duke urology update - duke department of … · elcome to our fall 2014 edition of duke urology...

Welcome to our Fall 2014 edition of DukeUrology Update. It has been anothereventful 6 months for Duke Urology, high-

lighted by our #7 national ranking from US News andWorld Report. The myriadof updates presented inthis Newsletter highlightjust a small portion of theclinical, educational andresearch aspects of DukeUrology. We continue tostrive to accomplish ourmission to provide com-passionate and excep-tional care for patientswith urologic conditions;to advance the field ofurology through innova-tion in basic and clinicalresearch and to train the nextgeneration of urologic cliniciansand scientists.

Special congratulations goout to John Wiener who has re-cently been appointed to theABU-AUA Examination Commit-tee, a distinct recognition ofJohn’s national prominence inPediatric Urology. Our bestwishes go out to Sherry Ross, anadmired faculty member at Duke who recently left topursue her academic and clinical interests.

Thank you for your continued support of DukeUrology. It is only through your financial backing thatwe can continue to train the best and brightest youngUrologists, perform pioneering research and offer com-passionate and exceptional care for our patients.

All the best,Glenn

DUKEUROLOGY

A Divisionof the Department of Surgery

INSIDE:

Faculty News ...... 2

Clinical Section ... 4

Resident Section . 5

Research Section . 7

Recent Significant

Papers................ 8

Continuing

Medical Education

Section...............10

Duke Urologic

Assembly............11

Alumni Section ...12

DUKE UROLOGY UPDATEFall 2014

Glenn M. Preminger, MDChief of the Division of Urology

W E L C O M E

US NEW AND WORLDREPORTS RANKING

The 2014 US News and WorldReport ranked Duke UrologyNumber 1 in North Carolinaand Number 7 in the UnitedStates. Duke Urology has beenconsistently ranked as one ofthe 10 best Urology programs inthe country for more than 15years. We are proud to be rec-ognized as a leading center forthe treatment of urologic dis-eases and continue to strive toprovide the highest quality care,innovating urologic education,and ground breaking research.

John S. Wiener, MD

The AUA International Office coordi-nates several academic exchanges be-tween the United States and diverse

countries throughout the world. The goal ofthese exchanges is to foster new and strongrelationships between young academic urolo-gists in the US and their counterparts in othercountries. This year I was selected as one ofthree urologists from the USA that would visitEurope as part of the 2014 AUA-EAU Interna-tional Exchange. This particular exchange hasbeen in place since 1993 and two other Dukefaculty, Judd Moul and Stephen Freedland,have previously participated. There were threeAUA urologists selected this year, StephenBoorjian from the Mayo Clinic, John Stoffelfrom the University of Michigan and myself.We spent approximately three weeks travel-ing together in Europe while visiting four aca-demic medical centers, and here is a briefsynopsis of our adventure.

Katholieke Universiteit (KU)Leuven, Belgium

Leuven is a small and very beautiful cityin the Flemish part of Belgium, located ap-proximately 25 kilometers east of Brussels.KU Leuven was founded in 1425, and is Bel-gium’s largest and oldest university. The mainhospital associated with KU Leuven is knownas UZ Leuven Gasthuisberg. With 1,995 bedsand an enormous sprawling campus, it istruly one of the largest hospitals in Europeand its roots trace back to the first hospitalin Leuven in 1080. Famous scientists associ-ated with KU Leuven include Andreas Vesal-ius (the father of modern anatomy), GeorgeLemaitre (discovered the big bang theory),and Christian de Duve (discovered the lyso-some).

We were received in Belgium by Profes-sor Hein van Poppel, current chair of Urologyat KU Leuven and one of the leading urolo-gists in Europe. Each day started with a tripto the hospital to observe surgery and shareresearch ideas. We interacted with co-assis-

tants (medical students that spend an entireyear on the urology service in order to get ac-cepted as residents), residents, nurses andstaff physicians. It was incredibly stimulating.Despite what would be considered a smallfaculty at most American universities, KU Leu-ven is incredibly productive academically. Pro-fessor van Poppel and Stephen Joniau leadthe oncology group, Guy Bogaert the pedi-atric group, Ben Van Cleynenbreugel the en-dourology program, while Frank Van der Aaand Dirk De Ridder lead the functional urol-ogy group. The concept of “functional urol-ogy” was pervasive throughout Europe and Ifound it to be a perfect descriptor of the partof urology that consists of neurourology, in-continence, prolapse, and reconstruction.This concept could be useful in the USA tounite subspecialties that are highly inter-re-lated.

Hôpital Tenon, Paris, FranceAfter a short high speed rail trip, we ar-

rived in Paris for our second exchange sitevisit. Hôpital Tenon is a 564 bed hospital lo-cated in the 20ième arrondissement, the lastof the 20 districts of Paris that is famous forPère Lachaise Cemetery where several fa-mous composers are buried. For lovers ofFrench music, Edith Piaf was born at hospitalTenon. While most hospitals in Paris providecomprehensive medical care, they do tend tospecialize in certain disciplines, and hôpitalTenon is known most for pulmonary medi-cine and urology.

Our host at Tenon was Professor OlivierTraxer, an expert endourologist that performsover 800 ureteroscopies a year (a truly stag-gering number). We were fortunate that dur-ing our stay at Tenon, Professor Traxer wasgiving an endourology master course withProfessor Jean de la Rosette (AMC University,Amsterdam). We sat in on the course andlearned a lot of interesting technical tricks forureteroscopy. One interesting aspect of thiscourse was the live demonstration of supine

percutaneous nephrolithotripsy combinedwith retrograde ureteroscopic lithotripsy formanaging a difficult stone patient withstaghorn calculi.

