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UAB Urology welcomes Pankaj P. Dangle, M.D., M.Ch., and Kyle D. Wood, M.D., to the department as assistant professors on July 1st, 2016.

“We are pleased both Dr. Dangle and Dr. Wood will be joining us at UAB,” said Dean Assimos, M.D., chair of UAB Department of Urology. “Dr. Dangle brings expertise in robotic assisted pediatric urology to UAB, and, to my knowledge, will be the only urologist in the state of Alabama trained to perform these robotic procedures on pediatric patients. Dr. Wood is an outstanding young urologist who recently finished his training at Wake Forest University.”

Dr. Dangle was born in India and obtained his medical degree MBBS from University of Mumbai. After completing his general surgery training, he successfully completed superspeciality training in urology with highest awards and Gold Medal from the prestigious University of Mumbai, India. He moved to United States and did his urology residency training at The University of Chicago. He recently finished a pediatric urology fellowship at The Children’s Hospital of Pittsburgh.

Dr. Dangle will see pediatric patients at Children’s of Alabama. His practice focuses on Complex hypospadias, disorders of sex development, vesicoureteral reflux, Myelomeningocele, Ureteropelvic junction obstruction, renal stone disease and robotic surgery.

His interest includes mentoring medical students in pursuing research during training, outcomes research, epidemiologic outcomes and testicular microvasculature with focus on endothelial progenitor cells and its role in hypoplastic testis.

Dr. Wood completed his undergraduate degree at Brown University, graduating with honors. He then attended medical school at University of Massachusetts, and recently completed his residency at Wake Forest University.  

Dr. Wood will be significantly involved in kidney stone research. His focus will be on the metabolic pathways that lead to kidney stone disease. His surgical expertise is in kidney stones, benign prostatic hyperplasia, genitourinary reconstruction, and benign renal pathology. He is trained in open, endoscopic, laparoscopic, and robotic surgery.

UAB Medicine’s departments of urology and nephrology have collaborated to create a kidney stone clinic to reduce patients’ risk of further stone development through education and dietary and medical therapy. The group clinic, which will be conducted in the former patient resource library at The Kirklin Clinic of UAB Hospital, is one of the first such multi-disciplinary clinics in the south. Physicians are encouraged to refer patients to this clinic. Patients may also refer themselves.

Suzanne Bergman, MD, of the UAB Division of Nephrology, and Dean Assimos, MD, Chair of the Department of Urology, are to some extent modeling the clinic based on their observations at the Metabolic Stone Clinic at the University of Wisconsin Hospital.

The clinic is designed to provide an impetus for patients to get involved in their care, because most treatment regimens often call for big lifestyle changes that patients must manage themselves. Assimos notes that kidney stones impart a major economic burden on this county—several billion dollars per year—as well as having a negative impact on quality of life.

“Many patients suffer from recurrent stone events,” Assimos says. “There is high-level evidence that dietary modifications and medical therapy can limit new stone formation. The goals of this clinic will be to help select the best strategy for patients to prevent recurrent stones. It is expected that group interaction will enrich the patient’s experience.”

Bergman, too, recognizes that patients tend to feel more comfortable asking questions in a relaxed, informal group setting.

“Rather than give a patient medicine and just send them home, we will provide an opportunity for patients to share and learn in a guided setting,” Bergman says. “The studies that were done at Wisconsin suggested that patients retained information about their condition, and tended to grasp and follow treatment plans consistently, in this type of clinical setting. Bergman emphasizes that not only will every participant walk away with their own action plan, but also will benefit from participating with a group. They may also become eligible for clinical trials.

The Kidney Stone Group Session participants attend a one-time meeting of six to eight patients whose medical information and treatments will be discussed with both physicians and a nutritionist. Vital signs and blood work will be gathered so that a profile of each is available for discussion during the meeting. Participants will need to collect two 24-hour urine samples for analysis prior to the group session. The group will learn basic knowledge of conditions and treatments from an educational presentation, but nutrition and therapy regimens will be applied individually according to each patient’s history and risk factors.

“In a group ‘round table’ setting, patients can learn a lot, and maybe be inspired to make crucial lifestyle changes, when others share their experiences,” Bergman says. “We may have a patient in the group who was not drinking enough fluid, or another whose job doesn’t allow for them to go the restroom several times in a short time span. Maybe three or four in the group have low citrate. So we will discuss these topics and how they can be resolved with medication plus lifestyle changes. Patients still have the option to see both physicians individually.”

For more information about the kidney stone group sessions, physician referrals, or self referrals, please contact Lisa Harvey in Dr. Assismos’ office, 205-996-2613.

Our department had a strong showing at the 80th annual Southeastern Section of the American Urological Association meeting in Nashville, Tenn., held March 17-20, 2016.

Faculty members and residents were involved in several sessions, and the department had a particularly strong showing in the areas of kidney stones and prostate cancer.

