Conditions Benign Prostatic Hyperplasia (BPH) Benign prostatic hyperplasia (BPH) is a common condition in men due to a noncancerous enlargement of the prostate that can lead to significant urinary symptoms. The prostate is a gland, one of the organs of the male reproductive system, located just below the bladder and surrounding the urethra. As men age, the prostate naturally increases in size and can slow down or sometimes block the flow of urine from the bladder at the time of urination. Symptoms can include: Slow urinary stream Sensation of incomplete emptying Urinating several times at night (nocturia) Urinary frequency or urgency Treatment can include: Medication UroLift Transurethral resection of prostate (TURP) Laser ablation of prostate (Greenlight laser) Bladder Cancer Bladder cancer is an abnormal growth of bladder cells in the urinary bladder, forming a mass or tumor. Most bladder cancers form initially on the inner lining of the bladder. Risk factors for bladder cancer include smoking, industrial chemical exposures or chronic urinary irritation (ex., long-term urinary catheter). Most patients who have bladder cancer will present to the doctor with symptoms and are diagnosed after a CT scan or cystoscopy. Most bladder cancer is superficial (just on the surface of the bladder) and can be easily treated, but does require ongoing follow-up evaluation. Symptoms can include: Blood in the urine (either gross hematuria or microscopic hematuria) Significant worsening of urinary complaints Treatment can include: Transurethral resection of bladder tumor (surgical removal of the bladder tumor) Intravesical therapy with medication Cystectomy with urinary diversion Blood in the Urine (Hematuria) Blood in the urine (hematuria) is an abnormal finding and can be an indication of other problems. Some patients will be able to see the blood in the urine (gross hematuria), while others are unable to see the blood, but it is detected on microscopic analysis of the urine (microscopic hematuria). Some patients may have accompanying symptoms, while others have no symptoms. Causes can include: Kidney stones Enlarged prostate (BPH) Bladder infection or irritation Disease of the kidney Tumors Trauma Evaluation can include: CT scan or ultrasound Cystoscopy Urine culture Urine cytology Elevated PSA (Prostate Specific Antigen) Prostate specific antigen (PSA) is a protein produced exclusively by the prostate gland in men and can be measured with a blood test. PSA has largely been used as a screening test for prostate cancer, and there has been significant debate about the role of this lab test in prostate cancer detection. There are normal levels of PSA in all men with a prostate, and this level will increase slightly as a man ages. PSA can be elevated for a number of reasons, including an enlarged prostate, prostate infection and prostate cancer. Causes can include: Enlarged prostate Prostatitis Age-related elevation Prostate cancer Treatment can include: An evaluation to rule out prostate cancer (prostate biopsy) MRI of the prostate Medications Erectile Dysfunction (ED) Erectile dysfunction (ED) is a condition where the penis fails to achieve or maintain sufficient rigidity at the time of sexual arousal. It is a common condition, affecting more than 30 million men in the United States. Men with ED should undergo an evaluation as it can be a very frustrating problem that responds well to treatment and can be an early symptom of other medical problems. Causes can include: Low hormone levels Other medical conditions Neurological conditions or nerve damage Inadequate blood flow to the penis Treatment can include: Oral medications Injected medications Mechanical devices Placement of a penile implant (prosthesis) Interstitial Cystitis Interstitial cystitis (IC), also known as bladder pain syndrome (IC/BPS), is a chronic condition that causes pain, pressure or discomfort that tends to be associated with bladder filling. This typically leads to urinary urgency and frequency in addition to the pain. The disease can range from causing mild urinary symptoms to very severe symptoms such as significant pain, blood in the urine and scaring of the bladder. The exact cause is unknown. Evaluation can include: Medical history and physical exam Patient questionnaires Cystoscopy (looking into the bladder) Treatment can include: Dietary modification Stress management and physical therapy Medical therapy Surgery (bladder stretching, Botox injections, Interstim™ Neuromodulation) Kidney Cancer Renal cell carcinoma (RCC) is an abnormal growth of cells in the kidney, forming a mass or tumor. Risk factors include smoking, obesity and a family history of kidney cancer. The tumor may cause flank pain or blood in the urine, but many times they don’t cause symptoms at all and are diagnosed when someone has a CT scan or ultrasound of the kidney for some other reason. Not all kidney cancer requires treatment since small tumors (less than 3 cm) rarely spread outside the kidney, but surgery is usually curative. Evaluation can include: Medical history and physical exam Ultrasound of the kidney CT scan or MRI Treatment can include: Observation (watching to see if it grows) Percutaneous ablation (cryotherapy or microwave) Partial nephrectomy (removing the tumor out of the kidney) Radical nephrectomy (removal of the entire kidney) Chemotherapy Kidney Stones Kidney stones are the formed by the accumulation of crystals in the urine. There are several different types of kidney stones, each having different causes for why they form. They typically don’t cause pain while they grow in the kidney, but may cause severe symptoms when they are in the ureter (the tube that drains urine from the kidney into the bladder). Symptoms may include blood in urine, flank or groin pain, nausea and vomiting. Evaluation can include: Medical history and physical exam Urinalysis Plain film X-ray (KUB) Ultrasound of the kidney CT scan without contrast 24-hour urine collection and analysis Treatment/prevention can include: Staying well hydrated to prevent them (greater than 2 liters of water daily) and dietary modification Medicines to decrease the chances of forming stones Medical therapy to let a stone pass on its own Shock wave lithotripsy (ESWL) Ureteroscopy with laser lithotripsy Percutaneous removal (PCNL) Low Testosterone (Hypogonadism) Testosterone is a hormone made in the testicles that plays a variety of important roles in a man’s body over his lifetime. During