father worked for Michigan State University as a professor.
Interesting enough, education was important in my family. I always had a curiosity about learning and understanding things, so that’s what they gave me, they gave me a curiosity of trying to understand things.
It’s funny, urology came about by a rotation through medical school, all the medical school students said, hey you got to try urology, they let the medical school, medical students close the wounds, that’s a pretty rare thing.
So all the guys were very nice, these guys took me under their wing like a little brother and so with that they said, hey why don’t you, they liked me, I liked them, they said why don’t you stay here and be a urologist.
Now urology was something that I never even knew existed, in fact they gave a lecture in the second year of medical school, I said who would want to do that, that is the grossest thing I’ve ever seen, but here I am being a urologist all because of a great experience that people provided me, took me under their wing like a little brother. So for me, I always felt like being a doctor you had to have four qualities. The first quality you had to have is you had to understand medicine. You don’t have to be the valedictorian of the class, but you got to understand medicine fairly well.
The next thing you have to have is stellar social intelligence. You got to be able to talk to a human being like a human being, be able to read social cues, know what to say, when to say and how to say it. Then above all you have to care and have empathy for another human being. You have to have all four of those qualities.
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.
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.
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:
You are finding it problematic to start to urinate.
You frequently have a sudden, uncontrollable urge to urinate.
You have dripping or leaking of urine after you urinate.
You have weak, slow or interrupted urine streams.
You urinate frequently, particularly at night.
You experience pain or discomfort or have to strain or push to urinate.
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.
After a diagnosis of prostate cancer, there are several treatment options you may want to consider. However, there is no single option that is right for all men with prostate cancer. Some prostate tumors grow very slowly or don’t grow at all, so you may never even need treatment if you have such a tumor. Then there are tumors that grow rapidly and spread quickly to different areas of the body. Either way, you should work with your doctor to decide what is best for you. As you discuss your treatment with your cancer care team, it is important that you weigh the benefits of every option against the possible side effects and risks.
The factors to consider when choosing treatment for prostate cancer include:
Stage of your cancer (how far it has spread).
Severity of the tumor (how large in size and how serious the symptoms are).
How quickly the cancer is growing or spreading.
Your age, state of health, lifestyle and expected lifespan.
Any other serious conditions you may have.
What every treatment involves.
Possible side effects of the treatments.
The possibility that the treatment will cure the tumor or help in some way.
How the treatment chosen may affect other treatment options later should the cancer recur or spread.
Your personal feelings about each treatment option.
Practical issues such as nearness to hospital.
The most common treatments for prostate cancer include:
1. Active surveillance
The doctor keeps an eye on the cancer to make sure it can be treated should it begin to spread or grow aggressively. This option is appropriate if you have a small, localized, slow-growing tumor. The doctor will wait until symptoms appear in order to begin treatment. During active surveillance, the progress of the tumor is monitored through regular PSA blood tests, ultrasounds, rectal exams and biopsies. The tests help to check whether the cancer is getting worse so appropriate treatment can be administered as soon as it begins to grow or spread.
2. Radiation therapy
Radiation is aimed at the cancer to destroy the cells and treat the tumor. Image-guided radiotherapy ensures that prostate cancer can be treated with minimal effect on healthy cells. However, radiation therapy is still often considered more ideal for older men and those who have other serious health problems and less so for younger men. You also may undergo radiotherapy after surgery to help get rid of any cancer cells that remain behind or to treat cancer that has reached the bones. There are two forms of radiotherapy: external beam radiotherapy that is applied by a machine placed outside the body and internal radiotherapy (brachytherapy) that involves inserting small radioactive “seeds” into the body either near or into the cancer.
3. Surgery
If you are healthy and have a localized cancer, you may choose to have an operation to remove the prostate gland or to remove the gland and surrounding tissue. But surgery for prostate cancer is often associated with problems getting an erection and controlling urine, so you should speak with your urologist before the procedure to find out if measures are in place to protect your nerves and minimize such effects.
4. Hormone therapy
Prostate cancer cells require the hormone testosterone to keep growing. Hormone therapy, also called androgen deprivation therapy, is when the urologist applies treatment to ensure the cancer cells can’t get the hormone. The treatment either may lower the body levels of testosterone and other male hormones or block the way testosterone works.
