By utilizing the da Vinci Robot, our physicians are able to re-enact traditional open surgical principals with the highest degree of accuracy and precision.
The Urologic Institute of New Jersey offers extensive general and
specialty care treating pediatric, adult, and geriatric urologic
conditions. Our Physicians specializes in the management of complex
kidney stone disease, urologic oncology, genitourinary reconstructive
surgery, minimally invasive procedures to treat enlarged prostate,
bladder and prostate cancer. We have considerable experience in
advanced laparoscopic adrenal, kidney, bladder, and Ureteral surgery
and offer laparoscopic and minimally invasive treatment alternatives
for your urologic needs. We also offer Robotic prostatectomy using
the da Vinci robotics surgical system at Hackensack University Medical
Center and the Valley Hospital.
The Urologic Institute provides a full complement of urological
services (disease information, office procedures, and Hospital services)
for both males and females of all age groups.
Our physicians treat a variety of urological conditions; Listed
below are the most common conditions encountered:
The Urologic Institute of New Jersey offers extensive general
and specialty surgical procedures treating pediatric, adult,
and geriatric urologic conditions. This web page can be used
in learning about your planned surgery as well
as pre and post-operative instructions.
Endoscopic Cases:
Cystoscopy Under Anesthesia (CUA)
Transurethral Resection of Bladder Tumor
Transurethral Cystolithalopaxy – Bladder Stone removal
Trocar Suprapubic Tube
Bladder Neck Ablation (laser or loop)
Hydrodistention of the Bladder
Open Cases:
Nerve Sparing Robotic Prostatectomy
Open Simple Prostatectomy for BPH
Mini-Pelvic Lymph Node Dissection
Endoscopic Cases:
Transurethral Incision of the Prostate
Transurethral Resection of Ejaculatory Ducts
Transurethral Resection of the Prostate
Transurethral Green-light Laser Ablation of the Prostate
Indigo Laser Coagulation (ILC) of the Prostate
Open Radical Nephrectomy
Laparoscopic Radical Nephrectomy
Open and Laparoscopic Nephroureterectomy
Open and Laparoscopic Partial Nephrectomy
Percutaneous Nephrolithotomy
Ureteroscopy (stone/filing defect)
Shock Wave Lithotripsy (ESWL) of the Kidney
Ureter
Open Cases:
Robotic Pyeloplasty
Ureteral Re-Implant
Endoscopic Cases:
CUA with Ureteral Stent
Shock Wave Lithotripsy (ESWL) of the Ureter
Percutaneous Laser Endopyelotomy
Ureteroscopy (stone/filing defect)
Ureteroscopic Laser Endopyelotomy
At the urologic Institute, our physicians perform many procedures
in the office for your convenience. We treat a variety of
urological conditions and the most common procedures that
we perform in the office are described on this page.
To learn about the particular procedure that interests you,
use the list below to link to the detailed information.
Once a decision has been made that no further children are desired,
a vasectomy can be performed in our office. A consultation,
physical exam, and the vasectomy are all performed in the office.
Very little discomfort is associated with the procedure. The
skin is numbed with lidocaine and then a small incision is made
in the scrotum. The vas deferens is isolated, tied and cut.
A single dissolvable suture is placed to close the skin incision.
The process is repeated on the other side. The procedure only
takes 10-15 minutes. Two semen analysis samples are inspected
for sperm after approximately 20 ejaculations. You cannot assume
that you are sterilized until the semen analysis is cleared
of sperm, dead or alive. You must continue your current contraception
until you are cleared. We ask that you stop using any aspirin
or blood thinners 7 days before the procedure. A no-incision
vasectomy is available also.
