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Newsletter

OFFICIAL NEWS BULLETIN OF UROLOGY SOCIETY OF INDIA WEST ZONE

Visit : www.wz-usi.org


West zone council details :

President’s Message....

Dr. Deepak Kirpekar 09822022842 deepakkirpekar@gmail.com Dr. Sadanand W. Thatte President Elect.09820095112 swthatte@vsnl.com Dr. Harshad Punjani Past President09833987313 punjanih@gmail.com Dr. Ravindra Sabnis Secretary 09426422002 rbsabnis@hotmail.com Dr. Umesh Oza Treasurer 09820058623 uzoa@bom3.vsnl.net.in Council Members Dr. J. Lalmalani 09820071046 lalmalani@hotmail.com Dr. Anil Bradoo 09820303774 bradooa@gmail.com Dr. Prashant Mulawkar 09823043864 pmulawkar@hotmail.com Dr. Jaydeep Date 09822040813 jaydeepdate@gmail.com Ex-officio Members Dr. Shailesh Shah 09824035673 kidneyline@gmail.com Dr. Makarand Khochikar 09822052731 khochikar@gmail.com

President-

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

CONTENTS

2

President's message

2

Secretary's message

3

Information of awards by WZUSI

4

Debate

6

Interview

8

Instruments sterilization : Myths & Realities

10

Solapur Conference information

12

Scientific programme-Solapur Conference

13

Happenings in the zone

15


From the Desk of Hon. Secretary & Editor At the outset, I wish to apologize for the delay in

members especially PG students had desired to know

publishing this newsletter due to some unavoidable

details of various awards that are given by the west

circumstances, which I will let you know at an

zone. I am giving all the details in this bulletin for

appropriate time.

your ready reference.

I am happy that most members liked our last

We have several other activities under auspices of

newsletter. Many appreciated the change in design,

west zone USI.

format, & the overall look. I am going to continue

1)Dr. Subodh Sheide, Dr. Bhalchandra Kashyapi

with the same format. I once again request all of you

& Dr. Jaydeep Date had organized 2 days of Uro-

to contribute significantly, send some articles,

radiology teaching programme for the PG students at

information, interesting events, happenings in your

Dinanath Mageshkar Hospital Pune.

area, I will like to publish all that.

2)At Nadiad we have planned a big event A live

At zonal level, there was a lull in between, but now

operative workshop on PCNL & URS. The theme is

we are geared up for various activities in coming

“PCNL:Basic to advanced� I am putting all details of

months. Solapur conference preparations are in full

this workshop in this newsletter. I request all of you

swing. Registrations are satisfactory but we wish to

take advantage of this mega event of our zone.

have some more response especially from Mumbai &

3) Dr. Barbagli-reknowned name in urethroplasty

Gujarat. The scientific programme is also finalized.

is coming to Pune. Dr. Sanjay Kulkarni is organizing

I am giving all details in this newsletter itself. You

live operative workshop on urethroplasty. Please

will realize that even this time, we have continued

find all details in this issue. Register early to avoid

with interactive & practical oriented sessions. Even

disappointment.

this time we have encouraged younger & newer

4) Dr. Brajesh Singhal has finalised organising

members to participate as speakers. Dr. Raghoji &

CME on common urological topics at Gwalior in

his team are carefully planning the organizational

association with local IMA branch.

aspects. I have no doubt that Solapur conf. is going to

I still want many members to contribute towards

be a grand event both academically & otherwise.

this newsletter. Please send something, which you

Don't miss it.

feel, is worth informing to all your colleagues. It

This time also we had an excellent response of

could be some achievement, some programme/event

papers & have received more than 80 abstracts. We

in your area, some medico-legal incidence, it could

are going to have strict selection criteria so as to

be anything. Please feel free to write. I have kept

improve the standard of papers & also do justice to

ample space for this purpose, so don't

the presenters. All these papers are coded & are sent

hesitate.

Please also send your reactions, suggestions about

to a panel of 4 judges for their review & comments.

this issue, or for that matter anything related to our

On that basis we will select papers for acceptance.

zonal activities. I am eagerly waiting for that.

The council has decided to increase the prize money

Dr.Ravindra B. Sabnis

of all awards to make it double from this year. Many

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Information of awards by WZUSI 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 Eagle traveling fellowship: 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. Presentation: First prize - Cash Award Rs.5000/ -and Certificate Second prize : Cash Award Rs.3000/- and Certificate V.V.Desai oration : 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 Presentation: Plaque & certificate

A.N.Gaikawad Oration : 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 Presentation: Plaque & certificate Urology Gold Medal : 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. Presentation: Citation, certificate & gold medal MIUC fellowship : Aim of the fellowship: To recognize the talent of USIWZ who will present their work in one of the international conference like SIU,EAU, AUA‌etc 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

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Best paper award Poster :

6) Candidates having 2 publications in international journals (as first author) will be preferred

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.

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.

2. The paper must be in the field of urology or ancillary discipline contributing to urology.

9) After selection applications, if required the authorization committee (which includes president USIWZ & SIU representative) can take interview of the candidates for final round

3. The material being presented in the paper must not have appeared elsewhere in any form viz.: presentation, publication, lecture, movie etc.

