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Urology

Meet Our Specialists

About Urology

Our urologist expertise includes stone disease, enlarged prostate, cancer surgery (kidney, bladder, prostate), men’s health, and sexual dysfunction.

We connect with patients, build solid relationships, and improve outcomes. By taking a personal approach to treatment, our physician provides the type of individualized care you need. Compassion and understanding is at the forefront of our medical philosophy. HTX Urology strives for excellence in medical care and patient satisfaction.

We Provide Expertise in:
  • Men’s Health
  • Kidney Stones
  • Benign Prostatic Hyperplasia
  • Urological Cancers
  • Bladder Problems
  • Minimally Invasive Treatment
Procedures
  • Bio-identical Hormone Optimization (Pellets)
  • Erectile Dysfunction Medications
  • Hydrocelectomy
  • Laser Prostatectomy
  • Prostate Biopsy
  • Transurethral Resection of Prostate (TURP)
  • Urolift
  • Vasectomy
  • Wave Therapy for ED
  • Intravesical Botox for Overactive Bladder
  • Extracorporeal Shock Wave Lithotripsy
  • Ureteroscopy with Laser Lithotripsy
  • Male Infertility Treatment
  • Rezum
What’s New in Urology: Minimally Invasive Treatment for BPH

The UroLift® procedure is a short clinic or outpatient procedure that offers rapid relief from symptoms of enlarged prostate. There is minimal downtime and absolutely no sexual dysfunction, unlike major surgery.

  • Water Vapor Therapy (Rezum®)

The Rezum treatment, or Water Vapor Therapy, is a short clinic or outpatient procedure that can treat BPH effectively and prevent progression of disease over time.

What's Happening in Urology - Recent Blog Posts

What is finasteride?

Finasteride, along with its cousin Dutasteride, is a medication Urologists have been describing for decades.  Some of you may also know these medications by the names Proscar, Avodart, and Propecia.

These medications are FDA-approved to treat benign prostatic hyperplasia (BPH, enlarged prostate) as well as androgenic alopecia (male-pattern baldness).  Recently, these medications have gained some popularity as you can order these medications shipped to your door through companies like Roman and Hims.

How does finasteride work?

Finasteride and dutasteride block Testosterone’s conversion to DHT (dihydrotestosterone) by inhibiting many cell receptors in the body.  DHT is very potent, and contributes to prostate enlargement, male pattern balding, facial hair growth, and acne.  DHT receptors are located in the prostate, testes, brain, skin, and in many other human tissues.

By blocking the receptors, men on finasteride have less DHT which shrinks an enlarged prostate and helps slow hair loss.  50% of men will suffer from BPH once over age 50 and 50% of men will lose hair by age 40 – it is easy to understand why so many men take these medications.

What are the risks?

Post-Finasteride Syndrome (PFS) encompasses a constellation of adverse symptoms that can affect a man physically, neurologically, psychiatrically, and sexually when taking finasteride.  These symptoms include:

  • Erectile dysfunction (ED)
  • Decreased desire for sex
  • Chronic fatigue
  • Atrophy (tissue breakdown) of genitals
  • Muscle wasting
  • Increased fat deposits
  • Breast tissue growth
  • Anxiety & “Brainfog”
  • Blunted affect or emotional sensitivity

Obviously, this is a very long list of side effects and there are others reported as well.  PFS can start shortly after starting the medication and can possibly last months to years after stopping.  Decreasing the dosage strength is unlikely to reduce the risk of PFS.  Patients considering using these medications should be very careful and speak to a Urologist in person about risks, benefits, and indications of treatment.

I take finasteride, what should I do?

There is much to still learn about PFS, and more long-term studies are needed before we decide to stop prescribing these medications entirely.  For now, my recommendation if you are taking finasteride is to schedule an appointment with me to discuss alternatives to medication for enlarged prostate.

It is important to note that edications like finasteride typically only mask the symptoms of BPH but do not offer a cure for symptoms of enlarged prostate.  Definitive treatment is becoming the key to preserving bladder health and avoiding harmful side-effects of medication as mentioned above.

For example, the UroLift System can get men off medication and cure BPH symptoms in an office procedure in under 10 minutes.  If the prostate is significantly enlarged, a TURP may be needed which can be performed under anesthesia without incisions or need for post-operative pain medication.

For more information on PFS, please visit the PFS Foundation website.

What is Movember?

Some of you may have already heard of a campaign called “Movember”.  Perhaps your friend or family member was growing some ridiculous moustache last November and you may not have really understood why.

Movember, or “Moustache November”, is far more than a gag to look like a dashing young Tom Selleck.  It is a cause to support the men in our lives.  It promotes awareness of issues that can be quite difficult for many men to discuss.  This includes tackling tough issues like Prostate Cancer, Testicular Cancer, Mental Health, and Suicide Prevention.

Can Prostate Cancer be Prevented?

Yes!  Unlike many other aggressive cancers, prostate cancer can be screened, treated, and cured as long as men get yearly visits to their primary doctor or Urologist.  Starting at age 50, it is important for men to get a PSA blood draw and a digital rectal exam yearly until age 70.  If over 70, talk with your doctor to see if screening is still in your best interests.  If you have a brother or father with prostate cancer, or are African American, then the age of yearly screening should start at age 45 as you are at higher risk.

