Alexander Gomelsky, MD, FACS

Alexander Gomelsky, MD, FACS

LSU Health Shreveport Department of Urology

Shreveport, Louisiana

Dr. Alex Gomelsky received dual BA degrees in Russian and Natural Sciences from Johns Hopkins University and his MD from the University of Maryland School of Medicine. He completed his urology residency at Northeastern Ohio Universities College of Medicine, followed by a fellowship in female urology at Vanderbilt University. He joined the LSU Health Shreveport Department of Urology in 2004. Dr. Gomelsky is the B.E. Trichel Professor and Chair in the Department of Urology. He has served as Residency Program Director since 2011 and is the Director of the Section of Female Urology, Neurourology and Pelvic Reconstructive Surgery. He has served on the AUA SUI Guidelines Committee and the ABU/AUA Written and Oral Examination Committees. Dr. Gomelsky received the 2012 Paul Zimskind Award from SUFU for contributions to the organization and served as a Southeastern Section Representative to the AUA Leadership Program from 2008 to 2010. He has also served as the President of the Louisiana State Urological Society and was General Faculty President of LSUHSC-Shreveport in 2014. He has published over 100 peer-reviewed manuscripts and book chapters, and is a popular lecturer and contributor to meetings and panels. He is passionate about resident and medical student education and his clinical research interests entail outcomes in incontinence and pelvic organ prolapse surgery.


Talks by Alexander Gomelsky, MD, FACS

Best Treatment for Male Incontinence: Sphincter

In the second part of this urologic debate, Alexander Gomelsky, MD, FACS, B.E. Trichel Professor and Chair of the Department of Urology at LSU Health Shreveport, argues that artificial urinary sphincter (AUS) is the best treatment for post-prostatectomy stress urinary incontinence. Dr. Gomelsky first describes possible surgical complications and how to set patient expectations, then reviews data on AUS and the male sling, and finally contrasts the benefits of AUS against the sling. In comparison with the sling, which is best used in patients with mild incontinence, AUS can handle any degree of incontinence including severe and persistent presentations. Noting that AUS can also be used in patients who have undergone radical therapy, those with prior urethral stricture or bladder neck contracture, and those who have undergone urethral bulking, Dr. Gomelsky suggests that AUS outperforms the sling in all scenarios. Additionally, data suggests that a sphincter would be placed after a sling failure, further underscoring its utility. Brian S. Christine, MD, argues in favor of using a sling in the first part of the debate here.

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Current Diagnosis and Management of Female Stress Incontinence

Alexander Gomelsky, MD, FACS, B.E. Trichel Professor and Chair in the Department of Urology at LSU Health Shreveport, discusses current guidance regarding the diagnosis and surgical management of female stress incontinence (SUI). He frames his presentation around the 2017 AUA/SUFU Guidelines which, while based on more high-level evidence than prior guidelines, still use an index patient who does not match the majority of women urologists are likely to see for SUI. Dr. Gomelsky particularly focuses on this limitation, noting for instance that doing urodynamic testing, which does not appear to be useful for index patients, can help urologists meet the particular needs of non-index patients (e.g., women of advanced age, women with high BMIs, women suffering from recurrent/persistent SUI, women who have had prior surgery for SUI, etc.). He further discusses both the benefits and adverse events associated with different available surgical therapies for treating SUI, emphasizing that while mesh for transvaginal repair of pelvic organ prolapse has been banned, evidence still supports mesh placed abdominally for pelvic organ prolapse, as well as midurethral slings for SUI.

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