Spring 2016 Message from the Chief - Duke Department of Surgery › sites › surgery.duke.edu › files... · 2017-09-19 · next generation of urologic clinicians and scientists

The missions of Duke Urology are to provide compassionate and exceptional care for our patients suffering from urologic condi-

tions; to advance the field of Urology through inno-vation in basic and clinical research and to train the next generation of urologic clinicians and scientists. I believe that this issue of the Duke Urology News-letter demonstrates that we continue to grow the team across all of our missions. As we finalize this issue of the Newsletter, we have just returned from the Duke Urologic Assembly Meeting in Hilton Head, SC, where close to 75 participants learned from 14 of our Duke Urology faculty members, as well as five of our partners from Medical Oncology, Radia-tion Oncology and the Duke Cancer Center (http://urology.surgery.duke.edu/education-and-training/continuing-medical-education-cme/dua-2016). The DUA continues to be one of the oldest post gradu-ate courses in the United States as this was our 48th iteration of a comprehensive review of urology. This event is only one example of our educational mis-sion to improve care for patients afflicted by various urologic conditions.

The Newsletter highlights a number of additional missions where we continue to excel. John Wiener reviews the tremendous advances that we have made

within Duke Pediatric Urology. Now with five members of the Duke Pediatric Urol-ogy Team, we not only offer all-inclu-sive care for pediat-ric patients, but also provide tremendous Clinical and basic sci-ence research exper-tise. Todd Purves and Monty Hughes offer a summary of their innovative and im-

portant research in bladder dysfunction. In addition, Leah Gerber Davis reviews the significant expansion of our clinical research efforts utilizing the compre-hensive Duke Urology Clinical Database to answer clinical questions and to further utilize this informa-tion to support our educational efforts. Mike Lipkin, who currently serves as the Chief of the Clinic for the Duke Department of Surgery, provides us with the outstanding improvements being made in the clinical arena both in our outpatient and inpatient operations. In our partnership with Duke Health, we believe that our multiple providers, including addi-tional sites of care such as Duke Urology of Raleigh, now offer our patients a myriad of opportunities to provide cutting edge clinical care. Towards that end, Aaron Lentz, who directs our Duke Urology of Ra-leigh office, provides our vision for the Duke Center for Male Wellness which will officially open later this spring. This new initiative will now provide an in-credible range of services for Men’s Health including sectional sexual dysfunction, urinary incontinence, infertility, low testosterone and BPH in one easy to access location. Finally, Chuck Scales reiterates cur-rent innovations in urologic education not only for our students, residents and fellows, but for practic-ing urologists as well.

Our Residency Program had a major showing at the recent SESAUA meeting in Nashville with over 40 presentations by our medical students, residents, and fellows. Similarly, we expect an even bigger presence at the AUA annual meeting in San Diego this May. We hope to see all of you at our DYS-URIA Reception during the AUA meeting on Satur-day evening, May 7 (http://urology.surgery.duke.edu/dysuria). Please stop by to say catch up with our current faculty, fellows and residents and also to connect with your fellow DYSURICs from around the world. We continue to appreciate your support and hope that you can attend a future Duke Urology event either in Durham or at another educational venue across the US.

DUKE UROLOGY UPDATESpring 2016

Message from the Chief

Glenn M. Preminger, MDChief of the Division of Urology

DUKE UROLOGY

A Divisionof the Department of Surgery

INSIDE:

Pediatric Urology .. 2

Research Initiatives 6

Statistics & Ed ....... 7

Clinic Operations .. 8

Ed Innovation ....... 9

Male Wellness ....... 10

All the best,

2 • DUKE UROLOGY UPDATE • SPRING 2016

PEDIATRIC UROLOGY

P ediatric Urology at Duke continues to grow as a clinical center of excellence in the Southeast and as a research leader nationally. The pro-

gram has earned national ranking in pediatric urology every year by US News and World Report. The addi-tion of new providers in the past year has boosted our productivity on both fronts. Maryellen Kelly, DNP joined in May 2015, bringing her clinical expertise from Children’s Hospital of Orange County, CA, and J. Todd Purves, MD, PhD arrived in July 2015 from Medical University of South Carolina.

