How Did Janelle Bunce, PA Become a Physician Assistant?

KEY TAKEAWAYS:

  • Physician assistants play an important and involved role in patient care, and can complete their degree programs in as few as six years.
  • Physician assistants in urology can address a variety of medical issues, such as urinary incontinence, kidney stones, vaginal prolapse, and overactive bladder, assisting doctors in treating a wide range of conditions.
  • Janelle Bunce, PA is a dedicated physician assistant in urology who began assisting doctors within six years of starting her degree program and enjoys working with a team of healthcare professionals to ensure top-notch patient care.

The field of medicine offers many opportunities for people who want to dedicate their lives to helping others. With hard work and study, almost anyone with a desire to work in healthcare can achieve that dream. One growing role in this field is that of the physician assistant who plays an important and involved role in patient care.

Unlike doctors, who spend up to a decade or longer in training, physician assistants can complete their degree programs in as few as six years. This makes earning credentials and beginning a rewarding career less costly and achievable in less time.

Janelle Bunce, PA from Naples, FLAlthough they may not be doctors, physician assistants have some of the most important jobs in healthcare and carry a great deal of responsibility. They assist with surgeries, see patients independently and take an active role in decision making with the doctors. They are an important part of the patient experience and share in the satisfaction of participating in overall patient care.

Physician assistants in the field of urology address a variety medical issues. From urinary incontinence, kidney stones and vaginal prolapse to an overactive bladder, a physician assistant in the specialization of female urology can assist doctors in treating a wide range of conditions while creating lasting relationships with their patients.

One physician assistant who is enjoying a rewarding career in urology is Janelle Bunce, PA. The educational requirements made it possible for her to begin assisting doctors within six years of beginning the required degree program. Janelle enjoys working with a team of nurses and doctors to ensure that her patients receive top-notch care. Her story and success are an inspiration to anyone with a desire to pursue a career in medicine.

Dedicated urology physician assistants, like Janelle Bunce, PA can be found providing excellent patient care every day at the Advanced Urology Institute. For more information, visit the Advanced Urology Institute website or make an appointment for a consultation today.

TRANSCRIPTION: 

My name is Janelle Bunce, I’m a physician assistant with Advanced Urology Institute.

I was a single mother actually and I started college when my daughter was six weeks old and physician assistant field was a place in medicine that you could advance pretty far. We can assist with surgery, we can see patients independently and yet it wasn’t a prolonged education where I needed to be in school ten to twelve years, it was six and a half years. 

I have a masters degree so I started my undergrad degree in biology and then went on to the PA program which was a masters of medical science. I decided to be a physician assistant because this is an area that we can help people from birth to death. In particular urology has a lot to do with quality of life. I like that it’s a nice mix of autonomy but also there’s always a supervising physician that we can bounce ideas against and we work together as a team with our supervising physician.

REFERENCES: 

How to Treat Kidney Stones with Dr. Rolando Rivera?

KEY TAKEAWAYS:

  • Treatment for kidney stones varies depending on their size, type, and location. Small stones can typically be passed with hydration and medication, while larger stones may require more extensive treatment like lithotripsy or surgery.
  • Lithotripsy, a non-invasive procedure, uses high-energy shock waves to break larger kidney stones into smaller pieces, allowing them to be passed during urination. This treatment has largely replaced surgical removal of stones.
  • Preventing kidney stones involves drinking plenty of water, reducing intake of oxalate-rich foods, limiting dietary salt and animal proteins, and taking medications to target specific types of stones.

Treatment of Kidney Stones

The treatment available for kidney stones varies according to the size and type of kidney stone and its location.

If the stones are small, they probably won’t require invasive treatment and can be passed with hydration and medication like pain relievers and alpha blockers that relax the muscles in your ureter. This is how most kidney stones are resolved.

Dr. Rolando RiveraIf you have large stones, however, your urologist may approach them with more extensive treatment. There are several ways to eliminate them. If you have severe pain, an infection, or your kidney function is threatened, your doctor will want to act quickly. Fortunately, during the 1980s a new approach to getting rid of the stones appeared on the medical scene and quickly replaced surgical removal of the stones. This treatment, called lithotripsy, uses sound waves to break larger kidney stones into tiny pieces so they can be passed during urination. These sound waves are also called high-energy shock waves and are usually implemented from outside the body in what is called “extracorporeal shock wave lithotripsy” or ESWL. The procedure takes about 45 minutes to an hour and you may be put under light sedation during treatment.

If the stones are larger and located in the kidney, or if ESWL did not break them down, your urologist may perform surgery to remove them. Your doctor can explain the surgical approach he recommends.

What Causes Kidney Stones?

Calcium phosphate stones are caused by overactive parathyroid glands which are located below your Adam’s apple. When these glands overproduce the parathyroid hormone the result is hyperparathyroidism, resulting in an excess of calcium that may cause kidney stones. Your doctor likely will recommend treatment to stop your parathyroid gland from overproducing the hormone.

Prevention of Kidney Stones

You may lower your risk of kidney stones if you:

  • Drink large amounts of water during the day. If you are in a dry environment or exercise significantly, you may need even more water, drinking enough so your urine looks almost clear.
  • Consume fewer oxalate-rich foods. If your doctor determines you have calcium oxalate stones, he may recommend dietary changes to reduce foods that are high in oxalate, like beets, spinach, sweet potatoes, tea, chocolate, nuts and soy products.
  • Reduce your dietary salt and consumption of animal proteins.

Medications

Medications may help prevent kidney stones, depending on the type of stone. Uric acid stones, calcium stones, cystine stones and struvite stones each require a different plan for prevention.
If you reside in Florida, you are probably not far from an Advanced Urology Institute location. If you are near Naples or Bonita Springs, you may wish to consult with Dr. Rolando Rivera for your kidney stone symptoms and treatment. For more information, visit the Advanced Urology Institute website.

TRANSCRIPTION: 

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

The treatment options will depend on the size of the stone and the location. The smaller the stone, the more likely that we would recommend a trial of passage because the majority of them can pass on their own with appropriate hydration and medications. The bigger stones we would treat with either endoscopic procedures with lasers or shockwave therapy, depending, and other stones can be treated with external shock wave literacy as well. Really big stones that are really hard can be accessed directly, externally, whether they’re in the kidney, through the back, or with other robotic surgeries as well.

