New Jersey Urology Partners with Premier Urology Group

18 Sep 2019 News

The partnership creates largest urology network in the northeast

New Jersey Urology (“NJU”), the leading urology service provider in New Jersey, and Urology Management Associates (“UMA”) are pleased to announce a partnership with Premier Urology Group LLC (“Premier”), effective September 13, 2019.

The partnership creates one of the largest urology groups in the United States, with 124 providers in 52 locations, including five cancer treatment centers. Combined, the organizations will have more robust resources for patients and employees alike and be able to better serve patients in northern and central New Jersey.

“We are very excited to welcome them as partners,” Scott Ciccarelli, Chief Executive Officer at UMA, said. “Their innovative practices and prime location strengthen NJU’s ability to provide high quality care offerings to all patients across New Jersey.”

Premier physician Dr. Benjamin Fand said, “We have been committed to providing cutting-edge, compassionate urologic care for more than 55 years. Partnering with the NJU platform is an exciting opportunity for us to leverage their extensive resources and expand our range of clinical services.”

Premier physician Dr. Kenneth Ring added, “The integration of our practice with NJU will allow our patients access to the latest technological breakthroughs in the fields of urological oncology, stone disease, enlarged prostate (BPH), voiding dysfunction and incontinence in women and men, and pediatric urology. We are thrilled to join the team and look forward to continuing to provide best-in-class care to our growing patient base.”

The Bloom Organization served as a sell-side advisor to the Premier physician owners. Henry Bloom, founder of The Bloom Organization, said, “NJU and Premier physicians have long standing relationships with one another through their work in the New Jersey communities. I am thrilled to see these two groups come together and excited to witness the building of the country’s preeminent urology group.”

NJU welcomes the Premier physicians: Andrew Bernstein, MD; Benjamin Fand, MD, FACS; Joshua Fiske, MD; Michael Lasser, MD; Bernard Lehrhoff, MD; Alon Mass, MD; Mark Miller, MD; Zein Nakhoda, MD; Rupa Patel, MD; Kenneth Ring, MD; Malcom Schwartz, MD; Neil Sherman, MD; William Terens, MD; and Joshua Wein, MD, FACS. Premier physicians will continue to provide care in their existing offices serving Union, Essex, Hudson, Cranford, Edison and Old Bridge communities.

Wilentz, Goldman & Spitzer served as legal counsel for Premier. McDermott Will & Emery LLP advised UMA.

About Urology Management Associates:

Urology Management Associates was formed in August 2018 to provide administrative services to New Jersey Urology. The establishment of UMA enables NJU to continue to focus on providing world-class urology services while remaining a physician-led organization. UMA plans to partner with additional urology groups to provide administrative practice management services initially in the greater New York metropolitan area with long-term plans to expand nationally.

About The Bloom Organization:

Bloom has been advising physicians on transactions since 1990. Founded and lead by Mr. Henry Bloom, the Company is based in Aventura, FL and serves clients nationwide. Bloom’s investment banking expertise is in the healthcare services sector.

6 Ways to Reduce Your Risk of Prostate Cancer

16 Sep 2019 Blog

Wouldn’t it be wonderful if prostate cancer could be prevented? Unfortunately, we’re not there yet—but we do have an understanding of what measures can be taken to help reduce your risk of developing prostate cancer.

Precancerous lesions are commonly seen on prostate biopsy many years before the onset of prostate cancer. We also know that there’s an increased prevalence of prostate cancer with aging. These facts suggest that the process of developing prostate cancer takes place over a long period of time—often more than a decade—from the initial prostate cell mutation to the time when prostate cancer manifests with either a PSA elevation, an acceleration in PSA, or an abnormal digital rectal examination. This means that there’s an opportunity for intervention before prostate cancer is established.

