Practice Profile: BPH Canada

Urology Times’® Practice Profile series takes readers behind the scenes of US and Canadian-based urology practices. From solo practitioners to large groups, each installment highlights these practices’ unique qualities, successes, and challenges. To have your practice featured in this series, please email Hannah Clarke at hclarke@mjhlifesciences.com.

Kevin Zorn, MD, FRCSC, FACS

In this installment, Kevin Zorn, MD, FRCSC, FACS, highlights his disease-specific practice, BPH Canada, which he designates as a “one-stop shop” for patients with benign prostatic hyperplasia (BPH).

Could provide some background on yourself and your practice?

I am Kevin Zorn. I was born and raised in Montreal, Canada and completed my undergrad and medical school training at McGill University. Thereafter, I got inspired to do urology. That was around the age where robotics was introduced into surgical care which directed me into fellowship training. I then travelled to the University of Chicago and underwent a 2-year fellowship in cutting edge robotics, laparoscopic and laser surgeries. Timing, again, is everything. I was fortunate to be mentored by Dr. Arieh Shalhav, Dr. Greg Zagaja, and Dr. Gary Steinberg. I was also surrounded by other great fellows including Dr. Marcelo Orvieto and Dr. Ofer Gofrit who helped our research and incredible publications. The energy was there, the research database was there, so, it worked out great. Upon completing the fellowship, I then stayed on faculty for another few years. I also brought in some of the BPH techniques (laser, enucleation) I had acquired from McGill from the former Dr. Mostafa Elhilali, who was a mentor of mine as well.

Early on in my academic journey, there was a potential for me to be distinguished, aside from being one of the many urologist surgeons in the mid-west offering robotic surgery. In the Chicago area, no one else was performing laser BPH surgery, so that gave me an edge to be competitive in a huge city like Chicago. After having our firstborn child, we moved back to Montreal Canada after being recruited to develop a robotics and MIS BPH program. And, lo and behold, BPH and all the cool technologies that exist now, flourished. Throughout this journey, I had an opportunity now to create, after 18 years of academic urology, something that's unique: a one-stop BPH shop option.

Most patients, if you have an enlarged prostate, you go to a urologist, and quite commonly, in the surgical armamentarium of that urologist, they may have 1 or 2 surgical treatment options. There are now 8 or 9, but they're going to offer 2. Most men don't know their prostate size; they don't necessarily know if they have a median lobe. So, they come to the urologist, and then they start that engagement. Most often, it's an initial consult and then they come back for other studies, imaging, cystoscopy, urodynamics. After you’ve identified what your prostate size looks like, then you look at your treatments. What does my provider offer?

Our Canadian health care structure is socialized, so the process and timing between studies and visits are much slower in Canada. Most patients don't have the same opportunities in the USA to getting second or third opinions in the public health sector. Even the time from primary care physician to urology consultation can take 6 to 12 months. So, we developed BPH Canada. It's a unique clinic that's open to all Canadians and offers a one-stop shop for BPH solutions. A patient will come in and I'll do the cystoscopy, the ultrasound, the uroflow, and all the necessary questionnaires in a 1-hour setting. So, after 1 hour, they walk out knowing what's going on and they have all the decision-making details at hand. Moreover, we also take the time to study all the approved surgical BPH options. Of those 9 different treatments, we narrow it down. Then, we really get personal. Are you sexually active? How often you having sex? Is ejaculation important to you? What are your desires for durability and recovery time? How do you feel on post-procedure catheterization?

In our environment, the average time with a urology physician in the public sector is 7 to 10 minutes per consultation. Most urologists in Canada are seeing 50 to 60 patients per day, divide that by 8 hours. Here, we have a great opportunity to provide private, personalized consultations in the 1-hour setting. That's what BPH Canada is all about.

What are some challenges that you have faced in getting started? How have you overcome those obstacles?

Well, I think the first thing is believing in yourself. You're in the battleship of the public sector system. You just turn the sign open, and your clinic is full. As such, the case volume is there, and patients need you. The downside to that is it may not be necessarily the case types I specialize in. My focus is BPH, but I'm seeing hematuria, orchialgia, trauma, kidney stones; even though it's not really my academic focus. So, I think the biggest challenge is believing in yourself and taking a jump and investing in yourself.

Over a period of 3 months, I traveled North America to other urology experts and got on-boarded with UroLift and a few other training sessions. I took the time to visit other expert clinics and saw what that structure looked like. If you want to be the best, go to the best, see what they do, and pick the feathers from everyone's hat and make your own wings that are even bigger. So, I think that would be part 1 is overcoming that fear and believing in yourself.

