Urology

Introduction

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 north India. The department was formally started in 1982 with Dr. BK Vohra as its head. It has many firsts to its credit. The Department was recognised as a Centre of Excellence by the Govt. of India in 1986. The Department comprises of 8 full time faculty and 6 post graduates residents and fellows all committed to provide exceptional and innovative patient care.

Chronological Order of Firsts for the Department at Sir Ganga Ram Hospital

• Year Procedure
• 1975 TURP
• 1983 Urodynamics
• 1987 PCNL
• 2000 ESWL
• 2002 Laparoscopic Urology
• 2005 Laser Prostatectomy
• 2012 Robotic Surgery

Subspecialties

1. Robotic Surgeries

Surgery is performed by the surgeon using a console that controls instruments attached to a robot, allowing the robot to act exactly the way the surgeon does. It is technical more advanced and precise. There is increased motion range, improved dexterity, enhanced visualization with magnification thus improving the access, quality of surgery and its outcome. The blood loss is less, less pain shorter hospital stay and faster functional recovery. Various surgeries performed by Robot are robotic radical prostatectomies, radical cystectomy, radical and partial nephrectomy, pyeloplasteis, re implantation of ureter, Boariflap, repair of VVF/UVF.

2. Endourology

Procedures like PCNL (Percutaneous Nephrolithotomy), 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. Trans urethral resection of prostate is being done in our department for more than three decades. KTP laser prostatectomy was started in 2005. The department also has a 30-watt holmium laser for treating stone disease.

3. Laser prostatectomy

This is the latest method of treating prostate enlargement. This technique uses KTP laser, which has property of vaporization of tissue without causing bleeding. More than 100 operations have been done successfully with good results. This is practically bloodless operation, and can be done on patients who are on anticoagulant therapy i.e. patients on aspirin, clopidogrel, acitrom etc. It can be done on day care basis i.e. patient can be discharged same day without any catheter.

4. Laparoscopic Urology

In 2002, laparoscopic (key hole) urology was introduced. Today a majority of surgeries like nephrectomies, pyeloplasties, repair of vesicovaginal fistula, ureterolithotomies are being done laparoscopically with excellent results. Over 1000 operations have been done in last 8 years. Laparoscopic technique decrease the postoperative pain, hospital stay and gives good cosmetic results. Laparoscopic radical prostatectomy was started in 2005. It is the standard operation for localized prostate cancer. We are the only hospital in Delhi and one amongst few where this operation in done extraperitoneally which is safer as there is no bowel or bladder injury and hospital course is shorter than transperitoneal route. Approximately 60 such operations have been performed in 5 years with no complications.

5. Urodynamics

This was the first department in Delhi to start urodynamic studies in 1983. We have the latest state of the art urodynamics machine from Denmark. Patients from various hospitals all over North India are referred for urodynamic studies to our department for better understanding of lower tract dysfunction and neurogenic bladder.

6. Andrology

This subspecialty relates to male sexual disorders such as impotence, and male infertility etc. Erectile Dysfunction (Impotence) Psychosexual counseling, intracavernosal injections, vacuum erection devices are regularly used. Penile implants are being inserted for those patients not responding to the above treatment.

7. Male Infertility Sperm retrieval by all techniques like TESA, MESA and PESA for micromanipulation like ICSI is done in coordination with department of IVF. Operations such as vaso-epididymal anastomosis are performed for obstructive azoospermia.

8. Reconstruction Urology

Expertise is offered for all variety of upper and lower tracts reconstructive problems including pyeloplasty, ileal replacement of ureter, Boari flap, augmentation cystoplasty, whole range of urethral and genital reconstruction. Urethroplasty using buccal mucosa or penile skin is routinely done for complex urethral strictures.

9. ESWL (Lithotripsy) Non-invasive technique in which stones are broken by application of shock waves with latest shock wave generation Dornier lithotripsy machine. Approximately 1000o patients have been successfully treated with lithotripsy. It has got advantages that it can be done without hospitalisation and anaesthesia. Patients can resume their work early after the procedure.

10. Uro-oncology All types of genito-urinary cancers including kidney, bladder, prostate, testis, penis are treated with radical surgery as indicated.

11. Uro-gynaecology Treatment for stress urinary incontinence, recurrent urinary infection, and urinary fistulae is available. TVT, TOT (slings) for stress incontinence are being inserted on a regular basis.

Academics

The department has been running a well structured successful DNB program since 2002 and positions for training here are coveted. There is a teaching program where all aspects of urology and renal transplant are covered. The DNB trainees have done well in their urological career after graduating from this hospital. The department organizes regularly annual workshops and CME programmes inviting national and international faculty for promoting academics in Urology. Our Consultants are invited as faculty for national and international conferences and scientific papers are presented routinely at all urology forums. DNB trainees have submit theses as part of academic curriculum and these have been well received.