SERVING THE PENINSULA FOR MORE THAN EIGHT DECADES
….by any name, Riverside Urology Specialists is the premier provider of urologic care on the Virginia peninsula
Nearly nine decades ago, in roughly 1929 – so long ago that no one remembers the exact date for sure – a medical practice known as Hampton Roads Urology was established on the Virginia peninsula. The physicians who founded the practice were too busy offering long-needed medical and surgical care to their patients to note the day and time for posterity.
Today, the inheritors of that practice are continuing the tradition of excellence that earned Hampton Roads Urology a reputation for providing the highest and most innovative urologic care available. They do so under a different banner: eight years ago, when the practice affiliated with Riverside Medical Group, they proudly changed the name to Riverside Urology Specialists – although they acknowledge that some patients still occasionally use the old name.
By any name, Riverside Urology Specialists is the largest urologic practice on the peninsula, with offices in Newport News, Williamsburg and Gloucester, treating patients who present with nearly every condition or disease that can affect the very complex human urinary tract system and reproductive organs. Their patients include both men and women, and range in age from the early teens on up to the elderly.
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Kidney Stones.
Kidney stones are one of the most common disorders of the urinary tract, and research indicates that their
incidence is rising, particularly among women. “Southeastern Virginia is often referred to as ‘the stone belt,’” says Dr. Henry Prillaman. “There are a variety of factors that contribute to that, one being our climate. Particularly at this time of year, dehydration can cause the urine to become more concentrated, which creates the environment for stones to develop.”
There are medications that can alleviate the discomfort of stones, but for patients who require surgery, Riverside Urology Specialists has a comprehensive program that includes all of the current minimally invasive procedures. One is the lithotriptor, which pulverizes the stones by passing shock waves through a water-filled tube, with the patient lying on a table. This causes the stones to fragment into pieces small enough to expel in the urine. For larger, more complex stones, the urologists can go directly into the kidney through the skin and remove stones percutaneously. Each patient is assessed and the treatment plan individualized based on the size and location of the stone(s).
“The best thing about stone care today is that over time, it’s become much less invasive,” Dr. Prillaman says. “Stone disease is miserable for the patient, but with these techniques, people are bouncing back quicker than ever.”
Care for stone disease doesn’t end when the stones are gone: the next step is teaching patients how to keep them from returning. “There are four tenets of stone prevention for calcium stones,” Dr. Roger Schultz explains: “Drink more water, eliminate salt, avoid foods rich in oxalate and add lemons to the diet.”
For some patients, even adhering to those tenets isn’t enough to keep stones away. In those cases, Dr. Schultz says, “We’ll do a 24-hour urine collection to see what’s being produced in the urine, to proceed from there.” They also send the stones to the lab for analysis, says Dr. Karl Pete, “and then we modify treatment based on their composition. There are several types of stones: the majority are calcium or oxalate, and the others are uric acid, struvite or cystine stones, those formed as a result of certain medication.” And, he adds, while stones tend to run in families, they are to a great degree random.”
BPH – benign prostate hypertrophy.
Also known as an enlarged prostate, this condition affects men as they age, and often causes urinary symptoms. Medications can be effective, but in certain situations, surgery is indicated. In the past, that meant a hospital stay of one to three days, and the patient required a catheter for several days thereafter. Recovery time was significant. “Today, we’re using vaporization techniques on an out-patient basis, which give the same result,” Dr. Steven Marks says, “and at most, patients need a catheter only overnight. They’re back to work in a day or two. The procedure is a big hit with men!”
Prostate cancer.
For patients with low-volume, low-stage cancer, the first option is active surveillance, but “We’re not just watching,” Dr. Richard Rento emphasizes. “We’re doing regular PSA and rectal exams, and when indicated, further biopsies.”
Prior to the 1990s, the only surgical option was an open procedure that required a long hospitalization and painful recovery, including a lengthy period of urinary incontinence and erectile dysfunction. Laparoscopic radical prostatectomy resulted in less blood loss and pain, shorter hospital stays, lower risk of complications. But the turning point was the introduction of robotic surgery. “Robotics allows us even greater precision during the surgery; and from the patient’s standpoint, there’s far less blood loss, less pain, fewer days in the hospital and fewer days with the catheter,” Dr. Rento says. In fact, the first daVinci robot was brought to the peninsula to treat prostate cancer patients, and two years ago, says Dr. Scott Burgess, Riverside acquired the newest version of the daVinci.
Dr. Rento also performs brachytherapy, the only physician on the peninsula to offer this form of targeted radiation for prostate cancer. Brachytherapy involves placing seeds of radioactive material inside the prostate, where they remain, emitting radiation for a short time or several months. These seeds don’t travel beyond their destination, resulting in less damage to surrounding structures.
Kidney cancer.
