Erectile Dysfunction Treatment Options

Although it is very common, erectile dysfunction can be an embarrassing subject to discuss even with medical professionals. ED can affect men of all ages and can be caused by a variety of factors, so a wide range of treatment options are available.

How Is Erectile Dysfunction Diagnosed?

According to the Mayo Clinic, ED is the chronic inability to get and maintain an erection. It can be diagnosed by talking with a doctor, ideally a urologist, about the patient’s medical history. The doctor may perform a series of tests, including a physical exam, blood or urine tests, an ultrasound, or even a psychological examination to determine if mental health is a factor in the patient’s erectile dysfunction. Sometimes ED is connected to another underlying issue. All of these factors come into play when determining treatment.

What Are The Treatment Options For Erectile Dysfunction?

Mikhail Lezhak, PA of Daytona Beach, FLThere are many potential steps to be taken in the ED treatment process. The first step, especially when the patient is a younger man, is usually medical management. Doctors may prescribe common medications like Viagra or Cialis. Both medications are taken only when needed. They do not help cause an erection until the patient has already become sexually stimulated. They are safe, commonly prescribed medications; however, they can cause serious side effects in combination with other medicines, especially nitrates.

For many patients, Viagra or Cialis is enough to help solve the problem of erectile dysfunction. If, however, they are not, another option is a penile injection. The initial penile injection may be given at the doctor’s office as a way to introduce the patient to the process. After this introduction, the patient can self-administer the injections at home as needed.

When these medications are not enough to solve a patient’s erectile dysfunction, another option is penile implant surgery. This is only recommended in cases where no other treatment option has been successful and when the patient’s ED has no chance of being reversed. There are a variety of penile implants on the market to accommodate a patient’s lifestyle and needs.

Erectile dysfunction can lead to feelings of embarrassment and shame, relationship difficulties and lowered self-confidence. However, there is no need to worry that these issues will last a lifetime. With the wide range of treatment options available, ED can be managed, allowing patients to resume normal sexual activity after consulting with their doctor. Our team of urologists at Advanced Urology Institute have extensive experience in working with patients experiencing erectile dysfunction. For more information, visit the Advanced Urology Institute website.

Janelle Bunce, PA – Becoming a Physician Assistant

The field of medicine offers many opportunities for people who want to dedicate their lives to helping others. With hard work and study, almost anyone with a desire to work in healthcare can achieve that dream. One growing role in this field is that of the physician assistant who plays an important and involved role in patient care.

Unlike doctors, who spend up to a decade or longer in training, physician assistants can complete their degree programs in as few as six years. This makes earning credentials and beginning a rewarding career less costly and achievable in less time.

Janelle Bunce, PA from Naples, FLAlthough they may not be doctors, physician assistants have some of the most important jobs in healthcare and carry a great deal of responsibility. They assist with surgeries, see patients independently and take an active role in decision making with the doctors. They are an important part of the patient experience and share in the satisfaction of participating in overall patient care.

Physician assistants in the field of urology address a variety medical issues. From urinary incontinence, kidney stones and vaginal prolapse to an overactive bladder, a physician assistant in the specialization of female urology can assist doctors in treating a wide range of conditions while creating lasting relationships with their patients.

One physician assistant who is enjoying a rewarding career in urology is Janelle Bunce, PA. The educational requirements made it possible for her to begin assisting doctors within six years of beginning the required degree program. Janelle enjoys working with a team of nurses and doctors to ensure that her patients receive top-notch care. Her story and success are an inspiration to anyone with a desire to pursue a career in medicine.

Dedicated urology physician assistants, like Janelle Bunce, PA can be found providing excellent patient care every day at the Advanced Urology Institute. For more information, visit the Advanced Urology Institute website or make an appointment for a consultation today.

Becoming a Physician Assistant – Luis Camacho P.A.

Luis Camacho, P.A. is a physician assistant in urology with more than 14 years of experience. Physician assistants in Florida are highly trained professionals who can perform many of the same medical diagnoses and treatments as medical doctors. They first have to enter an accredited graduate medical program that is recognized by the Commission on Accreditation of Allied Health Programs.

Luis Camacho, PA of Fort Myers, FLEntrance into these programs is highly competitive. Students must first take all prerequisites for any of the required graduate classes before admission. Students are also admitted based on their ability to work with people, their understanding of the PA occupation, their prior health care experience and prior academic performance, and their life experiences. They also must pass the Graduate Record Exam.

