Continence Confidence: Prostatectomy Patients Reporting ‘Startling’ Success After Robotic Retzius-Sparing Surgery

For healthcare industry executive Sean Hawkins, prostate cancer runs in the family. After his own diagnosis last year, the then 49-year-old already knew the potential challenges of treatment -- including losing control of his bladder. However, a breakthrough method of prostate surgery known as Retzius-sparing is now eliminating continence issues for many men treated at MedStar Georgetown University Hospital.

MedStar Georgetown Patient Sean Hawkins“You go through all sorts of mental gymnastics when you’re confronted with cancer,” he says. “My main concern was the ability to get back to normal.”

After consulting with MedStar Georgetown urological surgeon Keith Kowalczyk, MD, Hawkins learned that he was a candidate for radical prostatectomy – or removal of his entire prostate. Despite the possibility of temporary (and sometimes permanent) continence issues, Hawkins was willing to make difficult sacrifices for another chance at a cancer-free life.

“The first thing people do is go to the store and buy the 300-count diapers,” he says. “I had diapers under my desk and meetings were spaced out to allow for bathroom breaks. I built in contingencies to anticipate a lot more frequency. I was also sort of budgeting coffee and fluid intake.”

After a successful surgery, Hawkins returned to work only 2 weeks later. He sat through his first round of meetings without a continence problem.

“I didn’t really have any major issues. I kept waiting and wearing the diapers and pads as a precaution. I worried about getting up or sneezing,” he says. “I was tempted to text Dr. Kowalczyk and ask if there was something going on, because I wasn’t having the control problems I anticipated. It was startling for sure.”

During his prostatectomy, Hawkins was one of the first patients to undergo the new Retzius-sparing approach; a more technically advanced, robotically-assisted technique. Kowalczyk, who specializes in robotic surgery, learned the approach from urological surgeons in Italy. He says Retizus-sparing removes the prostate by way of an alternate route, preserving attachments to the bladder and urethra that may play a key role in continence preservation. He is part of a small group of urological surgeons in the United States now performing the procedure on a regular basis.

“The big advantage is that these patients become continent much earlier, sometimes immediately” says Dr. Kowalczyk. “Patients getting the standard approach do well -- but it tends to be a much slower process, sometimes up to a year, in regaining their continence.  This is likely due to the need to cut through crucial suspension ligaments that seem to be important in maintaining continence.”

Kowalczyk says traditionally, prostatectomy patients can wait from 6 months up to a year to regain continence, if it comes back at all. In patients who have undergone the Retzius-sparing surgery at MedStar Georgetown, 96% of patients regained adequate urinary continence after only 6 weeks, with only 23% wearing one “safety” pad just for reassurance even if not needed.

Hawkins with his Family“I can really confidently tell my patients now that this should not be a problem,” Kowalczyk says. “They’ve just been doing astonishingly well.”

For some patients, like Hawkins, incontinence is never a problem at all. Aside from a healing incision scar, he reports no other side effects or complaints from the surgery. Considering all possible outcomes, Hawkins says his journey from the prostate cancer diagnosis to recovery has been a smooth one.

“I’m very fortunate and thankful. From the minute I walked into the hospital to the minute I was wheeled out, I couldn’t have asked for faster, better treatment. To be able to say that out loud in an affirmative manner is very important to me.”

Watch the video below as Dr. Kowalczyk answers commonly asked question about prostate cancer and the use of robotic surgery to treat prostate cancer. 

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Brendan McNamara 
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Personalized Medicine Clinical Trial Underway for Type of Incontinence Common in Women

WASHINGTON D.C. – A novel clinical trial aims to study a treatment for a common problem among older women––accidental urine leakage––by using a patient’s own muscle cells. The study, now underway in the Washington area, is for women with stress urinary incontinence that has not been addressed by conservative treatment such as behavior modifications and pelvic-floor muscle exercises.

Stress urinary incontinence, or SUI, often occurs when the tissues that support the bladder and/or the muscles that regulate the release of urine weaken, and can have a negative impact on a woman’s quality of life. The condition is especially common after childbirth. For patients with SUI, leakage can be triggered by physical activity or stressors such as coughing, sneezing, laughing, or heavy lifting.

In the new study, conducted by Georgetown University at MedStar Georgetown University Hospital, researchers will examine the safety and effectiveness of an investigational product (autologous muscle derived cells for urinary sphincter repair or AMDC-USR) derived from a woman’s own muscle cells that are collected, processed, and then injected into the tissues of the urinary passage.

