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ADULT & PEDIATRIC UROLOGY
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Diseases or infections of the kidneys, bladder or prostate
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FEMALE URINARY INCONTINENCE
(leakage of urine)
In our group we offer a variety of treatments for female urinary incontinence. We try to tailor those to the individual. These procedures include:
- Pubo-Vaginal Sling - Done with the patient's tissue, artificial material (TVT), and preserved tissue.
- Raz Endoscopic Suspension.
- Burch Procedure.
- Marshall-Marchetti Procedure.
- Intraurethral injections with Collagen and Durasphere.
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MALE URINARY INCONTINENCE
Medication, when appropriate
Collagen injections
Artificial Sphincter
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SURGICAL TREATMENT OF KIDNEY STONES
Urological Associates of Dothan offers the latest and most technologically advanced options available for removal of stones. Several treatments exist to remove stones which cannot or will not pass from the body on their own. The most commonly performed procedure is endoscopic stone retrieval, best known as a stone basket operation. This is usually an outpatient surgery and is occasionally done utilizing a laser which aids in stone removal. Larger and more difficult stones within the kidney may be treated with percutaneous nephrolithotomy. This involves removing the stone (or stones) through a small opening in the skin with direct access into the kidney. This usually involves an overnight hospital stay. Many kidney and urethral stones are able to be treated with Extracorporeal Shockwave Lithotripsy (ESL). Lithotripsy is an outpatient, non-invasive option. The stones are broken into smaller pieces using a high frequency sound wave directed at the stone. The pieces are then passed from the body via the urinary tract. In today's practice, the older methods of treatment, traditional surgery through an incision, is only rarely employed. |
Green light non contact photo vaporization of the prostate (PVP)
PVP is an improved laser system that is used for the treatment of prostatic obstructive systoms. In many cases it can be used in place of a TURP. Instead of removal or resection of tissue, as is done with a TURP, the PVP procedures vaporizies the tissue creating an open prostatic channel to allow better urinary flow and bladder emptying. The advantages of PVP when compared to a TURP are less hospitalization, less bleeding, and many times the patient does not need a catheter. The majority of patients have this procedure done as an outpatient. You go home the same day as admission, and most of the time without a catheter.
da'Vinci Robotic Prostatectomy
(Treatment for Prostate Cancer)
A robotic Prostatectomy is the newest for of surgical treatment for prostate cancer. It is an advanced laporascopic system that allows significantly improved surgical vision when compared with an open Prostatectomy. Because it is a laporoscopic procedure the size of the incision is much smaller than an open surgery. This means less postoperative pain and recovery time. The major advantages of a Robotic Prostatectomy are decreased time in the hospital, decreased blood loss, and deceased catheter time. Most patients go home the next day and have a catheter for 5 to 7 days. this is less than half the time for patients undergoing an open Prostatectomy. Overall patients have a much quicker return to normal activities and work.
CANCER OF THE PROSTATE
Prostate Cancer
Prostate cancer is the leading cancer among men. Over the past two decades, screening tools have enabled earlier diagnosis of this cancer, resulting in improved overall survival from this disease. Currently, the Digital Rectal Exam and a blood test called PSA, are the main components of prostate cancer screening.
PSA (prostate specific antigen) is a protein made by the prostate that can become elevated in certain circumstances. Prostate infection, prostatic enlargement, and prostate cancer can all lead to an elevated PSA. The normal lab value is 0.0 - 4.0.
Prostate cancer screening begins at age 50 with a comprehensive history and physical exam, including a DRE (digital rectal exam), and the blood test PSA. If there is a family history of prostate cancer, or if the patient is Afro-American, screening should begin at 40. If either the DRE or the PSA are abnormal, an ultrasound of the prostate with biopsy of the prostate, also referred to as TRUS/Biopsy, is recommended. This procedure is done in the office using a specialized ultrasound probe that allows the Urologist to image the prostate, measure its size, identify any abnormal or suspicious areas, and obtain tissue samples with precise targeting. It is a well-tolerated procedure with very few complications or risks. In 1984, Urological Associates of Dothan was one of the very first groups in the Southeast to utilize this diagnostic procedure. Over the past eighteen years, our ultrasound technicians and Urologists have performed several thousand of these TRUS/Biopsies.
