Men's Health

Eastern Urological Associates specializes in the treatment of male urology problems. Some of the urological problems we treat include:

Bladder Problems

Bladder and urinary problems can be distressing and embarrassing for adult men and women. An infection of the bladder and urinary tract often leads to discomfort and the need for frequent, painful urination. In men, enlargement of the prostate can also cause frequent urination, with difficulty in starting, and leakage. In women, escape of urine, incontinence, is a common urinary problem, which possesses a variety of causes.

Frequent symptoms of a bladder or urinary problem include:

  • Burning with urination – the most common symptom of a Urinary Tract Infection (UTI)/Cystitis.
  • Frequent urge to urinate without the ability to pass a desired amount of urine.
  • Urgent need to urinate. Symptoms of frequent urination in men can point to more serious conditions such as diabetes, urinary tract infection, benign prostatic hyperplasia (BPH) or other prostate problems.
  • Feeling of incompletely emptying of your bladder.
  • Blood in the urine (hematuria)
  • Leaking urine (incontinence)
  • Urinary Incontinence

Bladder Cancer

The bladder is an organ meant to store urine until it is time to be expelled from the body through the urethra.  The lining of this organ is named urothelium so cancer of the bladder is often referred to as urothelial carcinoma or sometimes more traditionally called transitional cell carcinoma.

Signs and Symptoms

Symptoms of bladder cancer such as frequency, urgency, dysuria (painful urination) are common to many conditions.  Also, slow intermittent stream, pelvic and flank (kidney) pain can be associated.  Hematuria (blood in the urine) is a hallmark sign of bladder cancer and is how most patients with bladder tumors are discovered.

Risk Factors

  • Smoking – the most common cause of bladder cancer
  • Chronic cystitis – inflammation of the bladder of long periods of time
  • Chemical exposures – certain industrial chemicals increase the chance of bladder cancer
  • Phenactin – previously common analgesic
  • Radiation – exposure to the pelvis; often to treat other malignancies
  • Cyclophosphamide
  • Age – elderly are more prone to this cancer

Diagnosis

  • Imaging – CT scan with intravenous dye usually of abdomen and pelvis
  • Cystoscopy – a small camera inserted in the urethra to inspect the bladder
  • Urinary markers – multiple urinary markers exist to aid in diagnosis and/or management.  FISH (flouroescent in-situ hybridization), cytology, NMP-22, BTA are a few of the common ones used
  • Ultimately if you are found to have a bladder mass or tumor a TURBT (transurethral resection of bladder tumor) is performed for formal diagnostic and pathologic analysis

Staging

Once formally diagnosed CT (likely already performed), chest x-ray, and blood studies such as LFT’s (liver function tests) are performed to Stage the cancer.

  • Stage 1 – confined to the lining of the bladder (often termed non-muscle invasive)
  • Stage 2 – disease has entered the muscular lining of the bladder (detrusor)
  • Stage 3 – disease is in the local tissue surrounding the bladder
  • Stage 4 – disease is found in distinct areas from the bladder

Treatment 

Surgery is the hallmark of treatment for bladder cancer depending its Stage and Grade especially with focus on wether or not there is muscle invasion.

  • TURBT – repeated surveillance in the office with re-resection if needed is often recommended for non-muscle invasive, low grade, low volume tumors.  Often times at the original diagnostic TURBT a chemotheraputic agent, Mitomycin C, is administered to the bladder and sometimes a chemical called BCG is instilled in the office for treatment.
  • Partial Cystectomy – if the area is isolated especially near the dome of the bladder, removing just the section of involved bladder is an option
  • Radical Cystectomy – the standard of care for muscle invasive disease, this surgery removes the entire bladder, sometimes urethra, and pelvic lymph nodes.  The urine has to be re-routed in some fashion.  Multiple options exist for urinary management; neo-bladder (new bladder), ileal conduit, continent stoma etc are options you can discuss with your Urologist
  • Radiation – often used in conjunction with chemotherapy of the patient can tolerate chemo this method is often used in lieu of surgery for those who are not surgical candidates
  • Chemotherapy – often used either as treatment before or after surgery this adjunct treatment may also be used in conjunction with radiation

Cancer

There are many Urological malignancies most of which involve surgical intervention by our Urology team and often are treated with multi-modal therapy to include Radiation Oncology and Hematology/Oncology. Click below on topics for more information.

Continence Services

Urodynamics is a group of tests that allow your healthcare provider to look at how your lower urinary tract works. Your lower urinary tract includes the bladder (which stores urine) and the urethra (which is the tube that carries urine from your bladder to the outside). This is the only form of testing we have to look at the function of the lower urinary tract.

Urodynamics helps indentify specific problems related to:

  • Controlling your urine
  • Not emptying your bladder completely
  • Feeling of frequent and/or urgent need to urinate
  • Weak or intermittent (stopping and starting) urine flow
  • Frequent urinary tract infections

Typically within 2 weeks after your Urodynamics are completed, and your healthcare provider will review all the information and discuss the results with you. Then you and your healthcare provider will decide on the best plan of treatment for you.

