DEPARTMENT OF UROLOGYNEWS

Volume 4 | SPRING 2020

CHAIR Benjamin R Lee, MD (interim)

FACULTY Juan Chipollini, MD Joel Funk, MD Matthew Gretzer, MD David Tzou, MD Roger Nellans, MD Christian Twiss, MD Deb Jur, FNP Rosa Garcia, FNP Alison Grabowski, FNP Carmen Panizo, FNP Cara Whittingham, FNP

RESEARCH Ken Batai, PhD Ava Wong, Coordinator

AFFILIATED FACULTY Michael Siroky, MD Maximiliano Sorbellini, MD Mark Cogburn, MD Alex Jule, MD Rajesh Prasad, MD Jonathan Walker, MD Philip Gleason, MD Barry Chang, MD Hiep Nguyen, MD , Ariella Friedman, MD ADAPTABILITY Tamis Thrasher, PNP SOCIAL DISTANCING AND Department of Urology is published annually yearly by the University of Arizona College of Medicine Department of Urology. CRISIS MANAGEMENT CONTACT: Dr. Benjamin R. Lee, MD Chair (Interim) & Professor [email protected] Department of Urology The George W. Drach, MD Endowed Chair Department of Urology College of Medicine, Room 5325 The University of Arizona 1501 N. Campbell Ave. P.O. Box 245077 Tucson, AZ 85724-5077 520-694-4032 Fax: 520-694-5509 urology.arizona.edu

All contents © 2020 Arizona Board of Regents. All rights reserved. The UA is an EEO/AA – M/W/D/V Employer. Design: UAHS BioCommunications To read this and past issues of Department of Urology Newsletter online, visit urology.arizona.edu/news-0 Deb Jur, NP Our Newest Nurse Practitioner