** This procedure requires an escort to drive the patient home!
Adult circumcision is completed for multiple reasons; it is
best to do it for medical reasons rather than pure cosmetic
reasons in the adult. The medical reasons are usually chronic
irritation, infection, phimosis, paraphymosis, penile cancer,
penile lesions, condyloma (venereal warts), and some other less
common conditions. Our office will do an adult circumcision
for pure cosmetic reasons, however, the patient must be aware
that there is a significant recovery period in which the male
is sore. Return to work is not immediate, usually after the
pain has resolved in one week. You will be mildly sore for the
next two weeks and the sutures will continue to bother you until
they dissolve.
The procedure involves a local anesthesia of the penis (Xylocaine
and Marcaine) around the base of the shaft and possibly just
over the midline pubic bone. One may require a separate injection
of the frenulum, which is near the head of the penis. We perform
a standard sleeve resection rather than the guillotine procedure.
Multiple dissolvable sutures are used to close the incision
site; a compressive dressing is placed for 24 hours. Narcotic
pain medication is required.
**** This procedure requires an escort to drive the patient
home!
A flexible cystoscopy is where our physicians look inside a man's
bladder and this can be viewed on a television screen. This is done
through a flexible scope that is no larger than a catheter. Very
little discomfort is associated with this procedure. Some of the
reasons for having this procedure are: blood in the urine, bladder
tumors, prostate enlargement, obstruction, chronic infections, bladder
stones, and urinary leakage and difficulty urinating. The urethra
is medicated with an anesthetic jelly prior to the procedure. An
antibiotic is given afterwards to prevent infection. This is done
as a precaution since all our instruments are sterilized just before
the procedure.
The Uroflow device is simply a special urinal that allows the urologist
to trace out your flow pattern and determine such parameters as
peak flow, average flow and total voided volume. We ask that you
come to the office with a partially full bladder and that you continue
drinking fluids on the way to the office so that you will have to
urinate shortly after you arrive. Do not over fill; we are trying
to get a picture in time that is a sample of your current voiding
habits. If you are to full or you try to urinate when you do not
have the urge too we will get incorrect results. If this occurs
then we would have to repeat the study and you will have to drink
fluids for a significant time before you get the urge again. We
consider a study a good one for evaluation purposes if you have
voided at least 200cc, if you don't have a significantly large post-void
residual volume.
The Post-Void Residual (PVR) volume is the amount of urine that
is left behind in the bladder after you are done urinating. Normally,
there is very little urine left in the emptied bladder. Those with
obstructive outlet disease such as prostate enlargement or urethral
stricture disease will have much more urine remaining in the bladder
after voiding. There are two possible ways to determine the PVR,
the most accurate one is using a catheter to empty the bladder,
and the other is the more commonly used technique called the bladder
ultrasound. An ultrasound probe is placed over the bladder and the
PVR is measured through the abdomen after some warm jelly has been
placed on the abdominal wall. There is absolutely no discomfort
associated with this test.
A CMG is a test used to determine how the bladder reacts to sterile
water that is instilled into the bladder through a catheter. A computer
tracts and records the pressures exerted in the bladder during filling,
straining and voiding. This is done with two small pressure sensors
placed in the bladder and the rectum with small tubes. This test
is usually used to help determine the function of the bladder, the
prostate in males, and the urethra in medical conditions involving
bladder control problems such as urgency, frequency, incontinence,
obstruction, etc. The results are recorded and then evaluated by
the physician. Depending on the results, specific treatments for
these conditions will be recommended.
An ultrasound of the prostate and seminal vesicles is used to determine
the size of the prostate. This in conjunction with the PSA (Prostate
Specific Antigen) blood test can be very useful in determining prostate
problems. An anesthetic jelly is inserted into the rectum and then
a rectal exam is performed to find any prostate irregularities.
An ultrasound probe is then placed into the rectum and a small balloon
is inflated. The prostate size and PSA-Density are determined. Presence
of prostate calcifications and specific lesions are noted.
