What is a PSA Test and When Should You Get It?

The PSA test measures the level or amount of PSA (prostate-specific antigen) in blood. The prostate-specific antigen is a protein synthesized by both non-cancerous and cancerous tissue in the prostate — a tiny gland found below the bladder in men. After it is produced, the PSA finds its way into semen and in small quantities in the blood. But since cancerous cells produce more PSA than non-cancerous cells, the test is carried out to detect high levels of PSA in blood, which may indicate the existence of prostate cancer.

What are the benefits of the PSA test?

Early detection of certain types of prostate cancer is critical for successful treatment and recovery. When the PSA test shows elevated levels of the antigen in blood, it may help to identify prostate cancer that is likely to grow quickly or spread to other parts of the body. In turn, the test helps to catch and treat such cancers early before they begin causing serious symptoms or become life-threatening. Also, by enabling early detection of prostate cancer when the necessary treatment is less aggressive, the test reduces the risk of certain adverse effects of treatment, such as urinary incontinence and erectile dysfunction.

What are the risks associated with the PSA test?

Carrying out the test itself comes with very little risk. It requires only a simple drawing of blood used to run the test in a laboratory. However, once the results of the test are out, there are a number of potential downsides involved. For instance, since false positives are quite common and elevated PSA results may have other causes other than prostate cancer, including prostate infection (prostatitis) and enlarged prostate (BPH), the test results may expose some patients to unnecessary or inappropriate treatments.

Some types of prostate cancer don’t produce much PSA, which means that a test may incorrectly indicate that you don’t have the cancer (a false negative). And follow-up tests for checking out the underlying causes of an elevated PSA test are often stressful, invasive, time-consuming or expensive. Furthermore, living with a localized or slow-growing prostate cancer — one that doesn’t require treatment — can cause stress and anxiety.

When should you get your first PSA test?

Before you get the first PSA test, it is recommended that you discuss the benefits and risks of the test with your doctor. During the discussion, a comprehensive review of your risk factors and preferences is done. For example, the urologist will consider your age, race, size of your prostate, medications you are taking (dutasteride and finasteride affect PSA levels), and how frequently your PSA levels change when making a decision about getting the test.

At St. Pete Urology, we advise men who are at higher risk of the disease, such as African American men and those with a brother or father who have had the cancer, to get their first test at the age of 40-45. Having the test before you reach 50 helps us to establish your PSA baseline and thereafter monitor the changes in your PSA levels to determine whether or not you’ll need annual PSA screening and prostate biopsy. If your blood PSA level is very low, we’ll put off any further PSA tests. But if you are a man of moderate to low risk of the disease, we recommend you get your first PSA test at age 50 or older (generally between 55 and 70).

What happens if your first PSA test result is high?

If you don’t have symptoms of prostate cancer, another PSA test may be recommended if your first test showed an elevated PSA level. The second test is used to confirm the validity of the original finding. But if the second PSA test still gives elevated PSA level, the urologist may direct that you continue with more PSA blood tests and digital rectal exams (DREs) at frequent intervals to monitor any changes in your prostate over time.

If your blood PSA level continues to rise over time or the urologist finds a suspicious lump in your prostate during a DRE, additional tests may be suggested to establish the nature of the problem. For example, a urine test may be run to find out if you have a UTI (urinary tract infection). Imaging tests like X-rays, cystoscopy or transrectal ultrasound also may be recommended. Then if prostate cancer is suspected, the urologist carries out a prostate biopsy — collecting multiple samples of tissue from your prostate by inserting hollow needles into the gland and withdrawing tissue. The tissues are examined under a microscope by a pathologist to confirm the cancer.

Treatment of prostate cancer

The type of treatment recommended for prostate cancer usually depends on whether it is early-stage or advanced-stage disease. For early-stage cancer the options include watchful waiting, radical prostatectomy, brachytherapy, conformal radiotherapy and intensity-modulated radiation therapy. At St Pete Urology, watchful waiting means no immediate treatment is offered but the cancer is closely monitored through regular PSA tests. Prostatectomy involves surgically removing part of or the entire prostate; brachytherapy involves implantation of radioactive seeds into the prostate to deliver specific amounts of radiation to the tumor. Conformal and intensity modulated radiotherapies deliver targeted amounts of radiation to the tumor with minimal damage or exposure of healthy tissues.

For advanced-stage prostate cancer, which is typically a more aggressive tumor that grows quickly and spreads faster to other areas of the body, treatment includes chemotherapy and androgen deprivation therapy. Chemotherapy can eliminate cancer cells that have spread to other parts of the body. Likewise, androgen deprivation therapy (androgen suppression therapy or ADT) is used to reduce the effect of androgens — male hormones that stimulate cancer growth — thereby slowing down or stopping cancer growth.

At St Pete Urology, we talk to our patients openly and candidly about the risks and benefits of the PSA test before we can advise them to get it. We also discuss the results of the tests, give our recommendations for those with positive results and typically repeat the PSA test for those with negative results. Our patients have always told us that our attention to detail, quality of interactions and efficiency during their visits is unmatched. If you would like to know more about the PSA test, visit the “St Pete Urology” site.