Dr. Rento and Dr. Burgess perform the practice’s surgical robotic oncology. In cases of kidney cancer, they are doing a large number of partial nephrectomies, or nephron-sparing procedures, removing the tumor while leaving the kidney intact. “It’s been shown for the better part of 10 years that you want to save the kidney whenever possible,” Dr. Burgess says. “Now we know that there are detrimental effects unrelated to kidney function when you remove an entire kidney.” The criteria includes the size of the tumor, its location in the kidney, and whether it’s on the upper or lower pole. Because the renal artery is clamped during the procedure, time is of the essence. The surgeons must complete the entire task within 15 or 20 minutes.
The vast majority of the time when a radical nephrectomy is indicated, it is performed laparoscopically. “The kidney is about nine to 10 cm. in size, and it’s not uncommon to find tumors that are between 10 and 20 cm. on top of it,” Dr. Rento says. “In those cases, we take not just the kidney, but several centimeters around that.”
Bladder cancer.
About 85 percent of these cancers are superficial, and can be scraped away. For the 15 percent whose cancer is already growing within the wall, cystectomies are performed. Very few patients are candidates for partial cystectomy. In a radical cystectomy, the bladder and prostate are removed in male patients, and the bladder, uterus and top of the vagina in women.
The majority of bladder cancer in men can be treated through an endoscope, a telescope that goes through the penis into the bladder to resect or remove the cancer.
Urinary reconstruction includes an ileal conduit, or urostomy, through which urine flows into an external bag. The ureters are sewn to the wall of the conduit, after which a stoma is created through which urine is eliminated. A different option is continent urinary diversion, which involves creating a new bladder from a piece of bowel, stomach or right colon. The new bladder is attached inside the body.
Treatment for bladder cancer has few side effects.
Infertility.
For some men, the decision to limit the number of children they father is a welcome and responsible one. Vasectomy, a quick and simple procedure that can be performed in the urologist’s office in about 15 minutes, Dr. Marks says. “Recovery is short and easy, and relatively free of long-term side effects.” In addition, Dr. Pete explains, “Vasectomy is a much safer option for men than tubal ligation is for women. Vasectomy requires only local anesthesia, whereas women must undergo general anesthesia for sterilization.”
But for many men, being unable to father children creates tremendous angst. Dr. Schultz spent four years at Naval Medical Center Portsmouth, treating sailors at every stage of their reproductive lives, and acquiring special knowledge in the area of male fertility. “When couples come in complaining of not being able to conceive – typically after six months of trying – I tell the woman to consult with her gynecologist or fertility expert,” he explains, “and I look at various aspects of the man’s history that might impact fertility, followed by a physical exam and semen analysis. The most common thing urologists look for is a varicocele, which we can treat surgically or radiologically. It often resolves the problem, so that sperm quality improves and pregnancy ensures.”
When urologic approaches to infertility have been exhausted, Dr. Schultz and his colleagues will consult with specialists in assisted reproductive techniques.
Reverse vasectomy is rarely requested these days, Dr. Marks says, although the procedure has a fairly good success rate.
Urogynecology.
Karanvir Virk, MD, is a urogynecologist who collaborates with Riverside Urology Specialists on conditions that affect only the female anatomy, including prolapse, urinary and fecal incontinence, urinary tract infections, hemorrhagia and similar problems.
The most prevalent of these conditions are prolapse and urinary incontinence. “These are not necessary conditions of older women,” Dr. Virk says. “These are pathological, and they can be fixed.”
Prolapse is not always symptomatic, and doesn’t require treatment unless and until it interferes with a patient’s quality of life. When symptoms do appear, the first option is a pessary, a device inserted into the vagina to support the pelvic organs. Kegel exercises are often prescribed as well.
Reconstructive surgery, which is performed laparoscopically or through an incision, is done to restore the organs to their original positions. Sexual function is not affected. In severe cases, obliterative surgery is done to narrow or close the vagina to provide support, after which sexual intercourse is no longer possible.
Urinary incontinence.
Urinary incontinence, or leaking when engaged in even the briefest strenuous activity, is one of the most vexing conditions a woman can suffer, but it can be successfully treated by any of the urologists. The most common treatment is the installation of a transobturator midurethral sling, a device that acts as scaffolding, or a shock absorber, that essentially closes the urethra so urine cannot leak.
Expanding urologic care to the people of the Virginia peninsula and beyond.
From its earliest days as the first urologic practice on the peninsula, the group once known as Hampton Roads Urology has grown with both the times and the population it serves – and it continues to grow. Riverside Urology Specialists will add two additional urologists in August 2015 – Dr. John McGill and Dr. Ostap Dovirak.
With a full complement of urologists, the practice will soon offer evening and Saturday hours to accommodate their working patients, to ensure all patients are seen in a more timely fashion, and that all receive the unparalleled treatment that is the hallmark of Riverside Medical Group physicians.
Please call (757) 873-1374 or visit our website: riversideonline.com/services/urology