Here are six ways to reduce your risk of prostate cancer (and reduce risk of progression for men on active surveillance):

  1. Maintain a healthy weight, since obesity has been correlated with an increased prostate cancer incidence.
  2. “Eat food. Not too much. Mostly plants.” The smart advice from Michael Pollan. A healthy diet consists of abundant fruits and vegetables (full of antioxidants, vitamins, minerals and fiber) and real food, as opposed to processed and refined foods. Eat plenty of red vegetables and fruits including tomato products (rich in lycopene). Legumes (beans, nuts, peas, lentils, etc.) have an anti-inflammatory effect. Consume animal fats and dairy in moderation. Eat fatty fish containing omega-3 fatty acids such as salmon, tuna, sardines, trout and mackerel.
  3. Avoid tobacco and excessive alcohol intake.
  4. Staying active and exercising on a regular basis can reduce your risk for prostate cancer. If you do develop prostate cancer, you will be in tip-top physical shape and will heal that much better from any intervention necessary to treat the prostate cancer.
  5. Get checked out! Be proactive by seeing your doctor annually for a digital rectal exam of the prostate and a PSA blood test. Abnormal findings on these screening tests are what prompt prostate biopsies, the definitive means of diagnosing prostate cancer. The most common scenario that leads to a diagnosis of prostate cancer is a PSA acceleration, an elevation above the expected incremental annual PSA rise based upon the aging process.

It’s important to mention that an isolated PSA (out of context) is not particularly helpful. What is meaningful is comparing PSA on a year-to-year basis and observing for any acceleration above and beyond the expected annual incremental change associated with aging and benign prostate growth. Many labs use a PSA of 4.0 as a cutoff for abnormal, so it is possible that you can be falsely lulled into the impression that your PSA is normal.  For example, if your PSA is 1.0 and a year later it is 3.0, it is still considered a “normal” PSA even though it has tripled (highly suspicious for a problem) and mandates further investigation.

A healthy lifestyle, including a wholesome and nutritious diet, maintaining proper weight, exercising regularly and avoiding tobacco and excessive alcohol can lessen one’s risk of all chronic diseases, including prostate cancer. Be proactive by getting a 15-second digital exam of the prostate and PSA blood test annually. Prevention and early detection are key to maintaining both quantity and quality of life.

Written by Dr. Andrew Siegel

NJU to Host Annual ZERO Prostate Cancer 5k Run/Walk this Fall

11 Sep 2019 News

New Jersey Urology is proud to present South Jersey’s ZERO Prostate Cancer Run/Walk to help end prostate cancer.

When: Sunday, November 3rd | 9 a.m.
Where: Valenzano Winery (1090 Route 206, Shamong, NJ 08088)

The 2019 ZERO Prostate Cancer Run/Walk – South Jersey features a 5K run/walk, 1-mile walk, Kids’ Superhero Dash for Dad, and virtual Snooze for Dudes program. Stick around for the family-friendly post-race celebration. Run/walk participants will receive shirts, free food and prizes, and the opportunity to connect with others who are impacted by prostate cancer. 5K and 1 Mile participants 21 and over (must show valid id) will receive a free wine glass and wine on race day.

The funds raised from 2019 ZERO Prostate Cancer Run/Walk – South Jersey are invested around the country to provide research for new prostate cancer treatments, free prostate cancer testing, and education for men and families about prostate cancer. No other prostate cancer charity spends more per dollar on programs – more than 85 cents. ZERO puts every donation to good use.

REGISTER HERE

Prostate Cancer: Risk Factors and Treatment Options

9 Sep 2019 Blog

After a prostate cancer diagnosis, there can be a lot of information to take in. The path you and your doctor decide to take for treatment depends on certain factors including the stage of the cancer, your age, and your prostate-specific antigen (PSA) test results, among others.

