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A.M.P. Urology

Prostate Cancer — Prostate cancer forms in the tissue of the prostate gland which is approximately the size of a walnut and found below the bladder and in front of the rectum. There are approximately 250,000 new cases each year with approximately 35,000 patients dying of the disease annually.

Prostate cancer is the third most common cause of death from cancer in men of all ages and the most common cause of death in men over the age of 75.

Known risks for prostate cancer include race with African American men being more likely to develop prostate cancer. Another risk factor is age, men who are older than 60 are at increased risk. Family history is also a risk factor, in particular patients with a father or brother diagnosed with prostate cancer.

Most patients with prostate cancer have no definitive symptoms when it is caught at early stages. Testing for prostate cancer includes an annual prostate specific antigen test (PSA) as well as a digital rectal exam to assess the prostate.

Some signs of advancing prostate cancer are also signs of benign growth within the prostate gland including: weakened urinary stream, difficulty evacuating the bladder, blood in urine or semen, and pelvic pain or bone pain once the disease has progressed.

There are multiple treatment options for prostate cancer which are best discussed with your urologist. However, these can include observation, hormonal ablation, cryosurgery, chemotherapies, high intensity focused ultrasound (HIFU), external beam radiation therapy, prostate seed implant, radical prostate surgery including: traditional surgery, laparoscopic surgery as well as da Vinci robotic-assisted prostatectomy, occasionally requiring removal of lymph nodes as well.
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Although most kidney cancers are found incidentally on radiologic imaging for other reasons, kidney cancers can include some symptoms such as abdominal pain, flank pain, blood in the urine, weight loss, and constipation.

Radiologic imaging can easily diagnose most kidney tumors including renal ultrasound or abdominal CT scan traditionally performed to evaluate the kidney as well as MRI's and multiple other radiologic imaging.

Treatment for kidney cancer typically includes removal of the kidney which was performed in the past using open surgical techniques and currently more commonly using laparoscopic or da Vinci robotic-assisted techniques to remove either the entire kidney or a portion of the kidney.

Most chemotherapy agents will not cure the cancer although it may decrease its growth once the tumor has spread.
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There are several risk factors that are known to increase the incidence of bladder cancer including cigarette smoking and other tobacco products as well as chemical exposure, chemotherapies, radiation treatments as well as chronic infection or indwelling catheters.

The typical signs of bladder cancer can include blood in the urine, irritative urinary symptoms including voiding frequently and urgently, incontinence, as well as lower abdominal pain and weight loss.

Bladder cancer is commonly diagnosed by cystoscopy which includes visualizing the bladder with a telescope performed in the office as well as x-ray imaging with CT scans or other x-rays using contrast such as IVP as well as urine cytologies which evaluate the urine for abnormal cells which have been passed.

Treatment options include removing the bladder tumor through telescopes placed into the bladder, chemotherapy agents which are placed into the bladder or if advanced it may require surgical removal of the bladder by traditional surgery, laparoscopic techniques, or da Vinci robotic-assisted techniques with alternative drainage of urine into small segment of bowel or a newly developed bladder pouch. There is also partial removal of the bladder, radiation therapy and chemotherapy which are alternative options for advanced disease as well as immunotherapy.
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There are two general categories of tumors including seminomas and non-seminomas. Risk factors include abnormal testicular development, history of testicular cancer, undescended testicles and congenital abnormalities.

The symptoms typically include pain in the testicle or scrotum, a testicular mass which is easily palpable or enlargement of the testicle, weight loss, and back pain. Evaluation typically includes physical examination, scrotal ultrasound, further x-rays to assess for any progression of the disease as well as blood tests which are used as tumor markers including alpha-fetoprotein and chorionic gonadotropin.

