Winter 2009 VOLUME 5 ISSUE 1 Dr. Sarah Mcachran: A .
WIWISCONSIN UrologyurologyTHE NE W S LETTER FOR AL U MNI AND FRIEND S OF THE U W U ROLO G Y P RO G RAMwinter 2009VOLUME 5 ISSUE 1D r . S a r a h M c A chr a n: a va lua bl ea d d i t i o n t o f em a l e u r o l o gyIn September, 2008, Sarah McAchran,MD, joined our faculty after completinga fellowship in female pelvic medicineand reconstructive surgery at theCleveland Clinic. She is workingwith Dr. Wade Bushman in theMultidisciplinary Pelvic Floor Center,with a particular emphasis on femaleurology and voiding dysfunction.“This is an exciting time to bestarting out in the field of femaleurology,” says Dr. McAchran. “Withour aging population, the commonlyquoted estimate is that demand forthe care of pelvic floor disorderswill practically double in the next25 years. This increasing demandcoupled with the growth of highquality research is very encouraging.”Pelvic floor disorders, which includesuch conditions as urinary andbowel incontinence and pelvic organprolapse, affect millions of womenAss i s t a n t P ROFE S S ORNewAdditionD a n W i l l i a m s , MD throughout the world. In the UnitedStates, it is estimated that one inevery nine women will undergosurgery for a pelvic floor disorder inher lifetime.“Unfortunately,” states Dr. McAchran,“as most of these disorders are notlife-threatening and sometimesdifficult to objectively define, theyhave been slow to be studied.Most of our data has come fromindividual surgeons' case series andretrospective reviews.”Over the last 10 years, however, withthe creation of such entities as theUrinary Incontinence TreatmentNetwork and the Pelvic FloorDisorders Network, both large, NIHfunded, multi-institutional researchnetworks dedicated to the study ofpelvic floor disorders, we have seenthe introduction of more evidencedbased medicine into the field. “Thisallows us the opportunity to providebetter, more informed treatmentrecommendations to our patients.”“In my opinion,” says Dr. McAchran,“one of the greatest advances, from apatient’s perspective, is the advent ofthe multidisciplinary approach.” TheMultidisciplinary Pelvic Floor Centerat UW combines the joint expertise ofurologists, gynecologists, colorectalsurgeons, and physical therapists.“I am very pleased to have joineda urology department with anestablished pelvic floor center.” AsDr. McAchran points out, becauseof the breadth of knowledge eachparticipant brings to the tableregarding both traditional surgicaland non-surgical managementpractices, “we are able to tailorour expertise to provide eachpatient with individualized careand attention.” This is of utmostimportance in a field wheresuccessful outcomes are not gaugedby negative margins or stone-freerates, but in degrees of improvementin quality of life.Dr. McAchran specializes in allaspects of female pelvic floordisorders including urinaryincontinence, voiding dysfunction,pelvic floor reconstruction for pelvicorgan prolapse, urethrovaginalreconstruction for urethraldiverticulum and fistulas, and femalesexual dysfunction. Her research hasfocused on sacral neuromodulationfor voiding dysfunction as well asvarious aspects of midurethral slingsurgery, including animal models,complications, and care pathways. WUDr. Sar ah McAchr a n
A M e s s a g e F r o m t h e c h a i radministrator, Stephen Hall. Mr.Hall joins us from the Departmentof Family Medicine and, since hisstart in September, he has donean outstanding job organizingthe departmental administrativeinfrastructure. Mr. Hall is anexceptional administrative leaderand very personable.S t ep hen Y. N a k a da , MDI am most delighted to send youour winter newsletter for 2009. Thisedition is published during veryunique circumstances in Wisconsin,regionally, nationally, and globally.We all feel significant uncertaintywith regards to the prevailingeconomic climate and the globalrecession. On the other hand, timeslike these further emphasize theneed to focus on improved qualityof care, the economy of care, and thecure of disease.I am most delighted to announcethe