The luck of the draw can be life changing. Ron Golan, MD was on a career path toward trauma surgery and disaster medicine. As a Fulbright Scholar at the University of Pennsylvania School of Medicine, he studied healthcare management during disasters and mass casualty events. He thought disaster medicine would be his life’s mission. But when the medical school’s system assigned him to the urology service during his surgical rotation, his trajectory changed.
“Once I saw what urologists do, my connection to the field was immediate,” he says. “The aspect of the field that attracted me initially, and that I still love, is its distinct parameters and results. In urology, patients typically seek help for a specific problem, and there are many well-defined treatments with proven endpoints and outcomes. For example, if someone has a complex kidney stone, we will identify a solution to break the stone and improve their quality of life almost immediately.”
Sansum Clinic’s Urology Department offers patients a wide array of treatment options including complex medical management and surgical choices for the entire spectrum of urological conditions. The department comprises a full team of collaborative professionals including nurses, medical assistants, and front desk staff who support five doctors. Along with Dr. Golan, who joined the team in September 2020, the department is anchored by Alexandra Rogers, MD; Alex Koper, MD; Scott Tobis, MD; and Daniel Curhan, MD.
“We have an agile group that delivers high-quality care to a very diverse patient population,” Dr. Golan says. “Patients benefit from the expertise of the entire team. We all work together at Sansum’s Foothill Clinic, and can discuss complex cases and review imaging to share professional opinions. Having that sounding board really improves the quality of patient care and contributes to the success of the entire department. Further, within Sansum it is really easy to share data and communicate across departments, which patients greatly benefit from as there is reduced redundancy in testing and more rapid access to critical information. Less fragmentation in healthcare results in better healthcare.”
Sansum Clinic’s Foothill Medical and Surgical Center recently completed a major renovation that provides the urology team with expanded state-of-the-art space and resources.
Personalizing Treatment Methods
Dr. Golan’s expertise is minimally-invasive surgery along with kidney stone disease. He also treats a wide variety of conditions related to general urology including the medical and surgical management of prostate gland enlargement, voiding dysfunction, erectile dysfunction, male sexual health, male fertility issues, blood or infections in the urinary system, diagnosis and management of both benign and malignant conditions involving the prostate, bladder, kidney, testes, or urinary tract.
Many procedures are office-based or performed in an outpatient setting at the Foothill Medical and Surgical Center. Those may include minimally invasive endoscopic procedures or other ambulatory urological procedures. Cases that require more involved open, laparoscopic or robotic surgery are usually performed at Santa Barbara Cottage Hospital and may require post-operative care during recovery.
Dr. Golan has a patient-centric approach. “I tailor treatment methods based on the individual characteristics of the patient, their condition, and their goals of treatment,” he says. “Not everyone is a good candidate for every procedure. I am very direct and honest with patients about their options and the risks and benefits of each option. And then we make decisions together.”
This methodology is important in Dr. Golan’s treatment of kidney stones. “Not every treatment of kidney stones is right for every patient,” he explains. “A lot depends on stone size and stone location. It’s important to balance the estimated success rates against the complication rates, with consideration of an individual’s risk tolerance profile. With more information, patients and their families can feel as though they are as well informed as possible before proceeding with any given intervention.”
Modern Care for Kidney Stones
Kidney stones are hard deposits of minerals and salts that form inside the kidneys and can cause problems along any part of the urinary tract from the kidneys down to the bladder. Dr. Golan says stones are formed due to a combination of diet, environment, and genetics. “The types of food people eat, the amount of fluids they drink, their lifestyle and even their profession can all contribute to the formation of stones,” he says. “For example, long-distance runners may be habitually dehydrated. Professions such as teaching in a school or working outdoors on a construction site may place people in situations where they can’t get to the bathroom often, so they reduce their fluid intake. That can contribute to the risk of forming stones.”
Dr. Golan says once a kidney stone has formed, it is very difficult to dissolve. The key then becomes taking the right steps to prevent the stone from growing, as well as preventing the formation of new stones. This involves a thorough metabolic evaluation of blood and urine parameters to identify how to best achieve this goal. According to the guidelines, patients who have had more than one kidney stone, have a family history, or are motivated to identify their risk factors should undergo a thorough metabolic evaluation.
Imaging for kidney stones
Dr. Golan prefers using ultrasound for imaging of kidney stones when possible because it provides valuable information without exposing patients to radiation. “I am very judicious with X-ray and radiation exposure,” he says. “Patients who form stones have a risk of increased radiation exposure over the course of their lives because the likelihood of stone recurrence is so high, and therefore they will likely have more X-rays and CT scans. Whatever we can do to minimize this risk of ionizing radiation is beneficial to patients.”
Observation of kidney stones
In the case of small, non-obstructing kidney stones, observation is a viable option as not every kidney stone will cause problems. Risks of observation include stone growth, stone passage resulting in pain, or risk of kidney injury due to chronic blockage. For those who are in high-risk professions such as pilots and flight attendants, truck drivers, or those who travel to remote or rural destinations, treatment may be preferable to observation.
