Prostate Problem Warning Signs


At Advanced Urology Institute, we frequently see first-time visitors with symptoms of advanced stage prostate problems. For us, that is quite heartbreaking because it means the patients come too late, when only limited treatment options are available for their conditions.

As urologists, we always want the best for our patients. We want to see them leave when they can pee better and are free from the embarrassment of accidental urine leaks. And because early detection and treatment of prostate problems — whether prostate cancer or non-cancerous condition — improve the chances of cure and of long-term survival, we always encourage men to be more mindful of their bodies, especially when it comes to their urinary function and habits. By doing that, they are able to detect warning signs of prostate issues early and can seek treatment.

Warnings signs of prostate problems include:

  1. Frequent urination or frequent urge to pass urine.
  2. Passing urine more often than usual, particularly at night.
  3. Pain, discomfort or burning sensation when passing urine.
  4. Dribbling urine
  5. Weak or interrupted urine streams.
  6. Accidental urine leakage.
  7. Blood in urine or semen
  8. Frequent stiffness or pain in your lower back, rectal area, hips, upper thighs or pelvic area.
  9. Difficulty or inability to urinate
  10. Trouble with starting or stopping your urine stream.
  11. Painful ejaculation
  12. A feeling that you aren’t able to empty your bladder completely.
  13. Swelling of lower extremities.
  14. Paralysis or weakness in lower limbs.
  15. Inability to pass urine while standing up.
  16. Loss of appetite and weight, fatigue, nausea and vomiting.

It is important to see a urologist immediately if:

  1. You find urination difficult, abnormal or painful. The doctor will examine your prostate gland to find out if it is inflamed, enlarged or has a cancer.
  2. You have frequent urination, urinary retention, blood in urine, dribbling or slow flow of urine, problems starting a urine stream, or repeatedly urinate urgently.
  3. You have a chronic pain in your pelvic, lower back, upper thigh or other areas of your lower extremities. While any unexplained ongoing pain in these areas may have various causes and always merits medical attention, seeing a urologist may help detect whether or not you have prostate cancer.
  4. You have swollen legs, weakness in your legs or trouble walking.
  5. You have unexplained weight loss.

As urologists, we have several options for tackling prostate problems, but our interventions normally depend on the severity of the symptoms, type of condition and how it is impacting your overall quality of life. For example, if the prostate condition is not severely affecting your quality of life and you have no complications (such as bleeding, bladder stones or urinary infections), the decision to treat the problem is often optional and left for you to make.

That means if you aren’t bothered enough to undergo a procedure or take medicine for the condition, then you’ll only need frequent follow-up with your urologist to check whether your symptoms remain stable over time and your bladder continues to empty well. But if you already have complications or your bladder is holding increased quantities of residual urine after urination, then we often begin treatment immediately.

To help you pass urine better, we may offer medications such as alpha blockers, 5-alpha reductase inhibitors or a combination of drugs. But minimally invasive surgical procedures such as TUMT (transurethral microwave thermotherapy) and TUNA (transurethral needle ablation), water-induced thermotherapy, PVP (photoselective vaporization of prostate), and HoLAP (holmium laser ablation of prostate) also may be considered. For more information on diagnosis and treatment of prostate problems, visit the “Advanced Urology Institute” site.

What is a Vasectomy?

A vasectomy is a simple and safe minimally-invasive surgery done by a doctor in a clinic, office or hospital. During the procedure, the small tubes called vas deferens that carry sperm are blocked or cut off to prevent sperm from leaving a man’s body and causing pregnancy. The sperm cells remain in the testicles and are reabsorbed into the body. So after about 3 months following a vasectomy, the semen doesn’t contain any sperm and can’t cause pregnancy. Of course you’ll still produce the same amount of semen as before except that there will be no sperm in them.

Quick and highly-effective

A vasectomy is a quick, 15-to-30-minute procedure and you can return home the same day. Designed to be a permanent form of contraception, a vasectomy is extremely effective in preventing pregnancy — nearly 100 percent. It is one of the most effective methods of birth control you can find. Vasectomy — also called male sterilization — is meant to protect against pregnancy permanently, so it’s super effective once you are past the first three months following surgery when the semen has become sperm-free.

