Vasectomy
Circumcision
Treatment of erectile dysfunction
Treatment of incontinence
Treatment of urinary tract infection
Treatment of prostatitis
Treatment of benign prostate hyperplasia (BPH)
Treatment of Peyronie’s disease
Treatment of Kidney stones
Treatment of kidney cancer
Treatment of bladder cancer
Treatment of testicular cancer
Treatment of prostate cancer
Treatment of urethral stricture
Treatment of overactive bladder
Treatment of prolapsed uterus
Vasectomy
Vasectomy is a surgical procedure used to create permanent contraception and male sterilization. The procedure entails cutting and sealing the vas deferens in the testicle. The vas deferens is the tube that stores and carries sperm and deposits into the ejaculate. As a result of a vasectomy procedure, the ejaculate does not contain any sperm and thus cannot fertilize an egg.
The procedure is done in the office or operating room under local anesthesia or sleeping under sedation if desired. It involves two small incisions on the sides of the scrotum. The vas deferens is identified, cut, cauterized, and capped. We also offer the no-scalpel vasectomy in which there is one single puncture in the scrotum that requires no stiches.
The vasectomy procedure is highly effective with a birth control success rate of greater than 99%. While there is the possibility of vasectomy reversal surgery, the success of such surgery is not 100%. The decision to have a vasectomy should be made with the idea that it is possible that it cannot be reverse and is a permanent form of conception.
Circumcision
A circumcision procedure is a surgery in which the foreskin is removed from the tip of the penis. The foreskin consists of skin, smooth muscle, blood vessels and nerves. Anatomically, it covers and protects the tip of the penis.
The circumcision procedure is done in the office or operating room under local anesthesia or sleeping under sedation if desired.
Indications for adult circumcision include, cosmetic preference, religious or cultural preference, chronic infections, phimosis (tightening of the foreskin which prevents retraction), and other problems of the foreskin and penis.
Treatment of erectile dysfunction
There are many different treatments for erectile dysfunction. There are oral medications, topical medications, injected medications, and penile implant surgery.
For patients with hormonal imbalance such as low testosterone, testosterone supplementation can be given orally, topically or through injections. There are three medications taken orally that make it easier to get an erection. There three medications are Viagra, Levitra and Cialis. They do not give the patient an erection, but make it easier for them to achieve one once stimulated. The main differences between these three medications are the duration that they last in order to ease the ability to get an erection.
Surgical treatment for erectile dysfunction involves the implantation of a device inside the penis. There are many type of penile implant devices. Dr. Larish is one of the leading experts on penile implant surgery. For more information on penile implant surgery, please see our webpage dedicated to this topic. INSERT LINK HERE
Treatment of incontinence
Treatment of urinary incontinence depends on the cause of it, and includes behavior modifications, bladder retraining, pelvic floor therapy, devices, medications and surgery.
The first line of treatment for women with stress urinary incontinence is kegel muscle exercises and bladder training exercises. Creating a set schedule for voiding often can allow for draining of the bladder prior to leakage occurring.
Devices to aid in incontinence include collecting systems, absorbent products, occlusion devices, indwelling catheters inserted into the urethra that are left for long periods of time, and intermittent use of catheters to drain the bladder.
If the incontinence is caused by a urinary tract infection, oral antibiotics are administered. A number of medications exist that treat incontinence but none are 100% effective.
Surgery for incontinence includes artificial urinary sphincter, slings, tension-free vaginal tape, bladder suspensions and others.
Treatment of urinary tract infection
Urinary tract infections are classified as uncomplicated and complicated.
Treatment for uncomplicated UTI includes oral antibiotics. There are many antibiotics that may be used. The proper choice of antibiotics depends on the type of bacteria present. The duration of antibiotic treatment depends on which antibiotic is prescribed. Symptoms of uncomplicated UTI generally resolve quickly.
Complicated UTI requires stronger antibiotics. These can be oral or intravenous. Often it requires the doctor to obtain cultures of the urine to identify exactly which bacteria is present and tailor the antibiotic to that particular bacteria. There are more and more bacteria that have become resistant to the usual antibiotics used to treat UTI
Treatment of Prostatitis
Acute prostatitis is caused by an infection of the prostate. Treatment involves the use of prescription antibiotics. The choice of antibiotic to use depends on the organism present and severity of the problem. Antibiotics are usually administered orally and maintained for two to four weeks to completely eradicate the bacteria. For more severe or nonresponsive cases, IV antibiotics may be given.
