Lifespan Division of Urology at Rhode Island Hospital and The Miriam Hospital

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Division of Urology

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DIVISION OF UROLOGY AT RHODE ISLAND AND THE MIRIAM HOSPITALS

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MEN’S HEALTH CENTER

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MINIMALLY INVASIVE UROLOGY INSTITUTE

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KIDNEY STONE CENTER

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GENITOURINARY MULTIDISCIPLINARY CLINIC

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PEDIATRIC UROLOGY

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UROLOGY AND NEPHROLOGY CLINIC

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RECONSTRUCTIVE UROLOGY

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FEMALE VOIDING DISORDERS

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TECHNOLOGY

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EDUCATION AND TRAINING

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RESEARCH

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OUR TEAM

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CONTACT INFORMATION

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DIVISION OF UROLOGY AT RHODE ISLAND AND THE MIRIAM HOSPITALS

The division of urology at Rhode Island and The Miriam hospitals provides comprehensive inpatient and outpatient medical care to patients with a wide range of urologic disorders. The division’s teaching partnership with The Warren Alpert Medical School of Brown University elevates our research initiatives and paves the way for the next generation of leading urologists. Our dedicated team of experts combines stellar care with the most advanced technology and treatment options.

We follow a multidisciplinary approach to diagnosis and treatment, working together with our Men’s Health Center, Kidney Stone Center, Minimally Invasive Urology Institute, and fertility preservation service to manage everything from routine procedures to the most complex urologic conditions.

Mark Sigman, MD has over 20 years of experience in the diagnosis and treatment of urologic and reproductive problems. An internationally recognized expert on male infertility and sexual dysfunction, Dr. Sigman is chief of urology at Rhode Island and The Miriam hospitals and the Krishnamurthi Family Professor of Urology at The Warren Alpert Medical School of Brown University. He is co-director of the Men’s Health Center and has authored more than 100 publications in the areas of male reproductive medicine and surgery and also has lectured extensively throughout the country on this topic. Dr. Sigman has served as president of multiple professional societies, including the New England section of the American Urological Association, the Society for the Study of Male Reproduction, and the Society of Reproductive Surgeons.

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We provide comprehensive care for patients experiencing urologic disorders, including:

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Treatment of ureter, renal pelvic, retroperitoneal and other soft tissue tumors

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Male sexual dysfunction, including hypogonadism

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Cryotherapy for prostate cancer

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Male infertility

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Radiation therapy, including brachytherapy, oncology services and clinical trials

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Urologic cancers including cancers of the prostate, bladder, kidney, and testes

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MRI fusion biopsies of the prostate

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Kidney stones

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Benign prostatic hyperplasia

Kidney stone treatment including minimally invasive endoscopic, percutaneous, and shockwave treatments

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Pediatric urologic conditions

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Treatment of enlarged prostates

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Female voiding disorders

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Treatment for male sexual disorders, such as erectile dysfunction and Peyronie’s disease

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Urethral strictures and other conditions needing reconstructive urologic surgery

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Testosterone replacement therapy

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Sperm banking prior to chemotherapy or radiation therapy

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Treatment of male and female urinary incontinence

Our medical and surgical teams take a collaborative approach to treatment, incorporating expert knowledge from research and a range of specialties to ensure that each patient is well-educated before and after their procedures and receives the highest quality of care for the most favorable outcome.

We offer the following services: •

Robot-assisted laparoscopic surgery for º

Prostate, bladder and kidney cancer

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Female pelvic prolapse

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Pediatric and adult urologic conditions such as UPJ obstruction

Our team consists of experts at the pinnacle of their respective specialties. From the most common urological disorders to reconstructive urology, we are committed to providing the most complete care to yield the best outcome for each patient.

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MEN’S HEALTH CENTER The Men’s Health Center at The Miriam Hospital provides specialized clinical and psychological care for sexual dysfunction. Our team of professionals is dedicated to identifying the source of a patient’s sexual dysfunction, which can be caused by heart disease, hormone deficiency, or psychological issues, and helping restore a normal level of sexual functioning, all in a comfortable, confidential environment.

