Dr. Rolando Rivera of Advanced Urology Institute Re-designated as a UroLift Center of Excellence

Dr. Rolando Rivera of Advanced Urology Institute Re-designated as a UroLift Center of Excellence

About Dr. Rolando Rivera

Rolando Rivera, MD, FACS is an established Urologist in Naples, Florida, who features over two decades of experience in his field. Dr. Rivera’s acclaimed career in medicine began in 1996, when he graduated from the University of Puerto Rico School of Medicine in San Juan. Upon earning his Medical Degree, he completed an internship at Brooke Army Medical Center in San Antonio, Texas, before undertaking his residency at the University of Florida Shands Medical Center in Gainesville. Pursuing advanced medical training, Dr. Rivera then completed a fellowship in Female Urology, Pelvic Surgery and Urodynamics at the University of Miami.

About Advanced Urology Institute

As one of the largest full-service urology groups Florida, our 37 locations offer comprehensive urology services, from evaluation and pre-surgical preparation, to surgery and rehabilitation. We have evaluated numerous patients and performed thousands of urologic surgical and cancer procedures in the last decade with excellent outcomes. We are dedicated to combining clinical excellence, advanced technology, and patient- and family-centered care.

For more information contact AUI at: 855-977-4888

Congratulations to Dr. Jonathan Jay for being selected as Top Doctor in 2021 for Naples Illustrated Magazine

Congratulations to Dr. Jonathan Jay for being selected as Top Doctor in 2021 for Naples Illustrated Magazine

About Dr. Jonathan Jay

Dr. Jay received his Bachelor of Science degree in Physiology from Michigan State University, graduating with Honors. He went on to complete his medical education at the University of Michigan, Ann Arbor. He completed his residency training at Henry Ford Hospital before entering and completing his fellowship training at Beth Israel Deaconess Medical Center, Harvard Medical School in Boston. He received numerous honors and awards throughout his training, including Outstanding Resident Training Award and Lansing School District Distinguished Alumni Award.

He has made national presentations on various urological topics and has published multiple scientific papers in peer-reviewed journals as well as book chapters. He is involved in clinical research, including clinical trials for the minimally invasive correction of bladder control problems.

About Advanced Urology Institute

As one of the largest full-service urology groups Florida, our 37 locations offer comprehensive urology services, from evaluation and pre-surgical preparation, to surgery and rehabilitation. We have evaluated numerous patients and performed thousands of urologic surgical and cancer procedures in the last decade with excellent outcomes. We are dedicated to combining clinical excellence, advanced technology, and patient- and family-centered care.

For more information contact AUI at: 855-977-4888

Janelle Bunce, PA-C of Advanced Urology Institute Re-designated as a UroLift Center of Excellence

Congratulations to Janelle Bunce, PA-C on having been re-designated as a UroLift Center of Excellence in May 2021.

About Janelle Bunce, PA-C

Janelle Bunce PA-C is a nationally certified Physician Assistant who earned her Masters of Medical Science and Physician Assistant studies degrees at Nova Southeastern a University in Davie, FL in 2004. She is a member of the American Academy of Physician Assistants, Florida Urological Society and the American Urological Association. She has participated in multiple medical mission trips. Her specialties include adult and pediatric urology. She is currently a practicing physician assistant in Naples, FL.

About Advanced Urology Institute

As one of the largest full-service urology groups Florida, our 37 locations offer comprehensive urology services, from evaluation and pre-surgical preparation, to surgery and rehabilitation. We have evaluated numerous patients and performed thousands of urologic surgical and cancer procedures in the last decade with excellent outcomes. We are dedicated to combining clinical excellence, advanced technology, and patient- and family-centered care.

For more information contact AUI at: 855-977-4888

What’s New in Prostate Cancer Research with Dr. Jonathan Jay?

