Urology

Enlarged Prostate (BPH)

1. What is Benign Prostatic Hyperplasia (BPH)?

As men get older, the prostate gland commonly enlarges. This enlargement is called Benign Prostatic Hyperplasia (BPH). Occasionally, this enlargement may represent cancer but usually is related to a benign, non-cancerous growth. BPH is the most common benign tumor in men and is responsible for some urinary symptoms in most men over the age of 50.

2. What are the symptoms of BPH?

• Hesitancy upon the start of urination
• Weak stream while urinating
• The sensation of not completely emptying the bladder
• Stopping and starting while urinating
• Frequent urination
• Frequent nighttime urination
• Urgency to urinate
• In extreme cases, the inability to urinate at all

3. What are the causes of BPH?

As men get older, the prostate gland routinely enlarges and therefore can constrict the passage of urine coming out of the bladder to the penis. This may cause difficulty voiding and the other symptoms of BPH.

4. How is BPH diagnosed?

Your physician may ask you questions about how you void or to fill out a questionnaire to help evaluate the severity of your symptoms. Some additional tests may be ordered to see if you have an obstruction. A rectal examination and a blood test to check for prostate cancer will most likely be done on the initial visit to the urologist.

5. How is BPH treated?

The urologist will consider the best option for the individual patient. Medications can be prescribed to help alleviate the symptoms of BPH. However, there are surgical options for BPH.

The "standard" treatment is the Transurethral Resection of the Prostate (TURP). This procedure has been done for years. It involves inserting a scope into the urethra (the tube inside of the penis) and surgically removing a portion of the obstructing prostate tissue.

In recent years, several alternative surgical techniques have been developed which employ lasers, special tools, or microwave therapies. The laser procedure, although effective in certain cases, is still not covered by several insurance companies. With the laser therapy, the physician uses a cystoscope to view the prostate. Then the laser tip is inserted into the prostate to destroy a precise area of the enlarged gland. The tissue that is destroyed is absorbed naturally by the body, decreasing the symptoms of BPH. The microwave therapy is a less effective alternative, but most insurance companies are starting to pay for this therapy. It works about the same as the laser, by increasing the temperature of the prostate to destroy the enlarged gland. It is not as precise.

Individuals should not suffer with BPH. There are many options available, and certainly each patient's needs may be met in choosing one of the alternatives. It is important to be evaluated by an urologist in order to make the right choice.

Epididymitis

1. What is Epididymitis?

Epididymitis is an inflammation or infection of the epididymis. The epididymis is the structure of tubes that transport sperm from the testicle. These tubes merge to form the vas deferens. The vas deferens is the tube that is cut during a vasectomy to prevent pregnancy.

2. What are the symptoms of Epididymitis?

• Discomfort in the region of the testicle.
• Swelling
• Firmness

3. How do you diagnosed Epididymitis?

The physician will do a testicular exam, and possibly a scrotal ultrasound.

4. How do you treat Epididymitis?

Treatments for epididymitis include antibiotic therapy, anti-inflammatories and scrotal support. In the cases of acute epididymitis, cold therapy is recommended.

Hydrocele

1. What is a Hydrocele?

A hydrocele occurs when fluid fills the membrane covering the front and sides of the testicle and epididymis in the scrotum. This is usually not painful but is often uncomfortable due to the increased size of the scrotum. A hydrocele commonly affects one side of the scrotum, but in some instances both sides may be affected.

2. What are the symptoms and causes of a Hydrocele?

As mentioned, a swollen scrotum is the first sign of a hydrocele, but it is seldom associated with pain. Possible causes of a hydrocele are: trauma to the scrotal area or inflammation or infection of the epididymis.

3. How do you treat a Hydrocele?

Some hydroceles do not need to be treated, as they will correct themselves or remain unchanged. Indications for hydrocele repair include pain and discomfort due to the size and/or location of the hydrocele. The most common procedure is a surgical procedure under anesthesia to correct the hydrocele. If surgery is not the best choice due to health or other reasons, the hydrocele can be aspirated. Hydroceles that are aspirated often re-occur.

Impotence/Erectile Dysfunction

1. How does an erection occur?

An erection is an involuntary reaction in response to sexual, psychological sensory, and nerve stimulation. This stimulation causes a rapid increase in the amount of blood flowing into the penis. An erection occurs when blood becomes trapped. As the shaft of the penis rapidly fills with blood, the penis becomes firm and elongated, resulting in a successful erection.

2. What is Impotence/Sexual Dysfunction?

Impotence/Sexual Dysfunction refers to the inability to have or maintain satisfactory erections, or the inability to achieve successful sexual intercourse. Impotence can be total or partial and it can affect men of different age groups. Some of the symptoms of impotence are:

• Decreased sexual drive
• Early loss of erection
• Inability to have a full erection
• Premature ejaculation

3. What can cause Impotence/Sexual Dysfunction?

Impotence/Sexual Dysfunction can be the result of medical, surgical, or psychological factors. The medical problems include illnesses like:

• Alcohol or substance abuse
• Arteriosclerosis (hardening of the arteries)
• Diabetes
• Hormonal Imbalances
• Kidney Disease
• Neurological Diseases
• Injuries or Pelvic Fractures

Some medications can cause impotence/sexual dysfunction. These drugs include:

• High Blood Pressure Medications
• Depression Medications

The surgical procedures that contribute to impotence/sexual dysfunction are:

• Removal of the Prostate for cancer
• Colon surgeries
• Blood vessel surgery

The psychological causes may include:

• Marital Problems
• Mental Problems

4. How is Impotence/Sexual Dysfunction evaluated?

The urologist will need to obtain a complete history of the patient's problem and information about previous operations, illnesses, injuries, and medications. It is important to understand the patient's development and social history. There may be some aspects of a person's life that would be affecting their impotence/sexual dysfunction. The physical examination of the penis and scrotal area may help find physical underlying problems. In some cases, blood tests, ultrasounds, and x-rays may be ordered.

