Jerry G. Blaivas, MD, FACS Dr. Blaivas is a world-renowned urological expert, surgeon, distinguished author, educator, and medical pioneer. He was one of the founders of urodynamics and established many of the current surgical procedures used to correct stress incontinence, urinary fistulas, urethral diverticulum, overactive bladder and neurogenic bladder. He is also one of the… Continue Reading
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The Most Common Causes of Perineal Injuries
When you see the term “perineal,” this is referring to the part of the body between the vulva and anus (for woman), and the scrotum and anus (for man), also called the perineum. This is an important part of the body, because the nerves and blood vessels that are there also connect to the urinary tract and the genitals. It also helps support the bladder and the bowels. Injuries to the perineal area can be either chronic or acute. Chronic injuries occur gradually over time, while acute injuries happen suddenly.
Perineal Injuries
If the perineum is injured, this can lead to problems including bladder control and sexual problems. Both of these injuries are a result of nerve damage, causing the signals that usually travel between the perineum and the brain. Without these nerves functioning properly, both these processes will not work the way they are supposed to work.
Causes
Perineal injuries can be caused by a variety of factors. These include straddle injuries, sexual abuse, impalement, perineal surgery (men), and childbirth (women). A straddle injury refers to an injury that someone gets when they fall on a something with their legs on either side of it, or while straddling it. These can happen in bike or motorcycle accidents, falling on equipment like monkey bars, some gymnastic injuries, and during horse riding. Sometimes, this can actually lead to a burst blood vessel, particularly in men. Impalement is less common, but refers to injuries when something pierces the perineum. This is more likely to happen on farms, construction sites, combat situations, and after a fall. Sexual abuse also can lead to perineal injury.
Perineal surgery is surgery that is performed on men. Part of it involves a cut in the perineum. Examples of perineal surgeries include a prostatectomy and perineal urethroplasty. Like perineal surgery for men, childbirth can lead to perineal injuries for women. Both of these injuries tend to be acute, and therefore need to be dealt with promptly.
Treatment
Treatments for perineal injuries includes bed rest, heating, and antibiotics. Sometimes, the tear will require stitches. This is particularly important after childbirth. The first step is often to make sure that the injury is not causing any loss of blood. Once the condition is stable, the next step is to help the patient find a treatment that will help them with their recovery.
If you are feeling any of the symptoms of perineal injuries, contact us today to schedule an appointment with the best urologist in New York City.
Call us today at 646.205.3039 to schedule an appointment to meet with the best NYC urologist.
What is a Cystocele?
What is a Cystocele?
A cystocele is a medical condition that is also referred to as dropped, prolapsed, or fallen bladder. This occurs in women when the bladder either drops or expands into the vagina. A cystocele can lead to uncomfortable urination. There are three levels of cystoceles. Grade One is mild, and means that the bladder is only partially in the vagina. In Grade Two, which is more severe, the bladder is far enough in the vagina that it has reached the outside of the vagina. The most advanced stage, Grade Three, means that the bladder has moved through the vagina, which connects the uterus to the outside of the body.
Causes
There are several causes of cystocele. One of these causes is muscle strain while giving birth. Heavy lifting, being overweight or obese, or regular difficult bowel movements can also cause strain on the muscles of the bowel, which can lead to a cystocele. A cystocele can also develop during menopause because women stop producing estrogen. Since estrogen is one of the things that keeps the muscles in the vagina strong, when the body is no longer producing estrogen the muscles may become weaker. This can lead to a cystocele, though there is some debate as to whether or not menopause causes a cystocele.
Signs and Symptoms
While mild cystoceles sometimes do not have symptoms, the symptoms tend to include one of several things. These can be either a vaginal bulge, difficulty urinating, a feeling that the pelvis is heavy, or a sense that something is falling out of the vagina. For more serious cystoceles, urinary retention may be a side effect. If you feel any of these symptoms, talk to your health care provider as soon as possible.
Treatment
The treatment for cystocele can be different, depending on the grade of the cystocele and how long it’s been there. One treatment for a cystocele is a surgery that will put the bladder and urethra back into the position that they are supposed to be in. After surgery, it is recommended that patients avoid standing for a long time or heavy lifting. Although they can gradually go back to their normal activities, too much strain can render the surgery useless. Other treatment options include avoiding straining those muscles, a series of exercises, and an implant to hold the bladder in place.
