Trust Our Experience and Care

For over 60 years, Urology Centers of Alabama has been committed to providing the highest quality medical services in a compassionate and caring environment. The practice has earned a well deserved reputation for excellence in the Birmingham medical community. The Urology Centers’ physicians are leading the way in cutting-edge medical procedures such as minimally invasive robotic surgery, endoscopic and laser surgery and radioactive seed implantation for prostate cancer. The practice also plays an integral role in the field of urology through research studies conducted at the facility. Urology Centers of Alabama is committed to investigating the effectiveness of all treatment options, including new drugs and procedures that hold great promise.

Browse the current list of treatments at Urology Centers of Alabama. If you have further questions or need a one-on-one consultation, don’t hesitate to contact us and set up an appointment.

Solutions

Botox Treatment

Botox is indicated for the treatment of overactive bladder (OAB) with symptoms of urge urinary incontinence, urgency and frequency, in adults who have an inadequate response to or are intolerant of an anticholinergic medication.

How does Botox work?

In your body, certain chemicals travel from nerve cells to muscle cells to make your bladder contract so you can urinate. With OAB, these muscles contract uncontrollably and you frequently feel like you have to empty your bladder. Botox calms the nerves that trigger the OAB muscle. This results in eliminating or substantially reducing leakage episodes, reducing the strong need to urinate right away and reducing the number of times that you need to empty your bladder daily. It generally will last 6-10 months. When your symptoms return, you can talk to your doctor and have the treatment done again. Usually, similar results are seen each time, and it can be done as many times as needed.

The Procedure

Botox treatment is a minor procedure for women and men that is usually done in the office. A gentle numbing agent, sometimes in combination with a light sedative is given so you are relaxed and comfortable during the treatment. Most patients report very little discomfort, and you can resume normal activities later that same day. Once your bladder is numb, the Botox is administered through a cystoscope with a small needle into the bladder muscle. A cystoscope is a thin-lighted tube that provides access and visibility inside your bladder. The total time in the office from start to finish is under an hour. The treatment itself only takes about five minutes. Talk to one of the Urology Centers of Alabama physicians to see if you would be a good candidate for Botox Treatment.

BOOK APPOINTMENT

Brachytherapy

Brachytherapy is often offered as an excellent option for the treatment of prostate cancer. At Urology Centers of Alabama, we utilize permanent seed implantation (brachytherapy), either alone or in combination with external radiation and/or hormonal blockade. The therapy or combination of therapies depends on the stage, extent, and aggressiveness of the individual’s prostate cancer. The outpatient procedures are performed at Trinity Medical Center or Baptist Hospital Princeton in Birmingham. Since the beginning of our Prostate Brachytherapy program in 1996, we have performed seed implants for prostate cancer at these hospitals.

Brachytherapy, which is derived from the Greek words for short distance (brachy) and treatment (therapy), is also referred to as seed implantation. Radioactive “seeds” are carefully placed inside of the cancerous tissue to attack the cancer at close range. Each radioactive seed is about the size of a grain of rice, and gives off radiation which travels only a few millimeters to kill nearby cancer cells.

Multiple seeds are generally implanted depending on the size of the area needing to be treated. With permanent implants the radioactive seeds lose strength, or “decay” over time. The seeds remain permanently implanted, but are no longer radioactive.. Brachytherapy has been proven to be very effective and safe, providing a good alternative to surgical removal of the prostate while reducing the risk of certain long term side effects.

Benefits of Brachytherapy

The benefits of brachytherapy include a quicker recovery time, less time spent in the hospital, and a reduced risk of postoperative infections. Other benefits of using brachytherapy in the treatment of early stage prostate cancer are quite pronounced. There is a lower incidence of impotence and incontinence than occurs with a radical prostatectomy, and most men resume walking within a few hours of the procedure and other normal activity within a few days. Brachytherapy has been proven to be comparably effective in the treatment of prostate cancer, and patients often suffer fewer side effects compared to when the employment of external radiation therapy or surgery is used.

