Technological Innovations in Urology

Technological innovations in urology have resulted in far-reaching improvements in patient care. At St Pete Urology, the implementation of new technologies and innovations has improved diagnostic accuracy, enhanced the safety and quality of treatments, and streamlined patient information systems. For example, the use of advanced imaging technologies has enabled urologists to visualize and diagnose different conditions more precisely while minimally invasive surgery results in significantly reduced pain and quicker recovery and convalescence.

Laparoscopic Surgery

Our urology specialists use laparoscopic surgery when applying miniature instruments inserted using a small tube (known as a laparoscope) through small incisions in the patient’s body. We use novel biological sensors, techniques and instruments to ensure less pain, faster recovery and better outcomes for urologic problems. For example, we offer minimally invasive laparoscopic surgery for kidney stones, pelvic organ prolapse, live donor nephrectomy, uretal stricture, uretopelvic junction obstruction, renal cysts, renal cell carcinoma, prostate cancer and more. Our urologists in St Petersburg have also refined laparoscopic surgery for use in children to remove dysfunctional or malformed kidneys, correct blocked ureters and treat undescended testicles.

Robotic Surgery

At St Pete Urology, every urologist is trained in the use of robotic surgery to perform operations with more precision. Robot-assisted surgery is a minimally-invasive operation similar to laparoscopy (performed through smaller incisions than open surgery), but in which small surgical tools are mounted on a robotic arm controlled by the surgeon using a computer. The urologist makes tiny incisions for inserting the instruments into the body then uses an endoscope to view enlarged 3-D images of the affected area during the operation. Our urology clinic boasts of the da Vinci machine, the world’s most advanced surgical robot, enabling our specialists to conduct operations with better vision, precision and control.

External Beam Radiation Therapy (EBRT)

Also called Image Guided Radiation Therapy (IGRT), this form of treatment has been implemented at St Pete Urology with great success for prostate patients. Our state-of-the-art imaging enables urologists to direct radiation with more precision to the area of the prostate that requires treatment. With better preparation and planning, this technology ensures more accuracy and allows the urologist to target the same area of the prostate for all additional treatments. In fact, EBRT ensures less radiation and pinpoint accuracy for better outcomes and reduced side effects associated with radiotherapy.

Cryosurgery and Cryosurgical Ablation

We have implemented new cryosurgical technologies for treating prostate cancer, making it easier for our urologists to map cancerous cells more precisely, and freezing and killing cells not reachable by means of radical prostatectomy surgery. Similarly, we use cryosurgical ablation to destroy diseased tissues and eradicate prostate cancer in patients who decline radical surgery (involving prostate removal). Our cryosurgical procedures can be performed on an outpatient basis and without incisions, ensuring minimal blood loss or side effects.

Selecting the Best Technologies

In a world with seemingly endless urology innovations and technologies, we have carefully selected and implemented only those that are effective and appeal to both patients and doctors. This means that all technologies at St Pete Urology have a proven efficacy, cause the least discomfort to patients, and can easily be performed by every urologist. For more information on safer and effective use of the latest technological innovations in the treatment of urological conditions, make an appointment at St Pete Urology in St Petersburg, Florida.

Should You Take Medicine for Treating Enlarged Prostate?

As a man ages, his prostate may become larger, a disorder known as Benign Prostatic Hypertrophy (BPH). While an enlarged prostate is neither a serious nor a life-threatening condition, it can cause urinating problems in men aged 50 years and older. Men with urinary problems should immediately see their doctor for a prompt and accurate diagnosis because symptoms of BPH are similar to those of prostate cancer. A patient should also see a doctor immediately when experiencing fever, chills, back pain, side pain, abdominal pain, bloody or cloudy urine, or pain when urinating.

Treatment of Enlarged Prostate

After a diagnosis of prostate enlargement, the urologist evaluates the severity of symptoms before recommending treatment. You are expected to participate in the decision making process to ensure you get the best treatment possible. Generally, no medications are prescribed for enlarged prostate unless the symptoms are severe, bothersome or accompanied by problems such as bladder stones or bladder infection. In fact, around 4 out of 10 men usually have no symptoms or have their symptoms improve without medications or surgery and only require lifestyle changes to manage BPH. Conversely, 1 in 4 men in their late 50s, 1 in 3 men in their late 60s, and 1 in 2 men in their late 70s and beyond can expect to have bothersome symptoms that require medications or even surgery.

