Plaza Ambulatory Surgery Center – providing comprehensive care from head to toe.

  • Gastroenterology


    Gastroenterology is a branch of medicine focused on the digestive system and its disorders. Diseases affecting the gastrointestinal tract, which include the organs from mouth to anus, along the alimentary canal, are the focus of this specialty. Physicians practicing in this field are called gastroenterologists.

    Procedure: Hemorrhoidectomy for Hemorrhoids

    Hemorrhoidectomy is surgery to remove hemorrhoids. You will be given general anesthesia or spinal anesthesia so that you will not feel pain. Incisions are made in the tissue around the hemorrhoid. The swollen vein inside the hemorrhoid is tied off to prevent bleeding, and the hemorrhoid is removed. The surgical area may be sewn closed or left open. Medicated gauze covers the wound. Surgery can be done with a knife (scalpel), a tool that uses electricity, called a cautery pencil, or a laser. There is a procedure that uses a circular stapling device to remove hemorrhoidal tissue and close the wound. No incision is made. In this procedure, the hemorrhoid is lifted and then “stapled” back into place in the anal canal. This surgery is called stapled hemorrhoidopexy. People who have stapled surgery may have less pain after surgery than people who have the traditional hemorrhoid surgery.

    Procedure: Colonoscopy

    Colonoscopy is an outpatient procedure in which your large bowel colon and rectum is examined. Your doctor may perform the procedure to diagnose and treat, when possible, certain diseases of the lower gastrointestinal (GI) tract, which includes the rectum and colon. A colonoscopy may be used to screen for colon cancer and evaluate many problems, including:

    • Abdominal pain
    • Anemia (low red blood cells)
    • Blood in the stool
    • Change in bowel habits
    • Unexplained weight loss

    Colonoscopy is often used to treat certain conditions:

    • Bleeding from diverticula or other lesions can be treated by injecting medicine around them or by applying heat to cauterize — or seal — them.
    • Polyps, some of which may be cancerous, can be removed using a lasso-like device through the colonoscope.
    • Narrowed areas or strictures can often be dilated using a balloon.
  • General Surgery Upper Endo

    Upper Endoscopy

    Esophagogastroduodenoscopy is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract up to the duodenum. It is considered a minimally invasive procedure since it does not require an incision into one of the major body cavities and does not require any significant recovery after the procedure (unless sedation or anesthesia has been used). However, a sore throat is common. Upper GI endoscopy is a procedure in which a doctor uses an endoscope—a long, flexible tube with a camera—to see the lining of your upper GI tract. A gastroenterologist, surgeon, or other trained health care provider performs the procedure, most often while you receive light sedation. Your doctor may also call the procedure an EGD or esophagogastroduodenoscopy. Upper GI endoscopy can help find the cause of unexplained symptoms, such as

    • persistent heartburn
    • bleeding
    • nausea and vomiting
    • pain
    • problems swallowing
    • unexplained weight loss

    Upper GI endoscopy can also find the cause of abnormal lab tests, such as

    • anemia
    • nutritional deficiencies

    Upper GI endoscopy can identify many different diseases

    • anemia
    • gastroesophageal reflux disease
    • ulcers
    • cancer
    • inflammation, or swelling
    • precancerous abnormalities
    • celiac disease

    During upper GI endoscopy, a doctor obtains biopsies by passing an instrument through the endoscope to obtain a small piece of tissue. Biopsies are needed to diagnose conditions such as

    • cancer
    • celiac disease
    • gastritis

    Doctors also use upper GI endoscopy to

    • treat conditions such as bleeding ulcers
    • dilate strictures with a small balloon passed through the endoscope
    • remove objects, including food, that may be stuck in the upper GI tract
  • General Surgery

    General Surgery

    General Surgery is a surgical specialty that focuses on abdominal contents including esophagus, stomach, small bowel, colon, liver, pancreas, gallbladder and bile ducts, and often the thyroid gland.

    Procedure Laparoscopic Inguinal Hernia Repair

    Laparoscopic hernia repair is similar to other laparoscopic procedures. General anesthesia is given, and a small incision is made in or just below the navel. The abdomen is inflated with air so that the surgeon can see the abdominal organs.