Physician assistant graduate medical programs run about 27 months with more than a thousand hours of classroom and laboratory experience. They must complete two thousand hours of supervised clinical experience, which can take up to a year. The program culminates by passing the Physician Assistant National Certifying Exam, a grueling 300-question exam that takes five hours to complete. Overall, that means a physician assistant has had at least three years of training before passing the certifying exam.

PAs must renew their license annually to continue practicing medicine. During every two-year period, they must obtain at least 100 hours of continuing medical education, which assures patients their PAs understand the most current medical thinking and practices.

Physician assistants must also work under the direct supervision of a board certified medical doctor. While PAs are fully capable of handling most common medical issues, this supervision assures the patients that their PAs are part of a medical team, always working together to provide the best in medical treatment.

Luis Camacho, P.A. works within a large practice at Advanced Urology Institute in Fort Myers, Florida, where he and all his colleagues work as a team under the supervision of a board certified urologist. He is a knowledgeable and experienced physician assistant who is dedicated to caring for patients. For more information, visit the Advanced Urology Institute website.

Treatments for Bladder Control Problems in Women

Urinary incontinence happens when the bladder becomes weak and urination happens by accident. Although they seldom want to talk about it, urinary incontinence affects women twice as often as men. The cause may be related to childbirth or menopause, and the structure of the female urinary tract plays a role as well.

If you suffer from this problem, it’s important to realize you are not alone. More than 33 million Americans deal with urinary incontinence or a bladder condition. Unwanted urinary activity occurs in both men and women and increasing age can be a partial cause. Is is estimated that one out of three women in the United States has a bladder problem.

Quynh-Dao Tonnu, PA-C of Daytona Beach, FLBladder control problems can vary, from occasional urine leakage that happens when you cough or sneeze, to having sudden urges to urinate so strong you do not make it to the toilet in time. There are several basic forms of incontinence and you can have more than one condition. There is urge incontinence, where you will feel a need to urinate all of a sudden as the bladder involuntarily contracts, compelling you to urinate immediately. Another form is stress incontinence. This is caused when physical stress from coughing or sneezing, or athletic activity, puts pressure on the bladder and causes leakage.

Some women experience overflow incontinence, which happens when you leak urine because your bladder does not empty all the way.

Assessing Causes of Urinary Leakage

When you make an appointment, your doctor or a physician assistant will ask for a thorough history of the problem, followed by a physical exam. Some simple and painless tests may be taken. Urinalysis is a test in which a urine sample is checked for traces of blood, signs of infection, nitrates, or other indications of a medical problem. You may be asked to create a bladder diary, keeping a record for a few days to track the amount of fluids you drink and the frequency and amount of urine, as well as details of urgency or leakage.

Another test may be a post-void residual measurement. You will urinate into a container, and then your doctor uses ultrasound to measure the amount of urine left in your bladder.

Treating Bladder Control Problems

  • Changing your diet and performing Kegel exercises may help with both urge and stress incontinence. Additional treatments may be recommended ranging from medications to surgery.
  • Medications can be prescribed, including anticholinergics (used to block neurotransmitters), antidepressants, estrogens, or nerve-stimulating drugs.
  • Injection therapy involves the injection of collagen and other compounds to bulk up the urethra.
  • Botox injection is another possibility. Injecting Botox into the bladder partially paralyzes muscles to help reduce overactivity.
  • Surgical options are available for treating bladder control issues. They include urethral slings or mesh tape inserted to support a sagging urethra, or sacral nerve stimulation through an implanted device that calms nerves of the bladder.

It is best to make an appointment with a urologist if you are experiencing bladder control problems. Our doctors at Advanced Urology Institute have years of experience with treating bladder problems and working with patients to find the best solutions. For more information, visit the Advanced Urology Institute website.

Becoming a Physician Assistant with Quynh-Dao Tonnu, PA-C

While certified physician assistants (PA-C) are not the same as American Medical Association board-certified medical doctors, they are competent medical professionals. Physician assistants often go into medicine later in life, having already worked in other occupations.

