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How to stay healthy, and maybe find a career, in the age of biotech

USC partnered with Univision for community health fair at East LA Community College. Some of 3500 people attended.

It was a honor to be part of this event. With everybody´s effort, we made a positive impact on our community.

Doctor’s orders: How to stay healthy, and maybe find a career, in the age of biotech

Get regular checkups, keep in touch with your doctor and be aware of opportunities in biotech. Those are doctor’s orders from Rene Sotelo, professor of clinical urology at Keck School of Medicine of USC, who spoke with community members and families during a health fair Saturday at East Los Angeles College.

“Take care of yourself,” said Sotelo, a pioneer in urinary robotic surgery, as he answered questions in Spanish about cancer screening and treatment from residents of Boyle Heights and other nearby communities. Sotelo also emphasized the educational and career prospects in medicine and biotech.

“There are many career opportunities for students, involving technology that will assist them to improve the quality of health care. This includes apps, medical devices, pharmaceuticals,” Sotelo said. “There’s technology that can help us follow the patient home after the surgery to see exactly how they’re doing. All this is part of it, and there are no barriers.”

Ghecemy Lopez, a cancer information resource and navigation specialist with the Keck School, took the stage along with Sotelo. She focused on engaging and educating youths about in the importance of creativity and critical thinking in STEM, cancer research and patient advocacy.

Lopez said that STEM education — focusing on science, technology, engineering and math — is an equalizer of economic and labor opportunities that can address health issues and break barriers, particularly those affecting the immigrant and low income community in Los Angeles. Lopez, who survived cancer at a young age, said she is grateful that STEM technology and research advances helped her beat cancer and gave her a second chance in life.

More at: News.usc.edu

 

 

Next Men’s Health Seminar

? Save the date!
We are reday for the next: Men’s Health Seminar
?¿Where? USC Verdugo Hospital, Los Angeles, California.
? July 11th
Free event – Free parking

Men Health Seminar

Men Health Seminar

Countdown to #AUA17! Course: Complication of robotic urological surgery

Dear friends, the Annual Meeting of the American Urological Association (AUA) will take place in Boston on May 12-16

As part of this academic event, I have the honor of sharing with outstanding specialists the postgraduate course: Complications of Robotic Urological Surgery: prevention, recognition and management.

When? On May 13th!!!

I hope you will join us! For any additional information I invite you to go to the event website www.aua2017.org/

 

Urine Myths

1. What exactly is in urine? What’s it composed of?

The function of our kidneys is to filter the blood and eliminate waste from our body. Urine is a body fluid produced by the kidneys, which contains the excreted wastes. Urine is composed of water, electrolytes, and nitrogen compounds, such as urea. It travels from the kidneys, down the ureters, and into the bladder, where it is stored. When we are ready to urinate, the urine leaves the bladder and body through the urethra.

2. Is there any truth to rumors that you can cure athlete’s foot with urine?

Some people say urine might cure athlete’s foot because of the urea that it contains. It would have to be a very large amount of urea (more than how much is normally found in urine) for it to be considered useful to treat tinea pedis (“athlete’s foot”). So in reality, no, it probably does not work.

3. Some people insist that drinking urine can cure all sorts of diseases and ailments. This can’t be true, can it?

The idea of urine therapy started around the 20th century. People claim that it works to cure some medical conditions, such as hair loss, it has been used in cancer treatment, for cleansing of the cardiovascular system, and to prevent viral and bacterial infections. Even famous people, such as Madonna or the former prime minister of India, have been quoted to partake in urine therapy for medical treatment. It is noteworthy to mention, however, that there is no scientific evidence showing that these treatments are effective.

4. Does urinating on a jellyfish sting actually accomplish anything?

Not really. In fact, if the urine is too dilute, it could actually increase pain because the urine activates the cells that are left in the skin by the jellyfish called, cnidocytes. Although some analgesics could be helpful in managing the pain, the best treatment is letting the effect of the venom from the jellyfish diminish over time.

