How Did Nicole Szell Become a Urologist?

KEY TAKEAWAYS:

  • Dr. Nicole Szell’s journey to becoming a urologist was driven by her passion for women’s health and her educational background in biology, chemistry, and osteopathic medicine.
  • Urology as a profession is intellectually challenging and rewarding, allowing practitioners to build trust-based relationships with patients and improve their quality of life.
  • Advanced Urology Institute is an ideal place for urologists like Dr. Szell to practice, as it offers a supportive environment with skilled professionals and a patient-centered approach to care.

To be able to dedicate your life to preventing, detecting and intervening in painful and embarrassing situations is an attractive and gratifying undertaking. It may not be for everyone, but for those of us in this profession it just brings incredible joy. As a urologist, you are able to direct your energy and enthusiasm to helping people. You are allowed into the lives of people facing painful conditions and are trusted to inject hope and bring back the joy to living. And as you are diagnosing, treating and educating patients, you make long-term connections and enjoy the thrill of being able to make other people well and happy again. It is a wonderful experience.

My Journey to Urology

Women’s health interested me from a very young age, driving me into many years of service as a volunteer and researcher in various women’s health programs and organizations. So when I went to college, my mind was already made up. I just wanted to pursue female urology and pelvic floor medicine. Being a native of the Midwest and Cleveland, Ohio, I went to Radford University in Radford for my bachelor of science in biology and chemistry. Upon graduation, I joined the College of Osteopathic Medicine, East Lansing, MI, for my medical school degree. Then I went to St. John’s Providence Health System, Detroit, for my urology residency program. I specialized in voiding dysfunction, pelvic floor disorders, sexual dysfunction, urologic reconstruction and pelvic organ prolapse, though I also handle general urology disorders such as kidney stones and bladder cancer.

Job Satisfaction

Urology is a field that challenges the intellect daily. It also inculcates the capacity to develop relationships based on trust. But most importantly, it offers the opportunity to solve women’s health problems, something I have been committed to since I was a young girl. As a urologist, I am able to engage with women in different situations and suffering from various conditions. It is a great privilege to listen to them, help them relax and find hope even in the face of a devastating diagnosis. I love my job because each day offers the chance to relieve discomfort, solve embarrassing conditions and improve the quality of life.

Why Advanced Urology Institute

Advanced Urology Institute is a great place to practice. I call it the urologist’s paradise. You are surrounded by passionate, skilled and talented professionals who are dedicated to a greater purpose. Each member of the pool has an unwavering drive to deliver the best possible care. As a team, we collaborate a lot when handling our patients. Since all administrative work has been centralized, we are left to focus on how to address the issues of our patients. So when patients come, they find us energetic and enthusiastic to serve them. And with our multidisciplinary, compassionate and patient-friendly approach, every patient can be sure of the best possible care. Want to know more about our services? Visit the “Advanced Urology Institute” site.

TRANSCRIPTION: 

Hi, I’m Dr. Nicole Szell. I’m a board certified urologist with Advanced Urology Institute.

I grew up in Cleveland. I am an only child. I moved to Michigan. I did my training at Michigan State for medical school. I did my residency in Detroit, Michigan, and then I went down to Miami for my fellowship in female pelvic medicine and urethral reconstruction. I also did specialized training in chronic pelvic pain, which was in Detroit, and I also did specialized training in female sexual function and dysfunction in San Diego, California, before coming here.

REFERENCES: 

Christopher Sherman Becoming a Urologist

To help a patient overcome an agonizing and upsetting condition brings extraordinary joy. That is the special kind of joy that this profession brings. As a urologist, patients come to you when they are at their worst, trust you with secrets they probably share with no other and put their faith in your ability to find safe and effective solutions for their problems. So whether it is the embarrassing urine leaks, difficulty getting an erection or a devastating genitourinary cancer, you are placed in a position to fix the problem and put a smile on the face of a trusting patient. It is a unique position, but one that brings amazing fulfillment and satisfaction.

The Long Path

Right from childhood, I have had a knack for helping people rise above their limitations. As a native of Florida’s Coral Springs I was often surrounded by people with various medical conditions who had few physicians to attend to them. I made up my mind early that I would pursue medicine to be able to make an impact on these lives. I got my undergraduate degree in health science at the University of Florida, then moved to the College of Medicine, Florida State University, for my medical school degree. After that I took a one-year general surgery training followed by a four-year urology residency at the University of Louisville in Kentucky.

Areas of Expertise

During my training, I became interested in medical technology and in advanced medical procedures. I not only honed my skills in minimally invasive techniques and robot-assisted surgery, but also mastered a number of specialized procedures such as laser surgery for BPH, Botox therapy for overactive bladder, interstim therapy for underactive and overactive bladder, and urethral slings for voiding dysfunction. Through my expertise as a urologist, I have been able to achieve my life’s dream of re-igniting the desire and joy to live in people facing their most uncomfortable, painful or lowest moments. As a urologist, I always feel a sense of peace and fulfillment after making a positive change in the life of a patient.

Job Satisfaction

As urologists, we work for long hours and often face stressful situations. But we take pride in our capacity to persevere and consistently deliver safe, timely and effective treatments. In fact, the challenges just help bring out the best in us and make our job even more interesting. We understand that to have the opportunity to help the sick is very rewarding. We also get to know our patients, win their trust and establish very close relationships. It is so satisfying to take care of patients and be able to make a difference in their lives.

Why Advanced Urology Institute

Every urologist yearns for a workplace that can bring out the best of their skills, talents and experiences and enable them to offer the best possible care. At Advanced Urology Institute, all administrative work has been centralized, allowing physicians to have enough time, tools and drive to collaborate, research, innovate and give the best possible care to their patients. AUI enables us to be in the company of other skilled, passionate, hard-working and creative people, making it easier for us to perform at our best and to take our careers to whatever heights we imagine. At AUI, urologists are living their dreams! For more information, visit the “Advanced Urology Institute” site.