Quynh-Dao Tonnu, PA-CCertified physician assistants go through a rigorous graduate-level training program that takes more than two years to complete. The degree program must be accredited by both the Committee on Allied Health, Education and Accreditation, and the Accreditation Review Commission on Education for the Physician Assistant. After successful completion of the academic portions, the graduates must pass the national Physician Assistant National Certifying Exam. The final stages include formal application with the Florida Board of Medicine and completion of 2,000 hours (about one year) of supervised clinical practice.

Physician assistants are important within medical practices because they relieve the physicians of much of the routine workload. They take medical histories and, because of their medical training and experience, they are able to notice when a patient has a special issue the primary physician should be aware of. They can understand medical histories written by other medical professionals and understand their patients’ backgrounds. For example, some fad diets can seriously affect a person’s digestive system, kidneys, urinary tract and bladder. An experienced PA knows when to ask patients if they have been on such diets.

With a solid understanding of pharmaceutical medicine, physician assistants can prescribe medications or recommend that the physician prescribe certain types of medications. PAs also approve prescription refills according to the physician’s practice and standard medical guidelines. If a patient has questions about how and when to take medications, PAs can give that information.

Quynh-Dao Tonnu, PA-C started her post-secondary education at the University of Florida, where she received her BA in Economics in 2005. Later in 2007, she completed a master’s degree at the University of South Florida in Library and Information Science. After that, she worked in hedge fund accounting, which she found interesting but not very personally fulfilling. In 2014, she changed occupations to become a medical assistant. She realized her most fulfilling job experiences involved working with people, so she went back to school and obtained her Physician Assistant degree in 2017. She has been working in urology for three years and is now fully certified. You can meet this talented PA at the Advanced Urology Institute Oxford office. For more information, visit the Advanced Urology Institute website.

Symptoms & Treatment of Kidney Stones

Kidney stones are a serious and painful medical issue. They cause a wide range of symptoms and can be treated in different ways depending on their size and the patient. Understanding the symptoms of kidney stones and the treatment options available are essential to passing them.

No two people are the same and the symptoms of kidney stones can vary from patient to patient. Some of the most common symptoms are pain in the back or belly, pain or burning during urination, a frequent and urgent need to urinate, urinating in small amounts, and cloudy or bloody urine. Someone experiencing these symptoms most likely has kidney stones and may need to consult a urologist for help.

One of the most troubling symptoms is the pain caused by kidney stones. Some female patients say the pain caused by the stones is worse than being in labor. In many cases, the person with kidney stones may suffer from nausea and vomiting. Although stones can often be passed by the patient on their own, in some cases medical assistance is required.

Treatment for kidney stones is done on a case-by-case basis, with the doctor examining the patient to determine the best treatment method for the individual. For patients experiencing pain, but who may be able to pass the kidney stone, the doctor may prescribe medication to ease the pain and make them comfortable as they wait for the stone to pass. In more serious cases, the doctor may need to surgically remove the stones or bypass them to drain urine and relieve pain.

A new way to remove large painful stones without surgery is Shock Wave Lithotripsy (SWL). With this non-invasive method the stones are broken up by a shock wave of energy focused on the point where the kidney stone is located. This shock wave breaks the kidney stone into a fine powder that is easier for the patient to pass. In severe cases, the doctor will enter with a scope through the urinary tract or kidney and destroy the stones with a laser.

Relief from the pain of kidney stones can be found at the Advanced Urology Institute, where experienced physicians determine the best treatment method available for each patient. For more information, visit the Advanced Urology Institute website.

Becoming a Urologist with Dr. John Pearson

Becoming a doctor requires a great deal of dedication and determination. Many choose this profession because, beginning at a young age, they feel a strong desire to help people. This desire becomes a commitment to put in the long hours and hard work needed to get through the tests, studying, papers and internships during medical school.

Dr. John PearsonThe result of their commitment is the dedicated professionals who are there for us when we need medical attention, including urologists who care for patients with medical problems that may be difficult to discuss. Urology covers a variety of conditions such as urinary incontinence, overactive bladder, vaginal prolapse and kidney stones to pelvic surgery.

One urologist who enjoys helping patients is Dr. John Pearson. After becoming sick as a child, Dr. Pearson had the chance to meet some terrific doctors who had a profound impact on his life. From an early age, Dr. Pearson knew he wanted to become a doctor and do the same for others. Now he gets to live that dream every day with his own medical practice treating patients with a wide range of serious and sometimes life-altering conditions.

