Urology refers to the medical and surgical specialty that focuses on the urinary tracts of males and females, and on the reproductive system of mails. The K and B Surgical Center offers a wide range of minimally invasive surgical procedures to address a variety of urological conditions.
Neurourology, a specialized field of urology,focuses on how the nervous system affects the urinary system. The brain, spinal cord and nerves are very important to the healthy function of the bladder. Neurological diseases and disorders such as multiple sclerosis, Parkinson’s disease, stroke and spinal cord injury can disrupt the lower urinary tract and result in conditions such as urinary incontinence and the inability to urinate. Birth conditions such as spina bifida also cause neurological dysfunction of bladder control. Neurogenic bladder is a term applied to a malfunctioning urinary bladder due to neurologic dysfunction or injury.
Reconstructive urology, another specialized field of urology, focuses on restoring function to any of various structures of the genitourinary tract. Prostate procedures, full or partial hysterectomies, trauma (auto accidents, gunshot wounds, industrial accidents, straddle injuries, etc.), disease, obstructions, blockages (e.g., urethral strictures), and occasionally, childbirth, can necessitate require reconstructive surgery. The urinary bladder, ureters (the tubes that lead from the kidneys to the urinary bladder) and genitalia are other examples of reconstructive urology. Often, plastic surgeons assist in these procedures, although purely cosmetic procedures such as penis enlargement do not fall under reconstructive urology.
The K and B Urology Surgery team can address a variety of urological conditions:
Incontinence and Voiding Dysfunction – Conditions in which the bladder is not able to store urine properly (incontinence) or empty properly (voiding dysfunction).
The accidental leakage of urine during activities such as coughing, laughing, sneezing, or lifting heavy objects is called stress urinary incontinence (SUI). A sudden and strong feeling of the need to pass urine resulting in urine leakage is known as urge urinary incontinence (UUI). A combination of both stress incontinence and urge incontinence is referred to as mixed urinary incontinence MUI).
Voiding dysfunction is often described by symptoms such as frequency (urinating more than 8 times a day), urgency (strong need to urinate) and urine retention (unable to empty your bladder). The problem can affect both women and men. In men, these symptoms can also be due to an enlarged prostate, a condition known as Benign Prostatic Hypertrophy (BPH). BPH can cause many of the urinary symptoms and it can be present with other conditions as well.
Urinary Incontinence – This is the loss of bladder control, a common and often embarrassing problem that can affect day-to-day activities. The severity of urinary incontinence ranges from occasionally leaking urine when one coughs or sneezes to having an urge to urinate that’s so sudden and strong, the individual is unable to get to the toilet in time.
Voiding Difficulties – A condition when a woman finds that her passing of urine has become abnormally slow and intermittent or she feels as though she has not completely eliminated all of urine after each void. This may begin suddenly or develop gradually. It can be accompanied by lower abdominal pain or it may be painless. Most often the condition is caused by an obstruction of the urethra (urine pipe) due to a urinary tract infection, vaginal infection, or post-menopausal changes of the vagina, genital and/or urinary tract. Bladder disorders due to neurological disease may also cause voiding difficulties.
Overactive Bladder (Urge Incontinence) – The strong, sudden need to urinate, due to bladder spasms or contractions. Neurological disorders, such as Parkinson’s disease, strokes and multiple sclerosis, are often associated with an overactive bladder. Although common among older adults, an overactive bladder is not considered a normal part of aging. There are a variety of treatments to alleviate the symptoms of this condition. Surgery is usually reserved for those patients with severe symptoms who don’t respond to other treatments.
Urinary retention – This can be caused by an obstruction in the urinary tract or by nerve problems that interfere with signals between the brain and the bladder. If the nerves aren’t working properly, the brain may not get the message that the bladder is full. Even if you know that your bladder is full, the bladder muscle that squeezes urine out may not get the signal that it is time to push, or the sphincter muscles may not get the signal that it is time to relax. A weak bladder muscle can also cause retention. With acute urinary retention, treatment begins with the insertion of a catheter through the urethra to drain the bladder. This initial treatment relieves
the immediate distress of a full bladder and prevents permanent bladder damage. Long-term treatment for any case of urinary retention will depend on the cause.