The hospitality afforded by the residentsand staff at Tenon was outstanding. We wereaccompanied by either a resident or fellow atall times and I was surprised to meet a recentgraduate of my former residency programthat was pursuing a fellowship in endourol-ogy with Professor Traxer.

Vrije Universiteit (VU)Amsterdam, Netherlands

From Paris, we traveled again by highspeed rail to Amsterdam, where we visitedthe VU Medical Center. VU stands for “FreeUniversity”, since the VU was founded in1880 as a liberated or reformed (i.e., protes-tant) university that was independent of thecatholic church and government. The VU

FACULTY NEWS

MY EXPERIENCE AS AN AUA-EAU INTERNATIONAL EXCHANGE FELLOW

Brant A. Inman, MD

2 • DUKE UROLOGY UPDATE • FALL 2014

DUKE UROLOGY UPDATE • FALL 2014 • 3

Brant A. Inman, MD, MS, FRCSC

Medical Center is one of the largest hospitalsin the Netherlands and is currently chaired byProfessor Jerome Van Moorselaar.

In order to follow the Dutch way of liv-ing, our hosts organized for bicycles duringour stay, and we did cycle everywhere. Thisincluded cycling in the wind and rain on theway to work at 7 am, while wearing businesssuits! At the VU Medical Center, like everycenter we visited in Europe, rounds in themorning occurred in a conference room andnot at the bedside. All inpatients andovernight consults were discussed, imagingand lab results presented, and the urology de-partment weighed in on patient manage-ment. It was a great way for all the traineesand attendings to get on the same page andI think would be a good think for the US set-ting as well. Attendings and residentsworked in a team-oriented fashion and therewere less hierarchical barriers than I haveseen in North America. Rounds were done inEnglish for our benefit, even though a coupleof residents no doubt found it a bit difficultto translate Dutch medical terminology. Verysurprisingly, all of the current residents at theVU Medical Center were women, which ap-parently is also quite unusual for Europe. TheDutch were also extremely tall, explainingtheir prowess in speed skating and cycling.

We saw several surgeries while in Ams-terdam, but the highlight, without question,was the female-to-male gender reassign-ment surgery led by Gary Pigot. Gary is a re-constructive urologist (and also our primaryhost during our visit to Amsterdam) and ispart of a comprehensive team of psycholo-gists, endocrinologists and plastic surgeonsthat performs gender reassignment. Approx-imately 1000 patients each year are consid-ered for gender reassignment at the VUMedical Center and about 500 make itthrough the rigorous psychological screeningprocess and become surgical candidates. Of

these, about 375 are male-to-female and125 are female-to-male. While these num-bers may appear shocking, the paucity ofcomprehensive gender reassignment pro-grams coupled with a lack of reimbursement(the Dutch government pays for these proce-dures) is probably the reason we don’t seemuch gender reassignment in the US. Thetechnical skill of the team (two plastic sur-geons and a urologist) and the wholistic pa-tient view, was truly impressive to see.

Karolinska InstitutetStockholm, Sweden

From Amsterdam we flew to Stockholmand the famous Karolinska Institute for thelast leg of our journey. The Karolinska Insti-tutet was founded in 1810 and is widely re-garded as one of the top ten medicaluniversities in the world. A large number ofoutstanding physicians have worked atKarolinska including Ulf con Euler (discoveredneurotransmitters including noradrenaline),Ragnar Granit (discovered the chemical visualprocesses in the eye), Hugo Theorell (discov-ered oxidation pathways), and Sven Seldinger(described the Seldinger technique). TheKarolinska University Hospital is also verylarge, housing 1,736 beds. Due to the EAUmeeting in Stockholm and the fact thatKarolinska was responsible for coordinatinga large number of live surgeries, our visit toKarolinska was relatively short and Olf Akreand Peter Wiklund were our hosts during ourbrief stay. We spent one day watching a ro-botic cystectomy with intracorporealneobladder and the other exchanging re-search ideas.

The European Association ofUrology (EAU) ConferenceStockholm, Sweden

The culmination of the exchange wasthe EAU meeting in Stockholm. Second only

to the AUA meeting in size (and rapidlycatching up), the EAU meeting is a grandscale academic meeting, full of wonderfulthings to discover and interesting people tomeet. Probably the highlight of the entireconference was that we were taken as guestsof honor at the EAU friendship dinner, whichwas hosted in Stockholm City Hall. This din-ner assembles the who’s who of Europeanurology and was held in the famous GoldenRoom, where the Nobel Prize ceremony isheld annually. In fact, we were served exactlythe same meal and entertainment as the2014 Nobel laureates were, including adessert bearing the image of Alfred Nobelpiped in chocolate sugar! We were awardedcommemorative plaques and dined with sev-eral of the new friends that we had met inBelgium, France, and the Netherlands. Itcapped off the conference wonderfully.

In summary, I had an exceptional time inEurope with two people that are now closefriends, John Stoffel and Steve Boorjian. Theacademic exchange was the highlight of myprofessional career thus far and I am honoredto have been selected. I learned a tremen-dous amount about other health systems,about teamwork, and about what makes ac-ademic medicineso great.

Patients undergoing radical cystectomyfor bladder cancer endure one of themost complex and arduous urologic op-

erations that we offer. The multiple phases ofthe operation, the division and isolation ofbowel, the exposure of the abdominal con-tents to urine, and the sheer length of the op-eration all lend to the myriad complicationsthat can exist peri-operatively as well as thosethat can occur in the future. Ileus causing pro-longed hospitalization occurs in approximatelyone third of patients undergoing cystectomy.In the era of bundled reimbursement and pos-sible capitation, these factors can significantlyimpact the financial burden to a healthcaresystem. Additionally, delay of reinstituting en-teral feeding is associated with increased mor-tality rates. As such, efforts to reduce time toreturn-of-bowel function are in the interest ofpatients, surgeons, and administrators alike.

