This Philly Doctor’s Revolutionary Techniques Help Patients Overcome the Life-Altering Effects of Urologic Cancer Treatment

With a cancer diagnosis, survival tends to be the first thought for most people and their loved ones. But cancer treatments can cause side effects in both the short and long term. These are often a mountain to climb all on their own, from the immediate effects of chemotherapy to the development of scar tissue following surgery. 

This is especially true with urologic cancers, including cancers of the prostate, bladder and urethra. Treatment, while life-saving, can produce side effects, including urinary incontinence or leakage and sexual dysfunction. It goes without saying that these conditions can, in turn, have a major impact on patients’ comfort with leaving the house, on their interpersonal relationships, and on their psychological well-being. The prospect of these effects can be a stressor on patients when making decisions about care, or even when considering getting screened for cancer.

With advances in cancer treatment, survival rates are on the rise. Comprehensive centers have begun finding new ways to improve quality of life post-treatment. For urologic cancers, the development of the field of reconstructive urology gives hope to patients who may have experienced permanent changes from treatment. In fact, in the last few decades, this area of specialty surgery has emerged as a transformative resource for rebuilding and restoring urinary and sexual function, including for patients affected by cancer.

The formation and success of that field has been driven by surgical innovations being produced right here in Philadelphia, led by a team of researchers including Dr. Jay Simhan. As a leader and the director of reconstruction and prosthetics at the Fox Chase – Temple Urologic Institute, the program enhances collaboration between cancer experts and reconstructive urology specialists, making the revolutionary techniques for reconstruction a standard, accessible part of post-cancer care.

“Our work revolves around reconstructive procedures to help restore function and can also include revolutionary urologic devices that have revitalized how patients feel from a quality of life standpoint, following a cancer treatment,” Simhan says. “We were one of the institutions that recognized the importance of that, and created a fellowship program that attracts people from near and far that are interested in pursuing that type of training.”

Simhan disseminates these techniques as a national leader. He actively participates in the Society of Genitourinary Reconstructive Surgeons, a leading international organization dedicated to reconstructive urology. His role extends beyond membership as he is part of the Society’s Board of Directors, contributing to the strategic direction and worldwide propagation of reconstructive urology methods and principles. In Philadelphia, his expertise extends to mentoring fellow physicians at the Fox Chase Cancer Center, where he leads the Reconstructive and Prosthetic Urology Fellowship program. His innovative techniques are revolutionizing our understanding of quality-of-life long-term outcomes in urologic cancer care and are essential in restoring function for a broad spectrum of complex conditions. Through his guidance, he is shaping a new generation of specialists at Fox Chase Cancer Center. As one of the few physicians who acknowledges the national need for an emphasis on quality of life improvements, he champions the widespread adoption of reconstructive training as a critical pathway to achieving this goal. His work underscores the importance of advanced techniques not just as medical interventions, but as means to enhance patient well-being across a spectrum of health issues. 

Rebuilding After Cancer

The urologic and sexual functions are complex, relying on the harmonious interaction of multiple systems, rather than on muscle movements alone. Cancer and its treatments can disrupt this delicate balance, leading to dysfunction. Aggressive cancers, in particular, may compromise these systems directly or as an unintended consequence of the therapeutic efforts to eradicate cancer cells. This emphasizes the importance of recognizing sexual health issues as deeply personal and multifaceted, necessitating sensitive and comprehensive care strategies.

That’s why the development of reconstructive urology as a field has been so pivotal for the treatment of these cancers–many of the techniques can help restore function that has been lost to cancer. In recent years, the field has taken a step forward thanks to protocols that Simhan’s team has established at the time of surgery, opening up new possibilities in the field, according to Dr. Daniel Swerdloff, Director of Urotrauma and Reconstruction at Lenox Hill Hospital, a former fellow of Simhan’s. 

“I already respected Dr. Simhan as one of few reconstructive urologists with a nationally renowned practice, his reputation as an innovator and thought leader was unmatched,” Swerdloff says. “He captivated me with his innovative surgical techniques. Many patients he treated had undergone failed repairs elsewhere.”

Previously, only a select number of skilled surgeons could perform intricate procedures to address the severe effects of urologic cancer treatment, with hours-long operations and lengthy recovery periods for patients. Thanks to advances in the field, pioneered by experts and disseminated through comprehensive training and research, these surgeries have become more efficient. While they still require significant expertise and time, they now result in quicker recoveries, a testament to the innovative strides made in reconstructive urology. 