Recurrent Urinary Tract Infection (UTI) – This is caused when microbes such as bacteria enter the urinary tract and remain there. Urinary tract infections are the second most common type of infection in the body. Women are especially prone to recurrent UTIs for anatomical reasons. A woman’s urethra is shorter, which allows bacteria quicker access to the bladder. Also, a woman’s urethral opening is closer to sources of bacteria from the anus and vagina. UTIs in men are not as common but they can still be serious when they occur.
Interstitial Cystitis – A chronic condition characterized by a combination of uncomfortable bladder pressure, bladder pain and sometimes pain in the pelvis, which can range from mild burning or discomfort to severe pain. While interstitial cystitis (also known as painful bladder syndrome) can affect children and men, most of those affected are women. While the severity
of symptoms caused by interstitial cystitis often fluctuates — and some people may experience periods of remission — it have an adverse effect on quality of life if not treated properly. A variety of medications and therapies can offer relief. There are no surgical procedures that have also proved effective. The urology surgeon can advise you on the most appropriate treatment for you.
Pelvic Organ Prolapse – Occurs when a pelvic organ, such as the bladder, drops (or prolapses) from its normal spot in the lower belly and pushes against the walls of the vagina. This may be the result of a weakening or stretching of the muscles that hold the pelvic organs in place, due to childbirth or surgery. Many women have some form of pelvic organ prolapses, and while it doesn’t necessarily present a major health problem, it can be uncomfortable or painful. The most common for of pelvic organ prolapse involves the bladder but it can also occur with other organs such as the urethra, uterus, vagina, or bowel. Surgery is a viable option for treating serious symptoms of pelvic organ prolapse.
Urethral Strictures – Caused by an abnormal narrowing of the tube that carries urine out of the body from the bladder (urethra). They can be caused by injury or disease such as a urinary tract infection or other forms of urethritis. During the early stages of the condition, an individual may experience pain when urinating and the inability to fully empty the bladder. It is not uncommon for the bladder’s capacity to significantly increase due to this inability to completely void. Symptoms may include blood in the semen, bloody or dark urine, difficulty and painful urinating, decrease urine output, pelvic pain, and even incontinence. While there are no drug treatments for the disease, several surgical procedures have proved effective.
Fistulas of the Urinary Tract – Abnormal openings either within a urinary-tract organ (such as the bladder) or an abnormal connection between a urinary-tract organ and another organ (such as the colon).
Fistulas are generally caused by injury to the organs in question, either during surgery or through trauma, such as in an automobile accident. The most common type of urinary fistula results from injury to the bladder during abdominal or pelvic surgery, such as a hysterectomy or a caesarean section for childbirth. Other causes of urinary fistula include pelvic malignancy, such as cervical or colon cancer; radiation therapy; and inflammatory diseases, such as Crohn’s disease. The most common cause of colovesical (between the rectum and the vagina) fistula is disease of the large intestine (diverticulitis).
Symptoms may include continual urine leakage from the vagina; irritation in the vulva; frequent urinary tract infections; fluid drainage from the vagina; diarrhea; abdominal pain; fever; nausea; and/or e weight loss. Some small fistulas that are detected early may be treated by catheter drainage. However, since a fistula is an undesirable connection between two organs, the treatment for most fistulas is surgical repair.
Kidney Stones – Also known as calculi, kidney stones are masses of crystals and protein that develop in the kidney from dietary minerals in the urine — and can cause urinary tract obstruction in adults. Relatively common conditions, they tend to be more prevalent in some families. The main symptom is severe pain that starts suddenly and may go away suddenly. The pain is usually felt in the belly area or side of the back and may move to the groin area or testicles. Other symptoms may include abnormal urine color, blood in the urine, chills, fever, nausea, and/or vomiting. Depending on the type of kidney stone, the doctor may prescribe medicine to decrease stone formation or help break down and move the material that is causing the stone. Surgery may be required If the stone is growing or too large to pass on its own; is blocking urine flow and causing an infection or damage to the kidney.
