Virginia Advanced Urology Clinic Specialties

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.

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

• 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

The prostate gland is a muscular, walnut-shaped gland in men. It is located right below the bladder and surrounds the urethra (the tube that carries urine out of the body). It is responsible for making the fluids that carry sperm. As a man ages, the prostate begins to slowly enlarge and may begin to squeeze the urethra, causing problems with urination.

The normal adult prostate weighs 18 grams; measures 3cm in length, 4cm in width, and 2cm in depth. The prostate is composed of approximately 70% glandular elements and 30% of fibromuscular stroma. Although anatomically divided into different zones, the prostate is described as having 2 palpable lateral lobes separated by a central sulcus and one nonpalpable median lobe that may project into the bladder in older men.

Typical symptoms of include:

• Decreased Stream — Decreased size and strength of urine stream; a weak urine flow
• Hesitancy— Having a hard time "getting started"
• Intermittence— An "on again, off again" flow of urine
• Incomplete Urination — The feeling that your bladder is not quite empty after you urinate
• Urinary Retention — Being completely unable to urinate
• Frequency— Having to urinate much more often than usual
• Urgency— An extremely strong desire to urinate as soon as possible
• Nocturia— The need to get up and urinate in the night
• Incontinence— Being unable to hold back urine until you reach the bathroom (often accompanied by feelings of urgency)

2.1 Microwave (TUMT)

TUMT is one of several alternatives for treating an enlarged prostate, a condition also known as benign prostatic hyperplasia (BPH). Other treatments include medications, transurethral resection of the prostate (TURP), transurethral needle ablation (TUNA), laser surgery and open prostatectomy.

2.2 Greenlight Laser Prostatectomy

The GreenLight™ Laser Therapy is a treatment that combines the effectiveness of the traditional surgical procedure known as "Trans Urethral Resection of the Prostate" (TURP) with fewer side effects.

GreenLight is suitable for most patients with an enlarged prostate. With over 200,000 procedures performed worldwide, the GreenLight procedure is creating a new standard of care — a standard that offers freedom from enlarged prostate symptoms.

Most patients return home a few short hours after the PVP procedure and can return to normal, non-strenuous activities within days. The GreenLight laser system delivers the ultimate benign prostatic hyperplasia (BPH) solution — free from urinary symptoms, free from compromise, free to go!

Benefits of GreenLight

• Rapid urine flow improvement
• Quick return to normal activities
• Virtually bloodless procedure
• Less than 1% reported cases of erectile dysfunction
• Short to sometimes no catheterization (less than 24 hours in most cases)
• Outpatient procedure in otherwise healthy patients
• Long lasting symptom relief

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.

Male sexual dysfunction is one of the most common health problems affecting men and is more common with increasing age. Male sexual dysfunction can be caused by physical or psychological problems. The June 23/30, 2004, issue of JAMA includes an article about the various types of male sexual dysfunction and treatments for them.

MAIN TYPES OF MALE SEXUAL DYSFUNCTION

• Low libido (sexual interest)
• Erectile dysfunction (ED, difficulty achieving or maintaining an erection)
• Premature ejaculation (reaching orgasm [sexual climax] too quickly)
• Delayed or inhibited orgasm
• Physical abnormalities of the penis

• Problems in the relationship with the sexual partner can lead to sexual dysfunction
• Lowered levels of the male hormone testosterone (a condition known as hypogonadism) can cause low libido or ED.
• Certain drugs, such as antidepressants and blood pressure medications, can cause sexual dysfunction.
• Erectile function can be impaired by a stroke or by nerve damage from diabetes or surgery.
• Disorders affecting blood vessels, such as atherosclerosis (hardening of the arteries) and high blood pressure, are risk factors for ED.
• Other possible causes of sexual dysfunction include smoking, obesity, kidney problems, depression, anxiety disorders, and alcoholism.

If you think you are experiencing male sexual dysfunction, see your doctor.

• Your doctor will ask you to describe the problem and will ask questions to help determine whether the cause is physical, psychological, or a combination of both.
• A general physical examination, including examination of the penis and testicles, will be performed, and other tests may be done to evaluate your health.
• Blood tests may be done to determine if there is a hormonal problem contributing to sexual dysfunction.

• For psychological causes of sexual dysfunction, such as relationship problems, counseling, either individually or as a couple, may be beneficial. Sexual therapy with a therapist who specializes in sexual dysfunction may also help.
• Depression or anxiety disorders may need treatment.
• Any physical problems that may be affecting sexual function should be addressed.
• If a medication is interfering with sexual function, it may be possible to change or discontinue the medication.
• Prescription medications that treat erectile dysfunction may help a man achieve and maintain erections.
• Prescription medications that treat erectile dysfunction may help a man achieve and maintain erections.
• Other non surgical treatments include injections therapy and vacuum erection device.
• Surgery is indicated when other options fail and consists of inflatable and semirigid penile implants. Surgery can be performed on an outpatient basis.

