The sub-specialty of Urology manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. A Urologist has comprehensive knowledge and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. They do procedures such as kidney stone removal, vasectomies, circumcisions, and reconstruction of these areas. They also treat (surgically and chemotherapy treatments) those patients that have developed cancer in the prostate, bladder or kidneys. A Urogynecologist works with female reconstruction such as repair of the bladder and surgeries for incontinence.
The Urology Department is run by Dr. David Couillard, MD.
Dr. Couillard is fellowship-trained in pediatric urological reconstruction and neurourology. He treats newborns all the way through adulthood for all urological needs. As a father of 3 children, Dr. Couillard knows how precious children can be. It is important to know that when choosing Dr. Couillard for pediatric urology, he has specific training in pediatrics and he truly enjoys taking care of children.
Dr. Couillard is experienced in the repair of pediatric congenital defects such as hypospadius, reflux and undescended testes. Voiding dysfunction, bedwetting, and urinary infections in children are also his specialty and he performs routine circumcisions on newborns.
Hypospadius is when the urethra does not develop all the way to the tip of the penis and requires surgical reconstruction using plastic surgical techniques. This is done usually at about 6-9 months of age. It most often involves one repair but may require revisions in some cases. These are short outpatient procedures in most. The repair is needed to establish normal look and function for later in life and for fatherhood.
Women’s Urology / Urogynecology
Dr. Couillard has specialized fellowship training in pelvic gynecological repair and reconstruction. He has seen and treated thousands of these patients successfully and performed several thousand operations for incontinence and prolapse with a high success rate.
A Urogynecologist is a gynecologist who specializes in the same problems. This field (a sub-specialty within Gynecology and Urology) is dedicated to the treatment of women with pelvic floor disorders such as urinary or fecal incontinence and prolapse (bulging or falling) of the vagina, bladder, rectum and/or the uterus. Most women often hesitate to talk to their doctor or wait years to admit these symptoms to their doctor because they are embarrassed. Below is a list of the different types of incontinence that can happen:
- Urinary incontinence (leakage of urine) is a very common condition affecting at least 10-20% of women under age 65 and up to 56% of women over the age of 65. While incontinence also affects men, it occurs much more commonly in women.
- Stress incontinence is when urine leaks during activity or strain such a cough, laugh or lifting. Pelvic exercises rarely control this problem and simple, safe outpatient surgery is the cure.
- Urge incontinence is due to an overactive bladder and it causes frequent urination and sudden leakage – “commonly known as not making it to the bathroom on time.” Urge incontinence is treated with medications, behavior modification, and occasionally biofeedback or electrical stimulation. There is a wide variety of surgical and non-surgical options available.
- Prolapse simply means displacement from the normal position. When this word is used to describe the female organs, it usually means bulging, sagging or falling. It can occur quickly but usually happens over the course of many years. On average, 11% of women will undergo surgery for this condition.
We never put plastic or mesh in our vaginal repairs as it can be unsafe and can cause lasting problems.
Men’s Urological Health
Although going under a vasectomy can be a scary consideration for most men, we are here to tell you that it is considered nearly 100% effective and a very safe procedure.
About half a million American men each year chose a vasectomy as a form of permanent birth control. A vasectomy is actually safer than the sterilization process for a woman which requires an anesthetic and an intra-abdominal procedure. It does not interfere with sexual pleasure or manhood. It is quick and it is relatively painless with rare complications that are easily managed. Dr. Couillard has done thousands of vasectomies using the No-Scalpel Vasectomy (NSV) technique.
What is the No-Scalpel Vasectomy (NSV)?
The no-scalpel vasectomy is a quick procedure (15 minutes) and it is relatively painless with rare complications that are easily managed. It is less invasive and tends to be gentler which causes minimal bleeding. As the name suggests, the “No Scalpel” method does not involve a scalpel, but rather a small opening. Special instruments are used that allow the procedure to be done with generally less manipulation of a man’s tissues. In an NSV procedure, Dr. Couillard locates the vas deferens under the skin of the scrotum by hand, and holds the tiny tube in place with a small clamp. Small pointed forceps separate the layers of tissue which creates a tiny opening in the skin to form an opening for the vas deferens to be gently lifted out, then cut, tied, clipped and/or cauterized and put back into place. The skin is then closed with sutures. This is all done in the office under a local anesthetic so that the procedure is very comfortable.
