At Wake Urological Associates we provide a full spectrum of medical and surgical options for our patients ages 15 years and older. In today’s often rushed and confusing medical environment, we are committed to taking the extra time to educate our patients about their condition and we pride ourselves in treating patients as individuals. At WUA we do not practice a “one size fits all” mentality in treating our patients.

We provide state-of-the-art diagnostic and therapeutic technologies in our offices and in the hospitals to which we admit our patients. We were the first urologists in Wake County to perform numerous minimally invasive surgeries, such as completely laparoscopic nephrectomy, partial nephrectomy, renal cryosurgery, and ureteropelvic junction obstruction repair. We are diligent in including the assistance of our patient’s primary care and specialty physicians in their urological decision making and care. We have found that “Word of Mouth” from our established patients is our greatest referral tool.

Here is a listing of some conditions we commonly treat:

 Urinary incontinence
 Benign Prostatic Hypertrophy
 Renal Stone Disease
 Urinary and Male Genital Cancers
 Male Infertility
 Vasectomy
 Erectile Dysfunction
 Urinary Tract Infections
 Urinary Retention
 Congenital Urinary anomalies
 Peyronies Disease

 Urinary Incontinence
There are numerous etiologies for Urinary Incontinence (involuntary loss of urine from the bladder). It is very important to properly identify the specific cause of each individual patient’s incontinence because of the different treatment options used for each.

-Stress Urinary Incontinence:
SUI is the involuntary loss of urine from the bladder with increased intra-abdominal pressure, such as coughing, sneezing, or activities such as bending or standing from a sitting position. It is usually the result of loss of pelvic support and/or sphincter tone in the female or radical prostate surgery in the male. The patient usually notices the loss of urine when the activity is taking place. There are non-surgical treatment options such as Kegel exercises and/or biofeedback, and surgical options such as collagen injection, pubovaginal sling, or the placement of an artificial urinary sphincter.

-Urgency Incontinence:
UI is the involuntary loss of urine form the bladder as a result of an increase in bladder tone or bladder irritation. Causes of UI include urinary tract infection, other inflammatory disease of the bladder, radiation injury or damage to the bladder, neurological conditions such as Parkinson’s disease, spinal cord injury, stroke, bladder cancer, and loss of bladder compliance (loss of the bladder’s ability to stretch). There are numerous medical, surgical, and physical therapy options to treat UI.

-Mixed Urinary Incontinence:
Having both Stress and Urgency incontinence. This is a common condition in women.

-Overflow Urinary Incontinence:
This condition is caused by an inability to empty the bladder, leading to a constantly full bladder. Causes include neurological conditions of the bladder, bladder prolapse, and obstruction of the normal flow of urine from the bladder (bladder outlet obstruction).

 Benign Prostatic Hypertrophy
BPH is the benign (non-cancerous) enlargement of the prostate gland, associated with aging, which causes a restriction of urine flow from the bladder. Common symptoms may include weak urinary stream, frequency of urination, getting up at night to urinate, severe urgency to urinate, and incomplete emptying of the bladder. There are numerous medical and surgical treatment options depending on the severity of symptoms (“quality of life”), the size of the prostate gland, or whether the obstruction is damaging the bladder and/or the kidneys. WUA urologists provide the entire range of medical and surgical treatment options including minimally invasive surgery such as Microwave Thermotherapy or Laser Vaporization Therapy.

 Renal Stone Disease
There are multiple causes for the formation of renal stones such as inadequate daily water consumption, elevated levels of calcium, oxalate, or uric acid in the urine, high or low dietary consumption of certain foods and/or minerals, and urinary tract infection. A strong family history of kidney stones is common. An analysis of the stone composition as well as blood and urine analysis are important in determining the cause of stone formation. The physicians at WUA feel it’s important not just to surgically treat a patient’s kidney stone(s) but also to do the necessary analysis to prevent further stone formation.

