Ariel Zisman

Reconstructive Urologist @RambamHCC | @MountsinaiUro Men’s Sexual health, Urethroplasty, Incontinence , BPH. Life long learner 🧘🏻‍♂️

[Dr. Chacón-Lozsán F .'. @franciscojlk]

🩻Contrast-induced AKI:
one of the biggest myths still shaping clinical decisions

For decades we were taught:

👉 “Contrast damages the kidneys”
👉 “Avoid CT with contrast in CKD”
👉 “Hydrate, protect, delay imaging if needed”

But what if… most of this is wrong?🤔

->The uncomfortable reality

Modern evidence shows:

👉 Low-osmolar contrast rarely causes true nephrotoxicity
👉 Even in CKD, AKI, and ICU patients
👉 The risk is often overestimated—or nonexistent

So where did the fear come from?

📍 1950s high-osmolar contrast (actually toxic)
📍 Poorly controlled observational studies
📍 “Creatinine rise = contrast injury” assumption

👉 Correlation became causation
👉 And the dogma stayed

⚠️What recent data tells us

✔ No difference in AKI rates with vs without contrast
✔ No benefit from bicarbonate, NAC, or aggressive hydration
✔ Even ICU and AKI patients show no worsening outcomes

->Translation to real life

👉 The patient was going to develop AKI anyway...Not because of contrast!!

->The real problem: “Renalism”

👉 Avoiding necessary imaging
👉 Delaying diagnosis
👉 Choosing inferior tests

And that leads to:

❌ Missed PE
❌ Delayed sepsis source control
❌ Worse outcomes

->Clinical mindset shift

Instead of asking:

👉 “Will contrast harm the kidneys?”

We should ask:

👉 “Will NOT doing the scan harm the patient?”

->Who still deserves caution?

✔ eGFR <30
✔ Severe hemodynamic instability
✔ Multiple nephrotoxins

Even then:

👉 Optimize volume
👉 Minimize dose
👉 Don’t delay critical imaging

🤓Bottom line

✔ Contrast nephrotoxicity exists… but is rare
✔ The fear is bigger than the risk
✔ The harm of NOT imaging is often greater

In critical care

👉 We don’t treat creatinine
👉 We treat patients

And sometimes…

👉 The most dangerous thing is NOT the contrast

👉 It’s hesitation.

📃Reference
Florens N, Demiselle J.
Kidney360 7: 445–449, 2026. doi: https://t.co/CWzi7WC9Wx

[Marni Basto @DrMarniqueB]

🇮🇳 Honoured to learn from pioneers of urethroplasty in India - legends whose work has defined the field

25 urethroplasties in 4 days, I’m blown away by the volume &amp; their enthusiasm to teach

Grateful for the opportunity to learn from the best 🙏 @sanjaybkulkarni @drjoshi_pankaj

[Ariel Zisman @ArielZisman]

I'm wrapping up an amazing weekend in #wien. A massive thank you to Professor Wilhelm Hübner and his team. Excellent Victo adjustable artificial sphincter workshop. It was a great experience. @icsoffice @Uroweb

[Ariel Zisman @ArielZisman]

@DrUroRecon We had some good times at the OR in Beth Israel. Sad to see it go. Best of luck at MS West!

[Ariel Zisman @ArielZisman]

@DrUroRecon @AnakaPurohit Congratulations! Great news 💫

[Ariel Zisman @ArielZisman]

What is the future of men’s health clinics? @dr_wardsam incorporating digital solutions into the treatment of erectile dysfunction
#penileprosthesis @KoenraadvanRen1

[Ariel Zisman @ArielZisman]

@GregAmend_MD @MSljivich Greg, congratulations! You deserve it.

[Ariel Zisman @ArielZisman]

@DrUroRecon @IcahnMountSinai @MountsinaiUro @TransCareSinai @SocietyGURS Congrats on your incredible journey!

[Ariel Zisman @ArielZisman]

Congratulations on the publication of your book with Dr. Djordjevic. Your commitment to treating transgender people is admirable. Best wishes.

[Rajveer Purohit MD, MPH @DrUroRecon]

The textbook on #transgender surgery I’ve edited with Miro Djordjevic is now available for Pre-order! Chock full of photos, tips &amp; tricks for top and bottom surgery from leaders in the field. @TransCareSinai @SocietyGURS @MountsinaiUro @wpath
https://t.co/4LFD1MDs8S

[Ariel Zisman @ArielZisman]

@DrUroRecon @MountsinaiUro @JerryBlaivasMD Teamwork makes the dream work. Happy holidays to you all at 77th street 🤩🙌

[Ariel Zisman @ArielZisman]

Scrotal incision is used for the entire procedure, including reservoir placement. There is no need to make a counter-incision in this technique

[Ariel Zisman @ArielZisman]

In men with inaccessible bilateral inguinal rings, reservoir placement in a submuscular rectus space is an easily reproducible and safe alternative at the time of inflatable penile prosthesis placement
Thank you @valenzuela_uro

https://t.co/4h0gNC2l8q

@SMSNA_ORG @essm_tweets

[Therapeutic Advances in Urology @TA_Urology]

👇 New Article! 👇

@ArielZisman et al. investigates reservoir placement for penile prosthesis in our latest publication.

Read more here:
https://t.co/Y9eCMQXNpd

@UroRazzleDazzle @ASiegalMD @MSljivich @luda__christine @PKHo43 @valenzuela_uro

#urology #FOAMed #OpenAccess

[Ariel Zisman @ArielZisman]

@NickelCityUro @PARjournal @DrUroRecon @JosephBaiocco I Appreciate it! @NickelCityUro

[Ariel Zisman @ArielZisman]

Excited to share our published article on Management of urethral strictures after masculinizing genital surgery @PARjournal

I am grateful for my supportive mentor @DrUroRecon and co-author @JosephBaiocco.

DOI: 10.20517/2347-9264.2021.113
https://t.co/XfVZ9u5O8C

[Alexandra Siegal, MD @ASiegalMD]

With the Penuma penile implant bigger may be better- and we now know it is safe too! Check out our safety and efficacy study @valenzuela_uro @MSljivich @ArielZisman @UroRazzleDazzle @IcahnMountSinai https://t.co/cJ9Qdp6uWj

[Ariel Zisman @ArielZisman]

If I have seen further it is by standing on the shoulders of giants. This week I finished a one year reconstructive urology fellowship at @MountsinaiUro. I'm grateful to @DrUroRecon @valenzuela_uro and Dr. Miro Djordjevic for their mentorship. Next stop: @RambamHCC

[Rajveer Purohit MD, MPH @DrUroRecon]

Graduation dinner for our reconstructive and gender affirming surgery fellow @ArielZisman @MountsinaiUro @GregAmend_MD @valenzuela_uro @nycrobotics @TransCareSinai Will be heading home to start a new program in Israel. Great things ahead!

[Rajveer Purohit MD, MPH @DrUroRecon]

Our GU recon fellow @ArielZisman doing a terrific job presenting data on the Penuma implant @valenzuela_uro #AUA2022 @MountsinaiUro

[Ariel Zisman @ArielZisman]

@DrUroRecon @valenzuela_uro @MountsinaiUro Thank you! Big credit to @ASiegalMD and @valenzuela_uro

[Shirin Razdan, M.D. @UroRazzleDazzle]

A successful MLD flap phalloplasty means team dinner! Always incredible work with @MtSinaiReconUro @DrUroRecon