Dr. Brandes, what influenced you to select medicine for your career and urology as your specialty?
I always knew I was going to be a physician. Many people in my family are doctors, including my father, brother, uncle, and sister-in-law. As I was growing up, there was never really another profession under consideration. My father was a gynecologic surgeon and he had a big influence on my eventual career choice.
The choice of urology as my specialty came later during medical school. A friend of my older brother, who was a urologist, suggested I give the field some study. As a result, I did a rotation and sub-internship in urology while in medical school. I found that Urology was a great combination of medicine and surgery. Now, for example, many of my patients are followed long-term, with medical interventions; with slightly more than half being surgical patients. I think urology gives a physician the best of both aspects of clinical treatment.
What aspect of your practice is most interesting?
My subspecialty is reconstructive Urology - reconstructing urologic organs and repairing injuries of the genitourinary tract due to cancer, radiation treatment, trauma, or infectious disease. Among these are patients with radiation fistulas and those who need reconstruction of their urethra, ureter, bladder, or external genitalia. The cases are challenging, difficult, and include patients that other urologists are reluctant to or do not know how to treat. In that sense it is intellectually satisfying to determine what the problem is and to devise ways to give the patient a successful outcome. Our long-term surgical success rate is at least 80%; and considering how much tissue has been lost in many cases, this is quite good.
Reconstructive urology is an extremely focused field and that aspect also appeals to me. I am more comfortable knowing all the aspects of and being an expert in one field, rather than dealing with a more general area of medicine.
My bench research interest is in wound healing and tissue engineering for replacement of tissues from traumatic injuries or tissue ablation. And of course I enjoy the academic exercise of teaching medical students and residents and being in the intellectual environment of a medical school.
How did you come to your interest in reconstructive urology?
I lay credit for my subspecialty interest to three mentors that I had during residency and fellowship training. First, was my Chief Resident in Urology, Dr. Mark Chelsky, who encouraged me to do outcomes clinical research on penetrating ureteral and genital injuries. These became my first couple of peer review publications in urology trauma and reconstruction. My second mentor was the Chief of Trauma at Temple University, Dr. Bob Buckman, a larger-than-life surgeon and army colonel. He was a key advocate and supporter, who invited me as a junior resident to be the guest editor of The Trauma Quarterly, a journal he edited. This was a big honor and a great success. Based on my initial success and interest in urologic trauma and reconstruction research, I went on to UCSF for extensive specialized training, under the mentorship of Dr. Jack McAninch. At the time of my fellowship, nearly 20 years ago, reconstructive urology was a very new subspecialty, just in its nascent stage, and not the established and codified field it is today.
What do you see as the future for urologic surgery?
Like other surgical specialties, urologic surgery will move to a less invasive mode. The use of radiofrequency ablation, percutaneous procedures, laparoscopy, and other minimally invasive methods will reduce the demand for traditional open surgery. Urological surgery in particular is technology driven. As technology improves, we will need less open surgery to remove tumors or repair tissues.
In reconstructive urology, we will begin to rely on tissue engineering or regenerative medicine. Instead of reconstructing a urethra or bladder, we will take an off-the-shelf tissue or organ construct and implant it in the body. Clearly this is the future of reconstructive urology.
Why did you choose Columbia University?
After 17 years in St. Louis at Washington University, I was looking for new challenges and an opportunity to reenergize and reboot. Columbia University and NewYork-Presbyterian Hospital are world class institutions that do not sit on their laurels and are always striving for excellence and have a vision for continued growth and innovation. It was very attractive for me to be part of such visionary and innovative institutions.
Which academic achievement has been the most gratifying to you?
I still have long way to go in terms of my personal and academic achievements. However, the achievement I am most proud of are my former fellows in reconstructive urology. Nearly all my fellows have gone on to become successful academic faculty at major universities and medical schools across the county, and even internationally, as in Sao Paulo, Brazil. It gives me great pride and fulfillment to see my former fellows doing so well.
What clinical and surgical experiences are most gratifying to you?
One of the more fulfilling and meaningful aspects of my profession are the surgical mission trips I take each year to a non-industrialized country. Over the years, I have operated on many indigent patients in Honduras, India, Nepal, Thailand, and Haiti. Some of the most complex reconstructive surgeries I have ever performed have been overseas, as the degree of traumatic and congenital urologic injuries are often more severe and acute in the underdeveloped world. Patients in such poor countries are typically very stoic, proud, and humble – good inspirations for us all.
What is the best career advice you ever received?
From a surgical point of view, two phrases I remember from my mentors were, “think fast, move slow” and “selection is the silent partner of the surgeon”. What this means to someone in my field, deciding who you operate on and when, often determines success more than does surgical skill. We want the tissues to be in the best possible condition, so rushing into surgery may not be the best option for a successful outcome. We always do the best possible surgery we can, however, sometimes the tissues have a very poor blood supply and quality and are thus sub-optimal. Thus, occasionally we cannot perform a total reconstruction and have to go with an alternative therapy that improves quality of life but does not restore to “normal” function. Most of our surgeries are about quality of life, and complex, surgical options are decided on by “shared decision making”, taking into account patient goals and expectations.
What do you do in your spare time?
I play acoustic guitar and mandolin. I inherited a 1920s, Gibson A4 mandolin from my grandmother a few years ago. In her honor, I took mandolin lessons for a while. I enjoy playing flat pick guitar and bluegrass mandolin songs. I have a good friend who plays in a bluegrass band, and I hope one day to play well enough to be on stage with him.
For exercise, I usually bike a few times a week and spend quality time with my family, as we chase after our kids.
What lifestyle change could most benefit our health?
I think it is still true – “mens sana in corpore sano” – sound mind in a sound body. If you have good mental health, your physical health will be better and vice versa. Change your behavior and good things will follow.