Scott Webb (Host): Today, we're discussing new innovations in urology with Dr. Jay Bishoff. He's a board-certified urologist with Eisenhower Health and he's here today to tell us about the common conditions that he treats and how he's using the da Vinci robot to perform many same-day surgeries that used to require hospital stays.

 This is Living Well with Eisenhower Health. I'm Scott Webb. Doctor, it's so nice to have your time today. I'm going to find out what you do and how you do it. And we're going to talk about the da Vinci robot and a whole bunch of good stuff today. But just as we get rolling here for listeners, just a foundational question, tell us a little bit about the specialty of urology and the subspecialty of endo urology.

Dr. Jay Bishoff: So, urology involves pretty much anything that deals with the urinary system and even more. So, urology handles the adrenal gland, the kidneys, the ureters, bladders, prostates, testicles, penis. We joke in urology that we are the common male denominator and what we mean by that is no man is going to get through his natural lifespan without seeing a urologist for something. So, we handle all of the enlarging prostate issues, prostate cancer, erectile dysfunction, low testosterone issues. We also handle infertility issues for younger couples. And in women, we also handle bladder incontinence, which is a commonly treated problem as patients get older. In terms of cancer, urology also involves cancer treatment for all of the urologic organs, which again, starting at the top, is the adrenal gland, kidney, bladder, prostate, testicle, and penis. We handle all of those cancers.

So, endourology is a really exciting subspecialty of urology. It requires additional training after residency. And that fellowship training is called the endourology fellowship. Basically, what endourologists do is try to find the least invasive means possible to treat all urologic conditions. So, endourology involves minimally invasive treatment of all of the cancers, urinary incontinence, as well as kidney stones, including complex kidney stones. All of that falls within the realm of endourology.

Host: Yeah. So, it's obviously a long list and comprehensive. And so, what are some of the signs and symptoms? What are the greatest hits, if you will, in terms of like when someone should see a urologist?

Dr. Jay Bishoff: So, people should come and see the urologist when they're having problems with the bladder, whether it's men or women with incontinence or difficulty urinating, really common complaints that we get. People should come and see a urologist when they're having screening for prostate cancer or when they find out that they have a mass in the kidney, a mass in the adrenal gland, elevated PSA, that's a prostate-specific antigen screening test for prostate cancer, when patients are having problems with erections, when patients are having low testosterone.

Another reason to come and see your urologist is when the pain of a kidney stone sets in. Urologists are very expert in not only treating kidney stones with surgical treatments and non surgical treatments, as well as prevention of kidney stones. So, those are some of the common conditions that you would come and see one of us to treat.

Host: Sure. Yeah. And I want to stay with prostate cancer. I'm 55, so I've been screened with PSA and all of that, but I wanted to have you sort of emphasize the importance of prostate cancer screening and also with the PSA. Why is it so important?

Dr. Jay Bishoff: Prostate cancer remains the number two cause of cancer deaths in men. And so because of that, it still remains a significant public health problem. And so, how do we go about screening for that? Really, it's, first of all, awareness. And second, it's a very simple blood test. And that's called the PSA, or prostate specific antigen test. And it's really important for men, starting at the age of 50, to about the age of 75 to 80, to get that test on an annual basis. So, a patient like you, you may have been screened for prostate cancer, and your numbers are all normal. But that doesn't mean prostate cancer isn't going to sneak into your prostate five or six years from the time you had your initial screening. So, we recommend annual screening for men. All men, and we recommend annual screening, especially for men who are at high risk for prostate cancer, and that would be men who have a strong family history of prostate cancer.

Host: Yeah, absolutely. And that checks out. I'm 55. So, many of the things you're talking about today, doctor. I have been, you know, seen for, screened for, all that good stuff. And we certainly hope that folks see their providers, get screened, get tested, all that good stuff. What are the most common ailments, both for men and women? What's at the top of the list each of us?

Dr. Jay Bishoff: So for men, common ailments as we get older is difficulty urinating. So, the prostate continues to enlarge. As you get older, everything seems to get smaller, at least that's what my older patients tell me. But the prostate never sleeps and the prostate never gets smaller. It just continues to get large and that's a benign condition called benign prostatic hyperplasia.

It also can cause the cancerous condition, but it enlarges and that causes getting up at night to urinate, a weak and dribbly stream, difficulty urinating, difficulty going long periods of time. And when that's happening, you need to come and see the urologist. We first treat those conditions, the benign conditions of the prostate, with medication. And many medications will help give immediate relief of the symptoms. And then if patients fail medication, we have minimally invasive treatments to help with that.

Now, in terms of women with incontinence, should come and see their urologist. No one should be leaking urine today, no men and no women, because we have so many different treatment options and many of those treatment options do not involve a surgical procedure. We have so many things we can do that nobody should be out there being incontinent today. We can help all of those. So, those are the really common conditions, men and women. But then of course, kidney stones, that's the ultimate non discriminator. It doesn't discriminate between race, religion, age, or sex. All urologists see a very large number of patients who are suffering from kidney stones.

Host: Yeah. And having had kidney stones, I don't wish them on my worst enemy. So, it is so good that there are experts and help available. I want to get in now and talk about robots. I always want to talk about robots, but especially when I talk with someone like yourself who uses, in this case, the da Vinci robot on a regular basis. So, tell us about the surgery, procedures, the robot, all that good stuff.

