Clinical Urology Associates offer ‘bladder pacemaker’


Photo courtesy of Clinical Urology Associates

By Emma Kirkemier, News Editor

Clinical Urology Associates has served the Gadsden area since its founding in the 1970s, but the practice has expanded in recent years to the surrounding communities of Albertville, Fort Payne and Pell City.

The Goodyear Avenue office hosts the practice’s six associates: Dr. John Pirani, MD, FACS; Dr. Merle Wade Jr., MD, FACS; Dr. Manish Shah, MD; Dr. Dawon Stephens, DO; Dr. Michael Jennings, MD and Dr. Marilyn Hopkins, MD.

Jennings is based in the Marshall County office in Albertville, which will host an open house in its new building this fall.

“The Marshall County office now has merged, so it’s right on the Albertville/Guntersville line,” he explained. “It’s right in between both hospitals (Marshall North and South). We have offices in Fort Payne, Pell City and then we will be opening Jacksonville by the end of the year.”

Jennings is an expert in robotic surgery, including surgical implantation of the up-and-coming ‘bladder pacemaker’ device.

“We call it a pacemaker just because it’s easy for people to understand,” Jennings said. “The long word, the doctor word for it is sacral neuromodulation, and what it does is it’s targeting the nerve that controls the bladder.

“People typically come in and they try lifestyle modifications for overactive bladder, so it’s treating overactive bladder and urge incontinence — when you’re leaking urine because you can’t make it to the bathroom on time.”

According to Jennings, recent research has identified potential health risks associated with common overactive bladder medications, causing many urologists to move away from using them. Jennings claimed that the pacemaker device, however, is a more sustainable option.

“This is kind of a long-term fix that allows people to get off the medications, and for people who need more help than the medications can provide,” he said. “It is recently more popular in this area. It’s been around for probably 25, 30 years. It’s just that they’ve made advances in the technology. The implant is much smaller; it can be done very easily in a day-surgery type setting. It does not take very long — 20, 30 minutes — (it has a) very small amount of discomfort and it’s well-tolerated.”

While some patients assume that the implant necessitates an invasive surgery, this is not the case.

“People think it’s going to go around their pelvic organs, their bladder; it actually doesn’t,” Jennings said. “It goes in the low back, because that’s where the nerve that controls the bladder is. So it’s hidden; it’s not going to interfere with lifestyle or sexual activity or anything like that.

“People get to try it, so it’s a two-part procedure. We don’t just put this thing in and hope that it works. You do a trial where the two little leads are taped to the outside of your skin, and you wear it for a week. It works about 90–95 percent of the time. But in the 5 to 10 percent of people that it does not respond to, you just remove it. They don’t have the full implant.”

Jennings and his colleagues have placed over 250 bladder pacemakers in the last several years.

“Last year, depending on how you look at the dates, we were either number one or number two in the state for these implants,” Jennings said. “Now we are the third center of excellence in the state of Alabama and the eighth one in the Southeast.”

Jennings said the “wide range of ages” spanned by his associates is one of the practice’s strengths.

“You have people who trained initially on the robot; that’s all they’ve ever known, done a ton of them, like my age and Dr. Hopkins’ age,” he said. “And then you have people who have done it both ways and learned the robot later in life but have done so many of the more traditional surgeries in the past, too, so it’s kind of a mixed experience.”

Jennings trained in robotic surgery during his residency at the University of Tennessee in Knoxville, and he noted that it has quickly become the industry standard.

“Robotic surgery is another thing that I think a lot of people don’t realize is in a town the size of Gadsden — and luckily soon to be in Guntersville also,” Jennings said. “People assume you have to go to a big city for that, but that’s the way all surgery is moving.”

The blend of experience and expertise each clinician brings to the table at Clinical Urology Associates works in their favor particularly because each robotic surgery is conducted by a pair of physicians: one at the bedside and one on the controls.