Length of Radioactivity

With seed implants, the “seeds”, or sources of radiation, ᅠremain in the body permanently, but the radioactive materials are specially selected such that the energy of the radiations emitted are so low that there is a negligible risk to others who come into contact with the brachytherapy patient. ᅠIt is, however, recommended that the patient avoid close contact with children and pregnant women for several months.ᅠ There are two types of seeds that we use for brachytherapy, Iodine-125 and Palladium-103. Iodine-125 seeds decay, or lose their energy, at a rate of 50% every 60 days. After 10 months, their radioactivity is nearly exhausted. Palladium-103 seeds decay much quicker, losing half their energy every 17 days. They are nearly inert after only 3 months.

Candidates for Radiation Seed Implants

In general, men who have small, early stage prostate cancers may be considered for a radiation seed implant. Several tests are necessary to ensure that radiation seed implantation is an appropriate treatment for your prostate cancer. With more advanced cancer some patients are candidates for a combination treatment consisting of seed implantation and the addition of external beam radiation with or without hormone blockade.

Before the Prostate Brachytherapy Procedure

Prior to implantation, your physician will order an ultrasound to help determine the size and shape of your prostate. This is often done at the time of the biopsy.ᅠ ᅠThis can also help determine the location and extent of the cancer. The ultrasound will help in planning your treatment and in determining the number of radioactive seeds to be ordered for the procedure. At the time of your procedure, your doctor will locate your prostate with a rectal ultrasound, and take measurements showing the exact location and size of your prostate. These images help your doctor to determine the number of seeds needed and their location, to most effectively treat your cancer. You generally will have preadmission testing at the hospital before the brachytherapy procedure. These tests may include blood tests, and electrocardiogram (EKG), and chest x-rays. Your doctor will determine which tests are necessary. The results are used by anesthesiologists to determine what kind of anesthesia to use for brachytherapy procedure. A few days before your procedure you will be given specific instructions about preparation, including diet and enemas. These instructions are very important to follow in order to make sure that the ultrasound image of your prostate will be clear.

After the Procedure

Immediately after the procedure you are taken to the recovery room until the anesthesia wears off, which usually takes 45 minutes to 1 hour. ᅠOnce you are awake and able to eat, drink, and urinate, you will be discharged home.ᅠ Occasionally, a patient will be kept overnight in the hospital for observation after anesthesia.

Activity Restrictions

Avoid strenuous activity for one month. Walking, swimming, and golf are okay. Riding a bicycle or a stationary bicycle is prohibited. After one month, you may return to your regular activities, but in the unlikely event the needle-entry site (perineum) remains tender, please avoid activities that irritate the area. DO NOT strain or push during urination or bowel movements. This may cause bleeding.

Diet

You may resume a regular diet unless instructed otherwise. Some foods can be irritating to the bladder causing frequent urination, discomfort, and possibly a slower urine stream. If you develop any of these urinary symptoms you may need to decrease your intake of the following foods:

  • Beverages
  • Foods/vitamins
  • Medications - Take your usual medications unless you are instructed otherwise. After the implant procedure your physician may prescribe one or more of the following medications.
  • Antibiotics - You may receive a prescription for an antibiotic to prevent infection. Take the antibiotic as prescribed until all the medication is gone. If you develop symptoms such as itching, hives, and/or shortness of breath, discontinue the antibiotic at once and call your physician.
  • Pain medication-Medication for discomfort will be available if necessary. Take acetaminophen (Tylenol™, Aspirin Free Anacin™) for discomfort. Any pain not relieved by acetaminophen, do not hesitate to contact your physician. Avoid the use of aspirin and aspirin containing products for one week after your procedure as they may increase the likelihood of bleeding.
  • Stool Softener-It may be helpful to use a stool softener for 1-2 weeks to prevent straining during bowel movements.
  • Alpha blocker-you may be prescribed a medication to help empty your bladder such as Flomax™, Rapaflo™, or Hytrin™.Avoid all over the counter medications that contain antihistamines and/or decongestants (ask your pharmacist if you are unsure). These may cause urinary retention.
  • Early Side Effects

    “Early” side effects are those that occur within the first 30 days of the procedure. They may include: Discomfort-It is not unusual to have some tenderness and/or bruising between the scrotum and rectum. There may be slight bleeding from this area for the first 2 weeks. If this persists or amounts to more than an ounce of blood within 24 hours, contact your physician. Blood in urine-There may be blood in the urine for several days following implantation. However, if large clots are passed with urine, or if it is difficult to urinate, call your physician. Drinking plenty of fluid can help move liquids through the bladder, thus decreasing or preventing clots from forming. Burning and difficulty with urination-After the urinary catheter is removed (usually within the first 24 hours) some men have difficulty urinating. You will be instructed on how to catheterize your bladder in the event you are unable to urinate. If you have the urge to urinate and cannot, or you are unable to do self-catheterization, you will need to go to an emergency room for evaluation and care. You may also have burning during urination. If this becomes a problem for you, please contact your physician. Ejaculation - You will probably experience diminished, discolored, delayed and/or dry ejaculate for several months to a year, which may be permanent in nature. This may happen immediately, or be delayed, but it is considered to be a common side effect after seeding.

