Turnquist Urology: Aaron Turnquist, MD

Products And Services

• Benign Prostate Hyperplasia Treatment

  Benign Prostatic Hyperplasia, also known as BPH, is an enlarged prostate that commonly causes urinary problems in men over the age of 50. It is a common condition that occurs as men age, causing the gland to press against the urethra and cause problems with urination. After BPH is diagnosed, a treatment plan is created based on the patient‘s specific condition. Treatment of Benign Prostatic Hyperplasia Treatment for benign prostatic hyperplasia may vary depending on the severity of the condition. There are various treatment options available for this condition. Monitoring Patients with mild symptoms may only need to monitor their condition for signs that it is worsening, while more severe cases may require medication to inhibit hormone production or relax the muscle in the prostate. Medication Two common types of medication for benign prostatic hyperplasia are: Alpha Blockers Alpha blockers relax the muscles in the bladder and prostate. They can help improve urine flow and reduce risk of bladder obstruction. They are often prescribed to men with smaller prostates. 5-Alpha Reductase Inhibitors 5-alpha reductase inhibitors block the male hormone that stimulates the prostate. These drugs are generally prescribed to men with significantly enlarged prostates or severe cases of benign prostatic hyperplasia. In addition to relieving symptoms, they increase urinary flow and may even help shrink the prostate. Surgery In some cases, surgery may be required to remove the prostate tissue that is blocking the flow of urine. There are several different surgical procedures available for treating benign prostatic hyperplasia, including: Transurethral Needle Ablation With transurethral needle ablation, or TUNA, needles are inserted in the prostate and emit low-level frequency radio waves that create a heat that destroys the prostate tissue. The TUNA procedure utilizes high-frequency radio waves to destroy the superfluous tissue of the prostate gland. Needles are inserted into the enlarged areas of the prostate gland and send high-frequency radio waves, which will destroy the tissue around the needles. This reduces pressure on the urethra, and therefore decrease urinary difficulties. Transurethral Surgery Transurethral resection of the prostate is a surgery with no external incisions. A modified cystoscope called a resectoscope is inserted through the urethra and uses an electrical wire loop that cuts tissue away from the center of the enlarged prostate. Urethral Stent A wire mesh stent is placed in the urethra within the prostate to hold the urethra open to allow the passage of urine. This is usually an option for patients who are unable to take medication or do not want to undergo more invasive surgery. Transurethral Microwave Thermotherapy Transurethral microwave thermotherapy, also known as TUMT, uses high-frequency radio waves to cause injury to the prostate and provides relief for bladder obstruction. The surgeon utilizes a special catheter, called an antenna, that is inserted through the urethra to a location inside the prostate. Microwave energy is then used to heat the inside of the prostate while cooling fluid is circulated around the microwave antenna to prevent heat from damaging the wall of the urethra. As the damaged prostate tissue heals, it shrinks significantly, reducing the blockage of urine flow. Transurethral Vaporization of the Prostate During transurethral vaporization of the prostate, also known as TUVP, an elecrode transmits a current that vaporizes prostate tissue. Using an instrument that delivers high-voltage electrical current, the doctor pinpoints the prostrate tissue that will be destroyed. Open Surgery In the case of a significantly enlarged prostate, open surgery is usually recommended. An incision is made in the lower abdomen and the interior of the prostate is removed, leaving the outer lining of compressed normal prostate tissue. This surgery results in the greatest increase in urinary flow of all treatment techniques. Surgery for benign prostatic hyperplasia usually provides effective results for at least fifteen years. Patients should continue to have rectal and prostate exams once a year and should see their doctor at the first sign of recurring symptoms. There are a wide range of treatment options available for benign prostatic hyperplasia and if treated promptly and effectively, patients can live relatively normal lives.

