Vasectomy: A Quick and Easy Birth Control

Vasectomy is a minor surgical procedure to cut or block the vas deferens. The vas deferens is a tube that runs from the scrotum which holds the testes in which sperm is manufactured and connects with the seminal vesicles to form the ejaculatory duct. When the vas deferens is cut or blocked during a vasectomy, sperm cannot reach the semen produced in the seminal vesicles. The result is that the semen discharged when a man ejaculates does not have sperm in it. Without sperm, there can be no pregnancy. So a vasectomy is considered one of the most effective methods of birth control.

A vasectomy can be done in two ways:

1. No scalpel Vasectomy. In this procedure, a urologist feels the scrotum and finds the vas deferens. Once the vas deferens can be felt, a clamp is placed on it to hold it in place. A hole is made in the skin and the vas deferens is lifted out. It is cut and the separate ends are tied and put back into place.

2. Conventional Vasectomy. Small incisions are made on each side of the scrotum. The vas deferens is then cut and a small piece of it may be taken out. The separate ends are then tied or seared. This procedure often requires the use of an anesthetic.

The procedure takes about thirty minutes. The outcome, however, takes a while to be realized. Most professionals advise that it takes about three months, or at least 15-20 ejaculations, for semen to become completely sperm free. Before then, it may be advisable to use other forms of birth control. Aftercare usually requires mild pain medication and wearing supportive underwear. Ice packs also can help with the pain. Most men recover within one week.

What to consider before undergoing a Vasectomy

The high success rate of a vasectomy requires absolute certainty on the part of the man that he does not wish to have any more children. In instances in which the man is married, it is necessary for him to discuss the matter with his spouse. A vasectomy is widely considered to be irreversible. When it is reversible, the procedure is sensitive and difficult.

The importance of having the advice of a urologist before, during and after the procedure cannot be understated. Qualified urologists can be found in most hospitals and the search for one can be undertaken online. The Advanced Urology Institute runs a site with very relevant information and this can be a good place to start. For more information on vasectomy, visit the “Advanced Urology Institute” site.

What Treatments Are Available For ED?

Erectile dysfunction is the inability to achieve or maintain an erection firm enough for sexual intercourse. It is not incidental to aging, though in reality it occurs mostly in men over the age of 40. The causes of erectile dysfunction are varied, and the first step is to establish whether it is caused by an underlying condition. Whatever the cause, however, there are various options when it comes to the treatment of erectile dysfunction.

1. Oral Medication (Pills)

Like many other medical conditions, erectile dysfunction can be treated effectively by taking medicine. Oral medicines for erectile dysfunction fall under a group called phosphodiesterase 5 (PDE 5) inhibitors. They work by preventing the functioning of the enzyme phosphodiesterase type 5 whose job is to control blood flow to the penile arteries. When the enzyme is not functioning, blood vessels relax, allowing blood to reach the penis, therefore causing an erection. The most common PDE 5 inhibitors are:

a. Sildenafil- commonly referred to as Viagra
b. Avanafil – also known as Stendra
c. Tadalafil – also known as Ciaris; and
d. Varednafil- also known as Levitra

Most of these medications are widely available. It is necessary, however, to consult with a urologist before taking any of them. A trained urologist should be able to assess a patient’s condition and advise whether oral medication is likely to work and if so, which of the available medicines is best suited to the patient’s case.

2. Penile implants

For some men, especially those with underlying conditions, oral medication does not work. They may have to resort to other treatment options and the most common of these is the penile implant. This involves a minor surgical procedure and the placing of an implant that causes an erection. There are two choices when it comes to the implant. There is the inflatable implant and the malleable/ semi-rigid implant. Both options have their advantages and disadvantages and the patient will decide based on his circumstances. Overall, however, both implant options report a success rate of over 90 percent.

3. Vascular reconstructive surgery.

Vascular reconstructive surgery involves reconstructing the arteries within the penis to increase blood flow. This last option is neither common nor popular. It is a very difficult, and therefore expensive, procedure. Additionally, it is not always successful and a patient might face the risk of relapse.

It is possible to treat erectile dysfunction. But the right treatment option must be sought for each individual case. It is recommended that anyone experiencing erectile dysfunction should see a urologist. The highly qualified and experienced urologists at Advanced Urology Institute can provide consultation, technology and treatment plans to help patients with erectile dysfunction. Want to find out more about erectile dysfunction? Visit the “Advanced Urology Institute” site.

Bay Regional Cancer Center Closing Down

We regret to inform you that due to Hurricane Michael, we are no longer providing Radiation Treatment and forced to close our facility at Bay Regional Cancer Center.

Your health and well-being are of utmost importance to the staff at Advanced Urology Institute/Bay Regional Cancer Center. Dr.Steven Finkelstein is still in our community and is currently practicing at Florida Cancer Affiliates North Florida. If you wish to keep him as a provider, please call his new office staff at (850) 763-0036. If you do not wish to continue your care with Dr.Finkelstein, we encourage you to choose another provider as soon as possible to ensure timely care for your medical needs.

