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OFFICIAL NEWS BULLETIN OFUROLOGY SOCIETY OF INDIA WEST ZONE
OFFICIAL NEWS BULLETIN OFUROLOGY SOCIETY OF INDIA WEST ZONE
Visit : www.wz-usi.org
CONTENTS
President’s Message....
Dear Friends,
I suggested UROLOGY FOR THE MASSES as
the theme for the year. Half the year has gone by and I
have received only 28 communications where our
members have reached out to nearly 600 people. THAT
IS NOT ENOUGH. I am sure there must be many more
from our zone who have been reaching out but
unfortunately, they must have been so busy that they
forgot to communicate. Please let me have the details
on my E- mail to compile.
We are looking forward to a PCNL workshop at
Nadiad followed by Urethral Reconstruction in
Pune.Both these events will be conducted by pioneers
in the subjects. Prof. Peter Alken for PCNL and Prof.
Barbagli for Urethral Reconstruction. I will request all
of you to participate and make it very interactive.th
Our annual meeting in Solapur scheduled for 14 to th
16 Nov.08 is shaping up well. Local organising
committee is all charged to welcome all of you.
Scientific programme has been designed by council to
make it interesting for everybody. Please, send your
registrations and book your stay.
At this point, I would like to share my thoughts with
you about my dream project in Pune, SRS Hospital.
Having created such a wonderful place, I am no more
associated with it as I could not accept the direction in
which the management was going as regards patient
care, attitude towards Indian patients, general ethics
and total lack of interest in teaching. Never mind. To be
able to understand your mistakes and get out at the right
time was a stroke of luck . Now, I consider this as a
blessing in disguise. Only on such occasions, you come
to know your true friends, well wishers and advisers. I
know I have many such friends, who like me , believe in
principles.
May this GANAPATI festival followed by the
festival of light DIWALI bring you all the happiness
and a prosperous New Year.
SEE YOU IN SOLAPUR
Deepak Kirpekar
West zone council details :
President-
President Elect.-
Past President-
Secretary
Treasurer
Council Members
Ex-officio Members
Dr. Deepak Kirpekar
Dr. Sadanand W. Thatte
Dr. Harshad Punjani
Dr. Ravindra Sabnis
Dr. Umesh Oza
Dr. J. Lalmalani
Dr. Anil Bradoo
Dr. Prashant Mulawkar
Dr. Jaydeep Date
Dr. Shailesh Shah
Dr. Makarand Khochikar
2
3
4
6
8
10
12
13
15
President's message
Secretary's message
Information of awards by WZUSI
Debate
Interview
Instruments sterilization : Myths & Realities
Solapur Conference information
Scientific programme-Solapur Conference
Happenings in the zone
2
At the outset, I wish to apologize for the delay in
publishing this newsletter due to some unavoidable
circumstances, which I will let you know at an
appropriate time.
I am happy that most members liked our last
newsletter. Many appreciated the change in design,
format, & the overall look. I am going to continue
with the same format. I once again request all of you
to contribute significantly, send some articles,
information, interesting events, happenings in your
area, I will like to publish all that.
At zonal level, there was a lull in between, but now
we are geared up for various activities in coming
months. Solapur conference preparations are in full
swing. Registrations are satisfactory but we wish to
have some more response especially from Mumbai &
Gujarat. The scientific programme is also finalized.
I am giving all details in this newsletter itself. You
will realize that even this time, we have continued
with interactive & practical oriented sessions. Even
this time we have encouraged younger & newer
members to participate as speakers. Dr. Raghoji &
his team are carefully planning the organizational
aspects. I have no doubt that Solapur conf. is going to
be a grand event both academically & otherwise.
Don't miss it.
This time also we had an excellent response of
papers & have received more than 80 abstracts. We
are going to have strict selection criteria so as to
improve the standard of papers & also do justice to
the presenters. All these papers are coded & are sent
to a panel of 4 judges for their review & comments.
On that basis we will select papers for acceptance.
The council has decided to increase the prize money
of all awards to make it double from this year. Many
members especially PG students had desired to know
details of various awards that are given by the west
zone. I am giving all the details in this bulletin for
your ready reference.
We have several other activities under auspices of
west zone USI.
1)Dr. Subodh Sheide, Dr. Bhalchandra Kashyapi
& Dr. Jaydeep Date had organized 2 days of Uro-
radiology teaching programme for the PG students at
Dinanath Mageshkar Hospital Pune.
2)At Nadiad we have planned a big event A live
operative workshop on PCNL & URS. The theme is
“PCNL:Basic to advanced” I am putting all details of
this workshop in this newsletter. I request all of you
take advantage of this mega event of our zone.
3) Dr. Barbagli-reknowned name in urethroplasty
is coming to Pune. Dr. Sanjay Kulkarni is organizing
live operative workshop on urethroplasty. Please
find all details in this issue. Register early to avoid
disappointment.
4) Dr. Brajesh Singhal has finalised organising
CME on common urological topics at Gwalior in
association with local IMA branch.
I still want many members to contribute towards
this newsletter. Please send something, which you
feel, is worth informing to all your colleagues. It
could be some achievement, some programme/event
in your area, some medico-legal incidence, it could
be anything. Please feel free to write. I have kept
ample space for this purpose, so don't hesitate.
Please also send your reactions, suggestions about
this issue, or for that matter anything related to our
zonal activities. I am eagerly waiting for that.
Dr.Ravindra B. Sabnis
3
From the Desk of
Hon. Secretary & Editor
Information of awards by WZUSI
4
Eagle traveling fellowship 2
VV Desai Oration
A.N. Gaikawad oration
Urology gold medal
MIUC scholarship
Best paper award Podium 2, Video -2, Poster 2
1. Two fellowships will be awarded every year.( first
prize & second prize)
2. All post graduate students undergoing training for
M.Ch.(Urol)or DNB (Urology) are eligible to apply.
3. Candidates will be selected by conducting quiz
during annual conference of urology society of India -
west zone.