KEY TAKEAWAYS:

  • Proper use of the prostate-specific antigen (PSA) test is a recent advance in prostate cancer research, allowing doctors to better identify and categorize high risk or low risk, aggressive or indolent cancers and develop targeted treatment plans.
  • Advances in molecular biology, such as studying abnormal prostate cancer genes, help identify high-risk cancers and better understand the likelihood of cancer growth and spread.
  • Advanced Urology Institute offers comprehensive prostate cancer care, utilizing the latest research knowledge and techniques to minimize overtreatment and unnecessary biopsies and develop targeted treatment plans for patients.
Prostate cancer is one of the most common types of cancer in men. However, it might not show any symptoms until it reaches an advanced stage. A considerable number of men only realize they have the disease when it is already adversely affecting their lives.“This cancer is a big thing, with huge effects on the lives of patients,” says Dr. Jonathan Jay, a board certified urologist at Advanced Urology Institute in Naples, Florida. “The condition can cause urinary incontinence, reduced sexual desire, erectile dysfunction, changes in orgasm, and infertility, among other problems,” he adds.
Treatable Condition

The good news is that there are various treatments and management options for prostate cancer, even if it is found at a later stage. When detected early, the cancer is highly treatable, and most men with the disease survive.

“Prostate cancer is quite complex, which makes it difficult to predict how fast or slow it will grow and the risk associated with it,” says Dr. Jonathan Jay. “That is why, during diagnosis, we evaluate several factors to determine the aggressiveness of the tumor. After we determine the risk associated with the cancer, we are better placed to recommend the right treatment for our patients, which can yield great results,” he affirms.

The cancer is categorized as low risk, intermediate risk, or high risk depending on its ability to grow and spread to other areas of the body. Low risk prostate cancer is slow-growing and unlikely to spread quickly. In contrast, a high risk cancer is likely to spread rapidly outside the prostate.

Improved PSA Screening

One recent advance in prostate cancer research is the proper use of the prostate-specific antigen (PSA) test. Although the PSA test has had its limitations, it is still valuable for identifying and categorizing cancer as high risk or low risk, aggressive or indolent. When correctly used, it shows with accuracy those patients who have the aggressive type of cancer. This finding effectively guides the doctor to develop a more targeted treatment plan.

“The PSA got a bad reputation because it was used wrongly,” says Dr. Jonathan Jay. “But today, urologists understand that the PSA is still a very valuable tool in prostate cancer diagnosis and treatment. And it is now known that the significance of the PSA is not in whether it is elevated relative to the average, but in how it changes over time,” he asserts.

Studies have shown that the PSA is not abnormal just because it is elevated compared to the average. If the PSA of a man is stable over time, it doesn’t show prostate cancer, let alone an aggressive type of the disease. But if the PSA of a man has been stable for a prolonged period and then changes suddenly, it shows that something is wrong.

“If your PSA is one over the years, but changes to 3, then something is wrong, regardless of the fact that 3 is still within the normal range,” explains Dr. Jonathan Jay. “And if you’ve had a PSA of 6 over the past many years, then it’s not abnormal since it remains stable, regardless of the fact that it’s not within the normal range,” he adds.

Enhanced Precision with Molecular Biology

Significant progress has been made in prostate cancer research in the area of biopsies. Traditionally, prostate cancer has been confirmed and graded through a biopsy. To confirm a diagnosis, a urologist takes 8-12 needle biopsies along the prostate in a random sample and examines the cells under a microscope. However, while a biopsy tends to provide more accuracy than a typical PSA, it doesn’t give a perfect picture of the cancer.

“It is difficult to detect an aggressive cancer through the way cells look or behave,” says Dr. Jonathan Jay. “Besides, a biopsy may miss the specific areas of the prostate that would help to distinguish an aggressive from an indolent cancer,” he adds.

Advances in this area have ensured more accuracy and reduced the risk of misdiagnosis. For instance, abnormal prostate cancer genes can now be used to identify high risk cancer. The look of genes, occurrence of virulence factors, behavior, and other features are studied to better understand how likely it is that a cancer will grow and spread.

“Nowadays, we look at genes to determine the aggressiveness of prostate cancer,” says Dr. Jonathan Jay. “For example, genes of cancer cells may contain virulence factors or show how fast the cells will multiply and spread to other areas. This helps determine which cancer should be treated faster, and which categories of patients may benefit from therapeutic interventions,” he adds.

Apart from genomics, urologists can now use magnetic resonance imaging (MRI) technology before a biopsy to look for areas in the prostate that are suspicious of the cancer. This is possible thanks to new technology that fuses MRI images with real-time ultrasound to guide prostate needle biopsies to areas of specific concern.

