Treatments and Surgery – Dr. Richard Bevan-Thomas, M.D.

Robotic Simple Prostatectomy (RASP)

agwebworx@gmail.com — Fri, 07 Nov 2025 13:31:23 +0000

TREATMENTS AND SURGERY

Robotic Simple Prostatectomy for Enlarged Prostate (BPH) in Arlington & DFW

View a new era of minimally invasive prostate surgery. As an experienced robotic surgeon with over 23 years of robotic surgery experience, Dr. Richard Bevan-Thomas offers Robotic Simple Prostatectomy (RSP). This is the definitive solution for patients suffering from severe BPH with a very large prostate (typically 80 grams or more), offering precise removal of obstructing tissue with less bleeding, faster recovery, and the most durable long-term results.

What, Who, How and When

WHEN THE ROBOTIC SIMPLE PROSTATECTOMY IS RECOMMENDED FOR BPH

Not all prostate surgeries are the same. A robotic radical prostatectomy is for prostate cancer and removes the entire gland. A Robotic Simple Prostatectomy treats Benign Prostatic Hyperplasia (BPH) by removing only the inner obstructing tissue, leaving the outer capsule intact.

As men reach their 50s and beyond, urinary changes often appear—weak stream, night-time urination, or a bladder that never feels empty. Once the prostate enlarges past a certain point, medications and smaller procedures usually aren’t enough. For these men, a Robotic Simple Prostatectomy offers one of the most definitive and lasting solutions in Arlington, TX.

Did You Know? Nearly half of men in their 50s already experience BPH symptoms—you’re not alone.

Why Size Matters (The 80-Gram Threshold)

A healthy prostate weighs ≈40 g (about an apricot).

For prostates this large, Robotic Simple Prostatectomy clears the obstruction and restores normal bladder function.

DocRBT Pro Tip: If your prostate is the size of a grapefruit, robotic simple prostatectomy is the most durable way to relieve the blockage.

THE AVOCADO ANALOGY:
How The Robotic Simple Prostatectomy Works

Think of the prostate like an avocado:

Skin = Prostate Capsule (left intact): This is the outer shell of the prostate, which is left intact (spared).
Flesh = Enlarged Tissue Causing Blockage (removed): This obstructing tissue (adenoma) is precisely removed.
Pit = Urethra and Bladder Connection (cleared): The connection is surgically cleared and opened for free urine flow.

Robotic instruments precisely scoop out the “flesh” while leaving the “skin.” Once the inner obstructing tissue is removed, urine flows freely again.

Did You Know?

Robotic Simple Prostatectomy removes 2–3 times more tissue than smaller procedures—making it the most durable, lasting solution for very large prostates.

Why THE Robotic Simple Prostatectomy Provides the Most Lasting Relief

Smaller procedures like TURP, GreenLight Laser, or UroLift® help men with smaller glands, but they remove less tissue and symptoms often return in a few years. Robotic Simple Prostatectomy removes much more obstructing tissue — delivering:

What About PAE? [Prostate Artery Embolization (PAE)

The Definitive Solution: PAE (Prostate Artery Embolization) is an excellent, minimally invasive option for many men. However, for patients suffering from the most complex anatomy—specifically very large prostates, the presence of a median lobe, or poor bladder function—Robotic Simple Prostatectomy (RASP) is the definitive, better choice to guarantee the most durable long-term results and symptom relief.

DocRBT Pro Tip: Durability is the advantage—by removing more tissue, you stay symptom-free longer.

Best for men who

Have prostates ≥80–100 g (the large-volume BPH candidate).
Struggle with severe symptoms despite medication and less invasive procedures.
Require repeated catheterization due to severe blockage.
Develop bladder stones or infections from incomplete emptying.
Show bladder damage after years of obstruction.

WHY ROBOTICS MAKES THE DIFFERENCE (RASP Benefits)

Before robotics, this surgery required a large open incision and a long recovery. The da Vinci® system now offers:

In short, robotics turns a major operation into a safer, more precise procedure with faster recovery.

What to Expect Before, During & After Surgery

Milestone	Typical Time
Hospital Stay	Same day or overnight
Catheter Removal	4–7 days
Return to Work	1–2 weeks (office)
Full Recovery	4–6 weeks
Symptom Relief	Often immediate

Milestone

Typical Time

Hospital Stay

Same day or overnight

Catheter Removal

4–7 days

Return to Work

1–2 weeks (office)

Full Recovery

4–6 weeks

Symptom Relief

Often immediate

Why Choose Dr. Bevan-Thomas in Arlington, TX

Take the Next Step

If you’re in your 50s or beyond and struggling with severe urinary symptoms, don’t wait until it becomes an emergency. Robotic Simple Prostatectomy is one of the most effective and lasting solutions for very large prostates in DFW.

Frequently Asked Questions

What’s the difference between a robotic simple and robotic radical prostatectomy?

No-Scalpel Vasectomy

agwebworx@gmail.com — Fri, 24 Oct 2025 12:40:48 +0000

Treatments & Surgery

No-Scalpel Vasectomy in Arlington & Dallas–Fort Worth

The No-Scalpel Vasectomy is the modern standard for permanent male contraception—it is quick, safe, and virtually painless. Dr. Richard Bevan-Thomas performs this refined vasectomy technique using just a tiny puncture—meaning no scalpel, no stitches, and minimal downtime. This makes it the most trusted and efficient option for men choosing a permanent form of birth control in the DFW area.

What, Who, How and When

NO-SCALPEL VASECTOMY EXPLAINED:
Technique, Candidates & Benefits

What Is a No-Scalpel Vasectomy?

