A urologist is a physician who specializes in the medical and surgical management of problems of the male and female urinary tract and the male reproductive organs, including infections, obstructions, stones, tumors and problems related to sexual dysfunction.
The loss of urine for women with stress urinary incontinence (SUI) is because the "valve" controlling the urine is weak. This conditio n affects women of all ages and is caused by aging, childbirth, hormonal changes and genetic factors.
The latest advance in the tension-free vaginal slings is the transobturator tape or TOT. TOT is less invasive than other tension free tapes and the TOT approach greatly reduces the risk of complications. A half-inch mesh is introduced under the urethra to support it during an outpatient or short stay procedure. It takes about 15-20 minutes. The TOT approach eliminates the risk of injury to bladder, bowel or major vessels. Because of the safety and simplicity of the TOT procedure, older women who were previously denied the more extensive retropubic sling procedures can now have an alternative procedure that will permanently rid them of stress incontinence.
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Extracorporeal lithotripsy, invented almost 20 years ago, has revolutionized the treatment of urinary calculi. This technique consists of fragmenting the stone, in situ, by means of shock waves generated by physical systems such as ultrasound, electromagnetic vibrations or the spark of a spark-gap. The debris of the fragmented stones is then eliminated by the urinary tract.
Treatment is generally performed as an outpatient procedure, without hospitalization or anesthesia, but anesthesia may be necessary in some cases, requiring a day-only admission.
The results of extracorporeal lithotripsy depend on the type of stone, its volume, the patient's anatomy, the operator's experience and the type of machine. The overall success rate is 65 to 70% of complete elimination, evaluated three months after treatment on plain abdominal x-rays.
A variable number of fragments persist in 20 to 25% of cases and, in 10% of cases, the stone is refractory to shock waves and does not fragment. A second extracorporeal lithotrispy session can be attempted in the case of partial fragmentation. Blood in the urine is frequent after lithotripsy and is not serious. Renal colic can occur when small fragments become obstructed in the ureter before being eliminated. Exceptionally, a catheter has to be inserted into the ureter to facilitate descent of the debris.