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Additional Info

• Segment Number 4
• Audio File slu_care/1430sc1d.mp3
• Doctors Siddiqui, Sameer
• Featured Speaker Sameer Siddiqui, M.D.
• Guest Bio Dr. Sameer Siddiqui treats all aspects of urology, including stone disease, incontinence, laser surgery for enlarged prostate, erectile dysfunction, blood in the urine, and elevated PSA. His fields of expertise are prostate cancer, kidney cancer, and kidney reconstruction, subjects in which he has published extensively. Dr. Siddiqui is fellowship trained in robotic surgery, having completed over 400 robotic cases.
  
  Dr. Siddiqui is assistant professor and division chief in the Department of Surgery, Division of Urologic Surgery, at Saint Louis University School of Medicine. He is a member of the American Urologic Association and the American Medical Association.
• Transcription Melanie Cole (Host): SLUCare urological surgeons specializing in diagnosing and treating common, rare and complex urological diseases. The SLUCare urological surgeons are also known for their expert diagnosis and patient care. Today, we have with us Dr. Sameer Siddiqui. He’s an assistant professor and division chief in the Department of Surgery in the Division of Urological Surgery at Saint Louis University School of Medicine. Welcome to the show, Dr. Siddiqui. Tell us what conditions you treat that you mainly see there at SLUCare.
  
  Dr. Sameer Siddiqui (Guest): Most of my practice is in the cancer realm for urology, so I take care of patients mostly with prostate cancer, bladder cancer, kidney cancer and then other rare forms of cancer that are related to the urinary tract. That is predominantly what my practice is right now.
  
  Melanie: Tell us a little bit about your department and your team and your services. If somebody suspects that they have prostate cancer or bladder problems and they come to see you, what can they expect?
  
  Dr. Siddiqui: So, before they come to see us, we usually have some sense of maybe they’re coming from an outside physician with the diagnosis already, so we can plan for that. A lot of times they come in with symptoms that may be suggestive of cancer; for example, if they have blood in their urine, they’re sent to a urologist, and myself or somebody in my team members will perform a procedure, such as a cystoscopy, and that’s where we place a camera inside the bladder and look for cancer. We also do imaging such as CAT Scans and MRIs to look for cancer in the kidneys as well. That’s typically the kind of workup that takes place to look for cancers of the urinary tract.
  
  Melanie: Are we still using PSA as the gold standard to look at the prostate and prostate cancer risk?
  
  Dr. Siddiqui: Unfortunately, yes. We are still using PSA, and I say ‘unfortunately’ as sort of tongue in cheek. PSA has been played a tremendous role in reducing the mortality of prostate cancer over the past couple of decades. Unfortunately, it’s not a very specific test, meaning a lot of times it can be elevated for reasons not related to prostate cancer and we will subject this men to biopsies and a lot of times, those biopsies come back negative. So, today in 2014, it’s still the best test that we have for prostate cancer, but I think in the next two to three years, we’re going to start to see newer, more refined options to test prostate cancer compared to PSA.
  
  Melanie: Tell us a little bit about your department and your team. How do they help you treat these patients just really successfully?
  
  Dr. Siddiqui: The biggest thing that we’ve done in our department is that we’ve split up our specialties; not only are we urology specialists but we have subspecialties within our division. So my specialty is focused mostly on the cancer patients as well as the patients who require minimally invasive surgery. We also have a surgeon who specializes in stone disease, so patients who have kidney stones, complex stone disease, that’s his realm. We have another surgeon who takes care of patients who have erectile dysfunction. Erectile dysfunctions are common medical diagnosis and her specialty deals with men who come in with this difficulty. We have oral treatment, we have injection treatments, and she even does the surgery called the penile implant for these men. We also have a specialist in pediatric urology. The pediatric urologic disease is very different than what we see in adults, and so they’re subspecialty trained to deal with those. So, the big way we’ve tried to make our division responsive to the needs of the community and be state-of-the-art is to make sure that we have people within the division who are focused on a handful of disease states.
  
  Melanie: How do you use robotic surgery to treat prostate cancer, kidney cancer, urological cancers?
  
  Dr. Siddiqui: The robot, the da Vinci Robot’s been around for over a decade now and it allows us to do surgery with small keyhole versus a big incision. What this means for the patient is they can have a shorter recovery time, they have less pain after surgery, and typically they have less blood loss and a lower transfusion rate. So, from a cancer standpoint, we’re doing things that are fairly similar to what we were doing 10, 20, 30 years ago; the advantage is we’re doing them in a way that makes the recovery faster and the pain less.
  