Watchful Waiting

Should you take medications for treating enlarged prostate? After the diagnosis of BPH, you will have to choose either watchful waiting or medicine as your primary treatment, though surgery is sometimes necessary for serious symptoms. The best treatment option for men with minimal and less bothersome symptoms is watchful waiting. It involves combining lifestyle measures that prevent or relieve symptoms of BPH with visits to the urologist at least once a year for physical examination, testing and symptom status review.

Men managing BPH through watchful waiting must limit the amount of fluid they consume at any given time, avoid drinking fluids after 7 p.m., avoid beverages containing caffeine, avoid delaying urination, cut back on salty or spicy foods, limit alcohol intake, engage in regular physical activity and Kegel exercises, avoid cold weather and keep themselves warm, control their weight, control their blood sugar level, eat diets rich in vegetables, and avoid over-the-counter antihistamines (decongestants).

You should opt for watchful waiting if:

  • (a) You experience mild and less bothersome BPH symptoms.
  • (b) The side effects of the medicine may bother you more than the mild symptoms of BPH.
  • (c) You can attend regular medical checkups (at least once a year).
  • (d) You can effectively use special bathroom techniques, cut back on your fluid intake and change your lifestyle.

Medicines

If your symptoms are severe or worsen during watchful waiting, you should consider taking BPH medications. The three types of drugs commonly used for treating enlarged prostate are alpha-blockers, 5-alpha reductase inhibitors and phosphodiesterase-5 inhibitors. Alpha-blockers are fast-acting drugs that relax prostate muscles and relieve urination problems within a few days or weeks. They include terazosin (Hytrin), doxazosin (Cardura), prazosin (Minipress), silodosin (Rapaflo), Alfuzosin (UroXatral) and tamsulosin (Flomax). Drugs called 5-alpha reductase inhibitors such as dutasteride (Avodart) and finasteride (Proscar) cause shrinkage of the prostate and improve symptoms, albeit after several months. Phosphodiesterase-5 inhibitor called tadalafil (Cialis for daily use) has also been approved for use in treating BPH.

When using a prescription for managing enlarged prostate, you will take the pills every day for life, have regular medical checkups, and use special bathroom techniques such as relaxation and double voiding. The medicines will reduce the risk of urinary retention, relieve symptoms and minimize risks of future surgery. However, prescriptions are often expensive and come with certain side effects such as trouble getting an erection, diminished sex drive, tiredness, dizziness, and stuffy nose.

Conclusion

When you have problems urinating, you should immediately see a doctor as you may have an enlarged prostate. At the urology clinic, the doctor will perform a physical exam and run a few tests to find out if you have BPH. If BPH is confirmed, the urologist will explain to you the treatment options available, such as watchful waiting, medications and or surgery for serious cases. The treatment option chosen will depend on the severity of symptoms and your desire to improve the quality of your life. You should consider watchful waiting if you have mild symptoms and want to avoid the adverse effects of drugs. However, in case of severe BPH symptoms, you should take medications to relieve symptoms and possibly prevent the need for surgery in the future. For more information on treating an enlarged prostate, visit St Pete Urology in St Petersburg, Florida.

Urology Patient Testimonial

Dr. Graves is the kindest, most thoughtful, genuinely caring doctor I have ever encountered in my entire life; and my brother had cancer when we were three and mom had a triple by-pass at twelve. I grew up in hospitals, but I have not spent much time in them for myself since very recently. I would rather pass a stone at home-and have twice- than have the kidney stone blasted at the hospital because of the pain afterward from endometriosis. Dr Graves called me HIMSELF to check on me. Choose him. – Kendra Burke

[Read Review…]

Are certain foods helpful in addressing erectile dysfunction (ED)?

It’s possible. Research published in January 2016 found that men who ate foods high in antioxidants called flavonoids had a lower risk of erectile dysfunction (ED) than those who didn’t eat a flavonoid-rich diet.

Flavonoids can be found in certain plant-based foods like citrus fruits, blueberries, strawberries, apples, pears, cherries, blackberries, radishes, and blackcurrant. Some teas, herbs, and wines also have flavonoids in them.

Past studies have shown that consuming flavonoids could reduce a person’s risk for diabetes and heart disease, both of which can lead to ED.

Eating a healthy diet overall, particularly a Mediterranean diet, can go a long way in preserving erectile function, however.