    Late Side Effects

    “Late” side effects occur after the first 30 days have passed and are almost always related to the radiation given off by the seeds in the prostate. Late side effects include, but are not limited to: Difficulties with urination-Inflammation and swelling in the prostate may result in frequent urination, burning during urination, the urgent need to urinate and/or a weaker urine stream. These symptoms are usually temporary, typically lasting anywhere from one month to a year or more. Avoiding foods and beverages that contain caffeine may help lessen these symptoms. Rectal irritation-Some patients may feel pain in the rectal area or pass blood with bowel movements, although it is not common. Impotence-Sexual potency in men can be influenced by a number of factors including age, medication use, tobacco use, and overall health (including cardiovascular problems, diabetes, and hypertension). Because many factors affect potency it is difficult to measure the precise affect that seed implantation has on a man’s sexual potency. Studies done on impotence following seed implantation show varied results. Current figures indicate that from 10 to 50 percent of men may have impotence following seed implantation. Impotence can be temporary or long lasting. Discuss this possible side effect with your physician.

    Follow Up

    You will be scheduled to return to the hospital radiation oncology department one month after the implant for a CT scan.ᅠ This is to document seed placement and allow calculation of the radiation dose to the prostate and other tissues achieved by the implant. An additional follow up with the radiation oncologist will be scheduled shortly after the CT scan.If additional radiation is planned after the brachytherapy procedure, treatment usually will begin 2 months after the implant. Some patients will require hormone blockade treatment in addition to the radiation treatment.Your doctor will tell you how often you need to be seen after the brachytherapy procedure. You need to be checked for treatment progress, treatment side effects, and to make sure that the cancer has not recurred. The schedule will often be more frequent during the first several years following treatment.

    BOOK APPOINTMENT

    Cryotherapy

    Urology Centers of Alabama’s Dr. Lee Hammontree has many years of experience with cryosurgery (using extreme freezing to destroy cancer) for both kidney cancer and prostate cancer. He has performed more cryosurgery procedures for kidney cancer than any other surgeon on the Southeast. Dr. Hammontree uses laparoscopic surgery along with an ultrasound to guide the probe and monitor the freezing process. A ball of ice forms around the probe, freezing the kidney tumor with a surrounding margin. Dr. Hammontree has presented results of over 274 patients treated since 2006 with laparoscopic cryoablation for kidney cancer at the 2015 Southeastern Section of the AUA. Results included a 1.9% local recurrence rate. This technique is best for tumors less than 4cm in size.

    We have also used cryosurgery to treat prostate cancer with good results since 2006. Treatment involves outpatient surgery involving placement of 6 small needle cryoprobes and 5 needle temperature sensors through the skin of the perineum into the prostate and surrounding tissue to perform 2 freezing and thaw cycles with ultrasound monitoring. This technique can also be used for “focal treatment” for limited prostate cancer in patient’s wishing to maintain some degree of prostate and erectile function and to minimize side effects. Salvage cryoablation of the prostate is used for treatment of prostate cancers which recur following previous radiation therapy. Dr. Hammontree has extensive experience with these techniques.

    BOOK APPOINTMENT

    da Vinci Sacrocolpopexy

    Sacrocolpopexy is a procedure performed using the da Vinci Robotic System to correct vaginal vault prolapse. The robotic procedure allows the physician to correct the prolapse and thus provide the patient with a durable repair. Unlike the open repair, the da Vinci System is minimally invasive, more precise, less pain, less blood loss, and better cosmetics. Most of the time, patients spend only 1 night in the hospital. The procedure uses mesh to hold the vagina in the correct anatomical position. Physicians can perform this procedure, to provide long term support of the vagina, with or without the uterus in place.

    The long term cure rates for this procedure range from 75-98%.

