A History of Excellence and Care Providing The Best Men's Health Services
At Urology Centers of Alabama, we understand the unique health needs of men. We take a comprehensive view of your health and we are always looking for the best and most efficacious treatments. For example, by being the first in the Southeast to perform the prostate robotic surgery, we have become one of the most experienced prostate cancer teams in not only the region, but in the world. Urology Centers of Alabama also offers these services for men:
The adrenal glands are small endocrine organs that produce a variety of hormones essential for regulating and maintaining fluid and electrolyte balance, blood pressure as well as other vital bodily functions. Anatomically they are located within the fat at the top of each of the kidneys and possess a delicate and rich blood supply. Due to the many functions these hormones control, many different disease states can result from decreased or increased production of these hormones. Increased production can result from hyperplasia, which is an abnormal increase in the number of cells, or from a tumor that can produce too much hormone. The diagnosis of these major adrenal disorders is actually simpler now than in the past because of precise diagnostic assays and radiological tests. Once an exact cause has been diagnosed different treatment options are available depending on the pathological process involved. Some disease states are treated medicinally while others may require surgical correction. Surgery of the adrenal gland consists of operative procedures to correct endocrine abnormalities due to over or under production of hormones or to treat malignant diseases. The preferred method now is either a laparoscopic or robotic approach which is normally associated with less blood loss and a shorter hospital stay.BOOK APPOINTMENT
Benign Prostatic Hyperplasia (BPH)is a non-cancerous enlargement of the prostate, which affects a majority of men over age 50. The symptoms of Benign Prostatic Hyperplasia usually begins with urinary frequency, having to get up at night, and other minor inconveniences. Many men who have enlarged prostates never experience any symptoms, but the likelihood of developing symptoms increases as men age.
The prostate is an internal gland of the male reproductive system that is located in front of the rectum and below the bladder. The prostate gland wraps around the upper part of the urethra, the tube that carries urine out of the bladder. Benign Prostatic Hyperplasia affects the innermost part of the prostate first, so the enlargement frequently results in a gradual squeezing of the urethra where it runs through the prostate, sometimes causing difficulty urinating or other urinary problems.
Benign Prostate Hyperplasia Symptoms
Many men with BPH may have no significant symptoms, but the most common symptom that men first notice as prostate enlargement progresses is difficulty in urination. Characteristic symptoms of BPH include:
As the prostate gland enlarges, the urethra is squeezed more tightly and it becomes difficult for the bladder to empty completely. In a small percentage of men, this leads to urinary tract infections or gradual bladder and/or kidney damage.
Diagnosing Benign Prostate Hyperplasia
If you are experiencing any of the symptoms listed above or burning or pain on urination you should see your doctor. Your doctor may ask you questions about how you void or want you to fill out a questionnaire to help evaluate the severity of your symptoms. Depending on the symptoms, some additional tests may be ordered to see if you have an obstruction. A rectal examination and a blood test to check for prostate cancer (PSA test) will most likely be done on the initial visit to the urologist. The American Urological Association recommends that men age 50 and over have a prostate exam with PSA every year.
We now have an online version of the BPH Symptoms Questionnaire. Click on the link below to complete the online questionnaire.
Benign Prostatic Hyperplasia Treatments
4 Types of Medications
0=Not at All
1=Less than 1 time in 5
2=Less than half the time
3=About half the time
4=More than half the time
Incomplete emptying over the past month, how often have you had a sensation of not emptying your bladder completely after you have finished urinating?
0 1 2 3 4 5
Frequency over the past month, how often have you had to urinate again less than 2 hours after you have finished urinating?
0 1 2 3 4 5
Intermittency over the past month, how often have you found you stopped and started again several times when you urinated?
0 1 2 3 4 5
Urgency over the past month, how often have you had a weak urinary stream?
0 1 2 3 4 5
Weak Stream over the past month, how often have you had a weak urinary stream?
0 1 2 3 4 5
Straining over the past month, how often have you had to push or strain to begin urination?
0 1 2 3 4 5
Nocturia over the past month, how many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning?
0 1 2 3 4 5
Add the numbers from your answers to questions 1 through 7. The maximum possible score is 35. Remember: This information is not intended as a substitute for medical treatment.
Note: This test is used to measure the severity of your symptoms. This is not a diagnostic test. In other words, it will not tell you whether or not you have BPH. Talk to your doctor to determine if your symptoms are due to BPH.
Adapted from Barry MJ, et al. The American Urological Association symptom index for benign prostatic hyperplasia. J Urol. 1992; 148: 1549-1557.
Diagnosing Bladder CancerYour doctor will perform a detailed history and physical examination, including a rectal and pelvic exam. Tests that may be done to look for bladder cancer include:
Bladder Cancer Treatments
Treatment depends on the stage of the cancer, the severity of your symptoms, and your overall health.