Penile Curvature (Peyronie’s Disease) – A condition resulting from a build-up of fibrous “plaque” or scar within the elastic covering (tunica albuginea) of the erectile tissue of the penis. The symptoms of Peyronie’s Disease include penile curvature, penile pain that may increase upon erection, and difficulties achieving or maintaining an erection. The penis may become rigid up to the area of the scar and remain flaccid past that point. A narrowing or “waist-line” may develop, giving the penis an “hour glass” appearance. Often a hard plaque can be felt along the penile shaft. Occasionally the penis may become so severely curved that intercourse is painful to both parties and penetration may become mechanically impossible.
While the exact cause of Peyronie’s Disease is unknown, several theories have been proposed. Many patients recall a history of seemingly insignificant penile trauma during an episode of vigorous sexual activity. The penis may have been accidentally injured against the partner’s pelvic bone. Repeated minor trauma may also lead to scar formation. An inherited form of Peyronie’s disease also exists.
While Peyronie’s Disease can be treated medicinally, reconstructive surgery is the only treatment that corrects the curvature and eliminates the pain on a consistent basis. Several types of reconstructive procedures have been developed and are tailored to the individual problem. Your surgeon can advise on which procedure is the best option.
Prostate Health – Focuses on the prostate gland, a walnut-sized organ in males only that surrounds the urethra, the tube that carries urine from the bladder to the penis. It lies at the base of the bladder, located between the pubic bone and the rectum. This gland secretes about 25% of the seminal fluid that’s combined with sperm during ejaculation. The prostatic fluid acts as a lubricant to prevent infection in the urethra and protects and energizes sperm.
It is common for the prostate gland to become enlarged as a man ages — a condition known as benign prostatic hyperplasia (BPH), or benign prostatic hypertrophy. About 1 out of men, aged 50 and over, have some symptoms related to an enlarged prostate.
Another condition that affects a large percentage of men is prostatitis, which is an inflammation of the prostate gland that is usually caused by a bacterial infection that has spared from another part of the body. Acute prostatitis is more common in younger men (ages 20 – 35) and men with multiple sex partners. Unlike acute prostatitis, chronic prostatitis develops gradually, continues for a prolonged period of time, and may have subtler symptoms. Chronic prostatitis will develop from an acute prostatitis bacterial infection that keeps recurring or from a urinary tract infection, urethritis, or epididymitis. Chronic prostatitis is more common in men aged 30 to 50 and is believed be associated to hormonal changes of aging and also certain lifestyle influences (excessive alcohol drinking, perineal injury and certain sexual practices).
Prostate cancer is the most common cancer in American men. Any man can develop prostate cancer, but the incidence is greater in African-American men, who are twice as likely as white men to develop it. Prostate cancer is less common in Asian and American Indian men.
A man’s risk of developing prostate cancer increases with age, and is most often found in men over the age of 50, and more than 75 percent of tumors are found in men over age 65. One out of every 10 men will develop the disease at some time in his life — most often after age 50.
A family history of prostate cancer may also increase an individual’s risk of developing the disease. Studies suggest that a high-fat diet may increase the risk of prostate cancer, and that a diet rich in vegetables, particularly cruciferous vegetables, such as broccoli, cabbage, cauliflower and kale, is associated with a reduced risk of prostate cancer.
The incidence rates of prostate cancer have nearly doubled over the past 20 years.. One possible explanation is that due to the decline in heart disease mortality in recent decades, more men are living to older ages, when prostate cancer risk is highest.
While many men experience no symptoms of prostate cancer before it is discovered, others may notice frequent urination or an inability to urinate, trouble starting or holding back urine, or frequent pain or stiffness in the lower back, hips, or upper thighs. However, these symptoms are also seen with a common, non-cancerous condition called benign prostatic hyperplasia (BPH), which is an enlargement of the prostate gland. It is important to seek medical attention for any of these symptoms to ensure the proper diagnosis and treatment.
Urologic Cancer – Includes cancers of the bladder, kidney, prostate and testicles, all of which are relatively common forms of the disease. Prostate cancer, for example, is the most common cancer in American men. Bladder cancer is the fourth most common cancer among men and the ninth most common among women in the United States. Each year, more than 50,000 new cases of bladder cancer are diagnosed.
