The Enjoyment of Being a Urologist

Urology is a wonderful specialty, being at the same time a surgical and medical practice. It offers an interesting mix of work in both the office and the operating room.

“For many of us, we enjoy spending time in the operating room—after all, we are surgeons by trade,” says Dr. Scott B. Sellinger, FACS, a board-certified urologist at Advanced Urology Institute. “But for many of us, we also enjoy interactions with our patients in the office. I love to see my folks, especially the ones I’ve been seeing for the past 25 years. They come back every year and we can chat about all kinds of things.”

Interesting surgical techniques

While most urology patients are followed long-term with medical interventions, at least half of them are surgical patients. The subspecialty of urology offers great opportunities to practice the surgical side of the profession, which includes the hands-on application of the latest technology, such as robots and lasers. “I enjoy the surgical side of our profession, and urology offers innovative techniques and technology that makes surgical procedures even more interesting,” says Dr. Sellinger.

Long-term relationships

The opportunity to build lasting doctor-patient relationships makes urology gratifying.

“As a urologist, you get to care for the entire spectrum of age groups of patients, such as children with congenital problems and patients in their declining years, when a lot of urologic problems tend to set in.” says Dr. Sellinger. “I like the fact that I see different patients every day, delve into their emotional problems, and with empathy, provide the support and solutions they need. I also enjoy speaking with the patients I see every year for several years since every time they come in they have something great to share,” he adds.

Tackling embarrassing problems

Urology brings relief to patients with personal and sometimes embarrassing medical problems. Through surgery, medications or both, urologists resolve these issues and improve the quality of life of their patients, which is quite appealing.

“As a urologist, not only do I treat life-threatening conditions like cancer, I also improve the quality of life of patients by freeing them from sexual dysfunction or incontinence,” says Dr. Sellinger.

Great outcomes

Unlike some other specialties, the treatments offered by urologists often provide quick relief and good outcomes. In fact, most patients treated by urologists do well and get better.

“Nowadays, urology is quite advanced, and we have at our disposal medicines, surgery, and the combination of both treatments that render our patients improved soon after they interact with us,” says Dr. Sellinger. “So we feel satisfied and secure in the knowledge that we can solve most, if not all, of the urologic problems,” he adds.

Because of consistently great results, urologists are held in high regard by their patients, who are usually grateful for the care. In turn, this gives a kind of satisfaction to urologists.

“I am happy that I chose urology. I’m always filled with joy every time patients come back to thank me for what I’ve achieved for them,” says Dr. Sellinger. “If I were to start all over again, I would still choose to become a urologist.”

Personalized, compassionate care

Want to have your urological problem treated by an effective urologist? AUI is a medical group with a long history of providing comprehensive, high-quality care. The urologists at AUI find it a joy to work in an environment that brings out the best of their knowledge and experience for the benefit of their patients.

Whether you have kidney, urinary tract, prostate, pelvic or other urological needs, at AUI you will find a urologist who can deliver the right treatment for you. For more information on the diagnosis and treatment of urological conditions, visit the Advanced Urology Institute website.

Types of Prostate Cancer: What You Need to Know

Prostate cancer is a complex disease. It is not easy to predict how any particular prostate tumor will grow, or how rapidly it will spread to areas outside the prostate. After a prostate cancer diagnosis, your urologist will assess various factors to determine the level of risk associated with the disease. Understanding the risk level—low, intermediate or high—will help you and your doctor make decisions to achieve the best survival rate and quality of life.

Types of prostate cancer

While there are many types of prostate cancers, urologists first divide them into two categories—aggressive and indolent—to begin determining the best treatment.

1. Aggressive prostate cancer

Dr. Scott Sellinger of Tallahassee, FLAggressive prostate cancer is the type that grows rapidly, spreads fairly early, quickly and widely, and causes massive body damage. Since it spreads swiftly via secondary deposits, it quickly becomes advanced stage cancer and is very difficult to treat, particularly during the later stages.