Superficial bladder cancer:Cancer in the lining of the bladder.
Muscle-Invasive bladder cancer:Cancer that has grown into the wall of the bladder.
Radical Cystectomy:Complete removal of the bladder.
Ileal Conduit:A small section of your small bowel is used to create an ostomy on your abdomen for urine to drain into a bag. This is the most common type of diversion, and offers greatest ease of use and lowest risk.
Bladder Cancer Prognosis
Erectile dysfunction is the inability to obtain an erection that is sufficient for satisfactory intercourse. Millions of men in the United States suffer from erectile dysfunction and many men do not seek treatment for this very common problem. At Urology Centers of Alabama we specialize in the non-surgical and surgical treatment of erectile dysfunction. Our surgeons and nurses have a strong commitment to treating patients with erectile dysfunction and their partners with compassion, respect and empathy. A man does not need to feel embarrassed when he comes to Urology Centers of Alabama seeking treatment for erectile dysfunction. Our goal is to return patients to these most intimate and private activities that can truly improve the quality of life. The non-surgical and surgical treatment options for erectile dysfunction can be highly effective. We encourage you to begin the journey toward erectile restoration by coming to see us.
Causes of Erectile Dysfunction
Erectile dysfunction results from inadequate blood flow into the penis that would normally allow for a rigid erection. There are a number of medical conditions that can cause erectile dysfunction, but the most common causes are diabetes and high blood pressure. Other conditions such as spinal cord injury can also lead to erectile dysfunction or the side effects of radical surgeries used to treat prostate cancer or bladder cancer. As a man increases in age it is increasingly common for the quality and stiffness of his erections to diminish. Again, the good news is that regardless of the cause of erectile dysfunction we can almost always be successful with our treatments.
Non-surgical Options to Treat Erectile Dysfunction
Medications can be used to treat erectile dysfunction, such as Viagra, Levitra and Cialis. Oral medications are effective in about 70% of men with erectile dysfunction. Other non-surgical treatment options would include the use of penile injection therapy. In this treatment a small needle and syringe are used to inject medication directly into the penis. These medications can increase blood flow into the penis causing a firm erection. The discomfort associated with penile injection therapy is not severe and the risk of complications is low. A side effect of non-surgical treatments is priapism, an erection that persists for several hours. Adjustment of the dosage of medications injected is critical to avoiding priapism, and the physicians and nurses in our ED Department are well schooled in helping the patient to determine the appropriate dose of injectable medications. Another non-surgical treatment is a vacuum erection device (VED). It is a plastic cylinder that goes over the penis and produces a vacuum. The vacuum draws blood into the penis and then a rubber constriction ring placed around the base of the penis holds the blood in the penis allowing for penile rigidity. We work with a patient to instruct him how to use the VED
Surgical Options to Treat Erectile Dysfunction
Penile Prosthesis are surgical treatments for men with erectile dysfunction. 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.BOOK APPOINTMENT LEARN MORE
Radical prostatectomy is a very effective way to treat prostate cancer, and the cure rates are very high. We know however that one of the potential side effects of the surgery can be persistent urinary incontinence (involuntary loss of urine). While the vast majority of men who undergo a radical prostatectomy will resolve their urinary incontinence completely, there is a small percentage of men in whom the urinary incontinence will persist and never correct itself. For these men there ARE effective treatment options, and at Urology Centers of Alabama there are specialists who perform these treatment procedures. The surgeries are minimally invasive requiring only small incisions and the hospital time is also minimal.
The use of synthetic slings to treat urinary incontinence has been a common practice in female patients for many years. We also offer this treatment option to men who suffer from persistent post-prostatectomy incontinence, and the results are quite good. The male sling is a ribbon of synthetic mesh that is placed below the urethra that supports the urethra. Placement of the sling allows the patient’s natural sphincter (the circular, muscular valve that prevents leakage of urine) to function more effectively and to maintain continence. The most ideal candidate for the male sling would be a man who has mild to moderate incontinence, following radical prostatectomy.
The male sling procedure itself is most often performed on an out-patient basis with the patient going home the same day as the surgery. Through a small incision in the patient’s perineum (the area under the scrotum and between the legs) the sling is placed into position beneath the urethra. The surgery takes less than an hour. Risks of infection and serious bleeding are both less than 1%. A catheter is placed into the bladder at the time of surgery and will be maintained for about 24 hours after surgery. The efficacy of the male sling is quite good and in the ideal patient cure rates (no further leakage, no further pads) approach 90%. Patient satisfaction with the male sling has been found to be very high.