The clinical enterprise includes clinical locations at Duke Children’s Health Center on the main campus, Southpoint clinic in south Durham, Duke Children’s Specialty Services in Raleigh, and Duke Children’s Specialties of Greensboro, as well as the Duke Com-prehensive Spina Bifida Clinic at Lenox Baker Children Hospital in Durham. With three pediatric urologists, two nurse practitioners, and a pediatric urotherapy nurse, Duke Pediatric Urology is able to offer care from consultations for fetal uropathies before birth to surgical and medical management of urologic problems throughout children and into adulthood for those with congenital urologic disorders. We have the only pediatric urodynamics and pelvic floor bio-feedback facility in the state. Surgery is performed at Duke University Hospital, Duke Ambulatory Surgery Center, and Duke Raleigh Hospital from the simple to the most complex reconstructive cases, including robotic assisted laparoscopic procedures. John S. Wiener, MD is director of the urologic portion of the Duke Comprehensive Spina Bifida Clinic and Fetal Urology Clinic. Jonathan C Routh, MD, MPH is in charge of the pediatric urologic oncology program

and sits on the national Chil-dren’s Oncology Group, as well as initiating Duke Center for Child and Adolescent Gen-der Care. Dr. Purves is director of the Duke Pediatric Stone Clinic, and Cythnia Camille, FNP continues to head up the Achieving Bladder Control at Duke (ABCD) clinic.

Research in pediatric urol-ogy is truly taking off. Duke is the only center in the country where all of the urolo-gists are federally-funded researchers. Dr. Wiener is the Principal Investigator at Duke for the CDC’s National Spina Bifida Patient Registry with over 350 patients enrolled locally (and 6000 nationally) and re-cently initiated Urologic Protocol for Young Children. The latter study is chaired nationally by Dr. Routh and is a prospective protocol to determine the optimal urologic management of children with spina bifida from birth to five years. Dr. Wiener is continuing as Co-Director of a NIH-funded center at Duke employ-ing whole exome analysis to identify genetic causes of congential abnormalities of the kidneys and urinary tract.

Dr. Routh is in the third year of his NIH K-08 award and continues to mentor PGY-3 residents and Duke medical students during their respective research years. His work is focused on health services and population-level analyses of pediatric urology topics, particularly vesicoureteral reflux, urolithiasis, spina bi-fida and neurogenic bladder, Wilms tumor, and disor-ders of sex development. By defining the underlying

Pediatric Urology Updatesby John Wiener, MD

n

John Wiener, MD

DUKE UROLOGY UPDATE • SPRING 2016 • 3

evidence behind surgical decision-making, primarily through identifying variations in surgical practice, he aims to improve overall care with a proven sci-entifically sound approach. His groundbreaking work resulted in 15 peer-reviewed publications in 2015. Further demonstrating the breadth of his curiosity, he was recently awarded the internal Department of Surgery Clarence Gardner Grant to conduct basic science immunologic investigation of Wilms tumor specimens.

Dr. Purves arrived at Duke with his lab director Francis “Monty” Hughes, PhD last summer with a newly awarded NIH R-01 grant in hand titled “Inflam-masomes Mediate Inflammation in Bladder Outlet Obstruction.” They have established Duke University Urinary Dysfunction (DUUD) Laboratory on Research Drive to investigate inflammatory mechanisms of de-terioration of the obstructed bladder in rats mediated by inflammasones. This work is applicable to, not just pediatric urologists managing boys with posterior urethral valves, but to most urologists managing men with prostatic enlargement. Their goal to is to identify

pharmacologic mechanisms to alter the innate immune system in order to pre-vent bladder deterioration. In a related mech-anism, they have found a l i p o p o l y s a c -charide in cell membranes of gram negative uropathogens responsible for activating in-f l ammasones

during cystitis, offering an avenue to enable faster recovery from UTIs. This sum of this work has resulted in three publications in the past four months. They are branching out to investigate the role of inflam-masones in diabetic bladder dysfunction; the promise of this work has led to the recent announcement that PGY-2 resident Brian Inouye, MD was awarded the

2016 Urology Care Foundation/ AUA Residency Re-search Award to work with Drs. Purves and Hughes next year. This marks the third time in the seven years of this award’s existence that it has been won by a Duke resident doing basic science research in pediat-ric urology!

