My name is Amar J. Raval and I’m with Advanced Urology Institute.
So kidney stone disease is very prevalent in Florida because of the heat, lack of hydration being a huge factor. Patients generally present with acute onset flank pain that doesn’t resolve with oral medication [and they experience] nausea, vomiting, fever, chills, even blood in their urine then they ultimately get some sort of imaging that shows that they have a stone that may be obstructing and causing them this discomfort. Approaches are very simple and they’re very endoscopic: they don’t require any incisions whether its leaving a stent to bypass a stone or if you’re going to treat the stone, you can use shockwaves from the outside to blast it or a laser to fine-tune the stone and take a piece of it and send it as a specimen to know what kind of stone it is. So technology certainly advanced in the realm of kidney stone disease, and there’s a lot of minimally invasive approaches to be able to treat that.
Well, yes—every day. At Advanced Urology Institute, we treat men with erectile dysfunction (ED) and achieve great results for our patients. Erectile dysfunction is a big issue for men today, regardless of their age. Up to half of all men experience some form of ED in their lifetime, with roughly 10% of men over 40 suffering severe forms of impotence.
What is erectile dysfunction?
Also called impotence, erectile dysfunction is the inability to regularly get or maintain an erection for satisfying sex. In general, an occasional problem should not be a cause for concern. In fact, it is normal to have trouble getting or keeping an erection for up to 20% of sexual encounters. But frequent trouble getting an erection indicates a medical problem. With ED, successful erections either become the exception more than the rule or they never happen.
Erectile dysfunction is a treatable condition. At Advanced Urology Institute, we offer several treatment options, generally beginning with the least invasive approach. We also give lifestyle advice that may help with overcoming the condition.
For instance, if your ED is due to inactivity, obesity, metabolic syndrome, high blood pressure or cardiovascular disease, we may recommend you engage in regular aerobic exercise to help reduce the symptoms. We may also recommend you quit smoking, minimize your alcohol intake and follow a healthy diet.
Treatments for ED include:
1. Phosphodiesterase type-5 (PDE5) inhibitors
PDE-5 medications are typically the first line of treatment we recommend for men with ED. They include Stendra (avanafil), Viagra (sildenafil), Cialis (tadalafil), and Levitra or Staxyn (vardenafil).
These oral medications work in a similar manner to boost the level of cGMP—a natural chemical in the body that promotes the widening of blood vessels following sexual arousal. In turn, more blood reaches the penis.
At the same time, these medicines enhance the relaxation of muscles of the penis in response to stimulation, hence increasing blood flow to the penis and allowing an erection.
2. Creams and injections
Sometimes we prescribe a topical Alprostadil cream as an alternative to the oral medications. The cream comes with a plunger and is applied to the tip of the penis and the surrounding skin 5-30 minutes before having sex.
At other times, we may prescribe penile injections as a treatment for ED. That is, we teach you how to inject a medicine at the base of your penis 5-20 minutes before sexual intercourse. After the injection, there will be increased blood flow to your penis and an erection will develop within 15 minutes.
3. Penis pumps (vacuum devices)
A penis pump (vacuum erection pump) is a tube that fits over the penis. A plastic container is placed over the penis and the pump draws air from the container to create a vacuum. The change in air pressure when the device is used causes blood to be drawn into the penis and triggers an erection.
Once the vacuum creates an erection, the retaining band is slid down the lower end of the penis and the pump is removed. An erection will typically last long enough for intercourse but the penis may be cold to the touch, and the rubber band may restrict ejaculation.
4. Penile implant (surgery)
We generally recommend surgery only when all other treatment options are not successful or not well tolerated. If that is the case, a penile implant (prosthesis) may help in achieving erections.
A penile implant is a medical device surgically placed into a penis to mimic the look and performance of a natural erection. The prosthesis involves an inflatable rod inserted in the middle of the penis, with a pump hidden in the scrotum. The pump is used to inflate the rod, which in turn causes an erection.
Penis pumps are custom-fit to your anatomy in a procedure that is performed carefully to ensure that the sensitivity of the penis and your ability to ejaculate are not adversely affected, allowing you to have a normal orgasm and great sexual encounters.
At Advanced Urology Institute, we recognize that erectile dysfunction is a common but very sensitive issue. That is why we provide a compassionate, patient-friendly approach to ED treatment to help men tackle it as soon as it starts. And because ED may also be a sign of a more serious medical condition, we encourage you to speak with a urologist as soon as possible to help you address the underlying condition and find the best treatment option.
Remember, the sooner you speak with your doctor about ED, the sooner you can go back to enjoying physical intimacy with your significant other. For more information about the diagnosis and treatment of erectile dysfunction, visit the Advanced Urology Institute website.
