Robert G. Pugach - Sorbet
Robert G. Pugach

Robert G. Pugach

To schedule an appointment, call 888-735-4336.  For prostate cancer diagnosis and treatment questions, the direct line is 844-HIFU DOC (844-443-8362).  For the No Needle/No Scalpel vasectomy, the direct line is 844-Easy Vas (844-327-9827).

A very important large clinical study was presented at the European Association of Urology 2021 Annual Meeting (EAU 2021).  The findings from the largest United States analysis for treatment of benign prostatic hyperplasia (BPH) reveal that overall complication rates are lowest after treatment with the Urolift® System when compared to surgery and other minimally invasive procedures.

The study clearly demonstrates that complication rates following surgery for BPH are higher than treatment with the minimally invasive Urolift® System. Dr. Daniel Rukstalis explains the importance of this study as research in the area of surgical or minimally invasive procedures for BPH is sparse. “We found the UroLift System had the lowest overall rate of complications at 300-days post-treatment,” says Dr. Rukstalis1.

As an early user of the Urolift® System and a certified Urolift® Center of Excellence2, and certified instructor for the Urolift technique, I am very excited to see clinical data that confirms the excellent outcomes my BPH patients experience in my private urology practice. Treating men with BPH, also known as enlarged prostate, is a major focus for minimally invasive treatments at Pacific Coast Urology Medical Center.

Many of my patients are surprised to learn that over 40 million men in the United States are affected by BPH. This condition occurs when the prostate gland that surrounds the male urethra becomes enlarged with advancing age and begins to obstruct the urinary system. While BPH is not life-threatening, the symptoms include interrupted sleep, daytime frequent urination, leakage of urine and an urgent need to urinate. Sometimes, it’s not possible to get to the bathroom in time! Urinary problems can cause loss of productivity, depression and decreased quality of life.

While medication has been the first-line therapy for enlarged prostate in the past, the treatment is often inadequate. Many patients do not experience adequate relief of symptoms. There are a number of side effects including, sexual dysfunction, dizziness, episodes of falling down and headaches. AND, NOW THERE IS MEDICAL DATA THAT SHOWS MEDICATION HAS BEEN LINKED TO DEMENTIA AND DEPRESSION.

When medication does not improve the quality of life for patients, the next treatment alternative often recommended by urologists is surgery. Unfortunately, surgery requires cutting, heating and/or removal of the prostate tissue to open the blocked urethra and can have numerous complications.

This large study documents that while surgical options can be effective in relieving symptoms, they can also leave patients with permanent side effects such as urinary incontinence, erectile dysfunction, and retrograde ejaculation.

With the FDA approved in-office Prostatic Urethral Lift Procedure we now have a truly minimally invasive procedure that affords patients the relief of symptoms without the effects and complications of surgery or medications. If you’re taking a medication, you should know that Urolift is 3 times as effective as any medication for prostate growth symptoms.

The FDA-cleared Prostatic Urethral Lift procedure using the UroLift® System is a clinically proven, minimally invasive technology for treating lower urinary tract symptoms due to BPH. If you would like to treat your BPH and learn more about the UroLift® System - done in an outpatient setting without cutting, heating, or removing prostate tissue, call to schedule your consultation.

Interstim® 2ND generation bladder control device can help!

An overactive bladder (OAB) can result in too frequent trips to the bathroom, bladder leakage or urinary retention.  These are common bladder symptoms that affect both women and men.

Bladder control problems should NEVER be considered a normal part of aging. Oftentimes, we cover up OAB symptoms and use expensive pads or diapers during the day. If you have tried treatments including limiting fluids, physical therapy exercises, bladder control medications or even bladder surgery - with limited or no success - there is an amazing alternative solution that can be effective for you!

Depositphotos 13942592 xl 2015The alternative is to continue to limit social and physical activities, family or friend interactions and physical intimacy.