    A thin, lighted scope called a laparoscope is inserted through the incision. The instruments to repair the hernia are inserted through other small incisions in the lower abdomen. Mesh is then placed over the defect to reinforce the belly wall.

    After your laparoscopic hernia repair surgery you are able to go home the same day. Recovery time is about 1 to 2 weeks. You most likely can return to light activity after 1 to 2 weeks. Strenuous exercise should wait until after 4 weeks of recovery.

    Procedure: Open Inguinal Hernia Repair

    For open hernia repair surgery, a single long incision is made in the groin. If the hernia is bulging out of the abdominal wall the bulge is pushed back into place. If the hernia is going down theinguinal canal the hernia sac is either pushed back or tied off and removed.

    The weak spot in the muscle wall, where the hernia bulges through, traditionally has been repaired by sewing the edges of healthy muscle tissue together. This is appropriate for smaller hernias that have been present since birth and for healthy tissues, where it is possible to use stitches without adding stress on the tissue. But the surgical approach varies depending on the area of muscle wall to be repaired and the surgeon’s preference.

    Mesh patches of synthetic material are now being widely used to repair hernias. This is especially true for large hernias and for hernias that reoccur. Patches are sewn over the weakened area in the abdominal wall after the hernia is pushed back into place. The patch decreases the tension on the weakened belly wall, reducing the risk that a hernia

  • Gynecology


    Gynecology is the medical practice dealing with the health of the female reproductive systems and the breasts. Almost all modern gynecologists are also obstetricians. In many areas, the specialties of gynecology and obstetrics overlap.

    Procedure: Hysteroscopy

    A hysteroscopy is a way for your doctor to look at the lining of youruterus. He or she uses a thin viewing tool called a hysteroscope. The tip of the hysteroscope is put into your vagina and gently moved through the cervix into the uterus. The hysteroscope has a light and camera hooked to it so your doctor can see the lining on a video screen.

    A hysteroscopy may be done to find the cause of abnormal bleeding or bleeding that occurs after a woman has passed menopause. It also may be done to see if a problem in your uterus is preventing you from becoming pregnant. A hysteroscopy can be used to remove growths in the uterus, such as fibroids or polyps.

    Your doctor may take a small sample of tissue.The sample is looked at under a microscope for problems. Another surgery, called alaparoscopy, may also be done at the same time as a hysteroscopy ifinfertility is a problem.

    A hysteroscopy may be done to:

    • Find the cause of severe cramping or abnormal bleeding. Your doctor can pass heated tools through the hysteroscope to stop the bleeding.
    • See whether a problem in the shape or size of the uterus or if scar tissue in the uterus is the cause of infertility.
    • Look at the uterine openings to the fallopian tubes. If the tubes are blocked, your doctor may be able to open the tubes with special tools passed through the hysteroscope.
    • Find the possible cause of repeated miscarriages. Other tests may also be done.
    • Find and remove a misplaced intrauterine device (IUD).
    • Find and remove small fibroids or polyps.
    • Check for endometrial cancer.
    • Use heated tools to remove problem areas in the lining of the uterus, called an endometrial ablation.
    • Place a contraceptive implant into the opening of the fallopian tubes as a method of permanent sterilization.

    How it works:

    A hysteroscopy is done by your gynecologist in the operating room of an ambulatory surgery center. You will be given anesthesia to help you relax, to numb the area, or to help you sleep.

    You will take off all of your clothes and wear a gown for the test. You will empty your bladder before the test. You will then lie on your back on an examination table with your feet raised and supported by footrests (stirrups).Your doctor will insert a lubricated tool called a speculum into yourvagina. The speculum gently spreads apart the vaginal walls so your doctor can see inside the vagina and the cervix. Your vagina will be cleaned with a special soap.

    The hysteroscope will be placed at the entrance to your vagina and gently moved through the cervix into your uterus. A gas or liquid will be put through the hysteroscope into your uterus to help your doctor see the lining clearly. Your doctor looks through the hysteroscope at a magnified view of the lining of your uterus. Your doctor can also see the uterine openings of the fallopian tubes. A video screen may be used during the test.

    If a biopsy or other procedure is done, your doctor will use small tools through the hysteroscope. A hysteroscopy takes about 30 minutes, unless other procedures are being done.

