Metro Urology. VOLUME 1 WINTER 2012 MAIN PHONE: (713) HMUtx.com. Houston Metro Urology Opens New Surgical Center

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1 HMU Houston VOLUME 1 WINTER 2012 MAIN PHONE: (713) Houston Opens New Surgical Center New HMU surgical center features six new state-of-the-art operating suites Houston (HMU) unveiled its new 11,500-squarefoot surgical center with an open house on Saturday, Oct. 15. The new surgical center, located on HMU s main campus at 4219 Richmond Avenue in Houston, features six new state-of-the-art operating rooms, and the most modern surgical technologies including ultrasound, flat-screen surgeon viewing consoles, lasers and lithotripsy units. The driving force behind constructing this new on-site surgical center is to significantly enhance the continuity of care for our patients, said Zvi Schiffman, M.D., F.A.C.S., President and Chief Executive Officer of Houston. In the past, both our patients and physicians had to travel to various surgical centers to complete treatment procedures. Having this new surgical center on our main campus helps streamline care for our patients while making our physicians more accessible to both our surgical patients and our clinic More than 150 people attended the open house of HMU's new ambulatory surgical center on Oct. 15. The new surgical center will enhance the continuity of care for HMU patients. patients, Dr. Schiffman said. HMU s new surgical center layout includes a reception area, pre-op area, operating rooms, procedure rooms, post-op area, and an area for discharging patients. HMU is very proud to bring this state-of-the-art surgical center to our fine community, said Kathy Hille, Ph.D., HMU s Chief Operating Officer. As the largest provider of urology services in the Houston region, we take (continued on next page) IN THIS ISSUE 2 President's Welcome COVER STORY Questions to Ask Your Doctor 10 Common Conditions HMU Staff News & Notes Robotic Surgery President & CEO: Zvi Schiffman, M.D., F.A.C.S. Chief Operating Officer: Kathy Hille, Ph.D. Public Affairs Officer: Wendell Champion, J.D. Advisory Board: Samuel Axelrad, M.D., F.A.C.S. Larry Baum, M.D. Paolo Champion, M.D. Karen Delhey, M.D., F.A.C.S. Richard Goldfarb, M.D., F.A.C.S. Ricardo Gonzalez, M.D. Alan Hananel, M.D. Gregory Hester, M.D., F.A.C.S. Stephen Lapin, M.D., F.A.C.S. Michael Lewitton, M.D., F.A.C.S. Robert Light, M.D., F.A.C.S. Brian Lord, M.D., F.A.C.S. Michael Mineo, M.D. Kevin Nickell, M.D., F.A.C.S. Carl Ogletree, M.D., F.A.C.S. Brian Powers, M.D. Zvi Schiffman, M.D., F.A.C.S. Mark Sutton, M.D., F.A.C.S. Rita Tibbs, M.D. Thanh John Van, M.D.

2 2 Personal Welcome to HMU From Our President Zvi Schiffman, M.D. On behalf of the physicians and staff of Houston (HMU), we would like to welcome you to our practice. We are pleased that you have chosen us to provide your urologic care. The 20 physicians and 160 staff members of Houston are dedicated to providing state-of-the-art urologic care in a cost-effective manner. The physicians and surgeons of HMU offer a full spectrum of expertise in all aspects of urologic care. These include general urology, urologic oncology, robotic and laparoscopic surgery, male infertility, female urology, erectile dysfunction, kidney stone management, incontinence and men's and women's health. It is our privilege and promise to provide the highest quality of healthcare to you and your family. Thank you again for choosing Houston for your care. Sincerely, Zvi Schiffman, M.D., F.A.C.S. President & CEO Houston Cover Story (continued from first page) great pride in offering the best treatments, technologies and surgical services possible. Our new surgical center is in keeping with this long tradition of the practice. It is going to increase our patients access to HMU physicians and surgeons, and will reduce travel time for both our patients and doctors, Hille said. The open house included tours of the new surgical center, an opportunity for visitors to ask questions directly of HMU physicians and surgeons, and an informal opening ceremony. About our practice Houston (HMU) is the largest urology healthcare provider in the greater Houston area. HMU was founded in 2006 as the result of a merger of several established practices in and around the city of Houston. Since the merger, Houston has grown to 18 urologists with a radiation oncologist, a uropathologist, and a team of radiologists who collaborate across 11 urology clinic locations to provide comprehensive care for men and women who are experiencing genitourinary conditions and have concerns about their sexual health. In 2006, the practice opened a radiation therapy center for prostate cancer patients. The center, which treats several hundred prostate cancer patients yearly, is well known for its advanced technology and state-of-the-art cancer treatment. In addition, HMU provides the entire spectrum of urologic services. To visit Houston 's web site, go to.