REFERENCES: 

What are the benefits of da Vinci Robotic Surgery According to Dr. Rolando Rivera

KEY TAKEAWAYS:

  • The da Vinci® robotic surgery technology has revolutionized the field of minimally invasive surgery, offering consistent and superior outcomes and enabling patients to recover faster.
  • The benefits of da Vinci robotic surgery for patients include reduced pain, less blood loss, reduced risk of infection or complications, less scarring, shorter hospital stays, and faster recovery.
  • The da Vinci system offers surgical professionals advantages such as improved dexterity, a wider range of motion, enhanced visualization, improved access to hard-to-reach areas, and improved outcomes that spare healthy tissue.

If you are facing surgery, you want the most effective and least invasive approach to the operation. You can rest easy when you hear that your procedure will be done with the da Vinci® robotic surgery technology.

The da Vinci approach has transformed minimally invasive surgery, enabling patients to get back to what matters sooner. Over the past 20 years, da Vinci platforms have offered consistent and superior outcomes, pioneering new capabilities in the operating room. The da Vinci robotic surgery has virtually revolutionized the field of minimally invasive surgery.

Dr. Rolando RiveraSurgical Approach with da Vinci Robotic Surgery

  1. Surgeons and operating room staff who use the da Vinci system are given comprehensive training by the manufacturer. Their professional education includes simulation for skills and procedures, along with practice and peer guidance.
  2. The da Vinci robotic surgical system offers a minimally invasive alternative to laparoscopy and also to open surgery. (Laparoscopy surgery is a procedure that uses fiber-optic instruments inserted through the abdominal wall to see and repair internal organs.)
  3. Because robotic surgery offers greater precision and control for the surgeon, and is performed by just a few tiny incisions, patients generally recover sooner.

Benefits of da Vinci Robotic Surgery for Patients

Patients will be thankful for the many benefits of robotic surgery using the da Vinci approach:

  • Reduced pain
  • Less blood loss
  • Reduced risk of infection or complications
  • Less scarring because of smaller incisions and fewer sutures
  • Briefer hospital stays/faster recovery
  • More rapid return to normal activities, including urinary continence, sexual function, and more.

Benefits of da Vinci Robotic Surgery for Surgical Professionals

To understand more about the benefits of the da Vinci system, consider these advantages. Aided by the da Vinci system’s ergonomic design, your surgeon is able to get a magnified 3-D view with high-definition while operating from a comfortably seated position. Your surgeon can operate precisely with these advantages:

  • Improved dexterity
  • Wider range of motion
  • Enhanced visualization including areas that are not visible by the naked eye
  • Improved access to otherwise almost inaccessible areas
  • Improved outcomes, sparing healthy tissue not impacted by cancer

The superior results with a da Vinci robotic surgery procedure are ideally suited for urologic conditions. At the Advanced Urology Institute, urologists such as Dr. Rolando Rivera perform minimally invasive robotic surgeries for prostate cancer, vasectomies and more complex surgeries such as reconstruction. For more information, visit the Advanced Urology Institute website.

TRANSCRIPTION: 

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

Yes, the DaVinci machine, which is a trademark platform in general robotic surgery, is designed to improve the ability of the surgeon to get the tissues and see the structures through small incisions via laparoscopy, it’s based on laparoscopic principles.

You can get to the different organs and use 10 times magnification in a three-dimensional array, so you can see things very close and very magnified. And the robotic platform allows you to have more precision, takes away the surgeon’s tremor because the instruments do all the movement that you guide in a console, so it allows you to do more refined treatments and surgical techniques. Well, because you’re not opening big incisions and you’re creating less trauma, less trauma leads to less inflammation, then pain is less of an issue. And whenever you have small incisions, less trauma, less inflammation, you’ll have quicker recovery.

REFERENCES: 

How Did Dr. Rolando Rivera Become a Urologist?

KEY TAKEAWAYS:

  • Urology is a challenging and diverse medical specialty, covering a broad range of issues such as urinary incontinence, overactive bladder, vaginal prolapse, kidney stones, and pelvic surgery.
  • Urologists have the opportunity to build long-lasting relationships with their patients and provide patient-specific treatments, creating a primary care type relationship that is rare in specialty medicine.
  • Dr. Rolando Rivera is a dedicated urologist who enjoys the ever-changing field of urology, aiming to improve the quality of life for his patients by providing the best care possible.

Becoming a doctor in any field requires a great deal of dedication and determination. Medical school is known for its years of hard work, difficult tests, internships and endless nights of studying. The product of this hard work is the excellent care provided by dedicated professionals when we are in need of medical assistance.

Dr. Rolando RiveraBecoming a urologist requires a special kind of person. Urology is one of the more challenging specialties a doctor can choose. Urological problems are broad and can encompass issues ranging from urinary incontinence, overactive bladder, vaginal prolapse and kidney stones to the advanced realm of pelvic surgery. Urologists are required to have a large skill set in order to take care of their patients.

Although the extensive field of urology requires a great deal of work, it is also very rewarding. Because of the wide range of issues within this specialization, patients might have to see a urologist many times in their lives. This gives urologists a chance to build relationships with their patients and learn their unique medical needs over time. Urologists have the opportunity to create an almost primary care type relationship with their patients, which is rare in fields of specialty medicine.

The wide spectrum of needs in urology also works to the advantage of the urologist. There are some fields of medicine that can become routine over years of practice, where patients come in with the same set of issues, needing the same kind of treatment. This does not happen in urology. With a wide range of medical issues, requiring patient-specific treatment, the phyisican enjoys a greater degree of variety at work. And with treatment options ranging from prescriptions to various levels of invasive surgery, urology is consistently an interesting and diverse field of medicine for those who practice it.

One doctor who enjoys this ever changing field of medicine is Dr. Rolando Rivera. After shadowing a urology student and friend in college, Dr. Rivera knew that this was the medical specialty for him. And after graduating with honors from the University of Puerto Rico, he started a rewarding and cutting-edge career. Improving the quality of life for his patients has been the goal that motivates Dr. Rivera to provide the best care possible.

For those who are willing to put in the long hours and hard work required to become a urologist, the reward is a lifetime of making a difference in people’s lives while also never being bored with their profession. For anyone in need of seeing a dedicated urologist like Dr. Rivera, he and many more great doctors can be found at the Advanced Urology Institute. Their team of qualified and experienced specialists can help you with any concerns related to urological conditions. For more information, visit an Advanced Urology Institute location near you.

TRANSCRIPTION: 

I’m Rolando Rivera and I’m board certified in urology and female pelvic medicine and reconstructive surgery with Advanced Urology Institute. 

I actually wanted to be a pilot, but I had glasses and back then pilots didn’t have glasses so my brother is a physician and I got interested in medicine early. I went to the University of Puerto Rico for medical school and I did my residency in the University of Florida in Gainesville.