    The da Vinci Sacrocolpopexy offers a number of benefits compared to the traditional treatment option. These benefits include:

    • Less pain
    • Less blood loss
    • Lower rish of infection
    • Less scarring
    BOOK APPOINTMENT

    Incontinence Treatments

    Slings

    This is a minimally invasive procedure that uses a small, thin mesh or “tape” to create a “hammock” effect under the urethra. This can be approached via the pubic symphysis or the obturator area. It is important to note that after careful data analysis, the FDA has stated that there is a low to modest risk with these “tape” type procedures. The mid-urethral sling has excellent long-term data and a high success rate, that is between 80-90%.

    Non-Mesh Option

    If a patient is opposed to mesh or cannot have the type of procedure for other reasons, there are other options available.

    The Burch procedure is done to support the hypermobile urethra that causes stress urinary incontinence. It can be done with a very small “bikini” incision or robotically. Sutures, not mesh, are used to support the urethra and bladder neck.

    The fascial sling procedure uses the patient’s own tissue or fascia as the “tape”. No mesh is used for this procedure. Once again, a “bikini” incision is made where the fascia is harvested. The fascia is then fastened and placed under the urethra through a separate vaginal incision.

    Both of these procedures are alternatives to the traditional mesh procedure, with good success. These procedures are slightly more invasive techniques and involve a slightly longer recovery phase.

    Bulking Agents

    Periurethral bulking agents are injected into the urethra and used to “plump up” the urethra to decrease or eradicate stress urinary incontinence. The procedure can be done under light anesthesia or even in the office. The bulking agents are effective for mild stress urinary incontinence and for women who have the diagnosis of ISD (intrinsic sphincter deficiency), where the urethra does not close completely. These are several FDA approved agents that are used and although they are effective for stress urinary incontinence, repeat procedures may be necessary.

    BOOK APPOINTMENT

    Interstim Therapy

    InterStim Therapy (also called “sacral nerve stimulaton”) is used to treat people with two seemingly opposite problems. The first is non-obstructive urinary retention (poor emptying in the absence of blockage of the urinary tract as may occur with prostate enlargement, prior bladder surgery, etc.). Additionally, it is used to treat patients with severe symptoms of overactive bladder (urinary urge incontinence and significant symptoms of urgency-frequency) in individuals who have failed prior behavioral therapies and treatment with multiple medications.

    The therapy uses a small, implanted medical device to send mild electrical pulses to a nerve located just above the tailbone. This nerve, called the sacral nerve, controls the bladder and surrounding muscles that manage urinary function. The electrical stimulation may eliminate or reduce bladder control symptoms in some people as well as helping those unable to urinate do so. A physician's examination and evaluation can determine whether you are a candidate for InterStim Therapy.

    InterStim Therapy does not treat symptoms of stress incontinence. InterStim Therapy has not been studied in pregnant patients or children/adolescents. It cannot be used in patients with neurologic causes of their urinary issues such as multiple sclerosis, stroke or spinal cord injury. It is not intended for patients with mechanical obstructions such as benign prostatic hypertrophy, cancer or urethral strictures.”

    BOOK APPOINTMENT

    Mesh Related Complications

    When mesh failure occurs, it causes great distress for so many women. We approach this problem with compassion and understanding.

    After mesh failure is confirmed, the least invasive treatment is usually attempted first. The treatment options can vary greatly depending on the location and severity of the damage:

    Treatment for Mesh Erosion:
    • Estrogen cream application to promote healing and blood flow
    • Re-sewing or replacing stitches
    • Trimming exposed vaginal mesh and re-sewing remaining mesh
    • Surgical or laser removal of mesh from vagina or surrounding organs
    • Removal of scar tissue if necessary
    • Vaginal packing with absorbent materials to minimize bleeding
    • Antibiotic therapy for current or potential infection
    Treatment for Mesh Perforation:
    • Partial or complete removal of the mesh from any damaged organs
    • Surgical repair of the damaged bladder, urethra or bowel
    • Removal of scar tissue as needed
    • Drainage of pus or of other abnormal fluids
    • Antibiotic therapy for current or potential infection

    Transvaginal mesh removal surgery is a delicate and tedious procedure. Several attempts may be necessary to completely remove the mesh, as tissue and nerves tend to grow in and through it. After the eroded mesh is completely removed, our surgeons are trained to deal with potential consequences of recurrent prolapse.

