Surgeries & Procedures

Radical Prostatectomy

A prostatectomy procedure has the goal of removing the entire prostate gland as well as the surrounding tissue. This procedure is usually restricted to patients with prostate cancer.

Open Surgery

In conventional surgery, the surgeon accesses the prostate through an incision either in the perineum or at the lower abdomen/upper pubis area. The retropubic approach is much more common as it allows simultaneous access to the lymph nodes adjacent to the prostate. These nodes are normally removed and tested for cancer depending on the results of the Prostate-Specific Antigen test.

The perineal approach may be preferred if the doctor believes that the lymph nodes are cancer free. In this case, the incision is made between the groin and anus, allowing a shorter recovery time and lower risk of impotence. However, this approach runs a risk of fecal incontinence which can be a difficult side effect to deal with.

Laparoscopic Surgery

This type of surgery is slightly less invasive than standard surgery because it uses multiple small incisions, significantly reducing the risk of infection, hemorrhage and other complications. A lighted miniature camera called a laparoscope is inserted in one of the holes while the tools for manipulation and excision of the prostate are used in the others. This type of procedure is relatively new and not practiced by many surgeons yet.

New advances in medical robotics have brought about Robot Assisted Laparoscopic Surgery, where the surgeon controls the laparoscope and tools from a central station and the computer moves the surgical arms. These new machines may allow for even greater degrees of precision to be obtained as their programs and controls become more refined.

For more information please call us at 415-422-0003 (San Francisco) or 650-991-3064 (Daly City) or email us.

Testicular Implants

There are issues in urology of such sensitive nature that they largely go underserved. The need for testicular implants is one of them. There are many men that for any number of conditions lose one or both of these organs, or suffer a severe loss in size. Cancers, inflammatory diseases, infections, endocrinological problems, or the long term use of testosterone and testosterone derivatives can lead to this point.

With loss of one or two testicles, one could potentially face infertility and the full spectrum of low testosterone symptoms, including sexual dysfunction. Moreover and largely ignored is the issue of poor self perception.

The absence of one or both gonads is oftentimes a great source of anxiety, sexual and social restraint, shame and depression. Patients go to great extremes to hide their handicap and rarely ever share their distress with their physician.

There is a very safe, well established, easy and very successful option for these patients. Testicular implants are prosthetic devices made of a silicone and/or saline solution. They come in a variety of sizes. This is a determination made intraoperatively.

The procedure, usually done under general or spinal anesthesia, is performed on an outpatient basis. It can be done through a scrotal or inguinal (groin) incision, and is fairly quick in most cases.

The recovery is minimal, ranging from several days to two weeks. Better yet, the procedure is surprisingly very well tolerated, with minimal pain issues. For some patients, this is a pain free experience.

The cosmetic results are excellent, and very natural looking. Of course one must understand that the implants will not recover the ability to produce sperm cells or testosterone, which must be provided by other means.

Breast implants and reconstructions are an integral part of the management of patients with breast cancer and other diseases. Testicular implants should be thought of in the same way for any patient that has lost one or two gonads. The complete relief from a crippling anxiety, insecurity, or depression is merely a short and successful surgery away. Don’t be afraid or ashamed to talk to your physician.