General Practitioners

• Osteoporosis
• Medical Weight Loss
  In adults, the most common type of kidney cancer is renal cell carcinoma. The incidence of kidney cancer has been increasing for reasons unknown. Kidney cancers are often detected incidentally during procedures such as CT scans shown to the left, which appear in the form of a solid renal mass or tumor. In the early stages of kidney cancer it is common to be without any symptoms. In later stages, kidney cancer symptoms may include blood in your urine, back pain, weight loss, fatigue, and intermittent fever. If a renal mass is found that is felt to be cancerous, we often will not biopsy that mass as surgery is usually the first line of treatment. Kidney biopsy carries the risk of a false-negative, so biopsy is ordered in rare cases that are felt to be non-cancerous or in patients with a variety of health issues where surgery is too risky. Surgical treatment options include radical nephrectomy (removal of the kidney), partial nephrectomy (removal of a portion of the kidney) cryoablation (freezing of the cancer cells), and radiogrequency ablation (heating of cancer cells).
• Pediatric Care
  Kathryn Villarreal has been in the Urology field for over 15 years. She initially started with Urology Associates of Central California in June of 1998.  She received her undergraduate degree at Fresno City College and California State University of Fresno, majoring in Health Science. She then went onto receive her degree as a Physician Assistant from San Joaquin Valley College.  She is Board Certified and licensed through the Medical Board of the State of California.  Kathryn’s professional experience took her to practice in Urology at Urology Associates of San Luis Obispo for three years and Marion Hospital in Santa Maria, California in the Emergency/Urgent care department. She moved back to  Fresno February of 2009 and rejoined UACC.  Kathryn is experienced and committed to all aspects of Urology to include adult and pediatrics.  Her emphasis though is on quality of life conditions – bladder dysfunctions, sexual dysfunction male and female, interstitial cystitis.  She is also involved in medical research and has been a Sub-Investigator in several research trials.
• Primary Care
  Dr. Christopher Julian is a founding member of Urology Associates of Central California, where his father, Dr. Robert Julian, is also a founding member and practicing urologist. Dr. Julian is board certified by the American Board of Urology and specializes in urological oncology, urinary incontinence and stone disease. Dr Julian welcomes male and female urologic patients above the age of 16 years old to his practice. His primary hospital affiliations include Saint Agnes and Community Medical Centers. christopher julian logoWith a Bachelor of Arts degree in Molecular Biology from the University of California, Berkeley, Dr. Julian went on to receive his Doctorate in Medicine from Georgetown University. After graduating Magna Cum Laude at Georgetown, Dr. Julian moved back to California to complete his internship and residency at Stanford University. There he was also a popular guest lecturer in the Department of Physiology. Following, Dr. Julian completed fellowships for the National Institute of Health, Medical Student Research and for Stanford University School of Medicine in the field of Transrectal Ultrasonography. In 2008 Dr. Julian was the proud recipient of Fresno Magazine’s annual “Best in Fresno” award honoring him as the best urologist in the area. This prestigious award was voted upon by Fresno’s primary care physicians making this honor even more meaningful. Aside from his very busy practice, Dr Julian participates in all technical committees within Urology Associates to ensure that equipment, surgery processes and techniques within the group are up-to-date. Additionally, he has served as Chief of Surgery at Saint Agnes Medical Center. He is currently a professional member of the American Medical Association and the American Urological Association. Born in Philadelphia and raised here in Fresno, Dr. Julian moved to California at the age of 6. Now an active family man, Dr. Julian and his wife, Julie, enjoy a busy and exciting life with their daughter. When not at work practicing medicine, Dr. Julian plays golf with his father and snow skies with his family.
• Male Infertility
  Urology Associates of Central California (UACC) is the largest urology group in the central valley. We provide the highest level of comprehensive care ranging from conservative treatment to surgical intervention in every area of urologic care. UACC’s 10 Board Certified urologists and eligible specialists offer a variety of experience and expertise including: Bladder Disorders, Kidney and Urinary Tract Disorders, Stone Disease, Urinary Incontinence in men & women, Prostate Disease/Health, Genito-Urinary Cancer, Robotic assisted Prostatectomy, Male Infertility, Sexual Dysfunction for men & women, Uro-Gynecology, Pelvic Organ Prolapse, Pediatric urology, Minimally invasive surgery for urologic diseases.
• Emergency Care
• Constipation
• Urinary Incontinence
  ECoin® is a tibial implant for Urge Urinary Incontinence (UUI). The coin sized neurostimulator is placed under the skin near the ankle during a consistent, minimally invasive procedure using only local anesthetic. The eCoin® device provides automatic stimulation on the tibial nerve via a forgiving dome shaped field. eCoin eliminates lead wires optimized by precise placement, patient management of the device with external remotes, recharge requirements, general anesthesia or sedation with placement.