5. If you ever laugh so hard, you release a little urine into your pants, is this cause for alarm?

This can happen sometimes. It could be because the bladder is too full, and any increase in the intraabdominal pressure can cause urine to leak out. Sometimes, this is a result of weakness of the pelvic floor muscles and urinary sphincter, which sometimes happens after pelvic surgery or having children. When a person performs any maneuver that increases the intraabdominal pressure (such as coughing, sneezing, laughing, bending down) high enough to overcome the resistance of the sphincter, leakage of urine can occur. This is not a life threatening situation, and more is related to a person’s quality of life.

6. We know that darker shades of urine can be a sign of dehydration, but what about if it takes on an alarming color, like green or blue?

Blue urine is not common at all. There is a medication¬¬ called methylene blue that can give the urine this color. Methylene blue is usually used as a contrast during surgery to help identify structures, but it is also used in the treatment of a condition called methemoglobinemia and, in which case it is given as a systemic form, which can turn your urine blue.

Green urine can occur after the ingestion of any medication that contains phenol groups. Also, a greenish/brownish color of the urine can be caused by urinary tract infections or fistulas (abnormal connections) between the bowel and the urinary systems.

The urine can also have an orange color after the ingestion of certain medications, such as rifampin and phenazopyridine.

Finally, one of the most important urine colors to take into consideration should be red, which may be the result of blood in the urine (hematuria). Hematuria suggests that red blood cells are in the urine. These individuals need a careful evaluation by a physician to identify the cause of the blood in the urine (such as infection, stones, irritation, and even cancer).

7. Why do some people smell asparagus in their urine and other’s don’t?

There is a study that found that the ability to smell the asparagus odor in urine is related to a gene on our DNA (chromosome 1) which is directly linked with the presence of certain smell (olfactory) receptors. It is expressed less in women, and as a result, females are less likely to be able to sense that particular odor in urine.

8. Maple syrup urine disease sounds like a fake disorder. Is it real, and if so, what causes it?

It is a real disease, caused by a genetic absence of an enzyme which is needed to breakdown (metabolize) some essential aminoacids in the body, for later use. An absent or defective enzyme leads to a broad spectrum of signs and symptoms such as seizures, diarrhea, and a sweet smell of urine.

9. Is the strength of your stream important? What does it mean if somebody is able to urinate from a great distance? Is there some advantage to being able to pee from further away?

The strength of your urinary stream, as well as the diameter, is important to use as a reference when considering a possible blockage of the urinary tract. This is most commonly associated with benign prostatic hyperplasia, which an increase in size of the prostate, something that happens with age in men. Men may experience symptoms such as a decreased force of their urinary stream, difficulty emptying their bladder, or being unable to start urination.

The distance from where you can urinate does not represent any advantage. With age, however, men tend to have a decrease in the strength of their stream, and so the distance from where they can urinate may be shorter.

 

Rene Sotelo

Rectourinary fistulas

Rectourinary fistulas (RUF) are uncommon. They include rectourethral, rectovesical, and enterourinary fistulas.
Signs and symptoms depend on the type of fistula and may include urinary tract infections, pneumaturia, fecaluria, and urine leakage per rectum. Evaluation and work-up for RUF includes a physical examination and history including previous radiation or gastrointestinal disease, cystoscopy, colonoscopy, barium enema, retrograde urethrogram, and CT scan with contrast.

Rectourethral fistula

The most common cause of the rectourethral fistula is a consequence of prostate treatments (e.g. TURP, EBRT, HIFU, cryotherapy, rectal surgery, brachytherapy (BT) and radiotherapy to the rectum). It is important to note that although it is thought that rectourethral fistulas occur after a radical prostatectomy, semantically, it should be considered a rectovesical fistula because it developed close to the anastomosis with the bladder being the origin.

Rectourethral fistulas have been reported in approximately 0.3-3% of patients after BT (1) and in 0-0.6% after EBRT (2). With the increasing use of HIFU, rectourethral fistula has been reported as a complication after this treatment modality; Netsche (3) reported an overall incidence of 2.2%, with a higher probability to develop a fistula after a salvage or repeated session of HIFU. Additionally, the use of cryotherapy and radiotherapy before rectal surgery has resulted in an increase rate of fistulas.