Ureteroscopy / Laser Lithotripsy (CULLS)

agwebworx@gmail.com — Fri, 24 Oct 2025 12:40:23 +0000

Treatments & Surgery

Ureteroscopy (Laser Lithotripsy) for Kidney & Ureteral Stones in Arlington & Dallas–Fort Worth, TX

Direct stone visualization. Precise laser treatment. Thoughtful stent care and prevention.

This definitive procedure, known internally as CULLS (Cystoscopy, Ureteroscopy with Laser Lithotripsy), is the most effective solution for clearing stones in the ureter or kidney. Care is provided by Dr. Richard Bevan-Thomas at both USMD Hospital Arlington and SCNT (Surgical Centers of North Texas), ensuring the highest standards of laser lithotripsy and stent management for patients in the DFW area.

The Path to Relief

BALANCED GUIDANCE: Your Kidney Stone Treatment Options

Kidney stone pain can stop life cold. After your scan confirms a stone, the real question is: what’s the best way to clear it?

Dr. Bevan-Thomas reviews your images with you and gives balanced advice:

ESWL (shockwaves) is the best approach for many patients—noninvasive and effective when stone size, location, density (Hounsfield units), and anatomy are favorable.
CULLS —our term for ureteroscopy with laser lithotripsy (URS/LL)—is a reasonable choice for select patients, especially for residual fragments after ESWL, lower-pole or anatomically challenging stones, harder (denser) stones, or when we need the certainty of direct visualization and removal.
PCNL is reserved for very large or complex stones.

Together, you and Dr. Bevan-Thomas choose the least-invasive option that will actually work for your stone.

What is CULLS (Ureteroscopy with Laser Lithotripsy)?

With CULLS, Dr. Bevan-Thomas passes a thin, flexible scope through the natural urinary tract to see the stone directly. The Moses laser then dusts the stone into sand-like particles or fragments it for removal with a tiny basket. No incisions.

We use “CULLS” internally as a simple name; it’s the same proven ureteroscopy + laser procedure.

When Dr. Bevan-Thomas Recommends CULLS Instead of ESWL

CULLS is typically preferred when one or more apply:

Typical procedure flow:

Residual fragments after ESWL that need definitive clearance.
Lower-pole stones or unfavorable infundibulopelvic angle where ESWL fragments don't clear well.
High-density (“hard”) stones less likely to break with shockwaves. Anatomic considerations (e.g., body habitus/skin-to-stone distance) that reduce ESWL success.
Obstruction with ongoing pain where direct relief and/or stent placement is prudent.
Multiple stones that can be addressed in one endoscopic session.

If there’s an active urinary infection, Dr. Bevan-Thomas treats the infection first and schedules CULLS when it’s safe.

What is CULLS

Ureteroscopy with Laser Lithotripsy

With CULLS, Dr. Bevan-Thomas passes a thin, flexible scope through the natural urinary tract to see the stone directly. A holmium:YAG laser then dusts the stone into sand-like particles or fragments it for removal with a tiny basket. No incisions.

ESWL vs. CULLS vs. PCNL
(Clear, Honest Comparison)

Not sure which kidney stone treatment is right for you in Arlington? Dr. Bevan-Thomas will review your CT/ultrasound, stone size/location, density, and anatomy to recommend.

Procedure	Key Benefit & Primary Indication	Internal Link
ESWL (Shockwave)	Non-invasive, quick recovery, often avoids a stent. Best for smaller, softer stones in favorable positions.	ESWL (Shockwave)
CULLS (Ureteroscopy/Laser)	Highest immediate clearance, direct visualization. Preferred for harder stones, lower-pole stones, or residual fragments.	CULLS (Ureteroscopy/Laser)
PCNL	Reserved for very large/complex kidney stones (>2 cm, staghorn). Requires a small back incision.	PCNL

Board-certified Urologic Surgeon • Arlington & Dallas–Fort Worth

What to Expect with Dr. Bevan-Thomas

Over 3,000 robotic surgeries since 2002; refined catheter-free suprapubic recovery protocol
Meticulous nerve-sparing and endopelpic fascia–sparing techniques to support erections and early continence
Full-spectrum care: NanoKnife® (IRE) focal therapy, full-gland cryoablation, coordinated IMRT, and Active Surveillance when appropriate.

Before Your Procedure

Day of Surgery

Aftercare & Recovery

Common, temporary symptoms: urgency/frequency, mild burning, blood-tinged urine, bladder spasms, and flank discomfort (often during urination). These improve over days to weeks.
Hydration: steady water intake helps flush dust/fragments.
Activity: light activity the same day; increase as tolerated.
Prefer to read more? Visit our Stone Education Library (internal resource) during recovery.

Stent Care

The Part Most People Worry About

Many patients leave with a ureteral stent for 3–10 days (occasionally longer if clinically needed). Dr. Bevan-Thomas will decide stent timing and removal based on your case.

Normal with a stent: urgency, frequency, blood-tinged urine, brief flank pain during urination.
Call us urgently for fever/chills, severe uncontrolled pain, inability to urinate, or persistent heavy bleeding.
Removal: typically a quick in-office removal (with or without a short string) after timing is confirmed.

Prevention Matters

How Dr. Bevan-Thomas Lowers Your Future Risk

Removing the stone is step one; preventing the next one is just as important. After you’re comfortable, Dr. Bevan-Thomas discusses:

Hydration goals and diet coaching (sodium moderation, appropriate calcium with meals, oxalate awareness).
High-Volume Endoscopic Stone Program at USMD Hospital Arlington.
Full Spectrum—ESWL, Ureteroscopy (CULLS), PCNL—so you’re never shoehorned into one approach.
Clear expectations, hands-on stent counseling, and a prevention-first mindset.