    BOOK APPOINTMENT

    No-Scalpel Vasectomy

    No-Scalpel Vasectomy

    A vasectomy is a safe surgical procedure that is used for permanent male fertility control. It is a simple procedure that severs and seals the vasa deferentia tube, which carries sperm from testicle to the seminal stream. Since the procedure cuts off the delivery of sperm, it does not change hormonal function, so it won’t affect your sex drive.

    The No-scalpel Procedure

    The main difference between the no-scalpel procedure and the conventional technique is the surgeon has more control over the procedure and it only takes about 10-20 minutes to complete. A local anesthetic is used to numb the area and a sharp hemostat is used to make single puncture in the scrotum. This results in a smaller opening and it also allows small vessels and nerves to be spread out of the way instead of being cut. This typically results in no stitches, a faster healing time with less pain and less of a chance of bleeding and infection. The vas deferens from each testicle is then clamped, cut and sealed which prevents sperm from mixing with semen. The testicles will still produce sperm, but the sperm will be reabsorbed by the body.

    Before Your No-scalpel Vasectomy

    While a vasectomy can be reversed, it is intended to be a permanent form of birth control. It is important to carefully make the decision to get a vasectomy. Before you come in for your procedure, please take the following steps to prepare:

  • Shave and remove all hair on your scrotum the day of the procedure
  • Bring a scrotal support, such as a jock strap, to help with comfort after the procedure
  • Wear comfortable pants
  • Refrain from eating or drinking three hours before your procedure
  • After Your No-scalpel Vasectomy

    Directly after your vasectomy, you can expect your scrotum to be numb for about an hour after the procedure. It is best to apply cold packs to the area and lay on your back the rest of the day. You may experience some soreness for a day or two afterward. You may resume sexual activity within a week. You will be asked to drop off a semen specimen in a cup provided to you in about six weeks. We will examine this semen to make sure there is no sperm still being released. About 85% of men test negative for sperm at 6 weeks, but occasionally it can take longer to “clear the pipes.” You should use another method of birth control until you are notified by our office that you have no sperm. Again, this is a permanent method of birth control. It is advised to consider this method when you are sure you do not want to have a child in the future.

    Risk Factors of No-scalpel Vasectomy

    There are risk factors like all surgeries and procedures. However the risk of complications of a vasectomy is very low. Complications may include the following:

  • Bleeding which may cause swelling or bruising
  • Infection at the incision site
  • Sperm leaking from a vas deferens into the tissue around it
  • Inflammation of the vas deferens
  • In rare cases, the vas deferens can grow back together
  • BOOK APPOINTMENT

    Ureteropelvic Obstruction/ Pyeloplasty

    Obstruction Pyeloplasty

    Urology Centers of Alabama offers robotic, laparoscopic surgery to reconstruct an obstructed ureter and renal pelvis due to a condition known as a uretero-pelvic junction (UPJ) obstruction. This operation is known as a pyeloplasty and can be done using the da Vinci robot system.ᅠ ᅠDuring this procedure, the obstructed, narrowed area at the junction of the kidney and the ureter is removed and the ureter and kidney are sewn back together over a hollow plastic tube called a ureteral stent.ᅠ This stent is completely internal and remains in place for a month. It is removed easily in the office. Pyeloplasty has a 95% success rate.

    BOOK APPOINTMENT

    Penile Prosthesis

    Penile Prosthesis

    Penile Prosthesis is one of several treatments for men with erectile dysfunction that is a very effective treatment option. Penile prostheses are safe and have been used for several years and are continually being improved. Patients have several different types of prostheses to choose from and your prosthetic urologist will help you make the decision that is best for you. The surgeons and nurses at Urology Centers of Alabama are committed to providing a high level of care to men with erectile dysfunction.

    Semi-Rigid Penile Prostheses

    A semi-rigid penile prosthesis (SRPP) is the simplest type of penile prosthesis. This device takes the form of a malleable, bendable rod. Two of the rods are placed into the penis at the time of surgery. The devices are simple and are have proven ability to produce a rigid erection during intercourse. The risk of infection and significant bleeding are low.