arrival of our newest facultymember, Sarah McAchran, MD, fromthe Cleveland Clinic. Dr. McAchrancompleted her fellowship at theCleveland Clinic in female urologyand voiding dysfunction aftercompleting her residency at the CaseWestern Reserve. An article featuringDr. McAchran is one of the highlightsof this newsletter. We are mostdelighted to welcome her onboard!Kudos go to our department forthe upcoming American UrologicalAssociation meeting in Chicago inApril. We have 18 accepted abstractsthis year. Drs. Wade Bushman andDan Williams are on the plenarysession, and Dr. Jason Gee ismoderating the bladder cancer basicscience session. I will be directingthe surgical stone disease courseand moderating a laparoscopysession. Our Endourology fellow,Dr. Dan Kaplon, will be presentingan abstract on renal ablationimaging outcomes.Finally, I want to personally thankDr. John Libertino for an excellentUehling Lecture this past fall. Dr.Libertino’s Friday evening lecture,titled “JFK at the Lahey Clinic,” wasquite fascinating. We look forward towelcoming our 2009 Uehling Lecturer,Dr. Anthony Atala, on November 6,2009. This year was also a recordturnout for the Uehling Lectures, andI hope that many of you will considerjoining us in Madison for Dr. AnthonyAtala in November.As always, please note theUniversity of Wisconsin alumnireception will take place during theAmerican Urological Associationmeeting on Sunday, April 26, 2009.Further details regarding the receptioncan be found inside this newsletter.We will look forward to seeingyou at the AUA this spring! WUChairThis newsletter marks ourofficial move into the WisconsinInstitute for Medical Research.Dr. David Jarrard has moved hislaboratory into this brand newfacility. Certainly, at this complex,the future of research is bright.I am also delighted to reportthe arrival of our new departmentS T E P H E N Y. NA K A DA , M DC H A I R M A N A N D T H E U E H L I NGPROF E S S OR OF U ROL O GY V I S IT U S ON THE W E B : RE SIDENCY UPDATE2 0 0 9 - 2 0 11ENDO U ROLO GYFELLO WTRICIA THA K ER , A P N PS U TCHINPATEL , MDThe Department of Urology ispleased to announce that SutchinPatel, MD, will be joining theDepartment as our 2009-2011Fellow in Endourology. Dr. Patelgraduated from Brown Universitywith a BS in Biochemistry. Hereceived his medical degreefrom the Warren Alpert MedicalSchool of Brown University,where he is also serving as chiefresident. Dr. Patel is recognizedas an exceptional student andresident by both faculty andcolleagues alike. He has published aconsiderable number of manuscriptsin peer reviewed journals and haspresented extensively at nationaland international meetings. Hewill be a wonderful addition to theDepartment in 2009. WU2009re sidencym atchre sult sA ARON potretzke, MDUniversity of MinnesotaMedical SchoolKelvin Wong, MDUniversity of ToledoCollege of Medicinew w w. u r o l o g y.w i s c . e d u
U W U ROLO G Y ATTHE A U A MRITRICIA M a i e rDr. Stephen Nakada will give alecture to the Spanish UrologicalAssociation regarding minimallyinvasive surgery. Annual UW AlumniReception AUA Abstract Podium andPoster Presentations Invasion of mouse prostate epithelialThe annual Alumni Reception willtake place Sunday, April 26, 2009, 5-7p.m. The reception will be held in theIndiana Room at The Palmer HouseHilton. Be sure to join us for thisannual event. We enjoy seeing andcatching up with everyone! Pleasecall Nancy Hawkins at 608-2631358 for further details.This year UW Urology faculty, staffand residents have 18 acceptedabstracts for either podium or posterpresentation. The abstract titlesand authors are listed below: UW Faculty at the AUADr. Stephen Nakada is CourseDirector for “Urolithiasis: SurgicalManagement: Percutaneous, SWL andUreteroscopy.” This course offers thepracticing urologist a comprehensive,case-based review of the surgicalmanagement of urolithiasis andwill pay special attention to theprevention of complications.Dr. Nakada’s course will take placeMonday, April 27, 6-8 a.m.Dr. Daniel Williams will participateas a panelist at the Plenary Sessionon Monday, April 27. He will take partin the Panel Discussion on DecliningSexual Function in the Aging Male.Dr. Wade Bushman is givinga state-of-the-art lecture at thePlenary Session on Wednesday,April 29, titled “The AUA’s Planfor Advancing Urologic Researchand Career Development” alongwith Dr. Anthony Schaeffer fromNorthwestern University.Dr. Jason Gee is moderating thebladder cancer basic science sessionand Dr. Stephen Nakada willserve as moderator on a robotics/laparoscopy session.Dr. Kristina Penniston has beenasked to participate on a panel bythe Society of Women in Urologyduring the Women Leaders inUrology Forum as a nutrition expertoffering ideas about nutritionmanagement of stone disease. Flexibleureteroscopy for proximalureteral stones in obese and nonobese patients: Single surgeonoutcomes. Sara Best and StephenNakada. 12-weekresults of a phase II trialof 100 and 300 units BotulinumNeurotoxin type A (BoNT-A) for themanagement of benign prostateichyperplasia (BPH). ReginaldBruskewitz and the MIST study group. Theutility of ultrasound derivedprostate parameters in predictingclinical response in men treated withBotulinum Neurotoxin (BoNT-A) forbenign prostatic hyperplasia (BPH).Reginald Bruskewitz and the MISTstudy group. Changesin sexual function inmen randomized into a two-stagephase II trial of 100 and 300units Botulinum Neurotoxin typeA (BoNT-A) for the managementof benign prostatic hyperplasia(BPH). Reginald Bruskewitz andthe MIST study group. E mbryonicsonic hedgehogsignaling stimulates prostatetumor growth using reactivestroma. Wade Bushman. Interleukin-1induced epithelialproliferation in prostatedevelopment and hyperplasia ismediated by stromal insulin-likegrowth factor-1 induction. TravisJerde, Amina Zoubeidi, MartinGleave and Wade Bushman. Inductionof heat shock protein25 activity during inflammatoryreactive hyperplasia of the prostate.Travis Jerde, Amina Zoubeidi, MartinGleave and Wade Bushman.and CT characteristics ofrenal cryolesions: Intermediatefollow-up. Daniel Kaplon, JessicaRobbins, Louis Henshaw, SeanHedican and Stephen Nakada.cells in vitro by uropathogenicEscherichia Coli. Brodie Marthaler,Susan Novotny, Linara Axanova, ScottCramer and Walter Hopkins. H omein 3 hours: Contemporarylength of stay when using a perioperative care pathway for midurethral sling surgery. SarahMcAchran, et al. Aunilateral ureteral obstructionmouse model is applied toinvestigate the pathophysiology ofobstructed ureters. Kwadwo OwusuOfori, Eric Wilkinson, WilliamMellon and Stephen Nakada. C ollageninfiltration duringurinary tract obstruction increasesCyclooxygenase-2 expression.Kwadwo Owusu-Ofori, EricWilkinson, William Mellon andStephen Nakada. Laparoscopic gastric band placementfor obesity is not associated withincreased metabolic risk factors forurolithiasis compared to the Rouxen-Y gastric bypass. Kristina Penniston,Jon Gould and Stephen Nakada. Ingestion of commercial supplementsmay provide clinically significantamounts of oxalate. KristinaPenniston, Stephen Nakada, et al. Prostatestem cells proliferate inresponse to androgen withdrawal.Xudong Shi, Jerry Gipp andWade Bushman. Lackof association between theTIr4d/d genotype and increasedsusceptibility to Escherichia colibladder infections in (C3H/HeJ xBALB/cAnN)F1 x C3Hej backcrossmice. Kaleigh Suhs, BrodieMarthaler and Walter Hopkins. Early vasectomy reversal experienceand outcomes of fellowship-trainedmicrosurgeons. Daniel Williams, et al. Thestudy of hedgehog signaling inprostate development: A role of bothparacrine and autocrine mechanism.Min Yu and Wade Bushman. WU