There is also a challenge to find a location. You want to find a place where you're going to be able to set up structure and have the resources needed. I was very fortunate; one of my chief residents, Dr. Andrew Steinberg, went into the private sector 5 years ago and has great experience. As such, his support and mentorship were a tremendous icebreaker. For years, we've been saying we should work together. At time point, we decided this may be an opportunity to work together and for me to join his team of incredible nurses, secretaries, and co-workers. To already have that mature system established, that learning curve had been overcome and made the initiation of BPH Canada center far easier.

I think another part is learning how to get the word out. You can't just say “I'm Dr. Kevin Zorn, I've been the author of the national guidelines. I'm part of the BPH committee in the USA.” That's my CV, but it doesn't mean much. You have to be creative and think, “How do I get that message out there?” It was a learning curve to get the word out that I'm here and that I'm offering these unique services. Getting onto Google and creating a web page, that was completely new. [I spoke with] Dr. Amy Pearlman and Dr. Rahul Mehan about use of social media. This was definitely a step to the side, a reset, and an opportunity to create my dream of what I'd like to see; I like 15 patients in a day, all for BPH and the things I do best. I feel so much more fulfilled giving that kind of care to patients. So, [the challenge was] getting the word out in a friendly, educational matter through touching base with website developers and using Instagram and social media. Educational pieces have been part of the weekly or biweekly activities now, [where I] record what I'm doing and what we're bringing in new. So, that's quite exciting.

What are some wins that you have experienced since getting started?

We're relatively fresh; BPH Canada started in January. But the big win would be getting technology that normally would take years to come into the hospital system. In the Canadian system, you need to build a file or dossier, as they call it, where you need to justify why you want to bring in some new technology. There's a fixed budget created yearly for a disease space or for a specialty like urology in the public health system. You have to fundraise or take money from another technology to bring anything new into the hospital. This can take years.

In some cases, like the da Vinci robot, in all of Canada, there are only 30 robots. Whereas in Chicago itself, there's well over 30 da Vinci robots, because it's a completely different mindset. So, a technology like Aquablation, I just went out and helped get it for our program. As of a couple of months ago, we were among the first Aquablation center for all of Canada, and the first in the world for an ambulatory care center. We perform this robotic BPH surgery as outpatient procedures, and that's what's being offered through our BPH Canada clinic.

If we want to bring it in, I speak with Dr. Steinberg and his team, and if it's FDA approved and Health Canada approved, we can bring it in to treat our patients. There's a lot less paperwork and administrative bureaucracy that unfortunately burns out a lot of physicians. I’ve seen all too often the passion, drive, and academic pursuit sizzle due to such perpetual frustrations. At the end of the day, we can deliver the best, newest technology earlier to patients and in a timely fashion. More specific, the patients don't have to wait months to come in. The time they see me to surgery is under 2 to 4 weeks. So, that's a huge win there.

The other thing is clinical trials. We're one of the few centers in Canada where we're going to offer Optilume. It just got FDA approval, and we're running a clinical trial here for about 30 men to be done in an outpatient [setting] instead of under general anesthesia under a local block. So, we're enrolling patients for that.

Those are the wins I would look at. I think the medal is that you can see that when patients come in, there's a stress that we take off them with just the knowledge that they're in experienced hands and they can get service quickly and tailored to what their needs are.

What are the services that you offer?

If you go to www.BPHCanada.com, the treatments span the BPH world and some in men's health. So, the upfront BPH, we offer the good old classic medications, medication to shrink the prostate, and surgery. We do TURP, the gold standard, and everyone's offering that. That's usually the staple to all urologists for BPH care; no matter what your prostate size is, they will offer simply a TURP. Well, there are high retreatment rates, you have typically only < 1 hour to resect tissue during TURP to prevent complications, there's bleeding, and you have to be in the hospital for 1-2 days after surgery.

Beyond TURP, then we also offer laser surgery including the GreenLight laser BPH procedure. As with all lasers, it emits energy through a focused beam of light that then rapidly gets transmitted to the tissue, vaporizes it, and creates coagulation. So, men who are older, who are on blood thinners, who have a tendency for bleeding, Jehovah's Witnesses, these are all patients where we don't want any bleeding and we want to go home the same day, so GreenLight is a wonderful, safe and well-studied, proven option.

