Washington University Division of Urologic Surgery - Annual Report 2022

Division of Urologic Surgery 2022 Annual Report Living Our Legacy

“In the Division of Urology, we are building on an historic legacy at Washington University by training future leaders in our field, reaching more patients in our community and making groundbreaking discoveries in our research laboratories.” -Sam B. Bhayani, MD MS 2 Washington University School of Medicine in St. Louis | Department of Surgery

LETTER FROM THE CHIEF The Division of Urology at Washington University School of Medicine in St. Louis places its emphasis on three key areas: training future leaders in our field, advancing the specialty through research discoveries and delivering world-class care to people with urologic conditions. Our training programs offer unparalleled experience across the breadth and depth of urology. For over a century, the Washington University Urology Residency has prepared trainees for careers at the forefront of urologic surgery. As a graduate of the residency program myself, I speak from experience. Additionally, we offer fellowships in pediatric urology, endourology, urologic trauma and reconstruction, and urologic oncology. Within the division, our faculty represent the Sam B. Bhayani, MD MS full range of our specialty, with particular expertise in: endourology, reconstructive Professor and Chief of Urologic Surgery, Department of Surgery surgery, minimally invasive surgery, Chief Medical Officer, Washington University Physicians male reproductive health, female urinary medicine, pediatric urology, stone disease, our urologists see patients at several clinical and urologic cancers including prostate, locations, many of them within traditionally bladder, kidney and testicular cancer. We underserved communities. For many patients far have developed key partnerships with from downtown St. Louis, world-class urologic specialists across disciplines to deliver care is now accessible and convenient. Reaching comprehensive care. more patients at additional locations has required Many historic advances in our field have us to grow. In recent years, we have expanded their origins at Washington University. our skilled nursing staff and increased our clinical From the development of PSA testing to faculty by over fifty percent. Every day, I hear laparoscopic nephrectomy, and even the stories of the lives touched by our urology team first description of urinary diversion via the and I am reminded why we do what we do: to ileal conduit, our division has long been a deliver the most advanced urologic care with national leader in urologic breakthroughs. respect and compassion. We continue that legacy today through I am incredibly proud of the progress we have multiple NIH-funded research projects, key made in 2022. Achieving significant results clinical trials and a robust basic science in academic medicine requires vision and program in prostate cancer. Partnering with expertise, but it also requires dedication. It is the our colleagues at Siteman Cancer Center commitment of our people—in our division and and BJC HealthCare, we are bringing the across the institution—that makes breakthroughs latest discoveries from bench to bedside in urologic care, research and education possible. to improve outcomes and better serve our I invite you to read the stories in this report for a patients. glimpse of what Washington University Urology A major focus of Washington University has achieved in the past year. Urology in recent years has been the expansion of our clinical programs to more locations across the region. Today, Division of Urologic Surgery | 2022 Annual Report 3

Division of Urologic Surgery From left: Jason Frankel, MD, Erica Traxel, MD, Kefu Du, MD. Carrie Ronstrom, MD. From left: James Gross, MD, Charles Nottingham, From left: Surbhi Chouhan, PhD, Shambhavi MD, MS, Christopher Arett, MD, Jay Jiang, MD. Bhagwat, MS, Nupam Mahajan, PhD. Faculty in this division are leaders and pioneers in their field. The long history of innovations and cutting-edge treatments within this division has contributed to its consistent ranking as one of the top urologic surgery centers in the country by U.S. News & World Report. Washington University urologists offer a range of treatment options, both surgical and nonsurgical, for conditions of the urogenital tract. The division is also nationally recognized for its research on detection and risk stratification of prostate cancer. The residency and fellowship programs train outstanding physicians through the expertise of faculty, high volume, diversity of cases and spirit of inquiry. 7,329 14,517 Operating room cases Office procedures 48,385 $2,332,551 Visits $$$ Research funding xx 62 Faculty Clinical research studies 4 Washington University School of Medicine in St. Louis | Department of Surgery

