What Urology Procedures Are Performed in Our Naples Office?

I’m Rolando Rivera, I am board-certified in urology and female public medicine and reconstructive surgery with Advanced Urology Institute.

So the surgery center is designed for primary outpatient interventions that are fairly uncomplicated, so we do do a fair amount of things at the surgery center. We do our prostate procedures…Urolift, we do a fair amount of those. Simple reconstructive procedures [such as] public reconstructive surgeries, stone disease, those kinds of things [and] the more complex reconstructive surgeries that require specific equipment like I do robotic surgery for prolapse, that is a hospital procedure.

Treating Kidney Stones

Treatment of Kidney Stones

The treatment available for kidney stones varies according to the size and type of kidney stone and its location.

If the stones are small, they probably won’t require invasive treatment and can be passed with hydration and medication like pain relievers and alpha blockers that relax the muscles in your ureter. This is how most kidney stones are resolved.

Dr. Rolando RiveraIf you have large stones, however, your urologist may approach them with more extensive treatment. There are several ways to eliminate them. If you have severe pain, an infection, or your kidney function is threatened, your doctor will want to act quickly. Fortunately, during the 1980s a new approach to getting rid of the stones appeared on the medical scene and quickly replaced surgical removal of the stones. This treatment, called lithotripsy, uses sound waves to break larger kidney stones into tiny pieces so they can be passed during urination. These sound waves are also called high-energy shock waves and are usually implemented from outside the body in what is called “extracorporeal shock wave lithotripsy” or ESWL. The procedure takes about 45 minutes to an hour and you may be put under light sedation during treatment.

If the stones are larger and located in the kidney, or if ESWL did not break them down, your urologist may perform surgery to remove them. Your doctor can explain the surgical approach he recommends.

What Causes Kidney Stones?

Calcium phosphate stones are caused by overactive parathyroid glands which are located below your Adam’s apple. When these glands overproduce the parathyroid hormone the result is hyperparathyroidism, resulting in an excess of calcium that may cause kidney stones. Your doctor likely will recommend treatment to stop your parathyroid gland from overproducing the hormone.

Prevention of Kidney Stones

You may lower your risk of kidney stones if you:

  • Drink large amounts of water during the day. If you are in a dry environment or exercise significantly, you may need even more water, drinking enough so your urine looks almost clear.
  • Consume fewer oxalate-rich foods. If your doctor determines you have calcium oxalate stones, he may recommend dietary changes to reduce foods that are high in oxalate, like beets, spinach, sweet potatoes, tea, chocolate, nuts and soy products.
  • Reduce your dietary salt and consumption of animal proteins.

Medications

Medications may help prevent kidney stones, depending on the type of stone. Uric acid stones, calcium stones, cystine stones and struvite stones each require a different plan for prevention.
If you reside in Florida, you are probably not far from an Advanced Urology Institute location. If you are near Naples or Bonita Springs, you may wish to consult with Dr. Rolando Rivera for your kidney stone symptoms and treatment. For more information, visit the Advanced Urology Institute website.

What are the benefits of da Vinci Robotic Surgery

If you are facing surgery, you want the most effective and least invasive approach to the operation. You can rest easy when you hear that your procedure will be done with the da Vinci® robotic surgery technology.

The da Vinci approach has transformed minimally invasive surgery, enabling patients to get back to what matters sooner. Over the past 20 years, da Vinci platforms have offered consistent and superior outcomes, pioneering new capabilities in the operating room. The da Vinci robotic surgery has virtually revolutionized the field of minimally invasive surgery.

Dr. Rolando RiveraSurgical Approach with da Vinci Robotic Surgery

  1. Surgeons and operating room staff who use the da Vinci system are given comprehensive training by the manufacturer. Their professional education includes simulation for skills and procedures, along with practice and peer guidance.
  2. The da Vinci robotic surgical system offers a minimally invasive alternative to laparoscopy and also to open surgery. (Laparoscopy surgery is a procedure that uses fiber-optic instruments inserted through the abdominal wall to see and repair internal organs.)
  3. Because robotic surgery offers greater precision and control for the surgeon, and is performed by just a few tiny incisions, patients generally recover sooner.

