Men's Urology
Modern Urology evaluates all urologic issues that men experience
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Transforming Lives with State-of-the-Art Urologic Care. Discover Our Cutting-Edge Treatments.
Unlock Your Full Potential with Dr. Carolyn Fronczak's Urological Care for Men & Women
Are you ready to reclaim your confidence? Look no further! Dr. Carolyn Fronczak’s urological care is here to empower you, regardless of your gender.
Men's Health - CONDITIONS WE TREAT
An enlarged prostate is also called BPH (benign prostatic hyperplasia).
An enlarged prostate causes urination problems in most men.
The prostate keeps growing throughout a man’s life. A normal prostate size is around 30-40g, about the size of a walnut.
Cancer and noncancerous growth of prostate tissue can co-exist in the prostate.
A wise urologist once said, “50% of men currently see a urologist, and the remaining 50% will eventually see a urologist.”
An enlarged prostate can affect men as early as 45 years of age.
50% of men will have BPH symptoms between 50-60 years of age.
90% of men over the age of 80 years will have urination symptoms from an enlarged prostate.
As the prostate grows, the prostate can pinch upon the tube that drains urine from the bladder. This tube is called the urethra. When the urethra gets narrowed or compressed, urine has a difficult time draining from the bladder (picture a kink in a hose). The bladder will work very hard to get the urine out, but a hard working bladder is not a healthy bladder. As the bladder works harder, the bladder gets weaker. Overtime, a hard working bladder remodels into a thick weakened poorly functioning bladder— the bladder muscle essentially burns itself out.
Symptoms of BPH can include weak urinary stream, getting up more than once at night, dribbling, frequency, urgency, difficulty starting the urine stream, straining to void, feeling that urine is left in the bladder.
Do not ignore these symptoms. The bladder can weaken so much that eventually it cannot empty urine. When the bladder cannot squeeze, a man may need to use a foley catheter to empty his bladder, which can be permanent for his lifetime. When a bladder cannot empty, there may also be kidney failure and possibly permanent kidney damage.
Fill out the form here and if your score is greater than 8, then make an appointment.
If you have bothersome urinary symptoms, these symptoms may be signs of urinary obstruction from an enlarged prostate, but also may be signs from stones, bladder infection, urethral stricture, overactive bladder, or even cancer.
Treatment of an enlarged prostate can be with prescription medications, in-office procedures, or surgery.
Medications for prostate obstruction include alpha blockers (Example – tamsulosin) and 5 alpha reductase inhibitors (Example – finasteride). All prostate medications have sexual side effects and these sexual side effects are often bothersome and undesired.
In office procedures, such as UroLift have revolutionized treatment for enlarged prostate symptoms.
Surgical procedures include transurethral resection of prostate and robotic simple prostatectomy.
There are additional prostate treatments on the horizon and Dr. Fronczakis actively evaluating new and upcoming technologies.
Nitrous sedation is offered for all prostate procedures at Modern Urology.
What is a PSA and why is it elevated?
- PSA stands for Prostate Specific Antigen.
- PSA is a protein released by the prostate and circulates in the blood stream. It is secreted by normal and abnormal prostate cells. PSA is only found in males. 4. A PSA is checked with a simple blood test.
- PSA a screening test for prostate cancer.
- If a patient has an elevated PSA, the reason for the elevation should be evaluated by a urologist.
Make an appointment here if you need prostate cancer screening or have an elevated PSA.
- PSA can be elevated due to prostate cancer, but also can be elevated due to normal but enlarged prostate tissue (BPH), infections, recent ejaculation, recent bike riding, pelvic trauma, and recent urologic procedures/foley catheter placement.
- The providers at Modern Urology offer innovative methods to evaluate an elevated PSA.
How do you evaluate an elevated PSA?
- The new technologies available today help make an informed educated decision on the need for further testing of an elevated PSA. These new tests can and do reduce the need for unnecessary biopsies.
- These innovative tests include but are not limited to:
- Genomic testing – blood and urine tests that determine the likelihood of detecting prostate cancer with a biopsy.
- Multiparametric Prostate MRI – an MRI that may detect the location of abnormal prostate tissue that may or may not be cancerous.
- UroNav MRI/Ultrasound
- The providers at Modern Urology are actively evaluating new and upcoming tests.
