Putting Patients First

Welcome to Fifth Avenue Urology, the practice of Dr. Yaniv M. Larish, located on Manhattan’s Upper East Side in New York City. We provide advanced diagnosis and treatment for the full spectrum of male and female urological conditions using the latest medical, minimally invasive, robotic, and reconstructive surgical techniques.

Dr. Larish is a board-certified urologist and surgeon who served as Chief Resident of Urology at Lenox Hill Hospital. He is also an Assistant Professor of Obstetrics and Gynecology at Rutgers University and serves as Director of Minimally Invasive Urological Surgery and Urogynecology at Jersey City Medical Center, part of Robert Wood Johnson Barnabas Health. He is recognized for providing thorough, individualized, and compassionate care while treating patients with a wide range of urological disorders, from common conditions to some of the most complex reconstructive cases.

His areas of expertise include kidney stones, enlarged prostate (BPH), urinary incontinence, erectile dysfunction, male infertility, urological cancers, robotic and reconstructive urologic surgery, and the multidisciplinary treatment of complex endometriosis involving the urinary tract, bladder, ureters, bowel, and pelvic organs. He is frequently consulted for second opinions and challenging cases requiring specialized surgical expertise.

At Fifth Avenue Urology, we believe that exceptional patient care begins with listening. Every treatment plan is personalized to each patient’s condition, goals, and quality of life, combining academic-level expertise with the individualized attention of a private practice.

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Yaniv M. Larish, M.D.

dr-yaniv-larish-fifth-avenue-urology2 Dr. Yaniv M. Larish is committed to providing compassionate, individualized care for every patient. Whether treating a common urological condition or managing a highly complex reconstructive case, he believes that every patient deserves the time, attention, and expertise necessary to develop the best treatment plan.

Known for his thoughtful approach and surgical expertise, Dr. Larish is frequently consulted for second opinions and challenging cases requiring advanced urologic and reconstructive care. Same-day appointments are available for urgent concerns whenever possible, and house calls may be arranged in select situations.

See our Main Site at www.FifthAvenueUrology.com

Blog Posts are Below:

What Is Neuropelveology? Understanding Pelvic Nerves, Pelvic Pain, and Complex Pelvic Disorders

Neuropelveology is a specialized field focused on the relationship between the pelvic nerves, pelvic pain, and complex pelvic disorders involving nerve function. The pelvis contains an intricate network of nerves responsible for sensation, movement, bladder and bowel function, sexual function, and other essential processes. When these nerves become compressed, injured, irritated, or affected by conditions such as endometriosis or previous pelvic surgery, symptoms can be difficult to diagnose and may extend well beyond the pelvis itself.

What Is Neuropelveology?

Neuropelveology combines detailed knowledge of pelvic anatomy, neurology, and minimally invasive pelvic surgery to evaluate disorders involving the nerves within the pelvis. The discipline was developed to address a challenging problem in pelvic medicine: many patients experience persistent pain or functional symptoms that cannot be fully explained by abnormalities of an individual pelvic organ.

Instead, the source of symptoms may involve nerves traveling through the pelvis. These nerves communicate with the bladder, bowel, reproductive organs, pelvic floor, legs, and central nervous system. Because symptoms can overlap with those caused by urological, gynecological, orthopedic, gastrointestinal, or neurological disorders, identifying pelvic nerve involvement requires a comprehensive approach.

Understanding the Pelvic Nerve Network

The pelvis contains both somatic and autonomic nerves. Somatic nerves help control voluntary muscles and transmit sensation, while autonomic nerves help regulate functions that occur without conscious control, including aspects of bladder, bowel, and sexual function. Major structures in and around the pelvis include the sacral nerve roots, sciatic nerve, pudendal nerve, obturator nerve, and autonomic pelvic nerve pathways.

The location of a patient’s symptoms can sometimes provide clues about which nerve structures may be involved. However, pelvic nerve disorders are often complicated because pain can radiate or be perceived some distance from the actual site of nerve irritation.

Pudendal nerve: Provides important sensation to the genital and perineal regions and contributes to urinary and bowel control.
Sacral nerves: Participate in bladder, bowel, pelvic floor, sexual, and lower-extremity functions.
Sciatic nerve: Travels from the lower spine through the pelvis and into the leg and can occasionally be affected by pelvic disease.
Obturator nerve: Travels through the pelvis to the inner thigh and contributes to sensation and movement of the leg.

How Pelvic Nerve Problems Can Cause Chronic Pelvic Pain

Pelvic pain is complex because the location where a person feels pain does not always identify its source. A compressed or irritated nerve can produce burning, stabbing, electric, tingling, aching, or radiating sensations. Symptoms may be continuous or intermittent and may worsen with sitting, exercise, intercourse, urination, bowel movements, or particular body positions.

For some patients, chronic pelvic pain has been present for years before a neurological component is considered. A patient may have undergone treatment for the bladder, reproductive organs, pelvic floor, or spine without obtaining a complete explanation for persistent symptoms. Neuropelveology provides another framework for investigating whether pelvic nerves may be contributing to the problem.

Endometriosis and Pelvic Nerve Involvement

Deep endometriosis is one condition that can involve structures close to pelvic nerves. Endometriosis lesions and associated fibrosis can develop deep within the pelvis and, in uncommon but important cases, affect nerves such as the sciatic nerve or sacral nerve roots.

Nerve involvement may produce symptoms that differ from what patients typically associate with endometriosis. In addition to pelvic pain, a patient may experience pain radiating into the buttock or leg, numbness, weakness, or symptoms that follow a cyclical pattern associated with menstruation. Deep endometriosis can also involve the bladder or ureters, making careful evaluation of urinary tract involvement important in selected patients.

Symptoms That May Suggest a Pelvic Nerve Disorder

Because pelvic nerve problems can resemble many other medical conditions, symptoms alone cannot establish a diagnosis. However, certain patterns may prompt further evaluation, particularly when symptoms persist despite conventional treatment.