Urge Incontinence Treatment for Women

Urge incontinence is often a symptom of an unstable or overactive bladder. Characterized by a sudden strong desire to pass urine that can’t be postponed (urgency), urge incontinence usually comes with frequency (more often than normal) during the day and several times at night. Some women may even experience urine leakage during sex, particularly during orgasm. Although many women may avoid leakage by urinating frequently, they find the continual need to visit a bathroom quite restrictive to their lifestyles.

How do you know you have urge incontinence?

With urge incontinence, you will have urine loss because bladder muscles squeeze or contract at the wrong times. These contractions occur repeatedly, regardless of how much urine is in the bladder. There are 3 main indicators that you have urge incontinence:

  1. Inability to control when you urinate
  2. Having to pass urine frequently during the day and night
  3. Needing to pass urine suddenly and urgently

Causes of urge incontinence

There are two principal causes of urge incontinence. Irritation within the bladder may trigger incontinence. Or it may be loss of the nervous system’s inhibitory control on bladder contractions. For example, neurological conditions such as multiple sclerosis, spinal cord injuries, Parkinson’s disease and stroke may diminish bladder control and cause urge incontinence. Likewise, cardiovascular disorders, diabetes, bladder cancer, bladder stones, alcohol consumption, infections, diuretic medicine and inflammation that irritate the bladder or damage its nerves may cause incontinence. Urge incontinence also may indicate a more serious problem. For instance, when the urgency to pass urine is accompanied by blood in urine, recurrent urinary tract infections (UTIs) or an inability to empty the bladder completely, these may be red flags for a more serious issue than just urinary incontinence.

How is urge incontinence treated?

Generally a few lifestyle adjustments may help a woman cope with urge incontinence. For instance, making it as easy as possible to get to the bathroom, avoiding caffeine (tea, cola and coffee), avoiding alcohol, reducing amount of fluid intake per day and losing weight can help relieve symptoms. Secondly, bladder training (also called bladder drill) and pelvic floor muscle exercises can be combined to treat urge incontinence. A third solution may be treating urge incontinence with medicines called anticholinergics (antimuscarinics) such as oxybutynin, solifenacin, tolterodine, trospium chloride, propiverine, darifenacin and fesoterodine fumarate. And if the urge incontinence is associated with the lining of the vagina after menopause, applying estrogen cream directly inside the vagina may help.

Urge incontinence is also treated using Botulinum Toxin A (Botox), a prescription-only medication that relieves the incontinence when other options such as bladder training and other medication have failed. When these treatments are not successful, the urologist may suggest surgery. Surgical procedures for treating urge incontinence include sacral nerve stimulation, percutaneous posterior tibial nerve stimulation, augmentation cystoplasty and urinary diversion.

At St Pete Urology, our doors are open to all women troubled by incontinence. We are a recognized name in the urological community and boast of a team of highly innovative, experienced and certified physicians who deliver leading-edge urology and patient-centered care. We know there are many women who live with severe urological problems and we do our best to help those who come to us. We are good at treating these disorders. For more information, visit the St Pete Urology website.

What is the best treatment for urinary incontinence?

The sling procedure is the best, safest and most effective surgical operation for treating urinary stress incontinence. During the procedure, the urologist creates a sling using an artificial mesh, animal tissue or human tissue and places it under the urethra to support the urethra and bladder neck and to prevent unintentional urine loss.

What is stress incontinence?

Unintentional urine leakage (loss) occurs when you engage in physical activities or movements, such as running, sneezing, heavy-lifting, coughing or any action that puts stress (pressure) on your bladder. The condition is triggered by the weakening of pelvic floor muscles (the muscles supporting your bladder) and urinary sphincter muscles (muscles that control the release of urine).

Normally, as the bladder fills with urine and expands, the valve-like muscles in the urethra remain closed to prevent leakage of urine until you have reached the bathroom. However, if those muscles weaken and are not able to withstand pressure, then anything that exerts pressure on your pelvic and abdominal muscles can cause unintentional loss of urine.

Your sphincter and pelvic floor muscles may weaken because of:

  1. Type of childbirth/delivery.
  2. Previous pelvic or abdominal muscle surgery.
  3. Obesity/increased body weight.
  4. Smoking, which may trigger frequent coughing.
  5. Prolonged involvement in high-impact activities, such as running and jumping for several years.
  6. Age — the muscles weaken with increasing age.

You have stress urinary incontinence if you frequently leak urine when you:

  1. Sneeze
  2. Cough
  3. Stand up
  4. Laugh
  5. Have sex
  6. Get out of your car
  7. Exercise
  8. Lift something heavy

While stress incontinence does not imply that you will lose urine every time you do these things, you will most likely experience frequent leakage of urine when you engage in pressure-increasing activities.

Why should you undergo the sling procedure for stress urinary incontinence?

Having stress incontinence can be really awkward and embarrassing. In fact, with frequent leakage of urine, you may begin isolating yourself and limiting your social and work life. For instance, you may find it difficult to engage in exercise and in different leisure activities for fear of urine leakage. But with treatment, you can manage the incontinence and improve your overall quality of life and well-being. The sling procedure is ideal for you if you’ve tried other measures and still find urine leakage disruptive to your life.

How does the sling procedure work?

The sling procedure is aimed at closing your urethra and the neck of your bladder. For the procedure, your surgeon uses strips of synthetic mesh, animal tissue, donor tissue or your own tissue to develop a sling (hammock) that is inserted under your urethra or bladder neck. Once the sling is placed, it supports the urethra and ensures it remains closed — particularly when you are engaged in pressure-increasing activities such as coughing, laughing, sneezing or exercise — preventing the leakage of urine.

