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 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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212-675-3186

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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

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Category Archives: Doctor for ED

Erectile Dysfunction (ED): Causes, Diagnosis, and Treatment Options

Erectile dysfunction ED 2023

Erectile dysfunction (ED) is a common condition that affects millions of men worldwide. It refers to the inability to achieve or maintain an erection sufficient for sexual intercourse. While ED can be a sensitive topic, it is important to address it openly and seek appropriate medical care. In this article, we will explore the causes, diagnosis, and available treatment options for erectile dysfunction.

Causes of Erectile Dysfunction

ED can stem from a variety of physical and psychological factors, including:

Physical Causes: Conditions such as diabetes, high blood pressure, heart disease, obesity, hormonal imbalances, and certain medications can contribute to erectile dysfunction.
Psychological Causes: Stress, anxiety, depression, relationship issues, and performance anxiety can all affect sexual function.
Lifestyle Factors: Unhealthy habits like smoking, excessive alcohol consumption, drug use, and a sedentary lifestyle can increase the risk of developing ED.

Diagnosis of Erectile Dysfunction

If you are experiencing symptoms of erectile dysfunction, it is important to consult with a qualified urologist for a thorough evaluation. The diagnosis may involve:

Medical History: Your urologist will discuss your symptoms, medical history, and lifestyle factors to understand the potential causes of your ED.
Physical Examination: A physical examination will be conducted to assess your overall health and identify any underlying physical conditions.
Diagnostic Tests: Your urologist may order specific tests. Blood tests to measure hormone levels, check for diabetes or other underlying medical conditions are common. Additional tests, such as a penile ultrasound or nocturnal erection test, may be performed to evaluate blood flow and the quality of nighttime erections.

Treatment Options for Erectile Dysfunction

The treatment approach for erectile dysfunction depends on the underlying causes and individual patient needs. Some common treatment options include:

Lifestyle Changes: Adopting a healthier lifestyle can have a positive impact on ED. This may include regular exercise, a balanced diet, stress management techniques, and reducing or eliminating smoking and alcohol consumption.
Medications: Oral medications, such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra), can help improve blood flow to the penis and facilitate erections. These medications should be taken under the guidance of a healthcare professional.
Psychological Counseling: In cases where psychological factors contribute to ED, counseling or therapy may be beneficial to address underlying issues and improve sexual function.
Hormone Replacement Therapy: If hormone imbalances are identified as the cause of ED, hormone replacement therapy may be recommended to restore hormonal levels and improve sexual function.
Penile Implants: For severe cases of ED that do not respond to other treatments, surgical placement of penile implants may be considered. This involves inserting inflatable or semi-rigid devices into the penis to achieve an erection.

Contact Fifth Avenue Urology for Expert Urological Treatment

If you are struggling with erectile dysfunction, the experienced urologists at Fifth Avenue Urology, led by Dr. Yaniv Larish, are dedicated to providing comprehensive and personalized care. They understand the sensitive nature of this condition and offer a supportive and discreet environment for evaluation and treatment.

Don’t let erectile dysfunction affect your quality of life any longer. Take the first step towards reclaiming your sexual health by scheduling an appointment with Dr. Yaniv Larish and the team at Fifth Avenue Urology.

FIFTH AVENUE UROLOGY
5 East 83rd Street
New York, NY 10028
Phone: 212-675-3186
Website: https://www.fifthavenueurology.com/

What Is the Link Between Erectile Dysfunction and Heart Disease?

Many men struggle with erectile dysfunction. Most of the time, when men begin to experience ED, they do not think there is anything wrong other than simply getting older or perhaps struggling with underlying conditions. But, there is a link between erectile dysfunction and heart disease. Your heart could be sending you a message through ED that something just is not right. The good news is, this could mean there are options available to you to help you to improve both concerns.

What Does ED Mean for the Heart?

The process that creates heart disease in most people can also cause erectile dysfunction and, when you begin to develop ED, you may also need to spend some time with a heart doctor ensuring you remain healthy.

Erectile dysfunction can actually be an early warning sign for heart concerns down the road. And, if you have heart disease, that could mean that getting treatment for it could help to improve your ED symptoms. But how is there a link here?

The buildup of plaque in the arteries is one of the reasons why erectile dysfunction often occurs. And, this is also why it tends to happen before the presence of heart disease occurs or becomes noticeable. Plaque builds up and reduces blood flow to the penis, creating ED. In addition to this doctors also know that this dysfunction can also be due to complications of the inner lining of the blood vessels and the smooth muscle. This can cause inadequate blood supply to the heart, limiting blood flow to the penis as well.