And then enter Aquablation. So, unlike a laser, you're moving around and you're fulcruming on the sphincter muscle; that's the sphincter for the Kegel muscles, the pelvic floor. There's potentially a little bit more risk of urinary incontinence, especially with HoLEP, another end firing laser. So, this is the latest and greatest. It's ultrasound-guided and planned and robot-executed, so it’s precise and has very little ejaculatory dysfunction. So, that's Aquablation.

Then we have the minimally invasive surgical therapies (MISTs). That’s the latest in the past 5 years. We offer Rezum. I joke with my patients that if they’re an Amazon-now guy, [meaning] you want your stuff today, don't go with Rezum. We also have stents, so there’s the UroLift. And we have the ZenFlow, which is a small spring, and we were part of the clinical trials for. Then there's the iTind. And the latest one is the Optilume.

Those are all the BPH modalities we have to date. Depending on the size, shape, and what the patient is looking for, we have a solution for them. A complement to that is the men’s health [offerings]; I'm doing male circumcisions, a penile girth enhancement procedure for certain patients looking for that element of their sexual health, and also testosterone replacement therapy. We also have some other things like for men's hair loss and a few others that Dr. Steinberg and his team has complemented with as well.

What is the makeup of your staff and the roles associated with your practice?

Just like anywhere else, I think it's a team approach. That's crucial from the phone call in to our 3 secretaries. I'm blessed by having Val, Aja, and Karen who [work] the front desk. We have Laura and Audrey on our team who answer emails. Patients call in or email info@BPHCanada.com, and they get a rapid response within 24 hours. That first experience and that first contact is as important for me as the surgery. From beginning to end, I think that's so crucial to having a good patient experience.

[As for] the nurses, we have Sharon, Kiren, and Rachel. They're great in terms of being there for the patient, prepping them for some of the MISTs we do here to the procedure itself, even just with that verbal discussion, reassuring them they're in good hands and coaching them. The setup, the ordering of the materials, whatever it is, they're there. So, that's fantastic.

And Stephanie, who's the office manager, I couldn't do it without her in terms of the marketing aspects, contacting patients, and any new materials we have to get in; she's been paramount for that.

And then the colleagues. So, I'm working with Dr. Richard Sioufi, Dr. Anis Aziz, and Dr. Andrew Steinberg, and we share ideas among each other. Among the referrals, we help each other out, and that camaraderie is huge.

On-site at BPH Canada, we have beautiful newly renovated office-space for consults, Uroflow technology, cystoscopy equipment, and everything that leads up to the proper diagnosis. As for surgery, I perform all procedures needing general anesthesia at another site. That's at Rockland MD, which is about a 10-minute drive from here. I have been working there alongside with Savy and her twin sister Maria who are phenomenal nurses who take care of patients all the way through including postop.

So, there's me, but I'm surrounded by these different team members that really make up the whole picture. The level of involvement, the passion, and the turnaround [are important]. Everyone at Rockland and many people I mentioned have all been here for 5 years. One thing I found at the hospital is every 6 months or a year, there's a lot of turnover. When I come to my team here, it’s the same team. I come in and they know, “Dr. Zorn likes to use this piece of equipment first,” or whatever it is. It's ritualistic. If everything is in the place that you like it, it allows you to focus 100% on what you need to do vs being distracted. So, if I can be the best environment with the best team, it just adds to the patient experience and the patient outcomes.

And it's the small details. There's such an appreciation for all those small details that make the experience better. The compounding details, the passion, the people, and the options are what I'm trying to make of BPH Canada. I'm blessed to be in an environment like this.

What are some unique elements to your practice?

In the next 10 years, the patient population over the age of 60 is going to double or triple. At least in my field, BPH and urology, there's going to be a bigger tidal wave coming toward us as urologists. If we look at the American Urological Association [AUA] census, and I give full credit to Dr. Claus Roehrborn, MD, from UT Southwestern, who really picked apart the AUA census. The average age of most urologists is 50 to 60, and the number of new residents that are going to fill our places will keep steady.

So again, [there will be a] doubling or tripling of the aging population, and the work force to maintain or keep up with that will be at best stagnant. So, there's going to be a lot of untreated BPH. And sprinkled in with the aging population, we're also living longer, which is good, but there are even more men to treat. By focusing in on BPH and delivering that, at least this disease space will have a home, and I'm excited to hear that there are a few other people looking to do similar practices across the globe.

Is there anything else you’d like to add?

I love being a urologist and love treating men for BPH. I'm passionate about it. I've been part of the guidelines and other things in my life. To [be able to] offer all options to any Canadian man who's suffering and having that as a free choice is the most rewarding aspect.

You can learn more about BPH Canada here.