David Robbins, MD is a board certified urologist and specialist in the medical and surgical management of BPH or enlarged prostate. Dr. Robbins has extensive experience in the treatment of enlarged prostate conditions and urinary retention using the state of the art Green Light Laser XPS system. Using this technology Dr. Robbins is able to improve patients burdensome voiding symptoms including urinary urgency, frequency, night time frequency, incomplete emptying, slow stream and incontinence even for prostates that are considered by others to be too large for minimally invasive surgery. Using laser technology, without the need for a surgical incision, Dr. Robbins uses Green Light Laser technology to relieve prostate obstruction in under an hour without the need for an overnight hospital stay or prolonged catheterization. Unlike the traditional TURP procedure, Green Light Laser technology, in the capable hands of a renowned expert like Dr. David Robbins, does not result in blood loss and the need for a hospital stay and prolonged catheterization.
“The article below was found on the medical x press blog online. It highlights research related to DNA methylation which may play a vital role in the development of more specific biomarkers used for earlier prostate cancer detection. In the era when the utility of the PSA test is continuously being questioned, the need for more sensitive and specific biomarkers is of paramount importance. Miami urologists David Robbins, MD and Amery Wirtshafter, MD are experts in the field of prostate cancer detection and treatment and employ the most up to date modalities in the fight against prostate cancer.” David Robbins , MD.
Researchers discover biomarkers for prostate cancer detection, recurrence May 14, 2012 in Cancer Alterations to the “on-off” switches of genes occur early in the development of prostate cancer and could be used as biomarkers to detect the disease months or even years earlier than current approaches, a Mayo Clinic study has found. These biomarkers — known as DNA methylation profiles — also can predict if the cancer is going to recur and if that recurrence will remain localized to the prostate or, instead, spread to other organs. The study, published in the journal Clinical Cancer Research, is the first to capture the methylation changes that occur across the entire human genome in prostate cancer. Ads by Google Prostate Cancer Failures – Hope for treatment failures/ Rising PSA after treatment – http://www.panamhifu.com Cancer Treatment Options – Diagnosed w/Adenocarcinoma? Learn About New Treatment Options at CTCA – http://www.CancerCenter.com The discovery could someday help physicians diagnose prostate cancer earlier and make more effective treatment decisions to improve cure rates and reduce deaths. It also points to the development of new drugs that reverse the DNA methylation changes, turning the “off” switch back “on” and returning the genetic code to its normal, noncancerous state. “Our approach is more accurate and reliable than the widely used PSA (prostate-specific antigen) test,” says senior author Krishna Donkena, Ph.D., a Mayo Clinic molecular biologist. The PSA test detects any prostate abnormality, whether inflammation, cancer, infection or enlargement, while the DNA methylation changes are specific to prostate cancer, she says. Though the instructions for all the cell’s activities lie within the genes, whether a particular gene is turned “off” or “on” is determined by the presence or absence of specific chemical tags or methyl groups — methylation — along the underlying DNA of cells. When this process of DNA methylation turns off the activity of tumor suppressor genes, cancer develops. Dr. Donkena and her colleagues analyzed the methylation status of 14,495 genes from 238 prostate cancer patients. The patients included people who remained cancer-free after treatment, those who had a localized tumor recurrence and those whose cancer spread. The researchers found that the DNA methylation changes that occurred during the earliest stages of prostate cancer development were nearly identical in all patients. Having discovered DNA methylation patterns that could distinguish between healthy and cancerous tissue, the researchers then searched for similar biomarkers that could distinguish between patients with varying levels of recurrence risk. They found distinct methylation alterations that corresponded to whether a patient had a slow-growing tumor known as an indolent tumor, or had a more aggressive one. If physicians can determine what type of tumor patients have, they can avoid exposing patients with indolent tumors to unnecessary treatment, and can treat those with aggressive tumors earlier and more effectively, Dr. Donkena says. Dr. Donkena and her colleagues are working to develop a DNA methylation test that is more cost-effective and practical for use in clinical settings. Currently, the test relies on microarray or gene “chip” technology that assesses methylation status of genes across an entire genome. The researchers are trying to generate more economical custom microarray to specifically look at only the genes that predict the development of prostate cancer or recurrence. They also hope to develop drugs that can reverse DNA methylation in prostate cancer cells. Similar drugs are already being used to treat certain forms of leukemia. Journal reference: Clinical Cancer Research Provided by Mayo Clinic
“An infection after placement of a penile implant is a potentially dangerous problem. The article below published on ABC news highlights the issues surrounding the controversial case of a Miami urologist who placed a penile prosthesis in a diabetic patient which resulted in a severe infection necessitating penile amputation. Fortunately, infections after placement of penile implants are rare complications. The penile implants that I place manufactured by AMS are antibiotic coated and have an infection rate of less than 1%. Although having diabetes is certainly not a contraindication to placement of a penile implant, certainly having poorly controlled diabetes increases a patient’s risk for developing an infection. For this reason, it is important for urologists to pay attention to a patients diabetes control and evaluate the hemoglobin A1c which is an indicator of the patients diabetes control over the past several months. In my practice, if a patient has refractory erectile dysfunction and is interested in a penile implant, but his hemoglobin A1c is elevated, I defer placement of the penile prosthesis until the patient in combination with his primary care physician or endocrinologist is able to improve his patients diabetes control and bring the hemoglobin A1c back down to normal levels. Unfortunately, even under optimal conditions, an infection can occur. The most important factor in the context of an infection of a penile prosthesis is early recognition and intervention to prevent severe complications such as a penile amputation as highlighted in the article below. ”
Diabetic Sues Doctor After His Infected Penis Is Amputated
A man who elected to have a penile implant in a Florida hospital is now suing his doctor after a post-surgical infection resulted in the amputation of his organ.
