New York Urologic

SHOULD I EXPECT PAIN AFTER CIRCUMCISION? Any pain after cosmetic circumcision should be very minimal, not more than 2-3 days. HOW LONG DOES THE PROCEDURE TAKE? The circumcision procedure typically takes about one hour. WHAT ARE THE RISKS OF COSMETIC CIRCUMCISION? There are many advantages to cosmetic circumcision as oppose to traditional circumcision. One of the main advantages of cosmetic surgery is that the penis maintains it natural image. The surgical scar is less visible and is not as much a sharp transition between skin color at the site of incision. Second most important advantage of cosmetic circumcision is that there is less chances of penile hyposensitivity after a cosmetic circumcision in compare to the traditional circumcision. Occasionally people complain about sexual sensitivities after the traditional circumcision. With cosmetic circumcision, this risk is less. In general, the main risks of cosmetic circumcision are risks of bleeding and infection. HOW LONG IS THE HEALING PROCESS? The healing process after cosmetic circumcision is typically 7-10 days. WHAT ARE THE BENEFITS OF BEING CIRCUMCISED? The benefits of any forms of circumcision includes reduced risk of catching or spreading sexually transmitted diseases, including HIV and the human papillomavirus, as well as reduced risk of infections and conditions that cause the inability to retract the foreskin (Phimosis).

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HAIR LOSS IN MEN Hair loss (alopecia) affects many men. It can be the result of aging, genetic predisposition, medication, or an underlying medical condition. Men can lose their hair in patterned areas or patches, or their hair can thin all over. Depending on what causes it, the condition can be temporary or permanent. There are several treatments for combating hair loss; the most common are taking medication to promote hair growth, and undergoing a hair transplant. CAUSES OF HAIR LOSS IN MEN Hair loss in men is caused by a variety of factors, including the following: Fungal infection of the scalp Male-pattern baldness Poor nutrition Certain medications Traumatic stress Thyroid or pituitary disorders Skin disorders (psoriasis or eczema) Chemotherapy or radiation therapy Alopecia areata (autoimmune disorder) Genetics A condition called telogen effluvium, in which too many hair follicles remain in a “resting” state rather than a growing one, is also a cause of hair loss. TREATMENTS FOR HAIR LOSS IN MEN Treatment for hair loss is usually based on its extent and cause. When hair loss results from a fungal infection, it is treated with antifungal medication. Hair loss that results from cancer treatments is generally temporary, so does not require treatment. For other types of hair loss, the following may be used: Hair transplants Over-the-counter medications (such as Rogaine or Nizoral) Finasteride (prescription medication sold as Propecia) Hair-transplant methods include follicular unit extraction (FUE) and strip grafts.

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Some children are born with an inherited birth defect in which the lingual frenulum, the tissue that connects the tongue to the bottom of the mouth, is abnormally short, which can restrict movement of the tongue. This condition is commonly referred to as “tongue-tied”. While this condition does not always cause symptoms, some children may experience difficulty nursing, eating, speech problems or social obstacles because of their condition. Because a shortened frenulum restricts the range of motion of the tongue, a frenuloplasty may be recommended. A frenuloplasty is a surgical procedure performed to clip the frenulum and release the tongue. This procedure is used for children over a year old, and is usually performed under general anesthesia. Stitches are used to close the wound after this procedure, and most patients can resume their regular diet immediately after treatment. Although it is considered a safe and simple procedure, risks of a frenuloplasty may include infection, scarring and excessive bleeding. This procedure results in increased tongue mobility and problems with eating and speech are greatly improved. After surgery, most patients experience effective symptom relief and restored full movement to the tongue. In some cases, tongue exercises may be recommended to improve the movement of the tongue after a frenuloplasty

