At Riverside, our goal is to help you live life to the fullest and with as little discomfort as possible. We provide a full range of medical services for urological conditions including nonsurgical and surgical treatments.

Treatments

Bladder cancer is a type of cancer that begins in your bladder. Your bladder is a balloon-shaped organ in your pelvic area that stores urine. In most cases, bladder cancer begins in the cells that line the inside of the bladder. Fortunately, the great majority of bladder cancers are diagnosed at an early stage - when bladder cancer is highly treatable.

What are the symptoms of bladder cancer?
Some of the symptoms of bladder cancer may include:

  • Blood in urine (hematuria)
  • Frequent urination
  • Painful urination
  • Back pain
  • Pelvic pain

How is bladder cancer diagnosed?
Along with a physical examination, your physician may perform the following tests to confirm a bladder cancer diagnosis:

  • Cystoscopy
  • Removing a sample of the bladder tissue (biopsy)
  • Urine cytology (analysis of urine for abnormal cells)
  • Imaging tests

Stages of bladder cancer

  • Stage I
    Cancer at this stage occurs in the bladder's inner lining but hasn't invaded the muscular bladder wall.
  • Stage II
    Cancer has invaded the bladder wall but is still confined to the bladder.
  • Stage III
    The cancer cells have spread through the bladder wall to surrounding tissue.
  • Stage IV
    By this stage, cancer cells may have spread to the lymph nodes and other organs, such as your bones, liver or lungs.

How is bladder cancer treated?
Treatment for bladder cancer varies depending on the type and stage of the cancer, your overall health, and your treatment preferences. Some of the options include:

  • Surgery
  • Chemotherapy
  • Radiation therapy
  • Immunotherapy (using your body's own immune system to help fight cancer)

Benign prostatic hyperplasia or BPH, is a noncancerous enlargement of the prostate gland. It is the most common benign tumor found in men. Prostate gland enlargement is a common condition as men get older.

What are the symptoms of BPH?
Many patients with benign prostatic hyperplasia experience no symptoms. When symptoms do occur, they range from mild and barely noticeable to serious and disruptive. Some of the most common signs and symptoms of BPH include:

  • Frequent or urgent need to urinate
  • Increased frequency of urination at night (nocturia)
  • Difficulty starting urination
  • Weak urine stream or a stream that stops and starts
  • Dribbling at the end of urination
  • Straining while urinating
  • Inability to completely empty the bladder

How is BPH diagnosed?
A doctor will ask you questions about your symptoms and perform a physical exam. This initial exam may include:

  • Digital rectal exam
  • Urine test
  • Blood test
  • Prostate-specific antigen, or PSA, blood test
  • Cystoscopy (using a telescope to view the bladder)
  • Neurological exam

After that, your doctor might recommend additional tests to help confirm an enlarged prostate and to rule out other conditions. These additional tests might include:

  • Urinary flow test
  • Postvoid residual volume test
  • 24-hour voiding diary

How is BPH treated?
There are a wide variety of treatments available for enlarged prostate, including:

  • Medication
  • Minimally invasive therapies
  • Surgery

The best treatment choice for you depends on several factors, and our doctors will help you make an informed decision based on your specific situation.

Erectile dysfunction is also called impotence. It is defined as the inability to get and keep an erection firm enough for sex.

If you are experiencing erection trouble from time to time it probably is not a cause for concern. However, if erectile dysfunction is an ongoing issue, it can cause stress, affect your self-confidence and contribute to relationship problems. In addition, it can be a sign of an underlying health condition that needs treatment.

In some cases treating the underlying causes of erectile dysfunction is enough. Other times, medications or other treatments might be needed.

What are the symptoms of erectile dysfunction?

  • Trouble getting an erection
  • Trouble keeping an erection
  • Reduced sexual desire

If you are experiencing these symptoms on a persistent basis, or you have concerns about your erections, it is a good idea to schedule an appointment with your doctor.

How is erectile dysfunction diagnosed?
In most cases, a physical exam and medical history exam are enough for a doctor to diagnose erectile dysfunction and recommend a treatment. If you have chronic health conditions or your doctor suspects that an underlying condition might be involved, you might need further tests. Tests for underlying conditions might include:

  • Blood tests
  • Urine tests (urinalysis)
  • Ultrasound
  • Overnight erection test
  • Psychological exam

How is erectile dysfunction treated?
There are several different treatment options, depending on the cause and severity of your erectile dysfunction and any underlying health conditions.

  • Oral medications
  • Other medications
  • Psychological counseling
  • Lifestyle changes (quit smoking, lose weight)

Kidney cancer, also called renal cancer, is a disease in which kidney cells become malignant (cancerous) and grow out of control, forming a tumor. Your kidneys are two bean-shaped organs, each about the size of your fist. They're located behind your abdominal organs, with one kidney on each side of your spine.

Almost all kidney cancers first appeagr in the lining of tiny tubes in the kidney. This type of kidney cancer is called renal cell carcinoma. Other less common types of kidney cancer can occur. Young children are more likely to develop a kind of kidney cancer called Wilms' tumor.

As with most cancers, early diagnosis of kidney cancer dramatically improves the chance for survival.

What are the symptoms of kidney cancer?
In most cases, kidney cancer rarely causes signs or symptoms in its early stages. In the later stages, kidney cancer signs and symptoms may include:

  • Blood in your urine, which may appear pink, red or cola colored
  • Back pain just below the ribs that doesn't go away
  • Weight loss
  • Fatigue
  • Intermittent fever

How is kidney cancer diagnosed?
In addition to taking a complete medical history and performing a physical exam, your doctor will likely recommend the following tests to diagnose kidney cancer:

  • Blood and urine tests
  • Imaging tests
  • Removing a sample of kidney tissue (biopsy)

Stages of kidney cancer:

  • Stage I
    At this stage, the tumor can be up to 2 3/4 inches (7 centimeters) in diameter. The tumor is confined to the kidney.
  • Stage II
    Kidney cancer is larger than a Stage I tumor, but it's still confined to the kidney.
  • Stage III
    The tumor extends beyond the kidney to the surrounding tissue and may also have spread to a nearby lymph node.
  • Stage IV
    Cancer spreads outside the kidney, to multiple lymph nodes or to distant parts of the body, such as the bones, liver or lungs.

How is kidney cancer treated?
Together, you and your cancer care team will discuss your kidney cancer treatment options. The best approach for you may depend on a number of factors, including your general health, the kind of kidney cancer you have, whether the cancer has spread and your preferences for treatment.

Possible treatment options include:

  • Surgical treatments
  • Robotic kidney-sparing surgery
  • Tumor ablation
  • Immunotherapy
  • Targeted therapy
  • Active surveillance

Kidney stones are small, hard mineral deposits that form inside your kidneys. The stones are made of mineral and acid salts.

Kidney stones have many causes and can affect any part of your urinary tract - from your kidneys to your bladder. Often, stones form when the urine becomes concentrated, allowing minerals to crystallize and stick together.

What are the symptoms of kidney stones?
A kidney stone may not cause symptoms until it moves around within your kidney or passes into your ureter - the tube connecting the kidney and bladder. You may experience these signs and symptoms:

  • Severe pain in the side and back, below the ribs
  • Pain that spreads to the lower abdomen and groin
  • Pain that comes in waves and fluctuates in intensity
  • Pain on urination
  • Pink, red or brown urine
  • Cloudy or foul-smelling urine
  • Nausea and vomiting
  • Persistent need to urinate
  • Urinating more often than usual
  • Fever and chills if an infection is present
  • Urinating small amounts of urine

How are kidney stones diagnosed?
If our doctors suspect you have a kidney stone, you may have diagnostic tests and procedures, such as:

  • Blood testing
  • Urine testing
  • Imaging

How are kidney stones treated?
Treatment for kidney stones varies, depending on the type of stone and the cause. Most kidney stones do not require invasive treatment. You may be able to pass a small stone by:

  • Drinking water
  • Pain relievers
  • Medical therapy

You may be asked to urinate through a strainer to catch stones that you pass, so that we can determine the makeup of your kidney stones. We use this information to determine what's causing your kidney stones and to form a plan to prevent more kidney stones.

However, kidney stones that are too large to pass on their own or cause bleeding, kidney damage or ongoing urinary tract infections, may require more extensive treatment. Procedures may include:

  • Using sound waves to break up stones
  • Surgery to remove very large stones in the kidney
  • Using a scope to remove stones

Low testosterone, known as hypogonadism, is a condition associated with low serum testosterone levels. Hypogonadism is a disease in which the body is unable to produce normal amounts of testosterone due to a problem with the testicles or with the pituitary gland that controls the testicles.

As you age, testosterone levels naturally decline so it is important to determine in older men if a low testosterone level is simply due to the decline of normal aging or if it is due to a disease such as hypogonadism.

What are the symptoms of low testosterone?
Some of the symptoms you may experience due to low testosterone include:

  • Low sex drive
  • Poor erections (weaker and fewer)
  • Wanting sex less often

Nonsexual signs include:

  • Increase in body fat
  • Lower energy
  • Reduced muscle mass
  • Feeling depressed
  • Anemia or low iron levels
  • Loss of calcium from bone

How is low testosterone diagnosed?
The only way to diagnose low testosterone is with a blood test. In general, a diagnosis of low testosterone is made if your hormone level is below 300 ng/dL.

How is low testosterone treated?
Men with confirmed low testosterone levels may be advised to begin a testosterone replacement regimen. If you have signs and symptoms of low testosterone that bother you, there are several choices for raising the levels. Not everyone chooses treatment. Testosterone replacement therapy can be given using:

  • Skin gel
  • Shots
  • Long-acting pellets
  • Patches
  • Pills

Discuss the benefits and risks of taking testosterone replacement therapy with your doctor. You should not be taking TRT if you do not have low levels of testosterone.

Infertility is defined as the inability to conceive or carry a pregnancy to term after 12 months of trying to conceive.

If getting pregnant has been a challenge for you and your partner, you're not alone. Of couples in the United States, 10% to 15% are infertile.

What are the symptoms of infertility?
The main sign of infertility is the inability for a couple to get pregnant. Many times there may be no other obvious symptoms.

In some cases, an infertile woman may have irregular or absent menstrual periods. An infertile man may have signs of hormonal problems, such as changes in hair growth, sexual function, reduced sexual desire, or problems with ejaculation. He may also have small testicles or a swelling in the scrotum.

How is infertility diagnosed?
Your doctor or clinic will need to determine what your sexual habits are and may make recommendations about changing them. In addition, the tests listed below can help to diagnose infertility. Specific fertility tests for men may include:

  • Semen analysis
  • Hormone testing
  • Transrectal and scrotal ultrasound
  • Genetic testing
  • Testicular biopsy

How is infertility treated?
Treatment of infertility depends on several things, including the cause, how long you've been infertile, your age and your partner's age, and many other personal preferences.

Some causes of infertility can't be corrected. However, a woman may still become pregnant with assisted reproductive technology.

Treatment for men:
Approaches that involve the male include treatment for general sexual problems or lack of healthy sperm. Treatment may include:

  • Treating infections
  • Treatments for sexual intercourse problems
  • Hormone treatments and medications
  • Surgery
  • Assisted reproductive technology

Treatment for women:

  • Stimulating ovulation with fertility drugs
  • Intrauterine insemination
  • Surgery to restore fertility
  • Assisted reproductive technology

Prostate cancer is cancer that occurs in a man's prostate - a small walnut-shaped gland that produces the seminal fluid that nourishes and transports sperm.

Prostate cancer is one of the most common types of cancer in men. When detected early - and confined to the prostate gland - prostate cancer has a better chance of successful treatment.

What are the symptoms of prostate cancer?
In its early stages, prostate cancer may cause no symptoms or signs. In its more advanced stages prostate cancer symptoms can include:

  • Trouble urinating
  • Decreased force in the stream of urine
  • Blood in the semen
  • Discomfort in the pelvic area
  • Bone pain
  • Erectile dysfunction

How is prostate cancer diagnosed?
To help diagnose prostate cancer early, the American Urologic Association recommends that men consider prostate cancer screening at ages 55-69, or sooner for men in higher risk groups such as African-Americans and those with a family history or prostate cancer.

Prostate cancer screening consists of:

  • Digital rectal examination
  • Prostate-specific antigen, or PSA, blood test

If your DRE or PSA test shows an abnormality, your doctor may recommend tests to determine whether you have prostate cancer, such as:

  • Ultrasound
  • Removing a sample of the prostate tissue (biopsy)

When a biopsy confirms the presence of cancer, the next step is to determine the level of aggressiveness of the cancer cells, called staging.

Stages of prostate cancer:

  • Stage I
    Signifies very early cancer that's confined to a small area of the prostate.
  • Stage II
    Cancer may still be small but may be considered aggressive when cancer cells are viewed under the microscope. Or cancer that is stage II may be larger and may have grown to involve both sides of the prostate gland.
  • Stage III
    The cancer has spread beyond the prostate to the seminal vesicles or other nearby tissues.
  • Stage IV
    The cancer has grown to invade nearby organs, such as the bladder, or spread to lymph nodes, bones, lungs or other organs.

How is prostate cancer treated?
Your treatment options will be determined on an individual basis, depending on what stage your cancer is, and your preferences for treatment. Procedures available to you may also be determined by other factors, such as your overall health.

Some of the treatment options include:

  • Watchful surveillance, because some cases never require treatment
  • Surgery
  • Cryosurgery
  • Prostatectomy
  • Radiation therapy
  • Hormone therapy
  • Chemotherapy

Xofigo - New treatment for advanced prostate cancer
Xofigo is an intravenous injection of the radioactive material radium 223. It is typical injected once a month and is used to treat prostate cancer that is resistant to medical or surgical treatments that lower testosterone, and has spread to your bones with symptoms, but not to other parts of your body. The medical term for this condition is metastatic castration-resistant prostate cancer.