How is the sling procedure performed?

Before the procedure begins, you are placed under either general or spinal anesthesia. With general anesthesia, you will remain asleep throughout the procedure and will feel no pain. With spinal anesthesia, you are completely awake except that the area of your body from the waist down is numb and you don’t feel pain as the procedure is performed. Following application of anesthesia, the urologist places a tube (catheter) into your bladder to drain any urine already inside it.

The surgeon then proceeds to place the sling in any of the following ways:

1. Retropubic Method (Tension-Free Vaginal Tape/TVT Method): The surgeon makes a tiny incision inside your vagina, just under the urethra. Two other cuts are then made above your pubic bone — large enough to allow needles through. The surgeon uses a needle to place the sling beneath the urethra and behind the pubic bone. Using stitches or skin glue that is easily absorbed by the body, the surgeon closes off the cuts.

2. Single-Incision Mini Method: The surgeon makes a single tiny incision in the vagina, then passes the sling through it. No stitches are used to attach the sling, but over time the scar tissue grows and forms around it, keeping it in place.

3. Transobturator Method: The surgeon makes a tiny cut inside the vagina, just under the urethra. Two more cuts are made, one on each side of the labia (folds of skin on either side of the vagina). Using the incisions, the surgeon inserts the sling under the urethra.

At St Pete Urology, we perform hundreds of sling surgery procedures every year with remarkable results for our patients. The sling procedure is an outpatient operation that takes about one hour to complete and the patient is free to go home the same day. After the procedure, we arrange for follow-up sessions with our patients in the doctor’s office to assess the efficacy of the procedure and help with any complications that may arise. So if you are feeling embarrassed by stress urinary incontinence or have tried other measures without success, check with us to find out if the sling procedure can help you overcome the condition. For more information, visit the “St Pete Urology” site.

Treating Erectile Dysfunction with Inflatable Penile Prosthesis

Prescription medications are typically the first treatment offered for men with erectile dysfunction. But for those who don’t respond well or are unable to be treated with these pills, a penile implant is a useful alternative. The penile implant (also called penile prosthesis) is a medical device that is placed surgically into the penis to generate a natural-feeling and natural-looking erection.

Simple, outpatient procedure

The operation to place a penile prosthesis is a quick and simple procedure that takes about 1 hour to complete. The device is inserted into the penis and custom-fitted to help with erection. After it is placed, a man can go home the same day and is ready to enjoy sex after a 4-6 week recovery period.

What is a penile prosthesis?

An inflatable penile implant is a self-contained, fluid-filled, supple and durable system designed to mimic both the look and performance of the penis during a natural erection. It has three components: a reservoir that is placed in the abdomen, two cylinders inserted in the penis and a pump located in the scrotum. The two cylinders situated in the penis are connected to the saline reservoir using a tubing. Because of the three components, the penile prosthesis is known as the three-piece inflatable penile implant.

How does the penile implant work?

To inflate the penile prosthesis, a man presses the pump to transfer the saline from the reservoir into the cylinders located in the penis. The cylinders are then inflated and the penis becomes erect. When the deflation valve found at the base of the pump is pressed, the fluid moves back to the reservoir, deflating the penis and making it flaccid. So the penile implant is capable of producing erections that are satisfactory for sexual intercourse.

Why should men with ED consider penile implants?

Once placed surgically by a urologist, an inflatable penile prosthesis helps a man to regain control of his body. Unlike other ED treatment options which require a slightly longer waiting period before use, the implant can be used at any time. Penile implants are an ideal option for men whose ED has not been resolved by other treatment options. It is a cost-effective option that achieves 98 percent satisfaction rate with patients and is not noticeable in a flaccid penis. In fact, even your sex partners will not know that you have the implant unless you inform them.

If you are looking for something to make you a confident, self-assured man again, a penile prosthesis may be just what you need. It effectively mimics the look and performance of a natural penis and will enable you to begin enjoying sex as soon as you are recovered from the surgery. Unlike remembering to take your medication every time you want to have sex, a penile prosthesis offers a more permanent and natural solution. For more information on treatment of erectile dysfunction, visit the “St Pete Urology” site.

What kinds of prostate problems are common in men over 50?

The prostate is a tiny walnut-sized gland that surrounds the urethra. But with hormonal changes that come with age, men of all ages usually experience changes in their prostate. As a result of these changes, prostate issues are quite common in men, particularly older ones. For example, the prostate often grows and swells with age, compressing the urethra and causing urinary issues.

Benign Prostatic Hyperplasia

With the prostate, there are usually two main issues: benign prostatic hyperplasia and prostate cancer. For men older than 50, benign prostatic hyperplasia (BPH) is the most frequent prostate issue. BPH, also called an enlarged prostate, means a non-cancerous increase in the number and size of prostate cells — so basically, it is an unhealthy increase in prostate size. While what triggers BPH isn’t well understood, it is believed that factors such as aging, inflammation, fibrosis and hormonal changes are the causes of the condition.

An enlarged prostate presses hard on the urethra and makes urination difficult. In men with the condition, symptoms include:

  1. Frequent urination, particularly at night.
  2. Difficulty starting a urine stream.
  3. Dribbling after passing urine.
  4. Weak urine stream, or a stream that starts and stops.
  5. Inability to empty the bladder completely.

