Hackensack Meridian Medical Group Urology


Urologic Oncology


Our Medical Group urologists are central to Hackensack University Medical Center’s Department of Urology receiving the Gold Seal of Approval® by the Joint Commission for Kidney and Prostate Cancer. Our urology specialists participate in research to find new, effective treatments and are among the most experienced in the world in using groundbreaking treatments for urological cancers including pioneering the newest generation da Vinci® single port robotic surgical system and UroNav MRI/ultrasound fusion-guided prostate biopsy, a diagnostic tool that improves the accuracy of prostate cancer biopsies.

Working in collaboration with the cancer specialists at our John Theurer Cancer Center, our team uses the latest techniques and the most advanced technology—along with a personalized approach—to diagnose and treat all types of urological cancers, including:


Advanced Surgical and Imaging
Techniques to Treat Urologic Cancer

With more than 15 years of experience in urological robotic surgery, our robotic surgeons are among the best in the field. Our urologists are leaders in the field of minimally invasive robotic surgery, using these techniques to treat all types of urologic cancer—with the goal of returning our patients to a normal and healthy life.

The team uses advanced diagnostic imaging such as MRI/ultrasound fusion-guided biopsy to detect urologic cancers in their earliest stages. Our surgeons are combining robotic technology with intraoperative imaging tools, including near-infrared imaging, 3-D modeling, and “drop-in” ultrasound technology.

Prostate Cancer

Our urologists are the backbone of the prostate cancer program at Hackensack University Medical Center—the highest volume prostate cancer institute in New Jersey and a recipient of the Gold Seal of Approval® by the Joint Commission.

Our experience and expertise allow our specialists to offer an individualized approach for the management of prostate cancer. We offer the latest diagnostic technology such as UroNav MRI/ultrasound fusion-guided prostate biopsy, which allows us to identify which men are best served by aggressive treatment and which men can safely be treated with a more conservative method. We have extensive experience with active surveillance, cryoablation, high intensity focused ultrasound (HIFU), radiation, immunotherapy, and prostatectomy.

Our surgeons are pioneers in nerve-sparing robotic surgical techniques that preserve sexual function and continence. Our urologists routinely participate in clinical trials and provide patients with access to the latest, most promising treatments. Many surgeries are performed using the latest single port robot which affords the patient just one incision without entering the abdomen allowing the patient to be release in less than 24 hours.

Kidney Cancer

Our kidney cancer experts use the latest diagnostic and treatment options for kidney cancer—including advanced robotic techniques, near-infrared imaging, 3-D modeling, and state-of-the-art “drop-in” ultrasound technology—to provide the best outcomes. In addition, we offer active surveillance for patients that do not need surgery, as well as the latest clinical trials with the focus of preserving kidney function.

Our surgeons are experienced in both partial nephrectomy (kidney-sparing surgery) and radical nephrectomy (complete kidney removal). Approximately 85% of our patients leave the hospital in 24 hours due to the use of advanced robotics minimally invasive techniques.  Though our personalized approach, we are able to preserve kidney function which does not expose patients to the long-term health risks associated with having only one kidney. Our HUMG urologists are principal investigators in numerous trials, research projects and manuscripts all designed to develop and study new approaches to improve patient outcomes with kidney cancer.

Bladder Cancer

Our urologists are among the region’s most experienced at treating all stages of bladder cancer. A collaborative team approach involves our urologic oncologists, medical oncologists and radiation oncologists, who develop an individualized treatment plan for curing bladder cancer while preserving quality of life.

Treatment options include minimally invasive endoscopic bladder-sparing surgery, immunotherapy, radiation therapy, chemotherapy, and robotic bladder removal and reconstruction in a single operation for patients with more advanced stage bladder cancer.

Ureteral Cancer

Cancer of the ureter and/or renal pelvis is a rare and complicated disease that often requires a multi-specialty team to provide the most effective care. We work closely with medical oncologists and offer early intervention with neoadjuvant chemotherapy or immunotherapy that is tailored to the individual patient to improve cure rates for this disease.

In addition to treating cancer, our specialists are committed to preserving our patients’ quality of life. Our urologists aim to preserve the kidney whenever possible. When surgical excision is required, 95% of ureter and renal pelvis cancer procedures are performed with a minimally invasive robotic approach.

