Specialty Center

Center for Prostate Health

Center for Bladder Health and Urinary Continence

Center for Kidney/Ureteral/Bladder Stone Management

Center for Advanced Urologic Laparoscopy

Center for Robotic Surgery and Nerve-Sparing Robotic Prostatectomy

Center for Cryosurgery

 


Center for Prostate Health


Urologic Institute of New Jersey has established the Center for Prostate health to provide specialized comprehensive services for the treatment of prostate cancer, prostate enlargement, prostate infections and myofascial pain syndromes that involve the prostate gland.

What is the prostate?

The prostate is a walnut-sized gland that surrounds the urethra just below the bladder. The urethra is the pipe that carries urine from the bladder to the head of the penis. It secretes seminal fluid, a milky substance that combines with sperm to form semen. During sexual climax, muscles in the prostate propel the semen through the urethra and out through the penis.

Typical Problems that arise in men are:

Prostate Enlargement or BPH

    - with mild to moderate voiding problems
    - with acute urinary retention.
Prostate Cancer
    - an elevated PSA blood test
    - a new diagnosis of Prostate Cancer
    - recurrent disease after failed primary therapy
    (surgery, external beam radiation and radioactive seed implants)
    - locally advanced and metastatic prostate cancer.
Prostate Infection
    - acute infections of the prostate
    - chronic infections of the prostate
    - chronic myofascial pain syndromes.
Health Calculators:
Prostate Enlargement or BPH:

Benign Prostatic Hyperplasia, or BPH, is a condition which affects many men, Over 80% of men over the age of 50 will have evidence of prostatic enlargement, up to 50% will experience some symptoms, and up to 25% may require some form of treatment or suffer side-effects from this problem.

The prostate gland itself is a structure that is found at the base of the bladder which surrounds the urethra. Its normal function is to contribute to the formation of semen. When the prostate enlarges, it can narrow the urethra with obstruction to the flow of urine.
Symptoms of prostate enlargement include diminished urine flow, frequent urination, nocturia (getting up at night to void), straining to urinate, sense of incomplete emptying of the bladder, and urgency (need to void quickly). More significant problems associated with prostatic obstruction include infection (prostatitis), bleeding, inability to urinate, development of bladder stones, or even kidney failure. When these later problems develop, or when the earlier symptoms become especially bothersome, treatment of prostatic enlargement may be recommended.
Evaluation of a man with prostatic enlargement is generally done in the office setting. History taking and physical examination are the most important evaluations, but sometimes other studies are indicated. Blood testing (Prostate Specific Antigen, PSA) is often done to evaluate for possible cancer.
Non-invasive studies such as bladder and kidney ultrasound and urinary flow studies are sometimes recommended. More involved testing could involve prostatic ultrasound, cystoscopy (looking inside the prostate and into the bladder) and urodynamics (to assess bladder pressure during voiding). All of these studies are done in the office.

    Treatment Options:

    When symptoms of prostatic enlargement are significant enough, treatment may be recommended. Modality of choice depends on the patients age, medical problems, medical necessity, and size and anatomy of the prostate.

    Medical Therapy:

    - Alpha blockers (such as Flomax and Uroxetrol) and 5-alpha reductase inhibitors (such as Proscar and Avodart)
    - Herbal medications (phytotherapies) which are being pursued by patients (often independent of their urologist).

    Minimally Invasive Prostate Therapy:

    Microwave Therapy (AKA TUMT) - use of microwave energy to heat and subsequently shrink the prostate. Outpatient. No General Anesthesia required.

    Indigo Laser Therapy - use of Laser to heat Prostate and subsequently shrink the prostate.
    Outpatient. Performed with sedation.

    * New * Green Light Laser Therapy - use of Laser to Vaporize the obstructing prostate for immediate relief. Outpatient. Requires some Anesthesia.

    Transurethral resection of prostate (TURP) - "gold standard" Hospital Requires Anesthesia and Overnight stay.

    Open and Laparoscopic Simple Prostatectomy - usually reserved for very large prostates (Greater than 100 grams) Hospital Requires Anesthesia and Hospital stay.

    The physicians at the Urological Institute are experts in the evaluation and treatment of BPH and offer a full range of treatment options, including medical therapy and microwave treatments.

Prostate Cancer:

Prostate Cancer, is the single most common cancer of non-skin cancer in men in the United States. In the year 2004, an estimated 192,000 men were diagnosed with prostate cancer, and some 30,000 will die of the disease. The cornerstones of diagnosis remain the digital rectal examination and PSA (Prostate Specific Antigen). Newer measurements of PSA, including %Free PSA, will allow more informed decision making by your urologist regarding prostate cancer diagnosis. Transrectal ultrasound and prostate biopsy are the procedures performed to diagnose prostate cancer.

The American Urological Association recommends an annual digital rectal exam and PSA for all men 50-70 who are in good health. High risk patients including patients with a family history of prostate cancer or African-Americans should have an annual PSA and a rectal exam beginning at age 40. Prostate cancer exacts a particularly high toll on African-American men; mortality rates in African-American men are more that twice as high as rates in white men.

