Bladder and urinary problems can be distressing and embarrassing. 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, difficulty in starting, and leakage.
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 the bladder
- Blood in the urine (hematuria)
- Leaking urine (incontinence)
- Urinary incontinence
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.
Orgasm and ejaculation are complex events coordinated by our neuromuscular systems. Loss or delay of orgasm or ejaculation and premature ejaculation can be incredibly distressing. Ejaculatory dysfunction as a whole is poorly understood, as we are just elucidating the physiology involved with the normal processes.
Loss or delay of orgasm or ejaculation is very difficult to treat. The culprit is usually prior surgery, other medical problems, and medications used to treat other medical problems. For instance, tamsulosin and fluoxetine are common medications that cause retrograde ejaculation and delayed ejaculation, respectively. Some spinal cord injury patients with loss of ejaculation have to rely on electrical/vibratory stimulation. Patients with many medical problems and on numerous medications may need to consider changing the therapy or medications traditionally used to control their medical issues.
Premature ejaculation (PE) can be equally distressing to the patient and partner. The prevalence is approximately 20-30% and is more common in younger men. It can have a significant impact and relationships and drives referrals to specialists for this reason. The time it takes from vaginal penetration to ejaculation is critical in determining the true definition of PE. PE technically has three components: 1) ejaculation that consistently occurs within 1 minute of vaginal penetration 2) the inability to delay ejaculation 3) and negative effects from this such as distress, frustration, and relationship issues. The normal time to ejaculation after penetration is 7 to 14 minutes. Possible contributors to PE are genetics, hyperthyroidism, and chronic prostatitis.
Treatment of PE involves either behavioral therapy or pharmaceutical therapy. Behavioral therapy, such as the "start - stop" and "squeeze" technique, can work, but the results are not permanent. Pharmaceutical therapy can have more lasting results, and a combination of behavioral therapy and medication can be effective. Common medications used are SSRI's such as Prozac and Zoloft, Tramadol (a synthetic opioid analgesic), PDE5 inhibitors such as Viagra, alpha blockers such as Flomax, and some topical applications which can be applied directly to the penis.
ED is more common than one might think - 20% of men worldwide are affected. It becomes more common in the aging male and those with other medical problems, such as diabetes, heart disease, and obesity. Management of ED has come a long way in the last 30 years. The idea that most cases of ED are psychogenic is largely considered archaic, as are previous management options that only involved counseling, sex therapy, and endocrine treatments. Fortunately, we have witnessed an explosion of medical therapies and major advances in surgical therapy over the last 20 years, providing a variety of safe and viable options.
There is a huge incentive to maintaining your overall health in addition to erectile restoration: as your medical problems become more complex, ED becomes more difficult to manage. Simple efforts towards lifestyle and diet modification, exercise, and seeing your primary care provider on a regular basis can not only save your life, but can greatly increase your odds of successful ED treatment outcomes.
The first step in treatment of ED is acknowledging it and talking about it. Talk to your partner, your primary care provider, and/or your Men's Health Specialist. If we can discuss the problem, we can identify it, then take steps to fix it. For instance, we would be interested in the following questions:
- If you wake up with erections in the middle of the night, do you get an erection that is not rigid enough for penetration?
- Do you get a rigid erection initially, but lose it prior to completing intercourse?
- Do you have significant penile curvature that is painful or making it difficult to penetrate?
These are examples of questions that would be asked during a consultation with our Providers. We are also interested in the complete health of our patients, so a detailed medical history would be gathered for anyone interested in treating their ED. This includes discussing other medical problems, past surgeries, and medications taken, alongside a thorough physical exam.
You may be asked to take the Sexual Health Inventory for Men questionnaire to diagnose the problem and/or to monitor progress during therapy.
Laboratory tests are often ordered, including electrolytes, glucose levels, blood counts, cholesterol levels, and testosterone. Other hormones assessed include prolactin, leutinizing hormone, and thyroid function testing.
Specialized testing is undertaken at times, but is less common today in the age of goal-directed therapy. There are numerous, safe pharmaceutical options, mechanical devices, and surgical options to help you achieve your goal of erectile restoration. With that being said, there may be a role for specialized testing with penile ultrasound or injection of an erection-inducing agent to assess the penile arterial and venous systems.
