www.NSAUA.org
HASSAN RAZVI, MD
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DEAR COLLEAGUES AND FRIENDS,
TH
A ANNUAL MEET -AU IN G NS
ALLS NIAGARA F
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PRESIDENT’S MESSAGE
Spring 2012
Sep
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ber 12-16, 2012 • Ontari
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On behalf of the Northeastern Section’s Board of
Dr. Tony Khoury, a former member of our section and now the Chief of
Directors I would like to invite you all to our section’s
Pediatric Urology at the University of California at Irvine will speak and
64th Annual meeting in Niagara Falls, Ontario, Canada
lead a panel discussion on pediatric urology challenges. Dr. Li-Ming Su will
September 12-16, 2012.
present a futuristic vision of minimally invasive surgery. Dr. Bodo Knudsen currently at Ohio State and a former resident from our section will speak on
With the two hundred year anniversary of the War of 1812 being recognized
recent advances in percutaneous renal surgery and ureteroscopy. A distin-
this year it seems only fitting that our meeting is being held in the Niagara
guished panel headed by Dr. Brent Hollenbeck will address surgical quality
region, an area that played a prominent and strategic role in the battle
assurance as it relates to prostate cancer surgery. Resident involvement
between the young nation of the United States of America and British
in the program will again include the popular resident debates as well as
North American forces. The outcome of the war had a significant impact on
“Urology Jeopardy” and a laparoscopic skills competition in the Exhibit Hall.
the maturation of America but also on the development of a new nation, Canada. The treaties and boundaries created from the armistice laid the
September in the Niagara region is a delightful time and the social program
groundwork for a strong and healthy relationship that continues to this day
will highlight the area’s natural beauty. The back drop for Fun Night will
and is a source of pride to the citizens of both our nations.
be the majestic Niagara Falls. Food and wine lovers will enjoy the many local restaurants and wineries. The world famous Shaw Festival will delight
Dr. Stephen Pautler, the Scientific Program Chair has assembled an out-
theatre-goers. The region is a golfer’s haven and we are fortunate to have
standing educational program that will be of interest to residents, com-
secured the Thundering Waters Golf Club for the Section’s golf tournament.
munity and academic urologists. The program has been devised to promote audience participation with the inclusion of a number of panel discussions.
While I realize there are many meetings each year that one can consider
Within our Section we are blessed to have an enormous array of urological
attending, I do hope those of you who have not been to a Section meet-
talent with many established as well as up and coming academic lead-
ing recently will plan to attend. Our Section is unique, with both U.S. and
ers. Dr. Michael Jewett, a highly respected educator, thought-leader and
Canadian members, and teaching and research programs that are the envy
pioneer will serve as this year’s Slotkin Lecturer. Dr. Mohit Bhandari, from
of the entire AUA. As a relatively small section by population, our meetings
McMaster University will give a thought provoking lecture on the revolution
are intimate allowing close interaction with leaders in our field and network-
in evidence-based medicine and the impact on surgery. We are also for-
ing opportunities with friends and colleagues from both sides of the border.
tunate to have secured a number of world renowned faculty from outside
I look forward to seeing you in Niagara Falls, September 12-16, 2012!
the section. Dr. Paul Russo from Memorial Sloan Kettering will provide a state-of-the-art review of advanced kidney cancer care. Dr. Ann Gormley will provide an update on the management of female urinary incontinence.
2011–2012 BOARD OF DIRECTORS OFFICERS PRESIDENT Hassan Razvi, MD London, Ontario PRESIDENT-ELECT Zahi N. Makhuli, MD Syracuse, New York
NEW AUA LEADERSHIP CLASS SELECTED In 2004, the AUA and Sections launched the AUA Leadership Program to identify urologists who have demonstrated strong leadership skills within organized medicine or community involvement and who have an interest in assuming future roles of responsibility within the AUA. The program provides the opportunity for younger members to polish their leadership skills, take advantage of networking opportunities and become better acquainted with AUA programs and services. To date, seven Northeastern Section members have participated in the program. The Board of Directors recently selected two Section participants for the 2012-2013 Leadership class. Congratulations to Dr. Jodi K. Maranchie of the University of Pittsburgh, and Dr. Wassim Kassouf of McGill University. The next leadership class kicks off in May at the AUA Annual Meeting in Atlanta.
PAST PRESIDENT Edward M. Messing, MD Rochester, New York SECRETARY Ronald P. Kaufman Jr., MD Albany, New York TREASURER D. Robert Siemens, MD Kingston, Ontario HISTORIAN Ronald Rabinowitz, MD Rochester, New York
JODI K. MARANCHIE, MD
AUA BOARD OF DIRECTORS Kevin Pranikoff, MD Eggertsville, New York
REPRESENTATIVES CANADA Karen J. Psooy, MD Winnipeg, Manitoba NEW YORK Elise J. Billings De, MD Albany, New York PENNSYLVANIA Timothy D. Averch, MD Pittsburgh, Pennsylvania
WASSIM KASSOUF, MD
AT-LARGE CANADA Kenneth T. Pace, MD Toronto, Ontario
Dr. Maranchie is currently Assistant Professor of Urology at the University of Pittsburgh where her clinical focus is urologic cancer. She received her ScB from Brown University and medical degree from Northwestern University. Dr. Maranchie completed the Harvard Program in Urology residency followed by a urologic oncology fellowship at the National Cancer Institute. Her basic research efforts are in molecular genetics of renal cancer and have been funded by the NCI and American Cancer Society. Dr. Maranchie is active in the Society of Urologic Oncology and Society of Basic Urologic Research. She chairs the Research Scholarship Committee of the AUA Northeastern Section and serves on the AUA Foundation Research Council and Journal of Urology Editorial Board.
Since 2006, Dr Wassim Kassouf has been on faculty at McGill University following a fellowship in urologic oncology at M. D. Anderson Cancer Center. Dr. Kassouf’s clinical practice focuses on all aspects of urologic oncology whereas his research focuses on bladder cancer. Presently, he is the Program Director of the McGill Urology Residency. He has led several national guidelines for optimizing quality of care in urologic cancer and has published over 140 peer-review manuscripts and book chapters. He has obtained independent peer-reviewed grant funding from the CRS and CIHR. He is the founder of the national Canadian Bladder Cancer Network, a cofounder of Bladder Cancer Canada, chair of the National Cancer Institute of Canada’s disease-oriented group in bladder cancer, and an executive member of the NIH Genitourinary steering committee Bladder Cancer Task Force. Dr Kassouf has received several awards including the AUA Research Scholar Award, CUA Scholarship, FRSQ Clinician Scientist Research Scholar Award, and the Everett C. Reid Teaching Excellence Award.
