Message From the Chief

It is with unbounded enthusiasm that I welcome you to the Duke Urology Fall 2011 E-Newsletter. It's been a whirlwind 2 months in my new position, and I have loved every minute. I'd like to thank Judd Moul, MD for his stewardship of Duke Urology over the last 7 years. Judd plans to remain at Duke as the James H. Semans, MD Professor of Urology and Director of the Duke Prostate Center.

We've had a busy 2011. Our Duke Urology residents, fellows and faculty had excellent participation at the SESAUA meeting in New Orleans in April and the AUA meeting in Washington, DC in May. In addition, one of the most exciting events in our residency program was the Urology RRC approval of a 4th resident slot, beginning July 2012. Over the next few years, we will grow the program to 20 residents.

June saw the graduation of our three chief residents, Joe Klink, Chuck Scales and Florian Schroeck. They each contributed significantly to Duke Urology, and I believe they will have an impressive impact in academic Urology in the near future. I have communicated with each of them since graduation, and they all are happy in their respective fellowships.

We began a new tradition this year at the Graduating Chief's Dinner. We sent a special invitation to the 5th and 25th graduating classes and welcomed 5th year DYSURIC Matt Young from Athens, Georgia and 25th year DYSURICs Michael Brown from Huntsville, Alabama; Robert Bertram from Salisbury, NC; and John Nesbitt from Glasgow, Kentucky to a wonderful evening at the Washington-Duke Inn and Golf Club. In addition, we inaugurated the first Duke Urology Resident-Faculty-Alumni golf tournament on Saturday morning. We anticipate that this new tradition will encourage new and "old" DYSURICs to attend the Chiefs' Dinner to honor our graduating Chiefs and to reminisce with friends and colleagues. Please save Friday, June 22 to attend the 2012 Chiefs' Dinner at the Washington-Duke. We will have more detailed information on this event in our Winter 2012 E-Newsletter.

Golf Outing Group - June 2011 

I was profoundly honored in July to be named the James F. Glenn, MD Distinguished Professor of Urology. This recognition was particularly meaningful to me as I personally knew Jim Glenn over the years when I was a medical student, resident and faculty member.   Duke Urology now has two endowed professorships, as Judd Moul currently holds the Semans Professorship.

Endourology, Metabolic Stone Disease, Laparoscopic and Robotic Surgery:

Iqbal W. Muhammad, MD

Agnes J Wang, MD

GU Cancer Survivorship:

                Raymond M. Bernal, MD

Reconstructive Urology, Female Urology and Urodynamics:

                Joshua M. Lohri, MD

Urologic Oncology:

                Michael R. Abern, MD

Current Advanced Practice Providers:

Shelby L. Barthel, RN, MSN, ANP-BC

Adult Nurse Practitioner

Training:Duke University, Adult Nurse Practitioner-Primary Care, 2009

Interests:  General urology in the adult & geriatric populations, urologic oncology, prostate cancer survivorship

Sarah Sebastian, PA-C

Physician Assistant

Training: George Washington University, 2010

Interests: Reconstructive urology, urinary incontinence, urethral stricture disease, erectile dysfunction, Peyronie's disease, and hypogonadism

Helen Tackitt FNP-BC, HCA

Nurse Practitioner and Practice Manager, Duke Urology of Raleigh

Training: Regis University, Denver, CO, 2006

Interests: BPH, incontinence, general urology

Jessica Clark, PA-C

Physician Assistant

Training: King's College, Wilkes Barre, PA, 2006

Interests: Surgical and medical management of urological cancers, obstructive uropathy, men's health, outpatient postoperative care, and PA education.

Cynthia J. Camille, FNP-BC, CPNP

Pediatric Urology Nurse Practitioner

Training: BSN, University of Iowa, 1975

PNP, University of Iowa, 1980

MSN, FNP, Duke University, 1999

Interests:  Voiding dysfunction, incontinence, enuresis, neurogenic bladder, spina bifida, hydronephrosis, vesicoureteral reflux, urinary tract infections, urodynamics, biofeedback for pelvic floor dysfunction, prenatal consultation for urinary tract abnormalities, patient and family education.

Thomas A. Esther, PA-C

Physician Assistant

Training: Howard University, 1997

Interests: Prostate cancer, BPH, erectile dysfunction, post prostatectomy incontinence , hypogonadism, Peyronie's disease

The Section of Pediatric Urology expanded to three urologists this past July:

John S. Wiener, M.D. trained in Urology at Duke and pediatric urology at Texas Children's Hospital in Houston under fellow DYSRUIC Edmond Gonzales. Dr. Wiener has been Head of the Pediatric Urology section since 1997-2003 and 2005-present. His primary research interest is in the care of spina bifida patients, and he was recently awarded a three year grant from the Centers for Disease Control and Prevention to enroll the Duke Comprehensive Spina Bifida Clinic as a pilot center in the National Spina Bifida Patient Registry.

