UAB Urology: A Leader in Kidney Stone Research
Tanecia Mitchell, Ph.D. and Sonia Fargue, Ph.D. have received NIH K01 grants, and John Knight. Ph.D. received a RO1 grant in the last year. Kyle Wood. M.D. was added as faculty last year and has research grants from the American Urological Association, Rare Kidney Stone Consortium and intramural grants from the Nutrition and Obesity Research Center.
John Knight, Ph.D., was recently the senior author of an article February 2017 in Journal of the American Society of Nephrology titled An Investigational RNAi Therapeutic Targeting Glycolate Oxidase Reduces Oxalate Production in Models of Primary Hyperoxaluria. This article lead Alnylam Pharmaceuticals to begin clinical trials using this target in the treatment of patients with primary hyperoxaluria. This partnership has led to the investigation of other targets, with Kyle Wood, M.D., as the project leader, that could be used to treat kidney stone disease.
Recently, the group presented on the effects in mice of targeting lactate dehydrogenase in the liver using RNA interference. They demonstrated a more than 75 percent decrease in urinary oxalate excretion in a mouse model of primary hyperoxaluria type I, which represents a complete correction of the hereditary abnormality. Primary Hyperoxaluria is a rare genetic disease that results in recurrent kidney stones and ultimately end-stage renal disease. Currently, the only reliable treatment is a kidney/liver transplant.
Billy Tingle, BSRN recently joined the group and has focused on patient recruitment for studies focusing on the role of the microbiome and obesity in kidney stone disease. Studies are ongoing to determine if subjects can be colonized with Oxalobacter formigenes, a bacterium that is capable of degrading oxalate in the gastrointestinal tract. Colonization with this may reduce kidney stone disease.
Overview: Gulf Coast Urology Seminar 2017
The UAB Department of Urology hosted another great session at the Gulf Coast Urology Seminar in Sandestin in July. Attendees were fortunate to have outstanding lectures from visiting professors Dr. Ganesh Palapattu from the University of Michigan, Dr. Ojas Shah from Columbia University and Dr. Drew Peterson from Duke University. Each was able to impart upon new knowledge in urologic oncology, stone disease and complex urologic reconstruction.
2017 American Urological Association Annual Meeting
UAB Urology held multiple activities and presentations this year. Dr. Soroush Rais-Bahrami was a faculty for the Hands-on MRI/US fusion biopsy course where he lent his expertise on the technology to guide urologists implementing this platform in their practice. Along with PGY-5 Dr. Win Shun Lai, he also presented data on renal cell carcinoma (RCC) in young patients. A review of the last five years at UAB found that 98/604 patients with RCC were less than age 46 years. The good news for these patients was that early onset RCC tended to be lower grade and organ confined, though more patients underwent radical nephrectomy as opposed to nephron-sparing surgery. The latter finding suggests that perhaps these patients are being over treated for their disease.
Dr. Lai and Dr. Dean Assimos presented a systematic review and meta-analysis on factors associated with post-operative infection after percutaneous nephrolithotomy. They found that preoperative urine culture, intraoperative renal pelvis culture, stone culture, the number of access points, the need for blood transfusion, stone size and duration of procedure were significantly associated with post-operative infection.
From Dr. Tanecia Mitchell’s lab, PGY-4 Dr. Vidu Yarlagadda presented a study on the effect of calcium oxalate crystals on mitochondrial dysfunction in monocytes. Their study found that in human monocyte cell lines, exposure to calcium oxalate crystals caused a dose-dependent decrease in mitochondrial function and cell viability. The result was upregulation of stress response proteins, which may have implications for cellular dysfunction in calcium oxalate stone formers. Dr. Yarlagadda also presented Dr. Patrick Selph's experience with the robotic-assisted use of the appendix as a ureteral interposition for ureteral stricture disease. The case was a 32-year-old gentleman with a 5 cm. proximal ureteral stricture, and the robot was used to interpose the appendix between the proximal and distal ureter. At 10 months after surgery, the patient is pain free and has no hydronephrosis.
Dr. Kyle Wood presented his work on increased urinary excretion of glycolate and oxalate in obese and diabetic mice models, as well as the association of hemoglobin A1c and urinary oxalate in stone formers. A review and video of his work can be found here.