Expanding Access to Exceptional Urologic Care As Washington University Urology continues to add several new surgeons to its faculty, patients throughout the St. Louis metropolitan area and beyond are now able to benefit from the expert care provided by the growing team of urologists closer to their own homes. The expanding faculty list, combined with the wide list of facilities maintained by the BJC HealthCare organizations throughout the region, provides patients with the full spectrum of care they may have only been able to receive if they traveled broad distances to visit the division’s major clinical site on the medical campus. “Our mission is to reach far beyond the main Michael Johnson, MD. academic and medical campus here in St. Louis City to bring high-level Washington University Urology and Siteman Cancer Center care to places that are the most convenient to our patients,” says Division Chief Sam Bhayani, MD, MS. Michael Johnson, MD, an alumnus of the division’s urologic surgery residency program, has returned to the institution to provide care for patients in St Louis County and at Barnes-Jewish Hospital.. Kimberly Berni, MD, and Jeffrey Glaser, MD, see patients at Progress West Hospital (O’Fallon, MO) and Barnes-Jewish St. Peters Hospital. Kenneth Sands, DO, MBA, and Zeynep Gul, MD, join urologists such as Arnold Bullock, MD, to provide care to patients at Christian Hospital in north St. Louis County. Across the river in Illinois, Paul Kogan, MD, sees patients for a variety of general urology services, including care for urological cancers and kidney stones at Memorial Hospital Belleville*. The Alvin J. Siteman Cancer Center has also expanded its presence throughout the region, giving patients who have been diagnosed with urologic cancers of the kidneys, prostate, or bladder access to nationally recognized cancer treatments and clinical trials closer to home. Urologists see patients at six Siteman locations in the St. Louis area and Illinois, including the Washington University Medical Campus, Barnes-Jewish West County Hospital, Barnes-Jewish St. Peters Hospital, Siteman’s standalone facilities in North and South St. Louis Counties, and in Illinois at Memorial Hospital Shiloh. “Our mission is to reach far beyond the main academic and medical campus here in St. Louis City to bring high-level Washington University Urology and Siteman Cancer Center care to places that are the most convenient to our patients.” Cross section -Sam Bhayani, MD, MS of kidney. *Clinical services in Illinois provided by Washington University Physicians in Illinois Inc. Division of Urologic Surgery | 2022 Annual Report 5

Urologic Surgery Highlights CLINICAL Erica Traxel, MD. Urologic surgeon Erica Traxel, MD, and Vicky Peck, RN, patient safety and quality coordinator, were recognized as institutional leaders in the area of quality improvement and honored with the Barnes-Jewish Hospital Team Award for Quality Improvement at the 12th Annual BJC Patient Safety & Quality Symposium. In their project, “iTRUST: Identifying and Tracking Retained Ureteral Stents,” the duo worked to track every patient who had stents implanted by a urologist in an online system. Tracking stents enabled the team to determine whether patients returned to have their stents removed or changed, which reduced adverse patient safety events associated with retained ureteral stents. RESEARCH Drug triggers immune cells to attack prostate cancer. Nupam Mahajan, PhD, and Kiran Mahajan, PhD, are leading the fight against castration-resistant prostate cancer through translational Nupam Mahajan, PhD, left, and Kiran Mahajan, PhD. research projects funded by the National Cancer Institutes, Prostate Cancer Foundation and other sources. In one study, published this year in Science Translational Medicine, the team discovered a mechanism by which prostate cancer cells become resistant through molecular modification of the androgen receptor protein and identified a potential therapy that could overcome this resistance. In another project, published in Cancer Research, a journal of the American Association for Cancer Research, the investigators identified a tumor-suppressive RNA sequence that downregulates androgen receptors, making way for new therapeutic options. EDUCATION Lewis Thomas IV, MD, center. Washington University Urology faculty are consistently recognized for their excellence in surgical education. This year, urologic surgery residents honored Lewis Thomas IV, MD, with the 2022 Charles B. Manley Teaching Award. Jason Frankel, MD, associate director of the Urologic Surgery Residency program, participated in the Program Director Bootcamp Certificate Program, sponsored by the Academy of Educators at the School of Medicine. Frankel described the program as an opportunity to connect with others passionate about education as he continues to learn from program director, Erica Traxel, MD. Chief Resident Laura Lee, MD, is also involved in advancing medical education and serves as a representative of the Graduate Medical Education Committees on campus. 6 Washington University School of Medicine in St. Louis | Department of Surgery