At Pacific Coast Urology Medical Center’s Women’s Bladder Control program, we have treated thousands of bladder control patients. When medications and other treatment options prove to be ineffective, we offer a medical device called InterStim®.

InterStim® is a tiny battery that is placed under your skin to deliver a signal to the nerves that control the bladder. This remarkable FDA-approved device has been in common use in the United States for more than 20 years!

Now, there is an improved battery that is MRI safe so you no longer need to be concerned about other effects.

How does InterStim® work?

One of the main causes of an overactive bladder or urinary retention is in the nerves that are near your tailbone. These nerves are responsible for controlling bladder function. Any disruption to these nerves may potentially cause bladder changes that include frequency, sudden urges, inability to make it to the bathroom in time, incomplete emptying or nighttime urination.

The Interstim® device sends a gentle, constant electrical impulse to the nerves that control the bladder and restores the bladder function. You will have a controller that is periodically used to adjust the setting of the battery/pacemaker and ensure that it is working properly. The results are typically immediate and the relief you feel is amazing.  You won’t even know when it’s working – it’s painless!

“Getting the Interstim therapy has created a new life for me. It’s terrific to be able to go out and run errands without having to plan “pit stops.” It’s truly wonderful being back to normal, to walk to the bathroom, particularly when I’m out in public. It gives me a great sense of security to no longer be obsessed with the need to control my bladder.” - MaryAnn K.

Read more patient reviews and view videos at https://www.pacificcoasturology.com/patient-videos/bladder-control/


Bladder Control is the most common urological problem we treat at Pacific Coast Urology Medical Center. Call us at 888.735.4336 to schedule your appointment.

Benign prostatic hyperplasia, (BPH), is a condition in men in which the prostate gland is enlarged and not cancerous.  BPH causes men to suffer with symptoms of frequent and urgent needs to urinate (especially at night!), a weak stream, dribbling or leaking and painful urination.

These symptoms make it difficult for men to enjoy many activities of daily living, including getting a good night’s sleep.

BPH is the most common prostate problem for men older than age 50. Treatment options for BPH include lifestyle changes, medications, surgery and minimally invasive procedures. For some doctors, the customary treatment is to prescribe medications but, besides being costly and having side effects, they can slightly relieve BPH symptoms in 25% of patients. Treatment effects are temporary because the prostate continues to grow and make medication ineffective.

At Pacific Coast Urology Medical Center, I advise my BPH patients that there are non-surgical treatment options that are 2-3 times more effective than medications.

One such new minimally invasive technology is The Urolift© System. Urolift© relieves prostate obstruction and opens the urethra directly by retracting the obstructing prostatic lobes. Small UroLift© Implants are used to hold the lobes in the retracted position, to open the urethra while leaving the prostate intact. The end result of a Urolift© procedure is the creation of an open urethral channel in less than 5 minutes! Catheters are rarely needed afterwards. And sexual function is never affected!

For men who are considered good candidates for Urolift©, success rates are around 90%. UroLift© has consistently demonstrated an excellent safety and benefit profile. Urolift® is FDA approved and is covered by Medicare and most other insurance plans.

If you suffer from BPH and are concerned about preserving your sexual function and your quality of life, call Pacific Coast Urology at 888-735-4336, to schedule an appointment to see if you’re a candidate for Urolift©.

Benign prostatic hyperplasia, (BPH), is a condition in men in which the prostate gland is enlarged and not cancerous.  BPH causes men to suffer with symptoms of frequent and urgent needs to urinate (especially at night!), a weak stream, dribbling or leaking and painful urination.

These symptoms make it difficult for men to enjoy many activities of daily living, including getting a good night’s sleep.

BPH is the most common prostate problem for men older than age 50. Treatment options for BPH include lifestyle changes, medications, surgery and minimally invasive procedures. For some doctors, the customary treatment is to prescribe medications but, besides being costly and having side effects, they can slightly relieve BPH symptoms in 25% of patients. Treatment effects are temporary because the prostate continues to grow and make medication ineffective.