 Urinary & Male Genital Cancers

-Prostate Cancer:
Prostate cancer is second only to skin cancer in frequency of diagnosis of all cancer types in North America. Since the routine use of the PSA (Prostate Specific Antigen) blood screen since the early 1990’s, detection of prostate cancer has in general been made earlier with increasingly better treatment outcomes. The Digital Rectal Exam (DRE) is still a very important part of the prostate cancer screening process. Factors for increased risk of developing prostate cancer includes advancing age, a family history of prostate cancer, ethnicity (black Americans have not only a greater propensity to develop prostate cancer in general but also a greater risk of developing a more aggressive prostate cancer), and dietary factors. Management options for prostate cancer include: a) “watchful waiting”; this is chosen when is specific form of treatment is not felt to be indicated or desired. In general, PSA and DRE screening is continued on a routine basis to monitor the cancer stage. Benefit of the management approach includes avoiding the risks and side-effects associated with surgery, radiation therapy, or hormone therapy. Risk of this approach to management of prostate cancer of course includes possible advancement of the cancer. b) Radical Prostatectomy ; complete removal of the prostate gland either via a “open” surgical incision ( retropubic or perineal approaches) or laparoscopic approach. Which approach is best for each individual patient is an important part of the physician consulting process. Dr. Mark Jalkut has been performing laparoscopic radical prostatectomies using the da Vinci Robot since October 2004 and is one of only a few urologists in Raleigh so trained. Primary long term side-effect risk of surgery includes incontinence and erectile dysfunction. c) Radiation therapy; radiation to the prostate can be given via radiation “seeds” (rice sized pellets) which are surgically implanted into the prostate, or via external beam radiation therapy. The seed implantation surgery is conducted at the direction of a Radiation Oncologist with the urologist participating in the placement of the seeds. Primary risks of radiation therapy include injury to adjacent organs such as bladder and rectum, development of obstructive or irritative voiding symptoms and urinary retention, and erectile dysfunction. d) Hormone Therapy; surgical or medical castration is achieved with the goal of stopping the growth of the cancer. This is not a curative therapy and is generally chosen when more aggressive therapy has failed to cure the cancer or when it is felt that a more aggressive treatment option is not necessarily indicated but that there is a risk of cancer advancement. Risks of hormone therapy include erectile dysfunction, “hot flashes”, loss of bone mineral density, and possible labile emotional effect. e) Chemotherapy; this treatment option may be chosen for more advanced prostate cancer, perhaps in conjunction with radiation or hormone therapy. A Hematologist/Oncologist would discuss the risks of chemotherapy.
Which management is best for each individual patient is an extremely important part of the physician-patient relationship. Patients should seek a physician who is not only well trained/educated in each of the treatment options but who will also take the time to treat them as an individual and not have a “one size fits all” mentality.

-Renal Cell Carcinoma:
This is cancer of the parenchyma (body) of the kidney. Symptoms may include blood in the urine or flank pain, however, most patients do not have symptoms at the time a tumor is found. Surgery is the only highly effective treatment for this type of cancer. Removal of the entire kidney may be necessary but attempts to save as much kidney tissue as possible are always considered depending on the size and location of the tumor. These kidney sparing approaches include partial removal of the kidney which can be done with minimally invasive surgery (laparoscopic). Recently, the surgeons at WUA were the first in Wake County to remove a portion of a kidney entirely laparoscopically.

-Transitional Cell Carcinoma:
This is cancer arising from the tissue lining the hollow portion of the kidneys, down through the ureters to the bladder, the bladder, and ending in the urethra (tube from bladder through penis). The majority of these tumors originate in the bladder (bladder cancer). The main treatment option is surgery. Cystoscopic and/or Ureteroscopic surgery (resecting the tumor(s) via a small telescopic-like instrument inserted into the bladder and/or the ureter and kidney) is usually the initial treatment. If the tumor is located in the kidney and/or the ureter, complete removal of these organs is often indicated, depending on the size and grade (aggressiveness) of the cancer, and the function of the other kidney. With bladder cancer, the organ can be spared in the majority of cases using routine cystoscopic techniques as well as immunotherapy and chemotherapy agents which are placed into the bladder. WUA urologists are now able to successfully resect many small bladder tumors in our office using local sedation with minimal discomfort.