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FEMTOUCH VAGINAL REJUVENATION Vaginal laser resurfacing or rejuvenation is the newest cutting edge treatment for vaginal health, especially for those suffering from post-menopausal vaginal dryness. The highly effective CO2 laser from FemTouch made by Lumenis is considered the gold standard laser for vaginal rejuvenation. FemTouch™ laser treatment is an out-patient, minimally invasive, non-surgical, non-hormonal treatment for treating and improving vaginal health. With FemTouch™ , women no longer have to live with painful and embarrassing situations such as painful sex or leakage. Start your treatment today and get your sex life back again! As women age, they will experience changes in their vaginal area which are largely due to decreasing levels of the estrogen hormone. FemTouch Fractional CO2 laser is an FDA approved treatment that is being used for various conditions related to aging and childbirth as an off label use. Various conditions that can be treated with FemTouch CO2 fractional laser include Vaginal atrophy after menopause or cancer treatments Vaginal dryness or itching Painful sexual intercourse Using Co2 laser vaginal treatment has also shown improvement in certain conditions such as: Vaginal laxity or looseness Urinary incontinence specially related to exercise and physical activities Inelasticity of the vagina Frequent Urinary tract Infection Usage of Femtouch laser for some of these conditions is considered an off label use, however, significant number of patients who were treated for these conditions as an off label use have reported substantial improvement in their condition such as urinary incontinence, vaginal pain and frequent urinary tract infection. HOW DOES FEMTOUCH CO2 LASER WORK? An innovative CO2 laser, FemTouch treatment laser is applied along the vaginal walls to deliver very gentle, controlled ablation and coagulation of the vaginal lining for improved vaginal tightness and health. The brilliant science of the FemTouch CO2 laser treatment is actually based on the human body’s amazing ability to heal itself. Imaging when you get an small cut on your finger or have your blood drawn with a small needle. Immediately after this minor trauma to the skin and tissues underneath, your body quickly begins the process of repairing this damage. Part of this repair is the production of a fresh and very important tissue called Collagen, which is a form of strong, elastic supportive connective tissue which provides both strength and flexibility to the tissues it connects. At the same time, the skin cells around the cut area or needle puncture hole begin to produce completely new skin to cover and heal the injury. Around these changes, there are new blood vessels form that bring vascularity and increase blood circulation to tissue and its surroundings. The way all the laser cosmetic skin resurfacing and vaginal rejuvenation lasers work is by making thousands of very small and deep holes on the skin or vaginal surface. These tiny holes promote a strong body response to rebuild new and strong collagen underneath the tiny holes while at the same time, new skin or vaginal tissue begins to grow on the surface. Collagen is produced naturally and quickly in our youth but as we age, its production drops significantly which is why a laser is used to create new and tiny punctures or holes- to cause the production of new collagen. VAGINAL ATROPHY AND LASER VAGINAL REJUVENATION As women age, they will experience changes in their vagina and vaginal area that are largely due to decreasing levels of the estrogen hormone. This results in the thinning of the vaginal wall and is often accompanied by dryness mostly during sex. This condition is commonly treated with the application of either vaginal estrogen creams or the taking of daily estrogen pills. Unfortunately, as women reach the age of menopause, Estrogen supplementation either through creams or pills, correlates highly with increased risks of stroke and heart attack among other conditions. In fact, women with a history of breast cancer can not take any Estrogen hormone replacement therapy. FemTouch Co2 Vaginal Laser treatment is an alternative, safe and non-hormonal treatment to treat and improve vaginal health, especially for menopausal women who cannot or choose not to undergo hormone replacement therapy. The FemTouch laser helps to rebuild vaginal tissue without the risks of Estrogen hormone exposure. FemTouch™ laser treatment is completely outpatient, which means you can come in during your lunch hour and be back at work in minutes! It consists of three painless, quick treatments, scheduled about six weeks apart. With FemTouch™ you no longer have to live with painful and embarrassing feminine problems like sexual dryness or urine leakage. Regain the sexual health and enjoyment of your 20’s and 30’s with the FemTouch laser. What are you waiting for?

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Overactive bladder, also known as OAB or urge incontinence, occurs when a person experiences a sudden and frequent urge to urinate that may also be accompanied by urine leakage. This happens because the bladder muscles contract at inappropriate times, regardless of how much urine has collected in the bladder. It can happen to anyone at any age, although it is most common in women and the elderly. CAUSES OF OVERACTIVE BLADDER An overactive bladder may be caused by various factors. In men, OAB may result from benign prostatic hyperplasia also known as BPH, or bladder obstruction due to an enlarged prostate. Underlying causes of OAB may include: Drug side effects Nerve damage Neurological disease or stroke The following bladder problems may also be the cause of an overactive bladder: Urinary tract infection Cancer Bladder stones Inflammation Blockage In some cases, a cause for OAB cannot be found. DIAGNOSIS OF OVERACTIVE BLADDER In addition to a physical exam, tests for OAB may include: Urinalysis Urinary stress test Ultrasound Cystoscopy A post-void residual (PVR) test may also be performed to evaluate bladder function. TREATMENT OF OVERACTIVE BLADDER Treatment for overactive bladder depends on the severity of symptoms, the underlying cause, and the patient’s and doctor’s preferences. Treatment options may include medication, bladder retraining and kegel exercises. Patients who are severely affected by their overactive bladder and incontinence may require surgery to increase bladder storage and decrease pressure in the bladder. Augmentation cystoplasty, where a segment of the bowel is added to the bladder to increase the bladder size and allow it to store more urine, is the surgery most often performed for this condition. An overactive bladder can be a chronic problem. While it can be treated, patients should continue to see their physicians to evaluate progress and monitor for possible complications.