For aggressive high-risk prostate cancer, treatment is most effective when it begins while the tumor is still in its early stages. Without early treatment, the cells of the tumor remain highly active, multiplying rapidly. The tumor grows swiftly, spreads rapidly and causes widespread damage.

2. Indolent prostate cancer

Indolent prostate cancer is the type that grows very slowly and is unlikely to spread to areas outside the prostate. Therefore, it is a low-risk, low-volume tumor that can exist in the prostate for several years without causing significant problems. Even if left untreated, it is unlikely to spread outside the prostate; and if it spreads, it only does so slowly and locally.

How are high-risk and low-risk prostate tumors identified?

If you are diagnosed with prostate cancer, your doctor will monitor the disease periodically to see if it is growing and spreading. The primary way for monitoring the growth and spread of the tumor is the prostate-specific antigen (PSA) level in blood. PSA is produced by the prostate and reaches the bloodstream; but larger amounts of PSA in the bloodstream are usually a signal that the prostate is enlarged, infected or malignant.

For instance, the PSA doubling time—the time it takes for a patient’s PSA level to double—predicts how aggressive the cancer is. The faster the PSA level doubles, the more aggressive is the cancer. Likewise, the PSA velocity helps to predict the aggressiveness of a tumor. If the PSA level increases sharply, then the cancer is likely aggressive.

Urologists also use the Gleason score to detect how fast the cancer is growing and spreading. This score is obtained by grading cells in the tumor on the basis of how abnormal or normal the cells look under the microscope. The two most abnormal areas of the tumor are evaluated, each given a score from 1-5, and then the two numbers are added. The higher the score (typically 6 or more), the more aggressive the tumor.

While immediate treatment is called for with aggressive, high-risk tumors, a patient can live with an indolent, low-risk tumor for 20-30 years without the cancer causing any serious effects. For the slow growing tumor, we may recommend observation or a watchful waiting called active surveillance, where we monitor the growth and spread of the tumor without medical intervention.

At Advanced Urology Institute, we offer a wide range of treatment options for prostate cancer, including chemotherapy, hormone therapy, radiotherapy, and surgery. But before we can recommend any treatment, we try to determine the risk of advanced disease. For more information on the diagnosis and treatment of prostate cancer, visit the Advanced Urology Institute website.

Common Cause of Kidney Stones

Kidney stones are a common condition in the United States affecting about 9 percent of Americans. Every year, roughly 500,000 patients are admitted into emergency rooms because of kidney stones. While the prevalence of the condition has risen over the years, increasing from 1-in-20 people in 1994 to 1-in-11 in 2012, the trend is expected to continue, both in broader geographic coverage and in greater numbers due to extreme temperatures associated with climate change. Higher temperature leads to dehydration, which in turn contributes to increased concentrations of dissolved salts and other substances in urine. When urine is super-saturated, it allows kidney stones to develop.

Low Urine Volume

The risk of kidney stones increases with decrease in urine volume. Caused by poor fluid intake or fluid loss (dehydration) due to hard exercise, living or working in a hot place, low urine volume means there is less fluid available to dissolve salts and other urine constituents. In turn, the urine becomes darker in color, more concentrated and easily forms stones. In fact, a urine volume below 1 liter per day is associated with 10 percent of all recurrent kidney stones while urine volume below 1.5 liters per day is linked with the formation of many recurrent and first-time kidney stones. Low urine volume due to chronic dehydration, defined as a history of prolonged exposure to heat, is the main cause of 20 percent of all incidents of kidney stones.

Effect of Warmer Temperatures

Cases of kidney stones typically increase shortly after episodes of hot weather, hitting a peak within three days of exposure to extreme heat. According to a recent study published in the Environmental Health Perspectives, daily increase in average temperatures leads to increased risk of formation of kidney stones. Another study published in 2008 by the National Academy of Sciences also reported that about 70 percent of Americans are under high risk of kidney stones due to warmer temperatures compared to just 40 percent of Americans at risk in 2000. The number of cases of heat-related kidney stones is projected to increase to up to 2.2 million by 2050.