Among American men age 15 to 44, testicular cancer is the most common. The American Cancer Society estimates that roughly 7,000 cases of testicular cancer are diagnosed each year in the United States.
Our patients at the K and B Surgical Center have access to some of the very latest treatments and therapies for urological cancer and a wide range of services for screening, detection and diagnosis.
Erectile Dysfunction (ED) – A condition characterized by the inability to develop or maintain an erection of the pennies during sexual intercourse. It is a relatively common condition that affects an estimated 18 million men in the U.S. alone. A variety of risk factors can contribute to the condition, including some medical conditions like diabetes or heart problems; tobacco use, which can restrict blood flow to veins and arteries; being overweight; certain medical treatments such as prostate surgery or radiation treatment for cancer; use of some medications such as antidepressants, antihistamines and medications for treating high blood pressure, pain or prostate cancer; drug and alcohol use; and certain psychological conditions such as stress, anxiety or depression.
There are a variety of treatments for ED, including oral medications and alternative therapies like acupuncture. Penile prostheses (penis implants) is a treatment that involves surgically placing devices consisting of either inflatable or semi-rigid rods into the two sides of the penis. The inflatable devices allow the patient to control when and long he has an erection. This treatment, while a permanent solution for the tradition, is recommended when other methods prove unsuccessful.
Male Infertility – Caused by low sperm production, misshapen or immobile sperm, or blockages that prevent the delivery of sperm. This may be cause by another of factors, including Illnesses, injuries, chronic health problems, lifestyle choices and even certain environmental conditions. Treatments for the condition include hormones and medications and, in some cases, surgery.
Our minimally invasive urological surgery includes the following laparoscopic and robotic procedures:
Laparoscopy – A diagnostic or surgical procedure in which a lighted viewing tube known as a laparoscope, is inserted through tiny incisions for examining internal organs directly or for surgery. This rapidly evolving branch of urology has successfully replaced many open surgical procedures. Robotic, or computer-assisted, surgery of the prostate, kidney, and ureter has also been expanding the field of urology and improving the quality, precisions and surgical outcomes of many procedures. Robot-assisted surgery is not only minimally invasive. It provides an enhanced 3D view, increased magnification of the surgical field, better manual dexterity, relatively bloodless field, reduction in a surgeon’s fatigue and other benefits. At K and B Surgical Center, we are at the leading edge of robotic techniques and continue to adopt the latest innovations in our treatments.
Adrenalectomy – The laparoscopic surgical removal of one or both adrenal glands. This procedure may be necessary when there is known cancer or a growth that might be cancerous. Sometimes a mass in the adrenal gland is removed because it releases a hormone that can cause harmful side effects. One of the most common tumors of the adrenal glands is a pheochromocytoma, which can cause very high blood pressure. Other disorders that may required an adrenalectomy include Cushing syndrome (a condition when the body is exposed to high levels of the hormone cortisol or Conn syndrome (when the adrenal gland releases too much of the hormone, aldosterone).
Microscopic Varicocelectomy – The most common operation performed for male infertility — a minimally invasive and highly effective approach to the treatment of varicocele, a mass of varicose veins in the spermatic cord. Varicoceles can significantly lower a man’s sperm count and undermine the quality of his sperm and may lead to infertility. A small incision is made in the abdomen close to where the testicles originally descended through the abdominal wall, The veins that produce the varicocele are identified and cut to eliminate blood flow to the varicocele. The patient can expect to go home within 4 hours of a routine varicocele surgery.
Partial nephrectomy – The removal of part of the kidney instead of the entire kidney as a treatment for kidney tumors — and the preferred treatment for small, single tumors located in only one kidney. Recent research shows overall higher survival rates for people who had a partial nephrectomy compared with people who had their whole kidney removed (radical nephrectomy).
Pelvic Organ Prolapse Repair – See Pelvic Organ Prolapse (above)
Pyeloplasty/Ureteral Reconstruction – An operation to correct a blockage between the kidney and the ureter, the tube that drains the kidney into the bladder. Removing the blockage allows urine to drain freely from the kidney to the bladder.