““Our team of urologists at Washington University has made a decades-long commitment to advancing care through minimally invasive strategies.” -Sam Bhayani, MD, MS Eric Kim, MD, left, and R. Sherburne Figenshau, MD. Sam Bhayani, MD, MS, at the 2022 Teaching Awards. Fostering a Legacy of Excellence Sam Bhayani, MD, MS, who has a long history of their problem with minimum downtime,” says Bhayani. of leadership at Washington University and BJC Much like Bhayani, R. Sherburne Figenshau, MD, HealthCare, is now chief of the Division of Urologic and Eric Kim, MD, have become divisional leaders Surgery. As Bhayani stepped into this role, he who perform minimally invasive procedures utilizing promised to continue to build on the division’s long surgical robot systems to treat prostate and kidney tradition of excellence and innovation in urologic cancers and research to support the efficacy and surgery, research and training. outcomes of these treatment methods. Zachary Bhayani, the Robert K. Royce Distinguished Professor Smith, MD, and Arjun Sivaraman, MD, MBBS, in Urologic Surgery, also serves as Chief Medical MS, MCH, have focused their research and clinical Officer of the Faculty Practice Plan at Washington practices on targeted urological cancer care, which University School of Medicine. He maintains an active will allow surgeons and oncologists alike to further clinical practice focused on the treatment of kidney personalize a patient’s urologic cancer treatments and prostate cancer with robotic surgery, and he exactly to their needs. introduced and started the robotic surgery program An outstanding surgeon-scientist who is at the at the academic campus. His research has focused on forefront of research and management of benign patient safety and quality improvement, screening lower urinary tract disorders, the division was and detection for urologic cancers, and developing honored to name H. Henry Lai, MD, as the Gerald L. new surgical techniques to treat kidney and prostate Andriole Professor in Urologic Surgery. cancer. Bhayani and his colleagues within the Division “For over 15 years, Dr. Lai has been committed to established robotic partial nephrectomy as the advancing our understanding of benign urologic standard of care for patients with renal cell carcinoma conditions and has garnered multiple grants that led at the institution. to key research discoveries,” says Bhayani. “He has This legacy of excellence in the division is evident served as a mentor to countless urologists, many of through numerous investigations into the use whom are now national leaders in caring for people of prostate-specific antigen testing, advanced with these conditions. His impact in the field is felt far procedures to treat kidney cancer, and image-guided and wide beyond our institution, and this endowed minimally invasive surgery. professorship recognizes his essential contributions “We want to perform surgery through smaller to urologic care.” incisions or even noninvasively so patients are cured 7 Division of Urologic Surgery | 2022 Annual Report

