Edward Gheiler MD FACS (Urologic Surgeon)

@ScottOliverX Please look at Focalyx we have been able to save many patients from surgery or radiation

Gentlemen: Could the “Life-Saving” Surgery You’re Being Urged to Have Ruin Your Life Instead? Imagine waking up six months after a so-called “life-saving” surgery, only to realize your sex life is gone forever. Now imagine discovering that the surgery you were rushed into… was never even medically necessary. If avoiding a surgery that could leave you leaking, bleeding, impotent, and broke matters to you, please take just three minutes to watch this short video, it could save your health, your manhood, and your future. Then join us at ProstateCancerWarriors. prostatecancerwarriors.org/public/113.cfm

@SPuro88 @Dr_KevinZorn How long do you keep the foley inflated in the prostatic fosa? How many CC’s do you put in? How long does it last cold before it warms up by the body?

Neat trick! Will keep this in the back pocket. Thanks @Dr_KevinZorn. We owe it to our patients to continue to innovate and perfect our techniques and improve outcomes.

@ValerieAnne1970 This post is messed up!!!! So much false information. You should be ashamed of yourself.

VASECTOMY...It Is A 24 Billion Dollar Industry. Doctors Profit From Men's Long Term Health Being Totally Destroyed. 70% Of Men Develop Autoimmune Disease. 40% Increase In Dementia & Aphasia. 20% Diagnosed With Aggressive Prostate Cancer. 33% Suffer Permanent Chronic Pain... You’d be hard pressed to find a urologist willing to be upfront about the risks associated with vasectomy - it’s a 24 billion dollar industry. A survey of 1,500 urologists in the US reported that 90% of doctors would not stop performing vasectomy, despite numerous reports of vasectomy being linked to prostate cancer & plenty of other medical conditions. After a vasectomy, the natural duct for sperm is closed off. The testicles continue to produce 50,000 sperm per minute. The sperm build up pressure in the epididymis of the testicles, which eventually ruptures from pressure. Research shows as high as 33% of patients experience long term post vasectomy pain. What happens to all those sperm cells? This is where the immune response comes in. The sperm are still produced & still burst out, but now they have nowhere to go except into the bloodstream, where they were never intended to be. Certain organs - including the testes & the brain - exist in what is the equivalent of a gated community in the body. Tiny tubes within the testes (in which sperm are produced) are protected by a physical barrier of Sertoli cells. The tight connections between these cells prevent blood-borne infections & poisonous molecules from entering the semen. After a vasectomy, however, the protective barrier is broken & semen mixes into the bloodstream. The immune system recognizes the sperm as invading foreign agents & produces anti-sperm antibodies in 70% of men. Sperm cells are naturally active & have very strong enzymes. This is why a man’s body has a strong layer of tissue known as the Blood-Testis Barrier (BTB). Vasectomy ruptures this barrier. A man’s immune system sees the sperm as an infection that needs to be addressed, resulting in an immune response that’s never ending. The body quickly (within 3-4 days) makes antisperm antibodies to attack his own cells. This assault is not just confined to the sperm themselves, but affects other cells & tissues as well. There’s no way to predict exactly what the reaction will be, but it is known that 75% or more of post vasectomy men will begin to produce these antisperm antibodies, leading to autoimmune disease pathology in almost 70%. According to a study in Finland, the “presence of sperm antibodies correlates with nearly every pathological condition of the male reproductive tract.” Documented Conditions Caused By Vasectomy: Sexual dysfunction Chronic pain Primary Progressive Aphasia (PPA) Frontotemporal Dementia (FTD) Prostate Cancer Testicular Cancer Antibody Autoimmune Disease Cardiovascular Disease 👇Immunological Consequences Of Vasectomy👇 pubmed.ncbi.nlm.nih.gov/7283529/ 👇Vasectomy Increases Prostate Cancer👇 pubmed.ncbi.nlm.nih.gov/31119294/ 👇Vasectomy Causes Primary Progressive Aphasia👇 pubmed.ncbi.nlm.nih.gov/17159614/ 👇Function Of The Testicular Epididymis👇 proteinatlas.org/humanproteome/… Speaker: Dr Nicole Rivera

@HVillarrealMD @bsc_urology @CityofHopeSurg Congratulations wishing you the best

Honored to be recognized as a @bsc_urology Penile Prosthesis Center of Excellence. Grateful for this partnership in advancing patient care and supporting the education of the next generation of reconstructive urologists @CityofHopeSurg #CancerSurvivorship #MensHealth #EDCure

@justindubinmd People seriously freak out. They are all convinced they have cancer.