AT-LARGE UNITED STATES Badar M. Mian, MD Albany, New York
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YOUNG UROLOGIST MEMBERS
If you have a Facebook account you can add the Northeastern Section to your profile page. You’ll be among the first to know about upcoming events, and you’ll have new opportunities to connect with professionals in your field and reconnect with old friends.
CANADA Julie Franc-Guimond, MD Montreal, Quebec UNITED STATES Michael Ost, MD Pittsburgh, Pennsylvania
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LEADERSHIP PROGRAM ALUMNI – WHERE ARE THEY NOW? Participation in the AUA Leadership program provides a valuable stepping stone to greater involvement in the Section and National AUA. Here’s a look at our Section alumni, and where they are now: Tim Averch, MD has been serving on the Section Board of Directors for the past three years, first as the U.S. Young Urologist member, and now as the Pennsylvania representative. He is also currently a member of the AUA Quality TIM AVERCH, MD and Patient Safety Committee and the Section Health Policy Committee. Dr. Averch was a member of the 2006-2007 Leadership class and had this to say: “My experience with the AUA leadership program opened doors into the AUA that I was not aware existed. The program allowed me to meet and expand upon my goals to work with and be a part of the AUA leadership: A career altering experience!”
D. Robert Siemens, MD is a graduate of the 2008-2009 Leadership class. He currently serves on the Section Board of Directors as Treasurer and on the AUA Investment Committee. He is Professor in the Departments of Urology, D. ROBERT SIEMENS, MD Oncology and Biomedical and Molecular Sciences at Queen’s University. Dr, Siemens describes the AUA Leadership program as “an outstanding experience and it certainly met my expectations. Having participated in several similar courses; I would recommend applying for this opportunity given its quality and focus in an arena that is of more substantial interest to many of us.”
Hassan Razvi, MD, current Section President, was also a member of the 2006–2007 Leadership class and speaks highly of his experience in the program: “I feel deeply honored and fortunate to have been chosen to participate in HASSAN RAZVI, MD the AUA Leadership Program as one of the Northeastern Section representatives. I had a wonderful experience and the skills and knowledge I obtained have been of immense help to me not only with my work on behalf of the Section and the AUA but with my other administrative and leadership responsibilities. These learnings have been utilized in my leadership roles as Treasurer and now President of our Section, as a member of the AUA Guidelines Panel, as Past Chair of the Canadian Urological Association Guidelines Committee and current Chairman of Urology at the University of Western Ontario. In addition, the program allowed me to make a number of acquaintances with colleagues that have led to lasting friendships. For individuals interested in refining their leadership skills, gaining a better understanding of the inner workings of the AUA and networking with colleagues from throughout North America I highly recommend the AUA Leadership Program.”
Ken Pace, MD is currently serving his fourth year on the Section Board of Directors. He had this to share about his experience in the 2010-2011 Leadership Program: “As one of the Northeastern Section representatives for the 2011 KEN PACE, MD AUA Leadership Program, I can attest just how useful and valuable the program was. From dedicated sessions on mentorship and leadership at AUA headquarters in Baltimore, to formal mentorship from senior AUA leaders who generously donated their time, to the Joint Advocacy Conference (JAC) in Washington DC, the program revealed the many facets of the AUA organization and its vital role for urology and urologists. As a participant I am now more involved than ever in the AUA, by serving on the Northeastern Section Board of Directors, as representative of the Leadership Program to the AUA Laparoscopy and Robotic Surgery Committee, and by serving on the scientific program committee for the Northeastern Section annual meeting in Niagara Falls. One of the main benefits of the program was getting the opportunity to work with the other participants, who represented a broad range of young urologists from all other AUA sections, with a wide mix of interests and practice types. This was an incredibly talented and accomplished group of urologists. The senior mentors for the program provided incredible role models of leadership, commitment, and professionalism. These new professional relationships will last a lifetime.”
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Ronald Kaufman, MD has served on several Section and AUA committees since his participation in the Leadership Program in 2004–2005. He is the current Chair of the AUA Coding and Reimbursement RONALD P. KAUFMAN, Committee. This committee JR., MD represents urology in the area of coding, terminology development and reimbursement. This committee also seeks new and updated codes to ensure accurate identification of urologic diseases and procedures. In his role as Chair of the Coding and Reimbursement Committee, Dr. Kaufman is liaison on several other AUA committees to offer his expertise. Dr. Kaufman is also currently a member of the Section Board of Directors, in his second year as Secretary. Dr. Kaufman is Associate Professor of Surgery, Division of Urologic Surgery and Assistant Professor of Physiology & Cell Biology, at Albany Medical College. Jean Joseph, MD has served on the Section Development Committee since his participation in the AUA Leadership Program in 2008-2009 and he currently serves on the Section Bylaws Committee. Dr. JEAN JOSEPH, MD Joseph is the head of the section of laparoscopic and robotic urologic surgery at the University of Rochester Medical Center. Dr. Joseph has been integrally involved with the Society of Robotic Urologic Surgeons and helping plan live surgeries and other activities at the AUA Annual Meeting. Badar Mian, MD participated in the AUA Leadership Program in 2010-2011 and currently serves on the AUA Education Council. He is also a member of the Section Board of Directors, serving his fourth year as the U.S. BADAR MIAN, MD At-Large Representative. Dr. Mian is an Associate Professor of Surgery in the Division of Urology at Albany Medical College.
