Sandeep Mehta, MD

An elevated PSA does not automatically mean prostate cancer. We use a step-by-step approach to understand your risk before deciding whether a biopsy is needed.

• What PSA means: PSA reflects prostate activity — not a cancer test by itself. It can rise from an enlarged prostate (BPH), infection or inflammation, recent ejaculation, or urinary irritation, as well as cancer.
• MRI & risk review: For most patients the next step is a prostate MRI, which gives a PI-RADS score and prostate size (used to calculate PSA density). We also weigh age, family history, and prior biopsies.
• Biopsy vs. monitoring: Not every elevated PSA needs a biopsy. Options may include repeat PSA, continued monitoring, or biopsy. The goal is to avoid unnecessary biopsies while still catching cancers that matter.
• If a biopsy is recommended: Dr. Mehta performs a transperineal prostate biopsy (through the skin), sampling 10 standard sectors plus 2–3 targeted samples from any MRI region of interest.

A prostate cancer diagnosis doesn't mean everyone needs the same treatment right away. For most localized cancers there is time to review your options carefully. Your risk comes from your PSA, MRI, biopsy (Gleason / Grade Group), stage, and sometimes genetics — and the choice balances cancer control against urinary control, erections, bowel effects, and recovery time.

• Active surveillance: close monitoring with PSA, MRI, and repeat biopsy for many low-risk and select favorable intermediate-risk cancers. This is careful monitoring, not ignoring the cancer.
• Robotic surgery: removes the prostate (checking lymph nodes when needed) and provides final pathology; PSA is expected to become undetectable afterward. Main tradeoffs are catheter recovery, urinary leakage, and erection changes.
• Radiation ± hormone therapy: whole-gland treatment without surgery. If you choose radiation, Dr. Mehta typically places a SpaceOAR spacer and gold markers beforehand; hormone therapy depends on your risk category.
• Focal therapy (HIFU): treats a single targeted cancer area in carefully selected cases, with less long-term data than surgery or radiation.

Androgen deprivation therapy (ADT), or hormone therapy, lowers testosterone — the main signal prostate cancer uses to grow. It is often paired with radiation, used for cancer that has come back, or used for cancer that needs longer-term control. ADT is not chemotherapy.

• How it's given: most patients get a long-acting injection in the office — in our practice usually a 6-month injection. Some patients also take pills, depending on their cancer plan.
• Why, and for how long: the plan depends on your PSA, biopsy grade, imaging, and stage. Your team follows bloodwork (PSA, and sometimes testosterone) to confirm it's working.
• Protect your bones: ADT can thin bones over time. Don't skip calcium (about 1,000–1,200 mg/day total) and vitamin D (usually 800–1,000 IU/day), make sure your primary care doctor knows you're on ADT, and ask about a baseline DEXA bone-density scan if treatment will be long-term.
• Common side effects: hot flashes, fatigue, lower sex drive and erection changes, weight gain, muscle loss, and mood changes. Over the longer term, ADT can also raise blood sugar and cholesterol and affect heart health.
• Feeling your best on ADT: regular aerobic and strength exercise, a heart-healthy diet, and keeping up with blood pressure, cholesterol, and blood sugar through your primary care doctor all help. Tell us if side effects are affecting your quality of life — there are often ways to help.

BPH (benign prostatic hyperplasia) means the prostate has enlarged and is squeezing the urine channel. It is common with age and is not cancer. It can cause a weak stream, straining, starting and stopping, frequency, urgency, getting up at night, or a feeling that the bladder doesn't empty — and in some men, urinary retention, recurrent infections, bladder stones, or blood in the urine.

Why see a urologist? Many men start treatment with their primary doctor. Urology gets involved when symptoms persist, medicines aren't tolerated, or there may be a fixable “plumbing” problem. Our job isn't to pressure you toward surgery — it's to understand your symptoms, check how well your bladder empties, and explain every option.

Medications are usually the first step — and different medicines treat different symptoms. Most can be started by your primary care doctor; you don’t always need to see a urologist first just to try a medication.

• Weak stream, straining, trouble getting started (flow symptoms): alpha-blockers — tamsulosin (Flomax), alfuzosin, or silodosin — relax the prostate channel and often help within days.
• Larger prostate: 5-alpha-reductase inhibitors (finasteride, dutasteride) slowly shrink the prostate over months; a PSA is usually checked first, because these change how PSA is read.
• Urgency, frequency, getting up at night, urge leakage (bladder/storage symptoms): bladder-calming medicines — see the box below.
• Urinary symptoms and ED: daily tadalafil (Cialis) can help both in selected men.