Why Seek Prostate Cancer Treatment At Advanced Urology Institute?

At Advanced Urology Institute, we understand that prostate cancer is highly treatable when detected early and accurately.

We offer comprehensive prostate cancer care that includes the use of the latest research knowledge and techniques. With the advances in prostate cancer research, we can know who has aggressive or indolent cancer with greater accuracy, minimizing the chances of overtreatment and unnecessary biopsies.

Moreover, our urologists are acquainted with up-to-date prostate cancer knowledge, tools, and techniques. All of this helps guide treatment and enables us to develop more targeted treatment plans for our patients.

When you come to see us at our Naples, Florida office for diagnosis or treatment, we will consider your unique situation from a point of knowledge and recommend the best possible treatment for you.

For more information on prostate cancer treatment and diagnosis, visit the Advanced Urology Institute website.

TRANSCRIPTION: 

I’m Jonathan Jay. I’m a board-certified urologist with Advanced Urology Institute.

Listen, I’m excited about all facets of urology. You know, cancer is a big thing. Remember, prostate cancer didn’t have a chance when we died of our heart attack at 60 and 70, but it lived to be 90 and 100. Prostate cancer has got a big chance. We’re going to see a lot of patients, actually, their lives being affected by this disease.

So, one of the things that I like is that our ability to define the disease is improving. For instance, not only do we have PSA, PSA stands for prostate-specific antigen. This is a protein excreted by the prostate that can be detected at certain numbers, and there should be a certain number within the serum at a certain age. And if it’s elevated, or if it’s different than it used to be, then we know something’s wrong. And that’s important to understand. PSA got a bad reputation. Why was that? Because we used it wrong, not because it was a bad test.

The significance of PSA is not what it is in you relative to average, but what it is in you over time. For instance, my PSA for the past 10 years has been one. If my PSA is 3, which is considered normal, something’s wrong. Mr. Jones has a PSA of 6 for the past 10 years. This is above average. But he doesn’t have prostate cancer because his PSA is stable. So, again, we use this PSA in a wrong manner. That’s been one of the great evolutions of understanding this. And understanding, too, there’s some molecular biology. Again, we used to grade prostate cancers by looking at a prostate cancer under a microscope to understand the pattern and what it looked like.

You can’t really tell the aggressiveness of a prostate cancer by looking at it in its morphology. For instance, you’ve got two people walking down the street. You’ve got a young kid with a hoodie on. You’ve got a well-dressed man with a trench coat. Who’s your bank robber? Well, the guy with the trench coat has a machine gun under his trench coat. You can’t tell the behavior of something by the way it looks. So what we’ve done with prostate cancer is we have the ability to take that cancer and look at the genetics and define if it can multiply fast, can it move to other places. We can look at the virulence factors of these cancers to tell which cancer should be treated and which cannot. This is early in the process of looking at molecular biology and making decisions on how to treat and who to treat for prostate cancer. But it’s the light that we need as we hone this in and become more, be better at defining it. We’re going to make better decisions on who to treat and not to treat.

REFERENCES: 

What Urology Procedures Are Performed in Our Naples Office?

KEY TAKEAWAYS:

  • The Advanced Urology Institute’s Naples office, led by Dr. Rolando Rivera, offers a range of outpatient urology procedures, including prostate procedures, reconstructive surgeries, and stone disease treatment.
  • Complex cases requiring specialized equipment, such as robotic surgery for pelvic organ prolapse, are performed at the hospital.
  • The Advanced Urology Institute is the largest urology practice in Florida, providing comprehensive and personalized care to patients seeking a urologist in Naples, FL.

Introduction

Urology is a specialized field of medicine that focuses on the diagnosis, treatment, and management of various conditions related to the urinary tract and male reproductive system. At the Advanced Urology Institute in Naples, Florida, Dr. Rolando Rivera, is a board-certified urologist who is also specialized in Female Pelvic Medicine and Reconstructive Surgery. In this article, we will discuss the various urology procedures performed at the Naples office and how Dr. Rivera can help you.

Outpatient Urology Procedures in Naples

The surgery center in Naples is designed for primarily outpatient interventions that are fairly uncomplicated. A range of procedures can be performed at this facility, catering to the diverse needs of patients seeking a urologist in Naples, FL.

