Urology Newsletter University of Rochester Medical Center Fall/Winter 2021

University of Rochester Medical Center | Urology News | Fall/Winter 2021

Leaders in pediatric urological care

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URology

| Fall/Winter 2021

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Letter from the Chair Distinguished Career and Contributions

Jean Joseph, M.D., M.B.A., F.A.C.S. Winfield W. Scott Professor and Chair Department of Urology Professor of Oncology Wilmot Cancer Institute University of Rochester Medical Center

On the cover: Ronald Rabinowitz, M.D. and Jimena Cubillos, M.D.

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The decision to pursue a medical career is often followed by deliberate planning, given the rigidity of the course of study and schedule. It is also quite easy to recognize the medical students who made an early choice to pursue urology, as we go annually through the residency selection process. This is reflected in their choice of extracurricular activities, academic pursuits, and mentorship.

To many, however, such a choice is often a last-minute decision, or a story of serendipity, as is commonplace in the field of medicine.

A number of great medical discoveries were found unexpectedly while looking for something else. The stories of penicillin and Viagra are among many that are well known to us. As with many great contributors to the field of urology, the choice of the field they committed their life’s work to has often been a story of being in the “right place” at the right time.

The cover story of this edition of URology tells one story of serendipity leading to a defining moment in the academic career of one of the country’s most accomplished pediatric urologists. Dr. Ronald Rabinowitz can trace his roots to the birth of the specialized field of pediatric urology. As an aspiring pediatric urologist, he accepted a position in clinical pediatric urology and was offered a second fellowship in pediatric urology research when the intended recipient chose an alternate path at the last minute.

This launched a remarkable career in research and patient care. As a devoted educator, and one of the world’s earliest pediatric urologists, he has contributed to the development of many other pediatric urologists. He was honored this year with the AUA’s Lifetime Achievement Award for his numerous contributions to the field of pediatric urology.

Dr. Rabinowitz has been in Rochester for more than 45 years and has built the largest pediatric urology program in upstate

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New York. A team that includes Jimena Cubillos, M.D., an expert in minimally invasive, laparoscopic and robotic pediatric urology, focused on advancing our knowledge of pediatric urological conditions, providing advanced patient-centered care, and training the next generation of pediatric urologists. The team recently recruited Dr. David Diamond, a world-renown pediatric urologist, who most recently served as chair of urology at Boston Children’s Hospital.

This issue also highlights URMC’s role in embracing the single-port robot, a promising novel technology. This innovation is opening new doors to new applications or types of surgeries that we are only beginning to discover. Harnessing the potential of single-port robotic surgery is facilitated using advanced simulation platforms to test new procedures and train surgeons. Our Simulation Innovation Lab, led by Dr. Ahmed Ghazi, is working with surgeons and industry leaders to advance this exciting new technology.

Through a multitude of collaborations, many are benefiting from our work in the Simulation Innovation Lab. This work is possible thanks in great part to philanthropy.

In this issue we recognize Andy Glanzman, a remarkable entrepreneur who built a global company with a $500 bank loan back in 1978. Andy has been a great friend to the department. His generosity has enabled us to acquire equipment that helps us replicate the operating room environment during simulations.

We are indebted to innovative surgeons such as Dr. Rabinowitz and generous donors such as Andy Glanzman as we continuously strive to improve the care we provide our patients – or, in the word of the University of Rochester’s motto Meliora, to make the world “ever better.”

| Department of Urology | urology.urmc.edu

Single-Port Robotic System Augments Care, Spurs Innovation and Training Curriculum The URMC Department of Urology continues to lead the field of robotic surgery, utilizing the fourth-generation, single-port Intuitive da Vinci SP to provide patients the most precise surgical option available, and applying surgical simulation expertise to develop training curriculum for this newest robotic technology.

URMC is the sole institution in upstate New York to offer the single-port option that, compared with standard multi-port surgery, includes smaller instruments, a broadened range of motion, and improved optics. Providing enhanced precision and the ability to do complex surgeries within a very confined space, transvesical robotic surgery is an evolving approach steadily gaining popularity.

