Dr. Ralph Zagha. Board Certified in Urology

Hospital/Operative Procedures

Laser/Plasma Vaporize Prostate Enlargement (TURP)
There are many procedures available for men with prostate related voiding issues/urinary retention. These procedures are typically offered after medical therapy has be exhausted. Minimal discomfort is expected and urethral catheter duration is short. The procedure is done under anesthesia with the use of a cystoscope (without an incision). A variety of energy sources are available such as GreenLight, Holmium, monopolar and bipolar (plasma vaporize). They are performed in a hospital/surgery center setting as an outpatient or overnight stay.

Please click on the following useful links to learn more about this condition.
GreenLight Laser - http://www.amsgreenlight.com/
Holmium Laser - http://www.holmiumforbph.com
Plasma Vaporize - http://plasmabutton.com/Patient/Why_PlasmaButton_sup_trade_sup
& http://www.olympus.es/medical/en/medical_systems/applications/urology/plasma_vaporization/plasma_vaporization.html

Laser Ureteroscopy
It is a procedure in which a small scope (like a flexible telescope) is inserted into the bladder and ureter and it is used to diagnose and treat a variety of problems in the urinary tract. For ureteral stones, it allows the urologist to actually look into the ureter, find the stone, break it with a laser and remove it. The surgeon passes a tiny wire basket into the lower ureter via the bladder, grabs the stone and pulls the stone free. This is an outpatient procedure with or without a stent inserted (a tube that is placed in the ureter to hold it open). However, depending on the skill and experience of the surgeon, ureteroscopy can be used for virtually any stone of a size appropriate for it. Fragmentation of stones using helium laser device ureteroscopy is more assured than with shock wave lithotripsy (SWL).

Kidney Stone Lithotripsy (ESWL)
Shock Wave Lithotripsy (SWL) is the most common treatment for kidney stones in the U.S. Shock waves from outside the body are targeted at a kidney stone
causing the stone to fragment. The stones are broken into tiny pieces. lt is sometimes called ESWL: Extracorporeal Shock Wave Lithotripsy.

These are what the words mean:
extracorporeal: from outside the body
shock waves: pressure waves
lithotripsy (the Greek roots of this word are "litho" meaning stone, "tripsy" meaning crushed)

So, SWL describes a nonsurgical technique for treating stones in the kidney or ureter (the tube going from the kidney to the bladder) using high-energy
shock waves. Stones are broken into "stone dust" or fragments that are small enough to pass in urine. lf large pieces remain, another treatment can be performed

Percutaneous Kidney Stone Treatment (PCNL)
Percutaneous nephrolithotomy, or PCNL, is performed under general anesthesia. During the procedure, your doctor makes a small incision in your side about the size of a fingertip. A narrow tunnel is then created directly into the kidney. A special telescope (called a nephroscope) is used to examine the inside of
the kidney. Stones are broken by high speed vibration or a laser. This procedure usually requires a one to three day hospital stay and most patients resume normal activity within two weeks.

Minimally Invasive (laparoscopic) Kidney Cancer Procedures
Kidney surgery is possible with use of open, laparoscopic, percutaneous, and/or robotic techniques. Minimally invasive procedures allow for similar long-term outcomes with the advantage of a quicker recovery. Larger renal masses/tumors may require removal of the entire kidney while smaller masses may benefit from a partial nephrectomy or a ercutaneous/laparoscopic thermal ablation.

Bladder Cancer Surgery
Surgery for bladder cancer includes:
•Transurethral resection of the bladder (TURB): Cancerous bladder tissue is removed through the urethra.
•Partial or complete removal of the bladder: Many people with stage II or III bladder cancer may need to have their bladder removed (radical cystectomy).
Sometimes only part of the bladder is removed.

Scrotal Surgery
The scrotum usually consists of a very flexible and wrinkly skin sack which accommodates the testicles. It’s shape and size is usually adjusted to the size of the testicles in a way that it looks “filled out”. Some conditions such as undescended testicles (testicles remain in the groin area and need to be surgically moved down into the scrotum or removed in order to eliminate risk of cancer), testicular atrophy (testicles were originally “normal” in size, but have shrunk over time due to several conditions such as hormonal imbalance or testosterone abuse), removal of one or both testicles due to cancer, and originally smaller size of the testicles compared to the scrotal sack may require a surgical correction of the scrotal aesthetics. Fluid in the scrotum, called hydrowells, can be drained or surgically corrected.

Vasectomy
Vasectomy is a surgical procedure for male sterilization and/or permanent birth control. During the procedure, the vasa deferentia of a man are severed, and then tied/sealed in a manner such to prevent sperm from entering into the seminal stream (ejaculate). Vasectomies are usually performed in a physician's office or medical clinic. Due to the simplicity of the surgery, a vasectomy usually takes less than 30 minutes to complete. After a short recovery at the doctor's office (usually less than an hour), the patient is sent home to rest. Because the procedure is minimally invasive, many vasectomy patients find that they can resume their typical sexual behavior within a week, and do so with minimal discomfort.

Circumcision
Circumcision is the removal of the foreskin, which is the skin that covers the tip of the penis. In the United States, it is often done before a new baby leaves
the hospital. There are medical benefits and risks to circumcision. Possible benefits include a lower risk of urinary tract infections, penile cancer and sexually transmitted diseases. The risks include pain and a low risk of bleeding or infection.