Urologic Institute of New Jersey offer all treatment options for prostate cancer including nerve sparing open and Robotic radical prostatectomy, hormonal therapy, and the newest - cryotherapy (whereby, the prostate gland is frozen to kill the cancer kills). We also participate with our radiation oncology colleagues in placing radioactive seeds into the prostate (brachytherapy) for select patients. Prostate cancer treatments should be selected based on many criteria, including pathology information, patient age, and medical history.

    Treatment Options:


    Localized Disease:

    Nerve-Sparing Open Radical Prostatectomy

    Nerve-Sparing Robotic Radical Prostatectomy - (see center for Robotic Surgery)

    Cryosurgical Ablation of the Prostate


    Brachytherapy

    External Beam Radiation Therapy – reserved for ages > 70 or those with multiple medical problems.

    Hormonal Therapy– reserved for those with high risk features depending on pathology and age.


    Metastatic Disease :

    Local Therapy + Hormonal + Chemotherapy


Prostatitis:

Prostatitis,
is a term used to describe inflammatory conditions of the prostate gland. It is thought that most cases of prostatitis result from bacterial infection, but evidence of infection is not always found. An infected or inflamed prostate can cause painful urination and ejaculation, and if left untreated, serious complications.
    Incidence and Prevalence:

    Prostatitis can affect men of any age and it is estimated that 50% of men experience the disorder during their lifetime. Prostatitis is the most common urological disorder in men over the age of 50 and the third most common disorder in men younger than 50.

    According to the National Institutes of Health, prostatitis accounts for 25% of all office visits involving the genitourinary system by young and middle-aged men.

    Nonbacterial prostatitis and prostatodynia, which is also called chronic pelvic pain syndrome (CPPS), are the most common diagnoses. Bacterial prostatitis (acute and chronic) accounts for less than 5–10% of cases. Acute bacterial prostatitis occurs most often in men under age 35, and chronic bacterial prostatitis primarily affects men between the ages of 40 and 70.

    4 Types of Prostatitis:

    Acute bacterial prostatitis (ABP) is inflammation of the prostate gland caused by bacteria such as Escherichia coli and Klebsiella. Severe complications may develop if not promptly treated. ABP can be fatal if the bacterial infection is untreated and travels to the bloodstream (sepsis).

    Chronic bacterial prostatitis (CBP) is a recurrent infection and inflammation of the prostate and urinary tract. Symptoms are less severe than those associated with acute bacterial prostatitis.
    Nonbacterial prostatitis is an inflamed prostate without bacterial infection.

    Prostatodynia, sometimes called chronic pelvic pain syndrome (CPPS), is the occurrence of prostatitis symptoms, without inflammation or bacterial infection.

Center for Bladder Health and Urinary Continence

The Urologic Institute of New Jersey, under the directions of Dr. Jack Vitenson and Dr. Sergey Rome, has established the Center for Continence and bladder health in order to provide specialized comprehensive services for the treatment of all types of bladder control problems, urinary incontinence, and interstitial cystitis for both males and females of all ages.

Do you have a bladder-related problem?

What is Urinary Incontinence?

What is the Bladder and How does it Work?

Causes/Types of Urinary Incontinence

Male Incontinence

How is Incontinence Evaluated?

Incontinence Treatment

Interstitial Cystitis


What is Urinary Incontinence?

Urinary incontinence is a voiding disorder characterized by any "uncontrollable" or accidental leakage of urine. It is embarrassing, uncomfortable and can directly affect not only a person's health but the quality of everyday life. It affects both men and women from the very young to the elderly. This problem affects over 14,000,000 Americans a year. While it is not a normal part of aging, it is often curable and definitely treatable.


What is the Bladder and How Does it Work?

The urinary bladder can be compared to a big flexible muscular balloon that stores urine produced by the body from its kidneys. To fill and store urine, the bladder expands. When it wants to empty, it contracts, thereby pushing urine out. At the base of the bladder, a tube called the urethra is attached and is the path though which urine comes out. The urethra is surrounded at the base by a muscle valve mechanism called a urinary sphincter that stays closed to keep urine in and opens to let urine out. To fill, store and keep urine in the bladder, a coordination of closing the sphincter and relaxing.



Causes/Types of Urinary Incontinence:

The causes of urinary incontinence are many and treatments are aimed at each of these causes.
Incontinence is classified into four basic categories:
    Transient Incontinence is associated with the physically and mentally challenged, especially the elderly. It has many causes and is the most difficult to treat. It is usually related to side effects of medications, confusion, poor eye sight, impaired mobility.

    Urge Incontinence is described by patients as the urge to urinate but being unable to hold the urine in time to get to a bathroom. It is characterized as an uncontrolled spasm of the bladder muscle resulting in its contraction and emptying of urine. Sometimes these uncontrolled spasms may occur without a patient's awareness.
    It can be caused by to a variety of disease such as diabetes, strokes, Parkinson's disease to simple urinary
    tract infections.

    Stress Incontinence is characterized by leaking with an activity or when coughing and sneezing. These stress events cause an increase in pressure from outside the bladder. Normally, the sphincter and support structures at the base of the bladder are weakened and can no longer remain closed effectively. Structures of the bladder and urinary tract can be damaged or weakened from events such as surgery, childbirth or other diseases, and stress incontinence may occur.

