Thousands of patients annually are plagued by urinary leakage, yet many feel reluctant to raise this sensitive issue with their doctor. Many patients have been led to believe this is a “normal part of the aging process” or “an unavoidable consequence of childbirth”. Although age and child bearing can impact the bladder, this is an area where there are a growing number of treatment options which can improve the quality of life.
It’s critical to understand there are two types of urinary leakage. And it’s important to differentiate between the two as the treatment options depend on the type.
Stress Urinary Incontinence is the involuntary passage of small amounts of urine that occurs when one laughs, coughs/sneezes or exercises. This is often experienced after pregnancy/childbirth but can also be seen with significant weight gain and conditions associated with chronic pushing/coughing such as chronic constipation or asthma. It may also be more noticeable after the onset of menopause.
Stress urinary incontinence is treated with physical exercises. When this fails, there are surgical options. Surgery for stress urinary incontinence is an outpatient procedure with excellent outcomes.
Conversely, Urgency and Urge Incontinence is the involuntary passage of urine that is accompanied by the desire to urinate. Individuals feel they are unable to “make it to the toilet in time”. Patients often describe specific triggers, such as “putting a key in their apartment door” or “opening the bathroom stall”. This condition is often more noticeable with age, and is often worsened by bladder irritants. The most common bladder “triggers” are caffeine, tobacco, alcohol and artificial sweetener.
For urgency and urge incontinence, counseling and behavioral modifications are sometimes all that is required to improve bladder symptoms. For some, bladder medications provide relief. There are many medications from which to choose, including a newer medication with fewer side effects. When these options fail to bring relief, patients may choose to have a Botox bladder injection which will relax the bladder and thus prevent the spasms which are responsible for the leakage. Or, they may choose to try a sacral neuromodulator which is a tiny device that sends an electrical impulse to the bladder to prevent involuntary bladder contractions and therefore improve leakage.
In 2017 we are fortunate to have many tools in our armamentarium to offer to those suffering with urinary leakage. Please give us a call or request an appointment online to see how we can help.
We have recently seen some exciting responses using an innovative treatment for Peyronie’s Disease. This condition often causes pain and angulation in the erect penis. It may also inhibit full erections. Some of our patients found out they had this condition while being seen for having difficulty during sexual activity. Specially trained and certified urologists are now using the medication Xiaflex (TM), a form of botox to soften the angle and reduce the nodular plaque that often occurs in this condition.
While not everyone is a candidate, some men can benefit from this treatment. Typically 6 applications are required, although some of our patients have reported improvement after as few as 2! An evaluation is required to determine if this treatment is likely to help an individual. If you’re having difficulties with penile pain and/or erectile dysfunction, and would like to be evaluated for this exciting therapy, kindly call our office for an appointment.
Note that many plans require authorization for prescriptions. It seems that even commonly prescribed medications require it. Unfortunately, this way your insurance makes the process of providing you with your needed medications most time consuming. Insurance suggest that the doctor calls to obtain authorization. However, it is a most time consuming process. More often than not the doctors have several requests for pre-authorization at hand. Rather than making a call, our practice prefers to fill out a pre-authorization form. These are normally provided by your insurance and contain all information and/or questions pertinent to your particular prescription.
For that reason, if needed we ask you to obtain the required PRE-AUTHORIZATION forms from your PRESCRIPTION INSURANCE and have them forwarded to our office for the doctor’s review and fulfillment. This will allow the doctor to tend to the patients at the office as opposed to being held on the phone for several minutes a day jumping through insurance imposed processes.
Without the pre-authorization forms you will have to pay for your prescriptions out of pocket. Also, some plans have no coverage for certain medications. You’re welcome to have the insurance fax these to our main fax line:
In preparation for the forecasted blizzard, our office will be closed today. The inclement weather makes it unsafe for some of our patients and our core staff members to commute. We hope all of you stay safe, warm and cozy as this weather clears. We shall be open tomorrow, at 9am as usual. See you then.
Kidney stones may present in various ways. Most often, they present with intermittent radiating pain on one side and can be accompanied by waves of nausea and/or vomiting. Other, may lead to significant changes in voiding patterns, such as increased urgency and frequency of urination, intermittent flow, burning and/or blood in the urine. Sometimes kidney stones are completely asymptomatic and may be picked up as an incidental finding when patients undergo imaging for other reasons. Patients may have a “positive urine analysis” and be found to have microscopic blood or inflammatory markers in the urine. Kidney stones may be diagnosed with medical imaging such as ultrasound, xray and/or CT scan of the Abdomen and Pelvis. Once diagnosed, if a patient is asymptomatic, it is important to follow them to confirm passage of the stone, either with spontaneous passage or with some type of intervention.
Most often, stones that are found within the ureter (the tube that drains the kidney and connects to the bladder) or those that are obstructing the kidney (which means they are causing backup of urine, thereby putting pressure on the kidney) require treatment. An “obstructing stone” prevents drainage of urine from the kidney and can lead to infection, sepsis and over an extended period of time, loss of renal function. These could also lead to formation of ureteral strictures. Kidney stones don’t always require immediate intervention. They may not need any treatment, other than making dietary and or medication changes to avoid an increase in stone size and number.
