1625 N. George Mason Drive • Suite 415 • Arlington, VA • 22205 • Tel: 703.717.4200 • Fax: 703.717.4201 • VIEW MAP >>

  E-mail This

Service Descriptions

Laparoscopic adrenalectomy
The adrenal glands are paired organs that are found just superior and adjacent to the kidneys. They are mainly responsible for steroid and adrenaline production. Benign and cancerous tumors can develop in these glands. Up until several years ago, large incisions were made to remove these small glands. Currently an adrenal gland can be removed by making 4 small (0.5-1.2 centimeter) incisions. Some diseases of the adrenal gland still require a traditional open incision. The decision to remove the adrenal through minimally invasive means is made based upon the available medical history and the radiological imaging.

Laparoscopic nephrectomy
This minimally invasive procedure is used for the removal of kidney cancer or for the removal of a non-functioning kidney. Rather than making a large 10-15 centimeter incision, 3-4 small incisions (measuring from 0.5-1.2 centimeters) are made for removing the entire kidney. Using an enlarged incision or a separate "cesarean section-like" incision, the kidney can be removed intact. The length of the hospital stay is 1 to 2 nights and the overall period of recovery is 2 to 4 weeks rather than 4 to 6 weeks for open surgical removal of the kidney. Most, but not all, patients are candidates for a laparoscopic nephrectomy. We therefore provide our patients with an individualized evaluation and consultation.

Laparoscopic partial nephrectomy
This minimally invasive procedure is used for the removal of kidney cancer or for the removal of a non-functioning kidney. Rather than making a large 10-15 centimeter incision, 3-4 small incisions (measuring from 0.5-1.2 centimeters) are made for removing the entire kidney. Using an enlarged incision or a separate "cesarean section-like" incision, the kidney can be removed intact. The length of the hospital stay is 1 to 2 nights and the overall period of recovery is 2 to 4 weeks rather than 4 to 6 weeks for open surgical removal of the kidney. Most, but not all, patients are candidates for a laparoscopic nephrectomy. We therefore provide our patients with an individualized evaluation and consultation.

Laparoscopic nephroureterectomy
This procedure is performed to eradicate cancers of the renal pelvis and ureter renal pelvis and ureter. The most common cell type is a transitional cell cancer. The operation consists of removing the kidney and the entire ureter. In years past, a standard 12th rib flank incision was used to remove the kidney and a second incision in the lower abdomen was used to complete the removal of the ureter. This procedure can now be performed laparoscopically with outcomes that are similar to its open counterpart. Three to four small incisions are used to dissect the kidney and the ureter. Using an enlarged incision or a separate "cesarean section-like" incision, the kidney can be removed intact.

Single port laparoscopic subrapubic prostatectomy
There are many treatment options available for men with benign, non-cancerous enlargement of their prostate (also known as "BPH"). These include medications, office-based microwave thermal heating, laser vaporization and transurethral resection ("TURP"). Very large glands, however, are best managed with open surgical removal. Although a very effective surgery, this operation traditionally required a several day hospital stay for recovery and a relatively high risk of intraoperative bleeding. Drs. Mordkin and Joel have now pioneered a new method for doing this operation called a single port laparascopic suprapubic prostatectomy, and they were the first surgeons in metropolitan Washington, DC to perform this procedure. Compared to the standard open apporacoh, it affords a significantly reduced blood loss, dramatically smaller incision size and accelerated recovery period, allowing most patients to be discharged from the hospital within 48 hours.

Robot-assisted laparoscopic prostatectomy
The laparoscopic prostatectomy now has been combined with robotic technology. The Da Vinci Surgical System by Intuitive Surgical consists of 3-4 surgical arms that are controlled by the surgeon. One surgical arm holds a 3-dimensional camera that provides for better visualization than a conventional laparoscopic camera. The other surgical arms hold instruments that are capable of replicating the exact movements of a surgeon's hand. Standard laparoscopic instruments do not allow for such movement replication. The data to date appear to be promising and similar to those of the established conventional open surgery. When robotics are involved, such procedure is often called "robotic-assisted laparoscopic radical prostatectomy" or "Da Vinci radical prostatectomy." Dr. Mordkin has significant experience performing this procedure and travels nationally as an instructor for Intuitive Surgical. Click here to see interactive video.

Laparoscopic retroperitoneal
lymph node dissection
This minimally invasive procedure is performed on male patients diagnosed with testicular cancer testicular cancer. Some types of testicular cancer are treated by removing lymph nodes that are found along the major blood vessels in the abdomen. The laparoscopic removal of these lymph nodes results in similar diagnostic and therapeutic outcomes. Additionally, patients enjoy less pain, shorter hospital stays, and quicker recovery times.

