APPOINTMENTS

Do I need a referral to be seen at Western Michigan Urological Associates?

Ask Your Primary Care Provider for a Referral. We accept most major insurances, but you should confirm coverage and eligibility prior to scheduling your appointment.

With which physician should I make my appointment?

When you call for your appointment, our scheduler will ask you a few questions to better understand your needs. Our specialists are trained and experienced to handle all urology issues, but based on your needs and timing, our scheduler will set your appointment with the most appropriate specialist.

What can I expect at my first appointment?

Please arrive 15 minutes early for your appointment if you have not already completed your new patient forms.

If you have prior test results related to your current issue, please bring them with you.

Your appointment will include a review of your medical history and current problem, along with a thorough physical examination. If any testing is needed, your doctor will explain everything. Some tests can be conducted in our office at the time of your visit. Others will need to be scheduled at a separate time and location. We partner with Holland Hospital for many of our tests.

STONE DISEASE

How can I prevent kidney stones?

Drink more water. Drink enough water so your urine is clear to light yellow. Dark urine usually indicates you aren’t drinking enough water. For people who have more than one stone episode, we may recommend a chemical analysis of the stone and a metabolic workup, including a 24-hour urine collection, to look for factors. We may be able to provide dietary and medication recommendations based on information from these tests.

What causes kidney stones?

Kidney stones form when certain minerals and substances in the urine reach a high concentration, crystallize and form stones. This can result from dehydration, metabolic disorders or bowel disease. Other factors include family history of stones, dietary or genetic factors and frequent urinary tract infections.

What are the symptoms of kidney stones?

Symptoms depend on the location, size, and shape of the stone. Many times episodes are symptom free. They are called silent stones. Common symptoms include:

• Sudden, severe pain, starting on your sides and moving toward your groin area.
• Nausea and vomiting
• Blood in urine
• Increased urinary frequency
• Burning sensation when urinating
• Infection in urine

Who is at risk for kidney stones?

People who tend to form stones have certain common factors:

• Those who stay in the hot environmental condition, such as tropical area
• Positive family history of the stone disease
• Decreases fluid intake, which reduces urine output

PROSTATE CANCER

How is prostate cancer detected?

We can perform prostate cancer screenings using two tests:

• Prostate-specific antigen (PSA) blood test — A blood sample is drawn and the amount of prostate- specific antigen (PSA) is determined. PSA is a marker that, if present in higher than average amounts, may suggest prostate cancer cells.
• Digital rectal exam (DRE) – a gloved finger is inserted into the rectum to feel the prostate gland through the rectal wall to check for bumps or abnormal areas.

What are the chances for survival?

Prostate cancer is highly curable when detected early. In advanced stages, chemotherapy may extend survival among men who have failed hormone therapy. We will provide you with specific guidance based on your facts and circumstances.

BLADDER CANCER

What is bladder cancer?

Bladder cancer begins in the bladder, the organ that stores urine. The bladder wall has several layers, and cancer may appear on the surface layer, in the muscle layers, or even spread to surrounding organs.

Over 90% of bladder cancers are Transitional Cell Carcinomas (TCC). These cells can undergo changes in size from cubical (when the bladder is empty) to flat (when the bladder is full).

Is smoking linked to bladder cancer?

Smokers are two to five times more likely to get bladder cancer. The more they smoke, or the longer they smoke, the higher the risk. It is estimated that half of all bladder cancers in men, and one third in women, result from smoking.

How effective are treatments in eliminating the cancer and preventing recurrence?

When found and treated early, the five-year survival rate for bladder cancer is 92%.

KIDNEY CANCER

What is kidney cancer?

The kidneys are two large, bean-shaped organs on both sides of your backbone. Kidney cancer, also known as renal cancer, occurs when kidney cells grow out of control, clump together and form a malignant tumor.

What are the types of kidney cancer?

There are two parts to each kidney. One is the kidney cortical area, which filters blood and produces urine. The other part is the renal pelvis. Cancer can occur in both areas, though 90% occur in the kidney cortical area, with less than 10% in the renal pelvis.

