Dr. John P. Stein, a professor at the USC Keck School of Medicine and an internationally known specialist in urologic cancers and bladder reconstruction, died Friday at a hospital in Naples, Fla. He was 45.
A research scientist and unusually skillful surgeon beloved for his compassionate bedside manner, Stein was a star in his field, who was, according to Keck Dean Carmen A. Puliafito, "what every dean of a medical school wants in a faculty member. He was a dedicated clinician, a state-of-the-art surgeon. He was a great innovator, a scientist . . . a terrific role model," who touched the lives of thousands and saved many lives.
Athletic and robust, Stein became seriously ill while attending a meeting of the American Assn. of Genitourinary Surgeons in Naples and was taken to a local hospital. Although doctors worked furiously to combat what appeared to be a massive infection, he died the next day.
Preliminary signs suggest a form of toxic shock syndrome, but the cause of death awaits the completion of autopsy studies, said Dr. Donald Skinner, a renowned USC urologic cancer surgeon, who trained Stein and helped guide his care at the Florida hospital.
Along with colleagues and patients, Skinner mourned Stein's death as a tragic end to a brilliant career on the cusp of advancement.
"I consider him the finest surgeon I trained, an extension of my own hands, a member of my own family, like a son," said Skinner, who established Keck's prestigious urology department 30 years ago.
Stein, who was born in San Francisco in 1962 and grew up in Walnut Creek, Calif., was a graduate of the University of Notre Dame in South Bend, Ind., and the Loyola University Stritch School of Medicine in Chicago. He completed his residency under Skinner at the USC/Norris Comprehensive Cancer Center and became a professor of urology and co-director of the center's Genitourinary Cancers Program.
Early in his career, he and three colleagues published a landmark study that helped to identify which patients had more aggressive forms of bladder cancer. Published in 1994 in the New England Journal of Medicine, the study found that an alteration in the DNA of bladder cancer cells, called a molecular marker, could help predict who would most benefit from continuing treatment after surgery and who would be more likely to face a relapse.
In another major study, Stein demonstrated the importance of thorough lymph node removal in the successful treatment of bladder cancer, said Dr. Peter T. Scardino, a urologic oncologist and chairman of the department of surgery at Memorial Sloan-Kettering Cancer Center in New York City.
Working with Skinner in the late 1980s, Stein also helped to develop a technique for reconstructing the bladder in patients who had lost the organ to cancer. Building a so-called neo-bladder using part of the patient's intestine was a breakthrough that vastly improved the quality of life for bladder cancer survivors by allowing them to urinate normally. Bladder cancer is the fourth most common cancer among men and the eighth among women in the United States.
Bladder replacement initially was performed only on men because not enough was known about female urinary anatomy to ensure that women could successfully undergo the procedure. In women with bladder cancer, doctors routinely removed the urethra, where urine drains from the body, to prevent the spread of the cancer. Unconvinced that removing the urethra was necessary, Skinner and Stein studied cancer specimens and found that in women the cancer rarely spread that far. With other doctors, Stein conducted further studies, particularly examining the nerves that affect continence, and concluded that the urethra could be preserved.
"This revolutionized bladder reconstruction in women," Skinner said.
Colleagues said Stein was one of the rare doctors who could conduct basic research and apply it in the operating room.
"He was a marvelous surgeon to watch, quick, highly adept, with extraordinary hands and great understanding not only of the anatomy but of the disease and what needed to be done to remove the cancer and reconstruct the anatomy for the best possible function," Scardino said. "He had a great sense of the organization of an operation, the flow of it. It's like being a very good fighter pilot in a time of war. . . . I never knew anyone better at it than John Stein."
At the relatively young age of 42, Stein was elected to the highly prestigious American Assn. of Genitourinary Surgeons. He also served on the editorial board of four major urologic journals and in 2003 received the Young Investigator Award by the Society of Urology Oncology.
He also earned the adoration of patients, who valued his humanity as much as his expertise. He hugged them, sometimes prayed with them, sat by their side when they cried, and joked with them to relieve their fears.