Baylor St. Luke’s Medical Center is an internationally recognized leader in research and clinical excellence that has given rise to breakthroughs in cardiovascular care, neuroscience, oncology, urology, transplantation, and more. Our team’s efforts have led to the creation of many research programs and initiatives to develop advanced treatments found nowhere else in the world.

Our strong alliance with Baylor College of Medicine allows us to bring our patients a powerful network of care unlike any other. Our collaboration is focused on increasing access to care through a growing network of leading specialists and revolutionizing healthcare to save lives and improve the health of the communities we serve. 

Baylor St. Luke’s Medical Center is also the first hospital in Texas and the Southwest designated a Magnet® hospital for Nursing Excellence by the American Nurses Credentialing Center, receiving the award five consecutive times.

The Da Vinci SP robot represents a technologic leap forward to the next generation of surgical robotics as compared to traditional multiport robotic platforms, like the Da Vinci Xi. First, it allows complex surgery, including reconstructive procedures and cancer surgery to be performed through a single 2.5 cm incision. This versatile and miniaturized platform has revolutionized many urologic procedures, allowing them to be regionalized to small spaces around target organs such as the kidney, bladder, ureter, adrenal gland, and prostate. This new approach helps to avoid the discomfort and complications of surgery through the abdominal cavity and facilitates same day discharge even for complex surgical procedures. Along with the obvious cosmetic advantages of a single entry point which can essentially entirely hide the access incision, these regionalized surgeries significantly accelerate patient recovery and get them back to normal activities sooner with less pain.

At Baylor St. Luke’s Medical Center, we are utilizing the Da Vinci SP system for a broad range of diverse urologic procedures. This system represents the least invasive option for performing complex minimally invasive urologic surgery. Over the first year of system deployment at Baylor St. Luke's, we have performed nearly 100 major surgeries with the system. The volume and breadth of these procedures has rapidly made Baylor St. Luke's one of only a few nationally and internationally recognized leaders in single site robotic surgery. We are performing the highest volume of transvesical prostate surgery for benign prostatic hypertrophy, complex ureteral reconstruction following injury or strictures, and regionalized partial nephrectomy for kidney cancer with the Da Vinci SP system in the entire Southwest region. Dr Link, our most experienced single site robotic surgeon, has been extremely active in 2023 teaching this technology to other surgeons as invited faculty at multiple national and international courses and conferences. 

"The Da Vinci SP robotic system is empowering technology that helps to simplify complex urologic surgery and speed up patient recovery. This robot is allowing us to tackle urologic disease in ways we could not have even imagined a decade ago."

Single site robotic surgery is energizing the field of minimally invasive urologic surgery! Baylor St. Luke's remains committed to pushing the single site robotic surgery envelope and cementing our role as a world leader in this new frontier for the benefit of our surgical patients.

While urology covers a wide spectrum of care for both men and women, at Baylor St. Luke’s we are proud to offer specialized care for female patients looking for relief from a myriad of conditions that are unique to their anatomy. Our specialists are experts in identifying and creating personalized treatment plans for women seeking relief from conditions such as pelvic organ prolapse and urinary incontinence.

With the addition of Rotimi Nettey, M.D., M.H.S., Baylor St. Luke’s has expanded it care options for women with a specialized focus in pelvic floor health, pelvic organ prolapse, uterine sparing approaches, vaginal reconstruction, genitourinary and vaginal fistulae.

“Female pelvic medicine for a lot of patients can seem quite nebulous and vague,” says Dr. Rotimi Nettey. “Women have a lot of conditions, especially after childbirth such as incontinence, prolapse or sexual dysfunction, or complications such as UTI’s or pain. This is a home for any woman suffering from these conditions to be able to benefit from specialty care that can vary anywhere from medications to surgical interventions, and even working with a physical therapist. For a long time, women never came to the forefront in terms of seeking care for these quality-of-life issues that we treat as female pelvic medicine specialist. Women were either overwhelmed with their duties, whether it was taking care of their family or economic concerns. Now we are seeing more women coming forward with conditions that we’re happy to treat.”

Testosterone replacement therapy has garnered significant interest due to its potential implications for the cardiovascular health of middle-aged and older men diagnosed with hypogonadism. As the discourse around hormone replacement therapy continues to evolve, the Testosterone Replacement Therapy for Assessment of Long-term Vascular Events and efficacy ResponSE in hypogonadal men (TRAVERSE) trial provides pivotal insights.

The TRAVERSE Trial has become a significant contributor to the evolving discourse around hormone replacement therapy. These results were formally presented during a late-breaking science session at ENDO 2023, the annual meeting of the Endocrine Society, marking a significant milestone in our understanding of testosterone therapy’s cardiovascular implications.

This meticulously conducted, multicenter, randomized, double-blind, placebo-controlled, noninferiority trial elucidates the cardiovascular risks associated with testosterone replacement therapy.

The TRAVERSE trial enrolled 5,246 men between 45 and 80 years old, characterized by either a high-risk or preexisting cardiovascular disease coupled with symptoms of hypogonadism – a condition often termed “low T,” marked by testosterone levels below 300 ng/dL.

The trial randomly assigned these individuals to receive either a daily transdermal 1.62% testosterone gel (dose adjusted to maintain testosterone levels within 350-750 ng per deciliter) or a placebo gel.