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• Cystogram

  A cystogram is an X-ray examination of the bladder. It may be performed to detect polyps or tumors of the bladder, urinary abnormalities, or other conditions. A cystogram is performed on an empty bladder, so patients are asked to use the restroom immediately before the procedure. The Cystogram Procedure During the cystogram, patients lie down on their back and a catheter containing contrast dye is inserted into the urethra. The contrast dye helps create detailed images of the bladder. X-ray images of the bladder are taken as soon as it is full. The catheter is then removed, and the patient is asked to empty their bladder. Another X-ray of the bladder is taken after urination to determine whether any contrast dye has remained in the bladder. A radiologist interprets the results of the cystogram, creates a detailed report of their findings, and shares them with the doctor. Normal test results indicate no abnormalities within the bladder, while abnormal results can indicate varying conditions for which a doctor will develop a customized treatment plan for the patient. Risks of Cystogram A cystogram is a relatively safe test, although there is a slight risk of infection from the catheter. Another risk is a possible reaction to the iodine based dye that is injected into the bladder. There is relatively low radiation exposure during this test, however, patients who may be pregnant should notify their physician prior to this examination.

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• Cystoscopy

  Cystoscopy is a minimally invasive diagnostic procedure that is performed to examine and treat conditions within the bladder that may not show up clearly on an X-ray or other common imaging procedure. With this procedure, doctors can clearly visualize targeted areas within the bladder. Doctors may perform a cystoscopy for a variety of reasons that may include: Determining the cause of blood in the urine Investigating repeated urinary tract infections Evaluating blockages in the urethra Removing tissue samples for biopsy Removing foreign objects Placing a catheter in the ureter The Cystoscopy Procedure Prior to the cystoscopy procedure, patients are asked to empty their bladder. Local anesthesia is administered before the cystoscope, a thin lighted tube, is inserted through the urethra and into the bladder. Water or saline is then dispensed into the bladder through the cystoscope. As the fluid fills the bladder, the bladder wall is stretched, allowing the doctor to fully view the bladder in detail. Additional instruments may also be inserted to collect tissue samples or remove any abnormalities. The examination usually takes only about ten minutes to perform, although the entire process may last 45 minutes. Complications of Cystoscopy Cystoscopy is considered safe for most patients, with no permanent complications. After the procedure, there may be mild swelling in the urethra and burning during urination, however these side effects usually diminish within 48 hours after the procedure.

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• High Intensity Focused Ultrasound

  High intensity focused ultrasound, also known as HIFU, offers a targeted, noninvasive treatment for prostate cancer. Using ultrasound energy, or sound waves, HIFU can attack and destroy precise areas of malignant tissue within the prostate. These sound waves pass harmlessly through healthy tissue. When the sound waves reach the exact targeted focal point, they heat up intensely. The temperature increases to up to 90 degrees Celsius on the selected tissue, effectively killing the diseased cells. Candidates for HIFU HIFU is the most effective therapy for men who have early stage, localized prostate cancer that has not spread beyond the prostate. As every case is unique, it is recommended that patients discuss their individual diagnosis and medical history with their physician in order to determine whether they are a suitable candidate for HIFU. Patients who have undergone radiation therapy, brachytherapy or external beam radiation, and have had the cancer return, are often good candidates for HIFU, as long as the cancer has not spread to the bone or other organs. Men who are faced with a local recurrence after receiving a radical prostatectomy may also qualify for HIFU. Benefits of HIFU High intensity focused ultrasound destroys cancerous tissue only, leaving healthy tissue unharmed. There are many benefits to HIFU that may include: No exposure to radiation Local anesthesia No hospital stay and little post-procedure recovery Non-invasive HIFU therapy causes no scarring or blood loss as traditional surgery can. Unlike radiation, it doesn‘t have a cumulative effect, enabling repetition of HIFU treatment when necessary, without risk of damaging the healthy prostate tissue. HIFU can also be used as a treatment method when other forms of therapy have failed to cure the cancer. The HIFU Procedure Many physicians perform high intensity focused ultrasound with the use of the Sonablate 500®. The Sonablate 500®., developed by Focus Surgery, Inc., is a top-of-the-line device used for HIFU procedures. It is highly successful for treating both prostate cancer and benign prostatic hyperplasia. The Sonablate 500® combines high definition imaging with HIFU therapy to treat prostate cancer precisely. The ultrasound imaging provides high resolution 3D images of the entire prostate gland from different angles. Using these images, a physician can create a customized plan to determine exactly where the HIFU needs to be concentrated. Physicians can treat and monitor the progress of the HIFU treatment in real time with the Sonablate 500®. It integrates multiple focal length transducers in a single probe, allowing for faster treatment. The Sonablate also has important safety features that analyze temperature and distance data to maximize patient safety. Complications of HIFU High intensity focused ultrasound has very minimal side effects, however possible complications may include: Difficulty urinating Rectal burning or bleeding High intensity focused ultrasound offers a number of advantages over traditional prostate cancer therapies. There is little recovery time associated with HIFU and patients typically can resume their normal activities within a few days of the procedure.

