Urologists Daniel Lee, M.D. (left), and Brian Lindaman, M.D., provide care through Great River Urology, a clinic for the diagnosis and treatment of urologic conditions.

It seems you can’t watch TV for long these days until you see an advertisement for a product for “a going problem,” erectile dysfunction or another urinary tract condition.

To treat these and other conditions, Great River Medical Center has added two urologists, Daniel Lee, M.D., and Brian Lindaman, M.D. Both are 2007 graduates of the University of Iowa urology residency program.

PulseBeat Times and Dates In health care, technologies and treatments are advancing like never before. PulseBeat helps you keep abreast of these advances and shows you what’s happening in health care at Great River Medical Center. The next edition of PulseBeat features Great River Urology. Watch PulseBeat at the following times, dates and channels: 5:30 p.m. Saturday, Feb. 23, KLJB (FOX 18) 6:30 p.m. Saturday, Feb. 23, KHQA (CBS) 6:30 p.m. Wednesday, Feb. 27, KYOU (FOX 15)

“Urology is a specialty where a patient needs to see the physician frequently,” said Tony Hayes, executive vice president, Great River Medical Center. “That’s what made it so important for us to get that service back into the community when it wasn’t available locally for a while.”

Connecting with University of Iowa Hospitals and Clinics made it possible for Great River Medical Center to continue urologic care during the time without a resident urologist, and will help Great River Urology employ more high-technology services.

Urologists Treat a Variety of Conditions
The urologists often get calls from Great River Emergency Department, while many other Great River Urology patients are referred from area primary-care physicians.

“As a primary-care physician, I see a lot of ‘horses’ and some ‘zebras’,” said James McCabe, M.D., Burlington Area Family Practice Center. “With urology, the horses are kidney stones, urinary tract infection, incontinence and prostate cancer. We see these commonly.

“Then we see a few zebras – an unusual symptom, an abnormal blood test,” Dr. McCabe continued. “We do physical examinations, and there are screening situations, such as with prostate cancer, where we’re looking for problems in a particular age group. When we see there’s a problem that needs a urologist, we make that referral.”

“Beyond primary-care physicians, there’s overlap in women’s health care between urologists and OB-GYNs,” said Michael McCoy, M.D., Great River Women’s Health. “The main thing we would work together on is incontinence.”

“We have urodynamic testing to determine why a patient is leaking urine,” Dr. Lee said. “The tests are all done in our office.”

Dr. Lindaman said, “We also refer patients to a physical therapist for treatments for some cases of incontinence.”

“Anything to do with kidney stones or unexplained blood in the urinary tract we would always send to the urologists,” Dr. McCoy said. “In cancer cases, sometimes the anatomy is so obscured, and you worry you could injure someone. So we’ll call in a urologist.”

Rohini Reganti, M.D., an oncologist with Great River Oncology, said, “If we are taking care of a patient, and we suspect a kidney mass or a bladder problem, or testicular cancer, we usually refer to the urologists and get their opinion.”

“When patients are referred to us, if they need further testing, we provide it – X-ray, CT, MRI, PET – either in the clinic or next door in the hospital,” Dr. Lindaman said. “We do additional testing so we’re sure that the treatment is most appropriate.”

After conferring with other physicians or completing tests, Drs. Lee and Lindaman perform many procedures that use only slightly invasive technologies.

“With those technologies, we treat people and get them back to their lives faster,” Dr. Lindaman said. “We’ve done a lot of treatment for stone disease – in the bladder, kidney or in the ureter. The equipment we use is the latest technology.”

Urologists Bring New Capabilities
“Some of the procedures we’re doing now are new to this area, like the green light laser for an enlarged prostate,” Dr. Lee said.

“We use a scope with a green light laser, which opens the blockage caused by non-cancerous enlarged prostates,” Dr. Lindaman explained. “In the past, they had to stay in the hospital and have irrigation pumped through their bladder to keep it from forming blood clots. Now they can go home the same day.”

Another new procedure is minimally invasive kidney removal.

“In a laparoscopic nephrectomy – or the removal of a kidney – we usually make four small incisions and view with a scope to remove the kidney,” Dr. Lindaman said. “It’s much less painful and heals faster than previous surgical techniques.”

“Most procedures are done on an outpatient basis,” Dr. Lee said. “There are a few exceptions. After open abdominal procedures, we want patients in the hospital for 72 hours. Kidney removals usually go home in two days.”

When surgical patients arrive at Great River Medical Center, experienced hands guide them through the process.

“We assess them – do their vitals, start their IVs and make sure everything is in order,” said Angela Myers, nurse manager, Day Surgery and Postanesthesia Care Unit (PACU), Great River Medical Center. “And then they’re off to surgery.”

“After surgery, they’re held in the PACU until they’re stable,” Myers continued. “Back in their room, they’re assessed again, given medicine to control pain and encouraged to drink. Dr. Lee or Dr. Lindaman usually comes back to see the patient.”

“I think Brian and I can handle about 95 percent of urology cases we see here,’ Dr. Lee said. “Occasionally, a patient will need more-specialized care at the University of Iowa.”

Hospital Partners With University of Iowa to Provide Care
The University of Iowa helped provide continuity of urologic care when the community suddenly lost its urology service.

“When we lost our urology services, we quickly considered our options,” Hayes said. “One was to bring in a urologist to fill our need for a short time. Our other option was to aggressively recruit a new staff urologist.”

Great River Medical Center was fortunate to recruit not one, but two highly qualified urologists. But Drs. Lee and Lindaman still had a year left in their residency program, and it was proving difficult to find a urologist who could temporarily fill the urology needs until they could start in August 2007.

Drs. Lee and Lindaman told Hayes to call Richard Williams, M.D., chairman, Department of Urology, University of Iowa Hospitals and Clinics. Dr. Williams committed to cover the urologic service with university faculty members.

“They saw patients in the office at Great River Center for Rehabilitation,” Hayes said. “And any surgical work that needed to be done, they did at the University of Iowa.”

“That went on for about seven months,” Dr. Williams said. “Our faculty told me they thought Great River Medical Center was a great hospital, and there couldn’t have been better support when they were there. I’ve worked with many hospitals in Iowa, and Great River Medical Center was the best.”

Extensive Preparation Eases Transition
When the needs of the community’s urology patients were covered, Great River Medical Center worked to get its staff and facilities ready for the new urologists.

“We put together a team from across the hospital – inpatient, outpatient, surgery, billing, scheduling,” said Gail Boyd, B.S.N., RN, director, Surgical Services, Great River Medical Center. “We met weekly. We also knew we had to completely redo the surgical suite where urology cases are done.”

With such detailed preparation, Great River Medical Center was ready to provide comprehensive urologic services when Drs. Lee and Lindaman arrived.

New Treatments on the Horizon
A technology Drs. Lindaman and Lee know well will soon be phased back into service.

“The area of urologic treatment that hasn’t been developed yet with them – but will over time – is brachytherapy,” Hayes said.

Brachytherapy, or the insertion of radioactive “seeds” to attack prostate cancer, takes a team including a urologist, a physicist and a radiation oncologist.

“Another up-and-coming technique that Drs. Lee and Lindaman are already doing here is laparoscopic surgery,” Hayes said. “Laparoscopic procedures are new to urology, so they’re ahead of the curve.”

With revitalized urology services, Great River Medical Center continues to position itself among the leading-edge medical facilities in this region.

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