What are Dr. Gelman’s qualifications?

Dr. Gelman is a Board Certified Reconstructive Urologist who is fellowship trained and exclusively specialized in adult and pediatric male urethral and penile surgery. He has performed over 700 urethral and reconstructive surgeries including reconstruction for urethral stricture disease and penile curvature correction for Peyronie’s Disease.

What does it mean to be fellowship trained?

All Urologists complete a 5-6 year Residency after Medical School. During Residency, those pursuing a career in the specialty of Urology are exposed to all aspects of Urology including disorders of the prostate (prostate cancer, prostate enlargement), the ureters, the bladder (bladder cancer and other disorders), kidney cancers, kidney stones, female incontinence, pediatric urology, urethral disorders, sexual dysfunction, renal transplantation, testicular disorder (eg. cancer, torsion), laparoscopic and robotic surgery, adrenal disorders, and other diseases of the urinary and male genital tract.Subsequent to Residency training, some Urologists pursue sub-specialty training called a Fellowship where they focus on one particular area of Urology. Examples include Oncology and Pediatric Urology, and Female Urology Fellowships. Other Fellowships offer a more broad exposure to different areas of Urology, but in doing so, provide less exposure to a particular disease process.Dr. Gelman completed a formal Fellowship exclusively devoted to male urethral and penile reconstructive surgery.

What does it mean to be specialized in male urethral and penile urethral reconstructive surgery?

All Urologists are “specialized” in all aspects of Urology. This means that their practice does not involve the brain, the lungs, the heart, or other body systems and is instead limited to diseases of the urinary and male genital tract. Some Urologists focus on one or more aspects of Urology without first completing a formal fellowship. Others may specialize in Pediatric Urology or Female Urology or have General Urology practices, but include male reconstructive surgery as part of their practice.Dr. Gelman’s practice is exclusively devoted to male urethral and penile reconstructive surgery. It is Dr. Gelman’s experience and belief that he can best perform urethral stricture and Peyronie’s disease surgery, and other surgeries of the male urethra and external genitalia if his practice is exclusively limited to these areas of Urology.

Does Dr. Gelman treat children with hypospadias and urethral strictures?

Yes. Dr. Gelman has fellowship training in both adult and pediatric urethral reconstructive surgery. This training included the treatment of hypospadias, a congenital disorder associated with improper development of the urethra. However, Dr. Gelman does not frequently perform routine initial hypospadias surgery. Most boys born with hypospadias are diagnosed by their Pediatricians and then referred to their local Pediatric Urologist for surgical treatment. This is appropriate as most Pediatric Urologists are well qualified to perform hypospadias surgery. Pediatric patients who are referred to our Center generally are referred for treatment of complex urethral strictures or other complications of prior hypospadias surgery, or the management of urethral trauma, such as pelvic fracture or straddle trauma related injuries to the urethra.

Are you able to make special accommodations for patients who do not live in Southern California?

Many of our patients travel to our Center for care from all areas of California, other states across the country, and even other countries such as the Netherlands, Thailand, Saipan, and El Salvador. All patients are contacted by Dr. Gelman in advance so that any testing that is needed can be performed at the time of initial consultation.There are several hotels adjacent to the UC, Irvine Medical Center that offer discounts to patients who receive care at UC, Irvine. Patients are provided with written documentation to assist in the planning of travel. Additionally, the UC, Irvine International Relations Department offers assistance with the travel arrangements for our international patients.

Do you accept my insurance?

That depends on the definition of “accept.” When patients are referred to our Center and have HMO coverage, we are often able to obtain authorization and a letter of agreement to provide care. The patient then has complete coverage for all services, except perhaps for a co-pay, often less than $20. Patients are not “balance billed.”When patients have PPO insurance, coverage can vary depending on the benefits provided by the plan. When patients are scheduled for consultation, procedures, follow-up visits, and/or surgery, we first contact the insurance carrier to determine benefits. We are not responsible for what the carrier will cover as this is beyond our control. Patients are always provided with an estimate of the charges. In some cases, PPO insurance covers all charges. It is often the case, however, that the patient is responsible for a portion of the charges.We are unable to inform our patients exactly what an insurance carrier will pay, because when we inquire, we are informed that benefits are determined after a claim is submitted. In other words, the insurance carrier will not determine the amount covered until after the service is performed. In most cases, benefits include coverage of a percentage of \’usual and customary\’ charges, but most PPO carriers will not say in advance what they consider \’usual and customary\’ for a given service. When payment is a low amount, we routinely appeal.When surgeries are performed, we always submit the typed detailed operative dictation providing justification for the billed amount. We never collect in advance from the patient and then ask the patient to submit billing to their carrier to seek reimbursement. When a patient has a high balance after insurance payment, we often offer a payment plan to help ease the financial obligation and so that patients who want to receive care at our Center are not discouraged for financial reasons.

What is the recovery when urethral reconstruction for stricture disease is performed?

Patients are advised to “pretend they are sick” and remain at home and inactive for 3 weeks after surgery. During this time, patients often have a stenting urethral catheter and a tube that enters the bladder (suprapubic tube) and drains the urine into a collection bag as the urethra heals. Then, our patients return for their post-operative imaging.During this visit the bladder is filled with contrast and the urethral catheter is removed. During urination, a film is obtained. This study generally reveals that the urethral repair is “water tight” and the patient can then resume normal urination without catheters. Catheterization is never performed after surgery to “keep the urethra open” – as the objective of the surgery is to repair the urethra so that it remains open (widely patent) without the need for dilation. Should catheterization or dilation be required, this would indicate that the surgery failed to fix the stricture. We then encourage patients to continue to avoid activities that may cause trauma to the urethra such as running, bicycle riding, and mechanical bull riding in particular.We perform urethroscopy 4 months after surgery to assess the technical outcome of the surgery and advise routine annual follow-up after that. This annual follow-up is routine and does not require any special expertise. When patients are referred to our Center by their local urologists, we encourage them to return to the referring Urologist for this care as our role is to assist in the care of urethral strictures and not interfere in the relationship between patients and their local Urologists.