Urology

The Department of Urology at Westchester Medical Center offers the highest level of specialized urological care in a comfortable, patient-friendly environment. Our full-time, board-certified, and fellowship-trained faculty provide the latest in robotic and minimally invasive surgery for pediatric and adult patients, laser and sonic lithotripsy for urinary stone disease, office treatments for urinary difficulties and prostate enlargement, and counseling and therapy for men's health, infertility and sexual dysfunction.

The Urology Center at Westchester Medical Center provides the highest level of specialized services and care in all areas of urology.

Robotic and Minimally Invasive Surgery

Skilled in all aspects of laparoscopic and minimally invasive urologic techniques, our physicians employ the state-of-the-art Da Vinci S robotic interface for prostatic, adrenal, kidney, and bladder surgery.

Endourology and Stone Disease / Stone Therapies

Simple and complex stone disorders are treated surgically with laser, robotic, and out-patient sonic lithotripsy - all minimally invasive techniques.

Pediatric Urology

Therapy and correction of congenital problems of the newborn and growing child, kidney and bladder dysfunction, and urinary tract infections and disorders.

Incontinence Care and Women's Health

Our Incontinence Care Division offers diagnostic and therapeutic procedures for urinary incontinence and bladder control for males and females. We also offer specialized care for patients with neurological disease, including spine injury or stroke. Reconstructive surgery is available to correct vaginal prolapse and urethral penile disease.

Male Infertility and Sexual Center

Infertility and Male Sexual Dysfunction: All aspects of treatment for male infertility and sexual dysfunction. We offer vasectomy reversal and microscopic varicocele surgery, penile prosthesis implants and in-office vasectomy.

Benign Prostatic Hyperplasia (BPH)

Symptomatic enlargement of the prostate is effectively treated with medicines or new minimally invasive outpatient procedures. Holmium laser microwave therapy offers relief and often eliminates the need for medications.

Cancer

Our physicians are experts in cancer care with broad experience in the newest therapies for cancer of the prostate, kidney, bladder and other genito-urinary organs. Available treatments include nerve-sparing prostatectomy, seed implantation, cryosurgery, bladder replacement, and complex surgery for kidney cancer with vein involvement.

 

Do you perform robotic surgery?

Yes. Since 2003, we have offered the latest approaches in Da Vinci robotic surgery.

Do you offer counseling regarding prostate cancer?

Yes. We offer comprehensive services regarding all options for prostate cancer diagnosis and treatment including outpatient radiation, robotic prostatectomy, and, for some men, an active surveillance program. See the section below on prostate cancer to find out more.

Does the department offer screening PSAs?

No. PSA is a useful test for prostate cancer but currently the benefit of screening is still controversial. Instead, we sit down and discuss with a patient the risks and benefits of getting simple PSA blood test, what its results mean, and what do to if the level is abnormally high for the patient's age. In addition, we offer counseling for those men who have already had a PSA test and need direction as to the next best steps. See the section below on prostate cancer to find out more.

Is there any herbal or nutritional therapy for prostate or bladder cancer?

Yes, there are a number of foods and vitamins that are thought to be helpful in decreasing cancer progression. However, there is little data suggesting that herbal or nutritional therapy alone is better than standard medical or surgical therapy for these cancers. We recommend an in-depth discussion with our specialists regarding the role of nutrition in cancers and how diet can profoundly affect our urologic health.

Are there any new treatments for impotence?

Yes, a new gel is available that often can help men with erectile dysfunction but a thorough review of all treatment strategies can be obtained with our specialists to find the approach for ED that is right for you.

Is Botox a treatment for incontinence?

Yes, Botox is an excellent treatment for certain types of incontinence, specifically the incontinence that is associated with a strong urge to run to the bathroom or for certain conditions of the bladder associated with a neurological diagnosis. The procedure is a quick five minutes that can be performed in the office or at the Ambulatory Care Pavilion with light sedation.

Is there a way to avoid stone formation?

Yes. The majority of patients who have had a kidney stone are at some risk of forming another over their lifetime. Many patients benefit from a thorough metabolic and dietary evaluation to ensure that their risk is kept as low as possible. Our department offers single-access surgical stone treatments as well as no-incision ultrasonic stone therapies.