A Quick Patient Story

How a Decision is Made

A 52-year-old from Grand Prairie had a 9 mm lower-pole kidney stone with high density on CT. ESWL was discussed first—the best option for many—but due to the lower-pole anatomy and density, Dr. Bevan-Thomas recommended CULLS for a one-and-done solution. The stone was dusted; a stent stayed five days. At follow-up, he was stone-free and left with a simple prevention plan.

Why Patients Choose Dr. Bevan-Thomas & UPNT

Balanced Guidance: ESWL first when it’s truly best; CULLS when anatomy/density or residual fragments make it wiser.
Stone analysis to learn composition.
24-hour urine testing for recurrent stone formers.
Targeted medications when indicated (e.g., thiazides, citrate).

Schedule Stone Care in Arlington, TX

Ready for a plan that works the first time? Dr. Bevan-Thomas will help you choose ESWL, CULLS, or PCNL based on your stone—and get you back to normal fast.

Shock Wave Lithotripsy (ESWL)

agwebworx@gmail.com — Fri, 24 Oct 2025 12:40:13 +0000

Treatments & Surgery

Shock Wave Lithotripsy (ESWL) for Kidney Stones – Arlington & Dallas–Fort Worth

Non-invasive kidney stone treatment — no incisions, no scopes, no lasers.

When kidney stone pain hits, you want relief fast with the least invasive approach. That’s exactly what ESWL (Shock Wave Lithotripsy) delivers: focused sound waves from outside the body that break stones into passable pieces—often without a temporary stent and with minimal downtime. Dr. Richard Bevan-Thomas, board-certified urologist and founding partner of UPNT, offers high-volume ESWL in Arlington for quick scheduling at USMD Hospital Arlington (first floor) and at Surgical Centers of North Texas (outpatient).

Why Patients Choose ESWL with Dr. Bevan-Thomas

Our approach to Shock Wave Lithotripsy focuses on minimal invasiveness and rapid recovery:

Truly Non-Invasive: No skin incisions, no scopes, no lasers.
Outpatient & Quick Recovery: Most resume light activity in 1–2 days.
Often No Stent: Many candidates avoid a ureteral stent (and its urgency/frequency).
Effective for Many Stones: Ideal for stones typically ≤1.5 cm in the kidney or ureter.
Targeted Imaging: Real-time X-ray or ultrasound for precise targeting of the kidney stone.
All Options Available: If ESWL isn’t ideal, we offer ureteroscopy/laser (CULLS), PCNL, and a comprehensive stone prevention program for patients in the Dallas–Fort Worth, TX area.

How it Works

WHAT IS ESWL (Shock Wave Lithotripsy) & How it Works

ESWL uses a machine called a lithotripter to send thousands of focused shock waves through the skin. Soft tissues transmit the waves; the denser stone absorbs the energy and fractures into passable pieces.

For larger or lower-ureter stones, other options such as ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) may be more effective.

Am I a Candidate for ESWL?

In our program, most kidney stone patients are candidates, and for those patients, ESWL is typically first-line. You’re often a great fit if you have:

We’ll review together:

If ESWL (Shock Wave Lithotripsy) isn’t the best match, we’ll discuss ureteroscopy/laser (CULLS), PCNL, or short-term medical expulsive therapy when appropriate.

Benefits Patients Care About Most

No incisions or scopes → lower infection risk, no scope-related urethral irritation.
Outpatient → home the same day.
Minimal downtime → light activity in 1–2 days; many back to work quickly.
Often no stent → fewer urinary symptoms for many patients.
Proven → excellent clearance in appropriately selected stones; repeatable if needed.

How Successful is ESWL?

Short answer: in appropriately selected patients, ESWL clears stones in the ∼80–90% range. Your personal outlook depends on stone size and density, location (kidney vs. ureter, lower-pole vs. other), and skin-to-stone distance—we walk through these together before treatment.

ESWL vs. Ureteroscopy (Laser) vs. PCNL — How We Decide

Treatment	Indication / Key Benefit	Internal Link
ESWL	First-line for most eligible patients, especially stones ≤1.5 cm when a non-invasive, fast-recovery option is preferred; often avoids a stent.
Ureteroscopy + Laser (CULLS)	Highest immediate clearance for many ureteral or high-density stones, or when ESWL isn’t ideal; usually includes a temporary stent.	Ureteroscopy (CULLS)
PCNL	For large/complex kidney stones (e.g., >2 cm, staghorn); tiny back incision in the OR.	PCNL for Large Stones

Before, During, After ESWL

What to Expect

Before

Urinalysis to rule out infection (treat first if positive).
Medication review and safe management of blood thinners.
Hydration unless contraindicated.
Driver required due to anesthesia.
Pre-anesthesia instructions for food/drink.

During (About 30 minutes)

After

Same-day discharge.
Hydration goal: keep urine light yellow/clear to help pass fragments (How to pass fragments faster).
Pain plan: medications as needed; heating pad can help spasms.
Strain urine if asked so we can analyze fragments (guides prevention).
Activity: walk the same day; avoid heavy lifting for a few days.
Follow-up & imaging to confirm clearance (ultrasound/X-ray as needed).

Prevention Matters

Future Stone Prevention

Dr. Bevan-Thomas personalizes a plan so you’re less likely to meet another stone.

Stone analysis (composition).
24-hour urine testing (citrate, calcium, oxalate, uric acid, sodium, volume, pH) when indicated.
Simple wins: Hydrate to 2–2.5 L urine/day; add citrate (lemons/citrus; Rx if needed); moderate sodium; maintain normal calcium with meals; oxalate awareness if advised; optimize weight/activity; adjust meds when appropriate.

Frequently Asked Questions

Is ESWL really the first treatment you recommend?