Adrenal Cancer

Our specialists provide expert surgical treatment for benign and cancerous adrenal gland tumors and are among the most experienced in the area.

We work closely with endocrinologists to diagnose and treat adrenal gland cancer and perform adrenal gland-sparing surgery whenever possible to preserve the natural function of the adrenal glands.

Testicular Cancer

Testicular cancer is a highly treatable form of cancer that can develop in men of any age. A precise diagnosis is key to delivering the most effective testicular cancer care. Our experts will identify the exact type and stage of cancer using imaging studies such as ultrasound, CT, MRI, or PET scans, physical exams, and blood tests for tumor markers.

After our specialists determine the type and stage of cancer and whether it has spread to other areas of the body, we will develop a customized plan to deliver the most effective treatment. Our goal is to treat each patient’s cancer while preserving fertility and sexual function.

We engage with medical oncologists early in a patient’s treatment to ensure that whenever chemotherapy and/or immunotherapy is required, it is completed at the right time.

Our Medical Group urological cancer experts include:

Kevin R. Basralian, M.D.
David T. Chang, M.D.
Michael C. Degen, M.D.
Ravi Munver, M.D.
Michael Stifelman, M.D.

Men's Urology


 

The specialists at Hackensack Meridian Medical Group – Urology are at the forefront of the latest approaches to men’s urological care, including innovative techniques to preserve sexual function and urinary continence. Our experts treat a complete range of men’s urological conditions—from common to the most complex. Our Medical Group features a fellowship-trained urologist in male sexual function and fertility.

Using the latest techniques and most advanced technology we treat:

Elevated Prostate Specific Antigen (PSA)

Our specialists are experts in diagnosing and treating men with an elevated PSA level. An accurate diagnosis is important, as an elevated PSA may be a sign of a number of prostate problems including prostate cancer, benign prostatic hyperplasia (BPH or enlarged prostate), or a type of infection/inflammation called prostatitis.

Our experts will diagnose the specific cause of any elevated PSA and develop a treatment plan best suited to our patients’ condition and needs. Using the latest state-of-the-art MRI/ultrasound fusion-guided prostate biopsy, prostate cancer can be precisely targeted. If a condition requires surgery, our urologists will use minimally invasive robotic surgical techniques whenever possible to remove the cancerous prostate and help preserve the nerves that control erectile function.

In addition, our specialists use the latest genomic technologies consisting of blood-, urine-, and tissue-based assays that enable additional interpretation of an individual patient’s prostate cancer biology. These genomic assays allow the stratification of the risk of aggressive prostate cancer at the time of diagnosis. As a result, we are able to offer improved clinical management of the disease using a personalized approach.

Enlarged Prostate (BPH)

Benign prostatic hyperplasia (BPH), or an enlarged prostate, occurs in almost all men as they age. Most common in men older than 40, urinary symptoms usually begin slowly and can become bothersome very suddenly. We will assess the condition and the severity of any symptoms before developing a personalized treatment plan. State-of-the-art treatment options may include medication, office-based therapies, laser treatment, or surgery. All prostate surgeries are done using the latest incisionless minimally invasive techniques or with robotic surgery.

Erectile Dysfunction (ED)

Our sexual health specialist is board certified and fellowship-trained in sexual medicine. Once the exact cause of ED has been determined, our team will develop a customized treatment plan to help patients return to a healthy sex life. We offer a full range of treatment options and can help men who have not been successfully treated with prescription medications such as Viagra®, Cialis®, and others.

Incontinence

There are several types of urinary incontinence, including stress incontinence (urine leakage caused by pressure on the bladder when coughing or sneezing), urge incontinence (a strong need to urinate), and overflow incontinence (when the bladder becomes too full).

After we have diagnosed a condition, our team will create a specific treatment plan. A treatment may be as simple as changing certain lifestyle habits or retraining the bladder. However, if the condition requires more intervention, we offer effective minimally invasive procedures.

Low Testosterone (Low-T)

If a patient is suffering from Low-T, our urologists have the experience and training required to make a proper diagnosis, and safely prescribe the best formulation of testosterone replacement medication.

Peyronie’s Disease

We offer men with Peyronie’s disease the most advanced treatment options available. After a complete evaluation, our specialists will recommend a care plan that may include medication or surgery. Additionally, our physicians are trained to administer a series of injections of a medication called Xiaflex®. The medication breaks down the scar tissue that causes curvature of the penis and is the most effective nonsurgical treatment available for Peyronie’s disease.