Your medical records are confidential and will remain on file with Advanced Urology Institute. A copy of your records can be released to you or your new provider with your written permission. Please note, by law we cannot share your medical information without your written consent. You may sign this form at our office located at 80 Doctors Drive Panama City, FL 32405 or give us a call at (850) 785-8557.

Please be assured that my staff and I will do everything we can to make the transition smooth and stress free. Thank you for trusting Dr.Finkelstein and our wonderful staff with your healthcare needs. It has been a pleasure to provide your care, and we wish you the best in the future.

Miriam Williams
Chief Administrative Officer

What Does the Prostate Gland Do?

The prostate, found only in men, is a tiny, walnut-sized muscular gland in front of the rectum and just below the bladder. It surrounds the urethra, which transports urine to the penis from the bladder, and is essential for the normal functioning of the male genitourinary system. The prostate makes prostatic fluid, which forms a substantial portion of semen. During ejaculation the prostate contracts and closes off the opening between the urethra and bladder, ensuring that prostatic fluid squirts into the urethra and semen is pushed out at speed.

So what does the prostate do?

The prostate is not an essential organ for life, but it’s quite crucial for reproduction. It plays an active part in reproduction by secreting the prostatic fluid, which forms part of healthy semen — the perfect environment for the transit and survival of sperm. Healthy semen includes the enzyme PSA (often measured during screening for prostate cancer), together with other substances secreted in the prostate and seminal vesicles, such as citrate, zinc and fructose, which supply sperm with the energy to travel to the egg. There are also various antibodies in semen to protect sperm and the urinary tract from bacteria and different pathogens.

What are the constituents of prostatic fluid?

The prostate secretes a milky fluid, the prostatic fluid, which makes up about 30 percent of the total fluid that’s ejaculated. The prostatic fluid contains various ingredients, such as enzymes, citric acid and zinc, which keeps sperm alive and protects them and the genetic codes they carry. PSA (prostate-specific antigen) is one of the enzymes in the fluid that, after ejaculation, makes semen runnier and helps sperm travel through semen more easily, which increases the likelihood of successful fertilization of an egg. While prostatic fluid is weakly acidic, the other constituents of semen turn it alkaline overall, which helps to counteract vaginal acidity and prevent damage of sperm.

Growth of the prostate

The prostate grows bigger as men age. Typically the prostate undergoes growth during adolescence driven by the male hormone, testosterone, and the hormone’s byproduct, dihydrotestosterone (DHT). Testosterone hormone is primarily produced in the testes, but smaller quantities also can be secreted in the adrenal glands found just above the kidneys. By the age of 40 the prostate might have grown from a walnut-sized to apricot-sized gland. And by the age of 60 it might have reached the size of a lemon.

Benign prostatic enlargement (BPH)

While the prostate is strategically located to deliver the prostatic fluid and squeeze things along during ejaculation, its position around the urethra makes it a liability when it grows or gets bigger. A swollen prostate will compress the urethra and irritate the walls of the bladder, resulting in interference with normal urine flow. In fact, over 50 percent of all men in their 60s have symptoms of prostate enlargement, a condition called benign prostatic hyperplasia (BPH). And by the age of 70 to 80, a man’s risk of BPH increases to 90 percent, with symptoms such as leaking or dribbling urine, frequent urination, weak or stuttered urine stream.

While the size of your prostate will not always influence how severe the obstruction or symptoms are, BPH can cause serious complications over time, such as urinary tract infections, bladder damage, kidney damage, incontinence and bladder stones, due to bladder strain and urinary retention. So it’s important to see a urologist as soon as you have urinary issues so BPH can be detected early and treated.

Prostate cancer

Another health problem associated with the prostate is prostate cancer, which is the most frequent cancer in men. It occurs in 1 out of 7 men over their lifetime, and more than 200,000 men are diagnosed with the cancer annually. Prostate cancer is frequent in men age 50 and older, but the largest number of cases is found in men 70 to 80 years old. About 3.8 percent of men diagnosed with the cancer die of the disease, while 7 in 10 newly diagnosed patients currently survive past 5 years. As doctors, our role is to screen for the cancer, detect aggressive forms early and prevent any problems that may occur due to obstruction.

So what’s your role?

Tell your doctor about your urinary problems as soon as possible. The symptoms may not only suggest BPH, but also may indicate a more serious condition. With a prompt visit to the doctor, a more serious condition such as prostate cancer can be ruled out.

Want to know more about BPH, prostate cancer and other urological problems? Visit the “Advanced Urology Institute” site.

4 Effective Ways to Treat Kidney Stones

Dreading the agony and pain of kidney stones? You don’t have to because the condition is treatable. And the pain and discomfort disappears as soon as the stones are removed.