Dr. Purves is also working on constructing a three dimensional map of bladder innervation. This will allow chemodenervation of the neurogenic or overac-tive bladder with agents such as BoTox to more selec-tive target appropriate nerves where they penetrate the bladder wall while avoiding the risk of urinary retention. The ultimate goal of this work based on human cadaveric specimens is to develop an optimal bladder injection template for chemical agents.

Finally, Dr. Purves has begun work on an environ-mentally-friendly biodegradable urinary catheter for patients who require intermittent catheterization of their bladder. This work will allow patients to flush their catheters down the toilet after use to avoid em-barrassment and contributing to trash in our landfills. We are grateful to one of patients who has contrib-uted funds to CURED to directly impact the lives of patients with spina bifida.

Maryellen Kelly, DNP is continuing her research that she began in California involving management of neurogenic bladder in spina bifida patients and transi-tion of care in patients as they reach adulthood. She presented her work at the Society of Pediatric Urology meeting in Prague in October and will be presenting at the AUA meeting in San Diego.

Recent publications continued on next page.


RESEARCH con’t.Continued from page 3.

Recent publications:

1. Wang HH, Wiener JS, Ross SS, Routh JC. Emergency Department Care Patterns in Spina Bifida Patients:

a Case-Control Study. Journal of Urology. 193(1):268-73, January 2015.

2. Wang HH, Gbadegesin RA, Foreman JA, Nagaraj SK, Wigfall DR, Wiener JS, Routh JC. Efficacy of

Antibiotic Prophylaxis in Children with Vesicoureteral Reflux: Systematic Review and Meta-Analysis.

Journal of Urology, 193(3):963-9, March 2015.

3. Wang HH, Wiener JS, Ferrandino MN, Lipkin ME, Routh JC. Complications in Surgical Management of

Upper Tract Calculi in Spina Bifida Patients: Analysis of Nationwide Data. Journal of Urology, 193(4):1270

4, April 2015.

4. Wang HH, Lipkin ME, Scales CD Jr, Wiener JS, Routh JC. Estimating the Nationwide Hospital-Based

Economic Impact of Pediatric Urolithiasis. Journal of Urology, 193(5 Suppl):1855-9, May 2015.

5. Rialon KL, Gulack BC, Englum BR, Routh JC, Rice HE. Factors Impacting Survival in Children with Renal

Cell Carcinoma. Journal of Pediatric Surgery. 50(6):1014-8, June 2015.

6. Wang HH, Tejwani R, Zhang H, Wiener JS, Routh JC. Hospital Surgical Volume and Associated

Post-Operative Complications of Pediatric Urologic Surgery in the United States. Journal of Urology,

194(2):506-11, August 2015.

7. Nelson CP, Routh JC, Logveninko T, Rosoklija I, Prosser LA, Kokorowski PJ, Schuster M. Utility scores for

vesicoureteral reflux and anti-reflux surgery. Journal of Pediatric Urology. 11(4):177-82, August 2015.

8. Rice HE, Englum BR, Gulack BC, Adibe OO, Tracy ET, Kreissman SG, Routh JC. Use of patient registries

and administrative datasets for the study of pediatric cancer. Pediatric Blood and Cancer. 62(9):1495

500, September 2015.

9. Velasquez NM, Zapata D, Wang HH, Ross SS, Wiener JS, Lipkin ME, Routh JC. Medical Expulsive Therapy

for Pediatric Urolithiasis: Systematic Review and Meta-Analysis. Journal of Pediatric Urology. 11(6):321-7,

December 2015.

