What is endometriosis?

Do you experience unbearably painful periods? Do you have severe pain in your abdomen or lower back every time your menstrual cycle starts? Are your menstrual cycles characterized by excessive bleeding, painful urination, painful sexual intercourse, or painful bowel movements?

You might want to consider getting checked to see if you are suffering from a condition called endometriosis.

With these symptoms, you should see a gynecologist or female pelvic medicine and reconstructive surgery (FPMRS) physician as soon as possible. At Advanced Urology Institute, we have FPMRS physicians at our Fort Myers center who can provide a proper diagnosis.

What is endometriosis?

Endometriosis is a disorder in which a tissue, similar to the tissue that lines the inside of your uterus, grows in an area outside of it. Although found outside the uterus, the endometrial-like tissue behaves like a typical endometrium. That is, it thickens, breaks down, and bleeds with every menstrual cycle.

Unlike the by-products of normal endometrial tissue, they have no way of leaving your body. That means they are trapped somewhere in your body and eventually result in complications.

They cause severe irritation, pain, and excessive bleeding, particularly during menstrual periods. They may also cause scar tissue and adhesions, making pelvic tissue and organs stick to each other. Ultimately, this condition may interfere with your sex life and even cause infertility.

Learn more about Endometriosis causes and treatment options.

Vasectomy vs Tubal Ligation – Dr. Yaser Bassel

My name is Yaser Bassel. I’m a board certified urologist with Advanced Urology Institute.

I do perform no-needle, no-scalpel vasectomies and that is an easy in-office procedure for sterilization. For men, that oftentimes is the better option than for women undergoing a tubal ligation. In that case, women oftentimes will have to have general anesthesia and require a surgical procedure. For men this is typically a ten to fifteen (10-15) minute procedure that’s performed in the office and oftentimes we can give patients a Valium tablet so that they are relaxed during the procedure. Afterwards, as long as the patient is compliant with no strenuous activities for one (1) week, they typically do not have any issues with regards to healing. Oftentimes men are concerned that a vasectomy can affect their libido or affect their erectile function [but] there is absolutely no correlation with that and there’s no effect on erectile function or libido for men.

Female Pain During Sexual Intercourse

Sexual intercourse shouldn’t be painful. But for some women, it is.
For some, there may be pain during sexual entry or thrusting. For others, there is a burning, aching, or throbbing pain with every penetration, even pain that lasts several hours after intercourse.

What could be the reason for this?

Pain can be experienced before, during, or after vaginal sexual intercourse. Also called dyspareunia, painful intercourse occurs at the top of the vagina and intensifies with thrusting. It is characterized by a tearing, burning, or aching sensation.

Painful Intercourse The condition can happen at any age. It tends to occur in women who are still young, but you may also have the condition during or after menopause due to decreased elasticity of the vaginal walls, narrowing of the vaginal opening, or increased vaginal dryness. You may also experience painful intercourse after surgical menopause — the surgical removal of ovaries.

Learn more about the causes, diagnosis and treatment of Painful Intercourse.

When Should You Get a PSA Test – Dr. Yaser Bassel

My name is Yaser Bassel. I’m a board certified urologist with Advanced Urology Institute.

In particular it’s important for men with a family history of prostate cancer or Afrtican-American males to start screening at age forty (40). That’s typically done with an annual PSA blood test and also a digital rectal exam (DGA). For the general population, the American Urological Association now recommends screening at age fifty-five (55)

How is a PSA test done?

It’s pretty simple. It involves a simple blood test that’s done once a year and also a prostate exam or a digital rectal exam

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.

How Often Should Women See A Urologist

Female Urinary Incontinence: Lauren Masters, ARNPMy name is Lauren Masters with Advanced Urology Institute.

When we’re looking at urinary incontinence, for example, most women are having some degree of incontinence; whether it be soaking through one (1) pad a day or wearing depends all day long. Usually we can get someone at a minimum to a 50% improvement. It varies based on your history, your basic demographic and whatever else is going on in your body, but a lot of times we can get you to a good 50% and there are many women we can get to 80-90 [percent] and even a complete resolution of their issues.

Why Southerners Have a Higher Risk of Kidney Stone

I am Ketan Kapadia. I’m with Advanced Urology Institute and a board certified urologist.

Dr. Ketan Kapadia of St Petersburg, FLObviously the heat is going to play a major role, a lot of it has to do with our diet unfortunately as well. [As with] an American diet, we just don’t eat very well, we’re all a little heavier and that also increases the risk of kidney stones as well.

