Dr. Jason Wynberg Urologist Bayonne NJ

NJU Welcomes New Urologist Dr. Jason Wynberg

1 Oct 2019 News

NJU is pleased to welcome Dr. Jason Wynberg to our practice! Coming to us from Detroit, MI, Dr. Wynberg most recently served as the Chief of Urology at Sinai-Grace hospital. He is an expert in robotic surgery, complex penile implant surgery, complex kidney stone surgery, and the surgical management of prostate enlargement. Dr. Wynberg is board certified by the American Board of Urology and is a Fellow of the American College of Surgeons.

Dr. Wynberg has been invited to speak and perform live surgical demonstrations at international urology conferences in Paris, Istanbul, and India. He is a member of the American Urological Association, the Societe Internationale d’Urologie, and the Endourological Society.

Dr. Wynberg is committed to excellence in the entirety of patient care, especially surgical outcomes, building a warm relationship with patients, and providing great accessibility to both the patient and their primary care physician. He specializes in robotic surgery, complex kidney stone disease, surgical andrology, and prostate disease.

He will see patients at our Denville office.

What Causes Chronic Testicular Pain?

30 Sep 2019 Blog

Orchialgia is the medical term for chronic testicular pain, defined as constant or intermittent pain in the testicles, lasting for three or more months and interfering with one’s quality of life. It’s not an uncommon problem for men of all ages, but it is seen more frequently in young adults. It certainly keeps us busy in the office…some morning sessions seem like “ball clinics”!

What do the testes do?

The testes are paired, oval-shaped organs that are housed in the scrotal sac. They have two functions, testosterone and sperm production. The tough, protective cover of the testes (tunica albuginea) encase tiny tubes called seminiferous tubules which make sperm cells. The testes also contain specialized cells called Leydig cells that produce testosterone. Sperm from the testes travels to the epididymis for storage and maturation. The epididymis empties into the vas deferens, which conducts sperm to the ejaculatory ducts.

Where are the testes located?

The testes are suspended in the scrotal sac via the spermatic cord, a “rope” of tissue containing connective tissue, the vas deferens, the testes arteries, veins, lymphatics, and nerves. The spermatic cord is enveloped by tissues that are extensions of the connective tissue coverings of three of the abdominal core musclesThe most important of these coverings surrounding the spermatic cord is the cremaster muscle, which elevates the testes in a northern direction when it contracts.

What does the scrotal sac do?

The scrotal sac has several functions. The scrotal sac houses the testes and aids in their function by regulating their temperature. For optimal sperm production, the testes need to be a few degrees cooler than core temperature. The dartos muscle within the scrotal wall relaxes or contracts depending on the ambient temperature, allowing the testes to elevate or descend to help maintain this optimal temperature. Under conditions of cold exposure, the dartos contracts, causing the scrotal skin to wrinkle and to bring the testicles closer to the body. When exposed to heat, dartos relaxation allows the testicles to descend and the scrotal skin to smoothen.

What causes chronic testicular pain?

Chronic testicular pain can be caused by numerous conditions, and it’s important to rule out the following possibilities:

  • Infection: An infection of the testes (orchitis), epididymis (epididymitis), both (epididymo-orchitis), or the spermatic cord (funiculitis). Infections can be bacterial, viral, and at times inflammatory without an actual infection.
  • Tumor: A benign or malignant mass of the testes or epididymis.
  • Groin hernia: A prolapse of intra-abdominal contents through a weakness in the connective tissue support of the groin.
  • Torsion: A twist of the testes or one of the testes or epididymal appendages.
  • Hydrocele: An excess fluid collection in the sac surrounding the testes.
  • Spermatocele: A cyst resulting from a blockage of one of the sperm ducts within the epididymis.
  • Varicocele: Varicose veins of the spermatic cord.
  • Trauma: Injury.
  • Prior operations: Groin hernias are most commonly associated with chronic testes pain; less commonly, vasectomies and any other type of groin or pelvic surgery.
  • Referred pain: Pain perceived in the testes, but originating elsewhere, e.g., a kidney stone that has dropped into the ureter, or a lower spine issue affecting the nerves to the testes.
  • Tendonitis: There are numerous muscles with tendons that insert into the pubic bone region that can be subject to injury and inflammation.
  • Pelvic floor muscle tension myalgia: Excessive muscle tension in these muscles can cause pelvic pain, including pain in the testes.
  • Idiopathic: This fancy medical term means that we are clueless about the origin of the pain. Unfortunately, many men have idiopathic orchialgia, a distressing and frustrating experience for both patient and urologist.

The evaluation of the patient with chronic testicular pain includes a detailed medical history and a careful examination of the scrotal contents, groin, and prostate, if necessary. A urinalysis and urine culture will also be taken. It’s also helpful to obtain an ultrasound of the scrotum, a study which utilizes sound waves to image the testicle and epididymis. On occasion, it’s warranted to obtain imaging studies of the upper urinary tract and pelvis, as well as a CT or MRI of the spine if there is back or hip pain.

Can chronic testicular pain be treated?

