Dr. Brian Hale: Why Choose Urology?

My name is Brian Hale. I’m a board-certified urologist working with Advanced Urology Institute.

One of the nice things about urology is that most of the patients we see we can actually treat and help. We don’t have many things that we can’t fix for the patients, whether it’s medically or surgically.

Are urologists happy?

Yes, they are and I think it comes down to a lot of things that we do, we can actually be successful in treating the patients. When the patients are happy, we’re happy because of that.

Another thing is that urologists, I think, have a better work-life balance. We have emergencies like any [medical] position, but we don’t have so many emergency conditions we have to treat that we’re constantly away from home.

I went into urology because of surgery and when you’re in training, that’s pretty much all you’re doing. You have a little bit of clinic time but mostly you’re in the OR, because that’s the skill you’re trying to learn. When you come out [of surgery], there’s the medical side and I actually do like that side as well. I’m very happy that I’m able to do that medical side and talk with patients in the daytime and still have my surgeries as well. It’s kind of the best of both worlds.

Treating Benign Prostatic Hyperplasia

My name is Amar J. Raval and I’m with Advanced Urology Institute.

So one of the few things I specialize in my particular practice would be BPH or enlarged prostate. Whether it’s minimally invasive surgery like Urolift where you can kind of push the tissue away to open and to allow them to pee or whether its called Holmium or diode laser enucleation of the prostate and that’s where you carve out the prostate with the laser with one (1) incision in order to alleviate their outlet so that they can pee easier. I think that is very unique and it requires a unique skill set but it also has minimal bleeding and patients are generally satisfied when their catheter comes out quite quickly in the outpatient setting. That’s a unique skill that I offer to my patients. 


Treating Low Testosterone with Dr. Yaser Bassel

My Name is Yaser Bassel, I’m a Board-Certified Urologist with Advanced Urology Institute

Low testosterone at this point has come to the forefront a lot of times because of the advertising done by manufacturers of Testosterone. But for men the main reason for replacing testosterone is not necessarily to correct the number on a lab test but to correct symptoms. Mainly of low libido or mainly of fatigue, sometimes loss of lean body mass. All of those things can be corrected by fixing someone’s Testosterone, replacing their testosterone. And we can do that with topical agents that are applied to the skin, injections that are injected intramuscularly or sometimes pellets that can be implanted every 4-6 months. I will say for a lot of men, it can be life changing. You can change not only how they feel about themselves and their energy level and their libido but also their relationship with their partner, their wives and even the rest of their family for that matter.

Genetic Testing for Cancer Risk

My name is Amar J. Raval and I’m with Advanced Urology Institute.[For] men with prostate cancer or kidney cancer or upper tract urothelial carcinoma of the kidney, all of these can be predisposed to genetic risk factors. So [for example] if there’s family members with colon cancer or family history of prostate cancer or even females with breast or ovarian cancer. There are certain genes that are expressed that can be identified in these family members and so they can be screened earlier and be able to be detected earlier. This is huge in the realm of cancer and oncologic treatment because to be able to identify these patients earlier allows you to avoid bigger surgeries or avoid metastatic disease later in life and treat them so that you can extend years, joyous years in your life.

Bladder Cancer Treatment with Dr. Brian Hale

My name is Brian Hale. I’m a board certified urologist working with Advanced Urology Institute.

Fortunately, most of the patients that we find with bladder cancer have early stage cancer that we would cure with a simple outpatient procedure. If we find the cancer later, or the cancer is too large or so large that it invaded the bladder muscle then we have to do a more aggressive surgery, removing the entire bladder.

Technological Advancements in Urology

My name is Amar J. Raval and I’m with Advanced Urology Institute.

I love urology. I am privileged to be part of this community of urologists in the United States, and especially with Advanced Urology Institute. I think there are tremendous technological platforms that are available and we’re certainly unique in that field of surgery. From open [surgery] to robotics to laparoscopic to even prosthesis: whether it’s penile prosthesis or Interstim devices in the back to help control urinary incontinence, [and] urethral slings, there’s so much technology available in urology. It’s just a pleasure to be able to treat those patients.

Low Testosterone Symptoms with Dr. Brian Hale

My name is Brian Hale. I’m a board certified urologist working with Advanced Urology Institute.

Men with low testosterone usually have fatigue or loss of sex drive. That’s the thing that would prompt me to check a testosterone level. Lot of times they come in with erectile dysfunction and then I have to kind of bring that out of them [and ask] “Are you also having symptoms of low testosterone?”. If they do, we try to address that first before we treat erectile dysfunction.

The Advantages of Laparoscopic and Robotic Surgery with Dr. Amar Raval

My name is Amar J. Raval and I’m with Advanced Urology Institute.Laparoscopic and robotic surgery is unique because it minimizes your pain, it [does] small incisions, and less hospital stay. So those three things are a big deal and patients recover faster and can go home with minimal pain and discomfort.

Let alone with robotic and laparoscopic techniques, the visualizations are significantly improved. You’re able to small anatomy in great detail, in 3D and also make fine movements to have a nice outcome and surgery.

Advances in Prostate Cancer Research

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.

Kidney Stones Symptoms with Dr. Brian Hale

My name is Brian Hale. I’m a board certified urologist working with Advanced Urology Institute.

So patients who have kidney stones usually complain of flank pain, which is where the pain would be behind the lower ribs and sometimes it wraps around towards the front [and] down towards the groin area. Those are the most common symptoms, [sometimes] they’ll also have blood in the urine on our testing in the office.

Usually we’ll get an ultrasound or CT scan that diagnoses the stone, it’ll tell us the size and location. If the stones are smaller [about] less than 4 millimeters in size, ninety (90) percent of those times it will pass on their own. So on those patients, I give them a chance to try to pass the stone before we operate on them. When they’re bigger, they’ll be more than 6 millimeters in size, the less of a change of passing [the stone], less than ten (10) percent. For those patients, we look at the scheduling surgery for.