Efficient Procedure Allows Couple to Conceive, Changes Family’s Life Forever

Georgia Urology patient

Amy Chang of Alpharetta, Ga. longed for motherhood. Not just one child, but “an entire basketball team,” she said with a laugh.

When she and husband Peter agreed to marry more than a decade ago, Amy explained her desire for a brood. Her groom-to-be agreed. However, a serious obstacle blocked their road to biological parenting. Years earlier, Peter had undergone a vasectomy.

This would call for in vitro fertilization (IVF), but first Peter needed a sperm extraction procedure. So the couple called upon Dr. Jerry Yuan of Georgia Urology.

“For men with normal sperm production who have had a vasectomy, the extraction procedure has only minimal challenges,” said Dr. Yuan. “Fortunately, Mr. Chang fell into that category. It required a general anesthesia, making it virtually painless. …We used an operating microscope to aid in finding sperm.”

The extraction, which Amy said took less than 10 minutes from start to finish, proved successful. She recalled both her and Peter were surprised at the quickness and efficiency of the process. The sperm was then shipped to the specialists who handled the IVF procedure. In less than three weeks, the couple had conceived.

Dr. Yuan may have performed hundreds of these extractions throughout his career, but Amy doesn’t downplay the impact it had on her family. What the physician did in mere minutes, she said, was priceless.

“Dr. Yuan forever changed our lives for the better,” she said. “And today we have our 11-year-old son, Harrison.”

If you have any further questions about vitro fertilization or are considering the procedure yourself, click here to schedule an appointment with our expert urologists!

Peyronie’s Disease Front and Center

Urologist discussing Peyronie’s disease with patient.

By Dr. Emerson Harrison, M.D., F.A.C.S.

Peyronie’s disease was named after the famous French surgeon Francois Gigot de la Peyronie, surgeon to King Louis XV. In 1743, Dr. Peyronie described a condition characterized by scar tissue, or plaque, that forms inside the penis. This plaque caused curvature or bending of the erect penis. This disorder is now referred to as Peyronie’s Disease.

Keep reading below to learn more about this condition and how the experts at Georgia Urology can help.

Signs and Symptoms of Peyronie’s Disease 

A slight curvature of the penis is considered normal in most men. However, Peyronie’s disease is characterized by pain, hard lumps, or nodules (plaques) found within the penile shaft. This scar tissue may cause curvature as well as divots and/or indentations during erections. The condition may make sexual intercourse painful and/or difficult for the patient and his partner.

Causes

The underlying cause of Peyronie’s disease is uncertain and not well understood. The cause may be related to penile trauma, injury during sexual intercourse, or physical activity, although most patients don’t remember any traumatic event or injury.

Diagnosis

Most urologists can diagnose and institute and/or suggest treatment options for the disease. In most cases, the location, size, and hardness of the plaque in the penis are identified. A penile ultrasound can provide conclusive evidence of the Peyronie’s plaque. Patients are sometimes asked to bring in a photo of the erect penis so that the urologist can assess the degree of curvature of the penis.

Treatment

Goals of treatment include relieving pain and straightening the penis to allow for a return to satisfactory intercourse. The drug Xiaflex (or collagenase clostridium hisolyticum) was originally approved to treat a hand and forearm condition called Dupuytren’s Contracture. It is now the most common and first-line treatment for Peyronie’s disease. It is injected directly into the plaque scar tissue during several courses of treatment. This therapy dissolves the plaque tissue which causes straightening of the curvature.

Surgery

Surgery is usually considered as a last resort to correct the curvature. A penile prosthesis may be appropriate in severe cases of Peyronie’s in order to straighten the penis. Sometimes physical therapy and devices such as vacuum erection pumps are used as penile traction therapy in attempts to also straighten the curvature in the penis.

Counseling

Peyronie’s disease can often times be a physically and psychologically debilitating disease for men and their partners. Because Peyronie’s disease is difficult to cure, counseling can help men and their partners cope with the devastating effects of the disease. It is not uncommon for men afflicted with Peyronie’s disease to develop depression or withdrawal from their sexual partners.

The expert urologists at Georgia Urology can help restore confidence back to any man suffering from Peyronie’s disease. Contact us at 678-284-4053 to schedule an appointment today.

Hypospadias Basics: What Every Parent Should Know

Baby being examined for Hypospadias.

