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Our Services
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Urinary
Incontinence
A problem which commonly results from:
- Infection in the urinary tract
- Hormonal changes in women
- Malfunction in the nerves that allow the bladder to store urine
- Medication side effects such as tranquilizers, anti-histamines, or
diuretics
- Urinary sphincter (valve muscle) weakness, causing leakage with
stress maneuvers (coughing, sneezing, laughing, lifting, etc.)
- Bladder muscle over-activity, causing urge incontinence (leakage
when you are rushing to the bathroom.)
- Problems that may relate to a previous surgery, a neurological
problem and/or gynecological disorders
Unfortunately, many people do not seek help for
this problem, either because of embarrassment or because they are
reluctant to have surgery. Correct diagnosis is critical, and often simple
testing can tell whether non invasive treatment or more involved
treatments are necessary. Almost all people can be significantly helped
after proper evaluation and treatment.
Most patients with urinary incontinence can be
treated without surgery. We have an established program of biofeedback,
bladder training, and behavioral modification. These are highly successful
in treating bladder dysfunction without need for drug or surgery. The
emphasis of our treatment program is to provide the patient with the best
quality of life that is possible.
Surgical Procedures for Urinary Incontinence
We offer TVP (Tension Free Vaginal Tape), a non-invasive
procedure as an outpatient with great success rate. There is no surgical scar and the
patient may return to work after a few days.
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Benign Prostatic
Hyperplasia
Normal
Prostate
Enlarged Prostate
Normal Prostate:
Normally the size of a walnut, the prostate gland produces fluid to help
sperm survive in the acidic vagina.
Enlarged
Prostate: With aging prostatic growth may cause back-up and lead to infection, stone
formation, and kidney damage.
Some of
the commonly asked questions about Thermotherapy Treatment of an Enlarged
Prostate.
Q.What
happens during Thermotherapy?
A treatment catheter
with a tiny internal antenna is inserted into the urethra and positioned
at the center of the prostate. With a small external ultrasound probe, the doctor
then checks that the treatment catheter is in exactly the right place. The
prostatron then produces radiative heating through the antenna. The
antenna is connected to a computerized system that helps control the
treatment.
Q.How
long does the treatment take?
Thermotherapy with the
prostatron takes about 30 minutes. During the procedure, you lie on the
treatment table and can pass the time resting, reading, or sleeping. Because general anesthesia
is not required, you are free to go home soon after the
treatment.
Q.Will
I feel heat during the treatment?
Because the
prostatron system circulates cool water through the catheter applicator,
the urethra is constantly cooled and protected. Further, the system
includes a thermo sensor that continuously monitors the temperature during
treatment. During the treatment you may feel heat in the prostate area.
This sensation is normal and usually easily tolerated.
Q.Will I feel pain during the
treatment?
You should not feel pain during Thermotherapy.
Experience worldwide has shown that general or spinal anesthesia
is not required, but your doctor may give you medication for discomfort. During
the second half of the treatment, you may have a strong desire to urinate.
Patients are instructed to tell the doctor when this
occurs.
Q.Does
Thermotherapy cause side-effects?
There are no
serious side-effects associated with standard treatment. High-energy
treatment has more potential side-effects than standard treatment. Your
doctor will be able to provide you with more information about the right
prostatron treatment for your condition.
Q.Is Thermotherapy an effective treatment for
BPH?
Yes, it is. Numerous studies have shown that
prostatron's results are better than those associated with medication and
comparable to those associated with surgery in providing relief of
symptoms. In addition to being an effective long-term treatment for the
symptomatic BPH, Thermotherapy is safe, easy to administer, easy on the
patient and requires no hospitalization.
Q.How do I know if Thermotherapy with the
prostatron is right for me?
You should discuss Thermotherapy with your doctor.
We have done over 250 cases with excellent results. It is approved by Medicare and most
insurance companies, and is performed in the office under local anesthesia.
Surgical
Treatment
- Transurethral Resection of Prostate
(TURP)
Transurethral resection of the prostate (TURP) has
been the primary choice of treatment during the past 50 years for BPH that
causes obstruction of the bladder outlet.
Approximately 400,000 transurethral resections of the prostate are
performed annually in the United States. TURP is a safe procedure with
four out of five patients experiencing resolution of their voiding
symptoms with improvement of all of their urinary flow measurements.