    Overflow Incontinence occurs when the bladder is filled to its capacity, can not fill anymore and basically spill out. It is most common in men and especially those with enlarged prostate. A good analogy is when a sink is filled to the brim and begins to overflow as the faucet is left on. This occurs in situations when the bladder muscle is weak and unable to contract or when there is a blockage causing the bladder such as seen in men with Benign Prostatic Hyperplasia (BPH). Bladder muscle weakness can often occur in patients whose nerves to the bladder are injured after surgery, from diabetes or other disease of the nervous system.

Male Incontinence:

Males can also have significant problems with all three types of incontinence discussed earlier.
The most common male problems that lead to these bladder control issues are:

    Stress Incontinence:
    - Post-prostatectomy Incontinence
    - Prostate cancer surgery
    - Prostate enlargement surgery

    Transurethral Resection of the Prostate (TURP)
    - Urge Incontinence
    - Primary bladder instability (Overactive Bladder)
    - Prostate enlargement
    - Neurological diseases and conditions
    - Stroke
    - Parkinson's Disease

    Overflow Incontinence
    - Prostate enlargement
    - Advanced Prostate Cancer


How is Incontinence Evaluated?

Evaluation is often initiated by your primary physician with an examination consisting of a careful history and physical examination. Simple lab tests are performed to evaluate abnormalities in the urine and of the urinary system. If the problem is not easily identified, a specialist in incontinence such as a urologist may better diagnose the problem with additional tests that study the urinary tract and its functions.

Urodynamic Testing is often scheduled to study the functioning capabilities of the bladder provides information such as how much the bladder can hold, whether there are spastic contractions, whether the urinary sphincter is injured and cannot close, and whether the bladder muscle contracts properly to empty urine. Often the treatment of incontinence can become complex because there can be more than one type of incontinence affecting the urinary system.


Incontinence Treatment

Once incontinence is properly evaluated, a treatment plan can be formulated to treat a patient's incontinence. There are a number of different treatments for incontinence. These can range from simple behavioral training exercises, to drugs and surgery. Each treatment plan is tailored to a patient's type of incontinence, personal needs and expectations, and medical condition.

Various treatments available can be classified into four main groups: behavioral therapies, drugs, devices and surgery. Available behavioral therapies include Kegel exercises (exercises that strengthen the pelvic floor muscles) and biofeedback, a computerized training process that helps a patient become aware and control the muscles involved with urinating. Electrical stimulation and the newest Neotonus Magnetic Chair which emits an magnetic impulse to contract pelvic floor muscles. Drugs include those that treat infections such as antibiotics those that treat bladder spasms such as anticholinergic drugs; those that make tissue healthier in postmenopausal women such as estrogen and many others. Devices of which there are many include pessaries, pads, plugs, clamps and catheters. Surgical treatments can be as simple as a 20 minute office procedure like periurethral needle injection with collagen to bulk up the sphincter muscle area to complex surgical procedures that repair the support of the pelvic floor and bladder base area. The internal replacement of an artificial urinary sphincter (see Picture) to control the outflow of urine is also available for appropriate patients.

What is Interstitial Cystitis (IC)?

Interstitial Cystitis is a chronic inflammatory condition of the bladder. IC is a poorly understood disease, and its exact causes have yet to be identified. Although no bacteria, fungi, or viruses have been found in the urine of IC sufferers, some investigators believe that a yet-to-be discovered infectious agent causes IC. Some researchers believe that IC is toxin mediated, due to ischemia or an autoimmune disorder, which is a person's immune system, for unknown reasons, starts to "attack" its own cells. A popular theory, currently, is that the inner layer of the bladder (epithelium) is deficient in glycoaminoglycans, a protective coating on the bladder mucosa. Most investigators believe that the cause of IC has a number of factors and that it is better classified as a syndrome rather than a single disease.

A special IC diet can prevent worsening of your symptoms. Diet recommendations include avoidance of all caffeine products, carbonated drinks (pop, soda, etc.), tomatoes and tomato products, citrus fruits and juices, alcoholic beverages, and spicy foods.

An Interstitial cystitis symptom and problem questionnaire is one diagnostic tool used for IC.

Diet Restrictions for Interstitial Cystitis

There is no scientific link between interstitial cystitis and diet, but many IC patients find that modifying their diet helps to control their symptoms and avoid flare-ups.
The following is a list of foods by food group that many IC patients have trouble with and that the Interstitial Cystitis Association recommends avoiding:

    *Milk and dairy products: aged cheeses, sour cream, and yogurt and chocolate.
    * Vegetables: favabeans, lima beans, onions, tofu and tomatoes.
    * Fruits: apples, apricots, avocados, bananas, cantaloupes, citrus fruits, cranberries, grapes, nectarines, peaches, pineapples, plums, pomegranates, rhubarb, strawberries and any juices made from these fruits.
    * Carbohydrates and grains: rye and sourdough bread.
    * Meats and fish: aged, canned, cured, processed or smoked meats and fish, anchovies, caviar, chicken livers, corned beef, and meats containing nitrates or nitrites.
    * Nuts: most nuts.
    * Beverages: alcoholic beverages including beer and wine, carbonated drinks, coffee, tea, cranberry juice.
    * Seasonings: mayonnaise, miso, spicy foods (in particular Chinese, Indian, Mexican and Thai), soy sauce, salad dressings and vinegar.
    * Preservatives and additives: benzol alcohol, citric acid, monosodium glutamate, aspartame (Nutrasweet?), saccharine, foods containing preservatives and artificial ingredients and colors.
    * Miscellaneous: tobacco, caffeine, diet pills, junk foods, cold and allergy medications containing ephedrine or pseudoephedrine and certain vitamins that contain fillers especially aspartate.

