Urology pathways, step by step

Start here before any diagnosis. Repeat testing, prostate MRI and, when needed, an MRI-targeted biopsy, all with the surgeon who would treat you if it is cancer.

1. Your first visit (Within 24 to 48 hours)
   A raised PSA is common and often not cancer. Infection, an enlarged prostate or recent activity can all raise it. Dr. Farah reviews your PSA history, examines you and decides whether to repeat the test.
2. Repeating the test (Weeks 1 to 6)
   A second PSA, sometimes with an extra blood or urine test, shows whether the rise is real and how worrying it is.
3. A prostate MRI (If still raised)
   An MRI scan shows whether there is an area in the prostate that looks suspicious. Many men need nothing more after a normal MRI.
4. A targeted biopsy, if needed (If the MRI shows an area)
   Small samples are taken from the exact spot the MRI found, using the MRI images to guide the needle. It's a short procedure with numbing or light sedation.
5. Your results and next step (About 1 week later)
   Whatever the result, you'll know exactly what happens next. No cancer: Your PSA is checked again at regular intervals. If it keeps rising, the MRI can be repeated. Slow-growing cancer: Many low-risk cancers are safest watched closely with PSA tests and MRI, not treated. Treatment starts only if the cancer changes. Cancer that needs treatment: Dr. Farah explains every option. If surgery is right for you, the same surgeon who did your work-up performs your robotic prostatectomy.
6. The data
   Elevated PSA evaluated with repeat PSA, PSA density, free/total PSA and biomarkers (e.g. 4Kscore, PHI, urinary markers), then multiparametric MRI scored by PI-RADS v2.1. PI-RADS 3–5 lesions undergo MRI-ultrasound fusion biopsy, transrectal or transperineal, with systematic cores.

From MRI and biopsy review through robotic surgery, rehabilitation and the 6-month checkpoint, with restorative options if function doesn't fully return.

1. Your first visit (Week 1)
   Dr. Farah reviews your biopsy, scans and blood tests, explains what they mean in plain words, and tells you how fast or slow your cancer is likely to grow.
2. Choosing a treatment (Weeks 1 to 4)
   Some prostate cancers only need close monitoring. Others are treated with surgery or radiation. You'll see what each option means for bladder control and erections before you choose.
3. Robotic surgery (Surgery day)
   The prostate is removed with a surgical robot through a few small incisions. The nerves and muscles that control erections and bladder control are protected wherever the cancer allows.
4. The first weeks at home (Weeks 1 to 6)
   A small tube drains your bladder for about 7 days. Once it's out, some leakage is normal at first. Exercises for bladder control and treatment to help erections return start straight away.
5. Months 1 to 3: getting back to normal (Months 1 to 3)
   Bladder control usually improves week by week. Erections return more slowly. Regular check-ins track your progress and your blood test results.
6. The 6-month checkpoint (About 6 months)
   By now there's a clear picture of how bladder control and erections are recovering. Whatever the answer, there's a clear next step, with the same surgeon. Dry, and erections are back: You'll have regular blood tests to make sure the cancer stays away, less often as the years go by. Erections haven't come back: If pills and injections don't work well enough, an implant gives reliable erections. Dr. Farah places it himself through one small incision. Still leaking: For light leakage, a small sling supports the bladder outlet. For heavier leakage, an artificial sphincter gives the most dependable control. Dr. Farah measures your leakage first, then recommends one. Both: The implant and the sling or sphincter can be done as separate operations or at the same time, depending on what suits you, with the same surgeon for both.
7. The data
   Robotic-assisted radical prostatectomy (RARP) on the multi-port robot, with hood-sparing and urethral-sparing techniques, an extraperitoneal approach where suitable, and graded nerve sparing. Functional outcomes are reported as continence (0 to 1 pad/day) and erectile function (IIEF-5/SHIM) at 3, 6 and 12 months.

For men treated anywhere, by any surgeon, or with radiation. Assessment, a stepwise treatment ladder, and definitive prosthetic options.

1. Tell us what's going on (Before your visit)
   A short questionnaire on leakage and erections gives Dr. Farah a clear picture before you meet.
2. Measuring the problem (First visit)
   A simple exam, and sometimes a quick look inside the bladder with a thin camera, shows how much leakage there is and why.
3. Simple options first (Weeks to months)
   Pelvic floor therapy can help leakage. For erections, pills, injections or a vacuum device work for many men.
4. A lasting fix (When you're ready)
   A penile implant restores erections. A sling or artificial sphincter stops leakage. If you need both, they can be done separately or in the same operation, usually as a same-day or overnight stay.
5. Recovery and switch-on (About 4 to 6 weeks)
   An implant or sphincter is switched on at a follow-up visit once healed, and you're shown how to use it.
6. The data
   Post-prostatectomy incontinence (PPI) is graded by pad weight and pad count; erectile dysfunction after RARP or radiation is managed along a treatment ladder ending in an inflatable penile prosthesis (IPP). Device options: transobturator male sling or artificial urinary sphincter (AUS) for incontinence, and IPP for erectile dysfunction, staged or performed simultaneously when both are needed.