Prostate Procedures

One of the common procedures performed at the Naples office is the Urolift. This minimally invasive procedure treats benign prostatic hyperplasia (BPH), a condition characterized by an enlarged prostate gland. The Urolift procedure involves the placement of small implants to lift and hold the enlarged prostate tissue out of the way, relieving pressure on the urethra and improving urine flow.

Reconstructive Surgeries

Dr. Rolando Rivera performs simple reconstructive procedures at the Naples office, focusing on pelvic reconstructive surgeries. These surgeries address issues such as pelvic organ prolapse, in which the pelvic organs, like the bladder or uterus, descend due to weakened pelvic floor muscles and ligaments. The reconstructive procedures aim to repair and strengthen the pelvic floor to restore normal function and alleviate symptoms.

Stone Disease Treatment

For patients suffering from kidney stones, the Naples office offers various treatment options. Depending on the size, location, and type of kidney stones, Dr. Rivera may perform minimally invasive procedures like extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy to break up and remove the stones.

Hospital Procedures for Complex Cases

While the Naples office is equipped to handle a variety of urological issues, some complex cases require specialized equipment and hospital facilities. For instance, Dr. Rivera performs robotic surgery for pelvic organ prolapse at the hospital. This advanced technique uses the da Vinci Surgical System to perform precise, minimally invasive procedures that result in shorter recovery times and reduced complications.

Advanced Urology Institute: Comprehensive Urological Care

The Advanced Urology Institute is the largest urology practice in Florida, offering state-of-the-art facilities and a team of highly skilled urologists. With a focus on providing personalized care to each patient, the team at the Advanced Urology Institute works collaboratively to diagnose and treat a wide range of urological conditions. If you are seeking a urologist in Naples, FL, trust the expertise of Dr. Rolando Rivera and the team at the Advanced Urology Institute.

TRANSCRIPTION:

I’m Rolando Rivera and I’m board certified in Urology and Female Public Medicine and Reconstructed Surgery with Advanced Urology Institute.

So the surgery center is designed for primary outpatient interventions that are fairly uncomplicated. So we do do a fair amount of things in the surgery center. We do our prostate procedures, Urolift, we do a fair amount of those. We do simple reconstructive procedures, public reconstructive surgeries, stone disease, those kinds of things. The more complex reconstructive surgeries that require specific equipment, like I do robotic surgery for prolapse, that is a hospital procedure.

REFERENCES:

How Has Prostate Cancer Biopsy Advanced with Dr. Jonathan Jay?

KEY TAKEAWAYS:

  • GPS Guided Biopsies offer greater accuracy in detecting and determining the type of prostate cancer, as they can pinpoint the growth more precisely than a regular biopsy.
  • High-quality T3 MRIs, molecular biopsies, and patient follow-up allow urologists to monitor the cancer closely and make better-informed decisions about the need for aggressive treatment.
  • Urologists use tools like rectal exams and prostate-specific androgen (PSA) tests to monitor the progression of prostate cancer and recommend surgery or radiation therapy if the cancer becomes aggressive.

Prostate cancer is one of the most common forms of cancer found in men. The likelihood of it forming in the walnut-shaped prostate organ increases with age. Luckily, there have been many major advances in how prostate cancer is diagnosed and treated. When it comes to diagnosing, board-certified urologist Dr. Jonathan Jay says, “First we must define where it is, how much of it exists within your prostate, and then what its behavior is like.”

Answering the where, how, and what is key to determining the type of prostate cancer and how to watch or treat it. Urologists are using advanced technologies to answer these questions. Urologists want to know how aggressive a cancer is when determining how aggressively they need to treat it. They can use a molecular biopsy and a high-quality T3 MRI to pick up on aggressive cancers. If an aggressive cancer is found, urologists can perform a more focused biopsy.

Dr. Jonathan Jay - Naples, FLThis focused biopsy is called a GPS Guided Biopsy and it has some very important advantages over a regular biopsy. The cancer may exist in a very small portion of the prostate, especially early on. This small cancer can be missed during a biopsy just by a sampling error, leading to a diagnosis that may not give a completely accurate picture of the cancer. But with a high-quality MRI, a guided biopsy can pinpoint the growth and the urologist can detect and determine the type of cancer with greater accuracy.