5. Chemotherapy
Your urologist may prescribe drugs to kill prostate cancer cells or shrink the prostate. The drugs can be taken orally or may be injected directly into your bloodstream. Generally chemotherapy isn’t given for men with early-stage prostate cancer. But when the cancer is advanced or has spread to other areas of the body, then chemotherapy may be ideal. Apart from using drugs, the urologist may give the prostate cancer vaccine to boost your immune system in order to fight the cancer cells. The vaccine is often given to men who haven’t been successful with hormone therapy and it can help you live longer.
Surgery vs. radiotherapy: Which one is ideal for you?
While some men with low-risk localized prostate cancer and some with medium-risk cancer may find watchful waiting (active surveillance) appropriate, others with localized cancer may want to begin treatment right away. And in that case, either radiation therapy or surgery may be the suitable treatment.
Both radiation therapy and surgery work well for localized prostate tumors, limiting the possibility of the cancer spreading outside the prostate. Both treatments have side effects too, including bowel, bladder and erection problems. With radiation therapy, you are more likely to have bowel problems. But with surgery, you are more likely to have erection problems or leaking of urine. So the choice you make between radiation therapy and surgery should primarily depend on your treatment goals.
For example, if the goal is to treat the cancer by removing the prostate, then surgery is the proper treatment. Of course, there are men who just want to get the cancer out and they wouldn’t mind removal of the prostate too. Then there are some who want to avoid radiation so surgery suits them well. If the goal is treating cancer while also avoiding the risks associated with a major surgery, then radiation therapy is the ideal choice. Having radiation instead of surgery also will help to avoid erection problems and preserve your sexual function.
One form of treatment may be more appropriate for you than the other because of how you feel about it, other health problems you have and your life expectancy. For instance, young men do well after surgery while older men tend to respond well to radiotherapy. That is why you should discuss your options with your doctor before you make a decision.
Treating advanced-stage prostate cancer
For advanced prostate cancer — a cancer that has spread beyond the prostate and into other parts of the body — treatment may not cure the cancer, but will keep it in check and relieve symptoms. The treatment options for advanced prostate cancer include hormone therapy, chemotherapy plus hormone therapy and prostate cancer vaccine. Usually, hormone therapy is given for advanced-stage prostate cancer to help keep the cancer under control. But if after some time the cancer begins to grow again, other treatments may be administered along with the hormone therapy to control the cancer and alleviate the symptoms, though the hormone therapy regime is kept because it ensures that your testosterone level is low.
With prostate cancer, there is no perfect treatment for every patient. All definitive treatments come with side effects, which tend to vary depending on the patient and the actual treatment. As urologists, we are always endeavoring to minimize these effects by picking the appropriate treatment for each patient. We make sure that the treatment can effectively eliminate the cancer while also preserving the patient’s quality of life during and after therapy. For further information on treatment of prostate cancer, visit the “Advanced Urology Institute” site.
Immunotherapy is a beneficial treatment for men with prostate cancer, particularly those with incurable advanced-stage or recurrent form of the disease. The treatment works by activating your immune system to attack the cancer cells, shrinking the tumor or causing it to disappear altogether. Used alone or in combination with other treatments, like chemotherapy, hormone therapy or radiation therapy, immunotherapy is able to reverse the growth of prostate cancer after the other treatment options have failed.
How does it work?
Like many other tumors, prostate cancer evades the immune system by deactivation of T-cells, the blood cells that attack foreign materials and abnormal cells in the body. So immunotherapeutic approaches are designed in a way to enhance the response of the immune system to cancer cells by reactivation of the T-cells.
During immunotherapy, immature immune cells are obtained from a man with prostate cancer. This is done to allow the cells to get out of the environment where they can be detected and deactivated by the cancer cells as soon as they are mature. The immature cells then are re-engineered by combining them with an artificial version of PAP, the antigen expressed by 95 percent of prostate cancer cells. After re-engineering, they are supplied with a factor (GM-CSF) that boosts their survival, growth and maturity once they are infused back into the body.