Procedures become reasonable if medicines don't work, cause side effects, or you prefer a more lasting fix. The goal is to open the prostate channel and, when possible, reduce or stop BPH medicines. Options I offer at Baytown include:

• GreenLight PVP (laser vaporization): a side-firing laser vaporizes the blocking tissue. A good fit for smaller and moderate prostates (in our practice, generally up to about 60 grams). No incisions, and many patients go home the same day.
• HoLEP (laser enucleation): a laser “peels out” the entire inner blocking tissue — like removing the fruit and leaving the peel. It works for any prostate size, including very large glands, and has the lowest chance of needing another prostate procedure later.
• TURP: the long-established standard, trimming the blocking tissue through the scope; well suited to moderate-sized prostates.
• UroLift: tiny implants hold the prostate lobes open without removing tissue — best for smaller prostates, and the option most likely to preserve ejaculation.
• Aquablation: a heat-free, image-guided water jet removes blocking tissue, used for selected prostates.

Many kidney findings are discovered by accident on a scan done for another reason. A kidney finding does not automatically mean cancer — many are simple cysts, and some are small, slow-growing tumors found early.

• Get the right scan: Most patients need a dedicated renal mass protocol CT or MRI (imaging before and after contrast) to see whether an area truly enhances.
• Sort the finding: Scans help separate simple cysts, complex cysts (graded Bosniak 1–4), and solid masses.
• Choose a plan together: Depending on size, location, kidney function, and your health, options may include active surveillance, biopsy, ablation, focused radiation (SBRT), robotic partial nephrectomy, or radical nephrectomy.

Contrast questions: A CT contrast (iodine) allergy does not automatically rule out MRI contrast (gadolinium). Many patients with kidney disease can still be imaged safely with radiology's help.

Everything about your kidney stone in one place — whether you’re passing it on your own, having it watched, going home with a stent, or scheduled for treatment. Stone referrals often arrive with incomplete information, so at your first visit we’re answering three questions: is there truly a stone causing the problem, where is it and is it blocking the kidney, and is treatment needed now or is watchful waiting reasonable? A non-contrast CT stone protocol is usually the most useful test — please bring any outside images on a disc or USB, not just the report.

Where you are in the stone journey — most people fall into one of these:

• Passing it on your own. Stone pain comes in waves and can move from your side toward your groin as the stone travels down — moving pain is usually progress. A medication called tamsulosin (Flomax) relaxes the urine channel so the stone passes more easily (it can cause lightheadedness — stand up slowly); anti-inflammatories like ibuprofen often work best for the pain if they’re safe for you. Drink steadily. Catching the stone in a strainer is optional — we confirm it passed with repeat imaging.
• Being watched (observed). A stone that is not blocking the kidney often doesn’t need any procedure right now — the right, standard plan is to watch it and discuss options unhurried at an outpatient visit. This is not “doing nothing.” If you were treated for an infection, the stone is not removed until the infection has fully cleared.
• Home with a stent. A ureteral stent is a soft, temporary tube that keeps the kidney draining. Stents are uncomfortable, and that is normal — it does not mean the stent failed or moved. Expect bladder urgency and frequency, pressure or spasms, mild burning, a flank ache during or right after urinating, and pink urine that comes and goes. Medicines like tamsulosin, oxybutynin, or Pyridium can take the edge off. A stent must be removed or exchanged — never skip that appointment, because a forgotten stent can damage the kidney.
• An urgent stent was placed to drain the kidney (stone treated later). When a stone blocks the kidney — especially with infection — the safest first step is to drain it with a stent; the stone is usually not removed that night. This isn’t ignoring the stone: draining relieves pressure, protects the kidney, and lets antibiotics work, so the full stone surgery can be done more safely as a planned procedure once things settle.
• Getting the stone treated. Definitive options depend on the stone: ureteroscopy with a laser and a temporary stent (most common), shock-wave therapy (ESWL), or — for large or complex stones — a procedure through the back (PCNL).

Follow-up matters even if the pain stops. See urology in about 1–2 weeks — a stone can still block the kidney without causing pain. Repeat imaging (often ultrasound or X-ray) confirms the stone passed or plans the right procedure. If no one calls to schedule, call the office.

A CT scan or ultrasound showed hydronephrosis — swelling of the urine drainage system of the kidney. This is a finding, not a diagnosis. It is often picked up on a scan done for something else entirely. Once we have confirmed it is not an emergency, the next step is working out the cause at an office visit.

