Urology

Advanced Kidney Stone Treatment

The Soltive Laser

At Avita Health System, we are committed to providing innovative, quality healthcare. That’s why we have acquired the Olympus Soltive^TM SuperPulsed Laser System, making us the first healthcare organization in Ohio to offer this brand-new kidney stone treatment technology. The Soltive laser enables our urologist to deliver quicker, more efficient kidney stone removal, resulting in faster treatment times, fewer procedures, and less discomfort.

The Soltive laser, the first major innovation in laser technology for kidney stones in two decades, combines lower energy levels and higher frequencies. The benefits of the Soltive laser over other lasers include:

• Reduces kidney stones to dust in half the time
• Creates much finer particles making it easier for you to pass the stones
• May require less treatments needed to break them up
• Less time under anesthesia
• Faster recovery

Kidney Stones

Kidney stones are hard and rock-like and can affect any part of your urinary tract. They have no single cause, but several factors may increase your risk of developing kidney stones, including:

• Family or personal history
• Dehydration
• High protein, sodium, and sugar diet
• Obesity
• Digestive diseases and surgery
• Other medical conditions
• Certain supplements and medications

Kidney stones typically do not cause symptoms until they move around inside the kidney or pass into the ureters. Pain caused by kidney stones can change as they move through your urinary tract. If you have developed a kidney stone, you may experience the following signs and symptoms:

• Severe, sharp pain below the ribs to the side and back
• Radiating pain to the lower abdomen and groin
• Intermittent pain that fluctuates in intensity
• Pain or burning sensation during urination
• Pink, red, or brown urine
• Cloudy or foul-smelling urine
• An increased need to urinate more often than usual or urinating in small amounts
• Nausea and vomiting
• Fever and chills if an infection is present

While most kidney stones pass without medical intervention, larger stones can become lodged in your urinary tract resulting in a urinary infection which can cause further complications. At this point, surgery may be needed. Call your primary care provider or schedule an appointment with a urologist.

Peyronie’s Disease Treatment

Most penises are NOT perfectly straight – in fact, it’s quite common for a penis to curve slightly to the left, right, up, or down while erect. However, a new curve or a more significant curve that makes sex difficult or painful is a cause for concern.

Peyronie’s disease occurs when scar tissue, called a “plaque,” develops under the skin of the penis and pulls on the surrounding tissue, causing the penis to bend or curve, usually most noticeable when erect. Peyronie’s disease affects the shape and size of the penis but does not impact urination or ejaculation. The most significant impact stems from difficulty or discomfort for the man or his partner during sex.

Peyronie’s disease CAN be treated. Though surgery is the gold standard, there are also non-surgical options available.

What are the Risk Factors for Peyronie’s Disease?

What are the Treatment options for Peyronie’s Disease?

When a patient first notices a plaque or curvature, it is common for the symptoms to change, or “evolve,” during the active phase. Rarely a curvature will self-correct, and resolve or decrease. Most often, following a period of months, the curve “stabilizes” and stops changing. This is the time when treatment options can be considered.

Surgical Options for Treatment of Peyronie’s Disease

Surgery remains the gold standard therapy for Peyronie’s disease, as there is no oral medication that has been scientifically proven to improve the plaque. Options are plaque excision and grafting, penile plication surgery, and placement of a penile prosthesis. In patients with both Peyronie’s disease and erectile dysfunction, a penile prosthesis is an excellent option to cure both problems.

Non-surgical Options for Treatment of Peyronie’s Disease

The first FDA-approved non-surgical option for Peyronie’s disease is called Xiaflex®, which is a series of injections administered in the office. The medication is indicated for curvature of at least 30 degrees, and consists of a series of 4 cycles of 2 injections per cycle. The goal of Xiaflex is to create small tears in the plaque, softening it and decreasing the curvature. As with any treatment option, you should discuss the side effects and expected outcomes with your urologist.

Erectile Dysfunction Treatment

From time to time, every man can have difficulty achieving or maintaining an erection. However, erectile dysfunction, or ED, is when a man has a persistent inability to achieve and maintain an erection that is firm enough for sexual intercourse.

Erectile dysfunction is very personal and talking about ED is one of the more humbling conversations any man can have. Rest assured, however, you are in the right place. Our urologists are experienced in discussing, diagnosing, and treating erectile dysfunction.

No matter the cause of your erectile dysfunction, it can be treated.

Common Questions About Erectile Dysfunction

What Treatment Options are Available for Erectile Dysfunction?

Medication: Oral medications such as Viagra, Levitra or Cialis are commonly used to treat erectile dysfunction.

Penile injection: Injection therapy requires the man to use a small needle to inject medication directly into the penis, resulting in an erection.

Counseling: Counseling may help patients whose erectile dysfunction has resulted from anxiety or depression.

