A Publication of WTVP

Joseph Banno was born in Chicago. He attended Leo High School and St. Procopius College, majoring in biology and biochemistry. After completing college he received his medical education at the University of Chicago and was president of his graduating class in 1975. He spent two years in a general surgery residency at Saint Francis Medical Center, then attended the University of Chicago in a comprehensive urology program. During his training he spent time at Children’s Memorial Sloan Kettering Cancer Institute in New York. Upon returning to Peoria in July 1980, he joined a urological practice.

In 1983, Banno had his first glimpse of a new method for fragmenting kidney stones: extracorporeal shock wave lithotripsy. Armed with knowledge of this technical breakthrough, he and Dr. Robert Flinn convinced Saint Francis Medical Center that it was a needed technology. Peoria became the first extracorporeal shock wave lithotripsy treatment center in Illinois.

Over the next few years, Banno and Dr. Robert Stuart opened a new office building and an ambulatory surgery center. This culminated in the formation of Peoria Urological Associates and Peoria Day Surgery Center at 7309 N. Knoxville.

The city’s first free-standing ambulatory surgery center was created to offer patients an alternative for surgical treatment, while still providing cost effective quality medical care. After several years, Peoria Day Surgery Center received permission to build one of the first recovery care centers in Illinois. This demonstration project allows patients to spend up to 72 hours at the six-bed facility.

Three years ago, Banno began his most challenging project to date: assisting in development of the world’s first mobile ambulatory surgery center. This self-contained mobile surgery unit allows for medical and surgical treatment in remote areas of the world. The first unit was purchased by the United States Army for breast cancer research. Ultimately, sales are projected for Europe and South America, as well as rural areas of the United States.

Banno and his wife Tamilyn have six children: Daniella, 12; Joseph, 11; Gabriela, 9; Maria, 7; Tamilyn Christiana, 6; and Alesandra, 3.

You’ve been practicing medicine for seventeen years. Tell us how you became interested in being a doctor and why you selected urology as your specialty?

It is exciting to reflect that I am starting my seventeenth year in the practice of urology. I first became interested in medicine while attending Leo High School in Chicago. My uncle and grandfather, Dr. Vincent Renzino, was instrumental in introducing me to the practice of medicine. My grandmother, more, and father were extremely supportive of my pursuit of a medical career. At one time, though, my mother has aspirations of my becoming a priest. I toyed with the idea of being a missionary priest for a short period of time, but quickly realized that God had other plans in mind. At St. Procopius College (now called Benedictine University) is Lisle, Illinois, I majored in biology and biochemistry. During my junior and senior years, I worked at Argonne National Laboratory in the high energy physics division. It was there that Dr. Finley Markley was performing basic research on the artificial kidney. During this time I found I really enjoyed studying the physiology of the kidney.

During my first years of medical school at the University of Illinois in Chicago, I was certain that I could become a pediatrician or family practitioner. The thought of being a surgeon never really entered my mind. It was during my junior year in medical school that I encountered my first surgical rotation. During this segment, a disciple of the father of modern day surgery, Dr. Warren Cole, would instruct his residents that “a monkey can perform surgery, but it is knowing how to take care of sick patients, and knowing when and when not to operate that makes a great surgeon.” I found this segment of medicine extremely exciting. It was then I realized I would follow a surgical specialty.

Immediately following my general surgery rotation, I entered the discipline of urology. One reason that urology appealed to me is that I was able to perform operations and take care of patients in the office, thereby combining the best of surgical and medical practice. After my junior year of medical school I decided to pursue a career in urology.

Who were your mentors within the Peoria medical community and during your education as a physician?

I began my surgical residency at Saint Francis Medical Center where I was introduced to Dr. Stuart Roberts, chairman of the surgical residency program. His technical expertise, combined with his compassion for patients, was an inspiration to all the surgical residents. At one time, Dr. Roberts tried to convince me to stay in the general surgery program, but my desire to pursue a urological career remained.