Xofigo effectively targets cancer cells and provides pain relief, improved quality-of-life and longer survival time for men with late-stage prostate cancer that has spread to the bones. Xofigo works by using radiation to target cancer cells in bone tissue, while causing less damage to surrounding tissue than other types of radiation treatment.

As with most forms of cancer, the chance of survival associated with prostate cancer depends on what stage the cancer is in when it is detected, how aggressive the cancer proves to be and which treatment options your overall health permit you to try.

Urinary incontinence, or the loss of bladder control, is a common and often embarrassing problem. While some people experience occasional leaking urine when they cough or sneeze, others experience an urge to urinate that's so sudden and strong that they may not be able to get to a toilet in time.

If urinary incontinence affects your daily activities, don't hesitate to see your doctor. Simple lifestyle changes and medical treatment can ease discomfort or stop urinary incontinence.

What are the symptoms of urinary incontinence?
The main symptom of urinary incontinence is a problem controlling urination. Types of urinary incontinence include:

  • Stress incontinence
    Urine leaks when you exert pressure on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy.
  • Urge incontinence
    A sudden, intense urge to urinate followed by an involuntary loss of urine.
  • Overflow incontinence
    Frequent or constant dribbling of urine due to a bladder that doesn't empty completely.
  • Functional incontinence
    A physical or mental impairment keeps you from making it to the toilet in time.
  • Mixed incontinence
    You experience more than one type of urinary incontinence.

How is urinary incontinence diagnosed?
To diagnose urinary incontinence, our doctors perform a complete physical exam, and may also perform one of the following tests:

  • Urinalysis
  • Bladder diary
  • Post-void residual measurement
  • Cystoscopy (using a telescope to view the bladder)
  • Urodynamics

How is urinary incontinence treated?
Treatment for urinary incontinence varies, depending on the type of incontinence, its severity and the underlying cause. In some cases, a combination of treatments may be needed. We will suggest the least invasive treatments first and move on to other options only if these techniques fail.

A variety of treatment options include:

  • Behavioral techniques, including:
    • Bladder training
    • Double voiding
    • Scheduled toilet trips
    • Fluid and diet management
  • Pelvic floor muscle exercises
  • Electrical stimulation
  • Medications
  • Medical devices
  • Interventional therapies
  • Surgery
  • Absorbent pads and catheters

Services

A nephrectomy is a surgical procedure to remove all or part of a kidney.

A nephrectomy may be performed to treat kidney cancer or to remove a seriously damaged or diseased kidney.

What is the purpose of a nephrectomy?
A surgeon performs a nephrectomy either to remove a diseased kidney or to harvest a healthy kidney intended for an organ transplant.

Reasons why a nephrectomy is needed, include:

  • A damaged kidney
  • A kidney that is no longer functioning properly
  • Cancer in the kidney
  • Donating your kidney

Urogynecology is a subspecialty which encompasses the evaluation and treatment of conditions that affect the female pelvic floor.

Urogynecologists diagnose and treat women who have complex conditions of the pelvic floor, including:

  • Urinary incontinence
  • Pelvic organ prolapse
  • Fistulas
  • Congenital anomalies

Treatments
Urogynecologists offer a range of treatments for patients, including:

Conservative treatment

  • Pelvic floor re-education
  • Biofeedback
  • Urge suppression drill
  • Relaxation techniques

Surgical & nonsurgical treatment options

  • Vaginal reconstructive surgery
  • Abdominal reconstructive surgery
  • Laparoscopic reconstructive surgery
  • Pubovaginal slings
  • Fascial grafts
  • Sacral nerve stimulation
  • Botulinum toxin injection

Vasectomy is a form of male birth control that prohibits the supply of sperm to your semen. During the procedure the tubes that carry sperm are cut and sealed. Vasectomy has a low risk of problems and can usually be performed in an outpatient setting under local anesthesia.

Vasectomy is a permanent form of birth control, so patients should be certain they do not want to have children in the future.

What are the benefits of a vasectomy?
Vasectomy is a safe and effective birth control choice for men who are certain they do want to father a child.

  • Vasectomy is nearly 100% effective in preventing pregnancy.
  • The cost of a vasectomy is far less than the cost of female sterilization, called tubal ligation, or the long-term cost of birth control medications for women.
  • You won't need to take birth control steps before sex, such as putting on a condom.

What can you expect during a vasectomy?
A vasectomy is usually done under local anesthesia, which means you'll be awake and have medicine to numb the surgery area. The surgery usually takes about 15 to 20 minutes. After your surgery, you should avoid any sexual activity for a week or so. If you do ejaculate, you may feel pain or notice blood in your semen. If you have sexual intercourse, use another form of birth control until your doctor confirms that sperm are no longer present in your semen.