My name is Yaser Bassel, I am a board-certified urologist with Advanced Urology Institute.
I would say the vast majority of them, especially if they have not tried medications prior to them being seen in our office, probably 70-80 percent of those men will at least have a response to the medication oftentimes enough to basically be satisfactory to the patient or make them pleased with the way the medication is working. So most of them would actually get a good response to the medication.
Are there other treatment options for ED?
As far as what we have available to us now and what’s on the forefront, [for] those patients that do not want medication there are some newer technologies that are available that utilize shockwave energy to try and create newer vascularity in order to get a better response for that medication and that is something that’s basically come out over the past couple of years that we are starting to utilize in our practice. For those that do not respond to medication and still want to have treatment, the next step oftentimes [is] performing a test called a Penile Doppler where we will inject the penis with a vasoactive medication which will then initiate an erection so that we can measure blood flow and also measure for a venous leak which are two reasons why patients can have issues with erectile dysfunction.
The loss of bladder control known as Urinary Incontinence is a normal problem that is more common in women than men. The effects of urinary incontinence range from barely noticeable to severe. As Dr. Amar Raval from the Advance Urology Institute says, “It is a big issue for women out in public.” Incontinence can cause difficult and embarrassing situations.
There are many causes of urinary incontinence. To understand these causes, it is important to remember that urinary incontinence is a symptom, not a disease. Lifestyle choices that can exacerbate the problem include consuming alcohol, caffeine, spicy foods and certain medications. For women, life events that affect women’s bodies in a way that can cause incontinence include pregnancy, childbirth, menopause and aging. Other causes can be found in weight, family history and health.
The different types of urinary incontinence can exhibit a variety of symptoms. Stress incontinence is characterized by small leaks of urine due to pressure on the bladder while laughing, coughing, sneezing or exerting oneself. The small leaks of overflow incontinence happen when the bladder has not fully emptied during urination. Urge incontinence is the sudden and intense urge to urinate, sometimes resulting in an involuntary loss of urine. Having to urinate frequently through the night is another symptom experienced by women with urge incontinence. It is also common for women to be affected by more than one of these types of incontinence.
Fortunately, a wide range of treatment options is available. Women can work with their urologist to find the best treatment option for their individual situation. In some cases, treatment can be as easy as making slight lifestyle changes or taking an oral medication. Botox and acupuncture can help relieve stress incontinence. For more advanced cases, urethral slings can ease symptoms by lifting the urethra into a normal position, and robotic surgeries can lift the bladder in cases of incontinence caused by a prolapse.
The loss of bladder control can be a lifestyle limiting problem for women when it affects their ability to leave the house and maintain normal activities. The urologists at the Advance Urology Institute work closely with each patient to ensure they can live with freedom and confidence, and without the worries of incontinence. For more information, visit the Advanced Urology Institute website.
Prostate cancer is a health challenge that many men will face in their lifetime. What makes prostate cancer unique is the many forms it can take, with each form requiring a different treatment method and affecting men differently. According to board certified urologist Dr. Brian Hale, “Prostate cancer is extremely common and most men with prostate cancer will probably never have a problem from it.”Prostate cancer is so common that up to 80% of men who live to age 80 will have some form of it. Fortunately, for most of these men the illness will not be terminal. However, prostate cancer is still deadly enough to be the second leading cause of death for men in the United States. In other words, prostate cancer is often harmless; but when it isn’t, it can be deadly. This makes a proper and timely prostate cancer diagnosis essential.
For many men, their prostate cancer will not be aggressive and the symptoms will be manageable. In these cases, urologists rely on active surveillance as the best first treatment option. Rather than risk possibly harmful treatments on a non-aggressive cancer, the urologist will monitor the cancer with routine checkups. Other treatment options will be considered if the cancer becomes more aggressive.
If the prostate cancer is aggressive and immediate treatment is needed, urologists and their patients have a wide range of treatment options to choose from. The treatment option that works best will depend on a number of factors such as the cancer’s size and growth, and the patient’s age and health. Surgery to reduce the size of the cancer is often preferred for slow growing cancers. For more aggressive cancers, urologists may choose chemotherapy or radiation to kill the cancer cells as quickly as possible.
Although there are many possible causes of prostate cancer, there are certain factors that are known to raise the risk of its occurance. The first risk factor is age. As men get older, their likelihood of developing prostate cancer increases. African-American men have a greater genetic risk for developing an aggressive prostate cancer, while family history and obesity are also factors.
Early detection is the key to a successful treatment. Because prostate cancer is age related, it is recommended to most men that they begin having annual prostate checkups at age 50. African-American men and those with a family history of this cancer should be checked annually starting at age 40. Life saving screenings and successful treatments of prostate cancer happen every day at the Advanced Urology Institute, where trusted urologists like Brian C. Hale, MD guide their patients from diagnosis to recovery.