Unfortunately, there are some men who will have not only urinary incontinence, but also erectile dysfunction following their radical prostatectomy. Some of these men would have had erectile difficulties even before their prostate cancer surgery. For the man who does have erectile dysfunction and incontinence, a combination procedure utilizing the male sling and an inflatable penile implant is possible. In fact, some of the very first combination sling plus penile implant surgeries were performed at Urology Centers of Alabama. The safety, efficacy, high patient satisfaction, and low risk of this combination procedure has been well documented. For the right patient the combination of a male sling and a penile implant may represent the ideal treatment option.
Following radical prostatectomy some men may suffer from climacturia; this is the leakage of urine that occurs during sexual activity and orgasm. Some studies have indicated that climacturia can be present in up to 40% of men who undergo a radical prostatectomy, and patients and their partners find climacturia to be a very distressing and very bothersome situation. We have found that men who have the male sling placed will almost always completely resolve their climacturia. Therefore, use of the male sling can benefit the patient in several different ways.
Artificial Urinary Sphincter
Developed in 1972, the artificial urinary sphincter has long been a very effective way to treat urinary incontinence in men. The artificial sphincter is a synthetic cuff that is placed around the urethra, and also has a small pump shaped like the end of the pinky finger. The pump is placed under the skin in the scrotum. The entire device is completely contained in the body and no one would know that a patient has an artificial sphincter. The cuff of the sphincter compresses the urethra and that is what prevents leakage. When a patient needs to urinate, they will experience the normal sensation to void. They would then squeeze the scrotal pump and this allows the cuff to open and the patient to void. After voiding, the device automatically resets itself. Surgery to place the artificial sphincter is performed in less than an hour, and the risks of infection or serious bleeding are quite low. For the man with a more severe degree of urinary incontinence the artificial sphincter is the treatment of choice. Like the male sling, the artificial sphincter can be placed at the same time as a penile implant for the treatment of both erectile dysfunction and post- prostatectomy incontinence.
The male sling and the artificial sphincter provide very good treatment options for men with incontinence. Which surgery is best for you will be determined when you have your consultation with the prosthetic surgeon. Any kind of pre-operative testing to help decide, which surgery is best is painless and is performed in the comfort of the Urology Centers office. We strongly encourage all men with urinary incontinence that does not resolve after radical prostatectomy to speak to their prostate cancer surgeon. There are excellent treatment options for these patients. In this day and age, there is no need for any man with incontinence after radical prostatectomy not to seek effective treatment.
Urethral Stricture Symptoms
Diagnosis includes a detailed history and physical including onset of symptoms and severity. Your doctor may also choose to evaluate your urethra with a variety of office tests including:
Various treatment options exist, each with their own advantages and disadvantages.
Urethral Dilation: Gently stretching the stricture with sequential dilators. Usually performed in the office with local anesthesia, however recurrence rate is high.
Endoscopic Incision: The stricture is cut using a special cystoscope while under general anesthesia in the operating room. Typically performed on outpatient basis, and no formal skin incision is needed. Success rate is typically pretty good, but depends on location of the stricture and length of the stricture. Each subsequent incision carries higher recurrence rate.
Open Urethroplasty: Removing the diseased segment and replacing with healthy tissue. The technique used depends on location and length of the stricture, as well as surgeon experience. For longer strictures, a tissue graft is usually needed to bridge the gap. The tissue used for grafting can include local penile skin or even buccal mucosa from inside the cheek. Success rates are typically very good with low recurrence rates, especially with surgeons with experience in performing these procedures.
Kidney cancer is cancer that originates in the kidneys, two bean-shaped organs, each about the size of your fist. Each year about 190,000 people will be diagnosed with kidney cancer worldwide. Kidney cancer is slightly more common in men and is usually diagnosed between the ages of 40-80 years of age. Many kidney cancers are detected during procedures for other diseases or conditions. Imaging techniques such as computerized tomography (CT) are being used more often, which may lead to the discovery of more kidney cancers earlier. It is important to realize that with early diagnosis and treatment, kidney cancer can be cured.
Risk factors for renal cell carcinoma include smoking, long term dialysis, family history, Von Hippel – Lindau disease, age and African American race, and high blood pressure. Symptoms are usually none and tumors are most often found incidentally with CT imaging. Symptoms may include blood in urine, flank or side pain, a mass or lump felt in the side of the abdomen, and even an array of non-specific abnormalities including weight loss, appetite changes and lab abnormities of the blood.
