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 2,500 urethral and reconstructive surgeries including reconstruction for urethral stricture disease, penile curvature correction for Peyronie’s Disease and penile implant-prosthesis surgeries.

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 in male urethral and penile reconstructive surgery.  Currently, there are now an abundance of doctors indicating that they are Fellowship trained.  However, this designation no longer has the same meaning as it once did as there are a number of Fellowships that include male reconstructive surgeries as a minor component of training.  Moreover, it is common for those who do not gain acceptance into a recognized training program to work with an individual after residency and then indicate this represents Fellowship training.

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.   The most effective way to determine if someone has expertise associated with exclusive specialization is not to ask the doctor “how many X surgeries have you performed?” but rather, see if that doctor lists many other interests or has reviews associated with the treatment of unrelated conditions.

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

Yes.  When Dr. Gelman pursued Fellowship training, he selected a program that, at the time, was the only Fellowship training program in the world that was exclusively devoted to adult and pediatric urethral-genital 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, Spain,  El Salvador, Canada, and Dubai.    All patients are contacted by Dr. Gelman in advance so that any testing that is indicated 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.

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 a consultation, procedures, followup visits, and/or surgery, we first contact the insurance carrier to determine benefits.  However we can not be 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.  However, it is often the case that the patient is responsible for a portion of the charges.   We are usually 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 or 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 and then ask the patient to submit billing to their carrier to seek reimbursement.  When patients have a high balance after insurance payment , we often offer payment plans 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 to a collection bag as the urethra heals.   Then,  our patients return for their post-operative imaging.  During this visit, the urethral catheter is removed after the bladder is filled with contrast.  During urination, a film is obtained.  This study generally reveals that the urethral repair is “water tight” and the patient then resumed 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 widely patent without the need for dilation.  Should catheterization or dilation be required, this would indicate that the surgery failed to cure 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 followup after that.   This annual followup 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.