Image-Guided Radiation Therapy (IMRT)

agwebworx@gmail.com — Fri, 24 Oct 2025 12:39:27 +0000

Treatments & Surgery

IMRT for Prostate Cancer in Arlington & Fort Worth

For men who prefer radiation instead of surgery, Intensity-Modulated Radiation Therapy (IMRT) is a highly precise, non-invasive option with excellent long-term cancer control for appropriately selected patients. On my team, I coordinate your care with Texas Cancer Specialists—led locally by Dr. Peter Lanasa (Arlington) and Dr. Jerry Barker (Fort Worth)—so you get a seamless, multi-disciplinary plan from diagnosis through treatment and follow-up. Dr. Bevan-Thomas personally oversees your staging and uses advanced diagnostic data to ensure your radiation plan is precisely tailored to your specific needs.

Why Choose IMRT Prostate Cancer Treatment
in Arlington & Fort Worth?

We deliver a comprehensive approach to prostate cancer care:

True Team Care & Ongoing Coordination: I stay involved from prostate cancer biopsy and staging through your radiation plan and PSA follow-up. Your care is coordinated at every step.
Expert Radiation Oncologists: Dr. Lanasa & Dr. Barker deliver advanced image-guided IMRT (IGRT) in Arlington using state-of-the-art linear accelerators.
Local Convenience: Clinics are easily accessible in Arlington and Fort Worth with coordinated scheduling and communication.
Protection First: Routine use of rectal spacers (Barrigel®, SpaceOAR®) when appropriate to reduce rectal radiation dose and minimize side effects.
Comprehensive Treatment Options: If IMRT isn't ideal, I also offer catheter-free robotic prostatectomy, NanoKnife® (IRE) focal therapy, full-gland cryoablation, or Active Surveillance.

How Does it Work

IMRT: Precision External Beam Radiation Therapy

IMRT is a modern form of External Beam Radiation Therapy (EBRT) that sculpts dose to the prostate while avoiding nearby organs (bladder, rectum, urethra). It’s delivered as quick, daily outpatient sessions of precision radiation therapy prostate cancer fort worth. While different than SBRT (Stereotactic Body Radiation Therapy) which uses higher doses over fewer days, IMRT provides excellent dose control over a standard schedule.

How Your radiation Course Unfolds

Step	Description
Planning & Simulation	A planning CT (often fused with MRI) maps your prostate and surrounding anatomy. Skin markers or surface guidance may be used for set-up.
Smart Beam Shaping	Computer-guided, multi-angled beams (often with VMAT) conform to the prostate and limit dose to the rectum and bladder.
Daily Image Guidance	IGRT (daily cone-beam CT or equivalent) confirms alignment before each treatment.
Treatment Schedule	Typically 5 days/week for 5–8 weeks; each visit is about 10–15 minutes. Most men drive themselves and return to normal routines right after.

Protecting Healthy Tissue

Barrigel®, SpaceOAR®, BioProtect®

To shield the rectum during IMRT prostate cancer arlington tx, we commonly place a temporary spacer between the prostate and rectum:

Barrigel® (Injectable Hydrogel): Molds precisely to your anatomy; fully absorbed over months. (Barrigel arlington)
SpaceOAR® (Hydrogel Spacer): Creates space to reduce rectal radiation dose; typically absorbed by ∼4 months. (SpaceOAR arlington)
BioProtect® (biodegradable balloon): gently expands for defined separation and then resorbs. (bioprotect balloon spacer)

Placement: This is an outpatient procedure (local anesthesia ± light sedation). All spacers dissolve naturally, leaving no permanent implant. I’ll help you and the radiation oncologist choose the option that fits your anatomy and plan.

Who is a Good Candidate for IMRT?

IMRT is an excellent option for:

Men with clinically localized or locally advanced prostate cancer who prefer radiation or are not surgical candidates.
Men who require adjuvant or salvage radiation after a prior prostatectomy, based on pathology or rising PSA.
Men who value a highly targeted, non-invasive treatment with strong long-term cancer control and a predictable schedule.

If we find that another approach better matches your goals (e.g., focal therapy for unilateral disease or surgery for very large glands/obstructive symptoms), we’ll tailor your plan accordingly.

Side Effects

Side Effects: What to Expect with IMRT Prostate Radiation

Because IMRT is highly targeted, most effects are mild and temporary and resolve after treatment

Urinary: Mild urgency/frequency, occasional weak stream, or temporary nighttime urination.
Bowel: Softer stools, occasional rectal irritation. Rectal spacers (Barrigel/SpaceOAR) help significantly reduce this risk.
Sexual Function: Gradual change is possible over time; your baseline function, age, and medications matter.

Your team will review prevention and management (hydration, timed voiding, fiber, meds for urgency/irritation). Serious long-term issues are uncommon with modern planning and spacers.

Step-by-Step

Your Treatment Journey

Consult & Decision: We review pathology (biopsy), imaging (MRI), risk group, PSA trends, and your personal goals to tailor the plan.
Rectal Spacer Placement (if used): Quick outpatient procedure coordinated by Dr. Bevan-Thomas to create vital prostate-rectum separation.
Planning CT (Simulation): Comfortable mapping session to define the final target volume; tiny skin marks or surface guidance are used for daily setup.
Treatment Course: Daily IMRT sessions (Mon–Fri) for 5–8 weeks; each visit takes approximately 10 minutes.
Follow-up & PSA Monitoring: After IMRT, we check PSA periodically. We monitor your PSA trends closely, noting that the major PSA "bounce" is typically associated with brachytherapy.

IMRT vs. Other Options—How We Help You Choose

We’ll put your values—cancer control, recovery time, preservation of urinary/sexual function—at the center of this decision.