I actually got exposed to urology fairly early. I think I was a first year medical student and one of my brother’s classmates was a urology resident. I was walking down the hallway one day on a Saturday and he stopped me and said, hey, what are you doing? I said, I’m not doing much and he invited me to see one of his cases and after that everything had to compare to urology. I was hooked, yeah. You know, the most interesting thing about urology is of all the surgical subspecialties or of many of the surgical subspecialties is the one specialty where you can be very broad. I mean, I have relationships with patients that I’ve seen since I came into town 13 years ago so you can follow patients for a long, long time and have almost a primary care type relationship with your patients. 

You can be very obviously invasive and we do a lot of procedures and surgery and it’s open surgery, endoscopic surgery, very broad field and you never get really bored because it’s so diverse.

REFERENCES: 

What does a physician assistant do According to Janelle Bunce?

KEY TAKEAWAYS:

  • Physician assistants work in all areas of medical practice and are trained to perform diagnostic tests, interpret results, and develop treatment plans under the supervision of a physician.
  • In addition to their clinical roles, physician assistants also educate patients on preventative health, collect patient histories, and assist in surgical procedures.
  • The main purpose of a physician assistant’s job is to lighten a physician’s workload, enabling medical facilities to operate more efficiently and effectively.

Physician assistants, as the name suggests, are professionals whose main job is to assist physicians in their work. They work under the supervision of a qualified and registered physician and even when the physician is not physically present, they are expected to report on their activities to their supervising doctor.

To qualify as a physician assistant, you must obtain a bachelor’s degree with an emphasis on science courses such as anatomy. You need to apply to a Physician Assistant Training Program to obtain a masters degree. The training programs are quite intense, combining theoretical and practical classes in a hospital environment. After completing the training program, the student must pass the Physician Assistant National Certification Examination.

The Role of Physician Assistants.

Janelle Bunce: Physician AssistantPhysician assistants work in all areas of medical practice, from basic primary care to geriatric care, pediatrics, and even emergency medicine. Their roles can be summarized:

1. Studying diagnostic tests and developing basic treatment plans

Physician assistants can perform, order and interpret diagnostic tests. They also are authorized to perform physical tests on patients. Based on the results of the tests, physician assistants can develop a treatment plan but only after consulting with the physician. They are allowed to prescribe medication as part of a treatment plan.

2. Educating patients on preventative health

Physician assistants devote their efforts to educating patients and their families on the steps that can improve disease management and prevent its worsening. They also help by warning and educating people about harmful habits and health hazards.

3. Collecting Patient Histories

When patients go to a facility for the first time, physician assistants interview them to obtain any family history that might have a bearing on the patient’s state of health. Such records are maintained at the hospital and they inform the treatment plan of a patient.

4. Assisting in Surgical Procedures

Some physician assistants focus on being surgical assistants. They perform pre and post surgical roles such as preparing and counseling the patient and monitoring the healing process after surgery.

The essence of a physician assistant’s job is to lighten a physician’s work load. They make sure that the small number of doctors available see as many patients as possible. Physician assistants play a key role that makes them vital to any medical facility’s operation. At the Advanced Urology Institute for instance, every physician is teamed up with one physician assistant to ensure maximum productivity. For more information, visit the Advanced Urology Institute website.

TRANSCRIPTION: 

My name is Janelle Bunce. I’m a physician assistant with Advanced Urology Institute.

There’s a lot of responsibility in the position. We are here to work as a team. I keep telling patients that. I keep reiterating that today. We truly are a team. So if it helps make the physician’s life easier, that’s what we’re here to do. So whether that’s reviewing labs or taking phone calls or rounding at the hospitals in conjunction with them. It’s really to help them be able to have more free time so that they can continue to provide better patient care.

Primarily we work with one physician. So we’re a team of one physician and one advanced practice provider. So we have nurse practitioners and physician assistants. So I work with Dr. Wilkinson. Dr. Wilkinson is a great guy. He is a wonderful physician and we’re able to have a little fun while we work. We spend so much of our time with our work family and he is definitely a fun guy to work with.

REFERENCES: 

Is Vasectomy Easier Than A Tubal Ligation

Both a vasectomy and tubal ligation are minor surgical procedures done to prevent pregnancy. A vasectomy is performed on men. During the procedure, the vas deferens, which are the two tubes through which sperm is transported into the ejaculatory duct during ejaculation, are cut or closed off to prevent the release of sperm when a man ejaculates.

Tubal ligation is the equivalent of vasectomy for women. It involves cutting or sealing off the fallopian tubes. The fallopian tubes are the path through which the egg produced by the ovaries travels to the womb. When the tubes are cut or sealed, the egg cannot travel to meet the sperm. This means that fertilization never happens and no pregnancy results.

Comparing Vasectomy and Tubal Ligation.

1. Procedure

Dr. Rolando RiveraDuring a vasectomy,the urologist makes two tiny incisions on the scrotum, pulls out the vas deferens and snips them and ties the individual ends. For tubal ligation, the doctor makes an incision in the patient’s abdomen to reach the fallopian tubes. The tubes are then cut and closed off. Or the tubes can be left uncut and closed off using a clip or a band.

While both procedures qualify as minor surgeries, a tubal ligation is a little more invasive. It involves larger incisions and the risk of interfering with other internal organs is significantly higher. On this score, a vasectomy seems a better option.

2. Cost of Procedure

Tubal ligation takes longer. It takes more work to complete than a vasectomy. Additionally, a tubal ligation requires the use of general anaesthetic to a greater extent than a vasectomy. For these reasons, it is more expensive.

3. Risks and Side Effects

Although both procedures have side effects, it must be said that serious complications rarely arise from either procedure.

A vasectomy may cause some bleeding and a little pain in the scrotum. There is a risk of infection but because the incisions are usually so small, the risk is minimal. A tubal ligation, on the other hand, has an increased risk of infection. There is also a greater risk of injury to internal organs because fallopian tubes are located inside the body, unlike the scrotum. After the surgery, the woman may have bleeding in the abdomen.

Based on the general criteria, vasectomy is said to be preferred to a tubal ligation. The choice, however, should always be made by the couple involved after they have weighed the choices and their personal circumstances. The advice of a trained urologist can help make the decision process easier. The staff of experts at Advanced Urology Institute are experienced in helping with consultations, planning and doing both procedures. For more information, visit the Advanced Urology Institute website.

What Causes Kidney Stones

Kidneys perform the function of filtering blood to remove waste from it. This waste is mostly water that contains salts such as sodium, calcium and potassium, all collectively referred to as urine. Kidney stones form when these salts are so concentrated in the urine that they crystallize into clumps, that can be as small as a grain of sand or larger.