Chronic or unexplained pelvic pain
Burning, tingling, numbness, or electric-like pain in the pelvis or perineum
Pain that radiates into the buttocks, hips, thighs, or legs
Pain associated with sitting or certain positions
Changes in bladder or bowel control
Sexual dysfunction or pain involving the genital region
Weakness or altered sensation involving a lower extremity

These symptoms can also occur with other conditions, so a thorough evaluation is necessary rather than assuming that pelvic nerves are responsible.

Diagnosing Complex Pelvic Nerve Conditions

Evaluation begins with a detailed history. The physician may ask where the pain begins, where it travels, what it feels like, what activities make it worse, whether symptoms vary during the menstrual cycle, and whether bladder, bowel, sexual, or lower-extremity symptoms occur at the same time.

A physical examination can help identify sensory changes, muscle weakness, pelvic floor abnormalities, or patterns suggesting involvement of particular nerves. Depending on the clinical situation, imaging such as MRI may be used to investigate the pelvis and surrounding structures. Other neurological, urological, gynecological, or functional testing may be appropriate based on the patient’s symptoms.

For complicated cases, multidisciplinary evaluation can be particularly valuable. Pelvic nerve symptoms frequently cross the traditional boundaries between medical specialties, so collaboration among urologists, gynecologic surgeons, neurologists, pain specialists, physical therapists, and other specialists may be appropriate.

Treatment of Pelvic Nerve and Pelvic Pain Disorders

Treatment depends on what is causing the nerve dysfunction. Not every patient with pelvic nerve symptoms requires surgery. Conservative treatment may involve medications for neuropathic pain, specialized pelvic floor physical therapy, modification of activities that aggravate symptoms, or targeted pain-management techniques.

When a specific anatomical cause of nerve compression or injury is identified and conservative treatment has not been sufficient, specialized surgery may sometimes be considered. Minimally invasive laparoscopic and robotic techniques can provide surgeons with detailed visualization of deep pelvic anatomy. Depending on the condition, surgery may involve carefully exposing a nerve, releasing surrounding scar tissue or compression, or treating disease affecting structures adjacent to the nerve.

The Connection Between Pelvic Nerves and Urological Function

Pelvic nerves play a central role in storing and emptying urine. Normal bladder function requires coordinated communication between the brain, spinal cord, peripheral nerves, bladder muscle, urethra, and pelvic floor. Disruption anywhere along these pathways can contribute to urinary urgency, difficulty emptying the bladder, retention, incontinence, or other lower urinary tract symptoms.

This relationship is especially relevant in patients with complicated pelvic disease or a history of pelvic surgery. When urinary symptoms occur alongside neurological pain, altered sensation, endometriosis, or other complex pelvic symptoms, evaluating the pelvis as an interconnected neurological and urological system may provide important diagnostic information.

What Is Neuropelveology? Understanding Pelvic Nerves, Pelvic Pain, and Complex Pelvic Disorders: Conclusion

Neuropelveology provides a specialized way of understanding chronic pelvic pain and complex pelvic disorders by examining the role of the pelvic nervous system. For patients with unexplained pelvic pain, radiating leg symptoms, bladder dysfunction, deep endometriosis, or symptoms that have persisted despite previous treatment, pelvic nerve involvement may be one component worth investigating.

Because these disorders can involve multiple organs and anatomical systems, accurate diagnosis is particularly important. Treatment should be based on the specific cause of symptoms and may range from conservative therapies to highly specialized minimally invasive surgery for carefully selected patients.

Complex Pelvic and Neuropelveology Care at Fifth Avenue Urology

At Fifth Avenue Urology, Dr. Yaniv Larish provides specialized evaluation and treatment for complex pelvic and urological disorders. His work includes advanced robotic and reconstructive urologic surgery, female pelvic medicine, urinary tract endometriosis, and complex conditions involving pelvic anatomy and nerve function.

For patients whose symptoms involve multiple pelvic structures or who require coordinated surgical care, this specialized approach can help identify the underlying problem and develop an individualized treatment strategy.

FIFTH AVENUE UROLOGY
Dr. Yaniv Larish
5 East 83rd Street
New York, NY 10028
Phone: 212-370-4170
Website: https://www.fifthavenueurology.com/

Endometriosis Excision vs. Ablation: Understanding the Difference and Why It Matters

Endometriosis excision vs. ablation is an important distinction for patients considering surgery for endometriosis, because the two techniques treat endometriosis lesions in fundamentally different ways. Both approaches can be used during minimally invasive surgery, but the depth and location of disease, the organs involved, a patient’s symptoms, fertility goals, and previous treatments can all influence which surgical approach is appropriate.

Understanding Endometriosis

Endometriosis occurs when tissue similar to the lining of the uterus grows outside the uterus. Lesions may occur on the pelvic lining, ovaries, fallopian tubes, bladder, ureters, bowel, and other structures. The condition can cause chronic pelvic pain, painful menstruation, pain during intercourse, urinary or bowel symptoms, and fertility problems. Some patients have superficial disease, while others develop deep endometriosis that extends beneath the surface of affected tissues.

This variation is one reason endometriosis surgery must be individualized. The location and depth of lesions can influence not only symptoms but also how safely and completely abnormal tissue can be treated.

What Is Endometriosis Ablation?

Ablation treats endometriosis by applying energy to destroy or vaporize visible lesions. Depending on the surgical technique, this may involve electrosurgery or another energy source. Rather than physically removing the entire lesion, the surgeon destroys the abnormal tissue at its visible surface.

Ablation can be useful in selected cases of superficial endometriosis. However, one limitation is that the visible surface of a lesion does not necessarily indicate how deeply the disease extends beneath the tissue. This becomes particularly important when endometriosis is deep or involves structures such as the bladder, ureter, bowel, or pelvic nerves.

What Is Endometriosis Excision?