Dr. Peter Kolettis moderated a poster session on infertility therapy, and Dr. Selph was a faculty mentor in a speed mentoring session for urology residents interested in questions about career, work-life balance, leadership and research.
Last but not least, UAB Urology had its first annual alumni banquet at the AUA. Faculty members were excited to see Dr. Katherine Cameron, a 2007 graduate of the program, who works in Knoxville, TN., stomping out urologic disease. Faculty also caught up with Dr. Corey Passman, another 2007 graduate, who is enjoying his practice in Lynchburg, VA. Courtney Shepard, a recent graduate of UAB in 2015, loves her experience at the University of Michigan Department of Urology where she is finishing up her pediatric fellowship. Dr. James Lingeman from Indiana University graced was also in attendance, and it was fascinating to hear his experience with HoLEP and the early days of shockwave lithotripsy.
Joseph Receives Reginald C. Bruskewitz Distinguished Alumni Award
The University of Wisconsin Department of Urology awarded David B. Joseph, MD., Chief of Pediatric Urology at UAB, with its inaugural Reginald C. Bruskewitz Distinguished Alumni Award at the annual American Urological Association (AUA) Conference in Boston.Dr. Joseph graduated from the Wisconsin Urology residency program in 1985. He went on to complete a pediatric urology fellowship at Harvard. Since then, he has built an outstanding program at UAB and contributed to the field through active involvement in professional and academic societies and as Assistant Editor of Journal of Urology.
Congratulations, Dr. Joseph!
UAB Urology ranked #20 in U.S. News Best Hospitals
“UAB Urology is the only nationally ranked urologic program in Alabama, and we believe this recognition reflects our commitment to providing outstanding patient care,” said Dean G. Assimos, M.D., Chair, UAB Department of Urology.
A hospital’s score for Urology is based on various data categories, including volume of high-risk patients, nurse staffing and patient survival. UAB Urology was ranked highly for survival odds, patient safety, number of patients, advanced technologies and patient services, among other factors.
Overall, UAB Hospital was again ranked No. 1 in Alabama. Nine other UAB adult specialties joined Urology in the nation’s top 50, an increase from last year, and four others were named High Performing.
“We are pleased that UAB Hospital continues to be recognized for providing world-class health care to the residents of our state, region and nation,” said Health System CEO Will Ferniany, Ph.D. “The consistent excellence of our faculty and staff is a reassuring constant during times of change and uncertainty in our country’s health care system. We are proud of our national rankings, and proud to be acknowledged as Alabama’s best hospital.”
UAB’s highest ranked programs include:
- Rheumatology (10)
- Nephrology (14)
- Pulmonology (17)
- Urology (20)
- Diabetes and Endocrinology (21)
- Gynecology (26)
- Cardiology and Heart Surgery (30)
- Neurology and Neurosurgery (34)
- Geriatrics (47)
- Ear, Nose and Throat (50)
- Cancer (High Performing)
- Gastroenterology and GI Surgery (High Performing)
- Orthopedics (High Performing)
- Rehabilitation (High Performing)
U.S News and World Report also recognized UAB for High Performance in seven adult procedures/conditions, including chronic obstructive pulmonary disease, heart bypass surgery, heart failure, abdominal aortic aneurysm repair, aortic valve surgery, colon cancer surgery and lung cancer surgery.
Hundreds of UAB physicians named to prestigious 2015-16 Best Doctors in America list
Hundreds of the top physicians in the nation practice at UAB Medicine, according to the latest edition of the Best Doctors in America®.
The 2015 list recognizes 391 UAB physicians, the most in Alabama, in 38 specialties listed who are among the top 5 percent of clinicians in the United States, as voted by their peers.
View the full story and list of UAB physicians here.
Dangle establishes a pediatric robotic urologic surgery program at Children's
Dr. Pankaj Dangle has joined Children’s of Alabama as a pediatric urologist and has recently has recently established a pediatric robotic surgery program.
Robotic surgery allows specialists to perform surgery with tiny incisions and minimal effect on surrounding healthy tissue. Robotic surgery has several benefits, including a faster recovery time, less pain, little or no scarring, minimal blood loss, and a shorter hospital stay.