    Procedure D&C (Dilation and Curettage)

    Dilation and curettage (D&C) is a brief surgical procedure in which the cervix is dilated and a special instrument is used to scrape the uterine lining. Knowing what to expect before, during, and after a D&C may help ease your worries and make the process go more smoothly. Here’s what you need to know. You may need a D&C for one of several reasons. It’s done to:

    • Remove tissue in the uterus during or after a miscarriage or to remove small pieces of placenta after childbirth. This helps prevent infection or heavy bleeding.
    • Diagnose or treat abnormal uterine bleeding. A D&C may help diagnose or treat growths such as fibroids, polyps, or endometriosis, hormonal imbalances, or uterine cancer. A sample of uterine tissue is viewed under a microscope to check for abnormal cells.

    A D&C involves two main steps:

    • Dilation involves widening the opening of the lower part of the uterus, the cervix, to allow insertion of an instrument. The doctor may insert a slender rod called a laminaria into the opening to gradually cause it to widen. Or medication may soften the cervix to help it widen.
    • Curettage involves scraping the lining and removing uterine contents with a long, spoon-shaped instrument called a curette. The doctor may also use a cannula to suction any remaining contents from the uterus. This can cause some cramping. In many cases, a tissue sample goes to a lab for examination.

    Sometimes other procedures are performed along with a D&C. For example, your doctor may insert a slender device to view the inside of the uterus called hysteroscopy.

  • Neurology


    Neurology is a branch of medicine dealing with disorders of the nervous system. Neurology deals with the diagnosis and treatment of all categories of conditions and disease involving the centraland peripheral nervous systemand its subdivisions, the autonomic nervous system and the somatic nervous system. including their coverings, blood vessels, and all effector tissue, such as muscle.

    Anterior Cervical Discetomy

    Cervical disc disease is caused by an abnormality in one or more discs, the cushions that lie between the neck bones vertebrae. When a disc is damaged due to arthritis or an unknown cause — it can lead toneck pain from inflammation or muscle spasm. In severe cases, pain and numbness can occur in the arms from pressure on the cervical nerve roots.

    Surgery for cervical disc disease typically involves removing the disc that is pinching the nerve or pressing on the spinal cord. This surgery is called a discectomy. Depending on where the disc is located, the surgeon can remove it through a small incision either in the front (anterior discectomy) or back (posterior discectomy) of the neck while you are under anesthesia. A similar technique, microdiscectomy, removes the disc through a smaller incision using a microscope or other magnifying device.

    To close the space that’s left when the disc is removed and restore the spine to its original height, patients have two options:

        • Artificial cervical disc replacement
        • Cervical fusion

    Artificial discs can improve neck and arm pain as safely and effectively as cervical fusion while allowing for range of motion that is as good or better than with cervical fusion. People who get the artificial disc are often able to return to work more quickly as well. People who get an artificial disc can always opt for cervical fusion later. But if a patient has cervical fusion first, it’s not possible to later put an artificial disc in the same spot.

    Not everyone is a candidate for the artificial disc, however. Those withosteoporosis, joint disease, infection, inflammation at the site, or an allergy to stainless steel may not be candidates for disc replacement surgery.

    With cervical fusion surgery, the surgeon removes the damaged disc and places a bone graft, which is taken either from the patient’s hip or from a cadaver in the space between the vertebrae. The bone graft will eventually fuse to the vertebrae above and below it. A metal plate may be screwed into the vertebrae above and below the graft to hold the bone in place while it heals and fuses with the vertebrae. Discectomy with cervical fusion can often help relieve the pain of spinal disc disease.

    Recovering From Cervical Disc Surgery

    You should be able to get up and move around within a few hours of your cervical disc surgery. You’ll feel some pain in the area operated on, but it should ease over time.The fusion can take anywhere from three months to a year to become solid after surgery, and you could still have some symptoms during that time. Your doctor might recommend that you wear a cervical collar to support your neck for the first four to six weeks. Check with your surgeon to see what activity level is right for you before starting any exercise after surgery.


    Decompressive laminectomy is the most common type of surgery done to treat lumbar spinal stenosis. This surgery is done to relieve pressure on the spinal nerve roots caused by age-related changes in the spine. It also is done to treat other conditions, such as injuries to the spine, herniated discs, or tumors. In many cases, reducing pressure on the nerve roots can relieve pain and allow you to resume normal daily activities.Laminectomy removes bone and/or thickened tissue that is narrowing the spinal canal and squeezing the spinal nerve roots. This procedure is done by surgically cutting into the back.