Much of the reasoning behind how wedo things, as surgeons, is due to the fact thatwe teach and learn via an apprenticeshipmodel. This has led to many practices beingindoctrinated into daily life without much ev-idence supporting them. The Early RecoveryAfter Surgery (ERAS) perioperative care-plan-ning is meant to envelope evidence-basedpractices and augmented standardizationwithin hospitals and healthcare systems. Oneof the main benefits of ERAS protocols is thatthey are dynamic and are, therefore, subjectto change as evidence evolves.

Collaborating with Kerri Dalton, an on-cology clinical nurse specialist, we were ableto introduce a formal ERAS-for-Cystectomyprogram at Duke beginning in January, 2014.Preparation for the roll-out took about a yearas requisite approvals for various stages of theprocess were needed. The developmentbegan with my introduction to ERAS and itscompound parts: preoperative, intraoperative,and postoperative. A significant componentof the preoperative phase includes patient ed-ucation. We composed a patient educationpamphlet that all patients receive at the DukeCancer Institute (DCI) at the visit upon whichcystectomy has been decided. It continues tothe preoperative-screening platform wherethe patients are educated about the need fora carbohydrate load near the time of incision.This task is accomplished by ingestion of a

sports-type electrolyte drink 2 hours beforesurgery.

Intra-operatively efforts are directed in sev-eral ways. Postoperative pain management hasbeen shown to be improved with intraoperative“pretreatment.” In our ERAS cystectomy pa-tients, we place an epidural infusion catheter,thereby decreasing total narcotic needs postop-eratively, which improves ileus rates. Anothercomponent of most ERAS protocols involves ju-dicious fluid management. We manage fluidsby various invasive and noninvasive techniques.Presently we employ an esophageal Dopplerprobe.

Traditionally it was felt that fluid lossesneeded to be replaced, often at volumes muchmore than those being lost due to fluid shiftsout of the extracellular space. This practicebegan during the Civil War, with the assump-tion that blood-replacement reduced the num-ber of fatalities due to exsanguination. In fact,however, in hemodynamically stable patients,modern studies demonstrate increased mortal-ity in patients receiving blood replacement un-necessarily. Additionally, overloading patientswith fluid theoretically promotes intraluminalthird-spacing of the gut.

It is in the postoperative setting that ERASfor cystectomy is thought to be most impactful.One of the more dramatic changes has beenthe placement of patients in Step-Down bedsas opposed to Surgical Intensive Care Unit(SICU) beds if critical care nursing is not needed.Traditionally many believed that solid oral intakewas not to be reinstituted until return of bowelfunction as evidenced by passage of flatus.More recently, data has shown that solid foodmay indeed promote bowel function as fats

and starches can actually induce the secretionof promotility paracrine hormones. We also en-courage our patients to chew sugar free gumas it contains either sorbitol or xylitol, both ofwhich are to promote gastrointestinal motility.As always, early ambulation after surgery isstrongly encouraged. Immediate assessment ofneeds by Physical Therapy occurs, and ambula-tion is strongly promoted beginning the dayafter surgery. As part of our ongoing Quality As-surance program, we have created a dry-eraseposter that is placed in each patient’s room withboxes to check-off as they complete their as-signed tasks throughout their stay. We havefound that these task further involve patientsinto the process, and allow them to take own-ership of their recovery.

This table illustrates that we have madesignificant improvements in our length of stay(LOS). Although we were only aiming for a 2day improvement, we have witnessed a 4 dayreduction in LOS. Additionally, we have cut thetotal cost of the procedure by reducing the totalnumber of patients that are transferred directlyto the SICU. What can also be gleaned from thedata is that at Duke we take care of patientsthat are more medically complex than many ofthe other U.S. News Top 20 Cancer Centers.

We are highly encouraged by our initial re-sults and we will continue to monitor the im-pact of ongoing enhancements. We hope forcontinued success and will continue to evolvethe innovative treatment and exceptional greatcare of our complex cystectomy patients. More-over, we believe a similar ERAS protocol can beutilized for additional complex urologic proce-dure with equally impressive reductions in com-plications, length of stay and costs.


CLINICAL SECTIONEARLY RECOVERY AFTER SURGERY (ERAS) PROGRAM REDUCES

LENGTH OF STAY FOR BLADDER CANCER PATIENTSEdward N. Rampersaud Jr., MD

Jan 13, Jul 2012 - Jun 2013 Jul 2013 - Dec 2013 2014 - Mar 2014*

Mean LOS (Obs) DUH 14.45 14.84 10.00US News Top Cancer 9.21 9.36 8.54(2013)

CMI DUH 4.25 3.51 3.62Case Mix US News Top Cancer 3.25 3.18 3.30Index

Direct Cost Index DUH 1.27 1.28 1.05US News Top Cancer 1.09 1.1 1.06(2013)

RESIDENT SECTION

Dr. Michael Granieri, a thirdyear Duke Urology Resident,spent his research year under

the mentorship of Dr. Andrew Peter-son. His primary project was the devel-opment of a comprehensive urethralreconstruction data-base utilizing datafrom both Drs. Web-ster and Peterson’surethral stricture pa-tients. His work cul-minated in anurethroplasty data-base with almost1000 patients, thelargest of its kind.Says Dr. Granieri“Historically, urethralreconstruction re-search has beenchronically under-powered so I knewDuke Urology was ina unique position,primarily because of Dr. Webster’stenure, to create a large-scale compre-hensive urethroplasty database.”

