Reconstructive Urology and Genitourinary Cancer Survivorship

The reconstructive section of the Department of Urology has a multi-pronged approach to gaining experience with research. We have retrospective review projects that are based off of very large databases encompassing the field of urethral stricture, male incontinence, and urodynamics. Additionally, we have human use protocols that evaluate different aspects of genitourinary cancer survivorship as well as male and female incontinence, and voiding dysfunction. Finally, we offer an in-depth, comprehensive experience with basic sciences and the use of animal models in conducting research for the reconstructive patient as well as genitourinary cancer survivor. We are also an active collaborative member of the Trauma and Urologic Reconstructive Network of Surgeons (TURNS), with access to a large prospectively managed database and multiple other expert reconstructive surgeons in the field.

This experience is constructed to fulfill the student's primary goals as to what they wish to achieve within their research year.

Research Approach

We have adopted a multimodal approach to evaluate all of the above objectives. We have teamed with industry and have sponsorship grants to study post-prostatectomy incontinence with specific attention to currently available commercial devices for post-prostatectomy incontinence. We also work with basic science researchers utilizing computer models, animal models and in vitro models to study both urethral stricture disease bladder dysfunction as well as post-prostatectomy incontinence.

Introduction to Basic Sciences

We have teamed with researchers, including Matt Fraser, PhD, who runs a basic sciences animal lab specializing in bladder physiology. We have collaborated with his laboratory in order to create an animal model to study the effects of various translational agents on the prevention and treatment of radiation cystitis. Students taking part in this lab will be introduced to advanced animal care for research, surgery for the creation of animal models, development and implementation of various protocols to study bladder physiology in the animal, and implementation and conduct of basic sciences research utilizing animal models for various questions in reconstructive urology.

Introduction to Clinical Research

The reconstructive unit has constructed large databases of patients being treated for stress incontinence, urethral stricture disease and those who have undergone urodynamics. These databases may be queried for initial questioning and studies evaluating diagnosis, treatment, and outcomes in these patients. We have been involved in pre-marketing trials for new surgical treatment therapies for female stress incontinence and post-prostatectomy incontinence. We also have conducted multiple pre-market drug trials to increase our understanding of overactive bladder and its treatment with specific respect to anticholinergic medications. The reconstructive unit has also conducted trials for overactive bladder concentrating on Botox therapy as well as behavioral modification therapy.

Program Highlights

  • Understand the etiology, risk factors, and various modalities of treatment for post-prostatectomy incontinence.
  • Determine the causes and risk factors for overactive bladder.
  • Explore new surgical and medical treatments for various types of voiding dysfunction including female and male stress incontinence, urge incontinence, and overactive bladder.
  • Understand the risk factors, etiology, and natural history of genital skin and urethral disorders, including lichen sclerosus.
  • Establish continuous improvement of treatment options for all forms of urethral stricture disease.
  • Improve the quality of life and outcomes for patients who are survivors of genitourinary malignancies.