 

What is the prostate gland?

The prostate is a tangerine-shaped organ that develops below the bladder and around the urethra during puberty and allows the mixture of semen before ejaculation. It is not a necessary organ for sexual function or sex hormone production. It weighs about 5 ounces but increases in size with age. The prostate is the source for prostate specific antigen (PSA).

What is PSA?

Prostate specific antigen, or PSA, is an enzyme made in the prostate and is thought to improve the quality of semen for fertilization. Some PSA 'leaks' into the blood stream where it can be detected in a blood test. An elevated PSA does not always mean a patient has cancer. In fact, elevated PSA is associated with the five following conditions.

1. Prostate enlargement
2. Infection
3. Inflammation
4. Aging
5. Cancer

Is prostate cancer really that serious? Will prostate cancer kill me?

Prostate cancers can range from the very slow growing and inconsequential to extremely fast growing and deadly. It is said that most men "DIE WITH THEIR PROSTATE CANCER AND NOT FROM IT". This is why it is important for your doctor to determine the risk your cancer may carry regarding your own life. The risk of a cancer generally goes up with how aggressive the cancer looks under the microscope, your PSA blood test level, how the prostate feels on exam, and the number of biopsies that showed the cancer.

Why is treatment important? Why do I have to be treated even though I don't feel bad?

Prostate cancers that are curable are often very small and cause no symptoms. Conversely, prostate cancers that are incurable have often spread beyond the prostate and may be causing symptoms because of where it is growing. Prostate cancer does not respond to chemotherapy and once the prostate cancer has spread outside of the prostate gland, it is often too late for cure. That's why in order to cure someone, patients are sometimes treated when the tumors are small and not causing symptoms.

What are the best treatments for prostate cancer?

The goal of prostate cancer treatment is to:

1. Cure the patient but
2. Minimize the side effects.

Prostate cancer treatments involve either surgery, radiation, or both. After the decision to treat someone is made, next comes which kind of treatment. Although many treated patients are cured, maintain a happy sexual lifestyle, and have perfect urinary control after treatment, that may not always be the case. Patients have to be willing to accept some side effects in order to cure them of prostate cancer. In fact, it is often the list of possible side effects that sway a patient towards deciding upon surgery or radiation. In general, surgery is a major operation with a 1-5 day hospital stay, a 2-3 week recovery time, and from 1-12 months for erections to return. Radiation is either internal the form of implantable seeds placed during an outpatient surgical procedure or external in the form of X-ray beam therapy.

Will prostate cancer make me no longer a man? What will it do to my manhood?

Science has learned much about the prostate gland, especially the anatomy of sexual function (i.e. potency) and urinary control (i.e. continence). We now know that erections happen because the tiny nerves to the penis run next to the prostate. If the tiny nerves are damaged because of surgery or are scarred because of radiation, the penile tissues will not be stimulated adequately and erections may not occur. The goal of surgery and radiation, therefore, is to cure a patient of prostate cancer but to preserve sexual function and urinary control. Even if a patient loses sexual function because of surgery or radiation, there are treatments that can help regain function. One clear difference exists between surgery and radiation, however. After surgery, it is possible to have an orgasm but not ejaculate. After radiation, orgasm and ejaculation are possible.

What is nerve-sparing surgery?

Nerve-sparing surgery of the prostate occurs when the prostate is removed without damaging or injuring the nearby nerves that control erections. The nerves to the erection tissues of the prostate come from the lowest part of the spinal cord, wrap around the bottom of the bladder and are draped across the sides of the prostate as a bundle or nerve packet on the way to the penis. Although two nerve bundles are better than one, even preserving one nerve bundle may allow normal erections. Unlike large nerves such as the sciatic nerve to the leg, the erection nerves are tiny whisps of tissue which cannot be easily seen. Instead, the surgeon identifies the nerve bundle itself and saves them.

What is laparoscopic prostate surgery?