Treatment Option	Key Benefit	Internal Link
Catheter-Free Robotic Prostatectomy	Minimally invasive surgery with a suprapubic (no Foley) recovery; best for men who prefer surgical removal.	Catheter-Free Robotic Prostatectomy
NanoKnife® (IRE) Focal Therapy	Non-thermal, nerve-sparing focal option for unilateral disease in select cases.	NanoKnife® Focal Therapy (IRE)
Full-Gland Cryoablation	Effective freezing option, especially in salvage settings after radiation.	Prostate Cryoablation
Active Surveillance	Ideal for many low-risk men who want to avoid procedures unless disease progresses.	Active Surveillance

Frequently Asked Questions

How long does each IMRT session take?

Cryoablation (Prostate Freezing)

agwebworx@gmail.com — Fri, 24 Oct 2025 12:35:13 +0000

Treatments & Surgery

Cryoablation for Prostate Cancer — Arlington & DFW

Freeze the cancer. Protect your quality of life.

Dr. Rich Bevan-Thomas is a board-certified urologic surgeon in Arlington, Texas, with over 20 years of experienceperforming prostate cryoablation (cryotherapy). Recognized as an early adopter and national trainer, I am a leading expert in both focal and whole-gland cryoablation techniques, offering the highest standard of specialized care.

Understanding Cryoablation

What is Prostate Cryoablation?

Cryoablation is a highly effective, minimally invasive treatment that uses extreme cold (argon/helium gas) to destroy cancer cells inside the prostate.

Transperineal Probe Placement: Under real-time ultrasound guidance, I guide thin cryo-needles through the perineal skin (area under the scrotum) into precisely planned positions around the tumor.
Freeze–Thaw Cycles: We typically perform two cycles—using argon gas to form the controlled ice ball, and helium to thaw—to ensure thorough and irreversible cellular destruction.
Built-in Safeguards: I contour the ice ball on ultrasound, and we utilize a warming catheter to thermally protect the urethra and prevent surrounding tissue damage.

Who is a Good Candidate?

You may be a strong candidate for prostate cryoablation if, upon my review, we find your case meets the following criteria:

If your cancer is complex or high-risk, we’ll discuss alternative options: Catheterless Robotic Prostatectomy, NanoKnife® focal therapy, or coordinated IMRT.

Benefits & Recovery Timeline

Benefits of Prostate Cryoablation

Minimally Invasive: Needle-based procedure with no large incisions, significantly reducing surgical downtime.
Highly Versatile: Ideal for focal or whole-gland treatment, and the procedure is repeatable if future recurrence occurs.
Outpatient & Non-Radiation: Quick recovery, performed on an outpatient basis, with zero risk of secondary radiation exposure.
Powerful Salvage Option: An effective treatment choice even if you have previously received radiation therapy and have a recurrence.

Recovery:

Hospital Stay: Same-day outpatient procedure in most cases.
Drainage Tube (SPT): You will have a small, temporary suprapubic tube (SPT) for drainage, typically for 5–7 days. The painful urethral catheter is rarely needed for post-operative drainage. The SPT is removed quickly and easily in the office during your follow-up visit.
Return to Routine: Light activity quickly; most patients resume normal routines within 1–2 weeks.

Erections

An Honest Word about Side Effects

With Whole-Gland Cryo, the risk of erectile dysfunction is significant because the ice ball must fully extend past the capsule to ensure cancer destruction, which often affects the nearby nerves.

Focal Cryo dramatically reduces this risk because I meticulously plan the ice ball to avoid the uninvolved nerve bundles. The final outcome depends heavily on your baseline function, age, anatomy, and tumor location.

Why Choose Dr. Bevan-Thomas for Cryoablation in Arlington?

Typical procedure flow:

Pioneer & National Trainer: Dr. Bevan-Thomas taught cryoablation for Endocare® and has trained surgeons across the U.S., establishing two decades of mastery in this technique.
High-Volume Expertise: Thousands of ablations over 20+ years, including complex salvage cases after previous radiation treatment.
Meticulous Technique: Utilizing my high-level skill for transperineal placement, real-time ultrasound contouring, and thermal urethral protection.
Full-Spectrum Options: If cryoablation isn't the best fit, I offer the full range of solutions—including NanoKnife®, Robotic Prostatectomy, and coordinated IMRT—ensuring the treatment is built around you, not a single tool.

Schedule your prostate cryoablation consult (Arlington & DFW)

Request your Cryoablation consultation — Arlington & Dallas–Fort Worth.

NanoKnife® (Irreversible Electroporation)

agwebworx@gmail.com — Fri, 24 Oct 2025 12:34:59 +0000

Surgery & Treatments

NanoKnife® (Irreversible Electroporation) for Prostate Cancer — Arlington & DFW

Target the tumor. Protect what matters.

I’m Dr. Rich Bevan-Thomas. I’ve treated prostate cancer with ablation since 2002. Today, I center my focal program on NanoKnife® (Irreversible Electroporation or IRE) because it treats cancer without heat or freezing. Instead, it uses brief electrical pulses to create permanent nanopores in the cancer cells, leading to precise cell death. For the right anatomy, this non-thermal method means strong cancer control with a real chance to preserve urinary control and sexual function.

A Simple Deep Dive

HOW NANOKNIFE (IRE) WORKS: Creating Nanopores

The idea: use carefully timed electrical pulses to switch off cancer cells—without heat or freezing—so your body clears them naturally.

Inside the cells (“nanopores”):
Ultra-short electrical pulses create millions of nano-sized pores in cancer cell membranes. With the right number/strength of pulses, those pores don’t reseal, and the cell dies (Irreversible Electroporation - IRE).
Why “Non-Thermal” Matters:
Because we’re not cooking or freezing tissue, the supporting framework (collagen, blood vessels, and nearby nerves) is far less affected. This structural preservation is a major reason many men keep urinary control and maintain erections.

PLANNING FOCAL ABLATION (PRECISION & PROTECTION)

We build a precise map of where the cancer is and what must be protected.

