The University of Michigan Department of Urology 3875 Taubman Center, 1500 E. Medical Center Drive, SPC 5330, Ann Arbor, Michigan 48109-5330 Academic Office: (734) 232-4943 FAX: (734) 936-8037 www.medicine.umich.edu/dept/urology http://matulathoughts.org/

What's New August 24, 2018

NPR Division Update

Urology Department Faculty and Staff

7 Items, 18 Minutes

Good morning, everyone! I’ll be brief because we have a lot of great content to get to, today! I’d like to thank everyone from the Neurourology and Pelvic Reconstruction Division for contributing such a great array of updates, and I hope everyone has a good weekend before the arrival of football season. Now, please enjoy today’s edition of What’s New!

-Eric Anderson Dr. Irene Crescenze (with Drs. John Stoffel, Paholo Barboglio Romo and Diana O’Dell) PCORI Update Patient Centered Outcomes Research Institute sponsored a trial on the bladder-related quality of life in patients with SCI, recruited over 1400 patients over 1.5-year period and followed them for 1 year. The study was a combined effort of the University of Michigan, University of Minnesota, University of Utah, as well as Western University in Canada and recruited patients all across the US. The study is now closed and the final follow-up data has been collected. The baseline analysis so far has showed a significantly higher quality of life in patients who have had surgical management of their neurogenic bladder dysfunction (including continent and incontinent diversions, augmentation, and catheterizable channels) as opposed to those managed with clean intermittent catheterizations. The one year follow up data has just been finalized and we will hopefully bring some interesting findings to the AUA next year. Giulia Lane (with Dr. Priyanka Gupta) Resident Cadaver Lab

The NPR division has secured funding to host two cadaver labs for residents and fellows this fall. The first session on August 4th provided PGY-3 and PGY-4 residents with training and simulation in female pelvic reconstruction. The course included a 1-hour didactic session followed by a 4-hour cadaver simulation session. Residents were guided through performing mid urethral sling procedures, open sacrocolpopexy and Interstim lead placement by Dr. Gupta, Dr. Barboglio Romo and the NPR fellows (Irene Crescenze, Giulia Lane) and Uro-Gyn FPMRS fellow (Payton Schmidt). Dr. Pelletier Cameron has obtained funding to lead an advanced cadaver course for regional FPMRS fellows on September 28, 2018. FPMRS fellows from Henry Ford, Beaumont and the University of Michigan will participate in a didactic session, dry lab and cadaver lab. The NPR division also performed cadaver studies at both sessions in order to evaluate the depth of placement of sutures in the anterior longitudinal ligament for sacrocolpopexy and the location of the placement of Altis mesh for mid urethral sling. These studies will be submitted at national meetings this spring. Dr. Bahaa Malaeb VidScrip Some of you might have heard about a new partnership with Vidscrip (Vidscrip.com). We are working out the last few wrinkles and we will be reaching out to all urology providers to launch this exciting platform. Vidscrip is basically a service for medical providers’ user videos that are easy to create, edit and deliver. Every provider will have bundles of 20-30 second videos that are part of a template. One template, for example, would be your video profile; another would be, for example, post-visit questions regarding a certain diagnosis you see; another would be preop instruction, post op, or any other topic you would want to educate patients on. The best part of it is how easy it is to actually create these videos. We are looking to have these shared with the patient as part of their after-visit summary, or push them as a text message notification with a link to the packet that is relevant to that particular patient, their diagnosis and the time point in their treatment course. For example, Mr. Smith comes in for prostate cancer consultation. You discuss options. He goes home and tries to relay the info to his wife. Unfortunately, he only recalls 20% of what you told him. Now they have to schedule a second visit, or they call with additional questions. At his checkout, he could be given a link to a packet of several short videos that you have recorded that might answer most of his questions. These can potentially be searched on Vidscrip site, embedded in our homepage, or pushed to his device via a text or email, or even through the portal. Mr. Smith now is scheduled for prostatectomy on October 1st. You can send him a link for a group of short videos several days before to answer FAQs about anticoagulation, or bowel prep or anything you want him to know. Likewise, you can send them post op videos. This is just one of the numerous applications we can use this platform for. If your practice changes and a video does not fit, you can edit it or create new ones within minutes using your laptop, phone or tablet.