Shockwave lithotripsy
A non-invasive method for treating kidney stones is shockwave lithotripsy, which uses focused sound waves to break up stones. “It is a great option, for the right stone in the right patient,” Dr. Golan says. “But it doesn’t work in all cases. As many as twenty to thirty percent may be unsuccessful. Therefore, patients must be okay with the possibility of needing an additional treatment when electing this procedure.”
Ureteroscopy
Ureteroscopy is another minimally-invasive method for treating stones whereby the surgeon inserts a very small camera into the urinary system through a natural orifice, and then uses lasers to fragment the stone so it can be easily removed. This process does not require an incision and has much higher success rates than shockwave lithotripsy, but at the expense of being more invasive. It also allows doctors to retrieve a fragment of the stone for metabolic evaluation.
Laser technology
Dr. Golan is an expert in the safe and optimal use of laser technology in urology. “There are two types of lasers that are typically used in kidney stone procedures: holmium lasers and the newer thulium lasers,” he explains. “They both achieve the same goal of fragmenting the stone. The thulium laser is one of the biggest advances in the field right now, and we regularly use it here in Santa Barbara. It’s a really powerful laser and also minimizes retropulsion, which is the upward movement of the stone in the urinary system that can add significant time to a procedure. That allows us to more efficiently pulverize the stone into fine dust that patients can pass spontaneously.”
Percutaneous nephrolithotomy
For larger stones over two centimeters, percutaneous nephrolithotomy (PCNL) may be recommended. In this method, the surgeon creates a very small incision in the patient’s back to allow surgical entry into the kidneys to more efficiently fragment and extract the stones. “PCNL provides us with the best chance of treating a large stone in a single procedure,” Golan says. “But it is more invasive. A lot depends on the patient’s anatomy and their stone characteristics, but this procedure gives them the best shot of getting stone-free in the shortest amount of time.”
Minimally-invasive surgery in urology – additional applications
Dr. Golan strives to offer patients minimally-invasive surgery whenever feasible. The robotic-assisted Da Vinci System is offered for many urologic surgeries, in both benign and oncologic procedures. With traditional laparoscopic surgery, surgeons control the camera and surgical instruments by hand. With robotic-assisted laparoscopy, they move surgical tools and a 3D camera using robotic arms that are controlled via a console. “Robotic surgery offers incredible visualization and optimizes our control and movement of the surgical instruments within the abdominal cavity,” he explains. “It is less invasive than open surgery, generally requires shorter hospitalization and recovery time, and is usually less painful after surgery."
An Ounce of Prevention
Dr. Golan supports lifestyle modifications whenever possible to address kidney stones and other urological issues. “For the motivated patient, proceeding without medicine or surgery is the safest and most sustainable approach whenever feasible,” he says. “I’m very supportive of diet and exercise combined with behavioral modifications, and I always discuss that with my patients. The best thing you can do is be proactive.”
For example, it is known that diabetes, high blood pressure, and an unhealthy diet can exacerbate erectile dysfunction. “The number one thing men can do to prevent erectile dysfunction is to maintain a healthy diet and exercise routine,” Golan says. “In a similar manner, when I meet men with voiding issues for the first time, it’s always important to start with behavioral changes including voiding more frequently and with patience to ensure complete emptying, hydration, avoiding constipation and doing Kegel exercises, which involves strengthening the muscles of the pelvic floor to build strength.”
Golan advises preventative measures to reduce repeated kidney stone formation. “Fifty percent of people who have had one stone in their life will get another one,” he explains. “Metabolic evaluations that analyze factors such as urine, blood, and diet can help us determine why a patient formed a stone and how they can prevent them from recurring. But even if you have a healthy diet, that doesn’t mean you won’t form stones. Certain nutritious foods such as spinach and nuts have high oxalates, which may predispose people to forming kidney stones. Also paradoxical is that even though most stones are calcium-based, a low calcium diet may increase your stone risk if combined with high oxalates.”
A healthy lifestyle is not always sufficient for preventing disorders. Dr. Golan advises people to not delay seeking medical care for persistent symptoms. “Because urologic conditions and sexual health are private matters, a lot of people will suffer silently because they are embarrassed to discuss their condition or think there is no treatment available for them,” he says. “They may be unaware that we deal with these things professionally on a regular basis. And we have so many options that can help them. I treat people all the time who tell me they wish they had talked to a professional sooner about their condition. This goes back to being proactive. With awareness, anticipation, and planning, a lot of issues can be caught and treated early.” R
Dr. Ron Golan is a fellowship-trained urology specialist. He completed his residency at Weill Cornell – New York Presbyterian in New York City, and an endourology fellowship at Columbia University Medical Center. The Jersey Shore native graduated from the University of Pennsylvania School of Medicine. He began working with Sansum Clinic in 2020. Dr. Golan has published more than 20 articles in major urology journals and is the co-author of a textbook titled Operative Dictations in Urologic Surgery, which is a step-by-step guide for more than 120 common urologic surgical procedures. Along with his interests of reading and writing, he enjoys an active Santa Barbara lifestyle and spending time with his family.
For more information or to schedule an appointment, please contact the Sansum Clinic Urology Department at (805) 681-7564.
Sansum Clinic Foothill Medical & Surgical Center is located at 4151 Foothill Road - Building A, Santa Barbara, CA 93110.