“For many urologists, these procedures are not undertaken often,” Simhan says. “And I have often noted that operations done more efficiently by experts often lead to a better recovery for patients.”

According to Simhan, quality-of-life challenges after cancer care go beyond a nuisance–they can be debilitating in a way that can have a cascade of effects on a patient’s health, physically and mentally. 

“Being incontinent, or leaking urine, is so debilitating for many men and women in this country and worldwide. It’s been shown that people are unwilling to leave their house, they’re unwilling to socialize in a public or community setting, and they pull back. And that has detrimental health consequences,” Simhan says. 

But through Simhan’s work, that array of consequences can be resolved, often in short, relatively minor procedures. Through urologic implants, Simhan is able to sometimes add bulk back to the muscles that the body uses to unconsciously regulate urination, giving it back the strength to prevent leaks. For more severe leakage problems in men, Simhan may recommend an artificial urinary sphincter. After a different minimally invasive procedure where patients often go home the same day, the patient can control their urinary function by opening and closing the new sphincter with a small pump.

“The artificial sphincter sounds like an engineering marvel, because it largely is an engineering marvel,” Simhan says. “It was discovered, implemented, and improved with great data and great science, some of which we’ve helped advance here within Temple Health.”

Simhan’s techniques can similarly return sexual function with minimal impact. For erectile dysfunction that can’t be treated with standard oral medications, Simhan has helped implement erectile dysfunction injections. He notes that these personalized treatments can be initiated in-office and instantly return function for the patient. 

For those patients who suffer significant damage from treatment, penile implants can replace lost function, through inflation of a device with a pump contained entirely within the penis and scrotum with a “penis pump”. In previous decades, the surgery could be considered difficult and complex, but Simhan believes that with the right approach and expertise, the procedure could be considered as commonplace as cosmetic enhancements like breast implants.  

“Historically, people felt that penile implant procedures take months of recovery,” Simhan says. “We have published protocols that have helped the community of urologists who do this operation throughout the world, on how to recover patients such that their pain is largely gone within two weeks in a majority of cases.”

Urologic implants are mostly minor surgical procedures that are covered by a majority of insurance plans. 

Making Recovery Accessible

The effectiveness of these techniques has made Simhan a key part of the care team for urologic cancers. His role as an accessible resource from the outset of the patient’s cancer care is crucial, providing support and expertise to colleagues who manage these patients. This involvement helps to alleviate fears and significantly contributes to the formulation of a well-rounded treatment strategy. This approach helps give patients confidence to get the care they need while supporting a faster, fuller recovery. This not only achieves better results–it can make care decisions less agonizing and cancer treatment less scary for patients and their loved ones.

“I think it encourages people to get treated for cancer,” Simhan says. Thanks to the foundation of the Fox Chase-Temple Urologic Institute, that approach has become standardized. As a multidisciplinary team, the institute staffs experts focused on particular conditions, and connects patients to them–and the numerous clinical trials offered–as needed. With offices throughout the region, care is as accessible as possible for patients. 

These techniques are not only applicable for urologic cancers, however; they are just as revolutionary for other conditions as well. With 30 to 40 million American men faced with erectile dysfunction, for example, these techniques can help a broad swath of the population. Simhan points to diabetes, vascular obstructions and coronary artery disease as conditions that can be linked to sexual dysfunction. With advances in reconstructive urology, correcting these conditions is an easier decision for anyone affected by these common challenges. 

A wave of new physicians, trained in Simhan’s techniques, is rising to serve that population. Through Fox Chase’s Reconstructive and Prosthetic Urology Fellowship program, Simhan’s fellows have begun to change the standard approach to urology on a national level.

“The lessons imparted now guide me to elevate care, introduce cutting-edge treatments, and continue pioneering our field,” Swerdloff says of his time in the fellowship. “With an expert, model physician’s mindset to emulate, I feel equipped to manage complexity and innovate with integrity, as Simhan masterfully demonstrated during a transformative fellowship that profoundly impacted my career.”

For Simhan, it’s all about making life-changing care available to patients in a field where awareness can be challenging, given the sensitive and even stigmatized nature of many of the conditions. 

“We have already graduated fellows that are now standing up their own programs and using the model we have set here,” Simhan says. “And they have, in large part, trainees of their own that they’re teaching, so they can also help spread the word of how we can improve quality of life in patients, near and far away.”