Dr. Friedlander is director of Endourology and Einstein’s Comprehensive Kidney Stone Center. He specializes in the treatment and prevention of kidney and ureteral stones.
Perspectives: What is endourology?
Dr. Friedlander: It originally meant endoscopic, scope-related treatment of stones. It’s been broadened over the years to mean any urologic procedure that requires a scope. It encompasses minimally invasive urology, whether it be ureteroscopy for stones in the kidney, whether it be laparoscopy for removal of a kidney, or robotic surgery—it’s all under the umbrella of endourology. It was a term coined by one of my mentors at the Smith Institute for Urology. His name is Arthur Smith (MD, chairman emeritus of the Department of Urology at the Long Island Jewish Medical Center). He’s thought of as the father of Endourology. I was very fortunate to have worked with him.
Perspectives: How did that happen, and how did you decide to get into this field?
Dr. Friedlander: I was interviewing for residencies and, not knowing what I specifically wanted, I happened to go into that program. It was my top choice. I was fortunate. They had a fellow in urology but as I was transitioning from general surgery to urology, that fellow did not come to do his fellowship. I was the junior resident on service and for whatever reason, my upper-year colleagues didn’t really want to do much of the kidney stone cases, which I realize now is because they went later into the evening. Every Tuesday and Thursday, you were there late.
Being on the service of Dr. Smith and Dr. (Zeph) Okeke, who was his junior partner, I was thrust into the role of assistant on those cases. I just got very comfortable with the scopes and I grew into it.
Perspectives: How common are kidney stones?
Dr. Friedlander: The latest prevalence data suggests that one out of every 11 adults in the U.S. will have a stone at some point in their lifetime. It’s more common than most people think. However, once you have a stone, if you start asking around, a lot of people you know will say, “Oh, yeah, I had a stone.”
Perspectives: Are kidney stones becoming more prevalent?
Dr. Friedlander: As they keep updating the studies, the prevalence continues to rise over the last several decades. For a lot of people, there are dietary reasons. Western diets are very lithogenic (more likely to cause stones) in nature. The rise in obesity, the rise in diabetes, both of those conditions are associated with stone formation.
Perspectives: What treatment approaches are available to you now that might now have been available, say, 10 years ago?
Dr. Friedlander: From a surgical perspective, the three main treatment modalities, essentially they’re getting minor changes.
You have the shock wave lithotripsy, which is completely non-invasive. You use sound waves that are focused on the stone to break it. That technology continues to be refined.
Ureteroscopically, that’s when we use a scope to go through the urinary system. It’s minimally invasive. Instruments continue to get smaller. Different disposable graspers and lasers are developed, but it’s essentially the same procedure.
'I wanted a job where my chair was willing and wanted me to focus on what I loved and what I was passionate about.'
Then there’s percutaneous surgery, going through the flank directly into the kidney. The progress has been smaller incisions, smaller scopes, trying to miniaturize as best we can. That’s the trend, but in essence, it’s the same procedure. There’s only so many ways you can get from the external world to the kidney.
Perspectives: Is there anything different about your approach?
Dr. Friedlander: Most urologists have not been trained or are not comfortable doing their own access into the kidney. In my fellowship and residency, I was the one getting access into the kidney and taking care of the stones. For those urologists who don’t get access, they generally have an interventional radiologist do it, but the benefit is, there may be times when your radiologist might not get to the right part of the kidney you need, or there may be long delays.
Perspectives: You’re also involved in stone prevention.
Dr. Friedlander: It’s easy to see stones as an acute event, and you just feel better when it’s gone. But I view it as a chronic condition. Some people are fortunate in that it’s a very stable, mild condition. Some people are less fortunate; they’re more recurrent. It’s people who have already formed multiple stones who need prevention to keep them from needing procedures, to prevent them from episodes of pain and infection.
Perspectives: What do you do to prevent stones? Is it a combination of things?
Dr. Friedlander: It’s blood studies, laboratory studies, looking at certain potential conditions that could be reversible, like overactive parathyroid glands. For the majority of patients, it involves serial studies of urine, where we have them collect their urine for 24 hours.
Samples of that are sent to the lab and get analyzed for the major factors that go into stone formation, evaluating their parameters in the context of their medical conditions, and then instituting dietary and/or medical therapy as needed.
Perspectives: Why did you come to Einstein?
Dr. Friedlander: I wanted a job where my chair was willing and wanted me to focus on what I loved and what I was passionate about. Looking around, I met Dr. (Robert) Uzzo (chairman of urology at Einstein). He is a great leader. He really had a vision for what he wanted to do with the department at Einstein. I felt very confident that with him being my boss, I would be able to develop the Stone Center, where I could do both high-quality surgery and provide the medical care.I didn’t see in other areas I was looking at.
I should add, too, that I am from the Philadelphia area. The opportunity to come back and watch my sports teams, albeit they’re not so great these days, was a little bit of a draw, too.
What music do listen to when you’re performing surgery or doing a procedure?
I usually let the staff or the residents choose. I tend not to want anything that’s too slow or sleepy, and I’m not the biggest fan of country music.
What’s your favorite book?
The Count of Monte Cristo. I read it a long time ago. It really captured my attention, despite its verbosity at times. More recently, I’ve been reading Michael Chabon (author of the Pulitzer Prize-winning The Amazing Adventures of Kavalier & Clay).
What’s your favorite movie?
I love comedies. My favorite movie comedy is Old School. No matter when it’s on, no matter what part it’s in, I’ll watch it. For drama, The Shawshank Redemption.
What is one thing that people might not know about you?
I love “Jeopardy.” I tried out for “Jeopardy.” I haven’t heard the result yet, but I’ve taken the online test. I’ve always dreamed of one day being on “Jeopardy.” My grandfather loved “Jeopardy.” My mom likes “Jeopardy.” I love “Jeopardy.” I DVR “Jeopardy.”