For severe benign prostatic hyperplasia treatments, surgery is often the answer and usually requires complete removal of the enlarged prostate. There are several surgical options. Most of these options are performed in the hospital setting, although some laser procedures can be done comfortably in the office. Dr Kella has performed all the procedures below. Transurethral resection of the prostate (TURP), the most common procedure, involves inserting a scope into the penis to reach the prostate and remove it in small pieces. TURP is being replaced by newer procedures such as Thullium, Holmium, and Green-light laser therapy for enlarged prostate. The laser allows tissue to be vaporized. There is minimal bleeding during a laser procedure. Some patients may still need to spend a night in the hospital. Usually the catheter can be removed after 24 hours. The laser offers the advantage of minimal char. This allows for faster healing and less irritative side effects. Less than 1% of men experience sexual dysfunction after laser therapy. Nearly a third will have problems with a lack of ejaculation (retrograde ejaculation). Laser therapy allows you to return to work in a few days. Strenuous activity should be avoided for approximately 4 weeks. Clinical studies show that laser therapy can offer rapid and lasting relief lasting for at least 5 years. Most patients will have some slight burning for a week or so after the procedure. This can be managed with mild pain and anti-inflammatory medication. Another form of TURP is a bipolar TURP. With the bipolar, we use a “button” which creates a plasma that vaporizes tissue. The button TURP also has less bleeding vs a conventional TURP, usually. With all these surgeries, the flow rate is improved much more with surgery compared to oral medications. For the first few weeks, symptoms may actually be worse as the tissue can actually swell from the inflammation and eventual healing associated with treatment. The restrictions and results of the button turp are similar to laser therapy for enlarged prostate. Transurethral incision of the prostate (TUIP) for enlarged prostate. The urologist makes a small incision in the prostate tissue to widen the opening between the urethra and bladder outlet. Simple Prostatectomy. An open surgery to remove the inner part of the enlarged prostate gland. The robot can be used to perform this procedure. This allows for a faster recovery than a conventional open surgery. Read about robotic surgery and the importance of experience here . Call our office at (210) 617-3670 to schedule a time to speak with Dr. Naveen Kella on the best treatment option for you.

Women have had exclusive use of botox for beauty purposes for years. In urology, Botox actually has medical uses. We have used botox for bladder conditions for nearly 10 years. Overactive bladder or neurological issues with the urinary sphincter can be addressed with Botox. As urologists gained experience with Botox, we have thought about other areas where this drug can benefit patients. Some patients have complained of chronically tight scrotums and testicular discomfort. Botox? Well, it has now gone from a thought to real usage. Published data suggests good outcomes. Also, patients and reporters talk about their experience with Scrotox here. Risks with botox in the scrotum are minimal. However, the doctor needs to be careful to inject only the cremaster muscles. If the injection gets into the vascular system, you could get side effects in other parts of your body. Read more about scrotox here . If you think Botox for your scrotum might be for you, let our team know. Dr Timothy Hlavinka has been doing urological botox for years. He can see if Scrotox makes sense for you! Just remember, this is considered experimental. Your insurance will not cover the procedure.

Although a biopsy is the gold standard in detecting cancerous tissues and it's precise location, there are alternative options that can be considered. Here at The Urology Place, we offer tests such as ExosomeDx, SelectMDx, and an MRI of the prostate to screen the tissue prior to determining a plan of action. ExosomeDx and SelectMDx are urine tests that are used prior to a prostate biopsy or maybe even a repeat prostate biopsy to determine your EPI score. Your EPI score ranges from 0-100 and any score above 15.6 poses a risk for prostate cancer. If a score comes back with a “low risk” then it would be understood that we can defer from the prostate biopsy and continue to monitor the tissue through PSA blood tests, DRE’s, and periodic urine tests. This is a great non-invasive option to consider before undergoing a prostate biopsy. These tests provide helpful information to both the provider and patient in terms of how to proceed with a care plan. The other option we like to consider is an MRI of the prostate to detect active areas of the prostate gland. This is a non-invasive approach to detecting the size, shape, and location of the tumor. We typically suggest the 3T MRI to provide the highest quality imaging available. With these images, the provider is able to know what areas to target when pursuing a prostate biopsy. We offer various screening options to ensure you and the provider feel comfortable and confident in your care. Learn more about our various prostate biopsy options here at The Urology Place with Dr. Naveen Kella. Call our office at (210) 617-3670 if you have any questions or are ready to schedule an appointment.