• Urine drains from the kidney down a tube (the ureter) into the bladder. If drainage slows anywhere along that path, the system upstream can stretch and look “swollen” on a scan.
• Causes range from kidney stones, an enlarged prostate, or a full bladder, to narrowing of the tube — and sometimes it is a longstanding, harmless finding that has been there for years.
• Mild hydronephrosis with normal kidney blood tests and no infection is usually not dangerous and can be evaluated safely as an outpatient.
• At your visit we review your scans and kidney function and decide whether you need repeat imaging, a bladder check, or a special kidney drainage scan. Bring the date and location of your CT or ultrasound — plus your discharge papers if you were seen in the hospital or ER — and keep the appointment even if you feel completely well.

Urinary symptoms — burning, urgency, frequency, or bladder pressure — are a common reason to see urology, whether it's a single infection or ones that keep coming back. Your symptoms are real, but not every episode of burning or urgency is actually an infection, so our job is to confirm what's really going on and treat the right cause.

• One clue alone doesn't prove a UTI. A dipstick, white cells, or cloudy urine can suggest inflammation but don't always prove infection — and a CT that mentions “bladder wall thickening” isn't proof either. The clearest answer combines your symptoms, urine inflammation, and a urine culture, ideally collected during symptoms and before antibiotics (prior antibiotics can make a culture falsely negative).
• Symptoms can overlap with other things — overactive bladder or pelvic-floor spasm, vaginal dryness or irritation, kidney stones, incomplete emptying, or non-urologic pelvic and back pain. Treating these as infections with repeated antibiotics doesn't help and can cause resistance, yeast infections, and side effects.

Recurrent UTIs usually means 2 or more infections in 6 months, or 3 or more in a year. We look at the whole pattern — your symptoms, urine inflammation, culture history, prior antibiotics, and any kidney, bladder, or prostate factors.

• PCR / molecular urine testing can help in select tricky cases — for example, when cultures keep coming back negative or antibiotics were already started. But more sensitive isn't always better: a positive PCR can pick up harmless, leftover, or contaminating bacteria, so we read it together with your symptoms and history. A positive test by itself is not automatically an infection.
• We usually don't test or treat when you feel well. Bacteria can live in the urine without causing symptoms (called asymptomatic bacteriuria), and treating that tends to do more harm than good — with a few exceptions, like pregnancy or before certain procedures.

The “plumbing” check. Beyond choosing an antibiotic, urology looks for a fixable cause — incomplete bladder emptying, kidney swelling (hydronephrosis), stones, bladder-outlet or urethral narrowing, and, in men, the prostate. A bladder scan, selective imaging, or cystoscopy may be used when there are warning signs (such as blood in the urine, a smoking history, stones, or unusual symptoms), but these are not routine for every straightforward case.

• Women and men differ. In women, recurrent infections are common and menopause-related tissue changes often play a role — vaginal estrogen is one of the most useful non-antibiotic options. In men, recurrent infections more often point to the prostate or incomplete emptying from an enlarged prostate, which may need a different plan.
• Prevention is individualized. Depending on the cause, options include better hydration, vaginal estrogen after menopause, cranberry or methenamine, and carefully chosen preventive antibiotics. (Evidence for D-mannose is weaker after a 2024 trial.)

To your visit, please bring prior urine cultures or PCR results, imaging reports or discs, a list of antibiotics you've taken, and a timeline of your symptoms.

Finding blood in the urine — called hematuria — can be stressful, but most people who are evaluated do not turn out to have cancer. It comes in two forms: microscopic hematuria (seen only under the microscope on a urine test — you can't see it yourself) and visible (gross) hematuria (urine that looks pink, red, tea-colored, brown, or bloody). Visible blood usually needs a more complete evaluation.

Common causes include urinary infections or inflammation, kidney or bladder stones, an enlarged prostate, a recent catheter or procedure, vigorous exercise, benign kidney cysts, or medical kidney disease — and, less often, bladder, kidney, or upper-tract cancers. Sometimes no cause is found.

The testing is matched to your risk — based on your age, sex, smoking history, how much blood is present, whether it's microscopic or visible, and whether it keeps coming back. Not everyone needs the same tests. The workup may include:

• A repeat urine test to see whether microscopic blood clears or persists — often all that's needed for low-risk cases.
• Cystoscopy: a brief office camera look at the bladder and (in men) the prostate channel, done with numbing jelly; most patients drive themselves home. Imaging alone can't reliably rule out a bladder problem, which is why this matters.
• Kidney/bladder ultrasound: a no-radiation look at the kidneys and bladder, often used for intermediate-risk cases.
• CT urogram: a detailed CT scan with contrast of the kidneys, ureters, and bladder, used for higher-risk cases or visible blood when appropriate.
• Urine culture or cytology in selected cases (a culture checks for infection; cytology looks for abnormal cells).