If the cancer is diagnosed early, before it spreads outside the kidney, greater than 90% of patients can be cured.

Once the tumor spreads beyond the kidney, it is more difficult to treat. Depending on age and other factors, between 50% and 80% of patients diagnosed at this stage can be cured.

Advanced kidney cancer is difficult to cure completely and only about one in six or seven patients can be cured.

TESTICULAR CANCER

How can I prevent testicular cancer?

Just as women perform monthly self-breast examinations, all men should perform monthly self-testicular examinations. The best time is following a warm shower.

Using both hands, examine each testicle with the thumbs in front and the first two fingers behind the testicle. While feeling for lumps or bumps, the testicle should be rolled between the fingers and thumb.

Your testicle feels like a hard-boiled egg without the shell. If you discover lumps or bumps, contact us immediately. The greatest chance of prevention is early detection and treatment.

I have ongoing discomfort in my testicle, should I be concerned about cancer?

Testicular cancer is more common in young men, but returns as a risk after your 40s. If you experience persistent discomfort, contact us for an appointment. If you’ve been completing monthly self-exams, and no lumps or hard spots have developed, you likely do not have cancer, but it’s important to rule out the problem.

Various difficulties can lead to pain in one or both testicles. We may check for a hernina as well as cancer as hernias can cause similar symptoms.

If you experience pain mostly when you ejaculate, you may have an infection or sexually transmitted disease.

A general discomfort in both testicles may be due to muscle spasms. Most men do not realize how many muscles they have in the testicular area. If the symptoms disappear with a hot bath, this is a sign of muscle spasms. Regular baths along with medication to relax muscles will probably help. Wearing a jock strap will offer support.

How effective are the treatments for testicular cancer?

The current treatments are very effective. If the tumor is diagnosed early, a complete cure is achieved in nearly 95% of cases. Later tumors are more difficult to treat, but even in advanced testicular cancer more than 50% of patients are cured.

ERECTILE DYSFUNCTION

Is impotence the same as erectile dysfunction (ED)?

Yes, the terms mean the same.

Does ED indicate a loss of interest in sex, lack of vigor or sterility?

No, not at all. In most cases, affected men have the desire and the ability to have an orgasm and ejaculate. Erectile dysfunction means a difficulty with erections, not a loss of interest in sex, sterility, or a lack of strength, vigor or power.

Is ED a natural part of the aging process?

There is a higher rate of ED among older men because of age-related conditions, including vascular disease, diabetes and medications for these conditions. Although mainly affecting older men, ED also occurs in younger males. ED should not be considered a natural or acceptable part of aging.

What are the treatments for ED?

ED treatment depends on its cause. We will check for medical problems and medicines that might cause ED and may recommend a medicine to help with ED. Some medicines are injected into your penis. Other medicines are taken by mouth. Not everyone can use these medicines. We will help you decide if you can try them.

How do I know which treatment is best suited for me?

We will discuss all treatment options with you. Your treatment will depend on personal preference and economic factors. Both you and your partner should be comfortable with your choice.

INCONTINENCE

What is urinary incontinence?

Urinary incontinence means an involuntary loss of urine. The urine loss can range from slight leakage to severe, frequent wetting.

What is urge incontinence?

You often lose urine for no reasons while suddenly feeling the need (or urge) to urinate. The bladder involuntarily empties during sleep, after drinking a small amount of water, or while touching water or even when hearing it run (when someone is taking a shower or washing dishes).

What causes urge incontinence?

The most common cause is inappropriate and involuntary bladder contractions. These involuntary contractions may result from bladder inflammation or irritation or when certain neurological diseases reduce control of bladder contractions.

• Urinary tract infections
• Cancer
• Parkinson’s disease
• Alzheimer’s disease
• Certain drugs such as hypnotics or narcotics
• Injury (such as those occurring during surgery)
• Benign prostatic hyperplasia (BPH).

Urge incontinence can also occur when mobility is limited, such as patients with arthritis, making it difficult to get to the bathroom in time.

What is stress incontinence?

