Nocturia Interrupting Your Sleep? It Might Be Your Prostate’s Fault.

By: John Lynam, DO, FACOS

Depressed man at night feeling alone and useless

Nocturia is not restful. It’s a condition that causes you to wake up twice or more each night to go to the bathroom. Nocturia impacts men and women and can be caused by anything from drinking too much before bed to certain medications that contain diuretics.

For men, one of the most common causes of Nocturia is a growing prostate.

The Prostate

The prostate gland sits at the base of the bladder, behind the penis. Through its center runs the urethra, the tube that carries urine out of the body. A man’s prostate grows throughout his life, but if it grows too large, it compresses the urethra and makes it hard to urinate.

About half of all men by age 60 will experience this issue, known as benign prostatic hyperplasia (BPH). In fact, BPH is the leading reason men visit a urologist.

Benign Prostatic Hyperplasia (BPH)

The good news for men is that BPH is not cancerous, hence the word “benign.” The bad news is that BPH causes many irritating symptoms, including:

  • A frequent need to urinate both day and night
  • A weak or slow urinary stream
  • A sense that you cannot completely empty your bladder
  • Difficulty or delay in starting urination
  • An urgent need to urinate
  • A urinary stream that starts and stops

Untreated BPH Can Progress

BPH is more than a nighttime nuisance. Untreated, it can progress with serious health consequences.

  • Adult diapers. If the urethra is closed off, the bladder must contract harder to push urine out. Over time, this weakens the bladder and can lead to incontinence.
  • Urinary catheter. If your urethra becomes too obstructed or if bladder weakness becomes too severe, a catheter may be needed to drain the bladder fully.
  • Urinary tract infections (UTIs) and kidney stones. If your bladder isn’t fully draining, the residual urine left increases the risk of UTIs and kidney stones.
  • Kidney damage. The kidneys are attached to the bladder through two ureters, the ducts through which urine passes. If urinary retention causes pressure on the bladder, it could eventually damage the kidneys. Also, if the bladder is infected, that infection could spread to the kidneys.

BPH Can Be Treated

The first place to start treating BPH is with conservative management and behavior modifications. This includes steps like limiting beverages in the evening, limiting caffeine and alcohol consumption, avoiding bladder-irritating foods, and avoiding certain medications that can impact urination.

Your urologist can prescribe medications to help urine flow better and shrink the size of the prostate.

For more severe urinary symptoms, minimally invasive procedures like UroLift® and Rezum® can significantly improve your urinary health and quality of life.

Do not ignore the symptoms of BPH. You’ll sleep more soundly and live more fully when you prioritize your urinary health.

Wondering if your symptoms could be BPH? Learn more about BPH symptoms, diagnosis, and treatment at Advanced Urology Institute of Florida.

5 Urinary Issues that Can Interfere with a Woman’s Sex Life

By: Nicole Szell, D.O.

Love may be blind, but when urinary issues get in the way of sex, it can be blindsiding.

This is the case with four in 10 women experience sexual problems at some point in their lives, thanks in part to urinary infections, pelvic inflammation, and muscle weakness. This includes 40% of the nearly 6.4 million adult women who live in Florida.

The sexual side effects of these conditions are blindsiding because many are just so sudden, such as an abrupt drop in sexual arousal or physical pain during intercourse. Many women take these symptoms personally, as if they are at fault. As a result, a lot of women become embarrassed to talk about it.

Yet like many unexpected events in our lives, the conditions behind these symptoms are common, natural, and often unavoidable. And they can be treated in a variety of ways.

Linking Urinary Wellness with Sexual Health

There are overall health reasons for women to enjoy an active sex life. Sex can reduce stress, improve sleep, and lower blood pressure. Women with active sex lives are less likely to have heart attacks, research suggests. Women with active sex lives later on in their “golden years” also usually live longer.

But when urinary wellness suffers, so can your sex life. Following are some of the urinary-sexual issues we treat for women:

Vaginal pain ­– Characterized by a chronic ache, itching, and burning, vaginal pain can result from nerve damage, an overreaction to yeast or inflammation, or muscle spasms. (Broader pelvic pain, meanwhile, can be brought on by fibroids or endometriosis.) Treatments typically start with pelvic-muscle exercises (Kegels) and medications, including nerve blockers. If the condition does not respond to these options, our team of urologists can perform reconstructive surgery.

