Low Testosterone Treatment Options

Dr. Brian Hale of Palm Harbor, FLMy name is Brian Hale. I’m a board certified urologist working with Advanced Urology Institute.

Men with low testosterone are often treated in our practice, and we have several options in treating it: We have injections that we do every two to three (2-3) weeks, and we also have gels that they can put on their skin every morning to raise their testosterone levels back to normal levels. We even have pellets we put on the skin of some patients that we do every four (4) months. We have different options depending on what the patient wants done.

Common Urologic Conditions Are Treatable

The urinary system of the human body regulates, manages and eliminates urine waste. The organs in this system are the kidneys, ureters, bladder and urethra. But as with any organ or system of the body, the urinary system can have problems, commonly referred to as urologic diseases or urologic problems.

You can have urologic problems regardless of your age, ethnicity or gender. And when urologic conditions occur, in both men and women they have a direct effect on the urinary tract and how urine is expelled from the body. In men, urologic problems can also affect the reproductive organs.

Signs that you have urinary tract problems:

Urologic conditions are treatable

Urology is a dynamic and advanced field. Urologists know how to treat many urologic diseases, including cancer of the prostate. The first step in any successful treatment is to see a urologist on time. Do not delay. As soon as you experience any problems, visit a urologist for a medical exam.
Mikhail Lezhak, PA-C of Daytona, FL

Common urologic conditions

(1) Urinary Tract Infections (UTIs)

Urinary tract infections (UTIs) are the most frequent type of urologic condition, although they occur more commonly in women than men. Close to 60% of women and 12% of men experience UTIs at some point in their lives. These infections are easily treated with antibiotics, but the treatment should begin as soon as possible to avoid further infection and prevent complications.

(2) Urinary incontinence

Although many people resist seeking help because of embarrassment, urinary incontinence is treatable in most cases. The cause is usually either an overactive bladder (urge incontinence) or stress incontinence. Typically, urge symptoms come from the bladder wall and detrusor muscle and mucosa, while stress symptoms are due to the incompetence of the bladder neck or urethral sphincter.

The diagnosis of urinary incontinence can be reached through a careful patient history, thorough examination and proper tests. You may need bladder retraining, controlled fluid intake, reduction in caffeine intake, or deliberate delayed voiding to treat the symptoms. Your doctor can also recommend medication or perform corrective surgery.

(3) Pelvic Floor Dysfunction

Pelvic floor muscles support the bladder, vagina and rectum. At some point in life, particularly after childbirth, pelvic floor muscles can become irritated or inflamed. Since the pelvic floor has to relax during urination, having pelvic floor dysfunction can cause pain or difficulties. The problem is often treated through pelvic floor exercise, but when the exercises are ineffective, vaginal medications or muscle injections can be used.

(4) Prostatitis

Many urological problems in men are linked to the prostate. Prostatitis is the inflammation or abnormal swelling of the prostate. The most common symptoms of prostatitis are painful urination, fever, chills, abdominal pain, and pain in the lower back or pelvic region. If you are diagnosed with prostatitis, your doctor will recommend antibiotics to reduce the swelling and restore your prostate to normal size.

(5) Bladder and prostate cancer

The PSA test and prostate exam are great ways to check on your prostate health. Should cancer be found in your bladder or prostate, your urologist will offer lifesaving care. Prostate cancer is the second leading cause of cancer-related deaths in men. It results from the abnormal and rapid growth of prostate cells.

Prostate cancer is successfully treated when detected early, which is why men are encouraged to get checked once a year. In fact, the recommended treatment depends on the time of detection, and may include radiation, surgery or regular surveillance. Today, robotic surgery has helped to reduce the hospital stay for kidney, bladder or prostate cancer surgery to just a few days, or just one day.

(6) Prostate enlargement (BPH)

The prostate grows as you age. Over time, you may have to wake up at night to go to the bathroom or you may not be able to produce the stream of urine you once did. When diagnosed with BPH, your urologist will use various techniques to relieve the obstruction caused by the enlarged prostate. These techniques include consistent monitoring, medications, and in some cases surgery.

Your urologist may also recommend the Rezum procedure—which uses heated water vapor to shrink the enlarged prostate tissue—or the green light and thulium laser vaporization techniques, transurethral resection of the prostate, minimally-invasive thermotherapy, or a UroLift. You will likely return home the same day as one of these procedures.

(7) Erectile dysfunction (ED)

This is a common condition as men grow older. When a man in his 40s or 50s notices that his erections are no longer what they used to be, he should talk to a urologist. Erectile dysfunction is the difficulty in achieving or maintaining an erection for sexual intercourse.

