General Urology

The physicians at Urologic Specialists are committed to quality and the use of the latest diagnostic tools to provide the most comprehensive treatment to meet the needs of our patients. Many of our doctors have subspecialty training to give our patients the most advanced care and treatment available.

General Urology covers a wide variety spectrum of urologic diseases in men and women of all age groups. Our physicians are qualified and skilled in the diagnosis and treatment of urologic disorders and conditions.

General Urology Conditions and Treatments


Epididymitis and Orchitis

What is it?

Epididymitis and orchitis are common inflammatory conditions of the scrotum. Specifically, epididymitis is an inflammation of the epididymis. This is often caused by bacteria in the urinary tract, a urinary tract infection, or bacteria passed between partners during sex. It can occur in one or both tubes, and can be acute or chronic. When the inflammation spreads to a testicle it is called orchitis.

What is the cause or symptoms?

With acute inflammation the symptoms come on quickly and include: pain and swelling in the scrotum, fever, an urge to urinate often, a discharge from the penis, and pain during ejaculation.

With chronic inflammation, the symptoms may include: a dull ache or pain in the scrotum or groin and a heavy feeling in the scrotum.

How is it diagnosed?

Your doctor diagnoses epididymitis through a physical exam and possibly some simple laboratory tests. During the exam, the testicles are checked for swelling. The urethra may be checked for any discharge, and a urine sample is taken. If your doctor finds a mass on a testicle, an ultrasound may be ordered. This test uses sound waves to create a picture of the inside of your scrotum.

What can be done about it?

Treatment may include:

  • Antibiotics
  • Anti-inflammatories
  • Rest
  • Scrotum support
  • Ice and heat


Interstitial Cystitis

What is it?

Interstitial cystitis is a chronic inflammatory disorder of the bladder characterized by the findings of bladder pain or discomfort associated with urinary urgency and frequency. Interstitial cyctitis is also characterized by the absence of a demonstrative infection.

What is the cause or symptoms?

Most commonly in female patients, a long history of recurrent bladder infections can be obtained. This is not always the case but is probably the most common risk factor for ultimately developing interstitial cystitis. In men, the cause of interstitial cystitis is not as clearly noted by history. However, interstitial cystitis in men is underdiagnosed.

How is it diagnosed?

The most common method of diagnosing interstitial cystitis is looking in the bladder under anesthesia and gently overdistending the bladder. In 60-80% of cases, small red spots representing ruptured blood vessels just under the lining of the bladder will appear, which are called glomerulations. However, these are not always present. About 5-10% of patients also demonstrate ulcers in the bladder, which represents a more painful presentation of interstitial cystitis. Interstitial cystitis in its early phases may be suspected or diagnosed clinically without proceeding with cystoscopy or looking into the bladder.

What are the treatments of interstitial cystitis?

The treatments progress in a logical course beginning with dietary modifications, stress modification, and in some cases pelvic physical therapy. Following these measures, the use of medications such as Elmiron, Hydroxyzine, and Amitriptyline are frequently helpful. Bladder analgesics may also be employed. Additionally, the use of intra-bladder medications may be helpful. However, in some patients, these treatments actually will flare the pain. As mentioned earlier, pelvic physical therapy can be of great benefit for patients who demonstrate pelvic floor spasm in response to their bladder discomfort. The use of medications to relax the urgency and frequency to urinate, are frequently employed. Additional treatments for this particular symptom include the use of an InterStim pacemaker or the injection of Botox into the bladder wall. More complex medical management includes use of immune modulators such as cyclosporine. In patients with severe chronic pain, chronic pain management strategies are often employed in conjunction with pain management specialists. In the most extreme cases which have been present for a long period of the time, removal of the bladder may be contemplated.


Prostate Ultrasound and Biopsy

What is it?

Prostate ultrasound is a procedure that uses high-frequency sound waves delivered through a rectal probe to image, measure, and examine the prostate gland. If indicated, the ultrasound probe permits biopsy of the prostate using a small needle to obtain a core of tissue. These samples can then be examined under a microscope to determine whether cancer cells are present.

How do I prepare?

An oral sedative may be offered for relaxation during the procedure if desired. Antibiotics are commonly administered either orally or by injection before a biopsy procedure. An enema is recommended 1-2 hours prior to evacuate stool from the rectum and ensure proper imaging.

