Urology of Virginia
Medical Director of the Pelvic Health Program at Chesapeake Regional Medical Center
When Jennifer Miles was a three-year old growing up in Cleveland, she was diagnosed with meningitis, which meant that she spent a lot of time seeing a lot of doctors. They made an impression on the little girl, and it wasn’t long before she decided to become a physician herself. She admits she didn’t really understand what that entailed at such a young age, but says, “I believe we’re all here for a reason, and medicine is mine. I think our steps are ordered.”
Her admission to medical school was guaranteed in high school, and following graduation, her steps took her to VCU/MCV on a full scholarship named for Jean L. Harris, the first African American woman to graduate from MCV. She earned her Doctor of Medicine at Northwestern University’s Feinberg School of Medicine in Chicago.
Urology wasn’t her first choice of specialty, she recalls. “When I was in high school, Ben Carson was very popular, and I decided I wanted to be a black female neurosurgeon.” After a few rotations in neurosurgery, she changed her mind. She discovered that as she was shadowing urologists, the wives of patients would approach her and ask about their own symptoms. “They’d never seen a woman urologist before,” Dr. Miles-Thomas says, “because at that time, fewer than five percent of all urologists were women.”
That was the case when Dr. Miles-Thomas decided to pursue urology. “A lot of women didn’t go into urology because it was so male dominated, but it was a culture I was comfortable with,” she explains, “and I love a challenge.” Her next steps led her to Johns Hopkins, where she completed her internship in general surgery in 2002. She completed the remainder of her medical education at the James Buchanan Brady Urological Institute at Johns Hopkins: she was a Nagamatsu Fellow in Endourology from 2002 to 2003, a resident in urological surgery from 2003 to 2008, and completed a fellowship in female urology in 2007.
If this intense training weren’t enough of a challenge, Dr. Miles-Thomas notes that during her time at Johns Hopkins, she was only the fourth female urologist in the department’s history, and the first to not only be married but to have children during her residency. And she adds, “I was the first black woman at the Brady Institute since 1897.”
She has practiced urology in Hampton Roads since January of 2009, treating both women and men. She estimates that roughly 30 percent of her patients are men, who are referred to her for reconstruction or stone disease. If her male patients are self-conscious about being treated by a woman, she quickly puts them at ease. “Once they meet me and see that I’m pretty laid back, they feel comfortable,” she says. “And they realize I’ve been practicing for a good while, so there’s absolutely nothing they can tell me or show me that will surprise me.” The majority of the time, reconstruction is done on the penis or the urethra, and in cases of erectile dysfunction, she says, “We can place a prosthesis that can be inflated to give them an erection. If they’re incontinent, artificial sphincters can control leakage.”
Incontinence is far more prevalent in women than in men, and is one of the major presentations Dr. Miles-Thomas treats in her female patients. Prolapse is another. She tells her patients to think of their vagina as an empty room, with support structures on the back, the top and the floor. These structures hook the bladder up, the uterus and bowels back, and the rectum down. “Over time and after having children, those tissues can weaken and sometimes things will fall into the vaginal vault,” she says. “That’s prolapse.” Often it can be treated by careful observation and a change in eating and drinking habits; but depending on the severity of the case, she will either suggest a pessary – a device inserted into the vagina to provide support – or perform reconstructive surgery.
She also sees a fair number of ‘tweens and adolescents. “Usually their moms will bring them for some kind of voiding dysfunction; maybe they’re still wetting the bed or getting frequent UTIs,” she says. “Many teenage girls who are very active – like cheerleaders – can leak when they jump. As a mother myself, I can be empathetic and realistic with these girls at the same time.”
In both women and men, Dr. Miles-Thomas frequently sees cases of neurogenic bladders – patients with spinal cord injuries or MS or other neurological disorders, whose bladders will squeeze and empty slowly or inadequately – in most cases, function can be restored with medications, Botox, neuromodulation or reconstructive surgery. “Our practice also treats difficult urethral strictures with a procedure called an urethroplasty – reconstruction of the tube using tissue from the lining of the mouth,” she says. “We have realized excellent short-and long-term results with low post-operative complication rates.”
Dr. Miles-Thomas believes women will continue to pursue urology. “It takes a certain passion and motivation,” she says – and it’s clearly so for her, as for the past several years, she’s commuted to her Virginia Beach office from Williamsburg, where she lives with her husband, a basketball coach at Kecoughtan High School, and their three kids. She doesn’t mind the commute: “I listen to different podcasts, NPR programs, and Spanish language tapes,” she says. “I like to maximize my time learning about life and the world.”