Testosterone supplementation is the mainstay of hormonal therapy for ED. Low testosterone or hypogonadism is usually not the sole cause behind ED, and certainly not for moderate to severe ED. However, it can certainly contribute to it. Testosterone supplementation would be more appropriately described as treatment for a Men's Health condition that is important to treat for many reasons - and, if neglected, can certainly impact optimization of erectile restoration.
In conjunction with ED, there are a myriad of signs and symptoms that make up the low testosterone or hypogonadal syndrome. These include loss of sex drive, fatigue, decreased concentration, memory loss, irritability, depression, and loss of lean muscle.
There are several routes to administer testosterone supplementation. The most cost-effective, but least natural, are injectables. Injectable preparation cause a huge spike in testosterone levels over a 3 day period followed by a 1-2 week crash of low levels. Subcutaneous pellets are available as Testopel. These can be implanted every 3-6 months and provide steady levels without the hassle of daily applications. Various transdermal applications are available that provide steady levels, but require daily applications. These include patches such as Testoderm and Androderm, and several absorbable gels/liquids such as AndroGel, Fortesta, and Axiron.
Lifestyle Modification & Medication Changes
Lifestyle modifications includes keeping other medical problems under control and modifying behaviors detrimental to one’s health. This means tight glucose control for diabetes, a low-fat diet for high cholesterol, lowering stress, quitting smoking, and getting regular exercise. The importance of these conservative goals is often overlooked.
Certain medications used for blood pressure control and lower cholesterol are more detrimental to erectile function than others. This is a simple matter of carefully reviewing your medications with your healthcare provider and discussing each one's impact on erectile function.
The FDA approval of Viagra in 1998 revolutionized the management of ED and has made erectile restoration more accessible to all men; it has also “mainstreamed” the problem, making it easier to discuss with your partner, friends, and healthcare providers. Current ED oral therapies work by augmenting the natural erectile pathways; specifically, they block an enzyme that cannibalizes a messenger molecule critical for achieving and maintaining an erection.
There are now four oral ED medications available in the United States: Viagra (sildenafil, Pfizer), Cialis (tadalafil, Lilly), Levitra (vardenafil, Bayer Scherring Pharma), and, most recently, Stendra (avanafil, Auxillum). They all have similar modes of action, side effects, and results. These medications have to be taken in anticipation of sexual activity and require sexual stimulation to work. Typical side effects are headache, muscle aches, facial flushing, and blurry vision, among others. Patients cannot take nitrates such as nitroglycerin in conjunction with these medications, as it may cause an unsafe drop in blood pressure. Generally, oral medications have success rates of 70%. Success rates are significantly reduced with multiple medical problems, particularly diabetes. Another major drawback of oral therapy is cost. Each pill can cost $15-30. Dr. Reeves’ practice at Eastern Urological Associates has a special prescribing license for sildenafil that costs $1 per pill.
Administration of an erection-inducing agent into the urethra was developed as an alternative to penile injection therapy. Naturally, there is some anxiety over penile injections for some men, and intraurethral suppositories are a reasonable alternative, although not as effective. Meda Pharmaceuticals brought MUSE to market in 1996. It is a small wax-like pellet packaged in a special applicator for intraurethral deposition. The applicator is inserted into the urethra, activated, the medicine deposited, and then it absorbs into the nearby erectile tissue. Success rates are around 50%, and typical side effects are urethral pain and less commonly bleeding, low blood pressure, and dizziness.
Penile injection therapy is just what the name implies: injecting an erection-inducing medication directly into the penile erectile tissues. Benefits are that the medicine is delivered directly to the target tissue, creating quick onset compared to other non surgical therapies. The downside is that you actually have to stick a needle into the side of the penis to deliver the vasoactive agent. It is generally well tolerated, and although it may be initially anxiety-provoking, it is not very traumatic. Potential side effects are pain at the injection site or vague penile pain, bruising or bleeding, and the development of progressive penile curvature from scarring induced by chronic injection use. Of all the therapies on the market, this one has the highest risk of inducing priapism, a serious condition in which an erection that will not go away. Fortunately, this risk is weighed against very good success rates of over 70%, depending on which agent is used.
