So, You Have Some Blood in your Urine? Possible Causes, What Happens Next, and Treatment Options

By Dr. Bryce Wyatt, M.D.

Seeing blood in your urine can be an extremely dramatic and frightening experience that, unfortunately, many people will experience in their lifetime. Blood in the urine, or “hematuria”, is one of the most common reasons someone will seek the care of a urologist.  While it can be scary and seem like you’re losing a lot of blood, it’s important to remember that just a little drop of blood can make a lot of urine look red, just like a small drop of food coloring will turn an entire glass of water any color you like.

In general, there are two ways to classify hematuria, “microscopic” and “gross”.  Microscopic hematuria means that the blood can’t be seen with your own eyes. Oftentimes, your primary care doctor will mention to you that blood was seen on your urine sample. That is called microscopic hematuria. Gross hematuria is more obvious and is when your urine is red in color or you can see blood clots.  Both types of hematuria should be evaluated by a trained professional and should not be ignored, even if the bleeding goes away.

In this blog, we will talk about a few of the common causes of hematuria, how your doctor will determine why this is happening, and some treatment options for the various causes.

Possible Causes

Blood in the urine can come from anywhere in the urinary system. It can come from all the way up in the kidneys down to the bladder and there are many potential causes.  Furthermore, about one third to half of the time we never find a reason for microscopic hematuria. However, with gross hematuria, it can be easier to nail down a diagnosis.

The following are some of the more common reasons to have blood in your urine:

Urinary Tract Infections (UTI)

UTIs are extremely common and often easily treatable and can cause bloody urine. If you have a history of urinary tract infections, if you are peeing more often, feel pressure in your pelvis, pain in your back, start noticing a strong smell to your urine, it hurts to pee, or your having fevers/chills, you may have a urinary tract infection.

Kidney Stones

Kidney stones or bladder stones can result in severe pain in your back or stomach and can show up as blood in the urine. Kidney stones can sometimes cause damage to your kidneys and should be evaluated right away.


The most important reason to be evaluated for blood in the urine is to look for kidney or bladder cancer. Men over the age of 50 with a history of smoking are especially at risk of being found to have cancer.  Depending on the type and stage of cancer when it is found, it can be treated, which is why it’s so important to see a doctor as soon as possible when you have blood in your urine.

Other Causes

Having a large prostate, vigorous exercise, dehydration, sickle cell disease, recent surgeries, catheters, blood thinners, and other medical issues can lead to blood in the urine.

Next Steps

Your doctor has many tools in their belt to identify potential sources of blood in the urine, but, in general, there are four tests they will likely perform.

Urine Culture

Since a UTI is such a common cause of hematuria, oftentimes your doctor will first make sure you don’t have an infection. All you have to do is leave a urine sample for your doctor to test. Once an infection has been ruled out with a negative urine culture, the rest of the investigation will begin. It can take a couple of days for a culture test to result but your doctor may start you on antibiotics just in case before the test comes back.

Urine Cytology

This is another easy test to do. All you have to do is leave a urine sample just like with a culture. By looking at the urine under a microscope, we can identify any abnormalities that may be concerning for possible cancer.

CT Scan

A CT scan is an important part of finding the source of bloody urine. A CT scan can identify kidney or bladder stones, tumors in the kidneys and ureter, and even bladder cancer. Unfortunately, a CT scan does require radiation, but the small amount required is not considered to be harmful.

You will also need to have an IV placed as the CT scan requires an injection of something call “contrast”.  The contrast causes certain parts of the body to light up on the CT scan making it easier for the radiologist to identify any concerning findings. The contrast can make you feel a little funny including warm sensations, a metallic taste in your mouth or even sick feeling.  Rarely, contrast can cause hives, swelling, or skin redness. It’s important to let your doctor know if you have had a reaction to contrast before as special precautions will need to be taken.


Last and certainly the least fun of all the studies is the cystoscopy. Cystoscopy is using a small camera inserted into the bladder to get a direct look at the bladder wall. While it can be uncomfortable, it is a very quick and necessary study. The CT scan can only see large bladder abnormalities, but oftentimes bladder cancer can be small and flat appearing that only a cystoscopy will reveal. This is done in the office using a small flexible scope inserted through the urethra after applying some numbing cream to the area.

Treatment Options

Depending on the source of the bleeding, there are many treatment options available:

Urinary tract infection (UTI)

Antibiotics are the mainstay of treatment for UTIs and are typically given for three to seven days depending on how bad the infection is. Sometimes the antibiotics must be changed based on the urine culture result if the bacteria found is resistant to the first antibiotic.