The interesting thing here in Florida, which isn’t talked about very much and this is sort of the holistic treatment of the patient in urology, which is we get a lot of men who have prostate problems who start cutting back on their fluids because they don’t want to get up at night; And when you start cutting back on fluids and not getting up at night, now you’re at more risk of [getting] stones. We see a lot of older guys who come in with kidney stones for the very first time because they got a prostate problem as well and that hasn’t really been addressed.

Same with women who have overactive bladder. First thing most people do is they start cutting back their fluid so they’re not having to run to the bathroom all the time. Again, you cut back your fluid and now you’re living in Florida in the heat, you’re going to get kidney stones. So a lot of doctors will be more than happy to just get rid of your stone and have the surgery [but] I’m also interested in preventing that next stone. Part of that is getting twenty-four (24) hour urines, seeing why you’re making stones, addressing all the overactive bladder problems and prostate problems because I don’t want you to end up having more stones. I’m happy to operate and take out stones, that’s fun, but it’s my obligation to help prevent [it from happening agan].

Common Urologic Conditions Are Treatable

The urinary system of the human body regulates, manages and eliminates urine waste. The organs in this system are the kidneys, ureters, bladder and urethra. But as with any organ or system of the body, the urinary system can have problems, commonly referred to as urologic diseases or urologic problems.

You can have urologic problems regardless of your age, ethnicity or gender. And when urologic conditions occur, in both men and women they have a direct effect on the urinary tract and how urine is expelled from the body. In men, urologic problems can also affect the reproductive organs.

Signs that you have urinary tract problems:

Urologic conditions are treatable

Urology is a dynamic and advanced field. Urologists know how to treat many urologic diseases, including cancer of the prostate. The first step in any successful treatment is to see a urologist on time. Do not delay. As soon as you experience any problems, visit a urologist for a medical exam.
Mikhail Lezhak, PA-C of Daytona, FL

Common urologic conditions

(1) Urinary Tract Infections (UTIs)

Urinary tract infections (UTIs) are the most frequent type of urologic condition, although they occur more commonly in women than men. Close to 60% of women and 12% of men experience UTIs at some point in their lives. These infections are easily treated with antibiotics, but the treatment should begin as soon as possible to avoid further infection and prevent complications.

(2) Urinary incontinence

Although many people resist seeking help because of embarrassment, urinary incontinence is treatable in most cases. The cause is usually either an overactive bladder (urge incontinence) or stress incontinence. Typically, urge symptoms come from the bladder wall and detrusor muscle and mucosa, while stress symptoms are due to the incompetence of the bladder neck or urethral sphincter.

The diagnosis of urinary incontinence can be reached through a careful patient history, thorough examination and proper tests. You may need bladder retraining, controlled fluid intake, reduction in caffeine intake, or deliberate delayed voiding to treat the symptoms. Your doctor can also recommend medication or perform corrective surgery.

(3) Pelvic Floor Dysfunction

Pelvic floor muscles support the bladder, vagina and rectum. At some point in life, particularly after childbirth, pelvic floor muscles can become irritated or inflamed. Since the pelvic floor has to relax during urination, having pelvic floor dysfunction can cause pain or difficulties. The problem is often treated through pelvic floor exercise, but when the exercises are ineffective, vaginal medications or muscle injections can be used.

(4) Prostatitis

Many urological problems in men are linked to the prostate. Prostatitis is the inflammation or abnormal swelling of the prostate. The most common symptoms of prostatitis are painful urination, fever, chills, abdominal pain, and pain in the lower back or pelvic region. If you are diagnosed with prostatitis, your doctor will recommend antibiotics to reduce the swelling and restore your prostate to normal size.

(5) Bladder and prostate cancer

The PSA test and prostate exam are great ways to check on your prostate health. Should cancer be found in your bladder or prostate, your urologist will offer lifesaving care. Prostate cancer is the second leading cause of cancer-related deaths in men. It results from the abnormal and rapid growth of prostate cells.

Prostate cancer is successfully treated when detected early, which is why men are encouraged to get checked once a year. In fact, the recommended treatment depends on the time of detection, and may include radiation, surgery or regular surveillance. Today, robotic surgery has helped to reduce the hospital stay for kidney, bladder or prostate cancer surgery to just a few days, or just one day.

(6) Prostate enlargement (BPH)

The prostate grows as you age. Over time, you may have to wake up at night to go to the bathroom or you may not be able to produce the stream of urine you once did. When diagnosed with BPH, your urologist will use various techniques to relieve the obstruction caused by the enlarged prostate. These techniques include consistent monitoring, medications, and in some cases surgery.