Painful intercourse Vaginal dryness is usually caused by a lack of the female hormone estrogen, which is commonly associated with genitourinary syndrome of menopause. However, some medications and breastfeeding can contribute to dryness as well. It can make intercourse painful, even producing blood with sexual activity. You can approach treatment by regularly applying lubricant or through regular use of maintenance vaginal estrogen therapy. If these options do not provide relief, ask your doctor about outpatient laser procedures that resurface the vaginal endothelium.

Interstitial cystitis (IC) ­– Also called painful bladder syndrome, IC describes symptoms that occur when the bladder lining breaks down. The pain can feel like a urinary tract infection, and women are 10 times more likely than men to develop IC. Your prescribed treatments will depend on the symptoms and can include Kegel exercises, bladder training, medications, nerve stimulation to block the pain, or even procedures that help to re-surface the lining of the bladder. This procedure is known as “hydrodistension” and is performed by our expert team of urologists.

Pelvic organ prolapse ­– When your pelvic muscles weaken due to childbirth, strain, or post-menopausal hormone changes, the body parts they hold in place can drop through the vagina. Nearly half of all women develop pelvic prolapse, which can cause vaginal numbness and pressure. Non-surgical approaches include Kegels and small silicone devices (pessaries) that hold the organs in place. More advanced cases could be treated with reconstructive surgery or a hysterectomy.

Urinary incontinence ­– Bladder problems can weaken your ability to control urine leaks, which can be a mood killer when it comes to sex, let alone achieving orgasm. We can determine the kind of incontinence to treat with a simple physical exam. Stress incontinence – when urine leaks during pressure-related activities – can be treated with Kegels, bladder training, pessaries, or a medication to strengthen the urethra. Urge incontinence – the hard-to-control need to urinate – can be treated with medications that calm bladder muscles, including Botox.

Don’t Feel Awkward About Good Health

If you’re experiencing a change in sexual enjoyment, it’s likely due to another health issue that you can seize control of. Talk about it with your partner, friends, and your doctor. You might just love the results.

The staff at Advanced Urology Institute are your partners in good overall health. You can read about all the women’s health conditions we treat, with symptoms and treatment options, on our website.

Don’t Live With an Accident-Prone Bladder: OAB Is Highly Treatable

By: Nicole Szell, D.O.

Remember when being accident-prone meant you had a knack for tripping on uneven sidewalks? If you’re among the more than 33 million U.S. men and women living with overactive bladder (OAB) today, then accident-prone has taken on a potentially more awkward meaning.

OAB, a common condition characterized by the sudden and frequent urge to urinate, affects an estimated 40% of women and 30% of men. Yet many of them never seek a doctor’s help. Instead, they try to cope with OAB symptoms because they’re embarrassed, aren’t aware of available treatments, or just don’t know how to bring the issue up.

But we do know how to bring it up. OAB and incontinence are so common, in fact, that our urologists talk about it every day.

Why Your Bladder Becomes ‘Overactive’

OAB is a condition in which the bladder squeezes out urine at the wrong time; typically before it is full. While this issue becomes more common with age, OAB also can be brought on by illness or changes to your urinary system. Among them:

  • Obstructions including bladder stones, tumors, constipation, or (in men) an enlarged prostate
  • Hormonal changes from menopause (in women)
  • Chronic, recurrent UTIs
  • Pelvic floor dysfunction
  • Diabetes
  • Misfires by the nerves that control bladder muscles
  • Neurological disorders including Parkinson’s disease, multiple sclerosis, or stroke

Getting Ahead of OAB: Your Treatment Options

The most common symptoms of OAB include needing to urinate more than every two hours, urine leaks (incontinence), and waking up more than twice a night to urinate. If you experience these symptoms, your doctor can help, starting with a physical exam and urinalysis to screen for OAB. Other possible tests include going to the bathroom to determine how much your bladder empties or to assess the strength of your urine stream.

If your symptoms require it, your doctor might also perform one of the following tests:

Cystoscopy – Examining the inside of the urinary tract using a slender, camera-equipped scope.

Urodynamics – Gauging bladder pressure using two scopes, in the urethra and the rectum.