Essentially, TURP is the removal of the obstructing portion of the
prostate with a telescopic knife. The TURP requires an anesthetic and
takes about 30-60 minutes to perform. A tube or catheter is inserted
into the bladder and is left in place for 24 to 48 hours. The
hospitalization lasts from 1-3 days and requires two weeks of severe
activity restrictions and another two weeks of modest restriction. No
treatment to date has bettered the long term effectiveness of TURP in
alleviating obstruction caused by benign prostatic hyperplasia.
Because TURP is a surgical procedure with some risks, and because
of the costs and time off work. Other methods of therapy currently showed similar & less complications.
- Transurethral Vaporization of the Prostate
(TVP)
'Vaporization' of the prostate is one of the new treatment options for
prostate enlargement. The Vaporizor uses a high energy electric source
similar to the electrical source used for transurethral resection or
incision of the prostate mentioned above. The difference is the amount
of electrical current used (all are safe) and the type of contact made
with instrument. For transurethral resection the electric current is
passed through a small wire and this allows cutting of the prostate
tissue to remove it, but if the current is turned to a higher setting
and blunt roller ball is used (about the size of a BB) the tissue
actually melts or vaporizes.
Essentially, the procedure consists of passing an electrode into the
prostate under telescopic guidance. The electrode is then used to
vaporize the obstructing portions of the prostate. Compared to
transurethral resection, the advantages of the vaporization procedure
are: no significant bleeding and shorter hospitalization. The
vaporization prostatectomy is not optimum in the treatment of the very
large prostate, because of the necessity for multiple treatments.
Another concern is that no prostate tissue is removed so we cannot be
certain that cancer does not exist. The biggest advantages: it is an outpatient
procedure with very little bleeding!
- Transurethral Incision of Prostate
(TUIP)
A transurethral incision of the prostate (TUIP) is
the alternative to TURP that comes closest to matching its results in
both terms of symptom relief and improvement in flow rates. The basic
goal of the procedure is to remove the minimum amount of prostate
tissue to allow adequate flow through the urinary channel. This is done by
making a simple cut or incision along the entire length of the prostate.
Because of the circular muscle fibers running around the prostate, the
TUIP is particularly beneficial for smaller prostates and does have a
lower incidence of ejaculation disturbances. The success rates for the
TUIP are about the same as for TURP, but only in those patients that are
carefully selected (smaller prostate). Hospital stays and recovery are
much shorter.
- Prostatectomy
Open prostatectomy
refers to a major surgical procedure for removal of the obstructing
portion of the prostate. Open prostatectomy entails an incision in the
lower abdomen. The prostate can be approached either through the bladder
(suprapubic) or directly through the capsule of the prostate
(retropubic). In either case, the blocking or obstructing portion of the
prostate is shelled out from the prostate capsule in one piece. The end
result is similar to the TURP in which the obstructing portion of the
prostate is removed, leaving the prostate capsule behind. The reason to
do an open prostatectomy is the size of the prostate. The telescopic
approaches (TURP, TUIP, laser, hyperthermia and balloons) are
ineffective or impossible with prostate glands that are in the upper
5-10% of size (usually greater than 75-100 grams). Open prostatectomy
requires an anesthetic (general or spinal) and usually 3-5 days of
hospitalization. Some prostates are large enough that open prostatectomy
is the only treatment option. Open prostatectomy, also called simple or
subtotal prostatectomy should not be confused with radical
prostatectomy, an operation done for prostate cancer in which the entire
prostate including capsule is removed.
Laser of Prostate,
GreenLight Laser
GreenLight PVP - Photoselective Vaporization of the Prostate, and it can free you from urinary problems without compromising lifestyle or health, giving you the green light to live life the way you want to, without compromising.
The GreenLight PVP Laser Procedure (Photoselective Vaporization of the Prostate) offers a unique and simple solution to BPH because it combines the effectiveness of TURP, the surgical "gold standard" with the safety, comfort and ease of minimally invasive heat treatments.
The GreenLight PVP Laser Procedure uses a very high powered laser to immediately vaporize and precisely remove enlarged prostate tissue.