Dr. Dangle earned his medical degree from University of Mumbai, where he also completed training in general surgery and urology. He completed his urology residency at the University of Chicago and his pediatric urology fellowship at the Children’s Hospital of Pittsburgh.
Dr. Dangle’s practice focuses on robotic surgery, complex hypospadias, disorders of sex development, vesicoureteral reflux, myelomeningocele, ureteropelvic junction obstruction, renal stone disease and urinary reconstruction. He also serves as an assistant professor in the University of Alabama at Birmingham School of Medicine Department of Urology.
He is from Mumbai, India, lived for last several years in Midwest, and lives in Homewood with his family.
He is passionate about pediatric urology, being a proud father, and he takes utmost interest in managing patients and their families through their illness with personalized care.
Alumni Spotlight: Ben Martin, M.D.
Dr. Martin graduated from UAB Urology residency in 2011. He then joined Urology of Indiana, LLC, where he practices general urology.
Q: What made you decide to be a urologist?
During medical school, I was attracted to urology because of the wide variety of conditions treated. I also enjoyed working on men’s health issues, and I had several great urologist mentors. I remember I looked up to their professionalism and sense of humor.
Q: What is your current practice and how did you choose to practice this area of urology?
From the beginning, I knew I wanted to enter into private practice. After graduation, I joined a large (30 physician) urology group in Indianapolis. At Urology of Indiana, I work with seven other urologists in my call group and cover three separate hospitals. Our group performs all types of urologic surgery. We also have an active robotic oncologic program. My current practice is what I call “General Urology for the 21st Century”. I personally perform all general urology cases, including my own robotic cases; specifically prostatectomy, partial nephrectomy, and full nephrectomy.
Interestingly, I was very involved with the first robotic cystectomy cases that were performed at UAB. However, I did not plan on performing robotic cystectomy cases in my practice once I graduated. But over the past four years, a urologic oncologist (Dr. Michael Large) and I have performed, on average, six to eight robotic cystectomies per month. When I graduated from UAB, I did not anticipate being involved in such a robust and busy robotic oncology practice, but UAB gave me the tools and urologic training needed to adapt in a busy, modern and successful private practice.
Q: How did you land at UAB for residency?
I am from Ohio and attended medical school at University of Cincinnati. When I was applying to residency, my mentors told me that UAB had a very well respected urology residency. So I decided to apply. I had never been to Birmingham until I showed up for my interview! I immediately fell in love with the town and UAB. The residents, physicians, and staff were all very welcoming and professional. It was clear that UAB was a great place to train and would be a good fit for me.
Q: What aspect of your time at UAB do you believe was most valuable as you started your career?
I believe I was well prepared for my career after residency. I had the technical skills and urologic knowledge to be successful. UAB has a very good operative experience for the residents. I was very comfortable operating on my own, from my first day in private practice.
However, no amount of training will fully prepare you for being on your own. My mentors at UAB (Dr. John Burns and Dr. Jim Bryant) told me to keep pushing myself and continue the learning process after residency. They were right! A lot of learning occurs in the first few years after residency. UAB prepared me to keep learning and for the challenges of a busy private practice.
Q: Did you have a particular mentor while at UAB? If so, why were they a good mentor?
Dr. Jim Bryant was a special mentor to me. He had just joined UAB from private practice, and I was his first resident on the urology service. He practiced, at that time, at UAB Highlands Hospital. Working with Dr. Bryant, I was able to learn from someone who is a true gentleman surgeon that treats his patients, staff, and colleagues with respect. Also, Dr. Bryant spent years in private practice and was very familiar with the business of medicine. He was willing to share his knowledge of practice outside the university setting with me.
Q: What is one of your fondest memories from UAB?
One of my favorite memories was working with Dr. Burns on Fridays. Dr. Burns performed all of his stone surgeries, including his PCNL cases, on Friday. Dr. Burns would routinely take the residents to Subway for a break in the middle of the day. It was a great time to unwind and recharge, before restarting the cases in the afternoon. Dr. Burns treated everyone, including the residents, as equals. As I look back at those Friday lunches today, I have come to value the advice and mentorship shared during that time.