Treatment is usually surgical and we at Urology Centers of Alabama offer all the cutting-edge treatments including, robotic surgery for removal or partial removal of the kidneys and the tumor, laparoscopic cryoablation of small kidney masses, and other open or laparoscopic techniques.BOOK APPOINTMENT
Many patients consider kidney stones as simply a very painful nuisance which has to be tolerated periodically. In fact, kidney stone disease is a complex problem with various types of stones and with many different causes. At Urology Centers of Alabama, we utilize state of the art equipment and techniques to successfully treat stones. However, careful evaluation and management options also allow us to successfully prevent recurrent stone episodes in many patients.
What Causes Kidney Stones?
Stones may develop because of one or a combination of reasons:
What Symptoms Caused Kidney Stones?
Everyone knows about the terrible flank pain associated with kidney stones. Many think that this pain is caused by a scratching of the stone as it passes through the ureter. In fact, most of the pain is caused by obstruction of the ureter, causing a backup of urine into the kidney with resultant stretching and dilation of the tissue. Nausea and vomiting are often present during acute episodes. Some patients may have an urgency to urinate or blood in the urine. Some patients may even have no symptoms at all.
Treatment of Kidney Stones
There are various methods and equipment used for treating kidney stones, depending on the situation.
Kidney Stone Prevention
Even though we have a multitude of treatment options and equipment to successfully treat kidney stones, our goal is to help patients avoid recurrent stones. To achieve this, your urologist might recommend a change in your diet or a special medication. Calcium stone formers might be advised to drink more water, avoid salt, decrease oxalate intake and avoid calcium supplements.
Low Oxalate Diet
The following foods and drinks should be avoided when trying to maintain a low oxalate diet:
The following foods contain oxalate , but not as much as the above products: Beans, blackberries, celery, dark leafy greens, swiss chard, draft beer, sweet potatoes, eggplant, white corn grits, instant coffee, okra, leeks, and soy tofu.
Testosterone is a male sex hormone mainly produced by the testicles. It is becoming increasingly more common for male patients to come in talking about low testosterone, also known as hypogonadism. This isn’t necessarily a new problem; men are just becoming more open to talking about erectile dysfunction. As men age, most will begin to experience a gradual decline in testosterone. Often the most noticeable side effect is a decrease in sex drive.
Symptoms of Low Testosterone
There are both sexual and non-sexual symptoms of low testosterone. Some sexual signs include poor erectile function, low libido and weaker erections. Non-sexual symptoms related to low testosterone include reduced muscle mass, decreased energy and fatigue and depression. Men with high blood pressure and high cholesterol levels can also have low testosterone levels. Other diseases that can contribute to lows testosterone are diabetes, obesity, HIV / AIDS and chronic opioid. Low Testosterone is diagnosed with a blood test with the presences of symptoms.
Treatments for Low Testosterone
There are several ways to treat low testosterone. Replacement therapy can be used in many forms including skin gel, injections, patches, oral inserts and pellets. Skin gel or cream can be applied to the skin each morning and the testosterone is absorbed into the bloodstream.
Injections are a very reliable treatment that can be administered every week or every other week.
Testosterone pellets are tiny pellets places under a patient’s skin that needs to be repeated every 5-6 months.BOOK APPOINTMENT
About Peyronie's Disease
Peyronie's disease is the development of scar tissue in the penis. We do not always know what causes Peyronie's; however, most times Peyronie's the result of an injury or decreased blood flow. Peyronie's can cause pain and/or curvature of the penis and may also result in a decrease in penile size and erections.
Treatments for Peyronie's Disease
There are a number of treatment options and each will have different results. These include:
Dr Brian Christine, our expert in men's sexual health and prosthetic urology, is one of a limited number of urologic surgeons who has been trained to offer XiaFlex as a treatment option.BOOK APPOINTMENT
The prostate gland is part of the male reproductive system and is responsible for the production of fluid to nourish and transport sperm. The prostate lies deep in the male pelvis between the bladder and the urethra (the tube that transports the urine and semen through the penis). Prostate Cancer develops when the cells of the gland mutate and undergo malignant changes. Cancer cells grow more rapidly than normal cells and refuse to die, and they also develop the ability to invade and destroy normal tissue. Over time, the spread of the malignant cells can result in the patient having symptoms, health problems and ultimately death.
Prostate Cancer is one of the most common male malignancies in the United States and it is expected that more than 241,740 men will be diagnosed with this condition annually. Men have a 1 in 6 lifetime chance of prostate cancer and it is the third leading cause for cancer death in men. The annual prostate cancer death rate has been declining recently which we think may be due to screening and early detection of the disease. Prostate cancer usually occurs later in life and grows slowly, but this is not always the case. While some types of prostate cancer may need minimal or no treatment, other types are aggressive and can spread quickly. If prostate cancer can be detected early while it is still confined to the prostate, the chance for successful treatment of disease is very good.
For most men, prostate cancer is first detected during a routine screening such as a Prostate Specific Antigen blood test (PSA) and/or a digital rectal exam (DRE), and since the cancer is usually detected much earlier with screening, there are often no associated symptoms. Later in its course, the cancer can cause compression on the urinary tract and this compression results in urinary symptoms such as decreased force of stream and stopping & starting of the urinary stream. Since these are the same symptoms associated with Benign Enlargement of the Prostate (BPH), it is important to be checked with the PSA and DRE to be sure that the symptoms are not due to Prostate Cancer. Later stages of Prostate Cancer can cause pelvic pain, bone pain or bone fractures, but because of routine screening, Prostate Cancer rarely presents with these advanced symptoms.
The main risk factors include:
Age –Prostate cancer is more common as men get older
Race or Ethnicity –For reasons that aren’t well understood; African American men have a higher risk of developing and dying of prostate cancer.
Family History –If there is a family history of prostate cancer, the chances of getting it are higher. The closer the relative, the more relatives with this condition and the younger that it was found in the relative, all increase the risk of getting and dying of prostate cancer.
Diet –A high fat diet and obesity may increase the risk of prostate cancer.
When to seek medical advice
If you have difficulties with urination, contact your doctor. These symptoms are not always caused by prostate cancer, but screening for prostate cancer is advisable.
The American Cancer society and the American Urological Society recommend that the pros and cons of regular prostate cancer screening be discussed with the patient starting at age 40.
If the screening tests suggest prostate cancer (the Prostate Specific Antigen blood test and/or the Digital Rectal Exam), the pros and cons of a Prostate Biopsy will be discussed with the patient. This is an outpatient procedure using a small ultrasound probe in the rectum to visualize the prostate. Guided by images from the probe, numbing medication is injected around the prostate and using a fine, spring-propelled needle, samples of tissue are taken from the prostate to determine if cancer is present and how aggressive the cancer is. Using the current technique, most patients tolerate the procedure well and complications from the biopsy are rare.
The decision for treatment of prostate cancer depends on the age and health of the patient, the aggressiveness of the cancer and the extent of the cancer at the time of diagnosis. Virtually all treatments for prostate cancer except observation may have an effect on the quality of life with urinary control, erectile function and bowel function being the primary concerns. So, it is important to have a thorough discussion with your urologist about the benefits, risks, morbidity and side effects of the treatment options.
If the patient is older and has a slowly progressive prostate cancer, observation and treatment with palliative therapy at a later date is an option. Some younger patients with low volume non-aggressive cancer may be candidates for surveillance in which case the cancer is carefully watched by doing infrequent, repeated prostate biopsies and curative therapy is done if the cancer shows signs of progression.
For many patients, curative therapy is the best choice and there are basically 4 options:
If the cancer is very aggressive or more extensive than usual, a combination with hormone therapy (shots to remove male hormone) or a combination of surgery followed by EBRT or Radioactive Seeds plus EBRT may give the best chance for cure. When surgical removal of the prostate is indicated, we are fortunate to have well qualified, experienced robotic surgeons at Urology Centers of Alabama, and we feel that the robotic technology offers less morbidity & side effects and excellent cancer control.
Hormone therapy involves stopping your body from producing the male sex hormone testosterone which stimulates the growth of prostate cancer cells. Another type of this therapy can block testosterone from getting into the cancer cells. Sometimes a combination of two drugs is used to achieve both effects. Hormone therapy is occasionally used to stop the growth of the cancer when needed curative therapy cannot be given in a timely manner, sometimes it is used as adjunctive therapy to improve the cure rate of Surgery and External Beam Radiation Therapy (EBRT) and often, it is used as palliative therapy to stop the progression of widespread, incurable cancer. It is a very effective and useful treatment for prostate cancer but does have some side effects. Side effects of hormone therapy can include:
Reduction in muscle and bone mass
Recent reports have shown that men who undergo hormone therapy for prostate cancer may have a higher risk of having a heart attack in the first year or two after starting hormone therapy. So you doctor should carefully monitor your heart condition and aggressively treat any other conditions that may predispose you to a heart attack, such as high blood pressure, high cholesterol or smoking.
Surgery to remove the testicles, which produces most of the testosterone is as effective as other forms of hormonal therapy. Many men are not comfortable with the idea of losing their testicles, so they opt for shots or medication to control the testosterone. However, removing the testicles has the advantage of not having to have an injection every 3 to 6 months and can be less expensive. The surgery to remove the testicles is done on an outpatient basis.
Prostate Cancer Prevention
Prostate cancer may not be preventable in some people but you can take measures to reduce your risk or possibly slow the disease’s development. This includes the following:
Healthy Eating.High-fat diets and obesity have been linked to prostate cancer as well as a number of other health problems. Limiting your intake of high-fat foods and emphasizing fruits, vegetables and whole fibers may help you reduce your risk. Foods and supplements containing lycopene (an ingredient in cooked tomatoes), selenium, soy, vitamin D and Vitamin E may also be of help.
Get regular exercise.Regular exercise can help prevent a heart attack and conditions such as high blood pressure and high cholesterol. When it comes to cancer, the data aren’t as clear cut, but studies do indicate that regular exercise may reduce your cancer risk. Exercise has been shown to strengthen your immune system, improve circulation and speed digestion – all of which may play a role in cancer prevention. Regular exercise may also minimize you risk of prostate gland enlargement or benign prostatic hypertrophy (BPH).
The important thing to remember is that what is prostate healthy is heart healthy, cancer healthy and healthy for your vascular system. In addition, healthy living helps to prevent obesity and diabetes and it improves your quality of life.
Prostatitis is swelling and inflammation of the prostate gland, a walnut-sized gland located directly below the bladder in men. The prostate gland produces fluid (semen) that nourishes and transports sperm. Prostatitis can be caused by the same bacteria that commonly cause urine infections. However, in most cases, an identifiable cause is not found and may not be an infection, but just inflammation and irritation of the prostate gland.
Symptoms of Prostatitis
Tests for Prostatitis
Antibiotics:specific antibiotics are chosen to target the most-common causative bacteria. Complete eradication of prostate bacteria may take weeks, so be sure to take ALL of your prescribed antibiotics, or your infection may recur.
Alpha blockers:these medications help relax the muscle fibers in the prostate, helping you to urinate more freely. These may also help to clear infection more quickly.
Urinary analgesics:help to alleviate discomfort when urinating
Prostate massage:not done very often anymore, however may be recommended by your doctor for prolonged infections that are not responding to antibiotics.
Other treatments:other treatments are being studied, since as stated earlier, often times a chronic “infection” is likely not infectious at all. Thus repeated course of antibiotics may not be useful.
Surgery is rarely needed.
Having prostatitis does not increase your risk of developing prostate cancer. However, you should continue to have regular exams and blood work (PSA) to check for prostate cancer.BOOK APPOINTMENT
Sexually Transmitted Diseases
“Sexually transmitted diseases (STDs) are infections passed from one person to another during sexual contact. There are numerous sexually transmitted diseases, most of which cannot be diagnosed with certainty without specialized testing. The only STD that rarely needs any special testing to diagnose is HPV which causes genital warts (also called condyloma). The other common STD’s (Genital Herpes, Chlamydia, Gonorrhea, Syphilis, HIV) usually require diagnostic testing that is not readily available in physician offices. For these, the patient needs to be seen at their local county Public Health Department.”
Genital human papillomavirus (HPV) is the most common sexually transmitted infection (STI). There are more than 40 strains of HPV that can infect the genital areas of males and females. HPV can also infect the mouth and throat. Most people who become infected with HPV do not even know they have it. Very rarely a mother with HPV infection can transmit the virus to her infant during delivery.
Symptoms of HPV
Most people with HPV do not develop symptoms or health problems. Approximately 20 million Americans are currently infected with HPV. In 90% of cases, the body’s immune system clears HPV naturally within two years. However, certain strains of HPV can cause genital warts in males and females. High-risk or oncogenic HPV strains can cause cancer. There are roughly a dozen high-risk strains that have been identified that affect approximately 5% of all cancer patients.
HPV and Cancer Risks
High-risk or oncogenic HPV strains, mostly commonly types 16 and 18, can lead to cancer. These strains can cause cervical, vaginal, vulvar and penile cancers. HPV strains cause normal cells to turn into abnormal cells and when the body can’t fight them off it can lead to cancer. Early stages of cervical cancer often don’t cause signs or symptoms, therefore is it is important for women to have regular Pap tests to detect precancerous changes in the cervix.
There is a vaccine called Gardasil that protects against some strains of HPV that cause warts or lead to cancer. Another vaccine called Cervarix protects against some strains that lead to cancer, but not warts. It is recommended for boy and girls to get the vaccine between the ages 12-26. It is most effective if given before becoming sexually active.
There is currently no cure or treatment for HPV. Most inflections are fought off by the body’s immune system and go away on their own. Abnormal cells can be removed by biopsy to help decrease the chance of abnormal cells reproducing. Removing abnormal cells can be treated through colposcopy, cryotherapy and LEEP treatments.
Medications can be used to eliminate warts that are a side effect of some strains of HPV. Medication can be applied directly to the lesion and usually goes away after several applications. If medications don’t work, warts may be physically removed by freezing with liquid nitrogen, electrocautery or laser surgery.
If you suspect you may have Genital Herpes, Chlamydia, Gonorrhea, or Syphilis, you need to seek care at your local county public health departmentBOOK APPOINTMENT
Genital herpes is a sexually transmitted disease (STD) caused by the herpes simplex viruses type 1 (HSV-1) or type 2 (HSV-2). Most patients have no or only minimal signs or symptoms from HSV-1 or HSV-2 infection. Genital herpes is a fairly common and highly contagious STD affecting about 16.2% of people ages 12 to 49 years old in the United States.
HSV is spread from person to person during sexual contact. There is a higher probability of spreading HSV when a person has an outbreak, but you can still spread it between outbreaks as well.
Symptoms of Genital Herpes
Genital Herpes typically appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur. Typically, another outbreak can appear weeks or months after the first. The second outbreak is usually less severe and shorter. Other symptoms may include decreased appetite, fever, general sick feeling, swollen and tender lymph nodes in the groin during an outbreak, muscle aches in lower back, buttocks, thighs or knees.
Although the infection can stay in the body indefinitely, the number of outbreaks tends to decrease over a period of years. Various factors can trigger future outbreaks which include:
Tests for Genital Herpes
A doctor can usually diagnose genital herpes based on a physical exam and laboratory tests. Your doctor can order a DNA test, blood test or viral culture to determine if you have genital herpes.
Genital Herpes Treatment and Prevention
There is no cure for genital herpes but medication can help relieve discomfort. Medications may help sores heal sooner, lessen the severity and length of symptoms with breakouts, reduce the recurrence of breakouts and minimize the chance of transmitting the disease to others. Your doctor might recommend taking medication during the breakouts or every day.
The only way to 100% prevent genital herpes is to abstain from sexual activity. The lesions are highly contagious when present, so abstain from sexual activities during the breakouts. Other ways to avoid getting an STD include using condoms correctly.
If you suspect you may have Genital Herpes, Chlamydia, Gonorrhea, or Syphilis, you need to seek care at your local county public health departmentBOOK APPOINTMENT
Chlamydia is a common sexually transmitted disease (STD) caused by the bacterium, Chlamydia trachomatis. Like some other STDs, a patient might not know they have chlamydia because some people never develop symptoms. Chlamydia can affect both men and woman and isn’t difficult to treat once you know you have it, however untreated it can cause more serious health problems.
Chlamydia and Infertility
If women go untreated the infection can spread into the uterus or fallopian tubes and cause pelvic inflammatory disease (PID). This happens in about 10 to 15 percent of women with untreated chlamydia. The inflection can also cause fallopian tube infection without any symptoms. PID and “silent” infection in the upper genital tract can cause permanent damage to the fallopian tubes, uterus and surrounding tissues. This damage can lead to chronic pelvic pain, infertility and potentially fatal ectopic pregnancy (pregnancy outside the uterus).All pregnant women should have a screening test for chlamydia.
Often there are no early signs of chlamydia. Symptoms will usually occur one to three weeks after the patient has been exposed to the STD. Sometimes symptoms are mild enough that a patient might not recognize them. Symptoms of infection may include:
If you show any signs or learn that a sexual partner has chlamydia you should contact your doctor. If your partner has the infection, your doctor will give you antibiotics even if you do not show signs. A swab or urine test can be used to determine if you have chlamydia.
Chlamydia Treatment and Prevention
Chlamydia is treated with antibiotics. In most cases the infection clears up within one to two weeks. Patients should abstain from sex during this time. Your sexual partner should also receive treatment even if he or she does not show symptoms.
If you suspect you may have Genital Herpes, Chlamydia, Gonorrhea, or Syphilis, you need to seek care at your local county public health departmentBOOK APPOINTMENT
Gonorrhea is a common sexually transmitted disease (STD) that is caused by Neisseria Gonorrhoeae, a bacterium that can grow and multiply easily in the warm, moist areas. Gonorrhea can infect both females and males and most often affects the urethra, rectum or throat. While gonorrhea is most commonly spread through sexual intercourse, babies can be infected during childbirth.
Signs and Symptoms of Gonorrhea
Symptoms of gonorrhea most commonly appear in the genital area, but can also affect other parts of the body. Symptoms vary slightly from males to females. Male symptoms include painful urination, pus-like discharge and pain or swelling in one testicle. Woman may experience increased vaginal discharge, painful urination, abdominal or pelvic pain or vaginal bleeding between periods and after vaginal intercourse.
Symptoms of gonorrhea on other places on the body
Gonorrhea can affect other parts of the body including the rectum, eyes, throat and joints. Patients may experience anal itching, push-like discharge from the rectum, bright red bleeding or strain during bowel movements. Symptoms in a patient’s eye will cause pain, sensitivity to light or pus-like discharge. If the disease reaches a patients throat will become sore and have swollen lymph nodes. Joints can become warm, red, swollen or extremely painful when affected with gonorrhea.