Prostate surgery is typically done through a 5 to 7 inch incision below the belly button or a crescent-shaped incision behind the scrotum. Both of these approaches allow 'open' access to the prostate. The prostate is deep in the pelvis, however, and the nerves and muscles for normal erections and urination are difficult to see. Laparoscopy refers to surgery done with out making an incision open to the air. Rather, small tubes are inserted into the body to allow magnifying lenses and instruments to be inserted through ¼ or ½ inch incisions. The first operations which were successful were to remove the gall bladder, the ovaries, and other internal organs. Prostate removal is of the most difficult and challenging. However, once mastered, laparoscopic removal of the prostate may be better than the traditional open operation. Laparoscopic removal may allow:

1. Better sparing of the erection nerves
2. Better preservation of the urinary control muscles
3. Quicker recovery time in and out of the hospital
4. Less pain regarding incisions
5. Improved cosmetic appearance of the abdomen after surgery

What is robotic surgery?

Recently a patient asked whether the newest technique, using a robot to remove the prostate, meant that no human being was involved with the surgery, and that buttons were merely 'pushed' and the procedure was automated. A robotic device now only assists the surgeon to perform laparoscopy for prostate removal. The device makes laparoscopy easier and more like traditional surgery than regular laparoscopy.

The 'robot' is merely a connection between the surgeon and the patient. The robot holds the surgical instruments which are tiny, delicate machines capable of allowing wrist-like movements not possible with traditional rod-like laparoscopic instruments. An assistant at the patient's side, ensures the moment-to-moment positioning of the instruments. Sitting at a nearby visual console, the surgeon is hooked up to the magnifying lenses and can operate the surgical instruments as if he were standing next to the patient. Robotic surgery is there better thought of as robot-assisted laparoscopic surgery.

Westchester Medical Center has the latest upgrades in robotic surgery and provides urologic, gynecologic, and now liver surgery with this technique.

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Our Urology Team

Muhammad Choudhury, MD, FACS
Director, Urology

Robotic and Laparoscopic Surgery

John L. Phillips, MD, FACS (Chief) 

Urologic Oncology

John L. Phillips, MD, FACS (Chief)
Muhammad Choudhury, MD, FACS

Kidney Stone/Obstruction/Minimally Invasive Urology

Majid Eshghi, MD, FACS, MBA (Chief)
Daniel C. Rosen, MD (Associate Chief)
Sean Fullerton, MD

Infertility and Sexual Dysfunction

Gerald Matthews, MD, FACS (Chief)

Neuro-urology/Voiding Dysfunction

Siri Drangsholt, MD

Female Urology/Urogynecology

Siri Drangsholt, MD
Cara Grimes, MD, FACS (Gyn/Uro-gyn)
Dominique Malacarne Pape, MD, FACS (Gyn/Uro-gyn)
Patrick Popiel, MD (Gyn/Uro-gyn)

Pediatric Urology
Telephone: 914.493.8628

Paul Zelkovic, MD, FRCS (chief)
Richard Schlussel, MD, FRCS
Lori Dyer, MD, FRCS
Miriam Harrel, MD

Voluntary Staff

Jack Bruder, MD
Marc Chang, MD
Marc Janis, MD
Jaime Freyle, MD (Pediatric Urology)
Jack Hershman, MD
Jordan Gitlin, MD (Pediatric Urology)
Michael Grasso III, MD (Endourology, Laparoscopy)
Steven Friedman, MD (Pediatric Urology)
George Owens, MD
Christopher Dixon, MD (Reconstructive Urology)
David Schwalb, MD (Urologic Cancer)
Stephen Trauzzi, MD
Michael Werner, MD (Infertility)

Our specialized urologists are fellowship trained in the following:

• General urology
• Uro-oncology
• Laparoscopic & robotic urology
• Endourology & stone disease
• Thermal, laser, cryo
• Surgical treatments
• Female urology & continence center
• Male infertility & sexual dysfunction
• Minimally invasive prostate surgery
• Robotic surgery
• Neuro-urology
• Bladder reconstruction
• Vasectomy and vasectomy reversals
• Collagen therapy
• Greenlight laser for enlarged prostate
• Rezum® for enlarged prostate
• Bulking agents for incontinence including Bulkamid®