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Urologic Oncology

Virginia Urology is a leader in the treatment and research of urologic cancers. Virginia Urology has a highly-skilled and experienced team of physicians who have sub-specialized in the treatment of prostate, kidney, bladder and testicular cancers. In addition to being board certified in urology, many of our physicians have also completed sub-specialty fellowship training in urological cancer surgical techniques at world-class academic institutions. Therefore, our physicians are able to offer the latest therapies in urologic cancer care including advanced laparoscopic and robotic treatment options.
    
Our physicians have been closely involved in collaborative and in-house research in the field of urologic oncology for more than 15 years. This allows our patients to benefit from and often participate in urologic cancer research. More specifically, Virginia Urology is currently one of 17 national research sites involved in High Intensity Focused Ultrasound (HIFU) therapy for prostate cancer. Our center is the second leading national site in experience with this important new therapy which involves local heat energy in an outpatient setting.

Virginia Urology physicians also work closely with in house pathologists, radiologist and radiation oncologists with sub-specialty training and years of experience in urologic oncology. Virginia Urology is able to offer the latest multidisciplinary cancer care through our well trained staff.  Our surgical teams offer state-of-the-art surgical options including minimally-invasive laparoscopic and robotics. In addition to these surgical therapies, Virginia Urology offers External Beam Radiation, Brachytherapy (Seed Implantation), Cryotherapy, HIFU and medical therapies.  

All patients facing the difficulties of a new cancer diagnosis are somewhat overwhelmed by the complexity of the challenges they face. Our comprehensive cancer team strives to offer patients multiple options with a focus on quality and compassionate care.

Kidney Stones

The physicians and staff of Virginia Urology understand that kidney stones can be very painful. In an effort to ensure you receive prompt medical attention, Virginia Urology offers the Kidney Stone Hotline and the latest evaluation and treatment options available. 

To evaluate a kidney stone, the physicians may use any of the following imaging procedures:

  • IVP
  • Ultrasound 
  • CT scan* 
  • KUB

Most of these imaging procedures can be conveniently performed at several of the Virginia Urology locations (* CT scan at Stony Point office only), and often at the time of your office visit.

Some of the treatment options for stones include:

  • Laser treatments
  • Ureteroscopy
  • Percutaneous surgery 
  • Extracorporeal shock wave lithotripsy (ESL)
  • Observation

Most treatments can be performed on an outpatient basis at either the Stony Point or Hanover locations. 

The Kidney Stone Hotline is a resource to assist you when experiencing the first symptoms of a kidney stone.  When experiencing such symptoms, please call our hotline at 804-560-STONE. When you call this number, a staff member will coordinate appropriate care by either scheduling you an appointment at our office for same or next day evaluation or directing you to the emergency room. (Please note:  To ensure your safety and provide quality care, our physicians do not prescribe pain medications (i.e., narcotics) over the telephone.  If it is necessary to control pain after hours, then you may be directed to a local emergency room and given a follow-up appointment in our office the next business day.)
Hopefully, you will not have the unfortunate experience of a painful kidney stone attack.  But if you do, the experienced physicians and staff at Virginia Urology are here to help by offering you prompt care with the convenience of all these services at one location.

Robotic/Laparoscopic

Robotic & Minimally Invasive Surgery

Virginia Urology has a highly-trained and experienced team of robotic surgeons. Virginia Urology physicians have performed hundreds of robotic surgeries using the da Vinci® Surgical System. Some of the minimally-invasive procedures our physicians perform include prostatectomy, pyeloplasty, partial nephrectomy and adrenalectomy.

da Vinci® Robotic Surgery

When the da Vinci® robotic surgery is performed, the surgeon is able to control the instruments through small incisions or laparoscopic ports. By doing so, the surgeon is able to have greater control and accessibility than traditional surgical instruments. The surgeon controls the instruments by looking through a specialized telescope. This telescope allows the surgeon to view the site at 12x magnification and in 3D. This provides the surgeon with greater precision while in the surgical site.

For additional information about the da Vinci® Surgical System click here.

Minimally-Invasive Surgery

Minimally-invasive surgical procedures can be performed through the smallest of incisions, often only 1-2 cm! These types of procedures can be much more beneficial to patients than undergoing an open surgery. Minimally invasive surgeries can be very effective in treating your condition and provide better clinical outcomes. In addition, patients often may experience less pain, a shorter hospital visit and allows patients to return to their daily lives much quicker! Ask your physician about what minimally-invasive surgical options are available for you.

