Dr. DiBlasio specializes in minimally-invasive surgery for men and women. These include endoscopic (scope procedures performed through the urethra), laparoscopic, and robotically-assisted surgical techniques, in addition to traditional incision-based surgeries. Surgical conditions treated range from small office-based cosmetic procedures to major cancer surgery. Additionally, Dr. DiBlasio performs diagnosis and treatment for many medical urologic conditions.
Dr. DiBlasio serves as a physician training center and surgical proctor for holmium laser based prostate surgery, as well as for prostate and kidney cryoablation (a minimally-invasive approach to kill cancer cells through freezing and heating the cancerous tissue). He has travelled nationally to lecture on these approaches and has trained dozens of surgeons in these techniques throughout the United States.
CRYOSURGERY and HIFU
Cryosurgery involves ablation (destruction) of tissue through the process of cooling and heating tissue. Using specialized needles called cryoprobes, compressed helium and argon gases are used to produce tissue cooling and heating, respectively. Simultaneously, a different set of needles are used to monitor tissue temperatures in real-time to ensure an appropriate treatment. Dr. DiBlasio performs cryosurgery to treat and destroy prostate and kidney cancer.
In the prostate, cryosurgery can be used to treat newly diagnosed prostate cancer as well as those which have recurred after initial treatment with radioactive seeds, external radiation or cyberknife. This incision-less surgery is performed through needles inserted into the prostate using general or epidural anesthesia. Prostate cryoablation is an outpatient, same-day procedure with minimal morbidity and recovery time. In select patients with very focused prostate cancer, subtotal cryoablation (freezing only select areas of the prostate) can be rendered to minimize potential side effects even further. A new very exciting technique involves "MRI-fusion selective cryoablation" which incorporates MRI findings into the treatment program in order to provide even less invasive and more precise targeting of disease, bring a long-needed evolution to the technique of prostate ablation. Dr. DiBlasio has been a key player in the inception and launch of this exciting approach.
In the kidney, masses less than 4 cm can be treated using cryosurgery. Cryoprobes specifically engineered for this process are inserted into the tumor using ultrasound guidance. This is typically performed using a laparoscopic approach to minimize morbidity and provide faster recovery and healing.
HIFU (high intensity focused ultrasound) uses high frequency ultrasound waves to generate heat. These high temperatures result in destruction, or ablation, of prostate tissue. This incisionless, ambulatory surgery is offered worldwide for treatment of localized prostate cancer. Early outcomes data is encouraging, particularly with regards to maintenance of erectile function. However, this modality remains under investigation in the United States and is to be considered experimental at this time. Dr. DiBlasio performs HIFU surgery internationally and is available for consultation to discuss this treatment option.
PROSTATE SURGERY FOR BENIGN PROSTATE HYPERPLASIA (BPH)
Dr. DiBlasio provides an array of treatment for prostate enlargement causing urinary symptoms or retention. For those patients who have failed trials of medications, Dr. DiBlasio provides comprehensive office testing to ensure appropriate treatment. Treatment options range from office-based procedures to in-hospital or ambulatory surgery. In the office, Dr. DiBlasio offers microwave thermotherapy, a procedure where a specialized catheter is placed into the urethra which heats and destroys the prostate tissue. This creates a channel for improved voiding. Microwave thermotherapy is performed with local anesthesia and is generally under 1 hour of procedure time.
Dr. DiBlasio specializes in holmium laser prostate surgery. Using the holmium laser, the prostate is vaporized and carved out in sections and removed through the urethra - a process called enucleation. Long-term outcomes are excellent and recovery time and morbidity are minimal. The precision of the holmium laser allows a very safe and effective procedure with the ability to remove the majority of prostate tissue in a single stage, even for very large prostates. This procedure can be safely performed on blood-thinning medications and is typically outpatient without the need for an overnight hospital stay or surgical incision. Dr. DiBlasio serves as a training site and proctor for holmium based prostate surgery.