Your urologist may also recommend the Rezum procedure—which uses heated water vapor to shrink the enlarged prostate tissue—or the green light and thulium laser vaporization techniques, transurethral resection of the prostate, minimally-invasive thermotherapy, or a UroLift. You will likely return home the same day as one of these procedures.

(7) Erectile dysfunction (ED)

This is a common condition as men grow older. When a man in his 40s or 50s notices that his erections are no longer what they used to be, he should talk to a urologist. Erectile dysfunction is the difficulty in achieving or maintaining an erection for sexual intercourse.

Although not fatal, it can cause stress, embarrassment and a strain on your relationship. Urologists will help you determine the underlying conditions and recommend treatments. Your urologist may prescribe medications—such as PDE5 inhibitors Cialis and Tadalafil—penile injections, a penile pump or, as a last resort, penile implant surgery.

(8) Kidney and ureteral stones

Kidney and ureteral stones occur when crystal-like particles in urine develop and grow into larger masses. As the stones pass along the urinary tract, they can get blocked and cause pain. Although most stones are passed naturally, larger stones may require surgery or specific procedures to break them.

One of the most common treatments is the Extracorporeal Shock Wave Lithotripsy (ESWL) technique in which sound waves are used to break up stones into smaller pieces. Also, since kidney stones can recur, patients often need long-term care. Your urologist will advise you on how to prevent kidney stone formation and how to best manage any potentially painful stones that develop.

At Advanced Urology Institute, every day we help people solve problems they may be hesitant to talk about. Since these problems are distressing or awkward to discuss, our goal is to help make you comfortable. We are proud of the long-term relationships we enjoy with our patients. Our knowledgeable urological specialists provide carefully tailored and confidential care. At AUI, patients get a proper diagnosis and the correct treatment, and we are willing to answer any questions you may have about your health.

If you suspect you have a urological problem, we encourage you to make an appointment at one of our many locations. For additional educational resources on urologic conditions, visit the Advanced Urology Institute website.

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.

Becoming a Urologist – Dr. Howard Epstein MD

To become a urologist, one must really be committed to both people and study! First, students have to be top high school students. Then they go to a college or university to study the subjects needed before attending a graduate-level medical school.

Medical School

After completing the required subject courses, students take the Medical College Admission Test (MCAT) and complete medical school applications. Applicants then must pass face-to-face interviews with professors who are medical doctors and have just one question: “Would I want this person to be my doctor?”

Once admitted to medical school, the future urologist can look forward to a program that will last at least four years, including grueling residency requirements and more exams. Upon completing exams, the student is a doctor, but merely graduating from medical school does not make a urologist!

Urology Studies

Howard Epstein, MD of St Augustine, FLThere is yet another exam called the American Board of Urology (ABU) Qualifying Examination, Part 1. Then the future urologist must complete five more years of schooling and residency practice. During this time, the new doctor must learn general surgery, surgical critical care, trauma, colorectal surgery, transplantation and plastic/reconstructive surgery. Also during this time, at least four years of clinical urology training are required. After all of that has been completed, the doctor must pass the ABU Certifying Exam (Part II) to become an ABU certified urologist.

There are a few medical programs that can shorten this process of nine years of graduate school, but they are not accepted in every state.

Re-certification as a urologist must occur every ten years. To continue as a licensed medical doctor, one must do a certain amount of continuing education credits each year. The learning never ends.

Urologists must learn how to examine and treat a large number of different disorders. They work with all kinds of diseases and injuries related to the urinary tract. The urinary tract includes the kidneys, ureters, the adrenal glands, the related arteries and veins, the bladder and the urethra. Urology also includes the male reproductive system, which means urologists also treat issues concerning erectile dysfunction.

The urinary tract is one of the most important parts of the body. It regulates which chemicals, vitamins, minerals and gasses go to every part of the body. While the urinary tract does not regulate what goes into the body, it does regulate what comes out, at least as urine, and ensures that blood composition is just right.

Dr. Howard Epstein

Dr. Howard Epstein did not have a traditional course of undergraduate studies for medical school. His first university degrees were a dual-major in electrical engineering and business administration. From friends who were in medical school, he discovered that he was more interested in their work than in the fields for which he had degrees, so he went back to school.

Dr. Epstein has been practicing medicine since 1984. He is a board certified urologist with the American Board of Urology, a fellow of the American College of Surgeons and a member of the American Urological Association. He is also with the Florida Urologic Association. Serving as the chief of urology at the Gainesville Veteran Administration Medical Center increased his awareness of the unique needs of American veterans. He currently practices medicine at the Advanced Urology Institute’s two offices in St Augustine, Florida at the Southpark and Tuscan locations. To contact Dr. Epstein or for more information, visit the Advanced Urology Institute website.