Urinary incontinence, also known as UI, is a common condition that involves the involuntary loss of urine. Although it is not usually a serious condition, UI can be embarrassing and affect a person’s daily life. Urinary incontinence is most common in women, especially during and after pregnancy, but can affect people of all ages. CAUSES OF URINARY INCONTINENCE Urinary incontinence is often caused by a urinary tract infection or weak muscles in the urinary tract. Some medications may cause weak bladder muscles, therefore causing urinary incontinence. Weak muscles may prevent the closing off of the urethra, and doing certain activities may cause urine to leak. Normal urination involves emptying the bladder when the desire to urinate occurs, at which point the bladder contracts and flows out of the body. Once the bladder is empty, the muscles contract and urination stops. People with UI experience a disruption in this process that causes a loss of bladder control and results in troubling symptoms. SYMPTOMS OF URINARY INCONTINENCE In addition to leaking urine, people with UI may also experience: Strong desire to urinate Pelvic pressure Frequent urination Nocturia, or the need to urinate at night while sleeping Painful urination Bed wetting UI is a common condition with many treatment options that can relieve symptoms and allow patients to perform their regular activities without the embarrassment and worry of urinary leakage. TYPES OF URINARY INCONTINENCE Urinary incontinence may be classified into three different types based on causes and symptoms. URGE Urge incontinence is the most common type of incontinence. This type of incontinence involves urine leakage that occurs after a sudden urge to urinate, because the muscle wall of the bladder is overactive. STRESS Stress incontinence is defined as urine leakage that occurs after an activity places pressure on the bladder. Activities may include coughing, laughing or sneezing. OVERFLOW Overflow incontinence occurs as the result of an inactive bladder muscle that does not completely empty the bladder after urination. This is the least common of the types of incontinence. DIAGNOSIS OF URINARY INCONTINENCE Patients exhibiting the symptoms of UI should see their doctor to determine the cause, type and severity of their condition. Doctors can diagnose urinary incontinence through a series of tests and an evaluation of the patient’s medical history. Patients may also be asked to keep a bladder or urination diary to record the frequency and circumstances of their urination troubles. Testing may begin with a pelvic exam to detect any physical abnormalities, and may also include: Blood tests Urinalysis Cystogram A stress test to determine if any urine leaks during physically stressful situations After a diagnosis of UI, the physician may perform further testing to determine the cause of the condition, in order to recommend the most appropriate treatment approach. TREATMENT OF URINARY INCONTINENCE There are many different treatment options available for urinary incontinence, depending on the severity of the condition. Conservative treatments are often effective, and may include: Bladder training Avoiding alcohol and caffeine Medication to control pelvic muscle spasms. Kegel exercises For more severe cases, a medical device such as a urethral insert or pessary may be inserted through the vagina to prevent urine leakage. Surgery may also be recommended to provide support to the bladder neck to relieve symptoms caused by UI. However, there are certain risks associated with surgery, including infection, bladder spasms or recurring incontinence. A doctor will determine which treatment is best for each patient after a thorough evaluation of their condition. PREVENTION OF URINARY INCONTINENCE Not all cases of urinary incontinence can be prevented, however the following recommendations may help in controlling urinary incontinence in some people: Drinking less fluids Emptying the bladder regularly Avoiding caffeinated beverages Kegel exercises may also be effective at strengthening the muscles of the pelvic floor which can help to prevent incontinence.