Benefits of da Vinci Robotic Surgery for Patients

Patients will be thankful for the many benefits of robotic surgery using the da Vinci approach:

  • Reduced pain
  • Less blood loss
  • Reduced risk of infection or complications
  • Less scarring because of smaller incisions and fewer sutures
  • Briefer hospital stays/faster recovery
  • More rapid return to normal activities, including urinary continence, sexual function, and more.

Benefits of da Vinci Robotic Surgery for Surgical Professionals

To understand more about the benefits of the da Vinci system, consider these advantages. Aided by the da Vinci system’s ergonomic design, your surgeon is able to get a magnified 3-D view with high-definition while operating from a comfortably seated position. Your surgeon can operate precisely with these advantages:

  • Improved dexterity
  • Wider range of motion
  • Enhanced visualization including areas that are not visible by the naked eye
  • Improved access to otherwise almost inaccessible areas
  • Improved outcomes, sparing healthy tissue not impacted by cancer

The superior results with a da Vinci robotic surgery procedure are ideally suited for urologic conditions. At the Advanced Urology Institute, urologists such as Dr. Rolando Rivera perform minimally invasive robotic surgeries for prostate cancer, vasectomies and more complex surgeries such as reconstruction. For more information, visit the Advanced Urology Institute website.

Becoming a Urologist with Dr. Rolando Rivera

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.

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 Causes Kidney Stones

Kidneys perform the function of filtering blood to remove waste from it. This waste is mostly water that contains salts such as sodium, calcium and potassium, all collectively referred to as urine. Kidney stones form when these salts are so concentrated in the urine that they crystallize into clumps, that can be as small as a grain of sand or larger.

Ordinarily a kidney stone causes no symptoms until it begins to move in the kidney or to other parts of the urinary system. A small kidney stone can be passed painlessly by urination. Bigger kidney stones, however, can be very painful to pass. But kidney stones are treatable and treatment should help you avoid the painful experience.

Causes of Kidney Stones

Kidney stones result from the clumping together of salts. Most kidney stones are calcium oxalate stones that form from calcium salts and oxalates. Oxalates occur naturally in some fruits, vegetables and nuts. There are also uric acid stones, which form due to lack of fluid in the body or a significant loss of fluid. Risk factors for the formation of kidney stones include:

1. Lack of Water/ Dehydration
This is without a doubt the most common cause of kidney stones. Stones form when urine salts occur in very high amounts in urine. Drinking adequate amounts of water can dilute the urine and reduce the concentration of salts. People in hot areas should take special care to drink a lot of water because they lose a lot of it in perspiration.

Dr. Rolando Rivera 2. High sodium diet
Many kidney stones have an element of calcium. Too much sodium increases the amount of calcium that kidneys have to process, thereby making it more likely for stones to form. Animal proteins such as red meat and shellfish, also have a reputation for making urine acidic, thereby increasing the possibility of having uric acid stones.

3. Personal or family History
A person who comes from a family with a history of having kidney stones is at an increased risk of having them. Similarly, a person who has had kidney stones before is very likely to suffer a recurrence.

4. Digestive illnesses and surgery
Serious inflammations of the digestive system, chronic diarrhea and gastric bypass surgery all can negatively affect the absorption of fluids and calcium by the body. This makes it more likely for the patient to have kidney stones.

Kidney stones are very common despite the fact that they can be prevented by staying hydrated and watching your diet. If you have them, you should consult a doctor immediately so treatment can be administered promptly. The Advanced Urology Institute offers effective treatment for kidney stones. Its staff of specialists are available to help with diagnosis and treatment and can answer any questions about prevention of kidney stones. 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.