Urology Frequently Asked Questions (FAQ's)

I invite all of my patients to freely ask questions. Here I have listed the most commonly asked questions along with brief answers. I invite you to visit me in the office so that we can discuss your individual concerns.


David Cornell

Quick Jump Links:
Impotency (Erectile Dysfunction)

Incontinence (Loss of Urine)
Kidney Stones
Nerve Sparing Radical Prostatectomy
Prostate Cancer

Radiation Seed Implant Surgery

Prostate Enlargement
Vasectomy Information
Viagra® Information

Q: For what reasons do you perform circumcisions?
A: The most common reasons for which I perform circumcisions are:

· Cosmetic appearance
· Paraphimosis (inability to pull the retracted foreskin back over the glans)
· Balanitis and balanoposthitis (inflammation of glans and foreskin)
· Frenulum breve (short frenulum which tears with intercourse)
· Diseases of the foreskin, including cancer
· Phimosis (tightness of foreskin)

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Q: What is available for impotency (erectile dysfunction)?
A: Erectile dysfunction (ED) is a common disorder impacting up to 40% of 40 year old men. The physical causes of ED are cardiovascular disease, diabetes, surgery on the prostate, colon, or bladder, neurological diseases such as disc disease, stroke, or MS, or hormonal (testosterone) deficiency. Psychological causes of ED include excess alcohol consumption, depression, anxiety, fatigue, or marital discord.

Evaluation of a man with ED is quite simple, consisting of history and physical examination and a limited number of blood and urine tests.

·Treatment options for ED include:
·Testosterone replacement (topical gel or injection)
·Oral medication (Viagra, Cialis, or Levitra)
·Urethral suppositories (MUSE)
·Penile injections (Caverject)
·Vacuum erection devices
·Inflatable penile prosthesis implants

Most insurance companies, including Medicare, will cover the evaluation and treatment of impotence.

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Q: How do you treat women with incontinence (loss of urine)?
A: Urinary incontinence is a very fascinating and complex problem which adversely impacts the lifestyles of many women. The vast majority tolerate it without seeking medical advice. This is unfortunate, since at least 80% of incontinent women may be rendered dry with simple medications.

The cornerstone to successful treatment is a thorough basic evaluation. This includes history and physical exam and then perhaps some specialized testing. None of this evaluation should be painful, nor time consuming. If testing suggests that there is any medically-treatable component to the problem, I will begin by treating this with medication as this often produces dramatic results which exceed expectation.

In the event that medical treatment does not produce dryness, a number of non-invasive or minimally-invasive surgical techniques may be used. These are all outpatient therapies and produce high rates of success in properly selected patients. The key to successful treatment of incontinence is to individualize therapy to the patient. No single treatment, whether medical or surgical is successful for all patients.
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Q: How are kidney stones treated?
A: My practice offers many advanced treatment options for kidney stones, such as:

·Shock wave lithotripsy
·Laser lithotripsy
·Percutaneous nephrolithotomy

No one single treatment is appropriate for all stones. These are all usually outpatient treatments. Prior to any treatment, X-rays or a CT scan is used to locate the stone so that you may receive accurate information about your treatment options. I also provide patients with information regarding prevention of future stones.

Q: How do kidney stones form?

A: Kidney stones are the result of mineral precipitation in the urine. The most common cause is dehydration which causes the urine to become saturated with specific minerals that begin to precipitate as crystals and subsequently stones.

Q: What are kidney stones made of?

A: About two-thirds to three-fourths of all kidney stones are of calcium oxalate content.

Q: Is it true that cranberry juice is a good preventative for kidney stones?

A: If a person forms calcium oxalate kidney stones, cranberry juice is not recommended since it is very high in oxalate content. Cranberry juice got its reputation for being helpful for kidney stone prevention many years ago when a larger percentage of stones were the result of infection. This is now a rare cause of stone formation.

Q: How can kidney stones be prevented?

A: The single best means of preventing kidney stones is drinking enough water to cause production of two liters of urine daily.

Q: What causes the pain of kidney stones?

A: For the most part, a kidney stone does not cause pain while it is located in the kidney where it was formed. When a kidney stone becomes dislodged and falls into the ureter (the tube which drains the urine from the kidney down to the bladder) the person feels pain. The pain is due to the obstruction of urine flow caused by the kidney stone blocking off the ureter. The pain is actually due to back pressure of urine in the affected kidney.

Q: How do you diagnose kidney stones?

A: Pain in the back or flank area or blood in the urine may suggest the presence of a kidney stone, but the diagnosis requires imaging. The most accurate (and currently most popular) means of diagnosing a kidney stone is a CAT Scan. The specific technique used is helical kidney stone protocol.