Vasectomy Reversal

We provide expert surgical care for patients who elect to have a vasectomy reversal, using the latest minimally invasive microsurgery techniques to minimize discomfort and decrease recovery time while maximizing fertility potential.

Our Medical Group men’s urology experts include:

Kevin R. Basralian, M.D.
David T. Chang, M.D.
Michael C. Degen, M.D.
Michelle J. Kim, M.D.
Ravi Munver, M.D.
David Shin, M.D.
Richard A. Watson, M.D.

Women's Urology


Hackensack Meridian Medical Group – Urology is one of the only groups in New Jersey with two female urologists on staff that use advanced techniques and state-of-the-art technology to treat women with simple to complex urological conditions.

Our experts understand that women have unique needs when it comes to urological care. Whether a patient is suffering from incontinence, prolapse, a urinary tract infection or another urological condition, our board-certified urologists deliver expert and compassionate care.

We take the time to get to know each patient and listen to their concerns. With years of experience in the field, our urologists are able to make quick and accurate diagnoses using the latest diagnostic technology.

After determining a condition, our urologists will use the most advanced techniques and treatments to provide the best urological care in the region. For conditions that require more comprehensive treatment, we work closely with other health care providers, including nephrologists, infectious disease specialists, oncologists, and gynecologists.

Conditions we treat include:

Urinary Incontinence and Overactive Bladder

One out of three women in the U.S. has urinary incontinence, which can range from occasionally leaking urine when coughing or sneezing, to having sudden urges to urinate that are so strong a patient cannot get to the toilet in time.

Our experts use the latest state-of-the-art urodynamic technology to diagnose the cause of incontinence. After we diagnose a condition, we offer a range of effective treatments—from pelvic floor exercises, to electric stimulation, to Botox, to surgical cures—that allow patients to return to normal day-to-day life with confidence.

Urinary Tract Infection (UTI)

Our urologists specialize in treating persistent UTIs (infections that don’t go away with treatment), as well as chronic UTIs (infections that happen often). We will conduct a thorough exam and use advanced technology to diagnose problems with the bladder or urethra that may be causing UTIs.

After testing is complete, we will develop a customized treatment plan to help patients feel better, fast. The personalized plan may include low-dose antibiotic therapy or treatment of underlying conditions that are causing UTIs. In addition to treating any UTIs, our urologists will help prevent future infections by recommending behavioral and lifestyle changes as well as supplements and medical therapy.

Pelvic Organ Prolapse

Our experienced urologists help women experiencing prolapse of the uterus, bladder, or rectum. After conducting a thorough exam, our specialists will determine the right treatment option, which may include pelvic floor exercises, pessary fitting, or reconstructive surgery.

Our urologists perform expert, advanced reconstructive surgery using native tissues, mesh, or biological materials to provide support to the uterus, bladder, or rectum. This can be done transvaginally or with the assistance of the da Vinci® robotic surgical system.

Interstitial Cystitis (IC) and Pelvic Pain

The symptoms of IC range from mild to severe discomfort and include recurring pain in the bladder and pelvic region, urinary frequency (needing to urinate often), and urinary urgency (feeling a strong need to urinate). Because these symptoms often overlap with those of more common conditions such as UTIs and overactive bladder, IC can be challenging to diagnose and treat.

Our team has the expertise and resources to diagnose this condition and provide a range of treatment options to give relief. The treatment plan may include bladder training, medications, physical therapy, bladder washes, or surgery.

Urinary Tract Fistula

Our urologic surgeons provide expert treatment for urinary tract fistulas, which are abnormal openings that connect the organs of the urinary tract to other nearby hollow organs. We take a multidisciplinary approach to fistula care and work closely with gynecological and colorectal surgeons to treat and reconstruct affected organs.

Women’s General Urology

With two female urologists on staff, we are able to meet the unique needs of the female patient with urologic issues such as bladder cancer, kidney stones and blood in the urine.

Our Medical Group women’s urology experts include:

David T. Chang, M.D.
Debra L. Fromer, M.D.
Michelle J. Kim, M.D.

Pediatric Urology


Our fellowship-trained pediatric urologist at Hackensack Meridian Medical Group – Urology is among the most experienced in the region at treating pediatric urological conditions, including the diagnosis and treatment of these conditions before birth.