Tracey Wilson, M.D., moderated the podium session on incontinence and voiding dysfunction, and she also lent her expertise in the management of refractory overactive bladder for a panel-of-experts discussion on botulinum toxin and neuromodulation. Jeffrey Nix, M.D., moderated several oncology sessions, including a prostate cancer podium session and a kidney and adrenal cancer session.

Dean Assimos, M.D., highlighted his expertise in nephrolithiasis by moderating the debate on management of the 1.5cm renal pelvis stone. His work in the lab was also represented in multiple presentations. Thanmaya Reddy, M.D., PGY-4, presented data on oxalate concentrations in human gastrointestinal fluid, showing that in a fasted state, there is a wide range of small intestinal oxalate concentrations among individuals. This finding likely indicates inter-individual variability of the mechanisms responsible for oxalate transport and warrants further study. Ellie Killian, M.D., PGY-4, presented data on the effect of alanine on cell viability and oxalate production in primary hyperoxaluria type 1, showing that supplemental alanine in a hamster ovary model reduces the production of oxalate and improves cell viability. This finding may help guide future studies on supplemental alanine as a mechanism to reduce endogenous oxalate production in patients with type 1 primary hyperoxaluria.

Soroush Rais-Bahrami, M.D., made several presentations on prostate cancer imaging and lymph node yield. Patrick Guthrie, M.D., PGY-3, presented data showing that despite prior studies showing the African-American (AA) males have been shown to have a higher risk and grade of prostate cancer, cancer grade among a cohort of 177 AA and non-AA men at UAB undergoing MRI/US fusion-guided biopsies was equivalent. Win Shun Lai, M.D., PGY-3, presented data showing that submitting lymph node specimens taken during radical prostatectomy as an entire packet rather than individual packets yields a higher lymph node count; furthermore, the PGY status of the pathology resident affected yield--a more experienced pathology resident found more lymph nodes. The implication is submission of a single packet of lymph nodes during prostatectomy will yield higher lymph node counts and thus affect prognosis and therapy for the patient.

Members of the department also received numerous honors and awards. Dr. L. Keith Lloyd, a member of the UAB Department of Urology since 1974, was recognized at the SES meeting with a Distinguished Member Award. Dr. Lloyd’s decades of dedication and experience has been invaluable to the department.

“Dr. Lloyd is a true gentleman, and we are honored to have him as part of our department,” said Dr. Assimos. “It is not unusual for patients whom he has treated for 40 years to continue to come to see him in clinic because of the genuine, competent, and unparalleled care he provides them. We look forward to him going strong for decades ahead!”

Jubilee Tan, M.D., PGY-5, highlighted her urologic trivia knowledge by being part of the winning team during the Quiz Bowl, and she earned herself a paid trip to the AUA meeting in San Diego to represent the SES in this test of knowledge. While unfortunately the SES did not bring home the crown in San Diego, we were wowed by her trivia prowess!

Last but not least, Dr. Assimos officially began his role as president of the SESAUA for the 2016-2017 year. Among his goals are plans to increase funding for residency programs to send residents on international outreach missions, and we are all looking forward to the meeting in Austin, Texas, from March 23-26, 2017.

Congratulations to our resident class of 2016! We wish them all the best in their future endeavors. Dr. Daniel Benson will join a private practice in Dallas, Texas. Dr. C. Tanner Hughes will join Urology Oncology Associates in Mobile, Ala. Dr. Jubilee Tan will begin a Female Pelvic Medicine and Reconstructive Surgery Fellowship here at UAB.

We also welcome our new interns: Carli Calderone, Baylor College of Medicine; Luke Ellenburg, UAB School of Medicine; Ava Saidian, University of Kansas School of Medicine.  

Carli Calderone

Carli Calderone was born and raised in Akron, Ohio.  For her undergraduate degree she attended Miami University (of Ohio, not Florida!) where she studied Zoology, Spanish and Latin American Studies.  Combining her interest in global health, science, and love of people, she decided to become a doctor.  Wanting simultaneously to pursue a career in medicine and avoid another freezing Midwest winter, she decided to attend Baylor College of Medicine in Houston, Texas.  There, she fell in love with the field of urology, and is lucky enough to pursue her training at UAB.  In her free time, she enjoys traveling, playing and watching sports, exercise of all kinds, and most importantly, spending time with her husband and dog, Sadie.

Luke Ellenburg

Luke Ellenburg grew up in Arab, Alabama. He graduated magna cum laude from Samford University in 2012 with a Bachelor of Science degree in Biology. He then attended the University of Alabama School of Medicine, where he was inducted into the Alpha Omega Alpha Honor Medical Society during his fourth year. An interest in surgery and the disease processes treated by urologists initially attracted Luke to the field of Urology. As a medical student, he was able to further explore this interest by working with several UAB urology residents and faculty on various research projects. At this early stage of training, his interest in subspecialties remains broad. In his free time, he enjoys running, traveling, and spending time with family and friends.