Gynecologists

• Gynecology
• Female Infertility
• Pelvic Pain
• Pregnancy
• Labor and Delivery

Internists

• Bladder Cancer
  The symptoms of bladder cancer can be very generalized. Pain with urination, blood in the urine and urinary frequency are some of the symptoms one might experience. In order to diagnose a bladder tumor the urologist will look inside the bladder with a cystoscope. Often, this is can done in the office as a surveillance procedure. If an abnormal growth is found it will usually need to be removed and you will need general anesthesia in our ambulatory surgery center. Depending on the status of your health, this procedure may need to be done in a hospital.
• Urology
  We would like to welcome you as a new patient to Urology Associates of Central California. If you are interested in becoming a new patient, please call us at 559-321-2800 to schedule an appointment.
• Kidney Cancer
  As with any type of nephrectomy, the removed kidney will be sent to pathology for analysis and diagnosis of the type of kidney cancer that has been treated. The kidney cancer is also staged, which determines how extensive the local spread of the disease has been, and will indicate if future adjuvant treatment is necessary.
• Kidney Stones
  Shock wave lithotripsy crushes a kidney stone that is still inside your body.  It does not require any incisions.  Instead, sound waves are sent through your body.  When these sound waves hit the stone, it crumbles into tiny, sandlike pieces.  As a result, it is easier for the pieces to pass through the urinary tract.
• Interstitial Cystitis
• Urinary Tract Infection
  The test involves taking a series of radiographs after injecting non-ionic contrast material (dye) into a vein, usually in the arm. The contrast agent flows through the veins, is excreted by the kidneys, and enhances the x-ray images of the kidneys, ureter and bladder.
• Prostate Cancer
  After the patient receives anesthesia, the surgeon inserts an instrument called a resectoscope through the tip of the penis into the urethra. The resectoscope contains a light, valves for controlling irrigation fluid, and an electrical loop that cuts prostate tissue and seals blood vessels. The removed prostate tissue is then carried by the irrigating fluid into the bladder and flushed out. This tissue is sent to pathology to make sure it is benign or does not contain prostate cancer. At the end of the surgery, a catheter is placed in the bladder through the penis. The bladder is continuously irrigated with fluid through the catheter in order to monitor bleeding and prevent blood from clotting which could obstruct the catheter. Patients usually go home with a catheter in place for about a week to give the prostate time to heal. See before and after images of the prostate below.
• Lung Cancer
  Prostate cancer is one of the most common cancer diagnoses in the United Sates, second to only lung cancer. In the next ten years prostate cancer will be one of the fastest growing cancers treated in the urlogy setting. Around 2013 there were significant changes in the treatment of prostate cancer with drugs such as Provenge, Xtandi, and Zytiga. Prior to these drugs coming out, once a patient became castrate resistant from hormonal therapy, the next step would be chemotherapy. These new therapies are extending life by years, and are much easier to tolerate than chemotherapy. These advancements in the treatment of prostate cancer have complicated the treatment of it, so our patient navigator is here for you as a direct contact to assist with referrals to specialists, oversee the care coordination plan and are responsible for orchestrating financial processing including financial assistance with prostate cancer grants amongst other duties.

Psychiatrists

• Mental Health
  A founding member of the Urology Associates of Central California, Dr. William Schiff is an accomplished urologist with subspecialty interest in Male and Female Sexual Dysfunction.  He has developed an innovative and comprehensive approach to Sexual Dysfunction whereby, a specially trained team of professionals accompanies patients through a focused process of evaluation and treatment that encourages a successful outcome. Also an expert in the placement of Penile Prosthetics, he is routinely called upon to consult with physicians and penile prosthetic companies regarding the management of patients and their significant others with sexual dysfunction, as well as the use of penile prosthetics. Dr Schiff accepts male and female patients above the age of 18 years old into his urology practice.  His primary hospital affiliations include Community Medical Centers, Saint Agnes and Tulare District Hospital. Dr. Schiff is a second generation Fresno urologist, following in his father Jack’s footsteps.  He attended schools in Fresno and matriculated to the University of Chicago with an undergraduate degree in Social Ecology with an emphasis in Mental Health and Criminal Justice and went on to receive his Doctorate degree in Medicine there.  He went on to complete his internship at the University of Southern California and his residency at Los Angeles County/University of Southern California Medical Center.