5. How is Impotence/Sexual Dysfunction treated?

The good news is that most men with impotence/sexual dysfunction can have their sexual function restored with proper treatment. There are many different treatments for impotence/sexual dysfunction. They are as follows:

• Pills taken orally to help achieve an erection.
• Directly injected medication into the penis - The patient can use a self-injection treatment to achieve an erection. These require the patient to inject the drug directly into the penis. It is surprisingly almost pain-free and well tolerated by patients.
• Inserted medication into the penis - Medical urethral suppository is a newly developed treatment that consists of a very small medicine pellet inserted into the urethra (tube inside the penis).
• Hormone replacement therapies - if the blood tests indicate there is a decrease in testosterone, then hormone treatment may help.
• Vacuum erection device (VED) – this is a mechanical device that allows for the expansion of the penis using an external vacuum pump and then when an erection is achieved, placement of a rubber ring at the base of the penis to sustain the erection.
• Surgical procedure – this would include the use of implants that offer predictable erections using mechanical methods. It requires a brief stay in the hospital.

Sexual and Marital counseling – this is important for those individuals and couples where an underlying emotional or relationship problem is a major contributor to sexual problems.

Penile Warts/Condyloma

1. What is Condyloma?

Condyloma is commonly called genital warts. It is a sexually transmitted disease (STD). It is spread by skin to skin contact. Condylomas can be found on the external or internal genital areas of men and women. Some condylomas can be pre-cancerous or even cancerous, so it is important to see a physician.

2. What are the signs and symptoms of Condyloma?

Condyloma may not be apparent for 2-3 months or even longer after being infected by the virus. Condyloma usually starts out as small bumps either singularly or in a group and may have a "cauliflower" look. Most of the time the individual will have no symptoms unless the virus has been active without treatment for some time. The most common symptoms if present are:

• Pain
• Itching
• Burning with intercourse

If the condyloma is in the anal area, there may be rectal bleeding and itching.

3. How is Condyloma treated?

Condyloma can only be treated, not cured. There are treatments that destroy the majority of contaminated cells and decreases the rate of recurrence. Some common treatments are as follows:

• Topical Solutions - these are often used on external condyloma as the first line of treatment.
• Surgical Procedures – this can be used if the area failed to respond to the topical solutions or if the warts are large. The condyloma can be removed by burning or freezing the infected area, and is done as an outpatient procedure.

​Peyronie's Disease

1. What is Peyronie's disease?

Peyronie's disease is an unnatural curvature in the penis, most noticeable during an erection. The disease may prevent a complete erection due to the plaque or scar tissue that develops in the penis. The curvature can cause painful erections and may be so severe that intercourse is impossible.

2. What are the signs and symptoms of Peyronie's disease?

The cause of the plaque is unknown but may develop due to a trauma to the penis or in the groin area. Some of the symptoms of Peyronie's disease are:

• Painful Erections
• Soft Erections
• Curvature in the Penis
• Fibrous area under the Skin of the Penis

Peyronie's disease is not cancerous and is not sexually transmitted.

3. How is Peyronie's disease treated?

There are many options in treating Peyronie's disease depending on the severity of the disease. In some cases, there is no need for treatment. However, if the curvature becomes much worse, treatment may be indicated. There are non-surgical and surgical treatments.

Non-surgical

• Oral medication used to decrease the pain, soften and reduce the plaque.
• Medication is injected directly into the plaque to soften and dissolve the plaque.

Surgical

• Excision of the plaque with repair by graft.
• Surgically shorten the unaffected side of the penis, to straighten the penis.
• Penile prosthesis may be implanted to straighten the penis and provides enough rigidity for intercourse.

After treatment, Peyronie's disease may return and may be a chronic problem. All of the risks and complications should be taken into consideration before a treatment is selected.

Prostate

1. What is the Prostate?

The prostate is a male sex gland that is important for reproduction, as it produces the majority of ejaculate fluid. It is a small walnut-shaped gland that is located above the rectum and at the bottom of the bladder. The prostate surrounds the urethra (the tube that carries urine from the bladder) like a doughnut, at the point where the urethra connects to the bladder.

2. How can Prostate abnormalities be detected?

A rectal examination should be considered as part of the annual physical checkup for men beginning at age 50. Rectal exams should begin at age 40 if you are exposed to increased risk-factors, such as having Afro-American heritage or a family history of prostate cancer.

Next, men should also have a Prostate Specific Antigen (PSA) test. The PSA is an effective tool available to physicians to help monitor the prostate gland.

3. What are some common Prostate abnormalities?

• Prostate Cancer
• BPH
• Prostatitis

Prostate Specific Antigen (PSA)

The PSA test has revolutionized the detection of prostate cancer and the monitoring of the effects of treatment. It has enabled the medical community to allow early detection of prostate cancer. However, prostate cancer may be present in a person with a normal PSA. Therefore, it should not be used as the sole method of prostate examination but should be performed in combination with the digital rectal examination.

Prostatitis

1. What is Prostatitis?

Prostatitis is the inflammatory condition of the prostate gland.

2. What are the symptoms of Prostatitis?

The patient may show a variety of symptoms. They often include:

• Low back pain
• Burning upon urination
• Frequent urination
• Urgent urination
• Pain deep in the rectum or scrotal areas.

At times the symptoms may also include joint and muscle aches, fever or pain almost anywhere within the pelvis and scrotum. The symptoms may be mild or may be overwhelming.

3. How is Prostatitis diagnosed?

The urologist will perform a digital rectal exam. This may reveal a very tender prostate gland. Urine and/or prostate secretions may be examined.