Meticulously re-engineered, activated, trained and matured T-cells are infused back into the body — now with the ability to attack and destroy cancer cells. They act as antibodies against the cancer cells and are able to detect and eliminate the cancer cells. The infusion of re-engineered cells or antibodies against prostate cancer is done three times. But as the treatment goes on, you still will be on the treatment or drugs you were already taking prior to immunotherapy. That will allow your body to produce enough activated, trained and matured T-cells to fight the prostate cancer without ever again being deactivated or bypassed by the cancer.
Why should you consider immunotherapy for prostate cancer?
Immunotherapy is an amazing and highly effective treatment for the cancer. During treatment, your cancer treatment team can use a wide variety of immune-based strategies to develop antibodies against the tumor, killing the cancer cells and preventing its recurrence. It offers excellent results in men with advanced-stage hormone resistant prostate cancer and reduces the risk of cancer recurrence in men with high-risk, localized tumors when it is administered in combination with hormone therapy. The treatment increases the survival rate from prostate cancer and enhances life expectancy by several years.
At Advanced Urology Institute, we are offering immunotherapy as a treatment option for prostate cancer, particularly tumors that have spread beyond the prostate or become resistant. And as our understanding of how cancer cells relate with the immune system deepens, we are tapping into that knowledge to help improve treatment outcomes for our patients. So if you have been diagnosed with prostate cancer, find out from your urologist if immunotherapy may be of help in your situation. Want to know more about the treatment options for prostate cancer? Visit the “Advanced Urology Institute” site.
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
At 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.
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.
Being a urologist is an opportunity to help people and make a difference in their lives. As a urologist, people come to you with sensitive and often awkward conditions of the genitourinary tract and you assess the problems and provide the most appropriate remedies. The goal of urologists is always to make interventions that ensure patients are able to live fuller lives. And that makes us proud of our work and of our unique place in the medical profession.
Urology — a big world of stuff
Many people think of urology as merely being about urine. But urology is a massive world that covers a wide range of stuff. It’s an amazing and exciting specialty, where you perform surgery, manage problems medically, develop enduring relationships with patients and go home every day feeling satisfied with your work. I like urology because I’m often able to see the results of my work. For example, when patients come with urological cancers — of the prostate or kidney — I am often able to make effective interventions and achieve great outcomes. Actually, almost all my operations usually result in improved quality of life.
Why urology?
Urology was a natural fit for me. I wanted to be involved in diagnosis, medical management and surgical procedures. With most of my cases I have found that wonderful balance of medicine and surgery in urology. I also like listening and talking to people, leading them to open up and share their problems, guiding them to see the bigger picture and helping them to make informed decisions. In urology, I’m able to do this and much more with my patients. Most crucially, I joined urology to have a chance to make a difference in people’s lives. And indeed, I have found the specialty well-rounded, fascinating and exciting, as well as a powerful instrument for improving people’s lives.
Path to urology
I was born and grew up in Tampa, Florida, where my passion for the health and well-being of the people around me and for public health and sanitation made me a volunteer in many causes right from a young age. I soon realized that pursuing medicine would help me to make a better contribution in health care and improve people’s lives. So I joined the University of Miami for my medical education, graduating with AOA honors. Then I went to Shands Hospital, University of Florida for my urology residency. Currently I am happy and proud to be back in Florida where I’m practicing and living the dream of my life — making a difference in people’s lives.
Areas of expertise
As a urologist, I routinely deal with a wide variety of issues, such as urinary tract infections, overactive bladder, urinary incontinence, low testosterone and prostate enlargement. I also offer procedures for kidney transplants, interstitial cystitis, prostatitis, overactive bladder, congenital abnormalities, urinary stones, correcting stress incontinence, operating on adrenal glands and treating bladder, prostate and kidney cancer. I provide vasectomies, vasectomy reversals and treat erectile dysfunction and infertility issues in men.
What makes urology even more interesting is the continuous integration of advanced technology. Today we can access the urethra via the bladder and get into the kidneys without making any incisions. Even operations to remove kidneys or prostates, which previously required open surgery, are now routinely performed robotically or laparoscopically — using tiny, image-guided instruments.
At Advanced Urology Institute where we use the da Vinci surgical system for several operations, a urologist can now just sit at a console, have fingers in sensors and remotely control a multi-armed robotic surgeon, which ensures access to more areas in the body and provides seamless movement during operation in ways that are impossible laparoscopically. Application of such technology guarantees less scarring, less blood loss and quicker recovery for our patients. And for the urologist, it’s always exciting in the operating room working with such technology.