FOR MORE INFORMATION ABOUT THE AUA LEADERSHIP PROGRAM, VISIT WWW.AUANET.ORG. 3
HIGHLIGHTS FROM THE BOARD OF DIRECTORS – MARCH MEETING
DREW SHIFFLET, CAE EXECUTIVE DIRECTOR
Finance The Board approved the yearend 2011 Financial Statements. The Combined Statement of Financial Position for the 12-month period reflects Total Assets of $1,854,828, with Net Assets (Equity) of $1,780,771. The Statement of Activities for the year shows total revenue of $447,495 and total expenses $491,923 resulting in an operating deficit of ($44,428). Total investment income of $13,556 results in a year end decrease in Net Assets of ($30,871).
Audit Ms. Tracy Pruitt of the auditing firm McGladrey & Pullen, LLC, reported on the Section’s yearend audit. McGladrey audited the consolidated statements of financial position and the related consolidated statements of activities and cash flows. The auditors found no unusual or significant transactions conducted without proper accounting and guidance, there were no disagreements with management over the application of accounting principles, and all internal controls are in place. McGladrey therefore provided an unqualified opinion that the 2011 financial statements present fairly, in all material respects, the financial position of the Northeastern Section and its Foundation. The Audit Report was approved as presented. Investments Ms. Dorothy Boyer, Merrill Lynch Investment Advisor, reported that for the calendar year 2011 the Section and Foundation combined investment return was a positive .87%. The Board acknowledged that cash and near cash investments in the past two years have been higher than normal, based on purposely not investing in low interest CD and bond products. This led to discussion of whether the Section should consider a change in allocation policy. After discussion, the Board took no action and agreed to “stay the course” with regard to the Section’s “Moderately Conservative” investment allocation. The Board continues to address operational deficits. From the Secretary Dr. Kaufman provided a synopsis of the AUA Section Secretaries Membership Council meeting held in January. Items pertinent to the Section included a potential Canadian representative on the AUA Residents Committee and other administrative protocols regarding membership. The Board was given an update on the Section Residents Committee, the new Young Urologist Mentoring Program, the AUA Residents Bowl and the AUA/Section 2012-2013 Leadership Program. Section Meeting with Canadian Industry Dr. Razvi reported on the March 23rd meeting with Canadian industry. In attendance were he, Dr. Siemens, Dr. Joseph Greco (Development Committee Chair), Dr. Stephen Pautler (2012 Annual Meeting Scientific Chair), Dr. Jerzy Gajewski (Canadian representative on the Development Committee) and Mr. Shifflet. The meeting was designed as an exchange of information and several suggestions and requests were received. These ranged from enhancing communications and targeting the exhibits and support prospectus to key individuals, to meeting together more strategically up to a year in advance of the Section Annual Meeting. The Board agreed that a follow up meeting with both U.S. and Canadian industry representatives should be planned if possible in September in Niagara Falls.
The Board engaged in discussion about more actively partnering with allied nursing groups whenever possible to strengthen and offer education to nurses, physician assistants and other technician members of the urology care team. All agreed that if the Section can identify individuals to champion and help plan the program, and a partner organization to organize and promote the program, Allied education at the annual meeting should be undertaken in those years the meeting is held within Section. The Board further agreed to the concept of establishing a nursing/allied membership category, and agreed to explore a potential dues/benefits structure. Annual Budget and Operating Deficits The Board considered a number of options to address operational deficits over the past three years, which combined with low investments have resulted in a decrease of net assets for the Section and its Foundation. The Board approved a $50 increase in Annual Meeting registration for Active Section and AUA Members, Non Member Physicians, Spouses and Guests, and a $25 increase for urology Residents and Allied Health Professionals (effective 2012). The increase is to help offset the actual cost of approximately $475 per person to attend the meeting, which has been heavily subsidized. The Board also made modest adjustments to the social events template and budget relating to two functions at the Annual Meeting. Further announcements about the registration fee increase will be communicated in upcoming e-news updates, and reported at this year’s annual business meeting. Historian’s Report Dr. Rabinowitz distributed a written report and described AUA’s history exhibit which this year is entitled “Skeletons in the Closet: Indignities and Injustices in Medicine.” A book will be printed this year (as opposed to exhibit brochure). His report was received as information. Dr. Rabinowitz was asked if a history exhibit would feasible at the Niagara Falls meeting. Report from AUA Board Representative Dr. Pranikoff reported on various items including AUA’s financial status and new reserve policy, AUA’s new simulation advisory board, policy debate on training non-physicians in cystoscopy, a new philanthropic outreach policy, and a new Men’s Health checklist. His report was received as information. Scholarship Research Committee A report from Dr. Jodi Maranchie, Committee Chair, summarized the work of the committee in 2011 in selecting the Young Investigator nominee and winners of the Resident Prize Essay contest, and plans for the committee in 2012. The final research report from Dr. Yves Caumartin was also received by the Board. Development Committee A report from Dr. Joseph Greco, Chair, highlighted the fundraising activity of the committee in 2011, including the successful member giving campaign in. Dr. Psooy and other Canadian members of the Board reiterated some concern that donations to the [U.S. based] Foundation are not tax deductible for Canadians. Mr. Shifflet agreed to talk further with tax advisors and research possibilities to offer this tax benefit in the future.
Allied Health Education and Membership
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SPRING 2012
WORLD FAMOUS NIAGARA FALLS The roar of the falls, the flashing lights of the casinos, the great outdoors, the excellent food and drink in wine country . . . these are a few of the things to look forward to for the Northeastern AUA annual meeting in Niagara Falls! The action packed academic program will be highlighted by state-of-the-art talks from our expert faculty! STEPHEN PAUTLER, MD CHAIR, SCIENTIFIC PROGRAM COMMITTEE
Our scientific program will be held in the new stateof-the-art Scotiabank Convention Centre in Niagara Falls. We have an exciting list of plenary speakers covering the broad spectrum of Urology and beyond. Sessions focusing on oncology, pediatrics, reconstruction, female urology, evidence-based medicine, endourology and minimally-invasive urology will interest both academic and community urologists. Again this year, there are resident debates, but we’ve added two new challenges: a laparoscopic skills competition, and “Reach for the Top”. These two competitions will feature residents from American and Canadian training programs going for gold. Reach for the Top was a featured television quiz show in Canada in the 1960’s and 70’s. The format is similar to Jeopardy and our Northeastern AUA version should prove to be tons of fun!