Most patients return home a few short hours after the procedure and can return to normal, non-strenuous activities within days. GreenLight PVP delivers the ultimate BPH solution - free from urinary symptoms, free from compromise, free to go!
Questions About The GreenLight PVP Laser Procedure.
Q.
What is Thermotherapy?
Thermotherapy or TUMT uses controlled h
Q.
Where is GreenLight PVP performed?
GreenLight PVP is performed in a hospital or ambulatory surgery center.
Q.
Will I experience pain during the procedure?
Patients have not reported any pain during the procedure.
Q.
Will I need to wear a catheter?
Many patients do not need a catheter. If one is required, it is usually removed in less than 24 hours.
Q.
What are the risks or complications?
There are few risks with GreenLight PVP. Most patients report a very high level of satisfaction. Patients may experience slight burning during urination and/or a little bit of blood in the urine for a couple of weeks. Retrograde ejaculation, or "dry climax", may occur.
Q.
Will I experience pain after the procedure?
After the procedure you may have some mild discomfort such as slight burning during urination for a week or so. This can be managed with mild pain medications and anti-inflammatory drugs.
Q.
How long before I see results?
Many patients obtain immediate relief of symptoms and a dramatic improvement in urine flow usually within 24 hours of the procedure.
Q.
How soon can I return to normal activities?
Most patients can resume normal activities like driving a car or working a desk job within the week.
Q.
Will there be any sexual side effects?
The GreenLight PVP Laser Procedure should not affect your ability to have an erection or an orgasm. Retrograde ejaculation "or" "dry climax", may occur. If you are sexually active, you can look forward to remaining so.
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Laser of Prostate,
Holmium Laser
Holmium laser treatment (also known as HoLAP - Holmium Laser Ablation of the Prostate) uses laser energy designed to alleviate BPH symptoms and reduce some of the traditional complications associated with surgery.
Holmium Laser Treatment (HoLAP) use laser energy to remove obstructing prostate tissue. Holmium laser vaporization is generally performed with the patient under spinal, epidural or general anesthesia. Your urologist will pass a cystoscope into your urethra, enabling him to view the bladder and prostate. A thin flexible fiber is inserted into the cystoscope and used to transmit the laser energy to the prostate with a very high degree of precision.
The laser energy instantly vaporizes the obstructing tissue. The laser also seals the area, resulting in little if any bleeding during and after the procedure. And if you should also have a bladder stone, the holmium laser can be used to fragment and remove your stone during the prostate treatment. The procedure may be completed in an hour or less, depending upon the size of your prostate.
There are few risks for postoperative complications than TURP and recovery time is shorter. Most patients experience little or no bleeding and go home without a catheter after a few hours or an overnight stay. Pain medication is rarely needed and you can be back to normal activities soon after going home.
Benefits of Holmium Laser
Treatment for BPH
- Safe and effective procedure
- Immediate relief of symptoms
- Virtually bloodless
- Little risk of bleeding or transfusion
- Limited or no catheterization required
- Outpatient procedure
- Return home in 24 hours or less
- Recover and return to normal activities rapidly
- Less complications than standard TURP procedure
- Long lasting results
- Shown durable for over 7 years
- Can be performed while on anticoagulant medication like Coumadin (warfarin sodium)
- Eliminates need for drugs that were taken to relieve BPH symptoms
Laser of Prostate,
Indigo Laser
- A new special laser used to heat prostate tissue. The treated
tissue is absorbed by the body leaving unobstructed urinary
channel
- Minimally invasive and no risk of bleeding,impotence, retrograde
ejaculation or urinary incontinence as is seen with TURP (transurethral
resection of prostate). With laser treatment the urethral mucosa remains
intact with no significant burning sensation or bladder spasms
- Hospitalization is not required. it is available as an office procedure using only IV sedation.
- Catheter is needed post procedure for 1-5 days depending on the size
of the prostate
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Urological Cancer
This includes adrenal, kidney cancer, ureteral
and bladder cancer, scrotal, penile, and testicular cancer.
We specialize in the latest surgical laparoscopic radiologic and medical therapy of urologic malignancy, combining this
with nutritional and life style counseling.