Chronic bacterial prostatitis is also caused by bacteria but are more difficult to treat. A longer course of antibiotics is given which is often four to eight weeks long. The choice of antibiotic depends on the bacteria present and the severity of the infection. Oral or intravenous antibiotics may be chosen.
Asymptomatic prostatitis often does not require treatment. When treatment is administered it consists of antibiotics and anti-inflammatories.
Chronic pelvic pain syndrome is difficult to treat as patients do not all respond to the currently used treatments. A number of medications exist. Often it is treated with anti-inflammatory medications, antibiotics, alpha blockers, and estrogen reabsorption inhibitor.
Treatment of benign prostate hyperplasia (BPH)
Treatment for BPH includes lifestyle modifications, medications, catheterization, and surgery.
Lifestyle modification for BPH include increased exercise, decreased fluid before bed, decreased alcohol and caffeine, avoid anticholinergic medicines, and adopting a timed voiding schedule.
Medications used to treat BPH include alpha blockers that relax the smooth muscle to decreases urethra blockage, and five alpha reductase inhibitors that inhibit the production of DHT which is a hormone that is responsible for enlarging the prostate.
Self-catheterization involves the patient with urinary retention inserting a catheter into the urethra in order to completely empty the bladder alleviating the main symptom of BPH, urinary retention.
Surgery for BPH in indicated in patients that have failed conservative treatments and are experiencing adverse symptoms. There are many surgical invasive ways to treat BPH.
Open prostatectomy is rarely performed these days despite having a high success rate in order to try to avoid the associated complications.
Transurethral resection of prostate (TURP) is the most commonly used surgical procedure. This procedure is performed by inserting instruments and a camera into the urethra and the inside of the prostate is removed leaving the outer rim and relieving pressure on the urethra.
Photoselective laser vaporization of prostate (PVP) is a method of destroying an enlarged prostate using a laser. It is called the Greenlight Laser. A fiber optic cable that is connected to the laser is inserted into the urethra along with a camera. The surgeon points the laser at the prostate gland. The laser is absorbed by blood and tissue within the prostate creating enough heat to vaporize the tissue. This is continued until enough tissue is removed to relieve the restriction on the urethra.
The Rezūm procedure is transurethral radio frequency thermal therapy. The probe is inserted along with a camera into the urethra. Heat is generated by the radio frequency probe to destroy the enlarged prostate tissue. This is continued until enough tissue is removed to relieve the restriction on the urethra.
The UroLift system is a procedure that lifts and holds the prostate tissue out of the way so that it does not restrict the urethra. The UroLift instruments are inserted along with a camera into the urethra. Where the urethra passes through the prostate, the canal is expanded. The small UroLift implants are inserted into the prostate gland in order to lift hold the prostate tissue out of the way increasing the opening of the previously compressed urethra. Multiple implants are inserted in order to hold the prostate open in all directions.
Treatment of Peyronie’s disease
For many patients Peyronie’s disease can be tolerated and does not require treatment. When symptoms worsen and there is pain and interference with sexual activity treatment becomes warranted. Injections can be attempted in order to soften the scar tissue. A series of six to twelve Verapamil injections are given into the scar tissue. In the active phase of the disease, these injections often arrest the worsening of the curvature.
Surgery for Peyronie’s disease involves suturing inside the penis or elongating the scar by incising or excising it and using a graft. Sutures are placed on the side of the penis opposite the contracture in order to attempt to straighten the penis. In the grafting technique, the scar is cut and either removed or elongated. The deficit where the incision is made is filled in with a graft obtained from the patient elsewhere. This allows the contracted side to be moved and elongated to reduce the curvature.
Treatment of Kidney stones
In some patients, the stone may pass without any medical intervention, depending on the size of the stone, however, stones larger than 0.5 mm tend to require medical treatment. The acute, severe pain associated with kidney stone movement into and through the ureter is treated with anti-inflammatories and narcotics, oral, intermuscular and intervenous.
Medications are also utilized to speed up the passage of stones through the ureter. These medications include alpha adrenergic blockers, calcium channel blockers and corticosteroids.
Lithotripsy uses high energy pulses of ultrasonic energy, shock waves delivered through the skin without incision, in order to break the stones into smaller pieces that can easily travel through the urinary tract. For small stones one treatment may be necessary. For larger stones, multiple treatments may be required.