General Urology

Urology is a surgical subspecialty that treats conditions of the urinary system of both males and females and the male genital system. The urologists of Virginia Urology are all highly trained and board certified to provide adult urologic care. Our physicians are able to fully assess and treat a wide range of conditions such as:

  • Benign Prostatic Hyperplasia (BPH)
  • Bladder Cancer 
  • Erectile Dysfunction 
  • Hematuria 
  • Incontinence 
  • Kidney Stones 
  • Male Infertility 
  • Prostate Cancer 
  • Prostatitis
  • Renal Cell Cancer
  • Testicular Cancer 
  • Testosterone Deficiency 
  • Varicocele
  • Vasectomy

Occasionally a higher level of care may be needed for some conditions. What distinguishes Virginia Urology from other urology practices is our ability to concentrate (within the practice) the management of selected or complicated problems in the hands of urologic subspecialists or Centers of Care. The physicians that have specialized training and/or experience in the conditions being managed in each center provide superior care because of their expertise in treating patients with specific conditions.

Vasectomy

A vasectomy is a safe and effective means that millions of American men have used for permanent birth control. At Virginia Urology, this is one of the most commonly performed procedures done on an outpatient basis in our surgery center and usually only takes 15 to 30 minutes. You are able to go home immediately, and after a few days of light activity, you can resume your normal routine including sexual intercourse. Vasectomies are often covered by insurance, and in the long run are a very cost effective and convenient method.

After you have a vasectomy at Virginia Urology, there are guidelines for post-vasectomy semen analysis.  You will have two samples of semen examined after your vasectomy.  Your first sample is due no sooner than 12 weeks after your surgery. Any sample brought in early will be rejected. At that time you will be advised as to when you should bring in your next sample.

Urinary Incontinence

What is urinary incontinence?

Urinary incontinence is the involuntary loss of urine. It is not a disease but rather a symptom that can be caused by a wide range of conditions. Incontinence can be caused by diabetes, a stroke, multiple sclerosis, Parkinson's disease, some surgeries or even childbirth.

More than 15 million Americans, mostly women, suffer from incontinence. Although it is more common in women over 60, it can occur at any age.

What are the various types of urinary incontinence?

Stress Incontinence:

  1. The most common type of leakage.
  2. Occurs when urine is lost during activities such as walking, aerobics or even sneezing and coughing due to both the abdominal pressure associated with these events and weakened pelvic floor muscles.
  3. Weakened pelvic floor muscles can be a result of previous childbirth or surgical trauma.
  4. Menopausal women can also suffer from small amounts of leakage as a result of decreased estrogen levels.
  5. In men, the most common cause of incontinence is prostate surgery, such as with a radical prostatectomy.

Urge Incontinence:

  1. Often referred to as "overactive bladder."
  2. Occurs when a person has an uncontrollable urge to urinate but cannot reach the bathroom in time and has an accident.
  3. Some people have no warning and experience leakage just by changing body position (e.g., getting out of bed).
  4. Associated with strokes, multiple sclerosis and spinal cord injuries.

How is the diagnosis made?

First a thorough medical history and physical examination will be conducted. This will be followed by a urinalysis and cough stress test will be conducted at your first consultation. If some findings suggest further evaluation, other tests may be recommended -- such as a cystoscopy or urodynamic testing. Both of these tests are performed on an outpatient basis.

What are some treatment options for each type of incontinence?

In most cases of incontinence, minimally invasive management (fluid management, bladder training, pelvic floor exercises and medication) is prescribed. However, if that is unsuccessful, surgical treatment can be necessary.

Stress incontinence

Males: Use of urethral injections of bulking agents to improve the function of the sphincter. The injections are done under local anesthesia and can be repeated. The most effective treatment for male incontinence is implantation of an artificial sphincter.

Females: Initially, treatment options include behavior modification and pelvic rehabilitation. Techniques like biofeedback or electrical stimulation of the pelvic muscles can help. However, with more severe symptoms and the conservative measures did not help, the treatment is surgery. Surgical treatment options include several minimally-invasive procedures such as the use of bulking agents to the most common procedure, the sling.

Urge incontinence

There is a large array of treatment options available. The first step should be behavior modification -- drinking less fluids; avoiding caffeine, alcohol or spices; not drinking at bedtime and urinating around the clock. Exercising the pelvic muscle (Kegel exercises) and other physical rehabilitation also helps. Often the treatment for overactive bladder is with medication. This consists of the use of bladder relaxants that prevent the bladder from contracting without the patient's permission.

Other options available to patients, who do not respond to behavior modification and/or medication, include the implantation of a bladder pacemaker to control bladder function.  This latest technique, the Interstim®, consists of a small electrode that is inserted in the patient's back close to the nerve that controls bladder function. The electrode is connected to a pulse generator and the electrical impulses control bladder function.