Enrique Milla, 65, who was reportedly deported from the United States last year back to his native Peru, has been testifying in court via Skype that the medical procedure robbed him of his dignity and manhood.
In a medical malpractice trial that began this week, Milla claims that his doctors should have known that he was not a good candidate for the procedure because of his diabetes and high blood pressure.
“This has been devastating, painful and embarrassing,” said Milla’s attorney, Spencer Aronfeld of Coral Gables, according to ABC’s affiliate WPLG.
Milla alleges that his anesthesiologist Dr. Laurentiu Boeru “failed to evaluate properly the risks of this procedure.” He first filed the lawsuit in 2009, naming Boeru and Dr. Paul Perito, the urologist who performed the surgery.
According to the Miami Herald, which obtained records that are not publicly available, Perito settled the case out of court.
“At the end of the day, he has to sit down to pee through a tube,” Aronfeld told the Herald.
Penile implant surgery is most commonly performed after all other treatments for erectile dysfunction have failed. It is also used to treat some cases of Peyronie’s disease, a condition that causes scarring inside the penis, leading to bent, painful erections.
Implant surgery comes with a risk of infection, which can occur at any time after surgery — in rare cases, even years later, according to the Mayo Clinic.
Milla suffered from a number of medical conditions, including erectile dysfunction, according to court records. Milla, who had lived in Miami for 40 years working in a medical supply business, received the surgery in 2007 at Coral Gables Hospital.
“He didn’t do this to have a bigger penis,” said Aronfeld. “This was because of medical reasons: He just wanted to have relations with his wife.”
But two weeks after the operation, Milla developed an infection that eventually turned to gangrene. Amputation of his penis was necessary to save his life, according to his lawyer, who alleges Boeru didn’t exercise proper care after the surgery.
“Post-operative period is about anywhere between six to 24 hours after surgery. It does not include either days or months,” testified Boeru.
“This is an infection that occurred in this gentleman because he didn’t do what he was supposed to do post-operatively nine days after the surgery,” Boeru’s lawyer Jay Chimpoulis, told WPLG.
He suggested that Milla ignored medical instructions to avoid sex and developed a fecal infection.
“There are any number of ways he could’ve gotten that. None of them had anything to do with [Boeru],” Chimpoulis said.
Dr. Pravin Rao, director of reproductive medicine and surgery at the Johns Hopkins Brady Urological Institute, said penile implants, called prostheses, are safe for patients who are in good health — even those with diabetes, as long as the disease is “controlled.”
The risk rate is lower than 3 percent, according to Rao, who did not treat Milla.
“Usually, it’s the last report option for men who just don’t want to use other treatments as options,” he said. “Sometimes, the individual wants a permanent solution and wants the spontaneity.”
Penile implants are among a “long algorithm of options” for those with erectile dysfunction, according to Rao. Urologists start with pills like Viagra — the least invasive approach –– to vacuum erection devices and injection therapy.
But sometimes those treatments fail because of the quality of the tissue in the penis or poor blood flow.
The most common reason for ED is chronic disease that affects the vessels in the penis — most often diabetes, hypertension, smoking or high cholesterol. Nerve damage, caused by spinal cord injuries, diabetes or radical prostate cancer surgery, can also trigger ED.
A poor candidate for a prosthesis is someone who is not in overall good health and may be at risk under anesthesia or not be able to withstand the blood loss of surgery.
“The number one concern is infection, and that’s why we make sure their overall health and immune status are good and their diabetes is under control,” said Rao.