Candidate Selection

Who I Treat with NanoKnife

Two groups benefit most:

The Key: The disease must be confined to one side or one area. If imaging/biopsy shows cancer in both sides or multiple regions, focal therapy may not be the best tool.

What to Expect

Your Day at the Center

I perform NanoKnife exclusively at Surgical Centers of North Texas in Arlington. It’s a same-day in and out experience.

Procedure Time: Typically 60–90 minutes.
Anesthesia: You’re completely asleep and comfortable.
Placement: Transperineal route (through the skin crease—no abdominal incisions).
Recovery: Most men leave with a small catheter for a few days and a simple recovery plan. Return to routine is within several days to about a week.

Function and Control

How Well Does NanoKnife Work?

Two groups benefit most:

If Focal Therapy Isn’t the Match: I also perform—and coordinate—definitive options like Catheterless Robotic Prostatectomy, Full-gland Prostate Cryoablation, and IMRT with my experienced partners. You’re never boxed in—we pick the plan that fits you.

Cost Transparency & Long-Term Vigilance

Where I Treat & How We Handle Costs:

Aftercare: Follow-up includes PSA and symptom checks (1, 3, 6 and 12 months), and MRI at 12 months to document success and survey the rest of the gland.

Frequently Asked Questions

Is NanoKnife “approved”?

Catheter-Free Robotic Prostatectomy

agwebworx@gmail.com — Fri, 24 Oct 2025 12:34:37 +0000

Treatments & Surgery

Catheter-Free Robotic Prostatectomy — Arlington & DFW

Da Vinci® Precision. Catheter-Free

Dr. Bevan-Thomas is a board-certified urologic surgeon in Arlington, Texas, recognized for high-volume expertise with over 3,000 robotic surgeries since 2002.

At UPNT, we collaboratively refined the Catheter-Free approach using a small suprapubic tube instead of the standard urethral Foley. I deliver this refined surgical technique personally, ensuring minimized irritation and bladder spasms, and providing less discomfort and a smoother, easier first week of recovery at home—without ever compromising cancer control.

What is a Catheter-Free Robotic Prostatectomy?

This is a minimally invasive Da Vinci® robotic prostatectomy where I remove the prostate and carefully reconnect the bladder to the urethra (vesicourethral anastomosis) utilizing 3D magnification and precise, wristed micro-instruments

THE CATHER-FREE DIFFERENCE: Instead of the standard urethral catheter (Foley) being placed through the penis, I use a small, temporary suprapubic tube (SPT) placed through the lower abdomen. This single change is the key to minimizing irritation, spasms, and discomfort during your recovery.

Why patients prefer it

Less Irritation: No tube through the penis means less irritation, better sleep, and easier walking/sitting.
Fewer Bladder Spasms: This refers to the cramping, uncomfortable sensation in the lower abdomen that feels like an urgent need to urinate, often lasting 15 to 20 seconds. By avoiding the urethral catheter, we significantly reduce these spasms for many men.
Uncompromised Cancer Control: The exact same cancer operation, including precise nerve-sparing and lymph-node assessment when needed.

Why the Da Vinci® Robotic System Matters

Outcomes reflect technique + experience, which is why my 3,000+ robotic cases and anatomic focus matter.

3D, high-definition, magnified view to see delicate vessels and the neurovascular bundles.
Wristed instruments with tremor filtration for precise dissection and micro-suturing.
Meticulous reconstruction for a watertight, low-tension anastomosis, supporting continence.
The Resulting Functional Difference: My technique, enhanced by the Da Vinci's technology, is designed to deliver industry-leading results for both urinary continence and sexual potency along with cancer control. This level of surgical precision is the foundation for your life after cancer.

How I Protect Function: Nerve & Continence Sparing

Protecting Erections (Nerve-Sparing Approach)

Multiparametric Prostate MRI (mpMRI)

agwebworx@gmail.com — Fri, 24 Oct 2025 12:34:02 +0000

Treatments & Surgery

Multiparametric Prostate MRI (mpMRI) in Arlington & Dallas–Fort Worth, TX

Multiparametric Prostate MRI (mpMRI) is the most advanced non-invasive tool available for accurately detecting and localizing clinically significant prostate cancer. We recommend Gateway Imaging for the best result for your prostate MRI. Dr. Bevan-Thomas personally reviews your MRI with you—including second opinions on outside MRIs—and then we discuss the precise next steps together.

WHY mpMRI MATTERS: A Diagnostic Advantage Since 2011

A concerning PSA used to mean a random biopsy—missing important cancers and finding many that never needed treatment. Since 2011, Dr. Richard Bevan-Thomas has integrated multiparametric MRI (mpMRI) to:

mpMRI is central to how we help patients across Arlington and the Dallas–Fort Worth area make informed, confident decisions.

WHAT mpMRI SHOWS
(The Imaging Components & PI-RADS Foundation)

MRI uses strong magnets and radio waves—not radiation—to create detailed images. A multiparametric study combines complementary sequences in one visit to reveal both anatomy and tissue behavior:

Where you’ll have the scan: Your MRI is performed at Gateway Imaging, which we recommend for the best result. A typical prostate MRI takes about 45 minutes.

Interpreting Results

PI-RADS & PSA DENSITY: Expert Review for Prostate Cancer Risk

Dr. Bevan-Thomas personally reviews the MRI images and report with you—often serving as a second opinion—and explains how the findings relate to your history and goals.

Radiologists use PI-RADS to grade how suspicious a region appears:

PI-RADS	Likelihood of Clinically Significant Cancer	Approx. Probability
1	Very low	<5%
2	Very low	5–10%
3	Low	10–20%
4	Moderate	30-50%
5	Very high	90-95%

We also calculate PSA density (PSAD = PSA ÷ prostate volume). Low PSAD (<0.15) and PI-RADS 1–2 often mean biopsy avoidance. High PSAD or PI-RADS 4–5 means we proceed with an MRI-targeted biopsy.