The TRAVERSE trial significantly enhances our understanding of the cardiovascular implications of testosterone replacement therapy. It provides valuable evidence that testosterone therapy does not increase the risk of major adverse cardiovascular events in men diagnosed with hypogonadism and preexisting cardiovascular disease. However, it also brings to light potential risks associated with this therapy, emphasizing the importance of careful patient selection and monitoring during treatment. As the medical community continues to interpret and apply the TRAVERSE trial’s findings, its lessons will undoubtedly shape the future management of hypogonadism and contribute to improved cardiovascular health in this patient population.

Dr. Christopher P. Smith, M.D., M.B.A., M.S.S., a urologist at Baylor St. Luke’s Medical Center, is using a minimally invasive procedure to resolve urinary symptoms caused by an enlarged prostate in men older than 45.

Called the Urolift® System, the procedure is FDA-approved for the treatment of urinary symptoms related to benign prostatic hyperplasia (BPH). BPH occurs when the prostate becomes enlarged due to its continuous growth throughout a man’s life. It presses on the urethra, and the wall of the bladder thickens, both of which can cause difficulty urinating, blood in the urine, incontinence, and urinary tract infections, among other symptoms. BPH affects 41 million men, yet only 2% elect to do anything about it. Those who do most often take medication to control their symptoms but with disappointing results.

The UroLift® System uses a set of permanent implants to lift and hold enlarged prostate tissue to keep it from blocking the urethra. The procedure reduces symptoms of BPH without the need for cutting, heating, or other invasive approaches. And unlike other procedures, the Urolift does not cause new or lasting sexual dysfunction. Patients can return home on the same day and typically do not require a catheter. Following the procedure, they often see a resolution of BPH symptoms within two to four weeks.

Dr. Lerner is the national principal investigator of this trial, which he designed with colleagues in the Southwest Oncology Group (SWOG) Cancer Research Network. SWOG is a National Cancer Institute-funded cooperative cancer clinical trials group. 

This trial tested the hypothesis that a more extensive lymph node dissection (ELND) performed at the time of radical cystectomy – removal of the bladder – would lead to improved disease-free and overall survival within six years following surgery. ELND has been considered the standard of care for many years. The trial enrolled 658 patients starting in 2011 and set out to determine in a prospective fashion if in fact, ELND is better. The trial has now completed follow-up with participants. After a median six-year follow-up, the trial demonstrated no difference in DFS or overall survival between the two patient groups. Increased morbidity and mortality signals were noted in the extended arm. Dr. Lerner concludes that the standard of care should be bilateral standard node dissection, a viewpoint supported by a similar study conducted in Germany. While Dr. Lerner hoped for a benefit from extended node dissection, he also acknowledges that bladder cancer now aligns with other major solid organ site cancers, which show no benefit from more extensive node dissection.

Learn more about this work by viewing the Uro Today video here.

As part of our affiliation with Baylor College of Medicine, our urology team takes part in innovative research that we translate into state-of-the-art clinical options for those we serve. Here are some of the innovative contributions by physicians at Baylor St. Luke’s.

Applying genomics to bladder cancer treatment

Dr. Seth Paul Lerner, urologist at Baylor St. Luke’s, and his colleagues at Baylor College of Medicine study the genomic underpinnings of diverse characteristics in patients with muscle invasive bladder cancer as part of the Cancer Genome Atlas Research Network.

He and his team found a connection between cancer subtype and outcomes. “We were able to show that mutation signatures, molecular subtypes, load of new cancer-associated molecules and known clinical and pathological factors have a very clear influence on overall patient survival,” says Dr. Lerner.

Taking these factors into account allows for more personalized and effective treatment for patients.

“Of the 11 patients we identified as having a neuronal subtype, all of those evaluable for objective response responded to the treatment (two complete response, six partial response), or 72% overall. This translated to a very high survival probability which is unprecedented in advanced bladder cancer,” says Lerner.

“Although this is a small group of patients, it is very exciting to see that our basic research can be directly translated to the clinical setting allowing us to determine which subtype of bladder cancer has a better chance to respond well to a specific treatment.”

Fertility preservation in men on testosterone therapy

According to Dr. Larry Lipshultz, Baylor St. Luke’s urologist and Chief of the Scott Department of Urology’s Division of Male Reproductive Medicine and Surgery at Baylor College of Medicine, “low-dose hCG may be beneficial for men in their reproductive years requiring testosterone replacement therapy.”

Based on his data analysis and research, low-dose human chorionic gonadotropin, or hCG, may preserve spermatogenesis in men with hypogonadism treated with intramuscular or transdermal testosterone replacement therapy.

His suggested regimen for men hoping for a pregnancy now:

• Subcutaneous hcG at about 3,000 U, three times per week
• Clomiphene therapy
• Check follicle-stimulating hormone (FSH) levels at four months
  • If FSH levels aren’t adequate, stop clomiphene and replace with FSH

His suggested regimen for men hoping for a future pregnancy:

• Subcutaneous hcG at about 500 U, three times a week
• Cycle off of testosterone twice a year at a rate of about 3,000 U, three times a week for four weeks, in addition to 15 mg of clomiphene therapy daily

His suggested regimen for men just looking to prevent testicular atrophy:

• Subcutaneous hcG at about 1,500 U, once a week
• Cycle off of testosterone twice a year at a rate of about 3,000 U, three times a week for four weeks, in addition to 15 mg of clomiphene therapy daily

These treatment guidelines have achieved remarkable results. “To date, we have not had any patients who did not return to baseline,” says Dr. Lipshultz.