Laparoscopic and robotic rectourethral fistula management was described by Sotelo et al. For a fistula involving the prostatic capsule, the technique includes capsulotomy, excision of the prostate while preserving the seminal vesicles, and closing the rectum in two layers. The bladder is then mobilized distally, and urethrovesical anastomosis is performed in the standard running fashion, using an omental or peritoneal flap to interposition (4).

Rectovesical fistulas

Rectovesical fistulas are less common. They can occur at different locations, including the bladder dome, where diverticular disease (66% of cases) and colonic cancer (about 20% of cases) as more frequent etiologies (5); to the bladder neck, where it can follow extirpative or ablative procedures of the prostate for both benign and malignant conditions.

A review of complications after radical prostatectomy in the Medicare population revealed a 1% rate of RUF (6). For robot-assisted radical prostatectomies, the reported incidence of rectal injury is 0.17%, with most injuries detected intraoperative (7). There has been an increase in fistula rate as a result of an increase in the number salvage radical prostatectomies being performed.

Sotelo et al (8) was the first to report the use of a laparoscopic approach to the treatment of rectovesical fistula. He reported a transvesical approach, which reaches the fistulous tract through a vertical cystostomy, bivalving the trigone, which allows for a meticulous retrovesical dissection to separate the rectum from the bladder. Once the communication between the bladder and the rectum is identified, a careful dissection is performed to separate the rectum from the bladder. The rectum is then closed, and omentum can be brought down to serve as a tissue interposition to bolster the repair. The bladder closure is then performed. Parma et al (9) reported a similar case with the same success. The use of the robotic platform was first described by Sotelo et al (10) with shorter operative time and length of hospitalization, without fistula recurrence.

At USC we have performed pioneering work in laparoscopic and robotic surgery for complex urinary fistula management and repair. Our experience includes treatment of 100 cases rectourinary fistulas of all kinds. We have a dedicated team, including colorectal surgeons and urologic reconstructive surgeons, to offer the best collaborative treatment of this challenging condition.

References
1. Theodorescu D, Gillenwater JY, Koutrouvelis PG. Prostatourethral- rectal fistula after prostate brachytherapy. Cancer. 2000;89: 2085-2091.
2.Pisansky TM, Kozelsky TF, Myers RP, et al. Radiotherapy for isolated serum prostate specific antigen elevation after prostatectomy for prostate cancer. J Urol. 2000;163:845-850.
3. Netsch C., Bach T., Gross E., et al. Rectourethral fistula after high-intensity focused ultrasound therapy for prostate cancer and its surgical management. Urology 2011 Apr;77(4):999-1004
4. Sotelo R., Mirandolino M., Trujillo G., et al. Laparoscopic repair of rectourethral fistulas after prostate surgery. Urology 2007 Sep;70(3):515-8.
5. Venn S, Mundy T. Bladder reconstruction: urothelial augmentation, trauma, fistula. Curr Opin Urol 2002; 12:201–203
6. Benoit R., Naslund M., Cohen J. Complications after radical retropubic Prostatectomy in the medicare population. Urology 2000;56: 116–120
7. Wedmid A, Mendoza P, Sharma S et al. Rectal injury during robot-assisted radical prostatectomy: incidence and management. J Urol 2011; 186: 1928–33
8. Sotelo R, Garcia A.,Yaime H., et al. Laparoscopic rectovesical fistula repair. J Endou 2005; 19(6):603-606
*This is the first description of laparoscopic transvesical approach to a fistula.
9. Parma P., Samuelli A., DallOglio B., et al. Laparoscopic repair of rectovesical fistula after radical retropubic prostatectomy. Urologia 2011 Oct;78 Suppl 18:21-5
10. Sotelo R., De Andrade R., Carmona O., et al. Robotic repair of rectovesical fistula resulting from open radical prostatectomy. Urology 2008 Dec;72(6):1344-6

Save The Date For The 2nd USC Annual Conference: Practical Urology

Dear Friends,

On behalf of Dr. Inderbir Gill, and the entire faculty of the USC Institute of Urology, we would like to welcome you to participate in our second annual “Practical Urology” meeting, scheduled for January 26 – 28, 2017.

