NJU Physicians Selected as SJ Mag 2020 Top Docs

From sjmagazine.net: “At a time when South Jersey needed medical professionals the most, they showed up. That’s what superheroes do. They do what’s right, and they help people. Because of that, this year’s Top Docs list has taken on new meaning.”

Congratulations to our New Jersey Urology physicians for their selection as Top Doctors in the September 2020 issue of SJ Magazine! Learn more about each ‘top doc’ by clicking on their name below:

Read the complete list here >

new york magazine best doctors 2020

New York Magazine Names New York Metro Area’s Best Doctors 2020

We are proud to announce that 33 New Jersey Urology physicians have been honored as New York Magazine’s 2020 Best Doctors in Urology.

The New York Metro Area is home to some of the most prominent and sought after physicians in the country. New York Magazine works with Castle Connolly Medical Ltd., a New York City-based research and information company, who selects the top 10 percent of the region’s physicians by conducting a peer-reviewed survey. Licensed physicians vote for the doctors they view as exceptional, and the Castle Connolly physician-led research team tabulates the results and vets the nominee pool, confirming the doctors’ board certifications and licensing, and investigating their disciplinary histories.

Congratulations to our esteemed urologists from our multiple locations right here in New Jersey!

 

2020 NEW YORK MAGAZINE BEST DOCTORS (Full List):

Mutahar Ahmed, MD
Andrew Bernstein, MD
Rahuldev Bhalla, MD
Thomas Christiano, MD
Thomas Chun, MD
Michael Esposito, MD
Mark Fallick, MD
Joshua Fiske, MD
Glen Gejerman, MD
Martin Goldstein, MD
Steven Katz, MD
George Klafter, MD
Vincent Lanteri, MD
Bernard Lehrhoff, MD
Gregory Lovallo, MD
Daniel Lowe, MD
Eric Margolis, MD
Mark Miller, MD
Thomas Mueller, MD
Marcella Nachmann, MD
Adam Perzin, MD
Ravi Rajan, MD
Steven L. Richards, MD
Kenneth Ring, MD
Gene Rosenberg, MD
Hossein Sadeghi-Nejad, MD
Frank Salvatore, MD
Domenico Savatta, MD
Eric Seaman, MD
Andrew Siegel, MD
Robert B. Simon, MD
Alan Strumeyer, MD
Gary Wasserman, MD

 

The complete list of NJU Best Doctors can be viewed here  >

Bergen County Top Docs 2020

Bergen Magazine Names Bergen County’s Top Docs 2020

We are proud to announce that 7 New Jersey Urology physicians have been honored as 2020 Bergen County’s Top Doctors by BERGEN Magazine.

Bergen County is home to some of the most prominent and sought-after physicians in the country. BERGEN magazine commissioned Professional Research Services (PRS) of Troy, Michigan to select the finalists. All final honorees were fact-checked with the State of New Jersey and the New Jersey Division of Consumer Affairs License Verication System.

Congratulations to our esteemed urologists from our Englewood, and Maywood / Teaneck locations!

 

2020 BERGEN COUNTY’S TOP DOCS:

See BERGEN Magazine’s complete list of Urology doctors here >

NJ Monthly Top Doctors 2019

NJU Physicians Selected as New Jersey Monthly 2019 Top Doctors

We’re proud to announce that 12 New Jersey Urology physicians have been honored as 2019 Jersey Choice Top Doctors by New Jersey Monthly Magazine.

More than 25,000 New Jersey–based doctors were invited to recommend the physicians they would choose to treat their own family members.

2019 Jersey Choice Top Doctors in Urology:

See New Jersey Monthly’s complete list here >

Bladder Cancer: Symptoms, Diagnosis & Treatment

Bladder Cancer: Symptoms, Diagnosis and Treatment

In the United States, the prevalence of bladder cancer has increased greatly over the last few decades, with more than 60,000 new cases diagnosed annually. It occurs more frequently in men than in women, and is usually diagnosed in adults over 60 years old. When bladder cancer is diagnosed and treated in the early stages, the chances of survival are excellent.

More than 90% of newly diagnosed bladder cancers are urothelial cell carcinomas (cancers originating from the unique lining of the urinary tract). Most patients have superficial cancer that involves the very inner layers of the bladder wall. Less than one fourth have invasive disease that involves the deeper layers of the bladder wall, and less than 5% present with metastatic disease, defined as spread beyond the confines of the bladder.

What causes bladder cancer?

Cancer-causing agents (carcinogens) are most often responsible for bladder cancer. Bladder cancer is highly associated with tobacco smoking. Even if one stopped smoking years ago, the risk is related to the quantity of tobacco smoked over the years. The carcinogens that are present in tobacco are absorbed through the lungs, into the bloodstream, and are filtered through the kidneys directly into the bladder, where their prolonged contact time with the lining of the bladder leads to cancerous changes.

Certain occupations put people at a greater risk for bladder cancer because of exposure to chemicals, including: hairdressers, painters, machinists, printers, and those who work with dyes, textiles, rubber, leather, and petrochemicals.