In addition to the science, we hope that you will be able to take in the great sights in Niagara. This region of Ontario is known for its fabulous vineyards due to modified climate created by its location between two great lakes. There are many tours available (driving, biking and walking), or if you are adventurous, you could participate in a harvest program available at some of the wineries. Niagara is rich in history. This year is the 200th anniversary of the War of 1812. This was the last time our two countries had conflict and several key battles were fought within Niagara. Parks Canada has several programs available to those who are interested. Niagara Falls has many family friendly attractions. Many tourist attractions, in all their tackiness, form the Clifton Hill Area, just a short walk from the conference hotel. See the history of daredevils who challenged fate by taking the plunge over the falls in a barrel! For golfing enthusiasts, there are world-class courses including Legends on the Niagara, Whirlpool and Thundering Waters (a John Daly signature course). Fall fishing in the Niagara River or Lakes Ontario or Erie is always great. Whatever you fancy, you will be able to find something to enjoy. Please join us for this year’s Northeastern AUA annual meeting in Niagara Falls!
LEARN HOW TO “TAKE CONTROL OF YOUR FINANCIAL LIFE” AT THE YOUNG UROLOGIST MENTORING PROGRAM IN NIAGARA FALLS! As the financial world becomes more complex the time required by individuals to understand such changes becomes time consuming and quite burdensome. Such is the case with those working in health care. As physicians move through the stages of their careers their goals and desires grow and evolve yet taking the time to adjust becomes more of a challenge. In addition, as they begin the journey toward meeting their goals DAVID MANDLER, PARTNER, QUATTRO they will encounter many obstacles within the financial ADVISORS world. Some of the questions they begin to ask themselves are: How do I get started? How am I doing currently? How long is it going to take? When do I know I can retire? How much and what types of insurance do I need? The presentation,” How to Take Control of your Financial Life” is going to answer some of those questions as well as cover the obstacles you will face. In your financial life there is no magic product. You must begin to focus on the coordination of financial advice. In order for you to start planning you
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must start treating your finances the way a business treats its financial life. In order to obtain financial success there must be an understanding of the areas that consistently need to be addressed. There must also be an appreciation for the different phases of planning. To help with this we will discuss risk tolerance vs. rate of return, inflation, lost opportunity cost, economics of distribution, and longevity. We will discuss the three phases of financial planning as well as the key areas that you should protect. This presentation is designed to educate and advise you so that you may become the CEO of your financial life. By understanding the financial world and how it is designed, you as the consumer/CEO will understand how to make informed financial decisions. The Young Urologist Mentoring Program is open to all attendees who are 10 years or less out of residency. It will be held on Friday, September 14, 4:30 – 6:00 p.m. You can sign up for the event when you register for the annual meeting.
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LESSONS FROM A MEDICAL MISSION In January 2012 I had the privilege of joining a Fistula mission to Burkina Faso Africa with “Fondation Mères du Monde en Santé” (Healthy Mothers of the World), led by Jacques Corcos, M.D. Professor of Urology, McGill University, past General Secretary of the International Continence Society. ELISE DE, MD ALBANY MEDICAL CENTER
There is no anticipating the impact of a medical mission on the participant. The experience cannot be controlled or anticipated beyond reading and gathering supplies. One must then be open to the necessity of situation, whatever it may be.
I knew I would be gaining surgical skills on the trip – and these were in fact beyond my expectations - both in Dr. Corcos’ skill and in the complexity of the surgical experience. Learning is optimized when every participant passionately wants the patients to do well. The patients we took care of had severe disease, we were well equipped to address it, and Dr. Corcos imparted as best he could his years of experience by demonstration, discussion, and constructive critique. However, I received an even greater gift: the distillation of teamwork. We planned to arrive and depart on the same flights. We met in Montreal ahead of time to delegate supplies and discuss anticipated challenges. Upon arrival in the capital Ouagadougou, we slept a bit, had breakfast, changed money, secured cell phones, and headed to the grocery store. Here the 10 of us had to agree on purchases – no small feat. Innumerable boxes and suitcases had to be strapped to the vehicle – and restrapped as they loosened – as a team. By the time we arrived at the rural house in Boromo, we had ten task-oriented individuals doing whatever they could for the group: cleaning bathrooms, cooking, counting supplies, charging computers, scouting out the hospital, preparing spreadsheets, uploading reports to the MMS website at 45 minutes per paragraph, etc. Under strong leadership we ate all meals together, went to and from the hospital as a group, had daily debriefings from each individual, and enjoyed all leisure time in the same space. This teamwork not only continued but expanded throughout the week. We
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consisted of two surgeons, and anesthesiologist, a respiratory therapist, two scrub nurses, a PACU nurse, a secretary/business person, and an anthropologist. We were joined locally by an interpreter/psychologist, a go-for person, two African Urologists, the heads of Maternal Fetal Medicine and of the hospital, multiple anesthetists, and many local nurses in our efforts. With each step in the trip – the very FACT that patients were organized and waiting when we arrived, the task of engaging and assessing the frightened, hopeless yet hopeful women in a dirty exam room with carried-in supplies and no soap, setting up the instruments with the help of local technicians who did not maintain the same concepts of sterility, successfully carrying out epidurals for intra- and post-op analgesia in women whose backs required scrubbing and in patient care areas covered with red dust, communicating post –op instructions through 3 layers of translation, paying the bribes and managing further negotiations, formulating diplomatic social events, and imparting the surgical follow-up to the local team and the French Mission to follow ours – I realized the value of each individual member of the core visiting team as well as our colleagues in the African system. The trip was put into relief by the importance and needs of these suffering patients, whose pieced-together care clarified the intense interdependence we share with our colleagues in our average day at home. We never think about this partnership in our daily grind, but in Boromo we truly could not have succeeded as we did without any one member. Even the person who brought us bread and made sure there was water at hand was essential. It was Dr. Corcos’ leadership that allowed us each to perform to our best and revel in our successes with a sense of individual accomplishment while blending our effects with those of the group. Vesico-vaginal fistula is a major health problem in the developing world, especially in sub-Saharan Africa and South Asia, a problem that is now rare in Western countries with the exception of iatrogenic fistula. The majority of fistulae worldwide are a result of obstructed labor during delivery - but trauma, sexual abuse, coital injury in child brides and female genital cutting practices also contribute to the phenomenon. Obstetrical fistulas form when there is a discrepancy between the size of the fetus and the space available in the pelvis (cephalopelvic disproportion). The fetus is impacted in the birth canal often for as long as 3 to 5 days. The vaginal and vesicourethral (or more rarely ureteric or rectal) tissues are compressed between