Excision involves surgically cutting out an endometriosis lesion rather than destroying its visible surface. The surgeon carefully separates the lesion from surrounding healthy tissue and removes the affected tissue when it can be done safely.

Excision also allows removed tissue to be sent to pathology for microscopic examination. The technique can be particularly important when treating deep endometriosis because the surgeon can identify the boundaries of the disease and address tissue extending beneath the surface.

International guidance from the European Society of Human Reproduction and Embryology (ESHRE) states that when surgery is performed, clinicians may consider excision rather than ablation to reduce endometriosis-associated pain. The guideline also notes that excision is likely to be more suitable for deep endometriosis because it can be difficult to determine whether an entire deep lesion has been destroyed using an ablative technique.

Full guideline: https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Endometriosis-guideline.aspx

Excision vs. Ablation: The Key Differences

Although both procedures are intended to treat endometriosis, there are several practical differences patients should understand:

Excision removes lesions: The surgeon cuts out affected tissue, including deeper portions when appropriate.
Ablation destroys lesions: Energy is applied to the visible disease rather than physically removing the lesion.
Excision provides tissue for pathology: Removed specimens can be examined microscopically.
Depth matters: Deep infiltrating disease may extend below what is visible during surgery, making treatment more complex.

Importantly, this does not mean that excision is automatically superior for every patient or every endometriosis lesion. Evidence comparing the two approaches is mixed for some forms of superficial or minimal-to-mild endometriosis. ESHRE’s review found evidence supporting excision for certain pain outcomes, while another analysis found no significant differences for several pain measures at 12 months. The appropriate surgical technique therefore depends heavily on the type, depth, and location of disease.

Why Deep Endometriosis Requires Special Consideration

Deep endometriosis can involve organs and structures well beyond the reproductive tract. Disease may affect the bladder or grow around the ureters—the tubes that transport urine from the kidneys to the bladder. In complex cases, endometriosis can also involve the bowel, pelvic sidewall, or structures close to important nerves and blood vessels.

Surgery in these areas requires detailed knowledge of pelvic anatomy and may involve specialists from more than one surgical discipline. ESHRE’s surgical recommendations specifically address deep endometriosis involving areas including the urinary tract and emphasize the specialized technical considerations involved in these procedures.

Endometriosis of the Bladder and Urinary Tract

Urinary tract endometriosis deserves particular attention because symptoms can sometimes resemble more common bladder disorders. Depending on the location of disease, women may experience pelvic pressure, urinary urgency, painful urination, recurrent bladder discomfort, or pain that changes with the menstrual cycle. Some patients may have few obvious urinary symptoms despite significant disease.

Ureteral involvement can be especially important because obstruction of a ureter may interfere with drainage from a kidney. For patients with suspected bladder or ureteral endometriosis, appropriate imaging and evaluation can help define the extent of disease before surgery and determine whether a urologic surgeon should participate in treatment.

Choosing the Appropriate Surgical Approach

There is no single surgical technique that is appropriate for every patient with endometriosis. The decision should take into account the location and depth of disease, severity of symptoms, previous surgeries, fertility goals, involvement of the urinary or gastrointestinal tract, and the potential risks associated with operating near critical structures.

Patients considering surgery should understand what their surgeon expects to find, whether excision or ablation is planned, how deep disease will be addressed, and what will happen if endometriosis involving the bladder, ureter, bowel, or other organs is discovered.

Endometriosis Excision vs. Ablation: Understanding the Difference and Why It Matters: Conclusion

Understanding the difference between endometriosis excision and ablation can help patients have more informed conversations about surgical treatment. Ablation destroys visible endometriosis tissue, while excision physically removes lesions and may be particularly important when disease extends deeply beneath the surface. Neither technique should be viewed in isolation—the appropriate approach depends on the individual patient’s anatomy, symptoms, disease location, and treatment goals.

For women with complex endometriosis involving the urinary tract, specialized urological expertise can become an important part of surgical planning. A comprehensive evaluation can help determine whether the bladder, ureters, or other urinary structures are involved and how they can be protected or reconstructed during treatment when necessary.

Advanced Endometriosis and Urinary Tract Care at Fifth Avenue Urology

Dr. Yaniv Larish at Fifth Avenue Urology has a special interest in complex endometriosis involving the urinary tract, including bladder and ureteral endometriosis. His expertise includes advanced robotic and reconstructive urologic surgery, urogynecology, female pelvic health, and complex pelvic reconstruction.

For patients whose endometriosis affects or threatens the urinary system, this specialized urological experience can be particularly important when planning treatment as part of a multidisciplinary surgical approach.

FIFTH AVENUE UROLOGY
Dr. Yaniv Larish
4 East 76th Street
New York, NY 10021
Phone: 212-675-3186
Website: https://www.fifthavenueurology.com/

Urge Incontinence in Women: Causes, Diagnosis, and Advanced Treatment Options

Urge incontinence in women is a common bladder-control problem characterized by a sudden, difficult-to-delay need to urinate followed by involuntary urine leakage. Although occasional urgency can happen to anyone, repeated episodes of urinary urgency and leakage can interfere with work, exercise, travel, sleep, and social activities. Fortunately, modern urology offers several effective approaches for identifying the underlying problem and treating symptoms, from behavioral therapies and medications to advanced bladder treatments.

What Is Urge Incontinence?

Urge incontinence is a type of urinary incontinence that occurs when a strong urge to urinate is followed by an involuntary loss of urine. It is commonly associated with overactive bladder (OAB), although overactive bladder does not always involve leakage. Women with OAB may experience urgency, increased urinary frequency, nighttime urination, and, in some cases, urge incontinence.

The bladder normally stores urine until a person decides it is an appropriate time to urinate. With urge incontinence, abnormal bladder contractions or problems involving the communication between the bladder, nerves, and brain can create urgency before a woman is prepared to empty her bladder.