Based on my poll, about 80% of providers have had an increase of men over the age of 70 asking to be screened for prostate cancer since Biden’s diagnosis. It’s honestly encouraging to see more men take interest in their health but it’s also very difficult for providers who want to stick to guidelines. Of course shared decision making is key, and any conversation with a doctor about one’s health is a good conversation!

@SPuro88 TP no doubt

Did he have a TR or TP biopsy is the real argument we all should be having.

@DutchRojas We try, it’s impossible to do what you ask. Prices are crazy for piss poor benefits. Especially if you have a few older sicker employees.

UnitedHealth deserves every ounce of this rage. But here’s the part nobody says out loud: Self-funded employers ARE the insurance company. They design the plan, approve the network, choose what gets covered and most of them have no clue what they’re doing. Under ERISA, they have a fiduciary duty to act in the best interests of their employees, not just rubber-stamp insane prices because “that’s what the broker recommended.” If you’re a self-funded employer and you’re still handing employees a broken plan… you are the scam now. I’ve built better plans. I’ve seen it done. The solutions to this “insurance” nightmare have existed for a long time and employers refuse to act. It’s not magic. It’s just guts and accountability. #HealthcareReform #EmployerResponsibility #ERISA #FixHealthCare

@olsonplanner Totally disagree. Life in practice much better if you set it up correctly. Work efficiently, control your time don’t let others do it. Be home for your wife and kids. If you want to learn how come by and I will show you. Good luck

Yesterday, a doctor told me the only difference between training and attendinghood is the income. That his life still doesn’t feel like it’s his own. What can he do to change that?

@KirtishriM @SMSNA_ORG I find entering the capsule proximally and retuneling thereby avoiding an additional distal incision works best. Especially in diabetics where they are at increased risk of gland necrosis with distal incisions.

In cases with distal device erosion or perforation, making a distal incision and corporotomy with adjunct procedure is ideal because you can navigate past the capsule and reposition in the ideal location. Minimal risk and benefit is well justified. 👍🏽 @SMSNA_ORG

Probably only Urology Practice in the world with 2 BSCI implant centers of excellence. Super proud! Congratulations Dr. Rodriguez

@pearlythingz She smokes and is out in the sun all day

Fellas, what are the key signs that you can tell a woman is not going to age well?

@DrDiGiorgio Only Veterans would tolerate such a health system.

The VA works so well that a significant number of patients have surgery at private hospitals because the system is too inefficient to care for them. Nobody who has worked at a VA would say it’s a model for anything except inefficiency.

@DrDiGiorgio Nobody take Medicaid and soon the same will be true for Medicare. How can you keep your office open if the overhead is more than then the payment. Leads to going bankrupt fast.

Medicaid only appears "cost effective" because it severely underpays physicians and hospitals. If you can’t see a doctor for six months or wait years for necessary surgery, then those delayed (or foregone) treatments lead to worsened health, increased ER visits, and more expensive downstream care. If we could reliably measure access, we would see the opposite chart, with private insurance having the best access, Medicare next, and Medicaid last. This is not hyperbole. There are locations where simple ortho procedures take 2 years, or cataract surgery can be greater than a 5 year wait for Medicaid patients. Meanwhile, private patients can get in and out within a few weeks or months. A system that simply spends less by paying doctors below market rates isn’t inherently efficient. It’s just rationing care through attrition. A system that saves money by functionally denying care isn’t cost-effective; it's dysfunctional. Medicaid’s payment model ensures there are too few doctors willing to accept it, which leads to waitlists, deferred treatment, and worse outcomes. The real question should be: What happens to Medicaid patients compared to those with other forms of insurance? The answer is clear: Medicaid patients face systemic barriers to timely care, worse outcomes, and poorer health.

