Cystoscopy
Cystoscopy is a bread and butter tool of urologists. What it allows us to do is to see inside the lining of the bladder and urethra. We can see and learn a lot about anatomy using cystoscopy.
Cystoscopy, the word is broken down, means cysto-, the bladder, and -oscopy meaning camera. Simply put, it is a camera looking into the bladder to tell us about your anatomy.
We perform this procedure to diagnose obstruction and tumors or bladder cancer. Cystoscopy is an outpatient procedure and we provide it in our office with no anesthesia. You can drive yourself and eat breakfast before the procedure.
The idea of a cystoscopy is very stressful for a lot of people because they don’t know what to expect.
Step By Step
You will drive yourself to the surgery center after eating a lovely full breakfast because there is no anesthesia.
You will check-in, and the nurse will fill out the customary paperwork. She will also take your vitals and address any other concerns that you have
You will need to get undressed from the waist down because that is where the bladder is. We will provide you with a gown to keep you as modest as possible during this procedure.
The nurse will then clean you off with some soap to keep the procedure as clean as possible.
The doctor will then come in, answer any questions that you have, and then begin with the procedure.
The camera used for the cystoscopy is a long catheter with a digital camera attached. It enables you an a doctor to see what is going on.
Looking in the bladder takes about 1-2 minutes. And we will talk you through it the entire time if you like. The whole experience is less than 1/2 hour.
Cystoscopy should not be painful, but you may feel wet because of the water used to allow the catheter to go in. And it feels like you have to urinate. We do use lubrication to guide the catheter in without additional anesthesia.
Side effects of cystoscopy are minimal and rare. However, in some cases, you may experience mild pain, burning with urination, the urge to urinate, or a urinary tract infection.
Prostate Biopsy
A prostate biopsy is usually recommended to determine if you have prostate cancer. It is the only test able to diagnose cancer definitively. The procedure is typically performed in our ambulatory surgery center and takes about five to 10 minutes total.
Before the procedure, your urologist will ask you to stop aspirin, Plavix, or any blood thinners from helping prevent excessive bleeding. A doctor will prescribe you antibiotic to take to help prevent infection.
At the surgery center will change you into a gown and come into one of our procedure rooms. The urologist will use a specially designed ultrasound to help identify the prostate and give a local anesthetic nerve block to prevent any pain. Generally, there are 10 to 16 biopsies. The size of the prostate is measured as well to help with treatment options in the future.
Then we send the biopsies to a pathologist who will then look at them under the microscope. It generally takes between two and seven days to get the results back to tell if there is cancer or not. We’ll typically call you with those results and schedule an office visit if needed.
Following the procedure, you can expect blood in your urine and stool for several days. And your ejaculate for about 10 to 15 ejaculations.
Infections are rare but typically present with fevers or chills. If you have these, it may be a sign of a severe infection. Please call our office or go to the emergency department for the evaluation.
Urodynamics
Urodynamics test measures the function of the lower urinary tract system. The lower urinary tract system includes the bladder, which stores the urine, and the urethra (the tube where the urine travels through).
Why do I need to do the urodynamics procedure? Sometimes symptoms are vague, and a urologist wants to do more invasive procedures or recommend surgery. He or she wants to know what exactly is the function of the bladder in the disease process.
The urodynamics looks at the function in the muscle and the emptying of the bladder to answer a question.
What should you expect when you come in for urodynamics?
It’s good to come with a medium-full bladder. The beginning of the test is usually just boiling into a measuring cup, which measures both the flow speed and how well you emptied afterward.
The next step is a catheter going into your bladder, which measures how well you emptied or a post-coital residual. This catheter specialized catheter has pressure sensors. It allows urine to go out and sterile fluid to go back in your bladder to fill your bladder.
The next step is cystometrogram. We place a catheter outside of the bladder to measure the interim domino pressure. A very small tube through the rectum or vagina.
Then, small sticky pads are placed on either side of your bottom to measure your external sphincter activity, both during filling and urination. It is called electromyography. This lets us look at your bladder function as it tries to empty
After The Test
After you’ve emptied your bladder, all of the tubes will be removed, and you’re allowed to leave. There are no special instructions after you’ve had a urodynamics test.
It’s normal to possibly feel a little irritated when you urinate for the day of your study, but this should clear up. And if it doesn’t, call our office or health care provider to check for infection, which is very rare.
Ultrasounds
Our specialist perform thorough ultrasound test of the kidneys, bladder, prostate and penis in our comfortable office.
Pessary Insertion
A pessary ring is in a medical device inserted inside the female vagina to support the prolapse. The prolapse is a widespread condition where the bladder, uterus, or different bowel parts can descend into the vagina and even bulge.
When prolapse bulges out, it might cause an unpleasant sensation like vaginal pressure discomfort, difficulty emptying the bladder, and sometimes sexual intercourse problems.
A pessary has a firm outer rim and in the middle has a membrane. It just folds in half, slips into the vagina. The vaginal sidewalls are what actually hold it in place.
After placing the ring, the urethra has a firm surface to close on when exertion like the cough, laugh or sneeze causing the leak.