Ordinarily a kidney stone causes no symptoms until it begins to move in the kidney or to other parts of the urinary system. A small kidney stone can be passed painlessly by urination. Bigger kidney stones, however, can be very painful to pass. But kidney stones are treatable and treatment should help you avoid the painful experience.

Causes of Kidney Stones

Kidney stones result from the clumping together of salts. Most kidney stones are calcium oxalate stones that form from calcium salts and oxalates. Oxalates occur naturally in some fruits, vegetables and nuts. There are also uric acid stones, which form due to lack of fluid in the body or a significant loss of fluid. Risk factors for the formation of kidney stones include:

1. Lack of Water/ Dehydration
This is without a doubt the most common cause of kidney stones. Stones form when urine salts occur in very high amounts in urine. Drinking adequate amounts of water can dilute the urine and reduce the concentration of salts. People in hot areas should take special care to drink a lot of water because they lose a lot of it in perspiration.

Dr. Rolando Rivera 2. High sodium diet
Many kidney stones have an element of calcium. Too much sodium increases the amount of calcium that kidneys have to process, thereby making it more likely for stones to form. Animal proteins such as red meat and shellfish, also have a reputation for making urine acidic, thereby increasing the possibility of having uric acid stones.

3. Personal or family History
A person who comes from a family with a history of having kidney stones is at an increased risk of having them. Similarly, a person who has had kidney stones before is very likely to suffer a recurrence.

4. Digestive illnesses and surgery
Serious inflammations of the digestive system, chronic diarrhea and gastric bypass surgery all can negatively affect the absorption of fluids and calcium by the body. This makes it more likely for the patient to have kidney stones.

Kidney stones are very common despite the fact that they can be prevented by staying hydrated and watching your diet. If you have them, you should consult a doctor immediately so treatment can be administered promptly. The Advanced Urology Institute offers effective treatment for kidney stones. Its staff of specialists are available to help with diagnosis and treatment and can answer any questions about prevention of kidney stones. For more information, visit the Advanced Urology Institute website.

What Procedures Are Performed in the New AUI Surgery Center?

Advanced Urology Institute offers a wide range of outpatient urology procedures in every new surgery facility. Whenever possible, there is a preference for treating patients in outpatient settings where primary, less complicated interventions are provided by board-certified urologists and other skilled medical professionals. Patients have the same quality of care they would get at a hospital setting at a lower cost. And with increased availability of advanced medical technology for outpatient care, new surgical centers have ensured redistribution of procedures and improved the efficiency of delivery of services.

Large number of procedures

At AUI, new surgery centers are used for a large number of procedures, including simple reconstructive operations, stone disease, scrotoplasty, meatoplasty, orchiopexy, pelvic prolapse, prostate and bladder procedures. For instance, urologists at new surgery centers treat incontinence, hematuria, kidney stones, urethritis, inguinal hernia, hydrocele, prostatitis, BPH, urinary tract trauma, urethral strictures, inflammatory urinary tract and bladder diseases, and urinary tract infections. And the fact that the centers are found in different locations encourages redistribution of care and access by more patients.

Common procedures performed in new AUI centers include:

  1. Prostate biopsy: Sampling of diagnostic tissue to be used to test for cancer cells.
  2. Bladder biopsy: Removing or sampling of tissue from the lining of the bladder.
  3. Ureteroscopy: Removing kidney stones using thin telescopic instruments
  4. Cystoscopy: Using a tiny camera to examine an affected area in the bladder through the urethra.
  5. Lithotripsy: Using shock waves to break down kidney stones.
  6. Penile prosthesis: Implanting a device in the penis to treat erectile dysfunction.
  7. Vasectomy for male sterilization.
  8. Circumcision: Removing some or all prepuce (foreskin) from the penis.
  9. Incontinence sling procedure: Implanting an internal support to the urethra to lift it to the normal position and treat incontinence.
  10. Laser vaporization or transurethral resection of prostate: Using a tiny instrument with a laser or electrical loop inserted into the penis to help remove obstructing tissue.
  11. Brachytherapy: Treating prostate cancer by inserting radioactive “seeds” directly into the tissues harboring the cancerous tumor.
  12. Hypospadias: Reconstructing a straight penis, making its urethral opening as close to the penis tip as possible.
  13. InterStim (sacral nerve stimulation): Implanting a tiny pacemaker near the tailbone.
  14. UroLift: Procedure to lift or hold the enlarged prostate tissue out of the way to prevent blockage of the urethra.
  15. Botox injection: Injecting Botox directly into bladder muscles.

For the more complex procedures that require special equipment, patients are usually admitted to the hospital. For example, robotic surgery procedure, pyeloplasty (reconstruction of renal pelvis), nephrectomy, ureteral reimplants and ureteral stent placement are conducted in hospital settings.

At Advanced Urology Institute, we are committed to delivering top-notch urological care to all our patients. Our surgeons are fully-qualified, board-certified, fellowship-trained urologists, who are renowned for their exceptional expertise in treating urological problems. We also have surgical centers that are supplied with the latest medical equipment and technologies to provide the best possible care.
For more information about our urological services, visit the Advanced Urology Institute website.

Prostate Cancer Recurrence: What Should You Know According to Dr. Jonathan Jay?

KEY TAKEAWAYS:

  • Prostate cancer recurrence can occur due to cancer cells left behind during treatment or because the cancer was initially diagnosed as less advanced than it actually was.
  • A rise in Prostate Specific Antigen (PSA) levels and the use of PET/CT imaging scans are effective ways to diagnose recurrent prostate cancer.
  • Treatment options for recurring prostate cancer depend on the initial treatment and may include radiation therapy, surgical removal of the prostate, cryotherapy, or hormone therapy.

Cancer of the prostate affects a small gland that is situated just in front of the rectum and around the base of the urethra in men. It is the most common type of cancer in men, with those over age 50 facing the greatest risk. The good news is that prostate cancer is treatable. Treatment options include surgical removal of the prostate gland, radiation therapy, hormone therapy and chemotherapy. A combination of various treatment methods may be applied for full effect. Sometimes, however, even after treatment has been administered successfully, the prostate cancer returns. This is called a recurrence and it occurs with other types of cancer too.

Causes of Prostate Cancer Recurrence

Prostate cancer can recur for two main reasons.

1. A small clump of cancer cells left behind during the earlier course of treatment can grow into a larger number.

2. The cancer initially was diagnosed as being less advanced than it actually was. For instance, a patient might be diagnosed with cancer that is limited only to the prostate while in fact, the cancer might have advanced to the surrounding lymph nodes.