During my two years of surgical training, my faculty advisor, Dr. Robert Flinn, became my mentor. Following my surgical residency at Saint Francis Hospital, I continued my residency at the University of Chicago in the department of urology. The University of Chicago had some of the most outstanding urologists in the field of medicine. One in particular, Dr. Charles Huggins, was the only urologist who received the Nobel Prize in Medicine for his work on prostate cancer.

Two months into my urology training, my father died. This was a very difficult time for me. Dr. Harry Schoenberg, head of the urology department, became my mentor and, more importantly, a good friend.

Another professor, Dr. Edward Lyon, was a researched and clinician. It was at the University of Chicago that Dr. Lyon developed ureteroscopy. I was fortunate enough to be one of the first residents in the world to perform ureteroscopy. I remember while presenting a research paper on ureteroscopy at the chief residents meeting in San Francisco that some of the most famous urologists in the world discussed ureteroscopy. It was their conclusion that it held very little promise for the future of urological medicine. I am happy to say now that the ureteroscope is the basic instrument used by every qualified urologist in the world.

What are the different fields of practice within urology?

One of the early reasons for choosing urology is that I thought I would become an expert in every aspect of the practice. However, as time progressed I realized I was quite mistaken. There are several different disciplines within the scope of urology: pediatric urology, surgical oncology, infertility, incontinence, stone disease, and erectile dysfunction, just to name a few. Therefore, one can only hope to focus on a few of the major aspects of urology.

It appears that public awareness of prostate cancer is increasing. Is there a higher incidence these days or are men just becoming more willing to discuss and face up to the problem?

It is true that public awareness of prostate cancer is increasing. Prostate cancer is a very complex disease – the awareness level is where breast cancer was ten years ago. More cases of prostate cancer are being diagnosed than ever before. Approximately 314,000 new cases of prostate cancer were diagnosed in 1996. This is due in part to the tremendous campaign that The American Urological Association and The American Cancer Society have provided.

The third week in September of every year is dedicated to prostate cancer awareness. During this period, urologists across the nation provide a digital rectal examination and blood test determination of PSA (prostate specific antigen). Peoria Urological Associates (PUA) was the first in central Illinois to perform the free service. These screenings have been so successful that we have added several additional screenings throughout the year.

It is recommended that men over 50 receive a digital rectal examination and a PSA blood determination on an annual basis. If there’s a family history of prostate cancer, this annual examination should begin at 40. African-American men, who have a higher incidence of prostate cancer, should begin their annual screenings at age 40.

In layman terms, what are the basic treatment options?

This is a complex problem, and no one treatment is always best. The main treatments include surgical removal, external beam radiation, implantation of radiation seeds, chemotherapy, hormonal manipulation, or observation.

The treatment of prostate cancer is very controversial. However, if you have a young individual with a high-state cancer, his best chances for long-term survival are with surgery. If you have an older individual with a low-stage tumor, then implantation with radioactive seeds may be appropriate. As in all treatment modalities, it takes a concerted effort among the family practitioner, the urologist, the patient and the family to decide on a viable option for that particular patient.

What general advice do you have for men in terms of reducing the seriousness of the cancer or the risk of getting it?

The only clear method of reducing one’s risk for prostate cancer is regular exercise combined with a low-fat diet. There have been numerous studies indicating other causes for prostate cancer. However, at this time reducing fat intake appears to be beneficial. A recent study showed men who have regular digital rectal examinations and PSA blood determinations have a very low incidence of advanced disease.

Treatment used to include several days’ stay in the hospital. Can you discuss the current trends in providing health care not only for urology, but medicine in general?

It is amazing how surgeries and hospital stays for patients have changed during my short time in practice. In 1985, patients would spend seven days in the hospital for a routine operation for benign enlargement of the prostate. Now this procedure can be performed on an outpatient basis or with only a one or two day hospital stay.