Vacuum Erection Device: These devices placed over the penis to draw blood into the shaft resulting in an erection. Once the erection is created, a retaining band is slid down to the lower end of the penis to sustain the erection. This band can be left on for up to 30 minutes.

Lifestyle Changes: Some healthy lifestyle tips can help treat your ED, including quitting smoking, reducing alcohol consumption, losing weight, exercising regularly, and reducing stress.

Penile Implants: A penile implant is a medical device that is surgically placed into a penis to produce a natural-looking and natural-feeling erection. Sensitivity and the ability to ejaculate are not typically affected, and barring no medical condition, you will be able to orgasm normally.

Got more questions about Erectile Dysfunction and your treatment options? Visit edcure.org.

Male Urinary Incontinence Treatment

Unintentionally leaking urine (“incontinence”) affects nearly 1 in 10 men in the United States, and the incidence is increasing as the population gets older. Quite understandably, most men are uncomfortable discussing such a personal problem, even with their doctors.

Urge Urinary Incontinence, or UUI, occurs when a patient feels the need to void, and cannot make it to the bathroom in time, and leaks urine. This is typically from a problem with the bladder muscle itself being overactive, and there are many good treatment options that can be very effective in decreasing the amount of leakage.

Male Stress Urinary Incontinence, or SUI, typically occurs after treatment for prostate or bladder cancer. This type of leaking happens with coughing, standing, laughing, sneezing, exercise, etc. “Collateral damage” from the prostate cancer treatment – surgery, radiation, brachytherapy (seeds), etc. – can cause a man to lose control of his urination.

What are the treatment options for Male Urinary Incontinence?

Physical Therapy Treatment for Urinary Incontinence

Working on your own (“Kegels”) can help regain some sphincter function and urinary control.  Additionally, seeing a dedicated Pelvic Floor Physical Therapist can be even more beneficial in treating stress incontinence.

AdVance™ XP Male Sling for SUI

AdVance XP Male Sling is a minimally invasive surgical option for select patients with mild to moderate stress incontinence.

Artificial Urinary Sphincter (AUS) for treatment of Urinary Incontinence

An Artificial Urinary Sphincter (AUS) is the gold standard for treatment of male stress incontinence. The AUS is a device surgically implanted through two small incisions, allowing patients to regain personal control of their urination.

Why choose Avita for treatment of Male Urinary Incontinence?

While a man might hesitate to bring up this issue with his friends, family, or even doctor, there is no need to suffer in silence. We do our best to make every patient comfortable throughout the evaluation and treatment process and will work with each patient to define their individual goals. There are multiple excellent and effective treatment options for most men with incontinence, and we will work together to find the best one.

Reconstructive and Prosthetic Urology Services

Male reconstructive urology, a sub-specialty of urology also called “male genitourinary reconstruction,” addresses problems affecting a man’s ability to urinate and perform sexually, as well as deformities and infertility. These problems are a common cause of physical and emotional hardship in men. Despite taking a toll on a man’s day-to-day living, many men suffer from treatable symptoms for years before seeking treatment.

Frequently Performed Reconstructive Urology Procedures

Urethral Reconstruction, Repair of Urethral Strictures (Narrowing of the Urethra)

When scar tissue forms in the urethra, the tube that carries urine outside of the body, it can cause a urethral stricture. This can lead to painful and obstructed urine flow as well as infections. Depending on the severity of the condition, urethral reconstruction may be recommended. During a posterior urethral reconstruction, the scarred portion of the urethra is removed and the two healthy ends are stitched together. If too large of a section must be removed, tissue may be taken from another area of the body, such as the mouth, to bridge the gap.

Procedures for Penile Curvature (Peyronie’s Disease)

Peyronie’s disease is when scar tissue, called plaque, develops under the skin of the penis and pulls on the surrounding tissue, causing the penis to bend or curve, usually when erect. Surgery remains the gold standard therapy for Peyronie’s disease, as there is no oral medication that has been scientifically proven to improve the plaque. Another option is Xiaflex, a series of injections administered at the office.

Penile and scrotal reconstructive surgery

All men are different when it comes to the appearance and function of their genitals. Certain conditions are congenital (present at birth) and some develop over time – due to age, trauma, prior surgeries, or from other factors. For men who are concerned about their penis or scrotum, there may be medical or surgical options available to help. Our urologists have extensive experience in evaluating and treating various conditions. They will evaluate your concerns, explain the risks and benefits of all options, and together you can decide on how best to address your specific needs.

Penile implants for treatment of erectile dysfunction

Erectile dysfunction, or ED, is when a man has a persistent inability to achieve and maintain an erection that is firm enough for sexual intercourse. A penile implant is a medical device that is surgically placed into a penis to produce a natural-looking and natural-feeling erection.