Practicing urology has also allowed Dr. Pearson to live in different parts of the country. From his beginnings in southern Illinois to busy San Francisco, from cold and rural parts of Washington state to the warm weather of Florida, Dr. Pearson has seen patients from all walks of life. It has been especially rewarding for him to meet so many people while fulfilling his promise to serve others.

At the Advanced Urology Institute, Dr. John Pearson gets to make a positive difference in his patients’ lives every day, just like the doctors who inspired him. For a consultation about your urological needs, make an appointment with Dr. Pearson or one of the many highly qualified physicians at the Advanced Urology Institute.

Kidney stones: What are the treatment options?

If you’ve been diagnosed or suspect you have kidney stones, you will want to know about your options for treatment right away.

Kidney Stones: What are they?

Kidney stones are technically referred to as renal calculi. They are solid entities formed of different types of crystals. When they become large, they are extremely painful. They are called kidney stones because they usually start forming in the kidneys, but they can develop anywhere along the urinary tract, including

  • kidneys
  • ureter
  • bladder
  • urethra

What Causes Kidney Stones?

Kidney stones have several variations, and they originate for different reasons. Some of the causes are:

  • Calcium. Calcium-based stones are the most common type and somewhat preventable by avoiding high oxalate-rich foods like potato chips, peanuts, chocolate, beets and spinach. Ironically, although some kidney stones form from calcium, getting sufficient calcium in your food can prevent these stones.
  • Uric acid. These kidney stones are found more often in men than women. They develop when the urine becomes too acidic due to a diet high in purines (animal proteins) like fish, shellfish and some meats.
    Struvite. Struvite stones are more often found in women who have urinary tract infections or a kidney infection.
  • Cystine. Cystine stones are less common. They are hereditary and caused by leakage of cystine into the urine from the kidneys.

What Treatment is Available for Kidney Stones?

If the stones don’t go away by passing naturally through the urogenital system, you should contact a urologist for treatment. There are several procedures they can employ to remove the stones. The type of treatment depends on the size of the stones and type of stone.

Here are some treatments your urologist might recommend:

  • Medication: The urologist may prescribe pain medications and/or antibiotics in case of an infection. Other medicines also may be prescribed depending on what type of kidney stone is found, including: allopurinol for uric acid stones; diuretics to avoid calcium stones; sodium citrate or sodium bicarbonate, which makes the urine less acidic; or phosphorus solutions which are found to prevent calcium stones from forming.
  • Modern methods of breaking up the stones like lithotripsy, in which sound waves are employed, so stones are more easily passed.
  • Tunnel surgery is a minimally invasive procedure in which the urologist makes a small incision on your back to retrieve the stones.
  • Ureteroscopy: If a kidney stone is lodged in the bladder or ureter your urologist may use a ureteroscope to retrieve it. In this procedure a thin wire with an attached camera is inserted into the urethra and bladder, and then the stones are retrieved. Stones are examined by a lab to give more insight into the type of stones being formed.

Kidney Stone Prevention

If you are prone to kidney stones, try to drink 6 to 8 glasses of water each day to increase urine flow. This preventative measure helps flush out the kidneys. Your urologist may prescribe medication to help prevent future types of stones from forming.

If you think you have kidney stones you will want to speak with a qualified doctor to discuss the best methods to prevent and treat them. If you are in Florida, call the Advanced Urology Institute for an appointment with a board certified urologist.

How Do I Know If I Have a Kidney Stone

Kidney stones is the common term for the medical condition of renal lithiasis or nephrolithiasis. The stones are made up of salts and minerals that form into hard deposits inside your kidneys.

Kidney stones can be caused by many different factors and can show up in different sections of your urinary tract. They may travel from the kidneys to your bladder, and from the bladder to the ureter. Sometimes kidney stones occur when the urine is too concentrated, which allows minerals to coalesce and crystallize. Heeding early signs like painful urination and an irregular urge to pee can help you seek medical help earlier and get treatment.

