Urology

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June 2011 Urology Newsletter (complete issue)

Individual articles below

Outcomes: Informing Health-Care Decisions

William A. See, MD, Professor of Urology, Chairman of Urology
Why is it that a consumer can obtain more performance information regarding an automobile than they can about the surgeon into whose hands they will be placing their lives?

Infertility Outcomes

Jay Sandlow, MD, Vice Chairman and Professor of Urology
In 2003, the Department of Urology, in conjunction with the Department of Obstetrics and Gynecology, initiated a novel concept in the management of the infertile couple by establishing a joint infertility clinic within the Froedtert & The Medical College of Wisconsin Reproductive Medicine Center. This center evaluates couples simultaneously, thus improving communication and treatment coordination. Over the past seven years, the Reproductive Medicine Center has expanded dramatically, providing cutting-edge, team-based care for infertile couples.

Overactive Bladder: Interstim Outcomes

R. Corey O'Connor, MD, Associate Professor
Michael Guralnick, MD, Associate Professor

Overactive bladder (OAB) is a common, chronic condition that affects about 37 million adults in the United States. Symptoms of OAB include urinary urgency and frequency with or without incontinence. Standard initial treatments include behavioral modification and anticholinergic/antimuscarinic medications. Unfortunately, a significant number of patients do not improve with these therapies or do not tolerate the drug side effects. Over the past decade, sacral neuromodulation has become an accepted modality for the treatment of OAB symptoms refractory of behavioral and drug therapy. While the exact mechanism of action remains unclear, most theories involve the modulation of afferent and/or efferent neural pathways of the bladder.

Teaching Residents to Evaluate Outcomes

Hrair Mesrobian, MD, MSc, Professor, Pediatric Urology
Our students and residents are constantly bombarded with medical information from diverse sources. Of the hundreds of articles published daily in the urologic literature, only a fraction are based on sound research methodology and are able to be generalized to positively influence outcomes. The teacher’s challenge is to show the student of urology how best to sift through the literature and select the best diagnostic test, treatment modality or procedure which, when applied in the context of the clinical scenario, yields the most desirable outcome. It is extremely rewarding to teach methodology which may be applicable throughout a career, as learning does not stop with the completion of residency. In fact, new knowledge supersedes (or even contradicts) the old very rapidly.

Kidney Cancer Outcomes

Peter Langenstroer, MD, MS, Professor of Urology, Director of Urologic Oncology
The management of kidney cancer has changed dramatically over the past 20 years. Whereas kidney cancer primarily remains a surgical disease, the techniques for surgical management have significantly improved and, in turn, have improved patient outcomes. Prior to the mid to late 1990’s, the standard of care for most patients with kidney cancer was kidney removal. In the latter part of that decade, it was recognized that partial removal of the kidney for patients with small kidney tumors could be safely performed without compromising cancer-specific survival.

Cryotherapy Treatment of Prostate Cancer

Robert Donnell, MD, Associate Professor of Urology
John Schmidt, MD, Clinical Professor of Urology

Cryotherapy offers the advantage of single modality ablative therapy with only a short overnight hospital stay. It offers prostate cancer ablation for patients with newly diagnosed prostate cancer and those who have disease relapse following radiation therapy. Very few options exist for patients who have cancers that recur following radiation therapy. Cryotherapy is a well established salvage therapy for prostate cancer patients who have failed primary radiation therapy. More recently, research has focused on focal or targeted cryotherapy in very select patients.

Clinical Trials Update

Holly Kelly, RN, Clinical Research Manager
A Multi-center, Double-Blind, Placebo-controlled trial of Sanctura XR 60 mg Daily in Female OAB Patients on Multiple Concomitant Medications Refractory to Detrol LA 4 mg Daily.
The study objective is to establish Sanctura XR 60 mg as an effective therapy for reducing overactive bladder (OAB) symptoms in female subjects who are on multiple concomitant medications and are still suffering from urgency urinary incontinence (UUI), despite a one month trial of Detrol LA 4 mg daily.

Prostate Cancer Outcomes

William A. See, MD, Professor of Urology, Chairman of Urology
Prostate cancer is the most common solid tumor in men, with approximately one in six men being diagnosed with this disease over the course of a lifetime. Despite its prevalence, there is a remarkable lack of consensus regarding the optimal management of prostate cancer. Disease characteristics, including a long latency period, slow growth rate and a low, but unpredictable risk of progression in the individual patient, combine with patient issues of late age at detection and competing diseases to make treatment decisions difficult.

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