Flagstaff Surgical Associates

Surgical Departments


Northern Arizona's experts in general surgery, urology,
audiology, allergy, & ENT treatment.

  • Procedures That We Perform



    Circumcision

    Properly performed neonatal circumcision prevents phimosis, paraphimosis and balanoposthitis, and is associated with a decreased incidence of cancer of the penis among U.S. males. In addition, there is a connection between the foreskin and urinary tract infections in the neonate. For the first three to six months of life, the incidence of urinary tract infections is at least ten times higher in uncircumcised than circumcised boys. Evidence associating circumcision with reduced incidence of sexually transmitted diseases is conflicting. Circumcision may be required in a small number of uncircumcised boys when phimosis, paraphimosis or recurrent balanoposthitis occur and may be requested for ethnic and cultural reasons after the newborn period. Circumcision in these children usually requires general anesthesia.

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    Cystoscopy

    Cystoscopy, or cystourethroscopy, is a procedure that enables a urologist to view the inside of the bladder and urethra in great detail. It is commonly used to diagnose bladder tumors, identify obstruction of the bladder and look for any abnormalities of the bladder and its lining.

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    da Vinci® Prostatectomy

    With the da Vinci System, surgeons operate through a few small incisions instead of a large open incision – similar to traditional laparoscopy. The da Vinci System features a magnified 3D high-definition vision system and special wristed instruments that bend and rotate far greater than the human wrist. da Vincienables your doctor to operate with enhanced vision, precision, dexterity and control.

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    da Vinci® Pyeloplasy

    If you or a loved one are diagnosed with urinary obstruction, surgery to remove the blockage may be recommended. This type of surgery is called pyeloplasty. Doctors remove the blockage in the urinary system and reattach the healthy part of the kidney to the healthy part of the ureter (tubes that carry urine from the kidneys to the bladder).

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    Nephrectomy

    Nephrectomy (nephro = kidney, ectomy = removal) is the surgical removal of a kidney. The procedure is done to treat kidney tumors as well as other kidney diseases and injuries. Nephrectomy is also done to remove a healthy kidney from a donor for transplantation. Thousands of nephrectomies are performed every year in the U.S.

    Vasectomy

    The decision to proceed with a vasectomy is a very personal one. So it is important that you have a clear understanding of what a vasectomy is and what it is not. The following will provide you with information that will assist you in deciding whether or not a vasectomy is an appropriate form of contraception for you.

    Shock Wave Lithotripsy

    Shock Wave Lithotripsy (SWL) is the most common treatment for kidney stones in the U.S. Shock waves from outside the body are targeted at a kidney stone causing the stone to fragment. SWL is nonsurgical technique for treating stones in the kidney or ureter (the tube going from the kidney to the bladder) using high-energy shock waves. Stones are broken into “stone dust” or fragments that are small enough to pass in urine. lf large pieces remain, another treatment can be performed.

    Ureteroscopy

    It is a procedure in which a small scope (like a flexible telescope) is inserted into the bladder and ureter and it is used to diagnose and treat a variety of problems in the urinary tract. For ureteralstones, it allows the urologist to actually look into the ureter, find the stone and remove it. The surgeon passes a tiny wire basket into the lower ureter via the bladder, grabs the stone and pulls the stone free. This is an outpatient procedure with or without a stent inserted (a tube that is placed in the ureter to hold it open).

    Ureteroscopy can be used for virtually any stone of a size appropriate for it. Fragmentation of stones using holmium laser device ureteroscopically is more assured than with shock wave lithotripsy (SWL).

    Transurethral Resection of the Bladder Tumor (TURBT)

    TURBT is a surgical procedure performed where a lighted tube is inserted through the urethra into the bladder. It serves as a diagnostic and therapeutic role in the treatment of bladder cancer.