Although not fatal, it can cause stress, embarrassment and a strain on your relationship. Urologists will help you determine the underlying conditions and recommend treatments. Your urologist may prescribe medications—such as PDE5 inhibitors Cialis and Tadalafil—penile injections, a penile pump or, as a last resort, penile implant surgery.

(8) Kidney and ureteral stones

Kidney and ureteral stones occur when crystal-like particles in urine develop and grow into larger masses. As the stones pass along the urinary tract, they can get blocked and cause pain. Although most stones are passed naturally, larger stones may require surgery or specific procedures to break them.

One of the most common treatments is the Extracorporeal Shock Wave Lithotripsy (ESWL) technique in which sound waves are used to break up stones into smaller pieces. Also, since kidney stones can recur, patients often need long-term care. Your urologist will advise you on how to prevent kidney stone formation and how to best manage any potentially painful stones that develop.

At Advanced Urology Institute, every day we help people solve problems they may be hesitant to talk about. Since these problems are distressing or awkward to discuss, our goal is to help make you comfortable. We are proud of the long-term relationships we enjoy with our patients. Our knowledgeable urological specialists provide carefully tailored and confidential care. At AUI, patients get a proper diagnosis and the correct treatment, and we are willing to answer any questions you may have about your health.

If you suspect you have a urological problem, we encourage you to make an appointment at one of our many locations. For additional educational resources on urologic conditions, visit the Advanced Urology Institute website.

Diagnostic Tools and Urodynamic Testing for Urinary Problems

Donna Irving, APRN of Naples, FLHi, my name is Donna Irving and I am a Nurse Practitioner with Advanced Urology Institute.

I think [with] the tool sets that we use, we have good ways to evaluate just with blood withdrawal, looking at the PSAs [etc.]. Then we have what’s called urodynamic studies, where we can put catheters in people’s bladder and we can actually tell them how well their bladder is working because we have men that will come in and we’ll say “We’re not sure if its your prostate or is it actually your bladder that’s not working”. [With Urodynamic Testing] we can actually measure both of them or we can do the cystoscopies, look up inside their bladder and tell them how big of a prostate that they have, how much is it impinging on their urethra and we can also measure their bladder so that we can tell them if they have a little bit of both, [and] so we’ll know how to treat them afterwards.

Types of Prostate Cancer: What You Need to Know

Prostate cancer is a complex disease. It is not easy to predict how any particular prostate tumor will grow, or how rapidly it will spread to areas outside the prostate. After a prostate cancer diagnosis, your urologist will assess various factors to determine the level of risk associated with the disease. Understanding the risk level—low, intermediate or high—will help you and your doctor make decisions to achieve the best survival rate and quality of life.

Types of prostate cancer

While there are many types of prostate cancers, urologists first divide them into two categories—aggressive and indolent—to begin determining the best treatment.

1. Aggressive prostate cancer

Dr. Scott Sellinger of Tallahassee, FLAggressive prostate cancer is the type that grows rapidly, spreads fairly early, quickly and widely, and causes massive body damage. Since it spreads swiftly via secondary deposits, it quickly becomes advanced stage cancer and is very difficult to treat, particularly during the later stages.

For aggressive high-risk prostate cancer, treatment is most effective when it begins while the tumor is still in its early stages. Without early treatment, the cells of the tumor remain highly active, multiplying rapidly. The tumor grows swiftly, spreads rapidly and causes widespread damage.

2. Indolent prostate cancer

Indolent prostate cancer is the type that grows very slowly and is unlikely to spread to areas outside the prostate. Therefore, it is a low-risk, low-volume tumor that can exist in the prostate for several years without causing significant problems. Even if left untreated, it is unlikely to spread outside the prostate; and if it spreads, it only does so slowly and locally.

How are high-risk and low-risk prostate tumors identified?

If you are diagnosed with prostate cancer, your doctor will monitor the disease periodically to see if it is growing and spreading. The primary way for monitoring the growth and spread of the tumor is the prostate-specific antigen (PSA) level in blood. PSA is produced by the prostate and reaches the bloodstream; but larger amounts of PSA in the bloodstream are usually a signal that the prostate is enlarged, infected or malignant.

For instance, the PSA doubling time—the time it takes for a patient’s PSA level to double—predicts how aggressive the cancer is. The faster the PSA level doubles, the more aggressive is the cancer. Likewise, the PSA velocity helps to predict the aggressiveness of a tumor. If the PSA level increases sharply, then the cancer is likely aggressive.