Erectile Dysfunction

Erectile dysfunction (ED) is a medical term that describes the inability to achieve and or maintain an erect penis adequate for sexual function. This condition is one of the most common sexual problems for men and the chance for a man to develop age increases with increasing age.

Most men have difficulty with erections from time to time, yet in some men, it is a regular and more severe problem. It can cause low self-esteem, performance anxiety, depression and stress. Erectile dysfunction may affect the quality of a marriage or intimate relationships. However, there are many safe and effective ED treatments available.

Infertility

Infertility is the inability to conceive after at least one year of unprotected intercourse. Physicians recommend that couples unable to do in this amount of time be assessed for fertility problems. In men, hormone disorders, illness, reproductive anatomy trauma and obstruction, and sexual dysfunction can temporarily or permanently affect sperm and prevent conception.

Kidney Problems

Your kidneys filter waste and excess fluid that your body does not need. Their function is essential for good health. Many kidney conditions may be painful, even life-threatening. Many treatment options and methods of prevention are available. Symptoms of kidney problems include sudden onset of shaking, chills and a fever of more than 102 degrees Fahrenheit, constant ache in the side, burning sensation when you urinate, urinating often, fatigue, and nausea and vomiting. If you experience many of these symptoms, you should make an appointment to see a urologist.

Possible Kidney Problems

  • Kidney Infection
  • Kidney Stones
  • Kidney Failure
  • Kidney Cancer

Penile Cancer

Penile cancer is rare in the United States. African American males are affected twice as often as Caucasian males. The peak incidence is age seventy-five, and is rare before age forty.

Prostate Cancer

233,000 new cases of prostate cancer are expected to be diagnosed in 2014, which makes this the most common cancer in men with the exception of skin cancer.  Of those diagnosed there are expected to be almost 30,000 deaths due to prostate cancer in 2014.  While prostate cancer screening remains a controversial subject in the medical field we believe that early detection of clinically significant prostate cancers can meaningfully impact patient outcomes.

Risk factors

Age – the older we get the greater the chance of developing prostate cancers although in the elderly these cancers are often indolent
Ethnicity – African American heritage tends to lend itself toward early and more aggressive diagnosis.
Family history– having a first relative such as a father or brother diagnosed with prostate cancer increases risk of being diagnosed significantly.

Screening

There are no significant symptoms that indicate prostate cancer so screening (while controversial) has been used and has been shown to decrease mortality.  Enlarged prostate (BPH) often causes urinary symptoms which many people confuse with concerns for cancer.  Because there are no symptoms until later stages of disease you should talk with your health care provider about the risks and benefits of screening to make an informed decision.

Diagnosis

The Digital Rectal Exam (DRE) and a blood test called Prostate Specific Antigen (PSA) are the screening methods used and if indicated lead to a biopsy of the prostate for diagnostic purposes.  If prostate cancer is found then imaging such as a CT scan and/or bone scan may be in order to help plan treatments.

Treatments

Many treatments are available which can make deciding on a treatment quite confusing.  The decision is usually based on age, health status, aggressiveness of disease based on biopsy, lifestyle etc.

Surgery – a radical prostatectomy is the technical name for removal of the entire prostate gland often with a lymph node dissection.  Our Urologic surgeons perform many of these each year and remains the “gold standard”of prostate cancer treatment.

Expectant management – also referred to as watchful waiting, is often suggested for less aggressive character tumors.

Radiation – several forms are possibilities:

  • Brachytherapy – insertion of radioactive pellets into the prostate
  • External Beam Radiation – traditional radiation delivered over 8 weeks
  • Proton Beam – newer method similar to external beam
  • Cyberknife – traditional radiation with slightly different delivery

Cryotherapy – freezing of the prostate gland to kill tumor cells.

Hormonal therapy – manipulation of testosterone to cause regression or slow the process.

Chemotherapy – usually later in the treatment process after failure of more traditional approaches.

High Intensity Focused Ultrasound – not available in the United States; still multiple concerns over true cancer control this method continues to be researched.

Prostate Enlargement

Benign enlargement of the prostate gland, also known as Benign Prostatic Hyperplasia (BPH), is a common consequence of aging. Although not completely understood, the symptoms include frequency, urgency and decreased force of the urinary stream.

Prostatitis

The term prostatitis implies inflammation (‘itis’) of the prostate. However, inflammation isn’t always present, and neither is infection. Most patients and many physicians assume prostatitis is caused by a bacterial infection, unfortunately, the term prostatitis has become a “catch all” used to explain any undiagnosed symptom or condition that might possibly emanate from the prostate. If you have continued problems with your prostrate you should see a urologist.

Renal Cell (Kidney) Cancer

Cancer of the kidney affected approximately 65,000 Americans last year and caused around 14,000 deaths.  This tumor historically presented late but with imaging being used more common in general most are picked up earlier and are more easily treated.  The rate of detection has been increasing by about 2% over the past ten years.

