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Urology

Urology is the practice of medicine that treats problems of the urinary tract and system that arise due to disease or dysfunction. Urologists treat males and females but often specialize in the male reproductive system.

Urology specialists in Western North Carolina

Urologic conditions require delicacy, and we are sensitive to how they affect daily life.

In the Mission Health family of hospitals, we diagnose and treat a range of urologic complications. Our board-certified urologists use surgical, oncologic and urogynecological care to support your improved wellness.

Urologic conditions we treat

Between common and complex issues, urologic conditions can impact crucial, personal aspects of life, such as urination, libido and overall comfort. We are prepared to treat all manner of such conditions, including:

  • Benign prostatic hyperplasia (BPH)
  • Erectile dysfunction (ED)
  • Hematuria (blood in the urine)
  • High prostate specific antigen (PSA)
  • Interstitial cystitis
  • Kidney stones
  • Low testosterone (hypogonadism)
  • Male factor infertility
  • Overactive bladder syndrome (OAB)
  • Pelvic organ prolapse (POP)
  • Peyronie's disease (PD)
  • Prostatitis
  • Stress urinary incontinence (SUI)
  • Urinary tract infection (UTI)
  • Urologic cancers

Types of urologic care we provide

Beginning with appropriate physical, laboratory and imaging testing, our urologists work to get to know you. They determine personalized treatments to fit your unique urologic needs.

Diagnostic testing

Some urologic conditions can be diagnosed through a physical exam, but others require other types of tests and radiology scans. Urologic testing that we conduct across our facilities includes:

  • Biopsy, including prostate
  • Blood test
  • Computerized tomography (CT) scan
  • Cystoscopy
  • Digital rectal exam
  • Hormone testing
  • Kidney, ureter and bladder (KUB) X-ray
  • Magnetic resonance imaging (MRI)
  • Physical exam, including pelvic and penile exams
  • Prostate biopsy
  • Semen analysis
  • Ultrasound
  • Urinalysis, including cultures and cytology
  • Urodynamic testing

Treatments offered by our urologists

Regardless of the severity of your condition, we work to ensure proficiencies in many treatments, so we can swiftly get you moving towards recovery and an improved quality of life. These treatment options include minimally invasive and traditional open surgical options, as well as noninvasive treatments, such as medication.

Additionally, we have robotic surgery capabilities, which allow our surgeons greater visibility and precision than is typically possible with traditional surgery. With minimally invasive robotic surgery, you experience less pain, less scarring, a faster recovery and a shorter hospital stay. Our treatments are personalized to you and we encourage you to ask as many questions as possible so that you are completely comfortable.

Artificial urinary sphincter (AUS) device

An AUS is a surgically-implanted device that is typically employed if you are experiencing significant SUI. If you have undergone previous surgery for prostate cancer, or have attempted less invasive treatments for incontinence, AUS implantation will usually be prioritized before exploring other avenues.

Botulinum toxin injections for OAB

Once OAB becomes an ongoing issue and conservative measures haven't improved your symptoms, we offer injections, often referred to as "Botox," as an alternative. During the procedure, our surgeons will make the injections in multiple locations throughout the bladder after a cystoscopy has been performed.

Extracorporeal shock wave lithotripsy (ESWL)

ESWL is a noninvasive procedure that treats kidney stones too large to pass through the urinary tract. If you are experiencing abnormal kidney stones and your doctor has determined that ESWL is right for you, our surgeons will use a machine called a lithotripter to attack the stone several thousand times with sound waves. By using these specialized sound waves, we are able to create tiny fracture lines that ultimately break the stone into pieces small enough to pass.

Mid-urethral sling for severe SUI

For females, Kegel exercises or pelvic floor physical therapy can effectively treat mild cases of SUI. For more severe and bothersome leakage, surgical intervention may be needed. One such solution is a urethral sling, which is a strip of artificial mesh that is fashioned into a hammock to support your urethra. This supports the urethra and significantly decrease leakage.