    Transurethral Resection of the Prostate (TURP)

    Transurethral resection is the most common surgery for BPH. In the United States, approximately 150,000 people have TURPs performed each year. This can be done using electric current or with laser light. After the patient receivesanesthesia, the surgeon inserts an instrument called a resectoscope through the tip of the penis into the urethra. The resectoscope contains a light, valves for controlling irrigating fluid and an electrical loop that cuts tissue and seals blood vessels. The removed tissue pieces are carried by the irrigating fluid into the bladder and then flushed out and sent to a pathologist for examination under a microscope. At the end of the procedure, a catheter is placed in the bladder through the penis. The bladder is continuously irrigated with fluid through the catheter in order to monitor bleeding and prevent blood from clotting and obstructing the catheter. Since there are no surgical incisions with this procedure, patients normally stay in the hospital only one to two days. Depending on surgeon preference, the catheter may be removed while the patient is still in the hospital or the patient may be sent home with the catheter in place, attached to a leg bag for convenience and removed several days later as an outpatient procedure.

    Urolift

    What is BPH? Benign Prostatic Hyperplasia, or BPH, is a condition in which the prostate enlarges as men get older. Over 70% of men in their 60s have BPH symptoms so it is very common1. While BPH is a benign condition and unrelated to prostate cancer, it can greatly affect a man’s quality of life. The prostate is a male reproductive gland, about the size of a walnut, that produces fluid for semen. The prostate surrounds the urethra, which is the tube that carries urine from the bladder out of the body. As the prostate enlarges, it presses on and blocks the urethra, causing bothersome urinary symptoms such as:

    Frequent need to urinate both day and night
    Weak or slow urinary stream
    A sense that you cannot completely empty your bladder
    Difficulty or delay in starting urination
    Urgent feeling of needing to urinate
    A urinary stream that stops and starts

    If you suffer from the above symptoms, you are not alone. BPH is one of the leading reasons for men to visit a urologist. What is the UroLift® System? The UroLift® System is a new, minimally invasive approach to treating BPH for patients looking for an alternative to drug therapy or more invasive surgery. The UroLift System is a straightforward procedure that utilizes tiny implants to lift and hold the enlarged prostate tissue out of the way so it no longer blocks the urethra. There is no cutting, heating or removal of prostate tissue. Clinical data has proven that the UroLift System treatment is safe and effective and can improve BPH symptoms 3 to 4 times greater than with medication1. Results have shown durability to two years with no impact to sexual function2. The goal is to relieve you of bothersome urinary symptoms so you can get back to your life and resume daily activities. Most common adverse events reported include hematuria, dysuria, micturition urgency, pelvic pain, and urge incontinence. Most symptoms were mild to moderate in severity and resolved within two to four weeks after the procedure. Visit uroliftforbph.com for more information.

    Rezum

    Rezūm is a treatment for BPH that can be performed in a clinic or out-patient setting. Rezūm uses the stored thermal energy in water vapor (steam) to treat the extra prostate tissue that is causing symptoms such as frequency, urgency, irregular flow, weak stream, straining and getting up at night to urinate.

    Rezūm provides the following benefits:

    Potential alternative to BPH medications
    Relieves symptoms safely and effectively
    Provides noticeable symptom improvement within two weeks
    Simple in-office/out-patient therapy
    Does not require general anesthesia
    Preserves sexual and urinary functions1
    Allows patients to return to regular activities within a few days.

    Urgent PC

    The Urgent PC system delivers a specific type of neuromodulation called percutaneous tibial nerve stimulation (PTNS). During treatment, a small, slim needle electrode is inserted near your ankle. The needle electrode is then connected to the battery-powered stimulator. During your 30-minute treatment, mild impulses from the stimulator travel through the needle electrode, along your leg and to the nerves in your pelvis that control bladder function. This process is also referred to as neuromodulation.

    Medtronic Interstim for Overactive Bladder

    Medtronic InterStim Therapy for urinary control is indicated for the treatment of urinary retention and the symptoms of overactive bladder, including urinary urge incontinence and significant symptoms of urgency-frequency alone or in combination, in patients who have failed or could not tolerate more conservative treatments.

    MonaLisa Touch

    The MonaLisa Touch procedure is a unique treatment that uses a medical laser that delivers controlled energy to the vaginal tissue so cells make more collagen.

    This procedure is:

    A virtually painless, in-office treatment.
    Performed without requiring anesthesia.
    Quick (it takes <5 minutes), resulting in virtually no down time.
    Able to yield results after the first treatment! (Three treatments are recommended)


  • Frequently Asked Questions

    Can I send the doctor emails?