Stress incontinence is a common condition involving an involuntary loss of urine that occurs when a physical movement places pressure, or stress, on the bladder. Patients with this condition may experience a leakage of urine while coughing, sneezing, laughing, jogging or lifting something heavy. This condition usually occurs as a result of weakened sphincter and pelvic muscles that cannot adequately support the bladder and urethra. While stress incontinence can affect women of all ages, it is most common in women who are obese, post-menopause, or have had multiple pregnancies, as childbirth tends to stretch the urethral sphincter. In many cases, stress incontinence is treated with a pubovaginal sling that is surgically inserted as a support for the urethra. A tension-free vaginal tape, or TVT sling is an advanced form of the traditional pubovaginal sling for the treatment of female stress incontinence. The TVT procedure is designed to create a support for a sunken or fallen urethra and eliminate the leakage of urine in women suffering from incontinence. BENEFITS OF THE TVT PROCEDURE TVT treatment is ideal for women with stress incontinence or intrinsic sphincter defects. The TVT sling is proven highly effective in the treatment of these conditions with long-term results. The TVT procedure is performed as an out-patient procedure and generally has a shorter recovery time than traditional pubic suspension surgery. It is important that women are healthy enough to undergo surgery and do not have any active infections. THE TVT PROCEDURE A local anesthetic is normally administered prior to the TVT procedure. During the procedure, two small vaginal incisions are made, into which a synthetic tape is inserted through the vagina and placed under the urethra as a permanent sling. The doctor then adjusts the tightness or tension of the tape just enough to support the urethra. After the tension is adjusted, the ends of the tape are cut and adjusted to the level of skin at the incisions. No sutures are used to hold the vaginal tape in place as scar tissue that forms at the incision sites will hold the tape in place. The TVT procedure usually takes 30 to 60 minutes to complete but the time may vary depending on the patient. RISKS OF THE TVT PROCEDURE As with any type of surgical procedure, there are risks of the TVT procedure which may include: Bleeding Reaction to anesthesia Infection Damage to the urethra, bladder or vagina Reaction to the synthetic tape Tape erosion exposing the vagina Inability to empty the bladder RECOVERY FROM THE TVT PROCEDURE After the TVT procedure, patients will usually be able to return home the same day, although an overnight stay may be required in some cases. Minimal pain and discomfort may be experienced and over the counter or prescribed pain killers may be used. Vaginal bleeding may also occur for a few days after the procedure. Most normal activities can be resumed in two to three weeks. However, patients should refrain from heavy lifting, strenuous activity, or sexual intercourse for at least six weeks. The TVT procedure can effectively reduce occurrences of urinary incontinence by forcing the urethra to close during any kind of strain, such as laughing, coughing or other types of pressure on the bladder. Most patients experience a decrease in urinary leakage after the TVT procedure, however, in some cases, over time, urinary leakage may reoccur.

Pelvic organ prolapse occurs when one or more pelvic organs prolapses, or drops from its normal location, and pushes against the walls of the vagina. This happens when the muscles in the area are weakened from either childbirth or surgery. Symptoms of pelvic organ prolapse include: Feeling pressure in the vagina from the pelvic organs Feeling very full Feeling a pull or stretch in the groin Having incontinence problems While this condition may be painful, it is often not serious and can even sometimes get better with time. For pelvic organ prolapse that does not improve on its own or results in severe symptoms, surgery may be necessary to repair the problem. Pelvic prolapse repair surgery includes many different procedures, depending on which organ is affected. These surgeries can include: Repair of the bladder or urethra Repair of the vaginal wall Closure of the vagina Hysterectomy While pelvic organ prolapse can affect women at some point in their life, it is important that they consult with their doctor so that it may be treated properly and determine what can be done to prevent future recurrences.

Hematuria is the presence of red blood cells in the urine. When blood is visible in the urine, it is called gross hematuria. Microscopic hematuria is visible only under a microscope and is most often discovered as part of a routine medical exam. CAUSES OF HEMATURIA Bleeding can occur at any location along the urinary tract. This includes the kidneys, ureter, bladder, urethra and the prostate in men. While blood in the urine is not always the sign of a serious disease or condition, it may be an indication of any of the following conditions: Urinary tract infection Prostate infection Cancer of the bladder, kidney, prostate or urethra Kidney disease Hematuria may also be caused by an injury to the urinary tract. DIAGNOSIS OF HEMATURIA To determine the cause of hematuria, a doctor may order a series of diagnostic tests that may include: Urinalysis Blood test CT scan Intravenous pyelogram, (IVP) A cystoscopy may also be performed to examine the lining of the bladder and the urethra. TREATMENT OF HEMATURIA The treatment for hematuria varies depending on the cause as well as the patient’s condition, symptoms and medical history. Often no specific cause of hematuria can be found. However, hematuria may be the result of another more serious condition, so it is important to consult a doctor at the first sign of blood in the urine.