  • Otolaryngology


    Otolaryngologyis the study of ear, nose, and throat conditions orENT. It is also referred to as Otolaryngology–Head and Neck Surgery orotorhinolaryngology.

    Otolaryngologists or ENT doctors often treat children with persistent ear, nose, and throat conditions to include surgery. Adult patients often seek treatment from an otolaryngologist for sinus infections, age-related hearing loss, and cancers of these regions.

    Procedure: Deviated Septum

    The nasal septum is the wall between the nostrils that separates the two nasal passages. It supports the nose and directs airflow. The septum is made of thin bone in the back and cartilage in the front. Adeviated septum occurs when the cartilage or bone is not straight. A crooked septum can make breathing difficult. The condition also can lead to snoring and sleep apnea.The septum can bend to one side or another as a part of normal growth during childhood and puberty. Also, the septum can be deviated at birthor because of an injury, such as a broken nose. Very few people have a perfectly straight septum.

    Surgery to straighten the septum is called septoplasty, submucous resection of the septum, or septal reconstruction. The surgery may be done along with other procedures to treat chronic sinusitis, inflammation, or bleeding, or to correct sleep apnea. Septoplasty also may be done to allow access into the nose to remove nasal polyps. In general, septoplasty is needed only when breathing problems or snoring do not get better without surgery.

    Before surgery, the doctor may use a thin, lighted instrument know as an endoscope to look at your nasal passages and to see the shape of your septum. In some cases, the endoscope may be used during surgery. You will receive local or general anesthesia for the 60- to 90-minute operation.

    The septum and nasal passages are lined with a layer of soft tissue called the nasal mucosa. To repair the septum, the surgeon works through the nostrils, making an incision to separate the mucosa from the underlying cartilage and bone. The doctor trims or straightens the bent cartilage and then replaces the mucosa over the cartilage and bone.

    Procedure: Tonisllectomy

    A tonsillectomy is the surgical removal of the tonsils. The adenoids may or may not be removed at the same time. A general anesthetic is always used to sedate a child having a tonsillectomy. Adults may need only a local anesthetic to numb the throat.

    A very sore throat usually follows a tonsillectomy and may last for several days. This may affect the sound and volume of the person’s voice and his or her ability to eat and drink. The person may also have bad-smelling breath for a few days after surgery. There is a very small risk of bleeding after surgery.

    A child having a tonsillectomy may feel “out of sorts” for a period of a week to 10 days. But if the child is feeling well enough, there is no need to restrict his or her activity or to keep the child at home after the first few days.

    A tonsillectomy may be done in the following cases:

    • A person has ongoing or recurring episodes of tonsillitis.
    • A person has recurring episodes of strep throat in 1 year despite antibiotic treatment.
    • Abscesses of the tonsils do not respond to drainage. Or an abscess is present in addition to other signs that point to a tonsillectomy.
    • A persistent foul odor or taste in the mouth is caused by tonsillitis and does not respond to antibiotic treatment.
    • A biopsy is needed to evaluate a suspected tumor of the tonsil.
    • Especially in children, the tonsils are so large they affect nighttime breathing, called sleep apnea.

    Large tonsils are not a reason to have a tonsillectomy unless they are causing one of the above problems or they are blocking the upper airway, which may cause sleep apnea or problems with eating.

  • Orthopedic


    Orthopedics is the branch of surgeryconcerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, sports injuries, degenerative diseases, infections, tumors, and congenital disorders. Knee arthroscopy is one of the most common operations performed by orthopedic surgeons today and is often combined with meniscectomy or chondroplasty. The majority of orthopedic procedures are now performed arthroscopically. At Plaza Ambulatory Surgery Center our talented physician

    Procedure types ACL

    Reasons for Procedure

    ACL surgery is an elective procedure. This means that surgery is not always necessary; it may depend on your lifestyle and age.