Sherry S. Ross, M.D came to Duke in 2009 after completing her residency and fellowship at Children's National Medical Center/George Washington University in Washington DC. Dr. Ross is a native of Troy, NC and is a graduate of East Carolina University and the University of North Carolina School of Medicine. Her primary research interest is in the study of urinary tract infections in neurogenic bladder, and her work in developing a rat model with Duke Urology resident Zarine Balsara, M.D., Ph.D. won Dr. Balsara the first AUA Russell Scott Jr. Resident Research Award in 2010. Dr. Ross is also working with other centers to set up PediUro - a multi-institutional collaborative to prospectively study pediatric urologic issues. Dr. Ross is Director of the Undergraduate Urologic Studies (for medical students), Pediatric Urology Research, and the Pediatric Stone Clinic at Duke.

Jonathan C. Routh, M.D., MPH began at Duke this summer after completing his fellowship at Boston Children's Hospital and earning a M.P.H. at Harvard University. Dr. Routh is a native of Raleigh, NC and graduated from NC State University and the University of North Carolina School of Medicine. He received his urology training at The Mayo Clinic in Rochester, MN. His primary research interest is in health services (outcomes) research, and he has an appointment at the Duke Clinical Research Institute. He is also bringing his experience in robotic surgery in infants and children to Duke and developing a program in minimally invasive surgery in pediatric urology with the assistance of Dr. Ross.

In addition to routine pediatric urology care, we have specialty clinics including the Duke Pediatric Stone Clinic (staffed by urologists, nephrologists, a dietician, and an endocrinologist), the Duke Comprehensive Spina Bifida Clinic (with urologists, neurosurgeons, orthopedists, developmental pediatricians, and allied professionals), and the Achieving Bladder Control at Duke (ABCD Clinic) run by Cynthia Camille, CFNP. We see patients in multiple locations in Durham, Raleigh, and Greensboro and perform surgery in Durham and Raleigh.

Andrew C. Peterson, MD, FACS

Clinical Operations:

The last year has been an exceedingly productive year for clinic 1G! Throughout this time we have seen multiple changes with respect to the facilities, how we deliver patient care, and how we staff the clinic. We have implemented the patient screening rooms and currently have two in full practice at all times. This has resulted in an improvement in the patient throughput of the clinic as well as utilization of rooms. We implemented the Tele-Health nurse service several months ago, starting with one provider on a full-time basis. After monitoring the call volume we've now added a full-time second Tele-Health nurse in order to provide this service to our patients. In addition to those changes we have been attempting to solidify the team aspect to clinic 1G, ensuring that the same team works with each physician during their clinic hours (obviously staffing issues mandate daily monitoring of this and changes).

With these changes we have seen a significant improvement in both patient satisfaction, ability to serve our providers, and improve access to the clinic. Over the last year patient satisfaction scores have significantly improved; and clinic 1G now consistently ranks in the top five clinics with respect to patient satisfaction on a weekly basis.

There are too many other positive things to report in this newsletter, needless to say we are extremely proud of our clinic and honored to practice in such an outstanding facility. Thank you to all those who make this possible, the nursing staff, the nursing leadership, the physician providers and all of the mid-level providers! We hope to make clinic 1G an even more enjoyable and rewarding place to work in 2012 as it continues to establish itself as the best clinic in the Duke system!

John S. Wiener, MD

Education:

Residency: We are excited to report that the Residency Review Committee of the Accreditation Council for Graduate Medical Education approved Duke Urology to expand to four residency slots per year beginning in 2012. Therefore, we are planning to take four interns in the upcoming application process. This is the sixth year that the Department of Defense has contracted with Duke Urology to identify one residency slot for a future Army urologist, and chief resident Dr. Danielle Stackhouse will be our first graduate from this collaboration. The expansion to four residents per year will allow us to have more residents at Duke Hospital which is opening a new Cancer Center in 2012 and hospital addition in 2013 (Duke Medical Pavilion - 16 new ORs, 96 critical care beds, and 64 intermediate care beds. ) In addition, we will eventually send two residents to Duke Raleigh Hospital to work with our four urologists there.

Post-Graduate Education:

Duke Tuesday in Urology

For the past 34 years, the Duke Tuesday program has brought together visiting professors, Duke Urology faculty, and urologists across the region for an afternoon of CME activities three days a year. Our future speakers include:

                November 15, 2011 - Dr. Claus Roehrborn - UT Southwestern Medical Center

                February 7, 2012 - Dr. Alan Retik - Children's Hospital of Boston/Harvard University

Duke Urologic Assembly

The 44th annual Duke Urologic Assembly will return to the western United States at the Arizona Biltmore in Phoenix, Arizona on April 19-22, 2012. Be on the lookout for program details.