Successful Interview Season Complete
UAB Urology interviewed 45 candidates for three slots in the incoming class of 2017. Interviews were held on Sept. 26 and Oct. 21. Thirteen of the 45 candidates participated in a visiting medical student four-week acting internship. For these 13 applicants, we piloted virtual interviews using GoToMeeting, allowing us to meet and interact with video conferencing as a follow-up to the rotation. With the rising costs of travel and applications for prospective residents, we hope to secure funding and perform further research on the use of virtual interviews for the urology match next year. Match day will be Jan. 19, 2017, and the new interns will start their general surgery PGY-1 year next June.
"We had an exciting interview season! The quality of the urology applicants is amazing! Each year, we see more and more outstanding applicants," said Peter N. Kolettis, M.D., professor and residency program director. "It is great to see so many bright students with diverse interests and diverse backgrounds interested in our field and in our program. The future of urology and our residency program is bright."
UAB Surgical Team Proud of Outcomes From ERAS Pathway
In determining clinical effectiveness, UAB Medicine relies on a thorough analysis of patient demographics, outcome and satisfaction metrics, and other information gathered across numerous disciplines.
That’s certainly true for the enhanced recovery after surgery (ERAS) pathway, which is designed to reduce post-operative complications, shorten length of stay, and hasten a patient’s return to normal functions. Outcome data suggest that ERAS is effective in improving patient experience at UAB. However, that data may be enhanced by feedback from the patients themselves, as a UAB surgical care team observed this past summer.
UAB Medicine patient Johnny Kline, diagnosed with bladder cancer in early 2016 and referred some months later to Jeffrey Nix, MD, for treatment involving a cystectomy and urinary diversion, returned to UAB in August to share his experience with his care team. The group met at the West Pavilion Conference Center for a celebration of Kline’s excellent outcomes (complete with cake and refreshments), but more significantly, the event allowed many of the 50-plus clinical and non-clinical staff members along Kline’s particular ERAS path to hear firsthand about the results of their efforts.
“UAB was too good,” Kline says. “I don’t have any problems or concerns you can learn from to improve the process, because it went too well. Dr. Nix warned me that I might be recovering in the hospital for almost two weeks; I went home on the fourth day. That new pain medication gave me no problems, just like we hoped. Through this entire surgery there was someone right there beside me asking how I was feeling or telling me what to expect, and always in plenty of detail. I was never alone, never in the dark about what was going on.”
Associate Chief Medical Officer Ben Taylor, MD, who directs UAB’s clinical effectiveness program, UAB Care, notes the value of Kline’s feedback in assessing the success of ERAS.
“The most appropriate way possible to recognize all that our teams do is having our patients here to share their experiences,” Dr. Taylor says. “It reminds us why we are all here in the first place: to take one patient, start to finish, and ensure that all procedures and elements of care line up for the best possible outcome. Input from patients guides us to do more of what works and less of what doesn’t.”
This setting also offers members of the team who engage with patients at the beginning of the ERAS pathway a chance to hear about the results of their work from a patient they might otherwise not see again. In Kline’s case, his poignant and at times emotional talk with the group reveals the morale-boosting component of sharing best-practices success stories, and in some measure reflects the “family” aspect of care that Dr. Nix emphasizes in his practice. Foremost, however, patient feedback is an additional element of cascading best practices to frontline staff.
“We anticipated that implementing ERAS pathways would have a positive impact on our patients and the care we provide at UAB,” Dr. Nix says. “Having Mr. Kline come back to share his story with our team was a tremendous opportunity to connect back to why we take process improvement so serious. This will serve as further motivation for us to continue to improve our practices going forward.”
The Appeal of ERAS
The ERAS pathway, which began at UAB in 2015 with colorectal surgery, is being applied in other disciplines and procedures throughout UAB Medicine. The results from these initial efforts demonstrated the value of ERAS, and the ERAS project for colorectal surgery received a first place UAB Health System Innovation Award for 2016, as part of a competition designed to encourage creative thinking, improve workflow, and disseminate best practices across UAB Health System entities and affiliates. That effort was led by colorectal surgeon Daniel Chu, MD, and anesthesiologist Jeffrey Simmons, MD, in close collaboration with the UAB Care team and many others.