Ten years ago, patients being worked up for having blood in the urine were admitted the night before, underwent an x-ray of the kidneys and bladder, underwent cystoscopy the following day, and were discharged from the hospital on the third day. Now the combination of x-rays and cystoscopy can be performed on an outpatient basis.

It is estimated that 72 percent of all surgical procedures are performed on an outpatient basis. Clearly 92 percent of all surgical admissions can be completed within less than 72 hours. The longer a patient stays in a hospital, the greater the chance for infections to occur. It is for the above reasons that almost nine years ago we began planning the development of Peoria Day Surgery Center.

Can you give us an idea of the kinds of procedures performed at Peoria Day Surgery Center?

Basic procedures such as circumcisions, cystoscopies, removal of stones, and shrinkage of the prostate can be accomplished at the surgery center.

The misconception of the surgery center, however, is that we do only urological procedures. Many general surgical procedures including hernia repair, laparoscopy, and varicose vein ligation are routinely performed. Gynecological procedures, including tubal ligation and D&C, are performed. Plastic surgeons perform a variety of procedures. Multiple ear, nose and throat procedures are performed, as well as orthopedic procedures.

The scope of procedures can be done in the surgery center has expanded with the recent addition of our recovery care center. We are now able to do procedures such as hysterectomy, mastectomy, gallbladder surgery and more. A pain clinic is also offered.

What is a recovery care center?

In December 1995, Peoria Day Surgery Center obtained a permit from the State of Illinois to construct and operate a recovery care center that began operation in June 1997. The Peoria Recovery Care Center is part of a demonstration program authorized by the Illinois Alternative Health Care Delivery Act. The center is designed to provide post surgical recovery care for generally healthy patients undergoing surgical procedures that require overnight nursing care, pain control, or observation that would otherwise be provided in a hospital setting.

The center consists of six private patient rooms, a food preparation area, a family living room and dining area, and a staff work area. The center offers a high patient-to-nurse ratio, which enables the center to give quality patient care while reducing health care costs to the patient and insurance carrier.

Along with being medical director of PUA and Peoria Day Surgery Center, you are executive vice president of Mobile Medical International Corporation. Can you comment on the Mobile Ambulatory Surgery Center and how it fits into merging trends in medicine?

Rick Cochran, president of Mobile Medical International Corporation, began development of this unit seven years ago. Mobile surgery centers are fully equipped, self-contained, state-of-the-art mobile units that hydraulically expand to 1,000 square feet and can be transported to remote areas of the world.

The operating room measures 15.5 feet by 22 feet, comparable to the finest operating rooms. Everything is designed for convenience and safety and built to U.S. health care standards. It houses a Caterpillar 50,000 watt turbo diesel generator that can operate for 24 hours a day, eight days continuously.

In a disaster situation, the pre-op and operating rooms combine to administer up to eight patients simultaneously. The unit has extensive telemedicine capabilities and its communications system provides instant access to electronic medical records and reference materials using land line, cellular, or satellite technology.

The mobile medical unity can be transported within a C-5 or C-17 cargo transport plane. The United States Army purchased our first unit, which will be deployed in various locations throughout the world, and via satellite will relate transmission of mammograms and biopsies back to a central interpretation center. In April 1996 our first unit was showcased in San Antonio by the United States Air Force. It was at this meeting that we were able to transmit a radiograph of a hand from Bosnia to San Antonio.

There are many other applications for the unit, including rural outreach, hospital renovation replacement facility, international health care delivery, mobile intensive care, mobile dialysis, disaster reaction, on-site prison care, mobile pain clinic, and a variety of military applications.

We are in the process of receiving a grant from the Department of Defense to create a smaller version of the present mobile unit. The smaller version will be transportable in a C-130 cargo plane.

Managing the business dimension of the day surgery center and your four offices requires considerable time and knowledge of administration and business practices. Does PUA have a business manager to look after the non-medical aspects of your company?

