Procedures

Bladder Neck Suspension

Needle bladder neck suspension, also known as needle suspension, or paravaginal surgery, is performed to support the hypermobile, or moveable urethra using sutures to attach it to tissues covering the pelvic floor. Of the three popular surgical procedures for urethral instability and its results in urinary stress incontinence, needle bladder neck suspension is the quickest and easiest to perform. Surgery for Intrinsic Sphincter Deficiency or ISD uses what is known as a Sling Procedure, or 'Hammock" effect, that uses auxiliary tissue to undergird the urethera and provide contractive pressure to the sphincter. Most stress incontinence surgeries fall into one of these two procedures and variants. Needle bladder neck suspension surgery can be performed as open abdominal or vaginal surgery, or laproscopically, which allows for small incisions, video magnification of the operative field, and precise placement of sutures.

Brachytherapy

Brachytherapy is a prostate cancer treatment. Radioactive seeds or sources are placed in or near the tumor itself, giving a high radiation dose to the tumor while reducing the radiation exposure in the surrounding healthy tissues. The term "brachy" is Greek for short distance and brachytherapy is radiation therapy given a short distance: localized, precise, and high-tech.

Cryotherapy

Cystoscopy

When you have a urinary problem, your doctor may use a cystoscope to see inside your bladder and urethra. The urethra is the tube that carries urine from the bladder to the outside of the body. The cystoscope has lenses like a telescope or microscope. These lenses let the doctor focus on the inner surfaces of the urinary tract. Some cystoscopes use optical fibers which are flexible glass fibers that carry an image from the tip of the instrument to a viewing piece at the other end. The cystoscope is as thin as a pencil and has a light at the tip. Many cystoscopes have extra tubes to guide other instruments for procedures to treat urinary problems. While the physician is completing this procedure he has a video camera so that the patient can see and understand what is happening at the time of the procedure.

ESWL

Lithotripsy

Extracorporeal shock wave lithotripsy is a technique for treating stones in the kidney and ureter that does not require surgery. In stead, high energy shock waves are passed through the body and used to break stones into pieces as small as grains of sand. Because of their small size, these pieces can pass from the body along with the urine. Using x-rays or ultrasound to pinpoint the location of the stones, the body is positioned so that the stones are targeted precisely. About 1-2 thousand shock waves are needed to crush the stones. The complete treatment takes about 45 to 60 minutes.

Neurosacromodulation with MedTronic Interstim System

Pelvic Organ Prolapse Repair

Penile Prosthesis

A penile prosthesis is another treatment option for men with erectile dysfunction. These devices are either malleable or inflatable. The simplest type of prosthesis consists of a pair of malleable rods surgically implanted within the erection chambers of the penis. With this type of implant the penis is always semi rigid and merely needs to be lifted into the erect position to initiate sex. Today, many men choose a hydraulic, inflatable prosthesis, which allows a man to have an erection whenever he chooses and is much easier to conceal. A penile implant is usually used when there is a clear medical cause for erectile dysfunction and when the problem is unlikely to resolve or improve naturally or with other medical treatments. Sometimes a penile prosthesis is implanted during surgery to reconstruct the penis when scarring has caused erections to curve. The inflatable penile prosthesis consists of two cylinders which are placed surgically in the body. The tow cylinders are inserted in the penis and connected by tubing to a separate reservoir of fluid. The reservoir is implanted under the groin muscles. A pump is also connected to the system and sits under the loose skin of the scrotal sac, between the testicles. To inflate the prosthesis, the man presses on the pump. The pump transfers fluid to the reservoir, deflating the penis. While men who have had the prosthesis surgery can see the small surgical scar where the bottom of the penis meets the scrotal sac, other people probably will be unable to tell that a man has an inflatable penile prosthesis. When the penis is inflated, the prosthesis makes the penis stiff and thick, similar to a natural erection. Most men rate the erection as shorter than their normal erection; however, newer models have cylinders that may increase the length, thickness, and stiffness of the penis. A penile prosthesis does not change sensation on the skin of the penis or a man's ability to reach orgasm. Ejaculation is not affected. Once a penile prosthesis is put in, however it may destroy the natural erection reflex. Men usually cannot get an erection without inflating the implant. If the implant is removed, the man may never again have natural erections.