Dr. Granieri, a Chicago native,came to Duke with prior experiencecreating and analyzing databases dur-ing medical school at Northwestern

University. “My previous research expe-rience designing and analyzing data-bases gave me a great foundation forsuccess during my research year. Attimes it can be a very painstakingprocess, but I personally believe it’s one

of the best ways to un-derstand the field andgenerate new researchideas.” He has under-taken several projectsfrom this database cul-minating in multiplepublications and inter-national presentations.He was recentlyawarded best overallposter in the field ofTrauma and Recon-struction at the 29thAnnual Congress ofthe European Associa-tion of Urology inStockholm, Sweden,for his project titled

“The evolution of urethroplasty for bul-bar urethral stricture disease; more op-tions, better outcomes.”

Dr. Granieri states that, “the op-portunity to present award winning re-search at an international level wouldnot have been possible without the

RESIDENT SPOTLIGHT: MICHAEL GRANIERI, MD

Effective July 1, 2014, Charles D. Scales, Jr., willassume the role of Assistant Program Directorfor Quality Improvement and Patient Safety. Dr.

Scales has substantial experience in both quality improve-ment and resident education. He received training inquality improvement methodology as a Robert WoodJohnson Foundation/VA Clin-ical Scholar, and participatedin quality improvement ef-forts at UCLA Ronald ReaganMedical Center. In addition,Dr. Scales previously servedas a Resident Member of theACGME Review Committeefor Urology. From 2011 –2013, Dr. Scales was a mem-ber of the Board of Directorsfor the ACGME.

As medical care in theUnited States becomes in-creasingly complex, there areincreasing demands placed on urologists to focus onhigh quality, high value, safe care delivery. Graduates ofour residency program will be expected to work in a sys-tem in which hospitals, healthcare organizations, andproviders will be held accountable for patient outcomesand the delivery of safe, efficient, and cost-effective care.Reflecting this expectation, the Accreditation Council forGraduate Medical Education (ACGME) requires that res-idents engage in practice-based learning and improve-ment, using systematic approaches to qualityimprovement. In order to accomplish these goals withinthe Duke Urology Residency Program, there needs to bea comprehensive curriculum to provide education inQuality Improvement and Patient Safety to residents aswell as a liaison to the Department of Surgery and DukeUniversity Health System in order to ensure alignmentof interests. For this reason, Duke Urology appointed anAssistant Program Director (APD) for Quality Improve-ment and Patient Safety. The goal of the APD is to de-velop and oversee resident education in QualityImprovement and Patient Safety as well as to coordinatedivisional efforts with department and health system tar-gets for improving care delivery.

DUKE APPOINTSASSOCIATE RESIDENCYPROGRAM DIRECTORFOR PATIENT SAFETY


Coninued on next page.

Learning howto independentlytake a substantialresearch project

from scratch to finish

(publication) wasan invaluable experience. “

“ Charles D. Scales, Jr., MD


RESIDENT Con’t.

GRADUATING 2014 RESIDENTS

Mark Anderson, MDPost Residency: Military Practice

Fort Hood Texas

Zarine Balsara, MDPost Residency: Pediatric

Urology FellowshipBoston Children’s Hospital

David Chu, MDPost Residency Position:

Pediatric Urology FellowshipChildren’s Hospital Of Philadelphia

INCOMING 2014 RESIDENTS

Steven Brousell, MD (PGY1)Medical School:

Robert Wood Johnson Medical School

Ruiyiang Jiang, MD (PGY1)Medical School: UT Southwestern

Matvey Tsivian, MD (PGY2)Medical School: University of Bolgona, Italy

Brian Young, MD (PGY2)Medical School:

University of New York, Buffalo

From L to R: Allan Kirk, MD, PhD, Professor and Chairman, Department of Surgery, ZarineBalsara, Glenn Preminger, David Chu and Mark Anderson.

support of my mentors [Drs. Petersonand Webster] and the Division. I washonored to represent Duke Urology atthe European Association of Urologymeeting.” In addition to this project, hehas analyzed the practice patterns ofurologists who refer urethral stricturepatients to Duke for definitive repair,produced the largest analysis to date ofthe complications after bulbar urethro-plasty, and analyzed the lower urinarytract symptoms associated with urethralstricture recurrence. It is Dr. Granieri’shope that these studies provide a betterunderstanding of the management andoutcomes of urethral reconstructionwhile also inspiring future prospectiveanalysis and the development of diseasespecific validated questionnaires.

Dr. Peterson adds “A significantweakness in Reconstructive Urology hastraditionally been the lack of large seriesto make valid conclusions from. Dr.Granieri’s ground breaking research is aproduct of hard work, attention to de-tail and focus that has given us atremendous tool to greatly advance thefield of urethral reconstruction.”

Looking back, Dr. Granieri believesthe research year will play an integralrole in his career. “Learning how to in-dependently take a substantial researchproject from scratch to finish (publica-tion) was an invaluable experience. It isalways more work than you think, butfortunately we have dedicated researchtime and an excellent research environ-ment at Duke. Drs. Jon Routh, MattFraser and my co-residents [Scott Wang,Richard Shin, and Tara Ortiz] were veryhelpful throughout the year. I now havea much better understanding of re-search design, statistical analysis, manu-script development, and researchpresentations skills.” So what advicedoes Dr. Granieri have for future re-search residents “set realistic goals,work hard, and be flexible.”

Coninued from page 5.