Common Causes and Contributing Factors

There is not always one identifiable cause of urge incontinence. Symptoms can develop as a result of changes in bladder function, neurological conditions, infections, medications, or other health problems. Aging can also affect bladder capacity and urinary control, although incontinence should not simply be accepted as an unavoidable part of getting older.

Possible causes and contributing factors include:

Overactive bladder: Involuntary bladder muscle activity can produce sudden urgency and leakage.
Urinary tract infections: Bladder irritation from an infection can temporarily cause urgency, frequency, and incontinence.
Neurological conditions: Disorders affecting the brain, spinal cord, or nerves can interfere with normal bladder signaling.
Pelvic floor changes: Pregnancy, childbirth, menopause, pelvic surgery, and aging can affect the structures involved in urinary control.
Bladder irritants: Caffeine, alcohol, and certain foods or beverages can aggravate urinary urgency in some patients.

How Urge Incontinence Is Diagnosed

A proper diagnosis is important because urinary leakage can have many causes. Stress incontinence, for example, typically occurs with coughing, laughing, exercising, or other activities that increase abdominal pressure. Some women have mixed incontinence, meaning that both stress and urgency-related leakage are present.

Evaluation usually begins with a detailed discussion of urinary symptoms, medical history, medications, previous surgeries, pregnancies, and other relevant health factors. A urinalysis may be performed to look for infection or blood in the urine. A bladder diary can also provide valuable information by recording fluid intake, bathroom visits, episodes of urgency, and urinary leakage over several days.

Depending on the patient’s symptoms and history, additional evaluation may include measuring the amount of urine remaining in the bladder after urination, pelvic examination, urodynamic testing, imaging, or cystoscopy. Not every patient requires all of these tests. The goal is to determine what is contributing to the symptoms so treatment can be appropriately individualized.

Behavioral and Pelvic Floor Treatments

Many women begin treatment with conservative approaches. Bladder training can help patients gradually increase the interval between bathroom visits rather than immediately responding to every sensation of urgency. Pelvic floor muscle exercises may improve the ability to suppress urgency and prevent leakage. Some patients benefit from working with a pelvic floor physical therapist who can teach proper muscle coordination and relaxation techniques.

Lifestyle modifications may also help. These can include adjusting the timing and amount of fluid consumption, reducing caffeine or other known bladder irritants, managing constipation, and maintaining a healthy weight. Patients should generally avoid severely restricting fluids without medical advice, because overly concentrated urine can itself irritate the bladder.

Medications for Urgency and Overactive Bladder

When behavioral treatments do not provide sufficient relief, medication may be considered. Antimuscarinic medications work by reducing involuntary bladder contractions. Another class, beta-3 adrenergic agonists, helps the bladder relax during its storage phase so it can hold urine more effectively.

The appropriate medication depends on a patient’s overall health, other medications, severity of symptoms, and potential side effects. Treatment should therefore be individualized rather than assuming that one medication is appropriate for every woman.

Advanced Treatment Options for Urge Incontinence

Women who continue to experience significant symptoms despite conservative treatment and medication may have additional options. Advances in urology have made it possible to target bladder function and the nerves responsible for urinary control without relying on major surgery in many cases.

Botulinum toxin injections: Botox can be injected into the bladder muscle to reduce excessive contractions and improve urgency and urge incontinence in appropriately selected patients.
Percutaneous tibial nerve stimulation (PTNS): This treatment stimulates a nerve near the ankle that communicates with the nerves involved in bladder control.
Sacral neuromodulation: A small implanted device can deliver electrical stimulation to the sacral nerves involved in bladder function and may help patients with persistent overactive bladder symptoms.

Each treatment has specific benefits, limitations, and potential risks. A urologist can determine which approach is appropriate based on the patient’s diagnosis, previous treatments, health history, and personal preferences.

When Should You See a Urologist?

Women should consider a urological evaluation when urgency or leakage becomes persistent, interferes with daily activities, disrupts sleep, or causes them to change their routines to remain close to a bathroom. New urinary symptoms should also be evaluated when accompanied by pain, difficulty urinating, recurrent urinary tract infections, or blood in the urine.

Urinary leakage is common, but that does not mean women need to simply live with it. Determining whether symptoms are caused by overactive bladder, infection, pelvic floor dysfunction, neurological problems, or another urological condition allows treatment to focus on the actual source of the problem.

Urge Incontinence in Women: Causes, Diagnosis, and Advanced Treatment Options: Conclusion

Urge incontinence in women can have a substantial effect on comfort, independence, sleep, and quality of life, but numerous treatment options are available. Bladder training, pelvic floor therapy, medications, Botox, and neuromodulation therapies give urologists multiple ways to tailor treatment to an individual patient’s symptoms and needs. Seeking an evaluation is particularly important when urinary urgency or leakage becomes frequent or begins interfering with everyday activities.

Specialized Care for Female Urinary Incontinence in NYC

At Fifth Avenue Urology, Dr. Yaniv Larish evaluates and treats women experiencing urge incontinence, overactive bladder, urinary frequency, and other bladder-control problems. By identifying the factors responsible for a patient’s symptoms, Dr. Larish can develop an individualized treatment strategy that may include conservative management, medical therapy, or more advanced urological treatment when appropriate.

Women experiencing persistent bladder symptoms can schedule an evaluation to discuss the options available for improving urinary control and quality of life. Call today to schedule.

FIFTH AVENUE UROLOGY
Dr. Yaniv Larish
4 East 76th Street
New York, NY 10021
Phone: 212-675-3186
Website: https://www.fifthavenueurology.com/

NYC Urologist Guide to Treating Male Infertility

Treating male infertility is a common yet often overlooked issue, impacting nearly half of all infertility cases in couples. In a city like New York, where access to specialized medical care is abundant, addressing male infertility with the help of a skilled urologist can lead to successful outcomes.

Understanding the causes, diagnostic methods, and treatment options is the first step toward reclaiming fertility and reproductive health.