This type of diet includes fruits, vegetables, whole grains, and olive oil. Nuts and fish are good additions.

What does diet have to do with erections?

When a man is sexually-aroused, his penis fills with blood, giving it the firmness it needs for sex. Many men with ED have poor blood flow to the penis. Some medical conditions, like diabetes and heart disease, can damage blood vessels and nerves that are critical for this process.

Eating a healthy diet keeps the body in good working order. It can help men maintain a healthy weight, keep their blood sugar under control, and reduce the risk of blood vessel damage, which can impair blood flow.

Diet isn’t the only path to good erections, however. Other lifestyle habits, like regular exercise, quitting smoking, and managing depression are important too.

A man’s doctor can help him decide which dietary changes to make. However, men who are having trouble with erections should be sure to mention it. Many factors can contribute to ED and it’s best to have a complete medical checkup. [Read Full Article…]

The Prostate Cancer Test That Saved My Life

“So, yeah, it’s cancer.”My urologist segued from talking about how inconvenient it was picking his daughter up at school that morning to dropping a cancer diagnosis on me without missing a beat. Two weeks earlier, I didn’t even have an urologist.

“Yeah,” he said, in a slightly nonplussed way, gazing at the results, “I was surprised myself.”

As my new, world-altering doctor spoke about cell cores and Gleason scores, probabilities of survival, incontinence and impotence, why surgery would be good and what kind would make the most sense, his voice literally faded out like every movie or TV show about a guy being told he had cancer… a classic Walter White moment, except I was me, and no one was filming anything at all.

I got diagnosed with prostate cancer Friday, June 13th, 2014. On September 17th of that year I got a test back telling me I was cancer free. The three months in between were a crazy roller coaster ride with which about 180,000 men a year in America can identify.

Right after I got the news, still trying to process the key words echoing dimly in my head (probability of survival–vival-vival-val…” “incontinence-nence-nence-ence …), I promptly got on my computer and Googled “Men who had prostate cancer.” I had no idea what to do and needed to see some proof this was not the end of the world.
John Kerry… Joe Torre… excellent, both still going strong. Mandy Patinkin… Robert DeNiro. They’re vital. OK great. Feeling relatively optimistic, I then of course had to do one more search, going dark and quickly tapping in “died of” in place of “had” in the search window.

As I learned more about my disease (one of the key learnings is not to Google “people who died of prostate cancer” immediately after being diagnosed with prostate cancer), I was able to wrap my head around the fact that I was incredibly fortunate. Fortunate because my cancer was detected early enough to treat. And also because my internist gave me a test he didn’t have to.

Taking the PSA test saved my life. Literally. That’s why I am writing this now. There has been a lot of controversy over the test in the last few years. Articles and op-eds on whether it is safe, studies that seem to be interpreted in many different ways, and debates about whether men should take it all. I am not offering a scientific point of view here, just a personal one, based on my experience. The bottom line for me: I was lucky enough to have a doctor who gave me what they call a “baseline” PSA test when I was about 46. I have no history of prostate cancer in my family and I am not in the high-risk group, being neither — to the best of my knowledge — of African or Scandinavian ancestry. I had no symptoms.

What I had — and I’m healthy today because of it — was a thoughtful internist who felt like I was around the age to start checking my PSA level, and discussed it with me.

If he had waited, as the American Cancer Society recommends, until I was 50, I would not have known I had a growing tumor until two years after I got treated. If he had followed the US Preventive Services Task Force guidelines, I would have never gotten tested at all, and not have known I had cancer until it was way too late to treat successfully.

Now, in my case, my doctor, Bernard Kruger, watched my PSA tests rise for over a year and a half, testing me every six months. As the numbers continued to rise, he sent me to the urologist, who gave me a slightly invasive physical check in his office using a gloved finger. This took all of 10 seconds. While I don’t recommend it for fun, amazingly some don’t recommend it at all. After this exam, and looking at my rising PSA numbers, he suggested an MRI to get a roadmap of my prostate.
It’s a non-invasive procedure like the one athletes get to check for torn ACLs. Loud, but painless. Only after studying the MRI results did my doctor recommend a not-fun-at-all biopsy. Unlike the MRI, the biopsy was as invasive as it gets: long needles in sensitive places and more small talk about kids and school pick ups while it was all going down.

