fall 07 newsletter...effort thereby breaking "bad" habits before they form. furthermore,...

Symptoms that may occur with alltypes of prolapse

Chronic discomfortDragging or heaviness in thepelvic areaFeeling ‘like my insides are fallingout’BulgingFeeling a lump or heavy sensationin the vagina Lower back pain that eases whenlying down Pelvic pain or pressure Pain or lack of sensation during sexAny unusual bleeding or dischargefrom the vagina

Minimally Invasive SurgicalTreatments for UrinaryIncontinence and Pelvic OrganProlapseUrinary IncontinenceDr. Regina Hovey specializes in thetreatment of urinary incontinence andfemale pelvic organ prolapse. She isa UC Irvine urologist, fellowship-trained in the area of bladder dys-function. Urinary incontinence (i.e.,involuntary loss of urine) is a commoncondition, affecting more than 13 million people in the United States.Dr. Hovey uses both surgical andnonsurgical techniques to treat urinary incontinence. She uses modern fluorourodynamic testing todetermine the precise cause of leak-age prior to initiating a specific treat-ment. With fluorourodynamic testing,she is able to diagnose and success-fully treat complex cases of inconti-nence and bladder dysfunction, evencases where previous surgery andtreatments have failed. She usesminimally invasive surgical techniquesto treat urinary incontinence, includingurethral slings in both women andmen.

By using minimally invasive surgerytechniques, most patients who under-go surgery for urinary incontinenceare hospitalized for less than one day.Her success in treating incontinenceof all types is greater than 90 percent.

Female Pelvic OrganProlapseIn addition to treating urinary inconti-nence, Dr. Hovey also specializes inthe treatment of female pelvic organprolapse (i.e., “dropping” of the blad-der or uterus) in women. Thisincludes treatment for cystocele (pro-lapse of bladder) and vaginal vaultprolapse commonly found in womenwho have had a previous hysterecto-my. Dr. Hovey has been using robot-ic surgery for the treatment of pelvicorgan prolapse since 2003. She wasone of the first urologists in OrangeCounty to perform robotic surgery forpelvic organ prolapse, which has ledto faster recovery times and shorterhospitalizations. Most cases offemale prolapse can be treated usingthis minimally invasive and effectivetechnique.

A significant portion of Dr. Hovey'spractice is dedicated to the treatmentof patients with neurogenic bladderdysfunction, including patients withspinal cord injury, multiple sclerosis,

Parkinsonism, stroke, and other neu-rologic diseases.

In addition to her practice at UCIrvine, she is chief of urology at theErnest Bors Spinal Cord InjuryCenter, where she oversees the uro-logic care for more than 1,000patients with spinal cord injury andneurogenic bladder dysfunction. Atthe Center for Urologic Care at UCIrvine Medical Center, Dr. Hovey hasstate-of-the-art equipment necessaryto care for all individuals with spinalcord injury. continued on page 2

Dr. Hovey is able todiagnose and successfully

treat complex cases ofincontinence and bladderdysfunction, even caseswhere previous surgery

and treatments have failed.

Health Science Associate Clinical ProfessorUC Irvine Department of Urology

Chief of UrologyErnest Bors Spinal Cord Injury Center

VA Long Beach Healthcare System

Your UrologyFall 2007

Regina M. Hovey, MD

continued from page 1

Patients with neurologic disease cansuffer bladder dysfunction, leading tourinary incontinence or retention ofurine. If left untreated, these patientsmay develop other urologic problems,including recurrent urinary infections,kidney stones, and impaired kidneyfunction. Using fluorourodynamicstudies and other diagnostic testing,Dr. Hovey is able to properly diag-nose and treat patients with neuro-genic bladder, preventing other uro-logic complications commonly seen inthese patients.

For appointments and referrals,please call:

Regina M. Hovey, MDOffice: 714.456.7128

Dr. Hovey has been usingrobotic surgery for the

treatment of pelvic organprolapse since 2003.