Urologists also use the Gleason score to detect how fast the cancer is growing and spreading. This score is obtained by grading cells in the tumor on the basis of how abnormal or normal the cells look under the microscope. The two most abnormal areas of the tumor are evaluated, each given a score from 1-5, and then the two numbers are added. The higher the score (typically 6 or more), the more aggressive the tumor.

While immediate treatment is called for with aggressive, high-risk tumors, a patient can live with an indolent, low-risk tumor for 20-30 years without the cancer causing any serious effects. For the slow growing tumor, we may recommend observation or a watchful waiting called active surveillance, where we monitor the growth and spread of the tumor without medical intervention.

At Advanced Urology Institute, we offer a wide range of treatment options for prostate cancer, including chemotherapy, hormone therapy, radiotherapy, and surgery. But before we can recommend any treatment, we try to determine the risk of advanced disease. For more information on the diagnosis and treatment of prostate cancer, visit the Advanced Urology Institute website.

Women have many treatment options for urinary incontinence

Female Urinary Incontinence: Lauren Masters, ARNPMy name is Lauren Masters with Advanced Urology Institute. When we’re looking at urinary incontinence, for example, most women are having some degree of incontinence; whether it be soaking through one (1) pad a day or wearing depends all day long.

Usually we can get someone at a minimum to a 50% improvement. It varies based on your history, your basic demographic and whatever else is going on in your body, but a lot of times we can get you to a good 50% and there are many women we can get to 80-90 [percent] and even a complete resolution of their issues.

Do You Treat People With ED

Well, yes—every day. At Advanced Urology Institute, we treat men with erectile dysfunction (ED) and achieve great results for our patients. Erectile dysfunction is a big issue for men today, regardless of their age. Up to half of all men experience some form of ED in their lifetime, with roughly 10% of men over 40 suffering severe forms of impotence.

What is erectile dysfunction?

Also called impotence, erectile dysfunction is the inability to regularly get or maintain an erection for satisfying sex. In general, an occasional problem should not be a cause for concern. In fact, it is normal to have trouble getting or keeping an erection for up to 20% of sexual encounters. But frequent trouble getting an erection indicates a medical problem. With ED, successful erections either become the exception more than the rule or they never happen.

Treating People with Erectile DysfunctionSome of the causes of ED include:

  • Alcohol use, illicit drug use, or smoking
  • Medications, such as for high blood pressure
  • Diabetes
  • High cholesterol
  • Heart disease
  • Obesity
  • Blocked blood vessels
  • Scar tissue inside the penis
  • Sleep disorders
  • Metabolic syndrome
  • Anxiety, stress, or depression
  • Emotional or relationship issues

Risk factors for erectile dysfunction include advanced age, diabetes, obesity, depression, cardiovascular disease, high blood pressure, low testosterone, high cholesterol and smoking.

What does treatment for ED involve?

Erectile dysfunction is a treatable condition. At Advanced Urology Institute, we offer several treatment options, generally beginning with the least invasive approach. We also give lifestyle advice that may help with overcoming the condition.

For instance, if your ED is due to inactivity, obesity, metabolic syndrome, high blood pressure or cardiovascular disease, we may recommend you engage in regular aerobic exercise to help reduce the symptoms. We may also recommend you quit smoking, minimize your alcohol intake and follow a healthy diet.

Treatments for ED include:

1. Phosphodiesterase type-5 (PDE5) inhibitors

PDE-5 medications are typically the first line of treatment we recommend for men with ED. They include Stendra (avanafil), Viagra (sildenafil), Cialis (tadalafil), and Levitra or Staxyn (vardenafil).

These oral medications work in a similar manner to boost the level of cGMP—a natural chemical in the body that promotes the widening of blood vessels following sexual arousal. In turn, more blood reaches the penis.

At the same time, these medicines enhance the relaxation of muscles of the penis in response to stimulation, hence increasing blood flow to the penis and allowing an erection.

2. Creams and injections

Sometimes we prescribe a topical Alprostadil cream as an alternative to the oral medications. The cream comes with a plunger and is applied to the tip of the penis and the surrounding skin 5-30 minutes before having sex.

At other times, we may prescribe penile injections as a treatment for ED. That is, we teach you how to inject a medicine at the base of your penis 5-20 minutes before sexual intercourse. After the injection, there will be increased blood flow to your penis and an erection will develop within 15 minutes.

3. Penis pumps (vacuum devices)

A penis pump (vacuum erection pump) is a tube that fits over the penis. A plastic container is placed over the penis and the pump draws air from the container to create a vacuum. The change in air pressure when the device is used causes blood to be drawn into the penis and triggers an erection.

Once the vacuum creates an erection, the retaining band is slid down the lower end of the penis and the pump is removed. An erection will typically last long enough for intercourse but the penis may be cold to the touch, and the rubber band may restrict ejaculation.