Dr. James Elmore, an expert Pediatric Urologist on the Georgia Urology team, sat down to answer parents’ most pressing questions about hypospadias.

What is Hypospadias?

Hypospadias is a common condition in boys where the meatus (pee opening) isn’t where it belongs near the tip of the glans (head) of the penis. Instead, the opening is located along the underside of the penis. The term actually comes from the latin hypo meaning “under” and spade meaning “opening”. It’s one of the most common congenital anomalies and occurs in about 1 out of 300 boys. In many cases, the low opening is also associated with a downward curvature of the penis called chordee (pronounced: Kohr-Dee)

Why Does Hypospadias Happen?

While there is some evidence it may result from certain environmental exposures, there is nothing parents did to cause it or could have done to prevent it from occurring. This is an ongoing area of research.

How will Hypospadias Impact my Child’s Life?

The vast majority of this condition is “distal” or mild. In these cases, the meatus is located close enough to the tip of the penis that it will not impact your child’s sexual function or fertility. However, less frequently, the opening is located in a position that may impact erections and/or fertility.

Can Hypospadias be Corrected?

Yes. Hypospadias can be corrected with outpatient surgery. The surgery is technical and may take 1-2 hours but is not dangerous. In most cases, once fully healed, the penis will look normal-as though surgery was never even done. Often a circumcision is done at the same time, but this is not mandatory. In many cases, a small stent (or catheter) is left in at the time of surgery and removed 1-2 weeks after surgery in the office. For more severe cases, two surgeries are sometimes required to both straighten the penis and to bring the opening into a more normal position.

Who Should do my Child’s Hypospadias Surgery?

The best opportunity for a “perfect” outcome is during the first surgery. We strongly recommend you choose a pediatric urologist who is experienced in this surgery and sees patients with hypospadias regularly. The pediatric urologists at Georgia Urology are experts in the treatment of hypospadias and see patients with this condition almost every single day. We monitor our outcomes very closely to ensure we are offering World-Class care and using state-of-the-art techniques.

When Should My Child Have Surgery for Hypospadias?

There is growing evidence that the earlier the surgery is done, the better. The ideal age to proceed with surgery is between 6 and 12 months depending on the severity. However, hypospadias repair can be done safely at nearly any age.

What are the Risks of Hypospadias Surgery?

While your Georgia Urology surgeon will make every effort to avoid complications following surgery, occasionally these do occur. The most common complications are meatal stenosis and a urethral fistula. Meatal stenosis is a condition where the meatus becomes abnormally small following repair. This can cause a narrow or deflected urinary stream. This is generally very easy to correct with short second surgery. A urethral fistula is an abnormal opening (or hole) along the repair line of the surgery. Similar to meatal stenosis, a second short surgery will likely be required if this occurs. In general, it is best to wait 6 months or longer to fix complications following hypospadias surgery.

Georgia Urology’s Dr. James Elmore is the Associate Director of Robotic Surgery at Georgia Urology, and works with Children’s Healthcare of Atlanta. He is a respected authority in the field of hypospadias, and developed the first and most widely used grading method for hypospadias. This scoring method helps to predict outcomes after surgery and has been adopted at several institutions in the U.S. and abroad. Dr. Elmore has a particular interest in all hypospadias surgery from minor to the most complex. To make an appointment with Dr. Elmore, click here!

What you need to know about Urethral Stricture

By Kristi Hebert, M.D.

The urethra is the tube that urine exits through when it leaves the bladder. A stricture occurs when a segment of that tube develops scar tissue and becomes narrow. This narrowing can affect how well the bladder functions to drain the urine.

Symptoms:

  • slow or weak urinary stream
  • difficulty urinating/straining
  • incomplete bladder emptying
  • urinary tract infections
  • frequent urination
  • blood in the urine

Occasionally, the symptoms can be severe enough to prevent any urine from exiting the bladder, prompting patients to visit an emergency room.

Causes:

Many times the cause remains unknown. However, there are some risk factors known to be associated with stricture development. These include a history of:

  • direct trauma (such as a bike straddling accident or being kicked in the scrotal area)
  • previous catheter use
  • previous surgical procedures on the bladder or prostate
  • prostate radiation therapy
  • some sexually transmitted infections

It is very common for symptoms to develop many years after the causative event.