Job satisfaction
It takes long and hard training to become a urologist. The residencies take 5-6 years and typically involve long hours of complex work and limited sleep. Then there are several hours per week spent in the operating room, which may test anyone’s tenacity and patience. However, it helps that urologists are generally professionals with a positive attitude, good bedside manners and vast empathy. So these challenges can hardly diminish our enthusiasm and commitment to urology.
As a urologist, you are always conducting tests and procedures that may be quite uncomfortable for your patients, delivering news about diagnoses that your patients may not want to hear, and facing medical emergencies requiring you to think on your feet and solve issues to the best of your ability. But with skills to communicate well, eyes for detail and unquenchable desire to help people, you’ll always find yourself on top of things.
I really like urology because I’m a hands-on person who enjoys the hours it offers in the operating room. There are many potential conditions to treat, a wide range of procedures to perform and different tools to use —so no two days are the same. From a vasectomy to vasectomy reversal, circumcision to delivering antibiotics for urinary tract infections, laser surgery to robot-assisted procedures, there’s a lot to keep a urologist engaged and involved.
Urologists also are at the forefront of advanced technology, having pioneered laparoscopic approaches that have been adopted by other medical specialties and now leading the way in the use of cutting-edge robotics. The field is ever growing and changing, and we are constantly researching, learning and innovating to perform our duties better.
Most essentially, urology allows you to build lasting relationships and make a difference in people’s lives. I follow my patients over time, getting to know how they are doing and helping them make informed decisions. I enjoy what I do because I’m always involved in improving, prolonging and saving lives.
Why Advanced Urology Institute?
Advanced Urology Institute stands out for its commitment to excellent urological care. By bringing together a huge number of driven, hard-working, experienced and certified professionals, and having them adopt a collaborative, multidisciplinary patient-centered approach to care, AUI not only gives urologists an opportunity to grow, but also offers them a working environment that brings out the best of their knowledge, skills and experiences. I like the fact that all administrative duties have been centralized and we have all the time we need to work with our patients and give our best.
It’s also good that colleagues at AUI are quite laid back, funny and relaxed people. We are serious about our work but we also enjoy jokes with each other and maintain a positive, friendly practice. It’s a fantastic place full of people who love what they do and who handle diverse issues and patients with utmost diligence and thoroughness. And because we love our job, we work harder to get better at it and to achieve great outcomes for our patients. For more information on our urological services, visit the “Advanced Urology Institute” site.
If I had to do it again, I would still happily choose urology. I really love urology and I’m always excited about the opportunity it offers to listen to people talk about distressing conditions, detect life-threatening conditions and make interventions that improve their lives. For me, the honor of being relied upon to offer advice, the awe of discovering problems in the genitourinary tract, the chance to provide life-improving and life-saving treatments, and the gratitude that comes with helping people through difficult illness — these things just never cease to motivate me. So even in my most stressful work days — when crushed by unbearable time constraints or enormous pressure — I have never felt anything like a drop in my passion for urology.
Why urology?
Ever since I was a child, I wanted to be a doctor. My mother, who was a teacher, realized this early and encouraged me to work hard in school to fulfill my dream. I went to Denison University for my undergraduate studies, then to Ohio State University for my medical degree, graduating in 1989. In medical school, I wasn’t really sure which field of medicine I wanted to specialize. In those days, the first two years of medical school were dedicated to intensive classwork and then in the third year we would go for clinical rotation.
When I went for my rotations, my first area was nephrology, medical care for kidneys. It was quite depressing working with patients with kidney problems and those under dialysis. I couldn’t figure out why patients who were not doing well were discharged to go home only to be back in the hospital the next day. This early experience shaped my attitude toward urology and at this stage, I felt strongly that I would never be a urologist.
We had eight choices as electives, including urology, but I didn’t want to work with kidneys and tried to avoid urology. However, as things turned out, I ended up picking urology. My eureka moment came when I watched from a side view as the prostate was being cut by a urologist. As the procedure went on before my eyes, I immediately changed my mind about urology.