Your Step-By-Step Therapy Options

Depending on the diagnosis, your doctor will likely advise non-invasive therapies first, such as:

  • Liquid and diet restrictions –Reducing caffeine, alcohol, and artificial sweeteners (bladder irritants); keeping a healthy weight; and avoiding liquids two to three hours before sleeping.
  • Kegels – Performing pelvic-strengthening exercises daily and at regular intervals.
  • Bladder training – Holding off on going to the bathroom for as long as you can, then gradually extending the waits.
  • Pelvic floor physical therapy – Performing physical therapy exercises to strengthen and tighten the pelvic muscles.
  • Biofeedback – While sitting in a comfortable chair (fully clothed), two sensors are used to measure the activity of the muscles that control bladder functions. This technique is used to help train patients on how to properly perform pelvic floor therapy.
  • EMSELLA Chair – Patients sit in a comfortable chair-like device (fully clothed) that uses high-intensity focused electromagnetic energy to strengthen the pelvic floor muscles.

If you do not respond to the above therapies, the doctor might suggest the following.


  • Oral prescriptions – Muscle-relaxing drugs can ease involuntary bladder contractions.
  • Botox – When injected into the bladder, Botox has proven effective in relaxing the bladder. Often, Botox is advised in cases where the patient does not respond to oral medications.
  • Estrogen replacement therapy (for menopausal women) – Reintroducing hormones to strengthen genital tissue.

Nerve Stimulation

  • Sacralneuromodulation – Think of this approach as the “pacemaker for the bladder.” The doctor implants a thin wire equipped with an electrode under the skin by the sacral nerve, which controls the bladder. The electrode delivers pulses to the nerve.
  • Tibial nerve stimulation – Here, electric pulses stimulate the sacral nerve via the tibial nerve, near your ankle. Rather than an implant, the electrode is delivered through a needle, usually over 12 weekly sessions.

You Can Make Accidents a Memory

Your first step to skipping urgent bathroom runs can start now. Keep a “bladder diary” to record your symptoms, how often they occur, and the activities that cause leakage. Then share it with your AUI doctor. Together, we will find a solution.

Don’t spend another night with OAB on your mind. Explore our OAB treatments and a video that explains our surgical options.


Is Hormone Therapy Right for Me?

By Stephanie DeRouin, APRN

Hormonal and metabolic changes are a natural part of aging but, unfortunately, not a positive change. Scientists have clearly documented the adverse effects of hormonal and metabolic decline as the primary contributors to the chronic diseases that impact our heart, brain, and bone health as we age. 1

That’s why hormone replacement therapies continue to be widely and carefully studied today – to see if they are the solution for a better quality of life as we age.

What are hormones?

Hormones are chemical substances secreted by various body organs that control the function of cells and tissues – everything from metabolism to behavior.2

We are most familiar with our sex hormones, which are responsible for puberty, menstruation, sex drive, pregnancy, sperm production, and menopause. These include estrogen, testosterone, and progesterone. These aren’t our only hormones. Human growth hormones, thyroid hormones, cortisol, and insulin also are critical to our health.

However, since urologists receive the most extensive training available in physiology, anatomy, and treatments associated with sexual issues, we are focusing on the sex hormones in this article.

Why is estrogen necessary?

Both men and women make estrogen, but it is most impactful to women. Its presence controls body composition and ovulation and keeps the vulva and urethra healthy.

Estrogen levels start to dip up to 10 years before menopause (the cessation of periods). On average, menopause occurs around age 50, so starting as early as age 40, women may begin to experience symptoms like lack of energy and fatigue, decreased sexual desire, weight gain, and hot flashes. As estrogen levels decline, pain or discomfort with intercourse can occur.

Estrogen is not only crucial for sexual function, though. It also affects women’s cholesterol, blood sugar, bone and muscle mass, brain function, and circulation.

Why is testosterone important?

Both men and women also make testosterone. While testosterone is most talked about for men, as it is the primary male sex hormone, there is a growing body of evidence that shows testosterone plays critical roles in women’s health as well – from sexual function to osteoporosis prevention to brain and breast protection.3

Testosterone for men is critical in triggering the development of male internal and external reproductive organs during fetal development. Like estrogen in women, testosterone plays a crucial role in body composition, the production of sperm, sex drive, and a sense of well-being. And, like estrogen in women, it starts to dip in a man’s third and fourth decades of life.