Banner – University Medical Center Tucson welcomes Deb Jur, FNP to the Urology clinic at 3838 N Campbell Ave. Deb has been enthusiastically providing nursing care for her entire career, and has been an NP Dr. George W. Drach, Dr. Benjamin R Lee, Dean Michael Abecassis at the Investiture Ceremony specializing in urology for for the 1st Endowed Chair of Urology over 10 years. In addition to her extensive experience, MESSAGE FROM THE CHAIR Benjamin R. Lee, MD she is also Nationally In March 2020, our lives were change. At the University of Certified in Urology through transformed by the COVID 19 Arizona College of Medicine, contributed to the endowment. the Society of Urological pandemic. Social distancing there have been several notable One of the first areas to support Nurses (SUNA). became the new norm, Grand responses to the pandemic – will be research championed Deb has a broad general Rounds went on-line with Personal protective equipment by Ken Batai, PhD, who has urology experience in Zoom, with a video education drives led by faculty & nurses been a beacon of research for male and female urologic format for our lectures: GU for N95 masks, personal mask the Department Dr. Batai is Tumor Board, AUA University construction and procurement working on racial disparities in conditions and also has a Conferences, Journal clubs and of PPE. There have been groups renal cell carcinoma in Native special interest in female Indications conferences. There creating COVID 19 specimen Americans as well as Hispanic pelvic medicine including has been an unprecedented collection kits, Researchers Americans, to better understand urinary incontinence, pelvic synthesis of rapid reactions, focusing on development of why kidney cancer has a higher organ prolapse, pelvic / decision making, reallocation COVID 19 antibody testing, incidence at a younger age in bladder pain and urinary of resources, punctuated by creation of safety and these populations, as well as tract infections. Previously, moments of re-evaluation and prevention training videos for understand why the mortality she has also served as an ultimately assessments for the COVID 19 first responders, as rate is higher. greater good. investigator in overactive well as Virtual Telemedicine It has been an amazing year bladder research. Our outpatient clinics training for rural healthcare of growth and stability for the An important aspect of integrated TeleMedicine visits providers. Department of Urology. Thank her practice philosophy to keep in touch with our On February 19, 2020, the you again to all who have is taking the time to patients at home, maintaining inaugural “George Drach supported us. social distancing to keep ensure her patients have Endowed Chair of Urology” everyone safe. a thorough understanding Investiture Ceremony was held, with Dr. Drach serving of their urologic conditions Ultimately, COVID 19 has touched both our personal and as extoller, and hosted by and treatment plan. She professional lives to respond Dean Michael Abecassis. It stays very active in her to one of the most challenging is humbling to be named as Benjamin R. Lee, MD spare time which includes global health challenges in recipient, and be associated The George Drach Endowed travel, handball, hiking, our lifetime. I would like to with its namesake. The George Chair of Urology and yoga. It is a pleasure thank our physicians, nurses, Drach Endowed Chair will go to welcome her to the residents, APPs, medical a long way towards achieving Professor, Department of Urology at assistants and administrators stability and growth in the Department of Urology Banner – University Medical for their willingness to be Department of Urology. University of Arizona College Center Tucson. adaptable in this time of Thank you to all who have of Medicine 2 Department of Urology News, Spring 2020 GREEN VALLEY UROLOGY CLINIC Urology Research The University of Arizona Department of Urology is committed to serving the patients of Southern Arizona and has expanded with a satellite clinic in Green Valley. On September 5, 2018, prostates, Benign Prostatic 2020 Ken Batai, PhD and Benjamin Lee, MD, the Banner – University Hyperplasia, prostate cancer are investigating genetic and biologic Medicine Green Valley Clinic screening, kidney and risk factors of early-onset kidney cancer. expanded from Primary bladder stones, bothersome Renal Cell Carcinoma incidence rates have Care and Cardiology services urinary symptoms and Dr. David T. Tzou increased over the past several decades, to include seeing patients recurrent urinary tract together with early-onset incidence rates with Urologic disease. infections. Dedicated to rising more rapidly than other cancer Since then the Green Valley providing comprehensive, types. Further investigation into whether Urology Clinic has seen compassionate Urologic genes involved in carbohydrate or lipid steady growth and provided care, the clinic is staffed by metabolisms, are expressed differently in Urologic care for local both Dr. David T. Tzou and tumors from early-onset cases compared residents in the region. Alison Grabowski, NP. to late-onset cases. Drs. Batai and Lee also Patients are seen for a variety For appointments, please have started a study to better understand of Urologic conditions call (520) 694-4032. Alison Grabowski, NP kidney cancer surgical disparities, including enlarged as Native Americans and Hispanic Americans have higher kidney cancer mortality rates compared to non‑Hispanic Whites. Their study will identify BANNER – differences in treatment patterns that may UNIVERSITY MEDICINE explain disparities in mortality rates. GREEN VALLEY CLINIC Juan Chipollini, MD, studies urinary microbiome characteristics in bladder 1141 S. La Cañada Drive cancer patients. He published his work Green Valley, AZ 85614 in Urologic Oncology demonstrating Appointments: (520) 694-4032 enrichment of different taxa of the microbiome based on case-control status, Fax: (520) 694-5509 risk groups, and stage. Dr. Chipollini After Hours: (520) 694-6000 plans to expand this research by including more patients undergoing cystectomy to understand how urinary microbes can play a role in bladder carcinogenesis and therapeutic response. Joel Funk, MD, published work in Urology® demonstrating same day outpatient surgery for holmium laser enucleation of the prostate (HoLEP) is safe and outcomes are solid. Even with shorter Continued on page 5

We would like to congratulate and extend a warm welcome to our WELCOME: incoming PGY-1 residents for the 2020-2021 academic year. Dr. Jonathan Seaman comes from Dr. Namita (“Natalie”) Lopes obtained the University of Nebraska College her MD from the Central Michigan of Medicine and is a graduate of University College of Medicine and Colorado State University where he obtained her undergraduate degree double majored in microbiology and in Biochemistry from the University chemistry. He already has several of Michigan, Ann Arbor. Natalie is a peer‑reviewed publications in the field Michigan native and also has several of urology. He is a native of Colorado peer-reviewed publications. In her and in his spare time enjoys rock spare time, she enjoys hiking, reading Dr. Jonathan Seaman climbing, singing and playing the violin. Dr. Namita Lopes and soccer.