A stepwise approach from oral therapy to injections to an inflatable penile prosthesis. You choose how far to go.

1. A private first visit (Week 1)
   A frank conversation, a short exam and blood tests look for the cause, including heart health, diabetes and hormone levels.
2. Pills and healthier habits (Weeks to months)
   Daily or on-demand pills work for many men, especially with better sleep, exercise and less alcohol.
3. Next options (If pills aren't enough)
   Small injections you learn to give yourself, or a vacuum device, work for many men when pills don't.
4. A penile implant (When you're ready)
   An implant gives reliable erections whenever you want them. It's placed through one small incision just above the penis, usually as a same-day procedure. Once healed, the implant itself can't be seen.
5. Switch-on and life after (About 4 weeks)
   At a follow-up visit you're shown how to use the implant.
6. The data
   Erectile dysfunction managed along the AUA treatment ladder: PDE5 inhibitors, intracavernosal injection therapy (ICI), vacuum erection device (VED), then three-piece inflatable penile prosthesis (IPP) via penoscrotal or infrapubic approach, with antibiotic- or hydrophilic-coated devices.

Lower urinary tract symptoms from benign prostatic hyperplasia: medical therapy, minimally invasive office procedures, or surgery.

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1. Your first visit (Week 1)
   A short questionnaire, a urine test and a quick bladder scan show how well you're emptying.
2. Habits and medicine (Weeks)
   Drinking less in the evening and a daily pill help many men.
3. Procedures that open the channel (If you want off pills)
   None of these involve a cut on the skin; all work through the natural channel. A quick steam treatment shrinks the prostate and can be done in the office. A robot-guided water jet removes the blocking tissue precisely, usually with one night in hospital. The traditional operation trims the tissue away from the inside.
4. Single-port robotic prostatectomy (If you need surgery)
   Dr. Farah removes the blocking tissue with the single-port robot, through one small incision, working through the bladder (a transvesical approach). It is for men with a large prostate and severe symptoms. It means one night in the hospital, and the catheter comes out in 5 days.
5. The data
   Benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS), measured by IPSS: alpha-blockers and 5-alpha-reductase inhibitors, then surgical therapy matched to prostate volume and anatomy: water vapor thermal therapy (Rezum), robotic waterjet ablation (Aquablation), transurethral resection of the prostate (TURP) or single-port transvesical robotic simple prostatectomy.

Leakage with coughing or exercise, or a feeling of a bulge. Conservative care first, then a sling or robotic repair when needed.

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1. Your first visit (Week 1)
   A conversation, a short exam and a simple bladder test show what kind of leakage or bulge you have.
2. Simple options first (Weeks to months)
   Pelvic floor physical therapy helps many women. A small support device worn inside can hold up a bulge without surgery.
3. If you need more (When you're ready)
   A small sling under the bladder outlet stops leakage with coughing and exercise. A bulge can be repaired with robotic surgery through small incisions.
4. Recovery (Weeks 2 to 6)
   Most women go home the same day or next day and are back to normal activity within weeks.
5. The data
   Stress urinary incontinence (SUI) treated with pelvic floor muscle training, then mid-urethral sling (MUS) or alternatives; pelvic organ prolapse (POP) treated with pessary or robotic sacrocolpopexy. FDA mesh guidance applies to transvaginal mesh for prolapse, not mid-urethral slings.

Medical expulsive therapy for small stones; ureteroscopy or PCNL for larger ones; a metabolic work-up to prevent the next.

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1. Pain and a scan (Day 1)
   A scan shows the stone's size and where it is. That decides whether it's likely to pass.
2. Wait, or treat it (Days to weeks)
   Small stones often pass with medicine that relaxes the tube from the kidney. Larger ones are removed with a thin scope passed up the natural channel, with no cut on the skin, usually as a same-day procedure. Very large stones are removed through a small opening in the back.
3. Stopping the next one (After)
   Tests on your stone and urine show why you form stones and what to change.
4. The data
   Medical expulsive therapy (alpha-blockers) for distal ureteral stones; ureteroscopy with laser lithotripsy, shock-wave lithotripsy (SWL) or percutaneous nephrolithotomy (PCNL) by size and location; 24-hour urine metabolic evaluation for recurrent stone formers.

Dr. Farah, a urologist in North Charleston, Summerville and Nexton, SC, diagnoses and treats bladder, kidney and testicular cancer, from the first scan or test result through treatment and follow-up.