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the fetal head and bony pelvic structures leading to ischemia and necrosis. The fetus dies 85% of the time leading to softening and delivery. The woman, if she survives, is left with a fistula and resultant incontinence of urine or feces. In addition to discomfort from the continuous soiling, these women are often rejected by their husband, their family and their community [1]. They cannot use transportation, walk for long periods of time, stand outside with friends, cook, participate in social and religious events, or go to the mosque or church. Since most of these women are left without children, they feel that they cannot fulfill their role as a woman, a wife or a mother. Most have trouble finding work. The combination of social and economic forces in many of these cases compounds the woman’s preexisting poverty, and malnourishment is the rule. These physical and psychological factors impact the success of surgery in the percentage of women who find treatment. It is estimated that there are about 124 obstetric fistulas per 100,000 deliveries in rural sub-Saharan Africa [2]. Lack of access to obstetrical care is the main risk factor for fistula. In Burkina Faso infant mortality is 20%. The average salary is $1 per day, as it is the 3rd poorest country in the world. A vaginal delivery costs 900 francs ($2), and not only does a C section cost 60,000 francs ($100), but the distance to C section is an average 1 day walk. A United Nations Population Fund (UNFPA) and the United Nations International Children’s Educational Fund (UNICEF) Survey found that Each African country surveyed had only one emergency obstetric center per 500,000 inhabitants. [3] What I enjoyed most about the organization of this mission was the multidisciplinary perspective that took the surrounding cultural and medical factors into consideration. Performing surgery in the setting of such public health issues can feel like putting a finger in the dyke, and in fact can worsen the patient’s situation if they are not well followed. However, while we were repairing women who may have had one or more surgical attempts prior, and who might be planning further pregnancies, the anthropologist and psychologist were studying factors that prevent access to prenatal care and were empowering the patients regarding their futures. The women reported they gained confidence through telling their stories, by rooming SPRING 2012
with other women in their situation, and through the process they learned of their future resources for obstetric care through the government clinic system. Regarding their existing diagnoses, follow up care was provided on two levels – the local urologists and the French team “Aupres de l’Enfant – Burkina” (ADE-Burkina) would be available to them, as well as our team again within the year. If you would like to learn more, to be involved, to make a donation, or to refer interested patients to donate, please visit http://www.fondationmms.org/index.php/en/homeeng
References [1] Ahmed S, Holtz SA. Social and economic consequences of obstetric fistula: life changed forever? Int J Gynaecol Obstet 2007;27:819-823. [2] Vangeenderhuyzen C, Prual A, Ould el Joud D. Obstetric Fistulae: Incidence estimated for sub-Saharan Africa. Int J Gynaecol Obstet 2001; 73:65-66. [3] Lewis G, deBernis L, editors. Obstetric fistula: guiding principles for clinical management and programme development. Geneva, Switzerland.: WHO; 2006, p. 78. Would you like to share your experience with a mission or other charity work? Send us an email - nsaua@auanet.org. 7
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SPRING 2012
LEND A HAND IN NIAGARA FALLS For the first time in 2011, the Section reached out to the local community for a rewarding experience, generously donating time with the St. Bernard Project. Section members, spouses, guests, and families spent Saturday afternoon rebuilding the homes and lives of Katrina survivors in New Orleans. Past President Dr. James W.L. Wilson and Mrs. Jean Wilson commented that “The opportunity to help at the St. Bernard Project was a unique experience for us at a scientific meeting. It allowed us to participate in something entirely different, to see a part of the community from a perspective not normally accessible to tourists and quite different from media reports, and perhaps even to be of assistance. Oh yes, we had a lot of fun too.” Board of Directors Representative Dr. Timothy D. Averch and Mrs. Joanne Averch rearranged their family’s schedule when they heard of the project in New Orleans, and their son, Jake Averch, missed a school dance, music rehearsal, two hockey games, and a friends’ Bar Mitzvah just to participate as a family! Mrs. Averch recognizes that “…taking the time as a family to enhance the life of someone in need is a humbling experience. There was a moment between prepping wall sockets and clearing debris from the yard, when Jake turned to me and said ‘I am glad we came’…as a parent that is an Aha moment!” With such enthusiastic participation in New Orleans, another volunteer opportunity is being planned for Niagara Falls. After the conclusion of the Plenary on Saturday, transportation will be provided to Red Roof Retreat, a Niagara Region Charity which has provided quality recreational, educational, and respite services to children, youth, and young adults with special needs and their families since 2001. Red Roof Retreat creates opportunities for relationships to develop and for skills to grow. This organization has been a leader in meeting the growing requirements of special needs families in the greater Niagara area. There are currently over 3,500 families in the
Niagara Region with special needs. It costs over $3,000 per weekend to provide respite care to 5 special needs children/young adults. This assistance is costly in a region where the median household income is $53,057, according to the last Census data, and 11% of Niagara families are living in low-income households. Red Roof charges families just $130 per weekend, making it more affordable, but increasing the demand for help to continue these programs. Red Roof Retreat is a rural-based retreat and our group will likely be working outdoors. Our exact activity will be determined at a later date, but previous groups have built a barbeque area, worked in the yard, built fencing, and done brickwork. Please consider spending Saturday afternoon with Red Roof Retreat. This volunteer opportunity will take place at 12:30-4:30 p.m. You can sign up to participate when you register for the Annual Meeting. Registration will open in May.