Stones can be treated in several different ways. Pain pills and medications can help with the passage of kidney stones but sometimes your doctor will have to perform surgery if the stone is too large to pass. Shockwaves can be used to break up the stone into pieces that will pass easily, or your doctor can go into your kidneys with a tiny camera and blast the stones with lasers if necessary.


Depending on the type and stage of cancer there are many treatment options available. Kidney cancer is often treated with surgery to remove part of or the entire kidney. Bladder cancer can be treated by using a small camera to enter the bladder and remove the cancerous parts.  Afterward, different medicines can be put into the bladder to help prevent cancer from coming back.  Sometimes if the bladder cancer is severe, the bladder may need to be removed.

Other Causes

There are many different procedures that can help with big prostates and bleeding. If you have difficulty with urination and hematuria, your urologist can discuss some of the many options available to help with both problems.

Hematuria is a very common and very important reason to see your urologist because the causes can range from being nothing at all to dangerous. If you or someone you know has blood in their urine, they should make an appointment right away to get checked out. Click here to schedule an appointment with the urology experts at Georgia Urology!

Percutaneous Nephrolithotomy (PCNL)

Two plastic kidneys with PCNL on a table with two stereoscopes.

By Dr. Jerry Yuan, M.D.

Percutaneous Nephrolithotomy (PCNL) is the procedure of choice when dealing with large bulky renal stones, especially those of dense consistency.

Standard treatments for routine kidney stones, such as shock wave lithotripsy or endoscopic removal via mini-endoscope through the ureter, are effective in dealing with most stones. However, when confronted with large stones of 1-2 cm or more in size compounded by those of very hard chemical makeup, more definitive steps are required. This is where PCNL comes in.

How Does PCNL Work?

PCNL allows for direct contact of the offending stones with full-size endoscopes & lithotripsy (stone busting) devices and simultaneous removal of fragments to achieve the most expedient & complete stone clearance.

During PCNL, an access or accesses are placed by our radiology specialists in the flank.

Xray of Percutaneous Nephrolithotomy, Needle and access placement

Once in place, the access is then dilated to allow placement of working ports gaining entry into the plumbing system of the kidney where stones reside. Various devices including laser, ultrasound or pneumatic jackhammer like probes are then used to disintegrate the stones, sizable fragments are easily evacuated without the need for the passage which often is not feasible when dealing with a large amount of debris.

Videos of PCNL

Three videos are provided to illustrate the large stones we often encounter or the so-called staghorn stones since they take up the entire interior of the kidney.

Video one is Before.

Video 2 is multiple sessions in progress with marked reduction of stone burden and multiple drainage catheters in place.

Video 3 is post-op with minimum debris remaining.

PCNL typically requires overnight stay and most patients are treated with a single session. Some require multiple sessions days apart to effect a satisfactory result.

If you have any more additional questions about PCNL, click here to contact any of our Georgia Urology experts.

Georgia Urology Adopts Groundbreaking Enlarged Prostate Surgery

Male doctor checking another male patient by pressing into his side as he lays down, checking for enlarged prostate to see if the groundbreaking enlarged prostate surgery is necessary.

Georgia Urology’s Dr. Brent Sharpe counts himself fortunate to not only witness revolutionary breakthroughs in his field, but to be a purveyor himself.

When treating patients for benign prostate hyperplasia (BPH), otherwise known as prostate enlargement, Dr. Sharpe can now offer the option of the groundbreaking enlarged prostate surgery Aquablation TURP, a game-changing urological procedure. Georgia Urology is the first practice in three surrounding states to perform the surgery.

BPH is a very common condition in which the prostate grows and obstructs the flow of urine. Its effects on the urinary system include decreased flow, difficulty starting the flow, starting and stopping during urination, frequency, urgency, and commonly getting up at night to use the bathroom.

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. In fact, operative times may be reduced as much as 50 percent. Finally, by not using heat energy during the procedure there is a reduction in the typical complications associated with standard TURP.

“It’s really revolutionizing robotic surgery for men with benign prostate hyperplasia,” Dr. Sharpe says, “ which may make other forms of transurethral surgery obsolete.”

After suffering from an enlarged prostate for approximately 12 years, Roger Lance of Buford, Georgia opted for Aquablation TURP and walked away astonished by the results.

Lance says the high-pressure saline stream basically obliterated the obstruction quickly and efficiently. The surgery itself only required an overnight hospital stay. After a one- to two-week recovery period, Lance says he regained bladder control, and things improved greatly.