• Nephrectomy

  A nephrectomy is a surgical procedure to remove part or all of a kidney. Depending on the reason it is required, a nephrectomy involves removing only the damaged or diseased part of one kidney; all of one kidney; or the entire kidney, along with the surrounding adrenal gland and lymph nodes. All nephrectomies are performed under general anesthesia. The kidneys are located at the back of the abdomen, and protected by the lower ribs. Their function is to filter blood, which passes through them several times a day. The kidneys remove waste, control fluid balance, and regulate the balance of electrolytes. As the kidneys filter blood, they create urine, which is then excreted through the urinary tract. Because there are two kidneys, and each kidney cell (nephron) is a microscopic filter, a patient can function well after a partial or complete nephrectomy. Reasons for Nephrectomy A nephrectomy may be necessary to treat the following: Congenital defect Kidney damage (from kidney stones or disease) Kidney cancer Kidney donation Traumatic injury Extremely high blood pressure and its effects can also make a nephrectomy necessary. Types of Nephrectomy There are three types of nephrectomy. 1- Partial Nephrectomy During a partial nephrectomy, only the damaged or diseased part of the kidney is removed. It is frequently performed to treat kidney cancer. 2- Simple Nephrectomy A simple nephrectomy involves the removal of an entire kidney. It may be performed to remove a diseased or severely injured kidney, or to remove a kidney for donation. 3- Radical Nephrectomy With a radical nephrectomy, the entire kidney, the surrounding lymph nodes, and the adjacent adrenal gland are removed. It may be performed when malignant tissue has spread from the kidney to surrounding tissue. Nephrectomy Procedure A nephrectomy can be performed in one of two ways. 1- Open Nephrectomy An open nephrectomy, which is the traditional procedure, involves making an incision in the patient‘s abdomen or side. It offers excellent access to the kidneys, as well as other organs, for more complicated cases. 2- Laparoscopic Nephrectomy A laparoscopic nephrectomy, which is less invasive, requires four small incisions; it is performed using a tiny camera and small instruments. It has many advantages over traditional surgery: less bleeding, scarring and pain, and a shorter recovery time. It is not, however, appropriate in all cases. Risks of Nephrectomy Every surgical procedure has risks, including excessive bleeding, adverse reactions to anesthesia or medications, post-surgical infection and damage to adjacent organs. Risks specific to nephrectomy include malfunction or failure in the remaining kidney, and hernia of the surgical wound. Recovery from Nephrectomy Depending on the type of nephrectomy, a hospital stay of from 2 to 7 days is required. A patient who has had a laparoscopic nephrectomy usually recovers in 4 weeks, whereas one who has had an open nephrectomy may require 6 weeks. Strenuous physical activity may be restricted for a longer period. During the post-surgical hospital stay, a patient can expect the following: Catheterization for 24 to 48 hours Surgical-wound drain Inability to eat for a few days Liquid diet (when capable of eating) To perform breathing exercises To wear special stockings and/or take medications to prevent blood clots A patient in good general health can usually function normally with one kidney, whereas a patient with advanced kidney disease may need a kidney transplant or long-term dialysis.