You should make an appointment with your doctor if you experience a burning sensation when you urinate or a pus-like discharge. You should also make an appointment if your sexual partner has been diagnosed with gonorrhea.
Treatments for Gonorrhea
Your doctor will use a urine test or swab of the affected area to determine if the gonorrhea bacterium is present in your body. Once a doctor determines you have gonorrhea, an antibiotic is used to treat the disease. It is recommended your partner be tested and treated even if he or she doesn’t show symptoms. Even if you have been treated, you can be reinfected by an untreated partner.
Untreated Gonorrhea can lead to complications
If gonorrhea goes untreated, the following complications could occur:
Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It has often been called "the great imitator" because so many of the signs and symptoms are indistinguishable from those of other diseases. The disease often starts as a painless sore typically on the a patients genitals, rectum or mouth. Syphilis can lie dormant in your body for decades before being active again after initial infection.
Symptoms and Signs of Syphilis
Syphilis develops in stages and symptoms can overlap and vary with each stage. A patient might also be infected and not notice symptoms for years. The following are the stages of syphilis and the symptoms that come with each stage.
Primary Syphilis and Secondary Syphilis
The first symptom of syphilis is a small sore that appears at the site where the bacteria entered your body. Most people only develop one sore, but several can appear. The sore usually appears three weeks after infect and most people don’t notice it because it is painless and hidden in the vagina or rectum. The sore will heal on its own within six weeks.
A few weeks after the sore has healed, a rash may develop on your core, but will eventually cover your entire body developing secondary syphilis. The rash usually is not itchy and may cause sores on the mouth and genitals. Other symptoms may include muscle aches, fever, swollen lymph nodes and a sore throat. These symptoms can come and go for up to one year
Latent Syphilis and Tertiary Syphilis
Patients who go untreated develop into the latent, or hidden, stage. This stage can last for years and symptoms may never return or may progress into the tertiary stage. Roughly 15-30% of people who aren’t treated for syphilis will develop the tertiary stage. In the late stages syphilis may damage your brain, nerves, eyes, blood vessels, liver, heart, bones and joints. These problems can occur years after the initial, untreated infection.
Mothers who are infected with syphilis can infect the baby through the placenta or during birth. Most babies with congenital syphilis display no signs or display a rash on the palms of their hands and feet. If untreated later symptoms may include deafness, teeth deformities or a saddle nose.
Syphilis can be diagnosed by testing blood, fluid from sores or cerebral spinal fluid. When diagnosed and treated in the early stages, syphilis is easy to cure. The preferred treatment is antibiotics that kill the organism that causes syphilis. If you have been infected with syphilis for more than a year, additional doses of antibiotics may be necessary to kill the disease. If you are treated for syphilis during pregnancy, your child should also receive treatment after birth.
You may experience slight side effects the first day of treatment including fever, chills, nausea, achy pain and headaches. These side effects shouldn’t last longer than a day.
After being treated for syphilis you may be asked to have blood tests to make sure your body is responding to treatments. You should avoid sexual contact until the treatment is completed and blood tests confirm the infection is gone.
Urinary Tract Infections
Urinary Tract Infections are one of the most common infections to affect people. Urinary tract infections (UTIs) can affect men, women, and children, but women suffer more frequently from these infections. Fortunately, UTIs can usually be treated successfully if they are diagnosed and treated early.
A urinary tract infection occurs when bacteria gets into the urinary tract and infects the system. Occasionally, the kidneys may become infected as well, causing a serious UTI, which could result in kidney damage. Many women who have one UTI will experience others in their lifetime. It is estimated that nearly 20% of women who have an episode of urinary tract infection will have another, 30% of those will have a third infection, and approximately 80% of those with recurrent infections will experience even more.
Bacteria can also infect a man’s urinary tract, even though this is not as common. The majority of UTIs in men are caused by an obstruction, usually an enlarged prostate gland. This type of obstruction can cause incomplete voiding and the back up of urine in the bladder. The residual urine can lead to an infection in the bladder.
Factors that contribute to Urinary Tract Infections
There are a number of factors that may increase a person’s risk of getting urinary tract infections. These include:
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 ProcedureBotox 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.
Benefits of BrachytherapyThe 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 RadioactivityWith 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 ImplantsIn 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 ProcedurePrior 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 ProcedureImmediately 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 RestrictionsAvoid 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.
DietYou 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:
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 UpYou 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.
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
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
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:
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:
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 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
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.
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?
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:
Score Card & Explanation
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 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:
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)
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:
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