MSU Health Care Urology Clinic an Innovative and Collaborative Home to Urologic Care and Research
The MSU Health Care Urology Clinic exists to cure or reduce suffering from urologic disease and disability within an innovative and collaborative setting of urologic care and research. On this edition of MSU Today, urology is the topic. Our guests are two DOs from the clinic, Todd Moyerbrailean and Arya Khatiwoda.
“Urology is a subspecialty,” says Khatiwoda. “It's a surgical subspecialty that focuses on the genital urinary systems and disorders of the genital urinary system. It’s essentially how you pee, how your kidneys work, your bladder, prostate in men, and some urethra and vaginal disorders in women.”
“My subspecialty is gynecology, and it's a blend of both urology and gynecology,” says Moyerbrailean. “Matter of fact, that's where it got its start. The two boards got together to make a discipline that just focuses on female pelvic floor disorders. In addition to problems with the bladder and the urethra, we also deal mostly with pelvic floor issues like prolapse, uterine prolapse, and bladder prolapse.”
“I'm a general adult urologist,” Khatiwoda says. “I see men and women and practice general urology. Kidney stones are a big part of it. Urinary disorders or what we call voiding dysfunction are a part of it. Incontinence in women or leakage of urine is a big part of it.
“When most people hear about urology, they usually think of men's health and men's issues. It's very nice to have someone who's female focused like Dr. Moyerbrailean. It brings a certain element to our practice that you don't always think about when you hear the word urology. In terms of practice philosophy, it's about providing something to the community that many may not even realize is available. Urology is a personal subspecialty. You're dealing with a lot of things that people aren’t always very forthcoming about. At MSU Urology, we're here to provide excellent care to the community and provide urologic care that's at the top of the technological forefront. For me personally, it's about building relationships with people and helping them open up about something that's quite personal that they may be embarrassed to talk about otherwise.”
What symptoms would someone experience that would lead them to seek out a urologist?
“In general, we see men and women who have urinary issues,” says Khatiwoda. “Are you peeing too much? Are you not peeing enough? Are you leaking when you shouldn't be? Are you not able to empty when you should be? And we see anyone who sees blood in the urine, anyone with a history of kidney stones, and anyone who has infections more frequently than they should. And there are things that they may not be aware of that their primary doctor would figure out, like is there a growth somewhere in one of the genital urinary organs, the kidneys, the bladder, the penis, or the urethra?”
“I don't treat men,” Moyerbrailean says. “My training was based in obstetrics and gynecology and branched out into urogynecology. But we also do similar treatments with women, especially women with overactive bladder. That's probably one of the biggest things we see and one of the areas that women tend not to want to come in to see the doctor about or are embarrassed to talk about. But it is so common. Up to 80 percent of women by the age 80 have an overactive bladder. They just feel like they have to go all the time. And a lot of times their friends are telling them that there's just nothing they can do about it. That's wrong. There are plenty of things that can be done that can actually help alleviate some of those symptoms. Where I differ from my urologic counterparts is I deal a lot more with pelvic floor problems, mostly the prolapse issues.
“Some would say it's a result of childbirth. And most women are afraid to come in and have that treated figuring that surgery is the only thing that can be done when that's not accurate either. That's one of the big myths in this field, and there are things you could do that actually help alleviate those symptoms.”
Say more about how you treat urologic disease.
“Urology is unique in that while it's a surgical subspecialty, we actually do a lot of nonsurgical treatments,” continues Khatiwoda. “For most of the benign disorders - so obviously not cancer, but non-cancerous disorders - the first step is very basic and it's usually behavioral therapy. There are medications and then typically the last step tends to be surgery. There are surgical treatments for almost every disorder that a patient might come to see us for. We tend to start very basic and then move up from there.”
“Sometimes people think all we want to do is perform surgery,” Moyerbrailean adds. “The majority of the time we're not doing surgery; we're actually treating the person first and finding out what exactly they need. What are their goals? We figure that out at the very first visit. Where are they in their care and what do they want? We give them the options and let them choose.”
Are there particular challenges in treating urologic diseases? And is there research or new treatments on the horizon you’re excited about?