What does this mean for you? The fact is, not all ED occurs because of the presence of heart disease and not everyone who suffers from heart disease will suffer from ED. However, when there is no obvious sign of ED, it is important for doctors to take a closer look at your heart function.

The good news is that we can help you. When you come in to see one of the best urologists in New York City, you’ll learn more about the risk factors you have for heart disease. Take the time to talk to our team about your overall health and what steps you can take to potentially improve ED symptoms that you may have or learn if you need more extensive treatment for heart-related concerns.

Call our offices today at 212-675-3186 to discuss the concern and to learn what solutions may be available to you.

Prevent Erectile Dysfunction

Is it possible to prevent erectile dysfunction? For many men, the thought of suffering through this condition is significant. They worry about what it may mean or what type of risk they could face. For others, they have suffered episodes of erectile dysfunction in the past and they do not want to have to go through that process again. The good news is there may be steps you can take to reduce the risk that you’ll suffer from this condition. For this to happen, though, you’ll need to be proactive and you may need to work with your doctor to ensure your safety.

What Should You Do About Your Diet?

One of the most common causes of ED is a poor diet. Some doctors recommend that you improve your diet to see improvement in ED or to help to prevent it from occurring. If you’re consuming a diet that’s bad for your heart, it can cause ED to occur. To avoid this, eat foods that are rich in nutrients such as fruits and vegetables. Reduce the amount of red meat you consume. Avoid foods that are processed or those that have a great deal of fat content. These foods create plaque along the interior of the arteries and that makes it hard for blood to flow from the heart to the penis, causing ED.

What Should You Do About Your Health?

There are additional risk factors related to your overall health that could lead to erectile dysfunction. The fact is, the healthier you are, the healthier your heart is. That means that if you have any of these risk factors, working to improve or control them can help reduce your risk of ED. This includes:

Avoiding high blood pressure
Reduce your body weight and maintain a healthy weight
Reduce or control high cholesterol
Ensure your testosterone levels are at the right levels
Avoid smoking and anabolic steroids

You may need medication or lifestyle changes to reduce these risks. You’ll also find that reducing the amount of alcohol you drink and getting regular exercise can also help you to prevent ED from occurring.

By taking these steps, you’ll be able to potentially reduce your risk of developing erectile dysfunction and even improve any symptoms that you may have right now. If you are suffering these conditions or want specific prevention tips, contact the best urologist in NYC today.

Erectile Dysfunction

What is Erectile Dysfunction?

Erectile dysfunction is an inability to achieve and sustain an erection that is adequately firm to engage successfully in sexual intercourse. Erectile dysfunction may affect half of American men between the ages of 40 and 70. Occasional erection difficulties do not constitute erectile dysfunction, and are experienced about 20% of the time by all men, but inability to achieve and maintain a firm erection 50% or more of the time signifies erectile dysfunction.

What are the Causes of Erectile Dysfunction?

Erectile dysfunction can be caused by a variety of physical or psychological problems. Many times, erectile dysfunction is caused by diseases that affect the blood flow to the penis, which is how an erection takes place. These chronic diseases, like atherosclerosis, diabetes, and vascular disease, are responsible for 70% of cases of erectile dysfunction. Neurological causes of erectile dysfunction include things like Parkinson’s disease, multiple sclerosis, or as injury to the spinal cord. Some men experience erectile dysfunction after nerves and blood vessels in the pelvis are damaged during prostate or bladder surgery.

Peyronie’s disease, an inflammatory disorder that results in scar tissue in the penis, can cause erectile dysfunction. Between 1% and 4% of all men with may have some degree of Peyronie’s disease, which usually occurs in middle age.

Alcoholism and cigarette smoking are both associated with erectile dysfunction. Sometimes, men with erectile dysfunction have low levels of testosterone, which can be easily corrected. Psychological problems, like stress or depression, can result in erectile dysfunction. If you are experiencing an inability to achieve or sustain an erection that is preventing your from enjoying sexual intercourse, you should call Dr. Larish, a top New York urology doctor, today.

