Urologic Surgeons of Washington

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Places Near Washington with Physicians & Surgeons, Urology

Arlington (6 miles)
Chevy Chase (8 miles)
Bethesda (10 miles)
Silver Spring (10 miles)
Hyattsville (10 miles)
Alexandria (11 miles)
Falls Church (11 miles)
Capitol Heights (11 miles)
Mc Lean (12 miles)
Temple Hills (13 miles)

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Urologic Surgeons Washington

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Physicians & Surgeons, Urology, Physicians & Surgeons, Physicians & Surgeons, Cardiology, Physicians & Surgeons, Family Medicine & General Practice, Physicians & Surgeons, Gastroenterology (Stomach & Intestines), Physicians & Surgeons, Gynecology, Physicians & Surgeons, Internal Medicine, Physicians & Surgeons, Nephrology (Kidneys), Physicians & Surgeons, Obstetrics And Gynecology, Physicians & Surgeons, Oncology, Physicians & Surgeons, Sexual Dysfunction, Physicians & Surgeons, Surgery-General

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Phone: (202) 223-1024

Address: 2021 K St NW Ste 408, Washington, DC 20006

Website: http://www.dcurology.net

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Urologic Surgeons of Washington

General Practitioners

Osteoporosis
Fibromyalgia
We don’t know what exactly causes IC. Theories suggest a disruption in the bladder lining, which allows substances within the urine to cause irritation. This irritation leads to inflammation. However, in patients with IC, the inflammation doesn’t end. We also see a higher prevalence of IC in patients with autoimmune disorders – fibromyalgia, IBS, etc. – conditions that are associated with whole-body inflammation. Of course, these are all unexplained chronic pain syndromes.
Cryotherapy
The entire prostate, except for the urethra which is warmed during the procedure, is frozen during the procedure. This kills most of the tissue in the prostate, although the capsule and some fibrous tissue does remain which preserves urinary function.. The performance of prostate cryotherapy is very similar to prostate brachytherapy, and the same needle template is used. However, where seeding takes up to 30 needles, cryotherapy uses only 6-8. Dr. Engel prefers cryotherapy to seed implantation because he feels that the treatment is far more controlled, tailored, and immediate with fewer side effects than seeds. The cure rate of prostate cryo is very similar to seed implantation or radiation in general. Another positive of cryotherapy is that if one does recur, a patient may be treated again, whereas with radiation one cannot be radiated a second time safely.
Medical Weight Loss
Primary Care
Ndidi is highly experienced with a 17-year nursing career, eight of which were as a Registered Nurse in the Critical Care unit and Medical-Surgical units at Cook County Hospital in Chicago (one of the oldest and most innovative teaching hospitals in the US on which the show ER was based). Ndidi also has eight years of experience in dialysis care and as a nurse practitioner in Pain Management and Primary Care.
Emergency Care
As instructed by your physician, if you experience fevers, chills and simply don’t feel well after the procedure you should immediately go to the nearest Emergency Room and have them call us from there.
Colonoscopy
A group of physicians working for the federal government called the US Preventative Task Force reviewed the data generated by all screening tests in America, including most notably PSA, but also mammogram, colonoscopy and others. They determined the usefulness of a screening test by estimating the number of patients screened or biopsied to save a life. Since that organization, which did not include an Urologist or an Oncologist, performed their work before 2010 and thus was reviewing the data generated by early usage of PSA, it should be no surprise that PSA was the worst performing screening test of them all, with mammograms in women between 40 and 50 also producing similar results. In the era where our government was/is promoting paying for treatments based on “evidence based medicine”, you might remember the first attempt at limiting payment for screening based on this idea when our government considered the performance of mammograms in younger women. It was not soon after that this same report was used as justification for a campaign against PSA screening in America.
Constipation
Erectile Dysfunction
Irritable Bowel Syndrome
In addition to the symptom of pelvic pain, patients will also commonly experience referred pain to their testicles, and overlap with other pain syndromes such as irritable bowel syndrome. Patients can also experience urinary and sexual dysfunction, all of which causing a severe impact on their lives. CP/CPPS necessitates a complex analysis and treatment plan to alleviate symptoms, as studies have not supported the use of a single therapy.
Electrocardiogram
Once there is confirmation of a reasonable gland volume, the procedure will be scheduled as a joint effort between your urologist and the radiation oncologist. Since anesthesia is required, we will ask that you receive medical clearance from your primary care physician. This will include laboratory studies, EKG and a chest x-ray if not done recently. You will be instructed to discontinue all medications that impair blood clotting, such as aspirin, anti-inflammatories, plavix, and coumadin, 7 days prior to the procedure. Discuss the timing for restarting these drugs, with your physician. On the evening prior to the procedure, have nothing to eat or drink after midnight. On the morning of the procedure, you should give yourself another enema.
Urinary Incontinence
Pelvic floor laxity is the decrease in tone or strength of the pelvic floor muscles. This frequently leads to conditions like urinary incontinence or pelvic organ prolapse. Conversely, pelvic floor hypertonicity, or an increase in tone of the pelvic floor, can also lead to pelvic dysfunction. This typically manifests as an inability for these muscles to relax.