Treatment options typically include removal of the affected testicle to assess the type of tumor as well as follow up radiologic imaging and blood testing to assess as to whether the disease has progressed. Further treatment may be necessary including possible radiation therapy or chemotherapy and becoming more popular is observation with careful follow with radiologic imaging to be sure that the disease is not recurrent in both that have been treated with chemotherapy and radiation as well as those that are simply being followed after removal of the testicle alone. The disease can progress into the lymph nodes and other parts of the abdomen as well as lungs, spine and brain with advanced disease. The prognosis in patients even with advanced disease oftentimes is quite good.
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Physicians at Associated Medical Professionals of NY are trained in Intuitive Surgical's Da Vinci Surgical System. This system allows increase precision, visualization, dexterity and control of laparoscopic instruments which are placed through small incisions into the abdomen to perform multiple urologic surgeries including treatment for:

  • Urologic Cancers
  • Prostate Cancer Surgery
  • Kidney Cancer Surgery
  • Bladder Cancer Surgery & Reconstruction
  • Reconstructive Female Incontinence Surgeries
  • Kidney Stones
  • Other Non-Invasive Surgical Treatments for Urologic Maladies.

These surgeries are performed at multiple hospitals by our Physicians including SUNY Upstate Community General Campus, St. Joseph's Hospital of Syracuse, and Crouse Hospital. We are working on expanding our robotic capabilities to other outlying hospitals in the Central New York area. The advantages of the da Vinci robotic-assisted surgical techniques including surgery through smaller incisions, faster recovery times, shorter hospital stays, use of less pain medications, overall faster recovery back to work and activities, better visualization for the surgeon with magnification, and generally less blood loss.
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Physicians at Associated Medical Professionals and their colleagues are trained in the latest techniques and treatment options for benign prostate disease.

The typical symptoms of benign prostatic enlargement can include:

  • Weakened urinary stream
  • Voiding more frequently
  • Getting up several times during bed time to evacuate the bladder
  • Urgent urination
  • Incontinence
  • Overall bothersome urinary symptoms
  • Urinary retention or inability to empty the bladder

Workup of BPH can include non-invasive studies performed in the office including uroflows, ultrasound evaluation of the bladder to assess for completion of emptying, more advanced testing with urodynamics to better assess the bladder function as well as possible obstruction, cystoscopic examination with lighted telescopes to assess for other causes for obstructed urination such as strictures and better assess response to possible treatment options. Treatment options can include medical therapy including 5-alpha-reductase inhibitors as well as alpha-blockers, minimally invasive in office procedures such as microwave therapy (TUMT) transurethral needle ablation (TUNA), in office laser procedures as well as operative procedures including traditional transurethral resection of the prostate, laser vaporization of the prostate, laser enucleation of the prostate, electro vaporization of the prostate.
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Physicians at Associated Medical Professionals are trained in a variety of treatment options for both acute kidney stone attacks which require urgent care and treatment as well as evaluation and treatment of non-obstructive and asymptomatic kidney stones as well as chemoprevention of patients who are chronic kidney stone formers.

Most patients are unaware of the presence of kidney stones until they end up in the Emergency Room with an acute attack of renal colic which typically means severe back and flank pain which may radiate into the groins as well as blood in the urine, severe nausea, vomiting, possible fever, or chills and passage of stone like material. It can also lead to irritated urinary symptoms of voiding more frequently and urgently as well as loss of bladder control.

Kidney stones are typically found on radiologic imaging which most commonly includes a CT scan of the abdomen and pelvis performed urgently in the office or in the hospital setting.

The initial management can include conservative therapies including pain control, increased hydration, straining of the urine to assess for passage of the stone as well as medical expulsive therapy which includes medication to assist in passage of the stone without surgical intervention. The symptoms of kidney stones can be associated with more serious disease including cancer that needs to be carefully evaluated by a urologist.

Treatment options for kidney stones include: observation as the majority of smaller stones will pass on their own, medical expulsive therapy which may include medications to help the stone pass more easily. Other options include in office procedures such as removing of the stone using telescopes, shockwave lithotripsy which is typically performed under mild sedation in order to fragment the stone in smaller passable fragments, interventions with endoscopes which means removal of the stone either by basketing smaller stones or performing laser procedures or other modalities to fragment the stone and remove it which are typically performed in an ambulatory setting. Percutaneous methods are also used to extract stones particularly from the kidney for larger stones that are more problematic, laparoscopic and da Vinci robotic-assisted techniques are considered for larger and more problematic stones.

