Introduction and History of the Department of Urology
Urology is one of the fastest progressing fields which deals with the management of surgical problems of kidneys, ureter, bladder, prostate, seminal vesicles and other genital organs like the testicles and penis in the males. In the females, besides dealing with management of surgical problems of kidneys, ureter, bladder, it deals with surgical problems of urinary incontinence, the urinary fistula like the ureterovaginal and vesicovaginal communications.
The Department of Urology has the distinction of being the first of its kind in any non-government hospital in this part of the country. Apart from this, it has many other firsts to its credit. It was second in the city of Delhi to start this procedure. We also started urodynamic laboratory catering for urodynamic investigations in entire Delhi including referrals from All India Institute of Medical Sciences for many years.
Percutaneous nephro lithotripsy (PCNL), the minimally invasive management of renal calculus disease was also started with its application in the majority of patients regularly. The hospital acquired the latest generation Extra Corporal Shockwave Lithotripter (ESWL). With this acquisition, the department is fully equipped with all possible latest methods to treat urinary stones viz. Ureteroscopy, PCNL and ESWL.
The Department was recognised as a Centre of Excellence by the Govt. of India. Subspecialties
1. Laparoscopic surgery
It was decided to embark on laproscopic surgery. For that purpose one of the consultant was sent to Cleveland Clinic in USA to work under Dr. Gill for one month. Since his return he has successfully done nephrectomies, pyeloplasties, repair of vesico vaginal fistula, ureterolithotomies with excellent results. Over 200 operations have been done in last 4 years.
In 2005, the same consultant visited Institut Mutuliste Montsouris (IMM), Paris , France for training in laparoscopic radical prostatectomy for the treatment of prostate cancer. IMM is the institute which developed this technique and trained many urologists in this procedure world over including USA . In India this is the only hospital which is providing extraperitoneal approach for laparoscopic radical prostatectomy. It has advantage over transperitoneal technique in terms of surgical complications like bladder or bowel injury and is more anatomical.
Good number of such operations have been done during last year with very good outcome and no complications.
Procedures like PCNL, endopyelotomy, ureteroscopy and most commonly TUR of prostate, bladder tumours and endoscopic removal of bladder stones, and optical internal urethrotomy, are done regularly as standard of care.
Since most of the urological procdures are amenable to endoscopic operation, this field is well developed and all newer modalities are promptly added to the armamentarium.
3. Laser prostatectomy
We added KTP laser in September 2005. It is also known as green light laser.
This is the latest method of treating the prostatic obstruction or commonly known as enlarged prostate. This technique uses KTP laser which has property of vaporisation of tissue without causing bleeding. This was started in this hospital in September 2005 and about 50 such operations have been done successfully with good results. This is one of very few centers offering this operation.
The advantages of this technique are manifolds. This is practically bloodless operation, and can be done on patients who are on anticoagulant therapy i.e. patients on blood thinners like aspirin, clopidogrel, acitrom etc. It can be done on day care basis i.e. patient can be discharged same day without any catheter (urine bag). Catheterisation time can be as low as 5 hours as opposed to 2 days in conventional TURP.
It is now fully developed and we have acquired the latest state-of-the-art urodynamic machine from Denmark with uro-video attachments.
5. Male infertility
Besides routine facilities for investigation, we regularly perform sperm retrieval by all techniques like TESA, MESA and PESA for micromanipulation like ICSI in coordination with department of IVF. Operations such as vaso-epididymal anastomosis are performed on a regular basis.
This subspecialty relates to male sexual disorders such as impotence, etc. We possess facilities for diagnosis and treatment of various types of impotence. Facility for colour Doppler for measuring penile blood flow is also available.
7. Reconstruction procedures
Expertise is offered for all variety of upper and lower tract reconstructive problems including pyeloplasty, ileal replacement of ureter, Boari flap, augmentation cystoplasty, whole range of urethral and genital reconstruction including complex strictures. Urethroplasty using buccal mucosa is done wherever required.
Non-invasive technique in which stones are disintegrated by application of extracorporeal stock waves with latest generation Dornier ESWL. Many patients have already been made free of their stones. It has got advantages that it can be done without hospitalisation and without anaesthesia. Invariably patient can resume his/her work straight away.
All variety of genito-urinary cancers including kidney, bladder, prostate, testis, penis are treated with radical surgery as indicated where needed further chemotherapy is carried out in coordination with medical oncology.
Recent addition is Laparoscopic radical prostatectomy for prostate cancer as the standard operation for localised prostate cancer.
Facilities have been upgraded to deal with problems of lower urinary and genital tract of females e.g. stress urinary incontinence, recurrent urinary infection, uretero-vaginal, vesicovaginal, utero-vesical fistulae besides the management of pelvic floor abnormalies particularly in respect of stress urinary leaks.
By virtue of facilities available, quantum of work load and nature of tertiary referrals and strength of staff and their experience and expertise in teaching and training the Department was recognised and approved for conducting 3 years course in DNB (Diplomate of National Board) Urology by the National Board of Examinations, two candidates per year are selected in June and session starts on 1st July.
OUR ACHIEVEMENTS LAPAROSCOPIC SURGERY IN UROLOGIC DISEASES.
With years of experience, we clearly know the reasons why laparoscopy is a better option in many urologic operation.
The technology provides such magnification that these operations can be done more precisely and completely.
The biggest advantage is that there is minimal blood loss - again due to a vision which is not possible by naked eyes.
In addition, the problems of large cut like pain, infection and scar etc. are also overcome.
Overall, laproscopic technique has shown clear advantages in various operations like -
- Removal of non functioning kidney
- Removal of kidney cancer
- Correction of blocks/ obstruction in kidney
- Prostate cancer
The other operations we have done with extremely good results are -
- Partial removal of kidney for cancer
- Large stone in ureter
- Kidney cyst
Our experience is now over 200 laparoscopic operations, over 70 were done on kidney, 13 for prostate cancer
Laparoscopic operation for prostate cancer is done in only few centres in India , and this department is one of these few.
Open operation for prostate cancer has average blood loss of one litre while it is only 300 ml by laparoscopy .
Due to the magnification and the vision, the quality of surgery is superb, especially in cancer surgery as the tumour is not handled, thereby reducing the chances of spread and tissues are not torn but cut cleanly.