    Surgery may be recommended if you have:

    • A complete tear of the ACL,
    • A high degree of joint instability
    • Injury to the knee that affects more than one ligament
    • A need to return to sports or other activities that require pivoting, turning, or sharp movements
    • No improvement with rehabilitative therapy
    • Possible Complications

    Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

    • Infection
    • Excess bleeding
    • Blood clots
    • Reaction to anesthesia
    • The operation does not provide the desired improvement in function
    • Instability of the knee
    • Numbness or stiffness in the knee
    • Kneecap pain after surgery

    Before surgery, you will need to:

    Arrange for help at home while you recover Talk to your doctor about any medications, herbs, or supplements you are taking Talk to your doctor about any allergies you have Ask your doctor about assisted devices you will need You may need to stop taking some medications up to one week before the surgery. Talk to your doctor about any medications that may need to be stopped. Do not eat or drink anything after midnight the day before your surgery, unless told otherwise by your doctor.

  • Pain Management

    Pain management

    Pain management is a branch of medicine employing an interdisciplinary approach for easing the suffering and improving the quality of life of those living with pain.Pain sometimes resolves promptly once the underlying trauma or pathology has healed, and is treated by one practitioner, with drugs such as analgesics and anxiolytics. Effective management of chronic (long-term) pain, however, frequently requires the coordinated efforts of the management team. Medicine treats injury and pathology to support and speed healing; and treats distressing symptoms such as pain to relieve suffering during treatment and healing. When a painful injury or pathology is resistant to treatment and persists, when pain persists after the injury or pathology has healed, and when medical science cannot identify the cause of pain, the task of medicine is to relieve suffering. Treatment approaches to chronic pain include pharmacological measures, such as analgesics, tricyclic antidepressants andanticonvulsants, interventional procedures, physical therapy, physical exercise, application of ice and/or heat, and psychological measures, such as biofeedback and cognitive behavioral therapy.

  • Podiatry


    Podiatry is a branch of medicine devoted to the study of diagnosis, medical and surgical treatment of disorders of the foot, ankle, and lower extremity. Podiatrists treat a wide variety of foot and lower extremity conditions, through nonsurgical and surgical approaches. Podiatric surgery is the surgical treatment of conditions affecting the foot, ankle and related lower extremity structures and is designed to ensure continued functionality of the foot and ankle areas. Patients who complain of joint and ligament problems, as well as those with congenital deformities, are offered surgical solutions that fix bones, muscles, and joints. Common surgeries performed are:

    • Removal of part of the metatarsal head (the part of the foot that is bulging out). This procedure is called exostectomy or bunionectomy.
    • Realignment of the soft tissues (ligaments) around the big toe joint.
    • Making small cuts in the bones (osteotomy) and moving the bones into a more normal position.
    • Removal of bone from the end of the first metatarsal bone, which joins with the base of the big toe (metatarsophalangeal joint). At the metatarsophalangeal joint, both the big toe and metatarsal bones are reshaped (resection arthroplasty).
    • Fusion (arthrodesis) of the big toe joint.
    • Fusion of the joint where the metatarsal bone joins the mid-foot (Lapidus procedure).
    • Implant insertion of all or part of an artificial joint.

    Plantar Fascia Release

    Plantar fascia release surgery involves cutting part of the plantar fascia ligament to release tension and relieve inflammation of the ligament (plantar fasciitis). Your doctor can use medicine that numbs the area (local anesthetic) for the procedure. Plantar fascia release can be done by cutting the area or by inserting instruments through small incisions.

    The surgeon may detach the plantar fascia from the heel bone or make incisions on either side to release tension.The surgeon may remove and smooth the bone surface to allow the plantar fascia to heal under less tension. Sometimes the surgeon removes a small wedge of damaged tissue.The surgeon may also free the thickest part of a foot muscle (abductor hallucis) to prevent nerves from becoming trapped as a result of the surgery.

    Hammer Toe Correction

    A hammertoe occurs from a muscle and ligament imbalance around the toe joint that causes the middle toe joint to bend and become stuck in this position.The most common complaint with hammertoes is rubbing and irritation on the top of the bent toe.

    In general, surgery is used only for severe toe problems. You may need surgery if other treatments don’t control your pain, if your toe limits activity, or if you can’t move the toe joint.For fixed toe problems, doctors often do surgery on the bones. Doctors can often treat flexible toe problems by moving tendons to release tension on the joint and let the toe straighten. In some cases, the surgery for a flexible toe problem will still include work on the bones.