She was one of the firsturologists in Orange Countyto perform robotic surgeryfor pelvic organ prolapse,

which has led to fasterrecovery times and

shorter hospitalizations.

If you do not want to receive further commu-nications from the Department of Urology,please contact Cynthia Shell.

UC Irvine Medical CenterDepartment of Urology333 City Blvd. West, Suite 2100Orange, CA 92868Tel: 714.456.5371

Your UrologyFall 2007, Issue 8The urology newsletter is published biannu-ally. We welcome your comments and ideasfor stories. Please send them to Dr. ElspethMcDougall, editor, at [email protected]; makesure to let us know if we have permission toreproduce your comment in full or in part inYour Urology. Copyright © 2007 TheRegents of the University of California. All rights reserved.

Department ChairmanRalph V. Clayman, MDNewsletter EditorElspeth M. McDougall, MD, FRCSCNewsletter CoordinatorCynthia Shell

Mission StatementThe Department of Urology at Universityof California, Irvine is focused on the fourmajor aspects of CARE: Clinical,Administrative, Research, and Education.Clinically, it is the goal of the departmentto provide optimal urological care for allpatients, with a specific interest in tertiarycare and less invasive surgery.Administratively, the department seeks tocreate a unique structure within a surgicaldiscipline to foster research and educa-tional activities while providing a nexusbetween these two disciplines and patientcare. Research on both a clinical andbasic level is sought in order to providenew knowledge on the developmentalaspects and therapies for urological dis-eases. Educational aims encompasspatients, medical students, residents, andpostgraduate urologists. To this end, aspecial emphasis has been placed ondesigning educational brochures, topic-oriented specialty conferences, annualpostgraduate courses, and new para-digms for teaching. Methods for assess-ing surgical skills are also a major focusof the department. In summary, theDepartment of Urology seeks to provideits patients with the absolute best in mod-ern urological care, its residents with asuperb educational and training experi-ence, and its faculty with every opportuni-ty to excel clinically while teaching andpursuing research of both a basic andclinical nature.

Questions to ask your doctorabout your prolapse

What type of prolapse do I have? How severe is it? Do I need treatment and if so,what treatment do you recom-mend and why? What if I choose not to haveany treatment? What can I do to ease thesymptoms?

A thorough pelvic examination canbe unnerving and many women(and men for that matter) find it diffi-cult to remember everything that issaid during the appointment, partic-ularly if the doctor uses technicalterms. It may help to write downeach of the answers to your ques-tions.

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Normal position of anatomy

Having realized the importance ofthese items for surgical training, ViceChancellor David Bailey has desig-nated approximately 1200 square feetof space in an area adjacent to ourcurrent surgical training center for theestablishment of a fresh tissue andsimulator facility. I have been provid-ed a two-year window in time to raisethe $2 million necessary to equip thisfacility and initiate its activity. Onceestablished, the facility shouldbecome self-sustaining through com-pensation received for its use as atraining facility, not only for our resi-dents but also for postgraduate sur-geons and other health care workersin 13 disciplines across the UC Irvinemedical campus (urology, OB-GYN,general surgery, ENT, orthopaedics,neurosurgery, gastrointestinalendoscopy, etc.).

Again, any and all support that youcan provide to help me with this veryimportant educational endeavor wouldbe deeply appreciated. I believe thatyour investment in the training of oursurgeons is one that will bear divi-dends of major importance for theOrange County community.

Many thanks.

Sincerely,

Addendum: I would be more thanhappy to show you our current centerand introduce you to our surgical sim-ulators. Cynthia Shell is available toarrange a tour of this nature at yourconvenience (Tel: 714.456.5371).

