Our shared vision of a healthier Atlanta drives our physicians and staff to focus on sharing information about urologic health and preventative medicine through proactive patient education. However, the information we are sharing here is not intended to replace a personal consultation with one of our fellowship-trained physicians. Click on the topics below to learn more.
BPH results from the natural, noncancerous growth of the prostate. The prostate encircles the urethra, the tube through which urine travels from the bladder to the penis and then to the outside. This growth leads to obstruction to the flow of urine and brings about a constellation of obstructive and irritative urinary symptoms. Obstructive symptoms include a slow starting and interrupted stream, decreased strength of stream, straining to urinate and incomplete bladder emptying. Irritative symptoms include daytime and nighttime urinary frequency, urinary urgency, and occasionally urgency incontinence. Treatment options range from medical management, minimally invasive office-based therapies and surgical intervention.
Bladder cancer begins in the cells that line the inside of the bladder and typically affects older adults, though it can occur at any age. Smoking is the #1 risk factor for the development of bladder cancer. Bladder cancer often causes painless hematuria (blood in the urine). This can present as bright red or cola colored urine but can also appear on a microscopic examination of your urine in the doctor’s office. Frequent urination, painful urination, recurrent urinary tract infections, abdominal pain and back pain can be other presenting signs and symptoms. Diagnosis is based upon inserting a scope into the urethra to see inside the bladder (cystoscopy), sending a sample of urine to be analyzed under a microscope to check for cancer cells (urine cytology), and imaging tests such as a CT scan that allows your doctor to better see the urinary tract and the surrounding tissues.
If an abnormal growth is identified, your doctor may pass a special scope through your urethra and into the bladder to remove the mass. This procedure is called transurethral resection of bladder tumor (TURBT). The specimen is then examined under the microscope to determine the extent of disease and to decide whether any further treatment is indicated. The great majority of bladder cancers are diagnosed at an early stage when bladder cancer is highly treatable. However, even early-stage bladder cancer is likely to recur. For this reason, bladder cancer survivors often undergo follow-up screening tests for years after treatment.
Erectile dysfunction (ED) is defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. It affects as many as 30 million American men, with more than 50% of men 50 to 70 years. Erectile dysfunction is more often caused by physical (organic) problems than psychological (non-organic) ones. It is important to undergo evaluation for ED as it can be an indicator of underlying heart disease, diabetes or other serious medical conditions. Erectile dysfunction treatment ranges from oral medications, vacuum erection devices, injection therapies and surgical implantation of a penile prosthesis to help restore sexual function.
Hematuria is the presence of blood in the urine. It can be visible and present as red or cola-colored urine known as gross hematuria. The urine may otherwise appear normal to the naked eye but have red blood cells seen under the microscope and is termed microscopic hematuria. Several conditions can cause hematuria and are divided into either painful or painless processes. Painful hematuria can result from kidney, bladder or prostate infection, stone passage or trauma and the workup is generally limited to treating the condition potentiating the blood. Etiologies for painless hematuria can include benign conditions such as medical renal disease, benign prostatic bleeding and strenuous physical exertion to more concerning causes such as kidney, ureteral or bladder cancer.
Painless hematuria, whether visible or microscopic, requires a thorough evaluation. The urine is sent for cytology, a microscopic evaluation of the bladder cells looking for malignancy. The kidneys and ureters are imaged with either a CT scan, intravenous pyelogram (an x-ray test where contrast is injected into the vein, travels to the kidney and is excreted in the urine, outlining the urinary system) or renal ultrasound. The bladder is evaluated with cystoscopy, a procedure where a camera is advanced through the urethra into the bladder and the bladder is visualized directly. In a majority of cases, no specific source of the blood is identified and the cause is termed idiopathic, meaning that no concern for a detrimental medical condition is present. If a pathologic process is identified, then treatment based upon the cause is discussed.
Incontinence is the involuntary loss of urine. This can occur with maneuvers that increase abdominal pressure such as coughing, bending or exercising. This is known as stress urinary incontinence (SUI). Others may feel a strong, sudden urge to urinate just before losing a large amount of urine. This is known as urge incontinence. Many may experience a combination of each. This is known as mixed urinary incontinence.
Incontinence occurs because of problems with the muscles and nerves that help to control and release urine appropriately. Treatment options depend upon the cause. Stress incontinence generally requires surgical intervention ranging from periurethral collagen injection to sling procedures that restore the normal support structure to the urinary system. Stress incontinence in men whom have undergone prostate surgery can be managed with sling procedures and collagen but may require placement of an artificial urinary sphincter. Urgency incontinence is managed with behavioral modification as well as medication. Urge incontinence that does not respond to these therapies is considered refractory and may require a special procedure called Interstim or sacral neuromodulation.