INVITATION TO BANFF: CUA 2012 ANNUAL MEETING As President of the Canadian Urological Association (CUA), I would like to invite you to attend the 67th Annual Meeting of the CUA taking place in beautiful Banff at the historic Banff Fairmont Resort, June 24-26, 2012! Drs. Jay Lee and Trevor Schuler have put together an outstanding list of guest speakers who will educate and distract you from the glorious natural beauty outside! With a record number of abstracts (334), you can expect a scientific program of exceptional quality. For all our US colleagues, you can claim Category 1 credits for the 23 or so planned hours of science. The updated program is now on our meeting website. Drs. Howard Evans and Marty Duffy know how to party like nobody else I know and trust me when I say their social agenda will keep you entertained! Lastly the spectacular natural beauty of Banff National Park needs little assistance in enticing you to come in June. Take some extra time off, bring family (there are those mandatory summer OR closures anyway), stay a while and enjoy all the natural beauty Alberta has to offer! Michael Chetner CUA President
SPRING 2012
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ROBOTICS IN RESIDENCY The Section Residents Committee takes a look at exposure to robotics training during residency on both sides of the border. Do you have an opinion or comment? Post it to the NS-AUA Residents Blog at www. http://nsauarc.blogspot.com/
GOING ROBOTIC: THE PAST, PRESENT AND FUTURE OF UROLOGICAL ROBOTIC SURGERY IN CANADA Urology is a specialty known for adopting new technologies. In some cases, minimally invasive techniques are overtaking their open counterparts as the standard of care. Robotic surgery has seen an exponential rise in the US in recent years. Certainly the idea of 3D visualization, reducing tremor, faster learning curve over laparoscopy, Endowrist® technology is appealing to Urologists. Patients also find shorter hospital stays, faster return to work and the allure of new technology too difficult to ignore. Nevertheless, the adoption of this technology has been much slower in Canada. Robotic consoles are found in academic centres in Vancouver, Calgary, Edmonton, London, Hamilton, Toronto, Ottawa and Montreal.
robotics may still be very different from 2008. For residents, the learning curve is still the largest obstacle. Not only are attending physicians building up their own case load and expertise, they may now be teaching someone with little to no robotic experience. Simulators and dual “teaching” consoles are aimed at bridging the gap. Now, there are dual consoles in three institutions (CHUM [St-Luc Hospital] in Montreal, Ottawa Hospital and St. Joseph’s Hospital in Hamilton) and simulators in five (CHUM [St-Luc Hospital] and Jewish General Hospital in Montreal, Ottawa Hospital, St. Joseph’s Hospital in Hamilton and Humber River Regional Hospital in Toronto). I recently had the privilege of spending a few hours on a MIMIC dv-Trainer™ robotic simulator as a study participant. I was impressed by 3D graphics, graduated tasks and feedback offered by the simulator. Commercial pilots are required to log a certain number of hours on a simulator, why not a robotic surgeon or trainee?
Two platforms have dominated the market: ZEUS Robotic Surgery System (Computer Motion Inc.®, Goletta, CA) and da Vinci Surgical System (Intuitive Surgical Inc.®, Sunnyvale, CA). The latter has come to the forefront of robotic surgery the last few years and the former is no longer commercially available. The initial Canadian series of robotic-assisted laparoscopic prostatectomy came out of the University of Western Ontario, with its first case in 2004.1 Since that time, the field of Urology has been a rapid adopter of robotic technology, when compared to other surgical specialties. Of the 6000 da Vinci procedures performed in Canada since 2003 across all specialities, 3845 have been urologic surgeries (D. Minogue, personal communication, February 4, 2012). Naturally, this new wave of “roboticism” has brought on its fair share of scepticism as well. In Dr. Curtis Nickel’s letter to the Canadian Urological Association Journal, he cautions urologists about becoming “seduced” by the technology before we truly understand the advantages and disadvantages over other non-robotic alternatives. He advocates that rather than getting caught up in the glitz and marketing of this new technology, we should take a step back and examine it critically.2 Dr. Yves Fradet argues that having a robot detracts from the real asset, which should be surgical expertise.3 Certainly, the realities of longer operative times, limited resources and longer wait times in a cash-strapped public Canadian health care system must be considered.
Canadian urologists may not be as rapid as their American counterparts at adopting robotic surgery, however, it does not mean that it doesn’t have a role in the future of robotic surgery. A group in Hamilton lead by Dr. Mehran Anvari and David Williams, a former astronaut, is working on developing a new robotic platform.5 Our institution has also taken a keen interest in simulation-based training for robotic surgery.
LINDA LEE, PGY-3 AT THE UNIVERSITY OF WESTERN ONTARIO, LONDON, ONTARIO, CANADA
The future of robotic surgery will affect the new waves of residency graduates in Canada. In a survey conducted during QUEST, an annual review course for chief residents, 36% of respondents were exposed to urological robotic procedures in 2008, compared to 4% the previous year. While 71% of chief residents surveyed thought robotic surgery will increase in the future, only 39% planned to perform robotic surgery after residency. Eleven percent even felt that robotic surgery is a fad that will ultimately fail.4 Anecdotally, I have spoken to other residents who are concerned that robotic training in residency may detract from training in open surgery. Nevertheless, the landscape of 10
The future of robotic surgery is still one that remains unclear. Whether it has a role in the future of urologic surgery or a passing fad, there are compelling arguments on either side of the argument. Nevertheless, more research in this field is crucial before we will ever know. Acknowledgements Special thanks to Dr. Stephen Pautler. References Chin JC, Luke PL and Pautler SE. Initial experience with robotic-assisted laparoscopic radical prostatectomy in the Canadian health care system. Can Urol Assoc J 2007; 1(2): 97-101. Nickel JC. Seduced by a robot. Can Urol Assoc J 2009; 3(5): 359-361. Fradet Y. Arguments against investing widely in robotic prostatectomy in Canada: a wrong focus on tool box rather than surgical expertise. Can Urol Assoc J 2009; 3(6): 486-487. Preston MA, Blew BDM, Breau RH, et al. Survey of senior resident training in urologic laparoscopy, robotics and endourology surgery in Canada. Can Urol Assoc J 2010; 4(1): 42-46. Pettapiece M. Rise of the robot. Hamilton Magazine 2011. Retrieved from http://www. hamiltonmagazine.com/sitepages/?aid=2076&cn=Features&an=FEATURE%20|%20 Rise%20of%20the%20Robot
SPRING 2012
ROBOTIC AND LAPAROSCOPIC SURGICAL TRAINING IN UROLOGY RESIDENCY - UNITED STATES With the advent and improvement of laparoscopic surgical techniques in the past 20 years, many traditionally open urologic procedures have been supplanted by minimally invasive modalities. Reasons for these changes have included less patient morbidity and overall decreased cost. This shift, however, has brought along with it steep learning curves. Some have argued that increasingly stringent residency work hour regulations, medico-legal concerns, and financial pressures for surgical efficiency have limited the ability of residents to obtain access to surgical mentoring in the operating room.1 This article seeks to explore the current state of robotic and laparoscopic training in the United States contingent of the Northeastern Section of the American Urologic Association (NSAUA).
and laparoscopic surgery during urologic residency was either not adequate or not ideal. For these respondents, a lack of structured robotic and laparoscopic simulation programs was the most commonly cited deficiency.
