Penile Fracture: A True Emergency

Man with penile fracture suffering in bed.

Most people have never heard or experienced a penile fracture. However, the penis can “fracture”, even if there is no bone in the penis.

Georgia Urology expert Dr. Zisholtz explains this urology phenomenon and the experience he’s had correcting these.

How Does a Penis Break?

During sex, and as the penis becomes erect, the pressure inside the two cylinders begins to rise. The pressure during sex inside the penis can increase to over 200mm of mercury in a healthy man.

However, if during sexual activity the penis accidentally hits the woman’s pubic bone, the immediate pressure is magnified and the cylinders can rupture.

What Does a Penile Fracture Feel Like?

Usually, there is a loud popping sound and sudden pain. The erection suddenly disappears, as all the pressure is relieved by the blood escaping into the soft tissues. Sometimes, the blood may also go directly into the urethra, resulting in bleeding from the tip of the penis.

How Do You Treat a Penile Fracture?

Ice and pressure should be applied, and emergency consultation is advised. The best treatment is to repair the rupture and any other area that was damaged. With repair of the fracture and drainage, there’s a much better chance for the gentleman to maintain his future sexual capacity.

Does Georgia Urology Treat Penile Fracture?

Over the last two months, I’ve had two patients with severe “fractures”. Both were operated on, repaired, and/or drained. I’m happy to report both are back in action!

If you have any more questions or concerns about this urological issue, contact the experts at Georgia Urology to make an appointment.

Learn About Extracorporeal Shock Wave Lithotripsy

An example of why Extracorporeal Shock Wave Lithotripsy is needed.

By Dr. Jerry Yuan, M.D.

Extracorporeal Shock Wave lithotripsy, or ESWL, has revolutionized kidney stone treatment since its introduction in the mid-1980s. Now, it’s the most commonly employed treatment for kidney stones in the US.

Learn more about this treatment Georgia Urology is proud to offer for our patients below.

What is Extracorporeal Shock Wave Lithotripsy?

The inspiration of ESWL derived from aeronautical science, where the shock wave at the leading edge of airplane wings at high speed was studied. In short, with ESWL, a source of shock wave (electromagnetic, as in our Dornier device) is focused and directed at the stone. Various physical forces are then optimized to induce stone fragmentation with the goal of reducing sizable stone to smaller entities to allow for spontaneous passage. Refinements over the last 30 years allow the current generation of lithotripters to precisely focus the shock wave energy and minimize unintended collateral injury.

When Would Someone Receive Extracorporeal Shock Wave Lithotripsy?

Most kidney stones maybe considered for ESWL. A typically patient is one who has a medium size stone in the ureter tube and is deemed unlikely to pass expeditiously as seen in the 1st radiograph.

How Does Extracorporeal Shock Wave Lithotripsy Work?

Usually, a patient is scheduled as an outpatient and is positioned on the treatment table under light general anesthesia.

Our office preparing patient for Extracorporeal Shock Wave Lithotripsy.

General anesthesia is recommended given the procedure is somewhat painful. Additionally, since precise shock wave delivery is paramount, patient movements as those under twilight anesthesia tend to compromise the overall success. The stone is then localized and positioned in the “crosshair” prior to initiation of treatment and will be monitored throughout the session.

An xray for an example of crosshair of Extracorporeal Shock Wave Lithotripsy.

What Should be Considered Before Receiving Extracorporeal Shock Wave Lithotripsy?

Large stones greater than 1 cm, especially the rather hard stones, may require multiple sessions. This is. Because the energy required for these stones surpasses the amount the body can tolerate at a single session. Large and difficult to break stones may be more expediently treated by surgical stone removal whereby an endoscopic portal is introduced via the flank to allow for direct visualization and stone fragmentation and removal (PCNL).

Stones located in the lower ureter may also be treated via mini endoscopes via the urethra for direct basket removal or laser lithotripsy with high success rate.