But BPH also may have rare and more severe symptoms like:

  1. Urinary tract infection
  2. Blood in urine
  3. Inability to urinate

Prostate cancer

Prostate cancer is another frequent condition in men. In fact, it is the most common cancer after skin cancer, with about 1-in-6 American men being diagnosed with the disease during his lifetime. And like BPH, the cancer is most common in older men, with two-thirds of men diagnosed with the condition usually over age 65.

The cause of prostate cancer isn’t clear, but risk factors include age, family history, race and diet. The cancer grows slowly and rarely shows symptoms, so most men may never know that they have developed the disease until it is in advanced stage. But that also means only around 1-in-35 men with the cancer dies of the disease. Nevertheless, while some prostate cancers grow slowly and often require no or minimal treatment, there are other types that are quite aggressive and spread really quickly.

When caught early, there is a better chance of successfully treating the cancer. However, since it has similar symptoms to BPH, the condition is quite difficult to diagnose and by the time men see blood in their urine or feel chronic pain in their thighs, hips or lower back, it is often quite late. That is why it is critical for men of average to high risk of the cancer to have annual screening as early as appropriate.

Actually, for men of average risk of prostate cancer, the discussion to begin screening should start at the age of 50. While for those of higher risk, it is prudent to begin this discussion a little earlier, though not earlier than 40. But before screening, it is vital to discuss the risks and benefits of the testing with the doctor so the test offered meets the personal preferences and values of the patient.

For more information on prostate problems and how to prevent, diagnose and treat them, visit the “St Pete Urology” site.

How can I prevent recurrent kidney stones

Kidney stones occur when tiny crystals form and stick together as solid masses in urine. Often, due to increased concentration of various chemicals in urine, crystals form and then grow into larger masses that move through the urinary tract. As they move, the stones may get stuck somewhere along the tract and block urine flow, causing pain. Most kidney stones are a combination of calcium with either oxalate or phosphate, but stones also may form when uric acid levels increase in urine as a result of protein metabolism.

Preventing kidney stone recurrence

For many people who have had a kidney stone, it is not a one-time thing. In fact, in about 50 percent of those who have had a stone, another one will appear within 7 years if no preventive measures are in place. At St Pete Urology, we ensure that our patients take the necessary steps to prevent a recurrence. That is why, after treatment, we conduct a special urine test on our patients to find out why the stone formed in the first place. Using the results of the test, we guide our patients on how best they can avoid a recurrence.

Some of the measures we recommend to avert kidney stone recurrence include:

1. Drinking enough water

Water dilutes urine, reduces the concentration of substances in it and prevents kidney stones. To prevent recurrent kidney stones, you should endeavor to drink enough fluid to pass at least 2 liters of urine per day. Increased fluid intake that is distributed throughout the day decreases kidney stone recurrence by about 50 percent and with virtually no adverse effects.

For better results, you may add orange juice or lemonade to the water so there is increased citrate in the fluid to block stone formation. Medication such as allopurinol, citrate or a thiazide diuretic can be taken with the fluid to minimize the chance of kidney stone recurrence. However, if you are already drinking that much fluid before your kidney stones, you should not increase your fluid intake.

2. Making dietary changes

Once you are treated for kidney stones, we will recommend that you reduce your intake of eggs, seafood, poultry, red meat and other animal protein. These foods increase uric acid levels while also reducing citrate levels in the body, which can trigger a recurrence of kidney stones. That is why after treatment for kidney stones, we recommend that you should cut down your daily meat portions to a size no larger than a pack of playing cards. Likewise, you should avoid foods such as chocolate, strawberries, wheat bran, beets, spinach, tea, rhubarb and most nuts that contain oxalate or the phosphate containing colas that may trigger kidney stone recurrence.

3. Increasing calcium intake

Oxalate levels may rise and trigger kidney stones if the level of calcium in the diet is low. So after treatment, it is important to ensure that you increase your calcium intake to match your age. For example, if you are a man 50 and older, you should get 1,000 milligrams of calcium every day, together with 800-1000 IU (international units) of vitamin-D to ensure your body absorbs the calcium properly. With increased dietary calcium, you can prevent a recurrence of kidney stones.

4. Reduced sodium intake

Kidney stones may recur if there is a lot of sodium in your diet because increased sodium leads to high concentration of calcium in urine. So after treatment for kidney stones, we usually recommend that you lower the amount of sodium in your diet, limiting your total daily sodium to 2,300 mg. But if sodium was responsible for your previous kidney stones, then we recommend that you should take at most 1,500 mg of sodium per day. Such a low level of sodium also will be good for your heart and your blood pressure.

Those are some of our most common recommendations for averting kidney stone recurrence. As you might have noticed, they are not complicated things to do, but they do require some commitment. For more information on prevention and treatment of kidney stones, visit the “St Pete Urology” site.

3 Effective Minimally Invasive Surgical Treatment For Kidney Stones

Over the last 15 years, kidney stone prevalence has doubled in United States. Today, roughly 1-in-10 Americans will have a kidney stone attack at some point during their lifetime. When they occur, kidney stones can cause agonizing and unbearable pain in the back and side, and may sometimes trigger nausea and vomiting. You can pass a stone by drinking plenty of water — taking pain medications to control the discomfort as you wait for the stone to pass. But if you have a large stone or one that’s causing complications, then a more extensive treatment may be necessary to remove the stone.