Ophthalmologists

Cataracts
There was a time not too long ago when the Trans-Urethral Resection of the Prostate was the most commonly performed operation in America besides cataract operations. This was before the advent of alpha-blockers and 5-alpha reductase inhibitors as medical therapy for benign prostatic hypertrophy (BPH). Now, patients with BPH symptoms that want to be treated, or must be treated due to a complication are usually treated by the surgeons at Urologic Surgeons of Washington in a stepwise fashion.
Cataract Surgery
The gold standard procedure in this category is now and has always been called a Trans-Urethral Resection of the Prostate, or TURP. TURPs have been performed for over 50 years. Before medicine for BPH existed, it was for many years, the most commonly performed surgery other than cataract surgery in America. The TURP has become much safer with the advent of bipolar technology, which allows the use of saline rather than water as the irrigant. Using water in the past always created a risk of diluting the blood and lowering key electrolyte concentrations that could lead to significant complications. This tended to limit how long a surgeon had to perform a TURP, and thus the size of the prostate that could be operated on in one sitting. With saline, the operation is far safer, and larger prostates can be treated. A TURP will require...

Pelvic Pain
Many men struggle with chronic prostatitis (CP) or chronic pelvic pain syndrome (CPPS). CP/CPPS is defined as long-standing symptoms of pelvic pain or discomfort not attributed to an infection, cancer, neurologic disorders, or anatomic abnormalities.
Pregnancy
Labor and Delivery
Stones are discovered in one of three ways. A patient may undergo a radiologic exam for an unrelated reason when a stone is found incidentally. A stone can be found as a result of a workup of hematuria, or blood in the urine, or a stone can be found when it decides to pass. Stone passage presents itself in many ways. Although the old adage is that stone passage is very painful, often likened to childbirth, this is not always true. Rather, many stones are very small and hardly noticed other than perhaps having what is felt to be an upset stomach or irritative urinary symptoms as the stone approaches the bladder. In some patients there is no pain at all, with perhaps the only sign that a stone is passing being the presence of blood in the urine. It is important to understand that pain occurs with a stone only when it is obstructing the flow of urine from the kidney to the bladder via a tube called the ureter. If a stone is small enough, it can slowly pass down the ureter without causing much obstruction and thus not much pain. It is for this reason that stones in the kidney itself are largely asymptomatic, a fact that surprises most patients.