THE “GRAY ZONE” (PI-RADS 3) & SECOND OPINIONS: Advanced Risk Stratification

PI-RADS 3 Strategy: For equivocal findings, Dr. Bevan-Thomas frequently adds ExoDx Prostate (ExosomeDx) biomarker testing to refine risk. Low ExoDx + low PSAD may allow surveillance.
Second Opinions: Already had an MRI elsewhere? Bring your DICOM images and report. Dr. Bevan-Thomas is one of the few urologists who routinely reviews the actual MRI images with you, so you fully understand what they show.

How mpMRI and MRI–Ultrasound Fusion Biopsy Fit Together

mpMRI comes first. If the scan shows PI-RADS 3, 4, or 5—or if overall risk remains elevated—we may recommend an MRI–ultrasound fusion biopsy, which uses your MRI map with real-time ultrasound to precisely target and sample suspicious areas.

Our Step-by-Step Pathway

Our Pathway to Precision: We use the mpMRI as the critical step to avoid unnecessary random biopsies. The image-guided pathway ensures we detect and accurately sample only clinically significant cancer, sparing you unnecessary procedures.

Consultation: History, PSA trends, risk factors, and your goals.
mpMRI at Gateway Imaging: About 45 minutes; oral sedation available if needed.
Personal Review with Dr. Bevan-Thomas: He reviews your actual MRI images and explains PI-RADS and PSA density.
Plan: Observation, biomarker testing (e.g., ExoDx), or MRI-targeted fusion biopsy when indicated.
Follow-through: Clear timelines for follow-up PSA/MRI or biopsy so you’re never left guessing.

Board-certified Urologic Surgeon • Arlington & Dallas–Fort Worth

About Dr. Rich Bevan-Thomas

Robotic Surgery Volume: Over 3,000 robotic surgeries since 2002; refined catheter-free suprapubic recovery protocol.
Technique: Meticulous nerve-sparing and endopelvic fascia-sparing techniques to support erections and early continence.
Full Spectrum: Full-Spectrum Urologic Solutions: Offering advanced therapies, including Robotic Surgery (RALP), NanoKnife® (IRE) focal therapy, full-gland cryoablation, coordinated IMRT, and expert management for early-stage prostate cancer.

Schedule your mpMRI or second-opinion review

If your PSA is elevated, if a biopsy has been recommended, or if you’d like a second opinion on an outside MRI, a multiparametric MRI can clarify the path forward.

MRI–Ultrasound Fusion Biopsy

agwebworx@gmail.com — Fri, 24 Oct 2025 12:33:46 +0000

Treatments & Surgery

MRI–Ultrasound Fusion Prostate Biopsy in Arlington & Dallas–Fort Worth, TX

Dr. Richard Bevan-Thomas is a recognized leader in prostate cancer diagnosis in DFW. We utilize advanced MRI-Ultrasound Fusion Biopsy to achieve pinpoint accuracy, performing well over 5,000 procedures. Our high-volume experience spans both targeted (fusion) sampling and full template mapping via both transrectal and modern transperineal techniques, ensuring the highest standards of diagnostic care.

Prostate Biopsy: MRI-Fusion Delivers Clarity—Not Guesswork

An elevated PSA or a concerning MRI can feel like limbo. You want answers you can trust, without unnecessary procedures. Dr. Richard Bevan-Thomas performs MRI–ultrasound fusion prostate biopsies to deliver precise, comprehensive information.

Second Opinion & When We Recommend Biopsy

If you’ve been told you “need a biopsy,” schedule a second-opinion review. Dr. Bevan-Thomas personally reviews the actual MRI images with you (not just the report) to discuss the next steps: biopsy, biomarker testing, or structured surveillance.

MRI Finding (PI-RADS Score)	Recommenion Ganceuiddat
PI-RADS 4–5	Fusion Biopsy Recommended. (High likelihood of clinically significant cancer.)
PI-RADS 3	Not automatic. Decision is individualized based on PSA density, trend, age, family history, prior biopsy results, and biomarkers (e.g., ExoDx).

How MRI–Ultrasound Fusion Works (Step-by-Step)

Build the MRI "Map": We mark the prostate and any PI-RADS 3–5 lesion(s) on your MRI files to create a 3D model.
Align MRI to Live Ultrasound (Registration): The fusion software aligns your MRI model with real-time ultrasound using elastic registration (molding the MRI to the ultrasound) for precise landmark matching.
Targeting—See It, Aim It, Sample It: Each MRI target appears inside the ultrasound view. A tracked needle path ensures accurate sampling of multiple targeted cores per lesion.
Saved "Map" for Continuity: Every core is logged on the 3D map with coordinates for Active Surveillance follow-up or future treatment planning.

Benefits of Choosing MRI Fusion with Dr. Bevan-Thomas

Platform	Location	Benefit
Transperineal Fusion (Koelis)	USMD Hospital Arlington (Conscious IV sedation)	Lowest infection risk (avoids rectal bacteria). Excels for anterior/apical lesions.
Transrectal Fusion (Invivo)	SCNT—Arlington (Sedation) or In-office (Local)	Efficient, widely covered, highly precise with the Invivo system.