At HTX Urology, many of my new patient referrals are from primary doctors identifying an elevated PSA level or a nodule on the prostate during exam.  In these cases, typically a prostate biopsy in the office is the next step.  In under 10 minutes with some light sedation and local nerve block, tissue samples can be analyzed for cancer cells.  Bleeding risk is negligible if you are not on blood thinners, and infection rate is under 1%.

What about Testicular Cancer?

Testicular cancer typically affects men in their 20s and 30s.  In fact, it is the most common cancer in males from age 15 to 35.  Risks factors can include race (white men), previous family history, or having an undescended testicle as a child.

It is important for young men to perform a self-exam in the shower each month.  If you feel an abnormal lump or growth, it is important to make an appointment with a urologist.  A scrotal ultrasound can also help assist with diagnosis.  If found early, testicular cancer, much like prostate cancer, is highly treatable even if cancer cells have spread beyond the testicle.

How do I support Movember?

Spread the word!  Join the cause and let your family and friends know on social media outlets like Facebook or Instagram that you think male cancer prevention is important.  Talk openly about these subjects as for far too long, men have unnecessarily suffered in silence and in embarrassment.  If you can, donate by visiting the top of the page and start growing those moustaches.

What is “Low T”?

Low Testosterone, commonly known as “Low T” or hypogonadism, refers to a decrease in a man’s testosterone levels causing unwanted symptoms. This can be attributed to problems with testicular production (primary hypogonadism) or with the pituitary gland (secondary hypogonadism). As men age, 1-2% of total testosterone is lost each year starting in the 3rd or 4th decade of life. Low T can lead to bothersome symptoms such as fatigue, weight gain, low sex drive, and erectile dysfunction (ED).

How Low T impacts Erectile Function

Erectile function is testosterone dependent. It is important to note, however, that not all men with ED suffer from Low T or vice versa. Furthermore, not all men with Low T and ED improve after replacement of testosterone to optimal levels.

Men may need to combine TRT with oral ED meds for optimal sexual function

Confused yet? I don’t blame you. With years of research, we now know there is a complex interplay between Low T and ED. Testosterone replacement therapy (TRT) for men with Low T will often improve ED, low sex drive, and other bothersome symptoms, however, if erectile function does not improve significantly, men may need to combine TRT with oral ED medications for optimal sexual function.

Causes of Low Testosterone

There are multiple possible causes of Low T including aging, stress, obesity, diabetes, sleep apnea, HIV/AIDS, testicular injury, infection, chemotherapy or radiation to the pelvis, and chromosomal abnormalities. Oftentimes, the cause is unknown.

TRT can dramatically improve quality of life

Regardless of cause, the symptoms of Low T can be quite debilitating. Testosterone replacement therapy can dramatically improve quality of life and can be used in a safe and effective manner. Improvements can be seen quickly, including strengthened bones, improved muscle mass, increased energy, improvements in erection quality, mental clarity, and fat loss. There is also new evidence that optimal testosterone levels can help prevent some chronic conditions such as hypertension, diabetes, and heart disease.

Low T Impacts Sex Drive

Low T almost always leads to a decrease in a man’s sex drive, or libido. A thorough history and physical exam from a physician who specializes in TRT, such as a Urologist, is essential to work through possible causes of a sudden loss of sex drive. Besides Low T, other conditions that could affect sex drive include thyroid disorders, sleep apnea, and (rarely) benign tumors of the pituitary gland.

Treatment Options for Low T

There are many forms of testosterone replacement available to men with Low T. Options include nasal sprays, topical creams or gels, intramuscular (IM) injections, and subcutaneous pellets.

Topical therapy is a simple way to replace testosterone daily without using needles or undergoing an in-office procedure. Care must be taken not to transfer the cream or gel after application via skin-to-skin contact to women or children.

Patients who are comfortable with needles are taught how to do the intramuscular injections in their physician’s office. The patient administers the treatments at home every 1-2 weeks depending on their doctor’s orders. There is no threat of transfer of the hormones to others with this treatment option.

Lastly, testosterone pellets are a longer-lasting injection therapy. Pellets are implanted under the skin in a quick office procedure. The therapy lasts for about 6 months and can minimize the roller coaster highs and lows some patients experience with IM injection therapy.

If You Want to Have Children

Talk with your physician if you are planning to have children. TRT causes infertility for a period of time, as exogenous testosterone suppresses your body’s ability to make viable sperm. Additionally, there is no guarantee fertility will be restored when you stop TRT. If you are of childbearing age, please speak with your physician about risks and benefits before starting any form of testosterone supplementation.

Men of childbearing age may be better suited to HCG and SERM

Human Chorionic Gonadotropin (HCG) and Selective Estrogen Receptor Modulators (SERM) are alternatives to TRT that can be prescribed to preserve fertility. An example of a SERM is the medication Clomid® (Clomiphene Citrate). Men of childbearing age with Low T may be better suited to these types of supplementation. After childbearing, a transition to TRT creams, injections, or pellets can then be made.

Side Effects

Possible side effects may include increased red blood cell count, worsening of urinary function, male-pattern balding, acne, and mood swings. There are also theoretical risks of cardiac issues or blood clots. If you have pre-existing cardiac risk factors, make sure to discuss this with your physician before starting TRT.

While on TRT, men must comply with a series of lab tests to ensure their testosterone level is on-target and other blood chemistries remain normal. Liver function tests, cholesterol panels, PSA for prostate cancer screening, and complete blood counts are closely monitored to help prevent any possible side effects of TRT.

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