Diagnosis:

To diagnose a urethral stricture, a small flexible camera is inserted into the urethra to visualize along its course. The camera is used to identify both the location of the stricture and how narrow it is. Imaging studies (x-rays) can then determine the length of the narrowing. All of this information is used to plan the proper treatment.

Treatment:

Once a stricture is diagnosed and assessed, surgery can be used to treat the problem. Reconstruction of the urethra can be performed by removing the narrow segment and connecting the healthy portions of the tube back together, or by transferring tissue from elsewhere in the body to the urethra in order to make it wider. Most commonly, this tissue is taken from the inner lining of the cheeks.

Strictures can also be managed with internal cutting or dilating in some cases. These procedures widely differ from reconstruction regarding the expected success rates. Occasionally, patients may choose to insert a catheter in the bladder instead of pursuing surgery.

If you believe you may be suffering from a urethral stricture, contact Georgia Urology at 404-252-8227 to schedule a consultation.

Everything You Need To Know About Benign Prostatic Hyperplasia

By Dr. Lewis S. Kriteman

Doctor discusses the noncancerous prostate condition benign prostatic hyperplasia

Benign Prostatic Hyperplasia (BPH) is the noncancerous growth of the prostate gland, which occurs normally in men as they age.  The prostate gland surrounds the urethra at the base of the bladder and compresses the urethra, which reduces the flow of urine emptying from the bladder.  This often causes voiding symptoms and affects more than half the male population after the age of 50 in the United States.

Benign Prostatic Hyperplasia Symptoms:

These are usually differentiated into obstructive symptoms and storage symptoms:

  • Obstructive Symptoms:
    • Trouble starting (hesitancy)
    • Slow stream
    • Straining to go
    • Stopping and starting numerous times
    • Dribbling at the end
  • Storage Symptoms (often referred to as “bladder symptoms”):
    • Sudden urges to go
    • Frequent voiding (usually more than 8 times per day)
    • Incomplete emptying
    • Frequent voiding at night (also called nocturia)

BPH symptoms can significantly affect a man’s quality of life (and at times his partner’s as well!) Make sure to call the professionals at Georgia Urology if you notice any of these symptoms happening to you or your loved one.

Diagnosis of Benign Prostatic Hyperplasia:

Typically, your doctor will diagnose BPH based mainly on history.  Questionnaires can be very helpful in assessing symptoms and the most common one is called the International Prostate Symptom Score (IPSS).  Examining the prostate (called a digital rectal examination or DRE) also is important in diagnosis but may not correlate with a patient’s symptoms. Your doctor may also draw a blood test called a PSA (Prostate Specific Antigen) which is used in conjunction with the DRE to diagnose prostate cancer.  PSA is NOT a test for BPH.  Additional tests to assess BPH may also include:

  • Uroflow (voiding in a special urinal to assess the strength of the stream)
  • Bladder Scan (an ultrasound evaluation of the remaining urine in the bladder after voiding)
  • Cystoscopy (using a tiny fiber-optic scope to look into the urethra and inner part of the prostate and bladder)
  • Prostate ultrasound (to assess the overall size of the gland)

Benign Prostatic Hyperplasia Treatments:

An enlarged prostate on examination does not necessarily require treatment.  If however a patient begins to have bothersome symptoms there are numerous options for treatment including:

  • Behavioral changes (e.g. better fluid management especially at night)
  • Phytotherapies (e.g. Saw Palmetto)
  • Medications (e.g. Flomax, Proscar)
  • Minimally invasive treatments (e.g. Urolift and Rezum)
  • Surgical procedures (e.g. Laser procedures such as Greenlight vaporization, TURP and Aquablation)

Complications of untreated BPH can include recurrent bladder infections, hematuria (blood in the urine), kidney damage, and kidney or bladder stones.  If you are experiencing any bothersome symptoms you should discuss this with your urologist who can work with you to devise the best treatment plan to improve your condition.

There are physicians at Georgia Urology who specialize in all the treatment options available for BPH including the newest therapies.  Call 678-284-4053 or make an appointment online today and let us get you on the road to improvement!

Your Child’s Risk of Testicular Torsion

By Dr. Michael Garcia-Roig

 

Male toddle who is playing with a toy car.

Sudden onset testicular pain can be a medical emergency. There are a number of things that can cause this, but one of the most concerning involves a sudden twisting of the testicle that cuts off blood flow to that area. This problem happens in some kids because the testicle isn’t held in place correctly, allowing it to spin on its stalk. If the testicle twists enough times, it can cut off blood to that area. Left undiagnosed and untreated, this can result in loss of the testicle.

