Advances in urology offer you diagnoses and treatments that weren't available only a few years ago.

Specialties

Dr. Frankel specializes in the treatment of the following:

• Less-invasive urologic surgery
• Urinary tract stones
• Female urology
• Male sexual dysfunction

We offer a variety of treatments for these common urological conditions:

• Bladder disorders
  • Bladder cancer
  • Dropped bladder
  • Painful bladder
• Prostate disorders
  • Enlarged prostate (benign prostatic hyperplasia/BPH)
  • Prostate cancer
  • Prostatitis (inflammation of the prostate)
• Urinary tract infections
• Hematuria
• Urinary incontinence
• Voiding dysfunction (including nighttime, daytime frequency, urgency)
• Kidney stone disease
• Interstitial cystitis
• Erectile dysfunction
• Male infertility
• Male sexually transmitted diseases (including chlamydia and condyloma)

We also provide circumcision.

Special Procedures

Dr. Frankel is experienced in performing the following special procedures:

• Cryotherapy of the prostate

• Cryotherapy of the kidney

• Laser ablation of the prostate

• Microwave thermotherapy of the prostate

• Laparoscopic cystocele repair - The least invasive repair of a dropped bladder. Over 350 successful surgeries since 1992, with no major complications. The procedure involves one night in the hospital. Patient resumes preoperative activity within 1 to 2 weeks.

• Laparoscopic bladder neck suspension for incontinence - this procedure means less pain, scarring, and an easier, faster recovery. Incontinence in women can be successfully treated, with results identical to traditional open surgery and a similar recovery to laparoscopic cystocele repair.

• TOS (transobturator support) is the latest addition to treatments for stress incontinence. It is the safest, most effective of the less invasive approaches for treating stress incontinence. [See more in the article on 2003 Update on Stress Incontinence by Dr. Frankel.]

• TVT - minimally invasive pubo-vaginal sling procedure (no bone stapling). The least invasive surgery for stress incontinence so far developed with the lowest complication rates, the least amount of time with a catheter, and the least amount of time to recover. Recreates the natural support that existed prior to development of relaxation. Over 200 performed. Initially, developed in Sweden in 1994, this procedure has been available in this country as of 1999. [See more in the article on TVT by Dr. Frankel.]

• Collagen injection for incontinence - The least invasive procedure requiring no incision and no overnight stay. Satisfactory response from 3 months to 24 months.

• Extracorporeal Shock Wave Lithotripsy (ESWL) of kidney stones - Fast and simple non-surgical technique that focuses low energy shock wave impulses onto the kidney stones. These impulses cause the stones to break into tiny particles, which can pass naturally from the urinary system.

Dr. Frankel's Classification of Surgically Correctable Stress Urinary Incontinence

This system assumes the following:

1. The patient is a candidate for elective surgery.
2. Childbearing is completed.
3. There are no complicating factors such as neurologic disorders that are causing the incontinence.
4. The patient understands the success rate is high but not 100 percent, the complication rate is low, but now 0, and it may take a short period of time before either the patient can void or be totally dry.
5. The most dramatic improvement is seen in incontinence when the patient strains, such as causing, laughing and/or exercising.
6. 95 percent of patients can be treated with minimally invasive or less invasive corrective surgery.

• Grade 1: a patient with satisfactory pelvic support, insignificant residual urine, and minimal, or no previous pelvic surgery.
• Grade 2: patient has dropped bladder in addition to stress incontinence. +/- significant residual urine. Minimal or no previous pelvic surgery.
• Grade 3: significant previous pelvic surgery, which may or may not include previous surgery for incontinence.
• Grade 4: in addition to grade 3, patient has evidence of bladder outlet obstruction.
• Grade 5: patient has significant pelvic prolapse besides the urinary bladder, in addition to stress incontinence.

• Grade 1: accounts for 40 to 50 percent of all patients. My approach is the TVT pubo vaginal sling. The procedure is 30 minutes long under anesthesia. Most patients are discharged the same day without a catheter and can drive the next day. Patients can return to office work in one to two weeks in most cases. Patients can resume exercising and relations usually at the end of two weeks.
• Grade 2: combination laparoscopic cystocele repair and TVT. Requires 60-90 minutes of surgery, and usually one night in hospital. Patients may drive within 24 hours of surgery. Usually patients require 2-6 weeks to resume preoperative activity and relations. Most patients require a catheter one night.
• Grade 3: requires laparoscopic dissection of adhesions, laparoscopic cystocele repair, and TVT. Otherwise, similar to grade 2.
• Grade 4: in addition to surgery for grade 3, requires dissection and removal of obstruction of bladder outlet. Can be done laparoscopically and/or vaginally with minimally invasive technique. Only difference is greater intraoperative time required. Otherwise, similar recovery and activity as grade 2.
• Grade 5: pelvic prolapse repair requires team approach with reconstructive gynecologist. May require traditional surgery, longer hospital stay and traditional recovery time and longer restrictions on activity indefinitely.