Becoming a Urologist – Dr. Arash Rafiei

Requirements To Become a Urologist

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

Dr. Arash Rafiei - Orange CIty, FL 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.

How Did Dr. Jonathan Jay Become a Urologist?

KEY TAKEAWAYS:

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.

REFERENCES:

“Urogenital Disorders | Pediatrics – Intermountain Healthcare.” https://intermountainhealthcare.org/services/pediatrics/services/urology/urogenital-disorders/.
“Pelvic Floor Reconstruction – Baylor College of Medicine.” https://www.bcm.edu/healthcare/specialties/obstetrics-and-gynecology/ob-gyn-procedures/pelvic-floor-reconstruction.
“BPH Treatment | Enlarged Prostate Surgery – UroLift.” https://www.urolift.com/what-is-urolift.

FL florida Jonathay Jay Naples urology

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.

David Harris Procedures Treatments urologist urology

Are Medications Effective in Treating Erectile Dysfunction

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

What ED pills are available?

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

How well do these drugs work?

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

How quickly do the pills work?

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

Which drug works best?

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

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

What are the alternatives to ED drugs?

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

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

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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:

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.

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How Is Prostate Cancer Treated

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.

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What is Immunotherapy for Prostate Cancer

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.

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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 Institute 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.

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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.

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Becoming a Urologist with Dr. Rishi Modh

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

Urology — a big world of stuff

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