Prostate Health

Prostate Cancer

Here are some important facts about prostate cancer:

  1. Prostate cancer is the most commonly diagnosed cancer in the US today
  2. Prostate cancer is the 2nd leading cause of cancer death in men
  3. 1 in 6 men will be diagnosed with prostate cancer - as compared to 1 in 7 women with breast cancer
  4. Prostate cancer is more common in African-American men than Caucasian men
  5. 2.5 times as deadly for them

These facts are quite astonishing, yet prostate cancer is rarely in the news. Virginia Urology has a strong commitment to raising the awareness of prostate cancer throughout the community. Virginia Urology has been a title sponsor of the American Cancer Society's African American Men's Health Day where we have educated over 1,200 men about prostate cancer and have offered free screenings at this event.   We hosted the first Great Prostate Cancer Challenge in September 2008. This 5k run/1 mile walk and a health fair was one of 5 events held in other large cities across the country to raise money for prostate cancer awareness and research. The Richmond community was very supportive and we were able to raise over $100,000 for prostate cancer research.

Enlarged Prostate

An enlarged prostate or Benign Prostatic Hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland that often occurs in older men. This affects over 17 million men in the U.S. As men age, their hormone levels change causing the prostate to continue to grow. This excess tissue can block the urethra and obstruct the urine flow. In addition, some men often experience many of the following symptoms:

  1. Frequent urination - especially at night
  2. Difficulty emptying the bladder completely
  3. Sudden urge to urinate
  4. Weak urine stream

The urologists may use several different diagnostic tests and procedures to determine if you have an enlarged prostate such as a digital rectal exam (DRE), cystoscopy - retrograde pyelography and a urinalysis.

There are several treatment options available that can meet the individual needs of each patient. These options range from oral medications, diet and exercise modifications or minimally-invasive surgical procedures. Also, your physician may recommend the following depending upon the severity of the enlarged prostate:

  1. Microwave thermal therapy
  2. GreenLightTM laser therapy
  3. Prolieve®
  4. Transurethral needle ablation 
  5. Transuretheral resection or the prostate (TURP).

Prostatitis    

Prostatitis is a common disease of the prostate gland and can be painful. There are different types and causes of prostatitis such as:

  1. Acute Bacterial Prostatitis - a bacterial infection that often occurs in older and middle-aged men who typically experience sudden fevers, chills, severe burning during urination and unable to completely empty the bladder.
  2. Chronic Bacterial Prostatitis - a recurrent urinary tract infection most commonly in young and middle-aged men with less severe symptoms than acute bacterial prostatitis such as burning during urination, frequent urination, especially at night, perineal, testicular, and low back pain. 
  3. Non-bacterial Prostatitis - is the most common type and can result from multiple infections and inflammation and/or muscle spasm but the exact cause is unknown. This is also referred to as prostatodynia, which is chronic pelvic pain syndrome.  Symptoms include difficult and painful urination, discomfort or pain in the perineum, bladder, testicles and penis, and painful ejaculation.

Acute and chronic bacterial prostatitis occurs when bacteria enters into the prostrate ducts from the urethra due to backward flow of infected urine. Bacterial prostatitis is not considered to be a sexually transmitted disease and therefore it is not contagious. There are certain medical procedures or conditions that can increase the risk of contracting bacterial prostatitis such as recent catheterization, bladder infection or an abnormality of the urinary tract.

Chronic prostatitis/chronic pelvic pain syndrome can be caused by chlamydia, mycoplasma (which may be transmitted by sexual contact) ureaplasma or due to a reaction to an initial injury. In response to an infection or an inflammation of the prostate, the nerves and muscles in the pelvis may cause pain in the area.

As there are different types and causes of prostatitis, the treatment options vary depending on the type of prostatitis. The various treatment options include antibiotics, anti-inflammatory drugs, muscle relaxants, heat therapy, biofeedback and diet modifications. The physicians of Virginia Urology will help you determine which treatment option is best for you.

Erectile Dysfunction

As many as 30 million men experience erectile dysfunction (ED). It can impact adult men at any age and can develop gradually or occur suddenly. In most cases of ED, it can be contributed to or caused by smoking, diabetes, high blood pressure, prostate conditions, surgery and certain prescription medications. There is even research showing the link between ED and cardiovascular disease. The MWC offers a full range of diagnostic tests to determine the cause of ED. Because no two people are alike, our approach to treating ED is not a "one size fits all" treatment. Our physicians offer lifestyle changes, medications, injections, vacuum devices and penile prosthesis as options for treating ED. Our physicians have the most experience in Virginia with the penile implant. If you are experiencing ED please give us a call, we are here to help you.