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Q: What treatments do you offer for prostate cancer?

·Surgical removal of the prostate gland (radical prostetactomy)
·Radiation seed implants (brachytherapy)
·External radiation
·Hormone therapy (Lupron, Zolodex)

Q: Do you perform nerve sparing radical prostatectomy?
Yes, nerve sparing radical prostatectomy was started in the early 1980's. I have been performing this operation since 1984 with very rewarding results.

Q: Who is a good candidate for nerve sparing radical prostatecomy?
Almost any man with localized prostate cancer who chooses to have his prostate gland removed is a candidate for the nerve sparing operation.

Q: Do you perform radiation seed implant surgery for prostate cancer? For whom do you recommend it?
Clinically referred to as brachytherapy, I have been performing radiation seed implant surgery for prostate cancer for almost 20 years. The current technique with ultrasound guidance is much more accurate than the technique of the 1970's and 1980's. Virtually any man with localized prostate cancer is a candidate for this procedure.

Q: What is prostate enlargement and how do you treat it?
A: The prostate gland is part of the male genital tract responsible for producing most of the semen men ejaculate. It surrounds the urethra (voiding channel) and lies at the base of the urinary bladder. Enlargement of the prostate is a normal part of aging in all men and begins after the age 40. As the prostate enlarges, it may obstruct the flow of urine through the urethra. This may cause a poor urinary stream, hesitancy in starting the stream, inability to completely empty the bladder, and difficulty with frequency of urination and control of urine.
There are a number of medical treatments for prostate enlargement:

·Saw palmetto is an herbal product which reduces the size of the prostate
·Finesteride (Proscar) is a pharmaceutical product designed to shrink the prostate
·Flomax, Hytrin, Cardura are medications which improve the urine stream
·Laser and heat therapies are surgical procedures done with light anesthesia that reduces the patient's gland size
·TURP (Transurethrithral resection of the prostate) is a surgical procedure in which the portion of the prostate causing obstruction is trimmed out through the voiding channel (urethra). This does not require an incision.
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Vasectomy Information

An informative resource for vasectomy and vasectomy reversal is vasectomymedical.com. Our office performs "no scalpel" and VasClip vasectomies.

In addition to vasectomy, there is a new alternative, called the Vasclip implant procedure. Dr. Cornell now offers the Vasclip implant procedure to his patients.

The Vasclip implant procedure is relatively new and, therefore, your insurance carrier may not cover the cost of the Vasclip device. If you are interested in having the Vasclip implant procedure, there will be an upfront charge of $500 to cover the cost of the Vasclip implant device. If your insurance carrier does cover the Vasclip implant device charge, you will be reimbursed the amount of that coverage when it is paid.

For more information on the Vasclip implant procedure, including a video that desribes the similarities and differences between vasectomy and the Vasclip implant procedure, please visit www.vasclip.com.

If you have any questions regarding either procedure, please be sure to bring them with you and ask Dr. Cornell during your consult.

Viagra® Information
Sildenafil citrate, or Viagra®, is a medication produced and marketed by Pfizer, Inc. that was approved by the FDA in April 1998 for the treatment of erectile dysfunction (ED). Since April 1998, over 15,000,000 patients have received prescriptions for the medication worldwide.

Q: What are the side effects of Viagra®?
A: The side effects of Viagra® are generally very mild and disappear within a few hours of taking the drug. The most common side effects are: headache (15%), flushing (10%), upset stomach (7%), and abnormal vision (3%).

Q: Is Viagra® addictive or habit-forming?
A: No. The medication has been well studied and there is also no evidence that Viagra® becomes less effective the longer it is used.

Q: At what age do men begin having erectile dysfunction?
A: At one time it was considered a normal part of aging, but this is no longer considered to be true. Erectile dysfunction affects nearly 40% of 40 year old men to some degree.

Q: How commonly is Viagra® prescribed?
A: As mentioned above, since becoming available in April 1998, more than 15 million patients have received the drug worldwide.

Q: Can men taking medication for high blood pressure take Viagra®?
A: Yes. Viagra® has been well-tolerated by men on antihypertensive medications in drug trials.

Q: Is it necessary to have severe erectile dysfunction to be a candidate for Viagra®?
A: No. In fact, better results occur in men with mild or moderate erectile dysfunction than in men with more severe dysfunction.

Q: Is Viagra® safe for all men?
A: No. The most common contradictions to Viagra® use are: patients who use nitrates, patients with heart disease, and patients with retinitis pigmentosa.

Q: Do you see patients for the sole purpose of prescribing Viagra®?
A: Yes. I am delighted to see men who want nothing more than a prescription for the medication.

(Viagra® is a registered trademark of Pfizer, Inc.)
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