In order to garner more information, I surveyed the programs that comprise the United States contingent of the NSAUA. Response rate was 60%. All programs have the daVinci robotic platform (Intuitive Surgical Inc., Sunnyvale, CA). Both the daVinci-S and daVinci-Si models are well represented. Since the inception of the robotic modifier in resident case logs (2011), chief residents in the Northeast section have performed 49-68 robotic procedures prior to their graduation. The vast majority of these are radical prostatectomies (80%) followed by partial nephrectomies (10%) and other procedures (cystectomies, pyeloplasties, ureteroneocystotomies; 10%). Virtually all (95%) of the recently graduated urology residents have incorporated robotic and/or laparoscopic surgery into their current practice.
Minimally invasive laparoscopic and robotic-assisted laparoscopic surgeries have been rapidly adopted by the urologic community. Currently, residents within the NSAUA are exposed to a variety of laparoscopic and roboticassisted laparoscopic cases with many incorporating these techniques into their practice upon completing residency. There are a variety of simulators available to facilitate learning and a standardized curriculum for laparoscopic urologic surgery is currently being developed.
BENJAMIN T. RISTAU UNIVERSITY OF PITTSBURGH
In an effort to improve laparoscopic training in urologic surgery, the American Urologic Association is championing a laparoscopic urologic surgery curriculum. Modeled after similar programs for general surgeons, the newly established Basic Laparoscopic Urologic Surgery (BLUS©) skills curriculum has demonstrated good acceptability and evidence of construct validity.3 Currently, the BLUS© curriculum is being examined at 10 facilities across the country. Within the NSAUA, the University of Pittsburgh is one of the pilot sites.
References Wignall GR, Denstedt JD, Preminger GM, et al. Surgical Simulation: A Urological Perspective. J Urol. 2008; 179: 1690-1699. Endai B, Tracy C, Reynolds C, et al. Evaluation of laparoscopic curricula in American urology resi-
But is this experience enough? According to a recently published survey of American urology residents, 78% had access to a surgical simulator and 44% of programs had an established laparoscopic curriculum.2 This is similar to the current survey in which all respondents had access to a surgical simulator and 33% had a laparoscopic or robotic curriculum. Interestingly, two-thirds of the respondents in the current survey felt that their current training in robotic
dency training. J Endourol 2011; 25: 1805-1810. Sweet RM, Beach R, Sainfort F, et al. Introduction and Validation of the American Urological Association Basic Laparoscopic Urologic Surgery Skills Curriculum. J Endourol 2012; 26: 190196.
TEAM PREPARES TO COMPETE IN FIRST AUA RESIDENTS BOWL You may have heard about the AUA National Residents Bowl that will be held at the Annual Meeting in Atlanta this May. This program is designed to foster spirited competition between the resident members of AUA’s eight regional Sections. Each AUA Section has put together a team of residents to compete, but only one will be crowned champion!
SPRING 2012
JOIN SECTION MEMBERS IN ATLANTA AND CHEER ON THE RESIDENTS OF THE NORTHEASTERN SECTION TEAM: Jason Archambault, MD – University of Manitoba Joel Bigley, MD – University of Pittsburgh Michael Feuerstein, MD – Albany Medical Center Joy Knopf, MD – University of Rochester Susan Marshall, MD – SUNY Buffalo Patrick Richard, MD – McGill University Piotr Zareba, MD – McMaster University Francisco Garcia, MD – University of Western Ontario
The Residents Bowl will take place in the Science & Technology Hall: Saturday, May 19:
12:30 – 1:30 pm & 4:00 – 5:00 p.m.
Sunday, May 20:
12:30 – 1:30 pm
Monday, May 21:
12:30 – 1:30 pm Finals
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September 12-16, 2012 Ontario, Canada
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2012 Scientific Program Chair, Dr. Stephen Pautler has been hard at work putting together a top notch program for you to enjoy this September in Niagara Falls. The format of this year’s program will include 9 cutting-edge presentations from distinguished lecturers as well as six physician panels on hot topics facing urologists today. You don’t want to miss it!
DISTINGUISHED LECTURERS Michael Jewett, MD Slotkin Lecture The Evolution of Testis Cancer Care Paul Russo, MD Aggressive Kidney Cancer: What to Do? E. Ann Gormley, MD Management of the Incontinent Woman: How do Guidelines and FDA Warnings Impact How We Advise Our Patients? Bodo Knudsen, MD ESWL: Is it Dead? Tony Khoury, MD Advances in Pediatric Urology
Mohit Bhandari, MD The Evidence Based Medicine Revolution: A Surgeon’s Perspective Brent Hollenbeck, MD Improving the Quality of Care Among Men With Prostate Cancer Li-Ming Su, MD Image-guided Robotic Urologic Surgery Cheryl Lee, MD AUA Course of Choice Management of Non Muscle Invasive Bladder Cancer: Practical Solutions for Common Problems
NEW FOR 2012! - Residents Laparoscopic Skills Competition in the Exhibit Hall - Young Urologist Mentoring Program - “Take Control of Your Financial Life” - Resident Reach for the Top Competition PANEL DISCUSSIONS - What to Do With a Small Renal Mass? - Difficult Cases in Endourology - Controversies in Pediatric Urology - Genitourinary Reconstruction - Laparoscopy Video – How I do it
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SOCIAL PROGRAM - Exhibit Hall Grand Opening Reception - Fun Night at Table Rock Centre – Elements on the Falls Restaurant & Grand Hall - President’s Reception & Banquet, Featuring Clark Bernat, Niagara Falls Museums Manager - Golf Tournament at Thundering Waters Golf Club - 5K Fun Run/Walk - Volunteer Program with Red Roof Retreat - Spouse tour options that include: - Shaw Festival at Niagara-on-the-Lake - Niagara Highlights Tour - Art of the Blend – create your own blend of wine
REGISTRATION AND HOUSING ARE NOW OPEN! REGISTER BEFORE AUGUST 21 TO SAVE $100! Visit www.NSAUA.org to register today.