A patient about to receive Extracorporeal Shock Wave Lithotripsy.

ESWL is one of several modalities at our disposal to allow for effective stone treatment. Each treatment has its pros, cons, and limitations. The best approach is by no means universal and is individually based taking into many factors such as size, location, chemical makeup or hardness, and patient preference. If you have any questions about this procedure, contact the urology experts at Georgia Urology.

Aquablation TURP: A Revolutionizing Robotic Surgery for BPH

Urologists perform Aquablation on patient.

By Dr. Brent A. Sharpe, M.D.

As urologists, it’s not often we get to witness something in our careers that revolutionizes the way we do things. The first time I ever experienced this phenomenon was after performing robotic surgery for prostate cancer. Within 10 years, more 95% of all prostate cancer surgeries in the US were performed using the robotic system.

However, I thought this would be my one and only opportunity to witness this moment of change in our field, but I was wrong. Now, there is a new revolutionizing robotic surgery for men with benign prostate hyperplasia, BPH, which may make other forms of transurethral surgery obsolete.

What is Benign Prostate Hyperplasia?

BPH is a very common condition in which the prostate grows and obstructs the flow of urine. Over 70% of men in their 60’s have BPH. It can have many effects on the urinary stream such as a decreased flow, difficulty starting the flow, starting and stopping during urination, frequency, urgency, and commonly getting up at night to use the bathroom.

How Has Benign Prostate Hyperplasia Typically Been Treated?

The mainstays of therapy are daily medications, in office procedures or transurethral surgery called TURP. A TURP removes the obstructive prostate tissue by using a heat-based system, such as laser or cautery, to resect the tissue. Historically, it also has been associated with significant complications and the need for repeat operations. One of the main reasons for this is that the surgery must perform the manually and without any guidance of how much tissue needs to be removed because there is no real time imaging to guide the surgery. Now enter Aquablation TURP!

What is Aquablation TURP?

Aquablation TURP by Procept BioRobotics utilizes the clarity of real-time multidimensional imaging, the accuracy of an autonomous robot, and the power of a heat-free water jet to produce a more reliable and predictable surgery. The use of real-time ultrasound permits for key structures to be identified to allow for normal sexual function and continence, as well as to determine the exact size and shape of the prostate.

The automatic robotic device allows for faster and more predictable removal of tissue. Finally, by not using heat energy during the procedure there is a reduction in the typical complications associated with standard TURP.

Is Aquablation TURP Successful?

In two multicenter, multinational studies, Aquablation has been proven to be safe, effective and consistent. The procedure times are drastically reduced and, in some case, may be reduced by more than 50%. Historically, a large prostate gland could take 2 hours to remove tissue, but in these studies, the Aquablation TURP took only 38 minutes.

Georgia Urology is the first practice in three surrounding states to use this new and exciting surgical robot to perform Aquablation TURP for men with BPH. Currently, Drs. Brent A. Sharpe and Lewis Kriteman have performed nearly 10 procedures with all patients experiencing a significant reduction in their BPH symptoms and are extremely satisfied. For more information, you can contact Drs. Sharpe and Kriteman at 678-205-8387 or click here to schedule an appointment.

What You Should Know About Vasectomy

Man at doctors to ask What You Should Know About Vasectomy

By Dr. A. Keith Levinson, M.D.

Deciding to have a vasectomy is a big decision, so Georgia Urology wants to make sure you have all the education you need to make an informed choice. Keep reading below to discover what you should know about vasectomy.

What is Vasectomy?

Vasectomy is the most common surgical procedure performed by urologists. Over 500,000 vasectomies are performed per year in the United States. It is a safe and simple procedure that renders a man sterile, and recovery is quick.

Safe, Effective Birth Control

Vasectomy is one of the most cost effective methods of contraception. It is equally as effective as tubal ligation in preventing pregnancy and is simpler, faster, and less expensive. It can be done under local anesthesia in a physician’s office as opposed to tubal ligation, which is done under general anesthesia in the hospital.