Understanding Male Infertility

Male infertility refers to a man’s inability to cause pregnancy in a fertile female. This may stem from issues with sperm production, quality, or delivery. In many cases, male infertility is treatable, especially when identified early through proper urological evaluation.

Some common causes of male infertility include:

Low sperm count or poor sperm motility
Varicocele (enlarged veins in the scrotum that impair sperm production)
Hormonal imbalances
Obstructive issues (e.g., blocked vas deferens)
Infections or inflammation of the reproductive tract
Lifestyle factors like smoking, excessive alcohol, obesity, and drug use

Diagnosis: What to Expect

When you visit a urologist in NYC for male infertility, the first step will be a thorough consultation and physical exam. A semen analysis is typically ordered to assess volume, sperm count, motility, and morphology. Hormone testing, scrotal ultrasound, and genetic evaluations may also be included to identify underlying issues.

For many men, the experience is more comfortable and streamlined when working with a urologist who specializes in fertility, like those at Fifth Avenue Urology, who are well-versed in state-of-the-art diagnostics and patient-centered care.

Advanced Treatment Options in NYC

Thanks to medical advancements and access to cutting-edge care in New York City, men with infertility now have a wide range of treatment options:

1. Surgical Interventions

Conditions like varicocele or obstructions can often be corrected through outpatient microsurgical procedures, improving sperm quality and fertility potential.

2. Hormonal Therapy

If hormonal imbalances are the root cause, medications such as clomiphene citrate, hCG, or aromatase inhibitors may be prescribed to restore natural sperm production.

3. Assisted Reproductive Techniques (ART)

When natural conception is not possible, ART options such as Intrauterine Insemination (IUI) or In Vitro Fertilization (IVF) using sperm retrieval techniques can offer hope. Procedures like TESE (Testicular Sperm Extraction) allow sperm to be retrieved directly from the testicle for use in IVF.

4. Lifestyle Modifications

Simple changes such as improved diet, regular exercise, quitting smoking, and reducing exposure to heat or toxins can significantly improve fertility outcomes.

Male Infertility Treatment in NYC: Conclusion

For men struggling with infertility, taking action with the support of a dedicated urologist is critical. A comprehensive evaluation can identify the root cause and lead to targeted, effective treatment. In NYC, patients have access to some of the most experienced and highly trained urologists who understand the emotional and medical complexities involved.

Specialized Male Fertility Care with Dr. Yaniv Larish

At Fifth Avenue Urology, Dr. Yaniv Larish offers expert evaluation and treatment of male infertility, combining advanced diagnostics with compassionate care. Whether you’re exploring surgical correction, hormone therapy, or ART coordination, Dr. Larish and his team provide individualized solutions for patients in NYC and beyond.

FIFTH AVENUE UROLOGY
Dr. Yaniv Larish
4 East 76th Street
New York, NY 10021
Phone: 212-675-3186
Website: https://www.fifthavenueurology.com/

Managing Frequent Urination and Overactive Bladder in NYC

Frequent urination and overactive bladder (OAB) are common urological conditions that can significantly disrupt daily life. If you’re experiencing a strong, sudden urge to urinate—sometimes accompanied by involuntary leakage—or finding yourself making frequent trips to the bathroom day and night, you may be dealing with OAB. For many patients in NYC, seeking help from a skilled urologist like Dr. Yaniv Larish at Fifth Avenue Urology is a crucial step toward lasting relief.

What Is Overactive Bladder?

Overactive bladder is a condition characterized by a sudden and uncontrollable urge to urinate. It can lead to:

Urgency (the sudden, intense need to urinate)
Frequency (urinating more than 8 times in 24 hours)
Nocturia (waking up two or more times at night to urinate)
Urgency incontinence (leakage caused by urgency)

While it affects both men and women, the causes and treatments can vary depending on age, gender, and other medical conditions.

What Causes OAB and Frequent Urination?

There are multiple potential causes for frequent urination and OAB, including:

Neurological conditions such as Parkinson’s or multiple sclerosis
Bladder muscle overactivity
Enlarged prostate (in men)
Urinary tract infections
Diabetes
Excessive fluid intake or caffeine/alcohol consumption

In many cases, no clear cause is found. This is why a proper urological evaluation is essential.

Diagnosis and Evaluation

If you’re seeking care in NYC for OAB or frequent urination, your urologist will typically begin with a thorough medical history and physical examination. Additional diagnostic steps may include:

• Urinalysis to rule out infection
• Bladder diary (tracking frequency and volume)
• Post-void residual measurement (to see how much urine remains after urinating)
• Urodynamic testing to assess bladder function
• Cystoscopy in certain cases to examine the bladder lining

Treatment Options in NYC

Treatment is highly personalized and may involve a combination of lifestyle changes, medications, and advanced therapies.

Behavioral and Lifestyle Therapies: These often serve as first-line interventions and include:

• Bladder training (gradually increasing the time between voids)
• Pelvic floor exercises (like Kegels)
• Reducing bladder irritants such as caffeine and alcohol
• Weight loss and managing fluid intake

Medications: Anticholinergic drugs and beta-3 adrenergic agonists can relax bladder muscles and reduce symptoms.

Advanced Treatments: Patients who don’t respond to initial therapies may benefit from:

• Botox injections into the bladder muscle
• Nerve stimulation therapies like sacral neuromodulation (InterStim)
• Percutaneous tibial nerve stimulation (PTNS)

Managing Frequent Urination and Overactive Bladder in NYC: Conclusion

Living with overactive bladder doesn’t have to mean living in discomfort or embarrassment. With today’s advanced diagnostics and treatment options, most patients can achieve significant symptom relief. Consulting an experienced urologist in New York City is the first step toward regaining control of your bladder and improving your quality of life.