Ava Saidian

Ava Saidian is from Wichita, KS and attended the University of Texas for her undergraduate degree. After receiving a degree in Neurobiology, she went on to medical school at the University of Kansas School of Medicine. In her free time she enjoys gardening, reading non-medical books and playing tennis. Her dream is to one day own a honey bee and berry farm and sell fresh honey and fruit jam at her store "Sweet Thangs." Until then, she is very much looking forward to studying Urology at UAB and being a Urological professor and physician at an academic hospital. 

Dr. Nix has been named the Director of Robotic Surgery for the University of Alabama Health System. He currently serves as the Director of Robotic Surgery for the Department of Urology. In this new role, he will work with faculty, staff, and administration to update and assess the process of credentialing, evaluating robotic surgery metrics (such as cost, operative time, and conversion rates), and developing a plan for the future direction of robotic surgery within the health system.

Dr. Nix joined the Department of Urology in 2013 and has helped advance the use of robotic-assisted surgery within both the Department and at UAB Hospital. He was an instrumental member of the team responsible for acquisition of the new da Vinci Xi systems brought to UAB, and he has participated in strategic endeavors with Intuitive Surgical and the UAB Health System. His robotic surgery experience has evolved to include post-chemotherapy retroperitoneal lymph node dissection, off-clamp partial nephrectomy, and nephrectomy with caval thrombectomy. We look forward to the evolution and advancement of robotic-assisted surgery at UAB under the guidance of Dr. Nix.

by Mary Elaine Killian, MD

The University Teaching Hospital in Lusaka, the capital and largest city in Zambia, is a massive complex with 1,800 beds and multiple departments, but there are no pediatric urologists. From September 22 to October 2, 2015, IVUmed, a nonprofit organization committed to making quality urological care available worldwide, hosted a pediatric urology week at the hospital to help address this unmet need. I was thrilled to participate as an IVUmed Resident Scholar, sponsored by the AUA Southeastern Section.

On the first day, the pediatric nursing station served as our clinic room, and patients -- many of whom traveled long distances -- lined up around the ward to be seen. We developed an efficient triage center, with stations for basic information such as weight to be recorded, and places for examinations by the local and IVUmed urologists and anesthesiologists.

We evaluated more than 50 patients with a wide range of urologic issues, including hypospadias, trauma, epispadias, fistulae, UPJ obstruction, exstrophy, and posterior urethral valves. The need for pediatric urologists was evident with each patient we saw. Children who would have had surgery before one year of age in the United States were presenting for the first time at six years of age or older, or with indwelling catheters instead of undergoing immediate surgery. After clinic, we had the difficult task of arranging this operating schedule for the week. Since there were only enough time and resources for about 25 cases, we had to pick the cases best suited for operation that week.

We performed numerous hypospadias repairs, some of which were repeat operations due to extensive scarring or wound breakdown. These are problems that we encounter in the United States but seemed to be more significant in this patient population. We also saw a three-year-old who had a ureteropelvic junction obstruction. His kidney was so dilated that it was easily palpable on physical exam and he had close to one liter of urine drain out intra-operatively once the obstruction was relieved. With the severity of his pathology, it might have been picked up on routine prenatal ultrasounds had he been in the United States. Several of the other cases performed were for patients with posterior urethral valves which were being managed with indwelling catheters, since they do not have a pediatric resectoscope with which to treat this problem. Procedures that would have been outpatient in the States were admitted to the hospital for management, largely due to the travel and financial limitations of many of the families.

Since medical school, I have wanted to participate in an international medical mission trip. I was overjoyed to be admitted to the IVUmed Resident Scholars Program, and the experience I gained exceeded my expectations. Working with the local urologists was an incredible and educational experience. I learned much about patient care, adaptability, and resourcefulness. Our host and local urologist at UTH, Dr. Nenad Spasojevic, is one of the most energetic, creative, and innovative persons I have ever met. “No” is not a word in his vocabulary. The week was not without difficulties, but he was able to find a solution to any issue we encountered, and his work ethic was unmatched.

During that week, the IVUmed attending urologists Dr. Stephany and Dr. Oottamasathien worked with the local residents and staff on each case, focusing on teaching. The patience, thoroughness, and expertise they displayed was inspiring. IVUmed’s motto is “Teach One, Reach Many”, and I plan to embody that by incorporating what I learned during the mission trip into my patient care back in the U.S. Similar to UAB, University Teaching Hospital in Zambia deals with a broad a range of pathology, but without the tools and resources that I realized I take for granted in Birmingham. I consider myself very fortunate to have learned from the creativity, problem-solving skills, and perseverance of the IVUmed staff and local urologists in Zambia.

Department of Urology Chair Dean G. Assimos, M.D., presented a plenary session titled "AUA Guideline: Surgical Management of Ureteral Calculi" at the 2016 American Urological Association annual meeting. He also participated in a panel discussion titled "Complex Cases: Stones: 15 mm Lower Pole Stone". Both are available as webcasts online provided by the AUA.