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InterStim® therapy involves the implantation of device to treat problems with urination. Urge incontinence, commonly known as overactive bladder, is a common condition that occurs when an individual experiences sudden, compelling urges to urinate, frequent urination, or urinary incontinence. These symptoms occur because the bladder muscles that control the release of urine contract at inappropriate times. The same neurological problem may also lead to urine retention. InterStim therapy stimulates the affected nerves with electrical impulses (neurostimulation) in order to overcome bladder issues. It is used when other methods of bladder control have been ineffective. CANDIDATES FOR INTERSTIM THERAPY InterStim therapy is recommended for patients who have had unsuccessful results, or unwanted side effects, from medications for an overactive bladder, and are seeking long-term relief from symptoms associated with the condition, such as: Urinary urgency Urinary frequency Urinary incontinence Nocturia, urges to urinate that interrupt sleep Because implanting the InterStim device is an invasive procedure, this treatment is usually employed only after a patient is able to document bladder issues through bladder function test results and after at least two medications have been tried without positive results. BENEFITS OF INTERSTIM THERAPY InterStim therapy has a number of advantages over other treatments for bladder problems, including: Pretest to determine potential for success High rate of efficacy (80 percent) Minimally invasive, short, safe procedure Immediate improvement following implantation Another major advantage of InterStim therapy is that, if the device proves problematic or ineffective, the implantation procedure is entirely reversible. THE INTERSTIM IMPLANTATION PROCEDURE InterStim is a device implanted near the tailbone to help facilitate proper communication between the brain and the sacral nerves, the nerves that transmit messages to the bladder and associated muscles. InterStim therapy uses a device about the size of a pacemaker, which is inserted under the skin. The device sends electrical impulses to the sacral nerves. offering relief to patients with bladder issues. Once the patient and doctor decide on this method of treatment, the InterStim device is commonly tried out in the doctor’s office to make sure it is effective. If the trial is successful, the permanent device is implanted low in the patient’s back. The procedure, which takes about an hour to complete, is performed with the patient under sedation and a local anesthetic. COMPLICATIONS OF INTERSTIM THERAPY Although the InterStim procedure is considered safe and effective, as with all medical procedures, there is a risk of complications. While relatively rare, some patients may experience the following at the site of the implant: Pain Irritation Infection Bruising While typically these side effects dissipate over a short time, if severe, they can be relieved by removing the device.

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Erectile dysfunction (ED), refers to the consistent inability to achieve or maintain an erection. For an erection to occur, a specific sequence of event needs to take place, allowing blood to enter the penis while restricting the outflow of blood. The pressure created by this “trapped” blood is what maintains an erection. If there is a consistent breakdown in any steps in the sequence, erectile dysfunction is the result. Erectile dysfunction may occur at any age, however, the occurrence of ED is increasingly common as a man ages. However, it should not be considered a natural part of aging. CAUSES OF ERECTILE DYSFUNCTION In older men, there may be physical or medical conditions that contribute to erectile dysfunction. Erectile dysfunction may be caused by a combination of medical, physical and psychological factors including: High blood pressure Heart disease Diabetes Physical injury Side effects from prescription medications Drug or alcohol use Psychological factors and certain lifestyle choices such as smoking, obesity, stress, anxiety, guilt and fear of poor sexual performance can also contribute to ED. DIAGNOSIS OF ERECTILE DYSFUNCTION Erectile dysfunction is diagnosed by evaluating a patient’s medical and psychological history, performing a physical evaluation, and conducting a series of laboratory tests that may include: Blood tests Lipid profiles Urinalysis Thyroid function tests Testosterone measurements Ultrasound A psychosocial evaluation may also be used to examine possible psychological factors. TREATMENT OF ERECTILE DYSFUNCTION Erectile dysfunction may be treated with: Medication Psychological therapy Vacuum devices Penile implants Surgical implantation of an inflatable prosthesis is also an option. During this procedure, the surgeon implants a device that simulates erection by pumping fluid from a reservoir into inflatable tubes in the penis. PREVENTION OF ERECTILE DYSFUNCTION Not all cases of erectile dysfunction can be prevented, however, doctors may recommend the following lifestyle changes for precaution: Eat a healthy diet Exercise regularly Stop use of tobacco products Cut back on alcohol use Reduce stress Individuals who are obese, may benefit from losing weight as a possible means of preventing erectile dysfunction.

Many women experience problems with sexual function throughout their lives. However, when sexual problems continue to occur over a long period of time, a woman may be suffering from sexual dysfunction. Sexual dysfunction is defined as any problems that prevent an individual from enjoying or receiving satisfaction from sexual activity. SYMPTOMS OF FEMALE SEXUAL DYSFUNCTION The most common concerns or symptoms of sexual dysfunction in women may include: Reduced sex drive Inability to maintain sexual arousal during sexual activity Inability to achieve orgasm Pain during sexual activity Women who exhibit any of these symptoms for a prolonged period of time, and as a result have feelings of personal distress, are usually suffering from sexual dysfunction. CAUSES OF FEMALE SEXUAL DYSFUNCTION Women may experience symptoms of sexual dysfunction at any age. Both physical conditions and psychological factors may contribute to the problem. Common causes of female sexual dysfunction may include: Hormonal changes such as the postpartum period and menopause Chronic illness or disease Antidepressants, blood pressure medications and antihistamines Alcoholism Stress Depression Past sexual trauma DIAGNOSIS OF FEMALE SEXUAL DYSFUNCTION Women who are experiencing sexual dysfunction are advised to speak with their doctors about their concerns. During the consultation, the doctor will discuss past sexual, medical and psychological histories to evaluate what may be contributing to the problem. A physical examination may be performed to rule out any physical causes for the problem. TREATMENT FOR FEMALE SEXUAL DYSFUNCTION Doctors may treat any underlying medical conditions and adjust any current medications that may be causing the sexual dysfunction. Additional treatments may vary depending on the patient and may include: Hormone therapy Psychological counseling Vaginal lubricants Reducing stress and anxiety Aside from seeking medical treatment, patients are encouraged to communicate with their partner about their concerns. Enhanced communication may lead to a heightened level of intimacy, which may help to reduce symptoms.