There are three medications used for injection therapy; they can be employed alone (called monotherapy) or combined with one another into a bimix (two agents) or trimix (all three agents together). The more agents combined, the higher the risk of priapism. However, the more agents combined, the better the success rates.
Many pharmacies can compound these agents as a generic alternative that is more cost effective, bundling the injection agents together with the appropriate syringes and needles necessary for success at home. These generic agents have to be kept refrigerated to maintain effectiveness. There are two commercially available agents (Caverject, Edex) that are travel-friendly because they do not have to be refrigerated, and the entire system of medication, syringe, and needle is conveniently pre-packaged.
Proper and successful use of injection therapy requires appropriate counseling and education. Good results while minimizing side effects stems from proper technique. Dr. Reeves gives his patients home education materials, does face-to-face counseling and education, performs a test injection to ensure proper techniques and assess response, and instructs his patients on how to titrate up on the dose and what to do if a side effect such as priapism is encountered.
A vacuum erection device (VED) is another option for men who decline or do not respond to oral meds or more invasive erection-inducing agents such as injections or suppositories. The idea behind a VED is to cause the penis to engorge with blood, and then trap it there. This is accomplished by a device about the size of a tennis ball can, which is slid over the flaccid penis. From there, a mechanical pump is activated to evacuate the air from around the flaccid penis, creating negative pressure in that space and allowing blood to freely flow into the flaccid penis and become erect. Then, a elastic band is placed around the base of the penis to trap the blood in the erect penis.
Use of this device requires fairly good manual dexterity, so those with significant tremors or residual problems from a stroke may find it difficult to operate. It does require some patience and perseverance to fine-tune your ability to use it properly. In terms of maintaining an erection, success rates are very good with this device; however, patient satisfaction rates are low, generally less than 50%. Problems encountered are discomfort from the elastic constriction band, bruising (particularly if you are taking aspirin or some other anti platelet therapy or anticoagulant), a blue and cool-to-the-touch erection as the penis is engorged with venous and not arterial blood, and difficulty penetrating because the erection ends at the level of the elastic band, which creates a floppy erection which is not anchored to the bony pelvis like a normal natural erection.
With that being said, many men are happy with this option. It is also very popular with penile rehabilitation protocols following radical prostatectomy or cystectomy. Dr. Reeves commonly prescribes it for the purpose of penile rehabilitation in his practice, as well to help his ED patients regain some lost penile length; it is also commonly used preoperatively leading up to placement of a penile implant. VED’s can also be used in combination with other therapies, including oral meds, injections, and suppositories.
These devices are covered by insurance, but there is usually some degree of out-of-pocket expense. Most of the companies that make vacuum erection devices are set up to assist with insurance issues.
Penile implants, or prostheses, have been available for use for decades. They are an excellent option for patients with moderate-to-severe ED who have not responded to other more conservative therapies, or who were not candidates for less invasive therapies. The products used have gone through refinements over the years in order to better reproduce a natural erection and minimize potential complications. Implantation of a prosthesis requires a minor surgical procedure and some type of anesthesia such as a spinal or general anesthesia. Patients must be healthy enough to undergo a minor surgical procedure and must be healthy enough for sex. Satisfaction of these requirements is vetted out during the counseling process.
The principle behind implants is surgically placing concealable rods or tubes into the erectile tissue. Inflatable implants allow the tubes to be flat and flaccid when not in use and resemble a normal non- erect penis. When ready for use, a small concealed pump is activated that cycles saline into the tubes, which can be distended until they become rigid, nearly reproducing a normal erect penis. When no longer in use, the pump can be used to deflate the tubes completely back to the normal flaccid state.
There are various models of implants, differing surgical approaches, and two different manufacturers. Models include semi-rigid or malleable prosthesis, 2-piece inflatable prosthesis, and inflatable 3 piece prosthesis. The malleable products are the simplest, least rigid, and least natural in feel and appearance. 2-piece implants will achieve excellent rigidity but fall short of reproducing complete flaccidity. 3-piece implants are the most natural in appearance; they feel and function more like a real erection. They will achieve complete rigidity and flaccidity, generally provide some length and girth expansion, and maintain rigidity until the patient desires to deflate the device. Placement of a prosthesis will not affect hormone levels, penile sensation, orgasm, or ejaculation.
