Consultants
Dr.
B.K. Vohra
(Advisor
Emeritus)
Dr.
S.N. Wadhwa
(Chairperson)
Dr.
Sudhir Khanna
(Vice
Chairperson)
Dr.
Ajay Sharma
Dr.
Sudhir Chadha
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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. In 1975, we
started trans-urethral surgery. The Urology Department was formally started in
1982 although trans-urethral resection of prostate (TURP) was started in 1975.
It was second in the city of Delhi to start this procedure. In 1983, we 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 started in 1987 with
its application in the majority of patients regularly. In July 2000 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 in 1986. Ministry of Health offered 2 crores
rupees as loan at subsidised rate of interest for further development of the
department.
Subspecialties
1. Laparoscopic surgery
In 2002, it was decided to embark on
laparoscopic surgery. For that purpose one of the consultant, Dr. Ajay Sharma was sent to
Cleveland Clinic in USA to work under Dr. Gill. Since
his return he has successfully done nephrectomies, pyeloplasties, repair of
vesico vaginal fistula, ureterolithotomies with excellent results. Over 300
operations have been done in last 5 years.
Later, in 2005, Dr. Sharma 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 world over including urologists in USA. In India this is the only hospital which is providing extraperitoneal
approach for laparoscopic radical prostatectomy. This approach has advantage over
transperitoneal technique in terms of surgical complications like bladder or
bowel injury and is more anatomical.
Dr. Sharma has performed many such operations during last 2 years with very good
outcome and without complications. He is also running a prostate
cancer clinic in the hospital.
2. Endourology
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.
4. Urodynamics
This was the first department in this part of the country to start urodynamic
studies in 1983. 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.
6. Andrology
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.
8. ESWL
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.
9. Uro-oncology: 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.
10. Uro-gynaecology: 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.
The Department has two units:
Unit I
- Dr. B. K. Vohra, FRCS , Patron
- Dr. Ajay Sharma, M.S. MCh (Urology), Laparoscopic Urologist
- Dr. Sudhir Chadha M.S, MCh. (Urology)
Unit II
- Dr. S.N, Wadhwa, M.S. M.Ch, FAMS, Chairman
(Formerly, Professor and Head, Deptt. of Urology, AIIMS, New Delhi)
- Dr. Sudhir Khanna, MS. Mch. DNB (Urology)
Dr. S.N. Wadhwa was unanimously elected President - Elect of Urological
Society of India in January 2002 and took over as President of the National
Society in January 2003.
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.
Interesting
Cases & statistics
Laparoscopic extraperitoneal radical prostatectomy
In this department, Laparoscopic operation for cancer prostate
is done with the latest extraperitoneal technique which is safer than usual
transperitoneal operation as there can be
no intestinal or bladder injury. This is the only hospital which is offering
this technique as the standard of operation.
The advantages of laparoscopic operation over open surgery are
mainly
- Improved vision due to magnification, leading to precise dissection and
preservation of important structures.
- The blood loss, which about 300 ml in LRP v/s about 1 litre
in open surgery
- Better reconstruction between bladder and urethra.
- Almost painless recovery.
In last two years,30 such operations have been done
successfully. All patients achieved continence by the end of 3 months. 8 of them
were continent in first week itself. The cancer control was excellent, PSA
coming less than 0.1 in 11 of them. Two patients needed additional treatment as
PSA came 1.2. The desirable PSA is less than 0.4ng /ml.
All patients were discharged on 4-5th day of surgery -
although they are dischargeable on 3rd day. All had normal diet after 24 hours
of operation. Most patients did not require pain killers after 24 hours of
surgery
Laproscopic repair of vesicovaginal fistula
A 60 years female was admitted with history of continuous leak of urine - 24
hrs, for 19 years. This happened after she had obstructed labour with still
birth. She consulted few doctors for initial few months and finally felt that no
treatment was available. She lived with this leak for 19 years when one of her
relative brought her here. She was investigated. Her general condition was good.
She was obviously smelling of urine. On examination about 2 cm fistula was felt
through vagina. IVP confirmed leak into vagina and rules out upper tract
pathology - cystoscopy was done - She had a 2 cm fistula which was supratrigonal,
away from ureteric orifices.
She was kept for surgery. Laparoscopic, transperitoneal repair was done. Both
orifices were catheterised beforehand. Bladder was mobilised extraperitoneally
and between vagina and bladder after opening it longitudinally. Vaginal defect
was closed with interrupted Intracorporeal laparoscopic suturing. Bladder was
closed. She had indwelling Foley's catheter post operatively.
The catheter was removed on 14th day. She voided normally
although frequency was 1 hour due to low capacity of bladder. She had no vaginal
leak. This was 14th case in the world done laparoscopically, according to review
of literature.
Laparoscopic Boari Flap - bridging ureteral defect using bladder flap.
A girl of 14 years underwent operation for ureteric stone. Following the
surgery, her ureter developed fibrosis leading to complete stricture of last 10
cm of ureter. This was affecting her kidneys. After a failed attempt to correct
it endoscopically, it required open surgery for Boari flap repair. This would
give her bad scar. It was decided to do it laparoscopically. World over only few
case had been done this way.
She underwent successful operation and is symptom free with a normally
functioning kidney after 2 years of surgery.
OUR ACHIEVEMENTS
LAPAROSCOPIC SURGERY IN UROLOGIC DISEASES.
With experience of 5 years now, 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
- Varicocele
- Large stone in ureter
- Kidney cyst
- Chyluria
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.
Photo
Gallery
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a. Kidney measuring 20 cm removed laparoscopically by 4 cm cut (above) |
laparoscopic
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open |
| Comparison of incision of
kidney removal (above) |
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| Laparoscopic removal of kidney
cancer, incision length 8-9 cm |
Kidney sparing laparoscopic surgery for tumour |
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