“We value that ability to operate together and ensure everything is going to go well,” Jennings said. “That’s where I think having the team approach is helpful. I kind of grew up doing this from the very beginning, but then Dr. Shah, Dr. Pirani, they remember seeing it a different way.”

The pacemaker procedure is just one part of a large scope of care offered by urologic surgeons.

“It’s a range, for sure,” Jennings said. “We do all the surgeries for prostate cancer, kidney cancer, bladder cancer, testicular cancer and then any surgery involving the male reproductive organs for prostate issues and the urinary tract for both men and women, so kidney stones, incontinence, things like that. We do, obviously, vasectomies and then (address) male infertility.”

While some prospective patients assume that urology only addresses the male anatomy, Jennings assured that men and women alike can and should seek care from a local urologist.

“A lot of people assume that we’re like a GYN who never sees a male patient, (that) we never see a female patient,” he said. “We have a lot of female patients. I always tell people, ‘Women have kidneys and bladders also.’ And the majority, I would say 90 percent, of the pacemaker patients are women.”

According to Jennings, the female anatomy tends more toward bladder incontinence with age, often exacerbated by childbirth.

“Men typically have more trouble urinating with age as women urinate too much, and it just has to do with anatomy,” Jennings said.

The male urethra is longer, which, along with the presence of the prostate, can cause difficulty urinating with age. Meanwhile the female urethra is shorter, leading to the opposite problem.

“Recurrent UTIs are a big thing,” he said. “Working through a plan for them to try to prevent that is important because they’re so common. Some women suffer from it a lot, especially around pregnancy and things like that, different parts of their lives. It’s just a shorter pathway for the bacteria to get in the bladder. And with age, women tend to leak urine — not always, there’s definitely some overlap — but women tend to leak urine where men have trouble going.”

According to Jennings, about 90 percent of his bladder pacemaker patients are women.

“Something I’ve found that has been a little bit surprising to me since I have moved here — since it’s a smaller town — is so many women say, ‘Oh, well that’s just part of aging.’ And it doesn’t have to be. A lot of people are thinking that there’s nothing that can be done or that there’s these big surgeries you have to have, which is not necessarily the case anymore. It can definitely be corrected, and a lot of people have better quality of life (afterwards).”

Jennings added that the pacemaker surgery can be performed in about 20 minutes, offered locally at Gadsden Regional, Riverview Regional and Marshall North and South.

Clinical Urology Associates prides itself on providing localized care to the small cities and surrounding rural areas of Etowah, St. Clair, DeKalb and Marshall counties.

“We can provide comprehensive urologic care here, close to home,” Jennings said.

According to Jennings, each partner in the practice prefers rural healthcare to city settings.

“I would just say that all of us are here because we want to be,” he said. “We all trained at very well-known places, and we chose to be in an area like this. We have a great physician relationship. When my wife or my kids have surgery, it’s here or in Marshall County. You definitely get more personalized, one-on-one attention.

“You’re saving people from having to drive a couple hours and allowing them to be close to their family. In a lot of cases, actually, it’s gotten to the point where we’re offering procedures that aren’t even available in some of the bigger cities, because we’ve kind of kept young partners coming in and things like that.”

The practice’s newest partner, Dr. Marilyn Hopkins, MD, is according to Jennings currently the only female urologist in North Alabama.

“Urology is a small world,” he said. “Urology is one of the most difficult specialties to get out of medical school, because it’s very sub-specialized surgery. People don’t realize that. I would also highlight Dr. Hopkins; she’s the only female urologist north of Birmingham in the entire state.”

Dr. John Pirani, MD, FACS, of Clinical Urology Associates is heavily invested in the community. Pirani is a cofounder with Marketing Director Teresa Taylor of Man Up Gadsden, a nonprofit that encourages awareness and prevention of prostate and testicular cancer.

Jennings, meanwhile, is heading up the practice’s expansion to the Albertville and Guntersville area.