@DutchRojas Elon help

Ever wonder why independent physicians are fighting to stay afloat while health systems are swimming in cash? It’s not because they deliver better care, it’s because they’ve stacked the deck in their favor. Health systems have engineered a system of subsidies, tax breaks, and hidden fees that funnel billions into their pockets while independent physicians get squeezed. They don’t just get paid more for the same work, they collect government handouts, dodge taxes, and manipulate the rules to eliminate competition. Want to see how deep it goes? Direct Government Payments & Subsidies: •Disproportionate Share Hospital (DSH) Payments •Graduate Medical Education (GME) Payments •340B Drug Pricing Program •Medicare & Medicaid Facility Fee Differentials •Indirect Medical Education (IME) Payments •Upper Payment Limit (UPL) Funds •Critical Access Hospital (CAH) Payments •Hospital Quality Payment Programs Tax Advantages: •Property Tax Exemptions •Sales Tax Exemptions •Income Tax Exemptions •Tax-Free Donations & Endowments •Municipal Bond Issuances •Government-Supported Loan Forgiveness Programs Financial Advantages & Market Manipulation: •Site-of-Service Differentials •Facility Fees •Certificate of Need (CON) Protections •Exclusive Payer Contracting •Cost-Plus Reimbursement •Preferred Network Inclusion •Hospital-Employed Physician Subsidies •Self-Referral Loopholes Hidden Revenues & Kickbacks: •Commercial Insurance Markups •PBM Rebates •Medical Device Markups •Hospital-Based Coding Upcharges •Emergency Department (ED) Visit Upcoding •Outpatient to Inpatient Status Manipulation •Research Grants & NIH Funding •Hospital-Owned Specialty Pharmacy Profits •Hidden Administrative Charges Strategic Market Power & Anti-Competitive Behavior: •Monopoly Pricing Power •Group Purchasing Organizations (GPO) Kickbacks •Vertical Integration •Cross-Subsidization Strategies •Land Banking & Real Estate Tax Loopholes •Political Lobbying & Influence •Hidden Executive Bonuses Tied to Market Consolidation •Charity Care Manipulation •Debt Collection Privileges The playing field isn’t just uneven, it’s built to ensure large health systems win and independents lose. Not #healthcare

@Bonakdar_Milad @Helo_MD @SexHealthMD @mjziegelmann @MayoUrology @SMSNA_ORG @andresguillenlz It’s the coloplast. I don’t see this happening in the BSCI cases.

Excited to share our latest publication! Surgeons should be cautious about using 0.05% CHG for both dip and irrigation without strong clinical evidence of its non-inferiority to antibiotic solutions. #Urology, #PenileImplants, #InfectionPrevention 🔗 academic.oup.com/jsm/advance-ar…

@elonmuskADO 12

@DrBruggeman Eliminate Referals

Love this! Absolutely spot on

@CanesDavid Agree 100%

Uncomfortable but honest question for my fellow doctors: How do you feel about patients requesting communication/interpretation of results through chart messaging? I'm talking about things that require more than a very brief analysis? My feeling is that when our analysis is in the context of a visit (virtual or in person), we get compensated for our time and expertise, just like other professions. As it should. Has anyone taken a hard line on this? Am I being too callous?

@GoumasUrologia 2 years not enough. XRT become progressively incontinent and well as increasing lots years later.

@its_The_Dr This is wrong and dangerous miss information

A Biopsy Is Almost A Guarantee Of Cancer Metastasis & Acceleration. Dr Thomas Lodi, MD The Problem With The Biopsy Is This. When A Cancer Tumor Is Growing, The Body Contains it Within A Fibrin Sheath. The Minute That Sheath Is Broken, By The Puncture Needle Of A Biopsy, The Cancer Metastasizes & Spreads.