Diagnosis of Recurrent Prostate Cancer

Dr. Jonathan Jay with patientA major indicator of recurring prostate cancer is a rise in Prostate Specific Antigen (PSA) levels. PSA is a protein produced by the prostate. A PSA test is always conducted as part of the preliminary work in the diagnosis of prostate cancer, whether initial or recurrent. Ideally, after successful treatment, PSA levels should go down and should stay consistently low. If the level starts to rise again, that is a red light that should be followed up with further testing.

Another test, which doctors agree is very effective in checking for recurrent prostate cancer, is the PET/CT imaging scan. Dr. Jonathan Jay, who has an office in Naples, FL, says the scan is effective because it has the ability to localize the cancer and map out its extent with great accuracy. Treatment of cancer usually depends on being able to tell exactly what part is affected. If this can be done, then it becomes easy to direct treatment at that specific area, which is what a PET/CT imaging scan does.

Treatment of Recurring Prostate Cancer

The form of treatment depends on what was initially administered. The following options are available:

1. If the prostate was surgically removed the first time, radiation therapy may be administered to treat the recurrent cancer;

2. If radiation therapy was administered the first time, a surgical removal of the prostate may be recommended. That decision depends on whether or not the cancer has spread outside of the prostate.

3. Cryotherapy. This treatment involves freezing the cancer cells to kill them.

4. Hormone Therapy. This may be used in combination with other methods. It is also used as a last option when the cancer has spread very far.

The management of recurrent prostate cancer depends on finding the cancer, which most likely would be detected in a post treatment screening. Men who have undergone successful prostate cancer treatment should attend regular screenings after the treatment is finished. Followup screening and checkups are important, and it is important to seek out a comfortable, patient centered treatment center, such as the Advanced Urology Institute. The staff at Advanced Urology Institute is very experienced in working with patients and helping with questions, diagnosis and treatment. They have the knowledge and technology to work with the patient through every step of the process. For more information, visit the Advanced Urology Institute website/

TRANSCRIPTION: 

Prostate cancer is one of the most common types of cancer in men, affecting about one in nine. While prostate cancer can be cured in some men, approximately one in three men will experience what is known as recurrent prostate cancer, which is prostate cancer that has come back after initial treatment. Now unfortunately, prostate cancer is the second leading cause of cancer death in men; about one in 41 will die from prostate cancer this year, and that’s according to the American Cancer Society.

The good news is that there are newer imaging techniques that can help locate recurrent prostate cancer. Being able to locate the disease in the body can really help doctors personalize care for patients living with recurrent prostate cancer. Here to help us understand more about this is Dr. Jonathan Jay and his patient Peter Irving. Welcome to both of you.

Thank you. Doctor, let me start with you. This is Men’s Health Month, so let’s start with prostate cancer and what it is.

Well, we’ll take a step back and start with what the prostate is because most people don’t understand what the prostate is. The prostate is a male reproductive organ, and one-third of the fluid that a man sees in his ejaculation comes from the prostate. The purpose of this fluid is to nourish and protect sperm until conception.

It’s treatable?

Yes, prostate cancer is treatable. Prostate cancer in its treatable stages is asymptomatic, so it’s very important for men to understand that they need to have an evaluation on a yearly basis starting at age 50, which would entail a rectal examination and a blood test called PSA.

Alright, so let’s bring in Peter. When were you diagnosed? What happened?

In 2008, I was diagnosed with cancer following a needle biopsy in which 12 out of 13 were positive. So you were doing a routine exam, Peter?

Just routine, and the PSA started to spike over a period of months. From what to what?

My normal was 1.5, let’s say, and this kept creeping up, and I think my general practitioner sent me to a urologist when it got to like four or five. But at that time, they still did not believe I had prostate cancer; things just weren’t what they thought they should be. That’s why I went to the urologist, and then I had the needle biopsy.

Which confirmed it?

Which confirmed it, and then I went and had surgery, had it removed, and followed with the same urologist. To be checked?

Yeah.

Alright, doctor, let me bring you in. If you could define PSA for us, please, and inform us of the levels that happened.

PSA stands for prostate-specific antigen; it’s a protein that’s excreted solely by the prostate, so it’s a great way of monitoring whether a patient has prostate cancer, develops prostate cancer, or has a reoccurrence of prostate cancer. The significance of PSA is what the PSA is in an individual. In Peter’s case, his PSA was one and increasing over time; that was indicative that something was changing and something was wrong.

Understood. So, Peter, you have the surgery, you’re living your life, and then you have recurrent prostate cancer?

Well, my PSA started to spike again, you know, in theory, you shouldn’t have any PSA.

Exactly. And I believe it was somewhere again in the ones, and then it kept rebounding and going up and up, and we watched it for four years. In 2016, they decided to do radiation therapy and hormone therapy together, and they concentrated on the spot they found through the new imaging, and today I’m zero.

That’s fantastic. Doctor, since he mentioned the new imaging, it’s a PET CT imaging test. Tell me, what is different about this test as opposed to what is always used, I guess, in a bone scan and CT, right?

Yes. So, what are the differences between what was used then and what he used?

We had to define the location and extent of this disease, so conventionally, how do we do that? CT scan is a test that has the ability to survey the body without making an incision; we can survey the body for soft tissue changes, we can detect enlarged lymph nodes, we can detect masses within the abdominal cavity. Bone scan surveys the bone for reoccurring disease. Now, think of this: with these conventional tests, you have to have a mass—a mass would be hundreds of thousands or millions of cells in one place—to be detected by these conventional studies. This newer CT PET scan has the ability to define the location and extent of prostate cancer, reoccurring prostate cancer, at an earlier stage and at a lower PSA.

And how does that make a difference then for the treatment?

It’s very important because we want to treat the disease; we need to define the extent and location of the disease, as that dictates our treatment options. So, as opposed to, let’s say, affecting other organs in the body, you’re minimizing the effects?

Absolutely. In Peter’s case, we were able to do a CT PET scan, localize reoccurrence to one area within the pelvis, and we were able to treat that, but we treated that with radiation or hormonal therapy. We were able to treat that without affecting any of the other organs around it.

Peter, you’re doing fine now, right? Everything is controlled?

A negative PSA test for two-plus years.

So, for our viewers out there, and we have lots of males, what would you say, what would be your final thoughts, your words of wisdom?

Just have a routine, probably at the age of 45.

45, 50, yes. Start getting your PSAs on a yearly basis, and it’ll make you feel much better. Absolutely. So not worrying about that.

Doctor, any final takeaways?

One of the important things is that prostate cancer is prevalent in our community, yes, but if found early, it’s a treatable medical condition, and all you have to do is a simple rectal examination and a blood test called PSA with your primary care physician. If something were to happen again in the future, would you suggest again this new imaging test to him?

