Cincy Live Well 2020 – Urology

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Urology

No Shame in Seeking Help DOCTORS STRESS THE NEED FOR BEING OPEN ABOUT UROLOGIC CONDITIONS AND PURSUING TREATMENT SOONER RATHER THAN LATER

By Kevin Michell

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rologic concerns can be no small source of embarrassment for sufferers of incontinence, urinary tract infections and other issues. But overcoming that shame to talk to a physician is the first step to improving quality of life and, in some cases, catching a more serious concern before it’s too late.

Dr. Brooke Edwards, chief medical officer for The Urology Group, sees part of her role as helping to remove some of the embarrassment of seeking treatment.

“How I look at it with medicine and specifically with urology,” she says, “it’s very much a privilege to take care of patients and for them to open up and talk about problems that they have that they are completely embarrassed to talk about and even embarrassed to talk to a family doctor about. I think when they come into a urology office, they understand this is why [they’re] here. It’s a subspecialty, it’s safe to talk about.”

Once patients are open to talking to a specialist about urologic issues, organizations like The Urology Group are able to offer treatments that many haven’t even

Dr. Eric Kuhn of The Urology Group talks with a patient about kidney stones. considered. A common barrier at this point is resignation—many men and women who notice problems with urination or sexual function often chalk it up to simply getting older.

A good example is benign prostatic hyperplasia, commonly known as BPH, which is when a man’s prostate enlarges and causes discomfort during urination and frequent nighttime urination. It is indeed a common issue in men—around 70 of men in their 60s and over 40 million men in the United States experience BPH. But that’s not to say that men should only treat it with a stiff upper lip.

“I think it’s common to say, ‘Well this is just something that happens. Dad had it, he dealt with it when he was older, [so] I’m

“It’s very much a privilege to take care of patients and for them to open up and talk about problems that they have that they are completely embarrassed to talk about and even embarrassed to talk to a family doctor about.”

—Dr. Brooke Edwards, chief medical officer for The Urology Group 82

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going to deal with it. It’s not a big deal,’” says Edwards.

BPH tends to first occur in a man’s 40s and worsens over time, which can lead to knock-on issues like a urinary tract infection (UTI) or, worse, bladder and kidney damage if left untreated. Treating BPH at 40 or 50 years old instead of later on in life—particularly for those who have suffered from it for years but haven’t addressed it with their doctor—not only lessens the symptoms to improve quality of life, it can prevent serious issues that result from untreated BPH, which range from necessitating catheter use to potential kidney failure.

Thus, Edwards stresses the importance of catching it earlier, which is helped by men being open and communicative with their doctors about their urination, particularly after they turn 40.

“As they ignore those symptoms, they’re doing something to their body that I can’t fix,” she says. “I can’t reverse the damage that they’re doing to their bladder.”

The same goes for frequently recurring UTIs in women, which can often be dismissed as an annoyance that is just part of life. But it could be a red flag for hidden kidney issues or other underlying problems. And, just as men are with BPH, women are more susceptible to very serious issues the older they get and the longer they avoid more intentional treatment.

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Edwards says that anything that affects quality of life should be checked out by a specialist if the patient is willing. It may seem routine, but treatment options for mitigating common urologic conditions are more numerous and effective than ever.

And getting a more in-depth examination can lead to catching the more serious problems—including cancer—earlier and thus widening the window of treatability.

One major issue is that UTIs share a lot of symptoms with the warning signs of kidney or bladder cancer. It’s normal for a UTI to result in blood in one’s urine but if there are no other symptoms of a UTI—a frequent need to urinate that often releases only small amounts of urine each time, burning or pain during urination or lower abdominal pain—it’s crucial that further testing takes place.

“One of the things about bladder and kidney cancer is that the blood in the urine—if you see it—is painless,” explains Dr. Gary Kirsh, president of The Urology Group. “So, if there are no symptoms of an infection and there’s blood in the urine, that should raise the radar that it may be something more dangerous than a simple urinary infection.”

But even if the worst-case scenario should arise and some form of cancer is spotted, the options for treatment are more targeted and effective than ever. In cases of prostate cancer, for example, The Urology Group utilizes what’s called somatic testing, which analyzes the genome of cancer cells when they are found.

“That’s looking at the DNA characteristics of how that cancer’s going to behave,” says Kirsh. After an initial examination under a microscope that results in a Gleason Score—a 1 to 5 scale of how aggressive the cancer appears—tumor tissue is sent off to an external lab. A DNA profile of the cancer is returned that provides a recommendation of starting treatment or, in cases of slow-growing, low-risk prostate cancer, safely continuing to monitor the patient.

It may be a surprise to many that one of the improvements to addressing prostate cancer is knowing when treatment isn’t necessary. For a long time, finding cancer cells in a man’s prostate meant immediate treatment, leading to the many side effects that diminish quality of life and invasive procedures.

“We now know that it is safe to watch— meaning surveil, which isn’t the same as

Dr. Justin Cox, a urologist with The Christ Hospital ignore—men who have a smaller amount of nonaggressive cancer as viewed under the microscope,” Kirsh explains.

For those who do have an aggressive cancer or one that has spread into other areas of the body—at that point referred to as metastatic prostate cancer—specialists like The Urology Group and those at The Christ Hospital Health Network have the tools and techniques to improve survivability.