Risk Factors

Smoking and obesity seem to be significant risk factors and there are some familial inheritance patterns that are associated with von Hippel-Lindau being the most common familial association.  Increasing age and renal cystic disease associated with renal failure are also common factors in people with renal masses.

Symptoms

Hematuria (blood in the urine) is the most common symptom.  A palpable abdominal mass and pain are also historically associated symptoms.  Other tumor effects such as weight loss, swelling and blood count abnormalities may be present.

Diagnosis

Imaging remains the gold standard of diagnosis.  A CT scan with contrast has a very high rate of accuracy as an initial diagnostic endeavor.  MRI, Ultrasound are also common modalities that are used.  Staging is based mainly on imaging.

Treatment

Surgery remains the hallmark of treatment for kidney cancer.  These tumors are generally not very responsive to chemotherapy and/or radiation although these other methods are used at times.  There are newer oral chemotherapy agents that have show some promise but are generally not used as first line treatment.  Unless there is extensive disease these surgical procedures are able to be performed  by minimally invasive techniques.

Radical Nephrectomy is removal of the entire kidney, partial ureter and the surrounding fat and lymph tissue.

Partial Nephrectomy is removal of the tumor only leaving as much of the normal kidney intact as possible.

Cyrotherapy is a procedure where the tumor is frozen to destroy the mass.

Radiofrequency ablation has been used at some centers but has some issues and is not often used on kidney masses.

Stone Disease

Stone disease, or nephrolithiasis, is a part of life in the South and particularly eastern North Carolina. It is slightly more prevalent in males compared to females and is also seen in children. It accounts for about 1% of hospital admissions. Unfortunately, without treatment most first-time stone formers will recur within 1-5 years. Your Urologist at Eastern Urological Associates has options for the conservative and medical treatment of stone disease to decrease r current stone forming episodes.

Humans are always on the brink of stone formation. Inadequate hydration, urinary tract obstruction, or the development of other medical problems may push these patients toward stone formation. The incidence of stone disease is on the rise due to poor diets, increasing complexity of other medical problems, and the epidemic of obesity in North Carolina. This region is also a high risk area due to dehydration from the warm climate and the high volume of gastric bypasses performed which predisposes patients to stone formation.

Stones seen in our are include calcium stones, uric acid, infection or struvite stones, and the rare cysteine stone. It is important to determine the type of stones being formed and to look for the metabolic disorder and/or anatomical problem predisposing one to stone formation. Common metabolic problems are dehydration, gastrointestinal malabsorption, high uric acid levels, and disorders of calcium metabolism. Please insert Harvard Health Watch recommendations and cite Daniel Pendick. Link to low oxalate diet recommendations.

Clinical presentations of nephrolithiasis range from asymptomatic to the critically ill, septic patient. Most patients, however, present with pain. Nausea, vomiting, bloody urine (hematuria), and fever are also common presenting complaints. Stone pain, or kidney colic, is typically episodic, severe, not relieved by over the counter analgesics, and not exacerbated by activity or positional changes.

Some stones are passable without intervention – only a specialist can determine this. Eastern Urological Associates (EUA) uses a thorough medical history, physical exam, and imaging to diagnose and manage nephrolithiasis. Their office has seven providers, a Phillips digital X-ray on site, as well as on site GE ultrasound and Nuisys multi slice CT scanner. EUA is a partner with Carolina Lithotripsy and uses EDAP TMS Sonolith technology to pulverize stones in a minimally invasive fashion. At Vidant Surgicenter and Vidant Medical Center all the latest technology is available including endoscopy equipment and laser technology for stones that require an operation. Our Urologists are experts in upper tract endoscopy and percutaneous approaches for the treatment of larger stones. They also assist their stone patients with lifestyle, diet modification, and other methods of conservative stone prevention.

Testicular Cancer

Testicular cancer is not overly common and is mainly a concern of men that are younger between 15 and 35 years of age generally.  Detected early testicular cancer has an excellent prognosis and self-exams are the main form of detection.

Risk factors

  • Undescended testicle – a history of undescended testicle increase ones risk
  • HIV
  • Genetic disorders causing changes in sexual development
  • Family or personal history
  • Infertility

Symptoms

Painless mass or swelling of the testicle

Diagnosis

  • Physical examination
  • Scrotal Ultrasound – based on imaging combined with exam and history most masses in the testicle can confidently be determined likely to be cancerous or not
  • Testicular cancer markers will be drawn
  • Orchiectomy – removal of the testicle surgically is performed for definitive diagnosis

Treatment

Testicular cancers are grouped into two categories: non-seminomatous and seminoma.  Treatment depends of the type of tumor and imaging studies (CT scan, chest X-ray, etc.) and marker status both pre and post-operative.  Modalities of treatment consist of possible further surgery to remove the lymph nodes associated, radiation and/or chemotherapy.

Vasectomy

Vasectomy is a simple office procedure in which a segment of the tubes carrying the sperm from the testicles is removed, and the ends are sealed off. The procedure is performed under a local anesthetic and only takes about ten minutes.