Urology covers the urinary tract in everyone and the reproductive tract in men. In practice that means the specialty sees a very wide range of problems, from a kidney stone at three in the morning to a PSA result that needs interpreting to a man who has not been able to raise the subject of his erections with anyone. The common thread is that most of it is treatable, and that the quality of the initial evaluation determines almost everything that follows.
How we approach it
Three habits characterise the urology service here, and they are worth stating because they are what patients notice.
The first is that we measure before we treat. A bladder ultrasound after voiding, a uroflow, a symptom score, a three-day bladder diary — these cost minutes and change decisions. A man told his prostate is large has been given a fact of limited use; a man told his bladder is retaining 180 millilitres after every void has been given a reason.
The second is that the least invasive option that can genuinely solve the problem is considered first, and the costs of each option — recovery, sexual function, continence, anesthesia, the odds of a second procedure — are stated before the success rates. That order is deliberate and is explained in how we choose treatments.
The third is that the diagnostics sit in the building. Ultrasound, cystoscopy and urodynamics, and an interventional radiology suite are all here, which compresses what is often weeks of referral into one or two visits.
The prostate
Prostate work divides into the benign and the malignant, and they are separate problems that happen to share an organ. On the benign side, enlarged prostate is managed across the full range from watchful waiting through medication, office procedures and prostate artery embolization, which this group built its interventional radiology service specifically to offer. On the malignant side, screening is approached as a decision rather than a reflex — PSA, adjunct tests including ExoDx, MRI before biopsy where appropriate, and active surveillance for men whose disease does not warrant treatment.
Waking at night to urinate is treated as its own problem rather than as a prostate symptom, because it frequently is not one. Nocturia has three separate mechanisms and only one of them responds to prostate treatment.
Stones
Kidney stones are managed acutely and then, more importantly, metabolically. A first stone has roughly a fifty per cent chance of being followed by another within a decade, and that number is modifiable. Stone analysis and a metabolic evaluation identify why a particular patient forms stones, which turns generic advice about drinking water into a specific plan. Treatment of the stone itself ranges from watching a small one pass to lithotripsy and ureteroscopy.
The bladder
Overactive bladder, incontinence, urinary tract infection and pelvic pain account for a large share of the practice, in both men and women. The evaluation matters here more than anywhere: urgency has a long list of imitators, and blood in the urine — however slight, however transient — is investigated rather than attributed. Bladder Botox and PTNS and pelvic floor rehabilitation extend what can be offered when medication fails or is not tolerated.
Men's health and fertility
Men's health here means testosterone managed with tests and honesty rather than enthusiasm, erectile dysfunction evaluated as the vascular warning sign it usually is, Peyronie's disease, fertility investigation, varicocele, vasectomy and circumcision and frenuloplasty.
Two things we say early and often. Starting testosterone suppresses sperm production, frequently to zero, and any man who might want children deserves to hear that before the first injection rather than afterwards. And any procedure performed under sedation is done in an accredited surgical setting with a separate anesthesiologist whose only job is watching you breathe — the anesthetic determines the setting, not the size of the operation.
Who provides it
Urology is led by Dr. David Shusterman, with Dr. Joseph Motta, and Marina Borukhow, PA-C and Khoa Ngo, PA-C, who have been with the practice long enough that many patients see them as their primary contact. Embolization procedures are performed by Dr. Yosef Golowa in the interventional suite.
Conditions & services
Enlarged Prostate
Another common issue that men face as they get older is known as BPH, or an enlarged prostate. Those who live with BPH
Kidney Stones & Shock Wave Lithotripsy
Kidney stone treatment in NYC with shock wave lithotripsy first when possible, avoiding stents. Same-day visits at NYM
Overactive Bladder (OAB)
Sometimes, men can find themselves urinating frequently. While this can be common on days when you drink excessive amo
UTIs
At some point in our lives, we’re all likely to be faced with a UTI (urinary tract infections). These infections are c
Incontinence
Urinary incontinence care at NYMD Center in NYC: sorting stress, urge and mixed leakage, office testing, pelvic floor rehab, Emsella, bulking and slings.
Vasectomy in NYC
In-office vasectomy in Manhattan and Forest Hills, done by a urologist under local anesthesia, with honest counseling
Nocturia: Waking at Night to Urinate
Nocturia evaluation in NYC that sorts bladder, kidney, sleep and medication causes with a timed bladder diary and offi
Prostate Artery Embolization (PAE) in NYC
Prostate artery embolization for enlarged prostate in NYC. A urologist and interventional radiologist team, no cathete
Questions patients ask
Do I need a referral to see a urologist here?
Usually not, though some insurance plans require one from a primary care physician for specialist coverage. Check your plan, and if you do not have a primary care physician our internal medicine service can take that on.
I have blood in my urine but no pain. Is that urgent?
It should be evaluated, yes, even if it happened once and stopped. Painless visible blood in the urine is the presentation of bladder cancer that is most often ignored, and the evaluation — urine testing, imaging and usually cystoscopy — is quick.
Can women see a urologist?
Yes, and a substantial share of our urology patients are women. Recurrent infections, urgency, incontinence and pelvic pain are urologic problems regardless of sex, and we work alongside our gynecology service where the two overlap.
What can be done in the office rather than an operating room?
A great deal: cystoscopy, urodynamics, bladder Botox, PTNS, vasectomy, frenuloplasty, ultrasound, and the embolization procedures in our interventional suite. Where sedation is needed, it is performed in an accredited surgical setting with a dedicated anesthesiologist.
Make an appointment
Manhattan (212) 991-9991 · Forest Hills (718) 360-9550 · same-week visits and all insurance accepted, including Medicaid and Medicare.