3 HMU Houston 3 Dr. Gregory D. Hester joins physician staff of HMU Greg Hester, M.D. Houston is pleased to welcome Gregory D. Hester, M.D., F.A.C.S., to the HMU team. Dr. Hester is board certified with the American Board of and the American College of Surgeons. Dr. Hester attended The University of Texas at Austin. He then continued his education at The University of Texas Medical School at San Antonio, where he received his medical degree. Dr. Hester completed his residency at The University of Texas Medical School at Houston and MD Anderson Cancer Center. He is published in several scientific papers and continues to be involved with medical education publications. Some of his specialties include: bladder pain, erectile dysfunction causes and treatments, laparoscopic surgery, urinary incontinence, kidney stones and prostate cancer. Dr. Hester has earned an outstanding reputation in the medical community and will be a wonderful addition to our practice, said Zvi Schiffman, President and CEO of Houston. Open invitation: Ask your doctors questions By Karen Delhey, M.D. We are pleased that you have chosen to trust your urology care to HMU. Here are some questions you might want to ask at the time of your first visit. After discussing your symptoms and past medical history, and having performed an examination, your doctor has an initial impression. Please feel free to ask us the following: Questions to ask at your first visit 1. Do you have a diagnosis? 2. Do I need further tests before you can make a diagnosis? 3. What treatment options are available? 4. Can you tell me what your long-range treatment strategy may be? 5. Can you tell me what my outcome may be? 6. Is my current mix of medications acceptable, given my symptoms and condition? After your evaluation is completed, surgery may be recommended. Here are some questions you should consider asking if that is the case: Questions to ask before undergoing surgery 1. Can you describe the surgery and what it will do for me? 2. Should I have the surgery right away, or can it wait? A Houston patient has her questions answered by Dr. Robert Light and Dr. Karen Delhey. 3. What, if anything, will I lose if we watch the condition and delay the surgery? 4. What alternatives to surgery may improve my condition? 5. What outcome can I expect if I have surgery? 6. How long should the recovery take? 7. What are the possible side effects? 8. How many of these procedures have you performed? 9. How do you feel about me getting a second opinion? As the doctors of Houston, we look forward to answering all of your questions.

4 4 Feature Story 10 Common Urological Conditions Medical terms you will frequently hear in a urology office 1 Overactive bladder Overactive bladder is a problem with bladder function that causes a sudden urge to urinate. The urge may be difficult to suppress, and overactive bladder can even lead to the involuntary loss of urine (incontinence). If you have this condition, you may feel embarrassed, isolate yourself, or limit your work and social life. The good news: A brief evaluation can help determine the cause, then you can receive treatments that may greatly alleviate your symptoms. Treatments range from dietary changes to biofeedback therapy to prescription medications. 2 Urinary incontinence Urinary incontinence characterized by the loss of bladder control is a common and often embarrassing problem. Millions of men and women have this problem, especially as they get older. Symptoms can range in severity from occasionally leaking urine when you cough or sneeze, to having an urge to urinate that is so sudden and strong that you don t get to a bathroom in time. The positive news is that solutions exist ranging from simple lifestyle changes to medications to minimally invasive procedures or surgery. 3 Kidney stones One of the most painful urologic disorders, kidney stones have plagued humans for millennia. The first recorded surgery performed on humans was for the removal of stones from the bladder in ancient Egypt. For unknown reasons, the number of people in the United States with kidney stones has been increasing over the past 30 years. Most kidney stones pass out of the body without any intervention by a physician. But stones that cause lasting symptoms can be treated by various techniques, most of which do not involve open surgery. In the majority of cases, sound waves can be used to break up a kidney stone. Research advances have led to a better understanding of the many factors that cause stone formation and, thus, better treatments for preventing kidney stones. Drinking more water is the easiest way to help avoid kidney stones. 4 Hematuria Hematuria is characterized by the presence of red blood cells in the urine. In microscopic hematuria, urine appears normal to the naked eye (but red blood cells are seen in the urine under a microscope). In gross hematuria, the urine is red or the color of cola. A number of conditions can cause hematuria. Although the majority of times the cause is not life threatening, hematuria is often the only warning sign for cancer of the kidney, ureters or bladder so timely evaluation is important. In many cases, the cause is due to less threatening conditions such as urinary tract stones, infections, enlarged prostate or even heavy exertion or exercise. Treatment for hematuria depends on the cause. 