What are the symptoms of bladder cancer?

Bladder cancer most commonly manifests with blood in the urine, either visible or microscopic (seen only under microscopic magnification). It may also cause irritative lower urinary tract symptoms including urgency, frequency, discomfort with urinating, and urinary leakage.

How is bladder cancer diagnosed?

The evaluation for blood in the urine includes imaging, cytology, and cystoscopy.

  • Imaging tests are means of visualizing the anatomy of the urinary tract, typically through ultrasound, computerized tomography (CT), or magnetic resonance imaging (MRI).
  • Cytology is a microscopic inspection of a urine sample by a pathologist for the presence of abnormal or cancerous cells that slough off the lining of the bladder, similar to a Pap smear done to screen for cervical cancer.
  • Cystoscopy is a visual inspection of the entire lower urinary tract (bladder and urethra) using a tiny, flexible, lighted instrument attached to a camera and monitor.

When a bladder tumor is identified on cystoscopy, attention is directed to the number of tumors present, their size, location within the bladder, and physical appearance.

Once a bladder tumor is recognized, it needs to be removed and sent for pathological evaluation. This is performed under general or spinal anesthesia via cystoscopy, using an electric loop which is used to remove the area of concern as well as cauterize (use electricity to coagulate tissue) the underlying and adjacent tissue, both to stop bleeding and further destroy tumor cells.

The biopsied tissue is carefully examined by a pathologist, who will provide valuable information regarding malignancy vs. benignity, the type of tumor, depth of tumor, and grade of tumor.

Types of Bladder Cancer

The biopsy information will enable the staging of the bladder cancer, a means of classifying the cancer. Staging of bladder cancer is as follows:

  • Ta: Superficial cancer is found only in polyps (papillary) on the surface of the inner lining of the bladder.
  • Tis: Carcinoma-in-situ. Tumor is found only in flat lesions on the surface of the inner lining of the bladder.
  • T1: Tumor is found in the connective tissue below the lining of the bladder but has not spread to the bladder muscle.
  • T2: Tumor has spread to the muscle layer deep to the lining of the bladder.
  • T3a: Tumor has spread through the muscular wall of the bladder into the fatty tissue layer as identified under microscopic examination.
  • T3b: Tumor has spread through the muscular wall of the bladder into the fatty tissue layer and is capable of being identified without a microscope.
  • T4: Tumor has spread to the prostate in men and to the uterus or vagina in women, or to the pelvic or abdominal wall in either gender.

How is bladder cancer treated?

Bladder cancer often needs to be treated with a surgical procedure involving either partial or complete removal of the urinary bladder. If the entire bladder needs to be removed, the ureters (tubes that conduct the urine from the kidneys to the bladder) need to be diverted to a piece of intestine that is either attached to the skin to a collection bag or attached to the urethra (neo-bladder or “reconstructed” bladder). At times, in lieu of surgery, chemo-radiation can be utilized (a combination of radiation therapy provided by the radiation oncologist and chemotherapy provided by the medical oncologist).

Superficial cancers are usually managed with cystoscopy, with regular “surveillance” due to the high predilection for recurrence. It’s important to have frequent check-ups (every 3 months for the first year after initial diagnosis), consisting of periodic urinalysis, urine cytology, imaging, and cystoscopy. If surveillance does not demonstrate any recurrences, the interval between follow up can gradually be increased (to every 6 months in the 2nd year; if there are no recurrences, to an annual check-up). If a recurrence is found, treatment must be repeated and the surveillance frequency then starts anew with the every 3-month cycle.

To help prevent recurrence, under certain circumstances it is beneficial to use a medication that is instilled in the bladder on a weekly basis—this is especially useful when many tumors are present, in the presence of a high-grade tumor, or cancers that have recurred. It’s particularly useful for carcinoma-in-situ (CIS), a variant of bladder cancer that is very superficial, flat, yet of a high-grade pathological nature. The medication of choice is tuberculosis vaccine—BCG (bacillus Calmette Guerin), which is a live, attenuated (weakened) form of tuberculosis bacteria!

Written by Dr. Andrew Siegel


Is This Normal? 10 Common Penile “Flaws” You May Have

A penis is a special organ—a man’s joy, if not pride—and certainly one of his most prized, appreciated and cherished possessions, to which he has a significant attachment. As multifunctional as a Swiss Army knife, it allows him to stand to urinate (an undervalued capability), rises and firms to the occasion to allow for sexual penetration, and ejaculates genetic material–the means to perpetuate the species. A marvel of hydraulic engineering, within nanoseconds of sexual stimulation it is uniquely capable of increasing its blood flow 50 times over baseline, transforming its shape and size. Penis magic!

Each and every penis is unique. As variable as snowflakes, they come in every size, shape, and color. Beyond “size matters”—often a source of male preoccupation—men are often obsessed, if not preoccupied, with the appearance of their genitals. In my interactions with patients, concerns are often voiced about symmetry, color, pigmentation, angulation, spots, blemishes, vein patterns, shrinkage, and other oddities. Unless you are in the habit of closely inspecting other men’s genitals (as urologists are), you are unlikely to realize how common and completely normal most of these genital variations are.