4. The names of the recipients of the awards will be
announced either at the end of conference or in the news
letter
5. During the course of the year, awardees will be
expected to visit urological centers of their choice in
India for a minimum period of 7 days
8. A detailed report of the visit must be submitted to the
office of the Secretary of USIWZ within fifteen days
after completion of each visit.
9. Only fifty percent of the fellowship award money
will be paid in advance and the remaining fifty percent
will be paid only when the visit report is submitted in
time.
1. The oration will be held every year in the plenary
session of the annual conference of USIWZ.
2. It will be delivered by the immediate past president of
the USIWZ.
3. In the event of the selected orator expressing his
inability to deliver the oration, USIWZ council
members will select the orator for the year.
4.The oration will not be delivered more than once by
any orator.
5. Total time allotted for the oration will be 30 mins
which includes introduction of speaker, information of
Dr.V.V.Desai & presentation of memento
Eagle traveling fellowship:
V.V.Desai oration :
Presentation:
First prize - Cash Award Rs.5000/ -and Certificate
Second prize : Cash Award Rs.3000/- and Certificate
Presentation: Plaque & certificate
A.N.Gaikawad Oration :
Urology Gold Medal :
MIUC fellowship :
1. The oration will be held every year in the plenary
session of the annual conference of USIWZ.
2. It will be delivered by an eminent personality who has
made significant contribution in the field of urology or
Para urological specialties.
3. Orator could be invited person from abroad or an
USI member either from the west zone or from outside
the zone.
4. Selection of orator will be done by the USIWZ
council.
5.The oration will not be delivered more than once by
any orator.
6. Total time allotted for the oration will be 30 mins,
which includes introduction of speaker, information of
Dr. A.N.Gaikawad & presentation of memento
1. Urology gold medal will be given once in the year.
2. The medal is to be awarded to a full member of the
USIWZ residing in west zone, who has made an
outstanding contribution to the progress of urology in
India. The contribution could be academic or
organizational.
3. The nominee for the award will be decided by
USIWZ council.
4. The name of the recipient will be announced at the
inaugural function of the conference. Secretary will
read the citation. At the same time, certificate & a gold
medal will be awarded by the chief guest of the
occasion.
5. No member shall be given this award more than once.
Aim of the fellowship: To recognize the talent of
USIWZ who will present their work in one of the
international conference like SIU,EAU, AUA…etc
The criteria of selection are as under
1) Age should be below 40 yrs
2) Should be full member of USI & USIWZ
3) Should be preferably a member of SIU
4) The amount of this fellowship will be Rs. 20,000
annually
5) Fellowship will be once in 2 years
Presentation: Plaque & certificate
Presentation: Citation, certificate & gold medal
5
6) Candidates having 2 publications in international
journals (as first author) will be preferred
7) Candidate should have 2 publications in national
journal (as first author)
8) Secretary will scrutinize the applications received on
plain paper with proof & send to authorization
committee to decide the recipient.
9) After selection applications, if required the
authorization committee (which includes president
USIWZ & SIU representative) can take interview of the
candidates for final round
10) The candidate shall apply to secretary before the
appropriate date declared on plain with all details
11) The fellowship will be advertised 1 month before
the last date
12) The candidate should mention in his application
about the aim of fellowship which means in which
conference he wants to present paper, video or poster.
13) The fellowship will be given only if the candidate
goes to present his work.
1. This annual competition is open to any member of the
USI, full or associate, who is either in urology residency
training or has been in practice for less than ten years
from the date of completion of his/her urology training.
2. The paper must be in the field of urology or ancillary
discipline contributing to urology.
3. The material being presented in the paper must not
have appeared elsewhere in any form viz.: presentation,
publication, lecture, video etc.
4. Authors must submit abstract / full text before the last
date of submission of papers.
5. The selection of papers for presentation will be done
by the committee appointed by the council of USIWZ.
6. The papers will be adjudged independently by judges
appointed by the council of the USIWZ through the
Secretary.
7. Winners will be announced either at the end of
conference (during valedictory function) or in the
newsletter.
Best paper award Podium :
Presentation :
First prize Rs 2000 & certificate
Second prize Rs 1000 & certificate
Best paper award Poster :
Best paper award Video :
1. This annual competition is open to any member of the
USIWZ, full or associate, who is either in urology
residency training or has been in practice for less than
ten years from the date of completion of his/her urology
training.
2. The paper must be in the field of urology or ancillary
discipline contributing to urology.
3. The material being presented in the paper must not
have appeared elsewhere in any form viz.: presentation,
publication, lecture, movie etc.
4. Authors must submit abstract / full text before the last
date of submission of papers.
5. The selection of papers for presentation will be done
by the committee appointed by the council of USIWZ.
6. The papers will be adjudged independently by judges
appointed by the council of the USIWZ through the
Secretary.
7. Winners will be announced either at the end of
conference (during valedictory function) or in the
newsletter.
1. This annual competition is open to any member of the
USIWZ, full or associate.
2. The paper must be in the field of urology or ancillary
discipline contributing to urology.
3. The material being presented in the paper must not
have appeared elsewhere in any form viz.: presentation,
publication, lecture, video etc.
4. Authors must submit abstract / full text before the last
date of submission of papers.
5. The selection of papers for presentation will be done
by the committee appointed by the council of USIWZ.
6. The papers will be adjudged independently by judges
appointed by the council of the USIWZ through the
Secretary.
7. Winners will be announced either at the end of
conference (during valedictory function) or in the
newsletter.
Presentation :
Presentation First prize Rs 2000 & certificate
Second prize Rs 1000 & certificate
First prize Rs 2000 & certificate
Second prize Rs 1000 & certificate
6
medical insurances patients want nothing but the best facilities that only corporate hospitals can provide.
Lets look at some clinical situations. I do a PCNL in a small nursing home and the patient bleeds. The problems would start with arranging blood, arranging quality intensive care, and if I need to do angio-embolization for my patient… then surely my patient and me are in a soup. Can I comfortably perform a TURP for an old man with associated major medical problems in a small hospital? Surely in my gamut of procedures, supra major procedures would get deleted if I were restricted by facilities. I would be forced to stay away from major cancer work, transplants and many more. Was this why I did my Urology training for, to do only scopies, TURP's and VIU's?