The management of chronic testicular pain is directed at the underlying cause, although unfortunately this cannot always be precisely determined. Often, a course of antibiotics may prove helpful even if the physical findings are indeterminate. Anti-inflammatory medications such as Advil and ibuprofen are often useful in the short-term management. Supportive, elastic jockey shorts as well as local application of a heating pad can be helpful. At times, amitriptyline or Neurontin can be helpful for neurologically-derived pain. If the source of the pain is felt to be tension myalgia, referral to a pelvic floor physical therapist can be beneficial. A referral to a pain specialist, typically an anesthesiologist who focuses on this discipline, can be advantageous.

An injection of a local anesthetic into the spermatic cord (spermatic cord block) can be a useful diagnostic test and a means of alleviating the pain. If spermatic cord block proves successful in relieving the pain, it may be necessary to surgically denervate the spermatic cord, a procedure in which the nerve fibers in the spermatic cord are divided. Under extremely rare circumstances, removal of the epididymis or the testicle is necessary. Often chronic testis pain remains elusive with the source undetermined and is thought to be similar to other chronic inflammatory conditions.

Written by Dr. Andrew Siegel

What Is PSA And Why Should It Concern Me?

23 Sep 2019 Blog

What is PSA?

PSA (prostate specific antigen) is a chemical produced by the prostate gland. It functions to liquefy semen following ejaculation, aiding the transit of sperm to the egg. A small amount of PSA filtrates from the prostate into the blood circulation and can be measured by a simple blood test. In general, the larger the prostate size, the higher the PSA level since larger prostates produce more. As a man ages, his PSA rises based upon the typical enlarging prostate that occurs with growing older.

Why screen for prostate cancer?

Excluding skin cancer, prostate cancer is the most common cancer in men (1 in 7 lifetime risk), accounting for about one-quarter of newly diagnosed cancers in males. Prostate cancer causes absolutely no symptoms in its earliest stages and the diagnosis is made by prostate biopsy done on the basis of abnormalities in PSA levels and/or digital rectal examination. An elevated or accelerated PSA that leads to prostate biopsy and a cancer diagnosis most often detects prostate cancer in its earliest and most curable state. Early and timely intervention for men with aggressive cancer results in high cure rates and avoids the potential for cancer progression and consequences that include painful cancer spread and death.

The upside of screening is the detection of potentially aggressive prostate cancer that can be treated and cured. The downside is the over-detection of unaggressive prostate cancers that may never prove to be problematic, but may result in unnecessary treatment with adverse consequences. The downside of not screening is the under-detection of aggressive prostate cancers, with adverse consequences from necessary treatment not being given.

How is PSA used to screen for prostate cancer?
Although it’s an imperfect screening test, PSA remains the best tool currently available for detecting prostate cancer. It shouldn’t be thought of as a stand-alone test, but rather as part of a comprehensive approach to early prostate cancer detection. Baseline PSA testing for men in their 40s is useful for predicting the future potential for prostate cancer.

Upon PSA testing, about 90% of men are found to have a normal PSA. Of the 10% of men with an elevated PSA, 30% or so will have prostate cancer. In a recent study of 350,000 men with an average age of 55, median PSA was 1.0. Those with a PSA < 1.5 had a 0.5% risk of developing prostate cancer, those between 1.5-4.0 had about an 8% risk, and those > 4.0 had greater than a 10% risk.

Why is PSA elevated in the presence of prostate cancer?

Prostate cancer cells do not make more PSA than normal prostate cells. The elevated PSA occurs because of a disruption of the cellular structure of the prostate cells. The loss of this structural barrier allows accelerated seepage of PSA from the prostate into the blood circulation.

There is no letter C (for cancer) in PSA

Not all PSA elevations imply the presence of prostate cancer. PSA is prostate organ-specific but not prostate cancer-specific. Other processes aside from cancer can cause enhanced seepage of PSA from disrupted prostate cells. These include prostatitis (inflammation of the prostate), benign prostatic hyperplasia (BPH, an enlargement of the prostate gland), prostate manipulation (e.g., a vigorous prostate examination, prostate biopsy, prolonged bike ride, ejaculation, etc.).

Why is PSA not a perfect screening test?

PSA screening is imperfect because of false negatives (presence of prostate cancer in men with low PSA) and false positives (absence of prostate cancer in men with high PSA). Despite its limitations, PSA testing has substantially reduced both the incidence of metastatic disease and the death rate from prostate cancer.

How is PSA used in men diagnosed and treated for prostate cancer?

PSA is unquestionably the best marker to gauge prostate cancer status in the follow-up of men who have been treated for prostate cancer by any means. After surgical removal of the prostate gland for cancer, the PSA should be undetectable and after radiation therapy the PSA should decline substantially to a reading of usually less than 1.0. Rising PSA levels after treatment may be the first sign of cancer recurrence. Such a “biochemical” relapse typically precedes a “clinical” relapse by months or years.

How is PSA best used to screen for prostate cancer?