Risk Factors for Prostate Cancer

You may have a higher risk of developing prostate cancer if you:

  • Are over 65 years old
  • Have a family history of prostate cancer
  • Are African American

Treatment Options for Prostate Cancer

There may be more than one treatment necessary and recommended by your doctor. Common prostate cancer treatments include:

  • Radiation therapy – Radiation therapy is often used after surgery when the cancer hasn’t spread outside of the prostate. This treatment requires radioactive seeds to be placed inside the prostate gland and is often done when the cancer is found early.
  • Hormonal therapy – These types of treatments block the effect or creation of testosterone. Because prostate tumors need testosterone to grow, hormonal therapy can prevent further growth of the cancer. This treatment does not cure the cancer.
  • Medication – Medication is given to help the body’s immune system fight cancer.
  • Prostatectomy – A surgical procedure to remove the prostate and surrounding tissue.

Types of Prostatectomy

There are four main types of prostatectomy:

  • Retropubic Surgery – requires an incision below the belly button to remove the prostate gland, causing as little damage to the nerves and blood vessels as possible.
  • Perineal Surgery – a cut is made between the anus and base of the scrotum. This is a smaller incision than the retropubic technique, but it is harder to spare nerves or remove lymph nodes.
  • Laparoscopic Surgery is when the surgeon makes several small cuts and uses long tools and a video camera to see inside during the procedure.
  • Robotic-assisted da Vinci® Surgery – the da Vinci® surgical system can be used to perform a prostatectomy. This technology allows your surgeon to make several small incisions as opposed to one larger incision, and the surgeon has a 3D view inside your body. The robotic-assisted surgical device can bend and rotate more than the human hand for better precision and control during the procedure.

Discuss your screening and treatment options with your urologist at New Jersey Urology.

NJU Welcomes New Urologist Dr. Christine White Cumarasamy

3 Sep 2019 News

NJU is pleased to welcome Dr. White Cumarasamy to our practice! Dr. Cumarasamy is a fellowship-trained urologist who specializes in urologic oncology and robotic surgery. She also practices general urology with interests in benign diseases including female and male urinary incontinence, stone disease, and prostatic enlargement. She offers both medical and surgical treatment options for her patients.

Dr. Cumarasamy uses a minimally-invasive approach to surgery with laparoscopic, robotic, or endoscopic technology when possible. Her goal is to provide patients with the best oncologic outcome while minimizing the incision, pain, and length of hospital stay and expediting recovery. She has trained under the nation’s pioneers of robotic surgery and utilizes the most advanced methods to give her patients the best possible treatment.

Dr. Cumarasamy also treats a wide range of other urologic problems, including nephrolithiasis, overactive bladder, prostatic enlargement, incontinence, and erectile dysfunction. Her care philosophy is to offer patients all feasible treatment options with a personalized discussion of patient preferences in order to deliver a customized plan for each individual patient.

She will see patients at our Clifton and Hackensack locations.

NJU Physicians Selected as South Jersey Magazine 2019 Top Physicians

27 Aug 2019 News

We’re proud to announce that three New Jersey Urology physicians have been honored as South Jersey Magazine 2019 Top Physicians. These physicians were chosen by South Jersey Magazine readers, who were asked to nominate doctors they trust in their time of need.

South Jersey Magazine 2019 Top Physicians in Urology:

Read South Jersey Magazine’s complete list here >

What to Expect After Adult Circumcision

26 Aug 2019 Blog

What is a circumcision?

Circumcision is the surgical removal of the foreskin. The procedure takes about thirty minutes and is performed under general anesthesia. The entire foreskin is removed using an incision just behind the head of the penis. This leaves the head of the penis completely exposed. Local anesthesia will be used to relieve discomfort after the operation.

Why is circumcision performed?

Circumcision is usually performed on newborns for medical, social, or cultural purposes. According to the CDC, more than 58% of newborns in the United States are circumcised. However, people with an uncircumcised penis may choose to become circumcised later in life for many reasons, including:

  • Phimosis (tight foreskin cannot be retracted to expose head of penis)
  • Paraphimosis (retracted foreskin cannot be brought back to cover head of penis)
  • Balanitis (inflammation of head of penis)
  • Posthitis (inflammation of the foreskin—pronounced pos-THI-tis)
  • Cosmetic or personal reasons
  • Tearing of the penile skin when sexually active

Although circumcision is a simple procedure, it’s a larger surgery for adults than it is for newborns.