If you are feeling any of the symptoms of a cystocele, contact us today to schedule an appointment with the best urologist in New York City!
Call us today at 646.205.3039 to schedule an appointment to meet with the best NYC urologist.
What is Hematuria?
Hematuria is the term that is used when blood is in urine. Basically, this is when the urinary tract is not keeping the blood cells out of urine. There are two types of hematuria, gross hematuria and microscopic hematuria. Gross hematuria is when there are enough red blood cells that the urine changes color. If the blood does not change color, that is microscopic hematuria. While individuals might notice gross hematuria, micro hematuria is only identifiable through urine samples. Most often, this is discovered during a routine checkup.
Causes
In many cases, the cause of hematuria is not something that can be identified. The main reason for this is because hematuria tends to be a symptom. Hematuria can be caused by several different factors related to the urinary tract. These include urinary tract infections, kidney stones, tumors, or trauma. Some drugs or intense exercise can lead to hematuria. While hematuria can affect anyone, there are some factors that make having one more likely. Older men, people with recent urinary tract infections, people with a family history of kidney disease, people taking medications like aspirin and penicillin, and long-distance runners are more likely to develop hematuria. In addition, high calcium concentrations in urine can lead to hematuria.
Signs and Symptoms
Other than blood in your urine, other symptoms can be present. Since hematuria is itself a symptom of other conditions, these symptoms can depend on the condition causing it. These can include swelling, nausea, back or side pain, fever, pain, or abnormal bleeding from a variety of places in the body. Other symptoms can include difficult urination. Difficulties can take the form of reduced, urgent, or painful urination. On occasion, the blood in the bladder can clot. This then prevents urine from flowing and can be extremely painful. These symptoms can help you know if you have microscopic hematuria.
Treatment
Several different tests can be done to see if you have hematuria. A urine culture will help your health care professional learn if you have an infection. In other cases, a CT scan, ultrasound, blood test, or cystoscopy can be the best way for your health care professional to know what is causing the blood. The treatment of hematuria depends on the cause of the condition. If an infection is the cause, your healthcare professional will prescribe antibiotics to clear up the infection.
Should you notice blood in your urine, or experience any of the symptoms of hematuria, contact us today to schedule an appointment with the best urologist in New York City.
Call us today at 646.205.3039 to schedule an appointment to meet with the best NYC urologist.
What is Prostate Enlargement?
The prostate is shaped just like a walnut and is used both in the male reproductive system and with bladder management too. The prostate is a cause of medical issues for men, most commonly over 50 and over 65, but occasionally in men under 50 too. One of the prostate-related issues that arises is called prostatitis. There are several causes of prostatitis, but one noticeable and painful condition is an enlarged prostate.
In this article, we cover what an enlarged prostate is, how it happens and what you can do about it.
Prostate Won’t Stop Growing
The prostate begins as a small gland situated below the bladder. It roughly doubles in size in the teenager years and then begins to grow once again around 25 years of age. From this time, it continues to grow and expand gradually throughout adult life which is where the trouble starts.
The rate of the enlargement is not standardized because there are some medical factors believed to cause more rapid gland growth in some men.
Unmanageable Size
A prostate enlargement is when the prostate has grown to an unmanageable size when compared to the other parts of the body situated nearby like the bladder above it and urethra below it.
At a larger size, the gland pushes uncomfortably against the urethra. As a result, the wall of the bladder thickens and struggles to let urine completely empty from the bladder. With a urethra that’s been size restricted, normal flow is lower that eventually makes it impossible to clear the bladder. As a consequence, other medical issues can result.
Causes of the Enlargement
It is known that during the latter aging process, older men lose testosterone leaving a greater amount of estrogen. It’s thought that perhaps the cell growth rate in the prostate is increased due to this factor. Another idea is that a hormone in men known as DHT which is involved in the management and growth of the prostate gets overloaded in the prostate again because of a lack of testosterone. Neither theory has been proven as yet but clearly estrogen and an absence of sufficient testosterone is seen by researchers as a likely central cause.
In most situations, an enlarged prostate is not an indicator of a cancer problem. Prostate cancer is another type of prostatitis but is not directly connected with enlargement specifically. The symptoms and outcomes are quite different.
It is always a good idea for men to consult a qualified urologist for a prostate screening. Contact us to arrange an appointment to see one of the best urologist doctors in New York City.