4. How is Prostatitis treated?

Prostatitis is most commonly treated with antibiotics. Anti-inflammatory drugs and sitz baths are often helpful. In very rare cases, surgery can be done to remove part of the prostatic tissue.

Testicular Self Examination (TSE)

Testicular self-exam is an important part of routine, health maintenance for men and should be done once a month.

• Start by holding your scrotum in the palm of your hands. Then feel one testicle. Apply a small amount of pressure. Slowly roll it between your fingers. Try to find hard, painless lumps.
• Now examine your epididymis. This comma-shaped cord is found behind your testicles. Its job is to store and transport sperm. Tender when touched, it is the location of most non-cancerous problems.
• Continue by examining the vas deferens, the sperm-carrying tube that runs up from your epididymis. Normally, the vas deferens feels like a firm, movable, smooth tube. Now repeat the exam on the other side.

Most scrotal or testicular masses are not cancer but if one feels an abnormality, a consultation with a urologist should be made as soon as possible.

Varicocele

1. What is a Varicocele?

A varicocele is the enlargement of the veins that drain the testicles. A left varicocele is more common. A varicocele affects fertility due to the decrease in circulation of blood in the testicular area.

2. What are the signs and symptoms of a Varicocele?

Some varicoceles may cause pain and/or the decrease in size of the testicle.

3. How is a Varicocele diagnosed?

A varicocele is usually diagnosed during an infertility work up.

4. How is a Varicocele treated?

Once diagnosed, a surgical procedure can be done to correct the problem. The procedure may be needed because of the decreased size of the testicle, infertility, or because of the size and discomfort related to the varicocele. If the varicocele is the cause of infertility, in many cases fertility will improve in a few months.

Vasectomy

1. What is a Vasectomy?

A vasectomy is the most effective means of permanent birth control. A vasectomy does not affect the production of male hormones nor does it alter sexual function. The vasectomy involves surgically cutting and closing off or blocking the vas deferens (the tube that carries sperm from the testicle). After the vasectomy, the testes continue to produce sperm cells that are simply absorbed by the body.

2. What to expect during surgery?

The urologist will make one or two small openings into the scrotum. The vas deferens will be cut and a section of the tube will be removed. Even with the local anesthesia, the patient will experience a tugging or pulling sensation in the scrotum or groin area. The two ends of the vas deferens will be tied or cauterized; the opening(s) will be closed with small sutures which will dissolve on their own; and a surgical dressing will be applied to the incision.

An athletic supporter or a brief type underwear should be worn following surgery to immobilize the scrotum and minimize discomfort.

3. What to expect after surgery?

The patient should make arrangements to have a family member drive him home following surgery. The patient may experience some discomfort within the first 24 hours. If necessary, the urologist will prescribe pain medication. The patient should avoid any heavy lifting or vigorous exercise for 24-48 hours following surgery. To protect the incision, do not bath or shower for the first 24 hours following surgery. Sexual activity with birth control protection can be resumed within one week.

After the vasectomy, it is necessary to continue to use some form of birth control until all stored sperm are cleared from your system. This usually takes at least 8-10 weeks. Two separate semen specimens should be taken to Meritus Medical Labortory to confirm that the specimens are free from sperm.

4. What are the possible complications?

No surgical procedure is without risk. However, the majority of complications associated with vasectomy are minor.

• Up to one week following surgery: Internal bleeding in the scrotum which may cause pain and swelling. There is always the risk of infection after a surgical procedure. Swelling, redness, pus, or pain are symptoms of a possible infection.
• Up to several months following surgery: Sperm granuloma- which is a lump at the site where the vas deferens is tied off. This will usually disappear in time.
• Congestion: This is caused by sperm within the epididymis which may cause aching. This symptom usually disappears without treatment.
• Spontaneous regrowth: Although rare, spontaneous formation of a new vas deferens through the scar tissue can occur. This is usually detected by a post-operative semen test.

5. Can a reversal of the Vasectomy be performed?

Although a vasectomy should be considered a permanent surgical procedure, there is a surgical procedure that can reverse a vasectomy. It is called a "Vasovasostomy." A vasovasostomy involves surgical reconnection of the vas deferens to re-establish the flow of sperm. Patients are cautioned that fertility is not guaranteed.

Bladder Cancer - Diagnosis and Treatment 

1. What is Bladder Cancer?

Bladder cancer is the sixth most common cancer in the United States. It is cancer of the bladder. The cancer may be only in the lining of the bladder, or more extensively could be in the muscular wall of the bladder. The most aggressive type of bladder cancer may grow through the bladder wall and spread to nearby organs. Bladder cancer is more common among whites and men and usually occurs among people in their 60's. There are a number of risk factors that are attributed to bladder cancer. Here are the most common risk factors:

• Smoking
• Industrial chemicals
• Chronic bladder inflammation

2. What are the signs and symptoms of Bladder Cancer?

Bladder cancer often doesn't produce signs or symptoms in its early stages. The first warning sign is usually blood in the urine. However, signs and symptoms of bladder cancer may be:

• Blood in urine
• Pelvic Pain
• Frequent urination
• Sensation for the need to urinate without results
• Slowing of the urinary stream

These signs and symptoms are the same as other diseases, so you should see your physician.

3. How is Bladder Cancer diagnosed?

The physician will ask for a medical history and perform a physical exam. In addition, a urine sample will be examined, and possibly sent on to a laboratory for the testing of blood cells and cancer cells. An intravenous pyelography (IVP) will be ordered, and a cystoscopic procedure will be performed. The cystoscopy will enable the urologist to look inside the bladder and perform a biopsy.

4. How is Bladder Cancer treated?

Treatment for bladder cancer is dependent upon the degree of the cancer. For very superficial cancer, i.e. just the lining of the bladder, biological therapy would be used.