“The University of Rochester Medical Center historically has invested in technology that offers the very best care for our patients,” said Jean V. Joseph, M.D., chair of Urology. “Access to leading-edge technology also allows our team to work closely with manufacturers to provide feedback and help shape the direction of future possibilities.” In fact, URMC developed and patented Near Infrared Fluorescence Imaging, commonly known as Firefly technology,

for robotic surgical systems in collaboration with industry.

Joseph was one of the first surgeons to utilize the original Intuitive da Vinci system two decades ago and has helped pioneer and promote subsequent robotic systems. His leadership in the robotic surgery field has placed him center stage demonstrating surgeries live for colleagues’ viewing at major professional conferences such as the American Urological Association and the World Robotic Urology Symposium.

“Our goal as leaders in academic urology is to think about what is best to care for our patients, and to challenge ourselves to investigate new and better ways to advance our field.”

“Our goal as leaders in academic urology is to think about what is best to care for our patients, and to challenge ourselves to investigate new and better ways to advance our field.”

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URMC’s expertise in surgical simulation technology has dovetailed with robotic surgery. Ahmed Ghazi, M.D., of Urology’s Simulation Innovation Lab, has created an innovative approach using 3D printing and hydrogel casting techniques to build patientspecific replicas of anatomy that allow surgeons to practice complex cases prior to actual surgery. The simulation model now is being applied to robotic surgery training, with URMC actively working with Intuitive to develop curriculum to train surgeons in the use of its newest technology.

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Leaders in pediatric urological care A fellowship with the founder of pediatric urology played an important role in the creation of the pediatric urology practice at the University of Rochester Medical Center (URMC) — the largest, most experienced pediatric urology practice in upstate New York.

In 1975, the Hospital for Sick Children in Toronto had two fellowship openings: one in pediatric urology research, another in clinical pediatric urology.

Ronald Rabinowitz, M.D., accepted the clinical fellowship and was preparing to leave for Toronto from his hometown of Pittsburgh. One month before his fellowship was to start, the person who was going to be the research fellow chose to accept a fellowship in England with David Innes Williams, the world’s first full-time pediatric urologist.

Rabinowitz could have both fellowship positions if he wanted them.

As a result of accepting both research

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and clinical positions, Rabinowitz was able to conduct research after spending his first two months in the hospital’s record room collecting data in addition to his clinical work. This resulted in the publication of 15 clinical research papers. It was a “right place at the right time” defining moment in his academic career.

“Whenever I have seen my British colleague at conferences through the years, I always thank him for choosing London over Toronto,” Rabinowitz said.

Rabinowitz’s career had another strong connection to David Williams. As Sir David served as the only pediatric urologist in England for about a decade in the 1950s and 1960s, he trained many other first-generation, North American pediatric urologists. The urologist Rabinowitz trained under at the Hospital for Sick Children was also trained by Williams.

A perfect match Growing up near Pittsburgh’s steel mills, Rabinowitz suffered from severe asthma. Spending time in the children’s hospital as a young boy led to his decision to become a doctor. While in medical school, Rabinowitz spent time in pediatric offices. He decided that, rather than become a primary care physician, he wanted to specialize.

Originally, he thought he would become a pediatric general surgeon.

But, while rotating in pediatric urology, he became interested in the prospect of treating children with birth defects through reconstructive procedures. He

completed his residency in Pittsburgh, including a year at the Children’s Hospital of Pittsburgh, before taking on the fellowships in Toronto.

A tennis match is responsible for bringing Rabinowitz to Rochester.

Forty-five years ago, while attending a match, met the then-chair of URMC’s urology department, who was looking for someone to handle pediatric urology.

Rabinowitz’s expertise was a perfect match for the needs of children in the region, and a new practice was born.

Since then, URMC’s practice has become the largest pediatric urology practice in upstate New York.

Specialized care for children Understanding that young people require very different care than adults, the practice’s urologists treat children exclusively and provide comprehensive care for a broad spectrum of urologic diseases.

“Abnormal organs and congenital deformities have a significant impact on young people so reconstructive procedures and specialized treatments are so important to their growth,” said Jean Joseph, M.D., M.B.A., chair of URMC’s Department of Urology. “We focus on giving children the best possible urological care as part and parcel of our medical center and department’s overall mission.”