Friends, today is an era for sub-specialization. This is feasible only in big corporate hospital full-fledged departments. Restricting your practice to the area of your interest and then promoting your work and yourself in your locality, region and among your peers is possible only on a large platform. How many individual owned small nursing home owners get invited as a faculty to urology meeting? I know of many who do not even attend conferences. How can they, no one to look after their work and patients when they are away. The fear is the income would be 'Zero' in those few days.
If I tabulate this discussion, where do individual owned hospitals stand?
Corporate Individual
Quality of instruments *** *
Quality of work *** *
Quality of life *** *
Quality of services *** *
Teaching, Conferences, Name *** *
In the end, considering today's vandalism, who stands by you in the event of eventuality at a small nursing home setup. Most such acts happen in smaller nursing homes. Hooligans shy away from institutes; they know pressure tactics do not work there.
Friends I see as much future for small nursing homes as I see for neighborhood cinema halls. When multiplexes are available where would you want to enjoy Ash's jhatka's? Surely, the weak individual owned nursing homes are destined to disappear; only the strong corporate institutes would stay.
Private practice pattern is changing not only in big cities but at smaller places as well, especially for last few years. The corporate hospitals have started opening chain of hospitals. They have aggressive marketing strategies, which are difficult to match with for an individual practitioner. Big Bazar & other big malls have resulted in disappearance of small Kirana shopkeepers. Is same thing happening in medical field? Where are we standing? Here are the views of two consultants. Dr. Maheshwari is in practice for >15 yrs & has always been associated to corporate hospitals. Dr. Bhandarkar is in practice for >15 yrs as individual owned nursing home.
Individual owned nursing Homes: Destined to Disappear - Dr. Pankaj Maheshwari
Debate
Friends, when was the last time you visited a neighbouring vendor for your day to day shopping. I am sure you do not remember it, because you would surely prefer to go to a mall where you have a wider choice, better quality, cheaper price, assured services & all your shopping under one roof. In this era
of the new age life style, when vegetables & Kirana are purchased in the Mall, how do you expect a patient to be happy and satisfied with an individually owned, single specialty neighborhood hospitals. With increasing urbanization, insurance & awareness they are surely destined to disappear.
Lets look at it from our point of view. Why did we become a Doctor & an Urologist? The common reasons for choosing medicine as a career are: it is interesting. You have an aptitude for it and you love helping people. You want reasonable money, good name and good quality of work & good quality of life. I see quite a few of my individual owned hospital owners. Yes, they may earn tons of money, but to earn this they have to compromise on the quality of work & quality of life. Instead of spending time on the self & urological improvement, they are spending time doing general administration, marketing, cost-cutting and sometimes even doing class three works. Doctor should be a teacher; does my friend have time for that? When you are in the organized sector of tertiary care multi-specialty hospitals all you do is what you are best at: spend your time in patient care, self-improvement and teaching. After this you still have time to attend conferences, time for your family and time for overall personal & society growth.
Now look at it from the patient's point of view. Any educated & informed patient would want a place that has quality instruments & infrastructure, state of the art operation theaters, and a good quality nursing care. There should also be other facilities like intensive care units, other specialty support, and modern diagnostics. There should be assured post-operative care. If all this can be offered at an affordable price that is the icing on his cake. Can an individual owned hospital provide all this? But for a corporate multi-specialty setup all this is easy. Funds are available, best quality instruments are procured. Trained and qualified staff helps you provide the state of the art services. With increasing net of
In last two decades, due to
economic liberalization, our
country has witnessed tremendous
growth in overall infrastructure
development. Tourism, retail and
healthcare sectors have grown
significantly in last two years. As far
as medical technology and expertise is concerned, India
is not far behind the western countries. Traditionally,
healthcare services are provided by large Public
hospitals and teaching institutes, charitable hospitals,
corporate hospitals and individually owned nursing
homes.
Public hospitals/teaching Institutes with total or
semi governmental control have problems like limited
resources, bureaucratic hassles and relatively
compromised infrastructure. Charitable hospitals have
their own objectives, goals and limitations. They
entirely depend on the whims and wishes of governing
trustees, who usually are non-medical people.
Corporate hospitals are fast proliferating in Metro as
well as smaller cities. Because of huge initial capital
investment and excellent marketing support, they
appear to outperform all other healthcare service
providers.
Even then, Individual Nursing homes are here to stay
only because, we ourselves own them and are
responsible for establishing and maintaining them. We
always put our heart and soul in our venture.
Unfortunately, during our training period in medical
schools, our main motto is always to gain maximum
medical knowledge and surgical expertise. Financial
management, marketing and practice related issues are
not well known to us. This might cause little bit of
insecurity and prevent us from getting into solo
practice, despite best of the medical education and
training.
Five "c" like Confidence, Courage, Conviction,
Communication skills and Careful Planning are a must
to become a successful Solo Practitioner. Development
of Individual nursing home practice should be done in
phase wise manner to avoid huge capital investment and
stress. Procuring equipments should be carefully
planned. Surgical specialities like cardiac and
neurosurgery were known to require huge capital
investment. Urology also has grown high-tech enough
to demand large financial resources. But, we can still
manage to start practice with modest investment. We
should never compromise with the quality of services
we provide to our patients. Value added services like 24
hours pharmacy, catering and laundry services can also
be provided in individually owned nursing homes with
little extra administrative efforts. Quality management
protocols should be adopted by front office staff and
coordinators of outdoor and indoor services for
professional management. The biggest advantage in
Individual nursing home practice is that, we can provide
personal and humane touch in all the services offered to
our patients.
We must know our limitations as Solo practitioner. It
pays to be extremely honest with ourselves and our
patients. Majority of clinical work can be very well
managed in our nursing homes with extra care, but,
those patients who need multispeciality care should be
shifted to appropriate centers without any
delay/hesitation.