Minimally-invasive surgical treatments

At St Pete Urology, we offer surgical treatment for kidney stones, focusing on minimally-invasive procedures even for the largest stones. Most operations for smaller stones can be done as same-day surgeries, giving patients greater flexibility and a faster return to their work and other routine activities. For larger stones, the planning and execution of the procedures may take a little more time, but with the use of small incisions only large enough to allow insertion of thin tubes, fiber-optic lights, cameras and other tiny surgical tools, we are able to ensure significantly less pain, less scarring, shorter hospital stay, faster recovery and increased accuracy than with traditional open surgery for the stones.

There are three main minimally-invasive techniques for removal of kidney stones. The least invasive being extracorporeal shockwave lithotripsy, followed by ureteroscopy then lastly percutaneous nephrolithotomy. The choice of a surgical technique depends on multiple factors, including the type of stone, size and location, medications taken by the patient, other medical problems the patient may have, and patient preferences.

Extracorporeal Shockwave Lithotripsy (ESWL)

This is the most popular option for treating small and medium-sized stones. Performed in an outpatient setting with the patient placed under general anesthesia, ESWL is the least invasive and takes 20-30 minutes to be completed. During the surgical procedure, intense sound waves are focused on the kidney stone, shattering the stone with minimal effect on surrounding tissue. Smaller pieces of stones that are produced get washed out of the urinary system with the normal flow of urine, often with slight or no discomfort. ESWL is a highly effective treatment for most stones that form in the kidney or ureter.

Advantages of ESWL include:

  1. It’s an outpatient procedure so patients return home after a few hours.
  2. It offers excellent success rate with most small-sized and medium-sized stones.
  3. It doesn’t require incisions or invasive techniques.
  4. It has minimal postoperative discomfort.
  5. It has a fast and easy scheduling.

Limitations of ESWL include:

  1. It’s ineffective for stones that are very hard or resistant to breakage by shockwaves.
  2. It’s not appropriate for stones that are invisible on X-ray such as uric acid, monohydrate and cystine stones.
  3. It’s not ideal for larger stones or those located in the lower part of the urinary tract.
  4. It’s not appropriate for patients with certain conditions or using certain medications, such as pregnant women or patients on blood thinning medications.


Ureteroscopy is another surgical procedure often used to treat small and medium-sized stones. The advantage it offers over ESWL is that it can treat kidney stones occurring in any part of the urinary tract. It’s a same-day procedure done after the patient is placed under general anesthesia. The procedure involves passing a small scope via the urinary opening and into the bladder then into the ureter. Once the stone is reached, it is targeted with laser so that it’s broken down into smaller pieces that are extracted out of the system or into pieces of dust left to wash out with normal urine.

Ureteroscopy is a little bit more invasive than ESWL, but it’s preferred in situations where kidney stones are too hard to respond to ESWL, or for stones that are invisible on X-ray. Ureteroscopy is also a better choice than ESWL when stones are located in the lower portion of the urinary tract, especially the region near the bladder. After the procedure, a small tube — a stent — is temporarily placed into the urinary system to help drain the kidney. The stent is totally internal, and is usually removed 3-10 days after the procedure. Stent removal is a quick and easy process done in the doctor’s office and without anesthesia.

Advantages of ureteroscopy are:

  1. Great results for small-sized and medium-sized stones.
  2. It’s an outpatient procedure.
  3. No incisions are necessary.
  4. Fast and easy scheduling.
  5. Done without stopping the use of blood-thinning medications.
  6. Effective for stones that are resistant to ESWL.

Limitations of ureteroscopy are:

  1. It’s not effective for very large stones.
  2. In some rare instances, scopes may not reach the stones.
  3. Many patients find the stents placed after the procedure a source of unease and discomfort.

Percutaneous Nephrolithotomy (PCNL)

For kidney stones that are exceptionally large, complex or several small stones bundled in one kidney, percutaneous nephrolithotomy (PCNL) is the most appropriate treatment. Conducted by a urologist, often assisted by an interventional radiologist, PCNL is typically an inpatient procedure requiring an overnight hospital stay. During the procedure, the urologist and radiologist collaborate to open a direct channel into the kidney’s drainage system via a small incision made in the back, often not larger than a dime.

After making the incision, the urologist uses a set of specialized tools to break the stones into pieces, which are then plucked out or vacuumed out of the kidney. With the procedure completed, a drainage stent or tube is left in place for temporary drainage of the kidney. For stones that are unusually large or complicated, the urologist may schedule a second “clean-up” surgery. In most cases, patients leave the hospital after PCNL within 24 hours of the procedure. And despite PCNL being a more invasive procedure than ureteroscopy and ESWL, it remains an effective and safe treatment that sees a high level of patient satisfaction.

Advantages of PCNL are:

  1. It is the gold standard treatment for very large or really complex stones.
  2. It is the most appropriate surgery for patients with a number of small stones bundled in one kidney.
  3. It clears most kidney stones fully in one procedure.
  4. It is highly safe and effective.

Limitations of PCNL are:

  1. A drainage tube or stent is necessary after the procedure, which may be uncomfortable for most patients.
  2. It is not appropriate for patients on blood-thinning medications.
  3. It is more invasive and so an overnight stay in hospital is a necessity.
  4. Though it clears most stones in one procedure, a repeat procedure may be necessary for the largest or most complex stones.