“I haven’t been able to go to the bathroom like this since I was a teenager,” Lance says. “It’s just amazing how much it changed everything.”

Millard Hixson of Toccoa, Georgia echoes the same sentiment. With an enlarged prostate four times larger than normal, Dr. Sharpe suggested they take action. Hixson chose Aquablation TURP.

“I couldn’t imagine the procedure going as good as it did,” he says. “It’s made a big difference. I don’t get up at night anymore, and I’m able to sleep a lot better. I didn’t realize how much continuous sleep night was important. Now I can sleep for seven to eight hours straight. I have a lot more energy now.”

According to Dr. Sharpe, providing this type of relief and lifestyle change to patients via groundbreaking technology remains one of the most rewarding aspects of his career as a urological surgeon.

“Every patient I’ve worked with has experienced a significant reduction in symptoms, and they’re extremely satisfied,” Dr. Sharpe says. “As a surgeon, you can’t hope for a better outcome than that.”

For more information, you can contact Dr. Sharpe at 678-205-8387 or click here to schedule an appointment.

Treatment and Prevention of rUTI in Women

White woman with short brown hair sitting with doctor in an office, discussing rUTI.

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

Symptomatic, recurrent lower urinary tract infections (rUTI) in women are a common condition for which best practice guidelines related to treatment and prevention have not been well established. rUTi affects women of all ages and is defined as 2 or more symptomatic episodes in 6 months or 3 episodes in 1 year. Between 20% to 30% of women who have one UTI will have a rUTI, and approximately 25% of these women will have more recurrent episodes.

Symptoms of rUTI may typically include burning with urination, foul smelling urine, urinary urgency, and frequency. Treatment strategies should focus on relieving symptoms while at the same time preventing the overuse of antibiotics, which can cause increased side effects as well as the development of antibiotic resistance.

Who is at risk or rUTI? 

  • For premenopausal women, sexual activity can be associated with rUTI.
  • Birth control products such as nonoxynol-9 spermicide can be a risk factor as well.
  • Lack of estrogen in postmenopausal women can lead to vaginal atrophy, acidic PH changes, and overgrowth of bacteria leading to UTI

What type of work up is needed to treat rUTI?

A urine culture prior to treatment with antibiotics is important to document infection and help determine optimal antibiotic treatment. More complex cases may require renal imaging or cystoscopy.

How is rUTI best treated? 

Short course treatment of 3-5 days is recommended. Preferred first line antibiotics are Nitrofurantoin, Trimethoprim-Sulfa, and Fosfomycin. Fluoroquinilones such as Cipro are discouraged.

rUTI prevention strategies:

Some prevention strategies include lifestyle and behavioral modifications:

  • controlling blood glucose in diabetics is important
  • Sexually active women should avoid spermicide gel use. It is unclear whether voiding after intercourse is useful
  • Avoid unnecessary or prolonged antibiotic use (more than 5 days)
  • maintain adequate hydration

There are also therapeutic interventions, such as antibiotic treatments:

  • The use of antibiotic prophylaxis may sometimes be indicated and can be done in several ways.
    • The use of a single low dose antibiotic immediately after intercourse can be very effective in preventing.
    • Once daily low dose antibiotics for 6-12 months may be required at times and is effective.
    • A patient self start 3 day course of antibiotics can be a convenient way to treat intermittent It is best to get a urine culture prior to starting treatment.

Nonantibiotic therapy: 

While commonly used to prevent rUTI, there is little data to support the use of Cranberry products or D-mannose. The value of oral and vaginal probiotics is questionable.

Vaginal estrogen therapy reduces vaginal PH, reduces bacterial colonization, restores lactobacillus, and reduces rUTI in postmenopausal women. There is no documentation of increased breast cancer risk or rise in serum Estrogen levels. Oral estrogens do not reduce UTI risk.

Methenamine Hippurate :

This is a bacteriostatic agent that increases urinary levels of formaldehyde. It does not promote antibiotic resistance. There is some evidence that using methenamine as prophylaxis may help prevent rUTI and reduce need for prophylactic antibiotics.


OM-89 (Uro-Vaxom) is an oral vaccine only available in Europe. It appears to be safe and effective in reducing rUTI. Hopefully, this will available in the U.S. soon

rUTI’s are frustrating for women and can significantly impact quality of life, and daily activities. Identifying underlying risk factors is important. There are potentially preventive measures worth discussing with your doctor.

If you have any more questions about the treatment and prevention of rUTIs in women, click here to schedule an appointment with a Georgia Urology expert today.