1. Your first visit (Within 24 to 48 hours)
   Dr. Farah reviews the scan, urine test or exam finding that brought you in, examines you and explains what it might mean.
2. Finding out more (Weeks 1 to 2)
   The tests depend on where the problem is: a thin camera look inside the bladder, a CT or MRI of the kidneys, or an ultrasound and blood tests for a lump in the testicle.
3. Diagnosis and your plan (After your tests)
   You'll know what was found and exactly what happens next. Bladder cancer: Most bladder tumors are removed through a thin scope passed up the natural channel, with no cut on the skin (TURBT). Some are then treated with medicine placed directly into the bladder. Kidney cancer: Some small kidney masses are safest watched with regular scans. Others are treated with robotic surgery to remove the tumor or the kidney. Testicular cancer: Testicular cancer is treated by removing the affected testicle through a small cut in the groin (radical orchiectomy), usually as a same-day procedure.
4. Follow-up (Ongoing)
   Regular check-ups, with scans or camera exams when needed, watch for any return of the cancer.

Urgency, frequency and urge leakage in men and women: behavioral therapy, medication, then advanced office-based therapies.

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1. Your first visit (Week 1)
   A urine test and a bladder diary rule out infection and show your pattern.
2. Bladder habits (Weeks)
   Cutting back on caffeine, timed bathroom trips and pelvic floor exercises help many people.
3. Medicine (Weeks to months)
   Daily pills calm the bladder muscle.
4. If pills aren't enough (When you're ready)
   A quick in-office treatment that relaxes the bladder lasts several months, or a small device that calms bladder nerves works long term.
5. The data
   Overactive bladder (OAB) per AUA/SUFU guideline: behavioral therapy, antimuscarinics or beta-3 agonists, then intradetrusor onabotulinumtoxinA, percutaneous tibial nerve stimulation (PTNS) or sacral neuromodulation (SNM).

Two or more infections in six months, or three in a year, deserve a closer look. The goal is to find the cause and stop the cycle, not just treat the next one.

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1. Your first visit (Within 24 to 48 hours)
   Dr. Farah reviews your past urine cultures and antibiotics, asks about triggers, and checks how well your bladder empties.
2. Looking for a cause (Weeks 1 to 4)
   Depending on your history, an ultrasound or CT scan and a quick look inside the bladder with a thin camera check for stones, blockages or other causes.
3. A prevention plan (Ongoing)
   Drinking more water and not holding urine help. After menopause, vaginal estrogen lowers the chance of infection. Some people do well with a low-dose preventive medicine, or with treating each infection quickly based on a urine culture.
4. Fixing the cause (If one is found)
   When a kidney stone, an enlarged prostate or poor bladder emptying is driving the infections, treating it is often the lasting fix.
5. The data
   Recurrent uncomplicated UTI in women (≥2 culture-proven infections in 6 months or ≥3 in 12 months) per the AUA/CUA/SUFU guideline: culture before treatment, vaginal estrogen for peri- and postmenopausal women, continuous or postcoital antibiotic prophylaxis, and non-antibiotic options such as methenamine hippurate. Complicated or male UTI warrants imaging and cystoscopy.

Dr. Farah, a urologist in North Charleston, Summerville and Nexton, SC, performs vasectomy in the office with a single-incision technique and numbing medicine. It is a permanent form of birth control for men.

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1. Your consultation (First visit)
   Dr. Farah explains how a vasectomy works, what to expect and the alternatives, and answers your questions. A vasectomy should be thought of as permanent.
2. The procedure (Procedure day)
   The procedure is done in the office with numbing medicine. Through one small opening in the skin of the scrotum, the tubes that carry sperm are closed off. You go home the same day.
3. The first days at home (First few days)
   Some soreness and swelling is common at first. Ice and rest help.
4. Confirming it worked (12 weeks after)
   You are not sterile right away. At 12 weeks, a semen analysis checks that no sperm remain. Until Dr. Farah confirms the result is clear, keep using other birth control.

Dr. Farah, a urologist in North Charleston, Summerville and Nexton, SC, evaluates and treats low testosterone. Low energy, low sex drive and erection changes have many causes, so the first step is confirming the diagnosis with blood tests.

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1. Your first visit (Week 1)
   Dr. Farah asks about your symptoms, medicines and health history, and examines you.
2. Blood tests (In the morning)
   Testosterone is checked in the morning, often on two separate days, along with other hormone levels, because levels change through the day.
3. Choosing a treatment (If levels are low)
   Options include treating the underlying cause, lifestyle changes, and testosterone therapy as oral capsules, gels or injections. Testosterone therapy can lower sperm production, so it is avoided in men hoping to have children.
4. Follow-up on treatment (Regularly while on treatment)
   Blood tests check your testosterone level, blood count and PSA while you are on treatment.

Kidney, bladder and testicular cancer, hematuria, recurrent UTIs, hypogonadism, vasectomy and scrotal conditions.

1. Tell us what's going on (Anytime)
   Kidney cancer, bladder cancer, testicular cancer, blood in the urine, repeat bladder infections, low testosterone, curved erections, vasectomy, testicle pain and more are all treated here.
2. Your plan (First visit)
   You'll leave with a clear plan and know exactly what happens next.