A kidney stone is a hard mass developed from crystals that separate from the urine and build up on the inner surfaces of the kidney. Normally, urine contains chemicals that prevent or inhibit the crystals from forming. These inhibitors do not seem to work for everyone, however, so some people form stones. If the crystals remain tiny enough, they will travel through the urinary tract and pass out of the body in the urine without being noticed.

Kidney stones may contain various combinations of chemicals. The most common type of stone contains calcium in combination with either oxalate or phosphate. These chemicals are part of a person's normal diet and make up important parts of the body, such as bones and muscles.

A less common type of stone is caused by infection in the urinary tract. This type of stone is called a struvite or infection stone. A bit less common is the uric acid stone. Cystine stones are rare.

Pediatric urology is the diagnosis and treatment of congenital (i.e., present at birth) and acquired urological conditions and diseases in children. Pediatric urologists treat conditions of the male reproductive tract (e.g., undescended testicle) and the male and female urinary tracts (e.g., urinary tract infection).

The urinary tract consists of the organs that filter the blood and form urine (kidneys), the tubes that carry urine from the kidneys (ureters), the organ that stores urine (bladder), and the tube that carries urine from the bladder and removes it from the body (urethra).

The most common condition treated by pediatric urologists is urinary tract infection (UTI).

Other conditions include the following:

• Abnormally located urethral opening (hypospadias)
• Backup of urine from the bladder into the ureter (vesicoureteral reflux [VUR])
• Bedwetting (nocturnal enuresis)
• Distention of the kidney in utero (antenatal hydronephrosis)
• Ureteropelvic junction obstruction (UPJ obstruction; may cause kidney damage)

Pediatric Urological Examination Most children under the care of a pediatric urologist are school-aged and younger. UTIs (e.g., cystitis) are most common in young girls and pediatric urological conditions are usually congenital and treated at a young age. Conditions such as vesicoureteral reflux and antenatal hydronephrosis are frequently diagnosed during prenatal ultrasound and hypospadias is usually diagnosed during infancy.

The pediatric urological examination includes a medical history and a comprehensive physical examination. A history of symptoms, illnesses, injuries, medications, prenatal ultrasound, and family history are documented. A urinary catheter may be inserted into the bladder through the urethra to withdraw urine.

Diagnostic tests include the following:

• Blood tests
• Cystometrogram, which measures bladder pressure at various stages of filling
• Cystoscopy, which is an examination of the bladder and ureter
• Intravenous pyelogram, which is a series of x-rays of the ureter and renal pelvis taken after injecting a contrast agent
• Magnetic resonance imaging (MRI scan)
• Renal scan
• Ultrasound (to detect blockage in the urinary tract)
• Urinalysis and urine culture (to detect UTI)
• Urodynamic studies, which measure the storage and rate of movement of urine from the bladder)
• Uroflowmetry, which measures urine flow
• Voiding cystourethrogram (VCUG; used to observe the urinary tract before, during, and after urination)

Vasectomy is a safe and effective method of permanent male contraception. In the United States, it is employed by nearly 7% of all married couples and performed on approximately one-half million men per year, more than any other urological surgical procedure.

Historically, some men have shied away from vasectomy because they fear pain and the possible complications. In clinical practice, however, one of the commonest voiced concerns is that of ‘the needle’ for injection of local anesthetic into and through the scrotal skin. Efforts to enhance the popularity of vasectomy have led the Chinese to develop refined methods of no-scalpel vasectomy that minimize trauma, pain and complications.

Vasectomy reversal is a surgery to undo a vasectomy. After successful vasectomy reversal, sperm are present in your semen again and you may be able to get your partner pregnant.

Statistically, five to ten percent of the over 600,000 men in North America who annually undergo a vasectomy, will choose to have theirs' reversed at some time.

Reasons for reversing a vasectomy can include the loss of a child, a new marriage, or just a desire to have more children to complete the family.

In recent years, with the development of better techniques and a larger pool of skilled microsurgeons to perform the reversal, excellent results can be obtained with a high chance of obtaining pregnancy. Vasectomy reversal is generally carried out in hospital as an outpatient procedure using a general anaesthetic. Success rates vary by individual patient and the surgeon. Two techniques may be employed depending upon the circumstances:

• Reconnecting the vas deferens (vasovasostomy) - the preferred connection, or
• Connecting the vas deferens to the epididymis (vasoepididymostomy) -when no sperm are identified in the testicular vas deferens.