Get Specialized Treatment for Overactive Bladder in NYC

Dr. Yaniv Larish at Fifth Avenue Urology offers expert diagnosis and individualized treatment plans for patients with overactive bladder and frequent urination issues. His advanced training and compassionate care help patients find long-term relief using both conventional and cutting-edge therapies. If you’re struggling with bladder control, Dr. Larish provides the expertise you need in the heart of Manhattan

FIFTH AVENUE UROLOGY
Dr. Yaniv Larish
4 East 76th Street
New York, NY 10021
Phone: 212-675-3186
Website: https://www.fifthavenueurology.com/

Pelvic Floor Therapy for Men and Women: Urologist-Recommended Solutions

Pelvic floor therapy, once considered a niche form of treatment, has become a widely recognized and urologist-recommended solution for men and women suffering from pelvic floor dysfunction. Whether due to aging, childbirth, surgery, or other health conditions, pelvic floor disorders can significantly impact quality of life. In NYC, specialists like Dr. Yaniv Larish at Fifth Avenue Urology are helping patients restore function and regain comfort through comprehensive, evidence-based pelvic floor therapies.

Understanding the Pelvic Floor and Its Function

The pelvic floor is a group of muscles and connective tissues that support the bladder, urethra, intestines, and, in women, the uterus. These muscles also control urination, bowel movements, and sexual function. When the pelvic floor muscles are too weak or too tight, it can lead to various urological symptoms such as urinary incontinence, pelvic pain, or incomplete emptying of the bladder.

Pelvic floor dysfunction affects both men and women, though it often manifests differently:

• In women, it may arise post-childbirth, with menopause, or after pelvic surgeries.
• In men, it’s frequently linked to prostate surgery, chronic constipation, or high-impact exercise.

Signs You May Benefit from Pelvic Floor Therapy

Pelvic floor issues are not always easy to recognize at first. Common symptoms that suggest you may need pelvic floor therapy include:

Frequent urination or urgency
Urinary leakage or incontinence
Pelvic pain or pressure
Pain during intercourse (for women)
Constipation or straining during bowel movements

These symptoms can be disruptive, embarrassing, and often go untreated because patients are unaware that effective, non-invasive treatment exists.

How Pelvic Floor Therapy Works

Pelvic floor therapy focuses on improving muscle strength, coordination, and relaxation. Treatment plans are tailored to the individual’s diagnosis and may include:

Biofeedback to retrain pelvic floor muscles
Manual therapy to relieve muscle tightness and trigger points
Electrical stimulation to improve neuromuscular control
Home exercises designed to strengthen or relax the pelvic floor

Sessions are typically conducted by a physical therapist with specialized training in pelvic health. Some urologists may also provide direct referrals and collaborate with therapists to optimize outcomes.

Benefits of Pelvic Floor Therapy for Urological Health

For many patients, pelvic floor therapy offers a non-surgical pathway to symptom relief. The benefits may include:

• Reduced urinary incontinence episodes
• Decreased pelvic pain
• Better bladder control
• Improved sexual health
• Enhanced post-surgical recovery (e.g., after prostatectomy)

Early intervention is key. In cases like overactive bladder or post-prostatectomy incontinence, starting therapy early can prevent long-term dysfunction.

Pelvic Floor Therapy for Men and Women: Urologist-Recommended Solutions – Conclusion

Pelvic floor therapy is an essential component of modern urological care, offering men and women in NYC a proven, non-invasive option for managing pelvic floor disorders. Whether you’re facing urinary incontinence, pelvic pain, or recovering from urologic surgery, therapy can improve function and quality of life significantly. If you’re experiencing symptoms, speak with a urologist who specializes in pelvic floor disorders to explore your options.

Expert Urological Care and Pelvic Health Solutions in NYC

At Fifth Avenue Urology, Dr. Yaniv Larish works with both men and women to diagnose and manage pelvic floor disorders with compassion and clinical expertise. His patient-first approach includes referrals to trusted pelvic floor therapists, along with medical management tailored to your unique condition. Regain control and confidence with care from one of Manhattan’s leading urologists.

FIFTH AVENUE UROLOGY
Dr. Yaniv Larish
4 East 76th Street
New York, NY 10021
Phone: 212-675-3186
Website: https://www.fifthavenueurology.com/

Vasectomy and Vasectomy Reversal: What NYC Patients Need to Know

Choosing a vasectomy or considering a vasectomy reversal in New York City can be a life-changing decision for men and their families. With modern advancements in surgical techniques and highly skilled specialists available, patients have access to effective, minimally invasive options for both procedures. Understanding what each procedure involves, and when to consider reversal, is crucial for making informed decisions about male reproductive health.

What Is a Vasectomy?

A vasectomy is a permanent form of male contraception. It involves severing and sealing the vas deferens—the tubes that carry sperm from the testicles to the urethra. The procedure is typically performed under local anesthesia and takes less than 30 minutes in most outpatient settings.

Most patients recover quickly with minimal discomfort and can return to normal activities within a few days. It’s important to note that while vasectomy is highly effective at preventing pregnancy, it does not provide immediate results. Sperm may still be present in the semen for several weeks after the procedure, requiring follow-up testing.

Is Vasectomy Reversible?

Although vasectomy is considered permanent, a vasectomy reversal is possible through a microsurgical procedure that reconnects the vas deferens. This allows sperm to once again enter the semen and potentially restore fertility. Success rates for reversal depend on multiple factors, including:

Time since the original vasectomy
Age and fertility of the partner
Surgeon experience and technique

Microsurgical vasectomy reversal, such as vasovasostomy or vasoepididymostomy, requires extreme precision and is best performed by urologists who specialize in male fertility restoration. In NYC, patients have access to world-class urological specialists equipped with the latest tools for high success outcomes.

Reasons for Vasectomy Reversal

Many men seek reversal for a variety of personal or family reasons. Some common motivations include:

Remarriage and desire for children with a new partner
Change in financial or life circumstances
Desire to grow an existing family

It’s essential to undergo a comprehensive fertility evaluation and consultation before making the decision to pursue reversal surgery.