(Caver Map)
- The latest advance in nerve sparing radical prostatectomy (Operation for Prostate Cancer)
- New technology is used to assist surgeons in locating, mapping and
ultimately sparing the nerves responsible for penile erection
- Preliminary data from different centers suggests better preservation
of the nerve when Caver Map technology is used
- There are about 50 centers in the U.S.A. using this device. We are
the first in Northern Virginia. We have had excellent initial
results using this new technology at INOVA Alexandria
Hospital.
- If you would like more information about Caver Map, you may email us or call our office
- We offer Hand Assisted Laparoscopic Surgery for renal kidney tumors.
It is minimally invasive, with a short hospital stay and a speedy return to work.
Brachytherapy
Radioactive seed implantation of the prostate
is a relatively new minimally invasive treatment for prostate cancer. This can be
done by one of our physicians at Alexandria Hospital, Arlington Hospital,
or Georgetown University Hospital.
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Hand Assisted Laparoscopic Procedure
Laparoscopic procedure has become one of the standards for care for many Urological diseases, such as renal tumor, renal cysts and adrenal tumors.
There are multiple reports showing that Hand Assisted Laparoscopic Nephrectomy is a safe and reliable procedure.
The advantage of the Hand Assisted Laparoscopic Nephrectomy and Adrenalectomy is that the specimens are removed through a small incision compared to standard Laparoscopic
procedure. This is very important for tumor staging and pathological identification. Plus, the operative time with Hand Assisted Laparoscopic is greatly reduced compared
to standard Laparoscopy. The recovery course and ability to return to normal activity is faster than open surgery.
As certified Urologists, we have been pleased to see excellent outcomes from the Hand Assisted Laparoscopic Procedure.
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Urinary Tract Infection
(UTI)
- This is an infection of kidneys, ureters, bladder, prostate or
urethra.
- It is caused by presence of bacteria which can be quantitive by
urine culture in the face of patients Signs and Symptoms.
It can be separated into two major groups, each of which is
diagnosed and treated differently:
- Uncomplicated UTI is the most common type. This problem often called Cystitis, results in an estimated 7 million
office visits yearly.
- Complicated UTI occurs because of underlying anatomic or functional factors.
It is associated with chills, fever, abdominal or pelvic pain, and is usually recurrent.
- The majority of patients are treated with antibiotics. Some patients
may require surgical treatment for urinary tract abnormalities.
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Complicated Kidney, Bladder & Ureteral
Stones
We treat kidney, ureteral and bladder stones.
The treatment will include:
- Metabolic evaluation to establish the cause of stones
- Stone prevention through diet and supplements
- And surgical therapy
We specialize in the following minimally
invasive and standard techniques:
- Laser treatment
- Shock wave lithotripsy (ESWL)
- Percutaneous removal (key-hole surgery)
- Electrohydraulic and ultrasonic stone dissolution
- Open surgery
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Pediatric
Urology
We treat all pediatric urologic problems
including:
- Voiding dysfunction
- Bed wetting - drug and behavioral therapy
- Urinary tract infection
- Congenital abnormalities
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Male Infertility
Diagnoses and Treatment:
- Varicocele Repair
- Microscopic vasectomy reversal (Vasovasotomy)
- Hormonal treatment
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Male Sexual
Dysfunction
Impotence, or erectile dysfunction, is a condition in which a man
either cannot get an adequate erection or cannot maintain that erection
long enough for vaginal penetration and successful sexual intercourse. If
you are experiencing erectile problems, you are not alone. An estimated
25-30 million men in the United States alone are affected by impotence.
The good news, however, is that successful
treatment is available for all impotent men. Today, all men with
erectile dysfunction can be treated. Treatments include:
- Sexual counseling
- Change of medications or lifestyle habits
- External vacuum therapy
- Penile self-injection
- Penile prostheses
- Drug therapy
Hypogonadism
Premature Ejaculation
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Emergency Care
If you need to be seen on an urgent basis,
please clarify this if you telephone during normal office hours. Call as
early as possible, so we may adjust our schedule to resolve your medical
problem promptly. After normal office hours, weekends, and holidays you
can reach one of our physicians by dialing the office number. The
answering service will contact the physician on call.
If the emergency is life-threatening, proceed
to the nearest emergency room immediately. Ask the hospital staff to
contact our physician.
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We participate with most medical insurances
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