Virginia Advanced Urology Clinic Specialties

1. daVinci Robotic Surgery

Davinci robotic surgery for prostate cancer

The daVinci® Surgical System is a robotic surgical system consisting of three main components:

The InSite® Vision System which provides the surgeon with a true minimally invasive 3-D view of the surgical field.

The Surgical Cart that includes theEndoWrist® Instruments. The EndoWrist Instruments are designed to mimic the movement of the human hands, wrists and fingers.

The Surgeon Console which contains the master controls that the surgeon uses to manipulate the EndoWrist Instruments.

daVinci Prostatectomy also offers these potential benefits:

Significantly less pain
Less blood loss
Fewer complications
Less scarring
A shorter hospital stay
And a faster return to normal daily activities

Following daVince Procedures have been performed by Dr. Singh

Radical Laparoscopic prostatectomy
Radical cystoprostatectomy
Pelvic lymph node dissection
Radical nephrectomy
Partial nephrectomy
Nephroureterectomy
Pyeloplaty
Ureteral reimplantation
Nehrolithotonmy for complex stone cases
Microsurgical vas reversal
Varicocelectomy
Neurolysis for chronic testicular pain

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2. Benign Prostatic Hyperplasia (BPH)

3. Urinary Incontinence

Urinary incontinence — the loss of bladder control — is a common and often embarrassing problem. The severity of urinary incontinence ranges from occasionally leaking urine when you cough or sneeze to having an urge to urinate that's so sudden and strong you don't get to a toilet in time.

If urinary incontinence affects your day-to-day activities, don't hesitate to see your doctor. In most cases, simple lifestyle changes or medical treatment can ease your discomfort or stop urinary incontinence.

Treatments and drugs

Treatment for urinary incontinence depends on the type of incontinence, the severity of your problem and the underlying cause. Your doctor will recommend the approaches best suited to your condition. Often a combination of treatments is used.

Treatment options for urinary incontinence range from more conservative approaches, including behavioral techniques and physical therapy to more aggressive options, such as surgery.

In most cases, your doctor will suggest the least invasive treatments first, so you'll try behavioral techniques and physical therapy first and move on to other options only if these techniques fail.

The success of your treatment depends most of all on the right diagnosis. Talk to your doctor about the specifics and possible complications of any treatment. Ask questions and express concerns to help determine which treatment is right for you.

3.1 Urodynamics:

Urodynamics is a study that assesses how the bladder and urethra are performing their job of storing and releasing urine. Urodynamic tests help your doctor or nurse see how well your bladder and sphincter muscles work and can help explain symptoms such as:

incontinence
frequent urination
sudden, strong urges to urinate
problems starting a urine stream
painful urination
problems emptying your bladder completely
recurrent urinary tract infections

These tests may be as simple as urinating behind a curtain while a doctor or nurse listens or more complicated, involving imaging equipment that films urination and pressure monitors that record the pressures of the bladder and urethra.

3.2 Biofeedback

Biofeedback is a simple painless teaching technique, providing people with on-the-spot information (or feedback) about a particular function of their body. In urology, biofeedback therapy is often used with patients who have pelvic muscle dysfunction, which can lead to symptoms such as incontinence, urgency or frequency of urination, difficulty emptying the bladder or pelvic pain. It may also be used prior to a surgery to reduce the likelihood of developing such problems. With the help of biofeedback, a patient can retrain the pelvic muscles to reduce or resolve their symptoms.

3.3 Interstim

InterStim is a revolutionary therapy to help patients with overactive bladder problems. This procedure been successful in patients who have tried other treatments like drinking less fluids, acupuncture and multiple medications, only to still experience bladder control problems. This FDA-approved treatment can eliminate or greatly reduce bladder control symptoms for people suffering from urinary frequency, urgency or leaking urine. The most remarkable part of InterStim therapy is that patients can first undergo a short trial period to help determine if the treatment will work well for them.

3.4 Female and Male Sling Procedures

Male Sling
The male sling safe and effective procedure for men suffering from severe stress urinary incontinence such as after prostate surgery and is not controlled by conservative measures. The procedure is a minimally invasive outpatient surgery that can restore bladder control immediately.

The sling is made of synthetic mesh and is placed inside the body through small incisions. It supports the urethra, restoring normal bladder control. Most patients are continent immediately following the procedure and can resume normal, non-strenuous activities shortly thereafter.

The procedure offers many benefits to men suffering from mild stress urinary incontinence:
• Short surgery ( usually 30-40 minutes), either as an outpatient or overnight stay
• May be performed under spinal or general anesthesia
• Recovery is often rapid — results may vary
• Often no catheter necessary upon discharge
• No device activation required
• Immediate improvement
• Restored dignity and quality of life

Female Slings
Urinary incontinence is a condition where there is loss of control in managing the flow of urine from your body.

Approximately 17 million women in the U.S. encounter urinary incontinence in their lifetime. This
condition can occur in women between the ages of 18 and 60 and beyond and is usually a result of the urethra not being closed tightly to keep urine in the bladder. Symptoms include an inability to prevent leaking urine when exercising or other involuntary actions such as coughing or sneezing.

Treatment includes conservative measures such as biofeedback and bladder retraining. Should
conservative measures fail, sling procedure such as OB tape is quite effective as a minimally invasive procedure.

3.5 Bladder Prolapse:

A cystocele is term for condition known as prolapsed bladder. This is a type of pelvic organ prolapse that occurs when the tissues and muscles that hold the bladder in place are stretched or weakened. This process can cause the bladder to move from its natural position and press into the vagina. A bladder prolapse may develop if a woman’s pelvic muscles become damaged. It is common case during pregnancy, labor, childbirth, or a previous pelvic surgery or are weakened by aging. In rare cases, a cystocele can be present at birth, and then it is called congenital cystocele. A cystocele may cause leaking of urine, especially during coughing, laughing, or jumping. It may also cause difficulty emptying the bladder, which may progress to a bladder infection known as cystitis. Exercises to strengthen the pelvic floor muscles, called Kegel exercises, may help relieve symptoms of a cystocele. A health professional may recommend use of a pessary, which is an instrument placed in the vagina to support the uterus. In severe cases, surgery may be needed as the only treatment for prolapsed bladder. This can be done transvaginally or via laparoscopic robotic surgery.

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