A major portion of kidney stone evaluation and treatment includes the prevention of stones following the acute episodes including possible 24 hour urine collections and evaluation of any stone material which may be passed to try to minimize any further stone production in those patients that have recurrent problems as well as in patients who are young.
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Simple urinary tract infections are relatively easily treated using antibiotics if they occur infrequently.

Progressive urinary tract infections can be signs of more serious urologic disease including obstruction of urinary passage from the kidney or bladder, signs of kidney stones as well as patients who have a tendency to develop more frequent urinary tract infections which can lead to more serious urologic issues in the future. The signs and symptoms of more serious urinary tract infections can include: fever, nausea, lower abdominal pain, flank pain, lower back pain, blood in the urine, foul smelling urine, cloudy urine, irritative urinary symptoms including burning, going more often, urge to void frequently and incontinence.

Workup of more serious urinary tract infections typically includes radiologic imaging with renal ultrasound or a CT scan to assess for kidney infections or obstruction as well as possible cystoscopy to assess the bladder and importantly urine cultures to be sure that the appropriate antibiotics are delivered and followed up urine evaluations to be sure that it is fully treated.
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Physicians at Associated Medical Professionals are well trained and can treat most forms of urinary incontinence both in men and women. Urinary incontinence can be signs of other significant medical issues including: neurologic disease, progressive dementia, anatomic abnormalities, and complications from previous gynecologic or urologic procedures, neurologic and urologic malignancies as well as other serious issues which need to be carefully evaluated. Evaluation typically includes urinalysis, possible urine cultures, complete urologic physical examination, possible cystoscopic examination, urodynamic testing to better evaluate bladder function and possible obstruction, neurologic evaluation and history.

Multiple treatment options include conservative measures such as Kegel exercises and biofeedback, as well as bladder training, medical management with multiple medications that are available for improving bladder control including pills and jells, implantable devices into the lower back which can better control bladder function including InterStim.

Surgical treatment options including bladder slings, intraurethral bulking agents including collagen, pelvic floor reconstruction including cystocele and rectocele repair, da Vinci robotic-assisted and laparoscopic techniques in order to improve incontinence.

Pelvic Floor Therapy is a conservative, non-surgical therapy used to treat incontinence, urgency, pelvic pain, or to re-educate the pelvic floor muscles to restore and maintain health. Using the pelvic floor therapy technology, a computer recorder monitors the strength of your pelvic muscles and your progress throughout the therapy. This computerized technology allows you to immediately see the results as you contract and relax the correct group of muscles according to a present pattern of exercises.
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There are many new treatment options for impotence as well as more traditional options. The best treatment for a particular patient depends on careful evaluation of the patient. Impotence can be a sign of other significant medical issues including vascular disease, neurologic issues, injuries, prostate cancer as well as other significant problems. Patients require careful evaluation by their Physician. Physicians at Associated Medical Professionals of NY are trained in the evaluation and treatment options for patients with both mild and complicated disease states. Evaluation requires a careful history of both, medical issues as well as sexual health issues and a complete urologic and neurologic physical examination with review of medications, previous procedures, and also evaluation of any medical conditions and assessment of the efficacy treatment. Further evaluation of erectile dysfunction and impotence may include laboratory studies such as blood work, Doppler Ultrasound studies to assess the penile blood flow. Treatment options can include oral PDE-5 inhibitors such as Viagra, Levitra, Cialis, and Staxyn, intraurethral treatment options such as Muse, intercavernosal injections, vacuum assist device, penile prostheses including inflatable penile prosthesis for surgical options.
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A vasectomy is one treatment option for possible permanent sterilization for patients and their spouse who are absolutely sure that they no longer desire any further children. It is a relatively simple in office procedure that is typically performed under local anesthetic and well tolerated. The option of sedation is available for patients who are very apprehensive about the possibility of local anesthetic. This is performed in a discreet and comfortable in office procedure with overall low risks and allows patients the ability to have the confidence of permanent sterilization for those patients who no longer desire any further children.