It is important to remember that each individual reacts differently, so what effects one person negatively will be fine for another. Many IC patients report having the least trouble with rice, potatoe, pasta, vegetables and chicken.




Center for Kidney/Ureteral/Bladder Stone Management

Urologic Institute of New Jersey has treated over 5000 patients with urinary stones. The institute offers all treatment options available including minimally invasive shockwave, laser, percutaneous and laparoscopic stone extraction. Learn more about urinary stones in this page.


What are urinary/kidney stones & how do they form?


What could happen if kidney stones are left untreated?

How are kidney stones treated?

What are the different types of kidney stones?

How does one prevent getting Kidney stones?


What are kidney stones & how do they form?

Kidney stones are hardened crystal clumps that can develop in the urinary system. They usually form because there is a breakdown in the balance of liquids and dissolved solids in the urine.

The body typically contains two kidneys. The kidney is bean-shaped organ about the size of a small apple and are located below the ribs and toward the back. The role of the kidney is to filter and clean the blood, and they produce urine from excess. They contain nearly 40 miles of tubes, most of them tiny, that process some 100 gallons of blood each day.

The kidneys must keep the right amount of water in the body while they remove materials that the body cannot use and sometimes an unbalance of liquids and dissolved solids in the urine. If this balance is disturbed, the urine can become overloaded with substances (usually small crystals) that won’t dissolve in water. Crystals begin to stick together and slowly add layer upon layer to form a stone. A kidney stone may grow for months or even years before it causes a problem.

Risk indications of kidney stones include being a male (4 out of 5 kidney stone suffers are male), family history, chronic dehydration, or little fluid intake. A number of other conditions can contribute to the production of kidney stones. These include urinary tract blockage, urinary infections that recur, bowel disease, and certain inherited disorders. People who are paralyzed or who have to rest in bed for long periods of time are also at increased risk for kidney stones, as are men and women who fly long space missions.

What could happen if kidney stones are left untreated?

Often the first signs of a kidney stone appear as pain on the right or left or both sides of the back. The pain often begins as slow and then becomes constant and severe. Other possible signs of a stone include burning during urination, blood in the urine, or a frequent urge to urinate. Nausea and vomiting may also occur, and the lower abdomen or bank may be painful if touched. The shape and appearance of kidney stones depends on what chemicals have created the stones. Most kidney stones are yellow or brown, but they can be tan, gold, or black in color. They can be round, jagged, or even have branches in shape. Kidney stones vary is size with most as specks to pebbles, however some stones can be as big as golf balls.

Problems and damage resulting from kidney stones may be minimal to severe. Whether there is damage and, if so, how much there is depends on the location of the stone in the urinary system. To avoid or minimize damage, it is important to eliminate stones that form and to prevent new ones from developing.

How are kidney stones treated?

Kidney stones can become stuck in any part of the urinary system. To begin to locate a stone, doctors may perform an x-ray or ultrasound study. This gives a good idea of the stone’s size and where it is located. Many patients also receive a CT scan of their abdomen and pelvis in order to localize the stone within the urinary system which will help the doctor decide on which treatment option is best suited for the patient.

It is estimated that between 30% - 40% of stones pass on their own in the urine, usually within 48 hours of the start of the symptoms. It is very important that the stone, if passed, be saved, so that it can be sent to a laboratory for evaluation. Long-term treatment and prevention plans depend on the type of stone. To catch a stone, patients are asked to urinate into a strainer, a cup with mesh in the bottom. All pieces of stone, no matter how small, should be collected and given to the doctor. If one stone is analyzed, more may not be needed, since most people develop just one type of stone.

Some kidney stones do not pass out of the body on their own and require that your doctor performs a procedure or surgery to eliminate them. Depending on the location of the stone at time of presentation, many minimally invasive options are available in order to eliminate the stones.


    ESWL(Extra-corporeal shock wave lithotripsy)

    A process called lithotripsy (from the Greek word for “stone crushing“) breaks stones into tiny fragments. Lithotripsy has been used in the U.S. since 1984. It is performed using a machine called a lithotripter. There are different types of lithotripters, but all focus sound shock waves from outside the body on the kidney stone. Repeated shock waves cause the kidney stone to disintegrate into tiny particles. These particles pass easily out of the body in the urine. This procedure is performed as an outpatient procedure either at Hackensack University Medical Center or at the Stone Center in Newark, New Jersey. Our doctors have had specialty training in performing these procedures and are experts in selecting proper candidates for such procedures.