FRONCZAK’S POSITION ON PSA SCREENING
PSA screening and a digital rectal exam should be a done after a conversation of risks and benefits with patients.
PSA screening involves a simple blood test that measures the amount of prostate specific antigen (PSA), a protein secreted by the prostate and circulating in the blood stream. It is secreted by normal and abnormal prostate cells. PSA is only found in males.
A digital rectal exam is when a provider with a gloved hand, inserts a finger into the anus to feel the prostate through the rectum for abnormalities and size.
PSA screening and a digital rectal exam (DRE) should both be performed in men with life expectance of greater than 10 years. The screening can be done by the primary care provider or a urologist.
I support PSA screening in men with greater than 10 years of life expectancy.
I support starting screening at age 50 for men without a family history of prostate cancer and starting screening at age 40-45 for men with a family history of prostate cancer.
Make an appointment here if you need prostate cancer screening.
An elevated PSA is traditionally defined as a value above 4ng/ml but trend and velocity of changes to this value matters, even in in PSA below 4ng/ml.
PSA can be high due to prostate cancer, but also high in the settings of larger prostates (BPH), infections, recent ejaculation, recent bike riding, pelvic trauma, and recent urologic procedures/foley catheter placement.
Fronczak recommends 5 days of pelvic rest before getting a PSA (pelvic rest = no sex, masturbation, ejaculation, bike riding).
A normal PSA value but an abnormal DRE needs to be further evaluated.
Fronczak offers the latest most innovative methods to evaluate an elevated PSA and/or abnormal rectal exam and make an educated decision on the need for further testing, such as doing a prostate biopsy. These revolutionary tests can and do reduce the need for unnecessary biopsies.
These innovative options include but are not limited to:
Genomic testing – more specific blood and urine tests that determine the likelihood of detecting prostate cancer with a biopsy.
4K score, Select MdX, ExoDx, and many others that are being developed.
https://mdxhealth.com/select-mdx-for-patients/
https://www.exosomedx.com/physicians/exodx-prostate-test
Multiparametric Prostate MRI
Why get evaluated for prostate cancer?
Prostate cancer is the number one cancer diagnosed in men and causes the second highest number of deaths from cancer in men (second only to lung cancer).
Prostate cancer can range from very low risk to very high risk in terms of aggressiveness and concern.
Goal of prostate cancer evaluation and treatment
- Maximize detection of lethal prostate cancer
- Accurately characterize the biology of the tumor.
- Risk stratification of the cancer so we avoid over-treatment of indolent cancers and proceed with treatment of potentially lethal prostate cancers.
What is the evaluation for prostate cancer?
- Evaluation for prostate cancer often begins with a PSA blood test (link to PSA section) and a digital rectal exam.
- There are new evaluation options for prostate cancer including genomic testing, prostate imaging with an MRI,2 and a prostate biopsy.
If you need an evaluation for prostate cancer, please make an appointment.
Prostate cancer is the number one diagnosed cancer in men in the United States and the second most common cause of cancer death in the United States.
Increased risk of prostate cancer is seen in
- Family history
- Father w prostate ca 2x more likely
- Brother w prostate ca 4x more likely
- Father and brother w prostate ca 8x more likely
- Ethnicity
- African Americans 1.6 x more likely to have disease
- Americans 2.2 x more likely to die of disease
Fronczak uses various lab tests, genomic tests, prostate biopsy, physical exam and a thorough discussion to help diagnosis prostate cancer and make an educated decision on treatment and/or surveillance options.
What is erectile dysfunction?
ED is the inability to maintain an erection sufficient enough for sexual activity. 3. It is not normal at any age.
The providers at Modern Urology will do a thorough evaluation as to the causes and risks associated with erectile dysfunction.
Checking a testosterone level, including bioavailable testosterone may be included in the evaluation.
Please make sure if you are getting your testosterone checked to have your testosterone lab drawn before 9am.
How is ED treated?
Treatment for erectile dysfunction can be medications (sildenafil (Viagra), generic tadalafil (Cialis), or other PDE5i medication), penile vacuum erection device, couples/sex therapy, penile injection, penile prosthesis.
Pills for ED are often insufficient to obtain an adequate erection and that is OK because there are other options.
A vacuum erection device and counseling with a sex therapist may also be discussed.
Gold standard treatment for ED is a penile injection of an erectogenic medication.