The treatment you get depends on the type, size and cause of the stones and on the severity of your symptoms. For instance, if you are having very severe pain, your urologist will give you an injection to relieve the pain. A second injection may be given after 30 minutes if you are still in deep pain. You also may be injected with anti-emetic medication to relieve vomiting and nausea.

Apart from dealing with the symptoms of the kidney stone, your doctor will administer treatment to remove the stone. The 4 effective ways to remove kidney stones include:

1. Spontaneous Passage

If your kidney stones are small (less than 4 mm diameter) and you have minimal symptoms, you won’t require invasive treatment. In fact, once your urologist assesses that you can tolerate the stone, you will be given time so the stone can pass out on its own. In such a case, the urologist will only make the following recommendations:

  • Drrink a lot of water, as much as 1.9-2.3 liters a day, to help you flush out the stone from your urinary tract. In this case, you have to drink enough fluid — until your urine is colorless. So if your urine is still brown or yellow after drinking water, then you know that you aren’t drinking enough fluid.
  • Use pain relievers as you wait for the stone to pass out spontaneously. Since even a very small kidney stone can be really painful, your urologist may recommend pain relievers such as acetaminophen (Tylenol or others), naproxen sodium (Aleve), or ibuprofen (Motrin IB, Advil or others) to relieve the pain. The pain will only last a few days and often disappears soon after the stone is passed.
  • Take medication to help you pass the stone. Such medication, often alpha blockers, help to relax ureter muscles and allow the stone to be flushed out of your urinary system faster and with less pain.

With these recommendations you are expected to wait until the stone passes out and then to collect the stone for analysis by your urologist in order to help determine if there is need for further treatment. To collect the stone, you simply filter your urine through a stocking or gauze as you urinate.

2. Extracorporeal Shock-Wave Lithotripsy (ESWL)

What if your kidney stone is too large to pass out in urine? In that case, your doctor may recommend a procedure called extracorporeal shock-wave lithotripsy. The ESWL procedure uses sound waves to generate strong vibrations (called shock waves), which break the stone into tinier pieces that can easily and less painfully pass through urine.

The high-frequency sound waves (ultrasound) are directed at the stone from a machine for 45-60 minutes. Because this can be a bit uncomfortable, you will undergo the procedure under light anesthesia or sedation to reduce the discomfort. The ESWL procedure is 99 percent effective for kidney stones that are up to 20 mm (0.8inch) in diameter. But you may require one or more ESWL sessions for the kidney stones to be effectively removed.

3. Ureteroscopy

What if the stone is stuck somewhere in your urinary tract, such as the ureter? In that case, your urologist may recommend ureteroscopy, a procedure that’s also called RIRS (retrograde intrarenal surgery). During ureteroscopy your doctor passes a long thin telescope, a ureteroscope, through your urethra, into the bladder and into the ureter, or wherever the stone is stuck.

After locating the stone the urologist uses a special instrument or laser energy to break the stone into tiny pieces that can pass out naturally in urine. The doctor then may place a small plastic tube (stent) temporarily in the ureter to help drain the stone fragments into your bladder, relieve swelling and hasten healing. Ureteroscopy is conducted under general anesthesia, so you shouldn’t operate machinery or drive for up to 48 hours after treatment. It is 50-80 percent effective for kidney stones that are 15 mm (0.6inch) in diameter.

4. Percutaneous Nephrolithotomy (PCNL)

In circumstances where ESWL isn’t appropriate, such as when you are obese, larger stones may require an alternative procedure called percutaneous nephrolithotomy (PCNL). It is a surgical procedure for removing kidney stones using a small thin telescopic instrument known as a nephroscope. The instrument is inserted through a small incision made in your back and guided carefully to your kidney or ureter. Once the stone is located it is either broken into smaller pieces (with pneumatic energy or laser) or pulled out. PCNL has 86 percent efficacy for kidney stones of 21-30 mm in diameter and is performed under general anesthesia.

When should you seek treatment for kidney stones? You need urgent treatment if:

  1. Your pain is sudden, severe or gets worse.
  2. You have a fever of 100.4 F or higher.
  3. You have one or more episodes of shaking or shivering.

At Advanced Urology Institute we have assembled a team of skilled and experienced urologists to help diagnose and treat kidney stones and other urological problems safely and effectively. We offer all 4 effective treatments for kidney stones and have the latest equipment and technology to make the treatment process as painless and comfortable as possible. So don’t try to endure the pain even a day longer before you see us and let us fix it. For more information on kidney stones and other urological disorders, visit the “Advanced Urology Institute’” site.