Benign prostatic hyperplasia, also known as BPH, is an enlarged prostate that commonly causes urinary problems in men age 50 and older. It is a common condition that occurs as men age, causing the gland to press against the urethra and cause problems with urination. BPH may also be due to an excess of certain hormones in the body. SYMPTOMS OF BENIGN PROSTATIC HYPERPLASIA More than 50 percent of men age 50 and older are affected by benign prostatic hyperplasia. While the exact cause is unknown, as the prostate expands, more and more urinary symptoms develop. Men with this condition may experience: Difficulty starting to urinate Inability to completely empty the bladder when urinating Slowed urine stream Frequent urination Sudden urge to urinate As symptoms progress, patients may also develop bladder stones, blood in the urine or a bladder infection. This condition will continue to worsen if left untreated. DIAGNOSIS OF BENIGN PROSTATIC HYPERPLASIA BPH is diagnosed through a physical examination by a doctor, which may also include the following tests: Digital rectal exam Urinalysis Prostate specific antigen test or PSA Cystoscopy A series of urodynamic tests may also be performed to investigate any urinary problems that may be caused by BPH. TREATMENT OF BENIGN PROSTATIC HYPERPLASIA Treatment for benign prostatic hyperplasia can vary depending on the severity of the condition. Patients with mild symptoms may only need to monitor their condition for signs that it is worsening, while more severe cases may require medication to inhibit hormone production or relax the muscle in the prostate. Two common types of medication for enlarged prostate are: Alpha blockers 5-alpha reductase inhibitors In some cases, surgery may be required to remove the prostate tissue that is blocking the flow of urine. There are several surgical procedures available for treating benign prostatic hyperplasia, including: Transurethral resection of the prostate Transurethral needle ablation Transurethral microwave thermotherapy Transurethral vaporization of the prostate Urethral stent Open surgery Surgery for BPH usually provides effective results for at least 15 years. Patients should continue to have rectal and prostate exams once a year and should see their doctor at the first sign of recurring symptoms. There are a wide range of treatment options available for an enlarged prostrate and if treated promptly and effectively, patients can live relatively normal lives.

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If conservative treatments for benign prostatic hyperplasia (BPH) and troubling urinary symptoms have been unsuccessful, a minimally invasive procedure using a GreenLight™ laser may be an option to improve urine flow. GreenLight laser therapy is an effective and low-risk procedure that uses high-power laser energy to remove the enlarged prostate tissue that is obstructing urine flow. During the GreenLight laser procedure, the patient is sedated using general anesthesia. The surgeon inserts a scope with a special camera through the penis into the urethra, prostate and bladder. The GreenLight laser fiber is then passed through the scope. The GreenLight laser vaporizes the targeted prostate tissue, clearing the passage to improve the flow of urine. In addition, the GreenLight laser seals the surrounding blood vessels, which results in significantly less bleeding than that from traditional surgical methods for treating prostate problems. When the procedure is complete, a catheter is temporarily placed in the bladder to drain urine for about 24 hours. After the procedure, patients may experience mild discomfort, which can be managed with anti-inflammatory medication. Most patients can resume normal activities within a few days, and experience significant urinary symptom relief within 1 to 2 days.

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Transurethral microwave thermotherapy, or TUMT, is a treatment for an enlarged prostate gland, also known as benign prostate hyperplasia, or BPH. The prostate gland is part of a man’s reproductive system. It is a walnut shaped organ located between the base of the bladder and the beginning of the penis. It surrounds the upper part of the urethra where it produces a fluid that is ejaculated with sperm. An enlarged prostate gland is usually a harmless but annoying condition that causes men to have to urinate more often than normal. In severe cases, BPH can completely block the ability to pass urine. Transurethral microwave therapy is an option for men whose symptoms have not responded to previous treatment. The TUMT procedure uses microwaves to heat the prostate to destructive levels. THE TUMT PROCEDURE The surgeon utilizes a special catheter, called an antenna, that is inserted through the urethra to a location inside the prostate. Microwave energy is then used to heat the inside of the prostate while cooling fluid is circulated around the microwave antenna to prevent heat from damaging the wall of the urethra. As the damaged prostate tissue heals, it shrinks significantly, reducing the blockage of urine flow. This treatment is done in a single session and usually does not require an overnight stay in the hospital. A general anesthetic is needed during the procedure. RISKS OF THE TUMT PROCEDURE One of the main complications of transurethral microwave therapy is the inability to urinate, or urinary retention, for more than a week. While not as common, other risks may include: Erection problems Persistent irritation of the urethra Blood in the urine During the procedure there is also a risk of damage to the penis or urethra. RECOVERY FROM THE TUMT PROCEDURE Patients are generally able to go home after surgery but may not be able to urinate and require catheterization to drain the bladder. For most men, this lasts for a week or less. They may also have to take antibiotics or anti-inflammatory medicine. Patients can usually return to work one to two days after treatment. Sexual activity can normally be resumed about two weeks after surgery. Most men find relief from the symptoms of BPH after TUMT treatment.

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Vasectomy is the most effective form of permanent contraception for men. A vasectomy is a minor surgical procedure that stops the flow of sperm between the testicle and the urethra by blocking the vasa deferentia, the tube-like structure that carries sperm to the testicle and through the urethra to the ejaculatory duct. THE VASECTOMY PROCEDURE A vasectomy is a minor procedure that consists of the cutting and sealing of the vas deferens tubes, which are responsible for transporting sperm to the prostate for ejaculation. The testes will continue to produce sperm, but it will be absorbed back into the body soon after production and will not be present in semen. However, it can take up to three months post-surgery before the patient is completely sterile. This is due to sperm lingering within the various tubes of the penile anatomy and may require upwards of twenty ejaculations to ensure complete sterility. The vasectomy operation is an out-patient procedure and can be performed right in the surgeon’s office. The duration of the surgery is normally between 20 and 30 minutes and requires only local anesthesia. SIDE EFFECTS OF A VASECTOMY A vasectomy has very few side effects. Some patients may experience the following side effects following a vasectomy: Sore and swollen scrotum Lower abdominal discomfort Most patients experience minimal discomfort that can be treated with over-the-counter pain medication. COMPLICATIONS OF A VASECTOMY There is always a risk for infection and bleeding when an incision is made, but the small size of the cut needed for a vasectomy ensures minimal risk. It is possible for sperm to leak into the tissue of the scrotum after surgery. These are usually attacked by the patient’s own immune system and may cause a small lump called a sperm granuloma. This usually clears up on its own, but in rare cases may need to be surgically removed. The libido of most men is unaffected by surgery. RECOVERY FROM A VASECTOMY If employed at a desk job, the patient can usually return to work within one or two days after the vasectomy procedure. Manual labor jobs require a a longer period of time before the patient returns to his job. Sexual activity can be resumed within about a week, but it is important to note that the vasectomy is not effective immediately, and if necessary, other means of birth control should be used temporarily. A follow-up sperm count test is recommended after two months to ensure sterility, as well as a second testing one month afterwards for complete confirmation. Patients should not assume that their vasectomy is effective until the semen analysis indicates the absence of sperm.

A kidney stone, also known as renal calculi or nephrolithiasis, is a hardened mass of mineral and acid salts that separates from the urine and travels through the urinary tract. The urine normally dilutes and dissolves these substances, but when the composition of urine is unbalanced, crystallized stones can form. Kidney stones are a common but painful urinary tract disorder and men are more likely than women to experience them. Kidney stones can cause severe pain, however they usually do not cause any permanent damage to the urinary tract or body. CAUSES OF KIDNEY STONES Kidney stones can form when substances in the urine such as calcium, oxalate, and phosphorus, become highly concentrated. While the exact cause of kidney stones is not always known, certain people may have an increased risk of kidney stones. This may include those with: Family history of kidney stones Gout Chronic diarrhea Crohn’s disease Obesity A high level of calcium in the urine People who do not drink enough fluids may have a higher risk for developing kidney stones, as their urine is more concentrated. Certain medications may also increase the risk of kidney stones. SYMPTOMS OF KIDNEY STONES Most kidney stones cause terrible pain as they move through the urinary tract and into the ureter. Common symptoms include: Severe pain in the lower side and back Pain radiating to the abdomen and groin Bloody or cloudy urine Frequent and painful urination Nausea Vomiting Fever Pain caused by a kidney stone may increase in intensity as the stone moves through the urinary tract. DIAGNOSIS OF KIDNEY STONES Kidney stones are diagnosed through a physical examination and a review of symptoms. Diagnostic tests may include: Blood tests Urine tests Intravenous pyelogram (IVP) CT scan Kidney stones can often be identified on X-rays, sometimes before they cause any symptoms. The X-rays can show the location of stones in the kidney or urinary tract. TREATMENT OF KIDNEY STONES Treatment is not usually necessary for small kidney stones as most stones typically pass on their own after drinking plenty of water. Pain medication may be prescribed to relieve symptoms. Larger stones that cannot pass on their own or that block the urinary tract, may require more aggressive treatment methods to locate the stone and break it up into tiny pieces so it can pass through the urine. This may be performed through a procedure known as a shock wave lithotripsy (SWL) or a ureteroscopy. In severe cases, more-invasive surgery may be necessary to remove very large stones. PREVENTION OF KIDNEY STONES While all kidney stones cannot be avoided, certain lifestyle changes may help reduce the risk of developing kidney stones. These may include: Drinking plenty of fluids Reducing fat intake Eating a low-salt diet Medication may be prescribed to help control the amount of minerals and acid in the urine of people who may be prone to developing kidney stones. People who have had previous kidney stones are more likely to have a recurrence, but implementing these changes may help to reduce future risk.

Ureteropelvic junction obstruction (UPJ), is a blockage in the area that joins the renal pelvis to the ureters, which are responsible for sending urine into the bladder. A UPJ obstruction causes the kidneys to produce urine at a rate that exceeds the amount that is able to drain effectively causing urine to accumulate in the kidney. Left untreated, the build-up of urine in the kidneys may lead to infection, kidney stones, damage to the kidneys or kidney failure. CAUSES OF UPJ While ureteropelvic junction obstruction is most commonly congenital, it may also occur in adults as a result of infection, kidney stones, or scar tissue from a previous surgery. SYMPTOMS OF UPJ Ureteropelvic junction obstruction does not always present symptoms. However, in some cases, affected patients may experience: Blood in the urine Kidney infection Urinary tract infection Abdominal mass Back or flank pain Some patients may also experience fever or vomiting as a result of UPJ. DIAGNOSIS OF UPJ Congenital ureteropelvic junction obstruction is often diagnosed in the womb during a routine ultrasound examination. After birth, this condition may be diagnosed through the following tests: Voiding cystourethrogram Intravenous pyelogram (IVP) CT scan A nuclear scan of the kidneys may also be performed to confirm a diagnosis of UPJ. TREATMENT OF UPJ In cases where UPJ obstruction is diagnosed in the womb, infants may be monitored after birth as the poor drainage function may be temporary and may improve. Monitoring may be practiced until about the age of 18 months old. If no improvement is shown after that time, treatment options may be considered. Surgery may be necessary to correct ureteropelvic junction obstruction and improve urinary flow. There are several surgical treatment options that may be used to treat UPJ. PYELOPLASTY Through a surgical procedure, the UPJ is removed and the ureter is reattached to the pelvis and kidney creating a wider junction between them. This allows proper drainage of the urine produced by the kidneys. Infants typically undergo open surgery, while adults and older children may be eligible for minimally-invasive procedures like laparoscopic surgery, that allow for quicker recovery times. WIRE INSERTION A wire is surgically inserted through the ureter and used to cut the UPJ from the inside. A special ureteral drain is then left in place for several weeks and then removed. The UPJ heals and widens in most patients. This treatment may need to be repeated and success rates are lower than those of open surgery. The advantages of this procedure are less pain and nausea. After receiving proper care, most patients recover well from surgery to treat ureteropelvic junction obstruction. Some patients may have pain for a few days following surgery and in some cases, a drainage tube may be left in place to help the kidney drain while it heals. Most patients experience minimal to no complications after treatment.

MORE CONTENT COMING SOON! We are working hard to bring you more details on all of the procedures we offer. Check back soon for updates!

MORE CONTENT COMING SOON! We are working hard to bring you more details on all of the procedures we offer. Check back soon for updates!

Hematuria is the presence of red blood cells in the urine. When blood is visible in the urine, it is called gross hematuria. Microscopic hematuria is visible only under a microscope and is most often discovered as part of a routine medical exam. CAUSES OF HEMATURIA Bleeding can occur at any location along the urinary tract. This includes the kidneys, ureter, bladder, urethra and the prostate in men. While blood in the urine is not always the sign of a serious disease or condition, it may be an indication of any of the following conditions: Urinary tract infection Prostate infection Cancer of the bladder, kidney, prostate or urethra Kidney disease Hematuria may also be caused by an injury to the urinary tract. DIAGNOSIS OF HEMATURIA To determine the cause of hematuria, a doctor may order a series of diagnostic tests that may include: Urinalysis Blood test CT scan Intravenous pyelogram, (IVP) A cystoscopy may also be performed to examine the lining of the bladder and the urethra. TREATMENT OF HEMATURIA The treatment for hematuria varies depending on the cause as well as the patient’s condition, symptoms and medical history. Often no specific cause of hematuria can be found. However, hematuria may be the result of another more serious condition, so it is important to consult a doctor at the first sign of blood in the urine.