Excelling in Education The residency and fellowship programs offered From left: Yifan Meng, MD, Alex Parker, MD, Erica Traxel, MD, and Carrie Ronstrom, MD, at the Class of 2022 Chief and Fellow by the Division of Urologic Surgery exemplify Graduation. Washington University’s proud legacy of world- class education. Trainees in these programs gain Urology fellows hold clinical and teaching responsibilities valuable experience alongside top-notch doctors and are provided with extensive opportunities and as their mentors and instructors, exposure to a resources for research. Operative care takes place at high volume of clinical cases and vast research Barnes-Jewish Hospital, where fellows encounter and opportunities. treat a wide array of conditions. Fellows gain graded The Washington University Urology Residency clinical responsibilities throughout the course of their has a long and distinguished history in preparing program and participate research program tailored to the graduates for successful careers in urologic surgery individual fellow’s background, interests and goals. dating to 1910. Today, the residency places major “Our trainees graduate into truly remarkable, capable emphasis on technical innovation and provides physicians with excellent reputations in urology,” says opportunities for residents to garner experience Division Chief Sam Bhayani, MD, MS, who is the Robert K treating a volume and diversity of surgical cases Royce Distinguished Professor in Urologic Surgery. “Your among the highest in the nation for urologic reputation is made while the patient is looking at you for residency programs. Led by Program Director Erica your leadership and your compassion.” Traxel, MD, the urologic surgery residency offers a The education programs in the Division of Urologic robust and well-rounded education to tomorrow’s Surgery prepare trainees for rewarding and successful innovators. careers as innovative academic surgeons. Each program In 2022, the Division of Urologic Surgery celebrated encourages outside-of-the-box thinking to support the graduation of chief residents Yifan Meng, trainees in advancing the field throughout their training, MD, Alex Parker, MD, and Carrie Ronstrom, MD; research and careers. With a history of graduating urologic trauma and reconstruction fellow Shellee nationally recognized urologic surgeons, the division Ogawa, MD; minimally invasive urology fellows proudly upholds its legacy of fostering the growth of the Mark Biebel, MD, and Brijesh Patel, MD; and nurse next generation of groundbreaking physicians. practitioner fellow Mandi Tuhro, MSN, APN, FNP. “The Division of Urologic Surgery is part of a small but elite group of academic urology programs that offers a nurse practitioner fellowship,” says Patient Safety and Quality Coordinator Vicky Peck, RN. “ “Experience is the teacher of all things, and experience is exactly what our fellowship provides. Our former fellows have gone on to practice in urology across the country.” -Vicky Peck, RN 8 Washington University School of Medicine in St. Louis | Department of Surgery

Pushing Onward As the highest recruiting site for the “ “Kidney stones are common, painful and expensive to treat. Over $10 billion Prevention of Urinary Stones with is spent annually on kidney stone Hydration (PUSH) study, the Division of treatment. Our goal is to prevent stone Urologic Surgery has received additional recurrence by encouraging hydration in funding from the National Institutes at-risk patients.”  of Health and National Institute of Diabetes and Digestive and Kidney Diseases to continue the research and development of the study. PUSH is a study of the potential of -Henry Lai, MD increased fluid intake to reduce the risk of recurring kidney stones and methods to encourage patients to increase their daily hydration. The study reached its target sample size of 1642 patients in January of 2022, making it the largest randomized trial to prevent kidney stone recurrence. Henry Lai, MD, who is the Gerald L. Andriole Professor in Urologic Surgery, and Associate Professor Alana Desai, MD, are principal investigators in the study. Lai serves as Director of Urologic Research at Washington University. His research has been consistently funded by the NIH and has made lasting contributions to the field of urologic research. “I am so impressed by the amazing research program Dr. Lai has put together and his history of continuous funding by the NIH,” says Chief of Urologic Surgery and Robert K Royce Distinguished Professor in Urologic Surgery Sam Bhayani, MD, MS. “He is an inspiration and an asset to the division, the department and the school.” The PUSH study utilizes smart water bottles and other incentive methods to allow participants to track their fluid intake and to encourage them to meet intake goals. Going beyond simply proving the benefits of hydration in preventing kidney stone recurrence, the study seeks to investigate methods of behavioral intervention to find the best ways to encourage patients to consistently meet fluid intake goals. The most recent grant, totaling $630,000, will allow the study to continue and expand its efforts. High fluid intake has shown to be a particularly effective and low-risk intervention in preventing kidney stones in patients who have suffered from stones previously. The PUSH study seeks to not only address the common health-care problem of lack of proper hydration, but to determine effective programs and incentives to keep patients on-track with their fluid intake goals and free from recurring kidney stones. Lai, Desai and their team have made great strides in this area of research over the course of the ongoing PUSH study and aim to continue pressing forward and determining the best methods of keeping their patients healthy and motivated to achieve their health goals. Henry Lai, MD. 9 Division of Urologic Surgery | 2022 Annual Report