The members of our multidisciplinary team utilize current research and technology in the field to improve the overall health of each patient. The center’s co-directors, Martin Miner, MD, and Mark Sigman, MD, and the staff of the Men’s Health Center have led research to identify the causes of patients’ dysfunction. Their work has brought national attention to the center, establishing it as a frontrunner in evaluations and treatments.

Our highly specialized services for men experiencing sexual dysfunction issues include: •

Erectile dysfunction

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Low testosterone

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Premature ejaculation

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Peyronie’s disease

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Erectile dysfunction after prostate surgery

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Low sexual desire

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Delayed or absent ejaculation

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Psychological sexual dysfunction

Our multidisciplinary staff works hand in hand with primary care physicians to guide patients towards healthier lifestyles. Our team includes leaders in family practice, internal medicine, urology, psychology, and physical therapy, who collaborate to provide highquality care delivered with expertise and sensitivity.

Kathleen Hwang, MD, is an awardwinning, board-certified urologist trained in male reproductive medicine and surgery. Dr. Hwang strives to promote safe and discreet fertility preservation for male patients, particularly those about to undergo cancer treatments.

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Fertility Preservation The division of urology at Rhode Island and The Miriam hospitals is the only program in the state to offer a wide variety of fertility management and preservation programs for male patients, including those who will soon begin cancer treatments. Sperm freezing (cryopreservation) is available and Lifespan uses a secure, off-site, state-of-the-art laboratory that is certified by the FDA. Sperm banking is not limited to cancer patients – our secure and convenient services are available to all.

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MINIMALLY INVASIVE UROLOGY INSTITUTE (MIUI)

The Minimally Invasive Urology Institute (MIUI) is committed to delivering excellence in urologic care, research, and education. The MIUI offers cutting-edge treatments and specialized urologic care to patients through a variety of minimally invasive surgical options, such as laparoscopic and robot-assisted procedures.

In 2006, The Miriam Hospital became the first Rhode Island hospital to perform a robot-assisted operation. Since then, thousands of robot-assisted surgeries have been performed.

This high volume translates to the best possible outcomes for our patients. Our goal is to preserve function and restore patients to health.

The conditions we treat include: •

Prostate cancer

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Bladder cancer

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Kidney cancer

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Ureter cancer

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Testicular cancer

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Kidney stones

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Benign prostatic hyperplasia

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Adrenal masses

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Ureteropelvic junction obstruction

The MIUI’s specialists provide complete, multidisciplinary care. Our teams, which include urologists, surgeons, internal medicine physicians, nephrologists, oncologists, anesthesiologists, nurses, physical therapists, dietitians, and social workers, work together to approach individual patient requirements to ensure the highest level of treatment.

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KIDNEY STONE CENTER The Kidney Stone Center at The Miriam Hospital is the only center of its kind in the region. We offer patients complete medical and dietary management, as well as diagnostic services, in one location. Innovative technologies and methods are in practice to provide individualized care for patients who have, or are recovering from, kidney stones.

Our center includes nephrologists, urologists, registered nurses and sonographers dedicated to giving patients the best options for surgical and nonsurgical treatment. We offer patients complete medical and dietary management in one location. Our commitment to kidney stone prevention through nutritional advisement sets us apart.

The Kidney Stone Center is not only focused on treating existing kidney stones, but also on preventing kidney stones from forming in high-risk patients. Medical conditions like metabolic syndrome, short gut, diabetes, and obesity, as well as patients who have undergone gastric bypass, are some risk factors that might merit

additional attention. The center offers all diagnostic testing. Ultrasound is frequently used as an effective tool in diagnosis and location. The test provides immediate information without the use of radiation.

