Prostate Problem Warning Signs

At Advanced Urology Institute, we frequently see first-time visitors with symptoms of advanced stage prostate problems. For us, that is quite heartbreaking because it means the patients come too late, when only limited treatment options are available for their conditions.

As urologists, we always want the best for our patients. We want to see them leave when they can pee better and are free from the embarrassment of accidental urine leaks. And because early detection and treatment of prostate problems — whether prostate cancer or non-cancerous condition — improve the chances of cure and of long-term survival, we always encourage men to be more mindful of their bodies, especially when it comes to their urinary function and habits. By doing that, they are able to detect warning signs of prostate issues early and can seek treatment.

Warnings signs of prostate problems include:

  1. Frequent urination or frequent urge to pass urine.
  2. Passing urine more often than usual, particularly at night.
  3. Pain, discomfort or burning sensation when passing urine.
  4. Dribbling urine
  5. Weak or interrupted urine streams.
  6. Accidental urine leakage.
  7. Blood in urine or semen
  8. Frequent stiffness or pain in your lower back, rectal area, hips, upper thighs or pelvic area.
  9. Difficulty or inability to urinate
  10. Trouble with starting or stopping your urine stream.
  11. Painful ejaculation
  12. A feeling that you aren’t able to empty your bladder completely.
  13. Swelling of lower extremities.
  14. Paralysis or weakness in lower limbs.
  15. Inability to pass urine while standing up.
  16. Loss of appetite and weight, fatigue, nausea and vomiting.

It is important to see a urologist immediately if:

  1. You find urination difficult, abnormal or painful. The doctor will examine your prostate gland to find out if it is inflamed, enlarged or has a cancer.
  2. You have frequent urination, urinary retention, blood in urine, dribbling or slow flow of urine, problems starting a urine stream, or repeatedly urinate urgently.
  3. You have a chronic pain in your pelvic, lower back, upper thigh or other areas of your lower extremities. While any unexplained ongoing pain in these areas may have various causes and always merits medical attention, seeing a urologist may help detect whether or not you have prostate cancer.
  4. You have swollen legs, weakness in your legs or trouble walking.
  5. You have unexplained weight loss.

As urologists, we have several options for tackling prostate problems, but our interventions normally depend on the severity of the symptoms, type of condition and how it is impacting your overall quality of life. For example, if the prostate condition is not severely affecting your quality of life and you have no complications (such as bleeding, bladder stones or urinary infections), the decision to treat the problem is often optional and left for you to make.

That means if you aren’t bothered enough to undergo a procedure or take medicine for the condition, then you’ll only need frequent follow-up with your urologist to check whether your symptoms remain stable over time and your bladder continues to empty well. But if you already have complications or your bladder is holding increased quantities of residual urine after urination, then we often begin treatment immediately.

To help you pass urine better, we may offer medications such as alpha blockers, 5-alpha reductase inhibitors or a combination of drugs. But minimally invasive surgical procedures such as TUMT (transurethral microwave thermotherapy) and TUNA (transurethral needle ablation), water-induced thermotherapy, PVP (photoselective vaporization of prostate), and HoLAP (holmium laser ablation of prostate) also may be considered. For more information on diagnosis and treatment of prostate problems, visit the “Advanced Urology Institute” site.

Becoming a Urologist with Dr. Rishi Modh

Being a urologist is an opportunity to help people and make a difference in their lives. As a urologist, people come to you with sensitive and often awkward conditions of the genitourinary tract and you assess the problems and provide the most appropriate remedies. The goal of urologists is always to make interventions that ensure patients are able to live fuller lives. And that makes us proud of our work and of our unique place in the medical profession.

Urology — a big world of stuff

Many people think of urology as merely being about urine. But urology is a massive world that covers a wide range of stuff. It’s an amazing and exciting specialty, where you perform surgery, manage problems medically, develop enduring relationships with patients and go home every day feeling satisfied with your work. I like urology because I’m often able to see the results of my work. For example, when patients come with urological cancers — of the prostate or kidney — I am often able to make effective interventions and achieve great outcomes. Actually, almost all my operations usually result in improved quality of life.