Causes

Torsion of the testicle typically occurs around the time of puberty, in males 10-25 years old, and sometimes happens a few hours after rough physical activity, minor trauma to the area, or even in the middle of the night while sleeping. The pain is usually severe, typically doesn’t go away, and can be associated with nausea or feeling like you’re going to throw up.

Treatment

It’s important to see a doctor emergently for sudden and significant testicular pain because there’s more than one reason this pain can happen. If your doctor suspects a testicular torsion, they may get more tests, like an ultrasound of the testicles. If the testicle is twisted, it can usually be saved if diagnosed and treated within 4-8 hours from onset of pain. Treatment involves surgery to untwist the testicle and secure it to the inside of the scrotum so it can’t move. Generally, if the pain has been going on for more than 12 hours, there is a good chance the twisted testicle can’t be saved and will need to be removed. Your doctor won’t know for sure until they’re doing the surgery. The normal untwisted testicle on the other side is also secured to the inside of the scrotum to prevent it from twisting. If the testicle has to be removed, your doctor may be able to put in a prosthetic testicle, or fake testicle, at the time of surgery or at a later date to give the appearance of two testicles.

Even if the pain goes away, it’s a good idea to get checked out because it’s possible for the testicle to twist and untwist on its own. If this happens and is confirmed with tests, your doctor may recommend surgery to secure the testicle to the inside of the scrotum so it can’t move.

Prevention

Unfortunately, testicular torsion can’t be prevented. It happens because the testicle isn’t secured to the inside of the scrotum correctly and this can’t be diagnosed with imaging studies like an MRI or ultrasound. The most important thing to keep in mind is to get your child examined by a doctor if there is a sudden onset of severe testicular pain accompanied by tenderness, swelling, and nausea.

If you suspect testicular torsion is happening to your child, give the trusted pediatric urologists at Georgia Urology a call at 678-284-4053.

Interstitial Cystitis: A Painful Bladder Condition

By Jeffrey G. Proctor

A woman suffering from pain of the bladder caused by interstitial cystitis.

Historically, interstitial cystitis (IC) was considered rare and has been an under-reported and under-recognized condition.  IC is more common in women than men.  However, more recent studies have shown that IC is more common than originally described.  The RAND Interstitial Cystitis Epidemiology (RICE) study found that up to 7.9 million American women have symptoms consistent with IC.  This study also showed up to 2.1 million men in the United States had IC and chronic pelvic pain syndrome (CPPS) symptoms.

Learn more about this medical condition below!

Symptoms

Interstitial cystitis is generally thought of as symptoms of urinary frequency, urgency, and bladder or pelvic pain.  Symptoms wax and wane and can progress over time, particularly when untreated. Symptoms associated with interstitial cystitis range from mild to severe. Patients may go several years between onset of symptoms and getting a diagnosis of IC.  Some may have symptoms for 5 years or longer and see 5-7 physicians prior to being diagnosed with IC.  They are often misdiagnosed with recurrent urinary tract infections, even when the urine cultures are negative.

To help distinguish a difference between the two, here are common symptoms of IC:

     *  Frequent urination (more than 8 voids a day), nocturia (wake up at night)

     *  Urinary urgency (sense of rushing to the bathroom)

     *  Pressure, discomfort or pain as the bladder fills

     *  Feeling the bladder is full even when you recently voided

     *  Lower abdominal pain

     *  Bladder spasms

     *  Pain with or after sexual intercourse

     *  In women, pain in the pelvis, vagina, urethra

     *  In men, pain in the penis, testicles, pelvis, painful ejaculation

     *  Worse symptoms with certain foods, spicy foods, alcohol, coffee, soda’s

Diagnosis

The diagnosis of IC is based primarily on symptoms of urinary frequency, urgency, with discomfort or pain for at least 6 weeks in duration, in the absence of identifiable infection, disease, or other disorders causing the symptoms. The diagnosis can be based on symptoms or by office-based tests. Recognition of IC early in the disease course can translate into earlier treatment and more rapid improvement prior to the development of more severe symptoms.

Treatment

There are several ways to treat IC. Multimodal treatment strategies are fundamental in the management of IC, and may include an IC diet, stress management, physical therapy, and medications.  There are also treatments that can be instilled into the bladder that in many situations can more rapidly improve the IC symptoms of pain and urinary urgency.