RESEARCH SECTION

MATT FRASER, PHDAPPOINTED

PROGRAM DIRECTOROF DUKE UROLOGYRESEARCH SCIENTISTTRAINING PROGRAM

Matthew O. Fraser, Ph.D. was ap-pointed as the new Program Directorfor the Duke Urology Research Scien-

tists Training Pro-gram this summer.

Dr. Fraser hasdual degrees inboth Physiologyand Neurosciencefrom the School ofMedicine at theUniversity of Pitts-burgh, where healso received hisNeurourologicalresearch trainingfrom William C.de Groat, PhD. Hewas the Directorof In Vivo Pharmacology for Dynogen Pharma-ceuticals. The Research and Developmentbranch of Dynogen Pharmaceuticals was pur-chased by Astellas, and Dr. Fraser continued onas the Director of In Vivo Pharmacology for thenew entity, Urogenix. In 2009, Dr. Fraser leftUrogenix to pursue fulltime academic researchonce again at the Durham Veterans AffairsMedical Center while maintaining his ties tothe Division of Urology at Duke. In 2012, hewas promoted to Associate Professor and Di-rector of Basic Science Research for Duke Urol-ogy. Dr. Fraser also holds leadership positionsin, and/or is an active contributor to, severalUrology-related scientific societies.

The Duke Urology Research Scientist Pro-gram is a mandatory one year protected expe-rience to provide residents with the basic toolsand knowledge to develop careers as academicUrologists, and learn the essentials of basic sci-ence and clinical research.

Matthew O. Fraser, PhD

Dr. Andrew Peterson was recently selected for par-ticipation in the Movember foundation’s “A Sur-vivorship Action Partnership-United States of

America” (ASAP – USA) project. This includes multiple sitesfor the next 3 years with support from the foundation ofover $10,000,000. Survivorship is the period of time afterthe end of definitive therapy for prostate cancer. Duringthis time patient needs don’t go away but change signifi-cantly as they experience the sequelae of their primary can-cer treatment whether it was surgical, radiation, ormedical. Duke Urology has the first fellowship in the worldfocused specifically on Genitourinary Cancer Survivorshipwhich has now been in existence for 3 years.

Dr. Peterson was chosen as one of the section headsto design an interactive cancer survivorship care plan for men living with prostatecancer after definitive treatment. This project in survivorship will study how to im-prove the physical, mental, and emotional well-being of those with prostate canceras well as their family and caregivers.

ASAP-USA includes a multi-disciplinary approach with collaborative networksto draw knowledge from healthcare professionals in either the clinical or communityfields. Non-medical members of the public (cancer survivors, patient advocates) areinvolved and weigh in on important issues and provide aid to those currently battlingthe disease. The intervention will be piloted and evaluated at selected sites in orderto help the hundreds of thousands of men surviving the disease to enjoy a betterquality of life. Made possible by funds raised through the Movember Foundation,ASAP-USA represents the most significant investment in prostate cancer survivorshipto date.

Members of this group include experts from top cancer centers in the UnitedStates including the Duke Cancer Institute, Dana Farber Cancer Institute, and Me-morial Sloan-Kettering Cancer Institute, just to name a few. The group is tasked withdeveloping evidence-based practical solutions to help men live longer and managetreatment side effects or symptoms that can be difficult to cope with such as pain,fatigue, incontinence, and erectile dysfunction.

Movember’s Executive Director of Programs, Paul Villanti, says, “We are acutelyaware that there are many unmet physical and mental health issues relating toprostate cancer that need to be addressed as a priority, which is why improving thequality of life for men living with the disease is very high on our agenda. Just as menare sprouting moustaches across the country to join in our fight against prostatecancer and prostate disease, we are going to join practitioners across the country toprove how we can do better for men.”

We are more than excited to see such a sizable investment into a field thatneeds attention and are extremely proud of Dr. Peterson’s pioneering leadership, theDuke Cancer Institute’s support, and the position of Duke Urology in this ground-breaking project.

DREW PETERSON, MD AND DUKE UROLOGY

SELECTED FOR MOVEMBER GRANT

Andrew Peterson, MD


RESEARCH Con’t.

ROUTH AWARDEDK08 FROM NATIONAL

INSTITUTES OFHEALTH

Jonathan Routh, MD, MPH, was recentlyawarded a K08 Career DevelopmentAward from the National Institute of Di-

abetes and Digestive and Kidney Diseases(NIDDK). This grant entitled “ComparativeEffectiveness of Vesicoureteral Reflux Treat-ments in Children” provides salary supportand a research budget (~$700,000 totalover 5 years) and is intended to explore themost effective and efficient treatments ofchildren with vesicoureteral reflux (VUR).VUR is one of the most common conditionstreated by pediatricurologists, affecting 1-10% of all children inthe United States. Inthe setting of a uri-nary tract infection,VUR can severelydamage a child’s de-veloping kidneys.However, it is alsoclear that some VURpatients actually suf-fer few long-termconsequences. Unfor-tunately, there are no data that clearly iden-tify which children are at risk of renaldamage from VUR. This lack of risk stratifi-cation has led to tremendous variation inVUR management: some clinicians treat VURwith surgery, others with endoscopy, otherswith long-term antibiotics, while others at-tempt to ignore the problem altogether. Itremains unclear which of these approachesworks best for which children; what is clearis that this variation in VUR management im-plies the existence of inefficiency in VURmanagement in our health system. Ulti-mately, this study is intended to help to de-fine the most appropriate treatment coursefor children with VUR and will help cliniciansto personalize and to optimize the treatmentof an individual child with VUR.

Inman BA, Abern MR. Interpreting a studyon bladder cancer screening. Eur Urol64(1): 48-50, July 2013.