Why urology?

Urology was a natural fit for me. I wanted to be involved in diagnosis, medical management and surgical procedures. With most of my cases I have found that wonderful balance of medicine and surgery in urology. I also like listening and talking to people, leading them to open up and share their problems, guiding them to see the bigger picture and helping them to make informed decisions. In urology, I’m able to do this and much more with my patients. Most crucially, I joined urology to have a chance to make a difference in people’s lives. And indeed, I have found the specialty well-rounded, fascinating and exciting, as well as a powerful instrument for improving people’s lives.

Path to urology

I was born and grew up in Tampa, Florida, where my passion for the health and well-being of the people around me and for public health and sanitation made me a volunteer in many causes right from a young age. I soon realized that pursuing medicine would help me to make a better contribution in health care and improve people’s lives. So I joined the University of Miami for my medical education, graduating with AOA honors. Then I went to Shands Hospital, University of Florida for my urology residency. Currently I am happy and proud to be back in Florida where I’m practicing and living the dream of my life — making a difference in people’s lives.

Areas of expertise

As a urologist, I routinely deal with a wide variety of issues, such as urinary tract infections, overactive bladder, urinary incontinence, low testosterone and prostate enlargement. I also offer procedures for kidney transplants, interstitial cystitis, prostatitis, overactive bladder, congenital abnormalities, urinary stones, correcting stress incontinence, operating on adrenal glands and treating bladder, prostate and kidney cancer. I provide vasectomies, vasectomy reversals and treat erectile dysfunction and infertility issues in men.

What makes urology even more interesting is the continuous integration of advanced technology. Today we can access the urethra via the bladder and get into the kidneys without making any incisions. Even operations to remove kidneys or prostates, which previously required open surgery, are now routinely performed robotically or laparoscopically — using tiny, image-guided instruments.

At Advanced Urology Institute where we use the da Vinci surgical system for several operations, a urologist can now just sit at a console, have fingers in sensors and remotely control a multi-armed robotic surgeon, which ensures access to more areas in the body and provides seamless movement during operation in ways that are impossible laparoscopically. Application of such technology guarantees less scarring, less blood loss and quicker recovery for our patients. And for the urologist, it’s always exciting in the operating room working with such technology.

Job satisfaction

It takes long and hard training to become a urologist. The residencies take 5-6 years and typically involve long hours of complex work and limited sleep. Then there are several hours per week spent in the operating room, which may test anyone’s tenacity and patience. However, it helps that urologists are generally professionals with a positive attitude, good bedside manners and vast empathy. So these challenges can hardly diminish our enthusiasm and commitment to urology.

As a urologist, you are always conducting tests and procedures that may be quite uncomfortable for your patients, delivering news about diagnoses that your patients may not want to hear, and facing medical emergencies requiring you to think on your feet and solve issues to the best of your ability. But with skills to communicate well, eyes for detail and unquenchable desire to help people, you’ll always find yourself on top of things.

I really like urology because I’m a hands-on person who enjoys the hours it offers in the operating room. There are many potential conditions to treat, a wide range of procedures to perform and different tools to use —so no two days are the same. From a vasectomy to vasectomy reversal, circumcision to delivering antibiotics for urinary tract infections, laser surgery to robot-assisted procedures, there’s a lot to keep a urologist engaged and involved.

Urologists also are at the forefront of advanced technology, having pioneered laparoscopic approaches that have been adopted by other medical specialties and now leading the way in the use of cutting-edge robotics. The field is ever growing and changing, and we are constantly researching, learning and innovating to perform our duties better.

Most essentially, urology allows you to build lasting relationships and make a difference in people’s lives. I follow my patients over time, getting to know how they are doing and helping them make informed decisions. I enjoy what I do because I’m always involved in improving, prolonging and saving lives.