• Biological Therapy- is a form of treatment that uses the body's natural ability to fight cancer. Biological therapy may be used alone or after surgery to help prevent the cancer from recurring. This treatment consists of placing a solution into the bladder. The bladder is stimulated by the immune system. The medicine stays in the bladder for about 2 hours before the patient is allowed to empty their bladder. The treatment is continued for approximately 6 weeks, once a week.
• Surgery- There are basically two types of surgery for bladder cancer. The less extensive, is where the physician will burn away the cancer cells. The treatment will be done on an outpatient bases for the most part, with anesthesia. There is also the surgery to remove the bladder called a Cystectomy. This surgery may be done when the bladder cancer invades the muscle wall.
• Chemotherapy
• Radiation Therapy

Kidney Cancer - Diagnosis and Treatment

1. What is Kidney Cancer?

The majority of kidney cancers are of the type known as renal cell carcinoma, which affect the "meat" of the kidney, rather than the drainage system of the kidney. A number of the kidney cancers have a heredity influence associated with diseases such as von Hippel-Lindau, adult polycystic kidney disease, tuberous sclerosis and a few others. Men are twice as likely to have kidney cancer than women.

2. What are the symptoms?

• Blood in urine
• Pain
• Mass
• Fever
• Weight loss
• Hypertension
• Varicocele (Abnormal dilation of the veins of the spermatic cord)

3. How is Kidney Cancer diagnosed?

The most common way to diagnose kidney cancer is with contrast studies such as intravenous pyelogram (IVP) and CT scans. The diagnosis can also be made with a renal ultrasound. The MRI is a useful diagnostic test that may also be used.

4. What are the treatments for Kidney Cancer?

Treatment options are almost exclusively surgical, the removal of the entire or partially affected kidney.

Kidney Stone

1. What are Kidney Stones?

Kidney stones are abnormal collections of mineral salts which form in the kidney and then can move down the ureter (tube connecting the kidneys and the bladder) and into the bladder. The movement of the stone can cause the following symptoms:

• Severe pain in the mid to lower back
• Nausea & vomiting
• Bloody urine
• Fever

2. What can cause Kidney Stones?

The causes of kidney stones vary, and men develop them twice as often as women. If someone else in your family has or has had kidney stones, then the likelihood to form stones is increased. Once a person has their first kidney stone they have approximately a 50% chance of developing another stone sometime later in life. A change in diet may decrease the chance of forming stones, if diet was a contributor to the formation of the stone originally.

3. How can Kidney Stones be prevented?

The primary way to prevent kidney stones is to drink plenty of fluids, ideally water. Some types of foods may be eaten in moderation and may decrease the chance of forming another stone, i.e. foods high in calcium (totally avoiding calcium, even if the stones are composed of calcium may do harm, since calcium is important in the body's function). There are medications that help prevent the development of certain kidney stones. Catching the stone so it may be analyzed for its composition is very helpful in knowing how and what to do to prevent further stones.

4. How are Kidney Stones evaluated?

When the symptoms are suspicious for a kidney stone, tests are done to determine if a stone is present. A urinalysis will be taken to look for blood, crystals or infection. An intravenous pyelogram (IVP) or CT Scan will be ordered to confirm the diagnosis of a kidney stone, and also to check the location of the stone. If an individual is allergic to iodine, an ultrasound of the kidney will be ordered.

5. How are Kidney Stones treated?

The good news is that the majority of stones do not require surgical intervention. The most common way to treat stones that will not pass on their own is Extracorporeal Shock Wave Lithotripsy (ESWL). ESWL is an outpatient procedure performed under intravenous (IV) sedation, using a high energy machine that delivers shock waves directed by live X-ray to the stone, resulting in the stone breaking into smaller pieces. These smaller pieces of the stone will pass into the bladder, and the patient will pass the fragments when urinating. About 20% of the stones will not break into smaller pieces or will fail to pass out of the patient, then surgery will be needed. The two most common surgical interventions are:

• Ureteroscopy- This procedure may be performed if the stone is located in the ureter. An instrument, like a small telescope, is passed through the urethra and bladder up to the stone. Then the urologist can use a laser to break up the stone, a small wire "basket" to grab and remove it, or other methods may be better suited for the location and size of the stone. These procedures do require anesthesia, and the patient is usually an outpatient at a hospital.
• Percutaneous nephrolithotripsy- A surgical approach less commonly done, a stone breaking laser instrument is passed directly into the kidney through an incision and tube placed in the patient's back. This is usually done for very large stones that cannot be treated in any other fashion. The patient is usually admitted into the hospital and will stay 1-2 days depending on recovery.

Urethral Stricture

1. What is a Urethral Stricture?

A urethral stricture is a narrowing of the urethra. Urethral strictures are more common in men. Some possible causes are: trauma in the pelvic area, sexually transmitted diseases, tumors in the area, swelling, or scar tissue.

2. What are the signs and symptoms?

• Slow stream of urine
• Painful urination
• Difficulty urinating
• Blood in urine
• Abdominal pain
• Discharge

3. How are Urethral Strictures treated?

Once the urologist has diagnosed a urethral stricture, the stricture may need to be dilated. This is accomplished by passing a urethral dilator or possibly incising the

stricture with a small blade using a cystoscope. More severe cases may require open surgery. A dilation may have to be repeated if the stricture re-occurs.

Urinary Incontinence

1. What is Urinary Incontinence?

Urinary incontinence is the inability to stop the loss of urine. This is not "normal" at any age beyond the toilet training stage. Loss of bladder control is a common problem, shared by millions of Americans.

2. What are the different types of Incontinence?

Urge Incontinence: The inability to hold urine long enough to reach a toilet. There is a strong and sudden urge to urinate followed by an involuntary loss of urine. People who suffer from urge incontinence say the need to void comes with little warning and may be present both day and night. Stress Incontinence: The involuntary loss of urine during coughing, sneezing, laughing or other physical activities. The amount of urine lost may vary from dribbling to gushes of urine. Factors associated with stress incontinence include weak pelvic muscles due to:

• Lack of exercise
• Overweight
• Strain of continuous coughing
• Injury to the pelvic muscles
• Complications of surgery involving the pelvic muscles or urethra

Overflow Incontinence: The bladder is unable to empty completely. A relatively large amount of urine is left in the bladder after urinating and may "overflow," causing leakage.