Members

Selected Achievements

  1. Peterson, AC, Chen, J: Patient Reported Incontinence After Radical Prostatectomy Is More Common Than Expected and Not Associated With the Nerve Sparing Technique: Results From the Center For Prostate Disease Research (CPDR). Neuourol and Urodyn. 31(1):60-63, January 2012.
  2. Tausch TJ, Peterson AC: Early Aggressive Treatment of Lichen Sclerosus may Prevent Disease Progression. J Urol.187(6):2101-2105, June 2012.
  3. Lentz AC, Peterson AC, Webster GD: Outcomes Following Artificial Sphincter Implantation After Prior Unsuccessful Male Sling. J Urol. 187: 2149-2153, June 2012.
  4. Bernal RA, Peterson AC: Evaluation of Post-prostatectomy Incontinence: Determining Candidacy for the Trans-Obturator Sling. Current Bladder Dysfunction Reports. 7(3):215-221, September 2012.
  5. Peterson AC, Curtis LH, Shea AM, Borawski KM, Schulman KA, Scales CD. Urinary Diversion in Patients with Spinal Cord Injury in the United States. Urology. 80(6): 1247-1251, December 2012.
  6. McNamara EA, Webster GD, Peterson AC. The UroLume Stent Revisited: The Duke Experience. Urology. 82(4): 933-936, 2013.
  7. Speicher PJ, Goldsmith ZG, Nussbaum DP, Turley RS, Peterson AC, Mantyh CR. Ureteral stenting in laparoscopic colorectal surgery. J Surg Res. 190(1): 98-103 2014.  
  8. Hanna JM, Peterson AC, Mantyh C. Rectourethral Fistulas in the Cancer Survivor. Current Bladder Dysfunction Reports. 24(4): 382-388, 2014.
  9. Gupta, S, Peterson AC. Stress Urinary Incontinence in the Prostate Cancer Survivor. Current Bladder Dysfunction Reports. 24(4): 395-400, 2014.
  10. Hanna JM, Turley R, Castleberry A, Hopkins T, Peterson AC, Mantyh C, Migaly J.  Surgical Management of Complex Rectourethral Fistulas in Irradiated and Non-irradiated Patients. Dis Colon Rectum. 57(9): 1105-1112, 2014.
  11. Granieri M, Peterson AC: The Management of Bulbar Urethral Stricture Disease Before Referral for Definitive Repair: Have Practice Patterns Changed? Urology, 84(4): 946-949, 2014.
  12. Granieri MA, Webster GD, and Peterson AC: The Evolution of Urethroplasty for Bulbar Urethral Stricture Disease: Lessons Learned from a Single Center Experience. J Urol. 192(5): 1468-1472, 2014.
  13. Granieri MA, Webster GD, and Peterson AC: Scrotal and perineal sensory neuropathy after urethroplasty for bulbar urethral stricture disease: an evaluation of the incidence, timing, and resolution. Urology, 84(6): 1511-1515, 2014.
  14. McNamara ER, Austin S, Case L, Wiener JS, Peterson AC, Kishnani PS: Expanding Our Understanding of Lower Urinary Tract Symptoms and Incontinence in Adults with Pompe Disease. JIMD Reports, 20: 5-10, 2015
  15. Belsante MJ, Selph JP, Peterson AC: The Contemporary Management of Urethral Strictures in Men Resulting from Lichen Sclerosus. Transl Androl Urol, 4(1): 22-28, 2015
  16. Gupta S, Zura RD, Hendershot EF, Peterson AC: Pubic symphysis osteomyelitis in the prostate cancer survivor: clinical presentation, evaluation, and management. Urology, 85(3): 684-690, 2015.
  17. Granieri, MA, Webster GD, Peterson AC: Critical Analysis of Patient-Reported Complaints and Complications After Urethroplasty for Bulbar Urethral Stricture Disease, Urology, 85(6):1489-1493, June 2015
  18. Ajay D, Zhang H, Gupta S, Belsante MJ, Lentz AC, Webster GD, Peterson AC: The Artificial Urinary Sphincter is Superior to a Secondary Transobturator Male Sling in Cases of a Primary Sling Failure, J Urol, 194(4):1038-1042, October 2015
  19. Gupta S, Ding L, Granieri MA, Le NB, Peterson AC: Utilization of surgical procedures and racial disparity in the treatment of urinary incontinence after prostatectomy. Neurourol Urodyn, May 2015
  20. Selph JP, Belsante MJ, Gupta S, Ajay D, Lentz AC, Webster GD, Le NB, Peterson AC: The ohmmeter identifies the site of fluid leakage during artificial urinary sphincter revision surgery. J Urol, 194(4):1043-1048, October 2015
  21. Selph JP, Madden-Fuentes, R, Peterson AC, Webster GD, Lentz AC: Long-term Artificial Urinary Sphincter Outcomes Following a Prior Rectourethral Fistula Repair. Urology, 86(3):608-612, September 2015.
  22. Potts B, Belsante, M, Peterson, AC: Intraurethral Steroids are a Safe and Effective           Treatment for Stricture Disease in Patients with Biopsy-Proven Lichen Sclerosus. J Urol, 195(6): 1790-1796, December 2015.
  23. Granieri MA, Peterson AC: A Critical Evaluation of the Utility of Imaging after Urethroplasty for Bulbar Urethral Stricture Disease. Urology, 91:203-207, February 2016.
  24. Zaid UB, Lavien GD, Peterson AC:  Management of the Recurrent Male Urethral Stricture.  Curr Urol Rep, 17(4): 33, April 2016.

BOOKS

Editors: Peterson AC and Fraser MO. Practical Urodynamics for the Clinician. Springer, In press 2015

Ongoing Collaborations

Movember Foundation: “A Survivorship Action Partnership (ASAP USA) “ASCENT” (A Survivorship Care plan and Embedded Navigation Tool)”

$1.6 Million/3 years

This grant was awarded by the Movember foundation to help in the care of prostate cancer survivors. I am the principal investigator for a multisite intervention controlling $1.6 million to be used over the next 3 years among 6 sites. Our intervention will study the effects of an automated survivorship care plan on the care and quality of life of men surviving prostate cancer.

The Wallace H. Coulter Foundation (in association with H. Levinson, MD- plastic surgery): “Biofilms and Indwelling Catheters; How Long Does it Take For Biofilm to Form on an Indwelling Urinary Catheter?”

$193,999

This project is conducted in conjunction with the biomedical engineering department as well as the Division of Plastic Surgery at Duke. We have collaborated to develop a possible biofilm spoiling Foley catheter with the end goal being to reduce catheter associated urinary tract infections (CAUTI) in hospitalized patients with indwelling urinary catheters.

NIH-NIDDK:  Lower Urinary Tract Dysfunction Research Group (LURN) “Advancing the Measurement and Classification of Lower Urinary Tract Dysfunction”

$250,000/5 years

This grant was prepared in conjunction with a multidisciplinary group including representation from urogynecology, psychiatry, medicine, psychology, and basic sciences.

American Medical Systems: Medical Education Un-restricted grant, “Genitourinary Cancer Survivorship Fellowship”

$65,000

Coloplast Corporation: Medical Education Un-restricted grant, “Genitourinary Cancer Survivorship Fellowship”

$20,000

TURNS: Trauma and Urologic Reconstructive Network of Surgeons.

We are an active member in this multi-institutional collaborative group with access to a large prospectively managed dataset for patients undergoing any type of reconstructive procedure including sexual dysfunction, urethral stricture, male and female incontinence and abdominal reconstruction.

Advanced Training

We are very proud of our group’s involvement in a new field; genitourinary cancer survivorship. Our unit has established a several multidisciplinary genitourinary cancer survivorship working groups in the Duke Cancer Institute in order to efficiently provide care to this patient population. These working groups include teams designed to treat rectourethral fistula (colorectal surgery, plastic surgery, urology), pubic symphysis osteomyelitis (orthopedic surgery, plastic surgery, radiation oncology, infectious disease, urology), erectile dysfunction and incontinence.

Collaborate with Us

Please contact Andrew Peterson, drew.peterson@duke.edu.