Why Advanced Urology Institute?

Advanced Urology Institute stands out for its commitment to excellent urological care. By bringing together a huge number of driven, hard-working, experienced and certified professionals, and having them adopt a collaborative, multidisciplinary patient-centered approach to care, AUI not only gives urologists an opportunity to grow, but also offers them a working environment that brings out the best of their knowledge, skills and experiences. I like the fact that all administrative duties have been centralized and we have all the time we need to work with our patients and give our best.

It’s also good that colleagues at AUI are quite laid back, funny and relaxed people. We are serious about our work but we also enjoy jokes with each other and maintain a positive, friendly practice. It’s a fantastic place full of people who love what they do and who handle diverse issues and patients with utmost diligence and thoroughness. And because we love our job, we work harder to get better at it and to achieve great outcomes for our patients. For more information on our urological services, visit the “Advanced Urology Institute” site.

Options for Treating Benign Prostatic Hyperplasia

The prostate is a tiny gland situated between the bladder and the penis. But as men get older, the gland grows larger, putting pressure on the urethra and bladder and causing urinary problems. An enlarged prostate is medically called benign prostatic hyperplasia (or BPH), a condition that’s quite common in older men. In the U.S. around 50 percent of men 51-60 years old have BPH while up to 90 percent of men over age 80 are affected by the condition.

The common symptoms of an enlarged prostate are:

  1. Inability to delay urination.
  2. Urge to urinate more than 8 times a day.
  3. Frequently waking up at night to pass urine.
  4. Dribbling after urinating.
  5. Urinary incontinence (urinating accidentally).
  6. Inability to completely empty the bladder (urinary retention).
  7. Having intermittent or weak urine stream.
  8. Straining to pass urine or difficulty starting urination.

So what are the options for treating BPH?

As urologists, the first thing we do when a patient has symptoms is to rule out other possible problems. We talk with our patients to learn the nature and severity of their symptoms, conduct exams, do ultrasound and relevant tests. Once it’s confirmed that it is BPH, we begin treatment starting with the least invasive procedures. Treatment options for BPH include medication, minimally invasive procedures and surgery, although various lifestyle changes also can improve or prevent symptoms.

1. Medications

The urologist may recommend medication to help control prostatic growth and reduce symptoms. For instance, alpha blockers such as alfuzosin (Uroxatral), silodosin (Rapaflo), doxazosin (Cardura), tamsulosin (Flomax) and terazosin (Hytrin) may be used to relax prostate muscles and make it easier to urinate. They quickly increase urine flow and reduce the need to urinate frequently. Another type of medication that may be prescribed is 5-alpha-reductase inhibitors, such as finasteride (Proscar) and dutasteride (Avodart), which limit the growth of the prostate by blocking hormones that promote growth of the gland. It generally takes 3-6 months for 5-alpha reductase inhibitors to relieve symptoms.

Phosphodiesterase-5 (PDE5) inhibitors such as Sildenafil, (Viagra), Tadalfil (Cialis) and Vardenafil (Levitra) may be given to help relax urinary tract muscles and relieve BPH symptoms. However, in some cases, particularly when either a 5-alpha reductase inhibitor or an alpha blocker isn’t effective on its own, urologists may give a combination therapy. This typically involves a combination of a 5-alpha reductase inhibitor and an alpha blocker and usually results in greater symptom relief.

2. Minimally invasive procedures

When medications fail to relieve BPH symptoms, the next step in treatment usually involves minimally invasive interventions. During the procedure, a urologist inserts an instrument into the rectum or urethra to either widen the urethra or destroy excess prostate tissue. For instance, TUMT (Transurethral Microwave Thermotherapy) uses microwaves to heat and destroy excess prostate tissue. TUMT does not cure BPH but makes it easier to pass urine, cuts down urinary frequency and reduces weak flow. Another treatment, TUNA (Transurethral Needle Ablation), uses high-frequency radio waves that are delivered via twin needles to burn a specific area of the prostate. TUNA is an outpatient procedure that relieves BPH symptoms and improves urine flow.