Duke Prostate Center Symposium

We conducted our 7th annual Duke Prostate Center Symposium on September 16-17, 2011 at the Washington-Duke Inn in Durham. Both local and outside experts spoke at this CME event and patient symposium. One hundred seventeen attended the CME program, and 60 patients and advocates were present for the symposium.

International Symposium on Focal Therapy and Imaging in Prostate and Kidney Cancer

This fifth collaboration between Duke Urology, the University of Southern California, and AMC Amsterdam will be held June 6-8, 2012 at the Washington-Duke Inn in Durham. More details are available at http://www.focaltherapy.org.

Stephen J. Freedland, MD

Research:

Duke Urology research continues to be strong. A recent report card of the research productivity of various academic Urology centers in the US ranked Duke Urology as the 8th most productive group in the country (http://hospitalacademicrank.com/). This is not due to the productivity of one single person or one group, but rather is a testament to the broad strength of Duke Urology's research efforts. As such, it is not possible to highlight all the research areas that make Duke Urology so strong. Thus, for this Newsletter, we are going to highlight just 3 areas: prostate cancer, stone disease, and pediatric urology. Future newsletters will highlight the other areas of research strength.

A key area of expertise within Duke Urology lies in prostate cancer. Specific areas of interest include novel prostate cancer therapies, risk stratification, and the role of metabolism/lifestyle factors in influencing prostate cancer growth. The Duke Prostate Center continues to lead the way with innovative studies addressing which patients need the most aggressive therapy. Moreover, as we anticipate moving into the new Duke Cancer Institute clinic space early in 2012 where clinic space will be combined with our Medical and Radiation Oncology colleagues, we have begun to explore the outcomes of our patients who initially presented to Duke through our Multi-Disciplinary Clinic (MDC). In our initial analyses lead by one of our residents, Dr. Suzanne Stewart with the help of Drs. Lionel Banez (Assistant Professor of Urology) and Judd Moul (Professor of Urology), we found that patients who came through the MDC travelled farther than patients who just saw a Urologist at Duke. This suggests that the word is out and people are coming from long distances to be seen at Duke through a multidisciplinary approach to clinical care. Other advances from the laboratory of Dr. Stephen Freedland (Associate Professor of Urology) include recent findings that low-carbohydrate diets and statins to lower cholesterol, may both slow prostate cancer growth - at least in animal models. Human studies are either underway or preparing to start in the near future.

In regards to stone disease, work continues on two major fronts: 1) lowering the radiation dose needed to accurately diagnose a stone, lead by Drs. Michael Ferrandino, Michael Lipkin, and Glenn Preminger and 2) optimizing the lenses used to focus shock waves to maximally break up the stones under the leadership of Drs. Glenn Preminger and Pei Zhong. Work from Duke has shown that lower doses of radiation are safe, result in similar stone detection rates, and may well be the future of stone diagnosis.

With regards to pediatric urology research, to date the focus has been on preventing urinary tract infections in children with poorly functioning bladders - a common issue in children with spinal cord problems. However, before effective therapies could be tested, an animal model needed to be developed. Lead by one of our residents, Dr. Zarine Balsara, under the leadership of Drs. Sherry Ross (Assistant Professor of Urology), Patrick Seed (Assistant Professor of Pediatrics), and Paul Dolber (Associate Professor of Surgery), the work has developed a viable animal model that develops a poorly functioning bladder and is thus more susceptible to urinary tract infections. Now the researchers are poised to begin testing different treatments and preventative agents for urinary tract infection which hopefully will one day be useful in the clinic to reduce the suffering of our youngest patients.

In summary, Duke Urology research remains strong. Though challenges remain especially in this highly regulated and under-funded environment, the perseverance of Duke Urology has resulted in great strides. We are excited about the future and continuing to translate today's research into tomorrow's practice.

DUKE UROLOGY RESIDENCY TRAINING PROGRAM

Congratulations, Graduates

Recent Publications: 

Congratulations: 

John S. Wiener, MD, Pediatric Urology, has been awarded a three year grant from the Centers for Disease Control and Prevention to participate in a pilot project for a National Spina Bifida Patient Registry.

Judd W. Moul, MD has been reappointed to a second term for the American Joint Committee on Cancer.

Zarine Balsara, MD, PhD won first prize for her research presentation at the 11th annual N.C. Urology Resident Symposium at the Grandover Resort in Greensboro, NC, September 10, 2011.

Mark Anderson, MD won third prize for his research presentation at the 11th annual N.C. Urology Resident Symposium at the Grandover Resort in Greensboro, NC, September 10, 2011.

Erin McNamara, MD and Zach Goldsmith, MD were winners for their urologic debates at the 11th annual N.C. Urology Resident Symposium at the Grandover Resort in Greensboro, NC, September 10, 2011.

Save the Dates: