Urologic Services

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.

Urologic Conditions

Surgical Procedures

In-office Procedures


Urologic Conditions

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:

General Urology Urologic Oncology

Surgical Procedures

The Urologic Institute of New Jersey offers extensive general and specialty surgical procedures treating adult urologic conditions. This web page can be used in learning about your planned surgery as well
as pre and post-operative instructions.


Adult Surgical Cases:


Bladder
    Open Cases:
    Laparoscopic Cystectomy
    Radical Cystectomy, Continent Diversion
    Radical Cystectomy, Ileal Conduit
    Radical Cystectomy, Neobladder
    Partial Cystectomy
    Bladder Diverticulectomy
    Open Cystotomy (Suprapubic catheter)
    Vesicoenteric Fistula Repair

    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

Penis
    Ablation/Biopsy of Penile Lesion
    Adult Circumcision
    Ambicor Inflatable Penile Prosthesis
    AMS Inflatable 3-Piece Penile Prosthesis
    Malleable Penile Prosthesis
    Glansplasty
    Nesbitt Tucks for Curvatures

Prostate

    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


Kidney
    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
Scrotum
    Adult Hydroceolectomy
    Inguinal Hernia Repair
    MESA/TSA/Testis Biopsy
    Bilateral Simple Orchiectomy
    Epididymectomy
    Scrotal Exploration for Torsion
    Spermatoceolectomy
    Subinginal Microscopic Varicoceole Ligation
    Vasectomy
    Vasovasostomy/Vasoepididymostomy
    Radical Orchiectomy
    Retroperitoneal Lymph Node Dissection

Vaginal Surgery

    Pubovaginal Sling
    Cystoceole Repair
    Rectoceole Repair
    Enteroceole Repair
    Sacrospinalis Fixation
    Trans-obturator Slings
Urethra
    Open Cases:

    Artificial Urinary Sphincter (AUS-800)
    Fistulectomy-GU Tract
    Male Sling
    On-Lay Urethroplasty
    Open Urethroplasty
    Urethral Diverticulectomy

    Endoscopic Cases:
    Cysto-Bulking Agent Injection
    Direct Vision Internal Urethrotomy
    Laser Urethrotomy
    Urolume Stent Placement

In-Office Procedures

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.



Vasectomy

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

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!

Flexible Cystoscopy

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.

Uroflow with Post-Void Residuals (PVR)

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.

Urodynamic Testing (UDT)/Cystometrogram (CMG)(for bladder control problem, incontinence)

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.

Transrectal Ultrasound (for prostate problems)

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.

Transrectal Ultrasound and Prostate Biopsy

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!

Urine analysis (dip stick/microscopic)

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).


Guaiac Testing (test for blood in the stool)

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 Depot Injections

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 Depot Insertions

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.

Renal, Bladder, Scrotal, and Testicular Ultrasounds

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.

Intravesical Therapy for Interstitial Cystitis

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.

Intravesical Therapy for Recurrent Bladder Cancer

(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.

Penile Injections (for erectile dysfunction)

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 (for erectile dysfunction)

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.

Bulking Injections (for urinary incontinence)

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 Rubber catheter just in case you have to catheterize yourself later in the day.