Magnon C, Hall SJ, Lin J, Xue X, Gerber L,Freedland SJ, Frenette PS. Autonomicnerve development contributes to prostatecancer progression. Science 341(6142):1236361, July 2013.

Teeter AE, Presti JC Jr, Aronson WJ, TerrisMK, Kane CJ, Amling CL, Freedland SJ. Donomograms designed to predict biochemi-cal recurrence (BCR) do a better job of pre-dicting more clinically relevant prostatecancer outcomes than BCR? A report fromthe SEARCH database group. Urology82(1): 53-58, July 2013.

Goldsmith ZG, Oredein-McCoy O, GerberL, Bañez LL, Sopko DR, Miller MJ, Pre-minger GM, Lipkin ME. Emergent uretericstent vs percutaneous nephrostomy for ob-structive urolithiasis with sepsis: Patterns ofuse and outcomes from a 15-year experi-ence. BJU Int 112(2): E122-128, July 2013.

Freedland SJ. Dietary fat and reducedprostate cancer mortality: Does the type offat matter? JAMA Intern Med 173(14):1326-1327, July 2013.

Inman BA. Words of wisdom: Re: Final re-sults of an EORTC-GU cancers group ran-domized study of maintenance bacillusCalmette-Guerin in intermediate- and high-risk Ta, T1 papillary carcinoma of the uri-nary bladder: One-third dose versus fulldose and 1 year versus 3 years of mainte-nance. Eur Urol 64(1): 171-172, July 2012.

Tsivian M, Abern MR, Qi P, Polascik TJ.Short-term functional outcomes and com-plications associated with transperinealtemplate prostate mapping biopsy. Urology82(1): 166-170, July 2013.

Gbadegesin RA, Brophy PD, Adeyemo A,Hall G, Gupta IR, Hains D, Bartkowiak B,Rabinovich CE, Chandrasekharappa S,Homstad A, Westreich K, Wu G, Liu Y,Holanda D, Clarke J, Lavin P, Selim A, MillerS, Wiener JS, Ross SS, Foreman J, RotimiC, Winn MP. TNXB mutations can causevesicoureteral reflux. J Am Soc Nephrol24(8): 1313-1322, July 2013.

Granieri MA, Freedland SJ. Editorial: Theinterplay between obesity and the accuracyof prostate-specific antigen (PSA) for pre-dicting prostate cancer. BJU Int 112(4):E272, August 2013.

Tsivian M, Polascik TJ. Bilateral focal abla-tion of prostate tissue using low-energy di-rect current (LEDC): A preclinical caninestudy. BJU Int 112(4): 526-530, August2013.

Preminger GM. Micro-percutaneous neph-rolithotomy (micro-PNL) vs retrograde intra-renal surgery (RIRS): dealer’s choice? Thedevil is in the details. BJU Int 112(3): 280-281, August 2013.

Freedland SJ, Gerber L, Reid J, WelbournW, Tikishvili E, Park J, Younus A, Gutin A,Sangale Z, Lanchbury JS, Salama JK, StoneS. Prognostic utility of cell cycle progressionscore in men with prostate cancer after pri-mary external beam radiation therapy. IntJ Radiat Oncol Biol Phys 86(5): 848-853,August 2013.

Balsara ZR, Ross SS, Dolber PC, WienerJS, Tang Y, Seed PC. Enhanced susceptibil-ity to urinary tract infection in the spinalcord-injured host with neurogenic bladder.Infect Immun 81(8): 3018-3026, August2013.

Kokorowski PJ, Routh JC, Hubert K, Gra-ham DA, Nelson CP. Trends in revision cir-cumcision at pediatric hospitals. ClinPediatr 52(8): 699-706, August 2013.

Koontz BF, Quaranta BP, Pura JA, Lee WR,Vujaskovic Z, Gerber L, Haake M, AnscherMS, Robertson CN, Polascik TJ, Moul JW.Phase 1 trial of neoadjuvant radiation ther-apy before prostatectomy for high-riskprostate cancer. Int J Radiat Oncol Biol Phys87(1): 88-93, September 2013.

Moul JW, Walsh PC, Rendell MS, Lynch HT,Leslie SW, Kosoko-Lasaki O, FitzgibbonsWP, Powell I, D’Amico AV, Catalona WJ. Re:Early detection of prostate cancer: AUAguideline. J Urol 190(3): 1134-1139, Sep-tember 2013.

Jonathan Routh, MD, MPH

RECENT SIGNIFICANT PAPERS


Freedland SJ, Hamilton RJ, Gerber L, BañezLL, Moreira DM, Andriole GL, Rittmaster RS.Statin use and risk of prostate cancer andhigh-grade prostate cancer: Results from theREDUCE study. Prostate Cancer Prostatic Dis16(3): 254-259, September 2013.

Tsivian M, Abern MR, Yoo JJ, Evans P, Qi P,Kim CY, Lipkin ME, Polascik TJ, FerrandinoMN. Radiation exposure associated with ded-icated renal mass computed tomographyprotocol: Impact of patient characteristics. JEndourol 27(9): 1102-1106, September2013.

Ross SS, Masko EM, Abern MR, Allott EH,Routh JC, Wiener JS, Preminger GM,Freedland SJ, Lipkin ME. The effect of di-etary sodium and fructose intake on urineand serum parameters of stone formation ina pediatric mouse model: A pilot study. J Urol190(4): 1484-1489, October 2013.

Inman BA, Abern MR. Maintenance BacillusCalmette-Guerin: Why is there continued de-bate? Eur Urol 64(4): 586-587, October2013.