Determining the Cause of Erectile Dysfunction

If you are experiencing problems achieving or maintaining an erection, the first step in treatment is finding the cause. Dr. Larish will take an extensive medical history at your consultation, which include questions about physical, social, and psychological aspects of your life. He will also ask questions about stressors, habits, and your relationship with your partner. After obtaining a thorough medical history, Dr. Larish will complete a physical examination. A simple exam of the penis can reveal many clues through characteristics like sensory responses of the penis to touch, pulses, and hair growth patterns. Unusual characteristic of the penis may reveal a problem like, for example, Peyronie’s disease.

Dr. Larish also obtain blood tests that measure hormone levels, blood sugar, cholesterol, thyroid function, and function of the liver and kidney, to search for conditions that impact normal erectile function. An ultrasound examination will evaluate blood flow to the penis and any leaks from the veins or signs of atherosclerosis. You will be tested to see if you have nocturnal erections, and there are several highly specialized tests that can be performed by an experienced urology doctor to check the state of the blood vessels in the penis, if further investigation is required.

Treatment Options

Depending upon the results of your examination and diagnostic tests, there are a variety of treatment options available for the treatment of erectile dysfunction. You can be successfully treated for your problem, so you can once again enjoy sexual intercourse. Call 212-675-3186 today to schedule your consultation with Dr. Larish, one of the top New York urology doctors, to begin your evaluation and treatment of erectile dysfunction.

Treatment for Erectile Dysfunction

What is Erectile Dysfunction?

Erectile dysfunction happens when a man cannot obtain or keep an erection during sexual activity. Erectile dysfunction is an ongoing problem which can cause stress and problems in your relationship and even affect your self-confidence.

Symptoms of Erectile Dysfunction

The symptoms of erectile dysfunction may be:

Inability to get an erection
Problems keeping an erection
Sexual desire is reduced

Causes of Erectile Dysfunction

The causes of erectile dysfunction can be difficult to pin point because the process requires the cooperation of your brain, hormones, emotions, muscles and blood flow.

Physical Causes:

Heart disease
Clogged blood vessels
High cholesterol
High blood pressure
Diabetes
Obesity
Alcoholism
Tobacco usage
Prescription medications

Tests and Treatments for Erectile Dysfunction

Erectile dysfunction is often treatable without the need of invasive methods. Your urologist will perform a physical exam and your medical history. If underlying problems may be involved or you have a chronic health condition your urologist may order tests.

The tests may include:

Blood tests
Urine tests
Ultrasound
Overnight erection test
Psychological exam

Treatments to Correct Erectile Dysfunction

A variety of treatments are available for treating erectile dysfunction, important factors your urologist will consider are the severity and causes of your condition. Your urologist will discuss the options with you and your partner to make the right decision for the right course of action.

Medications for Erectile Dysfunction are:

Viagra
Cialis
Levitra
Staxyn

If the medications are not effective your urologist may prescribe a different treatment.

These other treatments for Erectile Dysfunction include:

Penis pumps
Penile implants
Blood vessel surgery

Healthy lifestyle choices are the best methods to assist in correcting your erectile dysfunction, along with the treatments your urologist NYC prescribes for you. If you are experiencing erectile dysfunction, don’t be embarrassed, it is a common condition and when you call the best urologist in NYC you will be glad you did.

BestUrologustNYC6

Erectile Dysfunction: Causes and Treatments

Erectile dysfunction doctor nyc 2013 p01 Erectile dysfunction, or ED, the inability to achieve or sustain an erection, troubles 18 million American men. The National Institutes of Health estimate that between 15% and 25% of 65 year old men experience erectile dysfunction on a chronic basis, interfering with their ability to enjoy sexual intercourse.

Erectile dysfunction is not a problem with sexual desire, or ejaculation. Most men at some point in their life have an occasional failure to achieve an erection, but erectile dysfunction is a chronic condition. There are many possible causes of erectile dysfunction, and if this problem affects you, don’t suffer in silence. The cause of your condition can be diagnosed by a urologist, and in New York City, Dr. Melman sees many patients achieve sexual satisfaction after their condition is diagnosed and treated. A top American urologist, Dr. Melman is available for consultation in New York City.

Erectile dysfunction doctor nyc 2013 p02 You may experience problems with erections as a result of medications you take, fatigue, alcohol, or chronic diseases that include diabetes. For an erection to occur, blood circulation to the penis must be sufficient, and the nerves to the penis must function properly. When the blood flows to the penis during the process of erection, veins within the penis collect the blood and keep it within the penis until ejaculation, under normal circumstances.