Another strong point which favors Individual
Nursing home is cost control. Despite providing high-
tech quality services to our patients, overall cost may
not be as high as corporate hospitals. We have total
control over expenses and charges collected from our
patients. One can always extend discounts to needy
patients.
Our country has large middle and lower middle class
population which still needs better healthcare. Public
hospitals have failed to sustain confidence and
corporate hospitals are yet to reach out to masses.
Healthcare insurance schemes have not been able to
cover these masses. If an individual nursing homes
which provides quality healthcare services at
reasonable costs and has generated tremendous
goodwill, insurance companies can not afford to ignore
such service provider.
Faith still remains the major factor in doctor-patient
relationship. If you have quality service back-up in your
own nursing home with all necessary surgical expertise,
I don't see any major threat by any other healthcare
provider to Individually owned Nursing homes in our
country.
Individual Nursing Homes: Here to stay - Dr. Ajay Bhandarkar
7
Sir, at the outset, on behalf of west zone USI, I thank
you for giving me time for this interview from your
busy schedule.
Q: Sir, I have seen you many times in our annual
conferences. When was your first visit to India &
how often have you been to India?
A: My first visit to India was almost 15 years back to
attend a meeting in AIIMS. That time after the
meeting, I went to Jaipur and moved around few
places in Rajasthan. Mind you, it was a fantastic
experience. Very next year I came to attend
Kanyakumari meeting. That time I saw Ajanta
Ellora caves. It was again a mind-boggling
experience. That time only I realized that this is the
country, I am going to visit again and again. And
since then in last 15 years I must have come about 10
times to India, I have visited Tamilnadu, Bangalore,
Kerala, Maharashtra, Patna, Varanasi, Agra,
Gujarat, and various other parts of country. I have
not yet visited North East which I am keen to do so in
near future.
Q: It s a pleasant surprise to hear such thoughts about
our country. Sir, having visited India for last 15 yrs,
do you see any change in our country? What is your
personal experience?
A: Yes, very much. India has radically changed in last
15 years. What I see is roads are improving,
connectivity is improving, domestic flight services
are improving. I am quiet impressed with Jet
Airlines. I was also very much impressed by the
Express Way from Ahmedabad to Baroda. Indian
economy is booming and I can certainly experience
all that in my every visit.
Q: Sir what changes do you see in Urology?
A: So far as Urology is concerned, I have been seeing
and visiting several centers across the country. I am
quite impressed with the kind of Urology being
practiced in India especially PCNL & Laparoscopic
urology. My own assessment is that Indian
Urologists acquire skill very well & use the
technology very effectively.
Q: Sir, you are the editor in chief of BJUI, I would like
to know, how many papers do you receive from
India for publications in BJUI?
A: Well, the number of papers received from India are
much less than what I would have expected. India
has much more potential but some how publications
are far less.
Q: Sir, since this topic has come, I wish to tell you that
many of us from different institutes across the
country, send lot many articles to BJUI but most of
them are rejected. Somehow impression is created
in our mind that papers from India or Asian
countries are more often rejected than accepted.
Sorry to say this but this is our feeling. Is it true?
A: No, No! that certainly is not true. Our process of
selecting an article for a publication is very much
transparent, impartial & purely on merit. We have
set protocol & a system that we rigidly follow. We
receive articles from all over the world and they are
sent to several reviewers for critical analysis. Since
they are coded, they don't know from where the
articles have come from. All reviewers are given
guidelines about acceptance or rejections. Articles,
which have prospective controlled studies with
clear messages, are likely to get accepted whereas
retrospective analysis carries less weightage. As
you know the standard of not only BJUI but also all
international journals is becoming high day by day,
competition is increasing & hence we have to
maintain certain standard. We receive large no of
Interview
Recently Prof. John Fitzpatrik visited Nadiad to conduct prostate workshop. Prof. Fitzpatrik a past president of BAUS - is consultant & chairman at University college hospital, Dublin. He has performed 54 visiting professorships, given 225 guest lectures, produced 306 peer review publications, 84 book chapters, 16 books, edited 11 journals, is on editorial board of 25 journals & is editor in chief of BJUI. It was my great privilege to talk to him during his visit about various issues urological & non-urological. These are some of the excerpts of the interview.
8
articles. Our overall acceptance rate is only 15-20%.
For India it is about 10%. My own articles in past
were rejected. So Indian urologists should not get
disheartened if their articles are rejected. On the
contrary they should learn the lessons, improve
upon themselves & try again. Let me tell you, we are
always in need of good article irrespective of
whichever part of world it comes from.
Q: Thank you very much for clearing lot of doubts in our
mind. The way you have described the functioning,
what it appears that to be an editor on chief of BJUI
is a tough job. How do you cope up with it?
A: Well, editing BJUI is no doubt a tiring job but is
challenging too. I have been an editor for last 5 years
and am going to remain so for the next 5 years. As an
editor I have a very different philosophy. One day
one publisher asked some other editor what your
journal want to be? He said I want my journal to
become number one in the world. When this
publisher asked me same question I said I want my
journal to be most advanced, most modern and
reader friendly. That is the philosophy I work with. I
have tried to modernize the journal time and again. I
have changed the color, changed the format,
changed the design so as to look attractive,
interesting & make it reader friendly, at the same
time elevating the standard. Editing BJUI has
become a part & parcel of my life. Wherever I go,
whatever I do, editing BJUI is constantly in mind. So
yes, it is a tiring job but, I thoroughly enjoy it.
Q: Sir, you are one of the most respected urologists of
the world. You have so many achievements. You
have become an icon for the budding urologist.
What is the secrete of your success & what is you
message to young urologists particularly in India?
A: Anybody whether urologists or not, who wishes to
achieve something, should be sincere &
hardworking towards his goal. He should be self-
critical & should establish his own standard of
practice. That is how I have reached this stage & am
sure everybody has potential to reach a top slot
provided they follow these principles. My advice to
young urologists - who have obtained degree and
who wish to remain in academic atmosphere / in a
medical colleges is, they should visit certain centers
abroad and try to get fellowship. It is always better to
focus on a particular topic and do fellowship in that.
There are many centers that offer such fellowships.
The best way to get such fellowship is to get a
contact with some international urologists who then
can recommend your name. This will start the ball
rolling and then it is up to you to get the advantage of
that. It is always better to see different centers doing
same thing in different manner. That is the best way
of acquiring the skill & improvising on yourself.
Q: Do you have any hobbies other than Urology?
A: Oh yes! I have a lot of hobbies. I love cricket and of
that I like the test format most. I have visited Lords
several times to watch test matches. I am also very
much fond of fitness. I do exercise daily, running,
jogging are my hobbies and I enjoy to be fit. I have
taken part in many cycle racing conducted for
charity purposes. I like music and I am extremely
fascinated by history. I have done extensive reading
on European, American and British history. I have
read several books on Indian history too. The book
named “The last Mugal” and “Indian summers”
based on partition fascinates me.
Q: Very surprising! But sir, how do you get time to all
these things?
A: There is always time if you really wish to do
particular thing. No time, I believe is always an
excuse.
Q: If you were not urologists, what you would have
been?
A: If I was not urologist, I can't certainly tell what I
would have been - may be a historian or a musician.
But let me tell you a reality, before I got into
medicine I had almost taken admission in Oxford for
classes in Greek and Latin. So in all probability, if I
were not urologist I would have been a teacher.
Q: Sir one last question. According to our religion, we
believe in rebirth. Suppose you were to reborn, what
you would like to be reborn as?
A: Your last ball is a real googly. Well, if I have to take a
rebirth I would like to be born again as John
Fitzpatrick. I would like to offer more services to
improve urology standard not only in my own
country but also all over the world.
Thank you sir for sharing your views with us so
frankly.
9
Sterilization is an important aspect of surgery. The
credit for advances in Urology largely goes to
development of sophisticated, delicate & miniature
instruments. Sterilization of these delicate & costly
instruments is an important issue. This article briefly
reviews various methods of sterilization, their advantages,
disadvantages & misconcepts.
1) Heat High pressure steam (autoclave), Dry heat
2) Chemical agents Glutarldehyde (cidex), Formaline
solution or tablets,
3) Gas sterilization Ethelene oxide ETO
4) Plasma sterilization Hydrogen peroxide - Sterrad
5) Physical agents - Radiation
This is a method of choice for open surgical
instruments. Greasy or oily materials can protect
microorganisms against the effect of steam, thus hindering
the process of sterilization. This emphasizes the need for
thorough cleaning of objects before sterilization. All
jointed instruments (assembled endoscopes) should be
opened or unlocked to allow the steam to reach all parts of
the instrument. Temperature should be 121.C, with
pressure of 106 kPa(15lb/in2) for 30 minutes. 20-30
minutes should elapse to permit the sterilizer to cool
sufficiently. This ensures complete sterilization.
Common mistakes - 1) Not allowing sufficient time
hurrying up to get instruments/linen fast thus not
achieving enough pr or exposure time
2) Tight packing of linen in drums not allowing enough
steam to circulate
3) Autoclaved items stored for long time without lid
Following devices may be steam sterilized - Rigid
Telescopes (autoclavable), Working Elements,
Trocars/Sheaths, Reusable thick tubing, 3 Lt saline
bottles, Insulated and non-insulated surgical instruments
(forceps, scissors, suction tubes, etc.) Sharp instruments
are not autoclaved as their sharpness is lost.
Wherever possible this method should be used, as it is the
cheapest & most reliable method of sterilization,
It is another way to sterilize
needles and endoscope instruments. A convection oven
with an insulated stainless steel chamber and perforated
shelving to allow the circulation of hot air is
recommended, but dry heat sterilization can be achieved
with a simple oven as long as a thermometer is used to
verify the temperature inside the oven. It has got
Common methods available to us for sterilization of
instruments are
Autoclave:
Dry heat Sterilization:
advantages of being an effective procedure even for
instruments that can not be disassembled, protective of
sharp instruments, leaving no chemical residue and
eliminating wet pack problems in humid climates. The
main disadvantage as compared to stem sterilization is
requirement of more time, continuous source of electricity
besides being contraindicated for plastic and rubber items.
Generally, after the desired temperature is reached, timing
is begun. The following temperature/time ratios are
recommended;
170. C 60 minutes
160. C 120 minutes
150. C 150 minutes
140. C 180 minutes
Depending upon the temperature selected, the total
cycle time (preheating, sterilization time and cool down)
will range from about 2.5 hours at 170.C to more than 6
hours at 140.C.
This is next best method for heat-
sensitive materials such as biological materials,
fibreoptics of endoscopic lens, electronics, and many
plastics. Chemical solutions are accepted “liquid chemical
sterilizing agents”, provided that the immersion time is
sufficiently long.
Decontaminate, clean, and thoroughly dry all instruments and other items to be sterilized. Water from wet items will dilute the chemical solution, thereby reducing its effectiveness. Prepare the glutaraldehyde-containing solution (or other chemical solution) by following the manufacturer's instructions. After preparing the solution, put it in a clean container with a lid. Always mark the container with the date the solution was prepared and the date it expires. (Usually 2 weeks). Open all hinged instruments and other items and disassemble those with sliding or multiple parts. The solution must contact all surfaces in order for sterilization to be achieved. Completely submerge all instruments and other items in the solution. All parts of the items should be under the surface of the solution. For sterilization, 10-12 hrs of soakage is required. After that, instruments should be cleaned by sterile water, as gluteraldehyde is toxic to the endothelium.
Myths 1) Cidex is commonly used for rapid sterilization. Instruments are soaked only for 20-30 mins. This achieves only disinfection. Telescopes if soaked for 12 hrs may cause damage of cement resulting in fogging of telescopes. Even other instrument's life may be reduced with long soakage. Thus it is myth that cidex sterilizes instruments, it only disinfects!!