Endocrinologist

• Diabetes Care

Radiologist

• Ultrasound
  DEXA is most often performed on the lower spine and hips. Portable DEXA devices, including some that use ultrasound waves rather than x-rays, measure the wrist, fingers or heel and are sometimes used for screening purposes.
• MRI
  Typically, an MRI or CT scan is scheduled for six months after the procedure has been performed. Depending on the final pathology report which establishes the type of cancer which was removed, a future follow-up regimen is then established.
• Radiology
  You will be positioned on your back on the x-ray table, with your knees flexed. Your pubic area will be washed, and then the radiographer or a radiology nurse will gently insert a small, flexible catheter into your urethra, the duct from which you urinate. Skin tape may be used to hold the catheter to your inner thigh.
• X-Rays
• Computed Tomography
  Yes, CT imaging is considered a safe examination. In general, the diagnostic benefit of a CT scan outweighs the risk of x-ray radiation exposure or injection of imaging contrast (if applicable). If your procedure involves contrast, we pre-screen all patients for prior contrast reactions, history of renal insufficiency, and diabetes to avoid any contrast reactions. Pregnant women should not have a CT exam or any x-ray examination, especially if the woman is in her first trimester (first of three 3-month periods of pregnancy).
• Chemotherapy
  Major treatment options for prostate cancer include surgery, radiation, hormonal therapy, chemotherapy, and watchful waiting. Bone densities are done for patients that decide to go with hormone therapy to treat their prostate cancer and the effect it can have on your bones.
• Radiation Therapy
  Hydrogel is not painful, remains stable during radiation therapy and then is gradually absorbed by the body after radiation therapy has been completed.