What can I expect afterwards?

You will be sent home with a compression dressing that can be removed in 48 hours. If it falls off sooner than that it’s not a problem. Absorbable stitches are used that do not require removal. After the dressing is removed, petroleum jelly can be applied to the stitch line to prevent the penis from sticking to your underwear.

You will likely experience pain for a few days that can be managed with analgesics that will be prescribed. Anti-inflammatories such as Advil and Ibuprofen are preferred to the narcotics as they are equally effective and have less side effects. You should not drive a car or operate machinery if you are using a narcotic for pain relief.

Activities need to be restricted for a few days. Sexual activity cannot be pursued for at least six weeks to allow full healing. You may experience pain with spontaneous erections.

When do I need to follow-up in the office?

You will need to be checked back in the office a week or two after the circumcision, and at the six-week point.

Written by Dr. Andrew Siegel

What to Expect: Botox Injection for Overactive Bladder (OAB)

19 Aug 2019 Blog

You’ve probably heard of Botox being used to improve the cosmetic appearance of facial wrinkles. However, botox has many medical uses that go beyond improving one’s appearance. For example, botox is commonly used to improve internal body functions. In the field of urology, it can be injected into the bladder muscle to improve symptoms of overactive bladder (OAB).

What is botox?

Botox is derived from the most poisonous substance known to man—botulinum toxin. This neurotoxin is produced by the Clostridium bacterium, responsible for botulism. Botulism is a rare but serious illness that can result in paralysis. Botulinum toxinwhen used in minute quantities in a derivative known as botox, is a magically effective and powerful potion.

How does botox work?

Botox is a neuromuscular blocking agent that weakens or paralyzes muscles. Beyond cosmetics, it can be beneficial for a variety of medical conditions that have some form of localized muscle overactivity. Botox is generally used to improve conditions with muscle spasticity, involuntary muscle contractions, excessive sweating and eyelid or eye muscle spasm.

Botox to treat Overactive Bladder (OAB)

Overactive Bladder (OAB) syndrome can be described by the symptoms of urinary urgency (the sudden desire to urinate), with or without urgency incontinence (urinary leakage associated with urgency). It’s usually accompanied by frequent urination during both day and night hours. OAB has been described as the “bladder squeezing without your permission to do so.”

When botox is injected into the bladder muscle, it treats the thick muscle bands, known as trabeculation. These are typically present in conditions that cause obstruction to the outflow of urine or bladder overactivity. By temporarily paralyzing a portion of the bladder muscle, OAB symptoms can improve dramatically.

The goal of botox in the bladder is to effectively treat persistent and disabling urinary urgency, frequency and urgency incontinence. Botox can be used to treat OAB for both males and females. It’s usually a plan B treatment for those who haven’t responded well or have been intolerant to bladder relaxant medications. Botox is FDA approved in the USA in a 100-unit-dose for OAB and 200-unit-dose for OAB associated with neurological conditions.

What to expect during a bladder botox injection

Bladder botox injection is a brief office procedure usually done under light sedation. It involves placing a cystoscope into the bladder and injecting botox into numerous sites in the bladder via a needle that fits through the cystoscope. The entire procedure takes about 10 minutes.

How to prepare for your bladder botox injection, and what to expect after the procedure:

  1. Stop blood thinner medications one week before botox injection
  2. Start antibiotics 2 days before and continue for 2 days after
  3. You may experience blood-tinged urine, burning with urination and pelvic pain for a day or so after the procedure.
  4. You may experience difficulty urinating and feel that you are not emptying completely. If so, you may require a catheter or learn how to temporarily do self-catheterization.
  5. It may take 1 -2 weeks to notice improvement. Although botox is highly effective, it’s not so in everyone.
  6. A follow up appointment with urinalysis and check of the post-void residual volume (how much urine is left in the bladder after voiding) will be scheduled for two weeks.
  7. Botox should last 6-9 months or so. After the improvement wears off, the injection can be repeated. If ineffective or only partially effective, the botox dosage can be increased.