FACULTY DIVISION OF UROLOGIC SURGERY Sam B. Bhayani, MD, MS Professor and Chief of Urologic Surgery, Department of Surgery Chief Medical Officer, Washington University Physicians Sunil M. Apte, MD Jason K. Frankel, MD Kenneth Sands, DO Christopher T. Arett, MD Jeffrey Glaser, MD Arjun Sivaraman, MD, MBBS, MS, MCH Kimberly Berni, MD Zeynep Gul, MD Woodson W. Smelser, MD Arnold D. Bullock, MD Dane P. Johnson, MD Zachary L. Smith, MD Erica Card, MSN, FNP-C Michael H. Johnson, MD Christina Stephan Stark, RN, MSN, CPNP Emily S. Cherry, MSN, APRN, AGPCNP-C Eric H. Kim, MD Lewis J. Thomas IV, MD Gilbert Comola, ANP-C Paul Kogan, MD Ralph J. Torrence, MD Douglas E. Coplen, MD H. Henry Lai, MD Erica J. Traxel, MD Alana C. Desai, MD Kiran Mahajan, PhD Ramakrishna Venkatesh, MD Kefu Du, MD Nupam Mahajan, PhD Gino J. Vricella, MD Jason Farrow, MD Gregory P. Murphy, MD Renee Warmbrodt, RN, MSN, CPNP R. Sherburne Figenshau, MD Charles U. Nottingham, MD, MS Anita Wilson, BSN, MSN, ANP, FNP 2022 Urology team. 10 Washington University School of Medicine in St. Louis | Department of Surgery

RESIDENT CORNER Our five-year residency program offers a high clinical volume of diverse patients. Our residents choose Washington University for world-class urologic training, a supportive learning environment, and the ease of living in St. Louis. “ WHAT SETS WASHINGTON UNIVERSITY UROLOGY APART? “Excellent research opportunities, top-notch surgical training, high volume. Plus, there is no group of people I would rather work alongside for five years.” Nick Pickersgill, MD UROLOGY PGY-4 Nick Pickersgill, MD. “ WHAT ARE YOUR GOALS FOR THIS YEAR? “I hope to improve to improve my surgical skills and increase my medical knowledge while also balancing family life as a new mom!” Katie Agamawi, MD UROLOGY PGY-5 Katie Agamawi, MD, left. “ WHY DID YOU CHOOSE WASHINGTON UNIVERSITY? “St. Louis was the perfectly-sized city for me, the program had experts in all the fields I wanted to explore, and the high operative volume made me feel like I would be prepared by the end of residency. When I interviewed, it felt welcoming and genuine. As a female entering a male- dominated field, this program was extremely diverse in both residents and faculty members.” Helen Kim, MD UROLOGY PGY-3 Helen Kim, MD, right. 11 Division of Urologic Surgery | 2022 Annual Report

DIVISION OF UROLOGIC SURGERY OFFICE OF THE CHIEF Sam B. Bhayani, MD, MS Division Chief of Urologic Surgery Robert Royce Distinguished Professor of Surgery ADMINISTRATIVE OFFICES 4960 Children’s Place MSC 8242-22-02 St. Louis, MO 63110 APPOINTMENTS (314) 362-8200 urology.wustl.edu PARTNER INSTITUTIONS The 1,500 specialty and primary care clinicians who make up Washington University Physicians comprise the medical staffs at Barnes-Jewish Hospital and St. Louis Children’s Hospital. SHARE ON TWITTER @WashU_Uro SCAN ME CONTACT: For more, please scan the QR code below or visit [email protected] urology.wustl.edu/ 12 Washington University School of Medicine in St. Louis | Department of Surgery