Karlin JD, Koontz BF, Freedland SJ, MoulJW, Grob BM, Wan W, Hagan MP, AnscherMS, Moghanaki D. Identifying appropriatepatients for early salvage radiotherapy andprostatectomy. J Urol 190(4): 1410-1415, Oc-tober 2013.

Lloyd JC, Wiener JS, Gargollo PC, InmanBA, Ross SS, Routh JC. Contemporary epi-demiological trends in complex congenitalgenitourinary anomalies. J Urol 190 (S4):1590-1595, October 2013.

Punnen S, Cooperberg MR, D’Amico AV,Karakiewicz PI, Moul JW, Scher HI, SchlommT, Freedland SJ. Management of biochemi-cal recurrence after primary treatment ofprostate cancer: A systematic review of theliterature. Eur Urol 64(6): 905-915, Decem-ber 2013.

Eaton SH, Cashy J, Pearl JA, Stein DM, PerryK, Nadler RB. Admission rates and costs as-sociated with emergency presentation ofurolithiasis: Analysis of the nationwide emer-gency department sample 2006-2009. J En-dourol 27(12): 1535-1539, December 2013.

Neisius A, Wang AJ, Wang C, Nguyen G, Tsi-vian M, Kuntz NJ, Astroza GM, Lowry C,Toncheva G, Yoshizumi TT, Preminger GM,Ferrandino MN, Lipkin ME. Radiation expo-sure in urology: A genitourinary cataloguefor diagnostic imaging. J Urol 190(6): 2117-2123, December 2013.

Lloyd JC, Masko EM, Wu C, Keenan MM,Pilla DM, Aronson WJ, Chi J-TA, FreedlandSJ. Fish oil slows prostate cancer xenograftgrowth relative to other dietary fats and is as-sociated with decreased mitochondrial andinsulin pathway gene expression. ProstateCancer Prostatic Dis 16(4): 285-291, Decem-ber 2013.

Allott EH, Abern MR, Gerber L, Keto CJ,Aronson WJ, Terris MK, Kane CJ, Amling CL,Cooperberg MR, Moorman PG, FreedlandSJ. Metformin does not affect risk of bio-chemical recurrence following radical prosta-tectomy: Results from the SEARCH database.Prostate Cancer Prostatic Dis 16(4): 391-397,December 2013.

Cabrera F, Preminger GM, Lipkin ME. Aslow as reasonably achievable: Methods forreducing radiation exposure during the man-agement of renal and ureteral stones. IndianJ Urol. 30(1): 55-59, January 2014.

Rampersaud EN, Klatte T, Bass G, Patard JJ,Bensaleh K, Bohm M, Allhoff EP, Cindolo L,DeLaTaille A, Mejean A, Soulie M, Bellec L,Christophe Bernhard J, Pfister C, ColombelM, Belldegrun AS, Pantuck AJ, George D.The effect of gender and age on kidney can-cer survival: Younger age is an independentprognostic factor in women with renal cellcarcinoma. Urol Oncol 32(1): 30, January2014.

Stewart SB, Reed SD, Moul JW. Will the fu-ture of health care lead to the end of the ro-botic golden years? Eur Urol 65(2): 325-327,February 2014.

Balsara ZR, Martin AE, Wiener JS, RouthJC, Ross SS. Congenital spigelian hernia andipsilateral cryptorchidism: Raising awarenessamong urologists. Urology 83(2): 457-459,February 2014.

Neisius A, Astroza GM, Wang C, Nguyen G,Kuntz NJ, Januzis N, Ferrandino MN,Yoshizumi TT, Preminger GM, Lipkin ME.Digital tomosynthesis: A new technique forimaging nephrolithiasis. Specific organ dosesand effective doses compared with renalstone protocol noncontrast computed to-mography. Urology 83(2): 282-287, February2014.

Cabrera FJ, Preminger GM, Lipkin ME. An-tiretropulsion devices. Curr Opin Urol 24(2):173-178,March 2014.

Moul JW. Utility of LHRH antagonists for ad-vanced prostate cancer. Can J Urol 21(1):22-27, April 2014.

Chaudry R, Madden-Fuentes RJ, Ortiz TK,Balsara Z, Tang Y, Nseyo U, Wiener JS, RossSS, Seed PC. Inflammatory response to Es-cherichia coli urinary tract infection in theneurogenic bladder of the spinal cord injuredhost. J Urol 191(5): 1454-1461, May 2014.

Scales CD Jr, Saigal CS, Hanley JM, Dick AW,Setodji CM, Litwin MS; NIDDK Urologic Dis-eases in America Project. The impact of un-planned postprocedure visits in themanagement of patients with urinary stones.Surgery 155(5): 769-775, May 2014.

Abern MR, Scosyrev E, Tsivian M, MessingEM, Polascik TJ, Dudek AZ. Survival of pa-tients undergoing cytoreductive surgery formetastatic renal cell carcinoma in the tar-geted-therapy era. Anticancer Res. 34(5):2405-2411, May 2014.


CONTINUING MEDICAL EDUCATION

DUKE TUESDAY IN UROLOGYJANUARY

Our first Duke Tuesday in Urology of the year took place on Feb-ruary 11, 2014. The visiting professor was Christopher Saigal, MD,MPH, Professor and Vice-Chair of Urology at UCLA. Dr. Saigal spokeon “Improving Decision Making in Urology: Challenges and Oppor-tunities” . He was a fellowship mentor of our newest Duke Urologyfaculty Chuck Scales, MD who also spoke on “Unplanned Post-Pro-cedure Care in the Treatment of Patients with Stone Disease”. Dr.Saigal has a focus on health services research, particularly as it relatesto prostate cancer. Urology Residents had the opportunity to spendthe morning with Dr. Saigal during a Case Conference event.

