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urologyupdate News and Views from The Mount Sinai Medical Center, NY | Winter 2012

Pediatric Urology at Mount Sinai Dr. Jeffrey A. Stock, Director of Pediatric Urology and Dr. Grace Hyun, Associate Director of Pediatric Urology at Mount Sinai are among a select few pediatric urologists in the tri-state area. Both are skilled minimally invasive surgeons who utilize such procedures for a variety of complex urological conditions seen in infants, children, and adolescents. Dr. Stock has performed robotic assisted surgery on children as young as eight months to repair obstructed kidneys, ectopic ureters, vesicoureteral reflux and intra-abdominal testis with outstanding results. “The ability to perform surgery which is virtually bloodless, offers 3D magnification plus the ability to make precise movements is especially impor tant when performing surgery on an infant or small child,” says Dr. Stock. Additionally, children can be returned home within a day or two, compared to open surgery where they must remain in the hospital typically up to 5 days. Certain pediatric conditions seem to be on the rise, according

to Drs. Stock and Hyun. Hypospadias, a common genital abnormality seen in male infants, is a condition associated with older maternal age, though a definitive cause has not been established. In this condition, the urethral opening is not at the top of the penis but further down, between the head of the penis and the scrotum. According to statistics from the CDC, women continue to delay childbearing so the increase is not all that surprising to Dr. Hyun. Fortunately, surgery to correct hypospadias, when performed by a specialist with extensive experience can be done on an ambulatory basis and is highly successful. Kidney stones, once believed to be the domain of adults only, Dr. Grace Hyun and also appear to be increasing Dr. Jeffrey A. Stock among young children. The cause is unknown, but researchers hypothesize that diet, especially salt, may be associated with stones. Similar to adults, stones can often be treated with medication or shock wave therapy, eliminating the need for large incisions. Importantly, Drs. Stock CONTINUED ON PAGE 2

Welcome from Dr. Simon Hall, Chairman I am pleased to welcome you to the debut issue of Urology Update. Many of you are familiar with The Deane Center Quarterly, which focuses on issues of prostate health and treatments offered at The Barbara and Maurice Deane Prostate Health and Research Center. Urology Update has been developed to acquaint you with the entire scope of services at Mount Sinai’s Department of Urology and provide insights about urologic health from our outstanding faculty and staff. We care for individuals at all stages of life…from infancy to old age…and with a broad range of urologic conditions. We treat children with congenital abnormalities, men with erectile dysfunction, couples CONTINUED ON PAGE 2

more updates inside: Staff Introductions Kidney Cancer Treatment Residency Program Did You Know? Web Welcome

Simon Hall, MD


The Faculty of the Department of Urology Urology Associates is comprised of board-certified and fellowship-trained physicians who are consistently recognized by their peers and their patients as the best in their fields. Please see www.mountsinai.org/urologydocs for more information or call 212-241-4812 for an appointment.

Dr. Natan Bar-Chama Director, Male Reproductive Medicine and Surgery Erectile Dysfunction, Male Infertility, Andrology

Dr. Adam W. Levinson Assistant Professor of Urology Bladder, Kidney, and Prostate Cancers, Kidney Stones, Robotic Kidney Surgery

Pediatric Urology at Mount Sinai Continued from page 1

and Hyun work in partnership with pediatric nephrologists and nutritionists to develop preventive follow-up plans. The pediatrics practice is one of the busiest at Mount Sinai’s Department of Urology. “Parents are increasingly knowledgeable and proactive in the metropolitan New York area,” says Dr. Hyun. “It’s great,” she adds, “as we see children earlier in their disease states. And we have developed strong ties with referring physicians, who appreciate the close lines of communications from time of referral through intervention and follow up.” n

Welcome from Dr. Simon Hall, Chairman Dr. Michael J. Droller The Katherine and Clifford Goldsmith Professor of Urology Bladder, Kidney, and Prostate Cancers

Dr. Michael A. Palese Director, Minimally Invasive Surgery Kidney and Bladder Cancers, Prostate Health, BPH Laser Surgery, Kidney Stones, Robotic Kidney Surgery

