ROBOTIC PROSTATE & KIDNEY SURGERY
Highly technical, daVinci robotic surgery is used to remove the prostate – (Click here for more information) – for organ-confined prostate cancer, whether low, intermediate or high grade. Robotics enable delicate tissue handling, reduced bleeding, reduced recovery time, and reduced hospital & catheter time. Nerve sparing surgery for preservation of erectile dysfunction and improved urinary control highlight the advantages of robotics for prostate cancer by our highly trained and experienced urologists at ASUI.
Small kidney tumors (<4cm), can be addressed with less invasive daVinci robotics (Click here for more information). If the kidney mass is suspicious for cancer, the tumor can be removed (Partial Nephrectomy) while preserving the rest of the kidney. Large kidney tumors that occupy a majority of the kidney, only previously removed with open flank surgery, may be removed using robotic techniques as well by our urologists at ASUI. In addition, freezing the tumor, or “Cryotherapy” (Click here for more information) can be achieved using robotic techniques if the tumor is small enough or if it cannot be directly excised.
WOMEN'S BLADDER & PELVIC HEALTH
Urinary Incontinence (UI) and/or Pelvic Organ Prolapse (POP) are common conditions the women begin to experience in their 30s or 40s. However, non-surgical strategies are often successful in managing these embarrassing issues. If dietary, behavioral or other non-surgical strategies fail, corrective surgery may be appropriate. The most recent FDA bulletin of 2011 on vaginal mesh – (Click here for more information) – helped raised awareness. Mid-urethral mesh slings are the standard of the care – (Click here for more information) – to treat women who are bothered by Stress Urinary Incontinence (SUI). Mesh complications from slings are uncommon, and the highly trained urologists at ASUI are vigilant in procedural techniques and familiar with early complication recognition and treatment.
If Urge Urinary Incontinence (UUI) fails medical and behavioral management, then patients can opt for INTERSTIM Neuro-modulation or in-bladder injection of BOTOX to control the bothersome urge, frequency, UUI and night time frequent urination. Approved by the FDA in late 1990s for UUI – (Click here for more information) – and 2011 for fecal (stool) incontinence –(Click here for more information) – INTERSTIM can improve bothersome, embarrassing loss of urine and stool, often at once. In office testing avoids the operating room for “Stage 1” to reduce inconvenience and cost the patient.
BOTOX (Botulinum A toxin) was approved by the FDA in early 2013 – (Click here for more information) – for injection into the bladder muscle to control otherwise severe UUI that has failed non-surgical treatments. Overactive Bladder (OAB) and Neurogenic Bladder (NGB) can both be controlled with BOTOX injection. In-office injection makes this treatment straightforward and minimally invasive. Our urologists at ASUI are experienced and well trained in proper patient selection and performance of INTERSTIM and BOTOX.
Pelvic Organ Prolapse commonly occurs after childbirth, menopause, hysterectomy and for other reasons. If the bladder, rectum, vaginal walls, uterus or small bowel drop and push into the vagina, a careful exam and assessment can easily determine if surgery is necessary or not. If non-surgical management fails or is not desired, surgical correction can be performed. Mesh is NOT required for correction of any prolapsing organ, but mesh – (Click here for more information) – can be used if a prolapse was corrected and then recurs or if patient conditions warrant its use. Non-mesh grafts such as tissue from cadaver or animal may be used during surgery in place of mesh as well. An in depth discussion of all surgical options and techniques are one of the benefits of seeing a highly trained urologist at ASUI. For the 2011 FDA Update on Urogynecologic Surgical Mesh, – click here.
Recurrent urinary tract infections (UTIs) and Interstitial Cystitis (IC) are two conditions that can occur separately, overlap, or be confused with one another. A careful inventory of patient daily habits, prior treatments, dietary and medication use, as well as a detailed pelvic exam, and possibly other in office tests can help map out a treatment plan. Many women can have bladder pain, but bladder pain does not always mean Interstitial Cystitis – (Click here for more information) – which is a diagnosis of exclusion.