3. How is Urinary Incontinence diagnosed?

A thorough medical history and a complete physical exam will be conducted by your doctor. The doctor will need a detailed account from you to accurately diagnosis your problem. The physician will order laboratory and imaging tests. Further diagnostic testing may be done with Urodynamics testing.

4. How is Urinary Incontinence treated?

Treatment of incontinence, non-invasive or surgical is dependent upon what type of incontinence a patient has.

Non-invasive

Healthy bladder habits: The following are steps that can be taken to add in proper bladder function:

• Practice healthy toilet habits. Try not to go to the toilet "just in case." This may result in perpetuating the need to go to the bathroom more frequently. Avoid straining when you are passing your urine. Maintain healthy bowel habits. Constipation can adversely affect your bladder.
• Maintain an adequate fluid intake. Try to drink 6 - 8 glasses of fluid per day. Do not drink large quantities of caffeine and alcohol.
• Try to maintain an ideal body weight.

Bladder Training Program: Bladder training can help individuals with the symptoms of urgency and frequency. The idea behind a bladder-training program is to gain control over your bladder. It involves a variety of components, including maintaining a voiding diary to assess baseline bladder habits and capacity. One technique applies delaying exercises over a period of time. This is a program that works best with regular meetings with a healthcare professional for guidance and education. Biofeedback & Electrical Stimulation: This involves using a small vaginal or anal probe that allows the patient to see that activity of their pelvic muscles on a computer screen. The patient is then taught to physically identify the pelvic muscles and methods to strengthen and prolong their contractions. Low-grade electrical stimulation, utilizing the same type of probe, may also be utilized to help re-train the bladder. Oral Medications: Due to the different types of incontinence there are many medications that can be prescribed to the patient. Medications can be used in conjunction with other treatment options or by themselves. These are often prescribed for urge incontinence.

Surgical

Surgical Procedures: Varied types of procedures will be dependent upon the need of the individual with incontinence. Some of the procedures restore the bladder function by lifting the bladder neck and urethra into its normal position. While other procedures create a seal that stops the leaking of urine by injecting material into the urethra. The urologist will determine the appropriate surgical procedure. The following are some of the surgical procedures:

• Bladder Neck Suspension
• Sling Procedure
• Retropubic Suspensions
• Contigen Treatments
• Carbon Treatments

Urinary Tract Infections (UTI)

1. What are the causes of a UTI?

An infection occurs when bacteria invades the urethra and start multiplying. If the infection remains localized to the urethra, it is called urethritis; if the bacteria enters and invades the bladder, the ensuing infection is called cystitis. Finally, the infection can travel up the ureters to involve one or both of the kidneys and is called pyelonephritis. In addition to bacteria, other microorganisms can cause infections of the urinary tract. The most frequently encountered are Mycoplasma and Chlamydia that usually cause an infection of the urethra and/or the prostate in men and/or the pelvic organs in women. They are usually sexually transmitted and require treatment of both partners. Normally, the act of urination will wash invading bacteria out of the urethra to help prevent infections.

2. What are the symptoms of a UTI?

• Frequent urination
• Urgency of urination
• Burning during urination
• Pain in the lower abdomen
• Pain in back or side
• Frequent urination at night
• Pelvic discomfort

The urine may appear:

• Discolored
• Cloudy
• Brownish or reddish

If the kidneys are involved:

• High fever
• Overall bad feeling
• Nausea
• Vomiting

3. How is a UTI diagnosed?

A "Clean Catch" or catheterized urine sample.

4. How is a UTI treated?

Urinary tract infections usually require treatment with antibiotics that are often selected according to the sensitivity test done in the office. Most UTI's are treated with short courses of antibiotics usually only one to three days. However, some infections require treatment for one to two weeks. Treatment of urinary tract infections involve not only an antibiotic but also measures to alleviate the discomfort that may be caused by a UTI. Warm tub baths or sitz baths can often be beneficial as can heating pads. Avoidance of urinary tract irritants such as caffeine, alcohol and spicy foods can also help alleviate some of the symptoms.

5. Infections in Pregnancy

Urinary tract infections in pregnant women require prompt treatment as the infection can be serious - either for Mom or the baby. There are antibiotics that can be used that are safe for both Mom and baby

6. Recurrent Urinary Tract Infections in Women

Women are at risk for developing recurrent urinary tract infections primarily because of the short length of the urethra and the proximity to the anus and vaginal areas. It is estimated that four out of five who develop a urinary tract infections - usually cystitis - will have another episode of urinary tract infections even more often. Three or more infections per year usually require evaluation by a urologist. Women who have recurrent urinary tract infections can take steps on their own to avoid infection which include drinking plenty of water every day and some medical professionals feel that drinking large quantities of cranberry juice may be beneficial since it contains a substance which inhibits the growth of bacteria. Also, the bladder should be emptied when the need to urinate arises since holding the urine may be harmful. Wiping with toilet tissue should be done from front to back to keep bacteria away from the urethral area. Showers should be taken instead of tub baths and cleansing the genital area or taking a shower prior to sexual activity can be helpful as well as emptying the bladder shortly before and after sexual activity. Finally, douches and feminine hygiene sprays as well as other related products should be avoided since they can irritate the tissues of the genital area.