“Being able to use a woman’s own cells as a treatment for stress urinary incontinence holds promise, and we’ll know more about whether this treatment is safe and effective for these women after this clinical trial is completed,” says the study’s principal investigator, Elizabeth Timbrook Brown, MD, MPH, assistant professor of urology at Georgetown University School of Medicine and a specialist in the medical and surgical management of urinary incontinence at MedStar Georgetown University Hospital.

The clinical study lasts two and a half years and participation includes approximately 8 to 11 office visits and 3 to 5 scheduled phone calls. The study will consist of a screening period, which may last up to 8 weeks to determine eligibility.

If eligible, Brown will perform a biopsy to collect muscle tissue from the thigh. Local anesthesia will be used for the office procedure.

“The muscle tissue is then grown in a laboratory until there are enough cells to be injected into the urinary passage as a second office procedure,” Brown explains. “It is believed the cells will become part of the tissue where they have been injected. In theory, we think this may help women have more control over urine storage and urination and may decrease urinary leakage.” Current conservative treatment options are available for women with SUI and include external collection devices (diapers and pads) and pelvic floor exercises. Some examples of surgical treatments include injection of bulking agents into or around the urethra, a synthetic mesh midurethral sling, or creation of a sling using a woman’s own tissues, as well as other surgical procedures.

Women ages 50 to 75 with SUI are invited to volunteer in this phase 3, randomized, double blinded, placebo-controlled study. Participants will be “randomized” into one of two study groups––half will receive AMDC-USR (injections with cells) and the other half will receive a placebo (injections that look and feel exactly the same but will have no cells). Randomization, is done by computer. Neither the volunteers nor the researchers will know what group you are in (double blinded). If the participant receives the placebo injection, the participant will still have the option of receiving a second injection with their own cells (the AMDC-USR product) after 12 months.

Based on information from similar clinical studies using AMDC therapy, urinary tract infections are very common. Other less common risks will be explained to each participant. Up to 320 subjects at 25 study centers across three countries will take part in this study; approximately 15 subjects per year will participate at Georgetown. There are no study-related charges for the participants.

Cook MyoSite, Incorporated is the sponsor of this study. MedStar Georgetown University Hospital is being paid by Cook MyoSite, Incorporated, to conduct this study. Brown reports having no personal financial interests related to the study.

To learn more about this clinical trial, please click here. Women who are interested in volunteering for the clinical trial should call Kelsey Morgan, BSN, RN at 202-444-7513 or email her at [email protected].

 

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Brendan McNamara 
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Prostate Cancer Patient Does His Research and Chooses Proton Therapy to Treat His Aggressive Disease

Dr.-Lischalk-with-Denwiddie(Washington, D.C.)  When Melvin Denwiddie, 73 was diagnosed with prostate cancer in late 2016 his physicians first told him the “watch and wait” strategy would be sufficient.  But in 2017 further testing showed that his cancer had become more aggressive and it was time to get treated.

“My prostate cancer was potentially fatal if I didn’t start treatment,” says Denwiddie. “My choices were surgery to remove the prostate, traditional radiation or proton radiation,” says the great-grandfather of three. “I did my research and I wanted proton therapy.  I found that proton therapy would be the most accurate; it would follow the shape of my tumor and would penetrate only the tumor and not any of the tissue outside of the tumor.  That was very important to me.”

That’s when he found proton therapy at MedStar Georgetown University Hospital and his radiation oncologist, Jonathan Lischalk, MD.

“It’s important to sit down with patients and discuss their treatment options,” says Dr. Lischalk. “For localized prostate cancer, a variety of treatment options exist including surgery and radiation therapy.  Even within radiation therapy, many options exist including proton therapy, x-ray-based therapy, and brachytherapy.  Helping a patient understand his treatment options, the related side effects, and the clinical outcomes is extremely important.”

The proton therapy system at MedStar Georgetown is the first and only in the Washington, D.C. metropolitan area and is the first in the world to offer proton therapy with HYPERSCAN™ technology. HYPERSCAN produces beams that are sharper than other proton systems and treats patients faster.

Denwiddie received 43 proton treatments over the course of July through September 2018.

“From my standpoint, proton therapy is a very good treatment process. It was not invasive, it wasn’t painful and I experienced very few side effects,” says Denwiddie.  “Aside from my bladder becoming overactive, it was a pretty easy treatment from beginning to end.  And any side effects I had are getting better.”