At St Pete Urology, we perform hundreds of minimally-invasive surgeries for kidney stones every year. We have several surgeons with extensive training, skill and experience in ESWL, ureteroscopy and PCNL, delivering excellent outcomes even for the most difficult kidney stones. Our collaborative, compassionate and patient-centered approach to care also means our patients enjoy utmost comfort and convenience throughout their procedures. So if you have symptoms of what you suspect to be kidney stones, don’t hesitate to come see us. We fix kidney stones safely and effectively. For more information on the prevention, diagnosis and treatment of kidney stones, visit the “St Pete Urology” site.

What treatments are available for erectile dysfunction?

Are you struggling to achieve or maintain an erection? Whether you are under 35 or over 65, you are certainly not alone. Erectile dysfunction (ED) is quite common in American men, affecting more than 20 million men. Statistically, 52 percent of men between 40 and 70 years old have some form of erectile dysfunction while 25 percent of men younger than 40 suffer from the problem on a regular basis. At St Pete Urology, we see a lot of cases of erectile dysfunction every month, administer treatments and achieve excellent results for our patients.

Types of ED treatments

There are a number of safe and effective treatments for erectile dysfunction which, when properly applied, help in achieving and maintaining an erection for satisfactory sexual intercourse. The main treatments include oral medications, penile injections, vacuum erection devices and surgery. The choice of treatment depends on factors such as underlying causes and severity of the dysfunction, and overall health and preferences of the patient.

Oral medications

Dr. Adam Oppenheim of Advanced Urology InstituteAt St Pete Urology, oral medications are typically our first line of treatment. The medications commonly given are vardenafil (Levitra, Staxyn), sildenafil (Viagra), avanafil (Stendra) and tadalafil (Cialis). All these medications work by improving the action and efficacy of nitric oxide, which is a natural chemical produced by the body and used to relax penile muscles. With increased activity of nitric oxide due to these drugs, there is increased relaxation of the smooth muscles, improved blood flow to and in the penis and greater likelihood of developing an erection when there is sexual stimulation.

Though the oral ED drugs are similar in their mechanism of action, they vary slightly in chemical makeup, timing of dosage and expected period of effectiveness, and potential side effects. For instance, sildenafil (Viagra) produces the best effect when taken without food about one hour before sex and its effect lasts six hours. Vardenafil (Levitra, Staxyn) can be taken with or without food one hour before sex and its effect lasts seven hours. Like vardenafil, avanafil (Stendra) can be taken with or without food, but 15-30 minutes before sex (depending on the dose) and its effects lasts six hours. Tadalafil (Cialis) should be taken in small daily doses or in a large dose (as needed) with or without food about 1-2 hours before sex and its effect lasts 36 hours. Doctors usually consider these differences before prescribing oral ED medications.

Penile injections

An effective alternative to oral medications is injectable ED medicine. The specific injectable medication may vary, but some of the most commonly used ones are papaverine hydrochloride, alprostadil, prostaglandin E-1 and phentolamine. An injection of one or a blend of these ingredients will relax arterial wall muscles, cause increased blood flow into the penis and result in an erection. A small, sharp needle is used for the injection and there is only minimal discomfort. At St Pete Urology, we teach patients how to do the injections and once they have mastered it, then drugs are ordered and sent to them to do the injections at home.

Vacuum constriction devices

Happy Couple ED TreatmentA vacuum device is an external pump supplied with a band to help trigger an erection by driving blood into the penis. Vacuum constriction devices (VCDs) have three components: the plastic tube placed around the penis, the pump that draws out air from the tube and creates a vacuum, and the elastic ring that helps to maintain an erection during intercourse by preventing the flow of blood back into the body. The elastic ring should only remain in place for a maximum of 30 minutes and then should be removed to restore normal blood circulation and prevent potential skin irritation. Using a vacuum pump requires adjustment and practice — it may make the penis feel numb or cold, purple in color and bruised, although such effects are often painless and go away in a few days. The devices also may weaken ejaculation, but they do not affect orgasm (pleasure of climax).

Implant surgery

Surgery is often a last resort treatment for ED. At St Pete Urology, we speak with our patients about whether or not surgery is right for them. Surgery can be done either to implant a device into the penis that makes it erect or rebuild the arteries and veins around the penis to improve blood flow. Implanted devices (prostheses) are an effective treatment for ED with implant surgeries typically taking about one hour to complete and usually done in outpatient setting.

There are two types of penile implants: inflatable implants that make the penis wider and longer via a pump in the scrotum and malleable implants that are basically rods allowing for manual adjustment of the position of the penis. Patients leave the hospital the day after their implant surgery and are able to use the implant to achieve an erection 4-6 weeks after surgery. Possible challenges with the implants include infection and breakage, but they are generally effective in getting and maintaining an erection.

Vascular reconstructive surgery

Another option is the urologist can perform a vascular or arterial reconstruction surgery to improve blood flow to and in the penis. Vascular reconstructive surgery is a highly delicate procedure involving either the re-routing of arterial pathways leading to the penis to bypass blocked arteries that are restricting blood flow, or to unblock blood vessels causing an obstruction. An artery can be bypassed by moving an abdominal muscle artery to a penile artery. Alternatively, a penile vein can be modified to work like an artery.