Wetting - Nocturnal Enuresis

1. What is Bed Wetting/Nocturnal Enuresis?

Bed Wetting/Nocturnal Enuresis is persistent, involuntary bed wetting during sleep, without the evidence of an abnormal urinary system. The widely accepted view of the cause of nighttime bed-wetting is that the child has failed to learn to awaken to the bladder pressure and volume before the bladder automatically empties. By age 6-7 years, if the problem still persists then treatment should be started.

2. How is Bed Wetting/Nocturnal Enuresis diagnosed?

The urologist will take a complete history, do a complete physical and exam the urine. As long as there is no other problems such as urinary infection, painful urination, stream abnormality, daytime incontinence, bowel problems or anatomic disorders, most bed wetters become dry without treatment. Patience and understanding are the best things of offer.

3. How is Bed Wetting/Nocturnal Enuresis treated?

There are different treatment options available. The urologist may use a combination of treatments depending on the individual situation.

Behavior Programs

• Timed Urinating Program- The waking hours are used to set a schedule to empty the bladder during specific times. In timed urination, the child assumes the responsibility for identifying when the bladder is full and initiates voiding at his/her convenience.
• Fluid Restriction- Parent(s) are told to restrict the child's fluid intake in the evening and take the child to the bathroom prior to going to bed.
• Self-Awakening Program- Teaches the child to wake-up during the night to urinate. A self-awakening approach can be tried at any age if the child is willing. Awakening the parents is discouraged because it takes away from the child's need to feel responsible for getting up.
• Alarm Conditioning- The quickest way for a child be become dry is to awaken during the night to urinate. The goal of conditioning treatment is to teach the child to respond to their bladder pressure by awakening.

Medications

• The urologist may prescribe medication as part of your child's plan of treatment.

Hypospadias

1. What is Hypospadias?

Hypospadias is a birth defect found in boys in which the urinary tract opening is not located properly at the tip of the penis. There are varying degrees of severity of hypospadias and several different surgical procedures to correct it.

2. Why should Hypospadias be treated?

The ability to stand and urinate is important for boys. When the urethra opens before it reaches the tip of the penis, a boy may be unable to stand and urinate with a direct stream. Additionally, as an adult male, a straight penis is necessary for satisfactory sexual function and reproduction.

3. How is Hypospadias treated?

Hypospadias is treated surgically. The surgical procedure for a mild case of hypospadias may be corrected by a simple outpatient procedure. Moderate to severe cases of hypospadias may require more extensive surgery with a stay in the hospital.

4. What are the possible complications of Hypospadias repair?

• Bleeding
• Bladder spasms
• Infections
• Fistula - urine leak
• Stenosis - a narrowing of the urethra
• Recurrent Chordee

Undescended Testicle

1. What is an Undescended Testicle?

An undescended testicle is a birth defect found in boys in which one or both of the testicles are not properly positioned in the scrotum. Sometimes the testicle will come down on its own by the age of one year.

2. How is an Undescended Testicle diagnosed?

The initial evaluation will include a thorough history, physical examination, and inspection of the child's testicles. Sometimes, ultrasound or other imaging tests may be performed. There is a need for concern with an undescended testicle. Permanent damage can occur, resulting in scarring and poor sperm development.

3. How are Undescended Testicles treated?

There are two options, non-surgical and surgical. The non-surgical option is a series of hormone injection treatments. This is effective in about 30% of the cases. The other option is surgical. The urologist will perform an outpatient procedure, where he will bring the undescended testicle down into the scrotum.

4. What are the possible complications?

There are a number of possible risks associated with any surgical procedure. Some of the more common are:

• Bleeding
• Infection
• Atrophy - the shrinking of the testicle
• Infertility
• Re-ascent - the testicle may move back up into the body.

Urinary Tract Infections (UTI) in Children

1. What causes a UTI?

An infection occurs when bacteria enter the urethra and start multiplying. If the infection stays within the urethra, it is called urethritis. If the infection enters the bladder, the infection is called cystitis. The infection will sometimes involve the prostate, this is called prostatitis. Last, the infection can go into the kidneys, this is called pyelonephritis. UTI's can occur in infants and children who are born with urinary tract abnormalities, some of which need to be corrected with surgery.

Normally, the act of urination will wash the bacteria out of the urethra to help prevent infections.

2. What are the symptoms of a UTI?

• Frequent urination
• Urgency of urination
• Burning during urination
• Pain in lower abdomen
• Pain in back or side
• Frequent urination at night
• Pelvic discomfort

The urine may appear:

• Discolored
• Cloudy
• Brownish or reddish

If the Kidneys are involved:

• High fever
• Overall bad feeling
• Nausea
• Vomiting

Children’s symptoms also can consist of:

• Irritability
• Abnormal eating pattern
• Unexplained fever
• Loss of bladder control
• A change in the child's urinary pattern

3. How is a UTI diagnosed?

A "Clean Catch" or catheterized urine sample.

4. How is a UTI treated?

Urinary tract infections usually require treatment with antibiotics that are often selected according to the sensitivity test done in the office. Most UTI's are treated with short courses of antibiotics usually only one to three days. However, some infections require treatment for one to two weeks. 

Treatment of urinary tract infections involve not only an antibiotic but also measures to alleviate the discomfort that may be caused by a UTI. Warm tub baths or sitz baths can often be beneficial as can heating pads. Avoidance of urinary tract irritants such as caffeine, alcohol and spicy foods can also help alleviate some of the symptoms.

Bladder Cancer

1. What is Bladder Cancer?

Bladder cancer is the sixth most common cancer in the United States. It is cancer of the bladder. The cancer may be only in the lining of the bladder, or more extensively could be in the muscular wall of the bladder. The most aggressive type of bladder cancer may grow through the bladder wall and spread to nearby organs. Bladder cancer is more common among whites and men and usually occurs among people in their 60's.