    Inflatable Penile Prosthesis

    The inflatable penile prosthesis (IPP) is the most commonly used device at Urology Centers of Alabama. The three piece IPP has two inflatable cylinders that are placed into the penis, a pump that is shaped much like the end of your thumb is placed into the scrotum and a reservoir that holds sterile saline is placed into the abdomen. All three of these components are placed through a single incision that is either in the scrotum or just above the base of the penis. The incisions are about 2-3 inches in length and are sutured using stitches that will dissolve on their own.

    Benefits of the Inflatable Penile Prosthesis

    The main benefit of the IPP is that it provides the most natural erection for the patient and his partner. In the deflated state the penis is soft and when the patient desires an erection he compresses the pump in the scrotum causing fluid to move from the reservoir into the inflatable cylinders. This produces the rigid erection. A penile implant is not visible to anyone else and it is a completely contained device within the patient’s body. The presence of the penile implant does not change urination, sensation or orgasm/ejaculation. The surgery to place an IPP takes around 45 minutes. This procedure is occasionally an out-patient procedure, but most of the time patients are kept overnight for observation.

    Risk Factors for IPP

    The risk of infection is very low and the IPP is actually impregnated with antibiotics to further reduce the potential for infection. The risk of severe bleeding is less than 1% in men who are not taking blood thinners. A prescription for antibiotics and pain medicine is given to the patient at the time of discharge.

    After the Surgery

    A patient can go back to work between one and two weeks depending on the kind of work they do. Patients with more strenuous work activities can return to work closer to two weeks. Your prosthetic surgeon will help determine when to go back to work following the surgery. Patients can begin use of the inflatable implant about 5-6 weeks after surgery though we instruct the patient in how to inflate/deflate the device starting at 2-3 weeks after surgery.

    BOOK APPOINTMENT

    Radiation Therapy - IGRT

    Radiation Therapy – IGRT

    One of the more exciting developments over the past several years at the Urology Centers of Alabama has been the addition of Radiotherapy to the treatment options offered to patients with prostate cancer and other malignancies.ᅠ The construction of the Radiation Oncology department - The Van Scott Cancer Center – at the Homewood office has been the culmination of much effort on the part of the Urologists and Dr. Brian Larson, a Radiation Oncologist. ᅠDr Larson has worked in Birmingham at BMC Montclair (Trinity Medical Center) and BMC Princeton, as well as Medical Center East.By bringing state of the art equipment including the latest in computer planning and treatment techniques to the facility, we are able to provide treatment for prostate cancer that is second to none. Radiation treatment for prostate cancer is one of the major treatment options available for patients.ᅠ The advantages of radiation include avoidance of major surgery, including the required hospitalization, anesthesia, and post-operative recovery period of surgery.ᅠᅠ Radiation treatment for prostate cancer has been used successfully for decades, but recent advances in technology have allowed an increase in the safe radiation dose achievable to the prostate, while minimizing the radiation effects on the normal tissues, such as the bladder, rectum, and pelvic bones.ᅠ This allows an improvement in cancer control, while reducing the side effects of the radiation treatments.

    Who will be involved in this procedure?

    Our facility relies on a specially trained team for IMRT delivery. This team includes the radiation oncologist, medical radiation physicist, dosimetrist, radiation therapist and radiation therapy nurse.

    The radiation oncologist, a specially trained physician who heads the treatment team, sets an individualized course of treatment with the help of the radiation physicist, who ensures the linear accelerator delivers the precise radiation dose and that computerized dose calculations are accurate. A dosimetrist, under the supervision of the medical radiation physicist, calculates the IMRT exposures and beam configurations necessary to deliver the dose prescribed by the radiation oncologist. Highly trained radiation therapists position the patient on the treatment table and operate the machine. The radiation therapy nurse provides the patient with information about the treatment and possible adverse reactions.

    What equipment is used?

    A linear accelerator generates the photons, or x-rays, used in IMRT. The patient lies on the treatment table, while the linear accelerator delivers beams of radiation to the tumor from various directions. The intensity of each beam's radiation dose is dynamically varied according to treatment plan.

    How does IMRT work?

    IMRT represents an evolution of radiation technology, from standard to 3D to IMRT. The evolution in technology offers the possibility of better cure rates with fewer side effects.

    Standard radiation involved starting with plain x-rays of the pelvis. Lines were hand drawn on each x-ray film to make "radiation fields". Lead blocks were then created which matched the hand drawings. Usually, four radiation beams were used, entering the body from the front, back, and both sides.