Prostatectomy – The surgical removal of all or part of the prostate gland, usually because of cancer.
Renal Cryoablation – A surgical procedure that uses extreme cold (cryo) to treat smaller tumors found in the kidney and adrenal gland.
Vasectomy – A surgical procedure for male sterilization and/or permanent birth control. During this relatively simple procedure, which usually takes less than 30 minutes to complete, the man’s vasa deferentia (the ducts that transport sperm from the epididymis in anticipation of ejaculation) are severed, and then tied and sealed to prevent sperm from entering into the seminal stream (ejaculate). Because the procedure is minimally invasive, many vasectomy patients find that they can resume their typical lifestyle routines within a week, with minimal discomfort.
Vasectomy Reversal – A surgical procedure that re-approximates the cut ends of the vas deferens, restoring the flow of sperm from the testicle to the prostate. The use of microsurgical techniques allows for more precise approximate of the ends of the vas deferens, which results in higher success rates.
Meet our Urology Surgery Experts
Dennis Kim, M.D.
Dr. Kim did his undergraduate work at the University of Michigan, Ann Arbor, where he graduated with a double major in chemistry and molecular biology. He then earned a masters degree in public health from the UCLA School of Public Health. Dr. Kim received his medical degree from Albany Medical College in Albany, New York, where he was elected to the Alpha Omega Alpha Medical Honor Society.
After finishing two years of general surgery training and four years of urology training at the Kaiser Foundation Hospital in Los Angeles, he completed a fellowship at the Cleveland Clinic Foundation Hospital in Florida, sub-specializing in urinary incontinence, voiding dysfunction,
and reconstructive urology.
Dr. Kim has published widely, having authored several peer-reviewed scientific papers and a book chapter on incontinence, voiding dysfunction, and female and male reconstructive urology. He is a member of the American Urological Association, the Endourological Society, the Los Angeles Urological Society, and the Society of Urodynamics and Female Urology,
Matthew H.T. Bui, MD, PhD
Dr. Matthew Bui was born in Saigon, Vietnam in 1968. He and his family barely escaped during the surrender of Vietnam in 1975 and came to the US as refugees. Dr. Bui grew up in Lancaster, Pennsylvania where he attended Franklin and Marshall College. He majored in Physics and graduated as valedictorian with Summa Cum Laude. In 1998, Dr. Bui attended the Yale School of Medicine in the Medical Scientists Training Program and earned both the M.D. and Ph.D. degrees. Subsequently, Dr. Bui did his urology residency at UCLA where he earned accolades for his scientific research in kidney cancer.
Dr. Bui’s ground breaking work on advanced kidney cancer earned him the first prize and second prize at the American Urological Association Western Section and national conference, respectively, along with best scientific poster at the Society of Urologic Oncology in 2002. After residency, Dr. Bui continued on with a fellowship at UCLA dedicated to laparoscopic, robotic and minimally invasive urology. Dr. Bui joined the faculty at the Mayo Clinic Scottsdale in 2005 as an assistant professor of urology.
David Y. Josephson, MD, FACS
Dr. David Josephson, a pioneer and expert in robotic surgery is unique in that he is one of very few urologic surgeons in the country who have extensive fellowship training in both open and minimally invasive techniques for the management of complex urologic disorders. He completed a urologic oncology and reconstructive urology fellowship at USC/Norris Comprehensive Cancer Center where he was also a Clinical Instructor of Urology. He subsequently had fellowship training in advanced laparoscopy and robotic surgery at City of Hope. He was recruited to stay at City of Hope, and became the Program Director of the Urologic Oncology and Robotic Surgery Fellowship. Prior to being recruited to the Tower Urology Institute of Minimally Invasive Surgery, he served as the Surgical Director of the Kidney Cancer Program at City of Hope helping establish innovative techniques to perform nephron- sparing surgery with minimal or no ischemia.
Clinically, he has performed and published several series that are among the world’s firsts in robotic assisted surgery, including robotic assisted inguinal lymph node dissection, robotic assisted cystoprostatectomy with urinary diversion, and robotic RPLND. Having done over 1100 robotic procedures, he is a recognized leader in nerve-sparing and endopelvic fascia sparing techniques to improve on potency and continence outcomes after robotic prostatectomy. His collaborative research with Intuitive Surgery has also focused on the use of intra-operative fluorescence markers to reduce positive surgical margins.