When bleeding is severe: cystoscopy & clot evacuation

Most blood in the urine is evaluated in the office. Occasionally the bleeding is heavy enough that clots fill the bladder and block it — and that is treated in the hospital, with a procedure called a cystoscopy with clot evacuation. If that is what happened to you, this is what it was for.

Many cases of blood in the urine can be watched or managed with a catheter and bladder irrigation. When clots fill or block the bladder and bedside irrigation is not enough, the urologist may recommend a hospital procedure — a cystoscopy with clot evacuation — to clear the bladder and control the bleeding.

What the procedure is for:

• Remove clots from the bladder and relieve painful blockage or stretching
• Help the catheter drain better
• Look for the source of bleeding and control active bleeding when it can be safely seen
• Stabilize the situation so a longer-term plan can be made

Common reasons for severe bladder bleeding include an enlarged or bleeding prostate, a bladder tumor or growth, radiation cystitis after pelvic radiation, recent catheter irritation or trauma, infection, blood-thinner use or a bleeding tendency, or bleeding after a urologic procedure. Sometimes no clear source is seen right away.

What happens during the procedure

• Before: the team reviews your imaging, labs, catheter drainage, blood-thinner status, and overall medical risk.
• Anesthesia: most patients receive anesthesia so the procedure can be done safely and comfortably.
• Cystoscopy: a small camera is passed through the urinary channel into the bladder — there is usually no abdominal incision.
• Clot evacuation & bleeding control: the urologist washes out and suctions old blood and clots, inspects the bladder lining, and may cauterize visible bleeding, take a biopsy, or remove abnormal tissue when safe. A Foley catheter is usually placed at the end.

After the procedure and going home

• Most patients wake up with a urinary catheter, which drains the bladder, lets the team watch urine color, and helps prevent new clots from blocking flow. Some patients continue continuous bladder irrigation (sterile fluid gently flushing the bladder).
• Light pink or red urine is normal while the bladder heals, and the color may change with movement, hydration, and bladder spasms.
• Will I go home with the catheter? Sometimes it is removed in the hospital for a voiding trial; sometimes it is safer to go home with the catheter and return to clinic for removal — especially after a large clot burden, bladder stretching, an enlarged prostate, ongoing bleeding, or prior retention.
• Even when the bleeding improves, urology may still need to review imaging, urine tests, pathology, your catheter plan, and your blood-thinner plan, and decide whether you need repeat cystoscopy, a CT urogram, prostate treatment, radiation-cystitis treatment, bladder-tumor treatment, or surveillance. Keep your follow-up to finish the evaluation.

Hearing “bladder mass” or “possible bladder cancer” is frightening — but the evaluation is very stepwise, and we don't decide treatment from a scan or a single look. A bladder mass is simply an abnormal area inside the bladder, usually found on cystoscopy or imaging (CT or ultrasound), most often because of blood in the urine. It isn't truly diagnosed until a sample is removed and reviewed by a pathologist.

The reassuring part: many bladder tumors are caught early, before they reach the bladder muscle (“non-muscle-invasive”), and many can be treated and followed entirely through the urinary channel — no abdominal cuts or major surgery.

TURBT — the key first procedure. TURBT (transurethral resection of bladder tumor) uses a scope passed through the urinary channel to remove or biopsy the visible tumor — there are no abdominal incisions. For many early tumors, this is also the first treatment. The tissue goes to pathology, and most patients go home the same day (sometimes with a temporary catheter; some mild bleeding, burning, and frequent urination afterward are normal).

The pathology report is the turning point. It tells the grade (how aggressive the cells look — low vs. high grade) and the stage (how deep it goes). The most important split is:

• Non-muscle-invasive (Ta, T1, or CIS): on or just under the bladder lining, not into the muscle — often managed with local urology care.
• Muscle-invasive (T2): the cancer has reached the bladder muscle — a different category that usually involves a larger treatment team.

Sometimes a second (repeat) TURBT is recommended soon after — for example if the tumor was high-grade, large, or T1, or if muscle wasn't in the first sample — to confirm the stage and clear any remaining tumor.

Treatment is guided by your risk group. For non-muscle-invasive cancer, low-risk disease is often TURBT plus surveillance; intermediate- and high-risk disease often add medicine placed directly into the bladder (“intravesical therapy” — through a small catheter, not IV chemotherapy) such as gemcitabine, mitomycin, or BCG. Muscle-invasive cancer is managed by a larger team and may involve chemotherapy, immunotherapy, radiation, bladder removal, or bladder-preserving approaches.