    3D-conformal radiation involved starting with a CT scan. The prostate, rectum, and bladder were circled on a computer screen which showed the CT images. Any number of radiation beams could be used, and the computer shaped the beams to precisely match the contour of the prostate. Beams could be angled so that they missed most of the bladder and rectum, but passed through the prostate.

    IMRT is even more computer intensive than 3D. Every beam is broken down into tiny "beamlets", and each beamlet can be given a different dose. This results in beams with different intensities across their surfaces. Multiple beams are used for each treatment. Although the beams are all different in shape and intensity profiles, once they all converge on the prostate you are left with a high dose covering the prostate gland, and a lower dose hitting the normal tissues, such as rectum and bladder.

    Studies consistently show that the higher the radiation dose is, the better the chance of curing prostate cancer.

    IGRT - Image Guided Radiation Therapy

    IGRT is an advanced technology that allows radiation to be delivered to tumors with more precision than was traditionally possible. One of the challenges encountered when radiation is delivered to a tumor is that the tumor can move based on the patient's day to day position on the treatment table, as well as internal organ motion. IGRT uses advanced imaging technology with on-board imaging (OBI). This OBI uses radiation beams with diagnostic x-ray energies in order to optimize the quality of the x-ray image and allow the radiation oncologist to visualize a patient's anatomy such as pelvic bones or implanted markers, with each radiation treatment. The Urology Centers of Alabama physicians use a special technique to insert fiducial markers into the prostate for Image Guided Radiation Therapy. This technique can be performed on an outpatient basis in the radiation oncology facility.

    This added accuracy allows radiation to be delivered to a tumor based on its location in the body at the precise moment of treatment. Thus IGRT allows the precise delivery of radiation to tumors in real time while allowing normal tissues to receive minimal radiation.

    IGRT sets the stage for allowing the radiation oncologist to safely increase the radiation dose to tumors while minimizing side effects. The potential for IGRT to result in increased tumor control and cure is unparalleled.

    BOOK APPOINTMENT

    Robotic Prostate Cancer Surgery

    Robotic Prostate Cancer Surgery

    Our team of skilled urologists is committed to providing you with high-quality, personalized medical care in our state-of-the-art facilities. Our physicians specialize in the comprehensive treatment of urological disorders using the most advanced technology available.

    Why UCA for Prostate Cancer and Robotic Surgery?
  • Experienced team: UCA is one of the busiest and most experienced robotic centers in the world.
  • Urology Centers continues to modify surgical techniques to improve outcomes. Current techniques include:
  • Bladder neck sparing procedure
  • Veil of Aphrodite nerve sparing technique
  • Pelvic floor reconstruction
  • Intraoperative pathology evaluation: frozen sections during surgery to reduce positive margins and PSA recurrence
  • Biofeedback training to reduce incontinence
  • Dedicated erectile dysfunction team to improve potency
  • Comprehensive data collection and monitoring of surgical outcomes
  • Why Choose Robotics?

    Studies of several thousand patients show that laparoscopic surgery is as effective as an open prostatectomy with less post-operative pain, fewer complications, shorter hospital stay and a faster recovery time. Compared to open surgery, robotic laparoscopic radical prostatectomies offer:

  • Less Pain
  • Fewer Complications
  • Shorter Hospital Stay
  • Faster Recovery
  • Earlier return of urinary control
  • Improved sexual function
  • Less internal scarring
  • Score Card & Explanation

    Procedure
  • Average operative time: 2-3 hours
  • Average blood loss: less than 100 cc
  • No mortality or re-exploration
  • 95% discharged in one day
  • Average hematocrit of 34.5 (preoperative/postoperative change of 3.1 points)
  • Average catheter time: 7 days
  • Oncology
  • Positive margin rates of 10.5% for the first 200, 7.7% for the first 350, and slightly less than 5% positive margin rates for the last 100 patients using intraoperative frozen section techniques.
  • Excellent tumor control with 95% having an undetectable PSA in one year.
  • Functional results
  • 27% with immediate continence requiring no pads; 47% in one month, 82% in three months, 94% in six months, and 98% in one year of continence without pads.
  • Potency data is pending but when nerve-sparing procedures are performed, the results have been very promising.
  • Back to normal activities in 9-10 days per third party questionnaire.
  • BOOK APPOINTMENT

    Stress Incontinence

    Stress Urinary Incontinence

    Symptoms

    Stress incontinence is the involuntary loss of urine associated with physical activity such as coughing, sneezing, and exercising. It is caused by several factors some of which may be childbirth and previous pelvic surgeries. As many as 50% of all women experience symptoms of stress urinary incontinence. As with urinary urgency incontinence, a thorough history and physical exam is crucial.