Robot-assisted Laparoscopic ureteropelvic
junction repair
An ureteropelvic junction obstruction (UPJ) is a blockage of urine as it drains from the kidney into the tube which ultimately empties into the bladder. This blockage, either congenital (meaning that you are born with it) or acquired, most commonly results in flank pain because the urine can not properly drain out of the kidney. Other complications of an ureteropelvic junction obstruction are infection, compromised kidney function on the affected side, and infection. The classic method for repair involved an open incision to approach the obstruction. The narrowed UPJ was then excised and the two ends were sewn back together. The procedure can now be performed laparoscopically with results that are comparable to the open approach. The pain medication requirements and length of hospital stay are significantly reduced with the laparoscopic approach. This translates into patients returning to work and their activities of daily living sooner.

Radical retropubic prostatectomy
This procedure is performed to eradicate localized prostate cancer. It is performed through a midline abdominal incision that extends from below the belly button to the top of the pubis bone. During this surgery, the prostate and seminal vesicles are removed while the pelvic lymph nodes may or may not be removed. The urethra travels through the center of the prostate. Therefore, when the prostate is removed the urethra must be reconnected to the bladder. This requires placement of a temporary urinary catheter that empties the bladder. The tip of the catheter sits in the bladder and exits through the end of the penis. The catheter is generally removed in the office within 7-10 days. The hospital stay is one to two nights and patients are often able to return to work and other daily activities in two to four weeks.

Radical cystectomy
Bladder cancers most commonly do not invade into the wall of the bladder. However, a subset of patients will have tumors that are no longer confined to the superficial lining of the bladder. Surgical management is required when such tumors have invaded into the muscle or fatty tissue around the bladder. In men, the standard surgical procedure is termed "radical cystoprostatectomy." This implies that the bladder, prostate, and pelvic lymph nodes are all removed. In women with bladder tumors that invade into the wall of the bladder, the standard surgical procedure is termed "radical cystectomy" or "anterior pelvic exenteration." These terms imply that the bladder, uterus, fallopian tubes, ovaries, cervix, anterior vaginal wall, and urethra are removed along with the pelvic lymph nodes.

Because the bladder is no longer present as a urine reservoir, the urine must be diverted either out of the body or into a newly constructed reservoir. The hospital stay is generally five to seven days and patients usually return to work or daily activities in four to six weeks.

Some patients have tumors that may benefit from chemotherapy before surgery while other patients require chemotherapy after surgery. Radiation therapy alone is generally thought to be unsuccessful and is reserved only for bladder cancers that can not be treated with surgery.

Urinary Tract Diversion
Urinary tract diversion is performed when the bladder has been removed, which is occasionally required to treat certain cancers. It is necessary to divert the urine out of the body because the kidneys will continue to produce urine even in the absence of a bladder. Urinary tract diversions take one of two forms. The first is an incontinent urinary diversion which is often referred to as an ileal conduit. This surgery utilizes a piece of the patient's intestine to divert the urine through a small hole in the abdominal wall. Patients who select this type of procedure will be required to wear an external appliance or "bag" which will have to be emptied into the toilet from time to time. The second type of urinary tract diversion is called a continent diversion which means that the patient will not have to wear an external bag to collect the urine. Following this type of surgery, the patient may either void normally through their own urethra or they may need to place a catheter themselves a few times per day to drain the urine. Continent urinary diversions are sometimes called neo-bladders. This type of surgery most closely approximates normal bladder function. Continent urinary diversion surgery is complex and requires certain expertise to be performed correctly. Both Dr. Mordkin and Dr. Joel have extensive experience in these types of procedures.

Cystolithalopaxy
Cystolitholapaxy is a procedure performed to treat stones in the bladder. This is usually done by placing a cystoscope through the urethra into the bladder. The surgeon then utilizes a laser fiber to fragment the stone into small particles which can be washed out. Surgery usually does not require an overnight stay in the hospital.

TURBT
TURBT stands for trans-urethral resection of bladder tumor. This is procedure is performed when a patient has a tumor in the bladder. A cystoscope is placed through the urethra into the bladder and a cautery loop is used to scrape the tumor off of the bladder's inner wall. Some blood in the urine is normal following this procedure. Most of the time, these surgeries are performed on an outpatient basis. Because there is a high likelihood that bladder tumors will recur, it is not unusual for patients to have repeat TURBT's in the future.