Common Questions about Urinary Control after Prostate Surgery

Portrait of happy woman surgeon standing in operating room, ready to work on a patient, ready to discuss Urinary Control after Prostate Surgery.

Expert urologist Dr. John Stites, M.D., answers the most common questions about urinary control after prostate surgery below.

Is it common to have urinary control issues after prostate surgery?

Recovery of urinary control is one of the most common concerns for men undergoing treatment for benign and malignant prostate disorders. While most men experience significant improvement or resolution in urinary symptoms, they remain a common source of stress before and after surgery.

Why do men have problems with urinary control after prostate surgery?

It might seem counter-productive that men may have issues controlling their urination after prostate surgery, especially since many men undergo surgery to treat their urinary symptoms to begin with. The underlying causes of these symptoms aren’t limited to the prostate itself; often other structures such as the bladder or urethra can undergo changes after surgery.

For example, a man may undergo surgery to reduce obstruction from his prostate gland so that he may more easily pass urine. Before surgery, his bladder must push harder than usual to pass urine beyond his prostate gland. When this obstruction is surgically removed, however, the bladder must adjust to changes caused by surgery. An unusual urge to urinate with or without leakage may occur during this recovery.

What changes in my urinary control can I expect after prostate surgery?

Individual changes after surgery cannot always be predicted, but there are many tools to help us identify those at risk for urinary control issues after surgery. Before surgery is performed, testing may be needed to determine the functional and structural characteristics of the urinary tract. This information helps us identify men at risk for postoperative urinary control issues.

Who is at higher risk for problems with urinary control after prostate surgery?

More invasive procedures (such as radical prostatectomy for prostate cancer) carry a higher risk for urinary control issues postoperatively. Many factors can influence urinary control after surgery, including underlying medical conditions, medications, diet, and daily activity. Many of these factors are modifiable, and improvement is often achieved by a comprehensive and motivated approach.

It is important to ask your urologist about urinary control when considering prostate surgery, and to discuss pre-existing urinary control issues. Patient education and motivation are among the most important factors in improving urinary control after prostate surgery.

If you have any additional questions regarding urinary control after prostate surgery, click here to contact our expert team.

Urinary Tract Fistula After Hysterectomy: What are the Options?

Urologist is speaking with patient about Urinary Tract Fistula.

By Dr. Lambda Msezane

Severe continuous leakage of urine is a rare complication after routine hysterectomy. This can be a sign of a fistula between the bladder, vaginal wall, or the ureter and the vaginal wall. A fistula is an abnormal tract that forms between two areas of the body.

Keep reading below to learn more about urinary tract fistula from a Georgia Urology expert.

What are the Symptoms of Urinary Tract Fistula?

The main symptom of a urinary tract fistula to the vagina is nonstop leakage of urine. Associated symptoms include abdominal pain or fever if urine collects in the abdomen. The type of leakage associated with a fistula is more severe than the typical stress and urge incontinence that can also occur. In most cases, it requires surgical intervention to repair this complication.

How is Urinary Tract Fistula Treated?

In the past, women would have to wait 6 weeks to 3 months before repairs could be attempted after a traditional open hysterectomy. This is due to the number of adhesions or scar tissue that forms after surgery. This was especially true because the signs of fistula can be delayed for a week to 10 days as the tract forms and this is when the adhesions start to become difficult. A woman would have to wait either with a catheter, a nephrostomy tube (a tube into the kidney through the back), or deal with the leakage until the repair could be attempted.  

Robotic-assisted surgery has changed the urologist’s approach to this life-changing complication. Due to the robotic arms and 10x magnification camera, we are allowed the ability to access the pelvis with great visualization and dexterity. This is done through small incisions as opposed to a large midline incision. Urologists no longer need to wait months to repair the fistula. We can either re-implant the ureter to move it away from the fistula tract in the case of a ureterovaginal fistula or dissect the bladder away from the vaginal wall in the case of a vesicovaginal fistula.

What is Recovery Like for Treating Urinary Tract Fistula?

Since the surgery is minimally invasive, the patient can go home the next day and can be completely healed in about 4 weeks. This significantly shortens the recovery time compared to open repair. An indwelling catheter to drain the bladder and a ureteral stent may be needed postoperatively for a short period of time.  

Although initially devasting, the repair of vesicovaginal or ureterovaginal fistula post hysterectomy can be performed in a timely fashion thanks to the robotic approach. Women with this complication can return to their normal life with a smaller incision, less pain and recovery time, and most importantly no further severe leakage of urine.