When the cancer is detected with greater accuracy, the urologist can now follow it more closely and understand what type the doctor and patient are dealing with. The urologist can perform a biopsy on the cancer to look at and understand its genetics. If the genetics show that it is not very aggressive or growing, then the urologist may decide to watch the cancer, as treatment may not be necessary. MRI’s and patient follow up can be used to watch the growth to see if there are any changes that may require more aggressive treatment.

Along with MRI’s, the cancer can be monitored with rectal exams and prostate-specific androgens (PSA) tests. These tools offer insight into the patient’s specific prostate cancer and its progression. If it becomes aggressive, the urologist can recommend surgery or radiation therapy.

A diagnosis is the beginning of a patient’s cancer treatment. At the Advance Urology Institute, urologists like Dr. Jonathan Jay utilize recent advancements in prostate cancer biopsies to provide their patients with the most accurate diagnosis and best treatment options.

TRANSCRIPTION: 

I’m Jonathan Jay, I’m a board certified urologist with Advanced Urology Institute.

One thing I’ve always said about prostate cancer, one you’ve got to be able to define where it is, how much of it exists within your prostate and then what its behavior is like.

So if we take that molecular biology and now we have MRI, T3 weighted MRI that can pick up aggressive prostate cancers and we do what we call GPS guided biopsy, a Euronav biopsy. So for instance, if I were sitting in this room and I’m the cancer, so this room is the prostate and I’m the cancer in the prostate, I could pass a needle through this room 15 times and miss me or just catch my baby toe. So I can miss the cancer just by sampling error. But if I had an MRI that said in this part of the room where I sit is an abnormality and it looks different than the other parts of the prostate and I focus on that, my ability to define and detect that cancer within that room is much higher. So we have the ability to do that. So not only did I detect the cancer in a much better way, but I have the ability now to follow the cancer. So if I biopsy that, look at the genetics of that cancer and it’s not very virulent, I can watch that cancer.

I got MRI which I can use to plot whether it changes in size or character. I can use the molecular biology to tell how fast it multiplies if it’s a virulent cancer. I’ve got PSA and I’ve got my rectal exam. So I’ve got three or four clinical tools for which I can follow that patient. We always talk about risk and benefit of treating any disease and we can watch this disease. If it shows that it’s being virulent or changing its character, then we can take the risk of having surgery or radiation. But we would not take that risk if it’s unnecessary if we saw something that was not changing much over time and a threat to the patient.

REFERENCES: 

What Female Urology Conditions Can Dr. Jonathan Jay Treat?

KEY TAKEAWAYS:

  • Dr. Jonathan Jay is a board-certified urologist with a fellowship in female urology, voiding dysfunction, and pelvic floor dysfunction, who treats a variety of urinary problems common in aging women, such as incontinence, overactive bladder, pelvic organ prolapse, and pelvic floor dysfunction.
  • A range of treatments is available in urology, with the least invasive options prioritized, including physical and behavioral therapies, nerve therapy, Botox injections, bladder pacemakers, pessaries, and medications; surgery is considered a last resort.
  • Most urinary problems are not life-threatening but significantly impact the quality of life; by resolving them, urologists can restore confidence, meaning, and hope to their patients’ lives, with most patients experiencing good results from minimally invasive procedures.

I am Dr. Jonathan Jay, a board certified urologist with Advanced Urology Institute. While I am board certified in general urology, I also did fellowship in female urology, voiding dysfunction and pelvic floor dysfunction.

Dr. Jonathan Jay of Naples, FLOne of the inevitable consequences of aging in women is urinary problems. With increasing age, the pelvic floor muscles—a group of muscles that support the bladder, vagina and rectum—face the risk of damage. Since these muscles need to relax in order to pass urine well or have smooth bowel movement, their disruption may result in urinary problems, such as incontinence, overactive bladder, pelvic organ prolapse or pelvic floor dysfunction. Tension in these muscles may also lead to pain during sexual intercourse, painful or frequent urination and lower back pain.