We are going to be looking at the impact of implementing this on our nursing call volumes, patient satisfaction, case cancellation and provider satisfaction. We will be reaching out to all the faculty to register them, start their profile videos and work on the templates for the conditions they see the most patients for. Benign prostatic enlargement, kidney stones, erectile dysfunction, incontinence, prostate cancer, kidney cancer, bladder cancer… we currently have over 20 templates for urologic conditions with the FAQs already there, you just need to plug in your videos. Stay tuned. We are expecting this to be up and running within the coming couple months. Dr. Anne Pelletier-Cameron FPMRS at Brighton Brighton Center for Specialty Care (BCSC) is set to open September fourth with our new adult urology clinic. The NPR division will have a strong presence at this facility with Dr. Anne Cameron moving both her Livonia and Taubman clinics there and Jessica Ball, our new PA, will be holding independent clinics there as well. This facility is ENORMOUS and we encourage you all to come visit this convenient location near the intersection of US 23 and 96. We have procedure rooms to accommodate our enormous volume of bladder Botox injections and a fully functional urodynamics suite. We will also be offering percutaneous tibial nerve stimulation (PTNS) to patients at the clinic. We will send pictures of the clinic and an update once we get up and running. Jessica Ball My name is Jessica Ball and I am one of the new physician assistants with the NPR team! I am originally from the Jersey Shore, but I’ve been in the southeast for the last 8 years so you may hear me say “y’all” every once in a while. I received my undergraduate degree in Microbiology at Clemson University (Go Tigers!), then briefly worked as a CNA on a surgical trauma floor before completing PA school in Savannah. Most recently, I was working as an inpatient PA for a neurosurgery group. Female medicine has always been an interest of mine, so I am looking forward to this new position working mostly in female urology. Outside the office, my hobbies include reading, cooking/baking and taking my 2 puppies, Brooklyn and Finn, to the lake! I have also recently started volunteering at the humane society. I look forward beginning this new adventure in Ann Arbor with all of you!

Janice Rushton Hi! I’m Janice, new to UM as a PA for NPR. I’m excited to be back at UM after graduating from UM with a degree in Economics a long time ago. I’m a bent arrow who “saw the light” and changed her ways to return to school for an MS degree in PA Studies after practicing law for 21 years. I’ve worked at Sinai Grace Hospital in inpatient Internal Medicine, Henry Ford in Urology, and Karmanos Cancer Institute in phase I clinical trials. I’m splitting my time between clinics at Taubman and LCSC in the process of moving from Bloomfield to Plymouth. I just returned from a favorite vacation spot – UM’s Camp Michigania near Petoskey where I like to sail and spend time with my family.

Dr. Quentin Clemens Map Research Network Update The NIDDK-funded MAPP research network is now in its tenth year. During the first phase (MAPP I), we conducted a 12-month cohort study involving 424 patients with IC and chronic prostatitis (collectively referred to as urologic chronic pelvic pain syndrome, or UCPPS). We also recruited two control groups - people with non-urologic pain diagnoses, and people without chronic pain. Analysis of the MAPP I data is nearing completion. Major findings are as follows: In UCPPS, pain and urinary symptoms vary independently and should be evaluated separately. This suggests that there are two major phenotypes – those with pain-predominant symptoms and those with urinary-predominant symptoms. Clinically this can be demonstrated by the patient who urinates very frequently (due to a near-constant bladder pressure or discomfort) but who does not endorse having pain. Interestingly, these two phenotypes were equally present in men and women, which suggest that IC may be more common in men than previously appreciated.

UCPPS participants who report pain beyond the pelvis have more severe UCPPS symptoms and more UCPPS symptom flares than those with pelvic pain only. This suggest the presence of a ‘centralized’ phenotype in many patients. UCPPS participants reported more psychosocial difficulties than pain-free controls, and poor psychosocial functioning was associated with a lower likelihood of symptoms improvement over time. Neuroimaging studies showed that UCPPS involves disturbances in brain-level sensorimotor systems regulating urine storage; these disturbances are powerful enough to produce not only differences in brain function, but also in brain structure. UCPPS symptom profiles can be distinguished by biological correlates (e.g., immune factors). In particular, the MAPP has produced novel findings about the potential role of toll-like receptor activation in mediating an aberrant inflammatory response, suggesting that there is an ‘inflammatory’ phenotype in certain UCPPS patients. Quantitative Sensory Testing revealed significantly increased pressure pain sensitivity in UCPPS participants compared to healthy controls; higher sensitivity was associated with the less likelihood of UCPPS symptom improvement. This provides additional evidence for a ‘centralized’ phenotype. These findings are leading to new disease and treatment models such as in the figure below.

During MAPP II, we are recruiting an additional 600 UCPPS patients, and following them for 3 years. A major focus of this cohort study is to correlate the phenotypes identified in MAPP I with treatment response. This is expected to lead to the development of focused clinical trials in the future. We expect MAPP II recruitment to be completed within the next few months. At Michigan, we have recruited 94 participants to date, which is the second-highest in the network. Additional funding for 3 years has been secured to continue longitudinal follow-up of the cohort through 2019, and to conduct data analyses. As a result of new developments in the field (in MAPP and elsewhere), a major NIDDK-sponsored meeting is planned in 2019 to discuss the development of new clinical and research definitions for both IC and chronic prostatitis.