Since implementing ERAS for colorectal surgery, the overall post-operative length of stay (LOS) was reduced to a median of 3 days, and previously observed disparities in LOS among minority patients were eliminated.
“The success of ERAS in colorectal surgery was a result of identifying, positioning, and empowering the right people to make change,” Dr. Simmons says.
The ERAS project is innovative in several ways, according to Dr. Chu.
“First, our project leveraged the infrastructure and processes of the UAB Care program to create truly multidisciplinary, team-based, and sustainable partnerships across UAB,” Dr. Chu says. “This project enlisted champions from all walks of surgical care, not only surgeons and anesthesiologists but also nurses of all specialties, HSIS programmers, residents, nutritionists, social workers, data analysts, UAB Care, etc. Many of these newly discovered relationships are now being utilized to develop other ERAS and cross-disciplinary projects such as readmission reduction programs. Second, this project was able to reduce disparities in LOS with ERAS. This finding is novel, as we show that minority patients benefit tremendously from ERAS. As a tertiary referral hospital serving a geographically wide, racially diverse population, reducing disparities is particularly relevant to our institution, and this work puts us at the forefront of recent National Institutes of Health initiatives on targeting surgical disparities. Third, our project demonstrated that change is possible. Barriers to ERAS implementation are well-documented, but with a coordinated, sustained, and multipronged approach, an entire continuum of care can be optimized to achieve potentially even better outcomes.”
Resident shares research experience
"During my UAB Urology residency, I’ve learned that performing research can be a sometimes frustrating, but also incredibly rewarding experience. I remember being dejected when my first project was not accepted for publication. I felt as if all I had to show for my hard work was criticism from reviewers. But I revised the article, incorporated the critiques, submitted to additional journals and ultimately the project was accepted. I have since presented 6 poster presentations at meetings and had 4 manuscripts accepted – including being published as first author on a paper in the Journal of Urology. This was a goal of mine since medical school, and accomplishing this goal was exciting and rewarding.
Mitchell receives K01 Award from NIH
Tanecia Mitchell, Ph.D., became the first faculty member of the UAB Department of Urology to receive a K01 award from the National Institutes of Health (NIH) to conduct her research, “Monocyte Mitochondrial Dysfunction and Kidney Stone Disease.” This is a five-year National Institute of Diabetes and Digestive and Kidney K01 Mentored Research Scientist Career Development award totaling $768,776. Her research will focus on understanding the significance of mitochondria, oxidative stress, and inflammation in monocytes using clinical samples and experimental models. Dr. Mitchell and colleagues recently published a pilot study in Urology demonstrating a potential role of monocytes in calcium oxalate kidney stone disease. She believes her investigations will provide novel insight into the role of monocytes in kidney stone formation, and may lead to strategies to intervene in the pathogenesis and prognosis of the disease.
UAB and Baptist Health partner to open new clinic in Montgomery
Urology is one of four specialties included in the new UAB Medicine Multispecialty Clinic, a partnership of Baptist Health and UAB Health System, and located at Baptist Medical Center South. The clinic opened Aug. 1 and will be located on the first and second floors of the UAB School of Medicine building (formerly the MCI building) on the campus of Baptist Medical Center South.
The urology clinic will house 3 new urologists who have been recruited by Baptist Health. All are highly trained and offer cutting-edge services and provide new surgical procedures and treatments not currently offered in the area.
- Dr. Himanshu Aggarwal is the first and only fellowship trained FPMRS/urogynecology/female urology/female incontinence specialist in river region and one of the few in whole state of Alabama.
- Dr. Geoffrey Habermacher’s practice consists of general urology with a special interest in prostate cancer, renal cancer, and laparoscopy.
- Dr. Joseph F. Pazona is the Chief of Urology at the UAB Multispecialty Clinic and Director of Robotic Surgical Services at Baptist Medical Center South. Dr. Pazona's clinical interests include: minimally invasive treatments of prostate/kidney/bladder cancer, kidney stones, male incontinence, male urinary dysfunction, and no-needle/no-scalpel vasectomy.