Benefits of Testosterone Therapy

Secreted primarily in the testicles, testosterone is a critical hormone responsible for male growth and masculine characteristics. The levels of testosterone increase exponentially in childhood and hit a peak during adolescence, then begin to decline by about 1 percent every year between the ages of 30 and 40 years and older. The gradual decline can be due to either normal aging processes or a condition called hypogonadism. Hypogonadism is a disorder in which the body fails to produce normal quantities of testosterone. It often occurs when there is a problem with the pituitary gland (which controls the testicles) or with the testicles themselves. For men with testosterone levels below the normal range, testosterone replacement therapy can relieve symptoms of low-T and provide many benefits.

Normal Testosterone Levels

For men, the normal range of total testosterone is 300-1,200 ng/dL (nanograms per deciliter). Men with testosterone levels within this range rarely have any problems associated with low testosterone. However, since total testosterone does not usually provide the full picture, doctors often measure and use the levels of free testosterone to assess a man’s vulnerability to low-T symptoms. Free testosterone means the amount of testosterone hormone that is active in the body at any given time. Men with total testosterone levels within the normal range can still suffer from the classic low-T symptoms if their free testosterone levels fall short.

Implications of Low Free Testosterone

The free testosterone level is a clearer indicator of a man’s true testosterone status. In fact, low free-T is almost exclusively associated with sex difficulties. Low testosterone diminishes sex drive in men and results in loss of energy and motivation and poor performance in bed. Men with low testosterone also may suffer from fewer spontaneous erections, slightly lower sperm count, increased body fat, decreased muscle strength and mass, fragile bones, tenderness or swelling of breast tissue, hot flashes, increased fatigue, feelings of depression and sadness, trouble with concentration and memory, lowered self-confidence and motivation, and a degraded overall sense of well-being. These symptoms can be relieved through testosterone replacement therapy.

Benefits of Testosterone Replacement Therapy

There is no doubt that testosterone replacement therapy (TRT) can quickly revive a man’s interest in sex, boost his ability to maintain an erection and recreate the “wow” factor of his orgasms. Treating sexual symptoms is a good enough reason for men to start testosterone therapy. But because testosterone therapy also can improve a man’s health beyond the bedroom, bringing testosterone levels back to normal is a good decision for every man who wants to feel better. Replacement therapy improves bone mineral density, boosts overall bone strength, increases muscle mass and strength, boosts red blood cell production, enhances hemoglobin levels and corrects both iron deficiency anemia and unexplained anemia. Testosterone therapy also improves mood, alleviates depression, irritability and fatigue, relieves disorders linked to testosterone deficiency such as osteoporosis and boosts insulin sensitivity, which can benefit men with diabetes or minimize the risk of diabetes in men with functioning pancreas.

Should You Opt For Testosterone Therapy?

Testosterone replacement therapy is ideal for men with testosterone levels below 300 ng/dL or those experiencing symptoms of low testosterone. Undergoing replacement therapy can help you restore your testosterone levels to normal and improve your libido, cognition, mood, bone density, muscle mass and red blood cell production. However, you should remember that the therapy is only necessary if you have low T. If you are not sure whether the therapy is right for you, speak with your doctor. The doctor will conduct the requisite tests for low-T and guide you accordingly.

At Advanced Urology Institute, we help men recover from their old, tired and depressed selves through safe and effective testosterone replacement therapy. We deliver this therapy after accurate measurements of testosterone levels to ensure that we give testosterone only to the right people. If you have symptoms of low-T or suspect that your levels could be low, speak to one of our urologists. We will ensure to get you back to a more energetic, motivated and happy self. For more information on the diagnosis and treatment for low testosterone, visit the “Advanced Urology Institute” site.

2 Common Types of Incontinence

Urinary incontinence, defined as involuntary and accidental leakage or loss of urine because of defective bladder control, is a common problem in the United States that affects an estimated 25-33 percent of the population. While both men and women can have the condition, more women are at risk of having urinary incontinence because of several factors unique to women. For instance, due to pregnancy, childbirth, different anatomical characteristics in the pelvic region, atrophy (shrinking) of sphincter muscles and menopause, women suffer from urinary incontinence much earlier and more frequently than men do. Urinary incontinence is not a normal consequence of aging, though its prevalence increases with age.

Repercussions beyond Health

Urinary incontinence is not only a health problem, but also poses a variety of psychological, social and emotional difficulties. For instance, women with urinary incontinence may want to avoid certain situations or places for fear of an embarrassing accidental leak. A strong and sudden urge to urinate may cause embarrassment and discomfort, particularly when you are not near a bathroom or toilet. Women also may withdraw from activities they love doing due to the risk of an accidental leak. As a result, urinary incontinence can limit a woman’s activities, diminish her self-confidence and reduce her joy in life. But urinary incontinence is a treatable condition as long as the underlying cause can be identified and addressed.

Two Major Types of Urinary Incontinence

There are two main types of urinary incontinence: stress incontinence and urge incontinence.