Dr. Couillard has extensive training and over 20 years of experience in treating and managing all urological cancers, laparoscopy and post surgical reconstruction (when necessary).
Prostate Cancer (CAP)
Prostate cancer is the most common cancer in men, but the good news is it can be treated very effectively when it is detected early. Despite what you have seen and heard from the government or maybe your doctor, PSA (Prostate Specific Antigen) screening is essential and necessary to save lives. More importantly, many men have read or have heard that prostate cancer surgery and other treatments can cause permanent dysfunction that will lower their quality of life. For most men this is not true. Most men after a short period of healing and recovery are able to return to sexual function and urinary control. Those who do not can often be treated with other methods.
It is true that if you are not going to live more than 10 more years you probably will receive no benefit from a PSA screening. In the United States, men who have less than 10 years left are being screened and treated for prostate cancer. This is what has led the government to recommend no screening. However, since we are now diagnosing CAP in most men from 55 to 75 years old they now can have more than 15 years left of life. Prostate cancer in those patients will kill many of them if not discovered early and cured.
To detect prostate cancer early, Dr. Couillard recommends that all men be screened regularly when over the age of 50 (over 40 if you have a strong family history). Since over 90% of prostate cancers detected early are curable with treatment, Dr. Couillard offers the following treatments for prostate cancer:
- Radical Prostatectomy
- Radiation Therapy
- Hormone Therapy
Dr Couillard has one of the most extensive experiences in Laparoscopic Nephrectomies in Northern California. He has performed hundreds of radical and partial surgical removals of kidney cancer.
Kidney cancer is most often found incidentally when a CAT scan or ultrasound is done for other reasons. Sometimes hematuria (blood in the urine) or more rarely, flank pain can be due to kidney cancer.
Laparoscopic (full or partial removal) surgery results in over a 90% cure in most patients with early detected kidney cancer.
Bladder Cancer is a common cancer in both men and women. It increases with age and with a history of smoking. It most often presents with gross or microscopic hematuria (blood found in the urine). Evaluation includes a radiographic study of the upper tracts (kidney and ureter) and a cystoscopy (looking in the bladder with a scope). These are simple, quick and very safe tests that are necessary to detect bladder cancer.
Bladder cancer most often is superficial and easily cured but on rare occasions, invasive cancer is found and must be treated aggressively. When this happens a Transurethral Resection of the Bladder Tumor (TURBT) is used to remove and accurately diagnose the grade and stage of the cancer. Often, superficial bladder cancer is later treated with intravessical therapy or washing the bladder with agents such as Bacillus Calmette-Guerin (BCG) to prevent the cancer from returning. BCG is a vaccine used to prevent tuberculosis (TB). Even though doctors do not know why, they have found that this type of immunotherapy drug (BCG) is very effective in treating bladder cancer.
After treatment a surveillance schedule is implemented with routine cystoscopies so if recurrence is found it will be found early and safely managed.
If invasive bladder cancer is found then removal of the bladder is considered, called radical cystectomy. Following this, Dr. Couillard must reconstruct a new pathway for the urine to get out. Most urologists are not trained or comfortable offering a surgical reconstruction of the bladder when appropriate. Experience does matter and Dr Couillard is specially trained and experienced in complex bowel reconstruction of new bladders.
Other Urological Cancers treated effectively include:
• Testicular Cancer
• Penile Cancer
Almost all urological cancers are treated effectively with surgery if caught before they spread. It is not always necessary to see an oncologist (medical cancer specialist who gives chemotherapy). An oncologist is needed when there is a need for radiation therapy. At that point, Dr. Couillard will refer you appropriately to his colleagues.