The most informative use of PSA screening is when it’s obtained serially, with comparison on a year-to-year basis providing much more meaningful information than a single, out-of-context PSA. Because PSA values can fluctuate from lab to lab, it’s always a good idea to try to use the same laboratory for the testing.

Who should be screened for prostate cancer?

Men age 40 and older who have a life expectancy of 10 years or greater are excellent candidates for PSA screening. Most urologists do not believe in screening or treating men who have a life expectancy of less than 10 years. This is because prostate cancer rarely causes death in the first decade after diagnosis and other competing medical issues often will do so before the prostate cancer has a chance to. Prostate cancer is generally a slow-growing process and early detection and treatment is directed at extending life well beyond the decade following diagnosis.

The age at which to stop screening needs to be individualized, since “functional” age trumps “chronological” age and there are men 75 years old and older who are in phenomenal shape, have a greater than 10-year life expectancy and should be offered screening. This population of older men may certainly benefit from the early diagnosis of aggressive prostate cancer that has the potential to destroy quantity and quality of life. However, if a man is elderly and has medical issues and a life expectancy of less than 10 years, there’s little sense in screening. Another important factor is individual preference since the decision to screen should be a collaborative decision between patient and physician.

What are refinements in PSA testing?

PSA Velocity – Comparing the PSA values year to year is most informative. Generally, PSA will increase by only a small increment, reflecting benign prostate growth. If PSA accelerates at a greater rate than anticipated—a condition known as accelerated PSA velocity—further evaluation is indicated.

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 one can be falsely lulled into the impression that their PSA is normal. For example, if the PSA is 1.0 and a year later it is 3.0, it is still considered a “normal” PSA (because it is less than 4.0) even though it has tripled (highly suspicious for a problem) and mandates further investigation.

PSA Density – PSA density (PSA divided by prostate volume) is the PSA level corrected to the size of the prostate. The prostate volume can be determined by imaging studies including ultrasound or MRI. PSA elevations are less worrisome under the circumstance of an enlarged prostate. A PSA density > 0.15 is concerning for prostate cancer.

Free PSA – PSA circulates in the blood in two forms: a “free” form in which the PSA is unbound, and a “complex” PSA in which the PSA is bound to a protein. The free PSA/total PSA ratio can offer a predictive value (similar to how HDL cholesterol/total cholesterol can be helpful in a person with an elevated cholesterol level). The higher the free to total PSA ratio, the greater the chance that benign enlargement of the prostate is the underlying source of the PSA elevation. In men with a PSA between 4 and 10, the probability of cancer is 9-16% if the free/total PSA ratio is greater than 25%; 18-30% if the ratio is 19-25%; 27-41% if the ratio is 11-18%, and the probability of cancer increases to 49-65% if the ratio is less than 10%.

4Kscore test – The 4Kscore Test is a refinement that measures the blood content of four different prostate-derived proteins: total PSA, free PSA, intact PSA and human kallikrein 2. Levels of these biomarkers are combined with a patient’s age, DRE status (abnormal DRE vs. normal DRE), and history of prior biopsy status (prior prostate biopsy vs. no prior prostate biopsy). These factors are processed using an algorithm to calculate the risk of finding a Gleason score 7 or higher (aggressive) prostate cancer if a prostate biopsy were to be performed. The test can increase the accuracy of prostate cancer diagnosis, particularly in its most aggressive forms. (It cannot be used if a patient has received a DRE in the previous 4 days, nor can it be used if one has been on Avodart or Proscar within the previous six months. Additionally, it cannot be used in patients that have within the previous six months undergone any procedure to treat symptomatic prostate enlargement or any invasive urologic procedure that may be associated with a PSA elevation.)

What is prostate MRI?

MRI is a high-resolution imaging test that does not require the use of radiation and is capable of showing the prostate and surrounding tissues in multiple planes of view, identifying suspicious areas. MRI uses a powerful Tesla magnet and sophisticated software that performs image-analysis, assisting radiologists in interpreting and scoring MRI results. A validated scoring system known as PI-RADS (Prostate Imaging Reporting and Data System) is used. This scoring system helps urologists make decisions about whether to biopsy the prostate and if so, how to optimize the biopsy.

PI-RADS Classification & Definition:
I – Most probably benign
II – Probably benign
III – Indeterminate
IV – Probable cancer
V – Most probably cancer

What is the definitive test for prostate cancer?

Prostate biopsy (ultrasound guided) is the definitive and conclusive test for prostate cancer. An elevated or accelerated PSA, abnormal digital rectal exam and suspicious MRI are all helpful, but “the buck stops here” with prostate biopsy, the conclusive test for prostate cancer.

Bottom Line: PSA testing provides valuable information in the diagnosis, pre-treatment staging, risk assessment and monitoring of prostate cancer patients. PSA screening has resulted in detecting prostate cancer in its earliest and most curable stages, before it has a chance to spread and potentially become incurable.  PSA screening has unequivocally reduced metastatic prostate cancer and death from prostate cancer and it is recommended that the test be obtained annually starting at age 40 in men who have greater than a 10 year life expectancy.

Written by Dr. Andrew Siegel

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

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