Urology is a surgical specialty which diagnoses and treats patients with conditions that affect male and female urinary tracts as well as the male reproductive systems. It calls for a diverse range of specialties, sub-specialties and services, offered within a solid foundation of expertise.
The Urology of Virginia physicians excel in the latest areas of diagnosis and treatment for urologic conditions. Among other things, we lead in introducing technological advances, from minimally-invasive laparoscopic surgery to intricate robotic surgery. We have pioneered healing approaches for the pelvic region with such things as in-house urological physical therapy. In collaboration with the Jones Institute for Reproductive Medicine and other advanced fertility clinics, we have helped men achieve fatherhood. And our list goes on further!
Every patient and his or her family can add the assurance of personal attention and understanding that is the hallmark of care delivered by Urology of Virginia. To help you understand the scope of our expertise and experience, we provide a brief description of the following conditions and procedures that we are involved in:
Benign Prostatic Hyperplasia
The prostate is a walnut-sized gland that forms part of the male reproductive system. The gland has two lobes, enclosed by an outer layer of tissue. It is positioned in front of the rectum and just below the bladder, where urine is stored. The prostate also surrounds the urethra, the canal through which urine passes out of the body. It is common for the prostate gland to become enlarged as a man ages, causing a condition known as benign prostatic hyperplasia (BPH). More than half of men 50 and older, and 90 percent of those 80 and older, have BPH. The condition can squeeze the urethra, making it harder for the bladder to empty and causing urinary symptoms such as urgency, leaking, dribbling and more frequent urination.
Initial treatment depends on the severity of symptoms. Mild cases may call for care that ranges from education on lifestyle changes, to medications relieving common symptoms, to procedures that reduce symptoms but are less invasive than conventional surgery. Some of these can be performed on an outpatient basis. In instances where surgery is indicated, Urology of Virginia physicians have expertise in a range of options, choosing the most efficient means to address problems and restore better health and quality of life.
The bladder, a balloon-shaped organ, collects urine from the kidneys, stores it, and passes it along for elimination through the urethra. The most common type of bladder cancer, transitional or urothelial cell cancer, starts in the lining of the bladder. This cancer occurs most often in individuals over the age of 55 years with approximately 80,000 new cases a year. When diagnosed early, bladder cancer can be treated with a high degree of success.
Symptoms may include frequent urination, painful urination and blood in the urine. Urology of Virginia provides the full complement of diagnostic tools and surgical treatment options and after-care, as called for by each individual’s disease state and health factors.
The presence of blood in the urine is defined as hematuria. It can indicate a serious problem yet, conversely, it may have no negative cause. Blood in the urine that can be seen by you should promptly be reported to your doctor. Often, however, hematuria is only visible under a microscope, found as part of a routine medical examination. It may originate from anywhere along the urinary tract – kidneys, ureters, bladder, prostate or urethra. Hematuria calls for further diagnosis when discovered, as it may be a marker for infection, kidney stones or a urinary tract cancer, among other conditions.
Further testing can include “dipstick,” additional microscopic evaluation, cytoscopic examination via videoscope, CT scans, ultrasound and other advanced means used to search for causes. At Urology of Virginia, your urologist will review results with you and create a treatment plan based on findings.
Bladder control problems that lead to too-frequent urination and actual leakage are a problem for millions of people, both men and women. It is unfortunate that many people don’t share their problem with their doctor. If incontinence is a concern for you and interferes with your quality of living, act promptly in seeking help. Types of incontinence include Overactive Bladder, or Urge Incontinence, in which the bladder contracts, urine leaks occur and you’re unable to get to a bathroom quickly enough. In Stress Incontinence, affecting mostly women of middle age and older, leaks may be caused by exercise, coughing or sneezing. In Overflow Incontinence, which mostly affects men, there is no urge to urinate, the bladder doesn’t empty well and urine may leak continuously. Patients often experience more than one type.
Urology of Virginia has the specialists, therapists and educators who can recommend many new treatments for incontinence. With their help, patients find they have a range of options to cure or manage their condition, freeing them from constant worry and embarrassment.
The search for a cause of infertility is typically initiated when couples are unable to conceive after a year of unprotected sex. One out of six couples are infertile, and a male factor is responsible about a third of the time. A leading cause is varicoceles, or dilated veins, which drain the testicles causing a temperature rise that can alter sperm production. Other factors include sperm disorders, obstruction of the sperm passage, and further issues as genetics, hormonal levels and the effects of certain medications.