With erectile dysfunction, any of these processes may go awry, leaving some men unable to achieve and sustain an erection more than 50% of the time. If this problem is keeping you from sexual enjoyment, you should consult a top urologist with experience in the diagnosis and treatment of erectile dysfunction.

In problems of circulation that contribute to erectile dysfunction, the veins of the penis may leak, or patients sometimes have difficulty achieving adequate blood flow to the penis because of atherosclerotic disease, which causes narrowing of the arteries through build-up of plaque.

Other causes of erectile dysfunction are caused by psychological factors. The brain must stimulate the erectile impulse, and depression, anxiety, and stress can all contribute to ED.

Some causes of erectile dysfunction can be treated by behavioral changes, which may include reducing the intake of alcohol or learning cognitive techniques to enable relaxation and relief of any performance anxiety. An experienced urologist will ultimately be able to perform the correct tests to identify the cause of your problem, and will be able to prescribe the best course of treatment. Your family doctor may address the symptoms by prescribing an oral medication like Viagra®, but a urologist has a variety of other treatment options to choose from, depending upon the etiology of your problem.

Erectile dysfunction doctor nyc 2013 p03 Treatments for erectile dysfunction include medications, penile injections, and surgically implanted devices known as penile implants. Dr. Melman, a leading urologist in the United States, sees many patients in his New York City practice who suffer from ED. His experience enables him is able to make the best recommendations in personal consultation with each patient. Contact us today to schedule a consultation, it may change your life.

Penile implant surgery

Best doctor for Penile Implant NYC 01 Today penile prosthetic implants are highly successful treatments for men with ED who do not respond, or who do not want to use, other forms of therapy for ED. Typically men who have penile implants have their sense of lot manhood restored. That restored sense of manhood, of being capable at any time, may be the most important outcome of prosthetic surgery.

Penile implants are inserted as simple outpatient surgeries in one hour or less with full recovery to intercourse in about 6 weeks. There are two types the semi-rigid or malleable and the inflatable device.

The first successful penile implant was developed in the late 1960’s in Los Angeles by one of my teachers at UCLA, Bob Pearman. The success of the implant became possible because of the invention of silicone® by Dow Corning a flexible plastic that is not rejected by the body. Non-inflatable Penile prostheses need to be flexible, not rigid, so that the penis can be comfortably located when the man is dressed and needed to be accepted by the tissues of the penis. That prosthesis was highly successful and for the first time allowed Urologists to treat men with ED. Prior to that time there were no successful ED therapies for men with physical and permanent causes of ED.

Best surgeon for Penile Implant NYC American Medical Systems AMS700 04 That first implant was soon improved upon with a more natural semi-rigid device (the Small-Carrion penile prosthesis) and in the mid-1970’s American Medical Systems introduced the first inflatable penile prosthesis. The inflatable penile prosthesis replicates a natural erection. It is a hydraulic, (i.e., fluid-based system) that at rest resembles the flaccid or non-erect penis and when inflated resembles a normally erect penis. Because prostheses are located within the body no one looking at the man with a prostheses can tell that it is place.

Through the next four decades technological advances have allowed penile implants to be modified and improved so that they can be considered to be as long-lasting, safe therapies for the treatment of ED. Unlike all of the other therapies for ED a man with a penile prostheses does not have to plan (by taking a pill, using a vacuum erection device, using injection therapy) to have sex- he is always able and ready.

How to choose semi-rigid or inflatable penile implant device


Semi Rigid Penile Implant	Inflatable Penile Implant

Because most insurers cover each device the choice is personal taste usually not financial.

The advantages of the inflatable penile implant device (IPP) are

· More natural non-erect to fully erect action

· More rigid erection

· More comfortable day to day

Disadvantages of the inflatable penile implant device (IPP)are

· Need to squeeze the scrotum to inflate and deflate the device

· More connections and material that have a higher failure rate than the semi-rigid device

The advantages of the semi-rigid penile implant prostheses are

· Simple design with low, long-term failure rate

· No need to pump up or inflate just bend the penis up

The disadvantages of the semi-rigid penile implant prostheses are

· Always erect

· Less rigid and stable erection

The primary surgical complication with either prosthesis is the possibility of infection in the near post-operative period. That rate is about 3%. To reduce the rate of infection as low as possible the man is given intraoperative antibiotics and one of the two companies that manufacturer the inflatable prosthesis now includes an antibiotic impregnated into the device. If a post–operative infection occurs the process almost always needs to be removed and a new device placed back a few months hence.