Our pediatric urology team treats children of all ages, from infants to teens, as well as providing prenatal care. Our group takes a team approach, working closely with other specialists, including pediatric nephrologists and maternal/ fetal specialists, to deliver the most comprehensive and innovative pediatric urology treatment available.

Our pediatric hospital, the Joseph M. Sanzari Children’s Hospital, is designed with children and families in mind. It features dedicated operating rooms for children and recovery areas designed for families. Our pediatric urologist works with a specialized pediatric care team that includes anesthesiologists, radiologists, nephrologists and nurses.

From simple cases to the most complex conditions, our staff members take the time to get to know each child, listen to their concerns and create a treatment plan designed specifically for each child’s condition.

Conditions we treat include:

Urinary Incontinence

Whether a child is suffering from urinary incontinence at night (bedwetting) or during the day, our team can be trusted to identify the cause. A child’s treatment may include behavior modification, medications, or surgery.

Anatomical Abnormalities

We provide expert diagnosis and treatment for:

  • Undescended testicle(s), which occurs when one or both testicles fail to move into the scrotum.
  • Hypospadias, which occurs in boys when the opening of the urethra (the tube that carries urine out of the body) is located somewhere on the penis other than the tip.
  • Hydrocele, which is a collection of fluid in the scrotum caused by a membrane that did not close properly during prenatal development.
  • Scrotal problems, such as lumps, pain, infection, or swelling.
  • Ambiguous sexual conditions, which occur when something goes wrong during the prenatal development of sex organs.
  • Circumcision revision, which may be necessary if too much skin is removed, too little skin is removed, or adhesions develop as a result of circumcision.
  • Prenatal hydronephrosis, when the prenatal ultrasound shows dilation of the fetal kidney(s).
  • Vesicoureteral reflux (VUR), which is the backward flow of urine from the bladder into the kidneys. VUR can sometimes lead to recurring urinary tract infections.

Our expert in pediatric urology:

Harry P. Koo, M.D.

Men’s Urology

Our fellowship-trained infertility urologist uses the latest techniques and technology to diagnose and treat male infertility. With noteworthy success rates, our specialist is among the most capable in the region at providing male infertility care and helping couples realize their dream of having a child.

Our physician offers minimally invasive surgical options and is specially trained in microsurgery and can correct a range of problems infertility problems. Other procedures performed include vasectomy reversal and sperm retrieval.

We conduct a thorough exam to help determine the cause of infertility, including a semen analysis to measure sperm count and assess the quality of sperm. Patients may also be asked to answer health questions or provide blood and urine samples.

Based on the diagnostic test results, our specialist will develop a customized treatment plan tailored to the condition. Specialized treatment for male infertility includes:

Surgery

Our specialist offers the safest and most up-to-date procedures to treat male infertility, including minimally invasive surgical options. Our urologist is specially trained in microsurgery and can correct a range of problems, including:

  • Varicocele, which is an enlargement of veins within the scrotum that can affect sperm production and quality
  • Obstructed vas deferens, which prevents sperm from being ejaculated properly
  • Nonobstructive azoospermia, which is a lack of sperm production in the ejaculate

Our specialists also perform:

  • Vasectomy reversal, which can reconnect the tubes (vas deferens) that were cut during the vasectomy
  • Sperm retrieval, which involves taking sperm from the reproductive tract

Medication

Sometimes male infertility can be caused by infection, problems with sexual intercourse, or hormone imbalances. Our urology specialist can prescribe medications to treat male infertility, including:

  • Antibiotics, if an infection is present
  • Hormone therapy, if hormone levels are too low or too high
  • Medications to treat erectile dysfunction or premature ejaculation

Fertility Procedures

Our urologist provides expert assistance to couples who are undergoing fertility treatments by obtaining sperm through normal ejaculation or other means.

Our Medical Group male infertility expert includes:

David Shin, M.D.

Stone Disease

Our Medical Group urologists are nationally recognized leaders in the field of minimally invasive endoscopic procedures to treat kidney stones of all sizes, including pioneering the use of the LithoVue™ Single-Use Digital Flexible Ureteroscope, single stage percutaneous stone removal and tubeless stone removal.