How Does a Vasectomy Work?

Most urologists perform a no-scalpel vasectomy. One or two small puncture wounds are made in the scrotum. Each vas deferens is then lifted through a puncture site, divided and sealed by heat (cauterized). They may also be tied or clipped. The procedure generally takes up to 30 minutes.

What to Consider Before a Vasectomy

If you’re considering a vasectomy, here are some facts and statistics worth thinking about:

  • Vasectomy is a permanent form of contraception. If a man changes his mind after a vasectomy, later options for fertility including vasectomy reversal and sperm retrieval with in vitro fertilization are not always successful and may be expensive. You can consider freezing your sperm before a vasectomy, but cryopreservation may be expensive and uncertain as well.
  • Vasectomy does not produce immediate sterility. Following vasectomy, another form of contraception must be used until a post-vasectomy semen analysis is confirmed to show no sperm
  • The risk of pregnancy after vasectomy is 1 in 200 for men who have no sperm seen on follow up semen analysis
  • The rates of surgical complications such as symptomatic infection or hematoma (bleeding) are 1-2%.
  • There is no long-term change in sex drive, sexual function, or volume of semen after the procedure.
  • Chronic scrotal pain after vasectomy may be seen in 1-2% of men. Few of these men will require additional surgery.
  • Vasectomy is not a risk factor for other medical issues including prostate cancer, heart disease, or dementia.

After the Procedure

As mentioned above, recovery is usually painless when it comes to receiving a vasectomy. Here’s what you might experience:

  • Post-procedure pain is often mild. Over the counter pain, medicine is usually adequate.
  • Stay off your feet and much as possible the first day. An ice pack can help reduce swelling.
  • Call your doctor if you have increased scrotal pain, redness, or swelling.

If you have any more questions after reading about what you should know about vasectomy, click here to schedule an appointment with any of our expert urologists.

What is Cystoscopy? Georgia Urology Explains

A urologist discussing Cystoscopy with her patient

By Dr. Fernando A. Duralde, M.D., F.A.C.S.

Cystoscopy means literally to look at the bladder with a scope. The expert urologists at Georgia Urology have performed many cystoscopes, so they’re extremely qualified to explain all about this medical procedure.

Why Should You Get a Cystoscopy?

Reasons for doing a cystoscopy include evaluation of lower urinary tract when there is blood in the urine. Similarly, a cystoscopy might be part of the evaluation for recurrent infections or issues of incontinence. Patients with a history of bladder tumors are followed in this way. Ultimately, cystoscopy is a diagnostic test to find the source of the problem and develop a treatment plan.

How Does Cystoscopy Work?

This procedure can be performed awake or asleep, in the office, the surgery center, or in the hospital. To reach the bladder, the scope normally goes through the urethra which, in men, includes the prostate. When this procedure is done in the office or surgery center, the urologist will most likely use a flexible scope. This means the scope can go around bends and curves. Overall, the procedure is mildly more uncomfortable than having a catheter placed.

In the office setting, a cystoscopy normally takes about five minutes to perform. The patient will be prepped and often given lidocaine jelly to numb the tissues. The most discomfort comes with passing the scope into the bladder. After that, there is a sensation of bladder fullness as the urologist instills water into the bladder. It is not unusual to experience some discomfort urinating after the procedure and blood can occasionally be seen. This will most likely clear. Drinking more fluids helps “flush” the bladder. Expect to recover within the next few days.

What Happens After a Cystoscopy?

Your urologist should be able to share the findings with you after the procedure is completed. In some cases, you will need to go to the hospital for a more involved procedure. Other times, you can be followed in a routine manner in the office. In either case, the cystoscopy is an important test to evaluate your lower urinary tract and can be well tolerated with little downtime.

If you have any more questions about this medical testing, click here to contact the urologists at Georgia Urology!