That was my first real experience with urological surgery and it inspired my career choice and my lifelong commitment to the field. I completed a six-year urology and surgery residency at Emory University, Atlanta, Ga., and soon became a certified urologist by American Board of Urology. And even though I heard people say that urology was boring, I have found it fun and fascinating.
Areas of expertise
As a urologist, I offer diagnosis, treatment and follow-up care for a broad range of urological ailments and associated emotional issues. I routinely provide medical and surgical treatments for conditions such as kidney stones, urinary incontinence, erectile dysfunction, male infertility, pelvic pain, urologic cancers and genitourinary tract injuries. But I also perform specialized laparoscopic, laser and robotic procedures for various conditions, such as laser enucleation and laser vaporization for prostatic problems, steam ablation (Rezum) of the prostate, da Vinci robot-assisted surgery for prostate and kidney issues and high-intensity focused ultrasound for prostate cancer. Most importantly, I believe that every patient has unique needs that must be fully understood by the urologist before treatment can commence. So I always make sure to take into account all the needs, concerns and presenting factors of every patient and to provide tailored treatments that meet the specific needs of individual patients.
Job satisfaction
Urologists manage genitourinary tract disorders medically and surgically, taking care of their patients from start to finish. The ability to fix urologic disorders, see the lives of your patients improve, have them enjoy life much better and establish enduring relationships with them is quite satisfying. Likewise, the chance to use some of the latest and most innovative technology, including scopes, lasers and robots for complex urology procedures makes the field continually interesting. Even though urology is a surgical subspecialty, we have far better working hours than in general surgery. There are much fewer urological emergencies and rarely are there painful trauma situations to handle, so urologists have more control over their work schedule and better control over their lives. While urology residency is quite grueling, it isn’t nearly as bad as general surgery residency. With urology you get a good mix of surgery and medicine and enjoy better working conditions and great outcomes, all of which makes it quite fulfilling.
Why Advanced Urology Institute?
When I was choosing urology, there were people around me who thought it was a boring field of medicine. So for me, the inspiration to join the specialty was not enough. I also wanted a practice that would make urology exciting and fun. Luckily I found that in Advanced Urology Institute. I joined AUI’s Pinellas Urology in 1995 and quickly found its collaborative, multidisciplinary and patient-centered approach to care useful in bringing out the best of my skills, knowledge and experiences. And with all administrative work centralized at AUI, there are no bothersome phone calls, electronic documentation, paperwork, quality assurance measures and insurance forms for me to deal with. That makes it easier for me to concentrate on providing the best possible care to my patients. So even if I can’t always guarantee that I’ll make my patients better, I have all the time to work out the best possible remedies for their conditions. For more information on urology and urological services offered by AUI, visit the “Advanced Urology Institute” site.
Robot-assisted (robotic) surgery uses small instruments attached to a robot’s arm to conduct surgical procedures. A qualified, highly-skilled surgeon controls the robotic arm, using it to enhance surgical precision. In fact, contrary to popular beliefs, it’s the surgeon behind the robot and not the robot itself that performs the procedure. The robot improves surgical outcomes and boosts patient safety by enabling the surgeon to use very tiny incisions and to achieve unmatched precision.
Robotic surgery in urology
Robot-assisted surgery has become very popular in urology, particularly in the United States. In urology centers where it is used, it’s extensively applied in surgery to excise prostate cancer as it enables access to anatomical areas that are difficult to reach. Other urologists use it for kidney cancer surgeries and to some extent in bladder surgeries. Through robot-assisted procedures, urologists are able to use the surgical assistance, enhanced precision, systems networking, dexterity and image-guidance made possible with robots. Urologists are able to easily perform complex procedures that are often difficult to do using conventional laparoscopy.
Pre-operation discussion
While robotics are excellent tools that improve the outcome of surgical procedures, they are not ideal for every situation. The need and value of robot-assisted surgery varies from case to case and it’s important to discuss this with your urologist before undergoing surgery. Being clearly informed of the benefits and risks associated with robotic surgery ensures that you can make an informed decision before the procedure.