At Pacific Coast Urology Medical Center, I advise my BPH patients that there are non-surgical treatment options that are 2-3 times more effective than medications.

One such new minimally invasive technology is The Urolift© System. Urolift© relieves prostate obstruction and opens the urethra directly by retracting the obstructing prostatic lobes. Small UroLift© Implants are used to hold the lobes in the retracted position, to open the urethra while leaving the prostate intact. The end result of a Urolift© procedure is the creation of an open urethral channel in less than 5 minutes! Catheters are rarely needed afterwards. And sexual function is never affected!

For men who are considered good candidates for Urolift©, success rates are around 90%. UroLift© has consistently demonstrated an excellent safety and benefit profile. Urolift® is FDA approved and is covered by Medicare and most other insurance plans.

If you suffer from BPH and are concerned about preserving your sexual function and your quality of life, call Pacific Coast Urology at 888-735-4336, to schedule an appointment to see if you’re a candidate for Urolift©.

Did you know that more than 8 million doctor’s office visits per year in the US are for Urinary Tract Infections (UTI’s)?  This common and treatable condition affects men and women of all ages; however, it is more commonly seen in women and the frequency of infections tends to increase with age.

In fact, urinary incontinence is twice as common in women as it is in men and more than 50% of older women struggle with involuntary leakage of urine.

If you have had a UTI, you know that it is an uncomfortable condition. The symptoms range from milder symptoms of painful urination, frequent trips to the bathroom and a feeling of urgency to more severe symptoms of lower abdominal or pelvic pain and pressure, fever, blood in the urine, and milky, cloudy, or pink/red foul smelling urine. All UTI’s should be treated!

As a urologist, I treat many patients suffering from recurrent UTI’s, (those who experience three or more UTI’s within a year). These women often wonder why they are getting frequent UTI’s despite antibiotic treatment and practicing good hygiene. Many of the women treated at Pacific Coast Urology Medical Center’s Women’s Bladder Control Center of Excellence are surprised to learn about the correlation of frequent UTI’s and incontinence.

Evans Tran, PA, Director of our Women’s Bladder Center conducts a thorough medical examination and lifestyle evaluation. “For women who wear absorbent pads or adult diapers, to cope with their involuntary leakage, we know there is a higher incidence of UTI’s,” says Ms. Tran.

Why is this the case? Simply because contact between wet absorbent pads or diapers and vaginal skin is a breeding ground for bacteria. There is no need to continue to wear pads when minimally invasive technologies to treat incontinence are available. We can help you with your incontinence and help you avoid another UTI. Schedule your consultation today!


Pacific Coast Urology Medical Center and Western States HIFU is one of the leading medical practices in the US specializing in diagnosis and treatment of bladder control for men and women. Call (562) 594-0860 or visit www.pacificcoasturology.com

I have just been treated for prostate cancer.  This is my personal story.  My prostate cancer was diagnosed last year.

My internist, as part of my annual check-up, ordered a PSA blood test and I requested that a “free” PSA be added to the total PSA level that is typically done. The next step was to undergo a biopsy, where a colleague of mine, got the honor/task of doing my biopsy. My biopsy showed a miniscule focus of cancer.

So, what to do about a tiny, moderately aggressive prostate cancer? Well, some would do nothing. I am a candidate for “active surveillance” or “watchful waiting.” There are many patients whose cancers will never progress to the point where they pose a danger.

My concern about that approach is that no one really knows what we are waiting for. There is no level of PSA and there is no imaging study that says when we must treat prostate cancer. Add to that the fact that 37% of men have more aggressive or more extensive prostate cancer than what is found on biopsy.

I am not a gambler, especially when it comes to my health. I desire and plan to live a long, healthy life. So, I’ve decided to have my prostate cancer treated with High Intensity Focused Ultrasound (HIFU).

In the weeks leading up to my treatment, I was surprisingly calm. I can honestly say that I never had a moment of fear, anger, panic or any of the other emotions that many of my patients have shared with me in over 30 years of treating this potentially lethal, terrible disease.