A host of new research findings and advances in male infertility care has raised both the hopes and the success rates of those wanting to become parents. At Urology of Virginia, the treatment options, depending on cause, may involve surgery, assisted reproductive technology, medications and education in lifestyle changes.
The American Cancer Society’s most recent statistics for this condition predict 64,700 new cases per year. Most are older individuals, over 45, and the risk is higher for men than for women. Medically defined as Renal Cell Carcinoma (RCC), it begins in the kidneys, the two large, bean-shaped organs located on either side of the backbone.
Symptoms include one or more of these: blood in the urine, a lump in the abdomen, swelling of legs and ankles, or persistent pain in the side, flank or lower back. Any of these call for a timely urological evaluation. Diagnostics include CT scan, MRI, ultrasound and blood tests.
Many kidney tumors have no symptoms and are incidental findings on radiographic tests ordered for other reasons. At Urology of Virginia, our physicians understand that this diagnosis causes many anxieties. Our surgeons are facile on all the latest treatment options for kidney cancer. You can expect support and understanding while your team works with you to develop the advanced therapies and procedures leading to the best possible outcome.
A kidney stone is a solid piece of material that forms, in a kidney, from substances in the urine. It typically forms when urine becomes too concentrated, causing crystals to build up inside the kidneys. Stones may be as small as a grain of sand or as large as a golf ball. Small ones may pass out of the body without causing too much pain. However, others can cause severe pain when trapped in one of the ureters carrying urine from the kidneys to the bladder.
Symptoms include sudden, intense pain in your back or side, radiating toward the groin, abdomen or genitals. Further symptoms that may indicate a kidney stone are nausea, blood in the urine, painful urination and fever. Any of these, alone or in combination, calls for attention by your doctor. While many kidney stones do not need treatment, there are non-invasive and minimally invasive procedures with which Urology of Virginia’s multi-disciplinary team can provide solutions.
It is commonly believed that kidney stones are exclusively a male problem. While less frequent, they can occur in women also.
The most common cancer in men, prostate cancer, affects one in every six American men. Fortunately, this cancer is usually slow-growing, and most tumors are found in time for effective treatment. Men aged 50 and older, African American men and men with a family history of prostate cancer are at higher risk. Early stage prostate cancer often has no warning signs, making regular screening tests such as PSA (Prostate Specific Antigen) tests and digital rectal exams important in early diagnosis.
Urology of Virginia offers many effective treatments for prostate cancer today, led by highly experienced urologic oncologists. The course of treatment is based on disease stage and grade, and individualized patient factors. We currently have nationally recognized expertise in the following treatment options for localized prostate cancer: active surveillance or observation, minimally invasive robotic and open surgery, brachytherapy, cryotherapy, and radiation therapy.
Urology of Virginia also offers a wide spectrum of treatment options for advanced prostate cancer including hormone therapy and immunotherapy, and are enhanced by an environment of comprehensive therapy and support. We currently participate in several research trials in the realm of advanced prostate cancer , and our research department has been instrumental in the trials that have led to the approval of some of the newest agents including: Provenge, Ztiga, Xtandi, and Xgeva.
Prostatitis is a noncancerous inflammatory condition of the prostate gland. Acute bacterial prostatitis occurs suddenly, with sharp, severe symptoms. Chronic bacterial prostatitis develops gradually, recurs often, and can last for prolonged periods of time. Diagnostic tests will help to determine the type of infection and indicate the course of treatment. Acute prostatitis is treated with antibiotics. Chronic prostatitis also will initially be treated with various courses of antibiotics for the recurring infection, sometimes in addition to other medications such as muscle relaxants and pain relievers. Physical therapy, relaxation techniques, dietary changes and heat therapy may also be part of the prescribed regimen.
Robotic / Laparoscopic
The word “laparoscopy” means to look inside the abdomen with a special camera or scope. Laparoscopic surgery involves filling the abdomen with gas to create an adequate space in which to work, making small cuts and placing telescopes, instruments and cameras through 1/4 inch port-holes. The telescope will show the operative field on a monitor screen. Watching this, a surgeon is able to perform many types of urologic and other surgeries.
Urology of Virginia surgeons are recognized experts in minimally invasive surgery to treat urological conditions from prostate, bladder, kidney and ureteral cancers to benign conditions of the urinary tract. In laparoscopic and robotic surgery, compared to traditional surgery where a much larger incision is made, the benefits to patients are considerable. They include less pain, decreased blood loss and speedier healing.
