Conditions Treated
ARTIFICIAL URINARY SPHINCTER (AUS)
The standard of care for men with severe incontinence after prostate surgery, the AUS is implanted and functions to control urine leak in order to restore continence and confidence.
BLADDER CANCER
It is often heralded by gross blood in the urine. Superficial and deep bladder cancers are treated differently. If superficial, surveillance with periodic cystoscopy, with or without instillation of medication into the bladder, is used. If deep, aggressive surgery with bladder removal and reconstruction is usually necessary.
BLADDER CONTROL / INCONTINENCE / OVERACTIVE BLADDER
Extremely common in women but also occurring in men, urinary leakage can occur with stress maneuvers (such as exercise, coughing, sneezing) or with uncontrollable urge or frequency. Often, fluid management and behavior/bladder retraining can achieve some success. More significant cases of urge incontinence can be treated with medication usually, and in severe cases with bladder neuromodulation ("InterStim"). Stress incontinence, if bothersome, can be treated with minimally invasive procedures such as "slings" or urethral injections with high degrees of success and satisfaction.
BLOOD IN THE URINE
“Hematuria” can be gross or microscopic. There are a variety of reasons someone may experience this. Infection, stones, and polyps in the urinary tract, whether bladder or kidney, are the most common causes of bloody urine.
CHRONIC PROSTATITIS
Painful Bladder Syndrome can mimic infection in the prostate or bladder. Often debilitating, it can flare at any time. Diet and fluid management can sometimes lower symptoms. Often, a variety of medications, massage, bowel management and other techniques can be employed for this difficult condition.
CIRCUMCISION
This procedure can be performed for men who have persistent infection and scarring of the foreskin.
ELEVATED PSA
Prostate Specific Antigen is the most studied tumor marker for prostate cancer. However, an elevated PSA does not always mean prostate cancer is present. It can be used in conjunction with "free PSA" and other tests in order to help guide treatment. Ultimately, prostate biopsy is the ONLY way to diagnose prostate cancer. Other very common causes of elevated PSA can be prostate enlargement or prostate infection.
ENLARGED PROSTATE
Benign Prostate Hypertrophy (BPH) or Enlargement (BPE) occurs in men beginning in their 40s or 50s. As it encroaches on the urethra, an enlarged prostate can give men the following symptoms: urinary urgency, frequency, waking up at night to void often, weakened stream, hesitancy and intermittency of stream and a sense of incomplete emptying. Symptoms can vary in severity over time, waxing and waning. Often, changes in medication, diet, and herbal products are used for early treatment. Often as symptoms progress, medications are often used. In severe cases, procedure can be performed to remove the obstructing prostate tissue, such a microwave thermotherapy, TURP (transurethral resection of the prostate) aka the "roto rooter", or a Laser TURP.
ERECTILE DYSFUNCTION
A common finding is aging men, it can be due to low testosterone, stress, injury, poor blood flow into the penis or even medication. Lifestyle changes and exercise can restore potency, but if not successful, a variety of treatments are available including oral medication, injection medication, vacuum devices and implants.
FEMALE PELVIC ORGAN PROLAPSE
Cystocele (Bladder Drop), Rectocele (Rectal Drop), Perineal Laxity (weak perineum) and Enterocele (bowel descent) are all pelvic hernia that create protrusions through the vagina. Often, women will feel a "bulge" or sense heaviness in the vagina, back pain, difficulty with urination, constipation, or feel they are "sitting on a ball". If severe, it may completely protrude through the vaginal opening. Surgical correction to restore proper anatomy, vaginal length and caliber is done minimally invasively through the vagina, often with mesh or grafts. Sexual function is restored or preserved. These conditions often occur with urinary incontinence.
HYDROCELE
Fluid surrounding the testicle can cause discomfort and scrotal enlargement. It can occur at birth, as a result of infection or injury, and even tumors.