With proton therapy complete, Denwiddie continues with hormone treatments for his prostate cancer under the care of his urology team at MedStar Georgetown.

Denwiddie with Dr. Lischalk in an exam room
Melvin Denwiddie (left) and Dr. Lischalk (right)

“Proton therapy is proving to be an excellent option for prostate cancer treatment,” say Ryan Hankins, MD, a urologist at MedStar Georgetown University Hospital. “From a urology standpoint, I am able to use a small needle through the skin to place the needed fiducial markers and gel spacer to help improve patient outcomes and make proton therapy more precise. This is done with no incisions on the skin. Dr. Lischalk and I also coordinate patient visits to help make the patient's visit to MedStar Georgetown as seamless as possible.”

Denwiddie is a retired accountant for NASA but continues to prepare tax returns and represent clients before the Internal Revenue Service. “It’s a labor of love I’ve been practicing since 1972.  It’s such a pleasure to know that I can continue to help people when they need it in this way.”

With his wife of more than 50 years newly retired and his prostate cancer treated, Denwiddie looks to the future with optimism and excitement.

“I feel confident that this prostate cancer is a thing of the past. The rest of my life, I’m looking forward to enjoying the freedom and flexibility to move around and travel with my wife.  That includes visiting family and places I haven’t had the opportunity to see yet. I’m very excited about my future.”

Media Contact

Marianne Worley
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Office: 703-558-1287
Pager: 202-405-2824
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Brendan McNamara 
Media Relations Specialist
Office: 703-558-1593
[email protected]

Men’s Health: New Treatment for Enlarged Prostate Offers Better Outcomes for Urination Problems

Same-day office procedure for BPH treatment offers faster recovery time, no sexual side effects

MedStar Georgetown University Hospital is the first center in the region to offer a new way to treat men with urination problems due to an enlarged prostate. The UroLift System is a minimally invasive procedure for men who experience difficulty urinating due to benign prostate hyperplasia (BPH), commonly known as enlarged prostate.

“For men who can’t control their urine or get a good night’s sleep, they need to know that we offer superior options for BPH that are life-changing compared to traditional treatments,” says Gaurav Bandi, MD, urologist at MedStar Georgetown. “Everything is done through a telescope today.”

A man’s prostate gland grows as he gets older. According to the National Institutes of Health, BPH affects 50 percent of men over 50 and 90 percent of men over 80. When the prostate gland enlarges, it squeezes the urethra, the tube where urine flows out of the bladder. This compression irritates the bladder and limits the ability of the bladder to empty completely.

UroLift Treats BPH in 5 to 10 Minutes

The UroLift procedure offered at MedStar Georgetown is a five minute, office-based procedure to safely and effectively treat BPH.

UroLift  is performed under local anesthesia and requires no cutting or heating of the prostate. During a single office visit, doctors insert four to six implants into the prostate to lift the prostate gland and relieve the compression, removing any blockage in the urethra. The procedure preserves sexual function and relieves symptoms. Patients experience minimal post-procedure bleeding or pain and require no special follow-up or medical management.

Men with a prostate size between 20 and 80cc are candidates for Urolift. Patients on blood thinners are also eligible for this procedure. For men with a prostate size over 80cc, other minimally invasive surgical options are available to treat BPH.

Traditional treatments for BPH were invasive, had significant sexual side effects, or required a man to take one to three medications daily for the rest of his life. New treatment options are less invasive, give the doctor better access to the prostate gland, and require minimal downtime after treatment.

BPH symptoms include:

  • Frequently urinating or trying to urinate during the day
  • A feeling that the bladder is not fully emptied
  • A slow or weak stream of urine
  • Trouble with starting to urinate
  • Feeling the constant need to urinate
  • Interrupted sleep in the middle of the night
  • Dribbling or leaking of urine

“A lot of what I do relates to the patient’s quality of life, so our team provides evidence-based care in an individualized fashion,” says Dr. Bandi. “Men should be encouraged to seek help for any prostate problems. A majority of the time, we can relieve their symptoms and improve their quality of life. And today the options we can offer are minimally invasive. There is help available!”

For more information about other treatments for BPH or schedule an appointment with a urologist, call 202-444-4922. Watch Dr. Bandi talk more about BPH and other condition of the prostate in this video.

 

Media Contact

Marianne Worley
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Office: 703-558-1287
Pager: 202-405-2824
[email protected]