A Message from the Chair

A Challenge in Education “You Can Make A Difference”In the realm of surgical training, noth-ing is more undervalued, yet morevaluable, than education. For sur-geons, time spent teaching is neitherreimbursable nor looked upon as "bill-able hours." Indeed, the effortexpended has a negative economicimpact on the teacher as his or hertime could be better spent in provid-ing patient care or pursuing research.Yet, each member of the Departmentof Urology is firmly committed to theteaching mission, for we all realizethat the future is not us but rather ourstudents, and on their shoulders willrest the excellence of tomorrow'shealth care.

To this end, I would like to enlist yourhelp. At the University of California,Irvine, the Department of Urology hasestablished one of the finest surgicaltraining centers on the West Coast.However, to date, a key component ofa training center has been missing -the presence of a fresh tissue andsimulator facility. The fresh tissuelaboratory makes cadaveric materialavailable for resident training; thesematerials provide the resident with theprecise and comprehensive under-standing of human anatomy essentialto performing the safest and mosteffective surgery. While present at afew sites on the East Coast and inthe South, this unique resource doesnot exist, to the best of my knowl-edge, on any of the medical campus-es on the West Coast; and yet, it is apowerful tool for the creation of sur-geons with the highest level of ana-tomical knowledge and surgical know-how.

The second missing component is theestablishment of a surgical simulator

facility. Surgical simulation, I believe,is going to become ever more estab-lished on medical school campusesthroughout the country. Presently, itcosts upwards of $50,000 a year toeducate each resident in the operat-ing room; similarly, there are justifi-able concerns about the safety andeffectiveness of this educationalexperience. Both problems can beresolved with a robust surgical simu-lator teaching facility. The high-fidelity,computer-based surgical simulatorhas the ability to help a residentdevelop each of the necessary skillsand tasks to perform a given proce-dure. In addition, the simulator, withits built-in curriculum and instructor,can correct and redirect an erranteffort thereby breaking "bad" habitsbefore they form. Furthermore, thesimulator can provide the residentwith complicated scenarios and "dis-aster" training, enabling the learner tobecome prepared to effectively han-dle any of the complications that canoccur during a given operation.Lastly, and of greatest importance,these simulators can record perform-ances and assess the resident'sprogress, thereby determining whenthe timing is optimal for this individualto participate in procedures within theoperating room. Eventually, I believethe simulator will take on the role ofactually testing, certifying, and recerti-fying the manipulative skills of all uro-logical surgeons. However, thesesimulators are still in the earlieststages of development. At UC Irvine,we have been able to obtain two ofthe earliest devices; however, we nowneed additional space and funds todevelop a true surgical simulator facility.

Ralph V. Clayman, MD

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It has been a banner year for the Department of Urology in 2007! After beingnamed to the top 50 urology programs in the United States by U.S. News andWorld Report in 2006, we set our sights on becoming one of the top 20 pro-grams over the next five years. To our surprise and absolute delight, the 2007ratings have placed the Department of Urology at the University of California,Irvine at #19. Out of 5,462 hospitals, only 173 made it into the rankings in atleast one of the 16 specialties. The credit for this accomplishment goes to ourfaculty, nurses, administrative assistants, and residents who throughout theyear provide superior service for all who come to us for urological care. This istruly the result of a wonderful "can-do" team effort!

Department ofUrology Top 20 NationalRanking!

EXCEL AwardPresented toDr. Elspeth McDougallfrom The Society ofLaparoendoscopicSurgeons (SLS)

Dr. Paul Wetter, chairman of TheSociety of LaparoendoscopicSurgeons, presented Dr. ElspethMcDougall with the 2007 ExcelAward. She was selected by theSLS Advisory Board in recognitionof her outstanding contributions tothe field of operative laparoscopy,endoscopy and minimally invasivesurgery, during the 16th SLS AnnualMeeting, September 5-8, 2007, inSan Francisco, CA.

3

Urology AdministrativeOffices Have RelocatedThe City Tower333 City Boulevard West, Suite 2100Orange, CA 92868Telephone: 714.456.7005

The Department of Urology administra-tive and academic offices have relocatedto The City Tower building on the 21stfloor (8,000 square foot facility). Thisrelocation will allow a unification of thedepartmental academic, administrativeand billing offices.