10) The candidate shall apply to secretary before the appropriate date declared on plain with all details

4. Authors must submit abstract / full text before the last date of submission of papers.

11) The fellowship will be advertised 1 month before the last date

5. The selection of papers for presentation will be done by the committee appointed by the council of USIWZ.

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.

6. The papers will be adjudged independently by judges appointed by the council of the USIWZ through the Secretary.

13) The fellowship will be given only if the candidate goes to present his work.

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

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.

Second prize Rs 1000 & certificate Best paper award Video : 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 : First prize Rs 2000 & certificate Second prize Rs 1000 & certificate

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 : First prize Rs 2000 & certificate Second prize Rs 1000 & certificate

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Debate 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 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 multispecialty 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

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 angioembolization 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.

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Individual Nursing Homes: Here to stay - Dr. Ajay Bhandarkar 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.

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.

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.

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.

Another strong point which favors Individual Nursing home is cost control. Despite providing hightech 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.

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.

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.

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

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.

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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.

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

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

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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.

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 selfcritical & 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

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Instruments sterilization : Myths & Realities 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. Common methods available to us for sterilization of instruments are 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 Autoclave: 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, Dry heat 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

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. Chemical Sterilization: This is next best method for heatsensitive 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. Gluteraldehyde (Cidex) sterilization: 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!!

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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. Plasma sterilization: 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. Radiation: 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.

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 Formaldehyde: 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…!! Gas sterilization: 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

- Dr. Shashikant Mishra

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18th WZUSICON 2008, Solapur 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 airconditioned 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. Fee Structure Spot Upto 31 Sept Category 4000 3000 USI member 5000 3500 Non USI member 2000 3000 Accom. person 1500 2000 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 drraghoji@wzusicon2008.org, 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.

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 swthatte@vsnl.com, 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.

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Scientific programme - WZUSICON 2008, Solapur Day 1 Friday

:

09.00 to 09.30 AM:

14th November 2008 Know your instrument - Rigid & semi rigid URS Milind Bapat, MukundAdanakar 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 Dr. Hiren Sodha Vs Dr. Radheshyam Verma

10.00 to 11.30

:

Symposium on urinary diversion Dr. Tongaonkar Convener, 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. Convener - Dr. Pankaj Maheshwari ,

12.45 to 01.15 PM:

Drugs for Overactive bladder debate / discussion / case scenario Comparison of Toltaridine , Oxybutonin, solifenacin, darifenacin Dr. Kanbur, Dr. Singhal

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, Convenor Dr. Hemant Pathak, Experts Dr. Madhav Kamat, Dr. S.S.Joshi

04.15 to 04.45

:

Mock trial Dr. Ajit sawant & his team

04.45 to 05.15

:

Know the drug Dr. Rajesh Kukreja, Dr. Ulhas Sathaye 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. Convenoer Dr. Pranjal Modi ,

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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 Sameer Desai Vs T.B.Yuvaraj

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. Convener Dr. Anup Ramani,

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

:

AGM

Day 3 - Sunday

:

16 November 2008

08.00 to 09.00

:

Andrology video instructional course role of andrologist in IVF set up.

th

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. Dr. Rupin Shah , Dr. Deepak Gupte, Dr.Sudhanshu Chitale 09.00 to 10.00

:

Quiz Dr. Jayesh Dhabalia

10.00 to 11.30

:

Symposium G.U.Trauma Convener Dr. Sanjay Kulkarni Panel Members Dr. Sujata Patwardhan Dr. Rasesh Desai Dr. Gyanendra Sharma Dr. Prashant Mulawkar

11.30 to 12.30

:

Great discoveries in Urology Dr. Vasudeo Ridhorkar

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Happenings in the Zone

Happenings in the zone

The first annual international symposium on Radical Prostatectomy and Robotics -New YorkMumbai was held on 15th and 16th March at P.D. Hinduja Hospital, 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 Codirectors.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.

Hearty Congratulations!! 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 15


Workshop on Reconstructive Urethral Surgery Forthcoming Events: 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. Details are as follows: Dates: 9-10th Oct.2008, 8am-5pm, Venue: Hotel Senator, Paud Road, Pune. Faculty: Prof. Guido Barbagli, Arezzo, Italy Prof. Sanjay Kulkarni, Pune, India Programme: Live surgeries: different types of urethroplasties Discussion 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 day Send DD to “Kulkarni Endo Surgery Institute” payable at Pune Kulkarni Endo Surgery Institute 3 Rajpath society, Paud road, Opp.Vanaz, Pune 411038 Tel Off.- 020 25380555, 25382554, Mob - 09822024050 Email: sanjaybkulkarni@gmail.com

“Basic to Advanced: The art of PCNL” 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..etc Hand on lab experience Registration 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 day For details please visit www.mpuh.org For any assistance please contact: Mr. N. Bhaskaran (nadiadbhaskaran@yahoo.com, 09824024976), Dr.R.B.Sabnis (rbsabnis@hotmail.com, 09426422002) Dr. Pradeep Ganatra (ganatra@mpuh.org, 09824387701) Muljibhai Patel Urological Hospital, Dr.V.V.Desai Rd, Nadiad-387001, INDIA Ph. No.:+91 268 2520323 upto 30 Fax : +91 268 2520248 Secretariat : Dr. Ravindra B. Sabnis 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 : rbsabnis@hotmail.com

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USIWZ Newsletter 2008 July  

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