    Your options may include one or more of the following:

    • Removing part of the toe bone. This is called phalangeal head resection, or arthroplasty.
    • Removing part of the joint and letting the toe bones grow together. This is called joint fusion, or arthrodesis.
    • Cutting supporting tissues or moving tendons in the toe joint.
    • Getting a toe implant to replace a bent joint or straighten a toe.
    • In rare cases, removing the toe amputation.
    • Surgery can reduce the pain from a deformed toe. But it may not help how your foot looks.
  • Urology


    Urology also known as genitourinary surgery, is the branch of medicine that focuses on the surgical and medical diseases of the male and female urinary tract system and the male reproductive organs. The organs under the domain of urology include the kidneys, adrenal glands, ureters, urinary bladder, urethra, and the male reproductive organs testes, epididymis, vas deferens, seminal vesicles, prostate and penis.

    Urology combines the management of medical conditions such as urinary tract infections and benign prostatic hyperplasia, with the management of surgical conditions such as bladder or prostate cancer, kidney stones, congenital abnormalities, traumatic injury, and stress incontinence.

    Urology has traditionally been on the cutting-edge of surgical technology in the field of medicine. Urologists are well-trained in minimally-invasive techniques, employing real-time ultrasound guidance, fiber-optic endoscopic equipment, and various lasers in the treatment of multiple benign and malignant conditions.In addition, urologists are pioneers in the use of robotics in laparoscopic surgery.

    Procedure: Cystoscopy

    Cystoscopy is a test that allows your doctor to look at the inside of the bladder and the urethra using a thin, lighted instrument called acystoscope.

    The cystoscope is inserted into your urethra and slowly advanced into the bladder. Cystoscopy allows your doctor to look at areas of your bladder and urethra that usually do not show up well on X-rays. Tiny surgical instruments can be inserted through the cystoscope that allow your doctor to remove samples of tissue or samples of urine.

    Small bladder stones and some small growths can be removed during cystoscopy. This may eliminate the need for more extensive surgery.

    Cystoscopy may be done to:

    • Find the cause of symptoms such as blood in the urine (hematuria), painful urination (dysuria), urinary incontinence, urinary frequency or hesitancy, an inability to pass urine (retention), or a sudden and overwhelming need to urinate (urgency).
    • Find the cause of problems of the urinary tract, such as frequent, repeated urinary tract infections or urinary tract infections that do not respond to treatment.
    • Look for problems in the urinary tract, such as blockage in the urethra caused by an enlarged prostate, kidney stones, or tumors.
    • Evaluate problems that cannot be seen on X-ray or to further investigate problems detected by ultrasound or during intravenous pyelography, such as kidney stones or tumors.
    • Remove tissue samples for biopsy.
    • Remove foreign objects.
    • Place ureteral catheters (stents) to help urine flow from the kidneys to the bladder.
    • Treat urinary tract problems. For example, cystoscopy can be done to remove urinary tract stones or growths, treat bleeding in the bladder, relieve blockages in the urethra, or treat or remove tumors.
    • Place a catheter in the ureter for an X-ray test called retrograde pyelography. A dye that shows up on an X-ray picture is injected through the catheter to fill and outline the ureter and the inside of the kidney.

    Procedure Extracorporeal Show Wave Lithotripsy (ESWL) for Kidney Stones

    Extracorporeal shock wave lithotripsy (ESWL) uses shock waves to break a kidney stone into small pieces that can more easily travel through the urinary tract and pass from the body.ESWL may work best for kidney stones in the kidney or in the part of the ureter close to the kidney. Your surgeon may try to push the stone back into the kidney with a small instrument called an ureteroscope and then use ESWL.

    You will lie on a water-filled cushion, and the surgeon uses X-rays or ultrasound tests to precisely locate the stone. High-energy sound waves pass through your body without injuring it and break the stone into small pieces. These small pieces move through the urinary tract and out of the body more easily than a large stone.The process takes about an hour.You may receive sedatives or local anesthesia.Your surgeon may use a stent if you have a large stone. A stent is a small, short tube of flexible plastic mesh that holds the ureter open. This helps the small stone pieces to pass without blocking the ureter.

    ESWL may be used on a person who has a kidney stone that is causing pain or blocking the urine flow.