The Urology Center Treatments
Extracorporeal Shock Wave Lithotripsy (ESWL) | Fertility | Laser Surgery for Prostate and Stones
Minimally Invasive Surgery | Urodynamics | Vasectomy | Vasectomy Reversal
Extracorporeal Shock Wave Lithotripsy (ESWL) is the non-invasive treatment of kidney stones (urinary calculosis) and biliary calculi (stones in the gallbladder or in the liver) using an acoustic pulse. The lithotriptor attempts to break up the stone with minimal collateral damage by using an externally-applied, focused, high-intensity acoustic pulse. An overview of the procedure is as follows:
- You lie on a water-filled cushion, and the surgeon uses X-rays or ultrasound tests to precisely locate the stone. High-energy sound waves pass through your body without injuring it and break the stone into small pieces. These small pieces move through the urinary tract and out of the body more easily than a large stone.
- The patient may receive sedatives or local anesthesia.
- Your surgeon may use a stent (a small, short tube of flexible plastic mesh that holds the ureter open) when your stones are larger than 2.5 cm. This helps the small stone pieces to pass without blocking the ureter.
- ESWL is an outpatient procedure. After the procedure it may take a few days for all the stone fragments to pass from your body. The treatment usually starts at the equipment's lowest power level, with a long gap between pulses, in order to accustom the patient to the sensation. The frequency of pulses and the power level are then gradually increased to break up the stone more effectively.
Fertility is the natural capability of giving life. Both women and men have hormonal cycles which determine both when a woman can achieve pregnancy and when a man is most virile. The female cycle is approximately twenty-eight days long, but the male cycle is variable. Men can produce sperm at any time of the month, but their sperm quality reduces occasionally, which scientists guess is in relation to their internal cycle.
In men, Erectile Dysfunction increases with age, but fertility does not decline in men as significantly as it does in women, however, evidence suggests that increased male age is associated with a decline in semen volume, sperm mobility, and sperm morphology.
In women, age plays a specific role in fertility. Although women can become pregnant at any time during their menstrual cycle, peak fertility occurs during just a few days of the cycle, usually two days before and two days after the ovulation date. This fertile window varies from woman to woman, just as the ovulation date often varies from cycle to cycle for the same woman. The ovule is usually capable of being fertilized for up to 48 hours after it is released from the ovary. Sperm survive inside the uterus between 48 to 72 hours on average, with the maximum being 120 hours (5 days).
Erectile Dysfunction: Options when oral medications do not work – Q&A with Dr. Honig
Articles
1) Fertility and Anabolic Steroids
2) War and Male Genital Trauma
3) Preserving Male Fertility in Sports Activity
Laser Surgery for Prostate and Stones
Prostate laser surgery is a minimally invasive procedure to treat urinary symptoms caused by an enlarged prostate, also known as benign prostatic hyperplasia (BPH). During prostate laser surgery, a laser is used to remove prostate tissue that blocks urine flow. Prostate laser surgery has been developed to speed treatment and recovery while avoiding complications that can occur with other types of prostate surgery. There are several types of lasers and laser surgery used in prostate laser surgery. All lasers work the same way, using concentrated light to generate precise and intense heat. The type of prostate laser surgery your doctor will use depends on several factors, including the size and location of your prostate enlargement and the type of laser equipment available. The four types of laser surgery are:
Transurethral Evaporation of the Prostate (TUEP). The prostate tissue is destroyed by laser energy. It is generally a safe procedure, and causes a small amount of bleeding.
Visual Laser Ablation of the Prostate (VLAP). This treatment uses great amounts of laser energy to dry up and destroy excess prostate cells. It can cause some complications and patients may also experience a burning sensation during urination.
Photosensitive Vaporization of the Prostate (PVP). This is one of the newest forms of laser treatment for prostate gland enlargement and one of the most effective ones. PVP uses laser energy to destroy prostate tissue. In general, PVP is better for smaller prostates.
Holmium Laser Enucleation of the Prostate (HoLEP). A newer laser procedure, which has shown to provide results similar to classical surgical methods, but with less chance of bleeding and a shorter recovery time.
For stones, laser surgery is most often prescribed for very small kidney stones averaging 5 mm in diameter or smaller. Though quite small, these kidney stones can still become caught in the ureter on their way to the bladder. Because they block the ureter, this can prevent urination. Typically, a course of excessive fluid consumption and pain relievers is prescribed, but if this does not get the kidney stone dislodged, laser surgery, specifically laser lithotripsy, is the next step. To remove stones, including kidney stones, a small, camera is inserted up the length of the urethra, through the bladder and into the ureter. The camera, called a uteroscope, is used to locate the kidney stone. A small laser, as thin as a fiber-optic cable, is set alongside the uteroscope. The laser fires in a continuous stream, which is played over the surface of the kidney stone, breaking it into smaller fragments. The uteroscope is retracted, and the fragments are allowed to pass when the patient next urinates.
Minimally Invasive Surgery
Laparoscopic surgery, also known as minimally invasive surgery (MIS), band-aid surgery or keyhole surgery is a modern surgical technique in which operations in the abdomen are performed through small incisions (usually 0.5 - 1.5 cm) as compared to larger incisions needed in traditional surgical procedures. Each incision is called a “port.” At each port a tubular instrument known as a trochar is inserted. Specialized instruments and a medical camera known as a laparoscope are passed through the trochars during the procedure. With minimally invasive surgery, there are a number of advantages to the patient versus a traditional open procedure including:
- Reduced hemorrhaging, which reduces the chance of needing a blood transfusion.
- Smaller incision reduces pain and shortens recovery time, resulting in less post-operative scarring.
- Less pain, leading to fewer pain medications needed.