The reason for my attitude was that my cancer was diagnosed at the earliest possible stage. The odds are overwhelmingly likely that it will never return. That meant that I was in charge of my cancer instead of it being in charge of me. I was spared the fear that patients experience when they are diagnosed with advanced prostate cancer that can be extensive or aggressive and, potentially, not curable.

I was also calm because I had the utmost confidence in my doctor. Like me, he had been traveling to other countries for the past 10 years treating patients with HIFU. On the morning of my procedure I awoke at 4:30 AM for my final HIFU preparations and went to the surgery center.

I woke up in the recovery room four hours later and saw my wife’s smiling face. I was a bit groggy, but pain free and comfortable. My doctor confirmed that my procedure went perfectly! Within an hour or so after waking up I was discharged.

There was no pain. The catheter was a bit uncomfortable. I had no ill effects and enjoyed a meal of clam chowder and pizza. I arrived in San Francisco with prostate cancer and would leave the following day cancer free. I had a HIFU procedure that has a 3% chance of bladder control problems and a 5-10% chance of erectile dysfunction. Contrast that with surgery where incontinence rates are typically 35% or higher and erectile dysfunction is common. I was able to return to normal activities 3 days later!

The key to successful treatment of prostate cancer is to have it diagnosed at its earliest stage so HIFU is a treatment option. I can tell you now, from my personal experience, that it’s the key to getting on with your life while leaving you whole.

I’ve been a practicing urologist for just over 30 years. I have always stressed the importance of annual prostate screening because early diagnosis saves lives.  While some feel that delaying the diagnosis or treatment of prostate cancer is justified, rising death rates from prostate cancer show that this approach is ill advised.

Prostate cancer is detected with a 15 second prostate examination and a blood test.  If either of those are abnormal, a prostate biopsy is the next step.  It’s virtually painless.  I can vouch for that because I just had one done! 

Traditional biopsies are done with ultrasound guidance in the office.  Now, there is a dramatic improvement in biopsy procedures.  For the first time, urologists have the remarkable imaging advances that most other areas of medicine use in biopsies of other areas of our bodies, including breasts, kidneys, bones, abdominal masses, etc.  Until now, doing a prostate biopsy did not benefit from the precision of real time imaging to direct a biopsy needle into an abnormal area. 

At Western States HIFU/Pacific Coast Urology Medical Center, we are proud to be the FIRST private practice west of the Mississippi to offer UroNav – an advanced technology for patients who may have prostate cancer!  This is truly a potential game changer in both diagnosis and treatment of prostate cancer.  

UroNav is a software program that fuses MRI images of the prostate with instant ultrasound images from our state-of-the-art GE Medical Systems Ultrasound system. Our new, GE Logic 8 is one of the most sophisticated ultrasound units in the world, allowing us to merge MRI data with ultrasound images, so our patients get the most precise biopsies possible. This can result in little or no damage to surrounding prostate tissue!  UroNav has the potential to diagnose and treat prostate cancer with more precision than ever before!

What does that mean for you?  I can give you proper information and counseling about your prostate cancer so you can choose among many treatment options that include surveillance (watchful waiting), radical robotic surgery, radiation (from proton beams to cyberknifes), cryoablation and the latest FDA-approved High Intensity Focused Ultrasound (HIFU).  We are the most experienced HIFU practice in the western United States to help you navigate all of your treatment options and choose what is best for your cancer.  Learn more about these treatment options at www.WesternStatesHifu.com

UroNav in detail:

We begin with a state-of-the-art multiparametric MRI.  Once MRI images are acquired, they are transmitted to our offices and uploaded into the UroNav software platform.  UroNav then “fuses” the MRI images into our GE ultrasound system so I can aim exactly where abnormal areas are located.

There is an even more amazing concept to fusion targeted biopsies with UroNav. We can fuse the biopsy images with the Sonablate HIFU treatment system so I can target specific areas of cancer in the prostate while sparing healthy tissue. The result is shorter treatment times, faster recovery periods and better cancer treatment outcomes.