Other diagnostic studies include: •

Noncontrast computerized tomography

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Assessment of blood hormone, calcium, and vitamin D levels

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Analysis of urine samples to determine factors that may increase risks for formation of kidney stones

The Kidney Stone Center offers the following minimally invasive treatment options at The Miriam Hospital: •

Medical expulsive therapy

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Shockwave lithotripsy

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Ureteroscopy

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Percutaneous nephrolithotomy

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GENITOURINARY MULTIDISCIPLINARY CLINIC The Genitourinary Multidisciplinary Clinic, a program run as a collaboration between the Division of Urology and the Comprehensive Cancer Center at Rhode Island and The Miriam hospitals, is committed to providing quality care to patients with a variety of urologic malignancies.

Patients find comfort in our comprehensive approach. Our center provides physicians of all disciplines, including medical oncology, radiation oncology, and surgery. After an initial visit, our team meets with the patient to offer a recommended course of action. Meanwhile, our experienced staff organizes future treatments, necessary follow-ups, and rehabilitation services. This approach to care allows our patients a seamless transition from care to recovery.

The Genitourinary Multidisciplinary Clinic is accredited by the Commission on Cancer of the American College of Surgeons and certified by the Quality Oncology Practice Initiative for providing the highest quality cancer care.

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One-time consultations, evaluations, and second opinions

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Screening and diagnostic tests

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Medical oncology and sophisticated radiation oncology

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Technical and surgical services

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Comprehensive complementary services, including nutrition consultation, social work, physical therapy, primary nurse and nurse practitioner services, patient education, and support groups

The Genitourinary Multidisciplinary Clinic offers treatment options for patients with: •

Prostate cancer

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Bladder cancer, including adenocarcinoma, transitional cell (urothelial), and squamous cell carcinomas

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Kidney cancer

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Penile cancer

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Testicular cancer

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Ureter cancer

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PEDIATRIC UROLOGY Hasbro Children’s Hospital’s division of pediatric urology provides wide-ranging inpatient, outpatient, and emergency urological services, from prenatal consultations to treatment for adolescents.

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Undescended testes

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Vesicoureteral reflux

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Ureteropelvic junction obstruction

Our specialists offer advanced treatments for a range of urological conditions, including both common and complex pediatric issues.

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Renal cystic disease

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Incontinence

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Neuropathic bladder

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Exstrophy and epispadias

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Kidney tumors

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Genital abnormalities

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Varicocele

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Acute scrotal swelling

We diagnose and treat a full range of urological conditions in children and adolescents, including: •

Hydronephrosis

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Urinary tract infection

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Disorders of sexual differentiation

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Hydroceles

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Hypospadias

Anthony Caldamone, MD, director of pediatric urology, directed the urology residency program at The Warren Alpert Medical School of Brown University from 1990-2016.

Dr. Caldamone has also served in multiple urological associations, including as president of the New England Urologic Association, and is currently editor of the Journal of Pediatric Urology.

Dr. Caldamone has taken his expertise to a global level, participating in more than a dozen medical missions to the Middle East, South America, and Bangladesh. His contributions to the field of urology and his global efforts to bring his expertise and resources to those who need it, earned him the University of Rochester Humanitarian Award in 2012.

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The division of pediatric urology at Hasbro Children’s Hospital now offers the latest in minimally invasive laparoscopic and robotic surgery for several urological procedures, including: •

Partial and total nephrectomy

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Pyeloplasty for ureteropelvic junction obstruction

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Ureteral reimplantation for vesicoureteral reflux

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Duplicated systems

Robotic surgery is an alternative to open surgery, offering numerous advantages, including a quicker recovery, less pain, and reduced scarring.

Our specially trained surgeons are able to make precise maneuvers with technology that increases surgical dexterity, range of motion, and utilizes three-dimensional imagery.

Ours is the only pediatric urology program in the state that offers laparoscopic and robotic surgery. The pediatric team is at the forefront of innovations in field research and technology, providing our patients the most advanced treatments for the best results.

UROLOGY AND NEPHROLOGY CLINIC Hasbro Children’s Hospital offers the care of both the pediatric urology team and the nephrology team in a single location. Our diverse clinic treats complex pediatric conditions such as obstructive uropathy, kidney stones, urinary reflux, and frequent urinary tract infections.

Liza Aguiar, MD, a pediatric urologist, joined the division of urology in August of 2015. She treats newborns, children, adolescents, and young adults affected by a wide range of genitourinary conditions.