Laser vaporization of the prostate

Although medications are usually the first treatment for an enlarged prostate that slows down or blocks the bladder's outflow of urine (otherwise known as BPH), surgery becomes necessary if medication proves ineffective. For men with moderately sized prostates who need to be on aspirin or other blood thinners, a reliable option is laser vaporization of the prostate. During this procedure, a cystoscope is placed down the urethra into the bladder, where a laser is used to vaporize obstructing prostate tissue. In the process, the laser also coagulates, or seals, blood vessels, so there is minimal bleeding.

Minimally invasive transurethral surgery

If you have a moderately-sized prostate and BPH medications have proven ineffective, we offer minimally invasive transurethral surgery. During these procedures, a specialized cystoscope is inserted down the urethra into the bladder, where implants are deployed into the obstructing prostatic lobes to retract them. This opens up the urinary channel through the prostate, with no uses of heating, cutting or removal of prostate tissue. If not as effective as it should be, the procedure doesn’t prevent you from having a future transurethral resection of the prostate (TURP) if your symptoms return.

Urologic cancer care

Cancers of the urologic system can be particularly complicated, as they can arise from several causes, be detected in different ways and also lead to several different sets of symptoms, if any. Specialists in our comprehensive oncology program are prepared to expertly treat whichever cancer you may be experiencing, including bladder, kidney and prostate cancer.

Penile implants

Penile implant surgery can be valuable if you are experiencing severe erectile dysfunction and other treatments have not proven effective. It can also be particularly useful if you have long-standing medical problems, such as diabetes, or have undergone surgery for prostate cancer but would like to remain sexually active. Although the penile implant can’t be used right away, it is typically activated in-office about a month after surgery. Most penile implants are replaced after ten years, but some need sooner replacement.

Posterior tibial nerve stimulation (PTNS)

If you have overactive bladder, PTNS has proven to be a consistent alternative to surgery or medication. Consisting of weekly injections for about 12 weeks, PTNS involves a small acupuncture needle that is placed into the skin of your lower ankle, close to the posterior tibial nerve. This nerve travels back to the spinal cord, intertwining with nerves for bladder control. The acupuncture needle is then stimulated with a soft electrical pulse for about 30 minutes, activating the bladder nerves.

PTNS can lead to vastly improved symptoms, but you will typically need to return every few months before a difference is noticed.

Sacral nerve neuromodulation for OAB

Sacral nerve neuromodulation is typically performed in two stages. The first stage can be done in the operating room, but is typically done in a clinic. If your urinary symptoms improve, then the second surgical stage is performed. During this stage, the permanent lead and battery are implanted completely underneath your skin. You will need ongoing checkups every three to five years to follow up on its progress.

Transurethral resection of the prostate (TURP)

If you have a particularly large prostate and previous treatment has fallen short of the results you want, we offer TURP. In this procedure, a special scope is used to visualize the prostate and then they prostate is trimmed. Although there is a potential to have more bleeding than a laser vaporization, this surgery has excellent long-term results and there are no bandages or incisions.

Ureteroscopy (URS) for kidney stones

Kidney stones don’t always require surgical intervention. But if a stone is not able to pass on its own through conservative measures, URS — a minimally invasive therapy for kidney stones in the ureter or kidney — has a high success rate.

During this outpatient procedure, a small scope and a laser are typically required to break the stone into smaller pieces. After this, a temporary stent allows the ureter to heal. Depending on the size and location of the stone, the procedure may take 30 minutes or longer than an hour.

Vasectomy

A vasectomy can be an effective way of preventing unwanted pregnancies. Although no form of birth control is 100 percent effective, a vasectomy has one of the highest success rates.

During the procedure, small incisions are made in the scrotum, and a small segment of each vas deferens is removed, which prevents sperm from being transported to the penis and ejaculated. Though a vasectomy can be reversed, it should be viewed as a procedure for permanent birth control and not as temporary birth control.

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Kidney stone treatment

There are multiple treatment options for kidney stones. We tailor treatment to you, and may be able to offer surgical intervention if pain is too intense.

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