Call us today at 646.205.3039 to schedule an appointment to meet with the best NYC urologist.Causes of the Enlargement
What Is Enuresis?
Enuresis is a condition which affects a large number of children. It is usually something that they grow out of but it is worth understanding nonetheless.
What Is Enuresis?
Enuresis is the scientific term for bedwetting and is what is known as an ‘elimination disorder’. The most common form of enuresis, nocturnal enuresis, occurs at night, usually while the child is asleep. When enuresis occurs during the day, it is known as diurnal enuresis. It is possible for children to experience both.
What Causes Enuresis?
There are a number of factors which may be involved in a case of enuresis. For some children, the problem is a psychological one, for others it is rooted in physical causes, for example a small bladder.
Severe stress is the most common psychological trigger for the condition. It is not uncommon for the behavior to appear when the child is going through a difficult time, for example their parents are divorcing, or they are moving away from their current friends and surroundings.
If the causes are physical, then it may be due to a smaller than average bladder, persistent urinary tract infections, or a problem between the bladder and the urethra.
Enuresis can be either voluntary or involuntary. Voluntary, or intentional, enuresis is associated with a number of other psychiatric disorders, and it is usually seen in children who have already been diagnosed with an emotional or behavioral disorder. It is usually children who are prone to anxiety that exhibit signs of voluntary enuresis.
What Are the Symptoms?
The most prominent and obvious sign of enuresis is bedwetting. In order to be diagnosed as enuresis the child in question must be over five years old, and the wetting must occur at least twice a week for a sustained duration, usually defined as three months or more.
Treatment
Treatment will depend upon what determination the doctor makes as to the root cause of the problem. For many children, some form of therapy can help. The problem is often at least partially rooted in a psychological cause and identifying and addressing this will be the most effective treatment for most children.
Urologists won’t always recommend treatment, especially if it is not believed to be indicative of a more serious underlying mental health issue. Most children who experience enuresis will outgrow the condition before long.
If you think that your child might be suffering with enuresis then give our clinic a call today to consult with the finest urologist in NYC.
Call us today at 646.205.3039 to schedule an appointment to meet with the best NYC urologist.
What is Fournier Gangrene?
Gangrene occurs when body tissue begins to die and decompose, a process known as necrosis. Necrosis can occur because of either a restriction in blood flow, or a bacterial infection. In either case gangrene can quickly develop in to a serious and life threatening medical emergency and therefore needs to be dealt with as quickly as possible.
What Is Fournier Gangrene?
Fournier gangrene is a rare form of gangrene which effects the genitals and surrounding area. Fournier gangrene usually begins in the scrotum, testicles, penis, or perineum. It can stretch across the body however and ultimately affect the stomach, chest, and thighs.
Fournier gangrene is more common in men but can also be found, albeit far less frequently, in women and children. In all cases it is extremely rare, even more so than gangrene itself.
Causes
Fournier gangrene is usually the result of another infection in or near the genitals. Urinary tract infections are the most common root cause of Fournier gangrene; bladder infections are the next most likely cause.
In women, most cases of Fournier gangrene follow a hysterectomy and are more likely to occur where conditions are unsanitary. In children, the gangrene is usually caused by an insect bite which becomes infected, from accidental burns, or as the result of circumcision, particularly where the procedure isn’t carried out properly.
Symptoms
The following are common symptoms of Fournier gangrene;
- Fever
- Swelling or a shooting pain in the genitals or surrounding area.
- An unpleasant and persistent odor emanating from the infected tissue, usually the genitals.
- Very dry skin which sometimes makes a ‘crackling’ sound when manipulated with the hands.
- Persistent dehydration throughout the day.
Anemia, a deficiency of iron in the blood. Anemia can often leave sufferers feeling constantly tired and exhausted and can snowball into more serious health concerns.
Treatment
If you suspect you have any form of gangrene it is imperative that you see a doctor as soon as possible. The usual treatment for Fournier gangrene mimics that of other gangrenous diseases. Antibiotics are administered intravenously and, surgery is performed to remove any dead or dying tissue.
Some patients require reconstructive surgery following the removal of the dead and dying gangrenous tissue. Reconstructive surgical techniques are now much more advanced than they once were and so patients should not worry about disfigurement, it is more important to remove dangerous tissue.
Depending on how deep the gangrene has spread, the patient’s ability to pass urine and feces may be compromised. If this is the case, a catheter or colostomy bag will be fitted.
Fournier gangrene is thankfully a very rare condition but it is absolutely essential that when it strikes it is dealt with promptly. If you are concerned that you are exhibiting symptoms of Fournier gangrene then drop in to our clinic today to consult with a leading NYC urologist.
Call us today at 646.205.3039 to schedule an appointment to meet with the best NYC urologist.
What Minimally Invasive Treatments Are Available for Kidney Stones?
Kidney stones are generally painful and can be hard, if not impossible, to pass normally. This often leads to a hospital stay for many people. The pain can become severe and lead to numerous complications if it is not treated. When you work with your doctor, his or her primary goal will be the understand the underlying cause of the condition so that an effective treatment can be used. However, it does not stop there. Often, treatment also needs to be immediate when there is an acute concern at hand. Your doctor will work closely with you to do this and sometimes it may mean a minimally invasive procedure.
What Options Are There?
Endurology is the field that focuses on minimally invasive stone surgeries. Previously, the removal of a kidney stone that would not or could not be passed was done through open surgery involving a cut into the abdomen. Today, this is no longer the first choice for most doctors. Rather, nearly all urinary tract stones today can be treated in a minimally invasive procedure instead. And, there are many benefits to this.
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- This type of procedure will still remove the stone from your body.
- It often does not require a hospital stay or may involve just an overnight stay.
- It does not create a large incision, which means there are lowered risks for infection and complications.
- This procedure is generally better for those who may have other health problems that may limit their ability to have a traditional open procedure.
- You’ll heal faster, get back to work faster, and get back to your life sooner.
The procedure uses lasers that allow for the stones to be damaged significantly. Several options exist and all involve the use of high technology. Shock wave lithotripsy, flexible pyeloscopy and laser procedures, ureteroscopy and laser procedures, and percutaneous nephrolithotomy are some of the options today’s doctors have for treating your kidney stone in a less invasive manner.
If you have a kidney stone or you have had them in the past, talk to your urologist about the options available to you for minimally invasive procedures. It could help you to recover much sooner and with much less pain. Call our offices today to schedule a consultation with our experienced and trusted urologist. We’re available to meet with you in New York City for a consultation.
To find out what your options are and to ensure you have every treatment option available to you, call our offices at 646-205-3039 and schedule a consultation with one of the best urologists in New York City. Find out what your options are.
What Are Kidney, Bladder, and Ureteral Stones?
The development of kidney, bladder, or ureteral stones isn’t uncommon today. There are various types of stones that can develop as a part of the urinary tract system. This is often due to the development of minerals in your system that are too high, unable to be removed properly, or otherwise building up in the body. If you are struggling with the presence of these stones or you have a high risk for developing them, it is important for you to know what they are and why they can happen to you.
What Are They?
Known as renal calculi, these are a type of supersaturated urine filled with minerals such as struvite, calcium oxalate, uric acid, and cysteine. All of this means that they are a buildup of minerals in your body’s kidneys. As much as 80 percent of stones will contain calcium in them. They will range in size in most people. Some are very small and gravel like. Others can be much larger. The larger they are, the more of a risk they present to your health and to your pain levels.
Bladder stones make up about five percent of all urinary tract stones. These often occur as a result of obstructions, infections, or foreign bodies introduced to your system. The most common reason these develop is the inability or non-function of fully emptying the bladder after urination.
You are more likely to develop these stones if you have the following risk factors:
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- You have gout.
- You have a family history of renal stones.
- You have anatomical abnormalities especially in the urinary tract and kidneys.
- You have hyperparathyroidism.
- You have hypertension.
- You have some type of metabolic disorder such as chronic metabolic acidosis, hyperuricosuria, or hypercalciuria.
If you have these types of risk factors, it is important for you to take steps to get treatment for the underlying cause. With proper management, you may be able to avoid the development of future stones. And, in some cases, you do need to visit the hospital to get immediate help for these conditions. If your pain is significant, visit the ER for help.
When you come in to see one of the best urologists in the area, you’ll learn more about these types of stones, why you may be developing them, and what options you have to manage the immediate problem as well as to prevent future concerns.
To find out what your options are and to ensure you have every treatment option available to you, call our offices at 646-205-3039 and schedule a consultation with one of the best urologists in New York City. Find out what your options are.
What Can Be Done About an Overactive Bladder?
For those who suffer from an overactive bladder, the concerns can be many. You may feel you need to stay at home. You may stop engaging in activities that you liked to do. And, you may find yourself worried about knowing where the restroom is no matter where you go. You can often improve your life by finding a treatment option for your overactive bladder. By seeking out the help and support of a urologist, you may be able to reduce your symptoms and improve your quality of life significantly.
Behavior Treatment Options
The first step in most cases is behavior interventions. They are often very effective and have no negative side effects. The options for this include the following:
- Maintain a healthy weight. Losing weight can reduce the symptoms many have. It may also help to reduce the occurrences of stress urinary incontinence.
- The use of pelvic floor muscle exercises, called Kegal exercises, can also help. This can help to strengthen your muscle’s control over the bladder and reduce your symptoms as a result.
- In many cases, double voiding can be a solution. This means waiting several minutes after you have urinated and then trying to urinate a second time. This can help to ensure your bladder is actually empty.
- Reducing your fluid consumption, or controlling it, can also be helpful. You’ll want to work closely with your doctor to ensure you are still getting enough fluids to maintain your health.
Other Solutions
When these types of treatments for overactive bladder do not work, your doctor may recommend medications. A number of them exist and each works to reduce the urge to urinate. Some people also benefit from bladder injections. This is a form of Botox that that can help to create a paralysis of the muscles that are causing the underlying concerns. Nerve stimulation and surgical procedures may also be beneficial to some people. Surgeries can be extensive including removal of the bladder in severe cases.
What is the right treatment for you? To find out, your first step is to come in to see the best urologist in New York to talk about your condition. We’ll provide a full examination and talk to you about your symptoms. If you have an overactive bladder, we can often help you to find a solution to reducing this occurrence and improving your overall quality of life.
To find out what your options are and to ensure you have every treatment option available to you, call our offices at 646-205-3039 and schedule a consultation with one of the best urologists in New York City. Find out what your options are.
Urinary Incontinence in Women
Urinary incontinence in women is one of the most common complications for women having to do with the urinary system as women get older. This is not a disease specifically. Rather, it is a symptom of an underlying condition that is important for women to understand. There are many reasons women may suffer from this condition including due to physical problems, medical conditions, and everyday habits. It is not something to put off getting help for if you do suffer from it. Turning to a New York urologist can help you to overcome these types of complications.
What Causes It?
Most commonly, women experience temporary urinary incontinence. This may be due to the foods they consume (some foods work as diuretics, encouraging the bladder to work and increasing the amount of urine produced). This includes foods such as alcohol, caffeine, corn syrup, carbonated drinks, tea and coffee. In addition to this, temporary urinary incontinence can occur as a result of a urinary tract infection. These infections can irritate the bladder and cause strong sensations to urinate. Constipation can also cause this type of pressure.
For other women, the problem remains long term. For some, this is brought on by pregnancy. The hormonal changes occurring here and the increase in weight can cause stress incontinence. Childbirth can also be a concern. Delivery causes a weakening of the muscles that control the bladder and may damage the nerves that sense the need to urinate. Other causes of more long term development of urinary incontinence in women include:
- The onset of menopause
- Hysterectomy
- Obstruction
- Cancers
- Neurological disorders
What can be done if you suffer from this condition?
This depends on the cause and the underlying complications. Bladder training is one of the options for many women. Double voiding, scheduled trips to the bathroom, and fluid management can help. Improving the muscles in the pelvic floor can help many women as well. By strengthening these muscles, it becomes possible to tighten up control and to reduce the risk. Medications are available as well. And, for those experiencing more serious forms of the condition, medical devices and surgical procedures are available.
For most women, this isn’t something they want to talk about but it is something you should seek medical help for. Come in to see one of the best urologists in New York to learn more about all of your options for treatment.
To find out what your options are and to ensure you have every treatment option available to you, call our offices at 646-205-3039 and schedule a consultation with one of the best urologists in New York City. Find out what your options are.
Urologic Problems in Men BPH and other urinary issues Incontinence Kidney Stones Sexuality & Hormones Prostatitis Prostate cancer treatment complications Urethral stricture Urological cancers Continue Reading
Urologic Problems in Women Incontinence Mesh Complications Vesico-vaginal fistula Prolapse (dropped bladder) Nocturia Urological cancers Urinary infections Kidney stones Neurogenic bladder Continue Reading