In-Office Urology Procedures
Cystoscopy or Cystourethroscopy
This is a procedure that enables a urologist to view the inside of the bladder and urethra in great detail. It is commonly used to diagnose bladder tumors and identify obstruction of the bladder.
Prior to the procedure, the patient will need to provide a urine specimen in the office, then be positioned on an examination table. After administration of local anesthesia, a flexible cystoscope is inserted through the urethra into the bladder. The cystoscope is a thin, lighted tube that is either flexible or rigid. Water or saline is then instilled into the bladder through the cystoscope. As the fluid fills the bladder, the bladder wall is stretched thus allowing detailed viewing by the urologist. Under normal conditions, the bladder wall should appear smooth and the bladder should be normal size, shape and position and there should not be any blockages. If any tissue in the bladder wall appears abnormal, a small sample can be removed through the cystoscope to be analyzed.
The average cystoscopy takes about 5 minutes. It is done in the office, usually under local anesthesia. No special preparation is needed for the procedure. It is not necessary to bring someone to drive you home, unless you so desire.
After the cystoscope is removed, the patient’s urethra may be sore and they may feel a burning sensation for up to 48 hours. If discomfort persists, fever develops or urine appears bright red, a physician should be notified. Antibiotics are typically provided after the procedure.
Transrectal Ultrasound / Prostate Needle Biopsy
Another common indication for ultrasound is obtaining the volume or size of the prostate for treatment planning purposes. Patients being considered for radioactive seed implantation to treat prostate cancer (brachytherapy) undergo transrectal ultrasound of the prostate to determine prostatic volume. This is necessary to plan the distribution and number of radioactive seeds needed for treatment of the tumor. Transrectal ultrasound may also be performed when transurethral resection of the prostate or thermal therapies of the prostate are planned. Finally, the study is used to determine prostate specific antigen density.
NOTE: It is important that ALL blood thinners are stopped 5 to 7 days before the biopsy is performed. A list of blood thinners should have been provided at the time the biopsy appointment was made. If you are not sure which medications should be stopped, please call the office right away at (209) 833-3449, as this may cause a delay in having the biopsy performed.
The patient may be asked to use an enema prior to the procedure to better facilitate an adequate examination. The procedure is performed with the patient lying on his side on the examination table.
The ultrasound probe (transducer) is inserted into the rectum to obtain the image of the prostate. Local anesthesia may or may not be used when performing a biopsy. After measuring the prostate volume and identifying any suspicious areas, biopsies are obtained by inserting a special needle through a channel on the transducer. The needle is inserted and the biopsy is obtained quickly. The number of biopsy “cores” obtained is variable but averages 8 to 16.
The procedure requires 10 to 20 minutes and the main risks are infection and bleeding from the rectum or bladder. Patients are asked to refrain from heavy physical activity for 24 to 48 hours after the procedure. Oral antibiotics are administered prior to and after the biopsy to reduce the likelihood of infection. Some patients may notice blood in their ejaculate for several weeks after the procedure. This is common and not a cause for concern.
Results of the biopsy often take several days. It is important for patients to discuss the results of the biopsy with their urologist. If cancer is diagnosed, a discussion of treatment options is needed. If the biopsy shows no cancer, a strategy for follow up will be discussed. The pathologist may report a precancerous condition on the biopsy that may prompt more frequent follow up or even repeat biopsy.
This is a minor surgical procedure to cut and close off the tubes (vas deferens) that deliver sperm from the testes; it is usually performed as a means of contraception. The in office vasectomy procedure typically takes about 30 minutes and usually causes few complications and no change in sexual function. About 500,000 vasectomies are performed annually in the United States. A vasectomy is less invasive than a tubal ligation (i.e., the procedure used to prevent a woman’s eggs from reaching the uterus) and more easily reversed. An increasing number of couples choose it as a means of permanent birth control.
Renal / Bladder / Scrotal Ultrasound
Depending on the reason for the study and the circumstances, ultrasound imaging may be performed in the urologist’s office, in the hospital or in an outpatient facility.
In most cases, very little preparation is needed for an ultrasound examination. Some examinations, such as a bladder scan for residual urine, require limited experience while others, such as ultrasound examinations of the kidneys, testicles or prostate, require more experience or expertise.
The patient will be asked to lie down on the examination table. A clear, water-based gel is applied to the skin over the area to be examined. This gel helps with the transmission of the sound waves. A transducer, which is a hand-held probe, is then moved over that area. Prostate ultrasound examinations are performed by placing a specially designed probe into the rectum.
There is no risk of radiation with this study and the patient can resume their daily activities immediately following this test.
Minimally Invasive Office Treatments for BPH (Benign Prostatic Hyperplasia)
Dr. Razi performs in-office Prostiva® RF Therapy to relieve the symptoms of BPH. This is not considered a surgical procedure since it is performed in the office with the aid of oral and local sedation. Prostiva® RF Therapy has been available for over 10 years, and is considered safe and effective.
What is the Prostiva® RF Therapy like?
You will be given a mild sedative to take orally, and local anesthesia is delivered to the prostate via a small catheter inserted into the urethra. Dr. Razi will then insert the Prostiva® RF Therapy device, which delivers low-level radio frequency energy directly into the prostate. This energy shrinks and destroys the prostate tissue. It then relieves the constriction on the urethra and improves the symptoms of BPH. After the procedure is complete, you will be given fluids to drink and will be asked to remain in the office until you urinate. In some cases your doctor may elect to insert a catheter to ensure your comfort.
This procedure usually takes about 30 minutes. However, your entire visit will probably take from about an hour to an hour and a half, in order for your doctor to prepare you for the procedure, perform the procedure itself, and get you prepared to go home.
Most Prostiva® RF Therapy patients return to their normal activities quickly after the procedure, while some patients may require a day or two. Catheterization is required as needed, usually up to 2 days.
How soon can I expect my BPH symptoms to go away after my Prostiva® RF Therapy?
Generally, you will see improvement in your symptoms in 2 to 6 weeks after the procedure and symptoms may continue to improve over two to three months. Individual results may vary.
Will there be sexual side effects?
The ability to have normal and natural sexual relations is important at any age. During clinical study, less than 2% of Prostiva® RF Therapy patients experience impotence.
What are the other side effects?
For Prostiva® RF Therapy – some patients may experience obstruction, bleeding, pain/discomfort, urgency, frequency and urinary tract infection.
Additional information about Prostiva® RF Therapy can be found at the links below:
Male & Female Incontinence Management (including Bladder Pacemaker)
InterStim Therapy uses a small device to send mild electrical pulses to a nerve located in the lower back (just above the tailbone). This nerve, called the sacral nerve, influences the bladder and surrounding muscles that manage urinary function. The electrical stimulation may eliminate or reduce certain bladder control symptoms in some people. The system is surgically placed under the skin.
Dr. Razi has been performing this procedure both in the office and in the hospital for a number of years, with overwhelming success.
For more information, please visit:
Minimally Invasive Treatments for Stress Incontinence
Most urodynamic testing focuses on the bladder’s ability to empty steadily and completely. It also can show whether or not the bladder is having abnormal contractions, which cause leakage. Your doctor will want to know whether you have difficulty starting a urine stream, how hard you have to strain to maintain it, whether the stream is interrupted, and whether any urine is left in your bladder when you are done. The urodynamic test is a precise measurement using sophisticated instruments.