10. Wilcox Vanden Berg RN, Bierman EN, Van Noord M, Rice HE, Routh JC. Nephron-Sparing Surgery for

Wilms Tumor: a Systematic Review. Urologic Oncology. 34(1):24-32, January 2016.

11. Elahi S, Homstad A, Vaidya H, Stout J, Hall G, Wu G, Conlon P Jr, Routh JC, Wiener JS, Ross SS, Nagaraj

S, Wigfall D, Foreman J, Adeyemo A, Gupta IR, Brophy PD, Rabinovich CE, Gbadegesin RA. Rare

Variants In Tenascin Genes In a Cohort of Children With Primary Vesicoureteric Reflux. Pediatric

Nephrology. 31(2):247-53, February 2016.

12. Wang HS, Herbst KW, Rothman JA, Shah NK, Wiener JS, Routh JC. Trends in Sickle-Cell-Disease-Related

Priapism in U.S. Children’s Hospitals. Urology. ePub ahead of print, December 2015.

13. Wang HH, Lloyd JC, Wiener JS, Routh JC. Nationwide Trends and Variations in Urologic Surgical

Interventions and Renal Outcome for Spina Bifida patients. Journal of Urology. In Press.


14. Lloyd JC, Hornik CP, Benjamin DK, Clark RH, Routh JC, Smith PB. Effectiveness of Urinary Antimicrobial

Prophylaxis in Hospitalized Infants. Clinical Pediatrics. In Press.

15. Wang HH, Tejwani R, Wolf S, Wiener JS, Routh JC. Surgical Outcomes for Pediatric Urolithiasis: Increased

Retreatment Rates with Shockwave Lithotripsy Compared to Ureteroscopy. Journal of Urology. In Press.

16. Ellett J, Prasad MM, Purves JT, and Stec AA. Post-surgical infections and perioperative antibiotics usage

in pediatric genitourinary procedures. J Ped Urol, 11(6): 358.e1-358e6, December 2015.

17. Hughes FM, Turner DP, Purves JT. The potential repertoire of the innate immune system in the bladder

expresstion of pattern recognition receptors in the rat bladder and a rat urothelial cell line (MYP3 cells).

Int Urol Nephrol, 47(12): 1953-1964, Oct 2015.

18 Hughes FM, Hill HM, Wood CM, Edmondson AT, Dumas A, Foo WC, Oelsen JM, Rac G, and Purves JT.

The NLRP3 inflammasome mediates inflammation produced by bladder outlet obstruction. J Urol.

In press.

19. Hughes, FM, Kennis JG, Youssef MN, Lowe DW, Shaner BE, and Purves JT. The NACHT, LRR and PYD

domains-containing protein 3 (NLRP3) inflammasome mediates inflammation and voiding dysfunction in

a lipopolysaccharide-induced rat model of cystitis. J Clin Cell Immunol. In Press.

20. Kelly MS, Hannan M, Cassidy B, Hidas G, Selby B, Khoury AE, McLorie G. Development, reliability and

validation of a neurogenic bowel dysfunction score in pediatric patients with spina bifida. Neurourol

Urodyn. 2016 Feb;35(2):212-7.

21. Hidas G, Lee HJ, Bahoric A, Kelly MS, Watts B, Liu Z, Saharti S, Lusch A, Alamsahebpour A, Kerbl D,

Truong H, Zi X, Khoury AE. Aerosol transfer of bladder urothelial and smooth muscle cells onto

demucosalized colonic segments for bladder augmentation: in vivo, long term, and functional pilot study.

J Pediatr Urol. 2015 Oct;11(5):260.e1-6.

22. Hidas G, Billimek J, Nam A, Soltani T, Kelly MS, Selby B, Dorgalli C, Wehbi E, McAleer I, McLorie G,

Greenfield S, Kaplan SH, Khoury AE. Predicting the Risk of Breakthrough Urinary Tract Infections: Primary

Vesicoureteral Reflux. J Urol. 2015 Nov;194(5):1396-401.