What to Expect During Recovery

After a vasectomy or reversal, recovery time is typically short. Patients may experience mild swelling, bruising, and soreness, all of which are manageable with rest, ice packs, and over-the-counter pain medication. Most men can resume light activities within a few days and sexual activity within a week or two, depending on healing progress and physician guidance.

Choosing a Specialist in NYC

Because both procedures involve delicate microsurgery, selecting an experienced urologist is critical for the best results. Look for a provider with:

A high volume of successful procedures
Microsurgical training
Transparent data on outcomes
Excellent patient reviews and testimonials

NYC is home to many leading urologists who offer tailored care and use cutting-edge surgical tools, giving patients the highest chance of success whether undergoing a vasectomy or seeking reversal.

Vasectomy and Vasectomy Reversal: What NYC Patients Need to Know – Conclusion

Both vasectomy and vasectomy reversal are safe, effective procedures when performed by experienced urologists. Whether you’re considering permanent contraception or looking to restore fertility, understanding the process and partnering with the right specialist can make all the difference. For patients in New York City, expert care and advanced surgical options are readily accessible.

Expert Vasectomy and Reversal Care in Manhattan

At Fifth Avenue Urology, Dr. Yaniv Larish offers state-of-the-art care for men considering a vasectomy or exploring reversal options. With extensive experience in male fertility and microsurgery, Dr. Larish provides compassionate guidance and surgical precision for patients at every stage. His Manhattan-based practice delivers the highest standard of care in a discreet and comfortable setting.

FIFTH AVENUE UROLOGY 
Dr. Yaniv Larish
4 East 76th Street
New York, NY 10021
Phone: 212-675-3186 
Website: https://www.fifthavenueurology.com/

Common Urinary Tract Conditions Treated by NYC Urologists

Urinary tract conditions affect millions of individuals annually and can significantly impact quality of life if not treated effectively. In a metropolitan area like New York City, access to top urology specialists ensures early detection, accurate diagnosis, and state-of-the-art treatment for a wide range of urinary disorders. Understanding the most common urinary tract conditions treated by NYC urologists can empower patients to seek timely care and improve long-term outcomes.

Urinary Tract Infections (UTIs)

UTIs are among the most common conditions seen by urologists. They occur when bacteria enter the urinary system, causing symptoms like burning during urination, frequent urge to urinate, cloudy urine, and pelvic discomfort. While UTIs are more prevalent in women, men—especially older adults—can also be affected. Recurrent UTIs often warrant a urological evaluation to rule out structural abnormalities or chronic bladder conditions.

Kidney Stones

Kidney stones form when minerals and salts crystallize in the kidneys. They can cause intense flank or back pain, nausea, vomiting, and blood in the urine. Urologists treat kidney stones using various techniques such as:

Shock wave lithotripsy (SWL)
Ureteroscopy with laser lithotripsy
Percutaneous nephrolithotomy for large or complex stones

NYC urology centers offer some of the most advanced and minimally invasive stone management technologies available.

Overactive Bladder (OAB)

OAB is characterized by a frequent and urgent need to urinate, often accompanied by incontinence. Urologists in NYC use a range of treatments depending on severity, including:

Pelvic floor physical therapy
Bladder training and behavioral modification
Prescription medications
Botox injections and nerve stimulation therapies for refractory cases

Benign Prostatic Hyperplasia (BPH)

This condition, commonly known as an enlarged prostate, affects aging men and can cause lower urinary tract symptoms such as weak stream, incomplete emptying, and frequent nighttime urination. Urologists offer a variety of treatment options including medications, minimally invasive procedures like UroLift, and laser therapies to relieve obstruction.

Hematuria (Blood in Urine)

Hematuria may be caused by infections, stones, tumors, or trauma. It’s crucial to consult a urologist for a thorough evaluation, which may include urine tests, imaging, and cystoscopy. Identifying the underlying cause early is key to effective treatment.

Urinary Incontinence

Incontinence refers to the involuntary leakage of urine. It can result from a range of causes, including muscle weakness, nerve damage, or prostate surgery. Treatment depends on the type (stress, urge, overflow, etc.) and can include:

Lifestyle changes and pelvic exercises
Medications
Urethral slings or artificial urinary sphincters

Bladder Cancer

Bladder cancer is often first detected through symptoms like hematuria. NYC urologists are highly skilled in early cancer detection using cystoscopy, urine cytology, and advanced imaging. Treatment options include surgical removal, intravesical therapies, immunotherapy, and advanced reconstructive techniques for bladder preservation when possible.

Common Urinary Tract Conditions Treated by NYC Urologists: Conclusion

From minor infections to complex surgical conditions, urologists in New York City are equipped with the knowledge and resources to address the full spectrum of urinary tract disorders. If you’re experiencing symptoms such as persistent pelvic pain, blood in urine, or difficulty urinating, it’s important to consult with an experienced specialist.

Specialized Urology Care in Manhattan

At Fifth Avenue Urology, Dr. Yaniv Larish provides expert diagnosis and treatment for all major urinary tract conditions. With advanced tools and minimally invasive techniques, he delivers compassionate, patient-focused care tailored to each individual. Whether you’re dealing with recurrent UTIs, kidney stones, or prostate issues, Dr. Larish and his team are here to help.

FIFTH AVENUE UROLOGY
4 East 76th Street
New York, NY 10021
212-675-3186

What to Expect During a Cystoscopy Procedure

Cystoscopy is a diagnostic procedure used to examine the inside of the bladder and urethra. For patients experiencing urinary issues—such as blood in the urine, frequent urinary tract infections, or unexplained pelvic pain—this test offers a clear and direct view of the urinary tract to help identify potential conditions. Understanding what to expect during a cystoscopy can help ease anxiety and ensure you’re fully prepared for your visit to a urologist in NYC.

What Is a Cystoscopy?