5 Urinary tract infections Millions of men and women in the U.S. each year are treated for urinary tract infections. A urinary tract infection, or UTI, is an infection that can occur anywhere along the urinary tract. Urinary tract infections are caused by germs that typically enter the urethra, then the bladder. Women get more UTIs than men because their urethra is shorter. Also, a woman s urethra is closer to the anus where the germs that cause a UTI usually come from. Other factors that increase the likelihood of UTIs: diabetes, advanced age, kidney stones, enlarged prostate (anything that blocks the flow of urine), bowel incontinence, pregnancy, immobility (staying still for long periods of time), or medical conditions that require self-catheterization. Symptoms include: cloudy or bloody urine, foulsmelling urine, low-grade fever, pain, or a burning sensation while urinating. When you have a bladder infection, you will usually be treated with antibiotics. Kidney infections are much more serious than bladder infections. 6 Rapid ejaculation Rapid ejaculation, also sometimes called premature ejaculation, is the

5 HMU Houston 5 occurrence of ejaculation prior to the wishes of both sexual partners, typically within only a minute or two of foreplay or intercourse. The exact cause of rapid ejaculation sometimes can be difficult to diagnose because sometimes the problem is biological, sometimes the problem is psychological, and other times it s a combination of the two. Current treatment approaches are either behavioral or medicinal. Behavioral treatments emphasize control of ejaculation by learning new techniques, gaining confidence, lessening anxiety and learning better communication. There are also certain classes of prescription medication that are highly effective. 7 Erectile dysfunction (ED) Erectile dysfunction is the inability to initiate and maintain an erection for satisfactory sexual intercourse. ED is increasingly prevalent with age. At age 40, there is an approximately 40% prevalence (typically mild), increasing to almost 70% in men at age 70. Aside from age, other factors that relate to higher prevalence include heart disease, hypertension, diabetes and associated medications. The good news is that there are many treatment options available to physicians. Non-surgical treatment options for ED include pills, withdrawal of other offending medication such as certain blood pressure medications and diuretics, hormonal therapy, intra-penile injection therapy, intra-urethral therapy, vacuum pump devices, sex therapy and topical ointments. Surgical treatment options include the implant of a semi-rigid rod, or an inflatable penile prosthesis. Men have seen great success with all options. 8 Enlarged prostate The prostate is a walnutsized gland located just below the male bladder. It surrounds the urethra, the tube through which urine passes out of the body. The prostate produces fluid that carries sperm during ejaculation. In many men, the prostate begins to enlarge after about age 40. Enlargement of the prostate gland is a condition known as benign prostatic hyperplasia (BPH). When the prostate grows, it can constrict the urethra and cause urination and bladder problems. Symptoms of an enlarged prostate may include: dribbling at the end of urinating, inability to urinate, incomplete emptying of your bladder, incontinence, needing to urinate several times at night, pain with urination, bloody urine and weak urine stream. BPH can be treated with a variety of techniques ranging from medications to surgery. There are also new clinical trials utilizing simple injections into the prostate. If you have BPH, you should have a yearly exam to monitor progression of your symptoms and to identify when treatment is necessary. 9 Prostate cancer Prostate cancer is the second leading cause of cancer-related deaths in America, second only to lung cancer. If prostate cancer is detected before it has spread, it is often cured by surgical removal. Robotic surgery is currently the state-of-the-art surgical treatment. Radiation therapy may also cure prostate cancer that has not spread. If prostate cancer has spread, it can be put into remission with hormone therapy and, in more severe cases, with chemotherapy. The best opportunity for successful treatment is when the cancer is detected at an early stage before it has spread. If the cancer is very minor, it may require no treatment at all. The tests urologists use to diagnose prostate cancer include: digital rectal exam, prostate-specific antigen (PSA) lab test, PCA3 urine test, transrectal ultrasound, and prostate biopsy. Additional radiology studies may be ordered to determine if the cancer has spread. 10 Male infertility Infertility is defined as the inability of a couple to conceive. In some cases couples are advised to try for at least a year, but this is not always appropriate as some couples will have conditions affecting one or the other, including maternal age, that make a year too long to wait. Female infertility, which affects about 15% of the population, can be caused by many different factors, including: ovulatory problems, blocked (or scarred) fallopian tubes, and endometriosis (growth of endometrial tissue outside the uterus). Male infertility affects about 30% of men in infertile couples. This condition ranges from hidden abnormalities of otherwise normal-looking sperm to no sperm at all in the semen. The causes range from environmental toxins and injuries to hormonal imbalances to blockages to genetic causes and anatomic abnormalities. Sometimes male infertility is a sign of a more serious underlying condition.

