Dr. Steven Brandes is a professor in the Department of Surgery, the Division of Urologic Surgery. In addition to treating male and female urologic conditions with the full range of medical and surgical options, he is one of the few subspecialists in reconstructive urology in the Midwest.
|Dr. Brandes volunteers surgical care in less developed countries. Here he is in Bhopal, India with other physician volunteers (He is second row, left)
Dr. Brandes sees patients at the Urologic Surgery Center in the Center for Advanced Medicine, 4921 Parkview Place, St. Louis, and at Professional Building One, 1040 N. Mason Road, Creve Coeur (near Olive and Highway 270).
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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 another profession under consideration.
The choice of Urology as my specialty came later in my medical education. My older brother had a friend who was a Urologist, and he 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 good combination of medicine and surgery. Now, for example, many of my patients are followed long-term with medical interventions; while slightly more than half are surgical patients. I think Urology gives a physician the best of both facets 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. These tissue injuries are due to cancer, radiation treatment, trauma, or infectious disease. We are a Midwest referral center and deal with many patients who travel long distances for their surgeries. 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 treat or are unsure 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 85%; and considering how may patients have lost considerable tissue prior to reconstruction, this is quite good.
Reconstructive Urology is an extremely focused field and that aspect appeals to me. I am more comfortable knowing all the features of and being an expert in one field, rather than dealing with a more general area of medicine.
My research interests are in wound healing and tissue engineering for replacement of tissues lost from traumatic injuries or tissue ablation.I greatly enjoy the academic exercise of teaching, being in the medical school environment and being the residency director for the Urology Division.
What do you see in 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. Urologic surgery, in particular, is technology driven. As technology improves, the less we will rely on 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 chose Washington University ?
When I finished my Fellowship at University of California at San Francisco in 1998, there was no doubt in my mind that Washington University Medical School would be the best opportunity for me - from both the clinical and the research perspectives. Washington University Urology Division has an excellent reputation and is known nationally and internationally.
Which achievement has been the most gratifying to you?
I have long way to go in terms of personal and academic improvement. Ask me that question ten years from now.
What is the best advice you ever received?
From a surgical point of view, two phrases I remember from my mentors are “Think fast, move slow” and “Selection is the silent partner of the surgeon”. What this means to someone in my field is that you must determine the most opportune time to operate on a patient, if at all. We want the tissues to be in the best possible condition, so rushing into surgery may not be the best option for a successful surgery.
What do you in your spare time?
I play acoustic guitar and a Gibson A4 mandolin that I inherited from my grandmother. This has led me to take music lessons a couple times a week. I hope to get good enough to join a bluegrass band with other surgeons here at the medical school.
Each year I volunteer one week of my time to operate on indigent patients in an underdeveloped and medically undeserved country. Over the years I have been to Thailand, Nepal, Zambia, Honduras and India. On one trip to Bhopal India, we performed over 200 urologic surgeries in less then a week.
In your opinion, what life style change would most benefit our health?
I think it is still true – mens sana in corpore sano – sound mind in a sound body. If your mental health is good, your physical health will be better and vice versa. Change your behavior and good things will follow.
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