A cystoscopy involves the use of a thin, flexible or rigid tube called a cystoscope. This instrument is equipped with a camera and light, allowing the urologist to visually inspect the lining of the bladder and the urethra. Depending on the reason for the procedure, your doctor may perform a diagnostic cystoscopy or a therapeutic one—used to carry out minor treatments during the examination.

Preparing for the Procedure

Before the cystoscopy, your doctor will review your medical history and any medications you’re taking. In many cases, no major preparation is required, though you may be advised to:

Avoid blood thinners or anticoagulants temporarily
Empty your bladder before the procedure
Take a prescribed antibiotic to prevent infection (if recommended)

In-office cystoscopies are typically done under local anesthesia, while more complex or therapeutic procedures might require sedation or general anesthesia, usually in an outpatient surgical setting.

During the Cystoscopy

The entire process usually takes between 5 and 15 minutes. If a flexible cystoscope is used:

You’ll lie on an examination table while a numbing gel is applied to your urethra
The scope is gently inserted through the urethra into the bladder
Sterile water or saline may be introduced to expand the bladder and improve visibility

The doctor will then examine the bladder lining and urethra for abnormalities, such as inflammation, tumors, stones, or signs of infection. In some cases, tissue samples (biopsies) may be taken for further testing.

After the Procedure

Most patients can resume normal activities the same day, although some mild side effects are common:

A burning sensation during urination
Blood-tinged urine for a day or two
Increased urgency or frequency

Drinking plenty of fluids can help flush the bladder and reduce irritation. Your doctor may recommend taking a mild pain reliever, like acetaminophen, if discomfort persists.

When to Contact Your Doctor

While complications are rare, it’s important to reach out to your urologist if you experience:

Fever or chills
Severe abdominal or pelvic pain
Heavy bleeding
Inability to urinate

What to Expect During a Cystoscopy Procedure: Conclusion

A cystoscopy is a safe and effective way to diagnose urinary tract conditions and monitor ongoing urological health. Understanding the procedure, preparation steps, and what to expect afterward can empower you to approach the test with confidence.

Expert Urological Care in NYC

At Fifth Avenue Urology, Dr. Yaniv Larish provides advanced diagnostic procedures—including cystoscopy—with precision, experience, and patient-centered care. Whether you’re dealing with urinary symptoms or need a thorough evaluation, Dr. Larish offers expert insight and cutting-edge technology to deliver clarity and relief. If you’re preparing for your first cystoscopy or want a second opinion, Fifth Avenue Urology is here to help.

FIFTH AVENUE UROLOGY
4 East 76th Street
New York, NY 10021
212-675-3186

Minimally Invasive Treatments for Kidney Stones in NYC

Kidney stones are hard mineral and salt deposits that form inside the kidneys and can cause severe pain, urinary issues, and infection risks if left untreated. In a bustling city like New York, access to advanced and efficient care is crucial. Fortunately, modern urology offers a range of minimally invasive treatments for kidney stones in NYC, helping patients recover quickly with minimal discomfort and downtime.

When Are Minimally Invasive Treatments Necessary?

While small kidney stones may pass naturally with increased hydration and pain management, larger or obstructive stones often require medical intervention. Minimally invasive procedures are typically recommended when:

Stones are too large to pass on their own
There is persistent pain or urinary tract obstruction
Infection or kidney damage risk is present
Stones have recurred despite preventive measures

Types of Minimally Invasive Treatments

NYC urology centers offer state-of-the-art treatment options to effectively break down and remove kidney stones while preserving kidney function and ensuring patient comfort.

1. Extracorporeal Shock Wave Lithotripsy (ESWL)

ESWL is one of the most common non-invasive procedures. It uses high-energy sound waves to break kidney stones into smaller pieces that can be passed naturally through the urine. This is an outpatient procedure requiring no incisions and offers quick recovery.

2. Ureteroscopy with Laser Lithotripsy

This endoscopic technique involves guiding a thin scope through the urethra and bladder into the ureter or kidney. A laser fiber is used to break stones into fragments for removal or natural passage. It is ideal for mid-sized stones and offers high success rates with minimal trauma to surrounding tissues.

3. Percutaneous Nephrolithotomy (PCNL)

PCNL is used for large or complex kidney stones that cannot be treated with ESWL or ureteroscopy. A small incision is made in the back to allow access to the kidney using a nephroscope. Stone fragments are removed directly. Despite being slightly more invasive, it is still far less traumatic than traditional open surgery and allows for quicker recovery.

Advantages of Minimally Invasive Kidney Stone Procedures

Reduced pain and scarring
Shorter hospital stays and faster return to normal activities
Lower risk of complications compared to open surgery
High success rates for stone removal

Choosing the Right Urologist in NYC

For New Yorkers seeking the most advanced care, selecting a urologist with expertise in stone disease and minimally invasive techniques is critical. Look for board-certified specialists with access to high-end technology and a strong record of successful procedures.

Minimally Invasive Treatments for Kidney Stones in NYC: Conclusion

Thanks to technological advancements, minimally invasive treatments for kidney stones in NYC offer effective, efficient solutions with significantly less discomfort than traditional surgery. From ESWL to PCNL, patients can benefit from faster recovery times and better outcomes with the right care plan.

Consult with Dr. Yaniv Larish at Fifth Avenue Urology

Dr. Yaniv Larish of Fifth Avenue Urology offers expert diagnosis and treatment for kidney stones using cutting-edge minimally invasive procedures. His personalized approach ensures that each patient receives the most appropriate and effective care — whether it’s laser lithotripsy or PCNL. If you’re struggling with kidney stones in NYC, Dr. Larish provides compassionate, evidence-based treatment to help you return to wellness.

FIFTH AVENUE UROLOGY
Dr. Yaniv Larish
4 East 76th Street
New York, NY 10021
Phone: 212-675-3186
Website: https://www.fifthavenueurology.com/

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