Urology

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Fall 2011 Urology Newsletter (complete issue)

Individual articles below

Integrated Urologic Services

William See, MD, Professor of Urology, Chairman, Department of Urology
Healthcare delivery is changing before our eyes. Healthcare systems are positioning themselves for the future by building vertically integrated delivery systems based upon employed physicians. Beginning with a foundation of primary care physicians, systems are subsequently overlaying specialty services in a manner that provides a continuum of care and maximizes patient and revenue retention. The final piece of the strategic puzzle — geographic distribution — results in the need for a buy-it/build-it approach that further drives provider consolidation around care systems.

New Chief of Division of Pediatric Urology

William See, MD, Professor of Urology, Chairman, Department of Urology
I am pleased to announce the appointment of John Kryger, MD, as chief of the Division of Pediatric Urology within the Department of Urology effective January 1, 2012. In this role, Dr. Kryger will provide medical and academic leadership to the Division of Pediatric Urology. He will also serve as specialty practice unit leader for Pediatric Urology within the Children’s Specialty Group and medical director of Pediatric Urology at Children’s Hospital of Wisconsin

The Impact of Male Infertility on Men's Health

Jay Sandlow, MD, Vice Chairman and Professor of Urology
Male factor infertility impacts approximately 50 percent of couples who experience difficulty conceiving. The most common cause is varicocele, which is present in up to 40 percent of cases. Other causes, such as obstruction, hormonal dysfunction and genetic factors, account for another significant portion. However, it has become apparent that male infertility may be a harbinger of underlying issues, such as cancer and cardiovascular disease. The following is a short description of the potential health issues that may present with male factor infertility.

Benign Prostate Disease

Robert F. Donnell, MD, Associate Professor of Urology
The approach to benign prostate disease has evolved significantly since most of us completed training. This year, the latest update to the American Urologic Association (AUA) guidelines for benign prostate hyperplasia (BPH) was published, concluding almost three years of intense evaluation of the literature. The AUA guidelines panel, under the guidance of the AUA board of directors, employed new techniques that ranked publications for their quality of study methods, as well as data reported. I was asked to serve on the committee, where I worked with thought leaders from around the country interested in benign diseases of the prostate. We were dedicated to publishing guidelines based on robust information all practitioners could use in daily practice. As a result of this effort, I believe you will now find it easier to identify recommendations based on level 1, level 2 and level 3 data.

Managing Urinary Incontinence after Prostate Cancer

Michael Guralnick, MD, Associate Professor of Urology and R. Corey O’Connor, MD, Associate Professor of Urology
Urinary incontinence is a well-recognized and potentially devastating complication of prostate cancer treatment (surgery, radiation) that can have a significantly negative impact on quality of life. Typically, incontinence is activity-related (e.g., stress urinary incontinence) and caused by injury/weakness of the urethral sphincter muscle. Fortunately, less than 10 percent of patients treated for prostate cancer have urinary incontinence significant enough to warrant aggressive medical or surgical therapy. Several treatment modalities exist to help patients with post-prostatectomy stress urinary incontinence, including physical therapy/behavior modification, duloxetine, urethral bulking, male slings and artificial urinary sphincters.

Prostate Cancer Screening

Jessica Motl, PA-C, Physician Assistant
Prostate cancer is the most common non-cutaneous malignancy and the second leading cause of cancer-related deaths in men. It was estimated that 217,730 men would be diagnosed with and 32,050 men would die of cancer of the prostate in 2010.1 Overall prevalence in 2008 was more than two million men currently with active disease or cured of disease. Since prostate specific antigen (PSA) was first introduced in 1987, there has been a significant increase in the overall diagnosis of prostate cancer. An estimated 85 percent of these diagnoses represent clinically localized disease (diagnosed from an elevated PSA alone or a prostate nodule without evidence of spread beyond the prostate).

Clinical Trials Update

Holly Kelly, RN, Clinical Research Manager
The Department of Urology continues to be active in identifying research protocols that may benefit patients. Two of many protocols that are actively accruing participants are described here. Please contact the Department of Urology if you have patients who may be eligible.

Increasing Medical Student Awareness of Men's Health

Anthony Balcom, MD, Assistant Professor of Pediatric Urology
The old days of a medical student doing nothing but reading books and attending lectures, without seeing a patient for the first two years of medical school are falling by the wayside. Along with approximately 68 percent of United States medical schools, The Medical College of Wisconsin is revamping the entire four years of medical student education to an integrated curriculum. In the old days, medical students would read textbooks and attend lectures on anatomy, physiology, biochemistry, pathophysiology, pathology, pharmacology and embryology for two years before they ever saw a patient.

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