urology.arizona.edu 3 RETROPERITONEAL LYMPH NODE DISSECTION SURGERY We have seen a substantial the Department as a beacon of University Of Arizona, we growth in the urologic oncology academic urology serving the work together together with section of the Department in state of Arizona. a multidisciplinary team to both clinical and academic We continue to manage a mitigate barriers to healthcare arenas. Our robotic cystectomy high volume of complex cases that are unique to our state, program continues to grow such as the one highlighted which may pose difficult and our clinical trial team below demonstrating an challenges to those needing is very active in screening tertiary-level care. Dr. Juan Chipollini and enrolling patients into advanced germ cell tumor many of our clinical studies involving the vena cava and Access to surgical care is a at our NCI-designated cancer aorta. The patient underwent big priority for the healthcare program to improve patient center. Research efforts have a Retroperitoneal Lymph Node system, and we continually add access to the healthcare system also been prolific with many Dissection (RPLND) achieving resources to increase access and increase opportunities peer-reviewed publications in excellent local control and while maintaining high-level for multi-disciplinary care during the current academic optimal postoperative outcomes quality of care. We are actively and collaboration throughout year featuring the growth of with negative margins. At the developing our telemedicine the state.

15cm post-chemotherapy retroperitoneal tumor in a patient with (left) metastatic testicular cancer showing (center) complete resection with clear surgical margins. (right) Post RPLND demonstrating skeletonization of the Inferior Vena Cava, Aorta and renal vasculature.

Ava Wong, Research Coordinator University of Arizona, Department of Urology welcomes Ava Wong as our Clinical Research Coordinator. Ava joins our team from her previous Ava Wong appointment as Program Coordinator -Data Analyst with the Pima County Health Department. She is a University of Arizona alumni having earned her MPH, BS, BSHS and is a Certified Health Education Specialist. Ava has been a tremendous help in coordinating consents for the IRB, assisting with Clinical trials, and directing RedCap database management. Employee entrance at Banner – University Medical Center Tucson 4 Department of Urology News, Spring 2020 Urology Research 2020

Continued from page 3

hospital stays, the readmission rate and complication rate were comparable to the rates reported in the peer reviewed literature. Matthew Gretzer, MD, is developing a novel method to identify the presence of urethral obstruction utilizing a non-invasive method. Through fluid dynamics and morphological changes of the voided stream, he hopes to identify criteria that may be used to indicate the presence of obstruction within the urethra. Additional projects are investigating the practice Pictured (left to right): Patrick Evans MD (PGY-2), Chris Lopez RN, Maria Iturralde ST, Norma Mariscal CRNA, Cameron Hinkel MD of early urethral realignment (PGY-3), Joel Funk MD and effect on stricture incidence, need for repeat surgery and post-operative complications compared to BUMC-Tucson Welcomes staged urethroplasty. Christian Twiss, MD, is examining outcomes of Third Robotic System surgery for female pelvic floor disorders, including It has been an exciting year in the operating treatments for incontinence, vaginal prolapse, and vaginal rooms at Banner – University Medical Center ...the average mesh removal. He published Tucson! Not only was there the excitement of in Urology® demonstrating moving into 20 brand new operating theaters number of robotic autologous anterior and in April of 2019, including new cystoscopic apical pelvic organ prolapse capabilities, video intraroom transmission, and cases expects to (POP) repair using autologous two additional shelled out ORs to bring the total fascia lata is an efficacious to 22, we recently welcomed a new team member exceed 200 robotic treatment for patients desiring to these spaces. non-mesh POP repair with In early February 2020, BUMCT added a 3rd procedures in the intermediate outcomes. DaVinci Xi robotic system increasing the total David T. Tzou, MD, studies robotic availability. Dr. Joel Funk and the Urology upcoming year. calculous disease and the team christened the new system by performing a correlation of endotoxin levels Robot-Assisted Sacrocolpopexy on February 7th, With this increased capacity, the average with kidney stone patients’ 2020 as the systems’ inaugural case. The new number of robotic cases expects to exceed treatment outcomes. Dr. Tzou addition of this robot will allow additional 200 robotic procedures in the upcoming year. and his team have also advanced robotic reconstructive techniques, as New techniques utilizing the robotic platform developed a ultrasound‑guided well as allowing oncology and female urology for bladder diverticulectomy, robotic bladder percutaneous case availability to increase as well. Moreover, augmentation and ureteral reconstruction nephrolithotomy (PCNL) the new Xi system allows for integrated table utilizing buccal mucosa are on the horizon. model that has been found movement once the robot is docked, minimizing Finally, 2019 marked an auspicious year for our to provide an affordable the need to dock and un-dock the system for urologic-oncology program, with the first of high‑fidelity solution bilateral renal surgery or complex retroperitoneal several robotic-assisted cystoprostatectomy for for training urologists in surgery for testis cancer. muscle-invasive bladder cancer being offered. ultrasound guided-PCNL. urology.arizona.edu 5 UROLOGY HITS A HOLE IN ONE WITH THEIR FIRST PROSTATE CANCER GOLF BENEFIT The University of Arizona, Department of clinicians can better predict how each Urology hosted the 1st Benefit in theFight individual’s tumor will behave. Against Prostate Cancer Golf Tournament, Following lunch, our Organizing November 9th at Casino Del Sol’s Sewailo Committee held a silent auction, which Golf Club. We came together to honor was a great success and prizes were cancer survivors, raise awareness about awarded to our golf 4-some winners. prostate cancer research, and focused Thank you to our players, sponsors, efforts to be on the cutting edge of volunteers and organizing committee. Our research, education and state of the art inaugural event was quite successful in treatments for our patients. Our goal was raising funds for prostate cancer research. to provide a beautiful venue for cancer Our goals were achieved and a fun time survivors and those who support them. was had by all. November is the month of thankfulness and awareness, and also Prostate Cancer We hope to make this an annual event and Awareness month. hope to see many of you join us next year. It was a beautiful day for golf. During the lunch hour following golf, Dr. Benjamin Lee, Professor and Chairman of the Department of Urology, gave an introduction and talk about our new DEPARTMENT OF UROLOGY 1ST ANNUAL department. Dr. Roger Nellans spoke on GOLF BENEFIT FOR THE FIGHT AGAINST PSA screening and risk factors for prostate PROSTATE CANCER cancer. A grateful patient shared his Sponsored by: personal experience with Robotic Nerve Jon & Kathy Fogg Sparing Radical Prostatectomy, with Dr. Ben & Sharon Lee preservation of bilateral neurovascular BMW bundles, and Kendra Marr MD/PhD Dr. Sunchin Kim Candidate, gave an amazing summary of Brain Wealth ongoing research in the Arizona Cancer Coloplast Center focused on understanding the Univesrity of Arizona Foundation Welcome Back cellular and molecular events that drive prostate cancer progression so that Dr. Sunchin Kim!

The University of Arizona Department of Urology and Banner – University Medical Center Tucson is excited to announce that Dr. Sunchin Kim will be joining the Department of Urology Faculty. Dr. Kim completed his General Surgery Internship and Urology Residency at The University of Arizona and will have completed a Genitourinary Reconstruction Fellowship at The University of California, San Diego, CA (UCSD). Dr. Kim has a variety of clinical interests both in General Urology as well as upper tract reconstruction, in robotic, endoscopic and open approaches. Please join us in welcoming back Pictured (left to right): Benjamin Lee MD, Felice Serrano, Zullie Portugal, Cara Whittingham, Sheila Cabral, Dr. Kim! Belen Alcazar, Natalie Payne, Banesa Pineda, Roger Nellans MD.