During the work-up of prostate cancer, a transrectal prostate biopsy poses a real risk of serious infection. The Urology Place has invested in new ultrasound equipment and training to migrate to a transperineal approach. We are the first in Texas to offer in office, transperineal biopsy of the prostate. With the transperineal approach, there is a near-zero risk of sepsis. The work up for screening of prostate cancer has evolved considerably from prostate specific antigen (PSA) blood test and digital rectal examinations (DRE). However, despite all the changes, PSA remains a mainstay for screening patients. If needed, we employ serological, urine and imaging based tests during consultation to help patients predict their risk of cancer. This helps decide if prostate biopsy is necessary or not. A prostate biopsy can be a scary proposition for a patient. Our goal is to make the procedure as painless and safe as possible . This can be done for most patients while avoiding the costs of general anesthesia. We offer biopsies with nitrous gas and a mild sedative, which allows patients the convenience and cost savings of an office based procedure. Patients can even have an MRI fusion biopsy performed this way. MRI and ultrasound images are fused together, allowing the procedure to be more accurate due to the superior imaging of MRI. Both the transperineal and transrectal prostate biopsies can be done in our office and only require local anesthesia. General anesthesia in the surgery center is potentially available as well. If you or a loved one has a concerning PSA value, consider visit Dr. Naveen Kella's clinic, The Urology Place. Dr. Naveen Kella is the founder of The Urology Place, and he is one of the most experienced prostate cancer surgeons in the nation, having completed nearly 3000 prostatectomy cases in their entirety.

Have you heard of a non-invasive treatment for Erectile Dysfunction that has no downtime or side effects? Well, it exists! This treatment is known as GAINSWave and we have been certified providers for several years. GAINSWave uses low intensity shockwave therapy to restore blood flow with the goal of increasing sexual function and overall sensation. With medical technology advancing every day, it is important to understand your treatment and know that you are receiving a safe and effective solution. There are two types of probes that can be used with shockwave therapy, one is focused (linear) and the other is unfocused (radial). GAINSWave uses unfocused extracorporeal shockwave technology (ESWT) to break down plaque resting in the blood vessels. There are other shockwave products on the market that utilize focused (linear) ESWT, however, these are considered class III devices by the FDA. This classification means that the product can present a potential unreasonable risk of illness or injury and need to be administered by an MD. There are many studies that evaluate the use of radial shockwaves for erectile dysfunction. However, there was a study done by Taylor & Francis Group that looked into the difference between radial and linear shockwaves for erectile dysfunction. Forty men were involved in this study and split into two equal groups. One group received shockwave therapy through a focused probe and the second group received shockwave therapy through an unfocused probe. All men received treatment twice a week for three weeks followed by a three week break and resumption of two treatments a week for an additional three weeks. What they found from this study was that 13 of the 20 men who received the radial (unfocused) treatment had a significant improvement in their IIEF scores and concluded radial ESWT is more efficient than focused ESWT in treatment for ED. Here, at The Urology Place, our board certified urologists oversee your treatment plan. GAINSWave provides weekly journal clubs that our staff regularly participates in staying up to date on the latest protocols and training sessions. Call our office at (210) 617-3670 to set up a consultation and same day treatment for GAINSWave.