Visit our locations page to find a urologist near you.

Written by Dr. Andrew Siegel

6 Reflexes That are Vital to Your Pelvic Health

12 Aug 2019 Blog

A reflex is an automatic response to a stimulus, an action that occurs without conscious thought. Many of us are familiar with the knee jerk reflex, in which the knee straightens as a result of the quadriceps muscle contracting in response to the tendon of our kneecap being tapped with a reflex hammer.

Here are six reflexes that you probably aren’t aware of, but are vital to your urinary and sexual health:

  1.  Guarding Reflex. The sphincter muscles guard the entrance to the urinary bladder. The voluntary sphincter muscle—the one that you have control of and are capable of contracting at will—is largely composed of the deep pelvic floor muscles (PFMs). The deep PFMs are your friends, helping you store urine while the bladder fills up. Even when you are not actively squeezing the PFMs, they have a baseline tone, working to provide resistance that keeps you from leaking urine as the bladder becomes fuller. They only relax completely when you urinate. The guarding reflex is the increase in the contraction strength of these “guarding” PFMs as the bladder gets fuller and fuller, with stronger PFM tone as the volume of urine in the urinary bladder increases.
  2. Cough Reflex. This reflex increases the contraction of the PFMs when you cough—above and beyond their resting tone—preventing you from leaking urine. This is nature’s way of protecting you from leaking urine when there is a sudden increase in your abdominal pressure, as occurs with a cough. This protects against cough-related stress urinary incontinence.
  3. Pelvic Floor Muscle-Bladder Reflex (PFM-BR). The PFM-BR is a unique reflex that you are capable of engaging voluntarily, resulting in the relaxation of a muscle as opposed to its contraction.  Anyone who has ever experienced an urgent desire to urinate or move their bowels will find it of great practical use. When the reflex is deployed, it will result in relaxation of both the urinary bladder and rectum and a quieting of the urgency. It works when you feel the sudden and urgent desire to urinate—pulse the pelvic floor muscles (PFMs) five times—brief but intense contractions.  When the PFMs are so deployed, the bladder muscle reflexively relaxes and the feeling of intense urgency disappears. Likewise, when the PFMs are deployed, the rectum relaxes and the feeling of intense bowel urgency should diminish. This reflex is a keeper when you are stuck in traffic and have no access to a toilet!
  4. BulboCavernosus Reflex (BCR). The BCR is a contraction of the bulbocavernosus and its mates, the ischiocavernosus (IC) muscles when the glans (head) of the penis in a male or the clitoris in a female is squeezed. This reflex is important for maintaining erectile rigidity, since with each contraction of the BC and IC muscles there is a surge of blood flow to the penis/clitoris, maintaining the high blood pressures within the erectile chambers necessary for engorgement of these organs. Sexual stimulation can be thought of as a chain of linked BCRs.
  5. Double reflex. Did you ever experience an urgent desire to urinate and find relief by squeezing the head of the penis?  If so, you have discovered the linkage of two reflexes—the BCR coupled with the PF-MBR. Here’s what happens: A strong urge to urinate occurs and is managed by squeezing the head of the penis, which makes the urgency dissipate. What’s actually happening is that the squeeze of the penis triggers a PFM contraction via the BCR. In turn, the PFM contraction relaxes the bladder muscle via the PFM-BR and makes the urgency either improve or disappear. Reflex magic!
  6. Cremasteric reflex. The cremaster muscle surrounds the spermatic cord (the cord-like structure that contains the testicular blood supply, nerves, etc.). The cremasteric reflex occurs when the inner thigh is stroked and the testicle pulls up towards the groin via a contraction of the cremaster muscle. This is a brisk reflex in boys and tends to become less active with aging. It is a natural protective reflex that helps us avoid testicular injury when danger approaches, like a turtle pulling its head into its protective shell.

The reflexes described above are vital to your sexual and urinary health. Being aware of them, and knowing how to tap into them can be used to your advantage!