    You are able to communicate with our office through our patient portal. It is a great way to communicate on non-emergent issues, such as: prescription refill, appointment request, billing questions or medical records requests. You should have been provided a paperwork with portal registration information including a PIN number. If you don’t have this call our office to obtain you PIN and follow this link to get started!

    Access your patient portal

    Where will my surgery be done?

    Flagstaff Surgical Associates works with the hospital and two local surgery centers. We will schedule at the facility that best fits your surgery needs is contracted with your insurance carrier.

    Will I be able to eat or drink before my surgery?

    It is important to have an empty stomach before surgery to minimize the chance of vomiting during or after surgery to avoid complications. You will generally be instructed not to eat or drink after midnight the night before surgery. This is extremely important and your surgery will be cancelled if these instructions are not followed.

    Why does it take so long to schedule my surgery?

    On average, surgery takes 7 to 10 days to schedule. Insurance often requires precertification and/or authorization. There is usually preoperatively testing that the patient must have and patient, surgeon and surgery facility schedules need to be coordinated. We know that waiting for your surgery is not easy but we will do our best to get your surgery scheduled as soon as possible.

    How do I know if my surgery is healing normally?

    It is normal for your incision to appear discolored or slightly swollen. Call our office if you are having excessive pain, increased swelling or drainage or if you just have questions or concerns.

    When should I make my postoperative, follow up appointment?

    If you are not given a follow up time when you are discharged after surgery, please call our office to schedule an appointment as soon as possible after returning home. Typically, the postoperative appointment should be 7 to 10 days after surgery unless your doctor tells you something different.

    How long does it take until I receive my pathology results?

    We usually receive pathology results in 3 to 5 working days. If special stains are required or specimens are sent to outside facilities, the results may take up to 2 weeks longer. We will do our best to have the results to you as soon as possible

    Post-Surgery Catheter Removal Instructions

    The urinary catheter is frequently called a “Foley.” This is because it is named after its inventor, the famous Minnesota Urologist Dr. Frederick Foley. There are many different varieties and sizes, but the basic principles are the same. It is a rubber or silicone drainage tube with retention balloon on the tip. The retention balloon holds it in the bladder so urine can drain out and collect in a collection bag (see diagram below). It is a closed system to decrease the chances of infection developing. Most patients are able to remove his or her catheter at home. Most patients are able to remove his or her catheter at home. This is perfectly safe and avoids an unnecessary trip to the office.

    Follow These Steps

    1. Identify the “balloon port” at the end of the catheter (see the diagram). It has a colored valve on the end and has several numbers printed on the colored valve. This is the part of the catheter that holds the water in the retention balloon at the tip, which inside your bladder.

    2. Cut the valve off the “Balloon Port”. Do this by cutting the neck of the tube just behind the valve. The valve will come off and water will trickle out of the tube. This is clean water that was inside the balloon at the tip of the catheter.

    3. Wait for all the water to trickle out. When it stops, the balloon inside your bladder has been deflated.

    4. Pull the entire catheter out with a steady pull. Do not jerk it or yank it out – if you do, it will come out but will be more uncomfortable.

    5. Throw all the tubing and the collection bag away.

    Tips From Experienced Patients

    Lubricating the catheter with KY jelly helps reduce discomfort.

    Removing the catheter in the shower with warm water running on you makes it much less uncomfortable (and it make less of a mess). If you do this, we suggest doing it seated to avoid falling or injury.

See What's New

With Flagstaff Surgical Associates

Our

Mission


Our mission is to provide Northern Arizona with professional and patient-centered surgical and specialty healthcare services.
Our

Vision


Our vision is to provide patient care that consistently achieves superior levels of quality, safety, and patient satisfaction.

FSA's

Core Values


Quality

We've partnered with Arizona medical practices, hospitals, and services, gathering metrics so you receive the best possible treatment.

Community

We love the Northern Arizona community and are active in local charities, events and sponsorships.

Technology

Our physicians all use the latest proven techniques for surgical and non-surgical patient treatment.

Availability

By having several physicians of each specialty. You can be confident your needs will continually be met.