When infection does occur, the prosthesis must be immediately removed to clear the infection.
“Personally, I have heard of amputation, but not seen one,” said Rao. “We have definitely seen prostheses taken out due to erosion. The wrong size is chosen or there is poor wound healing.”
The prosthesis is an inflatable device that is inserted in the two tubes of the penis. The balloons can be filled up with fluid, creating an erection. A small pump is placed in the scrotum with a reservoir of fluid that connects to the tubing.
“When we first place it, we don’t have it activated to create a full erection,” said Rao. “Then after letting it heal for six weeks, [the patient] comes in and we teach them how to use the pump by squeezing it.”
Patients are told not to have sex during that recuperative period.
Rao said that penile implants are “very successful and infection is not the norm.”
Some studies of patients with diabetes and those without the disease had the same rate of infection. “But,” he said. “We have to be prudent about picking the patient.”
“Prostate surgery for BPH and urinary retention is regarded as a low risk procedure. In my opinion, although a traditional Trans Urethral Resection of the Prostate (TURP) is a safe procedure, it is not as safe as Green Light Laser Vaporization of the Prostate. Using the new Green Light Laser XPS system, I can successfully treat patients with very large prostates traditionally thought only amenable to TURP or Open Prostatectomy. Green Light Laser surgery is safer than TURP in many respects. There is certainly less bleeding, typically no need for overnight hospitalization, no risk for dangerous fluid shifts associated with absorption of glycine used in TURP and decreased length of catheterization. I have not performed a TURP in my urology practice in Miami for over two years now. I cannot comment on the details of the surgery or outcome related to Dick Clark, however, I do think there is virtually no role for a TURP surgery in the modern era where alternatives therapies for enlarged prostate and urinary retention such as Green Light Laser XPS exist. “
The Empowered Patient is a regular feature from CNN Senior Medical News Correspondent Elizabeth Cohen that helps put you in the driver’s seat when it comes to health care.
Hollywood producer and television legend Dick Clark died of a heart attack a day after having prostate surgery, according to a death certificate obtained by CNN.
Clark died last Wednesday at St. John’s Health Center in Santa Monica, California. The day before his death, he had an operation to relieve “acute urinary retention,” an inability to urinate.
“It’s a very painful condition,” says Dr. Kevin McVary, professor of urology at Northwestern University’s Feinberg School of Medicine in Chicago.
The operation is “exceedingly safe” according to McVary, a spokesman with the American Urological Association.
“The mortality rate is less than one in 1,000. That’s very low risk,” he says.
The death certificate lists acute myocardial infarction and coronary artery disease as the causes of death. In December 2004, Clark suffered what was then described as “a mild stroke,” just months after announcing he had been diagnosed with Type 2 diabetes.
Patients with this kind of health history are usually screened by a doctor to test whether their heart is strong enough to withstand surgery, McVary says.
The surgery, known as transurethral resection of the prostate, is considered lower risk because it doesn’t involve an external incision. Instead, doctors insert a surgical tool through the tip of the penis and into the urethra, and then cut away prostate tissue to unblock the flow of urine.
It’s not known why Clark had a heart attack after this procedure. Surgery can be risky for cardiac patients. Anesthesia, for example, can be difficult on the heart, and so can blood pressure fluctuations that occur during surgery.
“Having surgery is a stressful event,” says Dr. Kenneth Rosenfield, an interventional cardiologist at Massachusetts General Hospital in Boston. “It might have been enough to tip him over.”
Is it low T
“Is is low T” is the name of the website and slogan used by Abbott Laboratories to raise awareness regarding low testosterone levels in the aging male. It is a series of questions related to libido, energy, enjoyment and endurance which may be symptomatic of low testosterone levels.
Is it low T, the question raised in their website is a question pondered by many aging males as the experience andropause and notice decreased energy, libido, sexual function and concentration. Low testosterone levels can also result in changes in bone and muscle strength.
Is is low T? Many of our patients are wondering the same thing. At Urological Consultants of Florida, our Miami urologists David Robbins, MD and Amery Wirtshafter, MD are certified experts in the field of urology including the treatment of male andropause and low testosterone. We are available to help you answer the question of Is it low T get you on the path to a clear diagnosis and a treatment program resulting in improved quality of life measures.
Pyeloplasty surgery is performed to repair a narrowing or stricture at the junction between the kidney and the ureter known as the uretero-pelvic junction or UPJ. A crossing vessel or stricture at the UPJ causes progressive dilatation of the renal pelvis subsequently leading to swelling (hydronephrosis) and worsening renal function or renal failure.