After the procedure, pregnancy is prevented round-the-clock for the rest of your life. Once the doctor confirms that you no longer have sperm in your semen, then you don’t to do anything else to prevent pregnancy.Of course there is a very slim chance of the cut ends of the tubes growing back together after the procedure, making it possible to cause a pregnancy. That, however, very rarely happens.

Types of vasectomy

The vasectomy procedure involves cutting and blocking or partially removing both ends of the vas deferens (the sperm duct). Once that is done, sperm traveling from the testes can no longer reach the semen and form part of the ejaculate. Two types of vasectomies exist: the no-scalpel method and the incision method. The no-scalpel (no-cut) technique has a lower risk of infection and complications and generally requires a shorter recovery time. Because it’s classified as a minor surgical procedure, a vasectomy is often done in the doctor’s office with the patient under local anesthesia. It’s only in a small percentage of men where the procedure is performed in the operating room with general anesthesia or sedation — either due to the results of a doctor’s physical exam or patient preference.

Doesn’t hurt as much as often perceived

Vasectomy is a safer, minimally-invasive birth control method and a more effective procedure compared to tubal ligation. Guys generally tolerate it better than women do with tubal ligation. While you will experience a sharp sensation when the numbing medication is applied with a small needle, there should be no further pain after that. If you experience any further discomfort, inform your doctor so more of the numbing medication may be given or action is taken to alleviate the discomfort. Most men find vasectomy less painful than they anticipated, although a mild swelling and soreness may be experienced after the procedure.

Recovery after a vasectomy

Some mild swelling and discomfort is to be expected for a few days after the procedure, but almost always is gone completely by the end of the first week. It’s recommended that you take 1-2 days off work to reduce your activity level and get ample time to recover — although men with physically strenuous jobs may require a longer break from work. For the first 48 hours after the procedure, keep your activities limited and apply cold packs to your scrotum 3-4 times a day, with each application lasting for about 20 minutes. Wear supportive underwear until the discomfort subsides or for at least a week. Avoid sexual activity and exercise until the discomfort disappears, usually after around one week. Don’t soak in a pool, open water or hot tub for at least 3 weeks to ensure your wound heals quickly — you may just shower and dab dry. Return to normal activity slowly, building up your activity level gradually.

At Advanced Urology Institute, we do vasectomies in the office, using the no-scalpel, no-needle procedure. However, if you’re squeamish about it then you can have the procedure in a surgical room — although for most guys, doing it in the office is alright. The procedure takes about 20 minutes and is not bad in terms of pain. Recovery is also very fast. Most men schedule it on Friday and are back to work on Monday. As long as you don’t engage in strenuous activities such as a heavy lifting kind of a job, you can resume work quickly.

So if you want freedom from the fear of having unwanted children and want to enjoy your sexual relations without worrying about a pregnancy, a vasectomy is the ideal contraception for you. For more information on vasectomy, visit the “Advanced Urology Institute” site.

How are Kidney Stones Treated?

Kidney stones are a common cause of agonizing and debilitating pain in men and women. In the United States, the stones account for over one million hospital visits and more than 300,000 emergency room visits every year. When patients present with kidney stones, the treatment administered usually depends on the type, size and location of the stone and on the severity of symptoms. Apart from administering treatment, the urologist investigates the underlying cause of the stones and recommends ways of preventing a recurrence.

Spontaneous passage

Kidney stones smaller than 4 mm in diameter are often passed on their own in urine and may be treated at home. While such stones may be painful, the pain often lasts only a few days and usually disappears soon after the stone is passed. So, depending on how bad your symptoms are and how long you’ve had the symptoms, you may not be given any form of treatment and just wait for stones to pass in urine. It usually take up to six weeks to do so.

However, you should only do this if the pain is bearable, there is no sign of infection or kidney blockage and the stone is of a size that can pass on its own. As you wait for it to pass, you’ll need to drink plenty of water and take pain medication to help you manage the discomfort. If you suspect that you have a kidney stone, speak with your doctor to see if you need immediate treatment or if you can wait for it to pass spontaneously.

Medications

There are a number of medications that increase the chance of passing kidney stones. For instance, tamsulosin is commonly given to people with kidney stones to help relax the ureter and make it easier for stones to pass. Apart from medications to boost stone passage, your urologist may prescribe anti-emetic (anti-nausea) medication to reduce nausea and vomiting as you wait for the stone to pass. And if you are in severe pain, your doctor may give you 1-2 pain injections and then prescribe some painkillers and anti-emetics for you to take from home.