A third minimally invasive option for BPH is water-induced thermotherapy. During the treatment, hot water delivered through a catheter and into a treatment balloon located at the center of the prostate is used to heat up a definite area of the prostate and destroy problematic tissue. Once destroyed, the excess tissue is either reabsorbed in the body or excreted through urine. Another minimally invasive treatment option is the Urolift procedure, which involves inserting small implants into the prostate to retract, hold and lift the enlarged prostate tissue, opening up the passage for urine and relieving bladder blockage. While the Urolift procedure does not involve heating, cutting or removing the excess prostate tissue, it is effective in restoring normal flow of urine and relieving symptoms, and patients usually return home the same day without a catheter.

A revolutionary minimally invasive procedure for treating BPH is the Rezum system. During the treatment, sterile water vapor is injected into the prostate to help destroy overgrown tissue. It takes roughly three months for the body’s healing mechanisms to remove dead prostate cells and shrink the prostate, opening the passage for urine to flow. The Rezum procedure improves urine flow and relieves symptoms without the adverse effect of erectile dysfunction. It’s an ideal option for men who are medically unfit for the other procedures or for those already catheterized.

For prostates that have grown larger than 100 grams, a procedure called aquablation is a good option. It uses a high velocity saline jet to remove the overgrown prostate tissue. After the treatment is planned, the procedure is robotically driven, so its duration and side effects do not depend on prostate size. It does not use heat and postoperative bleeding is prevented by inserting a large catheter and applying a bladder washout (irrigation). The results achieved through aquablation are similar to TURP, except it comes with less dysuria and minimal irritation symptoms because no heat is used.

3. Surgical procedures for treating BPH

If both medication and minimally invasive procedures fail to improve BPH symptoms sufficiently, the urologist may recommend surgery. Surgical interventions also may be necessary if complications develop or symptoms become severe. The most common type of invasive surgery for BPH is TURP (Transurethral Resection of Prostate). In fact, it’s the first surgical option for treating BPH and involves the removal of excess prostate tissue by inserting a resectoscope through the urethra and into the prostate. Or the urologist can opt for TUIP (Transurethral Incision of Prostate) that involves making incisions in the bladder’s neck and into the prostate. The operation is done to widen the urethra and boost urine flow.

In other cases, the urologist may choose to perform laser surgery. This surgical procedure involves inserting a scope into the urethra and using the scope to deliver laser to the prostate tissue. The laser treats enlarged prostate through either enucleation (cutting) or ablation (melting). Both the GreenLight Laser PVP and Holmium laser ablation of prostate (HoLAP) procedures remove the excess prostate tissue by photoselective vaporization while holmium laser enucleation of prostate (HoLEP) uses two instruments, a laser for cutting and removing excess tissue and a morcellator for slicing extra tissue into tiny fragments for removal.

In complicated cases of BPH, such as men with much enlarged prostates or those with bladder damage, urologists may opt for open surgery. During an open simple prostatectomy, the urologist makes an incision just below the navel or numerous small incisions in the abdominal area via laparoscopy. The surgeon then removes the portion of the prostate that’s blocking urine flow.

At Advanced Urology Institute, our choice of treatment usually comes down to patient preferences and their ability to cope with BPH symptoms. We often prefer the least invasive options and give medication in many cases, but other treatment options are considered for patients who aren’t responding well to drugs or who can’t tolerate the adverse effects. As an alternative to TURP and open surgery, we prefer to treat BPH that’s characterized by acute urinary retention, high post-residual volume, recurrent urinary tract infections or bladder stones through the GreenLight Laser PVP or the newer heat treatments like TUNA and microwave. For more information on treatment options for BPH, visit the “Advanced Urology Institute” site.