Stress incontinence is the most prevalent incontinence in elderly patients. Malfunctioning urethral sphincter causes urine to leak from the bladder when abdominal pressure increases, such as during laughing, coughing or sneezing.

What causes stress incontinence?

Physical changes resulting from pregnancy, childbirth and menopause are common causes. It is the most common form of incontinence in women and is treatable. Certain muscles, known as the “pelvic floor muscles” support the bladder. If these muscles weaken, the bladder can move down, pushing slightly out of the bottom of the pelvis toward the vagina. This prevents muscles that ordinarily force the urethra shut from squeezing tightly.

What is overflow incontinence?

Overflow bladder is more relatively uncommon. It is more common in men because of enlarged prostate glands. In this form, urine collects in the bladder until the bladder reaches its capacity. It then leaks through the urethra by “overflow,” usually as dribbling. However, increased abdominal pressure, which occurs during coughing and sneezing, may also lead to overflow incontinence

What causes overflow incontinence?

• Weak bladder muscles caused by nerve damage from diabetes or other diseases (e.g., tumors, radiation, surgery)
• Obstructed urinary outflow, such caused by prostate enlargement and urinary stones
• Under active bladder contractions caused by certain medications.

How is incontinence treated?

Most urinary incontinence can be effectively treated. In some patients, incontinence often improves with weight loss. Smokers with a chronic cough have fewer problems when they stop smoking (and stop coughing). Some common drugs can also aggravate the problem so a prescription change can make a difference.

PELVIC FLOOR DYSFUNCTION

What is pelvic floor dyfunction?

Pelvic floor disorders occur when the “sling” or “hammock” supporting the pelvic organs becomes weak or damaged. The three main types of pelvic floor dyfunctions are:

• Urinary incontinence, or lack of bladder control
• Fecal incontinence, or lack of bowel control
• Pelvic organ prolapse, a condition in which the uterus, bladder and bowel “drop” onto the vagina and cause a bulge through the vaginal canal

Is pelvic floor dysfunction a normal part of aging?

Although pelvic floor disorders become more common as women age, they are not a normal nor should they be an acceptable part of aging. We can often reverse these disorders with treatment.

What causes pelvic floor dysfunction?

• Childbirth — A woman’s risk tends to increase the more times she has given birth.
• Being overweight or obese
• Having pelvic surgery or radiation treatments. These treatments can damage nerves and other tissues in the pelvic floor.
• Repeated heavy lifting
• Genetics

When should I seek help for pelvic floor dysfunction?

Many women don’t feel comfortable talking about personal topics such as pelvic floor dysfunction. You’re not alone, though, and you shouldn’t have to suffer. These are actually very common medical problems that can be treated successfully. Millions of women have similar issues.

VASECTOMY

What pain can I expect with a vasectomy?

Before the vasectomy, we inject the local anesthetic into the skin of the scrotum, you will feel some discomfort (a burning sensation for a few seconds). When the anesthetic takes effect, you should feel no pain. After the procedure, you will be sore for a few days and might want to take a mild painkiller.

Will I be sterile as soon as the procedure is over?

No. After a vasectomy, some active sperm remains in your system. It takes about 20 to 30 ejaculations to completely clear the sperm from your system. For most men, this takes about three to six months. You and your partner should use some other form of birth control until we test your semen and confirm it is sperm-free.

How am I different following a vasectomy?

After vasectomy, the only difference is your blocked sperm tubes. Sperm make up about 1% of the ejaculate. There will be no difference in volume. The testes still produce sperm, but your body simply re-absorbs them.

A vasectomy does not affect your sex drive, masculinity, testosterone levels or orgasm. Your ability to have an erection does not change.

Many men report better sex after a vasectomy because they no longer worry about an accidental pregnancy. With the security and peace of mind that permanent contraception brings, sex can be more relaxed and spontaneous.

Does a vasectomy cause any medical problems?

No. Most medical experts have determined that vasectomy is a safe procedure. Many studies including many thousands of men have examined the health effects of vasectomy and found no issues. Evidence continues to suggest men who have vasectomies (no matter the kind) are no more likely than other men to develop heart disease, prostate cancer, or any other medical conditions.