Dr. Jay Bishoff: So, there are very exciting advances in surgical care of urologic diseases today. So, the robot came out around 2000, somewhere around there, the first generation of the robot came out. And it's a little bit of a misnomer, because the robot actually does not do the procedure. It's more of what we would really technically call an effector arm, which means that the robot only translates my movements into the instrument's movements. So, we don't hook you up to the robot, turn it on, and then watch to see what the robot does. The robot only does what we tell it to do by moving our fingers and our hands and our arms. So, that's the first thing. So, some of our patients who've come to see me have been concerned. They say, "Hey, look, I don't want some autonomous mechanical device doing my surgery," but that's not what it is.

So, what this "robot", the da Vinci robot, allowed us to do instead of making large incisions, it allows us to put five small holes on the abdomen, put the robotic instruments and an assistant port in and then do the surgery, prostate surgery, kidney surgery, adrenal surgery, bladder surgery. It allowed us to do all of that with these small holes. And so, essentially, what the robot did is it put the wrist movement of a human wrist on the end of an instrument that was eight millimeters in size, less than a centimeter in size. So, we used to have to put physically put our wrists inside of you to do surgery. They put the human wrist on a very skinny, small instrument that we could insert and do that.

So, the multiport robot has been around in different iterations for many years. But about six years ago, a new robot platform came out, and that's called the single-port platform. So, I mentioned that the older platform requires five holes to do the operation, and the new platform only has one hole that's 2.6 centimeters, about 2.5 inches in length. And all of those robot instruments go through that tiny hole. And so, the robot instruments go in through this tiny hole, and we can do everything that we can do with the multiport robot. Those instruments then fold up, they come out, we close that 2.5-centimeter incision. And the exciting thing for our patients about this is that most of our patients who have a urologic procedure done with the single-port robot go home the same day of surgery.

Host: It's amazing. You know, one incision, same-day surgery. And as you emphasize there, you know, the robots help you to do the surgeries. They're sort of your arms inside, the hands inside, but the surgeons are performing the surgeries. We always want to make that clear. Many of us have seen too many movies, Star Wars and otherwise, but it's an instrument that you use and it helps you to do these surgeries. And the single port is just kind of mind-blowing. Wondering if we're getting to the point, doctor, where robotic surgery is not only preferred, but it's really becoming the sort of gold standard or replacement, if you will, for the standard open surgeries.

Dr. Jay Bishoff: You know, it really has. In urology, the robot has really replaced most open surgical procedures. The multi-port robot accounts for at least 90% of all prostates removed in the United States. So, 90 out of 100 men in the United States today are going to have their prostate removed, have that removed robotically.

What's exciting about the single port robot system is it allows us to do robotic surgery on patients who've had extensive abdominal surgery in the past. And those patients may have had significant bowel surgery, infections, bowel perforations, traumatic injuries to the abdomen. Traditionally, that would have made it very difficult or even impossible to do robotic surgery. With a single port, for urology single-port procedures, we can actually stay out of the abdomen. So, patients who've had a lot of abdominal surgeries are still candidates now for prostate and other urologic procedures because we don't have to go into the hostile abdomen to do that operation. It's been a godsend for some of our patients who've had a lot of abdominal surgery and problems in the past. It really has opened up windows of opportunity that they just never would have experienced before this single-port robot came to be.

Host: It's all just so encouraging. This is one of those podcasts where I'm just shaking my head saying, you know, "Yes, that's amazing. Tell me more. Do more." I mean, along those lines, are there some instances, doctor, where you just can't do urological surgery robotically?

Dr. Jay Bishoff: You know, so far with the single-port, I have not found a patient who is not a candidate for urologic surgery. With the multi-port, yes. The prior abdominal surgical history sometimes excluded patients. With the single-port so far, which I've been doing for the last four and a half years, I have not found a patient who we couldn't use that robot platform in to help them with a major surgical problem using the least invasive techniques possible today.

Host: That's just so cool. I just want to finish up here, give you a chance to talk about other cool stuff, other innovations in urology that you think the audience should know.

Dr. Jay Bishoff: There are really exciting innovations coming out, especially in the area of incontinence for women. A lot of different things are being done out there very minimally invasive. And for men with the prostate issues, we have different mechanisms where we can actually tack the prostate inside open, so we can use a tacking device to open that up. We have lasers we can use on the prostate. We have a high-heat steam therapy to vaporize tissue on the inside. So, men should not be concerned about having significant difficulty urinating today. They have heard horror stories of their grandfathers or fathers who had problems, and they just kind of put up with the symptoms. And today, we have so many different minimally invasive options. And that's after we've exhausted all of our medical treatments for those conditions.

So, that's what we're doing. It is exciting. It continues to evolve, which is why as urologists we never get tired of what we do. We love what we do because when patients come in to see us, we help them. It's very rare that a patient comes in who cannot be helped by their urologist.

Host: That's perfect. Exciting is really the perfect word. And so many folks suffer, as you say, because of what grandpa went through or grandma went through. And, you know, so much has changed and evolved. And the single-port da Vinci is just amazing, it's mind-blowing stuff, and some of these other innovations as well. So, just don't want folks to suffer, reach out to their providers, see a urologist, an endourologist, and know that help is available. So, thank you so much for your time today. You stay well.

Dr. Jay Bishoff: Thank you. Thanks for taking time to visit about this really important subject.

Host: And for more information, go to eisenhowerhealth.org/urology. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for additional topics of interest. I'm Scott Webb, and this has been Living Well with Eisenhower Health. Thanks for listening.