UC Irvine Health AffairsWeb Sites Have BeenUpdatedYou will see a new front page for thehealth sciences and patient care serv-ices web sites -- http://www.healthaffairs.uci.eduandhttp://www.ucihealth.com

The changes will better streamlinethose pages of interest to the public.

Paul Wetter, MD, and Elspeth McDougall, MD

Department of Urology Faculty and Staff

The City Tower Building

Department of UrologyFaculty Highlights

Dr. Elspeth McDougall has acceptedtwo new positions at UC Irvine. InJanuary 2008 she will assumeappointments as Associate Dean ofClinical Science Education and alsoDirector of Research in MedicalEducation.

Dr. Ralph V. Clayman was an invitedfaculty member to the 2007 PacificRim Robotics Symposium in China.

Dr. Leland Ronningen was inter-viewed by the OC Register, August28, 2007. Read the article:http://www.ocregister.com/ocregister/healthfitness/article_1834126.php

Dr. David Ornstein became the 6threcipient of the prestigious Investi-gator Award from the Society ofUrologic Oncology at the 2007 annualmeeting of the American UrologicalAssociation. This award recognizesexcellence in both research and clini-cal practice in the area of urologiconcology.

Dr. Thomas Ahlering was inter-viewed by the OC Register, sharinghis expertise on the robot-assistedlaparoscopic radical prostatectomyprocedure. This article will be fea-tured in early October.

The Department of Urology ispleased to announce that Dr.Esequiel Rodriguez, a urologicsurgeon with specific interests inpediatric and robotic surgery, hasjoined our faculty as an assistantclinical professor. He will serve animportant role in our program ineducating our residents while pro-viding outstanding urologic care tothe adult and pediatric population ofOrange County. In addition, Dr.Rodriguez has an appointment inthe PRIME LC program at UC Irvineand will provide much needed edu-cational opportunities in health careto the Hispanic community.

Dr. Rodriguez completed his under-graduate studies at the University ofCalifornia, Berkeley and receivedhis medical degree from StanfordUniversity School of Medicine. Hecompleted his urology residency atUC Irvine School of Medicine andcompleted a fellowship in roboticsurgery under the tutelage of Dr.Thomas Ahlering.


Esequiel Rodriguez, MDOffice: 714.456.7005

Dr. Atreya Dash has joined our fac-ulty as an assistant professor, spe-cializing in urologic oncology. Hecompleted his urology training at theUniversity of Michigan and then pro-ceeded to complete a three-year fel-lowship in urologic oncology atMemorial Sloan-Kettering CancerCenter in New York. Dr. Dash hasexperience in all areas of urologiconcology, including the advancedsurgical treatment of prostate, renal,testis and bladder cancers. Hispatient treatment modalities includeminimally invasive surgical technolo-gies such as laparoscopy toimprove the care and convales-cence of patients with urologic can-cers.

Dr. Dash's clinical research focuseson prostate, bladder, kidney andtestis cancers. He has authoredpublications in these areas, some ofwhich are currently in press. Hislaboratory research focuses onmolecular aspects of prostate andbladder cancer, including applicationof microarray technology. In 2002,Dr. Dash was awarded second prizefor best article by a trainee in thejournal, Urology. More recently, hereceived a 2007 ASCO FoundationMerit Award for work during his fel-lowship, presented at the AmericanSociety of Clinical Oncology annualmeeting. He is an active member ofthe American Urological Association,The Society of Urologic Oncology,and the American Society of ClinicalOncology.