4. Penile implant (surgery)

We generally recommend surgery only when all other treatment options are not successful or not well tolerated. If that is the case, a penile implant (prosthesis) may help in achieving erections.

A penile implant is a medical device surgically placed into a penis to mimic the look and performance of a natural erection. The prosthesis involves an inflatable rod inserted in the middle of the penis, with a pump hidden in the scrotum. The pump is used to inflate the rod, which in turn causes an erection.

Penis pumps are custom-fit to your anatomy in a procedure that is performed carefully to ensure that the sensitivity of the penis and your ability to ejaculate are not adversely affected, allowing you to have a normal orgasm and great sexual encounters.

At Advanced Urology Institute, we recognize that erectile dysfunction is a common but very sensitive issue. That is why we provide a compassionate, patient-friendly approach to ED treatment to help men tackle it as soon as it starts. And because ED may also be a sign of a more serious medical condition, we encourage you to speak with a urologist as soon as possible to help you address the underlying condition and find the best treatment option.

Remember, the sooner you speak with your doctor about ED, the sooner you can go back to enjoying physical intimacy with your significant other. For more information about the diagnosis and treatment of erectile dysfunction, visit the Advanced Urology Institute website.

Advantages and Disadvantages of Robotic Technology in Urology – Dr. Shaw Zhou

Shaw Zhou, MD of St Petersburg, FL

My name is Shaw Zhou, I am with Advanced Urology Institute.

Robotic surgery is truly precise, for example, the magnify [goes] up to ten times so the doctor can see better and if your doctor has a hand tremor [it’s still] very steady. You got four arms instead of two arms, so you have two arms to grab for you and so on and so forth. And you have three dimensional [view], you can see much better. The traditional labs got surgical screens which are two dimensional so you don’t have that sense of depth. However the drawback is first of all, the doctor sits 10 feet away, so God forbid if something happened, your doctor will have to go in, wash your hands and you are not by your patient

Also you lose the tactile sensation, cause you don’t feel it no more. When you tie a knot or whatever you know, the tactile sensor feed gives how much force you use now, [before] it’s purely by experience. Although the new robot that we’re talking about that has tactile sensationin other words you can visually see it. They see how much force [is needed] if its red or green. So it’s getting better and better, eventually new robots keep on coming out but in the future I think we can overcome all these shortcomings for robot surgery.

Are Medications Effective in Treating Erectile Dysfunction – Dr. Yaser Bassel

My name is Yaser Bassel, I am a board-certified urologist with Advanced Urology Institute.

I would say the vast majority of them, especially if they have not tried medications prior to them being seen in our office, probably 70-80 percent of those men will at least have a response to the medication oftentimes enough to basically be satisfactory to the patient or make them pleased with the way the medication is working. So most of them would actually get a good response to the medication.

Are there other treatment options for ED?

As far as what we have available to us now and what’s on the forefront, [for] those patients that do not want medication there are some newer technologies that are available that utilize shockwave energy to try and create newer vascularity in order to get a better response for that medication and that is something that’s basically come out over the past couple of years that we are starting to utilize in our practice. For those that do not respond to medication and still want to have treatment, the next step oftentimes [is] performing a test called a Penile Doppler where we will inject the penis with a vasoactive medication which will then initiate an erection so that we can measure blood flow and also measure for a venous leak which are two reasons why patients can have issues with erectile dysfunction.

What Urology Procedures Are Performed in Our Naples Office?

I’m Rolando Rivera, I am board-certified in urology and female public medicine and reconstructive surgery with Advanced Urology Institute.

So the surgery center is designed for primary outpatient interventions that are fairly uncomplicated, so we do do a fair amount of things at the surgery center. We do our prostate procedures…Urolift, we do a fair amount of those. Simple reconstructive procedures [such as] public reconstructive surgeries, stone disease, those kinds of things [and] the more complex reconstructive surgeries that require specific equipment like I do robotic surgery for prolapse, that is a hospital procedure.

Spanish Speaking Urologists at Fort Myers, FL

Luis Camacho, PA of Fort Myers, FLMy name is Luis Camacho. I am with Advanced Urology Institute. Dr Harris and I serve patients who speak Spanish. Spanish is my mother tongue and we want patients to feel comfortable in their own language. Sometimes, there are communication issues and when we speak our main language, we communicate better. Patients feel more comfortable. Our goal is to reach a bigger Hispanic audience so we can offer them a proper service for any urological condition they might have. Regardless if there are prostate problems, erection problems, [or] kidney stones, there are a lot of treatments we can provide in this field.