    Before receiving lithotripsy, the patient’s history is reviewed and the physical examination is completed. Laboratory tests also are performed, and the patient may be given some medication. Just before lithotripsy, most patients receive a sedative to help them relax. Occasionally, a patient is given anesthesia - either general anesthesia, which induces a sleep-like state, or a regional anesthesia, which numbs the lower body. The choice depends on physician and patient preference. Shock waves are then focused on the kidney stone for a total time of one-half hour to two hours. As the shock waves travel through body tissue, they may cause some mild bruising, which heals in a few days.


    Ureteroscopy with laser lithotripsy and/or Basket extraction of fragments

    Larger stones (1 -2 cm stones), multiple kidney stones or a stone has become lodged inside the ureter (tubal structure that normally drains the kidney) are often treated by ureteroscopy. By placing a fiberoptic camera thru the urethra, we can often directly visualize the stone and use a Holmium laser to fragment (Laser Lithotripsy) the stones. This procedure is minimally invasive and can be performed on patients taking blood thinners. It does require anesthesia but is performed as an outpatient procedure and there is no hospitalization.
    Dr. Rome and Dr. Ilbeigi have have expertise in these procedures and have successfully performed well over 1000 cases. At the end of these procedures, the doctors leave a stent (tube inside the ureter) to improve drainage and prevent pain resulting from edema. These stents are subsequently removed in the office with local anesthesia.

Ureteroscopy with laser lithotripsy

    Percutaneous Nephrolithotomy


    Large stones (greater than 2.5cm) or staghorn stones are usually removed thru a single 1-cm incision on the back. A small tube is initially placed into the kidney thru the muscles in the backby the interventional radiologist. We then dilate this tract and place a camera directly inside the kidney, find the stone and use a ultrasound lithotripter to break up the larger stones and suck them out. The whole process usually requires 1 hour and you are usually kept in the hospital overnight for observation. Dr. Rome and Dr. Ilbeigi teach these advanced procedures at Hackensack University Medical Center in North Jersey.
Percutaneous Nephrolithotomy
    Laparoscopic/Robotic Renal and/or Ureteral Stone Removal

    Dr. Ilbeigi and Dr. Rome are among a very few surgeons expertly trained in performing laparoscopic stone extraction. These operations are reserved for impacted stones (stones that can not be passed and those that have caused much local trauma that can not be safely treated by other modalities) and for kidney stones that have formed as a result of kidney urinary outlet obstruction requiring concomitant repair of these obstructions. Dr. Ilbeigi is the main author of the American Urologic Association 2006 award-winning Video production outlining this technique.

What are the different types of kidney stones?
    Calcium Oxalate and Phosphate Stones
    Calcium oxalate and phosphate stones are made up of a hard crystal compound and are the most popular of the stones with about 70% to 80% of all kidney stones currently made up of calcium oxalate and phosphate. Calcium oxalate is often mixed with phosphate, but either pure calcium oxalate or calcium phosphate stones may occur. The cause of calcium oxalate appears to be too much calcium in the urine or too much oxalate in the urine. This can result from too much oxalate production by the body or not enough calcium in your diet. Large doses of vitamin C or not enough vitamin B can also lead to excess oxalate in the urine.

    Struvite (or infection) Stones
    About 10% to 28% of all stones are associated with bacterial urinary infections and most common in women. In patients with struvite stones, it is important not only to remove the stone but also to prevent recurrence of the urinary infection.

    Uric acid stones
    About 5% to 13% of kidney stones contain uric acid, which arises when the body breaks down certain foods, especially meats. These stones are more common among men and develop when there is too much uric acid in the urine. Patients with gout, a metabolic disorder associated with high uric acid levels, are especially prone to uric acid stones as well as a diet high in purine from meat, fish, and poultry.

    Cystine stones
    Another inherited condition can cause too much cystine (produced by the breakdown of protein from your diet) to collect in the urine. The cystine tends to form crystals that develop into cystine stones. These stones are relatively rare, accounting for only about 1% to 3% of all kidney stones.

How does one prevent getting kidney stones?
    Hydration
    You should get into the habit of drinking 64 oz of water spread throughout each day. A good way to judge whether you’re drinking enough is to watch the color of your urine. If your urine is dark and yellow, drink more.
    It should be pale, almost watery. Drinking plenty of fluids also reduces the risk of urinary tract infections –
    a major cause of struvite stones. Any infections that do occur should be treated promptly and completely

    Dietary Changes
    Dietary changes may be necessary depending on the kind of stone involved and the results of laboratory tests, your doctor may advise you to eat less of certain kinds of foods. For example, patients with calcium oxalate or uric acid stones may need to reduce the amount of meat products and table salt in their diets and increase the amount of fiber. You and your physician may work with a dietitian to develop a diet suited to your particular needs.
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There are prescription medications that help some patients. Diuretics, such as hydrochlorothiazide, decrease calcium excretion. Potassium citrate binds calcium and helps to remove it safely. Allopurinol, which causes the body to produce less uric acid, is sometimes prescribed for patients with gout. It also reduces their risk of forming uric acid or calcium oxalate stones. Patients taking medications still need to drink at least ten 8-ounce glasses of fluid per day.
When cystine stone formation can’t be controlled by increased fluid levels alone, penicillamine or tiopronin may be prescribed to make it easier for the body to dissolve cystine. Other specific medications may be prescribed by your doctor. People who have had one kidney stone are prone to develop others. Without preventive treatment or changes in lifestyle, patients can develop a new stone within a year or two of the first one. About half of patients do develop a stone again within 5 to 10 years, and 80% do so sometime in their lives.