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• Robotic Urologic Surgery

  Surgery is often used to treat a variety of conditions affecting the organs of the male reproductive system and urinary tract. Given the sensitive nature of this area, many men are apprehensive about undergoing major surgery to treat their condition. Traditional urologic surgery requires large incisions to access the pelvic organs and may cause severe pain and long recovery times. There may also be long-term effects on continence and sexual function. Robotic urologic surgery can help ease common concerns by providing a safer, less invasive alternative to traditional surgery. Candidates for Robotic Urologic Surgery Robotic urologic surgery may be used to treat: Prostate cancer Bladder cancer Kidney disorders Robotic Urologic Surgery Techniques Prostatectomy, cystectomy, and kidney surgery are all urological procedures that can be performed through robotic-assisted surgical techniques. The da Vinci Surgical System® Robotic-assisted surgery can be performed with the da Vinci Surgical System®, a state-of-the-art console that provides the advantages of minimally invasive techniques along with more precise procedures. The da Vinci Surgical System allows surgeons to perform complex procedures through robotic arms that mimic the movement of their own. These arms are inserted into the body through tiny incisions and then guided to the area to be treated. The surgeon can view the area through a lens in the console that offers a three-dimensional, magnified view, allowing for more precise procedures. Benefits of Robotic Urologic Surgery The da Vinci Surgical System offers patients: Smaller incisions Less pain Less scarring Less blood loss Lower risk of infection Shorter recovery time While robotic surgery offers many advantages over open and laparoscopic techniques, this method may not be suitable for every patient. It is important that patients discuss treatment options with their doctor who will assess their overall health condition to find out if they can benefit from robotic urologic surgery.

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• Vasectomy

  Vasectomy is the most effective form of permanent contraception for men. A vasectomy is a minor surgical procedure that stops the flow of sperm between the testicle and the urethra by blocking the vasa deferentia, the tube-like structure that carries sperm to the testicle and through the urethra to the ejaculatory duct. The Vasectomy Procedure A vasectomy is a minor procedure that consists of the cutting and sealing of the vas deferens tubes, which are responsible for transporting sperm to the prostate for ejaculation. The testes will continue to produce sperm, but it will be absorbed back into the body soon after production and will not be present in semen. However, it can take up to three months post-surgery before the patient is completely sterile. This is due to sperm lingering within the various tubes of the penile anatomy and may require upwards of twenty ejaculations to ensure complete sterility. The vasectomy operation is an out-patient procedure and can be performed right in the surgeon‘s office. The duration of the surgery is normally between 20 and 30 minutes and requires only local anesthesia. Side Effects of a Vasectomy A vasectomy has very few side effects. Some patients may experience the following side effects following a vasectomy: Sore and swollen scrotum Lower abdominal discomfort Most patients experience minimal discomfort that can be treated with over-the-counter pain medication. Complications of a Vasectomy There is always a risk for infection and bleeding when an incision is made, but the small size of the cut needed for a vasectomy ensures minimal risk. It is possible for sperm to leak into the tissue of the scrotum after surgery. These are usually attacked by the patient‘s own immune system and may cause a small lump called a sperm granuloma. This usually clears up on its own, but in rare cases may need to be surgically removed. The libido of most men is unaffected by surgery. Recovery from a Vasectomy If employed at a desk job, the patient can usually return to work within one or two days after the vasectomy procedure. Manual labor jobs require a a longer period of time before the patient returns to his job. Sexual activity can be resumed within about a week, but it is important to note that the vasectomy is not effective immediately, and if necessary, other means of birth control should be used temporarily. A follow-up sperm count test is recommended after two months to ensure sterility, as well as a second testing one month afterwards for complete confirmation. Patients should not assume that their vasectomy is effective until the semen analysis indicates the absence of sperm.