Prostate cancer is a common cancer that affects the walnut-shaped male prostate gland. As with most cancers, early detection is an important part of any successful treatment. The most common way prostate cancer is detected is through prostate cancer screenings during a patient’s appointment with a urologist. According to Dr. Amar Raval, “Screenings are important, along with a digital rectal exam, because prostate cancer continues to be the number one cancer found in men.”
Should you be screened for prostate cancer? If you can answer yes to one or more of the following conditions, then you may need to be screened:
• If you are between the ages of 55 and 69.
• If there is a history of prostate cancer in your family.
• If you are African-American.
• If you have a pre-existing medical condition that makes treatment difficult.
These factors are known to increase the risk of developing prostate cancer, and it is recommended that someone who has one or more of these conditions is screened at least once a year.
There are two main types of prostate cancer screening tests that a patient may receive. The most common is a digital rectal examination (DRE). For this exam, the health care provider puts on a glove and inserts a finger into the patient’s rectum to feel for any abnormalities on the prostate that can be attributed to cancer. The other screening is a prostate specific antigen (PSA) blood test. This blood test checks the PSA level in the blood, as someone with prostate cancer will have an elevated PSA level.
If one of these tests leads to a prostate cancer diagnosis, the urologist will want to identify what kind of prostate cancer it is in order to develop the best treatment plan. Non-aggressive cancers may not necessarily need treatment and can be monitored with active surveillance, which means watching the cancer to make sure it doesn’t turn aggressive and spread. In cases where the cancer is of intermediate or high risk, early identification from a screening test can help make sure that the treatment used on the cancer has the best chance for success.
If you believe it is time for you to start being screened for prostate cancer, then you should have a conversation with your urologist. Early detection can be a life saver. For men who are concerned about prostate cancer, the Advance Urology Institute is an excellent place to begin screening.
Erectile dysfunction is a common disorder that affects men of all ages. It is a man’s inability to get and maintain an erection. There are many different causes of ED and in many cases there is more than one underlying cause. All a urologist needs is a physical exam and a few questions answered in order to diagnose erectile dysfunction in a patient.
For urologists like Dr. Brian Hale, treatment for erectile dysfunction begins with trying three different medications. The medications are generally oral and easy to take. The urologist will monitor the results of the oral drugs with the patient. Very often, at least one of the oral drugs prescribed will resolve the issue. For these cases, the urologist will write a prescription for the drug and continue to monitor its effectiveness through routine appointments.
If the urologist and the patient are unable to find an oral medication that works effectively, there are other options to consider. One possibility is injection therapy. Small injections into the shaft of the penis are used to dilate the penile arteries, helping increase blood flow, causing an erection. For most men who do not see results with the oral medication, injection therapy is their next best option.
For many men, injection therapy can seem a bit overwhelming at first, maybe even frightening. But in reality, the injections are easy to administer and are relatively painless. The urologist and the patient will begin the injection therapy with a teaching session at the urologist’s office. The urologist may use an ultrasound to monitor the reaction of the blood vessels to the injection to help determine the right dosage for the patient. The patient is also taught how to administer the injection on his own.
Patients are generally pleased after they start injection therapy. The teaching session at the office helps the patient see that the injections are not painful and can easily be done at home. It is very rare that a patient cannot do the injection therapy himself. For those who did not respond positively to the oral drugs, injection therapy is an ideal treatment to produce the desired results and overcome the erectile dysfunction.
Treating erectile dysfunction is an important part of a patient’s well being, both personally and within his relationships. The urologists of the Advanced Urology Institute offer many options for treatment and remain committed to finding the best one for each patient. For more information, visit the Advanced Urology Institute website.
Kidney stones can be stubborn and painful. In many cases, patients rely on a urologist for help removing these painful obstructions. Kidney stones are hard deposits of minerals that form in the body and can cause blockage in the urinary tract. Urologists will decide how to treat the stone based on factors like its size, the patient’s health and the amount of pain it’s causing.
One cutting-edge and noninvasive method for treating kidney stones is called shock wave lithotripsy. Board-certified urologist Dr. Brian D. Hale describes it as using water waves to break up the stone. A machine is put against the patient’s body and creates small explosions. The water waves from the explosions target the stone. As many as 2,500 water waves are directed at the stone during a single treatment.
These waves break the stone into small pieces similar to sand. The patient will be able to pass these much smaller pieces with greater ease. The whole treatment takes about 25 minutes. The procedure is mostly pain free but does require the patient to go under general anesthesia. In the early 2000s, patients were not required to go under anesthesia for this procedure. However, it was found that natural movements from the patient made it difficult to concentrate the water waves on the stone, so putting patients under anesthesia is now the general practice.