Conditions and treatments range from neurogenic bladder, voiding dysfunction and vesicoureteral reflux, to prenatal hydronephrosis, testicular

| Department of Urology | urology.urmc.edu

torsion, varicoceles, hypospadias, meatal stenosis, penile deformities, kidney stones, kidney abnormalities and urinary tract infections. Experts in pediatric urologic cancer, they also work closely with physicians at the Wilmot Cancer Center, the area’s most respected cancer center.

Utilizing video urodynamics, the practice looks at how a child’s bladder functions and provides better treatment.

Video game-like biofeedback therapy teaches children how to relax pelvic muscles to void more effectively.

Through animation, patients can see their pelvic muscles on a video screen to see if they are using them correctly.

Recently, the urology practice expanded in-office circumcisions, so infants from

newborns to age five or six months can have the procedure without going to the operating room or needing general anesthesia.

URMC’s practice also boasts Jimena Cubillos, M.D., an expert in minimally invasive, laparoscopic and robotic pediatric urology. A former University of Rochester medical student, Cubillos completed her surgery and urology residencies at Mount Sinai School of Medicine in New York City, and a twoyear fellowship in pediatric urology at Long Island Jewish/Schneider Children’s Hospital.

With robotic surgery, the practice can treat kidney blockage by accessing kidneys through a dime-sized incision as opposed to traditional surgery requiring access through layers of muscle. Patients benefit from faster recovery time due to the use of small incisions.

Because of Cubillos’ leadership in robotic pediatric urologic surgery, URMC’s practice receives numerous referrals from the surrounding area, such as Buffalo, Syracuse, Watertown, Ithaca, and northern Pennsylvania.

Teaching the next generation Following the model of Sir David, Rabinowitz has trained a hundred or so urology residents and medical students.

He also has authored or co-authored more than 200 scientific articles and textbook chapters.

Passionate about the history of urology, he currently serves as historian for the American Urological Association. He has also served on the AUA board of

Jimena Cubillos, M.D.

directors and as chair of the American Academy of Pediatrics Section on Urology. This year, Rabinowitz was honored with the AUA’s Lifetime Achievement Award.

Rabinowitz continues to train and educate the next generation of urologists. “Teaching is not just sharing techniques because I believe that appreciating where we came from makes us better educated,” he said.

“My philosophy is that residents are extremely intelligent. My job is to make them smarter and more educated about the history of where our specialty came from.”

Through teaching, advanced clinical care and research, the upstate New York region’s largest pediatric urology practice will continue leading the way in specialized care for children.

Ronald Rabinowitz, M.D.

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Profiles in Philanthropy:

Andy Glanzman Andy Glanzman is not only an entrepreneur who built a company with a global reach and a generous supporter of the arts, he is also a professional musician. The career switch came after Glanzman – the co-founder, and until recently, president and CEO of Northern Light Candles – sold and stepped away from the business. The company, which is based in Wellsville, NY and was started with a $500 bank loan collateralized by a 1950 John Deere tractor, quickly became one of the nation’s fastest growing companies with manufacturing in the U.S., Germany, Denmark, Holland, China, India, and Vietnam.

In 2019, the company was acquired by Zippo, allowing Glanzman to step back and pursue his lifelong passion for music. You can listen to his American roots band, the Mystic Twangers, wherever you stream your music or at www.MysticTwangers.com.

Andy and his wife Tina have been ardent supporters of the arts as well as a wide variety of community projects. Their generosity led to the creation of the Wellsville Creative Arts Center, a hub for art, culture, and creativity in the community. They also founded Art for Rural America, and the organization’s latest project has transformed a vacant lot in Wellsville into a commemorative sculpture park and community garden.

