Research Fuels Surgical Innovation

From the 2014 Department of Surgery Annual Report

Urology Gerald AndrioleGerald Andriole, MD, center, discusses a future case with Parris Weber, CST, and Megan McKnight, BSN, RN, in which they will use ultrasound and MRI to guide a prostate biopsy. The front screen shows ultrasound images; the rear screen displays MRI.INNOVATION IS A CENTRAL THEME in the history of the Division of Urologic Surgery. John Caulk, MD, the first chief of urologic surgery from 1910 to 1938, developed transurethral prostatic resection and the “Caulk Punch” for trimming the prostate from the inside. Many of the chiefs and surgeons who followed also contributed urologic advancements: the first clinical cystometrogram, now called urodynamics (Dalton Rose, MD, chief, 1939-1953); urinary diversion (Justin Cordonnier, MD, chief, 1953-1970, with general surgeon Eugene Bricker, MD); one of the earliest scoring systems for benign prostatic hypertrophy (Saul Boyarsky, MD, chief, 1970-73); prostate-specificantigen (PSA) test for prostate cancer (William Catalona, MD, chief, 1984-1998); and the first laparoscopic nephrectomy (Ralph Clayman, MD, faculty member, 1984-2001).

From 1965-2012, the division also made its mark in the scientific literature, credited as the institution with the second-highest number of articles cited in the top 100 articles in the field of urology.* It currently has 13 former faculty members, residents and fellows who have gone on to lead U.S. urology programs.

Under current Chief Gerald Andriole Jr., MD, the Robert K. Royce Distinguished Professor of Urologic Surgery, the division has played a leading role in shaping prostate cancer screening guidelines and remains a leading center in the diagnosis and treatment of the disease.

Andriole is chair of the prostate committee for the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Trial, a major multicenter, multicomponent study. Most recently, it showed that routine PSA screening does not reduce prostate cancer deaths among men ages 55-74 followed for a minimum of 13 years.

In a recent study, Andriole and colleagues found that using MRI in addition to the standard of ultrasound to guide biopsies in men with elevated PSA may improve biopsy accuracy, reduce biopsy infection rates, and more accurately assess tumor aggressiveness. The technology shows promise for greatly improving the process of determining which men need a biopsy and which cancers require aggressive treatment as opposed to watchful waiting, Andriole says.

Washington University urologists are leaders in the use of focal ablation to remove portions of the prostate in men with small tumors and are working with various companies to develop blood, urine and DNA tests that more accurately characterize prostate cancer aggressiveness.

*Gregory J. Nason, MD, MRCSI, Farhan Tareen, MD, and Alan Mortell, MD. The top 100 cited articles in urology: An update. Can Urol Assoc J. 2013 Jan-Feb; 7(1-2): E16–E24.