KIDNEY CANCER (and Laparoscopy)
Management depends heavily on size and position of the tumor in the kidney. If small, it can be removed while sparing the rest of the kidney, or in select cases, frozen and destroyed, sparing the rest of the kidney. If the kidney must be removed, it can be done minimally invasively by laparoscopy, reserving open surgery for large tumors or those not amenable to other techniques.
KIDNEY STONES
Kidney stones usually present with flank pain and bloody urine. Some stones, if small enough and in proper position, can be managed conservatively and allowed to pass with the aide of medication. If kidney function is disturbed, or pain too severe, or if infection is present, or if the stone is too large to pass, the stone is treated. Various minimally invasive procedures are available including "shock wave", and endoscopy with laser to fragment and remove stones. Once the stone is out, it is analyzed, and in addition, a metabolic workup is performed with blood and urine tests to figure out the cause of stones and implement a strategy for prevention. This may include diet modification, supplements, and/or medication.
MALE INFERTILITY
If the female partner has a negative infertility work up by her physician, the male partner is evaluated. Review of medical, surgical, or work history may reveal the source. Blood work and semen analysis are common tests.
NEUROGENIC BLADDER
This is the term reserved for bladder dysfunction secondary to neurological or surgical injury. Neurogenic bladders require special management in order to minimize recurrent urinary infections, and preserve kidney function. It can result for spinal cord injury, stroke, brain injury, Parkinson’s or Alzheimer’s diseases, multiple sclerosis, post-polio syndrome, tabes dorsalis, and after certain types of pelvic or back surgeries.
PENILE IMPLANT
In certain men who have erectile dysfunction that has failed all other therapies, a penile prosthesis is a reliable way to permanently achieve erections. Inflatable and semi-rigid models can be placed as an outpatient.
PROSTATE INFECTION
Acute bacterial infection of the prostate can present with urinary difficulty, frequency, stream intermitency, perineal pain, burning and some sometimes fever. This can one time or be a recurrent problem. Sometimes, prostate infection can lead to an elevated PSA. Chronic prostatitis, sometimes known as Chronic Pelvic Pain Syndrome, is not caused by infection, but is a pain syndrome similar to Interstitial Cystitis. Treatment is focused at the specific symptoms, yet it can be recalcitrant and difficult to manage at times.
PROSTATE CANCER (and Robotic Surgery)
The most commonly diagnosed cancer in American men, prostate cancer can be curable even if aggressive. It is slow growing, usually giving men time to research different options. Most standard treatments have similar cure rates, but treatment recommendations will vary based on age, stage, and grade of the cancer. Common curative options include radical prostatectomy (whether "open" or robotic using the Da Vinci system), external beam radiation or radioactive seed implantation. Da Vinci robotic prostatectomy offers equivalent cancer cure rates when compared to standard open robotic prostatectomy with improvement in qualtiy of life parameters, as well as less catheter-time and hospital stay.
RECURRENT URINARY TRACT INFECTIONS (UTIs)
Often occurring in women, there is a wide range of reasons why women would experience recurrent infections. These must be differentiated from persistent or sub-optimally treated infections. Recurrent UTIs can occur in men, children, and in those with neurogenic bladders. Chronic infections may warrant x-ray evaluation of the kidneys or even cystoscopy. Prostate infection can occur in men and can be chronic in nature as well.
TESTIS CANCER
A very common cancer in men ages 18-45, it is usually found by the man on self-exam. Sometimes radiation or chemotherapy is necessary after surgery, but cures rate are very high.
VARICOCELE
Boggy and enlarged veins near the testicle can cause ache and scrotal enlargement. Often they are found by accident and are asymptomatic, but may need to be treated if pain is present, infertility is diagnosed or testis size is affected.
VASECTOMY
Elective sterilization in men takes usually under 30 minutes and is done under local anesthesia in the office. It is considered permanent and is minimally invasive. A man is NOT considered cleared for unprotected sex unless the semen analysis reveals no sperm at follow up.
VASECTOMY REVERSAL
What takes 30 minutes to accomplish (vasectomy) takes about 3 hours to undo. Done with a surgical microscope and under general anesthesia, fine surgical technique and suture are required.