Our robotic surgeons have performed numerous and wide-ranging minimally invasive surgeries using the da Vinci® Surgical System. Looking through the da Vinci’s specialized telescope with 12x magnification in 3D, a surgeon is offered pinpoint accuracy in a surgical site.
Testicular biopsy is a minor surgical procedure that involves the removal of a small sample of testicular tissue. It may be performed to find the cause of male infertility or to confirm an obstruction of the male reproductive tract. It is only performed when other testing is inconclusive. It may also be done if there is a suspicious lump, to determine if it is cancerous, although that is not part of a male fertility work-up. Testicular biopsy may also be performed as part of testicular sperm extraction (TESE), which is a method of extracting sperm directly from the testes for use in In Vitro Fertilization (IVF) treatment or Intra-Cytoplasmic Sperm Injection (ICSI). This may be used in cases of azoospermia, when sperm does not get into the semen, but is still being produced in the testes.
Testicular cancer develops in one or both of the testicles, which produce and store sperm and testosterone. Compared with other types of cancer, testicular cancer is rare, but is one of the most common cancers diagnosed in young men, typically those 15 to 35. Most men with testicular cancer can be successfully treated, especially when the cancer is detected early. Even testicular cancer that has spread may respond well to treatment.
A lump or a mass in the scrotum is usually the first symptom. Following a range of tests that help to determine the stage of the disease, Urology of Virginia’s multidisciplinary urologic oncology team has advanced expertise in the surgery, radiation therapy, and chemotherapy techniques to treat testicular cancer in ways that avoid injuring nerves vital to sexual function.
Testosterone deficiency can have serious effects on a man’s sense of health and well-being. It plays an important role in male sexual and physical development and also maintains energy levels, fertility, sex drive and bone health. Also known as male hypogonadism, the disorder results when the body does not produce enough of the male sex hormone testosterone. It is most often experienced as a condition of aging. Research has shown that a third of men over age 45 will have low testosterone. Symptoms may include weight gain around the abdomen, muscle tone loss in arms and legs, fatigue and even depression. The loss of libido, or sex drive, is the concern that most often leads men to seek treatment.
Blood tests help determine testosterone levels, followed by treatment options at Urology of Virginia with Testosterone Replacement Therapy (TRT). Hormone levels can be increased through application of a patch, a gel, intramuscular injections, or pellets to alleviate symptoms, improve energy and increase well-being.
Urinary Tract Infection
A urinary tract infection (UTI) is an infection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a simple cystitis (a bladder infection) and when it affects the upper urinary tract it is known as pyelonephritis (a kidney infection). Symptoms from a lower urinary tract infection include painful urination and either frequent urination or urge to urinate (or both), while those of pyelonephritis include fever and flank pain in addition to the symptoms of a lower UTI.
The treatment of prostate, kidney, bladder and testicular cancer calls for a highly skilled team of physicians working with pathologists, radiologists and radiation oncologists. Urology of Virginia physicians have gained national and international recognition in the field of urologic oncology, from research findings to pioneering advanced state-of-the-art medical and surgical options as they emerge and are proven effective.
Varicoceles are abnormal enlargements of veins within the scrotum. They are similar to varicose veins of the leg. Often formed during puberty, they can become larger and thus more noticeable with time. Affecting about 20 percent of men aged 15 to 25, varicoceles usually develop above the left testicle and occasionally in both testicles. There are no known risk factors beyond being a male over 15. While a varicocele often causes no symptoms, it is the most common cause of sperm production problems leading to male infertility. About 40 percent of infertile men have a varicocele and approximately 80 percent of those who have already fathered a child but are now infertile have one.
Treatment methods at Urology of Virginia focused on improving fertility include outpatient surgery, laparoscopy and other options to repair the affected vein. A period of several months must elapse after treatment, during which new sperm growth is allowed to take place, improving the male fertility factor.
Millions of men have elected to have a vasectomy as a safe, effective birth control option. It works by cutting the vas deferens, the tubes that carry sperm from the testes to the penis. Sperm are then prevented from mixing with semen during ejaculation. After the procedure, sperm will continue to be produced but will be reabsorbed into the body. A vasectomy will not noticeably affect the appearance or feel of seminal fluid and will not affect a man’s libido, sexual pleasure or ability to have an erection.
One of the most commonly performed procedures by the experienced physicians at Urology of Virginia, a vasectomy is outpatient surgery involving only about 20 minutes of time. Typically, it leads to an immediate return home and the ability to resume normal routines, including sex, within days.