Forms of this medication are: Trimix, Bimix, Quadmix, alprostadil (Edex) and many other combinations.
An injection into the penis may sound scary or super uncomfortable, but a test dose is done in the office to show patients that this treatment option is not as bad as it sounds. Also the resulting erection is most times excellent.
Dr. Fronczak provides thorough instructions in the office and a trial injection to help the patient and his partner understand the injection process, the risks and benefits.
In advanced cases of ED, a penile prosthesis surgery may be indicated.
Treatment can be medications (generic sildenafil, generic tadalafil), penile vacuum erection device, couples/sex therapy, an injection of a very small amount of a medicine into the shaft of your penis to give an erection in less than 10 minutes), penile prosthesis.
Pills for ED are often insufficient to obtain an adequate erection and that is OK because there are other options.
Gold standard treatment for ED is a penile injection.
Trimix, Bimix, alprostadil (Edex) are penile injection medications.
This may sound scary or super uncomfortable, but rarely does a guy complain about pain as the needle is extremely small and the amount of medication is also very little. Also the resulting erection is most times excellent.
Fronczak provides thorough instructions in the office and a trial injection to help the man and his partner understand the injection process.
Key points to success with injectable medications for erection
Only inject the smallest amount of medication that give you the erection you desire. Injecting too much can cause a priapism.
A priapism occurs when an erection occurs but it does not go away.
If an erection lasts more than 3-4 hrs, it can lead to permanent damage to erectile tissue and permanent erectile dysfunction.
Trimix is very safe if used in the appropriate manner with appropriate dosing.
Fronczak makes sure her patients know that a little bit of this medication goes a long way.
When first starting out with an injectable erection medication, it is important to increase the amount injected slowly over time.
For example start with 0.05ml and then increase on 0.05ml to 0.1ml every 24-48hrs until desired erection is achieved.
If you are not achieving the desired erection, the medication may not be strong enough and you will need to discuss w Dr. Fronczak higher dosing options or the medication may be expired.
Keep the injectable medication in the refrigerator to prolong use past expiration date.
In advanced cases of ED, a penile prosthesis surgery may be indicated.
Testosterone levels should be normal.
Testosterone therapy may improve libido (sexual drive), sexual function, anemia, lean body mass, and depression.
Testosterone is checked with a blood test that needs to be drawn before 9am.
If testosterone level is low, additional blood tests will be ordered and again these blood tests need to be drawn before 9am and should be drawn after fasting for 8 hours.
Men have many issues with their bladder, sometimes as a result of the prostate and sometimes for reasons not related to the prostate.
Other possible reasons may include overactive bladder, a urinary tract infection, kidney or bladder stones, overflow incontinence, or maybe even something serious like cancer.
If a man has bothersome bladder symptoms including urinary leakage, urinary urgency, urinary frequency, it is never normal nor should be an accepted part of life.
The providers at Modern Urology are experts in evaluation and management of incontinence.
Different types of incontinence are treated differently. A patient may have more than one type of incontinence.
The providers at Modern Urology will do a thorough evaluation into the type(s) of incontinence and have significant experience in providing interventions and surgical treatments for all types of incontinence.
No one has to accept urinary leakage, which is also known as urinary incontinence.
Bladder leakage at any age is never normal and should not be an accepted part of life or aging.
Incontinence significantly impacts quality of life—leakage is very embarrassing and management with incontinence pads is very expensive.
Leakage and urinary urgency/frequency may also be a sign of something more serious like cancer.
The providers at Modern Urology are experts in evaluation and management of incontinence.
Different types of incontinence are treated differently.
A patient may have more than one type of incontinence.
Types of incontinence can include: overactive bladder (OAB), stress urinary incontinence (SUI), overflow incontinence.
Click here for information on OAB
Click here for information on SUI
Leakage can also be from a urinary tract infection and weak pelvic floor muscles.
The providers at modern urology believe in offering patients conservative treatments, such as behavioral modifications and pelvic floor physical therapy, in additional to medications and interventions.
The providers at Modern Urology have significant experience in providing interventions and surgical treatments for all types of incontinence.
- Urodynamic testing
- Evaluation and treatment of urinary retention
- Hydrocelectomy
- Spermatocelectomy
- Varicocelectomy
- Circumcision (ages 14 and up)
- Cystolitholapaxy – removal of bladder stones