This prostate biopsy procedure is performed when a lesion is seen
on ultrasound or an irregularity in the prostate is palpated with
the examining finger. An anesthetic jelly is inserted into the rectum
prior to the procedure. An antibiotic injection or oral antibiotics
are given prior to the procedure to prevent infections. All instruments
are sterile, so this is used as a precaution. The ultrasound probe
is inserted into the rectum and 10-12 needle biopsies are obtained
under ultrasound guidance. The needles pass through the rectal wall
and into the prostate in a split second to obtain these small samples
of tissue. Very little to mild discomfort is associated with this
procedure. It is well tolerated and most men just have a dull ache
for 24-48 hours after the procedure. Oral antibiotics are continued
for three days. It is recommended that no sexual intercourse or
masturbation occur for 72 hours to allow some healing of the fresh
needle tracts. It is common to have blood in the urine and stool
for one week, which over time will decease. Some patients will notice
blood in their semen (bright red to dark brown with time) for many
months after the procedure. Its takes quite some time to flush the
prostate of this blood. The blood will not cause any harm to your
sexual partner. We ask that you stop using any aspirin or blood
thinners 7 days before the procedure.
** This procedure requires an escort to drive the patient home!
Every patient that comes to the office for an evaluation will receive
a urine analysis. This will be used to screen for blood and infection.
If you are getting a procedure in the office, we use this to make
sure that we are not putting you at risk by proceeding in the face
of a urinary tract infection (symptomatic or asymptomatic). If you
were to get a procedure while infected you could become very ill
with infection in the blood stream, which could be fatal if not
treated immediately with IV antibiotics. Those patients that have
a urine dipstick test that is positive for white blood cells (infection)
or red blood cells (blood, infection, cancer or renal disease),
our office will examine the urine under the microscope to confirm
and quantify the finding. Sometimes the dipstick can be in error,
some tests turn falsely positive for other reasons. If your urine
is suspicious for infection, we will cancel your procedure, send
your urine for culture, and treat you for 7-10 days with oral antibiotics.
If your urine is infected, we will require you to take another urine
analysis and urine culture to make sure the infection was adequately
treated. We will have you reschedule the visit after we have worked
through this problem.
If we confirm blood on the microscopic analysis, we will proceed
with a hematuria work-up, which consists of blood work to make sure
you have normal renal function, an IVP x-ray study, a kidney/bladder
ultrasound and a cystoscopy (looking into the bladder with a telescope).
This test consists of obtaining a stool sample from the rectum
with the gloved finger. All males that come to the office will
get a rectal exam if not done within the last year by the same
urologist. At the time of prostate examination, a stool sample
will be wiped onto a Guaiac card and developed during the office
consultation. It determines if there is microscopic blood in
the stool. This is a screening test for tumors or bleeding disorders
of the gastrointestinal tract. All females that receive a pelvic
exam as part of the their urology consultation will also receive
a rectal exam and Guaiac testing. We do not routinely do this
procedure on females unless it is requested by the patient.
Lupron is an injection used in the treatment of advanced prostate
cancer or recurrent prostate cancer after failure of primary
treatment. Testosterone feeds prostate cancer (like adding fuel
to a fire) and Lupron acts to stop the production of testosterone.
These injections are given every 3-4 months depending on the
size of the depot.
The injection is administered in the hip. Hot flashes may be
a side effect of these injections, but will usually subside
after 2-3 months.
For a more in depth discussion of prostate cancer and our related
services please see our Center for Prostate Health.
Zoladex is an injection used in the treatment of advanced prostate
cancer or recurrent prostate cancer after failure of primary
treatment. Testosterone feeds prostate cancer (like adding fuel
to a fire) and Zoladex acts to stop the production of testosterone.
These injections are given every 3-months and is administered
in the abdominal wall. A local injection of numbing medicine
(Xylocaine) is administered to the site where to Zoladex pellet
is inserted into the skin. This pellet dissolves over 12-weeks.
Hot flashes may be a side effect of these injections, but will
usually subside after 2-3 months.