San Antonio, Texas—7/13/2020—The Urology Place today announced that Dr. Naveen Kella has been designated as a Center of Excellence for Rezūm™ Water Vapor Therapy treatment – a minimally invasive in-office procedure for men looking to treat their benign prostatic hyperplasia (BPH), not just the symptoms. Rezūm Therapy uses natural water vapor to reduce the size of the prostate and provide lasting symptom relief from BPH without invasive surgery or some of the potential side effects of prescription drugs.(1) The Center of Excellence designation recognizes Dr. Kella's high degree of experience with Rezūm Water Vapor Therapy and commitment to delivering significant, lasting symptom relief to men suffering from benign prostatic hyperplasia (BPH).(1)  BPH is a condition in which a man’s prostate enlarges and squeezes the urethra, causing frustrating symptoms such as frequent or urgent urination, a weak or interrupted urine stream, and the need to get up several times a night to urinate. It affects about 50% of men by age 60, and up to 90% of men by age 85.(2)  “Being designated as a Rezūm Center of Excellence is a meaningful recognition for us, as we strive to provide the best possible treatment of urological conditions for patients in the San Antonio area,” said Dr. Naveen Kella, MD. “For years, the primary options for treating BPH were through behavior modifications, medications or invasive surgery. However, medications may not work for everyone and may have undesirable side effects such as dizziness, sexual dysfunction and lower sex drive. (3) With Rezūm Therapy, we are able to provide relief of BPH for men who do not want to take medication or want to avoid invasive surgery and implants.”  During Rezūm Therapy, which takes place during one short office visit, natural water vapor is released throughout the targeted prostate tissue. When the steam contacts the tissue and turns back to water, it releases energy, killing the excess prostate cells that squeeze the urethra. Over time, the body’s natural healing response removes the dead cells and shrinks the prostate. With the extra tissue removed, the urethra opens, relieving BPH symptoms while preserving erectile and urinary function.(1) The procedure does not require general anesthesia and is performed under oral sedation or local anesthesia.(1) Rezūm Therapy has undergone extensive clinical trials to evaluate the safety and efficacy of the treatment.(1) It is now included in the American Urological Association's BPH treatment guidelines and has four-year follow-up data showing it’s ability to treat prostates with hyperplasia of the central zone, lateral lobe and/or median lobe.(4)  Rezūm Therapy is currently being used in many leading urology practices throughout the United States. To date, more than 55,000 patients around the world have been successfully treated with Rezūm Therapy. (5)   For more information, click here or visit Rezum.com. 1 McVary KT, Rogers T, Roehrborn CG. Rezūm water vapor thermal therapy for lower urinary tract symptoms associated with benign prostatic hyperplasia: 4-year results from randomized controlled study. Urology. 2019 Apr;126:171-9. 2 What is BPH? Urology Care Foundation website. https://www.urologyhealth.org/urologic-conditions/benign-prostatic- hyperplasia-(bph). Accessed August 5, 2019. 3 Roger K and Gilling P. Fast Facts: Benign Prostatic Hyperplasia, 7th edition. Health Press. 2011. 4 McVary KT, Gange SN, Gittleman MC et al. Minimally invasive prostate convective water vapor energy (WAVE) ablation: A multicenter, randomized, controlled study for treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Urol. 2016 May;195(5):1529-38. 5 Date on file with Boston Scientific. * Results from case studies are not necessarily predictive of results in other cases. Results in other cases may vary. IMPORTANT INFORMATION: These materials are intended to describe common clinical considerations and procedural steps for the use of referenced technologies but may not be appropriate for every patient or case. Decisions surrounding patient care depend on the physician’s professional judgment in consideration of all available information for the individual case. Boston Scientific (BSC) does not promote or encourage the use of its devices outside their approved labeling. Case studies are not necessarily representative of clinical outcomes in all cases as individual results may vary. Rezum.com is a website sponsored by Boston Scientific. Caution: U.S. Federal law restricts this device to sale by or on the order of a physician. All images are the property of Boston Scientific. All trademarks are the property of their respective owners. © 2019 Boston Scientific Corporation or its affiliates. All rights reserved. URO-703802-AA NOV 2019