The first complaints from most men with low testosterone are tiredness and decreased libido. But low testosterone levels also contribute to an increased risk of obesity, an increased risk for type 2 diabetes, high blood pressure, high triglycerides, and reduced muscle mass, strength, and bone density.

How can hormone therapy help?

Suppose you have a hormone imbalance of estrogen or testosterone (which can be diagnosed with a simple blood test). In that case, hormone therapy may help alleviate the symptoms associated with that hormonal decline. This can include:

  • Increased energy
  • Improved sleep
  • A more balanced mood
  • Better ability to control your weight
  • Increased mental clarity
  • Restored libido

At AUI, we use bioidentical hormone replacement therapy pellets to treat hormone imbalances from Biote® and TESTOPEL®. These hormone pellets contain compounded testosterone or estrogen identical in structure to your body’s natural hormones.

The pellets are placed under the skin in a simple, in-office procedure that takes no more than 15 minutes. No pills. No shots. And the pellets are ultimately absorbed by your body, leaving nothing behind.

This type of therapy delivers a steady stream of hormones to patients for several months. Most patients report feeling symptom relief after the first round of pellets. However, it may take up to two pellet insertions.

Are there risks?

Like all therapies, hormone replacement must be tailored to the individual. Your family and personal health history of cancer, heart disease, stroke, blood clots, and liver disease will determine if hormone therapy is right for you.

Everything from your dosage and treatment length to establishing regular reevaluation intervals will be determined with your physician.

Hormone therapy is not suitable for everyone and can lead to increased risks for some individuals.

Hormone Therapy at AUI

At Advanced Urology Institute, we know that hormones and health go hand in hand, so we are passionate about offering hormone therapy through a disciplined approach in a clinical setting under the careful watch of our extensively trained physicians and staff.

Learn more about our approach to optimize your hormones and enhance your well-being as you age.




Do You Have Kidney Stones? 6 Warning Signs

There’s good reason Florida counted 300,000 new residents in 2023. With 237 sunny days a year and consistently warm temperatures, we have an ideal playground all year long. But those sunny days can also contribute to one of the most common causes of kidney stones: dehydration.

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Do You Have Occasional ED? Don’t Panic. Here’s What You Should Know

By: Jonathan Beilan, M.D.

The state of Florida has the fifth-oldest population in the country, with a median age of 42. So, it might not surprise you that Florida outpaces all other southern states when it comes to filling prescriptions for erectile dysfunction (ED).

What might surprise you is that a good number of these prescriptions are probably for men at the median age mark, 42, or younger. This is because an estimated 43% of all men experience ED at one time or another, regardless of age.

If you are among those experiencing occasional ED, you too can find treatment, and not just through medication.

The Reasons Behind Occasional Erectile Dysfunction

Erectile dysfunction is the inability of the penis to become hard enough for intercourse, or difficulty with maintaining this rigidity for satisfactory sexual activity. Typically, ED is due to a lack of blood flow to the penis or damaged penile tissue. It is the most common sexual problem men report, affecting nearly 30 million men – many of whom experience it on a temporary or circumstantial basis, not necessarily chronically.

Still, even occasional ED could signal the onset of an underlying condition, including:

  • Diabetes – High glucose can narrow blood vessels and slow circulation. Nearly 11 million adult U.S. men have diabetes, and 35% to 50% are impotent. Furthermore, diabetic patients are less likely to receive meaningful benefit from oral ED medications such as Sildenafil or Tadalafil.
  • Heart disease – Plaque buildup in the arteries weakens blood vessels and blood flow. Erectile dysfunction can be a key indicator of heart disease.
  • Kidney disease – Your kidneys remove waste from the bloodstream, regulate blood pressure, and produce hormones. Therefore, kidney problems can threaten blood vessels, nerve function, and hormone levels.
  • Prostate conditions – Certain treatments prescribed for an enlarged prostate or prostate cancer, such as anti-testosterone drugs and chemotherapy, can have side effects that can contribute to ED.
  • Peyronie’s disease – This condition results from a buildup of scar tissue inside the penis, and causes curvature that can make an erections difficult and painful.
  • Low testosterone ­– Declining levels of this sexual hormone can result in reduced sexual drive and make erections more difficult.

What You Can Do If You Have Circumstantial ED

Even men in perfect health can experience ED. Emotional and psychological factors including stress, exhaustion, anxiety, and depression are associated with 10% to 20% of ED-related cases. This figure may be higher in younger, healthy populations.