Advantages of robot-assisted surgery
Robotic surgery is typically minimally invasive. So the patient suffers less pain, slight blood loss and minimal scarring, and requires only a short recovery time. With the robotic arm eliminating the natural limits of human wrists, surgery can be performed with more delicate, precise and efficient movements. The 3D imaging and endowrist technology of robots ensure surgery is more accurate, nerve bundles are dissected more precisely, erectile function is preserved, and there is a better chance of cure than with non-robotic surgery. The surgeon also enjoys more strength, dexterity, flexibility, control and a better view of the operated area. Robotic surgery allows the surgeon to get more comfortable, perform the procedure with increased concentration and focus, and can undertake complex procedures that are tougher or impossible with other techniques.
Disadvantages of robot-assisted surgery
With robot-assisted surgery, there is not only the risk of human error when operating the robotic system, but also the potential for mechanical failure. For instance, system components such as robotic arms, camera, robotic tower, binocular lenses and instruments can fail. In other cases, the electrical current in the robotic instrument can leave the robotic arm and be misapplied to surrounding tissues, resulting in accidental burn injuries. Likewise, robot-assisted surgery can cause nerve palsies due to extreme body positioning or direct nerve compression that may occur when using robots. It also takes longer to perform robotic surgery than non-robotic surgery in surgical centers with lower robotic volume or by less experienced surgeons.
Ways of improving robot-assisted surgery
It’s important that centers applying robotics follow standardized training, improved reporting and enhanced patient education to reduce errors related to robotic surgery. Robotic surgery should be conducted by urologic surgeons trained in robotics and have extensive robotic and laparoscopic surgical experience. It also must be remembered that adding robots to the surgical equation may create room for error in an already risk-fraught and complex arena. So proper steps must be taken to guarantee safe and effective robot-assisted procedures. Robotic surgery is getting better and better as more advanced robots are developed to overcome existing shortcomings. So patients should expect better outcomes with robot-assisted surgery as advanced machines are applied.
At Advanced Urology Institute, we believe that surgical outcomes are a direct manifestation of the experience and skill of the surgeon, and less about the approach or technology used. That’s why we have assembled a team of qualified, skilled and experienced urologists to offer surgical procedures for different urological disorders. Our urologists perform hundreds of laparoscopic and robotic surgeries every year and have achieved great success rates in terms of efficacy, cure and improved quality of life. Our approach to robotic surgery guarantees that you will get the best possible surgery with remarkable outcomes. For more information, visit the “Advanced Urology Institute” site.
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.
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.
Affable, available and able. That pretty much sums up what we are as urologists. Affable to break down barriers and discuss sensitive, sometimes awkward topics; available to help our patients and colleagues faced with unforeseen situations involving genitourinary organs; and able to deliver outstanding, standard-of-care treatments that guarantee excellent outcomes for our patients. We love our job as it offers an opportunity to provide life-saving treatments to patients. We also recognize that we are in a unique position where we can diagnose life-threatening conditions early, provide timely treatment and give patients a longer life span.
Who is a urologist?
A urologist is a specialist who treats disorders of the urinary tract and the male reproductive organs. As urologists, we look after organs such as the prostate, kidney, bladder, penis, testes, urethra and associated glands. When patients come to us with issues in any of these areas, we discuss the problems, examine the patients, investigate and make accurate diagnoses. We then can recommend medications, plan and undertake surgery, or use various techniques and methodologies to treat the problems. There is a misconception that we treat only men, but in reality we see men, women and children.
What conditions do we treat?
Urologists are experts in the surgical and medical management of urological conditions such as kidney stones, urinary incontinence, overactive bladder, sexual dysfunction, enlarged prostate, recurrent urinary tract infections and urologic cancers. Likewise, we deal with issues like interstitial cystitis, neurogenic bladder, pelvic organ prolapse, pelvic floor problems, Peyronie’s disease, hydrocele, varicocele, vesicoureteral reflux, traumatic injury of the urinary tract, priapism, recurrent urinary tract infections and urologic cancers. In children, we treat conditions like undescended testes, phimosis, hypospadias, epispadias and bladder exstrophy. We also perform kidney transplants and vasectomies.
Why urology?
From a young age, the sciences intrigued me. When I went to college, I was looking for a profession that would fulfill my compassion for people with sensitive and depressing medical conditions while also enabling me to tap into my passion for science to improve people’s quality of life. So after deep soul-searching and self-assessment, I realized that medicine was the right career for me — the profession that was very interesting to me and where I believed it would allow me to live my passion instead of just enduring a routine job.