24. Kelly MS, Dorgalli C, McLorie G, Khoury AE. Prospective evaluation of Peristeen® transanal irrigation

system with the validated neurogenic bowel dysfunction score sheet in the pediatric population.

Neurourol Urodyn. In press.

25. Ajay D, McNamara ER, Austin S, Wiener JS, Kishnani P. Lower Urinary Tract Symptoms and Incontinence

in Children with Pompe Disease. JIMD Rep. In press.

26. McNamara ER, Austin S, Case L, Wiener JS, Peterson AC, Kishnani PS. Expanding our understanding of

lower urinary tract symptoms and incontinence in adults with pompe disease. JIMD Rep. 2015;20:5-10.

B ladder outlet obsruction can occur in response to many agents such as bladder stones and in response to many different conditions, such

organ prolapse in older women or congenital de-fects in children, but by far the most prevalent and clinically important cause of BOO is BPH in older men. Consider the typical BPH patient who presents to his physician. If presenting in the early stage of the condition, he will likely complain of urinary hesitancy, slow stream, straining, and difficulties emptying the bladder, all classical symptoms of obstruction. The vast majority of these men will be started on alpha blockers to relax the sphincter and/or a 5-alpha re-ductase inhibitor to shrink the prostate. Few men at this point will opt for surgical resection of the pros-tate due to its morbidity and potential complications and, in fact pharmacotherapy is very effective in re-ducing symptoms to a tolerable level. However, this treatment does not completely eliminate the patho-logically high bladder pressures that the patient will experience. Over time these persistently elevated pressures produce a chronic non-pyrogenic inflam-matory state, referred to in other fields as meta-in-flammation, that leads to irritative symptoms such as urinary frequency, urgency and urge incontinence. Meta-inflammation eventually leads to bladder fibro-sis and once fibrosis is established, current therapies, such as invasive de-obstruction surgery, have poor success rates in relieving patients of their symptoms.

The Duke University Urinary Dysfunction Labora-tory, led by Dr. J Todd Purves MD, PhD and Monty Hughes Jr. PhD received a four year R01 grant, en-titled “Inflammasomes Mediate Inflammation in Bladder Outlet Obstruction” from the NIH-NIDDK to study this problem. Their lab was the first to local-ize and characterize several types of pattern recog-

nition receptors that form supramolecular complexes, called inflammasomes, in bladder tissue. These struc-tures are able to sense stress from external sources such as pressure or stretch and they can recognize distress signals from neighboring cells to initiate the process of inflammation. In an arti-cle published this year in the Journal of Urology, they demonstrated for the first time how the NLRP3 inflammasome located in the bladder urothelium becomes activated during outlet obstruction, leading to inflammation and pathologic changes in urinary physiology. Blocking the activa-tion of the inflammasome with a pharmacological inhibitor diminished the inflammatory response to BOO and prevented inflammation-induced changes in voiding function as determined by cystometry.

The results from this project may produce an im-portant therapeutic target that we can use to better treat our patients whose urinary symptoms arise from obstructive causes. More generally, an understand-ing of how the innate immune system senses and responds to environmental changes may open new avenues in how we approach many other chronic urologic problems. In the aging bladder, traumatic episodes from recurrent urinary tract infections, sur-gery or from hostile conditions such as diabetes all contribute to a life-long inflammatory process that culminates in functional deterioration. Specific mod-ulation of the innate immune system will allow us to mitigate sterile inflammation and prevent LUTS in our aging population.

Todd Purves, MD

RESEARCH con’t.

Pediatric Urology Research Initiatives

by Todd Purves, MDn



STATISTICS & ED

T he current trend in the healthcare industry is towards a rapid digitization of health records. Historically, a big challenge in research has

been finding the data to analyze. Today, we have massive amounts of diverse data at our fingertips which bring revolutionary implications by potentially improving outcomes while lowering costs. These ‘big data’ bring enormous opportunities but also significant risk and require careful research consid-eration.