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• Urodynamic Testing

  Urodynamic testing is a series of urological tests that may be performed to diagnose urinary problems. A physician may recommend urodynamic testing to investigate the cause of any urinary difficulties and assess the function of the bladder and its ability to store and empty urine. Urinary problems such as incontinence or an overactive bladder may be the result of several different conditions, including bladder infections, urethra or sphincter problems, enlarged prostate, nervous system malfunctions, or the side effects of medication. Types of Urodynamic Testing Urodynamic testing provides valuable data about bladder function and the urinary tract. Several different tests are used to evaluate symptoms of the bladder and lower urinary tract. Some tests may require preparation such as limiting fluid intake or temporarily stopping medications prior to the procedure. 1- Uroflowmetry A uroflowmetry test measures the speed and volume of urine flow. This test is used to determine if the bladder muscle is weak or urine flow is obstructed. 2- Cystometrogram A Cystometrogram measures how much pressure the bladder can hold before needing to empty. A catheter is placed in the bladder as more and more water is added until the need to urinate is felt. 3- Electromyography An electromyography test measures the muscles in and around the sphincter. This test is used to determine if the urological problem is related to nerve or muscle damage. 4- A Post-Void Residual Test A post-void residual test, also known as a PVR test, measures the amount of urine left in the bladder after urination. This test is performed using an ultrasound and inserting a catheter into the bladder through the urethra. 5- Pressure Flow Studies Pressure flow studies measure pressure in the bladder while urinating. These tests help distinguish between urinary symptoms caused by obstruction, and those caused by a problem affecting the bladder muscles or nerves. Other tests such as measuring residual urine and leakage may also be performed to assist the doctor in diagnosing urinary conditions. The series of tests may vary based on the individual‘s symptoms and the results of these tests help diagnose the cause and nature of a lower urinary tract problem.

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• Urinalysis

  A urinalysis is a test used to analyze urine and diagnose possible conditions. This test can be performed in the doctor‘s office simply by collecting a urine sample from the patient. It can help detect the presence of infection or diseases that may not present with any symptoms. A urinalysis may be performed as part of a routine medical exam to screen for early signs of illness. A urinalysis may be used to check for the following characteristics: Color Odor Clarity Urinalysis may also check for the presence of the following, in order to diagnose certain diseases or conditions: pH levels Protein Glucose Blood Bacteria Red or white blood cells Nitrites Hormone levels-especially during pregnancy Reasons for Urinalysis Urinalysis is used to detect various conditions and diseases, some of which may include: Urinary tract infection Kidney stones Kidney disease Bladder infections Diabetes High blood pressure Urinalysis may also be performed to monitor chronic conditions. Methods of Urinalysis The mechanics of testing the urine collected in a urinalysis are performed in several different ways. 1- Dip Stick Tests A test strip or stick can be dipped into the specimen, providing a color change to signify positive or negative results of specific tests. 2- Physical Observation A straightforward test that involves a physical observation of the sample which measures physical characteristics of the urine. 3- Refractometer A doctor may use the specific gravity of various substances within the urine to determine its composition, usually through the aid of a refractometer. 4- Microscopic Analysis A sample of urine is examined under a microscope by looking for indications of infection, bacteria, or white blood cells in the urine. It may also be examined for the presence of of glucose, protein and other substances, which can be indicators of certain conditions. It is important to notify the doctor of any medications or vitamins the patient is currently taking before undergoing a urine analysis. Many forms of medication, vitamins and even foods that are eaten can affect the results of this test.