Hidden Risk

Increase in ambient temperatures results in increased fluid losses through the skin. As more water is lost in sweat and less in urine, salts can build up in urine resulting in stones. Even in cold weather, dehydration occurs in the warm and dry indoor air without being noticed. And since dehydration often occurs without being noticed, it is a bigger factor in kidney stone formation in many patients. For instance, in drier climates, people lose a lot of water through sweat without realizing it and face a greater risk of kidney stone formation.

Are you or your loved one suffering from the symptoms of kidney stones? Would you like to receive world-class, safe, prompt and effective treatment for kidney stones? Or are you looking for the most comprehensive and accurate information on prevention, diagnosis and treatment of kidney stones? Then Advanced Urology Institute is the right place for you. At AUI, we offer patient-friendly and multidisciplinary urology services for a wide range of problems including kidney stones. For more information, visit the “Advanced Urology Institute” site.

Types of Prostate Cancer

Prostate cancer refers to an uncontrollable accumulation of cells in the prostate gland. When the cancer occurs it means the ability to control the multiplication, growth and death of prostate cells has been lost. The prostate cells form abnormal cells that join into masses known as tumors. Once formed, a tumor can remain at its original location and not spread to any location outside the prostate. Such a tumor is called a primary tumor. But some spread to other areas of the body outside the prostate and are called secondary tumors.

Prostate Cancer Is Generally Slow-Growing

Most prostate cancers are relatively slow-growing. This means that a prostate tumor typically takes many years to grow and reach a size that is detectable. Likewise, it usually takes even a longer time for prostate cancer to spread beyond the prostate. Nevertheless, in a small percentage of men, prostate cancer can grow rapidly and spread aggressively to other areas. Because of this, it is quite difficult to know with certainty which prostate cancers are likely to grow slowly and which ones are likely to grow aggressively. It can be quite difficult to make the right treatment decisions.

Aggressive Versus Indolent Prostate Cancer

While there are many types of prostate cancers, urologists usually break them down into aggressive and indolent categories to make it easier to determine the right treatment and to treat various types of cancers effectively. Aggressive cancer is a high-risk prostate tumor that if not treated remains highly active and very likely to spread to areas outside the prostate gland. The cancer grows quickly, spreads early, rapidly and widely, and causes increased damage in the body. Because aggressive cancer spreads as secondary deposits and can quickly result in widespread damage, it progresses rapidly to advanced stage cancer and can be very difficult to treat. So for aggressive prostate cancers to be treated successfully, they should be diagnosed early and treatment should be started when the tumors are still in their early stages.

On the other hand, indolent prostate cancer is a low-risk, slow-growing and low-volume tumor that can sit in the prostate gland for many years without causing any problems. An indolent cancer is not likely to spread outside the prostate even if not treated. But if it does, the spread will be local and slow. In fact, patients with indolent prostate cancers can live for 10-20 years without the cancer causing any serious effects on their lives.

Identifying Aggressive Prostate Cancer

When a patient is diagnosed with prostate cancer, the urologist will take a biopsy of the prostate gland to make sure the cells are checked under the microscope to determine whether the cancer is aggressive or indolent.

Various cancer cells are examined and their activity graded using the Gleason score. When the microscopic exam returns a Gleason score greater than 7 for cancer that has not spread beyond the prostate, the cancer is classified as aggressive and the patient is given the appropriate treatment. However, if the Gleason score is 7 or below, the prostate cancer may be classified as indolent, depending on other patient factors.

The Gleason score also helps the urologist to decide the appropriate treatment. For instance, if it is an early-stage, slow-growing cancer with a score of 6 or below, the urologist may recommend active surveillance, which means that treatment is postponed and the patient is closely monitored for progress, such as whether the tumor is spreading or worsening. But to determine whether active surveillance is ideal, the urologist also will have to consider factors such as the patient’s life expectancy, overall health and concomitant illnesses. For aggressive cancer, the urologist will work with other doctors to create a treatment plan.