“I love doing the actual pacemaker surgery because it helps people almost immediately,” Jennings said. “The cancer surgeries, too. And just having relationships with people, seeing patients that I’ve seen for a long time. A lot of times, we’re seeing them, diagnosing them, operating on them, taking care of them afterwards. It’s a full range of care.”

Jennings said his workflow is “close to 50/50” between clinic consultations and the operating room.

“Any type of urinary dysfunction, whether it’s men having trouble urinating or leaking urine, women having trouble, we’re going to do that type of surgery,” he said. “We’re going to help prevent and treat all types of kidney stones. And then also the male infertility, we can usually get a good head start on treating that and solve a lot of issues.”

The men’s clinic at the practice is prepared to treat a myriad of urologic, nephrological and andrological complaints.

“Testosterone replacement, erectile dysfunction and things like that (we offer in our offices), and I would just mention that we’re usually able to get it approved through insurance,” Jennings said. “I know a lot of people are driving to Huntsville and Birmingham for that.”

Jennings enjoys being able to offer healthcare solutions and impact patients’ quality of life. One such procedure is robotic prostatectomy.

“Prostate cancer is the most common cancer in men,” Jennings said. “There is a slow-growing type, and a lot of times you can watch prostate cancer. But there’s also a very aggressive type, and it’s still the second-leading cancer death in men. The main treatment, especially when it’s diagnosed younger, is surgery to remove the prostate, and the robot has made a world of difference on that.

“It has greatly reduced the side effects as far as urinary incontinence, erectile dysfunction, blood loss, hospital stay, things like that. It pretty much takes away any type of flaw any surgeon’s going to have. This is going to allow you to reach in places that a hand can’t reach, to see things that an eye can’t see and to take any type of tremor or flawed movement away. No matter how talented somebody is, there’s always going to be a little bit of human error, and this robot greatly reduces that.

“Because of the way it’s performed, blood loss is much less compared to the old-fashioned open surgery. This is the way about 95 percent of (prostatectomies) are performed in the country.”

Man Up Gadsden educates young men in local high schools on prostate and testicular cancer and provides screenings. As one of the organization’s slogans reads, “Early detection is key.”

“The Man Up Gadsden organization was founded for the education, prevention and treatment of illnesses afflicting men,” the website reads. “We aid in prevention and early detection. We will help you understand your diagnosis and the many options available to you. We can help you find a doctor, tell you how to prepare for chemotherapy, how to deal with the side effects of chemotherapy and how to stay healthy after treatment ends.”

Jennings gave insight into prevention of disorders like kidney stones, which are “rampant” in the Southeast United States.

According to Jennings, the prevalence of kidney stones has to do with diet, but it is also heavily correlated with humidity.

“People don’t realize how humid it is,” he said. “We have to drink a lot more water than people in, like, the Pacific Northwest. People in Colorado, Oregon, Washington State, they don’t make kidney stones like we make kidney stones. It’s called the ‘stone belt,’ from Louisiana, Mississippi, Alabama, Georgia, Tennessee.

“We don’t have the healthiest diets. And the other thing is (that) for five months out of the year, it’s like a sauna outside, and we are losing a lot of (water). Kidney stones, preventing them is all about hydration, and so when we’re dehydrated so much from living in this humidity, the kidney stone rate is much higher.”

Jennings said that many people — in the South and otherwise — underestimate the importance of staying hydrated.

“As a society, we’ve gotten to where we don’t want to take the time to go to the bathroom,” he said. “So it’s like, ‘I’m going to dehydrate myself so I don’t have to go to the bathroom.’ We’re not made to do that.”

According to Jennings, prevention of kidney and urinary tract disease is far more effective than retroactive treatment, and drinking water is a key component of that.

“It’s a lot easier to prevent and to correct things early than waiting until things have become a disaster,” Jennings said. “I think in the South we’re pretty bad about that. We don’t want to go to the doctor at certain times. A little bit of prevention can go a long way.”

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