In 2012, Glanzman was diagnosed with prostate cancer and came under the care of Jean Joseph, M.D., the chair of the URMC Department of Urology. After his surgery, the two began to talk about ways Glanzman

Andy Glanzman

could support the department’s mission. Glanzman was introduced to Ahmed Ghazi, M.D., and the Simulation Lab, which taps into advanced computer design and 3D printing to create lifelike replicas of organs that surgeons can use as a training platform and to rehearse complex surgeries. Glanzman has been a generous supporters of the program for a number of years with the most recent gift supporting the purchase of an Olympus endoscopy tower, which is being used in the Simulation Lab to enhance the training experience by recreating the environment of the operating room.

“The work they are doing in the Simulation Lab is part art and part science, and in my experience nothing gets accomplished without creativity,” said Glanzman. “My human mission is to help foster creativity, whether that is supporting the arts or, in this case, helping advance medical technology that will improve surgery.”

Diamond Joins Pediatric Urology Team David A. Diamond, M.D., has joined URMC as a professor of Urology and Pediatrics.

Diamond comes to Rochester from Boston Children’s Hospital, where he served as chair of the Urology Department and a member of the faculty at the University of Massachusetts Medical Center. His research and clinical interest is in Disorders of Sexual Differentiation (DSD’s) and complex genital reconstruction and transgender surgical care of young adults.

Diamond received his M.D. from the University of Rochester School of Medicine and Dentistry, and conducted his residency in Urology at Johns Hopkins University, and fellowship training at Great Ormond Street Hospital for Sick Children in London and Harvard Medical School.

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| Department of Urology | urology.urmc.edu

David A. Diamond, M.D.

Lab Profile

J. Scott Gabrielsen, M.D., Ph.D. Testosterone levels peak at puberty and decline with age. Low testosterone levels are strongly associated with many health conditions in men such as erectile dysfunction, frailty, obesity, depression, and cardiovascular disease. While there has been significant research into the risks and benefits of testosterone J. Scott Gabrielsen, M.D., Ph.D. supplementation and whom/ how/when to treat, our understanding of why testosterone declines remains poor. Treatment of low testosterone is largely limited to testosterone supplementation—a band-aid approach that often fails to improve and, in some cases, may even worsen associated conditions.

J. Scott Gabrielsen, M.D., Ph.D., is interested in identifying the mechanisms that lead to low testosterone levels.

This research will be critical to preventing low testosterone and its associated conditions as well as developing targeted therapies to treat the underlying causes more effectively.

Low testosterone is a well-known complication of severe iron overload disorders such as hereditary hemochromatosis and transfusion-dependent beta thalassemia. Due to iron supplementation and increased red meat consumption, the average man in the United States consumes 10-15 times more iron than needed to replace daily losses. This results in a slow, progressive increase in body iron levels with aging. Gabrielsen’s research has demonstrated that testosterone levels fall as body iron levels rise in the general population—even when iron levels are within the normal range. Using a model of dietary iron overload and genetic manipulation of iron regulatory mechanisms, his lab is now working to understand how iron regulates testosterone levels and whether treating iron overload may help to restore natural testosterone production.

Education Profile

Karen Doersch, M.D. Karen Doersch, M.D., is a fourth-year urology resident in her research year at URMC. She received an M.D./ Ph.D. from Texas A&M in molecular and cellular medicine with a focus on immunology and completed a B.S. in psychology and biology at Carnegie Mellon University.

She has extensive experience in both basic science and clinical research, and her graduate research focused on the molecular contributors to skin wound healing and scar formation, for which she received the Sigma Xi Grant-in-Aid of Research. She has also participated in clinical research related to office-based stent placement and factors impacting outcomes after holmium laser enucleation of the prostate, which generated multiple publications.

During residency, Doersch has performed research related to testicular development, for which she came in second in

the NSAUA Resident Prize Essay Contest and won an AUA Basic Sciences Symposium Travel Award. She has also performed research related to stent-related ureteral dysfunction and ureteral fibrosis, for which she is a finalist in the NSAUA Resident Prize Essay Contest. Her more recent projects focus on the immunologic basis of fibrotic Karen Doersch, M.D., Ph.D. processes within the urinary tract. She plans to spend her research year on a project related to factors impacting urethral stricture formation.

She anticipates continuing this research throughout her career.