For a more in depth discussion of prostate cancer and our related
services please see our Center for Prostate Health.
If your signs and symptoms require a kidney or bladder ultrasound,
we can do this in our office. It is a painless way of imaging these
structures using sound waves. We place jelly over the area to be
scanned and the probe is then rocked over the area to obtain the
ultrasound image of the organ.
Interstitial Cystitis is an irrative bladder condition involving
an idiopathic inflammation of the bladder wall, usually in women.
There are many theories regarding the etiology, however, there is
no definitive cause. Some symptoms are frequency, urgency and lower
abdominal pain. After an extensive work-up to rule out a multitude
of other causes, Interstitial Cystitis is finally the diagnosis
of exclusion. The bladder condition is chronic and frequently waxes
and wanes. The treatment is to relieve symptoms not cure the disease.
No cure has been found. Many treatments are usually required periodically
throughout the rest of a woman?s life. Before your first bladder
treatment you will be informed of helpful dietary restrictions for
IC that prevent worsening of your symptoms such as: all caffeine
products, carbonated drinks (pop, soda, etc.), tomatoes and tomato
products, citrus fruits and juices, alcoholic beverages, and spicy
foods. A list of dietary restrictions will be given to you during
your office visit.
Potassium Chloride Stimulation Test (K+ Leak Sensitivity
Test)
Over 75% of known Interstitial Cystitis patients will experience
pain with the intravesical instillation of a potassium chloride
solution. The test identifies patients with abnormal permeability
of the bladder epithelium. A urine specimen will be obtained and
checked for infection. A catheter is then placed into the bladder
and the bladder is drained of the residual urine. Slowly 40 cc of
sterile water is instilled into the bladder and left for 5 minutes.
The patient is given a Symptom Grading Scale questionnaire and grade
whether the solution provoked symptoms of pain or urgency on a scale
of 0(none) to 5 (severe). The water is drawn off and a 40cc solution
of 400meq/l KCL solution is instilled. If the patient reacts during
the instillation the test is positive, the instillation is stopped
and the patients symptoms graded. If no reaction occurs during the
installation the solution and catheter is left in place for 5 minutes
and the symptom grading scale is preformed. If the patient experiences
pain then a "rescue" solution of 20,000 units of heparin
in 20cc of 1% lidocaine is applied and the catheter removed. The
rescue solution should be held as long as possible or until 30 minutes
have elapsed. A positive test is pain during instillation of KCL
solution or if there is a greater than 2 point difference between
the water and KCL solutions.
DMSO bladder treatment
A urine specimen will be obtained and checked for infection. A catheter
is then placed into the bladder and the bladder is drained of the
residual urine. Next, a mixed solution of 10cc of Xylocaine and
10cc of sterile saline are instilled to numb the bladder. After
this is completed, a mixture of 25,000 units of Heparin, 40mg Solu-Medrol,
and 50cc of RIMSO will be instilled. The catheter is then removed
and the patient will lie 5 minutes on his/her back, right side,
stomach, and then the left side. The patient then empties the bladder
and a single dose of antibiotic is administered to prevent infection.
These treatments are done once a week for three weeks and then,
if needed, monthly for maintenance. A follow-up visit is made with
the physician 2-3 weeks after the treatment to analyze the results.
If successful, treatment will continue, if not, other alternatives
will be pursued.
Frequently Asked Questions - Is there a cure?
As of yet, there is no cure for interstitial cystitis, but with
treatment and diet modifications symptoms can be controlled for
most patients. There are some that have minimal response to all
therapies and require more drastic measures such a removal of the
bladder. - How often will I have to have bladder treatments?
Some patients only require one course of therapy; others require
prolonged maintenance therapy every month.