There are a number of risk factors that are attributed to bladder cancer. Here are the most common risk factors:

• Smoking
• Industrial chemicals
• Chronic bladder inflammation

2. What are the signs and symptoms of Bladder Cancer?

Bladder cancer often doesn't produce signs or symptoms in its early stages. The first warning sign is usually blood in the urine. However, signs and symptoms of bladder cancer may be:

• Blood in urine
• Pelvic Pain
• Frequent urination
• Sensation for the need to urinate without results
• Slowing of the urinary stream

These signs and symptoms are the same as other diseases, so you should see your physician.

3. How is Bladder Cancer diagnosed?

The physician will ask for a medical history and perform a physical exam. In addition, a urine sample will be examined, and possibly sent on to a laboratory for the testing of blood cells and cancer cells. An intravenous pyelography (IVP) will be ordered, and a cystoscopic procedure will be performed. The cystoscopy will enable the urologist to look inside the bladder and perform a biopsy.

4. How is Bladder Cancer treated?

Treatment for bladder cancer is dependent upon the degree of the cancer. For very superficial cancer, i.e. just the lining of the bladder, biological therapy would be used.

• Biological Therapy is a form of treatment that uses the body's natural ability to fight cancer. Biological therapy may be used alone or after surgery to help prevent the cancer from recurring. This treatment consists of placing a solution into the bladder. The bladder is stimulated by the immune system. The medicine stays in the bladder for about 2 hours before the patient is allowed to empty their bladder. The treatment is continued for approximately 6 weeks, once a week.
• Surgery - There are basically two types of surgery for bladder cancer. The less extensive option is where the physician will burn away the cancer cells. The procedure will be done on an outpatient bases for the most part, with anesthesia.
  There is also a surgery to remove the bladder called a Cystectomy. This surgery may be done when the bladder cancer invades the muscle wall.
• Chemotherapy
• Radiation Therapy

Kidney Cancer

1. What is Kidney Cancer?

The majority of kidney cancers are of the type known as renal cell carcinoma, which affect the "meat" of the kidney, rather than the drainage system of the kidney. A number of the kidney cancers have a heredity influence associated with diseases such as von Hippel-Lindau, adult polycystic kidney disease, tuberous sclerosis and a few others. Men are twice as likely to have kidney cancer than women.

2. What are the symptoms?

• Blood in urine
• Pain
• Mass
• Fever
• Weight loss
• Hypertension
• Varicocele (Abnormal dilation of the veins of the spermatic cord)

3. How is Kidney Cancer diagnosed?

The most common way to diagnose kidney cancer is with contrast studies such as intravenous pyelogram (IVP) and CT scans. The diagnosis can also be made with a renal ultrasound. The MRI is a useful diagnostic test that may also be used.

What are the treatments for Kidney Cancer?

Treatment options are almost exclusively surgical, the removal of the entire or partially affected kidney.

Prostate Cancer

1. What is Prostate Cancer?

Prostate cancer begins inside the prostate and may grow to involve the entire gland and then spread outside the gland. Cancer of the prostate is the second most common cancer in men, after skin cancer. It is the second leading cause of cancer deaths in men, after lung cancer.

2. Who is at higher risk?

Prostate cancer is the most common type of cancer found in American men. Here are some facts about what may increase the risk of prostate cancer:

• Prostate cancer is most likely to develop after the age of 55, with the highest incidence after age 65.
• African-American men have the highest rate of prostate cancer.
• Family history (father, brother, uncle) of prostate cancer increase one's risk.
• Exposure to cadmium in the workplace (welding, battery making, electroplating) increases one's risk for prostate cancer.

The cause of prostate cancer is unknown.

3. What are the symptoms of Prostate Cancer?

In its earliest stage, prostate cancer may produce no signs or symptoms. As the tumor grows, certain signs or symptoms may be noticed, including:

• Difficulty starting or stopping urinating
• Decreased strength of urinary stream
• Dribbling at the end of urination
• Painful or burning urination
• Frequent urination, especially at night
• Painful ejaculation
• Blood in the urine
• An inability to urinate
• Continuing pain in the lower back, pelvis, or upper thigh

4. Is early detection important?

As with many types of cancer, early detection and treatment of prostate cancer increase the chance of a cure. The five-year survival rate for prostate cancer patients whose cancers are discovered while in a localized stage (cancer remains in a contained area of the prostate) is 85%.

Cancer of the prostate is often a slow-growing type of cancer. When it develops very late in life, as is frequently the case, the impact of the disease is often minimal. In fact, many men with prostate cancer eventually die of causes unrelated to the prostate cancer itself.

5. How is Prostate Cancer diagnosed?

The only way to determine whether or not a suspicious lump or an elevated prostate specific antigen (PSA) is associated with prostate cancer is to microscopically examine a sample of tissue taken from the prostate. This tissue sample may be removed by a needle placed directly in the prostate gland. Laboratory tests and bone scans may be useful in determining the extent of the disease.

6. How is Prostate Cancer treated?

Treatment of prostate cancer is highly individualized. Many factors must be considered before a physician recommends a course of action. These factors include the severity of the cancer, the patient's general health and medical history, anticipated side effects the patient may experience from various treatments, and the patient's age and expected life span.

Surgery:

Radical Prostatectomy - This surgery is considered the preferred choice of therapy for localized disease and in theory, if the cancer is completely confined, then surgically removing the prostate should result in a cure. There are limitations to surgery and its ability to cure the patient of cancer, which are related to the severity and aggressiveness of the cancer.

The side effects of prostate removal are usually temporary, but in some cases can be permanent. They may include impotence (the inability to have or maintain an erection.) and urinary incontinence (the inability to control urinary function.).

Brachytherapy/Seed Implants - This is another surgical option for the treatment of prostate cancer. A urologist works with an oncologist to implant radioactive seeds into the prostate to stop or slow the growth of cancer cells. This treatment is still considered experimental.

If your urologist feels surgery is not the best option for your care, there are alternative choices.