1. Stress Incontinence

Stress incontinence is the accidental loss of urine from the bladder due to weak pelvic muscles. Urine loss occurs during physical activity such as when sneezing, laughing, coughing, exercising or doing an activity that exerts pressure on the pelvic muscles. When you are active, you put pressure on the bladder, which in turn allows urine to escape because the pelvic muscles are weak. Stress incontinence often occurs after pregnancy or childbirth because the pelvic muscles have been stretched and weakened and nerves to the bladder may have been damaged. Obesity or excess weight also can put pressure on the weak pelvic muscles and cause stress incontinence.

2. Urge incontinence

Urge incontinence (known as overactive bladder or OAB) is the sudden, intense and uncontrollable urge to urinate, which occurs when the coordination between the brain and bladder is out of sync. For instance, the brain may send voiding signals to the bladder without warning, or pelvic muscles may become too active and contract frequently even before the bladder is full, resulting in feelings of extreme frequency and urgency. Overactive bladder is the term used to describe any incontinence characterized by uncontrollable urgency, frequency, nocturia and dysuria. Urge incontinence is common in women with an inability to control detrusor contractions, but also may occur in women in menopause (due to inadequate estrogen) or with chronic or acute urinary tract infections, bladder stones, bladder cancer, stroke and multiple sclerosis (due to interference with nerve signals responsible for bladder control).

Sign of Something More Serious

There are many reasons why women may leak urine, from serious neurological conditions like multiple sclerosis, Parkinson’s disease and stroke, traumatic injury of the spinal cord, cardiovascular conditions affecting associated nerves, diuretic medicines, diabetes and obesity, alcohol consumption or recurrent urinary tract infections to inflammation that damages bladder nerves or irritates the bladder. It is therefore advisable to seek medical help as soon as you experience any sign of incontinence. Prompt and timely diagnosis and treatment may uncover a serious underlying problem early. At Advanced Urology Institute, we obtain a full history, conduct a comprehensive physical examination, perform specialized testing and treat urinary incontinence as safely and successfully as possible, making sure to deal effectively with all underlying issues.

A Wide Range of Treatment Options

Treatment of urinary incontinence at AUI depends on the type of incontinence and severity of symptoms. Options may include rehabilitation of pelvic muscles using weighted vaginal cones, electrical stimulation or Kegel’s exercises, sacral nerve neuromodulation, biofeedback and bladder retraining, extracorporeal magnetic innervation, occlusive devices (such as vaginal pessaries or urethral plugs), medications (such as Extended-Release Oxybutynin Chloride like Ditropan XL, tolterodine like Detrol, alpha-adrenergic drugs and estrogens), periurethral injection, and minimally invasive surgery. If you have any symptoms, you should see a urologist as quickly as possible to undergo testing, determine the underlying cause and detect any serious problem you may have.

At Advanced Urology Institute, your health is our foremost priority. We provide the right diagnosis and treatment of urinary incontinence that can quickly restore your confidence and enable you to get out there and do the things you love without worrying about accidental leakages. Do not suffer in silence. For more information on urinary incontinence, visit the “Advanced Urology Institute” site.

Treating Prostate Cancer

Prostate cancer is one of the most common cancers among American men. In fact, it is the most frequently diagnosed non-skin cancer in men, with over 2 million American men currently living with the cancer. Statistically, a new case arises every 3 minutes, one in six American men has prostate cancer, while an American man dies of it every 19 minutes.

Making treatment decisions

At Advanced Urology Institute, we make every effort to deliver world-class treatment and care for patients with prostate cancer. After a diagnosis, our physicians review various treatment options before picking any treatment for the patient. We also conduct further studies, such as biomarker testing and imaging studies, to ensure that we have correctly established the stage or extent of the disease. We use this information to make the right decisions and give prostate cancer patients the most effective treatments. We choose treatment options depending on the cancer itself (high-risk, intermediate risk or low-risk) and patient factors (personal preferences, age and other health issues).

Prostate cancer treatment options

Advanced Urology Institute offers a wide range of innovative and effective diagnostic and treatment procedures for patients with prostate cancer. At the institute, newly diagnosed patients get the opportunity to meet and discuss their condition with renowned and experienced specialists on the same day.

Our treatment options include:

  1. Active surveillance: For a low-risk prostate cancer that may not harm a patient over the course of his lifetime, urologists at AUI usually recommend close observation. It often comes with secondary chemoprevention.
  2. Prostatectomy: Prostatectomy is a surgical procedure to remove the prostate. For localized prostate cancer, radical prostatectomy may be employed. However, at Advanced Urology Institute, we commonly apply the robot-assisted technique, which is a minimally-invasive, laparoscopic procedure.
  3. Radiation: An external beam of radiation is directed at the prostate in order to kill cancerous cells.
  4. Cryotherapy: Probes are inserted into the prostate gland to allow for the introduction of liquid nitrogen into the gland. Once administered, liquid nitrogen produces an ice ball inside the prostate which destroys cancerous cells.
  5. Brachytherapy: A radioactive seed is implanted in the prostate. The procedure involves inserting and removing the needles that are used to place radioactive seeds inside the prostate.
  6. Hormone therapy: Various medications can be administered to reduce or inhibit the secretion of testosterone hormone. Diminished quantities of testosterone means reduced or no growth of the cancer.
  7. Chemotherapy: Certain drugs may be used to boost the effectiveness of the other treatments, both for metastatic and localized disease.