Absolutely. If we saw increasing PSAs, the first thing that I would do is this new CT PET scan.

Alright, thank you so much, gentlemen, both of you for your time. Thank you, and I’m glad you’re doing fantastic.

REFERENCES: 

Female Pelvic Medicine and Reconstructive Surgery at AUI

Advanced Urology Institute (AUI) is an organization that brings together trained, competent and board certified urologists. AUI is well known for its specialization in the treatment of urological disorders in men. Much less known is that urologists at AUI also offer treatment for urological and pelvic disorders in women. Female patients with pelvic organ prolapse can visit any AUI facility where they will find an impressive variety of treatment options. In addition to organ prolapse, AUI also treats kidney problems, bladder complications, urinary tract infections, incontinence, and problems with sexual function.

Treatment Options Available for Pelvic Organ Prolapse

A pelvic organ prolapse involves the drooping of pelvic organs due to a weakness in the muscles of the pelvic floor. When this happens, the bladder, the small intestine, the rectum, the uterus or the upper vaginal wall drops into the vagina. The condition disrupts the urine flow and can affect the reproductive function by making it difficult, uncomfortable or painful to have sexual intercourse.

The condition can be treated by:

1. Physical exercise

Kegel exercises can strengthen pelvic muscles. The exercises involve a woman imagining she has to urinate, then instead of letting it out, she squeezes her muscles to hold it in. It is recommended to repeat the exercises 10 to 15 times a day.

2. A pessary

This is a ring-like device that is inserted into the vagina to hold the affected organ in its proper place.

3. Pelvic Reconstructive Surgery

Dr. Rolando Rivera - Naples, FLReconstructive surgery is a testimony to how much technology has improved the practice of medicine. In cases of pelvic organ prolapse, the surgery is performed to restore the affected organ to its proper place. There are different types of reconstructive surgery, depending on the type of organ prolapse being treated. Whatever the type of reconstructive surgery, however, it is a minimally invasive procedure.

Even though it is effective, not every patient qualifies for reconstructive surgery. Some factors that must be considered include:

  • When a woman intends to have children. The surgery may be discouraged because the prolapse may return after the birth.
  • Age. Younger women may be advised not to have the surgery because of the risk that it may recur and they are more likely to have a child in the future, increasing the risk of a recurrence.
  • When one has a serious illness, it may be advisable not to have the surgery so as to avoid complications.

The well being of the patient is a top priority at AUI. A female patient with organ prolapse will not only receive the most advanced treatments available, the team also will listen to her questions and work with her on a plan of treatment that is best suited to her needs. AUI makes it a priority to provide information on the topic of pelvic organ prolapse and to be available to discuss any concerns. For more information, visit the Advanced Urology Institute website.

How Do You Treat Common Urology Problems?

There are numerous conditions that affect the urinary system in both men and women. Ordinarily, diseases of the urinary system affect one or more parts of the urinary system, including the kidneys, bladder, urethra, ureters, and in men, the prostate gland.Common urology problems include urinary tract infections, incontinence or urine leakage, pelvic organ prolapse in women, overactive or underactive bladder, enlarged prostate in men and kidney or bladder stones. Most urological conditions can be treated and the patient can return to full health.

Treatment of Common Urology problems

The treatment of a patient will depend on how far the illness has progressed and how severe the symptoms are. The most common treatment methods are:

1. Behavioral modifications and Physical Therapy

Once a specific condition is diagnosed, the first course of treatment focuses on:
a. Changing any of the patient’s behavioral practices that may contribute to the disease; and
b. Introducing practices that strengthen the affected organ or the body in general.
For example, when patients are diagnosed with incontinence, they may be advised to cut down on the intake of fluids such as water and coffee. Similarly, patients with pelvic organ prolapse may be advised to undertake pelvic exercises to strengthen the muscles of the pelvic floor.

2. Medication

Medication can be prescribed for urological conditions in the same way that they are prescribed for other illnesses. Medication works for moderate to severe illnesses that cannot be managed through behavioral modifications alone. Some medications are taken orally while others may be injected. The most common categories of drugs include:
a. Antibiotics. Antibiotics treat simple cases of urinary tract infections successfully.
b. Anticholinergics. These treat an overactive bladder.
c. Alpha-blockers. These are used to treat prostate enlargement in men.

3. Surgical Procedures

The severity of a problem may require that a patient undergo surgery. Most urological surgeries are minimally invasive. Urologists use technological tools that make the procedure less painful and less traumatic, with the result that a patient recovers very quickly. There are a variety of minimally invasive procedures for treating pelvic organ prolapse, incontinence and an enlarged prostate in men.

The appropriate course of treatment can only be determined after tests are conducted and a diagnosis is made. The available forms of treatment may be used. Our specialists at Advanced Urology Institute can help you find the right tests and work with you on a plan of treatment that is most beneficial to you. They can answer any questions or concerns and help you reach your own decisions on your care. For more information, visit the Advanced Urology Institute website.

Are Enlarged Prostate and Urinary Problems Common?

Enlarged prostate and urinary problems are quite common in Florida. At Advanced Urology Institute, we see hundreds of men and women with different kinds of urinary problems every month. And for men, the most frequent condition is enlarged prostate — also called prostate gland enlargement or benign prostatic hyperplasia (BPH). It is the most frequent problem for men over age 50; more than 50 percent of men have BPH by age 60. By age 85 and older up to 90 percent of men have the condition.

Normal part of aging

Just like gray hair, BPH is a natural result of getting older. But the trouble is, it is characterized by nightly trips to the bathroom which may become too frequent and eventually disrupt daytime routine. In some cases, an enlarged prostate may make it difficult for you to sit through a plane flight or meeting without getting up. So it can be a really annoying problem.

How does BPH occur?

As men grow older, the prostate gland becomes bigger with cells multiplying gradually and creating an enlargement that exerts pressure on the urethra. Since urine flows from the bladder through the urethra in men, an enlarged prostate blocks urine flow. With increased pressure on the urethra, the bladder is compelled to contract more forcefully to push urine through the body. With time, the bladder muscles become thicker, stronger and overly sensitive, beginning to contract even when only a small amount of urine is inside and triggering the need to pass urine frequently.

Eventually, bladder muscles fail to overcome the effect of a narrowed urethra and cannot empty all the urine. That means some urine is left inside the bladder every time after urination. When the bladder is continuously not emptied completely, there is an increased risk of urinary tract infections. Incomplete emptying also can lead to serious problems over time, including incontinence, blood in urine, bladder stones and acute urinary retention (the inability to urinate). In rare cases, incomplete emptying of the bladder may cause bladder damage or even kidney damage.