6 6 News & Notes Zvi Schiffman, M.D., Robert Light, M.D., and Kathy Hille, Ph.D., participated in the 2011 Large Group Practice Association (LUGPA) Annual Meeting Nov. 3-5 in Chicago. The HMU delegation returned with best practices information to ensure the practice utilizes the newest technologies, maximizes operational efficiencies, and operates in a clinically superior manner. At the meeting, Kathy Hille was elected to the LUGPA Board of Directors for a two-year term. Numerous HMU physicians have been named 2011 Texas Super Doctors: Richard Goldfarb, M.D., Stephen Lapin, M.D., Michael Lewitton, M.D., Mark Sutton, M.D., Brian Powers, M.D., Karen Delhey, M.D., Robert Light, M.D. and Kevin Nickell, M.D. Ricardo Gonzalez, M.D., has become an international expert in the use of GreenLight laser therapy. In October 2011, he made presentations in several countries to instruct other physicians in use of this advanced technology. Kevin Nickell, M.D., and Ricardo Gonzalez, M.D., were recognized this year by U.S. News & World Report as two of America's Outstanding Urologists. Richard Goldfarb, M.D., is a full Clinical Professor at Baylor College of Medicine as well as at Weill Cornell Medical College. He is the only private practitioner in the Houston area to be a full clinical professor. Carl Ogletree, M.D., and Larry Baum, M.D., recently participated in a successful community prostate cancer screening event at Methodist Sugar Land Hospital. The event drew more than 220 men. More than 240,000 men in the U.S. will be diagnosed with prostate cancer this year. Samuel Axelrad, M.D., and Ricardo Gonzalez, M.D., provide oversight of the HMU clinical trials program. Thanh John Van, M.D., is the on-staff Radiation Oncologist at HMU and provides oversight for the practice's Radiotherapy program. Mark Sutton, M.D., Chief of at St. Luke s Hospital, has been listed in Top Doctors in every year since HOUSTON METRO UROLOGY Brian Powers, M.D. was listed in U.S. News & World Report magazine as a Top Urologist, as well as being recognized as a Super Doctor in by Texas Monthly since Richard Goldfarb, M.D. and Stephen Lapin, M.D., participated in the 20th Annual Perspectives in : Point Counterpoint in Scottsdale, Ariz., in November, where they discussed the latest technologies for prostate cancer, kidney stone management and urinary stress incontinence. Stephen Lapin, M.D., a Clinical Assistant Professor at both Baylor and Weill Cornell Colleges of Medicine, received the prestigious award of Outstanding Surgeon from the Association of O.R. Nurses. Robert Light, M.D., was appointed Secretary to the Board of Directors of TMAIT (Texas Medical Association Insurance Trust) in October. He has served on the Board of TMAIT since Karen Delhey, M.D., has been actively participating in Gateway to Care, an organization that provides free medical care to patients who work, but have no insurance. Dr. Delhey has done a nephrectomy for renal cancer with an accompanying sling and most recently treated a patient with a large bladder stone and BPH. Michael Mineo, M.D., has been speaking in the community. He lectured on kidney stones and hematuria at The Methodist Hospital s Action Stat: Nurse Practitioner/Physician Assistant Boot Camp. He also spoke on prostate cancer and urologic preventive health at the Bay Area Physical Health & Mental Awareness Day. Brian Lord, M.D., was the keynote speaker at the Jan. 19 meeting of the Rotary Club of North Shore. Dr. Lord spoke on the topic of general men's and women's urological health. His presentation was followed by a question-and-answer session. HMU now accepting referrals for specialized treatments As the Houston region s largest and most experienced urology group practice, Houston (HMU) frequently accepts referrals from other physicians and group practices for general and specialized urologic treatments. Here are some of the many types of conditions for which you can refer a patient to HMU: Incontinence Urinary frequency / urgency Recurrent urinary tract infections Urinary tract stones (kidney, bladder) Hematuria Bladder cancer Kidney cancer / mass Prostate cancer Enlarged prostate Abnormal PSA Testicular cancer / mass / cyst Male infertility Vasectomy Vasectomy reversal Male sexual dysfunction Peyronie s disease Low testosterone Clinical trials If you have a patient who needs the care of a specialist, please contact us at: (713) Thank you.