The standard of care for men with severe incontinence after prostate surgery, the AUS is implanted and functions to control urine leak in order to restore continence and confidence.
BLADDER CANCER
It is often heralded by gross blood in the urine. Superficial and deep bladder cancers are treated differently. If superficial, surveillance with periodic cystoscopy, with or without instillation of medication into the bladder, is used. If deep, aggressive surgery with bladder removal and reconstruction is usually necessary.
BLADDER CONTROL / INCONTINENCE / OVERACTIVE BLADDER
Extremely common in women but also occurring in men, urinary leakage can occur with stress maneuvers (such as exercise, coughing, sneezing) or with uncontrollable urge or frequency. Often, fluid management and behavior/bladder retraining can achieve some success. More significant cases of urge incontinence can be treated with medication usually, and in severe cases with bladder neuromodulation ("InterStim"). Stress incontinence, if bothersome, can be treated with minimally invasive procedures such as "slings" or urethral injections with high degrees of success and satisfaction.
BLOOD IN THE URINE
“Hematuria” can be gross or microscopic. There are a variety of reasons someone may experience this. Infection, stones, and polyps in the urinary tract, whether bladder or kidney, are the most common causes of bloody urine.
CHRONIC PROSTATITIS
Painful Bladder Syndrome can mimic infection in the prostate or bladder. Often debilitating, it can flare at any time. Diet and fluid management can sometimes lower symptoms. Often, a variety of medications, massage, bowel management and other techniques can be employed for this difficult condition.
CIRCUMCISION
This procedure can be performed for men who have persistent infection and scarring of the foreskin.
ELEVATED PSA
Prostate Specific Antigen is the most studied tumor marker for prostate cancer. However, an elevated PSA does not always mean prostate cancer is present. It can be used in conjunction with "free PSA" and other tests in order to help guide treatment. Ultimately, prostate biopsy is the ONLY way to diagnose prostate cancer. Other very common causes of elevated PSA can be prostate enlargement or prostate infection.
ENLARGED PROSTATE
Benign Prostate Hypertrophy (BPH) or Enlargement (BPE) occurs in men beginning in their 40s or 50s. As it encroaches on the urethra, an enlarged prostate can give men the following symptoms: urinary urgency, frequency, waking up at night to void often, weakened stream, hesitancy and intermittency of stream and a sense of incomplete emptying. Symptoms can vary in severity over time, waxing and waning. Often, changes in medication, diet, and herbal products are used for early treatment. Often as symptoms progress, medications are often used. In severe cases, procedure can be performed to remove the obstructing prostate tissue, such a microwave thermotherapy, TURP (transurethral resection of the prostate) aka the "roto rooter", or a Laser TURP.
ERECTILE DYSFUNCTION
A common finding is aging men, it can be due to low testosterone, stress, injury, poor blood flow into the penis or even medication. Lifestyle changes and exercise can restore potency, but if not successful, a variety of treatments are available including oral medication, injection medication, vacuum devices and implants.
FEMALE PELVIC ORGAN PROLAPSE
Cystocele (Bladder Drop), Rectocele (Rectal Drop), Perineal Laxity (weak perineum) and Enterocele (bowel descent) are all pelvic hernia that create protrusions through the vagina. Often, women will feel a "bulge" or sense heaviness in the vagina, back pain, difficulty with urination, constipation, or feel they are "sitting on a ball". If severe, it may completely protrude through the vaginal opening. Surgical correction to restore proper anatomy, vaginal length and caliber is done minimally invasively through the vagina, often with mesh or grafts. Sexual function is restored or preserved. These conditions often occur with urinary incontinence.
HYDROCELE
Fluid surrounding the testicle can cause discomfort and scrotal enlargement. It can occur at birth, as a result of infection or injury, and even tumors.
KIDNEY CANCER (and Laparoscopy)
Management depends heavily on size and position of the tumor in the kidney. If small, it can be removed while sparing the rest of the kidney, or in select cases, frozen and destroyed, sparing the rest of the kidney. If the kidney must be removed, it can be done minimally invasively by laparoscopy, reserving open surgery for large tumors or those not amenable to other techniques.