6 Department of Urology News, Spring 2020 Reconstructive Urology Visiting Professor

DR. HUNTER WESSELLS

Dr. Hunter Wessells, Chair, University of Washington, with the Faculty and Residents of the University of Arizona College of Medicine. Dr. Hunter Wessells, Professor and Nelson one on Urological Complications of Type 1 visiting professor. The audience was truly Chair of the Department of Urology at Diabetes, and then followed up with a talk impressed with the depth and breadth of Sponsored by: the University of Washington School on Genetics of Erectile Dysfunction: From his reconstructive urologic knowledge. Our Jon & Kathy Fogg of Medicine was the George Drach Bench to Bedside and Back Again. visiting professor for April 13-14, 2021 will Dr. Ben & Sharon Lee Visiting Professor on March 3-4, 2020. The residents, under the guidance of be Kathleen Kobashi, MD, FACS, FPMRS, BMW Dr. Wessells specializes in genitourinary Dr. Matthew Gretzer, Associate Professor of Head of the Section of Urology and Renal trauma, reconstructive surgery and Transplantation at Virginia Mason Medical Brain Wealth Urology, and Dr. Christian Twiss, Residency erectile dysfunction. We welcomed back Center, Director of the Pelvic Floor Center Coloplast Program Director, put together several many of our alumni for the Visiting and Clinical Fellowship in Female Pelvic Univesrity of Arizona challenging case presentations including Foundation Professor lectureship, held in the new ureteral injury, calciphylaxis, bulbar urethral Medicine and Reconstructive Surgery Health Science Innovations Building on stricture, rectal injury and complications (FPMRS). We look forward to seeing campus. Dr. Wessells gave two lectures, of penile prosthesis to challenge the you there! GU Reconstruction and Trauma Update The section of dynamics of voiding and subsequent dorsal rates < 8% at 3 years. The GU Reconstruction, following urethroplasty. urethral buccal mucosa approach to this repair Department of Urology The last year was a robust inlay (middle). Final minimizes risk of fistula, remains vibrant with year (If there’s room outcomes (right) and also better tolerated continued treatment of can add table, if not, demonstrate appropriate by patients with minimal complex cases. We owe surgical images better durability with impact on penile healing gratitude to our local and as single figure) with a Dr. Matthew Gretzer regional urologists for variety of reconstruction reoperation/procedures and cosmesis. their kind referrals. As we and prosthetic cases. enter the 16th year of our The attached figures reconstruction program, demonstrate one of we are approaching the unique complex 900 urethral cases. We cases consistently continue to investigate being performed. As novel ways to follow described by Kulkarni, these men after repair to we are performing penile monitor outcomes, and urethral reconstruction are actively following cases via a perineal with our IRB approved incision (left) with Pictured (left to right): Penis inverted via perineal incision, Ventral urethrotomy with dorsal inlay of protocol to evaluate fluid inversion of the penis buccal graft, Urethrotomy closed and penis reposition.

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OPPORTUNITY TO GIVE: A new ROBOTIC ENDOUROLOGY FELLOWSHIP and/or FEMALE PELVIC MEDICINE & RECONSTRUCTIVE SURGERY (FPMRS) FELLOWSHIP donation can help support fellowship training. Please make a meaningful contribution today at GIVE.UAFOUNDATION.ORG/UROLOGY FOR QUESTIONS CALL: (520)626-2016

SCHEDULE AN APPOINTMENT www.bannerhealth.com/locations/tucson/banner-university-medical-center-tucson (520)694-4032 FAX (520)694-5509 THREE CONVENIENT LOCATIONS Banner – University Medicine North Campus 3838 N. Campbell Ave. Building 2 Urology Clinic “G”, 3rd Floor Tucson, AZ 85719

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