Background History

History / Background:

The Urology Department at the KEM Hospital is a unique department that has been built by the dedicated efforts of many stalwarts over the last fifty years.
It is draws patients from all sections of the society. Here the most state of the art treatment is made available to those who need it the most but cannot afford it.
The unit has always brought glory to this institution and will continue its efforts to do so in the future.

VISION FOR THE NEXT 10 years

Staff

The department has the following staff members:

Residents :

MCh Urology course-

Third year residents

• DrRishikeshVelhal, MS Gen Surgery
• DrYashPamecha, MS Gen Surgery

Second year residents

• NeerjaTillu, MS Gen Surgery
• SheshangKamath, MS Gen Surgery

First year residents

• PankajJhanwar, MS Gen Surgery
• Amit B, MS Gen Surgery
• Nikhar Jain MS Gen Surgery

Super-specialty Medical Officer:

1. Vinayak Wagaskar
2. Amit Sharma
3. Jay Dharmashi
4. Umesh Shelke.

Technical & supporting staff : Mr. SudhirBorade , Mr.Subhash, Mr. SudeshKadam

Facilities, Equipments & Special services

We regularly do all endoscopic, minimal invasive and reconstructive surgeries

We have all recent endoscopy, microscope and laparoscopic instruments

We also recently have received 3D laparoscopy camera system

Clinical Facilities:

Out Patient Department

In Patient Department

• 30 bed urology ward
• 4 Operation Rooms and operations are performed 5 days a week

Three outpatient department sessions (OPD) every week as follows :
Stone Clinic – Wed. 1.30 to 4.30pm – 350 to 400 patients / OPD session
General Urology – Fri. 8.30 to 1.30pm – 350 to 400 patients / OPD session
Andrology – Fri. 1.30 to 3.30pm – 20 to 30 patients / OPD session

Services Offered:

a) The department caters to an average of 7000 out patients per year. Total indoor admissions per year are about 1100. About 2000 major and minor operations are carried out per year.

b) Investigative Facilities offered by the department :

Treatment Offered:

1. Stone disease – Endoscopic    –           Suprapubic & transurethral Cystolithotrity

–           URS

–          PCNL

– Open surgeries

– Extra Corporeal Shockwave Lithotripsy (ESWL)

– RIRS – Laser surgery

2. Uro-oncology – advanced uro-oncologic surgeries like radical retropubic

prostatectomies, radical cystectomy with orthotopic neobladder etc.

3. Female Urology – Surgeries for SUI, genitourinary fistulas
4. Paediatric Urology – Hypospadias surgeries.

– Bladder neck reconstruction for incontinence.

– PCNL / URS / RIRS

5. Renal Transplant Surgery – Laproscopic donor nephrectomy / Open donor nephrectomy.

–  Recepient renal transplant(live related/cadaveric)

6. Andrological surgery –    for infertility –     VEA, VVA, TUIED (Transurethral incision of ejaculatory ducts)

– for impotence –     Penile prosthesis

–    Venous ligation

7. Laparoscopic surgery evolved from ablative to reconstructive procedures like Lap.VVF repair and Lap. Pyeloplasty.
8. Laser prostatectomy
9. Stricture surgery for complicated cases

– redo surgery- rectourethra fistula

HIGHLIGHTS AND ACHIEVEMENTS :

Laparoscopy :

We regularly perform all basic and advanced laproscopic urology surgeries

This department performs the maximum number of laproscopic donor nephrectemies in the government set up.

Lasers in Urology:

We have procured ‘Revolix Laser Machine’ dual Thulium and Holmium laser for comprehensive management of prostate, bladder cancer & stone surgery.

Laser enucleation of prostate is soon gaining acceptance as new gold standard for prostate surgery

Penile Implants:

For patients with erectile dysfunction with failure of conservative therapy, we do penile prosthesis implant

Pediatric Stone Management:

We regularly perform pediatric urolithiasis surgeries, including mini-Perc, PCNL, PCCL and URSL

We also regularly perform pediatric reconstructive surgeries, like hypospadias repair, bladder neck reconstruction for incontinence

Female urology-

We regularly perform TVT, TOT sling surgeries, vesico-vaginal fistula, uretero-vaginal fistula repair, prolapse repair.

Endoscopic surgeries-

URSL, PCNL, PCCL, TURP, TURBT

A-V fistula-

In chronic kidney disease patients, we perform arteriovenous fistula for vascular access for dialysis

ESWL- Extra-corporeal shock wave lithotripsy-

KEM Hospital Urology department has a state of art Dornier Lithotripter (to break kidney stones without surgery).  This is amongst the best such machine in India.

Workshops conducted-

Workshop on stricture urethra- April 2011

Live workshop on TURP- August 2011

Workshop on Pediatric Urology- November 2011

Workshop on Female Urology- August 2014

Workshop on Uro-radiology- Ultra-sound in Urology- December 2016

Live workshop on TURP:  February 2015

In addition to these workshops, we regularly conduct endo-urology camps to provide service to maximum patients on earlier basis.

Over 7,000 patients were treated on the all urology OPD’s during last year and over 1500 operations were performed including kidney transplantations.

For Student

Academic Activities:

The department has a full-fledged training programme for M..Ch. residents since 1980 which is recognized by the University of Mumbai.  It is also recognized by the Medical Council of India (MCI) and National Board of Examination, New Delhi to train DNB urology candidates.  Many urologists trained here occupy prestigious positions not only in India but abroad also.

Actual Teaching Works in the Department:

1. Inter-departmental meetings and Teaching Program : The teaching program includes regular integrated undergraduate lecture for all the 3 terms and post-graduate teaching schedule for M.Ch. (Urology) students in the form of clinical, case presentation, bed side clinics, ward rounds, uro-nephrology meetings, Journal reviews and operative video session.

1. Daily Morning rounds – 8.00am to 8.30am
2. Grand round  -Wednesday – 12 to 1 pm   Friday – 4 to 5pm
3. Clinics -Tuesday- 2.30pm
4. Transplant meet – once a week
5. To  discuss prospective and operated renal transplantation cases Wednesday-   4 to 5pm- case discussion
6. OPD  case discussion- Friday 12.30 to 1.30pm .

a)  Uroradiology : Basic instructions and teaching on various uro-radiological procedures. Discuss interesting and difficult cases of the week.3 to 4 pm

1. Uro-nephro meet : to discuss the management of urology cases with compromised renal function. Plan strategy for complex uro-nephrology cases
2. Symposium / Seminar
3. Classes- Wednesday 8 am to 9 am –

– Video class with Professor Dr.Ganesh Gopalakrishnan, Ex.Professor, CMCH,    

                  Vellore. Case presentation & one topic are discussed through skype.

– Instrument classes by Dr.Percy Chebber completed.

1. PG Teaching schedule in collaboration with Mumbai Urological Society every 3^rd and 4^th Saturday (1 to 2pm) {Journal Club, Uro-pathology, Symposium / Seminar}

• Medical Education : We get observers from various centers in India and abroad.

1. P.G. Teaching :
2. Didactic lectures as per University program
3. Discussion of thesis work
4. discussion of research projects at regular intervals.
5. Clinical case discussion

E.  Superspeciality Training By Rotation

1. Laparoscopic training on Animal Model at Johnson & Johnson Medical Centre, Mahim.

2.Reconstructive urology training with Dr.Sanjay Kulkarni at Pune

 F.Journal Review : Once in a month

G.  P.G. Teaching  as per the schedule / Lecture series prepared by Mumbai University

For Patient

PATIENT CARE: –    CLINICAL FACILITIES OFFERED BY THE DEPARTMENT :

• 30 Beds in Urology Ward
• There are 4 Operation Rooms and operations are performed 5 days a week
• Three outpatient department sessions (OPD) every week.
  • Stone Clinic               Wed.  1.30  to    5.30pm          210 patients / OPD day
  • General Urology        Fri.     8.30  to   1.30pm          165  patients / OPD day
  • Andrology                   Fri.     1.30 to   3.30pm           37  patients / OPD day

INVESTIGATIVE FACILITIES OFFERED BY THE DEPARTMENT

• Ultrasonography : Urology department has its ultrasound machine where scans of urological patients are done.
• Uroflowmetry : This laboratory, located in the department helps in evaluating   people with obstruction to urine flow.
• Doppler Ultrasound : This investigation helps in evaluating patients with infertility and following transplantation.
• Radiological investigations like Retrograde Uretherography and Retrograde Pyelography.
• RGP/PCN
• TRUS: Trans Rectal USG with prostatic Biopsy for diagnosis of Carcinoma prostate.
• Urodynamic study: Pressure flow studies. To evaluate neurogenic, dysfunctional voiding patients

Computerization of IPD & OPD records:

•  All patients examined in OPD and admitted in ward 36 are entered into the data base of the department and records are maintained on hard disk.

Other

Publications: (Last 5 years)

1. A Rare Case of Synovial Sarcoma of the Prostate. African Journal of Urology. 15, No. 3, 2009, 203-205.
2. Emphysematous pyelonephritis: tertiary care center experience in management and review of the literature. Urol Int. 2010;85(3):304-8. Epub 2010 Sep 2.
3. Duplication of urethra: review of three cases. Scand J Urol Nephrol. 2010 Nov;44(5):357-60. Epub 2010 May 15.
4. Silver nitrate sclerotherapy for chyluria: evaluation for the optimal instillation regime.Urol Int. 2010 Jul;85(1):56-9. Epub 2010 Mar 12.
5. A Prospective study to assess functional outcome of pyeloplasty.   Bombay Hospital Journal, 57, No.2, 2015, p-143-146.
6. Early Surgical Management in BEP Patients with Economical Constraints. Int J Med Sci Public Health. 2015; vol. 4, issue-8.
7. A Comparison of Efficacy of Segmental Epidural Block versus Spinal Anesthesia for Percutaneous Nephrolithotomy. Journal of clinical and diagnostic research, 2015 Aug, vol.9 (8): UC01-UC04.
8. Paraganglioma of Urinary Bladder Presenting as an Early Preeclampsia with Successful perinatal Outcome after Surgery: A Case Report and Review of Literature. Journal of Clinical and Diagnostic Research: Year : 2015 | Month : September| Volume : 10.
9. Missed iatrogenic bladder rupture following Normal Vaginal Delivery Journal of Clinical and Diagnostic Research. 2015 Oct, Vol-9(10): PD01-PD02
10. Can Erectile Dysfunction in Young Patients Serve as a Surrogate Marker for Coronary Artery Disease? Journal of Clinical and Diagnostic Research. 2015 Nov, Vol-9(11): PC01-PC03.
11. Placenta Percreta presenting with postpartum Hematuria. Journal of Clinical and Diagnostic Research. 2015 Dec, Vol-9(12): PD01-PD02.
12. An interesting and a curious case of a double J stent misplaced in inferior vena cava during Boari flap repair. Indian Journal of Urology, Jan-Mar 2016, Vol 32, Issue 1.

13.      An interesting case of Isolated Renal stab Injury. International Journal of Anatomy, Radiology and Surgery. International Journal of Anatomy, Radiology and Surgery, 2016 Jan, Vol 5(1) 54-55.

14. Urinary Tuberculosis with Renal Failure: Challenges in Management Journal of Clinical and Diagnostic Research. 2016 Jan, Vol-10(1): PC01-PC03.
15. Metabolic Evaluation in Paediatric Urolithiasis: A 4-Year Open Prospective Study. Journal of Clinical and Diagnostic Research. 2016 Feb, Vol-10(2): PC04-PC06.
16. Ante grade jj stenting after percutaneous renal procedures: The ‘pull and push’ technique (Letter to Editor).Arab Journal of Urology. doi:10.1016/j.aju.2015.11.001.
17. Surgical Management of Ectopic Kidney with Bilateral Iliac Vein Invasion. Journal of Clinical and Diagnostic Research [serial online] 2016 March [cited: 2016 Mar 21]; 10:PH01-PH02.

Archives

Research & Projects:

Completed :
1. Efficacy of Phlogenzyme in reduction of fibrosis of kidney, ureter and bladder.

2. Clinical trial of Propantheline Hydrochloride and Oxybutinin in patients of urge / urgency incontinence.

3. The evaluation of Doxazosin in the treatment of symptomatic BPH.

4. Clinical trial of Sildenafil Citrate for erectile dysfunction.

5. Evaluation of Ciprofloxacin 1000mg once a day (substained release preparation) vs. Ciprofloxacin 500mg (conventional) twice a day in complicated urinary tract infections.

6. A prospective comparison of endopyelotomy and open Anderson-Hynes pyeloplasty for pelvi-ureteric junction (PUJ) obstruction.

7. Phase II study with RBx 2258 in patients with LUTS due to BPH

8. Diet and its impact on stone disease.

9. The evaluation of Tamsulosin the treatment of symptomatic BPH

10. Clinical trial of dutasteride in BPH.

11. Testicular transplantation : Conservative of fertility in men rendered infertile by cancer therapy- Cryopreservation & germ cell transplantation in rat testis – In collaboration with National Institute for Resarch in Reprodutive Health.

12. PCCL – Percutaneous Cystolithotrity as minimally invasive surgery for large bladder stones especially in paediatric age group is being evaluated.

13. Extended Martius Flap – a new method of vascularized tissue support in vesico vaginal fistulae repair is being evaluated

Books:

1. BPH.
2. Urology Instruments.

On Going:

Workload: (For Last 10 Years)

Patient Workload:

Diagnostic Workload:

Operative Workload:

ACADEMIC ACTIVITES :

The department has a full-fledged training programme for MCh. residents since 1980 which is recognized by the University of Mumbai.  It is also recognized by the Medical Council of India (MCI) and National Board of Examination, New Delhi to train DNB urology candidates.  Many urologists trained here occupy prestigious positions not only in India but abroad also.

1. Inter-departmental meetings and Teaching Program : The teaching program includes regular integrated undergraduate lecture for all the 3 terms and post-graduate teaching schedule for M.Ch. (Urology) students in the form of clinical, case presentation, bed side clinics, ward rounds, uro-nephrology meetings, Journal reviews and operative video session.
2. Monday clinical Activity- 8 am to 9:30 am –

– Video class with Professor Dr.Ganesh Gopalakrishnan, Ex.Professor, CMCH,   Vellore

  Case presentation & one topic are discussed through Skype

1. PG Teaching schedule every 3^rd and 4^th Saturday (1 to 2pm) {Journal Club, Uro-pathology, Symposium / Seminar}
2. Journal Review : Once in a month