“Sometimes patients come to us with an expectation that we can't always meet,” Khatiwoda continues. “Let's say you have someone who has had a problem for 20 years and they finally can come and see a urologist. We do get some patients who expect immediate and 100 percent change. It's almost impossible to take a problem that's been there for 20 years and fix it in 20 minutes. But the nice thing is, you don't have to see a urologist once in your life.
“It's usually a lifelong relationship with your urologist. And there really is a certain trial and error that comes with a lot of the benign urology issues where you try something and if it doesn't work, then we reevaluate you in the clinic and then we try something else and ultimately look for a goal that improves your quality of life. You may never be how you were when you were 18 or 20, but we can certainly get you to a point where you're more comfortable and you're happier with your symptoms than you were when you came in.”
“We treat on a bother-most system where we go after what bothers you the most and try to help you in that respect,” continues Moyerbrailean. “Some things we can't cure. We are trying, and there’s always new research coming out. We're always talking about new things. But that's really where our challenge is. Some of our disorders are not curable, but they are certainly treatable. And we've got a lot of treatments to offer.”
“I feel like there's always something new,” Khatiwoda says. “We really are living in an exciting time of medicine where there is always something new. And from a general urology standpoint, the way we look for cancers, especially prostate cancer in men, has really changed the game. First, it used to just be a doctor felt your prostate and if there was something abnormal, they did a biopsy. Then it was the PSA lab test. Now we're at a point where we can do MRIs of the prostate and really pinpoint specific areas that need to be biopsied. Even since I graduated residency in 2018, there has been a huge shift in how we look at men and men's health and prostate cancer. So, yes, it seems like there's always something new every day. And it's a very exciting time to be a urologist.”
“Again, my specific focus is pelvic floor disorder,” says Moyerbrailean. “It's basically weakened tissue in the female pelvis. There's a lot of work being done now in stem cell research trying to figure out ways to improve the tissue quality. If we could improve tissue, then we would have a better chance at successfully fixing it or maybe preventing it all together.”
Is urologic disease hereditary, environmental, or a combination? Can we avoid some or all of it with a healthier life?
“It’s definitely a combination,” says Khatiwoda. “There are some things that genetics can be blamed for. Kidney stones are one of those. But at the same time, if you have a genetic predilection but you also don't drink any water, your risk is way higher than if you're someone who is well hydrated. Genetics are big. So are your environmental factors and the decisions you make about your health.”
“We go back and forth about that in the research world as far as the pelvic floor and whether or not that's something that's hereditary or not,” says Moyerbrailean. “We're still looking for answers in that respect. Smoking and occupations that are very strenuous are much more likely to lead to disorders. You can make a difference by changing your health and lifestyles.”
Are there some facts about urology you'd like to reinforce or some myths you often hear that you'd like to dispel?
“I have one that really gets my goat,” continues Khatiwoda. “It comes from anyone who has had a kidney stone and passed it on their own without seeing a urologist. They always come in and they say, ‘I have not had any calcium. I don't drink any milk. I gave up all dairy.’ That is not a good thing to do. It's typically not calcium that's the problem. It's other things in your diet. I mentioned a lack of hydration. It's usually not drinking enough water or other food issues.
“There are things called oxalates that are found in a variety of foods, even in foods we think are healthy, that can contribute to stone formation. The first thing I tell my patients, especially post-menopausal women who seem to get stones, is to make sure they get the amount of calcium that they need to get. That means the normal dietary recommendation because otherwise you're going to start having trouble with osteoporosis, and it’s probably not going to make your stone risk any better. That is something that I think people don't have a great understanding of because they think stones are made of calcium. They decide to cut out all calcium. But that's usually not what you need to do to make your situation better.”
“I think the biggest myth in my field is that surgery is the only possible option, and that's not true,” says Moyerbrailean. “As a matter of fact, we probably do nonsurgical therapy for eight out of every nine patients who come to us with some type of a pelvic floor disorder to give them adequate relief. One in five women actually in their lifetime will end up having surgery or some type of a treatment for either urinary incontinence or prolapse of some sort.”
“If you're concerned about a problem with your bladder or you've got a problem with your bowels, seek out your family doctor and talk to them. If they're not comfortable taking care of you, MSU Urology is here. We can definitely take them on and that's what we do. We do it day in and day out. It's pretty straightforward for us and we do everything we can to make our patients comfortable.”