Dr. Aguiar is specially trained in laparoscopic and robotic urological surgery and is experienced in minimally invasive robotic surgery, which is a growing field in pediatric urology.

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RECONSTRUCTIVE UROLOGY The division of urology offers reconstructive care to manage difficult urologic conditions. Severe urethral strictures, genital skin loss, and ureteral injury requiring ureteral replacement surgery are all afforded to patients in the care of our experienced, fellowship-trained staff.

FEMALE VOIDING DISORDERS Our team offers assistance in managing female urologic conditions, such as pelvic organ prolapse, and urinary incontinence and retention. Our fellowship-trained staff at the Women’s Medicine Collaborative’s Program for Pelvic Floor Disorders and at Rhode Island and The Miriam hospitals consists of experts in female voiding disorders, also called pelvic floor medicine, and female gastrointestinal disorders, colorectal surgery, and internal medicine. We also offer surgery through minimally invasive approaches, such as robot-assisted laparoscopic and vaginal surgery.

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TECHNOLOGY The da Vinci Surgical System

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Less postoperative pain and discomfort

The da Vinci surgical system is a sophisticated, minimally invasive approach that uses advanced technology to help our surgeons perform surgery with greater precision than conventional instrumentation allows. This 3D, high-definition, high-magnification system incorporates the best techniques of open surgery and applies them to a robot-assisted procedure.

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Less blood loss

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Fewer transfusions

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Less risk of infection

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Less visible scarring

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Shorter hospital stay

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Quicker recovery time

The surgical robot’s innovative instrumentation gives our surgeons more precision, a better view, and enhanced dexterity, facilitating a minimally invasive approach that yields several benefits over open surgery.

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More favorable clinical outcomes

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Surgical incisions of one inch or less

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Increased preserved function

In 2006, The Miriam Hospital received its first version of the da Vinci robot and became the first in Rhode Island to use this technology. Since then, thousands of urologic procedures have been performed.

Studies have shown that patients have better outcomes, shorter hospital stays, and fewer complications when they choose surgeons and hospitals that perform a large number of procedures each year.

The surgeons of the Minimally Invasive Urology Institute at The Miriam Hospital are among the most experienced in Southeastern New England in urologic surgeries. Our many years of experience and high volume of procedures translate to the best possible outcomes for our patients.

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Blue Light Cystoscopy

Blue light

The Miriam Hospital is the only hospital in Rhode Island, and one of only three in New England, to offer blue light cystoscopy to diagnose and treat tumors in the bladder. Blue light cystoscopy is a minimally invasive procedure that enhances bladder cancer detection and diagnostic abilities.

Hexaminolevulinate HCl (Cysview), an optical imaging Conventional agent, is instilled in the patient’s bladder about an hour before the blue light cystoscopy procedure. This agent binds to cancerous areas and highlights them, making them visible to the eye. During the procedure, the physician uses white light to examine the bladder, and then switches to blue light. When the equipment is switched to blue light mode, additional hard-to-see tumors that may be present become more visible. These tumors stand out against the normal bladder tissue, making it easier for our team to identify and remove them.

A study published in the Journal of Urology shows that one or more additional cancer lesions were detected by blue light cystoscopy in 16.4 percent of patients compared to white light alone. Additionally, according to a 2009 study published in the Journal of European Urology, a reduced recurrence rate and prolonged recurrence-free survival rates for oncology patients have all been seen, resulting in better overall disease management.

UroLift UroLift is a treatment available for men with benign prostatic hyperplasia (BPH).

UroLift pre-procedure

UroLift post-procedure

UroLift is an outpatient procedure that corrects this condition by lifting the enlarged prostate tissue, using suture-like implants, unblocking the urethra and allowing an unobstructed passage of urine. UroLift does not involve any cutting, heating or removing of prostate tissue and does not cause sexual dysfunction.