Dr. Reeves will provide you with all the information you need to decide which prosthesis is right for you. He will counsel you about the risks and benefits of an implant and describe the procedure and the recovery period in detail. He will make sure you make it comfortably through the recovery process and will educate you on how to properly use your implant.
Infertility affects about 15% of couples and renders 1 out of every 6 couples childless. There are a myriad of reasons for infertility; some are male-specific and can be treated by your Urologist. Your Urology provider will also have access to more specialized services, such as Reproductive Endocrinologists, if necessary. EUA works closely with our local Ob/Gyn services, as well as fertility specialists at UNC and Duke.
A thorough work-up for male infertility includes a medical and sexual history, physical exam, and laboratory evaluation including hormone levels and a semen analysis. Sometimes imaging is utilized.
Various problems can be diagnosed and successfully treated allowing natural conception. These include varicoceles, ejaculatory duct obstruction, and vasal obstruction. Other problems may need to be circumvented with assisted reproductive techniques, such as intrauterine insemination and in-vitro fertilization.
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, a fever of more than 102 degrees Fahrenheit, constant ache in the side, a burning sensation when you urinate, urinating often, fatigue, 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
Testosterone is an essential male hormone. It is important for male genital development, the male physical appearance, and for sperm production. Much is known about the detrimental effects of low testosterone from decades of research with the prostate cancer population. Some of these effects are weight gain, loss of lean muscle mass, decreased quality of life, sexual dysfunction, metabolic derangement, and musculoskeletal complications.
Testosterone supplementation is the mainstay of hormonal therapy for sexual dysfunction. Low testosterone, or hypogonadism, is usually not the sole cause behind erectile problems - certainly not for moderate to severe ED. However, it can contribute to it. It is important to treat low testosterone for many reasons. If neglected, it can impact the totality of male health, including the optimization of erectile restoration.
In conjunction with ED, there are a myriad of signs and symptoms that make up the low testosterone or hypogonadal syndrome. These include loss of sex drive, fatigue, decreased concentration, memory loss, irritability, depression, and loss of lean muscle.
There are several routes for the administration of testosterone supplementation. The most cost-effective, yet least natural, are injectables. Injectable preparations cause a huge spike in testosterone levels over a 3 day period, followed by a 1-2 week crash of low levels. Subcutaneous pellets are available as Testopel. These can be implanted every 3-6 months and provide steady levels without the hassle of daily applications. Various transdermal applications are available that provide steady levels, but require daily applications. These include patches such as Testoderm and Androderm, and several absorbable gels/liquids such as AndroGel, Fortesta, and Axiron.
The ADAM (Androgen Deficiency in the Aging Male) questionnaire may provide some insight into the nature and severity of potential low testosterone symptoms.
First reported in the 16th century, Peyronie's disease is a condition of fibrosis, or scarring of the penile shaft. It is present in 5% of the male population and more common in white men in their 50's. The spectrum of this disease can range from very mild, requiring only reassurance, to severe and debilitating, requiring reconstructive surgery or placement of a penile implant.
Peyronie's disease has been associated with other conditions, such as Dupuytren disease and diabetes, and medications like beta blockers. It is theoretically associated with buckling trauma to the layers of the penile erectile tissue, which results in fibrosis and the curvature of the penis - this can occur during normal intercourse, but is more likely in intercourse with a partially erect penis. It can also result from other external forces, such as trauma, or from chronic penile injection therapy for ED. A normal erection involves blood engorging the erectile bodies to rigidity; scarring of the erectile bodies causes disproportionate expansion and curvature towards the scarring. This can be so severe that the angle created by the curvature approaches 90 degrees and makes vaginal penetration difficult, painful, or impossible.
