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.

What is endometriosis?

Do you experience unbearably painful periods? Do you have severe pain in your abdomen or lower back every time your menstrual cycle starts? Are your menstrual cycles characterized by excessive bleeding, painful urination, painful sexual intercourse, or painful bowel movements?

You might want to consider getting checked to see if you are suffering from a condition called endometriosis.

With these symptoms, you should see a gynecologist or female pelvic medicine and reconstructive surgery (FPMRS) physician as soon as possible. At Advanced Urology Institute, we have FPMRS physicians at our Fort Myers center who can provide a proper diagnosis.

What is endometriosis?

Endometriosis is a disorder in which a tissue, similar to the tissue that lines the inside of your uterus, grows in an area outside of it. Although found outside the uterus, the endometrial-like tissue behaves like a typical endometrium. That is, it thickens, breaks down, and bleeds with every menstrual cycle.

Unlike the by-products of normal endometrial tissue, they have no way of leaving your body. That means they are trapped somewhere in your body and eventually result in complications.

They cause severe irritation, pain, and excessive bleeding, particularly during menstrual periods. They may also cause scar tissue and adhesions, making pelvic tissue and organs stick to each other. Ultimately, this condition may interfere with your sex life and even cause infertility.

Learn more about Endometriosis causes and treatment options.

Vasectomy vs Tubal Ligation – Dr. Yaser Bassel

My name is Yaser Bassel. I’m a board certified urologist with Advanced Urology Institute.

I do perform no-needle, no-scalpel vasectomies and that is an easy in-office procedure for sterilization. For men, that oftentimes is the better option than for women undergoing a tubal ligation. In that case, women oftentimes will have to have general anesthesia and require a surgical procedure. For men this is typically a ten to fifteen (10-15) minute procedure that’s performed in the office and oftentimes we can give patients a Valium tablet so that they are relaxed during the procedure. Afterwards, as long as the patient is compliant with no strenuous activities for one (1) week, they typically do not have any issues with regards to healing. Oftentimes men are concerned that a vasectomy can affect their libido or affect their erectile function [but] there is absolutely no correlation with that and there’s no effect on erectile function or libido for men.

Female Pain During Sexual Intercourse

Sexual intercourse shouldn’t be painful. But for some women, it is.
For some, there may be pain during sexual entry or thrusting. For others, there is a burning, aching, or throbbing pain with every penetration, even pain that lasts several hours after intercourse.

What could be the reason for this?

Pain can be experienced before, during, or after vaginal sexual intercourse. Also called dyspareunia, painful intercourse occurs at the top of the vagina and intensifies with thrusting. It is characterized by a tearing, burning, or aching sensation.

Painful Intercourse The condition can happen at any age. It tends to occur in women who are still young, but you may also have the condition during or after menopause due to decreased elasticity of the vaginal walls, narrowing of the vaginal opening, or increased vaginal dryness. You may also experience painful intercourse after surgical menopause — the surgical removal of ovaries.

Learn more about the causes, diagnosis and treatment of Painful Intercourse.

Vaginal Dryness: Causes, Symptoms, and Treatment

Has sex been giving you more discomfort than pleasure lately? Do you experience pain, irritation, burning or dryness? Is there bleeding or spotting during or after sex?

If there is, then you might be experiencing vaginal dryness.

For this condition, you may need to speak with a female pelvic medicine and reconstructive surgery (FPMRS) physician for help. At Advanced Urology Institute, we have FPMRS physicians at our Fort Myers center to ensure you get prompt attention from a location near you.

But first, what is vaginal dryness?

Vaginal dryness refers to a persistent irritating, burning, or itching sensation in the vagina. It is due to inadequate vaginal moisture that makes it feel too dry or too tight. The condition is more noticeable during sexual intercourse as it results in pain and discomfort.

Learn more about vaginal dryness, it’s causes, symptoms and treatment.

What is vaginal pain?

If something does go wrong down there, it can hurt a lot, incessantly presenting with a sharp pain or a constant unbearable ache. This pain can interfere with your sex life, your ability to socialize, and ultimately your quality of life.

What is vaginal pain?

It is chronic pain and discomfort in the vagina, usually with no known cause. Although the specific form of the condition varies with the underlying condition, it can be severe and excruciating to the point of interfering with your life. That’s why you need to see a female pelvic medicine and reconstructive surgery (FPMRS) physician for help.

At Advanced Urology Institute in Fort Myers, we have FPMRS physicians who ensure you get a diagnosis and treatment for vaginal pain.

Know more about the causes, symptoms and how it’s treated here.

How effective is a vasectomy reversal?

My name is Yaser Bassel. I’m a board certified urologist with Advanced Urology Institute.

When we counsel patients before they get a vasectomy, we do tell them that this is considered a permanent form of sterilization. However vasectomies can be reversed. The vasectomy reversal process is typically one that is not covered by insurance so it can be expensive but it is possible and typically with seventy-five to eighty percent (75-80%) success rates. [While], I do not personally perform the vasectomy reversals themselves, I do have a partner that specializes in that area. So if that is something men are interested in, that is something that is offered by our practice.

Common Prostate Health Issues – Dr. Yaser Bassel

My name is Yaser Bassel. I’m a board certified urologist with Advanced Urology Institute.

Most patients that come to us with regards to prostate health issues, the majority of them are dealing with benign disease, in particular something called Benign Prostatic Hyperplasia or BPH. Oftentimes those types of diseases and those types of symptoms can be addressed with medication and then beyond that, there are treatments for BPH that include in-office procedures and then beyond that, surgical procedures as well. 

The other spectrum is malignant prostate disease which is prostate cancer. Typically that is found with prostate cancer screening. We use the Prostate-specific Antigen (PSA) blood test for that and also digital rectal exam (DGA) to detect prostate cancer oftentimes in asymptomatic men. Typically treatments range from robotic prostatectomy, radiation therapy and now there are some newer technologies such as high intensity frequency ultrasound at our disposal. Beyond that, there are also new advanced prostate cancer therapies for prostate cancer that have gone out of the prostate as well.