“The importance of high quality statistical analysis in modern urological research can-not be overemphasized. Rigorous and techni-cal statistical data analysis allows not only for more accurate and reproducible research, but also tends to lead to the use of novel and more informative research methodologies than those available to most researchers. As Duke Urology pushes forward in the next decade, I envision our research portfolio to consist of projects of only the highest level of quality and with the best probability of significant medical impact. Without a doubt, biostatistics will be a corner-stone of this vision.” – Brant Inman, MD

There is considerable value in integrating sub-ject matter knowledge with biostatistical support to facilitate research by providing methodological expertise and by closely collaborating with faculty and trainees on all aspects of research studies from design and conduct of experiments, the mode and manner in which data are collected or obtained, the analysis of data, and the interpretation of results. By combining breadth of expertise in urologic research, data management, data visualization, and analytics we will ensure that Duke Urology remains at the forefront of urologic research.

“As the quantity and quality of our research in the Division of Urology grows, we are in-creasingly going to need high quality statistical insight provided in a timely manner by some-one well versed in urological research. To this end, we have helped support the development of Leah Gerber Davis, who currently oversees all Urology data issues, to obtain Master’s of Science level training in Biostatistics at Duke. Leah is a very talented individual and seeing her grow academically is precisely the type of thing we want to encourage within our Divi-sion.” – Brant Inman, MD

Duke Urology’s commitment to research and education, coupled with collaboration with Duke’s strong program in Biostatistics, provides a logical and seamless path to maintaining and promoting state-of-the-art analytic methods and expertise within Urology.

“It is my belief that allowing our research

team to grow professionally by supporting training opportunities will increase their job satisfaction, improve the quality of the work provided, and ultimately position Duke to bet-ter lead the field of Urology in the future.”

– Brant Inman, MD

Statistics & Educationby Leah Gerber Davis

n


CLINIC OPERATIONS

Urology is unique amongst surgical specialties in that we not only perform surgeries, we also medically manage a number of conditions.

Due to this fact, we spend approxi-mately 50% of our clinical time seeing patients in the clinic. Clinical operations can be complex requiring coordination of a number of sepa-rate processes and functions. These include patient scheduling, patient check-in and intake, preparing and completing procedures, and provid-ing education and instructions upon discharge of patients from clinic. When these processes are not in sync, it can negatively impact both patient and provider satisfaction.

Recently there has been re-newed interest in rigorously evalu-ating clinical operations within the PDC and Health System. Under the guidance of Dr. David Attarian, Chief Medical Office for the PDC, the PDC has held two clinical lead-ership summits. These have been in-teractive, one day summits focused on identifying both issues hindering the proper functioning of the clin-ics as well as best practices that can be shared between the clinics. These summits are the beginning of a process to bring improvements to the clinic environment and experience.

On the hospital side, Chad Seastrunk, Vice Presi-dent of Ambulatory Operations for Duke Hospital, has formed an Ambulatory Executive Committee made up

of physician clinic leaders as well as himself and nursing leader-ship. The goal of this committee is to identify issues in the opera-tions of the hospital based clinics as well as to share processes that are working amongst the clinics. This committee is a genuine ef-fort to increase the involvement of physician leaders in decision making and operations of the hospital based clinics. This is a tremendous step forward and will hopefully lead to better un-derstanding and communication between providers and hospital leadership.

The goal of both these ini-tiatives is to standardize and improve the clinical experience for providers in PDC and hospi-tal based clinics. The groups are dedicated to identifying ways to better support providers in delivering timely and excellent care to their patients. Though

we have a number of challenges that need to be ad-dressed, these are two very positive steps toward im-proving the clinic experience.

Clinic Operations:Engagement and dedication toward improvement

by Michael Lipkin, MDn


ED INNOVATION

Residents today must learn not only the funda-mentals of urology, but also the increasingly important principles of patient safety and qual-

ity improvement. These are critical skills for future practice in an environment that will place greater em-phasis on patient outcomes than ever before. How-ever, several barriers challenge resident education in this area, including limited faculty expertise, time de-mands of clinical care, and geographic distribution of learners across multiple training sites.