Bladder instillations (BCG and DMSO)
When patients have recurrent urinary tract infections or have the symptoms, when the culture is not positive for an infection, it means that your bladders inflamed. And when tissue becomes inflamed, it becomes more susceptible to further irritation, which creates a vicious cycle.
When that happens in the bladder, it becomes more susceptible to bacteria causing infections. So, what we like to try to do is settle down that inflammatory process. Often, when we settle down the inflammatory process, we notice the symptoms go away. The bladder can heal itself.
Bladder instillations are a special mixture of solutions that we mix up in the office. They can be a variety of different things. We have a standard solution that we use in the office or prescriptions such as DMSO or BCG.
We put a very teeny tiny catheter into the bladder. Then drain the bladder of all the urine and inject this solution into the bladder.
It helps to coat the lining of the bladder so that the bladder can heal. We tell the patient to hold it in their bladder for an hour or two, depending on the solution. Then the patient can void that out normally.
It takes 3 to 4 of these bladder cocktails to really start noticing benefits. You have to be patient. These symptoms didn’t generally start overnight. They develop over time, and when the bladder becomes so inflamed, it usually takes a few weeks to help that bladder settle down.
Prostate cancer injections
We offer our patients hormone therapy for the treatment of prostate cancer to decrease levels of testosterone. Testosterone is the primary fuel for prostate cancer. And the main goal of hormone therapy in prostate cancer is to deprive it of this fuel.
The main source of testosterone is testicles. Around 97 – 98% of testosterone produced in the body comes from there. Initially, we block the testes chemically, depriving the prostate cancer of its primary fuel.
We use hormone therapy for prostate cancer in advanced disease or locally advanced disease. In the setting of locally advanced disease, what we’re doing is we are trying to cure cancer. However, in the more advanced stage, we can only control the spreading of cancer cells.
From the whole spectrum of side effects, we can categorize them into what you see, what you don’t see, and what you feel.
What you don’t see are the metabolic side effects. What you see are the physical side effects that you see. Finally, what you feel are the side effects that have to do with cognition and processing.
Biofeedback and Electrical Stimulation
We provide this procedure in the office to strengthen the pelvic floor muscles for people with incontinence, overactive bladder, urinary frequency and pelvic pains.
Microwave Prostate Therapy (TUMT)
It is a safe and effective, non-surgical treatment for BPH and chronic non-bacterial prostatitis. It minimizes side effects and the risk of impotence associated with more invasive treatments. TUMT also makes it ideal for sexually active and other high-risk patients, offering men a significant life quality improvement.
TUMT creates heat by properly locating a microwave antenna in the prostate, destroying hypoplastic prostate tissue to facilitate urinary outflow. An applicator enables various positioning options and simplifies the procedure with a single protocol for all prostate sizes.
Thermostatic treatment is fast, efficient, and cost-effective. This minimally invasive procedure requires no anesthesia. That is why we perform the treatment in our office. With an average treatment time of just one hour, TUMT improves clinical results. It’s an effective alternative to more invasive treatments, reducing urinary frequency urgency, and intermittent flow.
Rigiscan
We perform this diagnostics to find out the the etiology of erectile dysfunction. If you suffer from erectile dysfunction, don’t forget to read our article about Viagra.
Injection for Peyronie’s Disease
There are several injections types of injections for Peyronie’s Disease. For example, if you have a penile curvature with the plaque, we would inject multiple times into this plaque.
The other injection type is an enzyme, which we would inject at one location within the plaque. That enzyme eats away at the plaque tissue to relieve the curvature. We provide the injections in conjunction with patients doing penile tracks and therapy at home.
Testopel®
Testopel® is an FDA approved treatment for testosterone replacement. If you have low testosterone and are on one of the testosterone replacement agents, you are a potential candidate for the Testopel®.
Testopel® is a palate based surgery or procedure that’s done in the office. It takes five minutes with pellets lasting for three to four months at a time. In other words, you come to the office, and we place the pellets underneath the skin using a minor procedure. And then you no longer have to apply the medication at all for the next three months.
Once every three months, you come back to the office, and we check your blood to make sure it’s time to replace the pellets.
The risks of the Testopel® are the same as the risks of the other testosterone preparations. And these are very safe when used under the care of a well-trained urologist or endocrinologist.
Interstim®
Interstim® removes the symptoms of an overactive bladder by affecting the nerves of the bladder. We use it for patients who do not respond to medications for overactive bladder or for patients who cannot tolerate medications.
Interstim® therapy or can work by stimulating the sacral nerves. It can reduce the signals to the nervous system that may be causing overactive bladder symptoms of frequency, urgency, and urge incontinence.
The first step within therapy is a simple test Interstim® implant. With this test implant, the software is implanted near the tailbone and is connected to an external stimulator. The patient then experiences the effects of the intestine during a one week home test period.
If this test is positive, the patient can then have a permanent implant placed, which is a similar but somewhat more involved procedure. It is a step where a permanent pacemaker-like device is placed entirely under the skin to stimulate the sacral nerve tailbone. It works much like a pacemaker. By stimulating the sacral nerve, it can help control the symptoms of overactive bladder.