The disease is usually present in two distinct phases: an active or progressive phase, followed by a phase of quiescence or stability. The process of progression can be psychologically devastating to men. Presenting symptoms are pain with erections, curvature or deformity of the penis, penile shortening, palpable plaque or scar on the shaft, and ED. Pain is often present in the active phase, but can resolve as inflammation improves and the problem stabilizes. Curvature can be up, down, or lateral, and is often tolerated up to about 45 degrees.
Evaluation involves a medical and sexual history, an exam localizing the plaque, and notation of the direction and degree of curvature. Induction of an artificial erection is sometimes necessary. It is paramount to assess the severity of ED that may be present. Severe ED in conjunction with Peyronie's is best treated with placement of a penile implant.
Medical therapy involves the use of multiple oral, intralesional, or topical agents, whose effectiveness is not well supported by scientific literature. This includes Vitamin E, Potaba, tamoxifen, colchicine, intralesional steroids, interferons, verapamil, various topical agents, shock wave lithotripsy, and vacuum erection devices. The only noteworthy medical treatment for Peyronie's disease is intralesional collegenase (which contains auxillum, an enzyme that breaks down scars), which is now FDA-approved and has been evaluated positively in well-designed scientific trials. Known as Xiaflex, this medication is available at Eastern Urological Associates.
Despite the promise of Xiaflex, surgical therapy is sometimes required. Surgical approaches include plication of the side opposite the curvature to straighten the penis, relaxation incisions of the plaques, plaque excision with grafting, and placement of a penile prosthesis.
Our Providers have extensive experience with medical therapy and are experts in the surgical therapy of Peyronie's, having performed hundreds of plications, plaque excisions with grafting, and placement of penile implants for straightening of the penis in those with concomitant severe ED.
Most men somewhat in tune with local and national news outlets are aware of the controversy surrounding prostate cancer screening and PSA testing. The controversy came to the forefront in 2012, when the United States Preventive Services Task Force released a recommendation against PSA-based screening for prostate cancer. This recommendation followed several years of a steady increase in the number of radical prostatectomies each year due to the emergence of robotic technology in the Operating Room. As the volume of surgeries increased, so did the treatment of lower-risk, lower volume-disease; from there, we saw a rise in the prevalence of ED and incontinence as a result of prostate cancer therapy. The following year, the American Urological Association released new prostate cancer screening guidelines and tightened the PSA based screening cohort to men aged 55-69. Naturally, Urologists have seen a decrease in the number of referrals for elevated PSA's, and most would also admit to seeing a trend toward more men presenting with higher-volume, higher-risk prostate cancer due to the decline in screening over the last 2-3 years. We are also seeing an increase in prostate cancer deaths with the trend away from routine screening.
In reality, serum PSA testing is a good screening test. PSA stands for prostate specific antigen. It is protein produced by the prostate which serves a fertility purpose. Prostate cancer can cause an increase in PSA levels, so men who undergo regular screening may uncover a life-threatening diagnosis of prostate cancer before it can impact their survival. However, many prostate cancers are not life-threatening, so Urologists must be very careful in deciding who requires aggressive therapy. Aggressive therapy can impact a man's quality of life, so the stakes in making the right decision are high. Our providers welcome discussing this delicate matter. We believe that the screening tools currently employed are adequate, but the problem lies in what we choose to do with that information. For instance, not every man with an elevated PSA requires a biopsy, and not every man diagnosed with prostate cancer needs invasive therapy. The art of Urology involves tailoring the right decisions to each patient.
With that being said, Eastern Urological Associates has extensive experience in all aspects of prostate cancer therapy, from watchful waiting and active surveillance to cryosurgery, radiotherapy, radical surgery, hormonal therapy, and chemotherapy. We have daVinci certified robotic surgeons and over 95% of his cases are performed robotically. We also have experienced open surgeons, able to perform radical retropubic and perineal prostatectomies. Our practice includes the experts needed to treat all aspects of prostate cancer survivorship.
Lastly, we have a variety of treatments for advancing prostate cancer, including Xgeva, Xtandi, Zytiga, Provenge, and Xofigo. Please inquire about these and our ongoing clinical trials.