Academically, his studies have been published in peer-reviewed journals such as the Journal of Urology, Journal of Endourology, Journal of Clinical Oncology, and Expert Review of Anticancer Therapy. Clinically, he has been recognized on lists as Los Angeles Best Doctors, Cambridge’s Who’s Who, and doubly awarded by Consumers Research Council as one of America’s Top Urologists since 2007 and as America’s Top Surgeons for Robotic surgery for the past three years.
Dr. Josephson is a member of the Society of Urologic Oncology, American Urologic Association, American Society of Clinical Oncology, and American College of Surgeons. He has also holds advisory positions for ASCO/Cancer.net and the National Comprehensive Cancer Network (NCCN) Kidney and Testis Cancer Guideline Committees.
Christopher S. Ng, MD
Dr. Christopher Ng was born and raised in Portland, Oregon. He traded rain for shine to attend the accelerated biomedical sciences program at the University of California at Riverside. He received his medical degree from UCLA School of Medicine, where he was awarded an American Federation of Aging Research Fellowship to study erectile dysfunction and earned the Dean’s Award for outstanding thesis. Dr. Ng then traded sun for snow during his urology residency training at the Cleveland Clinic Foundation. His extensive study of the immunology of kidney cancer was recognized with the First Place Award in Basic Science Research from the Ohio Urological Society. Upon graduation, he was honored with the George and Grace Crile Traveling Fellowship Award, in recognition of meritorious performance in the field of surgery.
Dr. Ng pursued subspecialty fellowship training in laparoscopy, robotic surgery and endourology at the Cleveland Clinic. He then returned to Southern California to join the faculty at Cedars-Sinai Medical Center in 2003, where he became the Director of Laparoscopic Urologic Oncology and Robotic Surgery, and Co-Director of the Minimally Invasive Urologic Surgery Fellowship program.
Dr. Ng has served on numerous committees at Cedars-Sinai and was honored with the Chief of Staff Award and the Friend of Nursing Award in 2006.
Dr. Ng is a Clinical Assistant Professor of Urology at Harbor-UCLA Medical Center, and was recently named the Clinical Faculty of the Year. Dr. Ng has authored over 50 peer-reviewed scientific publications and book chapters.
Paul J . Turek, MD
Dr. Turek is Director of The Turek Clinic (www.TheTurekClinic.com), a men’s health clinic in Beverly Hills and San Francisco. He is a former Professor of Urology, Obstetrics & Gynecology at the University of California San Francisco and held the Academy of Medical Educators Endowed Chair in Urology. He is recognized as a master microsurgeon in the field of reproductive urology.
Dr. Turek attended Yale College, followed by Stanford University Medical School. Following a urology residency at the University of Pennsylvania, Dr. Turek was fellowship trained at Baylor College of Medicine. His 200+ publications include clinical inventions and techniques in urologic microsurgery (varicocele repair, sperm retrieval, vasectomy and vasectomy reversal), discoveries in germ and stem cell genetics, and epidemiologic studies of men’s health issues. He is on the Advisory Board of the national Men’s Health Care Network and the NIH Reproductive Medicine Network and he is the Editor of the Reproductive Volume of Netter’s Images, 2nd Edition, published in 2012. He also maintains an active blog at www.TurekonMensHealth.com
Dr. Turek is Past-President of the American Society of Andrology, a Fellow of the American College of Surgeons, the Société Internationale d’Urologie and the Royal Society of Medicine (London). He is President of the Society of Male Reproduction and Urology. He is consistently listed as a “best doctor” in 7 national accrediting organizations including: US News and World Report Top Doctors, Marquis Who’s Who, Best Doctors, Patient’s Choice.org, Top MD-Consumer’s Checkbook, SuperDoctors and Castle-Connolly, Inc. He also recently founded a volunteer medical clinic powered by retired physicians for the working uninsured (www.ClinicByTheBay.org). His hobbies include vintage cars and longboard surfing.