KIDNEY STONES
Kidney stones usually present with flank pain and bloody urine. Some stones, if small enough and in proper position, can be managed conservatively and allowed to pass with the aide of medication. If kidney function is disturbed, or pain too severe, or if infection is present, or if the stone is too large to pass, the stone is treated. Various minimally invasive procedures are available including "shock wave", and endoscopy with laser to fragment and remove stones. Once the stone is out, it is analyzed, and in addition, a metabolic workup is performed with blood and urine tests to figure out the cause of stones and implement a strategy for prevention. This may include diet modification, supplements, and/or medication.
MALE INFERTILITY
If the female partner has a negative infertility work up by her physician, the male partner is evaluated. Review of medical, surgical, or work history may reveal the source. Blood work and semen analysis are common tests.
NEUROGENIC BLADDER
This is the term reserved for bladder dysfunction secondary to neurological or surgical injury. Neurogenic bladders require special management in order to minimize recurrent urinary infections, and preserve kidney function. It can result for spinal cord injury, stroke, brain injury, Parkinson’s or Alzheimer’s diseases, multiple sclerosis, post-polio syndrome, tabes dorsalis, and after certain types of pelvic or back surgeries.
PENILE IMPLANT
In certain men who have erectile dysfunction that has failed all other therapies, a penile prosthesis is a reliable way to permanently achieve erections. Inflatable and semi-rigid models can be placed as an outpatient.
PROSTATE INFECTION
Acute bacterial infection of the prostate can present with urinary difficulty, frequency, stream intermitency, perineal pain, burning and some sometimes fever. This can one time or be a recurrent problem. Sometimes, prostate infection can lead to an elevated PSA. Chronic prostatitis, sometimes known as Chronic Pelvic Pain Syndrome, is not caused by infection, but is a pain syndrome similar to Interstitial Cystitis. Treatment is focused at the specific symptoms, yet it can be recalcitrant and difficult to manage at times.
PROSTATE CANCER (and Robotic Surgery)
The most commonly diagnosed cancer in American men, prostate cancer can be curable even if aggressive. It is slow growing, usually giving men time to research different options. Most standard treatments have similar cure rates, but treatment recommendations will vary based on age, stage, and grade of the cancer. Common curative options include radical prostatectomy (whether "open" or robotic using the Da Vinci system), external beam radiation or radioactive seed implantation. Da Vinci robotic prostatectomy offers equivalent cancer cure rates when compared to standard open robotic prostatectomy with improvement in qualtiy of life parameters, as well as less catheter-time and hospital stay.
RECURRENT URINARY TRACT INFECTIONS (UTIs)
Often occurring in women, there is a wide range of reasons why women would experience recurrent infections. These must be differentiated from persistent or sub-optimally treated infections. Recurrent UTIs can occur in men, children, and in those with neurogenic bladders. Chronic infections may warrant x-ray evaluation of the kidneys or even cystoscopy. Prostate infection can occur in men and can be chronic in nature as well.
TESTIS CANCER
A very common cancer in men ages 18-45, it is usually found by the man on self-exam. Sometimes radiation or chemotherapy is necessary after surgery, but cures rate are very high.
VARICOCELE
Boggy and enlarged veins near the testicle can cause ache and scrotal enlargement. Often they are found by accident and are asymptomatic, but may need to be treated if pain is present, infertility is diagnosed or testis size is affected.
VASECTOMY
Elective sterilization in men takes usually under 30 minutes and is done under local anesthesia in the office. It is considered permanent and is minimally invasive. A man is NOT considered cleared for unprotected sex unless the semen analysis reveals no sperm at follow up.
VASECTOMY REVERSAL
What takes 30 minutes to accomplish (vasectomy) takes about 3 hours to undo. Done with a surgical microscope and under general anesthesia, fine surgical technique and suture are required.