KIDNEY STONE TREATMENT & PREVENTION
Kidney stones can occur for a variety of reasons, and a thorough analysis of the blood, urine and stone can easily discern the type of stone and ways to prevent recurrence of stones. This work up can be easily performed by our urologists at ASUI. If small and painless, stone treatment may simple be observational, but if large, multiple or causing pain, active stone treatment may be required. Dissolving stones is only successful for a small percentage, and thus stone break up can be achieved using various minimally invasive techniques. Shockwave lithotripsy (SWL) – (Click here for more information) – is the least invasive and most popular. However, laser surgery with a ureteroscope – (Click here for more information) – is often used if stones are “stuck” in the ureter leading to pain and hospitalization. It is direct and can be used to remove the stone after broken up with a laser. If stones are very large, they may require multiple treatments with SWL, laser ureteroscopy, or laser and scope access through the flank.
GENITO-URINARY CANCER TREATMENT
Our caring and specialized urologists at ASUI work on a daily basis with medical oncologists, radiation oncologists and gynecological oncologists if your prostate, bladder, kidney or testis cancer requires more than just surgery, or if surgery is not initially indicated. Our ASUI urologists are in frequent contact, by phone or text, in office, or while in the hospital, with your other cancer specialists. Sometimes radiation or chemotherapy is required to treat prostate, bladder or testis cancer, and facilitating these treatments and close follow up makes ASUI highly integrated in achieving the best cancer treatment goals.
Sometimes if surgery is not desired or indicated, freezing (Cryotherapy) the cancer within the prostate or kidney is desired – (Click here for more information) – Less invasive, it preserves the place of the prostate and the kidney. Cryotherapy can also be used if cancer recurs in the prostate after failed radiation or seed implantation, or if kidney preservation is paramount such as in cases of a solitary kidney, or diminished kidney function to minimize injury to the kidney. Our ASUI urologists work closely with your Nephrologist to keep track of growths such as kidney cysts which may not require removal, or treating kidney masses even in transplant kidneys.
Bladder Cancer is often removable via endoscopy, preserving the bladder, but chemical instillation in the bladder may be required to reduce the chance of recurrence or progression of the cancer if it recurs. If however bladder cancer requires the bladder to be removed, our ASUI urologists are skilled in different forms of bladder reconstruction from the intestine. Sometimes chemotherapy and radiation is necessary even after surgery is performed. Coordination with your medical or radiation oncologist is done closely by our ASUI urologists.
Testis Cancer can be a devastating finding in a young man, and proper diagnosis and work up is performed prior to testis mass removal. A prosthesis can be placed for cosmetic reasons at the time of surgery if the patient desires, but is not required. Sometimes close follow up after surgery for testis cancer is all that is needed, while other times radiation or chemotherapy is necessary. Close coordination with your medical or radiation oncologist is done by our ASUI urologists.
VASECTOMY, INFERTILITY & VASECTOMY REVERSAL
If a couple desires vasectomy for family planning, our experienced and caring ASUI urologists offer efficient in-office vasectomy. Multiple techniques are available, but ultimately what is desired is sterility, and physician experience is important in achieving this goal. A relaxing environment is provided, with oral sedation and music to help pass the time.
If a couple is experiencing difficulty getting pregnant, whether for the first time or even after they have a prior child, an in depth evaluation is necessary to determine the proper treatment course. Sometimes precise and delicate handling of sperm is required by our specialized urologists at ASUI, and coordination with the Gynecologist is paramount in achieving success.
Vasectomy Reversal (Click here for more information) – can be performed using multiple techniques, all very precise using high powered operative microscopes. Testing of sperm quality during the procedure helps determine how the Reversal should be best carried out. Experts in this challenging but rewarding surgery are what we provide at ASUI.