the normal aging process, there is a natural decrease in testosterone levels, but in some men this decrease can be too much, and the testicles don’t make enough for normal bodily functions. Symptoms may include general fatigue, decreased energy, loss of libido (sex drive) and erectile dysfunction. Other conditions such as obesity, depression, narcotic pain medication use or hypothyroidism may cause similar symptoms, and so must be evaluated for as well. Evaluation will include: Medical history and physical exam Lab testing (blood work) Treatment can include: Observation Transdermal testosterone replacement (patch or gel) Intramuscular testosterone injections Subcutaneous testosterone injections or pellets (Testopel) Male Factor Infertility Many couples experience difficulty achieving pregnancy, and if they have not been able to achieve a pregnancy after a long period of unprotected intercourse they may seek evaluation and treatment. Infertility can be caused by many factors including male factor infertility. For some men the problem may be in the production or delivery of sperm. Treatment begins with a thorough history and physical examination, but other testing may follow. Evaluation can include: Medical history and physical exam Ultrasound Hormone testing Semen analysis Treatment can include: Varicocele repair Sperm harvesting Medical treatment Overactive Bladder Syndrome (OAB) The bladder functions to store urine until the time you decide to urinate and empty the bladder in a controlled fashion. In overactive bladder syndrome (OAB), the bladder has uncontrolled and sudden contractions without warning, causing an increase in the frequency of the urge to urinate (“gotta go”). This may also cause urge incontinence, or unwanted leakage of urine during an uncontrolled bladder contraction. Evaluation may include: Pelvic exam Bladder diary Cystoscopy (looking into the bladder) Urodynamic testing Treatment can include: Fluid modification and bladder training and physical therapy Medical therapy Surgical therapy (PTNS, Botox injections, Interstim™ Neuromodulation) Pelvic Organ Prolapse (POP) The normal support system of a woman’s pelvis includes muscles and ligaments of the pelvic floor. If these become too loose or stretched over time, then there can descent or prolapse of pelvic organs into the vagina. This can occur with the bladder, uterus, small intestines or rectum. Genetics, childbirth or surgery may increase the risk for POP. Symptoms usually include sensation or visualization of a vaginal bulge, pressure, urinary retention and/or significant constipation. Evaluation may include: Pelvic exam Urodynamic testing Treatment can include: Pelvic exercises and physical therapy Pessary Surgical correction with or without mesh Peyronie's Disease (PD) Peyronie’s disease is the development of fibrotic scar tissue, called plaques, in a tissue layer of the penis. This can lead to bending or curvature of the penis, which may cause pain with erections, difficulty or inability to have intercourse or erectile dysfunction (ED). There is a short active phase of PD when the plaque and deformity develops, after which the curvature remains stable. This can be a very distressing condition. Evaluation may include: Exam of the erect penis Penile ultrasound Treatment may include: Pain control (NSAIDs such as Ibuprofen) Xiaflex® injections to break up the plaque Surgery to straighten the penis (plication or plaque excision) Placement of a penile implant (penile prosthesis) Prostate Cancer Prostate cancer is an abnormal growth of cells in the prostate, forming a mass or tumor. It is the most common cancer in men, after skin cancer. Risk factors include age and family history of prostate cancer. There are not any particular symptoms associated with localized prostate cancer. It is usually suspected if a man has an elevated prostate specific antigen (PSA) or abnormal digital rectal exam. Prostate cancer can only be diagnosed by a prostate biopsy (usually done with a transrectal ultrasound guided biopsy). Most prostate cancer is slow growing cancer, but aggressive forms do exist and those patients should be treated. Evaluation may include: PSA and digital rectal exam Transrectal or transperineal prostate biopsy MRI, CT scan or bone scan Treatment may include: Active surveillance (observation) Ablation (cryotherapy or HIFU) External beam radiation, Focused Ultrasound or radiation seeds (brachytherapy) Surgical removal (da Vinci robotic radical prostatectomy) Hormone therapy or chemotherapy for advanced/metastatic disease Prostatitis As with any organ in the genitourinary tract, the prostate is susceptible to infection and inflammation. Acute prostatitis is an acute infection of the prostate by bacteria, similar to a UTI, causing burning with urination, urinary urgency, frequency and pelvic pain. Chronic prostatitis may also be caused by a bacterial infection, but may also be a condition in which there is no infection at all, yet similar symptoms are present. This is called chronic pelvic pain syndrome (CPPS) and is treated differently from an infectious prostatitis. Evaluation may include: Digital rectal exam Ultrasound of the bladder and prostate Treatment may include: Short- or long-term antibiotics and pain control Alpha blockers (such as Tamsulosin) Pelvic floor physical therapy and pain management for CPPS Stress Urinary Incontinence (SUI) Stress urinary incontinence (SUI) is the unintentional and sudden leakage of urine from the bladder when the pressure in the bladder rises due to incomplete closure of the bladder opening (urinary sphincter). Many women will experience minor leakage with cough or sneeze, but one in three women will suffer from more significant SUI. Evaluation can include: Medical history and physical exam Functional testing Cystoscopy Urodynamic testing Treatment can include: Physical therapy and pelvic floor rehabilitation Surgical treatment Urinary Tract Infection (UTI) A UTI, or bacterial cystitis, is a bacterial infection of the bladder and is one of the most common illnesses in humans. Risk factors can include age, obesity and kidney stones. A UTI causes pain during urination, urinary urgency and frequency, and can cause lower abdominal pain and back pain. Symptoms usually improve with treatment, but can last for several weeks. Evaluation may include: Urine analysis Urine culture Blood work Treatment may include: Antibiotics and oral hydration with water Pyridium, or AZO, to treat the burning