Department of Urology

OUTCOMES DIVISION OF MEDICINE Department of Urology

About Cleveland Clinic Florida Cleveland Clinic Florida s medical staff are dedicated physicians who have joined the clinic as salaried doctors to practice a different kind of medicine: Where commitment to patients, providing expert innovative care, and involvement in medical education are the goals. We work as a team, access the same electronic medical records, and cooperate to give our patients the best care. Providing excellent care to our patients is why we are here.

Introduction/Department Overwiew The Department of Urology at Cleveland Clinic Florida, an integral part of the Glickman Urological & Kidney Institute, is a national leader in treating urologic and kidney disorders such as Prostate Diseases, Sexual Dysfunction, Peyronie s Disease, Stone Disease, Incontinence, Voiding disorders, Male Infertility, Bladder Cancer and Kidney Cancer. The renowned physicians in the Department of Urology at Cleveland Clinic Florida offer a high level of expertise and experience in the management of common and rare urologic problems. Their commitment to research and publication in peer-reviewed journals has given them national and international standing, and earned them a reputation as one of the finest urological departments in the southeastern United States. The staff represents many subspecialties of urologic care: cancer, prostate disease, sexual dysfunction and urination problems. While some diseases such as prostate cancer or benign prostate disease pertain only to men, the urologists treat men and women with kidney, bladder and other forms of urologic cancer; and sexual disorders, including urinary incontinence, overactive bladder and female pelvic prolapse. The full range of diagnostic testing and state-of-the-art treatment options is available right on the Cleveland Clinic Florida campus. Patients are also welcome to participate in the many clinical trials that are also available. The vast majority of tests and procedures are done on an outpatient basis. However, when hospitalization or surgery is necessary, patients are admitted to Cleveland Clinic Hospital.

Innovation DEPARTMENT SERVICES AND INNOVATIVE PROCEDURES The Glickman Urological & Kidney Institute is recognized around the world as the leading center for innovative treatments in urology. Dedicated to enhancing patient care, we offer pioneering procedures that minimize risk and enhance recovery. Urologic Cancers: Cleveland Clinic Florida s urologic cancer specialists provide state-of-the-art treatment for the full range of cancers found in the kidney, bladder, prostate, testes and penis. Advanced Options for Prostate Cancer: Cleveland Clinic Florida patients with prostate cancer have more effective treatment options than ever before. The urologic oncologists are skilled at performing ROBOTIC nerve-sparing radical prostatectomy, a procedure that offers less morbidity and helps to preserve continence and potency. Prostate cancers are also treated with tiny, implanted radioactive seeds that deliver radiation right to the tumor, sparing healthy tissue. Minimally Invasive (Laparoscopic) Surgery: Many patients with kidney cancer are relieved to learn that a tumor on the kidney or even the entire kidney itself can be removed through a very small incision. Without the pain and discomfort of major abdominal surgery, patients are usually able to return to a normal lifestyle more quickly and are physically stronger for any necessary chemotherapy or radiation. Cleveland Clinic Florida urologic oncologists offer laparoscopic kidney removal when appropriate. Benign Prostate Disease: Not all prostate problems are cancerous. Two common benign prostate diseases seen by Cleveland Clinic Florida urologists at the Men s Health Center are benign prostatic hyperplasia or BPH and prostatitis. In addition to effective medical therapies, our physicians offer state-of-the art minimally invasive procedures, including laser surgery. Sexual Dysfunction, Peyronie s Disease and Male Infertility: Male sexual dysfunction (including ED or impotence) and female sexual dysfunction (FSD) afflict more than 70 million people in the U.S. alone. Our research has shown that sexual dysfunction is often the first sign of underlying vascular, neurologic or hormonal disease. Common causes include smoking, high blood pressure, diabetes, sports injuries, cancer, high cholesterol and certain medications. In most cases, successful treatment is available. Cleveland Clinic Florida is the premier center for the diagnosis and treatment of sexual dysfunction in men and women. Because sexual dysfunction is a couple s problem, patients and their partners are typically seen together by a fellowship-trained physician whose goal is to find the best treatment for the individual situation. Stone Disease: At CCF, our physicians are experts in the medical and surgical management of stone disease and offer the latest advances in lithotripsy, minimally invasive and laser surgical techniques. Continent Urinary Diversion: Bladder cancer used to require an external bag once the bladder was removed. Today, Cleveland Clinic Florida urologic oncologists utilize advance robotics and reconstructive techniques to perform bladder removal and continent urinary diversion, which essentially recreates normal anatomy and eliminates the need for an external urine bag.

Innovation Continence and Pelvic Health: More than 10 million men and women suffer from urinary incontinence, and 30 million are estimated to have an overactive bladder. Symptoms include the urgent need to urinate, frequent urination or incontinence (involuntary loss of urine). At the Pelvic Floor Center, state-of-the-art evaluation is provided to patients with incontinence, voiding dysfunction and pelvic prolapse. Fluorourodynamics is among these methods of evaluation. Cleveland Clinic Florida urologists specializing in voiding dysfunction, female urology and pelvic reconstruction, offer a variety of effective methods for treating this embarrassing problem. Among these are biofeedback, collagen injections, sling procedures, Artificial Urinary Sphincter and bladder pacemakers (InterStim Therapy). Advanced surgical procedures, including continent urinary diversion, orthotopic bladder, augmentation cystoplasty and urinary fistulae repairs, are offered when needed. Female pelvic prolapse repair with or without grafts are offered based on thorough evaluation.

Our Doctors In the area of andrology surgery, Dr. Hakim specializes in the evaluation and management of male infertility, including the performance of microscopic varicocelectomy, no-scalpel vasectomy, microscopic vaso-vasostomy (vasectomy reversal) and microscopic epididymo-vasostomy, testes biopsy, micro-epididymal sperm aspiration (MESA) and sperm retrieval techniques utilized for various Assisted Reproductive Technologies. Lawrence S. Hakim, MD, FACS Chairman, Department of Urology Director, Men s Health and Wellness Center Cleveland Clinic Florida Glickman Urological and Kidney Institute Special Interests: Sexual Medicine and Surgery, Peyronie s Disease, Male Infertility and Andrology, Male Incontinence, Prostate disease and Prosthetic surgery Lawrence S. Hakim, MD, FACS is the Chairman of the Department of Urology at Cleveland Clinic Florida. Dr. Hakim is a Fellowship trained, Board- Certified urologist and has been a member of the professional staff since 2000. In addition, Dr. Hakim holds a faculty appointment as Clinical Associate Professor of Surgery (Urology) from the University of South Florida College of Medicine. Dr. Hakim is a nationally and internationally recognized leader in the field of male and female sexual medicine and surgery, male infertility and prosthetics and has served as Head of the Section of Sexual Dysfunction, Male Infertility and Prosthetics at CCF. He is also the Director of the Sexual Medicine, Andrology and Prosthetics Post-Graduate Fellowship Program at CCF. He is also recognized as a world-leader in the performance of difficult penile implant surgeries and the medical and surgical management of Peyronie s Disease and has lectured and performed advanced surgical prosthetic training seminars throughout the world. Dr. Hakim has established a state-of-the-art multispecialty Diagnostic Center in South Florida and is a leader in the evaluation and treatment of sexual dysfunction (including female sexual dysfunction, erectile dysfunction or impotence, ejaculation disorders and poor libido) and Peyronie s disease. Our state-of-the-art Diagnostic Center utilizes the most advanced technologies, such as vasoactive testing and penile color duplex Doppler ultrasonography for the evaluation of vasculogenic erectile dysfunction. Dr. Hakim is active in numerous national academic organizations, including the Sexual Medicine Society of North America (SMSNA), the Society of Urologic Prosthetic Surgeons (SUPS) and the American Urological Association (AUA). He is a past member of the Board of Directors of the Sexual Medicine Society of North America and has served on the American Foundation for Urologic Disease Committee on Priapism. Dr. Hakim currently serves on the Cleveland Clinic Florida Graduate Medical Education committee and Institutional Review Board (IRB) and has served as a NIH grant reviewer in the field of diabetic erectile dysfunction. Dr. Hakim is an Associate Editor of The Journal of Robotic Surgery and Fertility Today and is an active reviewer for multiple medical specialty journals, including: Urology, the Journal of Sexual Medicine (JSM), The Journal of Urology and the International Journal of Impotence Research (IJIR). Dr Hakim has served as primary or co-investigator on numerous funded clinical research trials and has authored over 60 original scientific articles, academic book chapters and published abstracts, and is the author of the best-selling book: The Couple s Disease: Finding a Cure for Your Lost Love Life.

Our Doctors Nicolas Muruve, MD Head, Section of Urologic Oncology Director: Urologic Stone Center of Excellence Special Interests: Urologic oncology, urologic stone disease, renal transplantation Nicolas Muruve, MD, is a Staff Physician in the Department of Urology, located on the Cleveland Clinic Florida campus, Weston, Fla. He was appointed in 2004, subsequent to serving as Director of Renal Transplantation at the University of Missouri, Columbia. Prior to that, he completed a research fellowship at Cleveland Clinic and a fellowship in renal transplant/renal-vascular. Dr. Muruve received his medical degree from the University of Manitoba, Winnipeg, Canada. He is licensed to practice medicine in Florida and Missouri. He is co-principal investigator or co-investigator of numerous research trials, and has contributed several chapters to medical textbooks and journals in his field. He has presented at conferences and seminars in the United States and Canada. Dr. Muruve is a member of the American Society of Transplant Physicians, the American Urologic Association and the Canadian Urologic Association, among others. He received the Excellence in Health Education by a Physician award from the University of Missouri Health Sciences two consecutive years.

Our Doctors Dr. Ghoniem currently directs the post-graduate Urologic Fellowship training program in Voiding Dysfunction at CCF and has trained numerous clinical and research fellows. He has edited two books: Practical Guide to Female Pelvic Medicine and Pelvic Floor Dysfunction: a Multidisciplinary Approach and has wrote or co-wrote numerous professional publications. He serves on the Editorial Board of Journal of International Urogynecology, Pelvic Floor Medicine Journal, and Journal of Neurourology and Urodynamics. Gamal Ghoniem, MD Head, Section of Voiding Dysfunction, Female Urology and Reconstruction Director, Pelvic Floor Center Special Interests: Female urology, voiding dysfunction and reconstruction. Dr. Ghoniem has improved and introduced many diagnostic and surgical techniques in the field of urinary incontinence and pelvic prolapse such as ISD classification, vaginal pack test, suburethral sling, Genisphere injection, bladder neck wrap, male sling, and trans obturator technique. Gamal Ghoniem, MD, is a Staff Physician in the Department of Urology, located on the Cleveland Clinic Florida campus. He completed his residency at the University of Alexandria (Egypt) in 1978 and was appointed as Assistant Lecturer. In 1980, he completed a fellowship in neurourology and female urology at Brown University in Rhode Island, and he also trained in urology at the University of Michigan, Ann Arbor, Mich. Dr. Ghoniem joined the Department of Urology at Tulane University and directed the Section of Urodynamics and Female Urology. In 1992, he was promoted to Professor of Urology and Gynecology. Some of his past positions include: Tulane Residency Program Director, former Secretary and President of The Egyptian American Urological Association, and past Chairman of the main session of the Urodynamics Society in 2002. Dr. Ghoniem is a member of several societies including the American Urological Association, Southern Medical Association, Southeastern Section of the American Urological Association, Society of Urodynamics and Female Urology, International Continence Society (ICS), International Urogynecology Association (IUGA) and the American Urogynecology Society. He is an elected member of the scientific committee of ICS and elected member of the SUFU executive committee.

Our Doctors Bassem Eldaif, MD Associate Staff Special Interests: General Urology, Prostate disorders, minimally-invasive treatment of urologic cancers, Robotic-laparoscopic surgery, urologic stone disease Dr. Eldaif recently joined Cleveland Clinic Florida after completing his residency training at Duke University School of Medicine, in Durham, North Carolina where he received several honors. He received his medical degree from Duke University School of Medicine, as well, where he was elected to the medical honor society. Dr. Eldaif is trained in all aspects of adult and pediatric urology and is one of the few urologists in South Florida who has advanced specialty training in robot-assisted surgery, specifically robotic prostatectomy for the treatment of localized prostate cancer. Dr. Eldaif specializes in adult urology and has particular interests in prostate disorders, robotic and laparoscopic surgery and the minimally-invasive treatment of urologic cancers as well as urologic stone disease. William H. Gans, MD Associate Staff Special Interests: Prostate disorders, urologic stone disease and the minimally-invasive treatment of urologic cancers Dr. Gans is a board-certified urologist. He recently joined Cleveland Clinic Florida after being in private practice for over 5 years in the Palm Beach area of South Florida. Dr. Gans completed his residency at Mount Sinai Medical Center in New York and as chief resident, he received several honors including the Pfizer Scholar in Urology Award and the Outstanding Resident Surgeon Award from the Society of Laparoendoscopic Surgeons. He received his medical degree from Upstate University in Syracuse, New York where he was elected to the AOA medical honor society. Dr. Gans graduated Cum Laude from Binghamton University where he was a member of the Phi Beta Kappa honor society. Dr. Gans was trained in all aspects of adult and pediatric urology. He is one of the few urologists in South Florida who has performed robot-assisted surgery. He is concerned with the ongoing improvement of patient care and has served on the Surgical Performance Improvement Committee, the Continuing Medical Education Committee, and the Cancer Care Committee. Dr. Gans specializes in adult urology and has particular interests in prostate disorders, urologic stone disease and the minimally-invasive treatment of urologic cancers.

Our Doctors Dr. Macchia has lectured at numerous academic institutions and meetings in the US, Europe and Japan. He has also co-authored over 100 scientific articles and abstracts including 26 textbook chapters and proceedings. He has been co-investigator on many collaborative projects and holds an NCI grant as principal investigator. He serves on the external advisory boards of several internationally renowned institutions. New York magazine named him as one of The Best Doctors in New York City on numerous occasions. Richard J. Macchia, MD, FACS Associate Staff Special Interests: Benign Prostate disorders, Prostatitis, Men s Health Issues, Urologic Oncology Richard J. Macchia, MD, FACS brings to CCF a lifetime of urologic experience, as professor and chairman of the Department of Urology at the State University of New York Downstate Medical School (SUNY-Downstate) since 1988 and program director for the urology training program since 1982. In 2003 he was appointed Consultant, Memorial Sloan Kettering Cancer Center (MSKCC). Following his graduation from New York Medical College in 1969, he underwent general surgical training at St. Vincent s Hospital Center in New York City. He then completed his urology residency under Dr. Keith Waterhouse at Downstate. He was awarded the F.C. Valentine Fellowship of the New York Academy of Medicine. That fellowship was served under Dr. Willet F. Whitmore, Jr. at MSKCC. Dr. Macchia served as the chairperson of the Section on Urology of the New York Academy of Medicine and as a member of its Advisory Council for 6 years. He was President of the New York Section of the American Urological Association in 1995-1996. His memberships include the Society for Urologic Oncology, the Society of University Urologists, the American Society of Clinical Oncology and many others. Dr. Macchia is a former associate editor of Urology and a regular moderator at scientific sessions for the annual meeting of the AUA. He has served as a study section member for the NIH.

Clinical Centers of Excellence The clinical expertise and academic pursuits of our staff at Cleveland Clinic Florida are exceptional. In keeping with the new paradigm of the Glickman Urological and Kidney Institute, based on organ and disease systems, we are dedicated to the development of world-class Urologic Centers of Excellence within the Department of Urology at CCF, in the areas of Stone Disease; Female Urology, Voiding Dysfunction and Reconstructive Urology; Men s Health, BPH, Sexual Medicine and Andrology; and Oncology, Minimally Invasive Therapy and Robotics. The Men s Health and Wellness Center of Excellence Over the past 15 years, we have developed one of the busiest programs in the region for the management of sexual dysfunction, BPH, male infertility and male incontinence. Along with a state-of-the-art Diagnostic Center for female and male sexual dysfunction, including hemodynamic testing, we are the major regional referral center for all penile prosthetic surgery (with special emphasis on re-operation, corporoplasty and difficult implant surgery), the medical and surgical treatment of Peyronie s disease, penile revascularization, male incontinence slings and artificial sphincters and the surgical management of male factor infertility. It has now been clearly demonstrated that sexual health and performance are directly tied to overall well-being and good health. In fact, ED (erectile dysfunction) is often the first sign of other disease states, such as hypertension, prostate disease, heart disease, atherosclerosis and diabetes. The Men s Health and Wellness Center of Excellence, as part of the Southeastern Glickman Urologic and Kidney Institute, under the direction of Dr. Hakim, has become a destination, uniquely differentiated by its world-class staff, geographic location and multispecialty approach available at the Cleveland Clinic Florida, including: VIP concierge medicine, and the related subspecialties (including internal medicine, endocrinology, cardiology and plastic surgery). Our collaboration with a world-class psychologist and sex therapist as part of our team, offers our patients the absolute best in care, while addressing all aspects of men s sexual health and wellness. Center of Excellence for Stone Disease Based on a foundation of collaboration with nephrology, we have developed a world-class Stone Center at Cleveland Clinic Florida, under the direction of Dr. Nicolas Muruve. This Center of Excellence is the first in the region to incorporate comprehensive medical and metabolic evaluation, complete laboratory and radiographic evaluation, and a complete arsenal of medical and surgical management options for the treatment of urologic stone disease. Using the Cleveland Clinic Model of collaboration among specialties assures that our patients continue to have access to world-class care in stone disease. Pelvic Floor Center of Excellence We have a world-class multidisciplinary Center of Excellence for Female Urology, Reconstruction and Voiding Dysfunction under the direction of Dr. Ghoniem that is unique in the region. We offer worldclass diagnostic and therapeutic management for patients with voiding dysfunction and incontinence, as well as reconstruction of complex urethral strictures and urologic fistulae. This program has an integrated Fellowship training program and works closely with the department of gynecology (based in our direct clinical area). Using the Cleveland Clinic Model of collaboration among specialties, we offer patients access to world-class care at the Glickman Urological and Kidney Institute. Robotic and Oncology Center of Excellence Based on a foundation of collaboration with the CCF Comprehensive Cancer Center, we have developed a world-class Robotics and Urologic Oncology Center at Cleveland Clinic Florida. This Center of Excellence is the first in the region to incorporate a Comprehensive Cancer Center and Fellowship training program, offering a complete arsenal of medical and surgical management options, including Robotic Prostatectomy. Using the Cleveland Clinic Model of collaboration among specialties assures that our patients continue to have access to world-class care in urologic disease.

Clinical Centers of Excellence COMMITMENT TO EDUCATION At Cleveland Clinic Florida s Glickman Urological and Kidney Institute, we firmly believe that the continuing education of our patients, our colleagues and ourselves is the cornerstone of our mission and will help us to achieve our goal of becoming the destination for urological healthcare in South Florida and the southeastern United States. By utilizing the vast resources of the Glickman Institute, we have begun developing an infrastructure within the CCF Department of Urology that provides educational resources and access to clinical research for both patients and physicians. Various Educational Programs are supported by the faculty of the Glickman Urological and Kidney Institute, including regular Community Awareness Programs in areas such as prostate cancer, stone disease, men s health issues and female urology. COMMITMENT TO RESEARCH In order to achieve our vision of continued clinical excellence in patient care, we continue to improve our practice through innovation and clinical-based research. Our current senior faculty members, as well as our new staff, have very strong academic credentials and significant experience in performing clinical trials. We are continuing to expand our involvement in clinical trials of innovative therapies, as well as clinical reviews of our outcomes data. Continuing Medical Education Programs are a critical component to our educational mission for physicians. By utilizing the clinical expertise of our faculty at CCF, along with our colleagues in Cleveland, we are developing a number of National and International CME-based Urologic Symposia, in addition to Specialty-Oriented programs. Our commitment to Graduate Medical Education has led to the development of post-graduate Fellowship training programs, as part of the various Urologic Subspecialty Centers of Excellence within the Department of Urology, in the areas of: Oncology, Minimally Invasive Therapy and Robotics; Urologic Stone Disease; Female Urology, Voiding Dysfunction and Reconstruction; Men s Health, Sexual Medicine and Surgery and Andrology.

Outcomes Data Major Surgical Cases (Inpatient) Prosthetic Surgical Cases % Complications % Complications Surgical Cases (Outpatient) Major Surgical Cases (Inpatient) % Complications % Mortality

Outcomes Data Partial Nephrectomy Surgery Radical Cystectomy Surgery