What to Expect

PROCEDURE, RECOVERY & RESULTS
(5–7 Day Timeline)

Why Patients Choose Dr. Bevan-Thomas

Unmatched Experience: Well over 5,000 MRI-ultrasound fusion biopsies performed.
Comprehensive Standard: Targeted and template sampling on every fusion biopsy for maximum accuracy.
Technology Leadership: Offers both Invivo (transrectal) and Koelis (transperineal) platforms.
Second-Opinion Expertise: Personally reviews the actual MRI images with patients—ideal when deciding whether to biopsy or proceed to Active Surveillance.
Location: Serving Arlington, Dallas, Fort Worth and the greater DFW area.
Surgical Insight: With 23 years of experience as an accomplished robotic and ablation surgeon, Dr. Bevan-Thomas analyzes your biopsy results through the lens of treatment candidacy and recurrence risk.
Balanced Recommendations: You receive truly impartial guidance. As a specialist fluent in surgery, ablation, and coordinated radiation, your plan is tailored to the most effective path, never confined by a single procedure.

Schedule a Second-Opinion Review—or Your Fusion Biopsy

Whether you’re deciding if you need a biopsy, proceeding to a Fusion Biopsy, or exploring Active Surveillance, Dr. Bevan-Thomas provides confident answers. As an accomplished robotic surgeon and ablation specialist, he provides truly impartial guidance on your best next step.

Treatments and Surgery – Dr. Richard Bevan-Thomas, M.D.

Robotic Simple Prostatectomy (RASP)

Robotic Simple Prostatectomy for Enlarged Prostate (BPH) in Arlington & DFW

WHEN THE ROBOTIC SIMPLE PROSTATECTOMY IS RECOMMENDED FOR BPH

Why Size Matters (The 80-Gram Threshold)

THE AVOCADO ANALOGY: How The Robotic Simple Prostatectomy Works

Think of the prostate like an avocado:

Did You Know?

Why THE Robotic Simple Prostatectomy Provides the Most Lasting Relief

What About PAE? [Prostate Artery Embolization (PAE)

Best for men who

WHY ROBOTICS MAKES THE DIFFERENCE (RASP Benefits)

What to Expect Before, During & After Surgery

Why Choose Dr. Bevan-Thomas in Arlington, TX

Take the Next Step​

Frequently Asked Questions

What’s the difference between a robotic simple and robotic radical prostatectomy?

No-Scalpel Vasectomy

No-Scalpel Vasectomy in Arlington & Dallas–Fort Worth

NO-SCALPEL VASECTOMY EXPLAINED: Technique, Candidates & Benefits

What Is a No-Scalpel Vasectomy?

Ureteroscopy / Laser Lithotripsy (CULLS)

Ureteroscopy (Laser Lithotripsy) for Kidney & Ureteral Stones in Arlington & Dallas–Fort Worth, TX

BALANCED GUIDANCE: Your Kidney Stone Treatment Options

What is CULLS (Ureteroscopy with Laser Lithotripsy)?

When Dr. Bevan-Thomas Recommends CULLS Instead of ESWL

Ureteroscopy with Laser Lithotripsy

ESWL vs. CULLS vs. PCNL(Clear, Honest Comparison)

What to Expect with Dr. Bevan-Thomas

Before Your Procedure

Day of Surgery

Aftercare & Recovery

The Part Most People Worry About

How Dr. Bevan-Thomas Lowers Your Future Risk

How a Decision is Made

Why Patients Choose Dr. Bevan-Thomas & UPNT

Schedule Stone Care in Arlington, TX

Shock Wave Lithotripsy (ESWL)

Treatments & Surgery

Shock Wave Lithotripsy (ESWL) for Kidney Stones – Arlington & Dallas–Fort Worth

Why Patients Choose ESWL with Dr. Bevan-Thomas

WHAT IS ESWL (Shock Wave Lithotripsy) & How it Works

Am I a Candidate for ESWL?

Benefits Patients Care About Most

How Successful is ESWL?

ESWL vs. Ureteroscopy (Laser) vs. PCNL — How We Decide

What to Expect

Before

During (About 30 minutes)

After

Future Stone Prevention

Frequently Asked Questions

Is ESWL really the first treatment you recommend?

Image-Guided Radiation Therapy (IMRT)

IMRT for Prostate Cancer in Arlington & Fort Worth

Why Choose IMRT Prostate Cancer Treatmentin Arlington & Fort Worth?

IMRT: Precision External Beam Radiation Therapy

How Your radiation Course Unfolds

Barrigel®, SpaceOAR®, BioProtect®

Who is a Good Candidate for IMRT?

Side Effects: What to Expect with IMRT Prostate Radiation

Your Treatment Journey

IMRT vs. Other Options—How We Help You Choose

Frequently Asked Questions

How long does each IMRT session take?

Cryoablation (Prostate Freezing)

Cryoablation for Prostate Cancer — Arlington & DFW

What is Prostate Cryoablation?

Who is a Good Candidate?

Benefits & Recovery Timeline

Benefits of Prostate Cryoablation

Recovery:

An Honest Word about Side Effects

Why Choose Dr. Bevan-Thomas for Cryoablation in Arlington?

Typical procedure flow:

Schedule your prostate cryoablation consult (Arlington & DFW)

NanoKnife® (Irreversible Electroporation)

NanoKnife® (Irreversible Electroporation) for Prostate Cancer — Arlington & DFW

HOW NANOKNIFE (IRE) WORKS: Creating Nanopores

PLANNING FOCAL ABLATION (PRECISION & PROTECTION)

THE AVOCADO ANALOGY:
How The Robotic Simple Prostatectomy Works

Take the Next Step

NO-SCALPEL VASECTOMY EXPLAINED:
Technique, Candidates & Benefits

ESWL vs. CULLS vs. PCNL
(Clear, Honest Comparison)

Why Choose IMRT Prostate Cancer Treatment
in Arlington & Fort Worth?

WHAT mpMRI SHOWS
(The Imaging Components & PI-RADS Foundation)

PROCEDURE, RECOVERY & RESULTS
(5–7 Day Timeline)