Dr. Neil H. Grafstein Director, Reconstructive Urology, Female Urology and Voiding Dysfunction Post-Prostatectomy Incontinence, Urethral Strictures, Pelvic Floor Prolapse

Dr. Courtney K. Phillips Assistant Professor of Urology Kidney and Bladder Cancers, Prostate Health, Kidney Stones, Complex Urinary Tract Infections

Dr. Simon J. Hall Chairman, Department of Urology Bladder, Kidney, and Prostate Cancers, Prostate Health

Dr. David B. Samadi Vice Chair, Department of Urology Chief of Robotics and Minimally Invasive Surgery Prostate Cancer, Prostate Health, Robotic Radical Prostatectomy

Dr. Grace Hyun Associate Director, Division of Pediatric Urology Pediatric Urology

Dr. Jeffrey A. Stock Vice Chair, Department of Urology Director, Division of Pediatric Urology Pediatric Urology Pediatric Robotic Kidney Surgery

Continued from page 1

facing the challenge of male infertility and women with incontinence and pelvic prolapse. We are on the forefront of advanced treatments for bladder, kidney and prostate cancers, choosing from a full spectrum of minimally invasive procedures whenever possible. Similar to our philosophy regarding care at The Deane Center, we offer personalized and comprehensive treatment for all urologic conditions and in partnership with our colleagues in Radiology, The Tisch Cancer Institute and other Mount Sinai faculty practice departments when appropriate. We also encourage patients to be as knowledgeable as possible about their conditions, so our conversations can be truly two-way, and patients can take an active role in the management of their health. In this issue, you will learn about our multidisciplinary approach to kidney cancer treatment and the common and notso-common conditions treated by our pediatric urologists. We are committed to training the next generation of urologists and hope you enjoy reading about our residency program. Dr. Natan Bar-Chama kicks off our Did You Know column, explaining the links between Erectile Dysfunction and health problems you may not have associated with ED. We hope you enjoy learning more about us. n To your health, Simon J. Hall, MD


Partners on the Forefront of Kidney Cancer Treatment

Drs. Galsky and Palese

Dr. Michael Palese, Director of Minimally Invasive Surgery and Dr. Matthew Galsky, Director of Genitourinary Medical Oncology at the Tisch Cancer Institute are helping Mount Sinai advance its leadership in the treatment and management of kidney cancer. Reflecting developments made on both surgical and medical fronts in recent years, they work hand-in-hand to create personalized treatment plans for patients in order to ensure the optimal protocol for each patient’s particular disease profile. Surgery is generally the primary treatment for kidney cancer (also known as renal cell carcinoma) and transitional cell carcinoma. This holds true for both early- and late-stage cancers (there are few definable symptoms early on). In renal cell carcinoma, total removal of the kidney (radical nephrectomy) has been increasingly displaced by partial nephrectomy in order to achieve excellent disease outcomes while maintaining adequate renal function and reducing other postsurgery complications. Mount Sinai has been a leader in minimally invasive surgery and pioneered robotic surgery for kidney cancer, an expeditious and effective technique. Trained in open, laparoscopic as well as robotic surgery. Dr. Palese and his team are uniquely qualified to utilize the robotic equipment successfully. Dr. Palese has performed over 500 robotic kidney procedures for cancer and other conditions and says the benefits are clear cut. There is “less blood loss, quicker recovery and a shorter hospital stay. Plus, 3D magnification and more