Symptoms of BPH include:

  1. Frequent urination
  2. Urgent urination
  3. Nocturia (frequent urination at night)
  4. Trouble starting urination
  5. Weak urine stream
  6. Urine stream that stops and starts
  7. Straining to urinate
  8. Inability to empty bladder completely
  9. Returning to the bathroom to urinate a few minutes after urinating
  10. Dribbling at the end of urination

In rare cases, signs of BPH also may include:

  1. Blood in urine
  2. Inability to urinate
  3. Urinary tract infection

A sudden and complete loss of ability to urinate is a medical emergency so you should see a urologist immediately. But you also should see a doctor whenever you are experiencing urinary symptoms, even if they are not really bothersome. Such visits to the doctor will ensure that the underlying causes of your condition are identified or ruled out. Remember that undiagnosed and untreated urinary problems may cause complete obstruction of the urinary tract, bladder and kidney damage and other serious problems.

At Advanced Urology Institute, we offer several safe and effective treatments for urinary problems. For instance, if you have BPH, we may:

  1. Offer a long course of antibacterial medication to treat bacterial prostatitis.
  2. Provide medication to improve your urine flow and relieve symptoms.
  3. Perform surgical procedures such as:
      • (a) Transurethral resection of your prostate (TURP).
      • (b) Transurethral incision of your prostate (TUIP).
      • (c) PVP (green light laser resection) or HoLEP (holmium laser resection) of prostate.
      • (d) Open prostatectomy for very large prostates.
      • (e) Urolift (transurethral insertion of clips to separate prostate lobes).
      • (f) Aqua-ablation (removal of prostate tissue with water jets).
      (g) Rezum therapy (removal of prostate tissue with steam).

So you don’t have to suffer embarrassing urinary symptoms when you have BPH. At AUI, we can fix your condition and enable you to live your life with freedom and confidence. For more information on our treatment options for BPH and other urinary problems, visit the Advanced Urology Institute website.

What is Erectile Dysfunction and How to Treat it?

Erectile dysfunction is the inability to have or maintain an erection firm enough for sexual intercourse. Any man may find himself occasionally unable to achieve an erection. That is normal. It is only when this inability becomes a sustained everyday occurrence that he may consider the possibility of erectile dysfunction.

The main factor for erectile dysfunction is aging, starting about the age of 50. Over 50 percent of men over 50 suffer from erectile dysfunction. Other risk factors include cardiovascular disease, high blood sugar, high blood pressure and high cholesterol levels. Emotional and mental conditions such as depression and anxiety also can cause erectile dysfunction.

Treating Erectile Dysfunction

Men who suffer from erectile dysfunction have a number of treatment options. If it is a symptom of an underlying illness, treatment should be focused on the underlying illness. When erectile dysfunction appears with no underlying cause, the following treatment options are available and are highly successful.

1. Oral Medication. These are pills given to increase blood flow to the penis, thus causing an erection. The most common ones are vardenafil or Levitra, Cialis or tadalafil, viagra and avanafil. Oral medication is most successful in patients with mild cases of erectile dysfunction.

2. Penile injections. The most common injectible drug is alprostadil. Using a very fine needle, a patient injects the drug into the base of the penis. The drug increases the size of the arteries that supply blood to the penis. Alprostadil also can be administered by placing a small alprostadil suppository at the opening of the penis, rather than by injection.

3. Vacuum erection device. This is a tube with a hand or battery powered pump. The tube is placed over the penis and the pump is used to draw air out, creating a vacuum. The vacuum thus draws blood into the penis, causing an erection.

4. Penile implants. A minor surgical procedure is used to introduce bendable rods at the sides of the penis. These rods give the penis a firmness that allows for intercourse. An alternative of the rods is the insertion of fluid filled cylinders connected to a pump placed in the scrotum. Engaging the pump inflates the cylinders which causes the penis to firm up.

It is advisable for men, especially those approaching age 50, to maintain a healthy relationship with a urologist. An experienced urologist can diagnose and offer advice on the best treatment options. It is also important to stay informed on the causes, signs and symptoms of erectile dysfunction. Many professional sites, such as the one maintained by the Advanced Urology Institute, are very helpful. Advanced Urology Institute also has an experienced team of specialists who can help with consultation, diagnosis and treatment. For more information, visit the Advanced Urology Institute website.

What are the advantages of the da Vinci surgical system?

The da Vinci surgical system is an advanced and effective tool for performing minimally-invasive surgeries. It is a state-of-the-art tool that makes the most of the surgeon’s skill, expertise and experience in conducting urologic procedures. Known as da Vinci because Leonardo da Vinci devised the first robot and used three-dimensional detail and incomparable anatomical accuracy to give life to his masterpieces, the surgical system gives physicians such precision and detail that it effectively simulates an open surgical environment while allowing the use of tiny incisions.

How does the da Vinci system work?

The da Vinci surgery is robot-assisted and minimally-invasive, done via small incisions. The robot’s hands offer a high degree of dexterity, which enables surgeons to operate in the very tight spaces and delicate tissues of the genitourinary tract that otherwise would only be accessed through the longer incisions of open surgery. The da Vinci robot is a self-empowered, computer-controlled device that has been programmed to help in the positioning and maneuvering of surgical instruments. It gives surgeons better precision, flexibility, accuracy and control over surgical procedures.

When using the da Vinci system:

1. The urologist operates from a computer console situated in the operating room, directing and manipulating miniaturized instruments mounted on 3 robotic arms to create small incisions in the patient.

2. During the procedure, the doctor looks through a 3D camera attached to a fourth robotic arm that magnifies the surgical site.

3. The hand, wrist and finger movements of the surgeon are transmitted straight through the computer console and to the instruments attached to the robotic arms, resulting in mimicked movements with the same range of motion as that of the surgeon and allowing maximum control.

4. The robot is supervised by the surgical team at the patient’s bedside.

What are the advantages of the da Vinci surgical system?

1. It ensures that surgeries are more precise by providing better visualization, improved dexterity and greater accuracy.

2. It enables surgeons to conduct complex surgical procedures using tiny incisions.

3. It replicates the surgeon’s technique and movements in real-time, with the surgeon seated just a feet away from the patient viewing an actual image of the operating field while performing the procedure in real-time by manipulating a miniaturized instrument and using tiny incisions.

4. It transmits force feedback sensations from the operating field to the surgeon, which are then used as a substitute for tactile sensations and are augmented by the superior vision offered by the high-resolution 3D view to deliver better visualization, accuracy and precision.

The da Vinci is designed to ensure that both simple and complex procedures are done using incisions of 1-2 cm (also called operating ports), potentially resulting in:

1. Reduced trauma, pain and discomfort to patients
2. Fewer complications
3. Shorter recovery time and quicker return to routine activities
4. Minimal scarring
5. Reduced blood loss and need for transfusions
6. Minimal hospitalization costs

At Advanced Urology Institute, we have incorporated the da Vinci surgical system into our practice. Over the years, we have been able to use the increased range of motion, improved visualization, enhanced dexterity and greater surgical precision offered by the robotic system to deliver improved treatment outcomes to our patients. We are also proud of the skilled and experienced professionals at AUI whose training, fortitude, passion and expertise in the use of advanced technologies have enabled us to provide the best possible care to our patients. For more information on our services, visit the “Advanced Urology Institute” site.

Ways to Treat Erectile Dysfunction

If you suspect that you have erectile dysfunction, you need to talk to your doctor about it. Then you can work with the doctor to determine the underlying factor or cause of the condition. Actually, ED can only be effectively treated if what is causing it is known. In fact, you may find that your condition improves with only simple lifestyle changes, such as losing weight, quitting smoking or drinking less alcohol. And if it is a medication you’re taking that is causing the problem, your doctor may treat the condition by reducing the dosage or having you try another drug.The treatment options for ED include lifestyle changes, counseling, medications, penile injections, vacuum pumps and surgery.

1. Lifestyle changes

Making lifestyle changes can reduce the severity or improve erectile dysfunction. Some of the changes are:

a. Quitting smoking
b. Stopping or reducing alcohol consumption
c. Increasing physical activity or exercise
d. Cutting down body weight
e. Stopping the use of illegal drugs

2. Seeing a counselor

Your urologist may recommend that you see a counselor if your erectile dysfunction is worsened by psychological or emotional issues. In many cases, counselors require that you go with your partner to the counseling sessions so she can know how best to support you. And as you work on the anxiety and stress issues with your counselor, your urologist will be focused on treating any underlying physical issues. Usually only a handful of sessions with the counselor will be enough for you to overcome ED.

3. Medication

The first treatment that your urologist will offer to treat ED is oral pills. Common oral medications for ED include:

a. Sildenafil (Viagra)
b. Tadalafil (Cialis)
c. Vardenafil (Levitra or Staxyn)
d. Avanafil (Stendra).

These medicines work by relaxing your smooth muscles and increasing blood supply to the penis following sexual stimulation. You’ll be required to take them anywhere from 15 minutes to 36 hours before sex, depending on the particular drug your doctor has prescribed. Vardenafil (Staxyn) dissolves in the mouth, but the other pills are swallowed. However, you aren’t allowed to take any of these drugs more than once per day. The drugs are effective in about 80 percent of men who use them, although if you have an erection that lasts beyond 4 hours, you should seek emergency medical help.

You should not take these medicines as treatment for ED if you are already taking nitrates for a heart disorder. Since nitrates also relax and widen blood vessels, their combination with these drugs leads to a sudden reduction of your blood pressure, which may cause falling, fainting or dizziness and possible injuries. Likewise, if you are already taking drugs to treat enlarged prostate (BPH), inform your doctor about them. A combination of BPH medications called alpha-blockers with ED medicines also may result in sudden reduction of your blood pressure.

In case your erectile dysfunction is due to low testosterone levels, the urologist may prescribe testosterone. However, testosterone therapy won’t work for you if you have nerve or circulatory problems. So you must be very open with your urologist about your other medical problems before you are given any medications.

4. Penile injections

Injecting the penis with a drug called alprostadil can trigger a stronger and firmer erection. While oral medications are able to cause an erection after sexual stimulation, you can’t get an automatic erection with them. That’s why your doctor may at times opt for injecting a drug into the penis to ensure you achieve erection automatically even without sexual stimulation.

5. Vacuum constriction devices (pumps)

Vacuum pumps pull blood into the penis, resulting in an erection. A typical vacuum device is an external pump supplied with a band that you can use to achieve and maintain an erection. According to several studies, up to 50-80 percent of men who have used vacuum erection devices are pleased with the results.

A vacuum device has three components:

a. A plastic tube (cylinder), which you place toward the end of your penis.
b. A pump, which drives out air from the tube in order to create a vacuum.
c. An elastic ring (band), which you place on the cylinder, on the other end applied to your body, and then move it from the tube to the penis in order to maintain erection.

To use the vacuum erection device, you place the pump over your penis and pump out air from the tube (cylinder) to create a vacuum. The vacuum then pulls blood into the penis’ shaft and makes the penis longer and firmer. Once the penis is erect, and with the help of a lubricant, you slide the retaining band downward onto the lower end of your penis. You also remove the pump once you have released the vacuum.

The elastic ring sustains the erection by stopping blood from moving back into the body during intercourse. So you can only attempt intercourse with the elastic ring in place. And the ring can be left in place for about 30 minutes to enable successful intercourse.

6. Penile prosthesis (Penile implant surgery)

Another option for treating ED is penile prosthesis in which your urologist performs an operation to implant either a malleable (bendable) device or inflatable device into your penis. A penile implant surgery is preferred when you have an obvious medical condition that is causing the ED and the urologist is sure that your condition won’t resolve naturally or with medications.

Usually, the simplest form of penile prosthesis is surgical implantation of malleable rods inside the erection chambers of your penis. Once implanted, the rods ensure that your penis is maintained in semi-rigid state and just requires lifting or adjusting to erect position for sexual intercourse. Malleable rods are a good option if you’ve had spinal injury or have limited hand strength.

Alternatively, your doctor may go for a hydraulic, inflatable implant. With this prosthesis, you can choose to get an erection when you need to. Inflatable implants increase the size of the penis through a pump that’s located in the scrotum. The advantage of an inflatable implant over malleable rods is that the erection is more natural and easier to conceal than one achieved with malleable rods.

Penile implant surgery takes about one hour to complete and is usually performed in an outpatient setting. Following penile implant surgery, you’ll be able to leave the hospital the same day after surgery and can resume sexual intercourse 4-6 weeks after the procedure.

7. Artery reconstruction (Vascular reconstructive surgery)

Artery reconstruction is often a last resort treatment for ED because the procedure is costly, technically difficult and does not usually work. But the aim of the procedure, when recommended, is to boost blood flow in your penis and help you achieve an erection. During the operation, the urologist transfers an artery in another part of your body (usually from a muscle in the belly) to one in your penis, creating a path for blood to move around the blocked (affected) area. The procedure is only rarely considered, but may be an option for men younger than 30 who have ED because of injuries to their penis or the area around it.
Want to find out more about erectile dysfunction? Visit the “Advanced Urology Institute” site.