Surgery Centers

The Virginia Urology Surgery Center is an affiliate of Virginia Urology.

Advanced surgical procedures and sophisticated new medical techniques have made it possible for many patients to receive surgical treatment and return to the comfort of their own home -- on the same day. Not only does this eliminate the anxiety of overnight hospitalization, it also minimizes disruptions in daily life and significantly reduces the medical costs.

At Virginia Urology Surgery Center (VUSC), we offer the same high standards of care that you have come to expect from us - a combination of state-of-the-art equipment and medical expertise second to none. Our staff includes a team of highly-qualified urologists, anesthesiologists, radiation oncologists, certified registered nurse anesthetists, surgical and recovery nurses and technologists who will help you and your family. VUSC facilities are fully licensed by the Commonwealth of Virginia and accredited by the Accreditation Association for Ambulatory Health Care (AAAHC).

Virginia Urology Surgery Center offers three convenient locations:

  1. Stony Point
  2. Hanover Medical Park
  3. Monument Avenue

Surgical Scheduling & Admitting Procedures

Your physician's office staff will schedule your surgical procedure and provide you with pre-operative instructions. A nurse at the VUSC will contact you two days prior to your scheduled procedure to inform you of your arrival time and provide you with any additional instructions.  VUSC's general overview of Pre-Op Instructions and Day of Surgery Expectations are available for you to review (please note this is an abbreviated overview and you will receive a complete set of instructions from your physician).

Prior to your procedure, a complete medical history will be taken and surgical consent forms will be presented for your signature. In addition, a physical examination will be performed by your physician. Some patients based on their medical history and the type of anesthesia they will receive may need to have a pre-admission testing (PAT) appointment scheduled to receive additional lab work or an EKG.

Please be assured that it is the policy of Virginia Urology Surgery Center that patients may select the facility of their choice for all surgical procedures.

Clinical Trials & Research

Welcome to Virginia Urology's Research Department. As part of our commitment to provide excellent medical care in the specialty of urology, we are involved in clinical research. This allows both Virginia Urology and you, our patient, to help further medical knowledge and improve medical care for ourselves and our children.

Virginia Urology frequently participates in studies testing new medications or devices for urologic care. Our Institutional Review Board reviews all studies for their potential benefits and risks to the patient before approving our participation. Patients who meet study qualifications and would like to try newer protocols are offered the opportunity to participate in clinical studies. Participation or lack of participation in any study does not affect the quality of care provided to our patients.

Virginia Urology Research Department has research coordinators who work under the direction of Nada Wood Ph.D. The research staff is dedicated to coordinate and carry out clinical studies and maintain large data bases of information on specific diseases and treatments. They work closely with the physicians and medical staff to constantly evaluate new and established treatment options.

Currently, Virginia Urology has studies ongoing in the following areas:

  1. Prostate cancer prevention
  2. Overactive bladder (frequency, urgency, and leakage)
  3. Stress urinary incontinence (leaking when you cough or laugh)
  4. Prostate cancer treatments (various stages of disease)
  5. Kidney stones requiring lithotripsy

If you are interested in participating, ask your physician about these studies. You may also call our Research Department for more information at (804) 288-2785.

Women's Urology

Virginia Urology for Women offers a full continuum of care for the treatment of female urological issues. We have a highly skilled team of clinicians to ensure you receive the most compassionate and comprehensive educational, medical and surgical services you deserve. Virginia Urology for Women is lead by fellowship-trained Dr. David Glazier and Dr. David Rapp. As we strive to offer the latest treatment options, we now have on staff, Kathy Oxford, D.P.T. and Laura Broman, M.S., P.T., A.T.C., both physical therapists dedicated to pelvic floor physical therapy.  Our specially trained team at Virginia Urology for Women has the expertise to diagnose and treat the most simple or complex urological problems such as:

  • Urge incontinence
  • Stress incontinence
  • Overactive bladder (OAB)
  • Voiding difficulties
  • Interstitial cystitis
  • Pelvic organ prolapse

Accurate diagnosis of your condition is key to successful treatment and we use state-of-the-art diagnostic procedures including:

  • Bladder scan
  • Cystoscopy
  • Urodynamics

Fortunately, there are many options now available for treating these conditions including:

  • Medications
  • Physical therapy
  • Urgent® PC (nerve stimulation)
  • Urethral bulking treatments
  • Interstim® 
  • Minimally-invasive surgery
  • Robotic surgery

As a result, thousands of women are now able to experience an improved quality of life without worrying about some of these debilitating and embarrassing conditions.

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