Surgical procedures

If the pain is so much that you can’t wait for the stone to pass in the urine, you’ll require a surgical procedure to remove it. Surgery is also necessary if the stone is too big to pass on its own or is hampering kidney function. Kidney stones may be removed surgically if they are causing repeated urinary tract infections or are blocking the normal flow of urine.

Surgical procedures to remove kidney stones include extracorporeal shock-wave lithotripsy (ESWL), ureteroscopy and percutaneous nephrolithotomy (PCNL). These procedures are usually chosen by urologists depending on the size, type and location of the stones.

1. Extracorporeal Shock-Wave Lithotripsy (ESWL)

This procedure is the most frequent way of treating stones that can’t pass spontaneously in urine. High-frequency waves (X-rays or ultrasound) are directed at the stone to break it into smaller pieces that can pass in urine. Often the tiny pieces require a few weeks to pass out in urine. While ESWL is 99 percent effective for kidney stones up to 20 mm in diameter, more than one session is usually necessary for the treatment to be successful.

2. Ureteroscopy

For kidney stones that are lodged somewhere in the kidney or ureter, ureteroscopy (also called retrograde intrarenal surgery) may be necessary. The procedure involves directing a long, thin telescope (called ureteroscope) through the urethra, into the bladder, then into the ureter or kidney where the stone is located. If the stone is stuck in the kidney or upper ureter, the urologist uses flexible telescopes for this procedure, but rigid telescopes are ideal for stones stuck in the lower parts of the ureter.

The ureteroscope helps the urologist to reach the stone without making an incision. After reaching the stone, the doctor either can use another instrument to remove it or direct laser energy on it to break it into smaller pieces that can pass naturally in urine. A stent (plastic tube) may be inserted temporarily into the bladder to drain out the stone fragments.

3. Percutaneous nephrolithotomy (PCNL)

For kidney stones that are too large (21-30 mm in diameter), percutaneous lithotripsy is the treatment of choice. During the procedure, a half-inch incision is made in the side or back, just big enough to allow passage of a telescopic instrument (called nephroscope) into the area of the kidney where the stone is located. The nephroscope is used either to pull out the stone or break it up with pneumatic energy (or laser) and suction out the pieces. In fact, it’s the ability to suction out tiny stone pieces that makes this procedure ideal for larger stones.

Kidney stones also can be removed through open surgery, laparoscopic surgery or robotic surgery. But this is only done when the less-invasive procedures fail. Routine surgical procedures for kidney stones require shorter recovery period and you can usually return home the same day after the procedure and resume normal activities in 2-3 days. If the urologist inserts a stent after a procedure, it is removed 4-10 days later. During treatment, you also may be provided with a strainer that you can use to collect stone pieces that pass in urine for laboratory testing and to enable the urologist to recommend appropriate ways of preventing stone recurrence.

At Advanced Urology Institute, we offer shockwave lithotripsy, ureteroscopy and percutaneous nephrolithotomy routinely, and perform robotic and laparoscopic procedures for kidney stones when necessary. We perform blood tests and 24-hour urine analyses for every patient to identify the cause of kidney stones in order to provide the right treatment. We also design prevention strategies tailored to each patient, including personalized dietary recommendations based on results of 24-hour urine analysis. Our aim is to always ensure that our patients properly understand why they have kidney stones and make the necessary lifestyle changes to prevent a recurrence. For more information on kidney stones and how they are managed, visit the “Advanced Urology Institute” site.

Becoming a Urologist with Dr. Rishi Modh

Being a urologist is an opportunity to help people and make a difference in their lives. As a urologist, people come to you with sensitive and often awkward conditions of the genitourinary tract and you assess the problems and provide the most appropriate remedies. The goal of urologists is always to make interventions that ensure patients are able to live fuller lives. And that makes us proud of our work and of our unique place in the medical profession.

Urology — a big world of stuff

Many people think of urology as merely being about urine. But urology is a massive world that covers a wide range of stuff. It’s an amazing and exciting specialty, where you perform surgery, manage problems medically, develop enduring relationships with patients and go home every day feeling satisfied with your work. I like urology because I’m often able to see the results of my work. For example, when patients come with urological cancers — of the prostate or kidney — I am often able to make effective interventions and achieve great outcomes. Actually, almost all my operations usually result in improved quality of life.