If you have any more questions about this urological condition or treatment options, get in contact with Georgia Urology physicians by clicking here.  

Can a Child with UTIs have Reflux?

Urologist and child patient are happy after finishing up treatments for VUR and UTIs.

By Dr. Michael Garcia-Roig

Urinary tract infections (UTI) can occur in children, as well as adults. This happens when bacteria normally living in the bladder grows out of control and irritate the bladder’s lining, causing symptoms like painful urination, having to run to the bathroom often, urine accidents, or blood in the urine.

If you find yourself asking can a child get a UTI or VUR, keep reading below.

What Causes UTIs in Children?

In young kids, a few common behaviors can cause urinary infections. Specific behaviors that put kids at risk for UTI are not urinating often, not drinking enough liquids, and ignoring a full bladder or the urge to urinate withholding behaviors like the “pee-pee dance” or holding the genitals. Constipation also plays a huge role in UTI’s, especially in kids. It doesn’t take long for the rectum to get full in kids. With the pelvis being small, the full rectum can get in the way of the nerve signals to the brain, or in the worst cases, it can even directly pinch the bladder and make it hard to empty.

What Causes VUR?

Normally, urine made by the kidneys comes down a small tube, called the ureter, to the bladder. This is intended to be a one-way trip- once urine makes it to the bladder it can’t go back up to the kidney. Vesicoureteral reflux, or VUR, happens when urine can freely flow back and forth between the bladder and kidney. In some people, this back and forth flow of urine can cause a small bladder infection to quickly turn into a miserable kidney infection. In kids with VUR who get kidney infections, especially those that get lots of them, long term kidney damage can happen.

Sometimes the bacteria causing a bladder UTI can make their way up to the kidney, causing a kidney infection, also called pyelonephritis. These kidney infections can be very severe in some children and are most commonly signaled by a UTI with a fever. There are several reasons why kids can get pyelonephritis, but this article will focus on the most common reason, vesicoureteral reflux.

How Do You Treat UTIs in Children?

The first step in managing a UTI is to get a urine sample before starting antibiotics to see what is causing the problem and what is the best medicine. Urine samples after antibiotics may give a false negative result. In kids who are not potty trained, this is done by passing a catheter into the bladder to get a clean sample of urine. Specimen collection bags that can be taped to the groin are good for checking the urine for a lot of things, but not for checking for urinary infection as they are very, very unreliable.

For children 2-24 months old with their first febrile UTI, the American Academy of Pediatrics recommends getting an ultrasound of the kidneys and bladder to rule out major kidney problems. Further testing is not recommended unless problems are noted on the ultrasound, or until a second UTI with fever happens.  At that time, your doctor will order a test called a voiding cystourethrogram, or VCUG, to look for vesicoureteral reflux or VUR. Vesicoureteral reflux is the medical way of saying urine goes from the bladder up to the kidneys. The VCUG is done by passing a small tube, called a catheter, through the urethra and into the bladder. The bladder is filled with x-ray contrast and x-rays are taken to see how the bladder and urethra look, and if contrast stays in the bladder, or goes up to the kidneys.

How Do You Treat Vesicoureteral Reflux in Children?

If vesicoureteral reflux is found after a febrile UTI, there are a few options for treatment. Sometimes a daily low dose antibiotic is started to prevent more kidney infections. In some kids, VUR will go away on its own as he or she grows. This usually takes one, two, or more years and a VCUG is repeated every year until its gone. Your doctor may be able to estimate the likelihood it will resolve in your child.

VUR can also be corrected with surgery. There are two basic approaches to surgery. First involves passing a small camera into the bladder through the urethra, and a small needle is used to inject a sugar-based substance called Deflux just under the ureter. In our hands, this stops reflux and infections 90-95% of the time. Kids go home the same day, there are no cuts, and there is typically little discomfort. Another way to fix VUR is called ureteral reimplantation. This surgery tucks the ureter into the side of the bladder and stops reflux and infections 95% of the time. It requires a small cut near the pubic bone, and kids stay in the hospital 1-2 nights. In some kids, a surgical robot can also be used to do ureteral reimplantation with similar outcomes and less pain.

There isn’t a one size fits all treatment for VUR, as each of these treatment options has its own pros and cons. What does need to happen is the prevention of kidney infections. Your doctor will go over options with you in detail to help find the best way to treat your child.

If you’d like any additional information on the question can a child get a UTI or VUR, click here to contact any of Georgia Urology’s expert pediatric urologists.

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.