ESWL
ESWL, or extracorporeal shockwave lithotripsy is a very common, non-invasive method for treating stones in the kidney or ureter. It utilizes an energy source which generates a shock wave that is directed at the stone. Shock waves are transmitted to the patient using a water-filled cushion that is placed against the skin. X-rays help aim the shockwaves at the stone and the repeated force caused by the shock waves fragments the stone into small pieces which can then be passed easily in the urine. ESWL is most often performed using IV sedation anesthesia or general anesthesia as an outpatient procedure. In certain cases, a small piece of plastic tubing called a "stent" may need to be placed up the ureter just prior to the ESWL to assist in stone fragment passage.Certain types of stone (cystine, calcium oxalate monohydrate) are more resistant to ESWL because of their density and may require another treatment to achieve adequate fragmentation. In addition, larger stones (generally greater than 2.5 centimeters) may break into large pieces that can still block the kidney. Stones located in the lower portion of the kidney also have a decreased chance of passage.

Cystocele
A cystocele is also known as a "dropped" or "fallen" bladder. This occurs when a women's vaginal weakens and allows the normal support of the bladder to fail. This condition is most often associated with previous child birth and the hormonal changes following menopause. Patient's with a cystocoele may first notice symptoms of vaginal pressure and may see a protrusion of tissue from the vaginal opening. It is not uncommon for women with a cystocele to also experience leakage of urine with coughing (aka "stress incontinence") and/or bladder frequency and urgency. Treatment options vary depending on the severity of the cystocele and include vaginal estrogen replacement, placement of a pessary, or surgical correction.

Urethroplasty
A urethroplasty is a surgery performed to treat a stricture or narrowing in the urethra. This often develops in male patients as a result of pelvic trauma or a sexually transmitted urinary tract infection. Patients with a urethral stricture will notice a slowing of their urinary stream and incomplete bladder emptying. The diagnosis of a urethral stricture is made by cystoscopic visualization of the narrowing and an x-ray image of the urethra called a retrograde urethrogram. A urethroplasty surgery is performed under a general anesthetic. The diseased portion of the urethra is removed and healthy tissue is used to repair the injured area. Patient's will generally have to have an indwelling bladder catheter for several weeks following this surgery to allow for proper healing.Urinary control and sexual function are typically not impacted by this surgery.

Cystoscopy
Cystoscopy is a procedure where a flexible or rigid telescope is used to examine the urethra and the inside lining of the bladder. Most patients have the procedure performed in the office with the aid of a local jelly anesthetic. This procedure is performed for many reasons, however, the most common reason is for the evaluation of blood found in the urine either grossly or microscopically.

Cryotherapy
Cryotherapy is an exciting and evolving method of managing cancers in the kidney and prostate gland. The technique involves insertion of a small "cryoprobe" into the kidney tumor (laparoscopically guided) or prostate (trans-rectal ultrasound guided). The cryoprobe cools the surrounding tissue to extremely low temperatures creating an "ice ball" which kills the tumor cells. Because the dimension of the ice ball can be very precisely controlled, this therapy destroys the diseased tissue while preserving surrounding healthy tissue. This is a minimally invasive treatment for prostate and kidney cancer and is usually done as an outpatient procedure under general anesthesia. In the case of prostate cancer cryotherapy, patients will usually have a bladder catheter for a week or two following the surgery to allow for proper bladder emptying during the healing process. Follow-up blood tests, CT scans, and/or biopsies confirm the destruction of the cancerous area. Although long-term data is still evolving, currently available results suggest very good cancer control using this novel form of therapy. The use of cryotherapy to treat patients with prostate cancer who have failed radiation treatment has been very promising.

Laser Prostate Surgery - Laser Vaporization of the Prostate
Up until the last several years there has been only one endoscopic (telescopic) way to manage the problem of urinary obstruction caused by an enlarged prostate (BPH or benign prostatic hyperplasia). This operation is known as the transurethral resection of the prostate (TURP or "roto-rooter") and it is still considered an effective operation. Today, however, an exciting new technology has emerged as a nearly comparable option for surgically managing an enlarged prostate - Laser vaporization of the prostate. This procedure utilizes a laser that vaporizes the prostate tissue without significant bleeding. Advantages of this procedure over the TURP are that this surgery is outpatient, can be performed on patients taking blood thinners, and does not have the risk of significant fluid absorption (making it a safer option for patients with cardiac and respiratory problems).

Vasectomy
A vasectomy is a surgical procedure that renders a man sterile. During intercourse, sperm cells travel from the testicles through the vas deferens, become part of the seminal fluid (from the seminal vesicles and prostate gland), and are ejaculated through the penis. When a vasectomy is performed, the surgeon cuts a small segment from each vas deferens and clips off the two remaining ends. The object of this procedure is to make it impossible for the sperm to become part of the seminal fluid. Since conception cannot take place in the absence of sperm, a vasectomy results in permanent male sterilization. For more information about the procedure, please visit the FAQ section of the Patient Information page.