Written by Dr. Andrew Siegel 

Is Active Surveillance the Best Treatment for My Prostate Cancer?

5 Aug 2019 Blog

Prostate cancer is the second leading cause of cancer death in men. There are 240,000 new prostate cancer cases diagnosed annually, and it accounts for 30,000 deaths per year. However, unlike many other cancers, prostate cancer is often not a fatal disease and may never need to be treated.

Patients with slow-growing, early stage prostate cancer as well as older men with other health issues may be put on active surveillance, also known as watchful waiting, as opposed to traditional treatment with surgery or radiation.

The problem is that not all prostate cancer cases are slow-growing and early stage. The challenge is predicting the future behavior of the cancer so it can be treated appropriately – offering cure to those with aggressive cancer, but sparing the side effects of treatment in those who have non-aggressive cancer.

What is active surveillance?

About 1 in 6 men will be diagnosed with prostate cancer during his lifetime, yet only 1 in 40 men will die from it. These statistics point out that many men with prostate cancer have a slow growing cancer. Because of this fact, an alternative strategy to aggressive management of prostate cancer is active surveillance, which includes careful follow-up with strict monitoring and immediate intervention should signs of progression develop.

The goal of active surveillance is to allow men with low risk prostate cancer to avoid radical treatment with its associated morbidity and/or delay definitive treatment until signs of progression occur. This involves two things:

  1. Vigilant monitoring
  2. A compliant patient who is compulsive about follow-up

Which patients are good candidates for active surveillance?

Being a candidate for this approach is based upon the results of the PSA blood test, findings on the digital rectal exam, and the details of the prostate biopsy. General eligibility criteria for active surveillance include all of the following:

  • PSA (Prostate Specific Antigen) less or equal to 10 (PSA is the blood test that when elevated or accelerated indicates the possibility of a problem with the prostate and is often followed by a prostate ultrasound/biopsy)
  • Gleason score 6 or less (possible score 2-10, more about this below)
  • Stage T1c-T2a

 (T1c = picked up by PSA with normal prostate on rectal exam; T2a = picked up by abnormal prostate on rectal exam, involving only one side of the prostate)
  • Less than 3 of 12 biopsy cores involved with cancer
  • Less than 50% of any one core involved with cancer

Note that these are basic guidelines and need to be modified in accordance with patient age and general health— certainly if one has a life expectancy of less than 10 years, he would be a good candidate for active surveillance, regardless of the above.

How is prostate cancer grade determined?

Prostate cancer grade is often the most reliable indicator of the potential for growth and spread. The Gleason Score provides one of the best guides to the prognosis and treatment of prostate cancer and is based on a pathologist’s microscopic examination of prostate tissue. This score can predict the aggressiveness and behavior of the cancer.

To determine a Gleason Score, a pathologist assigns a separate numerical grade to the two most predominant architectural patterns of the cancer cells. The numbers range from 1 (the cells look nearly normal) to 5 (the cells have the most cancerous appearance). The sum of the two grades is the Gleason Score. The lowest possible score is 2, which rarely occurs; the highest is 10. High scores tend to suggest a worse prognosis than lower scores because the more deranged and mutated cells usually grow faster than more normal-appearing ones.

Prostate cancers can be “triaged” into one of three groupings based upon Gleason Score. Scores of 2-4 are considered low grade; 5-7, intermediate grade; 8-10, high grade.

What is involved in active surveillance?

The active surveillance monitoring schedule is typically:

  • PSA and DRE every 3-6 months for several years, then annually
  • Prostate biopsies: once a year after initial diagnosis, then periodically until age 80 (this depends on the patient)

As long as the cancer remains low-risk, active surveillance may be continued, sparing the patient the potential side effects of surgery or radiation.

Approximately half of men on active surveillance remain free of progression at ten years, and definitive treatment is most often effective in those with progression. The absence of cancer on repeated prostate biopsies (because the cancer is of such low volume) identifies men who are unlikely to have progressive prostate cancer.

Written by Dr. Andrew Siegel

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