Then the biopsy came back positive. Of course “positive” for medical tests is usually not so positive. I had a Gleason score of 7 (3+4), which is categorized “mid-range aggressive cancer.” Surgery was recommended. At this point I decided to go out and get a few different opinions. All the doctors I talked to concurred that the tumor needed to be taken out.

Ultimately, I found a wonderful surgeon named Edward Schaeffer who I felt comfortable with. He performed a robotic assisted laparoscopic radical prostatectomy. Due to a lot of skill and a little beneficence from some higher power, he got all the cancer. As of this writing I am two years cancer free and extremely grateful.
So. What is the deal with this PSA test and why the controversy?

It is a simple, painless blood test. It is not dangerous in itself in any way. If the PSA (Prostate Specific Antigen) value is elevated in the blood, or levels rise sharply over time, it could indicate the presence of prostate cancer. It is definitely not foolproof.

The criticism of the test is that depending on how they interpret the data, doctors can send patients for further tests like the MRI and the more invasive biopsy, when not needed. Physicians can find low-risk cancers that are not life threatening, especially to older patients. In some cases, men with this type of cancer get “over-treatment” like radiation or surgery, resulting in side effects such as impotence or incontinence. Obviously this is not good; however it’s all in the purview of the doctor treating the patient.

But without this PSA test itself, or any screening procedure at all, how are doctors going to detect asymptomatic cases like mine, before the cancer has spread and metastasized throughout one’s body rendering it incurable? Or what about the men who are most at risk, those of African ancestry, and men who have a history of prostate cancer in their family? Should we, as the USPSTF suggests, not screen them at all? There is growing evidence that these guidelines have led to increased cases of prostate cancers that get detected too late for the patient to survive the disease.

Five years after their initial recommendation to stop PSA testing, the USPSTF is presently, per their website, “updating their recommendations.” I think men over the age of 40 should have the opportunity to discuss the test with their doctor and learn about it, so they can have the chance to be screened. After that an informed patient can make responsible choices as to how to proceed.

I count my blessings that I had a doctor who presented me with these options. After I chose to take the test, he directed me to doctors who worked at centers of excellence in this field to determine the next steps. This is a complicated issue, and an evolving one. But in this imperfect world, I believe the best way to determine a course of action for the most treatable, yet deadly cancer, is to detect it early.

10 Quick Facts About Lithotripsy by St Pete Urology

Lithotripsy is a medical procedure involving the disintegration of kidney stones, gallstones and bezoars using high-energy shock waves. Once the procedure is done, small stone fragments (or gravel) come out through urine. The Extracorporeal Shock Wave Lithotripsy (ESWL), in which the shock waves are produced outside the body, is the most common type of lithotripsy.

10 Quick Facts About Lithotripsy

1. An ESWL is generally done when a stone is too big to move on its own, or when it becomes entrapped in the ureter (the tube carrying urine from the kidney to bladder) causing enormous pain.

2. ESWL is not done on people weighing over 300 lbs, individuals with skeletal deformities, persons with severe bleeding disorders, and pregnant women. Patients with cardiac pacemakers should undergo this treatment only after being approved by a cardiologist.

3. Prior to lithotripsy, a thorough physical examination is done, followed by an intravenous pyelogram (IVP) test to determine the size, location and number of stones.

4. Older individuals should first undergo an EKG (electrocardiogram) test to detect possible cardiac defects. Also, women of childbearing age should take a pregnancy test. Some patients will have a stent inserted into the ureter to allow the passage of gravel through urine.

5. The entire lithotripsy process takes nearly an hour to complete, during which time up to 8,000 shock waves are administered. This may cause some discomfort to the patient based on tolerance level. In most cases, a urologist administers analgesics to relieve the pain.

6. After the treatment, most patients see blood in their urine. This clears out within a week, and patients are advised to drink extra fluids during this period to promote the flushing out of any stone pieces from the urinary system.

7. Patients should pay a follow-up visit to the urologist two weeks after the treatment to ensure that everything is going as planned. This is also the time when the stents will be removed.

8. The potential risks of the procedure include mild temporary abdominal pain. However, severe or persistent pain could imply an unexpected injury.

9. Renal pain is common when gravel passes through the urine. In about 60% of cases, blood clots may form in the kidney area. Other possible complications are pancreatitis, nerve palsies and obstruction of the stone pieces.

10. Alternatives to lithotripsy involve surgery (although this process has become obsolete) and altering the urine’s pH to dissolve the stones. These treatments, however, have had limited success.

Lithotripsy