Multi-disciplinary treatment and care

At Advanced Urology Institute, our goal is to cure prostate cancer while also maximizing the quality of life of our patients. We carefully weigh the benefits of every treatment option against the side effects and develop the most practical individualized treatment programs for all patients. We also believe that effective management of prostate cancer needs extensive collaboration. We have implemented a multidisciplinary approach to treatment that allows our various specialists, such as urologists, radiation oncologists, medical oncologists, radiologists, pathologists and clinical trial nurses to deliberate and get diverse, specialized perspectives before making treatment decisions for any patient. During AUI conferences, detailed discussions among experts help to clarify the benefits and risks of various diagnostic tests and treatment options, resulting in better treatment outcomes for our patients.

Advanced Urology Institute uses image-guided targeting, MRI, ultrasound and fusing 3-D guidance to boost the accuracy and usefulness of prostate biopsies. We also apply minimally-invasive, outpatient procedures in most cases. So, with our comprehensive consultation service and multidisciplinary approach that incorporates the latest technologies, research developments and expertise, all our patients can be sure of the best possible prostate cancer treatment. Want help with prostate cancer? Get more information from our “Advanced Urology Institute” site.

What are the Symptoms of Low Testosterone

Produced in the testicles (testes), testosterone is the hormone responsible for masculinity and muscular development. It is the hormone that fuels sex drive, creates a deep voice, boosts muscle mass, regulates mood, controls body and facial hair patterns, and regulates bone strength. Testosterone levels usually decrease as men age, with studies showing that a man loses roughly 10 percent of testosterone each decade after reaching the age of 30.

Symptoms of low testosterone levels

Since the reduction in the level of testosterone is typically gradual, the symptoms take longer to occur. Generally, however, about 30 percent of all men will experience symptoms of low testosterone after the age of 50. Andropause is the term used to describe a decrease in the level of testosterone hormone in men. Men experiencing andropause can suffer various symptoms associated with the condition and may be at risk of having other serious health problems like osteoporosis if proper treatment is not administered.

The symptoms of low testosterone include:

  1. Diminished sexual desire (low libido)
  2. Problems getting erections or weak erections
  3. Fatigue and weakness
  4. Hot flashes
  5. Irritable moods
  6. Depression
  7. Increased body fat
  8. Loss of muscle mass or strength

Low testosterone can cause various complications or even change a man’s body. For instance, it can lead to obesity, hair loss, muscular atrophy (less muscle mass), softer testicles, smaller testicles, cardiovascular problems, larger breasts and brittle bones (osteoporosis).

Causes of low testosterone

Even though aging is the most frequent cause of low levels of testosterone in men, several other factors may be involved. Common causes of low-T include:

  1. Kidney disease
  2. Diabetes
  3. Testicular injuries
  4. Liver disease
  5. COPD (chronic obstructive pulmonary disease)
  6. Radiation therapy
  7. Steroid medications
  8. Pituitary gland disorders
  9. Chemotherapy

Men also may be tested for low-T if they have very low sex drive, erectile dysfunction, low sperm count, hair loss, reduced muscle mass or osteoporosis. And because the symptoms of low testosterone are not specific, a doctor may want to first rule out other conditions with similar symptoms before treatment.

Treatment of low testosterone

Testosterone replacement is the most common treatment for men having low-T. The therapy is administered to relieve symptoms and improve quality of life. The testosterone used in the replacement therapy is usually available in various preparations, including gels, capsules, skin patches and injections. The doctor will decide if testosterone replacement therapy is appropriate for a patient. For instance, the treatment is not appropriate for men with prostate cancer and breast cancer. Men with an enlarged prostate, liver disease, kidney disease or who are using blood thinners may or may not undergo replacement therapy depending on their medical history.

At Advanced Urology Institute, we have a long history of treating low testosterone. We put the interest and health of our patients first and always discuss with our patients in great length their conditions and medical history before we administer treatment. For more information, visit the “Advanced Urology Institute” site.

What is Prostate and Prostate Cancer?

The prostate gland is a chestnut-shaped male reproductive organ located below the urinary bladder and surrounding the upper portion of the urethra, the duct that allows passage of semen and urine. It is a conglomerate of secretory ducts that emit fluids into the urethra and ejaculatory ducts. The prostate produces a thick, white fluid which mixes with sperm from the testicles to create semen, contributing 15-30 percent of the semen secreted by a man. The gland also produces a protein known as prostate-specific antigen (PSA), which turns semen into liquid. While the prostate matures into a small, walnut-sized gland at puberty, usually between 10-14 years old, it will still grow slowly with age. However, prostate enlargement after age 50 may lead to urinary problems, often occurring as a result of inflammation or malignancy.