Bladder Cancer
Bladder cancer is the second most treated cancer by a urologist and should therefore be considered common. Of course, any time a person is informed that they harbor a cancer it is a frightening time, but it should be noted that the vast majority of cases of bladder cancer are low risk, and thus have a low likelihood of spread. Such cases are in many ways analogous to suspicious colon polyps that, if monitored by regular scope procedures and addressed at an early stage, can be very effectively managed with minimal impact on one’s life. However, perhaps 10-20% of cases of bladder cancer are far different and are aggressive. As such, these cases will need to be treated that way. The main risk factor for development of bladder cancer, or cancer of the lining of the urinary tract at any location, is smoking. However, not all patients with bladder tumors are smokers.. It is largely accepted that environmental exposure to some chemicals also causes bladder cancer, but an exact list of all causative agents has not been completely outlined.
Urology
Dr. Engel has been in practice in Washington, D.C., since 1999. He is a local who grew up in Wheaton, Maryland, and ultimately graduated from Landon School. Then came the University of Virginia for his undergraduate degree with high distinction, the University of Pennsylvania for his M.D. (inducted into Alpha Omega Alpha, recognizing the top 10% of his class), followed by his surgical and Urology residency at Northwestern University in Chicago.
Kidney Cancer
The most common cell type found in kidney cancer is called clear cell renal cell carcinoma, but variants such as papillary, sarcomatoid, medullary and others are seen. Transitional cell carcinoma (TCC) is not uncommon, is typically found in smokers, and arises from the lining of the kidney rather than the functioning kidney tissue itself. TCC of the renal pelvis is more similar to bladder cancer than kidney cancer, carries a higher metastasis risk, and if found, typically necessitates removal of not only the entire kidney but also the entire ureter as well. Thus, if TCC of the renal pelvis or collecting system is found, a patient is offer a “nephro-ureterectomy”, also performed laparoscopically by Dr. Engel.
Kidney Stones
Another very common problem seen in an Urologist’s office, particularly here in the Mid-Atlantic and Southeastern United States (sometimes referred to as the “stone belt”) is kidney stones. Unlike years past where urinary stones were often managed with open surgery, today stones that do not pass on their own are nearly always treated in a minimally invasive fashion. The most common factor contributing to kidney stone formation is inadequate water intake, which many/most of us are guilty of. However, some patients will have specific metabolic abnormalities or hormonal abnormalities that predispose them to stone formation. If such an abnormality is suspected, special test will be performed and chronic medication may be prescribed. For most cases however, the key to stone prevention is simply increasing water intake.
Interstitial Cystitis
Interstitial Cystitis, or IC, can be a frightening diagnosis for many patients. It’s too often considered an umbrella diagnosis, meaning we’ve ruled out simple infection, we’ve ruled out anatomic abnormalities or tumors, and we’ve ruled out coexisting medical problems. However, the term IC, in the past, has been overused and, in large part, has now been substituted with the diagnoses of chronic pelvic pain syndrome and overactive bladder (OAB). It is a real and severe disease, and we tend to be very judicious in who we assign this diagnosis to. It’s estimated in the US that, up to eight million women and four million men are affected by IC.
Urinary Tract Infection
UTIs are one of the more common urologic concerns that our patients experience, especially women. Virtually all women will experience a UTI at some point in their lives. Studies have shown that some women have the propensity to have their vaginal bacteria attach or stick to the lining of their bladders, thus causing an infection, and that the only consistent activity or behavior that leads to UTIs in women is sexual activity. UTIs have never been shown to be a function of poor hygiene or other habits. E. Coli is the most common culprit, but all of the bacteria in our gut can be the cause. Although most UTIs are simple and uncomplicated, some women begin to experience chronic or repeated UTIs, which can cause significant impairment in their lifestyle and a feeling of helplessness.
Prostate Cancer
Prostate cancer is a unique but common medical problem and a very difficult one for the layperson to fully comprehend. The greatest challenge to the patient first diving into the topic, especially on the internet, is what Dr. Jason Engel calls the great paradox. On the one hand, prostate cancer is now often presented as always slow growing, not particularly dangerous or harmful, and eventually every man gets prostate cancer. On the other hand, the fact remains that prostate cancer can be as aggressive and as deadly as any other cancer, as it is indeed the number two cause of cancer mortality in men in the United States today. So, which one is true?

Depression
Mental Health
As you can see, general, physical, and mental health can be a significant factor in testosterone production. This is not to say that testosterone replacement isn’t necessary in some people who have true hypogonadism, but for most, avoiding unscrupulous health clinics and speaking to a knowledgeable urologist or endocrinologist is the best way to understand whether Low T is a problem or if there are other factors at play.
Anxiety