- Testicular Cancer:
The vast majority of testicular cancers occur in men ages 18-40. Complete removal of the testicle and spermatic cord through an incision in the inguinal region is the initial treatment. Depending on the type(s) and stage (extent) of the cancer, chemotherapy and/or radiation therapy is often indicated as subsequent therapy. The curative rate for testicular cancer is excellent and is one of the best success stories of modern medicine.

 Male Infertility
Approximately half of all cases of couple infertility can be attributed to the male. Numerous congenital and acquired conditions affecting the testicles can affect their ability to produce sperm, such as a history of undecended testicle(s) at birth, injury to the testicle(s), exposure to certain chemicals or drugs, or genetic diseases. Blockage of the flow of sperm from the testicle(s), to the urethra or the blockage or inadequate production of sperm or other semen products can be the cause of infertility. Detailed patient history and physical examination along with two or three properly collected semen analysis is the initial work-up. This is typically followed by certain x-ray studies, such as testicular and/or prostate ultrasound, sperm duct flow x-rays, or testicular biopsy.

 Vasectomy
The surgeons at WUA perform the no scalpel vasectomy technique, which involves the retrieval, cutting and suturing of the vas deferens (“sperm duct”) through one or two smalls punctures in the scrotum under local anesthesia.

 Erectile Dysfunction
ED is most often caused by organic (physical) causes. Psychiatric conditions may be associated with the loss of erections or the actual cause of ED. Organic causes include neurological diseases, vascular diseases, penile injury, or hormone deficiency. Diabetes is often associated with ED. Treatment options might include correcting hormone deficiency/imbalance, changing certain medications, oral and injectable erectile aid medicines, and surgical prosthesis implantation surgery.

 Urinary Track Infections
UTIs can be caused by bacteria, yeast, or viral agents. Symptoms can include urinary frequency, urgency, incontinence, dysuria (burning in bladder or urethra when urinating), back and/or side pain, and fever. Infections can originate in the bladder, kidneys, or urethra. The source of the UTI can be the result of several factors such as the presence of a large prostate, sexual activity, kidney stones, abnormalities in the bladder or the kidneys, or even cancer the kidney or bladder.. Accordingly, it is very important to do an adequate history and physical exam and to obtain properly collected urine for analysis and culture. Often, x-ray studies and bladder cystoscopy is performed to evaluate for the source of the UTI.

 Urinary Retention
In men the inability to empty the bladder is often the result of a large prostate. In both sexes, other causes of retention include neurological injury to the bladder or other forms of bladder weakness, bladder prolapse, or blockage in the urethra. The urologists at Wake Urological are able to diagnose in our office causes for urinary retention using state-of-the-art diagnostic equipment.

 Congenital Urinary anomalies
This is a term used to refer to disorders of the urinary tract inherited from birth. Various forms are listed below:

-Ureteral-Pelvic Junction Obstruction
The most common of these abnormalities, is a blockage of the ureter as it leaves the kidney. This blockage obstructs the flow of urine from the kidney causing it to swell. Often there is pain and blood in the urine. There can be loss of renal function. With the routine use of ultrasound this condition is usually discovered in pregnancy or in children, however, problems with this condition can develop in adulthood. Surgery for this condition usually involves cutting out the section of blocked ureter and reconnecting the ureter. Recently, WUA surgeons were the first in Wake County to do this repair laparoscopically.

-Ureteral-Vesicle Junction Obstruction:
This is a blockage of the ureter as in enters the bladder, causing blockage of urine flow from the kidney. Surgery is usually required to excise the structured ureteral segment and reattach to the bladder.

-Vesico-Ureteral Reflux:
This is the abnormal reverse flow of urine from the bladder to the kidneys because of an abnormally developed connection of the ureter to the bladder. The reverse flow of urine can cause infection and damage to the kidney. This can happen to both or just one kidney. This condition is usually diagnosed when a child develops a kidney infection.

 Peyronies Disease
Peyronies Disease is a condition where scar tissue develops in the penile tissue causing the penis to bend during erections. The cause of this condition in most cases is uncertain, however, some patients have a history of penile injury. Often, the scarring is thought to be caused by an immune inflammatory reaction. It can cause painful erections and erectile dysfunction. Mild cases can usually be treated conservatively while more severe cases can require surgery.


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