  Melanie: What can people expect when you say it makes the recovery faster and the pain less after the fact? Is this a quicker recovery because men suffering from prostate cancer worry so much, Dr. Siddiqui, about whether or not they’re going to be able to have sexual intercourse again, they worry about whether they’re going to have urinary issues afterward? Tell us a little bit about that recovery.
  
  Dr. Siddiqui: Sure, that’s a great question. Today in 2014 with the robotic surgery, urinary control is not a long-term issue anymore. It may have been 20, 30 years ago with the old-fashioned technique, but now, with this technique, most men are dry or having minimal leakage by the time they’re six weeks to three months after surgery, so I counsel my patients that this is a short-term issue. They need to have some pads on board; just in case that they cough or sneeze, they may leak a little urine. But long term, this is not an issue that affects quality of life. The long-term quality of life issue with men who are treated for prostate cancer, regardless of their treatment, is erectile dysfunction. I tell my men that if they are young, if they’re healthy, and they don’t smoke, then they’ve got a pretty good chance of having a recovery of their erectile function within a few months after surgery. The big risk factors for erectile dysfunction after surgery are your age, whether you’re a smoker and whether you’re a diabetic and what your sexual function was prior to treatment.
  
  Melanie: What about kidney cancer? You know, you really, you do all these cancers and you specialize in these, Dr. Siddiqui, and so kidney cancer is not one that we hear that much about. We hear about prostate cancer. What about kidney cancer? What might be a symptom that would send someone to see you in the first place?
  
  Dr. Siddiqui: The symptom that will send me a patient with kidney cancer is typically blood in the urine, so patient is going about their business and suddenly, they look in the toilet bowl and they see blood in the urine. That could be a sign of kidney cancer, and if that occurs, that patient needs to go to their primary care physician or seek out a urologist to be evaluated. The thing about kidney cancer is it’s not as common a cancer as prostate cancer. It’s anywhere from the 8th to the 10th most common cancer in men and women. However, the danger with kidney cancer is about a third of these patients present with disease outside of the kidney, meaning it is already metastatic in the third of these patients, which is a lot of patients, and so the risk of dying from kidney cancer can be greater than compared to prostate cancer.
  
  Melanie: So, blood in the urine would be something they would notice but that might already be, you know, when it’s already developed. Is there anything that would send them earlier, any kind of symptoms, and even give us a little bit of prevention if that’s possible?
  
  Dr. Siddiqui: Great question. If they are seeing a doctor on a regular basis and that doctor notices that there’s blood in the urine microscopically, then oftentimes that patient may warrant an evaluation by a urologist because if it’s found before the patient sees it but the doctor sees it, we may be able to catch the timber before it spreads to other parts of the body. Sometimes, they’ll have back pain or flank pain, where the kidney sits; that maybe a sign of a kidney tumor. Unfortunately, a lot of times these small tumors are found accidentally when they are getting a CAT scan or an MRI for some other reason. In fact, about 50% of the patients I see right now with kidney masses are sent to me because they were getting a CAT scan or an MRI done for a different reason, so they just happened to get it found, just because of luck.
  
  Melanie: Well, that is so interesting. In just the last minute and a half or so, Dr. Siddiqui, tell patients why they should come to you at SLUCare for their urologic care.
  
  Dr. Siddiqui: What I tell patients here is we are a hands-on facility. In other words, we spend time with the patients, we sit down with the patients; we are a teaching facility but we do make sure that we really sit down and give the patient as much information as they can to help to make a decision about how they want their disease treated. The main thing I tell them is it’s a hands-on approach and it’s a subspecialty approach. We have people who are specialized. If somebody comes to me with erectile dysfunction, I’ll do the initial work up but I’ll say, “Look, I’m going to send you to the expert in erectile dysfunction,” and then I forward that person onto one of my partners. If I have somebody comes over with a kidney stone, I’ll say, “You know, what? I’m going to get the workup started for you, but then I’m going to send you to the expert who really takes care of this on a regular basis, because that’s where you’re going to get the best care.”
  
  Melanie: Thank you so much, Dr. Sameer Siddiqui. You’re listening to For Your Health with the physicians of Saint Louis University, SLUCare Physician Group. SLUCare is the academic medical practice of Saint Louis University School of Medicine. For more information, you can go to slucare.edu. That’s slucare.edu. Thanks so much for listening. This is Melanie Cole. Have a great day.
• Hosts Melanie Cole, MS