If you experience one or more of these conditions, ask your doctor about talking to a therapist.

Also note that alcohol, smoking, and/or recreational drug use can also raise the risk of ED, even at a young age. If you regularly participate in these activities, hold off for a time to see if your erection improves.

How to Treat Time-to-Time ED: Your Options

If you experience occasional ED and don’t know why, talk to your doctor to determine if it’s the result of an underlying health issue or the side effect of a medication. Then you can choose a treatment option. Among them:

  • Oral medications – Viagra, Levitra, Cialis, and other drugs can improve blood flow to the penis.
  • Inserted drug therapies  Medications also can be self-injected directly into the base or side of the penis or inserted into the tip of the penis in the form of a small suppository. These drugs expand blood vessels to enhance blood flow on an as-needed basis.
  • Vacuum pumps – These hand-powered devices draw blood into the penis so it becomes erect.
  • Surgical therapy – penile protheses have been around since the early 1970’s and are an excellent option for men with moderate to severe ED. The erection still feels natural and the surgery doesn’t affect urination or ejaculation.
  • Low intensity shockwave therapy – This new approach uses a wand-like device to apply gentle pulses of sound waves outside the penis, stimulating the tissue and blood flow. However, use caution when considering this treatment as it’s still considered experimental by most U.S.-based guidelines and not fit for all patients. Patients should speak to a sexual health expert to see if this treatment option is right for them.

When In Doubt, See Your Doctor

If you experience ED, consult with a urologist specializing in sexual health. Whether you experience occasional or chronic ED, we have these conversations every day and are comfortable discussing them with patients. Remember: Treatment options are available, don’t suffer in silence!

Erectile dysfunction is a healthcare issue that should be talked about practically. To consult one of our physicians to diagnose the cause and suggest treatments, you can find an AUI office near you and request an appointment here.

BPH Treatments: Many Roads to Relief

By: Matthew Truesdale, MD, FACS

As men age, their prostate grows and they’re more likely to experience benign prostatic hyperplasia (BPH) – or an enlarged prostate. The prostate is a small gland that helps make ejaculate fluid. If the prostate grows too large, it can block the flow of urine out of the bladder. 

BPH is one of the leading reasons men visit a urologist – 50% of all men experience symptoms from an enlarged prostate by age 60. 

Waking up multiple times at night to go to the bathroom is one of the most common symptoms men describe. An enlarged prostate can also lead to difficulties urinating, such as a weak stream, having a stream that starts and stops, leakage, and the inability to completely empty the bladder. 

Is it BPH?

If you suspect you have BPH, visit your urologist. It is essential for men experiencing BPH symptoms to seek medical advice from a urologist to rule out prostate cancer and prevent other conditions from developing.

While BPH itself is not cancerous, it can cause other health issues if left untreated, such as urinary tract infections (UTIs), bladder or kidney damage, bladder stones, or urinary retention.

A urologist can put you on the path to wellness through a few simple tests and completing an International Prostate Symptom Score (IPSS).

Many Paths to Relief

There are many different paths to try for relief of BPH symptoms. If one path doesn’t work, don’t give up! 

A first step might be conservative or lifestyle modifications, including:

  • Limiting beverages in the evening
  • Limiting your caffeine and alcohol consumption
  • Avoiding bladder-irritating foods
  • Avoiding certain over-the-counter medications
  • Changing your bathroom patterns

Another option is medication to relax the muscles lining the urethra in the prostate to open the channel and allow urine to flow better. 

There are also many office-based and surgical options. Each method is minimally invasive and has its unique benefits. The UroLift® System, for example, uses a revolutionary approach to lift and hold the enlarged prostate tissue so it no longer blocks the urethra. 

The Optilume® BPH Catheter System uses a drug-coated balloon inserted through the urethra into the prostate to release a safe and proven drug into the prostate. 

Other surgical options remove the inside part of the prostate gland entirely using a variety of methods, from traditional surgery to laser vaporization and waterjet ablation. 

Patient Navigators

With so many ways to treat BPH, it can sometimes feel overwhelming. At AUI, specialized providers are here to help you understand your diagnosis, discuss your treatment options, and help you relieve your symptoms of BPH.

Learn more about BPH, including its causes, risk factors, and treatment options. Find an AUI office near you