Sandeep Mehta, MD

If any imaging, labs, biopsy/pathology reports, or urology records were done outside Houston Methodist, please bring them with you. Bring the actual imaging on a disc or USB plus printed reports — not just the report text. For many urology conditions, the doctor needs to personally review the actual images.

Please don't rely on faxing or other offices. Faxed records are often late, incomplete, or never arrive — which can delay your care.

What to bring if done outside Houston Methodist:

• Actual imaging on disc or USB: CT, MRI, ultrasound, X-ray, PET scan
• Printed imaging reports
• Prior urology records and operative reports
• Primary care or referring doctor notes
• Pathology or biopsy reports
• Recent labs (PSA, kidney function, urine tests, tumor markers)
• Current medication list — especially blood thinners

Care moves faster when testing and clearances are completed before your follow-up or surgery. Our office places orders and gives instructions; patients are responsible for completing testing and scheduling imaging.

• Imaging: We place the order, but you schedule your own imaging appointment using the number provided. Our clinic does not schedule imaging for patients.
• Labs: We don't draw labs in the office. Orders usually go to Quest Diagnostics — complete them before your follow-up when instructed.
• Surgery & medical clearances: You may need clearance from your primary care doctor, cardiologist, or other specialists — especially if you take blood thinners or have heart or lung conditions.

Urologists and nephrologists both care for kidney-related problems but focus on different things. Urology is the plumbing and surgical side; nephrology is the medical kidney-function side.

If you were referred to urology, we'll review the referral and confirm there's a urologic issue we can help with. If the problem is mainly kidney function, we may recommend follow-up with your primary care doctor or a nephrologist — so you're seen by the right specialist without delay.

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.

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.

Stone referrals often arrive with incomplete information. 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.

• Treatment depends on the stone: options range from observation (small, non-blocking stones) and a medication-assisted trial of passage, to shock-wave therapy (ESWL), ureteroscopy with a laser and a temporary stent, or — for large or complex stones — a procedure through the back (PCNL).
• Preventing the next stone: most stones are calcium-based, and the biggest drivers are usually dehydration and too much salt. Drink enough to keep your urine pale yellow (about 2–2.5 liters a day), cut back on sodium, keep normal dietary calcium with meals, add citrus such as lemon water, and limit sugary drinks.

Your symptoms are real. Our job is to confirm whether they're coming from the urinary tract — and whether there's a urologic "plumbing" problem we can fix.

• One clue alone doesn't prove a UTI. A dipstick, white cells, blood, or cloudy urine can suggest inflammation but don't always prove infection. Matching symptoms plus a urine culture give a clearer answer.
• Symptoms overlap. Back or lower-abdominal pain can come from muscles, spine, pelvic floor, constipation, gynecologic or bowel issues, or nerve pain.
• What urology checks: kidney stones, blockage, incomplete bladder emptying, blood in the urine, anatomy, and (in men) prostate obstruction.
• If we don't find a urinary source, it doesn't mean your symptoms aren't real — the best next step may be primary care, gynecology, GI, pelvic-floor therapy, or pain management.

Please bring prior urine cultures, imaging reports/discs, a list of antibiotics taken, and a timeline of symptoms.

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).

Testosterone is an important male hormone. It affects sex drive, erections, mood, energy, muscle, bone strength, red blood cell production, and sperm production. Levels can be lower because of aging, weight gain, diabetes, sleep apnea, certain medications, chronic illness, pituitary problems, prior cancer treatment, or testicle problems.

Testosterone treatment is considered when both your symptoms and your bloodwork fit low testosterone — we don’t treat the number alone.

• Symptoms that fit: low sex drive, fewer morning erections, ED together with low sex drive, fatigue or low motivation, depressed mood or irritability, or loss of muscle, low bone density, or unexplained anemia.
• Bloodwork that confirms it: we usually need two early-morning testosterone tests showing low levels. Symptoms without truly low testosterone may come from sleep problems, stress, depression, weight, diabetes, medications, or other hormone issues.

For the right patient, testosterone may help sex drive, morning erections in some men, mood in some men, muscle and body composition, bone strength over time, and unexplained anemia in selected men.

Because testosterone has real risks, treatment requires regular blood-test monitoring. Things we watch for include:

• High red blood cell count (polycythemia), acne or oily skin, fluid retention, breast tenderness, and testicle shrinkage
• Lower sperm production or infertility, and worsening of untreated sleep apnea
• Higher blood pressure, a PSA rise that may prompt prostate evaluation, and, in some higher-risk patients, blood-clot or heart-rhythm concerns

There are several ways to take testosterone — all aiming to bring low levels back into a healthy range. There is no single best option for everyone.

• Generic injections (cypionate or enanthate), and the weekly auto-injector (Xyosted)
• Daily gel, skin patch, nasal gel (Natesto), or oral capsules
• Long-acting in-office injection (Aveed), and pellets (we do not place pellets at our Baytown clinic, but include them so you know the full range)

Many products sold for testosterone, muscle, recovery, or “optimization” are not the same as prescribed testosterone and are often not FDA-approved.

• Testosterone boosters, SARMs or research chemicals, peptides, prohormones or “legal steroids,” post-cycle (PCT) stacks, and men’s-clinic products from outside clinics

A urologist-facing evidence reference for testosterone deficiency — intended for clinicians, not as a patient handout. Highlights:

• Diagnosis: compatible symptoms plus two early-morning total testosterone levels (AUA: <300 ng/dL a reasonable cutoff); LH/FSH to distinguish primary vs. secondary hypogonadism; confirm fertility goals before prescribing.
• TRAVERSE (NEJM 2023): physiologic transdermal testosterone was non-inferior for MACE (HR 0.96, 95% CI 0.78–1.17) in symptomatic hypogonadal men with CV disease/risk, with numerically higher atrial fibrillation, PE, and AKI signals.
• FDA 2025 class-wide update: removed the cardiovascular boxed warning, added/strengthened blood-pressure warnings, and retained the limitation-of-use for age-related hypogonadism.
• Fertility-preserving options: SERMs (clomiphene/enclomiphene), aromatase inhibitors, and hCG for men desiring fertility — off-label and conditional.
• Don’t over-promise: energy, cognition, weight loss, ED resolution, or fracture prevention. Includes a screening approach for SARMs, peptides, prohormones, and boosters, plus full references.

Getting here

Houston Methodist Baytown medical campus, 4201 Garth Road, Baytown, Texas. Free patient parking is available on campus.

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