At Advanced Urology Institute in Florida we have a knowledgeable and experienced team of urologists to help diagnose and treat all types of prostate cancers. Our multidisciplinary approach to treatment ensures that even the most aggressive forms of cancer are treated safely and effectively. For more information on the screening, diagnosis, treatment, care and support for prostate cancer, visit the “Advanced Urology Institute” site.

New Treatment Options for Erectile Dysfunction

Statistically, 50 percent of all men experience erectile dysfunction (ED) at some point of their life, with the risk of ED increasing with age. Roughly 30 million men in the United States suffer from ED, a condition that causes frustration and the breakdown of marriages and self-confidence.

Evolution of Erectile Dysfunction Treatments

Over the years, the medical management of erectile dysfunction has evolved greatly. For instance, before oral phosphodiesterase inhibitors (PDESi) like Cialis, Standra, Viagra, Levitra and related medications were introduced, doctors could administer one of only two effective treatments for erectile dysfunction: surgical penile revascularization and implantation of a penile prosthesis.

The emergence of Viagra and related oral drugs for ED ushered in a new age of non-invasive treatment of the condition. These drugs relax the muscles in the penis and increase blood flow, allowing patients to have an erection. However, while these drugs are helpful for many men, they are not safe for men with high blood pressure, severe liver disease, kidney disease, or who take nitrate drugs. The drugs also come with side effects such as a runny or stuffy nose, dizziness, fainting and blurred vision. Because of these limitations, doctors have continuously looked for new treatment options for erectile dysfunction.

New Treatment Options

New treatment options for ED include:

  1. Injection therapy: Drugs such as alprostadil (sold under the names Edex, Caverject and Prostin VR) and the suppository-form of alprostadil (sold as MUSE) are currently available to patients. Alprostadil causes expansion of blood vessels and increased blood flow to the penis, enabling patients to get erections.
  2. Extracorporeal shock-wave therapy (ESWT): Also called acoustical wave therapy or linear shockwave therapy, ESWT uses high-frequency acoustical waves for treatment of the root cause of ED. During treatment, the waves are used to open and repair blood vessels in the penis. The therapy improves blood flow in the penis by creating new blood vessels or rejuvenating existing ones, which in turn increases the patient’s ability to get an erection.
  3. Melanocortin activators: These drugs stimulate erection by acting through the central nervous system. For instance, the drug PT-141 is effective in stimulating erection when given through the nose to men with mild-to-moderate non-medical (emotional or psychological) erectile dysfunction.
  4. Topiglan: This is a cream that is applied to the penis. Topiglan contains alprostadil, the same drug that is injected or applied as suppository by men with ED.
  5. Uprima (apomorphine): Working to stimulate the secretion of the brain chemical dopamine, Uprima heightens sexual interest and increases sensations. It comes in tablet form that easily dissolves under the tongue. However, because of its major side effects of nausea and vomiting, research is still going on to find a nasal spray alternative that causes less nausea but is equally effective.
  6. Gene therapy: The therapy delivers genes that help generate proteins or products that can replace those that are not functioning well in the penile tissues of men with ED. While experimental use of gene therapy has reported tremendous success, regulatory approval and the public’s acceptance of the therapy may still take some time.

If you are suffering from erectile dysfunction, consider your options carefully. Talk to your urologist openly. Effective treatment of ED can improve your quality of life, ability to maintain intimate relationships and boost your self-esteem. At Advanced Urology Institute, we are always improving our range of treatment options to give the very best to our patients. When you visit our urology center in Florida, you can be sure that you will have a broad range of treatment options, including the very latest, for erectile dysfunction. For more information on diagnosis and treatment of erectile dysfunction, visit the “Advanced Urology Institute” site.