Dr. Justin Cox, a urologist with The Christ Hospital, says that robotic-assisted surgery and more targeted radiation therapy

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Urology extend the lifespan of men with prostate cancer while also helping to reduce the negative aspects of getting treatment. Side effects cannot be fully eliminated, but they can be lessened.

“The challenge for us has been trying to figure out from a surgery standpoint how can we minimize the injury to the bladder control muscles and be able to preserve those nerves and blood vessels for sexual function,” says Cox, adding that surgery and radiation options have become better at only targeting the problem areas without impacting nearby organs, nerves and muscles.

But beyond improved mechanisms for treatment, equally important are the improvements to how patients receive care from their physicians and specialists. That is why The Christ Hospital Health Network developed its Urologic Cancer Collaborative, a team of physicians meant to provide one resource for all of a patient’s concerns and questions.

“What’s nice about the collaborative is it’s an avenue for patients who have any

The recovery room at The Urology Group form of prostate cancer, be it newly diagnosed [or] guys who have very complicated cases. We see a lot of second opinions,” explains Cox. “But what’s nice is that it is a combination of a urologist, a radiation oncologist and a medical oncologist that all sit down as one with the patient. They can see all three specialties that they would potentially be involved with in their care.”

Together they can explore the patient’s options and determine what approach they

are most comfortable with. Everything can be discussed together in one setting, helping patients feel more confident about the care they’re getting and reassured about the road ahead. Between the advancements in identification and treatment of urologic cancers and how specialists in the field can communicate options to patients, prostate cancer and similar problems can be less of a death sentence and more of a chronic condition. n

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Unparalleled Care

THE UROLOGY GROUP BRINGS WORLD-CLASS CARE AND TREATMENT OPTIONS TO CINCINNATI THAT ARE RARELY FOUND ELSEWHERE

By Kevin Michell

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ince 1996, The Urology Group has operated as a collective of physicians focused on one of the narrowest specialties in the medical world. Urology accounts for 2 of all medicine practiced, but its role in treating common issues like benign prostatic hyperplasia (BPH) and urinary tract infections (UTIs), as well as cancers involving the kidneys, prostate and bladder, make it a vital discipline.

By being an organization that solely focuses on urology across its 11 Greater Cincinnati locations, The Urology Group offers best-in-class care for the whole spectrum of urologic ailments, from improving quality of life for sufferers of issues like incontinence to extending survivability for cancer patients.

“The Urology Group, fortunately, is very all-encompassing urology care,” says Dr. Brooke Edwards, The Urology Group’s chief medical officer, adding that its dedicated focus is what sets it apart from hospital systems and other, larger multispecialty groups.

The president of The Urology Group, Dr. Gary Kirsh, adds that having dozens of urologists under the group’s umbrella allows for an ability to scale that couldn’t be possible with the same specialists split into twos and threes among other care providers. That enables collaboration among the doctors who have their own lanes of expertise, such as research, surgery and oncology.

“We use that scale to deliver upon the promise of creating a center of excellence,” says Kirsh. “And when we do deliver on that—and I really mean this from the bottom of my heart—we become a community asset, a community resource.”

Delivering on that promise comes both from the quality of physicians and the access to technology that is on par with or better than much larger cities than Cincinnati.

The Urology Group is the only provider in the region to use CyberKnife radiation therapy exclusively for prostate cancer and has the only facility in the city that offers a DNA analysis of the cells shed during urination—called fluorescence in situ hybridization—that can determine how aggressively to look for recurrence of cancer cells in patients with a history of bladder cancer.

The Urology Group also has its own pathology laboratory with a permanent uropathologist, a level of specialized expertise that has resulted in other care providers and organizations sending samples to The Urology Group for analysis. Furthermore, it also is home to the largest independently owned and operated ambulatory urology surgery center in the country.

But beyond the access to world-class technology and methods, The Urology Group offers uniquely collaborative care that serves as a further benefit to its current and prospective patients. Nurse navigators provide

TOP: The Urology Group’s Norwood Surgery Center ABOVE: Dr. Gary Kirsch, president of The Urology Group an extra set of eyes on patients’ developments and can suggest treatment options that may have been initially overlooked. And the group’s own clinical research department allows patients access to research trials if standard therapy isn’t working.

In building a practice upon urology and its subspecialties, The Urology Group is able to be competitive in attracting physicians with top talent in their field, bringing in the best and brightest of a medical concentration that only sees 290 graduates enter practice in the U.S. each year.

And while urology may not be the most well-known and appreciated medical specialty, having the world-class care that The Urology Group can offer makes Cincinnati a more attractive and healthy place to live by elevating the quality of urologic care well beyond that of most other cities the same size or larger.

“Our group is widely recognized in the country as being one of the leading examples of what can be done with a urology company,” Kirsh says. “And we’re very proud of that.” n w w w.

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WE’RE IN THIS

TOGETHER. To us, you’re more than a patient.

We understand the sensitivities of urologic conditions and partner with you to find long-term solutions.

You’re not alone.

Incontinence | Kidney Stones | Prostate Cancer Overactive Bladder | Urinary Tract Infections Enlarged Prostate | Erectile Dysfunction

urologygroup.com | (513) 841-7400

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