Jay Simhan1, Jin Ye Yeo2
1Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA; 2TAU Editorial Office, AME Publishing Company
Correspondence to: Jin Ye Yeo. TAU Editorial Office, AME Publishing Company. Email: tau@amepc.org
Expert Introduction
Dr. Jay Simhan (Figure 1) is a Professor of Urology and Director of Reconstructive Urology at Temple Health and the Fox Chase Cancer Center. Additionally, he serves as Fellowship Director of the Society of GURS verified Male Reconstruction and Prosthetic Urology Program at Fox Chase. He is an active and contributing member of the American Urologic Association, American College of Surgeons, Society of Genitourinary Reconstructive Surgeons, Société Internationale d’Urologie, Society of Urologic Prosthetic Surgeons, and the Sexual Medicine Society of North America.
Dr. Simhan’s clinical practice is dedicated to urethral stricture disease, open and robotic urinary tract reconstruction, penile implant surgery, male anti-incontinence surgery, revision male prosthetic surgery, Peyronie’s disease, and complications from urologic cancer treatment. He has lectured internationally on a variety of topics in urologic reconstruction, trauma, and prosthetics and is an invited international proctor for training programs in prosthetic urology. He has published chapters in many leading textbooks, including the definitive chapter on lower urinary tract trauma in the gold-standard textbook, Campbell-Walsh-Wein Urology. Dr. Simhan has co-authored over 250 peer-reviewed publications, abstracts, and book chapters in leading journals including the Journal of Urology, Urology, European Urology, and the Journal of Sexual Medicine.
Figure 1 Dr. Jay Simhan
Interview
TAU: Could you provide an overview of the current landscape of publications in reconstructive urology?
Dr. Simhan: Reconstructive urology is an exciting field right now, mostly because the field itself is rapidly evolving. Over ten years ago, reconstructive urology centered around only urethral reconstruction. Even now, urethroplasty continues to be synonymous with reconstructive urology. However, the field has expanded to also cover prosthetic urology and general reconstruction including gender-affirming surgery. A newer avenue in reconstructive urology that is also highlighted through many efforts is the performance of abdominal reconstruction with a focus on ureteral work. Ureteral reconstructive cases can now be done either through conventional open surgery or via emerging technologies in robotics, which I think is one of the bright new sub-fields of the reconstructive urology space.
TAU: In your practice of prosthetic urology, you primarily treat patients with erectile dysfunction who have not responded to conventional medical therapy. Could you elaborate on your treatment approach and highlight its distinctions from conventional medical methods?
Dr. Simhan: I am very fortunate to have been able to develop a referral center here for patients who have complex erectile dysfunction that is refractory to conventional medical therapies. My treatment approach focuses on patient goals. Patients should be able to be treated to optimize quality-of-life deterring conditions based on tailored goals for treatment. As it relates to erectile dysfunction, I most often have noted that patients desire being able to return a level of intimacy. In the initial visit, our team aims to understand some of the frustrations of other medical therapies. In Philadelphia, we've nurtured a comprehensive care center renowned for assisting individuals who find themselves at the limits of medical therapy for erectile dysfunction. While our reputation often precedes us for surgical prowess, specifically in the adept implantation of various penile prostheses, we are equally committed to mastering medical treatments. Our approach is holistic: we listen, we evaluate, and we persist with non-surgical options when there's a clear path through the frustration. We do it all with a patient-centered ethos, and our center is acclaimed for this all-encompassing expertise.
TAU: How have recent advancements in surgical techniques impacted your practice of reconstructive surgery? Could you share any examples or case studies where these innovations improved the quality of life of your patients?
Dr. Simhan: Certainly, recent advancements in surgical techniques have markedly enriched the practice of reconstructive surgery within our field. Our efforts are particularly centered on the delicate areas of erectile restoration and stress incontinence in prostate cancer survivors, realms where patient needs have historically been overlooked. It is with great care and dedication that we have sought to bring these concerns into the light, offering new hope and specialized care to those who have long awaited it.
With a compassionate approach, we have the privilege of offering integrated surgical solutions that address both erectile restoration and stress incontinence, a reflection of the nuanced care we aspire to provide. This option is made possible through the continual evolution of our surgical practice, allowing us to tailor treatment plans to the unique needs of our patients. Beyond the technical aspects of surgery, my interest extends to comprehensive patient care, encompassing both perioperative and postoperative management. A prime example of our progress is our work on pain management following penile implantation. Historically regarded as a painful procedure, our research and publications have contributed to a better understanding of postoperative pain. This has been instrumental in developing new pathways to significantly reduce discomfort, enhancing the overall quality of life for our patients post-surgery. Our commitment to advancing these techniques and our holistic approach to patient care have proven to be game-changers in the field.
TAU: What do you consider to be some of the most challenging aspects of urologic reconstruction in your practice?
Dr. Simhan: The greatest challenge in urologic reconstruction, which might stem from my experience at a cancer center, has historically been managing patients with extensive surgical histories, including those with significant scar tissue from prior urologic or pelvic surgeries. This complexity is further heightened when treating patients who have also undergone radiation therapy. In urology, we frequently encounter patients who have had either combination surgeries or primary radiation treatments. For a long time, there was a reluctance to approach radiated cancer survivors for reconstructive procedures, due to the perception of these cases being beyond repair.
However, the landscape is changing. A growing number of dedicated professionals are now exploring the possibilities of reconstruction for these individuals, advancing the boundaries of what's possible. There's a burgeoning field of study focused on enhancing the quality of life for patients post-radiation. We're learning more every day, and it’s an area ripe with potential for significant advancements that could profoundly impact patient care.
TAU: How do you overcome these challenges? Are there any innovative solutions that you believe hold promise in tackling these challenges?
Dr. Simhan: We have to be willing to push the boundaries safely. Patients are very much in need or interested in having quality-of-life-preserving solutions. Managing the radiated urethral stricture patient has historically been quite challenging, and one of the innovative solutions relating to urethral reconstruction that has been increasingly implemented is buccal graft substitution urethroplasty in the radiated cancer survivor. For many years, people felt this condition was non-reconstructible as the placement of an oral buccal mucosa graft in the urethra in a patient with a history of radiation does not have a healthy environment for the buccal graft to survive. However, there have been great efforts made to show that there are opportunities for the buccal graft to survive in these patients. We are only scratching the surface of how to implement improvements to manage those types of patients. Another emerging area is either scar prevention or scar treatment. An innovative approach that has created a lot of “buzz” in reconstruction is the use of the paclitaxel-coated urethral balloon for treating urethral stricture disease. This technique is novel and aims to reduce the morbidity traditionally associated with urethral reconstruction. Preliminary data shows promise in select cases, but we are still investigating the long-term effectiveness, especially in more complex patients with a history of radiation therapy.
TAU: Moving forward, what do you envision as the next critical steps in the research and development of reconstructive urology?
Dr. Simhan: Within the past decade, the field has made a lot of progress. Ten years ago, this field mainly focused on single institutional studies that were retrospective. Only over the past few years, we started doing multi-institutional studies that are prospective in nature. Of course, many of these efforts will help us understand true benefits, limiting some of the suggestions of retrospective work.
TAU: How has your experience been as an Editorial Board Member of TAU?
Dr. Simhan: I must say that TAU has been such a breath of fresh air for the urologic community. For me, my experience has been fantastic. I am very lucky that I have been able to publish in the journal, so I understand what the expectations may be to gain publication. I also understand the process of being a reviewer for the journal because I have been lucky enough to review for it. Finally, I also have had the privilege of being a guest editor several times for several editions. Reflecting on my experience with TAU, it stands out as a journal where clinicians and researchers can anticipate a streamlined and efficient process from submission through review, leading to either acceptance or revision. It's a platform that has garnered trust for its clear and supportive editorial journey. My tenure as an editorial member has been thoroughly positive, thanks in large part to the journal's remarkable responsiveness. This attribute is commendable and contributes significantly to the positive experiences of its contributors.
TAU: As an Editorial Board Member of TAU, what are your expectations for TAU?
Dr. Simhan: TAU, despite being a relatively young journal, has paralleled the dynamic evolution of reconstructive urology over the last decade. My expectation is for TAU to persist in its efforts to spotlight and elevate thought leaders who are propelling the field forward. By empowering these innovators to bring forth emerging voices within the urological community, TAU not only enhances the stature of the journal but also enriches the discipline itself. It's important that we continue to uncover and amplify the work of researchers who may not yet be widely known, thereby advancing the entire scope of urological science.