Firefly Imaging Firefly Imaging is a near-infrared form of fluorescence imaging that allows us to map out the boundaries of the kidney, remove the diseased portion, and preserve as much of the healthy kidney as possible in surgery. Not only does Firefly Imaging allow for a maximization of kidney function, but it also allows us to better delineate renal tumors and tissue perfusion.

More than 80% of the kidney surgeries performed at the Minimally Invasive Urology Institute remove only the diseased part of the kidney.

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EDUCATION AND TRAINING Rhode Island and The Miriam hospitals value the opportunities afforded through education and professional training. The Warren Alpert Medical School of Brown University works closely with the faculty and staff of Rhode Island and The Miriam hospitals to train medical students, residents, and fellows. Simone Thavaseelan, MD, director of the residency program, oversees the entire program to produce residents who will excel in the management of urologic conditions.

Candidates have the option to specialize in specific areas of interest and can pursue a variety of fellowships, careers in research, or goals as private practitioners.

A demanding clinical and robust academic program pushes candidates to excel in all aspects of urology, while giving urology residents a diverse background.

A two-year endourology and robotic surgery fellowship with Brown University’s School of Public Health provides a masters degree in public health or in clinical and transitional research to graduating candidates. In 2016, the

division of urology added a fellowship training program specializing in male infertility and sexual dysfunction.

Our mission is to continue cultivating a desire for research among those who will soon enter the medical field. Our specialists frequently conduct research in tandem with their daily medical practices.

At the conclusion of the program, graduates will have authored multiple publications and presented at a variety of regional and national conferences. Combining this rigorous curriculum with our fellowship-trained faculty makes the urology programs of Rhode Island and The Miriam hospitals the most sought-after programs in New England.

For other health care professionals, we also offer certification and education programs for urologic care.

These courses can be taught at The Miriam Hospital or elsewhere for all provider levels.

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RESEARCH

The urology professionals at Rhode Island and The Miriam hospitals lead their field in vital, life-saving scientific and clinical research. Ventures into preserving and improving sperm health, researching the health benefits of scar-inhibiting peptides, and multidisciplinary approaches to the epigenetic effects of low-dose treatment therapies prove that the urology staff is committed to current and future patient health and disease prevention.

Notable research projects include ventures into pediatric renal traumas, treatment for hypospadias, and a partnered, longitudinal study on sperm health.

Researchers are also looking to expand an international descriptive classification system for urological results.

Currently used by Brown University, Duke University, and certain hospitals abroad, this technology would provide an international database for the comparison of certain medical outcomes. This promising technique has the potential to greatly accelerate urological research.

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Current Research Grants Anthony Caldamone, MD Update on pediatric renal trauma: Our experience at a level one trauma center

Gyan Pareek, MD Robot Assisted Laparoscopic Prostatectomy: The Miriam Experience with 1000 cases

Iatrogenic testicular ascent following inguinal surgery

Emergent retrograde ureteral stent vs. percutaneous nephrostomy in the setting of obstructing calculi and urosepsis

Mary Flynn, PhD, RD, LDN Dietary treatment of non-muscular invasive bladder cancer Dragan J. Golijanin, MD A prospective, open, comparative, within patient controlled multicenter phase 3 study of blue light cystoscopy with Cysview and white light cystoscopy using KARL STORZ D-Light C PDD Flexible (Clinical Research Study) Kathleen Hwang, MD Defining the Role of Ghrelin in Wound Healing and the Inflammatory Response in the Post-Operative Setting Erectile Dysfunction in HIV Positive Men The Effects of Chemotherapy Treatment on Transcriptomic and Epegenomic Profiles in Sperm Effect of Fertility Preservation Counseling on Sperm Banking Rates Among Cancer Patients

The Effect of Weight Gain During Early Adulthood on Stone Burden Joseph F. Renzulli II, MD Implementation of a Standardized Clinical Care Pathway on Patient Quality of Life Outcomes following Robotic Assisted Laparoscopic Radical Prostatectomy Characteristics and outcomes of patients treated for emphysematous pyelitis or emphysematous pyelonephritis at a tertiary care center Mark Sigman, MD Identification of Molecular Biomarkers in Rat Sperm and Testis Exposed to Bisphenol A Impact of Obesity on Sperm Transciptonomic & Epigenomic Profiles in Relation to Sperm Health DNA Methylation in Sperm and Male Infertility