2015 DUKE TUESDAY CMEEDUCATION SERIES

February 17, 2015 Robert B. Nadler, MD, FACS

Professor and Vice Chairman, Department of UrologyDirector of Robotic, Laparoscopic, & Endoscopic Urology

Northwestern University, Chicago, IL

July 21, 2015 Morris Center for Research LectureshipChristopher L. Amling, MD, FACS

John Barry Professor and ChairDepartment of Urology

Oregon Health & Sciences University

November 10, 2015John E. Dees LectureshipVictor W. Nitti, MD

Professor of Urology and Obstetrics & GynecologyVice-Chairman, Department of Urology

NYU Langone Medical Center

MORRIS CENTER for RESEARCHLECTURESHIP JULY

The 2014 Duke Tuesday in Urology, Morris Center for Re-search Lectureship was held on July 15, 2014. Joel B. Nel-son, MD, Chairman of Urology at University of Pittsburghwas the featured guest lecturer and spoke on “The Role ofRadical Prostatectomy in the Age of Active Surveillance, FocalTherapy, Advanced Imaging and Predictive Science”.

In addition, the following presentations were made byDuke faculty including: Michael N. Ferrandino, MD: “NewBiomarkers in Prostate Cancer Care”; W. Robert Lee, MD,MEd, MS (radiation oncology): “The Effect of Radiation Doseon Prostate Cancer”, and Cary N. Robertson, MD: “AblativeTherapies for Prostate Cancer Update: Present and Future Ap-proaches”. The afternoon audience included over 100 mem-bers from the tri-state regional urologic community.

JOHN E. DEES LECTURESHIPNOVEMBER

John W. Brock, III, MD, Professor and Chief of Pediatric Urol-ogy at Vanderbilt University will present the John E. Dees Lecture atDuke Tuesday on November 4, 2014. Duke Faculty speakers present-ing are: Glenn M. Preminger, MD; Aaron C. Lentz, MD; andPatrick C. Seed, MD, PhD, MS (infectious diseases).

The Duke University School of Medicine designates each DukeTuesday conference for a maximum of 4.0 AMA PRA Category 1credits. To register for the Duke Urology CME conferences http://urol-ogy.surgery.duke.edu/cme or contact Robin Phillips, CME Coordina-tor, [email protected].


The 46th annual Duke UrologicAssembly returned to its homeduring its early years in the

1960’s-1980’s – The Carolina Inn at Pine-hurst, NC – on April 3-6,2014. The weather wasspectacular as expected inApril in the Piedmont withdogwoods and azaleas inbloom. The first two dayswere dedicated to theDuke Urologic CancerSymposium sponsored byDuke Urology and DukeCancer Institute. Speakersfrom urology, medical on-cology, radiation oncology,radiology, immunology, andepidemiology gave 25 lec-tures related to a variety ofgenitourinary malignancies.

Our featured guest faculty speaker,Robert G. Uzzo, MD, Professor andChair from Fox Chase Cancer Center gavethe Victor A. Politano Lecture onNephrom-

etry Scores. Nineteen full time Duke Urol-ogy faculty members covered all aspectsof urologic care of adults and childrenduring the event. Professor emeritus,

David F Paulson, MD re-turned to North Carolina forthe event and served as amoderator. Richard C. Rink,MD, FAAP from IndianaUniversity/Riley Children’sHospital was an additionalguest faculty member toaugment the pediatric urol-ogy portion.

In addition to thelovely outdoor receptionand luncheon, golf was ahighlight for many atten-dees. Twenty guests andfaculty had the opportu-nity to play the famed Pine-

hurst No. 2 course where, for the firsttime ever, the U.S. Open Championshipfor men and women took place on con-secutive weeks in June 2014.

Leading Edge Urology: DUKE UROLOGIC ASSEMBLY

Mark your calendars for nextspring when the Leading Edge Urol-ogy: 47th Duke Urologic Assemblyand Duke Urologic Cancer Sympo-sium will return to one of its most pop-ular destinations – the Grand FloridianResort and Spa at Walt Disney World inOrlando, FL on March 5-8, 2015.

Conference information will beposted on the Urology website:http://urology.surgery.duke.edu/cme


Duke UrologyDivision of the Department of Surgery

Duke South, White Zone, Rm 1571-AMail: DUMC 3707, Durham, NC 27710

First Class MailU.S. Postage

P A I DPermit No. 60Durham, NC

ALUMNI SECTION

One of the highlights of the yearis the gathering of Duke Urol-ogy alumni at the annual AUA

meeting. DYSURIA filled the room onceagain in Orlando, FL on Saturday night May17. The diverse crowd spanned the rangefrom many of our current residents present-ing at their first AUA meeting to emeritusfaculty members David Paulson and George

Webster. One realizes how internationalthe AUA meeting has become and DukeUrology has always been with the group en-compassing former trainees from Israel,South Africa, New Zealand, and Germanyplus next year’s oncology fellow from Singa-pore. Among the US states representedwere Hawaii, California, Oregon, Colorado,Texas, Iowa, Tennessee, Michigan, Pennsyl-

vania, Florida, and North Carolina. Therewas great camaraderie among the alumniwho spanned six decades of training atDuke Urology. Some are in private practicein small cities, many have academic ap-pointments at some of the leading centersin the U.S., and some are departmentchairs. We hope to see you in New Orleansin May 2015.

DYSURIA COCKTAIL PARTY AT AMERICAN UROLOGICAL ASSOCIATION ANNUAL MEETING

duke urology update - duke department of … · elcome to our fall 2014 edition of duke urology...

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