Dr. Proctor is currently involved as an investigator in a national study for a bladder instillation for IC patients, so you know you can trust the physicians at Georgia Urology if you suspect you might have IC. Give us a call at 678-284-4053 to schedule an appointment today.

Bladder Cancer 101

By Dr. A. Keith Levinson

Bladder cancer is the fifth most common cancer in the United States. Nearly 82,000 people will be diagnosed in the United States with bladder cancer in 2018, and there were an estimated 16,000 bladder cancer deaths in the U.S. in 2015.

Bladder cancer is more common in males than females at a ratio of approximately 3:1. Learn your potential risk and more about this cancer below.

There are multiple risk factors associated with bladder cancer:

  • Smoking is the most significant and common risk factor. It is estimated to contribute to the development of 50% of bladder cancers. Former smokers still remain at a higher risk than those who never smoked.
  • Workplace exposure to chemicals used to make plastics, paint, textiles, and rubber.
  • Cancer patients treated with the chemotherapy drug cyclophosphamide or pelvic radiation therapy may be at an increased risk.
  • Patients with chronic bladder inflammation related to prolonged urinary catheters or infection are at increased risk.
  • Patients with a hereditary condition called Lynch syndrome may be at an increased risk as well.

Symptoms of bladder cancer:

There is no general screening recommendation for detecting bladder cancer. Most patients present with these symptoms of the disease.

  • The most common presenting symptom of bladder cancer is blood in the urine, otherwise known as hematuria. It is usually painless. This may be in the form of obvious visible red blood called gross hematuria or microscopic hematuria, where blood is noted under the microscope by your doctor. Symptoms may also include frequent and urgent urination in the absence of documented infection.
  • Hematuria should never be ignored. Not everyone with blood in the urine has cancer but it is important that even one episode be brought to the attention of your doctor and evaluated.

Diagnostic Tests for bladder cancer:

Patients presenting with gross hematuria will typically undergo a full body imaging test called a CT or CAT scan. Usually, a cystoscopy will be performed as well. This is a short test done under local anesthesia where the urologist will use a flexible telescope to look inside the bladder. If a mass in the bladder is seen, the next step is to perform a biopsy and hopefully resect the lesion under anesthesia. A visual resectoscope is used to do this. This procedure is called a transurethral resection of a bladder tumor or TURBT. This is usually done as an outpatient procedure with a short recovery time.

Types of Bladder Cancer:

The most common bladder cancer involves the lining of the bladder and is called transitional cell carcinoma. 75% of bladder cancers are noninvasive or superficial and 25% have already invaded the muscular wall of the bladder at diagnosis. Invasive tumors have the potential to spread to other parts of the body through the bloodstream and lymph nodes.

Once a cancer diagnosis is made, treatment recommendations depend on certain prognostic factors including:

  • Stage: depth of local tumor invasion and extent of spreading potentially to the pelvic lymph nodes and other organs.
  • Grade: the aggressiveness of tumor cells under the microscope is graded on a scale of 1-3. Grade three tumors are the most aggressive or fast growing.

Tissue Type or pathology:

Most bladder cancers are transitional cell cancers. Less common types include Adenocarcinoma, Squamous cell, Sarcomas, and small cell carcinomas.

Treatment:

Once stage, grade, and pathology are accounted for, bladder cancers can be classified as low, medium, or high risk:

  • Low risk: These tumors are at low risk for progression and after resection can often be followed with interval cystoscopy. In some cases, the urologist may instill a one-time chemotherapy treatment (Mitomycin) into the bladder immediately after TURBT which decreases the risk of recurrence.
  • Medium risk patients may need further treatment with medications instilled directly into the bladder for 6 weeks or longer, followed by close follow up. An immunotherapy drug BCG is used most commonly.
  • High-risk patients may need a prolonged course of bladder instillations with BCG for 1-2 years to decrease the risk of the tumor progressing to a more invasive disease. A minority of more advanced cases may require bladder removal along (Radical cystectomy) with possible chemotherapy.

In summary, bladder cancer is a common disease. There is hope and effective treatments for those with bladder cancer. It is important to avoid the above risk factors described, especially smoking and to never ignore any signs of blood in the urine. Early detection and treatment are critical, so call Georgia Urology at 678-284-4053 if you suspect something is wrong.