Infertility affects 10-15%% of US couples and is defined as being unable to conceive despite having frequent, unprotected intercourse for at least one year. Most pregnancies occur within the first six episodes of intercourse during the mid-cycle. Approximately 85% of couples will become pregnant during the first year with 50% of the remaining couples conceiving within the next three years. Infertility can result from male factors, female factors or a combination of each. Male factors include defects in sperm production or delivery, environmental and lifestyle factors such as excessive alcohol intake or stress, health status, age and genetic issues. Initial evaluation includes a detailed history and physical exam, two semen analyses and a blood test to measure male hormonal levels. Depending upon the findings, a transrectal or scrotal ultrasound may be ordered to look for evidence of abnormalities within the male reproductive system or a genetic evaluation may be obtained to look for chromosomal abnormalities. The female factor evaluation is undertaken by gynecologists specializing in infertility. Treatment depends on the cause and duration of infertility as well as the age and personal preferences of the partners. Options vary from medical management to increase sperm production to surgical interventions that relieve obstruction or treat anatomic abnormalities such as a varicocele and assisted reproductive technology ranging from in- vitro fertilization, intra-cytoplasmic sperm injection and epididymal or testicular sperm aspiration.
The American Cancer Society estimates that almost 62,700 people in the United States are diagnosed with kidney cancer each year. Many kidney cancers are detected incidentally with imaging techniques such as computerized tomography (CT) or ultrasound during evaluation for other diseases or conditions. Kidney cancer rarely causes signs or symptoms early on but can present with blood in the urine, persistent pain in the upper back just below the ribs, weight loss, fatigue or intermittent fever. Treatment options include removing either the entire kidney or if possible, removing the tumor from the kidney. This can be accomplished either through an open incision, laparoscopically or robotically. Other options include the utilization of freezing or heating techniques to kill the cancer cells by placing specialized needles into the tumor. Your doctor can explain each operation and discuss which is most suitable. The need for further treatment is based upon evaluating the extent of disease, also known as pathologic staging, after the tumor has been removed.
Kidney stones are one of the most painful of the urologic disorders. Stones form in the kidney and sometimes travel from the kidney down the ureter (the tube that carries the urine from the kidney) into the bladder. This can obstruct the flow of urine, thereby putting pressure on the kidney, leading to pain, nausea and vomiting. Most kidney stones pass out of the body without intervention. Stones that cause lasting symptoms, severe pain and vomiting or other complications may be treated by various techniques.
Treatment options include extracorporeal shock wave lithotripsy (ESWL), a procedure that entails placing a machine on the outside of the body and focusing sound waves on the stone to fragment it, and ureteroscopy, placing a camera through the urethra into the bladder and then up the ureter, breaking the stone and removing it under direct vision. Some stones may be treated medically, specifically uric acid stones. For very large stones within the kidney, a more aggressive surgical intervention called a percutaneous nephrolithotomy (PCNL) is performed. This procedure entails developing a tract from the back directly into the kidney, then utilizing a larger camera and larger instruments to fragment and remove the stone through this tract. Dietary and lifestyle modifications can be made so as to decrease your risk for developing kidney stones. These include increasing daily water intake, decreasing salt intake and decreasing red meat intake.
Chronic pelvic pain refers to any pain in the pelvic region (the area below your belly-button and between your hips), which lasts six months or longer. The pain may vary from mild to severe, from annoying to disabling. Diagnosing the etiology your chronic pelvic pain often involves a process of elimination. Determining the cause can many times be a puzzling and frustrating endeavor. Urologic evaluation includes a thorough history and physical examination, laboratory tests to rule out infection, cystoscopy (looking into the bladder with a camera) with possible biopsy, radiologic imaging, bladder function tests known as urodynamics, and in some cases, exploratory surgery. If your doctor can determine the source of your pain, then treatment can focus on eliminating that cause. If no cause can be found, then treatment focuses on managing the pain.
Interstitial cystitis (IC), also called painful bladder syndrome, is a chronic condition characterized by a combination of uncomfortable bladder pressure, urinary urgency, urinary frequency, bladder pain and sometimes pelvic pain. The pain can range from mild burning or discomfort to severe pain. IC is a potential cause of chronic pelvic pain (above). The severity of symptoms caused by interstitial cystitis often fluctuates and can be affected by diet, exercise and stress. Some people may experience periods of remission. Although no treatment reliably eliminates interstitial cystitis, a variety of medications, lifestyle modifications and other therapies offer relief.