FEMALE PELVIC SURGERY AND INCONTINENCE
Dr. DiBlasio performs a variety of procedures for pelvic organ prolapse and urinary incontinence. Dr. DiBlasio has expertise in pelvic reconstruction for prolapse of the bladder, rectum and intestines, and uterus. Using a mesh-free approach, the prolapse defect is addressed and surgically corrected. In addition to plication procedures, Dr. DiBlasio performs sacroculpopexy or sacrospinous fixations, where appropriate, to maximize outcomes with minimal morbidity. The majority of patients stay in the hospital the evening of the surgery and are discharged the next day. Procedures can be performed with general or epidural anesthesia and morbidity tends to be minimal.
In addition to pelvic prolapse, Dr. DiBlasio performs surgical repair of stress incontinence (urine leakage with heavy maneuvers such as lifting, sneezing, coughing, etc.). These range from injection of bulking agents to placement of mid urethral slings and urethropexy procedures.
For patients with urgency incontinence (leakage with an urge to void) that do not respond to medications, Dr. DiBlasio provides such treatment options as sacral neuromodulation or BotoxTM injections. Sacral neuromodulation, or InterstimTM, involves placement of a lead (small flexible wire) near the nerves controlling the bladder. A small device similar to a pacemaker is implanted and attached to the lead. This device provides stimulation to the bladder to modify the stimulus to void and control the urgency and frequency of urination. Many patients experience a dramatic improvement in urge incontinence. Additionally, Dr. DiBlasio performs InterstimTM , for fecal incontinence (incontinence of stool). BotoxTM can also be used to control urgency, frequency and urge incontinence. This can be injected into the muscle layer of the bladder in the office setting to improve urinary symptoms refractory to medications.
URINARY STONE SURGERY
Dr. DiBlasio performs workup and treatment for kidney stones.Regardless of location, stones are treated using minimally-invasive surgical techniques. In some cases, surgery is not even required and stones can be treated using medications to dissolve them. In the remainder of stones, Dr. DiBlasio provides an array of surgical options.
ESWL, or extracorporeal shockwave lithotripsy, is an outpatient procedure. This can typically be performed with "twilight anesthesia" and takes about 45 minutes. The patient is positioned on a specialized table and a treatment cushion is placed against the patients skin. Ultrasound energy is directed from the cushion into the body and transmitted to a very focused area where the stone is located using real-time imaging such as x-ray or ultrasound guidance. Through repeated ultrasound waves, the stone is broken into small fragments which will then pass more easily out of the urinary tract.
Endoscopy employs the insertion of small cameras into the urinary tract. For bladder stones, a cystoscope (camera inserted into the bladder through the urethra) is used to visualize the stones. The stones are then broken and removed using either the holmium laser or electrohydraulic energy without the need for incisional surgery. In patients with very large stones, laparoscopic bladder stone extraction can be utilized to provide rapid recovery. For stones in the ureters (tubes connecting the kidneys to the bladder) or the kidneys, ureteroscopy can be performed. This involves using a very small fiberoptic camera inserted into the urethra and bladder and then advanced into the upper part of the urinary tract. Once the stones are identified, the holmium laser can be used to provide precise and safe fragmentation and removal of stones.
For very large stones in the kidneys, PCNL (percutaneous nephrolithotomy) can be used. This involves placing a camera directly into the kidney through a small incision in the skin. Using this technique, large stones in the kidneys can be quickly and successfully removed in a minimally-invasive approach.
MENS HEALTH AND SEXUAL FUNCTION
Dr. DiBlasio performs "NO SCALPEL, NO SUTURE VASECTOMY", offering the least invasive approach possible for men seeking a vasectomy for sterilization.
Additionally, he provides comprehensive evaluation and treatment for low testosterone and erectile dysfunction. In patients who do not respond or tolerate medication, our office provides injection therapy and depot injections to provide long-term replacement. Dr. DiBlasio monitors patients on replacement therapy closely to ensure a safe and appropriate response.
LAPAROSCOPIC AND ROBOTIC SURGERY
Laparoscopic surgery involves the use of a camera and tiny instruments inserted through small incisions. Using this technique, Dr. DiBlasio performs various pelvic, prostate, bladder, ureter and kidney surgery. Laparoscopic surgery provides minimally-invasive techniques to reduce blood loss, hospital stay, and recovery times.
The advent of robotic surgery using the Da VinciTM surgical platform has allowed an evolution of laparoscopic surgery. Using robotic assistance, Dr. DiBlasio is able to perform complex urologic surgery for benign and cancerous conditions.