Men are travelling to our offices from all over the country because of our experience and excellent outcomes.  With the addition of UroNav, I’m proud to remain at the forefront of the latest in targeted biopsies and focal HIFU treatment.

It seems as if not a month goes by where we read headlines proclaiming new medical breakthroughs. A recent headline and article in the AARP Bulletin caught my attention. In the article, Brave New Worlds in Diagnosing Diseases, several new promising diagnostic tests, including one about a new prostate cancer assay, were outlined.

The test they discussed was captioned as a “less-guess” prostate test, the Oncotype Dx Prostate Cancer Assay test. While the AARP article implied that this was a brand new test, we’ve actually been using it at Pacific Coast Urology Medical Center for the past 6 months. We’ve been evaluating and using tests like this for the past several years. We made the switch to the Oncotype Dx test because it seems to provide better information than tests promoted by other companies.

The Oncotype Dx test looks at cancer from a molecular level. This new medical field is called genomics. By analyzing DNA sequences in prostate cancer specimens, it has the potential to give us far more precise information about an individual patient’s cancer than a traditional pathologist can do using slides and a microscope. It may become extremely valuable in helping to determine which prostate cancers need treatment and what type of treatment should be provided.

Do tests like Oncotype Dx replace standard prostate cancer screening measures like an annual digital rectal exam (DRE) and PSA blood test? Can it replace prostate biopsies? The answer to both questions is “definitely not.” Screening for prostate cancer remains the only way to determine if a patient may have it. Unfortunately, the death toll from prostate cancer is on the rise. Since the ill-advised recommendations of the U.S. Preventive Services Task Force three years ago, that advised against routine screening for all men, the number of cases of advanced, incurable prostate cancer has risen significantly. Equally worrisome is the fact that it has been responsible for more prostate cancer deaths. In 2011, 29,000 men died of prostate cancer; this year that number will be 30,400.

So, while all men should be screened for prostate cancer, the good news is that new tests like Oncotype Dx may help to target treatments only for those men with more aggressive genetic tumor markers. It may also allow us to develop therapies that target the genetic basis of cancer so that more minimally invasive therapies can be developed.

At Pacific Coast Urology Medical Center, we’re proud of the international reputation we have earned in the field of diagnosis and treatment of prostate cancer. If you haven’t been screened for prostate cancer in the past 12 months call us to schedule this potentially life-saving test.

Bladder control problems affect 50 million Americans and it is one of the most common health problems that women face. While many think that the condition only affects older women, the truth is that women of all ages may have urine leakage (incontinence) or other bladder control issues.

There are four main categories of bladder control problems:

Stress incontinence - leaking urine when you cough, sneeze, laugh or exercise. This occurs when the pelvic and sphincter muscles become weak or the urethra loses its support and moves too much.

Urge incontinence - leaking urine after a sudden and strong urge to urinate. This problem may be caused by nerve damage from diabetes, infection, a stroke, back problems, hormone imbalance or other medical conditions.

Overactive bladder - the need to urinate frequently during the day and/or getting up to urinate during the night. With this condition you may also have urge incontinence.

Mixed incontinence - a combination of stress and urge incontinence.

Some of these symptoms can get so bad that some women rarely leave home because of embarrassing leakage. At Pacific Coast Urology’s Bladder Control Center for Women we have helped countless women regain bladder control and return to the activities they love. From new medications to advanced biofeedback exercises, acupuncture (PTNS) to minimally invasive outpatient surgical procedures using a battery (Interstim®), there is an answer for most women that can help.

Pacific Coast Urology Medical Center, led by Dr. Robert Pugach, is one of the leading medical practices in the US specializing in the minimally invasive treatment of urological conditions, including procedures to improve and correct bladder control.

Connect with Dr. Pugach by calling (888) 735-4336 or visit www.pacificcoasturology.com

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