“We welcome these new faculty members to UAB Urology and are excited about the clinic opening in Montgomery,” said Dean G. Assimos, M.D., chair UAB Urology. “Assembling this team of highly skilled urologists with expertise in a range of areas will be a benefit to patients in the Montgomery area.”
In total, the clinic will initially offer four much-needed specialties, including urology, gastroenterology, endocrinology and rheumatology, and house a total of 10 new physicians.
“We look forward to extending the important mission of UAB Medicine to help more patients access world-class health care across Alabama,” said UAB Health System CEO Will Ferniany. “Closer proximity to care can improve health and quality of life, and this partnership will bring important specialties closer to those in and around Montgomery.”
Residents of central Alabama will no longer be forced to travel outside the area for medical services due to the overwhelming need, limited access and few similar specialists in the area. These new physicians will increase access to specialty care in a convenient, centralized location that will lead to earlier diagnosis and treatment of disease. In addition, patients will have access to clinical trials and research activities being performed at UAB that they otherwise may not have access to.
“We are excited to combine our medical experience and commitment to excellence with UAB’s highly skilled and qualified health care professionals as we work together to continue to raise the bar for top-quality medical care,” said Russell Tyner, president and CEO of Baptist Health. “I feel confident this will allow our organization to continue to meet its mission of providing the highest level of quality care to the residents of central Alabama while allowing Baptist Health to meet the growing need for health care services and expanding our services to those who matter most — our patients.”
Baptist Health has been an affiliate of the UAB Health System since 2005 and has partnered with UAB throughout the past four decades to support the UAB Internal Medicine Residency Program and, most recently, the addition of the UAB School of Medicine Montgomery Regional Campus at Baptist South. The clinic will be owned and operated by Baptist Health. UAB Health Services Foundation will employ the 10 UAB faculty physicians, several of whom will begin seeing patients in early August.
To learn more about the UAB Medicine Multispecialty Clinic and physicians, please visit www.UABMedicine-Baptist.com.
2015-2016 Update and Doximity Voting
Dear colleagues,
I hope the summer has started off well for everyone. 2015 was a good year for UAB Urology, starting with exceptional lectures from our own and visiting faculty at the Gulf Coast Urology Seminar in Sandestin, Florida. Dr. J. Patrick Selph, after finishing his fellowship in genitourinary cancer survivorship, joined the faculty in July. In October, Dr. Joseph was the first urologist in the history of the award to win the Wallace Alexander Clyde Distinguished Service Award for Excellence in Pediatrics from the Alabama Chapter of the American Academy of Pediatrics. And, last but not least, we recently matched three accomplished medical students from Baylor, Kansas, and UAB to join our program this summer. We also look forward to adding two new faculty in July -- Dr. Pankaj Dangle to our pediatric urology faculty, and Dr. Kyle Wood will be starting as an assistant professor and Urology Care Foundation grant recipient.
We are writing to ask for your help and participation in a survey of urology programs in the U.S. conducted by Doximity. U.S. News is using Doximity.com to conduct its survey of Urology programs (and other medical programs) with regards to: 1) Best Hospitals (Urology) (this is the conventional ranking they have done for many years); and, 2) Best Urology Training Programs (a new ranking performed in the late fall). Part of the Hospital rankings (number 1 above) includes a reputation score, and Doximity sends out solicited emails for your opinion on our program. If you sign up for Doximity, you may receive an invitation asking you to rate our program, and we would certainly appreciate your support.
While the survey will not come out again until winter, it is most helpful if you are already signed up for Doximity when the invitations are sent out. When the survey is sent out, you can participate in this important survey by downloading the Doximity app for your computer or phone (https://www.doximity.com) and then submitting your nomination.
Last year, UAB Urology was ranked one of the top 10 urology residency programs in the South. This recognition affirms our department’s culture and dedication to education. We are fortunate to be able to recruit outstanding residents and we are grateful for this recognition from our peer physicians in the Doximity network.
We would appreciate your consideration of signing up on Doximity.com, and, if given the opportunity, listing UAB Urology. We hope that your participation in these surveys will affirm our proud tradition of providing exceptional training in urology – past, present, and future.