Signs and Symptoms of Low Testosterone

Low testosterone (hypogonadism) is increasingly becoming a serious health concern for men. More men are being diagnosed with the condition, with studies indicating that 4 out of 10 men who are 45 and older have low testosterone (low-T). Likewise, 25 percent of men between 30 and 79 have low-T while about 50 percent of men over 80 have the condition. In fact, low testosterone is so common in men of various ages that numerous TV commercials have been created to make money promoting low-T solutions.

So what is low testosterone?

Also known as Testosterone Deficiency (TD), low-T refers to abnormal blood levels of the male hormone testosterone. The condition is characterized by testosterone levels below 300 ng/dl (nanograms per deciliter) in male patients when the measurement is done correctly. While low-T problems primarily occur in adult males, they are not restricted to male adults. However, when the condition occurs in women and young men, its definition and characterization are slightly different and less clear than for male adults.

Symptoms of low testosterone

Although the symptoms of low-T may differ from one man to another, the most common sexual signs are fewer and weaker erections and reduced sex drive, while non-sexual indicators are depression, low iron levels, increased fat around the waist and lack of energy. Other symptoms of low-T are reduced lean muscle mass, erectile dysfunction, irritability, absent or reduced orgasm, reduction or loss of facial, armpit or pubic hair, sleep disturbances, reduction in strength, sweating or hot flashes, breast enlargement or discomfort, reduction in testes size and memory reduction. Other signs observed only in tests or by doctor examination include osteoporosis, anemia, increased body fat and absent or reduced sperm production.

Treatment of low testosterone

While there are several options for treating low-T, the right treatment for any patient depends on various factors, including the severity of the symptoms, cause of the condition and the patient’s preferences. For instance, if the low-T is caused by lifestyle, a change of habits such as losing weight may be an effective and natural way to boost testosterone levels. Similarly, testosterone levels can be enhanced through supplementation. For men having bothersome or worrisome symptoms such as depression, testosterone replacement therapy (TRT) applied as a skin gel or a regimen of regular injections can improve testosterone levels and alleviate the symptoms.

At Advanced Urology Institute, we recognize that low testosterone is a common burden on many men. We endeavor to provide viable solutions including the safest and most effective testosterone replacement therapy for the needs of all our patients. Driven by the belief that every patient is unique and may suffer from serious complications if treatment is generalized, we deliver a highly personalized replacement therapy to our patients. We also follow our patients very closely and ensure we give testosterone therapy the right way. For more information on safe and effective treatment of low-T, visit the “Advanced Urology Institute” site.

Common Cause of Kidney Stones

Kidney stones are a common condition in the United States affecting about 9 percent of Americans. Every year, roughly 500,000 patients are admitted into emergency rooms because of kidney stones. While the prevalence of the condition has risen over the years, increasing from 1-in-20 people in 1994 to 1-in-11 in 2012, the trend is expected to continue, both in broader geographic coverage and in greater numbers due to extreme temperatures associated with climate change. Higher temperature leads to dehydration, which in turn contributes to increased concentrations of dissolved salts and other substances in urine. When urine is super-saturated, it allows kidney stones to develop.

Low Urine Volume

The risk of kidney stones increases with decrease in urine volume. Caused by poor fluid intake or fluid loss (dehydration) due to hard exercise, living or working in a hot place, low urine volume means there is less fluid available to dissolve salts and other urine constituents. In turn, the urine becomes darker in color, more concentrated and easily forms stones. In fact, a urine volume below 1 liter per day is associated with 10 percent of all recurrent kidney stones while urine volume below 1.5 liters per day is linked with the formation of many recurrent and first-time kidney stones. Low urine volume due to chronic dehydration, defined as a history of prolonged exposure to heat, is the main cause of 20 percent of all incidents of kidney stones.

Effect of Warmer Temperatures

Cases of kidney stones typically increase shortly after episodes of hot weather, hitting a peak within three days of exposure to extreme heat. According to a recent study published in the Environmental Health Perspectives, daily increase in average temperatures leads to increased risk of formation of kidney stones. Another study published in 2008 by the National Academy of Sciences also reported that about 70 percent of Americans are under high risk of kidney stones due to warmer temperatures compared to just 40 percent of Americans at risk in 2000. The number of cases of heat-related kidney stones is projected to increase to up to 2.2 million by 2050.

Hidden Risk

Increase in ambient temperatures results in increased fluid losses through the skin. As more water is lost in sweat and less in urine, salts can build up in urine resulting in stones. Even in cold weather, dehydration occurs in the warm and dry indoor air without being noticed. And since dehydration often occurs without being noticed, it is a bigger factor in kidney stone formation in many patients. For instance, in drier climates, people lose a lot of water through sweat without realizing it and face a greater risk of kidney stone formation.

Are you or your loved one suffering from the symptoms of kidney stones? Would you like to receive world-class, safe, prompt and effective treatment for kidney stones? Or are you looking for the most comprehensive and accurate information on prevention, diagnosis and treatment of kidney stones? Then Advanced Urology Institute is the right place for you. At AUI, we offer patient-friendly and multidisciplinary urology services for a wide range of problems including kidney stones. For more information, visit the “Advanced Urology Institute” site.

Vasectomy: Easy, Safe, and Effective Birth Control

Vasectomy is a common form of birth control. More than 50 million men have undergone the procedure worldwide. In the United States, around 500,000 men get a vasectomy each year. Vasectomy is an easy, safe and effective surgical procedure carried out in a clinic, doctor’s office or hospital. The outpatient procedure takes 10-20 minutes and the patient can go back home on the same day. While it is still the fourth most preferred method of contraception after oral pills, condoms and tubal ligation, it is one of the cheapest, safest and most effective family planning options.

Vasectomy Procedure

During a vasectomy, the small tubes of the scrotum that transport sperm are blocked or cut off to prevent sperm from leaving the body and causing pregnancy. The name vasectomy comes from the vas deferens, the scrotal tubes that are blocked or cut off during the procedure. Vasectomy is intended for permanent sterilization, so while it can be reversed, only those who are sure they no longer want more children should undergo the procedure.

There are two common vasectomy techniques: the no-cut (no-scalpel) method and the incision method. No-scalpel technique is a lower-risk procedure that minimizes the chance of infection and complications while also taking less time to heal. Nevertheless, whatever method is used, vasectomy is a quick procedure performed with local anesthesia or IV sedation, depending on the patient’s condition and surgeon’s preferences. After numbing, one or two small incisions are used to access the vas deferens so they can be clamped, sealed or cut to disrupt sperm flow. The procedure is performed on both sides.

Recovery from vasectomy

Recovery time after vasectomy varies, but most men are able to return to normal physical activity in 2-3 days. Recovery is quite easy as the patient is able to go home soon after the procedure, rest, apply ice packs for 24-48 hours, watch football over the weekend and be able to resume work the following week. However, it is important to notify your doctor of any severe bruising, swelling, fever, pus or chills. These may indicate internal bleeding or infection and should be dealt with appropriately.

Safety and efficacy

Vasectomy is a highly effective method of preventing pregnancy, guaranteeing almost 100 percent efficacy. It is a safe and low-risk procedure, with just about 1 percent of men reporting side effects such as infection, bleeding and pain. Compared to tubal ligation, vasectomy is faster, less painful and has fewer potential complications. Vasectomy does not significantly change the amount of semen as only sperm will be absent from the ejaculate. It also does not change the way a man ejaculates or feels when having orgasm, so your sex life will remain the same except there will be no worry about pregnancy.

At Advanced Urology Institute, we use the most up-to-date no-scalpel techniques to perform vasectomy and vasectomy reversal quickly, painlessly and effectively. We take great care to review the medical history of every patient, evaluate and counsel our patients, answer all patient questions and ensure that only the right candidates undergo the procedure. We also deliver a safe and effective procedure through a patient-centered, multidisciplinary approach that guarantees the best services for all our patients. At AUI, your health is our number one priority. For more information on vasectomy and vasectomy reversal, visit the “Advanced Urology Institute” site.

Robotic Technology in Urology: Da Vinci Robotic Prostatectomy

Urology has always been one of the leading medical specialties in the adoption and application of the latest cutting-edge technologies. For many decades urology has been one of the areas of medicine that has often readily embraced new technologies and incorporated them into everyday practice for the benefit of patients. Urology was the first medical field to espouse and use scopes for various procedures. And then with the invention of robotic systems, urologists quickly adopted and integrated the da Vinci system in their practices, using it for prostate surgery and making the da Vinci prostatectomy one of the first mainstream
surgical procedures to be performed using robotic technology.

Influence of robotic surgical systems

The introduction of robotic systems in urology has quickly enabled urologists to overcome the limitations of open prostatectomy (traditional laparoscopy) such as limited instrument movement, difficult suturing, complex reconstruction and two-dimensional vision. Likewise, the introduction and quick assimilation of robotic technology has helped to solve the problem of surgeon fatigue in laparoscopic urology. Robotic systems have enabled urologists to perform complex reconstruction and dissection in less than 2 hours delivering excellent outcomes.

Overcoming limitations of open prostatectomy

Before the emergence of robotic surgical systems, men suffering from prostate cancer had very few treatment options. The principal surgical option available was open radical prostatectomy, a procedure that involved large incisions and serious post-operative side effects. For example, when using open prostatectomy, the removal of the entire cancerous prostate resulted in increased risk of post-operative infections, excessive blood loss, considerable pain and longer hospital stays. Open prostatectomy also may lead to loss of sexual function and bladder control due to cutting of the delicate nerve plexus around the prostate. The da Vinci robotic surgery is a minimally invasive procedure that uses smaller incisions, reduces blood loss and ensures a shorter hospital stay, making things better for the patient.

Utmost precision, great outcomes

The intuitive nature of the movement of robotic instruments results in highly precise, accurate, effective and safe prostatectomy. While laparoscopic surgery’s precision is reduced by the fulcrum effect (movement of the instrument tip in the direction opposite to the surgeon’s hands), the da Vinci robotic system has no fulcrum effect, offers three-dimensional visualization, boosts degrees of freedom, eliminates tremor, reduces fatigue and provides motion scaling and ergonomic positioning. Robotic surgery is a remote controlled process in which the surgeon’s movements are precisely translated through sensitive fibers to the instrument’s tip. When applied in prostatectomy, robotic systems have been found to offer several advantages over traditional laparoscopic surgery, including minimal scarring, diminished risk of complications, clinically superior results and quicker recovery.

State-of-the-art prostatectomy at Advanced Urology Institute

Want to be treated by a highly trained and experienced team of surgeons, technicians and nurses? At Advanced Urology Institute, we have urologists who are specialists in robot-assisted surgery for prostate cancer and other urological conditions. We perform dozens of surgical procedures every month using the da Vinci robotic system. This minimally invasive, high-precision robotic technology delivers great results with complex and delicate surgeries such as prostatectomies, where the target site is surrounded and confined by the nerves regulating erectile function and urinary flow. At AUI, we use the robotic system as an exacting tool to avoid damaging these nerves, shorten recovery time and ensure quick return to normal activities.

For more information on exceptional, world-class treatment using robotic technology, visit the “Advanced Urology Institute” site.

Kidney Stones: Causes, Symptoms, and Treatments

When there is inadequate liquid to dilute salts and waste chemicals found in urine, hard masses called kidney stones may form in the kidneys. The stones can form in one or both kidneys and may vary in size, ranging from a tiny sugar crystal to a large golf ball. While kidney stones are hard to notice, a stone can be large enough to cause blockage or severe pain, particularly when it enters into one of the ureters. Kidney stones are a common condition in the United States, affecting up to 9 percent of the population and sending more than 500,000 people to emergency rooms every year.

What are the symptoms of kidney stones?

While very small kidney stones may just pass through the urinary tract without causing symptoms, a majority of people who seek medical care for the condition do so because of severe pain on the flank, which may extend to the belly, groin or back. The movement of kidney stones through the urinary tract also may cause extreme pain that does not go away, painful urination, blood in urine, chills, fever, nausea and vomiting. When experiencing such symptoms, it is important to see a doctor as soon as possible for prompt medical attention.

Causes of Kidney Stones

Kidney stones occur when there is inadequate liquid to dilute the waste chemicals found in urine, such as oxalate, calcium and phosphorous. When not properly diluted, the waste chemicals get more concentrated and form crystals. The most frequent type of stones is calcium oxalate crystals. While there are many factors that can trigger the formation of kidney stones, including what you drink and eat and chronic medical conditions, the most common cause is dehydration. For instance, people living in hot climates are more likely to lose a lot of water in sweat, resulting in limited amounts of fluid available to dilute urine. The frequently high concentration of urine in such people can trigger kidney stones.

Diagnosing Kidney Stones

Kidney stones are often diagnosed once they have caused obvious symptoms, usually severe pain. The pain is typically so severe that it can send patients to emergency rooms where a range of tests may be conducted to uncover the stones. Apart from the symptoms, kidney stones are diagnosed using tests such as X-rays, CT scan, urinalysis and ultrasound. Blood tests to determine the levels of various minerals involved in stone formation also can unearth kidney stones.

Treatment of Kidney Stones

For small stones, no treatment is necessary. You may only need to take pain medications and wait for the stones to pass out. A stone that is 5mm (1/5 inch) or smaller has a 90 percent chance of passing without intervention while one between 5-10mm has a 50 percent chance of passing. To increase the chance of a stone passing on its own, it is important to drink a lot of fluid every day, such as 8-10 glasses of water daily. A stone that is larger than 10mm may not pass on its own and may require either a non-invasive or invasive treatment to remove it.

Prescription medications may be used to facilitate the passage of some stones that do not pass on their own. For example, alpha-blockers can be used to relax the walls of the ureters and widen the passages to allow the stones to move out easily. Certain medications also may be used to stop the formation of new stones.

Apart from using drugs, the surgeon can pass a special instrument called the ureteroscope through the urinary tract to reach the stone’s location. The surgeon then applies laser energy to break the stone into smaller fragments and remove them through the tube. The procedure is called ureteroscopy and it does not require incisions.

Another commonly used treatment for kidney stones is extracorporeal shock-wave lithotripsy (ESWL). This treatment is ideal for very large stones or for stones that have blocked the urinary tract. During shock wave lithotripsy, the surgeon uses a machine that generates strong vibrations (called shock waves) to break large stones into smaller pieces that can pass out through the urinary tract. However, for kidney stones that are extremely large, the surgeon may need to conduct a surgical operation to remove them.

A lot of technology is currently available to help diagnose, treat and manage kidney stones. The technologies are safe and effective, relieving the symptoms of kidney stones without causing problems to the patients. So if you are experiencing symptoms of kidney stones, visit your doctor as soon as possible to benefit from these latest technologies and get the necessary relief. You do not have to live with a problem whose solution exists. For more information on the diagnosis and treatment of kidney stones, visit the “Advanced Urology Institute” site.

Treating Prostate Cancer

Prostate cancer is one of the most common cancers among American men. In fact, it is the most frequently diagnosed non-skin cancer in men, with over 2 million American men currently living with the cancer. Statistically, a new case arises every 3 minutes, one in six American men has prostate cancer, while an American man dies of it every 19 minutes.

Making treatment decisions

At Advanced Urology Institute, we make every effort to deliver world-class treatment and care for patients with prostate cancer. After a diagnosis, our physicians review various treatment options before picking any treatment for the patient. We also conduct further studies, such as biomarker testing and imaging studies, to ensure that we have correctly established the stage or extent of the disease. We use this information to make the right decisions and give prostate cancer patients the most effective treatments. We choose treatment options depending on the cancer itself (high-risk, intermediate risk or low-risk) and patient factors (personal preferences, age and other health issues).

Prostate cancer treatment options

Advanced Urology Institute offers a wide range of innovative and effective diagnostic and treatment procedures for patients with prostate cancer. At the institute, newly diagnosed patients get the opportunity to meet and discuss their condition with renowned and experienced specialists on the same day.

Our treatment options include:

  1. Active surveillance: For a low-risk prostate cancer that may not harm a patient over the course of his lifetime, urologists at AUI usually recommend close observation. It often comes with secondary chemoprevention.
  2. Prostatectomy: Prostatectomy is a surgical procedure to remove the prostate. For localized prostate cancer, radical prostatectomy may be employed. However, at Advanced Urology Institute, we commonly apply the robot-assisted technique, which is a minimally-invasive, laparoscopic procedure.
  3. Radiation: An external beam of radiation is directed at the prostate in order to kill cancerous cells.
  4. Cryotherapy: Probes are inserted into the prostate gland to allow for the introduction of liquid nitrogen into the gland. Once administered, liquid nitrogen produces an ice ball inside the prostate which destroys cancerous cells.
  5. Brachytherapy: A radioactive seed is implanted in the prostate. The procedure involves inserting and removing the needles that are used to place radioactive seeds inside the prostate.
  6. Hormone therapy: Various medications can be administered to reduce or inhibit the secretion of testosterone hormone. Diminished quantities of testosterone means reduced or no growth of the cancer.
  7. Chemotherapy: Certain drugs may be used to boost the effectiveness of the other treatments, both for metastatic and localized disease.

Multi-disciplinary treatment and care

At Advanced Urology Institute, our goal is to cure prostate cancer while also maximizing the quality of life of our patients. We carefully weigh the benefits of every treatment option against the side effects and develop the most practical individualized treatment programs for all patients. We also believe that effective management of prostate cancer needs extensive collaboration. We have implemented a multidisciplinary approach to treatment that allows our various specialists, such as urologists, radiation oncologists, medical oncologists, radiologists, pathologists and clinical trial nurses to deliberate and get diverse, specialized perspectives before making treatment decisions for any patient. During AUI conferences, detailed discussions among experts help to clarify the benefits and risks of various diagnostic tests and treatment options, resulting in better treatment outcomes for our patients.

Advanced Urology Institute uses image-guided targeting, MRI, ultrasound and fusing 3-D guidance to boost the accuracy and usefulness of prostate biopsies. We also apply minimally-invasive, outpatient procedures in most cases. So, with our comprehensive consultation service and multidisciplinary approach that incorporates the latest technologies, research developments and expertise, all our patients can be sure of the best possible prostate cancer treatment. Want help with prostate cancer? Get more information from our “Advanced Urology Institute” site.

Advanced Urology Institute Working Together For You

Advanced Urology Institute is a leading urology practice that excels in the diagnosis and treatment of disorders of the female and male urinary tracts and problems of the male reproductive system. Designed to be a world-class urology center, AUI brings together a huge group of doctors who are specialists in various areas to offer coordinated, effective and top-notch urology services to their patients. From restoring fertility to curing cancer, addressing incontinence to treating kidney stones, the urology services offered by AUI touch every sphere of life and bring back smiles to the faces of all who come to us for help.

Satisfying patient experience

By centralizing the administration of urology services, the doctors are able to concentrate on delivering the highest quality service to patients from initial consultation to follow-up care. The unique partnership and collaboration of many doctors and several care centers ensures that every physician or center in AUI can broaden the scope of expertise and services provided to patients, resulting in a positive experience to meet the unique needs of our patients wherever they are. At Advanced Urology Institute, we invest our time and effort, skills and experiences to make our services better. We are dedicated to delivering life-saving medical and surgical urology care in a prompt, safe and affordable manner. For us, it is not merely our job. The wellbeing and health of our patients is our number one priority.

Innovative and cutting-edge techniques

Advanced Urology Institute is a pool of urologists from multiple subspecialties. We pride ourselves on expertise and ensure that all members of our team continue to undertake training in the latest specialized surgical and medical techniques. Our experienced urologists work collaboratively to deliver highly complex treatment and care individualized to the needs of our patients. And with our exceptional range of specialist urologists, we are able to deliver more complex and innovative surgical services not available anywhere else. As a group, we are able to pool our resources, enabling all our members to have access to better equipment, instruments and tools for managing urologic disorders. Each member of the team has more experts to seek help from and we frequently send patients to other colleagues among us with more expertise and experience. As a result, we do as good a job and deliver as great results as any other premier urology centers in the country.

Unparalleled range of services

At Advanced Urology Institute, we offer a broad range of life-improving, life-extending and life-saving services to patients of all ages. Those who come to AUI have access to every possible treatment option available. In fact, most of the patients we see usually come with issues that other institutions are not able to diagnose or treat. As a team, we are committed to delivering the right care to every patient the first time they come, guaranteeing the highest rate of treatment success. We also endeavor to provide individualized, comprehensive care for all urologic conditions and diseases, giving every patient the opportunity to tap into our collaborative and team approach to have their issues resolved. At AUI, we ensure that all our hospitals, clinics, health care facilities and physicians serve with integrity and unwavering commitment to excellence. We listen to every concern, tailor every evaluation, apply the right treatment and do what is best for the patient. As a team, we deliver beyond the expectations of our clients.

For more information, visit the “Advanced Urology Institute” site.

What are the Symptoms of Low Testosterone

Produced in the testicles (testes), testosterone is the hormone responsible for masculinity and muscular development. It is the hormone that fuels sex drive, creates a deep voice, boosts muscle mass, regulates mood, controls body and facial hair patterns, and regulates bone strength. Testosterone levels usually decrease as men age, with studies showing that a man loses roughly 10 percent of testosterone each decade after reaching the age of 30.

Symptoms of low testosterone levels

Since the reduction in the level of testosterone is typically gradual, the symptoms take longer to occur. Generally, however, about 30 percent of all men will experience symptoms of low testosterone after the age of 50. Andropause is the term used to describe a decrease in the level of testosterone hormone in men. Men experiencing andropause can suffer various symptoms associated with the condition and may be at risk of having other serious health problems like osteoporosis if proper treatment is not administered.

The symptoms of low testosterone include:

  1. Diminished sexual desire (low libido)
  2. Problems getting erections or weak erections
  3. Fatigue and weakness
  4. Hot flashes
  5. Irritable moods
  6. Depression
  7. Increased body fat
  8. Loss of muscle mass or strength

Low testosterone can cause various complications or even change a man’s body. For instance, it can lead to obesity, hair loss, muscular atrophy (less muscle mass), softer testicles, smaller testicles, cardiovascular problems, larger breasts and brittle bones (osteoporosis).

Causes of low testosterone

Even though aging is the most frequent cause of low levels of testosterone in men, several other factors may be involved. Common causes of low-T include:

  1. Kidney disease
  2. Diabetes
  3. Testicular injuries
  4. Liver disease
  5. COPD (chronic obstructive pulmonary disease)
  6. Radiation therapy
  7. Steroid medications
  8. Pituitary gland disorders
  9. Chemotherapy

Men also may be tested for low-T if they have very low sex drive, erectile dysfunction, low sperm count, hair loss, reduced muscle mass or osteoporosis. And because the symptoms of low testosterone are not specific, a doctor may want to first rule out other conditions with similar symptoms before treatment.

Treatment of low testosterone

Testosterone replacement is the most common treatment for men having low-T. The therapy is administered to relieve symptoms and improve quality of life. The testosterone used in the replacement therapy is usually available in various preparations, including gels, capsules, skin patches and injections. The doctor will decide if testosterone replacement therapy is appropriate for a patient. For instance, the treatment is not appropriate for men with prostate cancer and breast cancer. Men with an enlarged prostate, liver disease, kidney disease or who are using blood thinners may or may not undergo replacement therapy depending on their medical history.

At Advanced Urology Institute, we have a long history of treating low testosterone. We put the interest and health of our patients first and always discuss with our patients in great length their conditions and medical history before we administer treatment. For more information, visit the “Advanced Urology Institute” site.

Satisfactions of Being a Urologist – Dr. Scott B. Sellinger

When the term urology is mentioned, what comes to mind for many people is urine. But urology is a really huge medical field. It covers the diagnosis, treatment and management of a wide range of conditions affecting the female and male urinary tract and upsetting the male reproductive system. It is a dedicated medical field with highly trained and skilled specialist doctors called urologists.

“Urology is a massive field,” affirms Dr. Scott B. Sellinger of Advanced Urology Institute. “It is incredible the many problems we deal with. And when you have operated and developed worthwhile relationships with your patients, you go home every day feeling satisfied with your work. It is a truly exciting specialty.”

Problems resolved by urologists

Urology covers a broad spectrum of medical disorders affecting the ureters, kidneys, bladder, prostate, urethra, testis, epididymis, scrotum, penis and seminal vesicle. The most common conditions that urologists see are ejaculation problems, urinary incontinence, erectile dysfunction, cryptorchidism (undescended testes), vasectomy, vesicoureteral reflux, urinary tract infections and cancers of the kidneys, prostate, penis, testicles and bladder.

“As a urologist at Advanced Urology Institute, it is nice to come to work each day and look forward to fixing a female or male problem,” says Sellinger. “Urology is very unique because you work with the patients throughout the treatment cycle, right from diagnosis, treatment and recovery, so you get great satisfaction from seeing people recover and get on with their lives.”.

“While some specialists only diagnose but not treat the conditions and others just treat but are not involved in the entire disease management cycle, urologists are in the thick of it,” Sellinger explains. “I believe urology is the best-crafted medical field because you see everything as it occurs. It is gratifying.”

A hands-on field

“I love urology because I am a hands-on person,” says Sellinger. “In this field you physically do something and then see the results. I draw a lot of satisfaction from this.”

He adds, “The results are generally great in urology. In fact, many people with serious urological problems such as bladder and kidney cancers achieve great outcomes after our interventions.”

The work is very rewarding for the urologist too. “When you operate on people and they recover from their disorders and get on with life, it is fulfilling,” Sellinger notes. “I really feel happy about improving the quality of other people’s lives and relieving their pain.”

Personalized attention

In urology, each patient has different needs. It calls for a personalized approach to every patient. The urologist must take into account the factors presented by each patient, break down the needs and concerns, and then modify the consultations, diagnosis, treatment and follow-up interventions to meet the unique needs of the individual.

“The entire process of tackling urological problems is both challenging and thrilling,” says Sellinger. “Each case is unique and every patient requires a listening ear. So when you deal with a patient warmly and candidly, formulate effective treatment plans and then see positive results, the entire process brings indescribable joy, peace and satisfaction to the urologist.”.

Urologists also spend their time educating patients and the general public on preventive measures for various urological problems. For instance, they speak with men on when to go for screening for prostate cancer, alleviate fears about the risk factors and advise those diagnosed with the cancer on how to live positively with it.

“As urologists, we help relieve pain and distress and improve the quality of lives of men and women plagued by urological problems,” he explains. “We educate people on how to prevent some of these problems, encourage them to seek help early enough and administer treatments to help them recover. Many times, the results are great and satisfying.”

At Advanced Urology Institute, there is a big pool of experienced, caring and skilled urologists to help diagnose, treat and manage your urological problem. If you are experiencing any symptoms of a urological disorder, just visit the institute and have your problem fixed. For more information, visit the “Advanced Urology Institute’” site.

Treatment Options for Urge Incontinence

Urge incontinence is not an inescapable consequence of aging. In fact, a huge majority of women with the condition have been effectively treated or helped. The trick is simply not staying at home and giving up, but visiting a urologist as soon as possible for help.

Factors that affect the treatment decision

Effective treatment of urge incontinence in women depends on the kind of incontinence, personal preferences, underlying causes and severity of the symptoms. Where the condition has more than one underlying cause, the most serious cause will be dealt with first. Likewise, your urologist most likely will opt for the least invasive treatments first before moving on to invasive ones.

Treatments for urge incontinence include:

1. Behavioral techniques

These treatments include making certain lifestyle changes to improve bladder control. They include:

  • (a) Bladder training: Entails delaying urination once the urge to pass urine comes. You can begin by holding off urine for as short as 10 minutes and then extending the holding time to hours. The goal of holding off urine each time the urge comes is to lengthen the duration between your trips to the toilet by up to 2.5 hours to 3.5 hours.
  • (b) Double voiding: Means that you urinate and then wait for only a short duration (a few minutes) then try again to pass urine. The goal of double voiding is to achieve complete emptying of the bladder to avoid overflow incontinence.
  • (c ) Scheduled toilet visits: Planning your toilet trips so that you urinate every 2-4 hours instead of waiting for the urge to come, will help you improve bladder control.
  • (d) Diet and fluid management: To improve your bladder control, you may have to cut back or avoid acidic foods, alcohol and caffeinated drinks. By increasing physical activity, reducing liquid consumption or losing weight you can ease urge
    incontinence.

2. Pelvic floor exercises

Also called Kegel exercises, pelvic floor exercises can strengthen the muscles responsible for bladder control and urination. To help you learn and perform these exercises, your doctor may recommend that you work with a physical therapist or to try using biofeedback techniques.

3. Electrical stimulation

The urologist may choose to insert electrodes into the vagina to strengthen and stimulate your pelvic floor muscles. With gentle stimulation, urge incontinence may resolve. However, you may need several treatments over many months to be successfully treated.

4. Medications

There are several common medications that are effective in treating urge incontinence. They include:

  • (a) Anticholinergics: Include solifenacin (Vesicare), trospium (Sanctura), tolterodine (Detrol), fesoterodine (Toviaz), oxybutynin (Ditropan XL) and darifenacin (Enablex).
  • (b) Alpha blockers: These drugs relax bladder muscles and make bladder emptying easier. They include alfuzosin (Uroxatral), doxazosin (Cardura), silodosin (Rapaflo) and tamsulosin (Flomax).
  • (c) Topical estrogen: Application of a low dose of a topical estrogen, such as a vaginal patch, cream or ring can rejuvenate and tone the tissues of the vagina and urethra, helping treat urge incontinence.
  • (d) Mirabegron (Myrbetriq): This drug relaxes the muscles of the bladder, increases the quantity of urine that the bladder can hold and increases the amount of urine that can be passed at any one time. As a result, it helps to empty the bladder more completely and treats urge incontinence.

5. Medical devices and interventions

Devices such as urethral inserts and pessaries can help to treat or relieve urge incontinence. Interventional therapies such as using a sacral nerve stimulator,bulking material injections, botulinum toxin (Botox) injections and nerve stimulators also can be used to treat urge incontinence.

6. Surgery

The doctor or urologist also may use surgery to correct the underlying cause of urge incontinence. Common surgical procedures include bladder neck suspension, prolapse surgery, artificial urinary sphincter and the sling surgery procedure.

7. Catheters and absorbent pads

If the urologist finds that no medical treatment can completely eliminate the incontinence, various products can be recommended to help ease the problem, minimize discomfort and reduce the inconvenience caused by urine leakage. The most commonly used products are catheters, absorbent pads and absorbent garments.

Urge incontinence is a treatable condition. As a woman, you should not continue living with this problem since there are solutions to help you. At Advanced Urology Institute,we have helped thousands of women with urge incontinence recover from it. Come see us so we can fix the problem. For more information,
visit the “Advanced Urology Institute” site.

What is an Erectile Dysfunction? with Dr. James E. Renehan

Erectile dysfunction (ED) is a man’s inability or difficulty to get or keep erections that are firm enough to enable sexual intercourse.

While occasional ED is very common in men, particularly during times of stress, depression or fatigue, frequent ED can really ruin a man’s life. For instance, some men with erectile dysfunction may avoid contact with their partners for fear that they will have trouble satisfying them sexually in the bedroom while others may get into a complete emotional and psychological meltdown.

Forms of erectile dysfunction

According to Dr. James E. Renehan of Advanced Urology Institute, erectile dysfunction can take a variety of forms. For example, some men may be unable to get an erection under any circumstance, while other men with ED may occasionally get an erection. In other men, getting an erection is possible but the erections are not strong enough for satisfying sexual intercourse.

“Erectile dysfunction does not mean that you are infertile,” says Dr. Renehan. “In fact, the majority of the men having difficulties with getting an erection are still quite capable of achieving an orgasm and getting children. ED just means that you cannot consistently get or sustain an erection.”

What are the symptoms of erectile dysfunction?

You could be suffering from ED if you frequently have:

  1. Difficulty getting an erection.
  2. Trouble sustaining an erection throughout sexual intercourse or during sexual activities.
  3. Diminished interest in sex.

However, there are also a number of factors related to erectile dysfunction, such as:

  1. Premature ejaculation.
  2. Difficulty achieving orgasm even after ample stimulation (anorgasmia).
  3. Delayed ejaculation.

Experiencing such symptoms for 2 or more months may indicate that you have erectile dysfunction. So it is important to speak with your urologist to determine if you have a sexual disorder.

“Men should know that erectile dysfunction is not in the head,” says Dr. Renehan. “You will not simply get an erection by stimulation, as 80 percent of all cases of ED are usually caused by treatable physical disorders, such as high blood pressure, high cholesterol or diabetes. So make sure you visit your doctor for advice.”

Causes of erectile dysfunction

Erectile dysfunction may have several possible causes, including both physical disorders and emotional problems. The most common causes are:

  1. Diabetes
  2. Obesity (being overweight)
  3. Smoking, alcohol use or drug abuse
  4. Hypertension
  5. Cardiovascular disease
  6. Hyperlipidemia
  7. Injuries
  8. Stress, anxiety or relationship problems
  9. Damage from surgery or cancer treatment
  10. Increased age

Because there are many possible causes of erectile dysfunction, it is important to work with a urologist so that any underlying medical conditions are identified and treated.

Diagnosis of erectile dysfunction

When you visit your urologist, you will be asked questions related to your symptoms, health history, emotional and physical problems. You also should expect a physical examination in which the doctor will listen to your lungs and heart, examine your penis and testicles and measure your blood pressure. The doctor may order various tests to determine whether you have an underlying disorder, such as blood and urine tests. A rectal examination may be requested to check your prostate.

Treatment of erectile dysfunction

The treatment chosen by your doctor will depend on the type of symptoms and any underlying causes for the dysfunction. At times, a combination of treatments may be necessary. The most common treatments for ED include:

  1. Medications: The doctor may prescribe medications to improve blood flow to the penis and improve ED symptoms. The drugs commonly indicated include Alprostadil (Caverject), Avanafil (Stendra), Sildenafil (Viagra), Tadalafil (Cialis), Testosterone (Androderm) and Vardenafil (Levitra).
  2. Talk Therapy: If it is established that the erectile dysfunction is caused by psychological factors such as stress, depression, anxiety or post-traumatic stress disorder, the urologist may recommend that you see a therapist. Working with the therapist, you will attend several sessions in which you will be helped to recover from stress, anxiety, subconscious conflict or negative feelings around sex. A relationship counselor also may be called upon if the ED is affecting your relationship.
  3. Alternative Treatments: Treatments such as prostatic massage, acupuncture, yoga and pelvic floor exercises also may improve your condition. Likewise, lifestyle and diet changes, such as regular exercise, losing weight, lowering your blood pressure and avoiding cigarettes and alcohol can be recommended to help you overcome erectile dysfunction.
  4. Surgery: When medications and exercises fail to work, the urologist may perform a surgery to correct any problems in the penis or to add a penile implant. Penile implants help to generate spontaneous and controlled erections.

Erectile dysfunction is treatable

Most cases of erectile dysfunction are treatable. At Advanced Urology Institute, we have helped thousands of men to improve their symptoms and regain their confidence through compassionate, multidisciplinary, patient-centered treatment approaches. Depending on your condition, we will administer the right medications or treatments to ensure that you achieve an erection and be able to have satisfying sexual intercourse. Come and discuss your symptoms with us so we can fix your problem. For more information on help with erectile dysfunction, visit the “Advanced Urology Institute” site.

What is Da Vinci Robotic Prostatectomy?

The da Vinci system is a revolutionary, minimally-invasive surgical robot for treating prostate cancer. Designed by Intuitive Surgical to help overcome the shortcomings of both the traditional laparoscopic prostatectomy and open prostatectomy, the da Vinci system enables a surgeon to conduct highly precise, nerve-sparing surgery using several dime-shaped incisions. With the da Vinci surgical procedure, entire cancerous tissue or prostate can be removed, cancer completely eradicated and internal repair achieved without interference with sexual function, potency and bladder control.

Also called robotic prostatectomy, the da Vinci uses a finely-controlled robotic apparatus, including micro-surgical instruments and high-resolution cameras, to perform prostate surgery safely, achieving faster patient recovery and better treatment outcomes.

High-Precision Prostatectomy

During da Vinci robotic surgery, urologists use the “motion scaling” feature on the system to convert subtle hand movements made outside the body into extremely precise and accurate movements inside the body. The urologist controls the robotic arms of the da Vinci console by applying natural wrist and hand movements. Through motion scaling, filtration and seamless translation of hand-and-wrist movements, the urologist can achieve greater precision that is normally not achievable during traditional laparoscopic and open surgery procedures. The da Vinci system not only provides urologists with enhanced dexterity, range of motion and flexibility, but also enables surgeons to safely access difficult-to-operate areas of the pelvis, abdomen and closed chest. The robot also filters and eliminates unpredictable hand movements and hand tremors that may occur during the operation.

Computerized 3-D Visualization

The da Vinci system dramatically improves visualization by providing a sharper and brighter view than can be seen during traditional laparoscopic endoscopes and by the eye during open surgery. The robotic system comes with a proprietary camera, enabling the surgeon to zoom in, rotate and even change image visualization. As a result, the 3-D image produced is clearer and brighter, and with no flickers as seen in traditional laparoscopic systems.

Even though the da Vinci robotic prostatectomy is a remote procedure, urologists have the feeling that their hands are fully immersed in the body and are able to complete all the necessary procedures efficiently. With the 3-D visualization and robotic hand simulation, the da Vinci system enables urologists to perform highly complex procedures more effectively than traditional laparoscopic surgery or open surgery.

Getting da Vinci Prostatectomy at Advanced Urology Institute

At Advanced Urology Institute, the da Vinci prostatectomy patients are usually discharged 24 hours after their operation. The system is used at AUI because it has superior benefits to traditional laparoscopic prostatectomy or open prostate surgery. The benefits of the da Vinci prostate surgery include:

  1. Reduced pain and higher nerve-sparing rate.
  2. Shorter hospitalization, with most patients going home the next day.
  3. Minimal blood loss, fewer transfusions and reduced risk of complications (such as impotence and incontinence).
  4. Quicker return to pre-surgery erectile function and urinary continence.
  5. Faster return to routine activities.

Are you looking for a da Vinci urologist near you? You can check out this life-changing technology at Advanced Urology Institute. For more information, visit the “’Advanced Urology Institute” site.

Types of Prostate Cancer

Prostate cancer refers to an uncontrollable accumulation of cells in the prostate gland. When the cancer occurs it means the ability to control the multiplication, growth and death of prostate cells has been lost. The prostate cells form abnormal cells that join into masses known as tumors. Once formed, a tumor can remain at its original location and not spread to any location outside the prostate. Such a tumor is called a primary tumor. But some spread to other areas of the body outside the prostate and are called secondary tumors.

Prostate Cancer Is Generally Slow-Growing

Most prostate cancers are relatively slow-growing. This means that a prostate tumor typically takes many years to grow and reach a size that is detectable. Likewise, it usually takes even a longer time for prostate cancer to spread beyond the prostate. Nevertheless, in a small percentage of men, prostate cancer can grow rapidly and spread aggressively to other areas. Because of this, it is quite difficult to know with certainty which prostate cancers are likely to grow slowly and which ones are likely to grow aggressively. It can be quite difficult to make the right treatment decisions.

Aggressive Versus Indolent Prostate Cancer

While there are many types of prostate cancers, urologists usually break them down into aggressive and indolent categories to make it easier to determine the right treatment and to treat various types of cancers effectively. Aggressive cancer is a high-risk prostate tumor that if not treated remains highly active and very likely to spread to areas outside the prostate gland. The cancer grows quickly, spreads early, rapidly and widely, and causes increased damage in the body. Because aggressive cancer spreads as secondary deposits and can quickly result in widespread damage, it progresses rapidly to advanced stage cancer and can be very difficult to treat. So for aggressive prostate cancers to be treated successfully, they should be diagnosed early and treatment should be started when the tumors are still in their early stages.

On the other hand, indolent prostate cancer is a low-risk, slow-growing and low-volume tumor that can sit in the prostate gland for many years without causing any problems. An indolent cancer is not likely to spread outside the prostate even if not treated. But if it does, the spread will be local and slow. In fact, patients with indolent prostate cancers can live for 10-20 years without the cancer causing any serious effects on their lives.

Identifying Aggressive Prostate Cancer

When a patient is diagnosed with prostate cancer, the urologist will take a biopsy of the prostate gland to make sure the cells are checked under the microscope to determine whether the cancer is aggressive or indolent.

Various cancer cells are examined and their activity graded using the Gleason score. When the microscopic exam returns a Gleason score greater than 7 for cancer that has not spread beyond the prostate, the cancer is classified as aggressive and the patient is given the appropriate treatment. However, if the Gleason score is 7 or below, the prostate cancer may be classified as indolent, depending on other patient factors.

The Gleason score also helps the urologist to decide the appropriate treatment. For instance, if it is an early-stage, slow-growing cancer with a score of 6 or below, the urologist may recommend active surveillance, which means that treatment is postponed and the patient is closely monitored for progress, such as whether the tumor is spreading or worsening. But to determine whether active surveillance is ideal, the urologist also will have to consider factors such as the patient’s life expectancy, overall health and concomitant illnesses. For aggressive cancer, the urologist will work with other doctors to create a treatment plan.

At Advanced Urology Institute in Florida we have a knowledgeable and experienced team of urologists to help diagnose and treat all types of prostate cancers. Our multidisciplinary approach to treatment ensures that even the most aggressive forms of cancer are treated safely and effectively. For more information on the screening, diagnosis, treatment, care and support for prostate cancer, visit the “Advanced Urology Institute” site.