Prostate Cancer screening & treatment
In addition to the certainties of death and taxes, men must also prepare for an enlarging prostate (EP) or the development of benign prostatic hyperplasia (BPH). This process begins in earnest around the fourth or fifth decade of life. Most men seek treatment for BPH due to bothersome symptoms, but other serious complications can dictate treatment. These include the development of bladder stones, recurrent urinary tract infections, bladder weakening, urinary leakage, blood in your urine, deterioration in kidney function, and the inability to urinate at all.
The prostate is an accessory sex organ. It creates fluid that accompanies the ejaculate necessary for fertility. The unfortunate design of this system is that long after the prostate is done serving its fertility function, it remains a source of urinary problems. This is because the male urinary tube, or urethra, empties the bladder travels directly through the prostate; as the prostate enlarges, it puts pressure on and increases resistance in the urethra as urine travels through the prostate. The bladder responds to the relative obstruction created by BPH, becoming unstable and non-elastic. Late-onset effects include decreased force of contraction with typical symptoms of slow stream, dribbling, hesitancy, and the sensation of not completely emptying.
The prostate and bladder behave as a unit, and it is now known that an enlarged prostate (EP) or BPH is not the only cause of urinary symptoms. Men also have urinary symptoms due to a deterioration in the ability of the bladder to squeeze, other medical problems that cause to one produce too much urine, and sleep disorders, to name a few contributing factors. BPH appears to be an inheritable trait, so if your father had urinary difficulties in his 60-70's, you most likely are destined for the same experience. Hormones such as testosterone may play a role in the process as they may cause inflammatory symptoms, such as chronic prostatitis.
Management of BPH is governed by the 1) presence or absence of serious BPH related complications and 2) the degree of bother created by BPH related symptoms. Most men present with mild-to-moderate symptoms that might not cause much bother. Options for these men are usually observation or pharmaceutical therapy. Men that present with moderate-to-severe symptoms or more clear cut indications for treatment, such as those listed in the opening paragraph, usually do not tolerate observation and are offered pharmaceutical therapy or surgery.
The International Prostate Symptom Score worksheet can help clarify the presence and severity of prostate-related symptoms.
Common medications used for BPH-related symptoms are alpha blockers, 5 alpha reductase inhibitors, and anticholinergics. Alpha blockers are prostate smooth muscle relaxers and include Flomax (tamsulosin), Uroxatral (alfuzosin), and Rapaflo (silodosin). 5 alpha reductase inhibitors are prostate shrinking medicines and include Avodart and Proscar (finasteride). Anticholinergics are bladder relaxants designed to improve irritative voiding symptoms related to BPH, including Ditropan (oxybutynin), Detrol (tolterodine), Vesicare (solifenacin), Enablex (darifenacin), and Toviaz (fesoterodine). A new class of bladder relaxant called Myrbetriq (mirabegron) has been developed with promising results.
Sometimes men do not tolerate these medications, their BPH progresses despite medical therapy, or they may present with serious BPH-related complications early on. These are all indications to consider surgical options for BPH. Some surgeons treat every prostate the same way, meaning they may be comfortable with only one surgical technique for treating BPH. In contrast, providers at EUA tailor surgical approaches based on each individual .
Minimally invasive in-office treatments for symptomatic BPH have been available at EUA since 2015. These include UroLift and Rezum. Both are well tolerated with minimal sedation in the office and allow quick return to normal activities, usually result in improvement in symptoms comparable to surgery, and avoid erectile and ejaculatory dysfunction.
Surgical options include endoscopic (using scope technology), robotic assisted laparoscopy, or open surgery (making an incision). Endoscopic techniques all involve the same principle which has been around for decades: removing bulky prostate tissue through a scope, a procedure called transurethral resection of the prostate, or TURP. This is vastly different from the radical procedure a man would undergo for prostate cancer. There are various energy sources used to accomplish this goal: cautery, bipolar cautery, electro vaporization, and laser. Significantly enlarged glands (>100 grams) are more efficiently and safely treated with either a staged TURP, robot assisted laparoscopy (particularly if bladder stones involved), or an open suprapubic prostatectomy.
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 term used to explain any undiagnosed symptom or condition that might possibly emanate from the prostate. If you have continued problems with your prostate, you should see a urologist.
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.