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Health Matters: Providence Cedars-Sinai Tarzana Medical Center | 7 H alf of men in their 50s suffer from benign prostatic hyperplasia—enlargement of the prostate gland—a progressive condition that, while initially only annoying and frustrating, can lead to significant lifestyle alterations. Providence Cedars-Sinai Tarzana Medical Center is the first hospital in the San Fernando Valley and surrounding communities—and one of just three in Los Angeles County—to provide a therapy called Aquablation, a state-of-the-art robotic procedure to treat men with enlarged prostates. This condition can cause symptoms including urgent urination and poor urinary flow. If left untreated, an enlarged prostate can cause significant health problems, including blockage, irreversible bladder or kidney damage, bladder stones and incontinence. Surgical treatment options often force men to choose between symptom relief and complications including sexual and urinary dysfunction. Recently, urologists Richard Shapiro, MD, and Ali Afshar, MD, successfully performed the hospital's first three Aquablation treatments, and they have a long wait list of patients seeking relief. Once word is out about the new technology, Dr. Shapiro expects men will travel significant distances for the procedure. "Our patients have been waiting and saying, 'When it's available, let us know,'" he says. One of the recent procedures took only 26 minutes. Dr. Afshar estimates that this procedure, if performed without Aquablation, would take an hour and a half. "Fantastic," he says of the inaugural run. "We couldn't be happier with the results. All the patients had good recoveries." HOW IT WORKS Aquablation therapy is a minimally invasive treatment that uses a powerful water jet that pulsates at nearly the speed of sound. Using a combination of real-time ultrasound and direct vision through a tiny camera inserted through the urethra, the robot controls the removal of the excess prostate tissue. Studies show the procedure is safe and effective, results in minimal bleeding and guards against complications including sexual side effects and incontinence. Most cases are covered by Medicare. The AquaBeam Robotic System is the first FDA-cleared surgical robot utilizing automated tissue resection for the treatment of enlarged prostate. Dr. Shapiro believes the procedure will replace all current standard treatments for enlarged prostate. The therapy appeals to men who have tried medication but are looking for a lasting solution with a very minimal risk of irreversible complications. Few hospitals have obtained the technology and training. In fact, the two urologists traveled to Phoenix to train for the procedure. Aquablation: New Prostate Treatment ALI AFSHAR, MD: Dr. Afshar became interested in urology while doing oncology research at Vanderbilt University Department of Urologic Surgery. He finished his urology residency at Cedars- Sinai Medical Center in 2016 and a fellowship in advanced endourology and robotic surgery at USC in 2017. Dr. Afshar has been practicing in San Fernando Valley since 2017 while also maintaining clinical privileges at Cedars-Sinai, He has trained under internationally-renowned surgeons. His training provides expertise in robotic assisted radical prostatectomy, radical nephrectomy, partial nephrectomy, nephroureterctomy, upper tract reconstruction and many more. RICHARD SHAPIRO, MD: Dr. Shapiro is a graduate of the University of Illinois in Champaign-Urbana. He earned his medical degree from Rush University in Chicago, where he was elected to Alpha Omega Alpha, the National Medical Honor Society. He completed his surgery and urology training at the University of California, Los Angeles and his advanced training in oncology and pediatrics at USC. Dr. Shapiro is board certified by the American Board of Urology. He is a member of the American Urologic Association and the California and Los Angeles Urological Societies and is a Fellow at the American College of Surgeons. He is the former Chief of the Medical Staff at Providence Cedars-Sinai Tarzana Medical Center.

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