Management of stones depends on the location, size and number of stones. It must be individualized to each patient and depends often depends on one’s overall medical health. For evaluation, a full dietary intake with a complete medical history and physical is required. Though most stones are composed of calcium oxalate, the reason one forms stones will vary from patient to patient. Issues may include poor hydration status, acidic urine, high salt intake, large meal sizes, too much animal protein (which is found in beef, chicken and fish). Excessive intake of vitamins C, D, high dietary salt intake or calcium supplements can also contribute. You should not make dietary or medication changes until a full evaluation has been completed. For example if you have been diagnosed with osteopenia or osteoporosis (i.e. bone loss), and have kidney stones, do not change your bone health medications without the proper medical advice. Patients with gout or high blood levels of uric acid have a higher risk of forming stones. Interventions shown to decrease stone recurrence rates include drinking at least 2.5 liters of water per day, maintaining a normal calcium diet and adhering to a low salt diet. Appropriate modifications can be made once a 24 hour urine collection is performed.
If you feel you may have a kidney stone, please call our office (212-570-6800) for an appointment. We can offer same day evaluation and treatment as indicated.
PATIENT RESPONSIBILITY DISCLOSURE
As the new year goes on, our patients are being confronted with subtle changes in their insurance plans. Patient responsibility is newly assigned. Commonly, the new year means Deductibles reset and start again at zero. Many of our patients who had no deductibles in the previous year have them now. A large number of them are “not aware” of these changes and in turn it makes it more challenging to collect on these claims which are not paid by the plan since they represent patient’s responsibilities.
For that reason, we some time have to remind our patients that our participation with Insurance Plans does not imply you as our patient will not get a bill for services rendered during your visits or surgical procedures. Note that your Insurance Policy may have multiple ways to assign the responsibility of our fees to you. This is done through DEDUCTIBLES, COINSURANCE and COPAY. It is important to be familiar with these aspects of your plan to avoid unexpected bills and be able to manage your medical costs efficiently and effectively.
DEDUCTIBLES are assigned as per your policy to ALL SERVICES or just to CERTAIN PROCEDURES. Your insurance will not pay for your claims until the total of your deductible has been satisfied by assigning it to approved claims. These DEDUCTIBLES may range anywhere from a total of $200.00 per year to a total of $5000.00 (or more). Note, most often it will take several claims to satisfy a large deductible. As an example, if one visit claim for a patient was around $350.00 and the total deductible is more than that, then your claim for $350.00 may be payable by you, as per your plan’s provisions. Please be aware of this.
CO-INSURANCE is a percentage (%) of your total approved insurance claim which is billable to you as per your insurance policy. This varies widely through the insurance companies. A common CO-INSURANCE is 20% of the approved claim. Normally coinsurance is due after DEDUCTIBLES have been satisfied.
Additionally, a COPAY is a set amount (anywhere from $5.00 to $75.00 or more) collected from the patient at the time of the visit. This is usually stated on your insurance card. Some plans will specify different amounts for your General Doctor and for Specialists.
We hope this helps keep things clear.
The Board of Directors of the American Urological Association (≥ 16,000 members worldwide) conferred Honorary Membership on John A. Fracchia, MD. This will be effective May of 2017.
According to the AUA, this is an honor bestowed on the few (<100 living) whose diligence and commitment surpasses the AUA’s greatest expectations. Honorary Membership is reserved for scientists who have achieved outstanding prominence in a field of medicine related to Urology, Officers of the Association, and/or distinguished Urologists.
You would think that with today’s technology there would be fewer problems with those services we depend on. Phone service, as ubiquitous as it is, it seems to fail more often than we’d like. We’ve had phone problems in the past and have had repairs done multiple times. However as the technology it relies on ages, the problems just resurface. Phone service providers at this point are putting most of their efforts in updating to new tech than maintaining and servicing old hardware. Whenever there are phone problems, with the old hardware, its more difficult to get it repaired quickly and efficiently. Today is one of those days. We hope it sorts out shortly. Kindly communicate with us by email whenever possible. We’ll be happy to address your concerns.
Happy holidays to all! Its been another amazing year. 2014 brought so many new challenges to the practice, new patients with numerous concerns. Through the year we tackled all to keep providing you with good healthcare services.
We had multiple interesting and challenging health problems to help our patients with and are happy to say we were able to help in great measure. From medical treatments to surgical procedures our patients were tended to through the year and even today we have new cases to add.
Thanks all for your support through the year. We want to wish you all a belated Merry Christmas and a very happy and prosperous New Year, 2015! We’re looking forward to leading the way in Urological care for our patients in this beautiful city New York and those who seek our care from all over the world.
Kidney Stones in 2013
Thirty years later, I came down with yet another kidney stone. Having experienced one back in ‘84 was enough for me to cringe at the possibilities. However nowadays we have more advanced medications like alpha blockers which can help facilitate passage of small stones. We used Toradol for pain, which is non narcotic. In the process of diagnostics, we used a CT scan, which are easier and quicker to perform and do not require IV contrast. CT scans also provide more information to help with the treatment process. Once the stone was found treatment was decided. We had some options. One of which was ESWL (Extra-corporeal Shock Wave Lithotripsy) which was not available back in 84. This procedure is non invasive.
However for my stone, a urethral stone extraction was done. Today’s instruments are more advanced and much smaller. This helped reduce pain and trauma during the procedure. This was carried out at an out patient facility. After the extraction was performed a stent was placed in. This was a more tolerable experience due to the softness and flexibility of today’s Stents. Additionally, the stent was removed in only 3 days.
All in all, treatment for kidney stones has advanced vastly. From medications to instrumentation we have great options to help you with this problem in an efficient and effective manner.