CLINICAL TRIAL SIN W I S CON S INJohnW eg e n k e , MDC l i n i c a l P r o f e ss o rAllow me to introduce Kathleen(Kathie) Smith-Zaremba, who isthe Research Program Manager inthe UW Department of Urology.She received both her Bachelor ofScience and her Master of PublicHealth degrees from the University ofMichigan. Kathie moved to Madisonin 1978 to work as a Research ProjectCoordinator in the UW Departmentof Human Oncology. In 1992, Kathiejoined the Wisconsin Cystic FibrosisNeonatal Screening Project in theDepartment of Pediatrics. Sheworked for 15 years as a ResearchProgram Manager, in the dual role ofpre/post-award grant managementand in the CF clinical trials researchproject. During that time she alsoheld a part-time instructor positionat Madison Area Technical Collegewhere she taught microbiologyand chemistry. Kathie joined theDepartment of Urology in April of2007 with the goal of continuingongoing research excellence andexpanding investigator-initiated andsponsored clinical research effortsin the newly established Departmentof Urology. She works with clinicalresearch investigators, institutionalresearch and review committees andstudy sponsors to initiate and conductclinical research.The Department of Urologycurrently has more than 35 clinicalresearch protocols underway and inpreparation, with others in planningstages. Many of our faculty membersare co-investigators with ongoingstudies such as those conductedthrough the Departments of Medicineand Human Oncology. Clinicalresearch is supported by sources suchas pharmaceutical and instrumentindustries, the National CancerInstitute, the UW Medical Foundation,the UW Hospital and the Departmentof Urology.UW-Madison requires that allindividuals conducting research withhuman subjects complete the online human subjects training coursefor IRB policies and guidelines. Thisincludes principal investigatorswho design and direct research, andall research personnel who enrollresearch subjects, conduct researchprocedures or analyze resulting data.Kathie would be happy to assist withlearning about the federal humansubject protection policies for thosewho are interested in conductingresearch studies.Kathie is looking forward to thecontinuation of ongoing clinicalstudies, the initiation of plannedclinical research within our newDepartment of Urology and tocollaborative research with others.Please contact her regarding newclinical research studies. Shecan be reached by telephone at(608) 263-1363, or by e-mail atzarembak@urology.wisc.edu. WU U P COMIN GW I S CON S IN E V ENT STRICIA M a i e r Department PicnicThe Department of Urology willhold its annual Summer Picnic onSaturday, June 13, 2009. Department VisitingProfessors2009 Winter Grand RoundsVisiting ProfessorFebruary 26, 2009MICHAEL E. MITCHELL, MDDr. Michael Mitchell will give alecture titled “Everything You EverWanted to Know About Exstrophy”.Dr. Mitchell is a professor andChief of Pediatric Urology in theDepartment of Urology at the MedicalCollege of Wisconsin in Milwaukee.Dr. Mitchell’s professional interestsinclude exstrophy of the bladder,bladder development and urinarytract reconstruction.2008-2009 AUAER/Pfizer VisitingProfessor in UrologyMay 27-29, 2009LARRY LIPSHULTZ, MDThe University of Wisconsin,Department of Urology is pleased toannounce that it has been selected as a2008-2009 Pfizer Visiting Professor grantrecipient. This spring, the departmentwill be hosting Dr. Larry Lipshultz, aProfessor in the Scott Department ofUrology at Baylor College of Medicinein Houston, Texas. Dr. Lipshultz holdsthe Lester and Sue Smith Chair inReproductive Medicine and is Chiefof the Division of Male ReproductiveMedicine and Surgery. The AUAER/Pfizer Visiting Professorship programprovides opportunities for academicinstitutions to host a recognized expertfor three days of educational exchange.This is a nationally competitiveunrestricted educational grant. Upcoming Uehling LecturesPlease mark your calendars forthis yearly event!2009 Uehling LecturesThe 2009 Uehling Lecture will takeplace Friday, November 6, 2009,at the Fluno Center. We have invitedAnthony Atala, MD, Professor andChair of the Department of Urologyand Director of the Institute ofRegenerative Medicine at Wake ForestUniversity School of Medicine, to beour 2009 Uehling Lecturer. Programinformation will be provided in thesummer issue of Wisconsin Urology. Future Uehling Lecturesat the Fluno Center2010 Uehling LecturesThe 2010 Uehling Lecture is scheduledfor Friday, October 29, 2010. Ourkeynote speaker is William D. Steers,MD, Hovey Dabney Professor ofUrology and Chair of the Departmentof Urology at the University ofVirginia, School of Medicine. WU