Surgeons

• General Surgery
  The physicians at Urology Associates of Central California have the capability of performing numerous procedures not offered at many other offices. Their complete practice is comprised of a full x-ray department including an 8 slice CT scanner, full-service laboratory, state of the art bone densitometry department, continence and urologic pelvic pain clinic, reproductive and sexual dysfunction medicine and adjacent Ambulatory Surgery Center. The Ambulatory Surgery Center at Urology Associates of Central California is designed to provide patients the finest in outpatient surgical services. It is equipped to offer our physicians all that they need to surgically correct virtually every urological condition that requires surgical intervention. Surgeries that necessitate an overnight stay are performed at qualified area hospitals.
• Wound Care
  In most cases your incision will have multiple sutures running along the course of your incision. Expect some redness around the sutures. If there is generalized redness, especially with increasing pain or swelling, let us know. The penis will very likely get black and blue as blood spreads in the tissue. Sometimes the whole penis will turn colors. Black and blue is followed by a yellow and brown color. In time, all coloration will go away.
• Minimally Invasive Surgery
  Aside from being a quality general urologist, Dr Leung joined Urology Associates several years ago to bring his micro surgery skills to Central California. Dr Leung is the leading daVinci robotic surgeon in Central California. We are pleased to have Dr.Leung join Urology Associates of Central California in 2005. Dr. Leung brings his micro surgery skills to Central California. Dr. Leung specializes in urology and minimally invasive surgery for urologic malignancies such as the prostate, bladder and kidney. Dr. Leung provides advanced health care services in robotic-assisted prostate surgery and is an expert in the use of the da Vinci robotic surgical system, and has been using this technique since 2004. With a unique background in advanced engineering technology and biomedical research, Dr. Leung has received his Urologic surgical training at University of Rochester Medical Center. Dedicated to minimally invasive laparoscopic and Robotic surgery not only to demonstrate beneficial clinical options to most patients for numerous reasons, but it provides significant benefits to patients, their families and communities. For this reason da Vinci surgery and expanding awareness surrounding it, has become an integral component of his practice. Dr. Leung’s goal is to raise public awareness, educate and offer da Vinci robotic-assisted surgery to communities that currently do not provide this technology. Over 80 percent of men with prostate cancer nation-wide are being treated with robotic surgery and it is Dr. Leung’s goal to provide patients in our community the same opportunity. The da Vinci technology has allowed dramatic reducing incidence of open surgery and patients have resulted in excellent clinical outcomes including:yuk Earlier discharge from the hospital – average length of stay is one-day Less pain, blood loss and scarring Return to normal routines quicker Fewer infections and other post-surgery complications Central Valley ‘s highest volume robotic surgeon successfully performing over 900 robotic cases from Prostatectomies to Partial Nephrectomies and has conducted seminars for other urologists to learn this advanced technique of robotic surgery. Dr. Leung was featured on the NBC Community Regional Medical Center program Med Watch in 2006. Dr Leung's urology practice is open to male and female patients, with a limited number of pediatric patients also being seen. His primary hospital affiliations include Community Medical Centers and Saint Agnes Medical Center. Dr. Leung is still actively involved with medical research and is a Principal Investigator/Sub-Investigator in several on-going medical research projects. He teaches at the resident and medical student levels and has a faculty appointment with the University of California San Francisco - Fresno School of Medicine and is Board certified by the American Board of Urology. A graduate from the University of Texas at Austin in electrical engineering and then completing his Master's Deg
• Vasectomy
  A vasectomy is a simple, safe, and effective surgical procedure that makes a man unable to father a child (sterile), blocking the flow of sperm by obstructing the vas deferens in the scrotum. The testes will continue to produce sperm, but since the sperm have nowhere to go, they die and are absorbed by your body. Vasectomy is the most effective birth control method for men. The operation does not affect male hormone production or nerve supply to male organs. Therefore, neither the ability to perform sexual intercourse nor the sensations from it are affected in any way. Ejaculation of fluid occurs after the procedure, but without sperm. There are many good reasons for choosing to have a vasectomy, but it is a serious step. You and your partner should understand all the facts and share in the decision.
• Robotic Surgery
  Less pain, blood loss and scarring Return to normal routines quicker Fewer infections and other post-surgery complications Central Valley ‘s highest volume robotic surgeon successfully performing over 900 robotic cases from Prostatectomies to Partial Nephrectomies and has conducted seminars for other urologists to learn this advanced technique of robotic surgery. Dr. Leung was featured on the NBC Community Regional Medical Center program Med Watch in 2006. Dr Leung’s urology practice is open to male and female patients, with a limited number of pediatric patients also being seen. His primary hospital affiliations include Community Medical Centers and Saint Agnes Medical Center. Dr. Leung is still actively involved with medical research and is a Principal Investigator/Sub-Investigator in several on-going medical research projects. He teaches at the resident and medical student levels and has a faculty appointment with the University of California San Francisco – Fresno School of Medicine and is Board certified by the American Board of Urology. A graduate from the University of Texas at Austin in electrical engineering and then completing his Master’s Degree in Biomedical Engineering Dr Leung went on to Johns Hopkins University and The State University of New York for his medical education. While Johns Hopkins University, he was involved in progressive medical research using advanced engineering technologies. He built machines and computer systems to study biological processes, and in an effort to combine and apply his engineering and biomedical research background, he attended the State University of New York and graduated with a doctoral degree in Medicine with “Distinction in Research”. While his focus has been his medical career, Dr. Leung in his spare time enjoys time with his family and spending time outdoors.
• Laparoscopy
  Da Vinci System is a remarkable improvement over conventional laparoscopy, in which the surgeon operates while standing, using hand-held, long-shafted instruments, which have no wrists. With conventional laparoscopy, the surgeon must look up and away from the instruments, to a nearby 2D video monitor to see an image of the target anatomy. The surgeon must also rely on his/her patient-side assistant to position the camera correctly. In contrast, the

Plastic Surgeons

• Botox
  If your current Overactive Bladder (OAB) treatment isn’t working or you can’t tolerate, ask your doctor if BOTOX® can help reduce unwanted leakage interruptions.

Dermatologists

• Skin Cancer
  Prostate cancer is the most common cancer among men (after skin cancer), but it can often be treated successfully.
• Lesions
  This process has become the standard of care for all patients that have a prostate biopsy at Urology Associates of Central California. Our pathology lab also processes vas deferens from vasectomy, penile lesions, and scrotal lesions among other samples including urine cytology. Urine cytology is a test that is used to look for abnormal cells in your urine. It is use along with other tests and procedures to diagnose urinary tract cancers such as bladder cancer. For patients that have hematuria (blood in the urine) or history of bladder cancer, your urologist may order a urine cytology as part of your workup.

Physical Therapists

• Back Pain

Allergists

• Allergies