Non-Surgical Therapies:

Radiation Therapy - Patients who elect to have some form of radiation therapy which is intended to cure their prostate cancer should have cancer that is confined to the prostate and/or the surrounding tissues. So-called "definitive" radiation therapy is delivered using an external beam of x-rays carefully directed to the areas of the pelvis that includes the prostate.

Like surgery, all forms of radiation therapy have complications including inflammation of the bladder, rectum and intestines. In addition, many radiation therapy patients have side effects like urinary and sexual problems.

Hormone Therapies - This therapy is primarily used to treat patients who have prostate cancer which is not confined to the prostate or a recurrence of cancer. It is not curative. The intent of hormone therapy is first to delay the progression of the cancer and second, increase the patient's survival while improving his quality of life. There are an increasing number of options available as methods for implementing hormone therapy. These are as follows:

• The surgical removal of the testes to prevent the production of testosterone.
• The use of various hormonally active drugs called LHRH agonists. These drugs lower the levels of testosterone in the bloodstream.
• The use of "antiandrogens" to suppress the activity of a male hormone known as dihydrotestosterone.
• The use of other techniques or drugs to suppress the hormones made by the adrenal gland.
• The combined use of LHRH agonists and antiandrogens.
• Use of hormonal therapy prior to surgery or radiation therapy.

The important factors in choosing a particular form of hormone therapy can include the cost of the treatment, the effectiveness and safety of the various treatment options, and the patient's quality of life.

Cryotherapy: This is an old technique that is having a comeback due to the advances in technical capability. Cryotherapy is a method of freezing the prostate and other appropriate nearby tissues to extremely low temperatures with liquid nitrogen. This technique is designed to kill all prostate cancer tissue without having to take the risks involved in carrying out surgery.

While cryotherapy is certainly an interesting and potentially important addition to the options which physicians can offer patients with prostate cancer, it should still be considered an experimental technique at this time, and used mostly as salvage treatment for recurrence.

The known side effects of cryotherapy can include impotence, scarring of the urethra and urinary system, and irritation of the bladder, the urethra, the rectal wall and the genitalia. This last group of side effects can include pain on urination, a burning sensation during urination, frequent and unexpected urination, blood in the urine, and swelling of the penis or the scrotum.

Testicular Cancer

1. What is Testicular Cancer?

Testicular cancer is cancer of the testes. Usually only one testicle is involved. The risk factors associated with testicular cancer are as follows:

• Undescended testicles in infants and young children.
• An identical twin with testicular cancer or family history of testicular cancer.
• Atrophy of testicles due to mumps or viral infection.

2. How is Testicular Cancer diagnosed?

The best way to diagnose testicular cancer is through self-examinations. The first finding is usually a painless lump in or on the testis, or a hardness or enlargement of the testis. Less commonly there is associated pain and tenderness. Upon seeing the urologist, the urologist will usually order a testicular ultrasound.

3. How is Testicular Cancer treated?

After the diagnosis of a solid testicular mass has been made, the initial management is to remove the testis and its associated cord, an orchiectomy. Depending on the type of cancer cells that are present, other therapies such as additional surgery, radiation therapy or possible chemotherapy may be indicated.

Using a combination of these therapies, testicular cancer has one of the highest cure rates of all cancers. Cures from testicular cancer can even be achieved in individuals who have had it spread into other parts of the body.

We Appreciate How You Feel

It's only natural for you to feel a little nervous about your visit with the Antietam UroSurgical Center. You have questions. You have concerns. And if you're like the rest of us, you probably have a few fears. We hope the information you find here will help to ease your mind.

Specific directions about your individual treatment plan will be available on a separate handout which your physician will provide.

We're All After the Same Thing: Quality Care

The Antietam UroSurgical Center exists for one reason - to provide high quality care and attention to every patient we see.

As our patient you can - and have a right to - expect us to respect your time, your concerns, and your special needs. We understand the critical value of family support, so we keep in mind both your needs and those of all who will be integral to your care.

On this website you'll find a list of Patient Rights which we honor. Please take the time to read them, for they clearly express the role we intend for you to play in your care. Those rights also define the relationship we want you to have with your physician at Antietam UroSurgical Center.

About Our Center

Today, the Antietam UroSurgical Center is one dimension of Meritus Urology. Located conveniently in the Robinwood Professional Center, the practice affords the community cost-effective, technically sophisticated, patient-oriented treatment options.

Our Physicians:

P.J. Dennis, MD, FACS

K.C. Hackett, MD, FACS

R.C. Bryson, MD, FACS

J. Maggioncalda, MD, FACS

Our Procedures:

All outpatient urological procedures/surgeries.

Our Treatment Sites:

One full operating room.
One procedure room.
One prostate-specific procedure room

Why Do Patients Prefer Antietam UroSurgical Center Over a Hospital?

Several reasons. First off, it's a friendlier environment. Since all of our procedures are done on an outpatient basis, you don't have endless corridors, unanswered call buttons, or hospital food to contend with. Most of our procedures take less than an hour, with just another hour required in recovery. Afterwards, you'll go home to the comfort and familiarity of your own surroundings.

We've Taken the Pain Out of Billing

 We're happy to handle the billing with your insurance company. Please note that if an anesthesiologist attends your procedure, you may receive a separate bill for those services.

For patients who are members of an HMO, IPA or other managed care provider, we ask that you tell us up front so that we can ensure proper authorization.

Occasionally these health care companies require us to use a particular laboratory's services. If this is the case with your insurer, we simply need to know beforehand.

More Questions? Just ask!

We hope that this information, along with the procedure fact sheet you'll be given by your physician, will answer all your questions. It's important that you feel comfortable and informed about the treatment or procedure you're about to experience, so if you're still uncertain about anything feel free to call the Center's staff and ask away. 

301-733-0022

To us, peace of mind is a giant step toward good health.