Why urology?

Urology was a natural fit for me. I wanted to be involved in diagnosis, medical management and surgical procedures. With most of my cases I have found that wonderful balance of medicine and surgery in urology. I also like listening and talking to people, leading them to open up and share their problems, guiding them to see the bigger picture and helping them to make informed decisions. In urology, I’m able to do this and much more with my patients. Most crucially, I joined urology to have a chance to make a difference in people’s lives. And indeed, I have found the specialty well-rounded, fascinating and exciting, as well as a powerful instrument for improving people’s lives.

Path to urology

I was born and grew up in Tampa, Florida, where my passion for the health and well-being of the people around me and for public health and sanitation made me a volunteer in many causes right from a young age. I soon realized that pursuing medicine would help me to make a better contribution in health care and improve people’s lives. So I joined the University of Miami for my medical education, graduating with AOA honors. Then I went to Shands Hospital, University of Florida for my urology residency. Currently I am happy and proud to be back in Florida where I’m practicing and living the dream of my life — making a difference in people’s lives.

Areas of expertise

As a urologist, I routinely deal with a wide variety of issues, such as urinary tract infections, overactive bladder, urinary incontinence, low testosterone and prostate enlargement. I also offer procedures for kidney transplants, interstitial cystitis, prostatitis, overactive bladder, congenital abnormalities, urinary stones, correcting stress incontinence, operating on adrenal glands and treating bladder, prostate and kidney cancer. I provide vasectomies, vasectomy reversals and treat erectile dysfunction and infertility issues in men.

What makes urology even more interesting is the continuous integration of advanced technology. Today we can access the urethra via the bladder and get into the kidneys without making any incisions. Even operations to remove kidneys or prostates, which previously required open surgery, are now routinely performed robotically or laparoscopically — using tiny, image-guided instruments.

At Advanced Urology Institute where we use the da Vinci surgical system for several operations, a urologist can now just sit at a console, have fingers in sensors and remotely control a multi-armed robotic surgeon, which ensures access to more areas in the body and provides seamless movement during operation in ways that are impossible laparoscopically. Application of such technology guarantees less scarring, less blood loss and quicker recovery for our patients. And for the urologist, it’s always exciting in the operating room working with such technology.

Job satisfaction

It takes long and hard training to become a urologist. The residencies take 5-6 years and typically involve long hours of complex work and limited sleep. Then there are several hours per week spent in the operating room, which may test anyone’s tenacity and patience. However, it helps that urologists are generally professionals with a positive attitude, good bedside manners and vast empathy. So these challenges can hardly diminish our enthusiasm and commitment to urology.

As a urologist, you are always conducting tests and procedures that may be quite uncomfortable for your patients, delivering news about diagnoses that your patients may not want to hear, and facing medical emergencies requiring you to think on your feet and solve issues to the best of your ability. But with skills to communicate well, eyes for detail and unquenchable desire to help people, you’ll always find yourself on top of things.

I really like urology because I’m a hands-on person who enjoys the hours it offers in the operating room. There are many potential conditions to treat, a wide range of procedures to perform and different tools to use —so no two days are the same. From a vasectomy to vasectomy reversal, circumcision to delivering antibiotics for urinary tract infections, laser surgery to robot-assisted procedures, there’s a lot to keep a urologist engaged and involved.

Urologists also are at the forefront of advanced technology, having pioneered laparoscopic approaches that have been adopted by other medical specialties and now leading the way in the use of cutting-edge robotics. The field is ever growing and changing, and we are constantly researching, learning and innovating to perform our duties better.

Most essentially, urology allows you to build lasting relationships and make a difference in people’s lives. I follow my patients over time, getting to know how they are doing and helping them make informed decisions. I enjoy what I do because I’m always involved in improving, prolonging and saving lives.

Why Advanced Urology Institute?

Advanced Urology Institute stands out for its commitment to excellent urological care. By bringing together a huge number of driven, hard-working, experienced and certified professionals, and having them adopt a collaborative, multidisciplinary patient-centered approach to care, AUI not only gives urologists an opportunity to grow, but also offers them a working environment that brings out the best of their knowledge, skills and experiences. I like the fact that all administrative duties have been centralized and we have all the time we need to work with our patients and give our best.