Men who are younger than 45 are the ideal candidates for reconstructive surgery, especially those who have experienced trauma or injury that resulted in the damage to blood vessels at the base of the penis. The goal of the procedure is to remove or bypass any blockages that may impede blood flow to the penis. And with the obstruction removed, there is increased blood flow to the penis and greater likelihood of an erection.

If you have erectile dysfunction, the first step is to speak with a doctor. The right treatment for you will depend on your overall health and the underlying cause of your ED. At St Pete Urology, we see a lot of cases of erectile dysfunction and endeavor to achieve the best possible outcomes for our patients. For more information on treatment of erectile dysfunction, visit the “St Pete Urology” site.

How To Treat Kidney Stones?

When certain minerals are in excess in the body, they accumulate in urine. The urine becomes more concentrated as the levels of minerals and salts increase, particularly when the body is not well hydrated. As a result, hard masses of minerals and salts called kidney stones — often made of uric acid or calcium — form inside the kidney and can travel to other areas of the urinary tract. About 1-in-11 Americans will have a kidney stone at some point in their lifetime, but stones occur more often in men, people with diabetes and those who are obese.

Stones come in different sizes

Kidney stones vary in size. While some may be as small as a fraction of an inch and others only a few inches across, some stones can be very large and may take up the whole kidney. Smaller stones tend to remain in the kidney and rarely cause pain as they pass out of the body. In most cases they are not noticed until the kidney stones pass into the ureter. But larger stones may block urine flow, cause pain and result in urinary tract problems. Fortunately, the stones rarely cause permanent damage, and there are effective treatments for them.

Pain due to kidney stones

Pain is the most common characteristic and frequent symptom of kidney stones. Although the pain associated with stones varies from person to person, it can be quite intense and agonizing when it occurs — accounting for over 1 million visits to the emergency room every year. Many women who have had the condition attest that the pain is worse than the cramps and spasms of childbirth; others say it’s like being stabbed with a knife. The pain is felt along the side and back and below the ribs, though it may radiate to the belly and groin area with the movement of the stone along the urinary tract. It also generally occurs in waves, each wave lasting a few minutes, before disappearing and coming back.

Treatment of kidney stones

At St Pete Urology, we admit many patients in our emergency department because of painful kidney stones. Some patients also present with symptoms such as nausea, vomiting and hematuria (blood in urine). We determine how to manage kidney stone disease depending on the location and severity of the stones. For patients with small stones — several millimeters in size — we may allow time for the stones to pass without intervention. In that case, a patient is given pain medication, advised to drink plenty of water and waits for the stones to pass, under our close observation. But for large stones or complex ones causing problems such as severe pain, infection or kidney failure, we usually intervene to remove the stones.

Types of treatments

We often intervene to remove kidney stones that fail to pass spontaneously, are affecting kidney function, are accompanied by too much pain to wait for their passage, are blocking the flow of urine or are causing repeated infections. The interventions involve tiny or no incisions, minimal pain and a short time off work. At St Pete Urology, the treatments we commonly provide for kidney stones are extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy and ureteroscopy.

1. Extracorporeal Shockwave Lithotripsy (ESWL)

ESWL (Extracorporeal Shockwave Lithotripsy) is the use of highly-focused sound waves released and focused from outside the body to crush kidney stones. The intense waves are able to reduce the stones into sand-like granules that can pass normally in urine over a few weeks. Before ESWL, patients are given a sedative or placed under regional or general anesthesia and ultrasound or X-rays used to pinpoint the location of the stones.

The procedure takes about 1 hour, but larger or more complex stones may need several ESWL treatments. Patients return home the same day and are able to resume normal activities in 2-3 days. Shockwave lithotripsy is not used for hard stones, such as cystine, struvite, and some types of calcium phosphate and calcium oxalate stones. It’s also not ideal for stones larger than 1 inch in diameter and for pregnant women.

2. Ureteroscopy (URS)

For some kidney stones, especially those located in the kidney and ureter, ureteroscopy is the preferred treatment. The treatment involves passing a small fiber-optic instrument called ureteroscope into the urethra and bladder, then into the ureter. The telescopic instrument enables the urologist to see the stone and to use a small, basket-like device to pull out a smaller stone. For larger stones that can’t be removed in one piece, the urologist uses laser or a similar stone-breaking tool to shatter the stone into smaller pieces.

Flexible ureteroscopes are used for stones located in the kidney and upper ureter while rigid ones are used when stones are located in the lower ureter near the bladder. During the procedure, you are placed under general anesthesia to keep you comfortable. A stent (or small tube) is left in the ureter to keep it open and drain urine from the kidney and into the bladder, but it’s completely within your body and doesn’t require an external urine collection bag. You can return home the same day and resume normal activities in 2-3 days, but the stent must be removed in 4-10 days to avoid infection and potential loss of kidney function.

3. Percutaneous nephrolithotomy (PCNL)

Percutaneous nephrolithotomy (PCNL) is the most appropriate treatment for larger or more complex kidney stones. It’s also the best treatment if several small stones are bundled up in one kidney. During the procedure, the surgeon makes a half-inch incision in the side or back and then guides a nephroscope (rigid telescope) through the incision and into the area of the kidney where the stone is located. Using the nephroscope, the urologist reaches the stone with instruments that fragments it into pieces that are then suctioned out. The ability to suction tiny pieces of stone from the urinary tract makes PCNL the best treatment option for larger stones.