Ultrasound
A specific type of kidney obstruction that is seen not uncommonly in the adult population, and is common in the pediatric population, is called a ureteropelvic junction obstruction, or UPJ obstruction. We will not spend too much time here discussing the problem of pediatric UPJ obstruction other than to say it is usually found on pre-natal ultrasound, is the most common cause of a baby having a dilated kidney on such an ultrasound, and often requires surgery to correct it. In the pediatric population, almost always the cause of an UPJ obstruction is that the ureter, or the tube that connects the kidney to the bladder, is malformed where the ureter meets the kidney at an area called the renal pelvis. Since the muscular ureter propels urine towards the bladder with a rhythmic motion called peristalsis, this area of malformed ureter does not squeeze and thus in essence serves to obstruct the normal flow of urine.
MRI
There are two types of prostate biopsies that are widely considered more accurate than a standard office transrectal biopsy, and those are called Saturation biopsy and MRI fusion biopsy. Dr. Engel is currently the only Urologist regularly performing Saturation biopsies on his patients; MRI fusion biopsy is a widely performed biopsy. Dr. Engel performs both, usually at the same time.
Radiology
When coming for your consultation, please bring all pathology, radiology, and lab reports with you. Also, we encourage you to bring your spouse, family, or significant other as usually these people are also integral to your education and decision process.
X-Rays
Nuclear Medicine
At the Urologic consultation, the patient must bring their imaging study. Here, we will not only look at the degree of hydronephrosis, but also get a sense as to whether chronic obstruction has led to kidney damage. Sometimes the damage is so severe that a determination must be made if the kidney is worth saving at all. The next study that will be ordered is called a renal scan, a nuclear medicine study that will allow us to quantify the degree of function in the affected kidney, as well as the exact degree of obstruction. Sometimes the degree of function will be borderline, the pain mild, or the kidney without damage. Such patients at times are followed with another renal scan to track the situation. Those where pain is severe, severe obstruction is found, or where the kidney is being damaged, are offered treatment.
Computed Tomography
However, some cysts can be classified as “complex”, and such cysts do carry some risk of malignancy. A CT scan with IV contrast is mandatory if at all possible in such circumstances so that the Urologist can assign a “Bosniak score”. This scoring system uses specific characteristics of the cyst like wall thickness, internal septations, calcifications and whether the cyst “enhances” to generate a score that predicts malignancy risk. A Bosniak 1 cyst is a simple cyst and would not be followed. A Bosniak 4 cyst is considered an enhancing renal mass and must be assumed to be malignant and thus treated accordingly. It is the intermediate grade complex cyst that requires judgment and counseling as to proper next steps. A Bosniak 2 cyst has a less than 1% chance of being malignant. They may or may not be followed based on the clinician’s judgment. A slightly more suspicious score is a Bosniak 2F, which will be malignant 5% of the time. These complex cysts are typically followed until complete stability is demonstrated over time. A Bosniak 3 cyst will be cancerous 50% of the time and unless there are co-morbidities that preclude surgery are usually dealt with in a similar fashion to solid renal/kidney masses.
Chemotherapy
If a primary tumor is found to be deeply invasive, there is at least a 50% chance of metastasis that has occurred, even if it cannot be found. Such tumors that are invasive into the deep muscle will necessitate the removal of the bladder. Contemporary thinking is that giving chemotherapy prior to bladder removal may be beneficial in such cases (neoadjuvant chemotherapy). Dr. Engel will always arrange a visit to an oncologist to be offered this approach but sees logic in some cases in proceeding with surgery directly and offering chemotherapy after the surgery based on the pathologic findings (adjuvant chemotherapy). Removal of one’s bladder is a very involved, major operation done in specialized centers in most cases. Dr. Engel has performed such operations regularly throughout his career. He is one of a few Urologists in the area who has performed complex urinary tract reconstruction to handle urination in a continent manner after bladder removal. In men, Dr. Engel will recommend a Studer ileal neobladder, whereas in women his preferred reconstruction is called an Indiana pouch. Many patients will opt for a simpler approach called an ileal conduit whereby the urine will flow into an ostomy bag placed on the patient’s abdomen. In men, removal of the prostate is usually also performed when removing the bladder, but in selected cases, Dr. Engel will perform a prostate-sparing cystectomy in an effort to preserve erectile function and potentially retain ejaculation. Feel free to view a video of Dr. Engel performing such a surgery found in the common procedures section of this site.
Radiation Therapy
Depending on the PSA, and the Gleason score, brachytherapy is either done alone, or in conjunction with external beam radiation therapy as part of a combination radiotherapy protocol.
Radiation Oncology
Radiation therapy can be a good choice as long as one understands the side effects of radiation, both short-term and long-term, and the lack of closure that sometimes occurs with it. The field of radiation oncology is dynamic, and technology continuously improves the ability to deliver radiation in a more focused beam. This allows for a higher dose, and hopefully, with that comes higher cure rates. Radiation Oncology is extremely research-driven, and as new technology progresses or new theories on cure rate improvement are fomented, large multi-center research trials are then performed to evaluate new protocols. Thus, the protocols used today may change later. A good example of this is how such trials went from recommending six months of hormone therapy to high-risk cases to now recommending this in lower-risk cases and two to three years of hormone therapy in high-risk cases.