We’re offering a full day of surgeries covering the entire scope of urology, two full days of scientific lectures from renown leaders in the world of urology, and a magical evening full of fun and laughter at our exciting program dinner scheduled to be held at the Globe Theater inside Universal Studios. There is no better way to start off the year, than by attending USC’s Practical Urology meeting!

Registration at https://keck.usc.edu/cme/

We look forward to having you join us in January 2017!

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EFE: Venezuelan surgeon trains doctors in robotic surgery in the US

My vocation to be a doctor arose at a very early age. I have always believed that with persistence and perseverance it is possible to achieve any goal. Today, I am in the University of Southern California sharing my experience in robotic surgery and urology, but my training is 100% Venezuelan. I am very grateful to EFE Agency for the interview that I reproduce below:

EntrevistaEfe

The skills of Venezuelan René Sotelo to treat urological problems with non-invasive robot-assisted surgeries made the University of Southern California (USC) call him to teach his techniques to his colleagues in the United States.

For this, this University applied for his medical licensure to the Medical Board of California in order to train his colleagues in the US, a request that USC has submitted only twice in its 130 years of institutional history.

In the US, obtaining a license to practice medicine is possible mainly if the applicant has graduated from a US university, and in the case of foreign health professionals, if they have approved the examinations of the relevant medical school.

However, as Sotelo, a professor of clinical urology at the Keck School of Medicine at USC, revealed to Efe, another option to obtain the medical licensure is through the academic way.

“This alternative applies when the Medical Board of California considers that the doctor or researcher has some uncommon abilities”, he said.

Sotelo, who is 53 years old, graduated in 1987 from the medical school “Luis Razetti”, of the Central University of Venezuela, and specialized in laparoscopic surgery.

With the creation of the “Da Vinci robotic surgical system”, which is available since 2000 in the operating rooms, he added his experience in “minimally invasive” surgery to robotic surgery.

Over time and after accumulating significant experience in that field, he received up to 70 doctors from all over the world to be trained by him.
In the US, “I operate, I am in charge of everything relating to laparoscopic and robotic surgery in the area of oncology; and besides surgery, I participate in teaching”, stated Sotelo.

Sotelo, who joined the team of professors from the USC School of Medicine in August 2015, also said that he shares his knowledge with colleagues all over the world in an annual medical conference, where he performs“live surgery”.

“Today I just operated on a patient who had two years with a probe and who could not urinate”, said the expert, referring to the satisfactions his profession has given him.

“It was a Mexican patient, he was scared, he was terrified to undergo prostate surgery. I met him, we talked to him, we developed an immediate connection, and then he said: God’s timing is perfect. I found the surgeon who will operate on me”, said Sotelo.

“I just operated on him and the surgery results are spectacular”, said Sotelo, who has performed more than 2,300 surgeries during his professional career, including procedures in 24 countries.

He considers that one of his greatest contributions is being a pioneer in complex urinary fistula surgeries, using surgical methods that have been published in scientific journals.

Inderbir Gill, the chairman and a professor of the Institute of Urology at USC, told Efe that “Dr. Sotelo is one of the leaders in robotic surgery in Latin America, and as USC is a leader in robotic surgery in the world, it is a natural integration”.

Aware that in the US union of health professionals Hispanics are needed to take care for patients of this demographic group, Gill recommended Latino students to collaborate with experts, seize the opportunities to obtain scholarships and do medical research.
The American Association of Medical Colleges (AAMC), in the report “Diversity in Physician Workforce: Facts and Figures 2014”, points out that by 2012 the total active doctors in the country increased to 834,769.

Of that amount, 48.9% are Caucasian, 11.7% are Asian, 4.1% are Afro-American, and 4.4% Latin-American.

Hispanics constitute 17.6% of the country’s total population.