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• Prostate Cancer Screening

  Prostate cancer is one of the most common types of cancer in men. This disease affects the prostate, the gland located under the bladder and in front of the rectum. This gland helps produce semen and allows for sperm to move more effectively, along with several other functions. The cancer cells develop in the prostate and invade the healthy tissues and multiply at a rate much faster than regular cells. The Prostate Cancer Screening Procedure In addition to a physical examination by a physician, the following two tests are commonly performed on men 40-60 years of age and older who have exhibited symptoms of prostate cancer: 1- Digital Rectal Examination A digital rectal exam is a tactile examination performed by a healthcare professional that actively feels the lower portion of the rectum to the prostate. Any malformations or growths of the prostate will be evident in normal testing circumstances. 2- Prostate-Specific Antigen or PSA Blood Test A PSA test is a special blood test that determines if the individual has elevated levels of PSA in his blood. Normal levels of PSA in men are anywhere between 0-4.0 nanograms per milliliter, while anything above the upper limit of 4.0 is considered a positive test and should be tended to immediately. It is important to note that PSA levels can be increased by other factors such as prostate infection, benign prostate hyperplasia or BPH, and recent ejaculation. Once the results of these tests are conclusive, a diagnosis will be given to the patient. If the tests are positive for prostate cancer, a comprehensive treatment plan will be created by the physician. When confined to the prostate gland, this disease can usually be treated effectively, making early detection crucial for handling prostate cancer.

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• Botox Treatment For Overactive Bladder

  Overactive bladder causes a sudden and frequent urge to urinate, which may be accompanied by urine leakage. It is caused by the bladder muscles‘ contracting at inappropriate times, regardless of how much urine the bladder contains. Overactive bladder is a common condition; it is estimated to affect more than 30 million adults in the United States. It can develop in anyone, at any age, although it is most frequently affects women and the elderly. There are many treatments, including lifestyle changes, Kegel exercises, biofeedback, nerve stimulation and medications, for overactive bladder. Recently, BOTOX® Cosmetic received FDA approval for treating overactive bladder in patients who have not found relief with other forms of therapy. BOTOX Cosmetic temporarily paralyzes muscles and blocks nerves. It is best known as an injectable cosmetic treatment for reducing the appearance of facial lines and wrinkles. When used to treat overactive bladder, BOTOX injections relax the bladder, increasing its storage capacity and lessening both the urge to urinate and the potential for leakage. BOTOX Cosmetic does not affect surrounding muscles, so their proper functionality is maintained. Candidates for BOTOX Treatment Candidates for BOTOX injections to treat an overactive bladder include most adult patients who have tried various forms of traditional treatments, including taking anticholinergics, without experiencing relief from their symptoms. BOTOX Cosmetic may not be considered appropriate, however, for those patients who: Are allergic to any of its ingredients Have an active urinary tract infection Suffer from certain nerve or muscle disorders Most patients who receive BOTOX treatment for overactive bladder see a noticeable decrease in symptoms. The BOTOX Procedure BOTOX treatment is typically provided in a physician‘s office, although it may take place in a hospital or other medical facility. There may be mild pain from BOTOX injections, so a local anesthetic or mild sedation may be given. The procedure generally lasts about 20 to 30 minutes. BOTOX Cosmetic is injected into various areas of the bladder; generally, between 10 and 20 locations are injected. Exactly how many areas are injected depends on the severity of the condition. It is often performed using a cystoscope, which helps the doctor to clearly see targeted areas within the bladder. There is no recovery time needed after the procedure is performed. Patients may return to work and other normal activities the same day. BOTOX injections provide relief of overactive bladder symptoms for approximately 4 to 6 months, which means that most patients will require repeat treatments. However, BOTOX injections should not be given less than 12 weeks apart. Risks of BOTOX Injections Treating an overactive bladder with BOTOX injections is considered safe, although there are certain risks. Potential risks may include: Urinary tract infection Muscle weakness Painful urination Difficulty emptying the bladder completely If a patient is not able to fully empty the bladder, a catheter may be necessary on a short-term basis. These serious side effects occur rarely.

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