Pain from Kidney Stones

How can you be sure that kidney stones are causing your pain?
Because there are other maladies that have similar symptoms to kidney stones, a visit to your urologist may save you from uneccesary grief. Some symptoms of kidney stones include:

  • Acute pain below the ribs on the side of your body or in your back. The pain may intensify or shift to various locations as the stones travel along the urinary tract.
  • Pain located in the lower abdomen or groin
  • Pain that fluctuates in severity
  • Painful urination
  • Cloudy or discolored urine (pink, red or brown)
  • Foul-smelling urine
  • Persistent need to urinate or urinating more than usual
  • Urinating in small amounts
  • Nausea and consequent vomiting
  • Chills and fever due to associated infection

You could have just one of these symptoms or several. If you are experiencing severe discomfort along with nausea or blood in your urine, you should seek medical help.

Kidney stones do not usually cause any permanent damage if treated early and correctly. You may be able to drink plentiful amounts of water, take a pain medication, and be able to pass the stone on your own. However, if the stones get lodged in the urinary tract or cause a urinary infection, more aggressive treatment may be in order.

Tests for Kidney Stones

There are several ways your doctor can test for kidney stones that will also reveal their size and precise location. These tests include:

  • Imaging tests: The imaging technology to determine if you have kidney stones includes X-rays, CT scans and ultrasounds.
    CT scans are more thorough than X-rays and result in lucid composite images of kidney stones. Ultrasound is also used to create images of the affected area.
  • Blood tests: Your doctor can determine if your have too much uric acid or calcium in the blood, which can cause kidney stones to form.
  • Urine tests: These lab tests can detect minerals that cause kidney stones in your urine. They can also reveal if you lack elements that prevent stones from forming.

Treatment for Kidney Stones

Your doctor can determine if sound-wave therapy can resolve the problem or if surgery is indicated due to stones being too large to pass, causing infection or other damage. If you are able to pass the stone on your own, saving it for your urologist to examine can help your doctor determine what causes your stones and what can be done to prevent additional ones from forming.

If you would like more information about kidney stones and their treatment, schedule a consultation at the Advanced Urology Institute location nearest you or visit the website.

Treating Kidney Stones

Treatment of Kidney Stones

The treatment available for kidney stones varies according to the size and type of kidney stone and its location.

If the stones are small, they probably won’t require invasive treatment and can be passed with hydration and medication like pain relievers and alpha blockers that relax the muscles in your ureter. This is how most kidney stones are resolved.

Dr. Rolando RiveraIf you have large stones, however, your urologist may approach them with more extensive treatment. There are several ways to eliminate them. If you have severe pain, an infection, or your kidney function is threatened, your doctor will want to act quickly. Fortunately, during the 1980s a new approach to getting rid of the stones appeared on the medical scene and quickly replaced surgical removal of the stones. This treatment, called lithotripsy, uses sound waves to break larger kidney stones into tiny pieces so they can be passed during urination. These sound waves are also called high-energy shock waves and are usually implemented from outside the body in what is called “extracorporeal shock wave lithotripsy” or ESWL. The procedure takes about 45 minutes to an hour and you may be put under light sedation during treatment.

If the stones are larger and located in the kidney, or if ESWL did not break them down, your urologist may perform surgery to remove them. Your doctor can explain the surgical approach he recommends.

What Causes Kidney Stones?

Calcium phosphate stones are caused by overactive parathyroid glands which are located below your Adam’s apple. When these glands overproduce the parathyroid hormone the result is hyperparathyroidism, resulting in an excess of calcium that may cause kidney stones. Your doctor likely will recommend treatment to stop your parathyroid gland from overproducing the hormone.

Prevention of Kidney Stones

You may lower your risk of kidney stones if you:

  • Drink large amounts of water during the day. If you are in a dry environment or exercise significantly, you may need even more water, drinking enough so your urine looks almost clear.
  • Consume fewer oxalate-rich foods. If your doctor determines you have calcium oxalate stones, he may recommend dietary changes to reduce foods that are high in oxalate, like beets, spinach, sweet potatoes, tea, chocolate, nuts and soy products.
  • Reduce your dietary salt and consumption of animal proteins.


Medications may help prevent kidney stones, depending on the type of stone. Uric acid stones, calcium stones, cystine stones and struvite stones each require a different plan for prevention.
If you reside in Florida, you are probably not far from an Advanced Urology Institute location. If you are near Naples or Bonita Springs, you may wish to consult with Dr. Rolando Rivera for your kidney stone symptoms and treatment. For more information, visit the Advanced Urology Institute website.