Prostatitis, an infection or inflammation of the prostate, is divided into acute or chronic and bacterial or nonbacterial. When no bacteria are present, it is termed nonbacterial prostatitis. Nonbacterial prostatitis accounts for ninety to ninety-five percent of all prostatitis. When it continues to recur, it is termed chronic prostatitis. A physical exam includes checking the abdomen and pelvic area for tenderness and a digital rectal exam to palpate the prostate. Urine and prostate fluid may be collected to look for bacteria and white blood cells. Acute bacterial prostatitis presents may with sudden fever, pelvic/perineal/low back pain, burning and frequency of urination, and at times, the inability to urinate. Pain relievers and several weeks of antibiotics are typically needed for acute prostatitis. A catheter may need to be placed into the bladder if the patient is unable to void. Chronic bacterial prostatitis develops more slowly than acute prostatitis with less severity of symptoms. Possible treatments include prolonged courses of antibiotics, anti-inflammatories and prostate relaxing medications called alpha blockers.
The signs and symptoms of nonbacterial prostatitis are similar to those of chronic bacterial prostatitis, although generally without a low-grade fever. Treatment of nonbacterial prostatitis is less clear and mainly involves relieving symptoms. Other treatment options include pelvic floor physical therapy, muscle relaxants, and at times, minimally invasive heat therapies.
One out of six men will be diagnosed with prostate cancer in their lifetime. Prostate cancer is the second leading cancer diagnosis in men. Screening for prostate cancer includes a simple blood test called a PSA test as well as a digital rectal exam (DRE). PSA (prostate specific antigen) is a protein the prostate makes that is secreted into the bloodstream. It can be elevated in prostate cancer, but an elevated PSA is not diagnostic. A prostate biopsy, an office procedure, is performed for abnormalities found in the PSA test or on the DRE. If prostate cancer is detected, treatment options include active surveillance, medical management, surgical removal, radiation therapy, and cryoablation (freezing the prostate). Discussions with your physician will direct the proper treatment choice for your specific situation.
Many processes can present as masses in the scrotum; fortunately, most are noncancerous. Testicular cancer is always a concern and needs to be ruled out. Other common conditions include hydrocele, varicocele and spermatocele. A hydrocele is a fluid filled sac that develops around the testicle. A varicocele is pooling of blood in the veins that drain the testicle and is often described as a “bag of worms” in the scrotum. A spermatocele is an out-pouching of the epididymis, the tube that lies atop the testicle and stores sperm. Most of these conditions do not cause problems, but at times, a hydrocele can be large and cumbersome and a varicocele can lead to fertility issues. A new onset or right-sided varicocele can be indicative of a more concerning intra-abdominal problem and requires evaluation. Scrotal masses are evaluated with a physical exam, and if necessary, a scrotal ultrasound. Treatment when necessary involves surgically correcting the abnormality, whether it be removing the hydrocele sac (hydrocelectomy) or ligating the offending veins (varicocelectomy).
Testicular cancer arises from cells in the testicle that produce either sperm or male sex hormones. While testicular cancer is rare, it is the most common tumor in men aged 15-34 years. Presenting signs and symptoms include a lump or enlargement of the testicle, a feeling of heaviness, dull ache or pain in the scrotum/testicle, a sudden collection of fluid around the testicle and rarely, breast tenderness or enlargement. Evaluation includes a physical exam, a scrotal ultrasound and blood tests to check for specific substances that the tumors may produce in excess (called tumor markers). If a mass is detected, then surgery is performed to remove the testicle. Once the diagnosis is confirmed, then a staging workup to evaluate for disease spread includes a CAT scan of the abdomen and pelvis, a chest x-ray and a repeat of the tumor markers if they were initially elevated. Upon completion of staging, the physician will determine whether any further therapy is indicated. Testicular cancer is fortunately very sensitive to radiation and chemotherapy, and men with disease that has spread still have a high likelihood for cure.
A urinary tract infection is an infection which is localized to the genito-urinary system. This system is composed of the kidneys, ureters, bladder and urethra. Any part of the system can become infected, but most infections involve the bladder. Women are at greater risk than men. A urinary tract infection limited to the bladder is also known as acute cystitis and presents with burning with urination (dysuria), frequency and urgency of urination with small volume voids, pelvic/suprapubic pressure and at times blood in the urine. The elderly or immune compromised may present with confusion or altered mentation. Diagnosis is based on performing a chemical and microscopic analysis in the office. A urine culture confirms the diagnosis while also providing the type of bacteria and a listing of antibiotics to properly treat the infecting organism. A short course of oral antibiotics are the typical treatment. A urinary tract infection involving the kidneys can be quite serious, causing high fevers, chills, and upper back pain. This type of infection may require hospitalization and intravenous (IV) antibiotics to resolve.
Recurring bladder infections are not uncommon and the workup includes radiologic imaging to rule out kidney stones or obstruction, bladder imaging to ensure complete bladder emptying and cystoscopy to exclude abnormal bladder anatomy.