SPRING 2012
AUA AND SBUR ANNOUNCE SUMMER RESEARCH CONFERENCE AUGUST 11-12, 2012 Please make plans to attend the 2012 AUA/Society for Basic Urologic Research (SBUR) Summer Research Conference, “Hormones in Urologic Health and Development”. The meeting is scheduled for August 11-12 at the AUA Headquarters in Linthicum, Maryland. This year marks the 20th anniversary of these annual conferences. This year’s symposium will enhance the understanding of the physiological interactions of hormone within the genitourinary system during development, assess the roles that hormones play as the body ages, define the current state of androgen receptor targeting, and will relate to the critical future of medical breakthroughs that are being made in urology to treat and cure diseases in patients of all races, ages, and ethnicities. The goal of these meetings is to inspire
young basic scientists and urologists by providing an outstanding scientific program presented by leaders in the field, as well as research funding information provided by NIH program officers and staff. There will also be a poster session, a funding workshop with roundtable discussions where researchers can talk directly with grant officials, and tour of the William P. Didusch Center for Urologic History. This meeting is intended for individuals at all levels of their research and/or clinical careers, and travel awards are available for young investigators. You can get more information or register for the conference at http://www.urologyhealth.org/research/src/ or call 800-908-9414.
DR. JEHONATHAN PINTHUS TO REPRESENT SECTION AT AUA RESEARCH FORUM
JEHONATHAN PINTHUS, MD, PHD MCMASTER UNIVERSITY
Congratulations to Dr. Jehonathan Pinthus of McMaster University who has been selected to represent the Northeastern Section at the 2012 AUA Research Forum in Atlanta. The Forum is a competitive program showcasing top young investigators with innovative, relevant and impactful research of high interest to the urologic community. Dr. Pinthus is one of nine finalists chosen by the AUA Research Council. He will present his research, “Adiponectin as a Tumor Suppressor and Metabolic Modifier: Role in Kidney Cancer and Link to Obesity as a Risk Factor” before a panel of judges in May.
THANK YOU MEMBERS! SPRING 2012
Those who heard Dr. Pinthus speak at the annual section meeting in New Orleans will agree that he is a dynamic individual with an exciting research program aimed at understanding host factors such as obesity, that influence tumor growth and progression. In his words, “we are living in an obese society, and the findings of my research are relevant to at least one third of the population we treat.” He has discovered that the fat-derived hormone adiponectin functions as a renal tumor suppressor, and he is working toward translating this finding into novel therapies for renal cancer. The Research Forum will be held at the annual AUA meeting in Atlanta on Sunday afternoon, May 20, from 3 to 5:30 pm in the Georgia World Congress Center. Please come and show your support for Dr. Pinthus and learn more about the exciting research advances taking place in urology.
A sincere thank you goes out to all Section members who generously donated to the Section Foundation Fundraising Campaign in 2011. Thanks to you, the Foundation was able to raise $10,700 last year! Over the past 16 years, the Section is proud to have awarded 23 research grants, numerous Resident travel grants, and continued sponsorship of the annual Prize Essay Contest. While we won’t have a single campaign push for fundraising in 2012, we hope to repeat and enhance fundraising programs in the future. Thank you for your support!
CONTRIBUTIONS TO THE SECTION FOUNDATION ARE APPRECIATED AT ANY TIME, AND MAY BE MADE ON OUR WEBSITE AT WWW.NSAUA.ORG OR BY CONTACTING THE SECTION OFFICE AT 410-689-4025.
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DATES TO REMEMBER RESIDENT PRIZE ESSAY CONTEST DEADLINE TO ENTER – JUNE 25, 2012
YOUNG INVESTIGATOR RESEARCH GRANT APPLICATION DEADLINE – JULY 9, 2012
EARLY BIRD REGISTRATION DISCOUNT DEADLINE – AUGUST 21, 2012
NOW ACCEPTING NOMINATIONS The Northeastern Section is now accepting nominations for open Section committee positions. Volunteers serve as the backbone of our Section and we are always looking for enthusiastic urologists who are interested in getting involved. The NS-AUA is also given the opportunity to nominate individuals for AUA’s national awards! To learn more about Section Committees and AUA Awards or to nominate yourself or a colleague, please visit www.nsaua.org.
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SPRING 2012
{ The Northeastern Section of the American Urological Association
Join us for the first
AUA National Residents Bowl – and Support Your
NORTHEASTERN Residents Bowl Team! Booth # 3863 Designed to foster a spirit of competition and Section pride, this fun-filled event will match residents in an ultimate battle of the brains. The AUA National Residents Bowl will test residents’ knowledge in different urological subspecialties, the history of urology and important new research findings.
SATURDAY SUNDAY MONDAY - FINALS
Eight AUA Sections will send four residents – only one team will be champion. This is the not-to-be-missed event of AUA2012. Visit the Science & Technology Hall Saturday-Monday afternoons to show your Section support and cheer on your residents as they compete for the championship.
12:30 - 1:30 p.m. 3:30 - 4:30 p.m. 12:30 - 1:30 p.m. 12:30 - 1:30 p.m.
Visit AUA2012.org/ResidentsBowl to learn more. SPRING 2012
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www.NSAUA.org
Fall/Winter 2011 The Northeastern Section of the American Urological Association
IN THIS ISSUE:
1000 Corporate Boulevard Linthicum, MD 21090 Address Service Requested
• PRESIDENT’S MESSAGE • UPDATE FROM THE BOARD • ROBOTICS IN RESIDENCY • LEADERSHIP PROGRAM PARTICIPANTS • ANNUAL MEETING PREVIEW • DATES TO REMEMBER • AUA RESIDENTS BOWL
Ontario, Canada
September 12-16, 2012
Visit www.NSAUA.org
Registration and Housing are Now Open
for the 2012 NS-AUA Annual Meeting
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