P e d i at r i cKidney StoneClinic is ateam effortStephenH a l l , C PAa d m i n i s t r at o rA little over a year ago, theMultidisciplinary Pediatric StoneClinic was created at American FamilyChildren’s Hospital. Departmentof Urology physician BruceSlaughenhoupt, MD, is part of the teamof UW Health professionals workingto treat and ultimately prevent furtherkidney stone development in children.“According to the medical literature,more children are developing stonesnow than did previously, and we areseeing that trend in Madison as well,”says Dr. Slaughenhoupt. Childrenwith stones are usually referredto the American Family Children’sHospital Emergency Departmentor Dr. Slaughenhoupt for treatmentduring the acute, painful episode.“The immediate priority is gettingthe child pain free with oral or I.V.analgesics,” says Dr. Slaughenhoupt.“We then follow the children, eitherin the hospital, or at home, and startthem on Medical Expulsive Therapy.”If the stone doesn’t pass on it'sown, the children are taken to theoperating room, where they eitherundergo shockwave lithotripsy orureteroscopy with possible laserlithotripsy and stone extraction.Historically, follow-up hasrequired parents to make separateappointments with multiple specialistsand make frequent trips to the clinic.Fortunately, three specialists fromUW Health came up with a bettersolution. Pediatric urologist, BruceSlaughenhoupt, MD, pediatricnephrologist, Sharon Bartosh, MD,and clinical nutritionist, KristinaPenniston, PhD, jointly staff thepediatric stone clinic one morningevery two months. Families meet withthe entire team at each visit. Thisnot only saves time for parents, butresults in increased communicationand coordination between allthe parties. Often, any requiredultrasounds, CT scans, and lab teststake place the day of the visit as well.“It just seemed to provide betterservice and patient care,” says Dr.Slaughenhoupt. “It is a great exampleof the value of team effort.”The clinic is in high demand. “Sincethe third session, our schedule hasbeen filled,” notes Dr. Slaughenhoupt.The doctors are considering holdingthe clinic once-a-month to meetadditional need. A typical morningclinic accommodates 10 patients.Dr. Slaughenhoupt attributes theincreased incidence of stones inchildren to a worsening diet, markedby higher volumes of soda, sportsdrinks, and fast-food. Foods andbeverages high in salt and low innutritional value are believed to bemajor factors in stone formation. Dr.Slaughenhoupt and other pediatricurologists around the country aretreating a growing number of kidsin all shapes and sizes – not justobese children.Dr. Slaughenhoupt encourageskids to eat healthy foods and drinklots of water to reduce the chance ofnew stones forming. Dr. Penniston iscurrently doing a research study todetermine whether drinking lemonadehelps reduce the incidence of kidneystones. Lemonade contains citrate,which helps prevent stone formation.Dr. Slaughenhoupt is analyzing datafrom ten years of clinical experienceto identify treatments that are mostsuccessful and is testing urinefrom healthy children to establishparameters for normal pediatric urineand metabolites. WU NOTA B LE ANDNE W S W ORTHY Mr. Robert Schnoes has endowed alecture series in the Department of Urology,to begin in the spring of 2009, that willfocus on the treatment of residual diseasefollowing urologic cancer procedures. Dr. Stephen Nakada has been namedto the ACS Board of Governors wherehe will serve as a Surgical SpecialtyGovernor representing the AmericanAssociation of Genitourinary Surg
dr. Sarah mcachran: a ValUaBle addition to female roloU Gy dan WilliamS, md - aSSiStant ProfeSSor dr. Sarah mcachran WISCONSIN Wi UroloGyUrology the neWSletter for alUmni and friendS of the UW UroloGy ProGram Winter 2009 VOLUME 5 ISSUE 1 In September, 2008, Sarah McAchran, MD, joined our faculty after completing a fellowship in female .
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