I completed my undergraduate studies at Indian University in 1994, then joined the University of Toledo, Medical School of Ohio, for my medical degree. Upon graduation, I went to the University Hospitals of Cleveland, Case Medical Center for my urology residency training, which included stints at the Cleveland Clinic Foundation, MetroHealth Medical Center and Cleveland V.A. Hospital. Over this period, I gained in-depth knowledge and skills in urology, learned several technologies and methodologies and attained broad general mastery of medicine. After I was licensed by the Florida Board of Medicine and certified by the American Board of Urology, I soon became a fellow of American College of Surgeons (ACS).
Areas of expertise
As a urologist, I treat a wide range of urological physical ailments, together with emotional problems that accompany them. Each of my patients has unique needs and I make every effort to appreciate that before commencing treatment, taking into account all presenting factors, needs and concerns of the patient. For me, every consultation, treatment and follow-up must be tailored to meet the needs of the individual.
I have a special interest in minimally invasive procedures, including laparoscopic surgery, robotic surgery and laser therapies. That’s why I am frequently involved in procedures such as Holmium laser enucleation for enlarged prostate, Holmium laser vaporization for prostatic problems, Prostiva RF prostate ablation and steam ablation (Rezum) of the prostate. I have performed these procedures since 2012 and was among the first surgeons to offer them in the Southeast. I also am experienced in HIFU (high intensity focused ultrasound) for prostate cancer and the da Vinci robotic surgery for the kidney and prostate, having offered these treatments to patients since 2007.
Job satisfaction
Caring for people with urologic disorders comes with its fair share of challenges. For instance, a sizeable number of patients come to you with later stage and more aggressive disease, whose treatment options are quite limited. This can sometimes make your work seem hopeless. The long work hours and the often stressful situations also may test your patience and tenacity. But the ability to make interventions that improve people’s quality of life will always keep you grounded in your work as a urologist. For there is nothing more satisfying than helping a man who doesn’t sleep every night because of unending urges to visit the bathroom, a child suffering the pain and humiliation of undescended testes, a woman frightened of laughing or sneezing because of urine leakage, or a patient struggling with a symptomatic urologic cancer.
Urology gives me the opportunity to live my dream of assisting those with urologic disorders enjoy their lives a little more. As a urologist, I am able to offer short-term and long-term fixes for various conditions, see the fruits of my work as patients get better, and establish lasting relationships with patients. I absolutely love the wide range of technology applied in urology procedures, such as lasers, scopes and robots used to perform complex surgeries. The use of minimally invasive techniques performed through small incisions is also something that is really exciting. For me, urology offers a great blend of surgical, medical and a variety of minor procedures that I enjoy performing.
Why Advanced Urology Institute?
When still in medical school, I wanted to excel as a doctor. I always looked forward to a practice that would bring out the best of my knowledge, skills and experiences and enable me to succeed. Many years later, I can say with a smile on my face that Advanced Urology Institute is exactly the kind of practice I wanted. AUI brings together a massive pool of skilled, passionate, creative and hard-working medical professionals who are committed to a collaborative, patient-centered approach to care. As a urologist, you can only get better when you are part of such a team. All the administrative work has been centralized and urologists are not burdened by loads of paperwork and tedious tasks as happens in many other practices. As a urologist you only concentrate on delivering the best possible care to your patients. For more information on the urological services provided at AUI, visit the “Advanced-Urology-Institute” site.
When choosing a urologist, you can specify that you would like a board certified doctor for your urology treatment. Make sure you write down all your questions for the doctor, and seek someone who will take into consideration your individual preferences. Ascertain that the facility and medical staff keep up to date on the latest technologies, such as minimally invasive techniques, as well as proven treatment guidelines.
My curiosity led me to study physiology — the study of how the body works — to learn more about the body. So I attended Michigan State University to pursue a Bachelor of Science degree in physiology. As I was studying physiology, I became interested in medicine. Upon graduation, I went to Ann Arbor, University of Michigan for my medical education. After that, I moved to Henry Ford Hospital for my residency training before going to and completing my fellowship training at the Beth Israel Deaconess Medical Center.
At Advanced Urology Institute, we understand that 