Atreya Dash, MDOffice: 714.456.7005

Esequiel Rodriguez, MD

Department of UrologyWelcomes

Atreya Dash, MD

5

UC Irvine urologists have successfullyperformed in the laboratory the firstminimally invasive kidney surgerytechnique using a specially designeddevice that allows for the use of multi-ple instruments without leaving a visi-ble scar. Dr. Geoffrey Box, clinicalfellow in endourology, led the effort in

developing this unique method ofgoing through two natural orifices toperform a nephrectomy, a proce-dure in which the kidney is removed.They presented their results in apaper which was awarded first prizeamong over 100 submissions at theannual Engineering and UrologySociety section of the AmericanUrological Association annual meetingin Anaheim in May 2007.

NOTES Natural Orifice Transluminal

Endoscopic Surgery

6

Geoffrey N. Box, MD

New UC Irvine MedicalCenter Hospital UpdateA New World-Class Academic Medical Center for our Community The new university hospital will blend pioneering medical care and patientcomfort. UC Irvine Healthcare has embarked in the next chapter of its mis-sion to provide high quality patient care. In February 2005, constructionbegan on the $371 million state-of-the-art hospital. When completed in early2009, the new hospital will house the latest medical technologies andstrengthen UC Irvine Healthcare’s ability to provide patients with the latesttherapies and treatments. The hospital will replace the main hospital building,which was built in 1960. The new 480,000-square-foot hospital promises toposition UC Irvine Healthcare as one of the world’s leading academic medicalcenters. Designed to create a patient-focused healing environment, it willalso serve as a center for excellence in health care for Orange County.

Patient-Focused Healing RoomsIn the new hospital, patients will be cared for in 191 spacious, mostly privaterooms that offer ample space for families to be part of the care team. Therooms are in addition to the existing 102 beds in the medical center’s towerand the 84-bed Neuropsychiatric Center. Designed with the patient in mind,rooms are being built to capture natural light and increase privacy. Instead oftransporting patients to different treatment areas, larger private patient roomswill allow multidisciplinary teams to care for patients on the spot.

An Environment for Teaching and Translational ResearchIn addition to emphasizing patient care, the new hospital will facilitate theteaching and research missions of the UC Irvine School of Medicine. Thenew hospital will include modern facilities for conducting the latest medicalresearch and training future and practicing physicians. In addition, the newhospital will allow researchers and clinicians to work closely together to bringthe latest therapies and treatment to patients.

State-of-the-Art FacilityCarefully planned intensive care units, treatment rooms, laboratories and sur-gical suites will further facilitate leading-edge care. The 15 new state-of-the-art surgical suites will include the latest equipment, including robotic surgicalsystems.

UniqueMinimallyInvasiveKidneySurgeryTechnique

Ralph V. Clayman, MDProfessor and ChairmanDepartment of UrologyDr. Clayman is world renowned for his clinical and laboratory workin minimally invasive surgery. He specializes in the treatment ofkidney stones, kidney cancer, strictures of the ureter and all other aspects of renal and ureteral diseases.

For appointments and referrals, please call:714.456.3418

Thomas E. Ahlering, MDProfessor and Director, Urological OncologyDr. Ahlering is well known for laparoscopic radical prostatectomyusing the da Vinci® robotic surgical system. He specializes intreatments for cancer of the prostate, bladder, kidney, and testis.

He did his postgraduate fellowship training in Urological Oncology at University ofSouthern California, Los Angeles.


Joel Gelman, MDAssistant Clinical ProfessorDirector, Center for Reconstructive UrologyDr. Gelman has expertise in male urethral and genital reconstruc-tion and sexual dysfunction. He did his postgraduate fellowship

training in Adult and Pediatric GU Reconstruction at Eastern Virginia MedicalCenter, Norfolk, Virginia.


Regina M. Hovey, MDAssociate Clinical ProfessorDirector, Urology Residency ProgramDr. Hovey specializes in female urology, urinary incontinence, neu-rourology, and lower urinary tract reconstruction. She did her post-

graduate fellowship training in Female Urology, Neurourology and ReconstructiveUrology at University of California, Davis.