Prostate Cancer: What is it?

Prostate cancer is a disease that occurs when changes in prostate cells make them grow uncontrollably or abnormally. The abnormal or cancerous cells then may continue to multiply non-stop and even spread outside the prostate into nearby or distant areas of the body. Prostate cancer is rare before age 50, but is common among older men and is the second most frequent cause of all cancer-related deaths in American men. The disease is typically slow growing, often showing no symptoms until it reaches advanced stage. Hence, most men with the cancer will never know it and will just die of other causes. Nevertheless, when prostate cancer starts to grow and spread quickly, it can be very lethal and requires prompt treatment.

Causes of Prostate Cancer

Prostate cancer occurs mainly in older men, with more than 80 percent of cases seen in men older than 65 and less than 1 percent observed in men younger than 50. Men who eat lots of high-fat diets such as red meat have a higher risk of getting the disease. Studies have shown that the disease is more common among men who consume meat and dairy products regularly than in those who eat vegetables, rice and soybean products. Fats increase the amount of testosterone in the body and in turn speed up the growth and spread of prostate cancer. Men from families with a history of the cancer are at a higher risk, as are welders, rubber workers, battery manufacturers and men frequently exposed to metal cadmium. Failure to exercise regularly also may make the cancer more likely.

Symptoms of Prostate Cancer

Prostate cancer tends to show no symptoms in the early stages, but will show some symptoms in the later stages. Common symptoms include sudden or frequent urge to urinate, trouble starting a urine stream or knowing when to urinate, pain or discomfort when urinating, blood in urine or semen, and pain in the upper thighs, lower back or hips. While these symptoms may not necessarily mean you have prostate cancer, you should see a urologist or GP when you have any of them.

Diagnosis and Treatment

When you visit a urologist, a medical history and physical examination will be performed followed by a digital rectal exam (DRE) and PSA test. If the doctor detects that you are at risk of prostate cancer, a biopsy will be requested to confirm it. There are several treatment options for prostate cancer including active surveillance (watchful waiting), surgery, radiation therapy, cryotherapy, hormone therapy, chemotherapy and bone-directed treatment. Remember that early diagnosis and treatment of prostate cancer improves your chances of survival. For more information on treatment of prostate diseases, visit the site, Advanced Urology Institute.

How Percutaneous Nephrolithotomy Works?

Percutaneous Nephrolithotomy (PCNL) is a minimally invasive surgical procedure for removing upper ureteral stones and kidney stones larger than 2 centimeters in diameter. Historically, larger stones were removed in open surgery, which required a larger flank incision. Percutaneous nephrolithotomy (nephrolithotripsy) is a more refined alternative to open surgery, using a 1-centimeter skin incision. The procedure reduces blood loss, pain and hospital stay and has an increased success rate.

During PCNL, the patient is given general anesthesia before a needle is inserted through the skin to puncture the kidney and create a channel through which a nephroscope is passed into the kidney to break the stone into fragments for easy extraction. The entire procedure takes 3-4 hours.

During percutaneous nephrolithotomy:

  • The patient receives general anesthesia to make the procedure less painful. The patient then lies face down on the abdomen.
  • The surgeon performs cystoscopy (telescopic exam of the bladder) and instills X-ray dye or carbon dioxide into the kidney using a small catheter through the ureter of the affected kidney. This helps the surgeon to locate the stone more precisely.
  • After locating the stone, the urologist makes a small incision on the back and passes a tiny needle through the skin (under X-ray guidance) into the kidney to directly access the stone.
  • The needle tract is dilated to about 1-centimeter to enable placement of a plastic sheath and telescope for visualizing the stone.
  • Using a laser or mechanical lithotripsy device, the surgeon breaks the stone into smaller fragments and extracts the pieces through the sheath.
  • At the end of the operation, temporary catheters, a nephrostomy tube for the kidney and a stent tube for the bladder, are used to drain urine. The catheters are removed before discharge from hospital, usually after 2-4 days.

Percutaneous nephrolithotomy is recommended when:

  • Urine flow is blocked.
  • Kidney stones obstruct several branches of the collecting system of the kidney (also called staghorn kidney stones).
  • Kidney stones are bigger than 2 centimeters (0.8 inch) in diameter.
  • Urine leakage is occurring inside the body.
  • There is severe pain even after treatment for a kidney stone.
  • Kidney stone is causing damage to the kidney.
  • Other treatment options have failed.
  • The urologist will request several tests before the operation. Blood and urine tests check for infection and other problems, while a computerized tomography (CT) scan helps to determine the location of the stones.