Chemical Sterilization:
Gluteraldehyde (Cidex) sterilization:
Instruments sterilization : Myths & Realities
10
2) For it to be effective, instruments should be cleaned
thoroughly preferably by enzymatic solution it is hardly
ever done thus severely compromising even the
disinfection process
3) All instruments should be dissembled. Many of our
scopes can't be dissembled; all joints can't be separated
thus further compromising disinfection process.
4) Instruments are taken in & out several times resulting
into dilution thereby further reducing efficacy of solution.
5) Not covering by lid continuously & no monitoring of
pH. Thus not knowing about effectiveness of solution.
Thus, cidex, the way in which it is commonly used is
nothing but eyewash & far from sterilization
One of the curious applications of this
agent, prevalent in surgical operation theatres in India, is
in the form of tablets for the sterilization of delicate
instruments that can be damaged by heat. These are
available in the form of Para formaldehyde polymer of
formaldehyde, as tablets of one gram each. A literature
search did not provide adequate information regarding the
efficacy of this form of formaldehyde in sterilization. This
form of sterilization is already discarded from almost all
countries. One Indian study suggested that exposure of
formaldehyde vapors for at least 24 hrs in airtight
compartment may result in sterilization. However this
recommendation is on personal experience & not
evidence based.
Myths: Formaline tablets are kept in Acrylic box
containing scopes. No standardization about no of tablets,
duration of exposure, how many times the door of box is
opened, when to change the tablets..etc. Thus commonest
method of instrument sterilization adopted in private
practice is the one, which is obsolete…!!
Ethylene oxide (EO or EtO) gas is
commonly used to sterilize objects sensitive to
temperatures greater than 60 °C such as plastics,
laparoscopes, endoscopic lens, wires, and electric
items….etc. Ethylene oxide treatment is generally carried
out between 30 °C and 60 °C with relative humidity above
30% and a gas concentration between 200 and 800 mg/L
for at least three hours. Ethylene oxide penetrates well,
moving through paper, cloth, and some plastic films and is
highly effective. EtO can kill all known viruses, bacteria
and fungi, including bacterial spores and is satisfactory for
most medical materials, even with repeated use. However
it is highly flammable, and requires a longer time to
sterilize than any heat treatment. The process also requires
Formaldehyde:
Gas sterilization:
a period of post-sterilization aeration to remove toxic
residues. Ethylene oxide is the most common sterilization
method, used for over 70% of total sterilizations, and for
50% of all disposable medical devices.
Instruments frequently gas sterilized in urology
practice include: Fiberoptic endoscopes, surgical
telescopes, Laparoscope, Plastic instruments (e.g.,
specula, syringes), Anesthesia masks and circuits, Rubber
and plastic tubing (e.g., catheters), Respirators and
inhalation therapy supplies.
Problem - It is the best & relatively cheapest method of
sterilization. But takes long time. Post sterilization
aeration does not make it useful on day to day basis.
This method uses 1.8 milliliters of
58 percent hydrogen peroxide, which is vaporized, in a
sterilization chamber. The vapor is converted into plasma
through the use of radio frequency (RF) energy. Plasma
consists of highly charged particles and free radicals to
sterilize instruments in about one hour without producing
toxic residues or emissions. Commercially, ASP as
STERRAD markets it.
It is useful to sterilize almost everything such as Rigid
Telescopes, Flexible Fiberscopes and Semi-rigid
Fiberscopes , Video Cameras, Fibre- and Fluid-Light
Cables, Surgical Instruments, Insulated (forceps, scissors,
etc.), Surgical Instruments, Non-insulated (forceps,
scissors, etc.), High frequency Cords ..etc
Advantages:
1)Consumes less power than traditional EtO sterilization
units.
2) Requires no water, drainage, or venting
3) Has shorter cycle times than traditional EtO
sterilization units (74 minutes vs. 12 hours)
4) Eliminates the use of EtO, a carcinogen/mutagen and
highly explosive chemical
5) Has significantly lower annual operating costs than
traditional EtO sterilization units
Disadvantages:
1) Not compatible with cellulose products,
2) More expensive than EtO sterilization units
3) Unable to handle large-volume requirements.
Almost all products can be sterilized by this
method but can't be implemented in day-to-day practice as
needs big units, Govt permissions, & radiation rules.
Plasma sterilization:
Radiation:
- Dr. Shashikant Mishra
11
18th WZUSICON 2008, Solapur
12
Announcements
MIUC fellowship : Please see the eligibility criteria mentioned in WZUSI awards article. Those eligible
should apply before 15th October to Hon Secretary. The application should be on plain paper with all details &
proofs mentioned therein.
Elections Following vacancies will be filled up during forthcoming Solapur conference.
1 President elect
2 Hon.Secretary Dr. R.B.Sabnis is eligible to contest for 1 more term
3 Hon. Treasurer Dr.Umesh Oza is eligible to contest for 1 more term
4 Council member 3 posts
Those interested should send their application to returning officer President Elect Dr. S. W. Thatte before 30th
October2008. For details please see constitution on our web site.
Address : 407, Shalaka, 9 Maharshi Karve road, Opp Kuperage ground, Mumbai Maharashtra 400021.
E mail [email protected], Mobile - 98200 95112
General body meeting will be held on Saturday 15 Nov. at 5.15 pm at the conference venue in Solapur. The
agenda will be circulated later. Any full members interested in including some issue in agenda, please inform
Hon. Secretary before 15th Oct.
The preparations for the conference are in full swing. Dr. Raghoji & his team are working day and night to make your
stay comfortable. There is an excellent big auditorium fully AC which will be our main Hall A. There are 2 other air-
conditioned satellite auditoria for other activities. The response of delegate registration is good. However more
delegates from Mumbai & Gujarat are expected. Scientific programme is very carefully planned. Please go thro the
detailed programme. You will be definitely tempted to attend. The trade exhibition area is huge & spacious. The trade
response is also satisfactory. The delegates are going to see various products of different companies. Certainly this is
going to be an opportunity to make purchases for the year. The evening programmes are going to be most entertaining
& novel. So come in large numbers. Meet the friends & enjoy the atmosphere.