Miami urologist, David Robbins MD is a board certified urologist and recognized leader in da Vinci robotic surgery and expert in robotic pyeloplasty surgery for both stricture disease and crossing vessel at the UPJ (UPJ obstruction). Dr. Robbins trained at New York University and learned to perform robotic pyeloplasty procedures from Dr. Michael Stifelman, internationally acclaimed leader in the field of robotic surgery for the kidney and ureter.
Pyeloplasty procedures using the robotic approach are a minimally invasive option for pyeloplasty performed though four keyhole sized incisions as opposed to a long painful flank incision traditionally used for this surgery. Robotic pyeloplasty procedures are associated with decreased blood loss, less pain and a shorter hospital stay. Miami urologist David Robbins, MD is currently performing robotic pyeloplasty surgery at Mount Sinai Medical Center in Miami Beach as well as Aventura Hospital and Medical Center in Aventura.
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(MayoClinic.com) Hormone changes are a natural part of aging. Unlike the more dramatic reproductive hormone plunge that occurs in women during menopause, however, sex hormone changes in men occur gradually — over a period of many years. Here’s what to expect, and what you can do about it.
Debunking the male menopause myth
The term “male menopause” is sometimes used to describe decreasing testosterone levels or a reduction in the bioavailability of testosterone related to aging. Female menopause and so-called male menopause are two different situations, however. In women, ovulation ends and hormone production plummets during a relatively short period of time. In men, hormone production and testosterone bioavailability decline more gradually. The effects — such as changes in sexual function, energy level or mood — tend to be subtle and might go unnoticed for years.
So what’s the best way to refer to so-called male menopause? Many doctors use the term “andropause” to describe aging-related hormone changes in men. Other terms for so-called male menopause include testosterone deficiency, androgen deficiency of the aging male and late-onset hypogonadism.
Understanding male hormones over time
Testosterone levels vary greatly among men. In general, however, older men tend to have lower testosterone levels than do younger men. Testosterone levels gradually decline throughout adulthood — about 1 percent a year after age 30 on average. By about age 70, the decrease in a man’s testosterone level can be as much as 50 percent.
Recognizing low testosterone levels
Some men have a lower than normal testosterone level without signs or symptoms. For others, low testosterone might cause:
- Changes in sexual function.This might include erectile dysfunction, reduced sexual desire, fewer spontaneous erections — such as during sleep — and infertility. Your testes might become smaller as well.
- Changes in sleep patterns.Sometimes low testosterone causes sleep disturbances, such as insomnia, or increased sleepiness.
- Physical changes.Various physical changes are possible, including increased body fat; reduced muscle bulk, strength and endurance; and decreased bone density. Swollen or tender breasts (gynecomastia) and loss of body hair are possible. Rarely, you might experience hot flashes and have less energy.
- Emotional changes. Low testosterone might contribute to a decrease in motivation or self-confidence. You might feel sad or depressed, or have trouble concentrating or remembering things.
It’s important to note that some of these signs and symptoms are a normal part of aging. Others can be caused by various underlying factors, including medication side effects, thyroid problems, depression and excessive alcohol use. A blood test is the only way to diagnose a low testosterone level or a reduction in the bioavailability of testosterone.
Feeling your best
If you suspect that you have a low testosterone level, consult your doctor. He or she can evaluate possible causes for your signs and symptoms and explain treatment options. You can’t boost your natural testosterone production, but these steps might help:
- Be honest with your doctor.Work with your doctor to identify and treat any health issues that might be causing or contributing to your signs and symptoms — from medication side effects to erectile dysfunction and other sexual issues.
- Make healthy lifestyle choices.Eat a healthy diet and include physical activity in your daily routine. Healthy lifestyle choices will help you maintain your strength, energy and lean muscle mass. Regular physical activity can even improve your mood and promote better sleep.
- Seek help if you feel down.Depression in men doesn’t always mean having the blues. You might have depression if you feel irritable, isolated and withdrawn. Other signs of depression common in men include working excessively, drinking too much alcohol, using illicit drugs or seeking thrills from risky activities.
- Be wary of herbal supplements. Herbal supplements haven’t been proved safe and effective for aging-related low testosterone. Some supplements might even be dangerous. Long-term use of DHEA, for example, has no proven benefits and might increase the risk of prostate cancer.
Treating aging-related low testosterone with testosterone replacement therapy is controversial. For some men, testosterone therapy relieves bothersome signs and symptoms of testosterone deficiency. For others, however — particularly older men — the benefits aren’t clear. The risks are a concern as well. Testosterone replacement therapy might increase the risk of prostate cancer or other health problems. If you wonder whether testosterone injections or other testosterone treatments might be right for you, work with your doctor to weigh the pros and cons.