Photoselective Vaporization of the Prostate (PVP)

PVP is a minimally invasive procedure that uses a special high - energy laser to vaporize excess prostate tissue and seal the treated area. The procedure is performed on an outpatient basis in a hospital or surgical center and may be performed under local, spinal or general anesthesia. PVP takes between 10 and 30 minutes to perform, depending on the size of the prostate and patients are usually discharged within a few hours. The type of laser used in PVP is delivered to the prostate through an endoscope which is a device that consists of a tube and an optical system that is inserted into the urethra. The procedure prevents damage to surrounding tissue and minimizes side effects such as pain, blood in the urine, and swelling.

Prostate Needle Biopsy

If prostate cancer is suspected, a biopsy is recommended. A prostate needle biopsy is a surgical procedure in which a small sample of tissue is removed from the prostate gland and examined under the microscope by a pathologist, a doctor specializing in identifying disease through the study of cells, tissue and organs. The procedure takes about 15 minutes and is usually performed in the urologist's office in conjunction with transrectal ultrasound or TRUS, a procedure that uses sound waves to create a video image of the prostate gland. With the help of TRUS, a doctor guides a biopsy gun - a hand-held device with a spring-loaded, slender cylinder of tissue called a core in a fraction of a second. Biopsy needles are tiny. A sliding sheath opens once the needle enters the prostate, closes onto a sample of tissue and the needle is withdrawn. A sextant or six part biopsy of each side is the most common prostate biopsy procedure. An average of twelve cores are taken form the prostate to get a representative sample of the prostate gland and determine the extent of any cancer. In order to make the patient feel a little more comfortable during the procedure, a local injectable anesthetic is given.

Pubovaginal Sling

The DaVinci Surgical System

Transurethral Resection of the Prostate

This is a surgical procedure used most often to treat men with benign prostatic hyperplasia or BPH. The operation removes part of the prostate gland surrounding and constricting the urethra, the tube that takes urine from the bladder through the penis and out of the body. A tool with wire loop on the end is passed into the penis and through the urethra to the prostate gland. Electricity is then passed through the wire to heat it and cut the tissue. A representative sample of the prostate tissue removed during TURP is examined by a pathologist to determine whether any cancer is present. Although, BPH is not malignant, it is possible for BPH and prostate cancer to exist within the same prostate gland at the same time.

Ureteroscopy

If you have a stone lodged in your ureter or have an area that needs more study in your ureter, your doctor may recommend an ureteroscopy, usually with general or regional anesthesia. The ureter is the tube that carries urine from the kidney to the bladder. The ureteroscope is a special, very thin instrument used to look directly at and visualize the inside of the ureter. Some ureteroscopes are flexible like a small, very long straw. Others are more rigid and firm. Through the ureteroscope, the doctor can see the stone. The doctor can then move the stone, either by removing it with a small basket at the end of a wire inserted through an extra tube in the ureteroscope or by extending a flexible fiber that carries a laser beam to break the stone into smaller pieces that can then pass out of the body in your urine. How and what the doctor will do is determined by the location, size and composition of the stone. The doctor may leave a stent, a flexible tube that keeps the ureter open for drainage after the procedure.

Vasectomy

Vasectomy is a minor surgical procedure in which the sperm duct, or vas deferens, is cut in order to achieve sterility.

In the male there are 2 muscular tubes, one leading from each testicle, called the vas deferens. The vas deferens carry sperm from the testicle to the prostate gland. By dividing the tubes we interrupt the normal flow of the sperm to the outside.

Following this operation there will be no change in masculinity or sexual potency. There is no detectable change in the quantity of semen; sperm makes up less than 1% of the volume of semen, the rest being made up by the fluids from the prostate and seminal vesicle. The sperm cells themselves are still produced, but are accumulated in the epididymis gland and are reabsorbed by the body.

ABSOLUTE STERILITY IS NOT GUARANTEED. There have been incidents of re-growth of the vas (0.2-1%). However, this is exceedingly rare. Most authorities agree that sterility has been produced once semen shows no sperm at 8 weeks after surgery, again there have been some late incidences of re-growth of the vas after several years (0.08). Vasectomy is probably the safest form of surgical contraception.

There are other methods of birth control including rhythm method, use of condoms, withdrawal, birth control pills, use of a diaphragm, use of spermicidal jelly or cream, and tubal ligation (ligating the fallopian tubes in the woman).

This procedure can be reversed; however, the results are not 100%. Complications are similar to those of any type of surgery and include delayed bleeding (1-3%) and infections (1%).

The procedure is usually done with local anesthesia in the office; however, it can be done with IV sedation or anesthesia, if so desired.

If possible, the patient should shave all hair from the scrotom before coming to the office.

If taking aspirin or blood thinners, the patient should discontinue this for one week prior to having the vasectomy performed.

Vasovasostomy