(BCG, Thiotepa, Mitomycin-C, Adriamycin, and Interferon-Alpha bladder
treatments)
These intravesical agents are used to treat recurrent or high-grade
superficial bladder cancer. These agents prevent or decrease the
recurrence of the disease. Superficial Bladder Cancer has a propensity
to recur in up to 65-85% of patients. This is why bladder surveillance
using cystoscopy is a life long protocol to prevent the progression
of these lesions into a more aggressive deadly form of bladder cancer.
Bladder instillation treatments are given in various regimens, the
typical course is weekly instillations for six weeks, a three-week
break and then an additional three weekly treatments. A cystoscopy
is completed about 3-6 weeks after the treatment cycle to determine
the effectiveness of the treatments.
The injection of vasodilator medications directly into the penile
shaft has been a successful treatment of impotence or erectile dysfunction
for many years. It is effective in 60-75% of patients that can tolerate
the self-injection of medicine. Our physicians are required to administer
the first few doses for instructional purposes and to determine
the correct dose. To large of a dose can cause a prolonged erection
for hours to days. Unless this is treated with medications immediately
after the erection has not subsided after 4-hours permanent damage
can be caused. Priapism, as this prolonged erection is termed, can
cause irreversible damage to the erectile tissue, which may prevent
any erections in the future.
The penis is cleansed with an alcohol pad and then a tuberculin
syringe with a 27 gauge needle (very thin) is injected into the
side of the penis near the base of the shaft laterally. After the
needle is in past the thick fascial layer and it enters the spongy
tissue, one should be able to draw blood back into the syringe.
Once this is accomplished, the medicine is injected into the spongy
tissue and the needle is removed. Pressure is then placed over the
site for 5 minutes until the bleeding has stopped. This procedure
in not recommended for those patients that are chronically on blood
thinners.
Penile Doppler Ultrasound is a procedure that is used to predict
the response of your erectile dysfunction to vasodilator medications.
It also allows the urologist to determine and document if you have
an inflow or outflow
type of erectile dysfunction. Erectile dysfunction has many etiologies,
some respond well to the vasodilator drugs initially and potentially
for the rest of your life. Others respond initially and then see
a decrement in the
effectiveness over the years. Some diseases such as arteriosclerosis
(associated with heart disease), high blood pressure, and diabetes
exert their effects on blood vessels throughout the body, the penis
included.
If your disease causes an inflow erectile dysfunction, over time
or when you present to our office for the first evaluation, the
vasodilator drugs may not be able to adequately dilate the arteries
feeding the erectile bodies.
It would be wasteful and an inconvenience to you to try all these
therapies if this study could predict their failure
up front.
If you have a severe outflow erectile dysfunction, then any therapy
that causes an increased inflow during erection may not be adequate
for maintaining erections hard enough and/or long enough for satisfactory
intercourse. Depending on the severity these outflow problems, you
may only be adequately treated with a penile prosthesis.
Contigen is a collagen material that can be injected just under
the urethral or bladder neck mucosa (inside lining)
to treat incontinence or leakage of urine. Come people can have
allergic reactions to this material, so a skin test is required
in our office 30-days prior to treatment with Contigen. To get the
best results it may take multiple treatments, since some of this
material is reabsorbed by the body over time. Even if the treatment
is successful after the first injection (usually in females, it
may be necessary to do it yearly to enjoy the maximum benefit of
complete dryness). Since the procedure may cause you to be obstructed
immediately after, we require that a preliminary office visit be
scheduled with the nurses to learn how to do self-catheterization.
That way if you are unable to void a few hours after the procedure
you can relieve yourself rather than come to the emergency room
in significant pain.
The procedure is done through a rigid cystoscope in both the male
and the female. This is done through a scope that
is no larger than a catheter. Very little discomfort is associated
with this procedure, except during the injection were you may feel
some stinging sensations that resolve as soon as the injection stops.
An oral antibiotic is given after
the procedure to prevent urinary infection. You will leave with
a 12Fr. Red Robbin catheter just in case you have to catheterize
yourself later in the day.
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