    Treatments

    Treatments for Stress Incontinence

      Non-Surgical:
    • Kegal Exercises
    • Dietary Modification / Times Voiding
      Surgical:
    • Sling
    • Non-mesh Option
    • Bulking Agents
    Treatments

    Small fistulas may sometimes resolve with a foley catheter drainage. However, the majority of times, surgical treatment is needed. Depending on the location of a fistula, the physician may repair the defect either vaginally or abdominally. Trained physicians can repair this robotically, which greatly minimizes post-operative discomfort.

    BOOK APPOINTMENT

    Vasectomy

    A vasectomy is a surgical procedure that is considered to be a permanent, male form of birth control. This procedure will not change hormonal function, so it won’t affect your sex drive.

    BOOK APPOINTMENT

    Vasectomy Reversal

    Vasectomy Reversal

    There are many reasons men who have had vasectomies may wish to have them reversed, including the desire to father children after a divorce or loss of a spouse or child or simply because they and their spouse have had a change of heart and want more children.

    With the development of the high-powered operating microscope, vasectomy reversal surgery has become much more precise and pregnancy rates have improved.

    What is vasectomy reversal?

    Vasectomy is a relatively simple surgery that involves cutting the tubes that carry the sperm, called the vas deferens, to keep sperm from traveling from the epididymis to the prostate. But a vasectomy reversal to reconnect these tubes, or connect the vas deferens directly to the epididymis, is far more technically demanding.

    BOOK APPOINTMENT

    Rezūm NEW

    Rezūm

    Rezūm is the newest treatment for BPH, or an enlarged prostate. Rezūm is a minimally invasive procedure used to reduce the symptoms of BPH, by using water vapor therapy.

    The FDA approved Rezūm as a treatment for BPH in 2015. Before Rezūm, BPH was typically treated through surgery or medications.

    How Rezūm Works


    The treatment involves applying small amounts of steam to the prostate. When this occurs, the cells causing the obstruction are damaged, which helps reduce the overall size of the prostate. Rezūm not only reduces the size of the prostate, but also the symptoms associated with BPH such as:

  • A weak urine stream
  • Trouble starting the flow of urine
  • Starting and stopping again when urinating
  • Not emptying your bladder completely
  • Urinating more often, especially at night
  • Sudden urges to urinate
  • Leaking or dribbling after you urinate
  • Straining to urinate
  • Rezūm
    Day of the Procedure

    The Rezūm therapy is an outpatient procedure, which is performed in one visit. This treatment does not require general anesthesia.

    When will I see improvements?

    Symptoms of BPH may improve in as little as two weeks. If you have BPH or are experiencing symptoms, speak with your Urology Centers of Alabama physician, to see if Rezūm is the right treatment option for you.

    SEE DETAILS

    High-Intensity Focused Ultrasound (HIFU) NEW

    High-Intensity Focused Ultrasound (HIFU)

    High-Intensity Focused Ultrasound (HIFU) is a newly FDA cleared, minimally invasive treatment designed to provide men with a surgery-free option for prostate cancer. The treatment uses high-intensity sound waves to heat and destroy cancer cells. This allows the cancer to be targeted rather than removing the prostate entirely.

    The benefits of this treatment include:
  • Shorter hospital stay
  • Lower risk of erectile dysfunction
  • Decreased probability of incontinence
  • Although side effects may be less likely with HIFU, there’s still a chance that you may have some. For example, you may have erection problems after the procedure. Some men have problems with urination and are more likely to have bladder infections, after the procedure.

    Drs. Andrew Strang and Bryant Poole are the certified physicians at Urology Centers of Alabama that will be performing this procedure.

    This treatment is not suitable for all cases of prostate cancer. Potential candidates for this procedure are men who have low-volume, previously untreated prostate cancer. Talk with your urologist to determine the best treatment option for you.

    SEE DETAILS