Kennon Miller, MD Outcome of Fournier’s Gangrene Urethroplasty Outcomes

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OUR TEAM

Liza Aguiar, MD

Anthony Caldamone, MD

Christy Ciesla, PT, DPT

Steven Irvin Cohen, MD

Jennifer Cunningham, NP

Thomas DiPetrillo, MD

Mary Flynn, PhD, RD, LDN

Boris Gershman, MD

Dragan J. Golijanin, MD

Vincent Harisaran, MD

Kathleen Hwang, MD

Harry M. Iannotti, MD

Anthony Mega, MD

E. Bradley Miller, MD

Kennon S. Miller, MD

Martin Miner, MD

Gyan Pareek, MD, FACS

Mark Paulos, MD

Lauren Pillsbury, MSN, ACNP-BC

Alan Podis, MD

Joseph F. Renzulli II, MD

Janice A. Santos-Cotes, MD

Stephen F. Schiff, MD

Rashmi Shetty Licht, MD

Mark Sigman, MD

Jie Tang, MD, MPH

Simone Thavaseelan, MD

Christopher Tucci, MS, RN, BC, CURN

John Wincze, PhD

Arthur W.Y. Wong, MD

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CONTACT INFORMATION

Chief of Urology Mark Sigman, MD male sexual dysfunction and infertility

Urology Liza Aguiar, MD pediatric urology Anthony Caldamone, MD pediatric urology

Janice A. Santos-Cotes, MD female urology Stephen F. Schiff, MD general urology Simone Thavaseelan, MD kidney stones and minimally invasive urology Arthur W.Y. Wong, MD general urology

Men’s Health Center Christy Ciesla, PT, DPT Vincent Harisaran, MD Kathleen Hwang, MD Martin Miner, MD Mark Paulos, MD Mark Sigman, MD John Wincze, PhD

Multidisciplinary Specialty Clinics/Institutes

Minimally Invasive Urology Institute (MIUI)

Dragan J. Golijanin, MD urologic oncology

Female Pelvic Floor Disorders Program

Dragan J. Golijanin, MD

Vincent Harisaran, MD male sexual dysfunction and general urology

Janice A. Santos-Cotes, MD

Boris Gershman, MD urologic oncology

Harry M. Iannotti, MD general urology Rashmi Shetty Licht, MD female and general urology E. Bradley Miller, MD oncology and general urology Kennon S. Miller, MD reconstructive urology Gyan Pareek, MD, FACS kidney stones and minimally invasive urology Joseph F. Renzulli II, MD urologic oncology

Genitourinary Multidisciplinary Oncology Clinic Jennifer Cunningham, NP Thomas DiPetrillo, MD Boris Gershman, MD Dragan J. Golijanin, MD

Gyan Pareek, MD, FACS Lauren Pillsbury, MSN, ACNP-BC, NP Joseph F. Renzulli II, MD

Female Pelvic Floor Disorders Program 401-793-7080 Genitourinary Multidisciplinary Clinic 401-793-3338 Kidney Stone Center 401-793-3158 Minimally Invasive Urology Institute 401-793-5400 Men’s Health Center 401-793-4MEN (4636) Pediatric Urology 401-421-0710 x1323

Christopher Tucci, MS, RN, BC, CURN Pediatric Urology Liza Aguiar, MD Anthony Caldamone, MD

Anthony Mega, MD Joseph F. Renzulli II, MD Kidney Stone Center Mary Flynn, PhD, RD, LDN Gyan Pareek, MD, FACS

To learn about LifeChart, Lifespan’s EHR system, and how to access it, go to www.LifespanLink.org.

Jie Tang, MD, MPH

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Division of Urology 401-444-8570 MiriamHospital.org/urology Rhode Island Hospital and Hasbro Children’s Hospital 593 Eddy Street Providence, RI 02903 The Miriam Hospital 164 Summit Avenue Providence, RI 02906