Urinary incontinence occurs in both males and females and drastically affects quality of life. Having to constantly think about your bladder during normal daily activities takes away from your ability to live in the moment. If you have tried kegel exercises and medications but haven't noticed any progress, it might be time to consider Emsella. Emsella is a High-Intensity Focused Electromagnetic Field (HIFEM) device that stimulates thousands of kegel exercises. A study by Lasers in Surgery and Medicine gathered seventy-five women who were experiencing stress, urge, and mixed urinary incontinence. Each individual received a total of six 28-minute treatments. The purpose of this study was to evaluate the women's incontinence progress and quality of life before and after the treatment. After evaluation following their sixth treatment, the researchers found that 81% of the participants had found that the treatments reduced their incontinence symptoms. According to their ICIQ‐SF (International Consultation on Incontinence Questionnaire‐Short Form) the average improvement rate after the sixth treatment was 49.93% and then at the follow-up appointment done after three months showed that the improvement rate had increased further to 64.42%. HIFEM technology utilizes an electro magnetic field to directly target the neuromuscular tissue of the pelvic floor and stimulate muscle contractions. Our office utilizes HIFEM technology through Emsella which is also known as the kegel throne. This non-invasive treatment can help you get back to your younger self in just six treatments. Learn more about Emsella here . Call our office at (210) 617-3670 if you have any questions or are ready to stop letting incontinence control your life.

What is ED? Erectile Dysfunction, also known as ED, is the inability or difficulty in obtaining an erection. There are many working body systems that are involved in maintaining an erection such as sufficient testosterone levels, healthy tissue and blood vessels, and proper nervous impulses to name a few. Not all components need to be met to allow for erectile function but ED can be a sign that there is a misconnect within the body and there may be an underlying health issue that needs to be addressed. ED can be a sign of diabetes, heart conditions, hormonal or psychological disorders so it is best to visit a physician to understand why you are experiencing this difficulty. Can younger men also have ED? When most people think of Erectile Dysfunction, they assume it is something they have the pleasure of looking forward to in their latter chapter in life. Over the past decade, men have been more prone to erectile dysfunction at younger ages. Younger men who partake in poor lifestyle choices such as frequent drinking and smoking are more prone to experiencing ED. It is also no surprise that men under 40 are experiencing high levels of stress as this is the point in their lives they are being introduced to big life decisions such as investments, children, and relationships. Stress is a strong contributor in ED, but if it is becoming more constant then it is best to visit your local provider on how to treat it before it becomes severe. How do you treat ED? Depending on the root cause of the ED which can be determined through a consultation with our providers there are several treatment options that can be beneficial to you. In younger men, sometimes lifestyle changes such as adjusting diet and exercise and limiting smoking and drinking alcohol can improve sexual function. Other treatments include but are not limited to hormone therapy, oral medications, shockwave therapy , and injections. Read more about ED here . Call our office at (210) 617-3670 if you are experiencing ED and find out how we can help find the best treatment for you.

A new year and a new decade! It's only right to start off with a strong resolution! One of the most common resolutions is to lead a healthier lifestyle, whether that be through exercise or diet changes. This week is statistically the most common week for people to drop their resolutions, so we want to provide you with a little extra motivation. A recent study conducted by Oxford Academic found that men who were more physically active had more motile sperm. This study included 746 men who provided multiple semen samples over a six-month period. The purpose of this study was to determine how physical activity affects the quality of sperm in terms of sperm concentration, sperm count, as well as progressive and total motility. All men had completed the International Physical Activity Questionnaire (IPAQ) to measure their total metabolic equivalents and were ranked in terms of how vigorous their activity was. Through this study they had found that men who had higher total metabolic equivalents had a respective correlation with sperm motility. In simpler terms, the healthiest sperm came from those who incorporated more physical activity into their daily lives. This study had provided evidence that male reproductive health is positively influenced by physical activity. Overall, healthier sperm come from exercising! So swim for better swimmers this 2020! To read more about this study by Oxford Academic, click here .