Follow-up is part of treatment. Bladder cancer (especially non-muscle-invasive) can come back, so surveillance cystoscopy is routine, on a schedule matched to your risk group.

The first question with urinary leakage is what type it is, because the treatment is different:

• Urgency leakage (overactive bladder): a sudden "I have to go right now" feeling, frequent trips, waking at night, or leaking before you reach the toilet.
• Stress leakage: leaking with coughing, laughing, sneezing, lifting, or exercise — usually related to pelvic floor support.

Many women have both (mixed leakage); we'll decide together which is most bothersome. Workup may include a symptom review, urine testing, a look inside the bladder (cystoscopy), and a cough stress test.

A vasectomy is considered permanent birth control. Only choose it if you're comfortable with permanent sterilization — if you're unsure, it's better to wait.

• What changes: Sperm is blocked from the semen. Testosterone, sex drive, erections, orgasm, and ejaculation should not change; semen looks essentially the same.
• Where it's done: About 90–95% of vasectomies are done in clinic with local numbing only. Many patients drive themselves home; bring a driver if you're nervous, prone to fainting, or take sedating medicine.
• Recovery: Plan for light duty 3–7 days, use scrotal support and ice, and avoid heavy lifting and strenuous activity until improving.
• It doesn't work right away. Keep using birth control until a semen test (usually 8–16 weeks later) confirms success. A vasectomy does not protect against STIs.

ED means difficulty getting or keeping an erection firm enough for satisfactory sex. It's very common, especially with age, and is often treatable. Because penile blood vessels are small, ED can sometimes be an early sign of cardiovascular disease — so it isn't just a "penis problem."

• Why a broader check-up helps: We often review diabetes (A1c), cholesterol, blood pressure, medications, cardiovascular risk, and testosterone when symptoms suggest it.
• First-line treatment is usually pills: PDE-5 inhibitors such as sildenafil (Viagra) or tadalafil (Cialis) improve blood flow — sexual stimulation is still needed.
• Important safety warning: Do not combine ED pills with nitrates (nitroglycerin, isosorbide) or "poppers" — the combination can cause a dangerous drop in blood pressure. Tell us about any chest pain or heart disease.
• If pills aren't enough: options include a vacuum erection device, penile injection therapy, intraurethral medication, or an inflatable penile prosthesis (surgery).

A testicular lump or mass can feel scary, but the first step is a careful, organized evaluation — and not every lump is cancer. Many findings come from the epididymis, cysts, fluid collections, infection, inflammation, or veins. A solid mass inside the testicle, however, needs prompt evaluation.

At your visit we review your symptoms, examine you, and usually order a scrotal ultrasound, which helps tell whether a mass is coming from the testicle itself or from nearby structures.

If a tumor is suspected — radical (inguinal) orchiectomy. If the ultrasound is concerning for a testicular tumor, the usual next steps are blood tests called tumor markers (often AFP, beta-hCG, and LDH), and sometimes imaging of the chest, abdomen, and pelvis.

• When testicular cancer is suspected, the standard surgery is a radical inguinal orchiectomy — the testicle is removed through a small groin incision rather than through the scrotum.
• The testicle is sent to pathology, and those results — together with your tumor markers and imaging — guide whether any additional treatment or monitoring (surveillance) is needed.
• Tumor-marker labs may be checked both before and after surgery.

Removal for benign (non-cancer) reasons — simple orchiectomy. Not every orchiectomy is for cancer. Sometimes a testicle is removed for benign reasons — this is a simple orchiectomy.

• Common reasons include ongoing testicular pain that hasn’t improved with other treatments, a severely damaged or non-functional testicle, chronic inflammation, recurrent infection or abscess, or other situations where the testicle is no longer healthy or is causing problems.
• A simple orchiectomy is usually done through a scrotal incision rather than the groin. In some cases a small temporary drain is left to help keep fluid or blood from collecting.
• The evaluation depends on the reason and may include an exam, urine testing, scrotal ultrasound, review of prior imaging, or treating infection or inflammation before deciding on surgery.

How your appointment gets scheduled. Your hospital team placed a referral to urology at discharge, and the office will call you. If you have not heard from anyone within 3 business days, please call us at 832.556.6046. Some visits start with the urology nurse practitioner (catheter removal, medication follow-up, mild imaging findings) and some are directly with Dr. Mehta — both are the same team working from the same plan.

What to bring:

• Your hospital discharge papers
• A list of your medicines, including blood thinners
• The date and location of any CT scan or ultrasound — bring a disc or USB if it was done outside Houston Methodist, not just the report
• Your stone, if you caught one in a strainer
• Notes on your symptoms since discharge