Aging and urinary problems

As women age, they may develop and overactive bladder, which means they urinate at all hours and with little warning. Many women suffer from incontinence after childbirth, a condition characterized by unintentional leakage of urine when coughing, sneezing, laughing or jumping. Childbirth may also cause injury to the pelvic floor muscles leading to weak spots in the walls and muscles of the vagina when adjacent organs move from their normal positions resulting in pelvic organ prolapse.

Informed decision-making

Unlike other specialties, such as neurology and oncology, urology offers a range of treatments that deliver great results for these conditions. Actually, most patients do get better after intervention by a urologist.

In fact, one of the reasons I chose this profession is that there are so many ways to help rectify problems and restore normalcy to people’s lives. As a urologist, I get the opportunity to care for patients in their declining years when urologic problems are so common. I care about both their medical and emotional challenges.

As urologists, we have the ability to find your problem when you present with symptoms. Once the problem is identified, we educate you on what you need to do and talk with you about the different treatment options available. I like counseling patients; talking to them about the bigger picture and helping them make informed decisions.

And as we define these problems, educate patients and talk about the different treatment options available, especially the positives and negatives, we help our patients to make choices that they are comfortable with. Still, because we understand that these choices have risks, we ensure that we provide enough information to minimize the risks.

Most urinary problems are not life-threatening, but are quality of life issues. That means that by resolving them, we restore confidence, meaning and hope into our patients’ lives.

What does the treatment involve?

When we make choices for treating urinary problems, we prioritize the least invasive procedures in order to minimize the risks. Typical treatment begins with a physical examination and evaluation followed by a discussion of options such as physical and behavioral therapies–including exercises to build strength in pelvic floor muscles–and reducing water, alcohol and caffeine intake.

As an option for treating overactive bladder, we may recommend nerve therapy, a procedure which involves placing a needle in the ankle to transmit electric stimulation to the nerves that control bladder function. We may also recommend more invasive options for overactive bladder such as Botox injections and an implantable bladder pacemaker.

Depending on the symptoms, we may choose to manage pelvic organ prolapse using silicon or rubber diaphragm called a pessary, which is inserted into the vagina to support the pelvic floor. We may also recommend vaginal medications or muscle injections to help with pelvic floor dysfunction. But if the problem persists or worsens even with these interventions, we may explore surgery as a last resort.

Remarkable outcomes

In urology, we are fortunate that most of the problems are clearly defined, the treatment path is clear, and the results are usually good. At Advanced Urology Institute, we offer everything, from observation, pessaries and medications to surgery. Fortunately, most of our patients do well and get better after we apply minimally invasive procedures.

We understand that many women with urological problems might not know how common and treatable these problems are—a fact that keeps them from seeking proper care. So at AUI, we try to provide information to the public so that people are aware that there are solutions for even the most awkward and uncomfortable urinary problems. For more information on female urology conditions and their treatment, visit the Advanced Urology Institute website.

TRANSCRIPTION: 

I’m Jonathan Jay, I’m a board certified urologist with Advanced Urology Institute.

I’m a board certified general urologist, but I also did a fellowship in female urology and voiding dysfunction and pelvic floor reconstruction.

As women age, one of the advantages of aging is that the parts that allow them to hold urine in place and allow their bladders to be supported within the pelvis are at risk of being damaged. So hysterectomy can damage that support and those mechanisms that allow them to be continent, so can child birthing. So again, some of the advantages of womanhood predispose to some of these problems which makes it a very common problem.

And so one of the reasons I chose to be in Naples, Florida after doing that fellowship is that I knew there would be a lot of those problems to be able to rectify and treat here. And so we have the ability again to define the problem for the patient, to educate them on what they have and what their options are. These are not life threatening problems, but they’re quality of life issues and they’re major quality of life issues. And so the choices that the patients make are not one that I make, but it’s one that they make and they’re comfortable with.

For instance, we first define the problem, educate the patient, then we talk about the different options that are available and we talk about the positive and negatives of each of those options and the patient then chooses what they want to do. The outcomes are good. Remember, we’re not doing anything that the patient doesn’t want to assume the risk for.

We offer everything from observation to pessaries, say if you have prolapse, to medications if you have incontinence. We try all the benign things first and then we work our way up to surgical procedures if they have to be bothered enough to want to pursue that.

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