Advantages of PCNL:

  • Minimally-invasive procedure, with less pain, quick recovery, shorter hospital stay (2-4 days) and quick return to work (7-10 days).
  • No surgical scar or complications associated with large incision operations.
  • Less risk of postoperative infections compared to open surgery.
  • Minimal harm to kidney function.
  • Limits residual stones, as the surgeon has the opportunity to look inside the renal calyx and ureter.
  • Percutaneous nephrolithotomy is effective for most people with stones in the ureter or kidney. Its stone free rate is greater than 90 percent and is the highest of all procedures.

For more information on treatment of kidney stones, visit Advanced Urology Institute.

5 Effective Treatment Options for Erectile Dysfunction

5 Effective Treatment Options for Erectile Dysfunction

There are several treatment options available for erectile dysfunction (ED), and the right one for an individual depends on the cause of the ED, age, health and lifestyle of the patient. In most cases, the use of oral medications such as Cialis, Viagra or Levitra is the recommended first option. Then, depending on the effectiveness and tolerance of the medication, other treatments may be tried. For example, microvascular surgery is recommended for patients with blood vessel leakage or blockage, while penile prosthesis is one effective alternative for those who fail to respond to non-surgical therapy or are not candidates for surgery.
Here is a look at 5 effective treatment options for erectile dysfunction:

1. Oral Medications: Phosphodiesterase-5 (PDE-5) inhibitors

Phosphodiesterase-5 (PDE-5) inhibitors, such as sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra) and avanafil (Spedra), are some of the most widely used and highly effective medications for treating erectile dysfunction. The pills work by temporarily boosting the flow of blood to the penis. Sildenafil, sold as Viagra by Pfizer, is the most commonly prescribed pharmacological medicine for ED. Though it is available in different forms, Viagra takes 30-60 minutes to show effect and has a 4-hour duration. The drug only boosts blood flow to the penis and therefore sexual arousal and stimulation are necessary in order to have and maintain an erection. Tadalafil (Cialis) has effects lasting longer (up to 36 hours depending on the dose taken) and takes effect sooner (15-30 minutes). Tadalafil is also more selective in action and does not show the side effects of sildenafil and vardenafil. Avanafil (Spedra) and vardenafil (Levitra) show similar mechanism of action as sildenafil (Viagra) and only differ in duration of onset and length of effect.

2. Urethral Suppository (MUSE)

The use of a medicated urethral system for erection (MUSE) is considered when oral pills are not effective. The treatment involves placing a small medicated suppository in the penile urethra without using needles so that the suppository is absorbed to help produce an erection. The main advantage of this treatment option is that the suppository is applied locally by the patient or his partner, and has very few side effects. After the suppository is inserted into the urethra, sexual stimulation is necessary for increased blood flow to the penis. Patients opting for MUSE should have the first suppository application done in the urologist’s office to prevent potential complications such as decreased blood pressure, urethral bleeding, and continued and prolonged erections.

3. Penile Injections

The urologist may recommend penile injections when oral medications prove ineffective. And even though the idea of injecting the penis may be quite unappealing, the effectiveness and ease of injections make this a worthwhile option to consider. Apart from Caverject and Edex that have been prescribed by urologists for a while, other commonly injected medications are papaverine, phentolamine and alprosdid. Often, urologists recommend a blend of two or three medications for use in the injections. The blend, called a Trimix, ensures a synergistic effect of three medications, keeps the dose of every drug low to prevent adverse effects, and delivers a response rate of up to 90%.

4. Vacuum Pumps

Vacuum devices are recommended for patients who have only partial erections and find other treatments ineffective or intolerable. A vacuum device is made of a plastic cylinder connected to a pump and a constriction ring. Using a battery power or manual pressure to create suction around the penis in order to bring blood into it, a vacuum pump causes an erection which is maintained by a tourniquet of sorts that is placed around the base of the penis and an elastic rind which stops additional blood from flowing out of the engorged penis. Vacuum pumps are a relatively inexpensive, safe and easy to use treatment option for erectile dysfunction with minimal side effects. Erections induced using pumps generally last for about 30 minutes.

5. Penile Prosthesis and Penile Vascular Reconstructive Surgery

Surgery is considered as the last resort when all other treatment options fail. However, it may be the best option for young men seriously injured in their pelvic area (such as in a car accident) and men with significant anatomical problems with their penis. A penile prosthesis is an effective and more invasive option in which either a semi-rigid or inflatable implant is placed on the penis through surgery. The use of penile prosthesis has been proven to offer up to 85% patient-partner satisfaction rate. Penile vascular (venous or arterial) surgery is recommended for young men who have erectile dysfunction due to congenital or traumatic leakage of the penis. Penile venous surgery is performed to boost the trapping of blood in the penis, boosting a man’s capacity to get and maintain erections. On the other hand, penile arterial surgery creates a path of blood flow to the penis by correcting/bypassing blocked arteries.

For more information on effective treatments of erectile dysfunction, visit the Advanced Urology Institute website or make an appointment with a urologist today.