Elspeth M. McDougall, MD, FRCSCProfessor and Director of the Surgical EducationCenter Dr. McDougall specializes in minimally invasive surgery for thetreatment of kidney stones, kidney cancer and strictures of theureter. She did her postgraduate fellowship training in

Endourology and Extracorporeal Shock Wave Lithotripsy at Washington UniversityMedical School, Barnes Hospital, St. Louis, Missouri.


Jerry B. Miller, MDClinical ProfessorDr. Miller specializes in general practice urology and supervisesresidents-in-training in the general urology clinic.

For appointments and referrals, please call: 714.456.7005

Leland Ronningen, MDAssociate Clinical ProfessorDr. Ronningen is particularly interested in benign diseases of theprostate and practices general urology.


Nader Sadoughi, MD, FACSClinical ProfessorDr. Sadoughi’s interest and expertise are in urologic oncologicsurgery and neuromuscular dysfunction of the lower urinary tractfor urinary incontinence. He is actively involved in teaching urolo-

gy residents at the VA Long Beach Healthcare System, where he sees patients.He did his postgraduate fellowship training at Sloan Kettering Cancer Center inNew York.

For appointments and referrals, please call:562.826.8000 x5562

Anne R. Simoneau, MDAssociate Clinical ProfessorAssistant Director, Urological OncologyDr. Simoneau has clinical trials in prostate cancer prevention andis working in the laboratory on bladder cancer prevention. She

did her postgraduate fellowship training in Clinical Urological Oncology atUniversity of Southern California, Los Angeles.

For prostate cancer prevention, please call:714.456.3330

David K. Ornstein, MDAssistant ProfessorDr. Ornstein completed a fellowship in urologic oncology at theNational Cancer Institute. He now treats patients with all types ofurologic cancers. He has extensive experience with open, laparo-scopic, and robotic surgery, and is particularly interested in potency

and continence-sparing radical prostatectomy using the da Vinci® Surgical Robot.For appointments and referrals, please call:

714.456.5378

Aaron Spitz, MDAssistant Clinical ProfessorMale Reproductive Medicine and SurgeryDr. Spitz has expertise in the treatment of male infertility and sexualdysfunction. He did his fellowship training at Baylor College of

Medicine, Houston, Texas. For appointments and referrals, please call:

714.456.7005

Atreya Dash, MDAssistant Clinical ProfessorDr. Dash completed a fellowship in urologic oncology at MemorialSloan-Kettering Cancer Center in New York. He has experience inall areas of urologic oncology including the advanced surgical

treatment of prostate, renal, testis and bladder cancers. His patient treatmentmodalities include minimally invasive surgical technologies such as laparoscopy toimprove the care and convalescence of patients with urologic cancers.


Esequiel Rodriguez, MDAssistant Clinical ProfessorDr. Rodriguez has specific interests in pediatric and robotic sur-gery. He has an appointment in the PRIME LC program at UCIrvine and will provide much needed educational opportunities in

health care to the Hispanic community. He completed a fellowship in robotic sur-gery at UC Irvine under the tutelage of Dr. Thomas Ahlering.


UC Irvine Healthcare Department of Urology Clinical Faculty

7

Department of Urology Newsletter333 City Blvd. West, Suite 2100

Orange, CA 92868-5395

Driving Directions to UC Irvine Medical Center -- From I-5 take the Chapman Avenue exit. Drive westbound on Chapman. Turn left (south) onto The City Drive South. Proceed to Dawn Way. Turnleft. The UC Irvine Medical Center visitor parking structure is on the left side. Upon exiting the parking structure after parking, continue down thebroad walkway until you see Miss Kelly's Coffee Cart on your right side. On your left side is the entry to the Pavilion III urology offices. If you are lost, please call 714-456-7005.

Visit the Department of Urology on the Web at -- www.ucihs.uci.edu/urologyUC Irvine Healthcare - Urology Newsletter Fall 2007

University of California, Irvine Medical Center101 The City Drive South -- Orange, CA 92868

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