precise movements allow surgeons to reduce operating time, a crucial element in successful removal of the kidney.” Mount Sinai surgeons also utilize other minimally invasive techniques for select patient populations. Percutaneous cryoablation (freezing) is a procedure performed in partnership with specialists from Mount Sinai’s Division of Interventional Radiology (recognized as one of the country’s most advanced for image-guided procedures) and most appropriate for patients for whom surgery would be too risky or for patients with very small tumors. In some cases Drs. Palese and Galsky determine that medical intervention should be implemented in conjunction with, or instead of, surgery. The treatment of metastatic kidney cancer, cancer that has spread from the kidney to other parts of the body, has changed dramatically in the past few years.There have been seven new drugs approved for the treatment of metastatic kidney cancer since 2005, many of which target the blood vessels which supply cancer cells with oxygen and nutrients. Dr. Galsky has been involved in clinical trials studying many of these drugs prior to approval, and is currently leading several studies evaluating new drugs or drug combinations. For example, a current clinical trial is evaluating the value of adding a new drug, known as BNC105P, when added to an approved drug known as everolimus. While there are multiple surgical and medical treatments available for kidney cancer, the choice of treatment is always individualized by Drs. Palese and Galsky based on a given patient’s tumor characteristics, his or her medical profile, and preferences regarding care. For other patients, Drs. Palese and Galsky will determine that neither medical intervention nor surgery is the recommended first-line treatment. Rather, active surveillance with oversight by a team of professionals can offer the option to delay surgery for small growths. Drs. Palese and Galsky are optimistic about the progress that has been made in treating kidney cancer and improving outcomes for patients with both early- and later-stage disease. They find great satisfaction in working in an integrated fashion and believe that more institutions will follow their model in the future. n

The Department of Urology’s Next Generation In an academic medical center, training the next generation of physicians is a serious endeavor. And so is finding the residents that will call Mount Sinai’s Department of Urology “home” for four years. On December 2nd and 7th, 37 finalists selected from a pool of over 220 applicants from the country’s most prestigious medical schools journeyed to New York to interview with our faculty in the hopes of securing one of three first-year spots. Our training program is designed to allow residents to obtain knowledge and proficiency both in making clinical assessments and in developing the technical endoscopic, laparoscopic and surgical skills for the treatment of patients with a broad range of urologic conditions. Residents rotate through six area facilities, including the Bronx VA and Memorial

Sloan-Kettering Cancer Center. Over 50 percent of graduating residents move forward to pursue subspecialty fellowships, and then go on to academic positions. n

Dr. Hall with residents


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Did You Know?

What health problems are associated with Erectile Dysfunction? Erectile dysfunction(ED) is associated with increasing age and common medical conditions such as diabetes, hypertension, peripheral vascular disease and obesity. It can be a consequence of surgical or radiation treatments for prostate, rectal and bladder cancers. ED may reflect hypogonadism (“lowtestosterone”). Importantly, ED is often a harbinger of cardiovascular disease. In numerous recent studies, men with ED were found to be at significantly increased risk for future myocardial infarctions and stroke. Thus, we strongly believe it is essential for men with ED to undergo a comprehensive medical evaluation to assess overall cardiovascular risk and ascertain the cause of their ED. ED offers us a valuable window of opportunity to prevent cardiovascular events and should be taken seriously. For the vast majority of men with ED,

safe and successful treatments exist. While first-line therapy with oral agents such as Viagra®, Cialis®, and Levitra® is effective for some, those with more severe ED should not give up hope to regain sexual function. We at Mount Sinai are able to offer the full spectrum of ED treatments, including psychological counseling, nutritional therapies, vacuum erection devices, intracavernosal injections and inflatable as well as semi-rigid penile implants. The bottom line? Men with ED should not suffer with this debilitating disease and should be confident that effective options are available. Please contact me if you have any questions about ED, your health, and/or treatments. n Dr. Natan Bar-Chama

Mount Sinai Urology Associates on the Web The Department of Urology has been upgrading our Web site to help you learn more about us, the conditions we treat, and advancements in treatments available at Mount Sinai. You will also find full profiles of our faculty, information on clinical trials, news articles, a newsletter archive and more. Please visit us at www.mountsinai.org/urology.

The medical information in this newsletter is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes or as a substitute for professional diagnosis and treatment. Please consult your healthcare provider before making any healthcare decisions or for guidance about a specific medical condition. The Mount Sinai Medical Center expressly disclaims responsibility and shall have no liability for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this newsletter. The Mount Sinai Medical Center and Department of Urology do not endorse specifically any test, treatment, or procedure mentioned in this publication. CONTACT US if you have a comment about an article or would like to see a particular topic featured in Urology Update. We welcome your feedback. Contact Kathy Gilbert, Communications Manager at kathy.gilbert@mountsinai.org.


Urology Update Newsletter Winter 2012