10 Common Penile “Flaws” You May Have That Are Actually Quite Normal

  1. Penis leans to one side. No human is perfectly symmetrical and the flaccid penis rarely hangs perfectly centered. Wherever your penis naturally lies when you are clothed—whether left or right—is not indicative of your political leaning or left vs. right-sided brain predominance and is of absolutely no significance or consequence whatsoever!Interesting trivia: “Throckmorton’s sign” is a term used jokingly by medical students, residents and attending physicians. A positive Throckmorton sign is when the penis points to the side of the body where the pathology is, e.g., if a man is getting surgery for a right groin hernia and the penis points to the right side. The Throckmorton sign indicates the proper side of the pathology at least 50% of the time! Operating room humor!
  2. Slight penile curvature when erect. Again, although perfect symmetry may be desirable, the norm for the erect penis is not to be perfectly straight. There is often a subtle bend to the left, right, up or down. Some men have a penis that has a banana-like curvature. Slight bends—considered totally normal—are to be distinguished from Peyronie’s disease, a condition in which there is significant angulation due to scarring of the sheaths of the erectile chambers. It is a potentially serious condition that can cause painful erections and erectile dysfunction.
  3. One testicle hangs lower. If you ever wondered why one of your testes is slightly bigger or heavier and hangs lower than the testes on the other side, you are in good company. Paralleling women with breast asymmetry, the vast majority of men have testes asymmetry, so your mismatched gonads are perfectly normal.
  4. Dark genital skin. Hyperpigmentation (darkening) of the median raphe (the line running from anus to perineum to scrotum to undersurface of the penis) and other areas of the penis is extremely common. In fact, it is normal for the penile skin color to be darker than other areas of the body, because of the effect of sex hormones on the cells that produce pigment (melanocytes). The circumcision line, as well, is often deeply pigmented
  5. Freckles, moles and skin tags. The penis is covered by skin–just like the rest of the body–and is therefore subject to common benign skin growths, including moles, freckles and skin tags. These are generally harmless and usually, do not require any treatment unless desired for cosmetic reasons. However, if you have a growth that changes in size, color or texture, you should have it checked out because penile cancers do occur on occasion. Skin tags are small fleshy protuberances and can be confused with genital warts, so if you have any doubt, get checked.
  6. Other penis and scrotal bumps and lumps. Pearly penile papules are raised “pearly” bumps that appear around the corona (the base of the head of the penis). They consist of one or more rows of small, fleshy, yellow-pink or transparent, smooth bumps surrounding the penile head. They are benign and do not cause harm, but sometimes are treated for cosmetic reasons, usually with freezing or lasering. Sebaceous glands produce oil that nourishes the hair follicles of the genitals. These glands appear as numerous small yellowish bumps on the scrotum and penile base. In some men, they are prominent and referred to as sebaceous gland hyperplasia. At times, they can exist without a hair follicle even being present. Regardless, they are a normal occurrence.
  7. Scattered scrotal spots. Angiokeratomas are benign purplish skin growths with a scaly surface that are not uncommonly present on the scrotum. They consist of dilated thin-walled blood vessels with overlying skin thickening. These skin lesions can occasionally bleed and also cause fear and anxiety since they can resemble more serious problems such as melanoma. If in any doubt, get it checked out.
  8. Veiny vanity. Every man has a unique penile venous pattern, the anatomy as unpredictable as the distinctive venous anatomy of the hand and wrist. In some men, the veins are twisted and prominent and in other men, they are barely noticeable. No matter what the pattern, venous anatomy is highly variable and individualized and is normal.
  9. Loose skin. Unlike most other skin on the body that is more tightly attached, penile skin is loosely attached to underlying tissues, allowing for expansion with erections. Since the physical state of the penis can vary from totally flaccid to totally rigid, when the penis is fully deflated, the skin may appear to be somewhat floppy and redundant, which is absolutely normal. Scrotal skin often becomes increasing lax with the aging process, such that the testicles typically hang quite low in the elderly male, paralleling the common situation of pendulous breasts of the elderly female.
  10. Shrinkage. Penile size in an individual is quite variable, based upon penile blood flow. The more blood flow, the more tumescence (swelling); the less blood flow, the less tumescence. “Shrinkage” can be provoked by exposure to cold (weather or water), the state of being anxious or nervous, and participation in sports. The mechanism in all cases involves temporarily reduced blood circulation. Don’t worry, that sorry and spent looking penis can magically be revived with some TLC!

Bottom line: If you have an imperfect penis…welcome to the club! No penis or scrotum is perfect. Far from being an object of beauty, genital imperfections are the norm, so there is no need for feeling self-conscious. Just be happy that your little “fella” can function properly and enjoy his own happiness from time to time! Function over form!

Written by Dr. Andrew Siegel


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