ARTIFICIAL URINARY SPHINCTER (AUS)
An Artificial Sphincter is placed in men only if they experience severe urinary incontinence after prostate surgery. It is considered the most effective treatment and is the standard of care for this condition.
BENIGN PROSTATE HYPERTROPHY (BPH)
Benign Prostate Hypertrophy (BPH) begins to occur in men as they age, sometimes as early as the 40s. The prostate may grow larger and lead to urinary symptoms by its size or the tone by narrowing the urethra it surrounds. A narrow urethra will give men the symptoms of weak stream, urge, nighttime urge and waking, sense of incomplete emptying, hesitancy, frequency and dribbling. Diet and lifestyle modification can improve symptoms, but if not, medication, supplements or surgery can improve BPH. A TURP (transurethral resection of the prostate) removes the obstructing tissue, and techniques using laser or vaporization reduce bleeding, recovery time and post operative pain.
for benign prostatic hyperplasia (BPH), which features minimal side effects and virtually no downtime
BLADDER CANCER (UROTHELIAL CARCINOMA, TRANSITIONAL CELL CARCINOMA)
The diagnosis of bladder cancer is most frequently made as a result of blood in the urine. Blood in the urine can be obvious, or microscopic. An office cystoscopy is performed to confirm the presence or absence of a tumor in the bladder. Most tumors can be removed endoscopically allowing preservation of the bladder. Chemical instillation into the bladder helps to preserve the bladder and reduce cancer recurrence. If bladder cancer is muscle invasive, then bladder removal and reconstruction is necessary.
BLADDER CONTROL / LEAKY BLADDER/ INCONTINENCE /BOTOX
The most common type of urinary leakage women experience are Stress Urinary Incontinence (SUI) or Urge Urinary Incontinence (UUI) that can overlap with Overactive Bladder (OAB). SUI can occur with exercise, jumping coughing, sneezing and during sex. UUI and OAB are due to the bothersome uncontrollable urge to void, frequent voiding, getting up at night to void and leaking on the way to the bathroom with an urge that cannot be suppressed. Many treatments are available for both ranging from noninvasive to surgery. Examples include behavior/lifestyle modification, medication and dietary modification, sling surgery, urethral injections, BOTOX injections, Interstim sacral neuromodulation. A complete physical evaluation is necessary to see which treatment is appropriate.
Urgent? PC Neuromodulation?non surgical treatment for Overactive Bladder and associated symptoms of urinary urgency, urinary frequency and urge incontinence.
BLOOD IN THE URINE
Otherwise known as Hematuria, it can be due to a variety of reasons: infection, bladder or kidney stones, injury, bladder or kidney tumors, vigorous exercise, enlarged prostate, or benign reasons.
Sometimes referred to a Chronic Pelvic Pain Syndrome, this condition can recur or be chronic at low levels of pain or urinary distress.
Removal of the foreskin can be performed if men have difficulty with pain, bleeding, tightness or cracking of the skin during erections, urination or difficulty with retraction.
Freezing cancer is an accepted alternative technique for either prostate cancer or kidney cancer. Cure rates are high and the technique is minimally invasive.
PSA stands for Prostate Specific Antigen, and is the most common and most studied tumor marker for prostate cancer. An elevated PSA does not always signify prostate cancer. Often times it is not. The PSA test is used to screen for prostate cancer and its use has reduced death from prostate cancer and the complications associated from late prostate cancer diagnosis. Other tests such as free PSA, PCA-3 and PSA trending can help determine if a prostate biopsy is necessary. A prostate exam is performed in conjunction with the PSA test on a yearly basis to screen for prostate cancer. Screening is determined by family history, risk of prostate cancer, and patient desire to know his status. Prostate biopsy is the ONLY way to ultimately diagnose prostate cancer. This is usually done via ultrasound in the office with local anesthesia.
ERECTILE DYSFUNCTION (ED)
ED naturally occurs with age but can and does occur for other reasons such as diabetes, high blood pressure, certain medications, injury, low testosterone, life stress and others. ED is usually caused by diminished blood flow to the penis which can be restored by weight loss, diet improvement, “wonder drugs”, injections, vacuum devices and implants.
A collection of fluid around the testis can leading to enlargement of the scrotum. It can be painful and grow. It is usually benign but an ultrasound is necessary to determine if a mass is also present since examination of the testis can be difficult when a hydrocele is present.
KIDNEY CANCER (RENAL CELL CARCINOMA)
Kidney Cancer is almost exclusively treated by surgery. If a tumor is found, the type of surgery depends on size and location of the mass. Other considerations are age of the patient, baseline kidney function, prior history of kidney tumors. Robotic or laparoscopic removal is often suitable, but if large, an incision may be necessary. If the tumor is small or kidney function is marginal, freezing the tumor (cryoablation) is a well-accepted alternative.