Category
USI member
Non USI member
Accom. person
PG Student
Please draw DD (or at par cheques only) in favour of WZUSICON-2008 payable at Solapur & send to Conf.
secretariat. Spot registration is by cash only.
Conference Secretariate:
Dr. Vijay Raghoji, Raghoji Kidney Hospital,
146/2, railway lines, Solapur, 413001 Maharashtra,
Tel 02172319700, Fax 0217 2319701, mob 09822072142
E mail [email protected], web site - www.wzusicon2008.org
Coming to Solapur is not difficult anywhere from our zone. Every day there 12 trains between Mumbai to Solapur.
From Pune it is only 4 hrs drive by road, besides there are more than 14 trains commuting between Solapur & Pune.
Thus if there is no direct train from your place to Solapur you can come to Mumbai or Pune & take any convenient
mode of transportation.
Fee Structure
Upto 31 Sept
3000
3500
2000
1500
Spot
4000
5000
3000
2000
13
thDay 1 Friday : 14 November 2008
09.00 to 09.30 AM: Know your instrument - Rigid & semi rigid URS
All details of it will be discussed. What are different sizes,
channel size, diff accessories and advantage of one the over other? Pros & cons of different
manufacturers Storz, Wolf, Olympus ..etc . What things to keep in mind while buying URS?
How to sterilize them? All such aspects will be covered
09.30 to 10.00 : Small fight by residents Topic Clinical situation - 62 yrs male, Borderline LUTS, for 6 mths,
H/O 1 episode of retention : Medical therapy Vs TURP
10.00 to 11.30 : Symposium on urinary diversion
Commonly preformed diversions after cystectomy are few Ileal conduit, orthotopic neobladder,
ureterosigmoid or rectal bladder. Thorough discussion of practical relevance is planned. Video
clippings will be shown of techniques, pros & cons of each will be discussed. How & why a
particular diversion is to be done will be discussed. Experts in the field will participate & at the
end of session delegates will have clear idea about diversions after cystectomy.
11.30 to 11.45 : Tea Break
11.45 to 12.45 : Trouble shooting
A situation will be presented where complications have occurred video clipping will be shown
either endoscopic or even open surgery. Expert panelists will be asked how to manage.
Audience will participate & then what was done will be shown. Like this 2-3 common
situations will be discussed.
12.45 to 01.15 PM: Drugs for Overactive bladder debate / discussion / case scenario Comparison of Toltaridine ,
Oxybutonin, solifenacin, darifenacin
01.15 to 02.00 : Lunch
02.00 to 03.30 : To be announced later
03.30 to 04.15 : Meet the expert interaction with experts Interactive session with case discussion,
04.15 to 04.45 : Mock trial & his team
04.45 to 05.15 : Know the drug th
Day 2 Saturday : 15 November 2008
08.00 to 09.00 AM: Cadaver transplant What every urologist must know - video instructional course
Awareness of cadaver kidney donation is increasing. There is move to recognize many centers
even in peripheral cities to retrieve cadaver organs. Hence every urologist must know how to
do retrieval of organs. At the end of this session you will have full information about cadaver
kidney retrieval. This session will discuss what is brain death, what sequence of events should
follow once brain death is declared, how to maintain cadaver for some duration, Video
clippings of technique of cadaver transplant will be shown & discussed.
Milind Bapat, MukundAdanakar
Dr. Hiren Sodha Vs Dr. Radheshyam Verma
Dr. Tongaonkar Convener,
Convener - Dr. Pankaj Maheshwari ,
Dr. Kanbur, Dr. Singhal
Convenor Dr. Hemant Pathak, Experts Dr. Madhav Kamat, Dr. S.S.Joshi
Dr. Ajit sawant
Dr. Rajesh Kukreja, Dr. Ulhas Sathaye
Convenoer Dr. Pranjal Modi ,
Scientific programme - WZUSICON 2008, Solapur
13
09.00 to 09.30 : V.V.Desai Oration
09.30 to 10.00 : A.N.Gaikawad Oration
10.00 to 10.30 : Big fight by consultants : Small single Bladder tumour T1 G3 - Cystectomy Vs Bladder
Preservation surgery
10.30 to 10.45 : Tea break
10.45 to 12.45 : Video Symposium on lap nephrectomy
Most urologists are keen to learn & start doing laparoscopy. First laparoscopic procedure
attempted is simple nephrectomy. This session will cover all details of simple nephrectomy
from start to end. At the end, delegates will get fair idea of everything about the procedure. All
the technical details will be discussed in details with video clippings Various instruments,
how to select them? Which are minimum mandatory? Disposable ports or reusable ports?
Technique of nephrectomy. Various approaches & steps of surgery with video clippings, what
complications can occur? How to manage them, how to prevent them? Tricks of the trade. All
these things will be elaborated.
12.45 to 01.15 : Know your Guru
01.15 to 02.00 : Lunch
02.00 to 05.00 : Free papers Multiple Halls
05.15 Onwards : AGMth
Day 3 - Sunday : 16 November 2008
08.00 to 09.00 : Andrology video instructional course role of andrologist in IVF set up.
Several IVF centers are coming up in different cities. Local urologists are keen to get
attachments to such centers. This session will give them full idea about what role they can play
& confidence to perform these procedures with good success rate. Video clippings of TISA,
PESA, micro testicular biopsy, multiple testicular mapping biopsies, preservations of sperm
…etc will be shown. How to perform these procedures with good success, problems
encountered & complications will be discussed in details.