Bladder neck reconstruction

Complications from surgery or radiation to the prostate can occur after treatment of malignant diseases like prostate cancer, or after procedures for benign prostatic hyperplasia (BPH). If scar tissue develops at the outlet of the bladder, also called the “bladder neck,” it can make urinating difficult and result in problems with urinary retention or even urinary tract infections. This is called a bladder neck contracture. Bladder Neck Reconstruction is a procedure that involves making a connection (anastomosis) of the bladder neck to the membranous urethra after the prostate is removed.

Surgical treatment of Male Stress Urinary Incontinence

When pelvic floor exercises (Kegels) don’t work, there are surgical options for treating male stress incontinence. For men with mild to moderate incontinence, a male sling surgery can be very effective. The sling supports and repositions the urethra into a more natural location. This prevents leakage with increased pressure, such as when coughing, laughing, or sneezing. For men with more persistent bladder leakage, the artificial urinary sphincter (AUS) surgery is an excellent option for most men. The AUS consists of 3 components: a urethral cuff, pressure regulating balloon and control pump in the scrotum. This mimics the function of a healthy urinary sphincter. Patients deflate the cuff by pumping when they need to urinate, and it automatically re-inflates to prevent leakage.

Cancer Survivorship

Urology Issues After Prostate Cancer

Prostate cancer is the most common non-skin cancer in America, affecting 1 in 9 men today. Nearly 3 million men in the U.S. count themselves as a prostate cancer survivor. Even after recovering from prostate cancer though, there are still multiple side effects that are common to prostate cancer treatment which include bladder leakage and erectile dysfunction.

Bladder Leakage After Prostate Cancer

After prostate cancer treatment, your bladder may leak anywhere from a few drops of urine to uncontrolled streams. Leakage typically tapers off within several weeks or months with most patients regaining bladder control within a year.

Persistent stress urinary incontinence (SUI) occurs when bladder control is not regained and urine persistently leaks out during activities such as exercise, sneezing, laughing, or coughing. Severe SUI may lead to leakage during simple activities such as walking or bending over. Urinary “accidents” can range from a few drops of urine to enough to soak through your clothes. Approximately 1 in 10 men who have recovered from prostate cancer still deal with persistent SUI.

Management options

For mild bladder leakage after prostate cancer:

• Absorbent pads
• Adult diapers
• Catheter collection device
• Penile clamp
• Pelvic floor physical therapy
  • Kegel exercises

For moderate bladder leakage after prostate cancer:

• Injections or bulking agents
• Male sling
  • Intended to support the urethra
  • Intended to prevent leaks when coughing, laughing and sneezing
  • Most patients can be continent immediately following the procedure

For persistent bladder leakage after prostate cancer:

• Artificial urinary sphincter (AUS)
  • 3 components: Urethral cuff, pressure regulating balloon and control pump in the scrotum
  • Mimics function of healthy urinary sphincter
• Deflate cuff when you need to urinate
• Automatically re-inflates to close off the urethra, preventing leakage

Erectile Dysfunction (ED) After Prostate Cancer

For some men, prostate cancer treatment may affect the nerves that control erections taking as much as 2 years or longer for a man to regain sexual function.

Penile rehab following radical prostatectomy surgery may help the nerves responsible for erections recover after surgery. If the ability to have erections doesn’t recover after prostate surgery, there are treatment options to help reestablish a spontaneous sexual relationship.

Treatment options include:

• Oral medications
  • May be offered before or after prostate cancer treatment
• Vacuum pumps
  • May be added to increase blood flow to the penis after treatment
• Penile injections
• Urethral suppositories
• Penile implants

FAQ:

How long does it take to achieve bladder control after prostate cancer?

SUI is usually resolved within the year following a prostatectomy, but in some cases SUI can persist past a year without improvement. One study found that at one year following a robotic prostatectomy, approximately 1 in 10 men still have persistent stress urinary incontinence (SUI).

Are penile implants covered by insurance?

Most insurers cover the diagnosis and medically necessary treatment of ED and SUI. Medicare has a national policy for penile implants–although coverage may depend on where you live. We will work with your insurance carrier to check coverage levels prior to receiving treatment.

Why don’t all men recover erectile function after prostate cancer treatment?

Your ability to have an erection after robot-assisted radical prostatectomy prostate treatment could be affected by pre-existing risk factors, including older age, cardiovascular disease, diabetes, cigarette smoking, physical inactivity and certain medications such as anti-hypertensive drugs or psychotropic medications. One year after prostate cancer treatment, up to 50% of men suffer from erectile dysfunction.

Don’t lose hope. We have helped countless patients regain control of their bladder and erectile issues. Request an appointment so we can start discussing which treatment options are right for you.