About 10% of men and women suffer from kidney stones. When an “attack” occurs, most people experience back or flank pain than can wrap around to the front, chills, and blood in the urine. An xray, usually a CT scan or KUB is ALWAYS required for diagnosis. Treatment can range from trying to let it pass with directed medication, laser surgery or shockwave treatments. Laser surgery is direct and highly successful for obstructing or painful stones. “Shockwave” treatment is also success for breaking up stones. Most stone procedures are relatively short and can be done as an outpatient.
“Low T” is a natural byproduct of the aging process, but sometimes low testosterone can lead to difficult symptoms such as poor concentration, poor memory, low energy, low libido, poor sleep, and other complaints. Replacement testosterone can be given as a patch, topical gel, pellet implant or injection. Screening for prostate disease and other health concerns are done prior to beginning testosterone replacement and close monitoring of blood work and potential side effects is done periodically and continuously.
Whether a man has never had children, or cannot now conceive but did so in the past, a work up for the cause of male infertility is straightforward. Highly specialized techniques are available to assist in conception and we work closely with Infertility Gynecologists to achieve success.
Mesh for vaginal or pelvic organ prolapse repair should be performed by a physician who is trained and able to properly utilize such grafts. Proper patient selection and mesh selection help optimize results and minimize complications. Mesh is NOT required to be used to correct prolapse of any vaginal prolapsing organ, but can be used to strengthen weakened tissue, or in cases of prior surgical failure. FDA trials of mesh pelvic kits are in progress.
NGB can result for spinal cord injury, stroke, brain injury, Parkinson’s or Alzheimer’s diseases, multiple sclerosis, post-polio syndrome, tabes dorsalis, and after certain types of pelvic or back surgeries. It is a condition where either the sensation, storage or emptying function of the bladder is not appropriate. It can lead to urinary retention, leakage, and urinary tract infections. A complex work up is required to determine the severity and lay out a treatment plan.
PELVIC ORGAN PROLAPSE
In the female pelvis, weakened muscle and tissue support can lead to “dropped organs” such as the bladder (cystocele), rectum (rectocele), vaginal vault (apical prolapse), uterus (procidentia), or small bowel (enterocele). These conditions can be mild and without symptoms or lead to pressure and problems with urination, passing bowel movements, or sex. There are surgical and nonsurgical treatments for these conditions.
Implantable prostheses can be placed for erectile dysfunction. Usually surgery is reserved for ED that is severe and when other methods for treating ED have failed. However, surgery is highly successful for achieving rigid erections.
PROSTATITIS (PROSTATE INFECTION)
Prostatitis can be very painful and present with fever, burning with urination, fever and inability to urinate. It can range from mild to severe requiring hospitalization. Immediate treatment with antibiotics and anti-inflammatories are required. Antibiotics may be required for a month or longer.
PROSTATE CANCER (and daVINCI SURGERY)
Prostate Cancer is one of the most common cancers in men and one of the most commons causes of cancer deaths as well. However, huge strides have been made in early diagnosis, surgery and treatment and preservation of continence and erectile dysfunction in the last 2 decades. Prostate cancer grows very slowly, even the most aggressive kinds. Robotic surgery enables delicate surgical handling, and affords better visualization, shorter hospital stay, less pain and less catheter time post operatively.
RECURRENT URINARY TRACT INFECTIONS (UTIs)
Women are subject to recurrent UTIs more than men. There are a variety of triggers and risk factors than can easily be discerned during an office visit and exam. Most symptoms involve the bladder with urge, burning, pressure and sometimes blood in the urine. Sometime the infection can ascend into the kidney leading to flank pain and fever.
A sling is performed to treat female stress urinary incontinence (SUI). It is the most successful way to surgically treat SUI, and the mid-urethral mesh slings are the standard of care. Mesh complications are minimal with a properly performed sling, which have relatively minimal recovery restrictions and long term durability. In addition, sling surgery can be done for men as well for stress incontinence, if severe, after prostate surgery.
Most testis cancer occurs in young men age 18-50, and is first noted on self-exam by the patient or his partner, as a hard, mainly painless mass on the testis itself. An exam, blood work and ultrasound are required for an immediate diagnosis.
Dilated veins that surround the testis can lead to ache. Often, a varicocele is incidental and painless, but occasionally can lead to infertility and stunted growth of the testis.
When a couple desires to elect for sterilization, vasectomy is one of the easiest and least invasive ways to achieve their desired result. Vasectomy can be done in the office with local anesthesia, mild oral sedation, and can be done usually in 20 minutes or less. Contraception needs to be maintained until sperm counts reach zero.
A technically delicate surgery, vasectomy reversal is performed in the hospital as a same day surgery.