Center for Advanced Urologic Laparoscopy


The Urologic Institute of New Jersey has established the Center for Advanced Laparoscopy in order to provide minimally invasive and laparoscopic alternatives to the following traditionally open surgical procedures. Our physicians have specialty training in performing highly complex operations such as laparoscopic removal of kidneys, adrenal glands and prostate glands.

Our physicians perform minimally invasive cystectomy (removing the bladder for cancer), ureterolithotomy (removing impacted ureteral stones), ureterolysis (digging out ureters from scars to improve kidney outlet drainage), and pyeloplasty with concomitant pyelolithotomy (removing kidney stones and correcting kidney outlet obstruction at the same time), as well as complex and advanced laparoscopic adrenal and renal surgery in patients with multiple and anomalous vasculature, obesity, and those with prior surgery.

The institute offers both transperitoneal (thru the abdomen) and retroperitoneal (behind the abdominal contents) approaches depending on the condition being treated. Patients, who have laparoscopic surgery generally experience less pain, have a quicker recovery and less risk of infection than those who have traditional open surgery.

Dr. Ilbeigi is the author of several publications in peer reviewed Journals and has produced several videos that have received “Honorable Mention” at the American Urologic Associated and World Congress on Endourology and laparoscopy. Dr. Ilbeigi was also the recipient of the outstanding Laparoscopic surgeon achievement award from the society of laparo-endoscopic surgeon (SLS) in 2005.


What is Laparoscopy?


How are laparoscopic procedures performed?

What urologic conditions can be treated using laparoscopic surgery?

What are the benefits of laparoscopy?

What are the risks of laparoscopic surgery?

Who are not good candidates for laparoscopic surgery?


What is Laparoscopy?

Laparoscopy is a technique of performing a surgical operation using instruments inserted through narrow hollow tubes ('ports') rather than through a larger incision, as in traditional surgery. Laparoscopy is a minimally invasive alternative to standard open surgery in which a special camera called a laparoscope is used to produce an inside view of the abdominal cavity. Surgeons use the laparoscope, which transmits a true picture of the internal organs onto a video monitor, to guide them through surgical procedures. The laparoscope magnifies these images many times their actual size, providing surgeons with a better view of the abdomen than with standard open surgery. Laparoscopy often results in shorter hospitalization and earlier convalescence, less bleeding and post-operative pain and fewer wound complications.

How are laparoscopic procedures performed?

During laparoscopy, 3 or 4 small (1/2-inch) incisions are made in the abdomen. Carbon dioxide is passed through one of the incisions into the abdomen to enlarge the cavity and lift the abdominal wall away from the organs. This creates more operating space, making it easier to manipulate the abdominal organs. The pencil-thin laparoscope and surgical instruments are then inserted through the other incisions. Sometimes, a hand is inserted thru a small (6-7cm) incision to facilitate dissection in difficult cases.

  Laparoscopy Open Surgery
Incision Either 3 or 4 small incisions (less than 1 inch) in the abdomen A 6 to 10 inch incision in the abdomen; may require removal of part of one rib
Length of hospital stay 1 to 2 days 3 to 5 days
Recovery Less bleeding & scarring after surgery.
Less pain
Increased scarring after surgery
More pain
Return to normal activity 2 to 4 weeks 8 to 12 weeks


What urologic conditions can be treated using laparoscopic surgery
at our institution?


Adrenalectomy
Partial adrenalectomy
Radical nephrectomy for cancer
Radical nephroureterectomy for cancer
Simple nephrectomy
Partial nephrectomy for cancer
Renal cryoablation (freezing renal cancers in the elderly)
Calyceal diverticulectomy
Renal cyst excision
Pyeloplasty
Ureteral surgery
Large ureteral stone
Female urinary incontinence
Vaginal prolapse
Pelvic lymph node dissection
Undescended testis
Retroperitoneal lymph node dissection for testicular cancer
Radical prostatectomy for prostate cancer
Radical cystoprostatectomy and urinary diversion for bladder cancer



What are the benefits of laparoscopy?

Patients who have laparoscopic surgery generally experience less pain, have a quicker recovery and less risk of infection than those who have traditional open surgery. Because the incisions are small, laparoscopic surgery produces less bleeding and scarring, reduced post-operative pain and shorter hospital stays, and patients experience a quicker return to normal eating habits and daily activities. (See chart below).

What are the risks of laparoscopic surgery?

As with all surgical procedures, there is a small risk of complications. A physician will complete a preoperative evaluation to ensure that the procedure is appropriate for you. However, in a small percentage of cases, even approved laparoscopic procedures may be converted to open procedures.
Reasons for conversion to an open procedure may include:
A significant complication during surgery If the operation is not proceeding as smoothly as the surgeon would like it to.

Who are not good candidates for laparoscopic surgery?

Most people are eligible for laparoscopic surgery. However, you may not qualify for the procedure if you have had multiple previous abdominal surgeries.