We also offer the possibility of vasectomy reversals for those patients who have undergone a vasectomy and have a new family situation either desiring another child or are in a new relationship.
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Testicular disease can present in many forms including some benign findings, although it can be very difficult to discern from life threatening disease states and needs to be carefully evaluated by a Physician.

The findings can present as either enlargement of the scrotum on one or both sides of the genitals versus areas of firm masses or tenderness that can slowly develop or maybe relatively acute in onset. It is important to see a Physician for any significant pain or changes in the testicles which should be examined routinely every month similar to women performing monthly breast exams. This can be embarrassing for many men to discuss this with their Physician, although delaying evaluation may pose significant risks to your health.

One of the most important findings to evaluate are testicular masses to be sure that this does not represent testicular cancer which is the most common cancer found in men between the ages of 18 and 35, although it can be found outside of that age group as well. The majority of these cases are curable although they need to be diagnosed quickly.

  • Epididymitis – There are also many benign diseases which can be distressing or cause pain including epididymitis which is inflammation within the tubule system next to the testicle which can cause significant redness, tenderness and even fever. It can progress relatively quickly and it needs to be evaluated and treated appropriately otherwise it can lead to damage to the testicle possibly requiring even removal of the testicle.

  • Testicular Torsion – Torsion presents itself very acutely typically with severe pain in the affected testicle where the testicle has twisted its blood supply resulting in the blood supply being compromised. This is usually a significant emergency and needs to be evaluated immediately in order to keep the testicle viable and it should be evaluated in the Emergency Room upon the first signs of acute testicular pain.

  • Hydrocele – A hydrocele is a fluid collection that develops around the testicle and this typically occurs relatively slowly, although it can be the result of an acute process as well and needs to be evaluated carefully to be sure that it is not the result of a testicular mass or tumor. This can be uncomfortable due to increasing size and requires a complete physical examination to be sure that there is no underlying pathology and it typically can be treated with surgical procedures.

  • Varicoceles – Varicoceles are dilated veins which return blood from the testicle back to the body. Typically varicoceles are seen just above the left testicle. If it is noted above the right testicle it certainly requires further evaluation by a Physician and possible imaging studies to be sure that there is no obstruction of the blood flow returning from that testicle. This can lead to issues with fertility and possible discomfort and need to be evaluated appropriately.

It is difficult to tell with many testicular abnormalities whether they represent significant disease such as testicular cancer versus other more benign findings. Any abnormality should be evaluated carefully by a Physician with physical examination and possible x-ray imaging.
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Infertility is diagnosed as couples that have been unable to become pregnant after at least one year of unprotected sex although we do oftentimes evaluate patients prior to this. It can include those patients who have secondary infertility which refers to couples that have been pregnant at least once although cannot conceive again. Physicians at Associated Medical Professionals of NY have been trained in the full evaluation of male infertility which may be secondary to low sperm counts or sperm that do not perform properly and are unable to fertilize the egg.

Multiple issues can lead to male infertility including birth defects, heavy use of alcohol or illicit drugs, hormonal imbalances, impotence, chronic or acute infections, advanced age, previous treatment with either chemotherapy or radiation for cancers, history of STD's leading to scarring or injury, retrograde ejaculation, smoking, and certain medications. This can be very distressing to couples and should be evaluated within 6-12 months of inability to conceive without the use of contraceptives.

Evaluation for male infertility typically includes multiple semen analysis to assess for sperm counts as well as dysfunction. It may occasionally also require blood work and rarely testicular biopsy.

Treatment options include:

  • Education
  • Invitro Fertilization
  • Medications to improve possibility of fertilization and setting up appropriate follow up and evaluation of the female partner as well.

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Urodynamics refers to a group of diagnostic procedures that are performed to evaluate voiding disorders. The goal of diagnosis and treatment of these disorders is to (1) protect the kidneys and (2) keep the patient dry.

Urodynamics are primarily performed for evaluation of the lower urinary tract. These tests include: Uroflow, CMG, flow/pressure, UP, UPP & EMG.
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