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University of Rochester Medical Center Department of Urology 601 Elmwood Avenue, Box 656 Rochester, NY 14642

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UNIVERSITY OF ROCHESTER PERMIT 780

DEPARTMENT OF UROLOGY FACULTY Jean V. Joseph, MD, MBA, FACS Professor of Urology and Oncology Winfield W. Scott Professor and Chair of the Urology Department Divya Ajay, MD, MPH Assistant Professor of Urology Zaheer Alam, MD Assistant Professor of Clinical Urology Jathin Bandari, MD Assistant Professor of Urology Jonathan Bloom, MD Assistant Professor of Clinical Urology Jimena Cubillos, MD Associate Professor of Clinical Urology and Pediatrics Director of Quality Improvement David Diamond, MD Professor of Urology and Pediatrics Thomas Frye, DO Assistant Professor of Urology and Oncology Associate Director, Clinical Trials

Joseph Gabrielsen, MD, PhD Assistant Professor of Urology

Joy Michaelides, MD Assistant Professor of Urology

David Gentile, MD, FACS Professor of Clinical Urology Chief of Urology, Highland Hospital

Jeanne H. O’Brien, MD Professor of Urology Associate Chair of Faculty Development and Resident Education

Ahmed Ghazi, MD, MSc Assistant Professor of Urology Co-Director, Endourology, Robotic/MIS Fellowship Director, Simulation Innovation Lab Rajat Jain, MD Assistant Professor of Urology Yi-Fen Lee, PhD Professor of Urology, Oncology, Pathology and Laboratory Medicine Diane Lu, MD Assistant Professor of Clinical Urology Edward M. Messing, MD, FACS Professor of Urology and Oncology Director, Clinical Trials

Jamie Connor, NP Jason Donovan, PA Karrah Gantz, NP Diane Giordano, PA Cassandra Gregoli, PA Kim Hoadley, PA Samantha Howell, PA-C Shawna Hyland, NP

Ronald Rabinowitz, MD Professor of Urology and Pediatrics Hani Rashid, MD Professor of Urology and Oncology Director of Residency Program Otto Sandoval, MD Assistant Professor of Clinical Urology Annette E. Sessions, MD Assistant Professor of Clinical Urology

William Tabayoyong, MD, PhD Assistant Professor of Urology Shlomi Tapiero, MD Assistant Professor of Clinical Urology Jared Wachterman, MD Assistant Professor of Urology Gareth Warren, MD Assistant Professor of Urology Guan Wu, MD, PhD Professor of Urology and Oncology Director of Urologic Oncology Co-Director, Fellowship in Robotic Surgery Shu-Yuan Yeh, PhD Professor of Urology, Oncology, Pathology and Laboratory Medicine

DEPARTMENT OF UROLOGY RESIDENTS/FELLOWS

ADVANCED PRACTICE PROFESSIONALS Meredith Abbasi, CPNP Jamie Allen, FNP-C Katie Bates, PA Dan Barney, PA Amy Beyrle, RPA-C Steve Blount, PA-C Amanda Buckner, RPA-C Mariya Canham, NP

Scott Quarrier, MD, MPh Assistant Professor of Urology Assistant Director Residency Program

Paul Shapiro, MD Associate Professor of Clinical Urology Chief of Urology, FF Thompson and Clifton Springs Hospitals

Chelsea Jones, PA-C Victoria Mesko, FNP-C Jillian Parshall, NP Emily Potter, PA Erin Ruggieri, NP Claire Smith, PA Kristin Smith, RPA-C Melinda Westbrook, NP

Nitin Sharma, MD, Fellow Alexander Cranwell, MD, PGY6 Thomas Osinski, MD, PGY6 Alexis Steinmetz, MD, PGY5 Kit Yuen, MD, PGY5 Karen Doersch, MD, PhD, PGY4 Elizabeth Ellis, MD, PGY4 Austin Lee, MD, PGY3

Aaron Saxton, MD, PGY3 Christopher Wanderling, MD, PGY3 Timothy Campbell, MD, PGY2 Stephen Hassig, MD, PGY2 Laena Hines, MD, PGY2 Trevor Hunt, MD, PGY1 Carl Ceraolo, MD, PGY1 Ashley Li, MD, PGY1

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