- Reduced hospital stay / quicker return to everyday life.
Robotic surgery is the use of robots in performing surgery. Three major advances aided by surgical robots have been remote surgery, minimally invasive surgery and unmanned surgery. Some major advantages of robotic surgery are precision, miniaturization, smaller incisions, decreased blood loss, less pain and quicker healing time. Further advantages are articulation beyond normal manipulation and three-dimensional magnification.
The da Vinci Surgical System comprises three components: a surgeon's console, a patient-side robotic cart with 4 arms manipulated by the surgeon (one to control the camera and three to manipulate instruments), and a high-definition 3D vision system. Articulating surgical instruments are mounted on the robotic arms which are introduced into the body through cannulas. The surgeon's hand movements are scaled and filtered to eliminate hand tremor then translated into micro-movements of the proprietary instruments. The camera used in the system provides a true stereoscopic picture transmitted to a surgeon's console. The da Vinci System is FDA cleared for a variety of surgical procedures including surgery for prostate cancer, hysterectomy and mitral valve repair, and is used in more than 800 hospitals in the United States and Europe. Robotic surgery is an ideal option for many urological conditions including prostatectomy, where the target site is not only tightly confined but also surrounded by nerves affecting urinary control and sexual function. Using da Vinci, your surgeon has a better tool to spare those delicate and critical surrounding nerves. This may improve your recovery experience and clinical outcomes with such benefits as:
- Significantly less pain
- Less blood loss
- Reduced scarring
- Minimized complications
- Shorter hospital stays
- Quicker return to daily activities
Urodynamics
Urodynamics is the investigation of functional disorders of the lower urinary tract, including the bladder and the urethra, using physical measurements such as urine pressure and flow rate as well as clinical assessment. For example, a patient complaining of urinary urgency, with increased frequency of urination can be said on the basis of their symptoms to have overactive bladder syndrome. The cause of this might be detrusor overactivity, in which the bladder muscle (the detrusor) contracts unexpectedly during bladder filling. Urodynamics can be used to confirm the presence of detrusor overactivity, which may help guide treatment. Most tests begin with the insertion of a urinary catheter/transducer following with complete bladder emptying by the patient. The urine volume is measured (this is the post-void residual volume, which shows how efficiently the bladder empties) and sent for microscopy and culture to check for infection. Depending on the issue, common tests conducted are:
Free Uroflowmetry: measures how fast the patient can empty his/her bladder.
Multichannel Cystometry: measures the pressure in the rectum and in the bladder, using two pressure catheters, to deduce the presence of contractions of the bladder wall, during bladder filling, or during other provocative maneuvers. The strength of the urethra can also be tested during this phase, using a cough or Valsalva maneuver to confirm genuine stress incontinence.
Pressure Uroflowmetry: measures the rate of voiding, but with simultaneous assessment of bladder and rectal pressures. Helps demonstrate the reasons for difficulty in voiding.
The tests are most often arranged for men with enlarged prostate glands, and for women with incontinence that have either failed traditional treatment or requires surgery.
Vasectomy
One of the most common and popular means for contraception around the world is vasectomy – a brief, surgical procedure used for male sterilization. It is a popular means of birth control for couples that have decided that their family is complete. It is nearly 100% effective and is intended to be permanent. Whether it is a traditional surgical or the less-invasive No-Scalpel vasectomy procedure, a successful vasectomy blocks the vas deferens, preventing sperm from becoming part of the seminal fluid that leaves the body at sexual climax. The vas deferens are the thin tubes in the scrotum that would normally carry sperm from the testicles to become part of the ejaculate. When the sperm channel is interrupted, the man becomes sterile and can no longer father a child.
No Scalpel Vasectomy (NSV) is an office procedure that some feel have advantages over traditional vasectomies. A no scalpel vasectomy is safe, effective, comparatively faster, and has a quicker recovery time. As the name suggests, the "No Scalpel" method does not involve a scalpel, but a small opening is still necessary. The major key to the No Scalpel Vasectomy is the special instruments that allow the procedure to be done with generally less manipulation of the patient's tissues. In an NSV procedure, the doctor usually locates the patient's vas deferens under the skin of the scrotum by hand, and holds the tiny tube in place with a small clamp. Small pointed forceps separate the layers of tissue and then creates a tiny opening in the skin to form an opening for the vas deferens to be gently lifted out, then cut, tied, clipped and/or cauterized and put back into place. The surgeon may choose to close the opening in the skin with sutures. However, because the skin opening is much smaller than a conventional incision, it can close quite quickly without the necessity of suturing.
Vasectomy – Q&A with Dr. Honig
Vasectomy Reversal
Vasectomy reversal is a surgical procedure that re-approximates the cut ends of the vas deferens, restoring the flow of sperm from the testicle to the prostate. This procedure generally requires an experienced microsurgeon using an operating microscope to achieve the best success rates. A vasectomy reversal can be accomplished in two ways: a vasovasostomy or vasoepididymostomy.
With a vasovasostomy, the surgeon sews the severed ends of the vas deferens back together.
A vasoepididymostomy attaches the vas deferens directly to the epididymis, the coiled tube on the back of each testicle where sperm matures. A vasectomy can cause blockages or a break in the vas deferens or the epididymis. This surgery is used when a vasovasostomy won't work because sperm flow is blocked. The vas deferens is connected to the epididymis above the point of blockage.
Essentially any man who has had a vasectomy is a candidate for vasectomy reversal. The advent of microsurgical techniques makes possible vasectomy reversal at any time after vasectomy. Discomfort is quite variable but typically is not much more severe than the original vasectomy. A Vasectomy Reversal is typically an out-patient procedure (patient goes home the same day).