09.00 to 10.00 : Quiz
10.00 to 11.30 : Symposium G.U.Trauma Convener
Panel Members
11.30 to 12.30 : Great discoveries in Urology
Sameer Desai Vs T.B.Yuvaraj
Convener Dr. Anup Ramani,
Dr. Rupin Shah , Dr. Deepak Gupte, Dr.Sudhanshu Chitale
Dr. Jayesh Dhabalia
Dr. Sanjay Kulkarni
Dr. Sujata Patwardhan
Dr. Rasesh Desai
Dr. Gyanendra Sharma
Dr. Prashant Mulawkar
Dr. Vasudeo Ridhorkar
14
15
Happenings in the Zone Happenings in the zone
Hearty Congratulations!!
T h e f i r s t a n n u a l
international symposium on
Radical Prostatectomy and
Robotics -New York-
Mumbai was held on 15th
and 16th March at P.D.
H i n d u j a H o s p i t a l ,
Mumbai.This was a novel
experiment of a joint
symposium between the
New York Presbyterian
Hospital and Weill Cornell
Medical college and The
Mumbai Urology Society.
Dr Ashutosh K Tewari, Associate Professor of Urological Oncology, Director Program on Robotic Prostatectomy
was the chief Symposium director . Dr V. Srinivas, Dr. J.N.Kulkarni, and Dr H. Tongaonkar were the Program Co-
directors.Superb demonstration of the technical steps involved in Open, Laparoscopic and Robotic nerve sparing
Radical Prostatectomy was witnessed by one hundred and twenty keen learners from the Urology community .An
overveiw of of novel concepts in neuroanatomy ,illustrations on mechanisms of urinary continence preservation and
potency preservation and detailed discussion on challenging problems in prostate cancer management were the
highlights of the programme.
The icing on the cake was off course the superb demonstration with 3-dimensional images of modern robotic
radical Prostatectomy.Dr Asutosh Tewari impressed the gathering with his comprehensive detailed knowledge and an
extremely rational approach towards Early Prostate Cancer.
Dr. Makarand Khochikar, Dr Samir Desai and Dr Anup Ramani contributed significantly with their presentations
.Dr Madhav Kamat ensured that proper guidelines to the use of Radiotherapy and Chemotherapy in prostate cancer
were given to all members by moderating a session with regards the same and he was instrumental in ensuring that the
programme was conducted efficiently. The team from New York appreciated the interaction with our Urologists and
were keen to have similar symposiums on an annual basis to facilitate exchange of views on different Urological
Problems in the future.
Dr. Pranjal Modi performed first successful liver transplant in Gujarat at IKD Ahmedabad
Dr. Rupin Shah was given prestigious B.C.Roy award at the hands of President of India on 1st Aug 2008
Dr.T.B.Yuvraj from Mumbai was awarded the Detroit Fellowship and the Chakraborty fellowship by the
Indian Urologists in America.
West zone USI feels proud of their achievements!!
15
Forthcoming Events:
16
Workshop on Reconstructive Urethral Surgery
“Basic to Advanced: The art of PCNL”
Secretariat :
Vice Chairman, Dept.of Urology, MPUH, Dr. V V Deshai Road, Nadiad 387001, Gujarat.
Tel. : 0268 2520323 to 30, Fax : 0268 2520248, Mob. : 9426422002, Email : [email protected]
Dr. Ravindra B. Sabnis
This live operative workshop is organized from 18 to 20 Sept. at Nadiad in association with JPAC & West Zone USI. We are privileged that Peter Alken a pioneering name in PCNL (Alken's dilator, sheath) is coming for the first time in India to conduct this workshop. It will be a great opportunity for all of us to watch him demonstrating various procedures & have one to one interaction with him. We are planning to show maximum procedures covering basics to advanced techniques of PCNL to be demonstrated by other national faculties. Apart from live operations, lot of time is kept for discussion. Everyday we shall have hands on lab experience on state of the art simulators, which will be quite beneficial. On last day we have kept ureteroscopy session, which will be useful to most delegates. We are also planning to collaborate with Cleveland for live transmission on robotics on ureteroscopy. In all this will be an opportunity to get updated with these procedures. Don't miss it….!!Scientific Programme :Live transmission of different types of PCNL Staghorn stone, calyceal stones, abnormal kidneys, solitary kidney, supine PCNL, Flexible URS, laser..etcHand on lab experienceRegistration fee: Rs 5000/- (without hands on lab experience) or Rs 10000/- (with hands on experience on lab), DD to be drawn in favor of “MPSRNU” payable at Nadiad. Hotels Nadiad A/C rooms Rs 500 per day, Non A/C rooms 350 per dayFor details please visit www.mpuh.orgFor any assistance please contact: Mr. N. Bhaskaran ([email protected], 09824024976), Dr.R.B.Sabnis ([email protected], 09426422002) Dr. Pradeep Ganatra ([email protected], 09824387701) Muljibhai Patel Urological Hospital, Dr.V.V.Desai Rd, Nadiad-387001, INDIA Ph. No.:+91 268 2520323 upto 30 Fax : +91 268 2520248
Dr. Barbagli is not a new name to all of us. He has conducted several workshops on urethroplasty in past & many of us have immensely benefited with them. We are fortunate that he is coming to our zone in Pune to conduct yet another workshop. We are thankful to centre for reconstructive surgery & Dr. Sanjay Kulkarni in particular to have organized this event. West Zone USI feels proud in associating with this academic activity. I request all those, interested in urethral surgery to participate & take advantage.
Dates: 9-10th Oct.2008, 8am-5pm, Venue: Hotel Senator, Paud Road, Pune.
Prof. Guido Barbagli, Arezzo, ItalyProf. Sanjay Kulkarni, Pune, India
Live surgeries: different types of urethroplastiesDiscussion on choice of techniques, complications, what is new & what is out!Conference fee Rs. 3000 (Conference only)Rs 6630 for conference and 2 nights stay (Hotel Senator - Twin sharing room, 8th and 9th Oct 2008), Double room- Rs 3630 per daySend DD to “Kulkarni Endo Surgery Institute” payable at PuneKulkarni Endo Surgery Institute3 Rajpath society, Paud road, Opp.Vanaz, Pune 411038Tel Off.- 020 25380555, 25382554, Mob - 09822024050Email: [email protected]
Details are as follows:
Faculty:
Programme:
