Ways to Pass Kidney Stones

Kidney stones can be a painful and difficult experience for the many men and women who get them. These stones are hard deposits of minerals that build up in the body and cause blockages in the urinary tract. The blockages can make it very painful and difficult to urinate. In addition to difficulty urinating, the stones can cause nausea as well as pain in the groin and abdomen. Luckily, there are many ways that urologists can help speed up the process.

Quynh-Dao Tonnu, PA-C: Physician Assistant in DeLand, FLFinding the best way to help a patient to pass a kidney stone depends on several factors. Not all patients are the same, and the size and difficulty of their kidney stones vary as well. If the stones are smaller than 5 millimeters, the urologist will want the patient to try and pass them naturally. This is the least invasive way to pass kidney stones, although it may not always be possible. Drinking lots of liquids for frequent urination is the key for this method. Urologists may also recommend movement like bicycling and jumping jacks to help dislodge the stones naturally.

If passing naturally is not an option, then medication may be the next step. Urologists will use some of the same medications that are used to treat an enlarged prostate. Medication like Flomax helps relieve pressure on the urinary tract by relaxing the muscles in the prostate. This allows for easier urine flow and can help the patient pass the stones.

Another treatment option that makes passing stones easier is called shock wave lithotripsy. This treatment uses a machine pressed up against the patient’s body that targets water waves directly at the kidney stones. With as many as 2,500 waves per treatment, these waves break the kidney stones into small, sand-like particles. The sandy remnant is then easily passed during urination.

In some cases, a more invasive treatment may be needed to remove the stones from the body. A surgeon may use a scope fitted with a medical laser to enter the patient’s urinary tract through the penis. They can then use the laser to break the stones up into smaller fragments for easier passing. This method is sure to help pass the stones, but a urologist may prefer to try more natural methods first.

There is no single method to passing kidney stones. What matters most is making the process as fast, safe and pain-free as possible. For more information about kidney stones, visit the Advance Urology Institute website.

Surgical Options for Overactive Bladder

If you feel frequent, sudden urges to urinate that you cannot control, you might be suffering from overactive bladder. This condition can lead to feelings of embarrassment or shame, but it’s a common problem and can be treated in a variety of ways. For many people, overactive bladder can be treated with lifestyle changes such as special diet, weight loss, regularly timed trips to the bathroom, and exercises to strengthen the pelvic floor. Dealing with symptoms by using absorbent pads is also an option.

However, for some people, these methods are not enough to ensure they can live a healthy, fulfilling life. In these situations, surgical intervention is an option to correct overactive bladder problems.

Augmentation Cytoplasty

One of the options for treating overactive bladder is called augmentation cytoplasty. This procedure increases the size of the bladder. The surgeon accomplishes this by removing a small part of the intestine and using it to replace parts of the bladder in order to increase its capacity. For some people, this procedure allows them to resume normal bladder function. For others, the use of a catheter may be necessary for the rest of their life.

Urinary Diversion Surgery

Another surgical treatment option for overactive bladder is urinary diversion surgery. This procedure involves diverting urine from the bladder. One option for bypassing the bladder involves linking the ureters, which normally connect the kidneys to the bladder, to an ostomy bag outside of the body. Another option involves the creation of a new bladder inside of the patient’s body, which means they will be able to continue normal urinary function.

Bladder Removal

Bladder removal surgery, or a cystectomy, is the last resort option for patients with overactive bladder for whom no other treatment has been successful. For men, bladder removal surgery also involves the removal of part of the prostate; for women, it involves removal of the uterus, ovaries and part of the vagina. Because this is a risky procedure that involves multiple organs, it is usually only used for more serious urological conditions such as bladder cancer or birth defects. Removal of the bladder necessitates the use of a urinary diversion such as an ostomy bag or a stoma.

An overactive bladder can be a debilitating condition, but there are many options for treatment. If you are dealing with this issue, the physicians at Advanced Urology Institute are here to help you reach a diagnosis and find a treatment to restore your quality of life.

Patient Communication: COVID-19

Coronavirus

Reschedule Appointment if you have Flu Symptoms

For patients who are experiencing flu symptoms: please reschedule your appointment for another time.

Please stay home if you are experiencing flu symptoms including fever, cough, sore throat, runny nose, aching, headache, fatigue, or have recently traveled out of the country or been on a cruise ship. The flu virus can spread very easily from person to person.

For the safety of patients, employees, and physicians, we will be implemented visitor restrictions to our facilities effective Wednesday, March 17th.

Patients who are minors, have disabilities, or need a translator will be allowed 1 companion. All other parties will be asked to wait outside of the facility. Please call to reschedule your appointment today if you are having any of the above stated symptoms. We are happy to reschedule you for a later date without penalty.

What Do Physician Assistants Do? – Mikhail Lezhak, PA

Ask Mikhail Lezhak what physician assistants do and you may be surprised by the answer. In the past, all professional medical care was performed by doctors and nurses. But doctors and nurses often spent a lot of time doing repetitive work that limited the time they had to focus on their specialty.

Mikhail Lezhak, Physician AssistantPhysician assistants, especially those in urology, may be called upon to do any of these things to assist the doctor:

  • Patient history checks, both directly with the patient and with recorded medical records. They will review records and update records. Based on what they learn, they will brief their supervising physicians about anything noteworthy
  • Perform physical exams. They can do the basic exams, but they also are trained to spot symptoms that require more advanced medical care
  • Order and interpret basic laboratory tests
  • For many relatively minor types of injuries, they may be qualified to handle the direct treatment
  • Assist surgeons doing surgical procedures
  • Perform minor surgical procedures, including suturing (making stitches); immunizations and injections; setting up, monitoring and removing intravenous feeds
  • Perform preoperative and postoperative care, including managing infection prevention
  • Prescribe medications as permitted
  • Provide patient counseling on medical issues, including self-care and follow-up
  • Set up health management plans and diets
  • Assist in maintaining a healthy, safe and sanitary healthcare environment, in accordance with health laws, regulations and accepted medical practices
  • Help maintain the proper stocks of medical supplies
  • Work with administrators and administrative staff to assure a more smoothly operating medical care environment

Essentially, PAs perform tasks that free up their supervising doctors for more difficult and complicated health issues. If this job sounds a lot like what nurses do, you are right. There is considerable overlap of responsibilities within medical communities.

In Florida, physician assistants do have a limited ability to prescribe and dispense medications. The ability for PAs to prescribe drugs is based on a written agreement between the PAs and their supervising board-certified doctors. That written agreement must have the following:

  • Effective for only five years, whereupon a new license is required
  • Requires the PA to take 10 continuing medical education credits before each license renewal period, including three hours about safe and effective prescribing of controlled substances
  • Only effective with that one PA-doctor agreement; it must be remade if the supervising doctor changes
  • Filed with the Florida Board of Medicine

There are some drugs that a PA cannot prescribe. For example, a PA working in urology cannot prescribe many of the same drugs that a PA working in psychiatry would prescribe, and vice-versa. Thus, there is local accountability for physician assistants within Florida about how they handle drugs.

Supervising doctors may have their PAs handle such duties as researching new medical device company products and keep the doctors advised on new drug formularies. PAs may be asked to scan medical journals for interesting issues as well as follow interesting and related legal cases involving their profession. They may help in medical research.

Just like nurses and nurse practitioners, PAs help the system run more smoothly by letting those who specialize spend more time on their side of the practice. The doctors can function more professionally as medical experts, and administrators can spend more time working with business management.

When you see Mikhail Lezhak, PA, at Advanced Urology Institute, you are seeing someone who has a wealth of training and experience in many of the same functions performed by a licensed medical doctor. Rest assured that your doctor still has you in good hands when your visit is with a medical professional who is a PA. For more information about physician assistants, visit the Advanced Urology Institute website.

Erectile Dysfunction Treatment Options

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

How Is Erectile Dysfunction Diagnosed?

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

What Are The Treatment Options For Erectile Dysfunction?

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

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

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

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

InterStim Therapy A Contemporary Approach to Overactive Bladder

InterStim therapy is a treatment option for patients with an overactive bladder, a serious case of urine retention or an uncontrollable frequent urge to urinate for reasons other than an overactive bladder. It gets its name from the InterStim, which is a small implantable device used to administer the therapy. There are other forms of treatment for overactive bladders, including medication and physical exercises. InterStim Therapy is used for patients who have failed to respond to the other treatments or who cannot undergo the treatments.

What is an Overactive Bladder?

Dr. Samuel LawindyAn overactive bladder is a condition characterized by sudden, frequent and uncontrollable urges to urinate. The patient feels the need to go to the bathroom numerous times during the day and the night. Sometimes, due to the uncontrollable nature of the urge, patients may have urine leakage, also known as urinary incontinence.

An overactive bladder may be caused by a neurological condition that interferes with the functioning of nerves that transmit messages between the brain and the bladder. Contributing factors can include diabetes, bladder complications such as tumors or stones, urine retention and an excessive intake of fluids.

InterStim therapy is focused on fixing the disconnect between the nerves in the brain and those that control bladder function.

The Procedure

The InterStim device is implanted in the upper buttock area through a minor surgical process called a Sacral Nerve Stimulation Procedure. Sacral nerves are located around the tailbone and regulate the operation of a person’s urinary function. Bladder movements are determined by the communication between the sacral nerves and the brain.

In patients suffering from an overactive bladder or urge incontinence, an InterStim device is implanted to enhance or correct the communication patterns between the sacral nerves and the brain, ensuring the person has full bladder control. Before the actual InterStim device is implanted, doctors place a temporary stimulator to observe how the patient responds. This helps to project what the efficiency of a permanent stimulator will be. If the patient does not respond at all to the temporary stimulator, then it would not help to implant a permanent one.

The success rate of the InterStim device is high, with patients reporting relief from their symptoms almost immediately. It is important to consult a urologist before having the device implanted because not every person may be a good candidate for the procedure. Since the surgery is a relatively delicate one, a patient should make sure to see an experienced urologist from a reputable institution, such as those from the Advanced Urology Institute. The staff of experts at Advanced Urology Institute can help with any questions, preparations and surgery. For more information, visit the Advanced Urology Institute website.

The Impact of Low Testosterone on Men

Testosterone is the hormone responsible for the development of the male sexual function. Besides being the main force behind a man’s sex drive and production of healthy sperm, testosterone also plays a role in the manufacturing of red blood cells and the distribution of fat in the male body as well as the regulation of muscle mass and bone density.

The production of testosterone drops gradually as men grow older and men over the age of 60 may develop symptoms of low testosterone. There are, however, instances where the production of testosterone slows down and falls below the required levels for reasons other than aging. Such men are said to be suffering from low testosterone. The level of testosterone can be measured through a simple blood test. In a normally functioning male, the level fluctuates between 300 ng/dL to 1000 ng/dL. If the level is below 300 ng/dL, then he may have low testosterone, also called hypogonadism.

Impacts of Low Testosterone on Men

Dr. Samuel Lawindy1. Reduced Sex Drive

A drastic decrease in a man’s urge to have sex may point to low testosterone. Often this will be accompanied by a failure to achieve or maintain an erection, or erectile dysfunction. It is common for men mistakenly to attribute a reduced sex drive to aging. While it is true that the older you are the less interest you may have in sex, this is a gradual process that keeps pace with other bodily changes so when it happens, it is not that much of a surprise. It does not happen abruptly.

2. Shrinking Testicles

Testosterone causes the increase in size of the testicles and the penis during puberty. If the levels go down, it is to be expected that these organs may shrink. The testicles also may feel much softer.

3. Low semen Volume

Testosterone stimulates the production of semen, so low levels of testosterone inhibit the normal production of semen.

4. General Fatigue
Low testosterone levels also may cause a proportionate decrease in energy levels, leading to fatigue. This may be accompanied by a dislike for physical activity and movement.

If left untreated, the symptoms of low testosterone increase in severity and with time may cause hair loss, infertility, low bone density that can develop into osteoporosis, loss of muscle and a marked increase in weight because fat distribution remains unregulated.

The symptoms experienced by patients with low testosterone can mimic symptoms of other conditions. It is therefore necessary for one to undergo diagnostic tests with a trained urologist to determine the cause. Men also should schedule regular screening sessions where their testosterone levels are measured. And it is important to note that hypogonadism is treatable. The Advanced Urology Institute has a highly qualified staff of specialists that can offer a wide variety of treatment options as well as answer any questions. For more information, visit the Advanced Urology Institute website.

How Is Prostate Cancer Diagnosed

The prostate gland is the part of the male reproductive system that produces seminal fluid. Prostate cancer is the type of cancer that affects this organ. It is the most common cancer in men, with men over the age of 50 being at the greatest risk. It usually does not manifest symptoms in its initial stages. This is unfortunate because it means prostate cancer may not be detected until it is more advanced. Even when it does present symptoms, they might resemble other conditions such as an enlarged prostate. For this reason, before one concludes that they have prostate cancer, it is necessary that they first undergo the specific tests geared toward detecting it.

Diagnosing Prostate Cancer

There are two preliminary tests for prostate cancer. These are:

1. PSA Test. This tests for an antigen produced by and specific to the prostate. It is normal for the antigen to occur in small quantities. An unusually high level of PSA, however, may indicate the presence of prostate cancer or some other inflammation of the prostate.

Dr. Samuel Lawindy from Daytona Beach, FL2. Digital Rectal Exam. This is very commonly used in prostate screening exercises. The doctor inserts a finger into the rectum and physically examines the prostate. If the doctor detects something unusual in the shape, mass or texture of the prostate, then there may be further tests to determine what the problem is.

The two tests are not conclusive. They simply inform the urologist that something might be wrong and that the patient needs further examination. In order to test for cancer of the prostate specifically, the following procedures may be done after either of the initial tests.

A. A biopsy. A prostate cancer biopsy involves the use of a very fine needle inserted through the rectum to collect tissue from the prostate. The tissue is then tested for cancer.

B. Transrectal ultrasound. The doctor inserts a small probe in the rectum. The probe produces high frequency sounds that bounce off the prostate, producing an image of the prostate that can be projected on a screen and observed in greater detail.

C. MRI Fusion biopsy. This combines an MRI and the transrectal ultrasound to produce a clearer image of the prostate. It gives a better view of the part of the prostate that is affected. If a biopsy is to be performed later, it provides a picture of the precise area where tissue should be tested.

Early detection of prostate cancer improves the chances of successful treatment. It is important for men starting about age 50 to have regular screenings so that any cancer can be detected early. Seek out experienced and certified urologists, such as those on staff at the Advanced Urology Institute, to discuss any concerns and set up screening tests. Such examinations should be a regular part of a man’s health care.
For more information, visit the Advanced Urology Institute website.

What is MRI with Transrectal Ultrasound Fusion-Guided Prostate Biopsy

Prostate cancer has a new standard of care in MRI-guided fusion biopsy with transrectal ultrasound. While a prostate biopsy has been the only way to get a definitive diagnosis of prostate cancer, it has only been working if cancer cells are identified in the sample tissue. But in some cases, such as when the tumor occurs at the top surface of the prostate or other unusual locations, a biopsy may not give a correct diagnosis. For instance, the standard TRUS (transrectal ultrasound) guided biopsy in which tissue samples are collected from the prostate in a systematic pattern gives a negative result with tumors located in unusual areas of the prostate. About 15-20 percent of tumor locations can be missed by the biopsy needle.

What makes the MRI-ultrasound fusion biopsy more definitive?

The MRI-ultrasound fusion approach is an improvement on the traditional 12-core TRUS, which involved taking biopsies from twelve prostate areas where the cancer is considered more likely to occur. With the TRUS biopsy, about 70 percent of men who have a negative biopsy result are not essentially free of the cancer. The MRI-ultrasound fusion technology blends the superior imaging capability of the high-definition multi-parametric (mp) MRI with real-time ultrasound imaging. There is better visualization of the suspicious areas of the prostate where the cancer may occur that may not be visible on ultrasound alone. The fusion-guided biopsy detects almost twice as many prostate cancers in all stages as the standard TRUS biopsy.

The ability of MRI-ultrasound fusion-guided biopsy to create a three-dimensional (3D) map of the prostate ensures that doctors are able to see the targeted areas of the prostate better and perform more precise biopsies. The technology uses a machine known as UroNav developed by Invivo, which is supplied with sophisticated software to produce super-detailed MRI images and fuse them with the ultrasound images generated by a transrectal probe administered on the patient in an outpatient setting. The resulting images enable the examining physician to direct biopsy needles with pinpoint accuracy and to easily access any lesions or suspicious areas revealed by MRI. The technology allows the urologist to hit the target spot more accurately and improves cancer detection rate. In fact, it is primarily used for men who have an ongoing suspicion of prostate cancer, such as those with consistently elevated PSA, but whose TRUS biopsy results are repeatedly negative.

Fewer biopsies, more accurate detection

The fusion-guided biopsy is a very targeted approach in which biopsies are performed only in highly suspicious areas of the prostate appearing in the MRI image. As a result, significantly fewer biopsies are done with the MRI-ultrasound fusion than with the traditional TRUS technique, minimizing the adverse effects that often accompany repeat biopsies. Multiple prostate biopsies can lead to complications such as bleeding, infection, urinary retention problems, sepsis or even death.

In spite of fewer biopsies, the MRI fusion approach increases the rate of detection of aggressive prostate cancer. The extensive MRI images obtained before the biopsy helps highlight both high-risk and intermediate-risk cancers often missed by traditional TRUS biopsy. With MRI-ultrasound fusion, the likelihood of detecting cancer increases as the grade of the tumor increases. The use of MRI fusion biopsy helps to avoid metastatic disease by finding cancer before it spreads to other areas of the body.

Improved cancer differentiation

Through MRI fusion, doctors are able to more accurately differentiate cancers that require treatment from the ones that should undergo watchful waiting (active surveillance). Fusion technology is able to show higher-risk cancers and does not highlight the insignificant low-grade tumors, making it less likely for urologic oncologists to over-treat indolent and low-grade cancers. A number of prostate cancers are low-grade, non-aggressive and do not cause problems at all and treating them through chemotherapy, radiotherapy or surgery can impair the quality of life or even cause death. MRI fusion effectively saves patients from the adverse effects of treating low-grade tumors. Fusion technology eliminates up to 50 percent of prostate cancer treatments that are unnecessarily administered on low-grade cancers.

At Advanced Urology Institute, we have adopted the MRI-ultrasound fusion biopsy and changed the way we screen, evaluate and diagnose prostate cancer. It has become our standard for detecting prostate cancer and we believe in the next few years it will be the gold standard for detecting the cancer. We are proud that it offers a higher detection rate, superior accuracy and reduces the rate of repeat biopsies — making our practice one of the best places for detection and monitoring of the cancer. It helps us deliver the best treatment outcomes for our patients.

If you think you are at high risk of prostate cancer or already have started experiencing some symptoms, let us show you how the precision of our high-definition MRI fusion machine, the expertise of our skilled physicians in MRI fusion biopsy and the know-how of our radiologists proficient in multi-parametric MRI imaging can help you. For more information on the treatment and diagnosis of prostate cancer, visit the “Advanced Urology Institute” site.

Life Changing Treatment At Advanced Urology Institute

What I Do as a Physician Assistant – Lisa Cunningham

 

 

Driven by an unwavering commitment to excellence in urology, Advanced Urology Institute offers a complete range of innovative, specialized and high quality medical services for male and female urological conditions. We have assembled a multidisciplinary team of specialists who work together for you, including preoperative nurses, urologists, pathologists, radiation oncologists, dedicated robotic surgeons, postoperative recovery specialists and nurse navigators who coordinate urologic cancer care. Our board certified experts will work with you to identify the most effective treatment that meets your individual needs, ensuring a minimal disruption of your lifestyle.

Better Outcomes

At Advanced Urology Institute, we recognize that the most effective treatment for urologic conditions requires close collaboration between urologists, oncologists and other medical specialists. We have therefore created an environment in which the interactions between different specialists result in better patient care and improved outcomes. Our specialists work together managing each case jointly right from the start because we have removed all artificial boundaries between specialties, thus ensuring that transitions are seamless. In fact, we can deliver comprehensive treatment from one location by combining surgical expertise, on-site pathology and clinical laboratories, imaging services such as radiation therapy and CT scan, leading-edge robotic technology and synchronized care, resulting in unmatched personalized patient experience.

Comfort and Convenience

As experts on the conditions of the female and male urinary tract and the male reproductive system, we endeavor to help patients navigate sensitive health issues with a focus on their comfort and convenience. Every urologist at our center is open, friendly and willing to listen to the unique story of each patient in order to correctly recognize the symptoms and provide proper diagnosis. This extends to the use of the most recent diagnostic tools and the development of personalized treatment programs for conditions such as kidney cancer, bladder cancer, prostate cancer, male erectile dysfunction, renal pelvic obstructions, adrenal disease and female urologic disorders.

Are you looking for the highest quality urology services? Visit our site ‘Advanced Urology Institute‘ for more information.