Each case of kidney stones is different, and noninvasive measures are not always an option. An alternative procedure for stone removal is to use a scope to go up the patient’s penis through the urethra to the kidney and then use a medical laser to break up the stone and pull out the fragments. This is the preferred method for some of the smaller stones that cannot be broken up with shock wave lithotripsy.
For larger stones in the kidney, urologists may recommend a more invasive form of surgery called percutaneous nephrolithotomy. In these cases, the urologist will make a small incision in the patient’s back to reach the kidney directly. The urologist then will use a scope and either a laser or ultrasound energy to break up the stone. This procedure also requires general anesthesia and the patient may need to stay in the hospital for one to two days to recover.
There are many options for patients suffering from painful kidney stones. The many urologists of the Advanced Urology Institute have committed to finding the best options to relieve the pain of kidney stones. For more information, visit the Advanced Urology Institute website.
Kidney stone disease is a common issue that affects men and women alike. There are many factors that can be attributed to developing kidney stones. According to Dr. Amar J. Raval, “Kidney stone disease is very prevalent in Florida because of heat and lack of hydration.” The state’s warm climate helps induce sweating and makes it easier to dehydrate, putting people who live there at a higher risk of developing stones.
In addition to climate, there are several other factors that can increase kidney stone likelihood. Family history is one factor. If someone in your family has a history of developing stones, you are at greater risk of developing them as well. Diets high in protein, salt and sugar also increase the risk. Salt especially is known to increase the amount of calcium your kidneys must filter, raising the chances of stone development. Certain conditions like irritable bowel syndrome and urinary tract infections are also known to increase kidney stone risk.
There are numerous symptoms associated with kidney stones and they can vary in seriousness and pain level. Doctors often see patients with acute onset pain in the upper abdomen that does not resolve with medication, nausea, fever, chills, difficulty urinating and even blood in the urine. The symptoms of kidney stones may present themselves differently depending on many different factors. It is important to know when something is not right and when it may be best to see a urologist for help.
Luckily for people suffering from kidney stones, there are many treatments doctors can use to help them. Many of the treatments are endoscopic, not requiring incisions and are minimally invasive. For instance, doctors may insert a stint into the urinary tract to allow the patient to pass the stone. Shock waves also can be used to break large stones into smaller more easily passable pieces. The shock wave treatment also is not invasive. Doctors can use lasers to break off a piece of the stone for a biopsy to determine exactly what kind of stone it is and what the best treatment may be.
Consulting a trusted urologist for diagnosis and treatment options for kidney stones is very important. Like many conditions, kidney stone treatment is easiest when caught early. Urologists like Dr. Amar J. Raval at the Advanced Urology Institute help many patients with kidney stones. They are familiar with kidney stone disease as well as the latest medical technology, and can provide the most advanced treatment options for their patients. For more information, visit the Advanced Urology Institute website.
A urologist plays an important role in healthcare. The field of urology encompasses many issues that people face throughout their lives, especially as they start to age. As urologist Dr. Amar Raval notes, urology allows him the opportunity to “provide a service to others.” As a urologist he gets to make a positive impact on his patients’ lives by helping them with many of the common issues that prompt people to seek medical help.
One common problem is kidney stone disease. Kidney stones form for a variety of different reasons. They are particularly common in warm climates, like Florida. Symptoms can vary, but they include severe abdominal pain, nausea, fever, chills, difficulty urinating or blood in the urine. Kidney stones can be very painful and some people need assistance to pass them. A urologist can assess the stones and determine the best way to remove them. In some cases, experienced urologists can break up the stones using a shock wave treatment that is totally noninvasive.
Urologists also frequently see cases of prostate cancer, one of the most common cancers for men. The disease comes in many different forms, making each case unique. While some need to be treated with surgery, chemotherapy or radiation, other forms are non-aggressive and can be left alone. Urologists also may recommend cutting-edge technologies like HIFU. Whatever the diagnosis, it is important to work with your urologist to monitor your prostate and find the best treatment plan for you.
Urinary incontinence is a common problem that many patients are embarrassed to discuss with their doctor. A urologist deals with many patients experiencing urinary incontinence and is accustomed to having in-depth conversations with their patients about incontinence. They know how to discuss the problem with patients so they feel comfortable while also finding the underlying issue causing the incontinence. Whether it is caused by stress, infection, lifestyle or another issue, a urologist can find the best solution and help a patient maintain a healthy and confident life.
There are countless other issues that bring patients to see a urologist for help. Dr. Amar Raval at the Advanced Urology Institute is one of many dedicated urologists improve their patients’ quality of life. For more information, visit the Advanced Urology Institute website.