Our board certified and fellowship-trained specialists treat all types of stone disease and kidney stones of all sizes, combining our experience with new technologies to achieve outstanding results. We also focus on understanding why each patient is developing stones and develop medical treatments and strategies to prevent them from reforming. Specialized treatment for kidney stones includes:

  • Shockwave Lithotripsy
  • Ureteroscopy
  • Laser Treatment for Kidney Stones
  • Single Stage Percutaneous Kidney Stone Removal

Advanced technology in the treatment of stone disease means surgeons can perform the procedure in a single stage, allowing patients to return home in one day.

Shockwave Lithotripsy

Shockwave lithotripsy is a noninvasive treatment that uses X-rays to locate stones, and sound waves to break those stones into small pieces that can be passed through the urinary tract. Our specialists use the latest, most effective shockwave lithotripsy technology—the Dornier Delta III®—allowing for better targeting and fragmentation of kidney stones, while reducing the risk of discomfort and bruising after the procedure.

Ureteroscopy

Ureteroscopy is a minimally invasive incisionless procedure in which a very small digital scope is passed up the ureter and is used to break up large or painful kidney stones, after which the fragments can be removed through the urethral opening. Hackensack Meridian Medical Group – Urology is the first group in New Jersey to perform this procedure using a novel single-use, disposable flexible ureteroscope. This procedure can offer faster and more effective relief for patients with stones that need immediate treatment. To further improve the use of the device, our specialists have created a novel algorithm to predict which patients would most benefit from treatment with the disposable flexible ureteroscope; an algorithm that has now been adopted by many other hospitals throughout the world.

Laser Treatment for Kidney Stones

The urologists at Hackensack Meridian Medical Group – Urology are among the few in the New York-New Jersey metropolitan area to use a state-of-the-art Lumenis holmium surgical laser—the most powerful holmium laser available. This technology allows our kidney stone specialists to safely, efficiently, and completely treat large kidney stones— creating smaller fragments than other kidney stone treatments. In fact, our holmium laser is so powerful that it has the potential to pulverize the stones, turning them into dust that can easily be passed through the urinary tract.

Single Stage Percutaneous Kidney Stone Removal

Percutaneous kidney stone removal is a surgical procedure to remove very large or difficult-to-reach kidney stones. A small incision is made in the patient’s back and the stones are broken up with high-frequency sound waves. Larger fragments are grasped, and smaller fragments are “vacuumed” up using a suction device.

Kevin R. Basralian, M.D.
David T. Chang, M.D.
Michael C. Degen, M.D.
Michelle J. Kim, M.D.
Ravi Munver, M.D.
Richard A. Watson, M.D.

 

Ureteropelvic Junction (UPJ) and Ureteral Reconstruction

For over a decade the surgeons at Hackensack Meridian Medical Group – Urology have been pioneers in the development of innovative robotic surgical techniques to treat ureteropelvic junction obstruction and ureteral strictures.  These urologists are world-renowned in the treatment of ureteral stricture, a condition characterized by the narrowing of the tube that carries urine from the kidneys to the bladder. We treat the most common type of ureteral stricture, known as ureteropelvic junction (UPJ) obstruction, and more complex ureteral strictures, that can be congenital or occur from ureteral stones, radiation, previous surgery or other causes of inflammation. A high-level of expertise is required to achieve a successful surgical outcome.

Our urologic reconstructive surgeons have  a vast experience performing advanced robotic upper urinary tract reconstructive surgery and have pioneered several minimally invasive approaches that are being used around the world today

Specialized procedures developed by our surgeons include:

  • Buccal mucosa ureteroplasty: A procedure for extensive stricture that uses tissue from another part of the body, such as the inside of the mouth, to reconstruct the ureter.
  • Near infrared imaging: The use of enhanced imaging techniques during surgery to make sure that healthy tissue is being reconnected.
  • Ureterolysis with omental wrap: A procedure to remove a mass of tissue or scar tissue that is pressing on one or both ureters, known as retroperitoneal fibrosis.
  • Single port robotic surgery: A procedure to repair and reconstruct the ureter through a single key hole incision using the da Vinci SP robotic system.

We are one of the founding institutions of the “Collaborative Robotic Reconstruction Urinary Study” (CORRUS).  The largest and most productive multi-institutional database on robotic urinary reconstruction which is defining best practices in this new and innovative field.

Our Medical Group ureteropelvic junction (UPJ) and ureteral reconstruction experts include:

Ravi Munver, M.D.
Michael Stifelman, M.D.