Video and Publication Citations:

Relevant Videos:
    Video: Robotic-assisted laparoscopic pyeloplasty with concomitant laparo-endoscopic pyelolithotomy
    of calyceal calculi
    .
    Ilbeigi P, lovallo GG, bhalla RS, sawczuk IS, munver R
    Awarded HONORABLE MENTION and the ANNUAL AUDIO VISUAL AWARD
    Production November 2005

    Video: Evaluation of the laparoscopic LigaSure Vessel-sealing system during Laparoscopic Adrenalectomy.
    Ilbeigi P, Lombardo SA, Munver R.
    Production October 2005

    Video: Laparoscopic Pyelo-Ureterolithotomy
    Ilbeigi P, Dakwar G, Rome S, Bhalla RS
    Production August 2006

    Video: Laparoscopic Ureterolysis for retroperitoneal fibrosis
    Description of techniqueIlbeigi P, Dakwar G, Rome S.
    Production: August 2006

    Video: Transurethral Cystolitholapaxy Made Simple
    Ilbeigi P, Brison DI, Sadeghi-Nejad H, Jordan M.
    Production: June 2006

Relevant Publications:

    1. Ilbeigi P, Munver R; Advanced hand-assisted laparoscopy: The new standard of care. Contemporary Urology. April 2006. Cover Manuscript

    2. Esposito M, Ilbeigi P, Ahmed M, Lanteri V; Use of the fourth arm in the da Vinci robot-assisted extraperitoneal laparoscopic prostatectomy: novel technique. Urology 2005, Sep:66(3):649-52.

    3. Ilbeigi P, Volfson IA, Lombardo SA, Munver R; Minimizing complications during laparoscopic extirpative renal surgery in the setting of complex anatomy or anomalous renal vasculature. J Endourol 2005, Aug: 19(Supp): A41.

    4. Ilbeigi P, Volfson IA, Munver R; Evaluation of the laparoscopic Ligasure™ vessel-sealing system during laparoscopic adrenalectomy. J Endourol 2005, Aug: 19(Supp): A163.

    5. Ilbeigi P, Lovallo GG, Bhalla RS, Sawczuk IS, Munver R; Robotic-assisted laparoscopic pyeloplasty with concomitant laparo-endoscopic pyelolithotomy of calyceal calculi. J Endourol 2005, Aug: 19(Supp): A270.




Center for Robotic Surgery and Nerve-Sparing Robotic Prostatectomy

 The Urologic Institute of New Jersey has established the Center for Robotic surgery and Robotic Prostatectomy in order to provide minimally invasive alternatives for genitourinary reconstructive surgeries such as pyeloplasty (correcting kidney outlet obstruction), ureterolithotomy (removing impacted stones), as well as Robotic-assisted Laparoscopic prostatectomy
for localized prostate cancer.

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. Dr. Rome, Dr. Rusnack, and Dr. Lebovitch have specialty training in performing these complex operations. Dr. Ilbeigi has specifically been involved in the evolution of several techniques using the da Vinci Robot surgical system, has authored peer-reviewed journal articles and has produced training videos about these operations. They perform Robotic surgery at Hackensack University Medical Center and the Valley Hospital in Ridgewood, New Jersey.

What is Robotic Surgery?

How are Robotic Prostatectomy Performed?

What are the Benefits of Robotic Prostatectomy?


What is Robotic surgery?

Robotic surgery involves use of the da Vinci robot surgical unit in performing complex surgical procedures such as prostatectomy (removal of the prostate gland usually for cancer) and pyeloplasty (reconstructing urinary drainage system from the kidney). This exciting technology allows the operating surgeon to sit comfortably behind a console and control the robot that is next to the patient to perform surgery. The da Vinci robot surgical system is now available at many centers including Hackensack University Medical Center and the Valley Hospital in Ridgewood New Jersey.



This exciting technology combines fine dexterity of laparoscopic instruments with 7 degrees of freedom, as well as 3-dimensional visualization for the operating surgeon while allowing him/her to be seated comfortably at aremote console. Consequently, robotic assistance has significantly decreased the learning curve for this technically challenging procedure.

How are Robotic prostatectomy performed?

Robotic Prostatectomy, also known as Robotic surgery for prostate cancer or da Vinci® Prostatectomy is a minimally invasive surgery that is now the preferred approach for removal of the prostate in those diagnosed with organ-confined prostate cancer. The da Vinci Prostatectomy may be the most effective, least invasive prostate surgery performed today. Though any diagnosis of cancer can be traumatic, the good news is that if your doctor recommends prostate surgery, the cancer was probably caught early. And, with da Vinci Prostatectomy, the likelihood of a complete recovery from prostate cancer without long-term side effects is, for most patients, better than it has ever been.

The operation is performed using the daVinci Surgical system and 3-D endoscopic and wristed instruments inserted through 5-6 small incisions across the mid-abdomen (See Figure below)

During the dVP, a telescopic lens is inserted into one of the small incisions. This provides a magnified 3 dimensional view of the delicate nerves and muscle surrounding the prostate, thus allowing optimal preservation of these vital structures. The cancerous prostate gland is dissected free from the bladder and urethra, and the bladder and urethra are sewn together without the surgeon's hands ever entering into the patient's body. The prostate is removed intact through one of the small incisions located at the belly button by extending the incision to accommodate the size of the prostate. These small incisions are closed with absorbable suture.