General Surgery
Dr. Tobon’s resume boasts an impressive educational background, having attended Columbia University for his undergraduate work and then attended Baylor College of Medicine, where he received his medical degree. He completed both general surgery and urology residencies there as well. Between 1997 and 2018, he imparted his considerable clinical knowledge to medical students and residents as a clinical assistant professor at the University of Texas, San Antonio.
Minimally Invasive Surgery
Dr. Engel has always been focused on innovation and minimally invasive surgery as it applies to Urology. He largely brought laparoscopy to Urology in Washington, D.C, which by 2004 led to his founding of the Robotic Surgery program at George Washington University Hospital. He was the first to perform a robotic prostatectomy in the Mid-Atlantic area and quickly became a leader and pioneer in Robotic Oncology and Reconstruction regionally and nationally.
Vasectomy
In more recent years, Dr. Engel has not only maintained his penchant for robotic surgery and oncology as well as complex urologic reconstruction as applied to urethral strictures and Peyronie’s Disease, but has also expanded his robotic expertise to vasectomy reversal. He has added significant focus to the minimally invasive treatment of BPH and helping men with and without a history of prostate cancer treatment with erectile dysfunction and their incontinence with contemporaneous reconstructive techniques.
Robotic Surgery
Dr. Engel is a pioneer in the area of robotic surgery. He founded the robotic urologic surgery program at George Washington University Hospital and has, to date, performed over 1500 robotic surgeries throughout the urinary tract. He is heavily published and through his outcomes research played a key role in the emergence of robotic surgery's acceptance and now dominance in the field. View Dr. Jason Engel's Bio
Laparoscopy
Dr. Engel prefers the hand-assisted approach to laparoscopic radical nephrectomy. He was a very early adopter of this type of surgery, and has been performing hand-assisted surgery as a pioneer for over 15 years. Hand-assisted laparoscopy is used in Dr. Engel’s practice when a nephrectomy is planned, or for very complex kidney cases. Such situations would include cases where there may be more than one tumor to be removed from a single kidney, or in the case of a solitary kidney where the renal vessels should not be clamped.
Reconstructive Surgery
Finally, the area of the urethra just under the glans (head of the penis), just before the meatus, is called the fossa navicularis. Strictures in this area are seen often after a catheter or scope has been placed in a man’s urethra, for instance after a TURP. These strictures often respond to simple dilation, and if recurrent can easily be managed by self-dilation. On rare occasions, reconstructive surgery is indicated.

Plastic Surgeons

Botox
BOTOX works by directly temporarily paralyzing bladder muscle fibers through a series of injections and dramatically reduces urge incontinence symptoms for qualifying patients. BOTOX has been proven effective, and as such, we encourage patients to visit us at the first signs of incontinence so they don’t have to live with the impediment that almost invariable goes hand in hand.
Laparoscopic Surgery
All patients undergoing laparoscopic kidney surgery will have undergone a full bowel prep. Patients undergoing a partial nephrectomy can expect to be in the hospital for three days, with the main complications that can occur being bleeding from the kidney or urine leaking from the resection site. All patients undergoing laparoscopic surgery are subjected to a very small risk of inadvertent bowel or vascular injury that may require repair.

Cyst
Lesions
If a kidney lesion is a solid mass, particularly one that picks up blood and thus “enhances” on contrast CT, it is considered malignant until proven otherwise. In the era of CT scan however, masses are found at a much smaller size than ever before. Now, if a mass is small, less than 2 cm, up to 20-25% of such lesions may be benign. The most common benign renal mass is called an oncocytoma. Oncocytomas have a typical appearance when large, but when small look similar to malignancy. Another common benign renal mass, more common in fertile women, is called an Angiomyolipoma. Such masses often contain fat that can be demonstrated on CT allowing for a definitive diagnosis by X-Ray alone. Angiomyolipomas are usually followed unless greater than 4 cm in largest dimension. Such lesions are usually treated with percutaneous embolization and not surgery.

Physical Therapists

Physical Therapy
If you’re having symptoms of frequent, urgent urination or pelvic pain, it’s important to schedule a consultation with your urologist for a better understanding of what may be available to you. Unlike when IC was first understood, various forms of treatment are available for patients. These include dietary and behavior modifications, pelvic floor physical therapy, oral medication, bladder neuromodulation, and even outpatient surgical procedures.

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