What Female Urology Conditions Can Dr. Jonathan Jay Treat?


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

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

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

Aging and urinary problems

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

Informed decision-making

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

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

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

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

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

What does the treatment involve?

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

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

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

Remarkable outcomes

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

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


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

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

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

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

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

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


How Did Dr. Rolando Rivera Become a Urologist?


  • 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.


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.


What does a physician assistant do According to Janelle Bunce?


  • 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.


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.


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 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.

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.

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.

How Did Dr. Jonathan Jay Become a Urologist?


  • Dr. Jonathan Jay’s path to urology began with a background in physiology, medicine, residency training, and fellowship training before becoming a board-certified urologist.
  • A proficient urologist requires not only a deep understanding of medicine but also emotional intelligence, honesty, empathy, and compassion to effectively treat and support patients with a variety of urological conditions.
  • Dr. Jay chose to practice at Advanced Urology Institute (AUI) due to its centralized administrative tasks, access to cutting-edge surgical and medical equipment, collaborative and multidisciplinary approach to patient care, and friendly working environment.

Urology is a fascinating, stimulating and satisfying field of medicine. As urologists, we treat conditions of the urinary tract in both men and women, together with disorders of the male reproductive system. Being a urologist is an opportunity to care for people with agonizing, embarrassing and life-threatening conditions, such as kidney stones, urinary incontinence, erectile dysfunction, and genitourinary cancers, restoring normalcy in their lives. For those like me who are passionate about saving and improving lives, urology is a worthwhile career. For me, every day spent with my patients is not only an opportunity to serve and help people, but also contribute to saving or extending lives. In turn, the positive outcomes from various interventions bring joy and satisfaction.

Why urology?

Well, mine is a funny story. Growing up in Lansing, Mi., with both my parents having PHDs — my mother working at the Lansing School District and my father being a Michigan University professor — I learned to be inquisitive from a very early age. Being educators, my parents always encouraged me to be curious; to try to understand how various things worked. Eventually I became profoundly curious about how my body works and searched for answers wherever I could find them. As a result, I ended up studying physiology, then medicine, and ultimately specializing in urology.

Path to urology

Dr. Jonathan Jay - UrologistMy curiosity led me to study physiology — the study of how the body works — to learn more about the body. So I attended Michigan State University to pursue a Bachelor of Science degree in physiology. As I was studying physiology, I became interested in medicine. Upon graduation, I went to Ann Arbor, University of Michigan for my medical education. After that, I moved to Henry Ford Hospital for my residency training before going to and completing my fellowship training at the Beth Israel Deaconess Medical Center.

During clinical rotations in medical school I came across urology. I actually did not know anything about urology until my classmates at medical school told me about it. They really took me under their wings like a little brother. And because they liked me and I liked them, we were able to speak freely about our career aspirations and interests. So when they recommended that I study urology, telling me repeatedly that I had to try urology —”stay here and be a urologist’ — I gave it a shot and here I am, a board-certified urologist.

What does it take to be a urologist?

As urologists, we see the whole spectrum of age groups — from newborns to elderly patients. For instance, we can see children with congenital problems and care for geriatric patients with bladder control problems, sexual dysfunction or benign prostatic enlargement. So we delve into deeply emotional problems that require empathy, support and effective solutions.

That is why to be a good urologist, you need not only to understand medicine very well and be able to offer effective treatments, but you also must have emotional intelligence. That is, you need to know what to say, why to say it, when to say it and how to say it, and to treat patients as human beings, handling them in a warm, friendly and respectful manner. Actually, honesty, empathy and compassion are the marks of a proficient urologist.

Areas of expertise

I have practiced urology for several years now, seeing patients for a broad range of issues. Frequently I treat patients with enlarged prostate, urinary stones, urinary incontinence, prostatitis, testicular pain, recurrent urinary tract infections, urologic cancers and erectile dysfunction. But my areas of special interest include voiding dysfunction, pelvic floor reconstruction, urinary incontinence, female urology, urodynamics, and urogenital disorders triggered by neurologic disorders.

Over the years, I have performed pelvic floor reconstruction surgeries in both men and women, neuromodulation, surgery for bladder dysfunction, MonaLisa Touch laser procedure for post-menopausal sexual and urinary symptoms, Botox (botulinum toxin) injections, UroLift System procedure for BPH, and da Vinci robotic treatment for post-menopausal sexual and urinary symptoms. I also keep improving my knowledge and refining my skills through continuous medical education, training and research. I understand that I can only deliver the best to my patients when I have the right skills, tools and methods.

Job satisfaction

Urology is about providing relief to people with troubling and humiliating conditions. Patients come to us when they are at some of the lowest moments of their lives and we are able to address their issues and see them restored to normal lives again. Something unique about urology is that the problems we handle are often clearly defined, which means that almost every time a patient presents with a urological condition, we are able to pinpoint the exact etiology and extent of defect and then provide an effective solution.

Therefore, we are able to achieve great outcomes for almost all our patients. In fact, unlike other specialties such as neurology and oncology, the majority of our patients get better and do well after interacting with us. And with this understanding that we can solve many — if not most — of the urologic issues of our patients, we really feel satisfied with our work. And since we are able to achieve great results for our patients, they are always grateful and hold us in high esteem. So with urology, we are largely contented and happy about the work we do.

Why Advanced Urology Institute?

Urologists need a working environment that can bring out the best of their knowledge, skills and talents. For me, that dream place is Advanced Urology Institute. At AUI, all administrative tasks are centralized to ensure that physicians find enough time to deliver the best possible care. Urologists also have access to cutting-edge surgical and medical equipment and are able to apply the latest methods and techniques as soon as they are available.

Urologists at AUI work under a thriving culture of compassionate, collaborative and multidisciplinary approach to patient care, which enables frequent cooperation with other board-certified, skilled and experienced medical professionals. To crown it all, AUI clinics are always warm, friendly and buzzing with colleagues sharing stories, cracking jokes and interacting freely. It is always a wonderful experience being at AUI and I really feel privileged being part of the team.

Want to know more about AUI and the services we offer? Find out more by visiting the “Advanced Urology Institute” site.


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

Funny story, I just had a curiosity about how my body worked, so that led me into physiology because that was a study of how your body really works and then with time that just led into medicine.

Lansing Michigan, my family and my parents were educators, both PhDs, my mother working in Lansing School District, my father worked for Michigan State University as a professor.

Interesting enough, education was important in my family. I always had a curiosity about learning and understanding things, so that’s what they gave me, they gave me a curiosity of trying to understand things.

It’s funny, urology came about by a rotation through medical school, all the medical school students said, hey you got to try urology, they let the medical school, medical students close the wounds, that’s a pretty rare thing.

So all the guys were very nice, these guys took me under their wing like a little brother and so with that they said, hey why don’t you, they liked me, I liked them, they said why don’t you stay here and be a urologist.

Now urology was something that I never even knew existed, in fact they gave a lecture in the second year of medical school, I said who would want to do that, that is the grossest thing I’ve ever seen, but here I am being a urologist all because of a great experience that people provided me, took me under their wing like a little brother. So for me, I always felt like being a doctor you had to have four qualities. The first quality you had to have is you had to understand medicine. You don’t have to be the valedictorian of the class, but you got to understand medicine fairly well.

The next thing you have to have is stellar social intelligence. You got to be able to talk to a human being like a human being, be able to read social cues, know what to say, when to say and how to say it. Then above all you have to care and have empathy for another human being. You have to have all four of those qualities.