How is it performed?

The procedure is done right in the clinic setting and generally can be completed in 10-15 minutes.

During the procedure, you will be positioned either on your side or back on the exam table. The ultrasound probe, which is about the diameter of a thumb, is inserted into your rectum. Sound waves from the probe are used to generate an image of the prostate on a video monitor. Using the ultrasound as a guide, local anesthetic is injected into the nerves around the prostate to eliminate pain. A small biopsy needle is then directed through the probe and into the prostate. Several tiny samples are obtained from representative areas of the prostate. The rectal probe is then removed. The tissue samples are sent to a lab for examination by a qualified pathologist.

How long is recovery?

The presence of blood in the urine, stool, or semen is common for up to a week. Heavy bleeding, difficulties urinating, fever, chills, or back pain should be reported to the physician.


PSA Test

What is it?

The prostate specific antigen (PSA) test is a blood test used to help in the early detection of prostate cancer. PSA, an ingredient of semen, is made by the prostate and can be detected in the blood stream. The PSA test measures the amount of PSA in the blood. As a man ages, more PSA leaks into the blood. Problems with the prostate - such as prostatitis (prostate infection), BPH (benign prostatic enlargement), or cancer - may cause extra PSA to enter the blood. A prostatic massage or prostate biopsy can also raise PSA levels. If a PSA test shows higher than normal blood levels of PSA, other tests are necessary to help determine the cause of the increase.

Why is it performed?

Your doctor may recommend a PSA test for one or more of the following reasons:

  • You are over 50 years old.
  • You are over 40 years old and African American or have a family history of prostate cancer.
  • An abnormality is detected during your routine prostate exam.
  • You have symptoms that suggest problems, such as frequent urination (especially at night), urgent urination, having to strain when urinating, blood in your urine, or painful urination.

How is it performed?

You'll be sent to have your blood drawn. Blood is taken from your arm and sent to a laboratory for evaluation.

The time it takes to get your test results varies from lab to lab. Ask your doctor when you can expect them. When the results return, you and your doctor can discuss what they mean. A normal range for your PSA depends on a number of factors. These include your age, the size of your prostate, your risk factors for cancer, your symptoms, and the results of your previous PSA tests, if any. These factors are taken into account when your PSA test numbers are interpreted and evaluated.


Vasectomy

What is it?

Vasectomy is a relatively simple office procedure for male sterilization. It is considered the most effective birth control method procedure for men. Surgical reversal of a vasectomy is possible, but it is technically difficult and expensive to perform. Couples should carefully consider the decision to proceed with a vasectomy.

How is it performed?

Vasectomy is performed in the office as an outpatient procedure. Some patients may receive oral medication to help with relaxation. After undressing and lying on a table, an injection of local anesthetic will numb a small area of scrotal skin. One or two small incisions are made in the scrotum with either a scalpel or a pointed clamp ("No Scalpel" method). The vas deferens is delivered through the incision, and the tube is sealed, cut, and the ends buried apart. The ends of the vas are then sealed off using one of several methods. The small skin incisions may be closed with absorbable stitches. The entire procedure usually lasts 15-30 minutes.

What happens after?

During a vasectomy, the two tubes (vas deferens) that transport sperm from the testicles to the urethra are cut and sealed. The testicles continue to produce sperm, but once the sperm reach the point of obstruction in the vas the body digests and absorbs them. Since sperm only contribute to a small percentage of semen volume, you will not notice any change in ejaculation. After a vasectomy, active sperm remain in a portion of the vas. Numerous ejaculations are required to flush the sperm and render the semen clear, so contraception will be necessary for a period of several weeks or even months.

How long is recovery?

On the day of the procedure, it is best to rest and use an ice pack on the scrotum. The scrotum may appear bruised and slightly swollen for up to a week. A small amount of blood or drainage from the incision is normal.

To speed the process of recovery, follow these tips:

  • Stay off your feet as much as possible for the first two days.
  • Wear an athletic supporter or sung cotton briefs for support.
  • An ice pack on your scrotum can reduce swelling in the first 48 hours.
  • Tylenol is best for mild discomfort. Avoid aspirin, ibuprofen or naproxen.
  • Avoid heavy lifting, exercise, and sexual activity for one week.

Remember:

You are not sterile until semen specimens have been examined and are clear of sperm. Continue contraception until advised.

 

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