In my experience, as described in one of my published follow up studies (see future blog) , the best results of penile prosthetic implant surgery occur when both the man and his partner are fully informed before hand so that neither of them have unrealistic expectations of the outcome. Remember the partner is the recipient of the surgical outcome and should be fully educated beforehand. After surgery orgasm and ejaculation (if the man can ejaculate) should be the same. The penis will stay erect after orgasm. The penis is not so rigid that it will hurt the woman if she has a normal vagina. The penis will not be larger then when the man was functioning normally. Many women are afraid that their partner will desire to become the neighborhood stud and might be unhappy if he goes ahead. Frank, open preliminary can avoid each of these pitfalls and create a more satisfactory surgical experience.

Is Erectile Dysfunction Reversible?

One of the common questions is whether or not the ED is reversible?

Unfortunately, with a few exceptions* the answer is NO.

This makes it such that treatment is needed to resume intercourse.

*The exceptions are

Psychogenic ED
Vascular ED
Hormonal ED
Smoking related ED

Psychogenic ED:

Is more common in younger men. Anxiety is the hallmark of psychogenic ED. The anxiety can be based upon fear of failure, fear or intimacy, fear of sexual adequacy. When a person is anxious, his fight or flight hormones –the adrenalines- are released and those hormones can completely prevent or prematurely stop an erection.

Vascular ED:

Is caused by damage to the arteries going to the penis. In younger men this can happen after trauma, such as a pelvic fracture or a straddle injury ( when you jump over a fence and don’t make it). That injury can be corrected with micro-vascular surgery. Quitting smoking helps to decrease vascular compromise as well.

Hormonal issues:

This usually involve low testosterone levels. This is not a common cause of ED. However, particularly in men with a very low sex drive, this is a cause that needs to be ruled out and can be done with a simple blood test.

Smoking:

Smoking leads to plaque build up in the arteries. This is called atherosclerosis. The build up of plaque obstructs some of the blood flow to the penis. Smoking a pack a day or more lead to a 60% greater risk of ED when compared to non smokers in a recent study.

If you suffer from Erectile Dysfunction call Dr. Arnold Melman today. He is the leading Urologist in NYC for the treatment of ED.

Stay tuned for our next blog post on the Treatment of Erectile Dysfunction.

What is Erectile Dysfunction? Top Urologist for ED in NYC, Drs. Brodherson and Larish

Erectile-Dysfunction doctor 01 ED, or erectile dysfunction, is defined as the inability to obtain or maintain an erection of sufficient hardness and for a long enough time to satisfy your partner sexually.

Erectile Dysfunction

The effects of Erectile Dysfunction on the man and his partner go beyond the inability to have sex. Most men who have the problem feel inadequate and become depressed. They can fight with their wives, have trouble concentrating at work, and tend not to talk about the real problem that is bothering them. They lose their sense of “maleness” and that sense does not return until after the problem is corrected or treated.

The good news is that there are many effective and specific treatments for Erectile Dysfunction and if desired, the ability to have intercourse again can be achieved.

I have specialized in the latest treatment options for Erectile Dysfunction throughout my Urology career. In fact I have founded a biotech company that is investigating the use of a breakthrough therapy for Erectile Dysfunction (see Gene Therapy in the Research Section) and hope that will be available in the near future for my patients.

What are the steps to get treated for Erectile Dysfunction?

The first rule is that you should not try your friend’s medicine to fix your problem or buy any online. In some cases that could even be fatal.

If you are serious about fixing the problem, you need to make an appointment for a proper history and physical examination so that the problem can be evaluated a diagnosis made, and the best treatment (s) selected.

I think it is important to listen to, and look at, patients so I do not have a computer on my desk to enter data and distract me from learning your true issues.

If your sexual partner can accompany you to the first meeting that’s even better. In the pre-Viagra days I used to interview all Erectile Dysfunction patients with their partner and a sex therapist. She in turn would do separate individual interviews of the couple. In that way everyone was on board and agreed with the choice of therapy. For many reasons that is not done today but I learned that having the partner participate if at all possible makes for more successful outcomes for all involved.

In summary, don’t live with Erectile Dysfunction anymore. Don’t be embarrassed to discuss Erectile Dysfunction with your doctor or your spouse. You are not alone.

Call Drs. Brodherson and Larish today to schedule an appointment with the top expert in Erectile Dysfunction in NYC.

Stay tuned for upcoming articles on the types of Erectile Dysfunction and the treatment options for Erectile Dysfunction.