Sometimes surgery may be required to treat kidney stones when there is complete blockage of the ureter, the presence of an infection, or if there is intractable pain. Ureteroscopic surgery entails the surgeon inserting a camera into the urethra and through the urinary tract to visualize the stones. Once visualized, the surgeon can extract the stones, place a stent in the obstructed ureter, break the stone using ultrasound shock waves internally, or break the stones using laser. The procedure of choice depends on the location, size and composition of the stones and will be decided by the surgeon.
Treatment of kidney cancer
Treatment of kidney cancer depends on the stage and type of the cancer. Kidney cancer usually does not respond to chemotherapy or radiation so surgery is most often indicated. If the cancer has not spread it can be locally removed. Removal of the tumor can be achieved by partial or total removal of the kidney.
Treatment of bladder cancer
Bladder cancer treatment depends on how deep the tumor has penetrated into the bladder wall. Tumors that have not penetrated the muscle layer are classified as superficial and can be shaved off the bladder. A camera and electric cautery are inserted though the urethra and advanced into the bladder. The surgeon visualizes the tumor and removes it. This procedure is called transurethral resection of bladder tumor (TURBT)
Tumors that have penetrated the muscle layer are classified as muscle invasive bladder cancer and require partial or total removal of the bladder depending on the size of the tumor. The urine flow is diverted into the bowel. Often, surgery for invasive tumors is combined with radiation and chemotherapy to enhance the efficacy of treatment.
Treatment of testicular cancer
Testicular cancer is treated with chemotherapy, radiation and surgery depending on the size, stage and type of cancer. Chemotherapy is the use of anticancer medications specific for the type of cancer present. The urologist will refer patients to an oncologist for chemotherapy for testicular cancer. Radiation therapy is the use of radiation aimed at the tumor to kill the cancer cells. The urologist will refer patients to a radiation oncologist for this treatment for testicular cancer.
Surgery for testicular cancer often involves removal of the entire affected testicle called an orchiectomy procedure. Incision is made above the scrotum where the leg meets the torso. The tumor is sent to the pathologist for identification and staging. The deficit in the scrotum is filled with a testicular prosthesis which is a saline filled device that is virtually undetectable from the normal anatomy.
Treatment of prostate cancer
Prostate cancer often grows so slowly that no treatment is necessary and surveillance begins. The tumor is observed over time via blood tests for PSA, repeat physical examination, and repeat biopsies. When treatment is necessary, it is determined by the stage, age, health status, and type of tumor present. Treatment options include radiation, chemotherapy and surgery. Possible side effects such as erectile dysfunction and urinary incontinence are considered when deciding to have surgery or not.
Often if radiation is done prior to surgery and fails, surgery becomes very difficult and may not be feasible sometimes. Radiation done after surgery does not have these consequences. Radiation and chemotherapy are usually done after surgery when the cancer has been determined to be more aggressive.
Surgery for prostate cancer involves removal of the prostate gland through an incision in the abdomen. The prostate gland is carefully dissected from the surrounding tissue, urethra, nerves and blood vessels. The entire prostate gland is then removed from the incision.
Treatment of urethral stricture
Treatment for urethral strictures include urethroplasty and urethral stent. Urethroplasty procedure refers to the open repair of the urethra. There are many methods of performing urethroplasty but share the similar goal of removing and the stricture and repairing the urethra after removal, sometimes utilizing a tissue graft. The urologist will choose the proper procedure based on the size, position and severity of the stricture.
Urethral stent procedure involves inserting a permanent stent into the urethra to maintain an opening where there is a stricture.
Treatment of overactive bladder
Treatments of overactive bladder include lifestyle modification, medication and procedures. Lifestyle modification includes fluid intake restriction, avoidance of alcohol and caffeine, bladder retraining, pelvic floor muscle exercise, and timed voiding.
A number of medications exist that act to reduce the number of times a patient urinates per day. These medicines include antimuscarinic drugs and adrenergic receptor antagonists.
Botox injected into the bladder suppresses involuntary contraction of the bladder. Invasive or noninvasive electrical stimulation of the bladder muscle. As a last resort, surgery to enlarge the bladder to increase the urine volume can be performed as well.
Treatment of prolapsed uterus
Muscle strengthening with kegel exercises can help the with prolapsed uterus. An elastic or rigid device called a pessary can be inserted into the vagina to support the uterus. The goal of surgery for prolapsed uterus is to prevent the uterus from falling. This can be achieved using the body’s own tissue, or an implanted mesh. A total hysterectomy may be performed to remove the uterus.