PCNL is performed with the patient under general anesthesia. The procedure requires hospitalization and you are discharged after 24 hours but resume normal activities after 1-2 weeks. Usually at the end of the procedure a tube is placed in the kidney to help drain urine into a bag outside the body. The tube remains for a few days or just overnight. Before you are discharged from hospital, the urologist may do X-rays to check if any pieces of stone remain. The nephroscope may be inserted again if any stone fragments are detected to remove the leftover fragments and to make sure you are completely free of the condition.

At St Pete Urology, we have experienced urologists, specialized equipment and highly-skilled support personnel to help us deliver excellent outcomes for patients with kidney stones. We use both surgical and non-surgical methods to tackle this painful condition, including the minimally-invasive procedures of shockwave lithotripsy, percutaneous nephrolithotomy and ureteroscopy, robotic surgical procedures, advanced imaging technology, medications and dietary changes. For us, the goal is not only to cure kidney stones but also to prevent a recurrence — striving to make your first stone surgery your last. So if you have symptoms of kidney stones or want advice on how to avoid this painful condition, come see us for help. For more information on prevention, diagnosis and treatment of kidney stones, visit the “St Pete Urology” site.

Meet Dr. Adam Oppenheim

Urology is a great blend of surgery and medicine and a specialty that provides an amazing work-life balance. It also brings profound satisfaction from the excellent outcomes with most cases. It is a wonderful opportunity to help people with embarrassing conditions and a chance to provide life-saving and life-extending treatments. Being passionate about making a difference in the lives of people, I found urology the perfect specialty for me.

Becoming a urologist

I was born and grew up in Yorktown, Va., and went to Virginia Tech for my Bachelor of Science in Biology. I went to the Nova Southeastern University, College of Osteopathic Medicine for my medical education. While a lot of factors were involved in choosing to become a doctor, my dad was a big influence. He was an ophthalmologist who spoke fondly about the joy of caring for patients — both in his office and in the operating room. My dad made medicine such a noble career that I was inspired to follow in his footsteps.

But it was when I was a third year medical student that I chose to become a urologist. My general surgery rotations allowed me to interact closely with many urologists. During those sessions I spent with them, I saw the enthusiasm the urologists brought to their work and it inspired me. They really appreciated their work and their passion and commitment translated into great care and excellent outcomes for their patients. They instilled that love for urology in me — a love that has continued to flourish ever since.

I completed my general surgery and urology residency at the Einstein Medical Center in Philadelphia. During those years in Philadelphia I also received urology oncology training at the Fox Chase Cancer Center — one of the nation’s top centers in cancer care. My urology training included working with the country’s leading doctors in penile implant surgery, enabling me to be solidly grounded in knowledge, skill and experience in penile prosthesis. Likewise, I took extra-curricular courses in mid-urethral sling insertion for stress incontinence in women, urologic prosthetics, GreenLight laser therapy and InterStim sacral neuromodulation for BPH.

What do we do as urologists?

We are specialists in treating medical problems of the urinary tract and the male reproductive system. The problems are found in organs such as kidneys, uterus, urethra, urinary bladder and male reproductive organs. When necessary, we perform surgeries to remove kidney stones, genital abnormalities present at birth, urinary tract obstructions, and other issues causing problems for patients. We diagnose and treat enlarged prostate, erectile dysfunction, urinary problems, urologic cancers, overactive bladder, urethritis, prostatitis and interstitial cystitis, among other conditions. We see patients of all ages, from babies and children to seniors.

Urology is a specialized field with a lot of things that I like. We do many procedures to improve the quality of life of our patients. For instance, we do prostate procedures to help patients pass urine, treat erectile dysfunction which is quite embarrassing to those who struggle with it, treat kidney stones that can cause agonizing pain, and tackle life-threatening conditions such as prostate cancer and kidney cancer. I practice every aspect of general urology but I have a special interest in erectile dysfunction, kidney stones, urinary problems, enlarged prostate, prosthetics and men’s health, spending the better part of each day doing exams on the male genitalia and performing a lot of surgeries on balls and penises.

Job Satisfaction

As a urologist, I always feel that I’m in a unique position. I am able to have a lasting relationship with my patients, which is something I find really gratifying. And after almost every successful diagnosis and treatment, my patients improve quickly and are able to enjoy life again — something that fills me with joy and satisfaction.

During our work, the most difficult part is usually for patients struggling with embarrassing and awkward conditions to walk in, sit down and discuss sensitive issues openly and honestly. With every encounter I try to provide a caring and compassionate environment that allows for frank and open conversations. The goal for me is to craft a personalized treatment plan that suits the goals and lifestyle of each patient. A plan may be as simple as changing medications or as complex as conducting surgery with sophisticated equipment.

Why St Pete Urology

St Pete Urology is a wonderful place with great professionals and state-of-the-art equipment. Working here always fills me with pride because of the excellent outcomes we achieve for our patients and the unwavering commitment to improving the standards of care through innovative and advanced techniques. It’s always buzzing with people sharing jokes and smiling, and that positive attitude is contagious. It also helps because we have to perform tests and procedures in an uncomfortable area of the body and there are often times we have to deliver news about diagnoses that patients may not want to hear. It has been an amazing time being here and I have only good things to say about urology — I would choose urology if I had to do so again.

For more information on our urologists and range of services, visit the “St Pete Urology” site.