Being medical director has resulted in a very exciting and energetic period in my life. Having offices in Bloomington, Pekin, Morton and Peoria allows our physicians to service a larger population. As with any successful corporation, one must have confidence in the staff. I have a very competent staff led by Bryan Zowin, our business administrator, and Wanda Spacht, our nurse administrator. We have tried to provide a positive work environment for our employees and their families. Demonstrated by the fact that we have a very low employee turnover rate, we feel we have been successful in this endeavor. Bryan and Wanda manage almost 70 full- or part-time employees.

An independent research company surveyed 100 surgery centers nationally. Peoria Day Surgery Center was in the top 10 percent of participating facilities. It ranked number one on composite quality, clinical staff, and facility characteristic scales.

Besides you, there are three other physicians and a psychologist on the PUA team. Do each of you have a special expertise?

Dr. Robert Stuart focuses on radiation seed therapy and urinary incontinence. Dr. Giovanni Colombo focuses on pediatric urology and cancer surgery. Dr. Jose Hernandez has special expertise in endourology and erectile dysfunction. My own expertise lies with erectile dysfunction, prostate cancer and stone disease. A new associate, Dr. Craig Smith, will join us this month. He has expertise in pediatric urology. All of us practice good, general urology.

Our other associate, Dr. Brian McIntyre, is a clinical psychologist. He has been associated with PUA for three years. In August, Dr. Richard Grant, a psychiatrist, started seeing patients at our facility. As with many medical problems, urological patients may have emotional factors, complicating treatment. Dr. McIntyre and Dr. Grant helped formulate the Sexual Health and Treatment Center of Illinois.

PUA also developed the Incontinence Center of Illinois, which features non-surgical approaches, such as biofeedback, to the treatment of incontinence. Dr. McIntyre has also been successful in developing the consortium of doctors working with the pain clinic.

What role do you see physicians and health care providers playing in the community’s future? Would you like to see doctors become more involved in local philanthropic, civic, and political matters?

I believe physicians must take a proactive approach toward the practice of medicine. We are in trying times in medicine, dealing with topics such as the role of the hospital in the future of medicine, a greater number of procedures and tests moving to the outpatient arena, assisted suicide, who should receive medical care and who should be denied treatment, managed care and insurance issues. These are just some of the issues that loom greatly in the eyes of the physician.

I think many of today’s physicians are active in civic and philanthropic matters. We may see more physicians entering the political arena, enabling them to participate in legislation of matters that affect the practice of medicine.

There’s a lot of talk these days about Peoria: its image, development potential, education, technology and neighborhoods. How is Peoria as a place to develop your business, practice medicine and raise a family?

Peoria offers a remarkable community in which to practice medicine. Peoria has a progressive medical community that is attractive to physicians.

I never thought I would leave Chicago. I have strong family ties with my mother, brother and sisters who still live in the Chicago area. When I first came to Peoria I knew that Peoria would be my future home. Peoria has allowed me to practice a high quality of medicine, but has also afforded my wife and children the opportunity to grow and prosper in a friendly, healthy environment.

Can you comment on advertising and marketing in the field of medicine?

This subject has raised many issues and opinions within and outside the medical community. At Peoria Urological Associates there are many ways we market urological health care. We strongly believe in marketing vehicles such as patient education, free screenings, and physician seminars. These methods provide the main thrust for our marketing endeavors.

As physician marketing is such a controversial issue, I am always happy to hear from a business as to how great our marketing approach has been. Today’s private practice is considered a managed business and its newest specialty is marketing.

Most physicians market their services to some degree and some are highly criticized, but to be successful you must promote your practice.

The business aspect of medicine has largely been ignored in medical school and residency programs. Recently, however, several programs are being developed to prepare young physicians for the business aspects of their practices.

What will your activities be when you finish practicing medicine?

With six small children in school, I plan to continue working for several years. It is hard to imagine not practicing medicine. I believe, however, that it is essential that one continues to set goals and objectives. Many of my patients are retirees. The individuals who seem to flourish best are the ones who have had a busy, active, fulfilling life. One should view retirement as a change in goals, but the level of intensity should remain the same in all endeavors. IBI