To overcome these chal-lenges, Dr. Chuck Scales, along with colleagues at UCLA, cre-ated a curriculum about qual-ity improvement and patient safety, and delivered it via a web-based, mobile-compatible platform. The curriculum was delivered to approximately 400 resident physicians from mul-tiple specialties at UCLA.

“One of our goals was to discover how we could create greater engagement in the program among the resi-dents,” said Scales. Participants in the educational program were randomized to either a team compe-tition environment, or an individual progress envi-ronment. In the competition environment, residents were assigned to teams based on their specialties (urology, general surgery, etc.). Each week, teams would be ranked by average score and a leaderboard

distributed to participants. In the individual progress environment, participants only saw how many key topics they had attempted and mastered. The game also used adaptive reinforcement and spaced learn-ing, evidence-based techniques to improve knowl-edge uptake and retention.

The results of the randomized trial were recently published in the International Journal for Quality in Health Care. The team competition environment

increased resident participation on several measures. Competition residents answered questions faster and attempted more questions at least once. In addition, a dose-response rela-tionship was observed: the longer a resident was in the competition environment, the greater the difference in participation versus the individual progress arm.

These findings support the use of behav-ioral economic principles, such as natural alle-giances and low-stakes competition, to increase physician engagement in educational activities. To explore this further, Dr. Scales has obtained funding from the Society of Urologic Chairper-

sons and Program Directors to develop and deploy a urology-specific program regarding quality improve-ment. The program will simultaneously compare the effect of team competition to individual lottery-based incentives to determine which approach fos-ters greater resident engagement. The program will be deployed to approximately 40 urology residency programs across the United States.

Educational Innovation: Novel methods for teaching quality improvement

by Charles Scales, MDn

Charles Scales MD


MEN’S HEALTH

F or many years, Men’s Health has focused

on single-system diseases, mostly of the GU tract. Prob-lems were isolated and treated in a tar-geted fashion with little consideration for the inter-relatedness of systems or the influence of factors beyond the GU tract.

At Duke, an evolution is occur-ring for Men’s Health. Much of what men are concerned about as they age – sexual dysfunction, urinary incon-tinence, infertility, low testosterone, and enlarged prostate glands – falls to urologists to treat. These sensitive health topics frequently bring men to the doctor when they might other-wise be reluctant to have an annual physical exam with their primary care physician. Urologists have a unique opportunity to influence healthy life-style choices while developing con-sistent, sustained relationships with their patients. Recognizing this op-portunity, Duke Urology now offers an innovative program caring for male patients.

Duke Center for Male Wellnessby Aaron Lentz, MD

n

Aaron Lentz, MD


The Duke Center for Male Wellness (DCMW) is a comprehensive approach to Men’s Health that will promote collaboration between specialists to elimi-nate barriers and coordinate care in all areas of men’s health. The DCMW will simplify the health care expe-rience so that the first point of contact becomes the gateway for access to all-inclusive specialty care.

“Our Duke Raleigh team is committed to improv-ing the health of our local community in all of our initiatives”, say Duke Raleigh President David Zaas, MD. “The launch of the Duke Men’s Health Program in Raleigh is an exciting next step to help improve the outcomes and quality of life for men in Wake County by providing the highest quality multi-disciplinary ser-vices all coordinated to provide the best experience for our patients.”

The DCMW will be located on the 5th Floor of Medical Office Building 8 on the campus of Duke Ra-leigh Hospital. The center will offer the services of two urologists, Aaron Lentz, MD and Brian Whitley, MD, an advanced practice provider, and a patient navigator. Included in the DCMW will be a primary care physician offering annual physical exams and preventive care exams for men. Additional services will include laboratory testing to assess for diabetes, HTN, hyperlipidemia as well as referrals to other ancil-lary health services such as physical therapy or regis-tered dietician when a fitness evaluation or nutritional assessment is required.


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Spring 2016 Message from the Chief - Duke Department of Surgery › sites › surgery.duke.edu › files... · 2017-09-19 · next generation of urologic clinicians and scientists