Brachytherapy
Brachytherapy (implantation of radioactive seeds) for the treatment of prostate cancer is also available here as a treatment option in properly selected patients. We have done several hundred cases of brachytherapy over the past 15 years. This is at times given as the only treatment, and at other times it is given in combination with external beam irradiation therapy, depending on the clinical situation at hand. As in all other treatment options, the earlier the diagnosis, and the earlier the treatment, the better the prognosis.
We work closely with our group of outstanding radiation oncologists here in Dothan, Dr. 's Stokes, Adams and Sharp, and we do this as a combined specialty procedure.
In general, we recommend this treatment for older or higher risk patients (with other significant health problems). However, we do discuss all modalities of treating prostate cancer with each patient and make out best recommendation to him in order that he can make an informed choice of treatment.
Radical Retropubic Prostatectomy
In situations where your urologist has recommended surgery for treatment of prostate cancer, radical retropubic prostatectomy, is one of the surgical options. This procedure is performed under a general or regional anesthetic. It is performed through an incision extending from just below the belly-button down to the pubic bone. The prostate, which is located between the bladder and the urethra, is surgically removed. Since the nerves that enable a man to achieve an erection run along side the prostate, when the prostate is removed these nerves are usually damaged, resulting in post-operative impotence. In cases where the patient is sexually active and the pathology of the prostate cancer is favorable, these nerves can possibly be spared, thus preserving potency. Once the prostate has been removed, the bladder and urethra are the reattached and a catheter is placed to allow urinary drainage during the post-operative healing phase. This catheter is left in place for approximately 2 weeks.
The operation usually takes between one and a half to two and a half hours to perform. The patient is in the hospital for approximately 4 days. Activity restrictions are required for 6 weeks to allow adequate healing of the incision. Once the catheter is removed, it is normal to leak urine. It is important for the patient to begin exercising his urinary control muscles immediately in order to regain urinary control as soon as possible.
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Benign Prostatic Hypertrophy
The prostate gland is located between the bladder and the urethra. As men age, their prostate gland continues to grow. Eventually, the prostate can restrict the flow of urine as it leaves the bladder, resulting in a weak, prolonged stream. Other symptoms can include urinating several times a night, feeling as though the bladder is not completely emptied, having to hurry to make it to the restroom, and having to urinate more frequently.
Several treatment options are available. There are medicines that can either relax the muscle tone of the prostate gland, or actually decrease the size of the gland itself. Possible side effects are dizziness, lack of energy, and decreased ejaculate volume. If the medication is effective, the patient must continue the medication indefinitely, or the urinary symptoms will return.
The third treatment option, commonly referred to as transurethral resection of the prostate, is considered the Gold Standard of therapies. Under either a general or regional anesthetic, the obstructing prostatic tissue is surgically resected using a specialized cystoscope. The patient will usually spend 1 to 2 days in the hospital, depending on the amount of post-operative bleeding. Over the next several weeks, the urethral lining must heal, resulting in some persistent urgency, mild burning with urination, and occasional light bleeding. Post-operative exercise limitations are necessary for 4 to 6 weeks to prevent recurrent bleeding and clot retention.
Targis Microwave
IIf medication is not successful, a minimally invasive treatment option using cooled thermotherapy (Targis Microwave) is available. This in an in-office treatment performed under light sedation. A local anesthetic is placed in the patients bladder; a specialized catheter equipped with a microwave antenna is positioned in the urethra; then a computer-controlled treatment protocol is begun. The treatment lasts between 30 and 60 minutes. During the treatment, microwave energy is applied to the enlarged area of the prostate, while cooling fluid protects the urethra. Over the next 6 to 12 weeks, the heated prostate tissue dissolves, relieving the previous obstruction. |
VOIDING DIFFICULTY
(male, female and children)
Bedwetting
Retention |
IMPOTENCE TREATMENT
Medications
Vacuum Devices
Penile injections
Penile Implants |
MALE INFERTILITY
Medications
Surgery |
VASECTOMY |
VASOVASOSTOMY
(microsurgical vasectomy reversal) |
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