I recommend robot prostatectomy as the surgical option for most patients with prostate cancer.

 At Beth Israel Dr. Caner Dinlenc leads our robot prostate program. Drs. Tareen and Grotas also perform this surgery. We are here to help!
Have you already had a robot? need follow up have erectile dysfunction? positive margin? rising PSA? incontinence?we can help click to on request an appointment if you have questions or need an opinion!

no medical advice will be given over email all urologic consultations are done in person.
NYTIMES 2-14-2010 Health
Results Unproven, Robotic Surgery Wins Converts
By GINA KOLATA
Published: February 14, 2010
Robot-assisted prostate cancer surgery makes sense on some levels but it costs more, and it is not clear whether its outcomes are better.

This article in the journal of urology highlights the need to repeat ruine test

when a dipstick urine test shows blood.

Formal urinalysis with a microscope and a urine cytology can be done before any

invasive tests need to be done.

If you have microscopic hematuria a Ct-scan ( xray tests) or ultrasound

and cystoscopy ( camera test ) fiber optic scope is placed into the penis or female urethra to inspect the bladder.

This study showed that dip stick tests caused invasive workups when urine tests should have been send for microscopic analysis first. 

dipstick analysis is very good at determining urinary tract infection but may have a trace of blood without a urologic hematuria problem

Dr. Grotas offers state of the art diagnostic testing without unnecesary tests.

call today to make an appointment if you have hematuria!!

Volume 183, Issue 2, Pages 560-565 (February 2010)

Dipstick Pseudohematuria: Unnecessary Consultation and Evaluation

Pravin K. Rao, Tianming Gao, Marc Pohl, J. Stephen Jones‡

Received 29 June 2009 published online 16 December 2009.

Purpose
While many primary care providers advocate routine screening urinalyses, a heme positive dipstick test often leads to a false-positive diagnosis of hematuria, or pseudohematuria. Thus, American Urological Association guidelines recommend urological evaluation for asymptomatic patients only for at least 3 red blood cells per high power field in 2 of 3 microscopic urinalyses. We determined the percentage of patients referred for asymptomatic hematuria undergoing unnecessary consultation and studies.

Materials and Methods
Patients were retrospectively identified if seen for initial consultation associated with CPT 599.7X, hematuria. Among these patients those referred for evaluation of asymptomatic nonmacroscopic hematuria were identified, and referral patterns, ancillary tests, procedures and findings were examined.

Results
Of 320 new patient visits with diagnosis code 599.7X, 91 were referred for asymptomatic, nonmacroscopic hematuria. Of these patients only 37 (41%) had microscopic urinalyses before referral and only 22 (24%) had microscopic urinalyses showing 3 or more red blood cells per high power field. Of the 69 patients referred without confirmed microhematuria approximately 25% had true microhematuria and 15 with no true hematuria had undergone imaging before referral. The Medicare reimbursement value for the evaluation of these 69 patients was $44,901. Of these patients 35 underwent cystoscopy and only 1 (with true microhematuria) had a malignancy.

Conclusions
Positive dipstick heme tests should always be confirmed by microscopic urinalysis before urological referral or evaluation. Education of referring physicians regarding the American Urological Association guidelines could possibly help limit costly and potentially harmful, unnecessary evaluation of patients without true microhematuria.

Onset of statin use is associated with a significant reduction in serum PSA level, data suggest.

David J. Mener, MD, and colleagues at the University of Rochester/Strong Memorial Hospital in Rochester, N.Y., used computerized medical records to identify men who filled statin prescriptions between May 31, 2008 and September 30, 2008. For their study, the researchers included 962 men who had at least one PSA test performed within two years before and at least one PSA test performed within one year after starting a statin. The mean serum PSA level decreased significantly by 0.29 ng/mL (8.04%) after the start of statin treatment, the investigators reported in The Prostate (2009; published online ahead of print).

Today “the Doctors” TV show will discuss in depth the implications of pregnancy and post partum changes to the female body. Do you have urinary issues after pregnancy? Dr. Grotas treats pregnant women and women who have had children. They have unique needs and urinary problems that need behavioral therapy, medicine and or surgery
click here to watch today’s episode.

Urologists treat men and women.  Dr. Grotas is married with children>  He understands that female urinary problems are different than male urinary problems.  We treat all our patients with compassion and respect.  We are here to help!

click here

androgel is one of several products to boost testosterone levels in men.

I have used it for patients for many years.  You can only get this medicine from a doctor.

Daniel J. Rosen, MD

Today I performed a laparoscopic vasectomy in collaboration with Dr. Daniel Rosen a general and laparoscopic bariatric surgeon at Beth Israel Medical Center in New York City. 

The patient had a right inguinal hernia and in addition desired a vasectomy as his preferred method of birth control.  Without adding any additional incisions and minimal time to the procedure a vasectomy was performed using cautery (heat energy) and titanium clips. 

 Vasectomy is normally done with an incision on both sides of the scrotum but with laparoscopic approach the internal cuts to the vas (or sperm channels) is done higher up in the abdomen or belly. 

This has been reported before in the journal of endourology and other places.  Laparoscopic procedures are not for everyone but Drs. Grotas and Rosen are able to provide you all the options available for hernia/vasectomy/varicocele combination operations. 

If you need a vasectomy or hernia repair request an appointment today!

Add foods to your diet that may help increase your sex drive, such as basil, pumpkin seeds, celery, chiles, curcumin (which gives the yellow color to turmeric), bananas, figs, avocados, garlic, sauerkraut, asparagus, almonds and raw oysters. Avoid sugary, high-fat and calorie-laden foods.

Get to the gym! Go for a walk!

Get your body moving and your male health should improve too!

Don’t use steroids.

If you Testosterone is low or you have symptoms of low libido come in for a blood test and examination!

Male health is important In 2010 don’t let these problems get ahead of you!

Dr. Grotas provides some insights! Make an appointment today!

1. prostate check up: PSA and digital exam for prostate

1. Do you have a family history of prostate cancer? Did you have I high PSA and not do anything about it?  All your friends have prostate issues?

2. lower urinary track symptoms: getting up at night, weak urinary stream, frequent trips to urinate

2. stop pushing to urinate, stop being sleep deprived because your bladder/prostate wake you at night, Do you DVR everything due to frequent bathroom breaks?

3. Male sexual perfomance:

3. inadequate erections for intercourse or unreliable erections may have bothered you in 2009 but in 201o you can get help

4. Birth control Blues:

Had enough kids?  Vasectomy may be the right choice for you.  Come in for a fair and balanced discussion of the risks, benefits and alternatives

prior blog entries go over these in detail