Expansion of Endourology Program Improving Outcomes for Patients
February 05, 2021
UH Urology Institute focuses on new techniques and research to improve care
Innovations in Urology | Winter 2021
With the addition of Amihay Nevo, MD as chief of endourology, University Hospitals Urology Institute continues to find new ways to use minimally invasive techniques to treat common urological problems and to research ways to improve patient care.
BUILDING A WORLD-CLASS ENDOUROLOGY PROGRAM
The prevalence of kidney stones and Benign Prostatic Hyperplasia (BPH), which affects half of all men 60 and older, means there is a vast pool of patients who could potentially benefit from new technologies and a broad range of treatment options.
“The endourology division of the Urology Institute is already a long-standing, trusted partner for kidney stone treatment, and our clinicians have been recognized for excellence in BPH procedures, such as UroLift and Greenlight. We also have the highest volume of HoLEP procedures in the state of Ohio,” Dr. Nevo says. “We’re continuing to build on our foundation of clinical expertise by focusing on patient care, new technology and research discoveries that will define new ways to treat patients and offer them multiple treatment options at our regional hospitals, close to where our patients live and work.”
UH’s comprehensive kidney stone and BPH clinics also offer metabolic evaluations for patients with recurrent stones; minimally invasive therapies for stone treatment, including shockwave lithotripsy, ureteroscopy and percutaneous nephrolithotomy (PCNL). We offer miniPCNL, a less invasive treatment for large stones; Percutaneous access is obtained intraoperatively with ultrasound or fluoroscopy, allowing flexibility and safer, more effective stone clearance.
EVALUATING NEW TECHNOLOGIES
Dr. Nevo, who is also an assistant professor of urology at Case Western Reserve University School of Medicine, thoroughly evaluates and tests new technologies so urologists can personalize their use with patients based on age, anatomy, symptom severity and expectations for the best outcomes.
Laser therapy. Although laser technologies have been around for 20 to 30 years, they have become a critical treatment tool for urologists over the past decade or so.
“Laser technology is safer and the most efficient source of energy we have to treat both kidney stones and BPH,” Dr. Nevo says.
While the newest generations of laser technology offer unprecedented opportunities for treating urologic patients, the data around how best to use them could be more robust. To that end, Dr. Nevo has initiated a study to compare head to head the two leading laser machines.
The Olympus Soltive SuperPulsed Laser System, which uses a thulium fiber laser (TFL), and the Lumenis Moses 2.0 Holmium laser device, show great promise. The new Moses technology has been shown to be far superior to the old technology for BPH, he says, but hasn’t really been demonstrated for stones. The newest TFL technology is smaller, quieter and more ergonomic, but hasn’t been directly compared to the Moses.
“This prospective study will compare the two devices in different clinical scenarios and help us find the most efficient treatments for patients,” Dr. Nevo says. “This research is also important for the urologic community because most clinics will only purchase one machine. We hope our study will help urologists choose which machine is right based on their clinic’s profile of procedures.”
Aquablation. Under the leadership of Irina Jaeger, MD, UH is also evaluating aquablation, a new computer-guided surgery for BPH that offers a very short operating time. This minimally invasive procedure uses heat-free, high-pressure saline to treat BPH, a condition that leads to surgery for approximately one-quarter of men 50 and older with lower urinary tract symptoms.
“This is one of the newest technologies being explored for BPH,” Dr. Nevo says. “It’s the first robotic guided prostate surgery. The computer decides how and when to apply fluid pressure to ablate the prostate.
IMPROVING PATIENT CARE THROUGH PREDICTIVE MODELING
Urinary tract infections (UTIs) are common and concerning so urine cultures are mandatory before any urologic interventions. UTIs occur even when the culture is sterile. Dr. Nevo has initiated a retrospective study to evaluate how well previous urine cultures predict the type and susceptibility of organisms in urologic surgery patients, and how the time until surgery affects the accuracy.
“Patients with foreign bodies often harbor more than one type of bacteria in their urine and the flora changes over time,” he says. “The idea here is to determine when should urine culture be obtained before surgery.”
Dr. Nevo hopes the study will lead to more definitive preoperative guidelines, especially in patients who have a high risk for infection.
“UH is very open minded,” he says. “We continually evaluate our tools and the necessary resources to provide the best possible treatment for patients.”