What are the benefits of Robotic prostatectomy?

The da Vinci Surgical System enables surgeons to operate with unmatched precision and control using only a few small incisions. Recent studies suggest that da Vinci Prostatectomy may offer improved cancer control and a faster return to potency and continence.

The da Vinci Prostatectomy also offers these potential benefits:
    Significantly less pain and scarring
    Less blood loss
    Fewer complications
    Less scarring
    A shorter hospital stay and faster recuperation
    Faster return to normal daily activities
As with any surgery, these benefits cannot be guaranteed, as surgery is both patient- and procedure-specific. While prostatectomy performed using the da Vinci Surgical System is considered safe and effective, this procedures may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits. If you are a candidate for prostate surgery, talk to a surgeon who performs da Vinci Prostatectomy.

Publications:
1. Robotic-assisted laparoscopic pyeloplasty with concomitant laparo-endoscopic pyelolithotomy of calyceal calculi.
Ilbeigi P, Lovallo GG, Bhalla RS, Sawczuk IS, Munver R; J Endourol 2005, Aug: 19(Supp): A270.

2. Use of the fourth arm in the da Vinci robot-assisted extraperitoneal laparoscopic prostatectomy: novel technique.
Esposito M, Ilbeigi P, Ahmed M, Lanteri V; Urology 2005, Sep:66(3):649-52.

Video:
1. Robotic-assisted laparoscopic pyeloplasty with concomitant laparo-endoscopic pyelolithotomy of calyceal calculi.
Ilbeigi P, lovallo GG, bhalla RS, sawczuk IS, munver R
2. Awarded HONORABLE MENTION and the ANNUAL AUDIO VISUAL AWARD
Production November 2005

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Center for Cryosurgery

The Urologic Institute of New Jersey has established the Center for Cryo-surgical ablation forprostate and kidney cancer. Drs. Rome, Rusnack, Lebovitch have specialty training in performing these minimally invasive operations in treating localized prostate cancer, recurrent prostate cancer after radiation, and small kidney tumors. Our doctors are some of the very few urologist in Northern New Jersey involved in the training of others in performing these techniques.
Please call our centers for more information and to find out if these approaches are right for you.
Prostate Cancer Cryosurgery

Renal Cancer Cryosurgery

Cryosurgery or cryo-ablation involves introducing needles that freeze targeted areas of the body to extremely cool temperatures (-190 Celsius) in order to kill cancer cells. The mechanism of this destruction includes disruption of the cell wall, organelles within the cell and prohibiting blood from circulating.

With the advent of newer delivery systems and ultrasound guidance, one can destroy a focal area of tissue/cancer with accuracy up to 2.5 mm. This technology was first described in 1966 but did not gain popularity until the late 1990’s when mobile targeting imaging modalities became more readily available and our access techniques improved. This technology has now been FDA approved and found to be very effective in treating localized prostate cancer as well as select kidney cancers.



Prostate Cancer Cryo-Ablation

Prostate Cancer Cryo-ablation Prostate cancer affects 1 out of 6 men in their lifetime. There are many options to treat prostate cancer. Depending on age, risk factors, medical co-morbidities and if the cancer is localized to the prostate, cryoablation of the prostate can be an excellent treatment choice. It can be used as a first-line treatment for localized prostate cancer or to treat recurrent localized prostate cancer having failed radiation treatment.

As primary treatment for prostate cancer, cryoablation has been found to be equally effective to other standard therapies for low grade prostate cancers. For high-grade cancers, cryotherapy appears to be more efficacious than conformal radiation therapy. In early studies, it appears to be equally effective to surgical removal of the prostate for high grade cancers as well, however, long-term data are lacking.



Renal Cancer Cryo-Ablation

Renal carcinoma is diagnosed in about 32,000 people each year in the US. Renal cancers are usually found incidentally on imaging studies performed for other reasons. If kidney cancer is confined to the kidney, then cure is likely if it is treated. In the past, the only available option for patients with localized kidney cancer had been open radical surgery to remove the entire kidney (radical nephrectomy). Through progress in research, partial nephrectomy was proved to have long-term equivalent cancer control rates. By the late 1990's, urologists began using laparoscopy to remove the entire cancerous kidney. This has resulted in remarkable improvements in how quickly patients have recovered after surgery without compromising their chance of being cured. Laparoscopy also provided access to deliver cryosurgical technology in the treatment of select renal malignancies.



There is now an increasing amount of evidence that targeted cryoablation of small renal cancers is equally efficacious to standard therapies. For tumors that are less than 4 cm in size, the success rate reaches 95% in multiple trials.

This exciting new technology has allows treatment of small renal tumors with minimal morbidity and virtually no blood loss using a laparoscopic approach. This involves making 3 or 4 small keyhole incisions rather than large disfiguring incisions. This approach also allows maximal preservation of renal units without compromising cancer control.
The majority of patients are discharged within 1 to 2 days after undergoing such therapy.