7 HMU Houston 7 HMU leader in minimally invasive robotic surgery In sci-fi movies, robots go places people can't. But it's not just fiction: At Houston, robotics are improving surgeons' vision and extending their reach. Robot-assisted laparoscopic surgery has dramatically expanded the treatment options for urologic diseases. Using Intuitive Surgical's da Vinci robotic surgery system, surgeons at HMU frequently employ this minimally invasive approach for a broad range of procedures. Several Houston surgeons specialize in use of the da Vinci robotic system. Traditional open-field surgical procedures are performed through significant incisions, from 4 inches for prostatectomy, to more than 12 inches for kidney and bladder cancer surgeries. In contrast, robotassisted laparoscopic surgery is performed through several halfinch incisions. With robotic surgery, postoperative pain is decreased, and hospital stay and recovery are shortened. Traditional laparoscopy is generally limited to straightforward procedures. Using robotic surgery, more complex surgeries can be performed laparoscopically. Robots are especially helpful in minimally invasive surgery. Robotic surgery systems have special instruments, such as scissors and needle holders, which are attached to robotic arms. In the operating room, the surgeon sits at a control console where they control the instruments, which are on "With robotic surgery, post-operative pain is decreased, and hospital stay and recovery are shortened." Larry Baum, M.D. various robotic arms. One arm holds a 3D HD camera, which can be zoomed in to provide a greater magnification of the surgical field. Other arms hold instruments that grasp, cut, cauterize and suture. Each movement of the robot instrument is modeled after the movement of the surgeon's hands. For men who undergo prostatectomy to treat prostate cancer, 80 percent of these cases are now performed robotically. Patients choose robotic surgery because of lower transfusion rates, shorter convalescence, faster recovery of urine control, and better preservation of sexual function. In the field of urology, robotic surgery also is used for kidney cancer surgery, bladder cancer surgery and other forms of surgery.

8 HMU Houston 4223 Richmond Avenue Houston, TX Website: Firstname A. Lastname 1234 Boulevard, West City Name, ST HMU Houston Introducing the Houston (HMU) Physician Team FRONT ROW (L to R): Paolo C. Champion, M.D.; Ricardo R. Gonzalez, M.D.; Karen A. Delhey, M.D., F.A.C.S.; Larry Baum, M.D.; Robert A. Light, M.D., F.A.C.S.; Zvi Schiffman, M.D., F.A.C.S. (President & CEO); Brian Lord, M.D., F.A.C.S.; Stephen Lapin, M.D., F.A.C.S.; Samuel D. Axelrad, M.D., F.A.C.S. BACK ROW (L to R): Mark A. Sutton, M.D., F.A.C.S.; Michael Lewitton, M.D., F.A.C.S.; Carl W. Ogletree, M.D., F.A.C.S.; Alan E. Hananel, M.D.; Michael T. Mineo, M.D.; Brian C. Powers, M.D.; Kevin G. Nickell, M.D., F.A.C.S.; Richard Goldfarb, M.D., F.A.C.S. Not pictured: Gregory Hester, M.D., F.A.C.S.; Rita Tibbs, M.D.; Thanh John Van, M.D. Web site: Houston