Varicocele Repair
Varicoceles are similar to varicose veins in the legs but these are located in the scrotum. In men, they usually occur on the left side of the body. If they occur only on the right side of the body, further investigation must be undertaken to ensure there is not a worrisome problem that is causing this abnormality. Varicoceles can sometimes cause discomfort in the scrotum. More commonly, varicoceles are discovered during an evaluation for male infertility. Varicoceles can decrease sperm numbers, alter sperm movement, and cause abnormally shaped sperm to be produced.

Treating varicoceles involves stopping the abnormal venous blood flow from the testicle. Some radiologists can perform this through injection procedures. Often, varicoceles are repaired surgically, either by microsurgery or by laparoscopy. Microsurgery involves using an operating microscope to find the abnormal veins and tie them off thereby stopping the abnormal blood flow. Microsurgery is advantageous because the high power magnification when using a true operating microscope allows one to treat only the abnormal veins: other normal structures like the artery and lymphatic vessels that supply the testicle are left intact. A true operating microscope provides better magnification and greater precision than the traditional operating glasses used by some surgeons which do not provide the same level of magnification. Laparoscopic varicocele repair involves using cameras and instruments inside the abdominal cavity to find the veins closer to their origin and stop the abnormal blood flow.

Vasectomy Reversal (Vasovasostomy and Vasoepididymostomy)
Vasectomy is a birth control method for men in which the tubes (the vas deferens) that transport the sperm from the testicles to the base of the penis are cut and tied off. It is usually considered a permanent form of sterilization however a percentage of men will want to have this reversed. Some urologists perform a vasectomy reversal without any magnification or use specialized magnification glasses but success rates are reported to be much higher when this surgery is performed using a dedicated operating microscope. The diameter of the vas deferens transport tube is just a barely perceptible to the human eye and the sutures used during the operation are as thin as fine hair. Striving for optimal success rates for all of our patients, we recommend using the best available technology and resources that are available. The operating microscope provides the highest level of magnification a surgeon can use for this procedure. It is our recommendation that the surgery be performed by a surgeon adept at using the operating microscope to ensure the best outcome for the patient. Vasovasostomy is one method of vasectomy reversal where the two ends of the vas deferens can be reconnected to one another. Vasoepididymostomy is another form of vasectomy reversal where vas deferens is connected to the epididymis, a storage sac that sits between the testicle and the vas deferens. This re-established the connection between the testicle and the vas deferens.

Sperm Harvesting
As more couples pursue families with the use of Assisted Reproductive Techniques (ART) such as In Vitro Fertilization (IVF) and Intra-Cytoplasmic Sperm Injection (ICSI), there is a need for obtaining sperm from men who are infertile. In some men, a semen analysis reveals that there are not any sperm in the ejaculate fluid. This condition is known as azoospermia. This can be a devastating set back for couples wishing to build their families. Some men with azoospermia will still have sperm in their testicles that does not reach the ejaculate fluid. This sperm, if retrieved, can still be used for ART. These men should be evaluated medically by a male infertility specialist to ensure there is no serious underlying medical cause for the absence of sperm in the ejaculate such as a genetic disorder, a hormonal problem, or other serious medical conditions. Men with azoospermia who undergo surgical sperm retrieval will have the best chance of success if the surgeon uses an operating microscope to retrieve the sperm. The surgeon uses the microscope to identify and harvest the healthiest part of the testicles which allows the best chance of finding sperm. Surgical harvesting of sperm using an operating microscope has proven to be superior to other methods of sperm retrieval as these structures are on the magnitude of millimeters in size.

Evaluation of Men Who May Be Infertile
As more couples build families, there is a focus on evaluation of the male partner. Of couples who are considered infertile, 20% of the causes can stem from the male partner and up to an additional 30% can involve a combination of both the male and the female partners. It is important to have a thorough evaluation of the male to ensure there is not a serious medical condition such a hormone deficiency, a genetic condition, and even rarely a serious underlying medical problem which can affect the man's general health. An evaluation of the male usually involves two properly performed semen samples, a complete physical exam, a hormone profile, and sometimes imaging techniques such as ultrasound and endoscopy. Often, a treatable reason for the infertility can be found. We offer a complete evaluation of the infertile male by a male infertility specialist who has completed additional training in this area of specialization.

Treatment of Peyronie's Disease
Peyronie's Disease is a condition in which scar tissue deep inside the penis causes a combination of pain, discomfort, or an abnormal curvature of the penis when it is erect. This curvature can interfere with intercourse, cause pain, and even decrease self confidence. Treatment varies from medications to surgery for correction of the curvature or removal of the scar. Medications are used as first line therapy to try to soften the scar tissue and stop the process and in some cases allow for regression. Surgical therapies are also available to correct the abnormal curvature after the scar tissue has stabilized.