It’s also good that colleagues at AUI are quite laid back, funny and relaxed people. We are serious about our work but we also enjoy jokes with each other and maintain a positive, friendly practice. It’s a fantastic place full of people who love what they do and who handle diverse issues and patients with utmost diligence and thoroughness. And because we love our job, we work harder to get better at it and to achieve great outcomes for our patients. For more information on our urological services, visit the “Advanced Urology Institute” site.

Advantages and Disadvantages of Robotic Technology in Urology

Robot-assisted (robotic) surgery uses small instruments attached to a robot’s arm to conduct surgical procedures. A qualified, highly-skilled surgeon controls the robotic arm, using it to enhance surgical precision. In fact, contrary to popular beliefs, it’s the surgeon behind the robot and not the robot itself that performs the procedure. The robot improves surgical outcomes and boosts patient safety by enabling the surgeon to use very tiny incisions and to achieve unmatched precision.

Robotic surgery in urology

Robot-assisted surgery has become very popular in urology, particularly in the United States. In urology centers where it is used, it’s extensively applied in surgery to excise prostate cancer as it enables access to anatomical areas that are difficult to reach. Other urologists use it for kidney cancer surgeries and to some extent in bladder surgeries. Through robot-assisted procedures, urologists are able to use the surgical assistance, enhanced precision, systems networking, dexterity and image-guidance made possible with robots. Urologists are able to easily perform complex procedures that are often difficult to do using conventional laparoscopy.

Pre-operation discussion

While robotics are excellent tools that improve the outcome of surgical procedures, they are not ideal for every situation. The need and value of robot-assisted surgery varies from case to case and it’s important to discuss this with your urologist before undergoing surgery. Being clearly informed of the benefits and risks associated with robotic surgery ensures that you can make an informed decision before the procedure.

Advantages of robot-assisted surgery

Robotic surgery is typically minimally invasive. So the patient suffers less pain, slight blood loss and minimal scarring, and requires only a short recovery time. With the robotic arm eliminating the natural limits of human wrists, surgery can be performed with more delicate, precise and efficient movements. The 3D imaging and endowrist technology of robots ensure surgery is more accurate, nerve bundles are dissected more precisely, erectile function is preserved, and there is a better chance of cure than with non-robotic surgery. The surgeon also enjoys more strength, dexterity, flexibility, control and a better view of the operated area. Robotic surgery allows the surgeon to get more comfortable, perform the procedure with increased concentration and focus, and can undertake complex procedures that are tougher or impossible with other techniques.

Disadvantages of robot-assisted surgery

With robot-assisted surgery, there is not only the risk of human error when operating the robotic system, but also the potential for mechanical failure. For instance, system components such as robotic arms, camera, robotic tower, binocular lenses and instruments can fail. In other cases, the electrical current in the robotic instrument can leave the robotic arm and be misapplied to surrounding tissues, resulting in accidental burn injuries. Likewise, robot-assisted surgery can cause nerve palsies due to extreme body positioning or direct nerve compression that may occur when using robots. It also takes longer to perform robotic surgery than non-robotic surgery in surgical centers with lower robotic volume or by less experienced surgeons.

Ways of improving robot-assisted surgery

It’s important that centers applying robotics follow standardized training, improved reporting and enhanced patient education to reduce errors related to robotic surgery. Robotic surgery should be conducted by urologic surgeons trained in robotics and have extensive robotic and laparoscopic surgical experience. It also must be remembered that adding robots to the surgical equation may create room for error in an already risk-fraught and complex arena. So proper steps must be taken to guarantee safe and effective robot-assisted procedures. Robotic surgery is getting better and better as more advanced robots are developed to overcome existing shortcomings. So patients should expect better outcomes with robot-assisted surgery as advanced machines are applied.

At Advanced Urology Institute, we believe that surgical outcomes are a direct manifestation of the experience and skill of the surgeon, and less about the approach or technology used. That’s why we have assembled a team of qualified, skilled and experienced urologists to offer surgical procedures for different urological disorders. Our urologists perform hundreds of laparoscopic and robotic surgeries every year and have achieved great success rates in terms of efficacy, cure and improved quality of life. Our approach to robotic surgery guarantees that you will get the best possible surgery with remarkable outcomes. For more information, visit the “Advanced Urology Institute” site.

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