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OSummeLr 2003OGY
Even though radical prostatectomy remains the gold procedure is performed in the same way as the LRP but standard for the treatment of localized prostate cancer, the with the assistance of a daVinci robotic surgical system radical retropubic prostatectomy (RRP) and radical per- (Intuitive Surgical, Inc., Mountain View, CA). This system ineal prostatectomy (RPP) are still associated with signifi- has revolutionalized the way that some centers are cant side effects. Both of these operations have become far approaching minimally invasive urology around the world.
less morbid with the extensive experience of urologists It allows the surgeon to perform the operation while sitting around the world. Improvements in transfusion rates, hos- at a console. This console is equipped with 3-dimensional pital stay, recovery time, erectile dysfunction rates, and uri- visibility, allowing for precise anatomical identification of nary incontinence rates have been remarkable, but they key structures, including small blood vessels and the nerves remain significant enough that many patients are pursuing that drive erectile function. The surgeon also controls two was first attempted in the early 1990’s and wasabandoned because it was found to be techni-cally too demanding. This was especially truewhen it came to the reconstructive aspect of theprocedure. It wasn’t until the mid 1990’s that afew European institutions established LRP as afeasible surgical approach. Centers in theUnited States then began to reassess the viabil-ity of this technically demanding procedure andvalidated the findings in France. Most of thesecenters came to the same conclusion that LRPwas feasible and offered significant benefits topatients once the surgeon made it through the initial learning curve. The advantages of theprocedure included decreased blood loss, decreased trans- robotic arms that have a full range of motion, allowing for fusion rates, decreased pain medication use, and improved much easier dissection and reconstruction as compared to recovery times and they occurred while preserving equiva- standard laparoscopy. In addition, the reconstruction per- lent oncologic results. In addition, some centers have formed with the robot is superior to the reconstruction reported improvements in urinary continence and erectile performed during open surgery. There is no question that dysfunction rates with LRP. It is the initial learning curve the robot provides tremendous advantages to the surgeon of LRP that has been a topic of extensive debate, with in terms of ergonomics and surgeon exhaustion, which many feeling that the technical difficulty of this operation allows him to focus completely on the operation without restricts its widespread applicability.
the physical demands that come with LRP. The surgeon is Robotic Radical Prostatectomy (RobRP) may be the also assisted by a laparoscopic surgeon at the bedside as answer to the technical challenges presented by LRP. This A B i - A n n u a l P u b l i c a t i o n o f t h e D i v i s i o n o f U r o l o g y , D u k e U n i v e r s i t y M e d i c a l C e n t e r , D u r h a m , N C ROBOTIC RADICAL PROSTATECTOMY continued
Since coming to Duke just two years ago, Dr. David W. Patrick Springhart, who all bring vast laparoscopic expe- Albala has managed to bring laparoscopic urology into the rience and interest to the program, which has been invalu- mainstream at Duke University Medical Center. Along able in the birth of the robotic prostatectomy program.
with his team, Dr. Albala has performed over 200 laparo- Duke University Medical Center is now one of the few cen- scopic urologic operations. These have included nephrec- ters in the country offering all surgical options to prostate tomies, nephroureterectomies, partial nephrectomies, pyeloplasties, cyst decortications, and other renal andureteral reconstructive procedures. Together, with the rest "Urologists are becoming increasingly skilled in of the Duke Urology faculty, he continues to build an all- minimally invasive techniques to treat cancer. These inclusive minimally invasive urologic center that is focused advances underscore the need to merge the unique skills on innovative treatments for all urologic diseases. Hisextensive laparoscopic experience has proven invaluable and perspectives of the endourologist and urologic for the initiation of the Robotic Prostatectomy program at oncologist. With the marriage of laparoscopy and Duke University Medical Center. Initial patient feedback oncology in daily practice, we may soon witness has been excellent, with the first patient being discharged the birth of laparoscopic urologic oncology as a Dr. Albala is Co-Director, together with Dr. Glenn Preminger, of the Laparoscopic and Endourologic – From Leonard Gomella’s Editorial: Laparoscopy and Urologic Oncology – I Now Pronounce you Fellowship Program here at Duke. Their current Fellows Man and Wife. J Urol 169: 2057-2058, 2003.
are Dr. Yeh Hong Tan, Dr. James O. L’Esperance, and Dr.
by Philipp Dahm, M.D., Assistant Professor, Duke Urology The Role of Finasteride in the
indiscriminate use of Finasteride as an agent to reduce the Prevention of Prostate Cancer
A recent article published in the New England Journal of Detection of Lymph Node Metastasis
Medicine suggests that Finasteride may have a potential role by MRI with Nanoparticles
in the prevention of prostate cancer (N Engl J Med 349(3):215-224, 2003). In this headline-making article Thompson A further noteworthy paper in the same journal et al. report the findings of a prospective placebo-con- recently reported on a new imaging modality for detecting trolled clinical trial that randomly assigned 18,882 men to lymph node involvement in patients with prostate cancer treatment with Finasteride (5 mg daily) or placebo for the (N Engl J Med 348(25): 2491-2499, 2003). Magnetic reso- duration of seven years. They found that significantly nance imaging (MRI) with lymphotropic superparamag- lesser patients in the Finasteride group compared to the netic nanoparticles was performed in 80 patients who placebo group (18.4% versus 24.4%) were diagnosed with subsequently underwent formal pelvic node dissection.
prostate cancer. Additionally, among those patients diag- Thirty-three patients (41%) were found to have positive nosed with prostate cancer, a high Gleason score disease nodes that were all preoperatively identified using this (Gleason score > 7) was twice as common in the enhanced MRI technique. The sensitivity of identifying a Finasteride than the placebo group (37.0% versus 22.2%).
single positive node by MRI with nanoparticles was vastly The reason behind the increased prevalence of high grade superior to MRI alone (90.5% versus 35.4%). The positive disease in the Finasteride group remains poorly under- predictive value of identifying a positive individual lymph stood. Gleason scoring bias, the induction of high grade node was 95.0%. The authors suggest that MRI with disease or the selective inhibition of low-grade tumors may nanoparticles may – if these results are confirmed in a all play a role. The study fails to answer the question larger study – provide important preoperative staging whether Finasteride indeed prevents prostate cancer or information that may make staging node dissection unnec- merely delays or alters its presentation. Pending further evidence, it appears prudent to caution patients against an D U K E U R O L O G Y T O D AY
After six years of service to Duke Urology, Dr.
John S. Wiener has accepted a position as Chief of Urologyat the University of Mississippi Medical Center. Dr. Wienerjoined our faculty in 1997 after completing his undergradu-ate studies and urology residency at Duke and a fellowshipwith Dr. Edmond Gonzales at Texas Children’s Hospital.
Upon his return to Duke, Dr. Lowell King retired after a dis-tinguished career as Head of Pediatric Urology and Dr.
Wiener assumed his position. Since that time, he has givencountless hours of devotion to expanding the clinical prac-tice of pediatric urology at Duke to its current level. Dr. Wiener’s commitment to patient care, presented withgenuine caring, and his energetic, well-rounded approach Dr. Wiener crowns Gloria Perry, “Queen of Cath” Friend and co-worker, Beth Stewart, Director of During a celebration at the Searle Center on May 19, Advanced Practice Nursing says of Gloria, “She has 2003, friends, family, and co-workers gathered to celebrate literally touched the lives of thousands of patients the retirement of Gloria Perry, R.N. after 35 years of service and families through her remarkable clinical expertise, to Duke. Gloria’s career began in 1968 when she joined the her tender touch, her excellent teaching, and her Urology Clinic as a Staff Nurse. In 1972, Gloria was pro- compassion as she’s helped many cope with and adjust to moted to Head Nurse of the clinic and in 1975 she received life-altering and body-changing procedures. Her patient’s an appointment as Urology Nurse Clinician. The remainder have described her as a “gift from God.” Talk with her for of her career at Duke was spent with the Department of even a few minutes and you’ll find one of the most unassum- ing, deeply spiritual, caring individuals, not just in nursingbut on this earth.” UROLOGY RESIDENCY TRAINING PROGRAM
2003 Duke Urology Graduates
Bertram A. Lewis, Jr., MD,
Jeffrey J. Sekula, MD
Dinesh S. Rao, MD
Ning Z. Wu, MD, Ph.D.
Pictured left to right: Dinesh S. Rao, MD, Ning Z. Wu, MD, Ph.D., Bertram A. Lewis, Jr., MD, Ph.D, and Jeffrey J. Sekula, MD ADDITIONAL RESIDENT HONORS AND AWARDS
Costas D. Lallas, M.D. received the Pfizer Scholar Award.
Jeffrey J. Sekula, M.D., Fernando C. Delvecchio, M.D. and Costas D. Lallas, M.D. received Academic
Ganesh V. Raj, M.D., Ph.D. received 2nd place for “Excellence in Urological Clinical Case Presentation” at the Annual
Alon Z. Weizer, M.D. received 3rd place for “Excellence in Urological Research Case Presentation” at the Annual
Duke Health Center, formerly known as the Duke Community Urology Center, has moved to a new location at 3116 North Duke Street in Durham. Duke urologist’s Thomas J. Polascik, M.D. and Brian C. Murphy, M.D. are Co-Directors of this specialty practice that was established in 1998 to provide urological evaluation and treatment to the Durham community.
Hours of operation are Monday thru Friday from 8:30 am to 5:00 pm. Appointments can be scheduled by calling (919) 684-2446.
Duke Health Center
3116 North Duke Street
Durham, NC 27704
Phone: 919-660-2200
Kudo’s …………….
Cary N. Robertson, M.D., Associate Professor of Urology and John S. Wiener, M.D., Associate Professor of
Urology and Assistant Professor of Pediatrics were named “Top Doctors in Urology for the Triangle Area” in the July2003 issue of Business North Carolina. Information for this listing was compiled by a non-profit research organization thatsent questionnaires to nearly all physicians in the Charlotte, Triad and Triangle areas of the State. Each physician wasasked to recommend the specialists they would consider as “most desirable for care of a loved one.” The doctors chosenwere named by the largest numbers of their peers.
Wendy Demark-Wahnefried, Ph.D., Associate Professor of Urology, received the 2003 Komen Professor of
Survivorship Award from the Susan G. Komen Breast Cancer Foundation. Established in 1999, this award recognizes and rewards efforts and achievements that improve the overall quality of life for breast cancer survivors.
The Urology Clinic Staff was one of four Duke outpatient clinics recognized during National Patient Advocacy
Week (April 13-18, 2003) for their outstanding team approach in creating excellent patient service and patient advocacy.
Duke University Medical Center
Durham, NC
Course Director: David M. Albala, M.D.
Professor of Urology
April 18
June 6 (Advanced Hand-Assist procedures)
July 12
August 8
September 12
October 10
November 21
December 5 (Advanced Hand-Assist procedures)
For further information or to register for the course, please contact: Allison Benjamin
Applied Medical • 22872 Avenida Empresa • Rancho Santa Margarita, CA 92688 FUTURE CONFERENCES
1:00-6:00 pm
1:00-6:00 pm
thru 2/7/04
thru 3/14/04
For more information, please call us at (919) 684-2033
or visit our website: www.dukeurology.com
919-684-2033 (Administrative Office)919-684-4611 (Fax) DIVISION OF UROLOGY CLINICAL FACULTY
David F. Paulson, M.D.
Bertram A. Lewis, Jr., M.D., Ph.D.
Cary N. Robertson, M.D.
Specialty: Urologic Oncology & General David M. Albala, M.D., F.A.C.S.
Johannes Vieweg, M.D.
Brian C. Murphy, M.D.
Specialty: Endourology & Minimally Specialty: Urologic Oncology & General Specialty: Urologic Oncology & Cindy L. Amundsen, M.D.
Assistant Professor of Obstetrics &
Thomas J. Polascik, M.D., F.A.C.S.
Philip J. Walther, M.D., Ph.D.,
Specialty: Urologic Oncology & General Associate Professor of PathologySpecialty: Urologic Oncology Philipp Dahm, M.D.
Glenn M. Preminger, M.D.
George D. Webster, M.B., F.R.C.S.
Specialty: Urologic Oncology & Specialty: Nephrolithiasis & Minimally Specialty: Reconstructive & Female Craig F. Donatucci, M.D.
Associate Professor of Urology
Specialty: Male Infertility & Sexual
Duke Urology Today is published twice a year by the Division of Urology
at Duke University Medical Center. Comments and inquiries are welcome
and should be sent to:

For more information,
Joan McAlexander, Editor
please visit our website at www.dukeurology.com
DUMC 3707
Durham, North Carolina 27710

Source: http://urology.surgery.duke.edu/files/Summer2003_UrologyNews.pdf


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