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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 President 09833987313 punjanih@gmail.com Dr. Ravindra Sabnis Secretary 09426422002 rbsabnis@hotmail.com Dr. Umesh Oza Treasurer 09820058623 uzoa@bom3.vsnl.net.in Council Members 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, We will be meeting in Solapur soon after DIWALI and I am sure this letter will reach you before, so HAPPY DIWALI and I wish all of you a very prosperous new year to come. I am happy to say that last 2 months have been academically active and fruit full. PCNL workshop at Nadiad was very well attended and everyone enjoyed seeing Prof. Peter Alken, the inventor, and Prof. Mahesh Desai, master craft man , at work. Reconstruction workshop at Pune was no different. This was attended by 110 delegates who had the pleasure of witnessing various urethral reconstruction procedures done by Prof. Barbagly and our own Prof. Sanjay Kulkarni. Thank you for your response to my last letter. I have now received more e.mails where our members have reached general population. Solapur team is all geared up and ready to receive you for the 18th annual conference. I am sure you will have a pleasant stay, a good academic experience with interaction and social get together. West zone council has planed a very interesting programme with topics of interest to all.

CONTENTS

I would like to thank all of you for giving me the opportunity to serve you as a President for the year and I sincerely appreciate the support and help from my council. I am looking forward to seeing you in Solapur.

Dr. Deepak Kirpekar

2

President's message

2

Secretary's message

3

West Zone Activities

4

Solapur Scientific Programme

6

Details of Free Paper Session

7

Management thoughts

9

Interview

10

Debate

12

Announcements

15

90/10 Principle

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From the Desk of Hon. Secretary & Editor Dear Friends,

programme under the banner of west zone USI. All other activities as detailed in this newsletter were

Diwali is a beginning of New Year. It is a

quite successful & well appreciated.

Festival of light, happiness and victory of good our evil. I wish this Diwali brings peace, Prosperity and

All of us are eagerly waiting for our grand annual

happiness to everyone.

event WZUSICON. All details are finalized. I take

I feel happy to release the last issue of current

this opportunity to congratulate all the members

year's newsletter. In the beginning of a year, I myself

whose papers are selected or presentation in various

took up the responsibility to edit the newsletters & I

categories. As promised, we have started a new

enjoyed compiling this year's 3 newsletters. I tried to

category of un-moderated posters with this even

change the design to make it attractive & formatted

those whose papers are not selected for presentation,

inner pages differently to make it reader friendly. It is

are also getting chance to display their work. I wish

up to you to judge whether I succeeded in my aim. I

all the participants best luck for various competitions

introduced the articles of debate, published articles

to be held in the conf.

informative to urologists about non-urological or

I am sure, you will realize that the scientific

para-urological topics, took interview of foreign

programme is carefully planned to cover more topics

visitors in the zone, & covered the happenings in the

& especially those, which we did not touch during our

zone. I will always be happy to know your reactions.

last conference. Speakers are mixed blend of seniors

One thing, which disappointed me & I must make a

as well as juniors & purely on merits. I request all of

mention that contribution from the members is still

you to participate actively in all scientific

not up to the mark. I hope the situation will improve

deliberations of the conference. Your contribution in

in the times to come.

deliberation will encourage speakers & make the

I am sure, all of you are aware of the issues that

programme successful. Don't forget to give your

society is facing today. As a secretary, it was a path

feedback only that will guide us as to what changes

full of hurdles. It was testing time not only for me but

are necessary.

also to everyone in the council. It was not easy to

I must appreciate the effort that organizing

neglect certain things & continue to work as if

committee is taking to make your stay comfortable in

nothing has happened. However, in a given situation,

Solapur. Dr. Raghoji's dynamism & enthusiasm is

I tried to give maximum that I could. I personally

remarkable. Everything is proceeding as per plan &

apologize for any lacunae that may have occurred. I

under his personal supervision. I have no doubt that

will elaborate more in my report during conference.

Solapur conf is going to be excellent & beyond your expectations

Well, even then, this year was quite eventful. We finished several academic activities and I had

Eagerly waiting to see you in Solapur.

privilege to attend all. I thank Subodh, Bhalchandra

Dr.Ravindra B. Sabnis

& Jaydeep for organizing first PG training

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West zone activities PCNL Workshop, Nadiad

Urethroplasty Workshop, Pune Live operative workshop on PCNL & URS was organized at Nadiad under auspices of west zone USI, on 18th to 20th September 2008. The

theme was “PCNL: Basic to advance” Prof. Peter Alken from Germany a pioneer in the field of PCNL- who has so many inventions to his credit like Alken needle, Alken sheath, Alken rod, Alken dilators….etc - came for the first time in India to conduct the workshop. Other operating faculty were Dr. Mahesh Desai, Dr. R.B.Sabnis, Dr. Percy Chibber, Dr. Madhu Agrawal & Dr. Kandaswamy. The workshop was inaugurated in the hands of Dr. Deepak Kirpekar President USIWZ. Prof Alken delivered his keynote address PCNL: Basic to Advance. Various lectures on different topics were refreshing. Operations were carried out simultaneously in 3 operation theatres. First 2 days were devoted for PCNLs. All varieties PCNL for different types of stones Staghorn, partial staghorn, calyceal calculi, recurrent stones with previous surgeries, undilted system, upper calyx approach, USG/ Fluro control punctures, supine PCNL, Multiple punctures, Puncture wash technique, Flexible nephroscopy …etc were demonstrated. Total 14 cases of PCNL were shown. Last day was devoted for ureteroscopy. Lectures covered various issues related to URS including lot of discussion on complications & its management. Live demonstration of RIRS with flexible URS & laser was interesting. Every day in the evening interesting cases were discussed. All the delegates actively participated in the discussion. 116 urologists coming from different parts of country attended the workshop. Foreign delegates included urologists from Qatar and Nigeria. All delegates were happy & took some message / hints back home. Prof Alken expressed satisfaction to conduct the workshop & promised to visit again.

Workshop on urethral reconstruction surgery was organized on 9,10 Oct. 2008. At Pune Dr. Guido Barbagly world renowed name in urethroplasty conducted this workshop. Other faculty included Dr. Sanjay Kulkarni, Dr. Ganesh Gopalkrishnan, Dr. Deepak Dube. Workshop was inaugurated in the hands of Dr. Kirpekar President USIWZ, Day started with operative demonstration of urethroplasty for membranous urtheral stricture following fracture pelvis. Total 8 operations were demonstrated in 2 days. All kinds of urethroplasties membranous uethral stricture, re-do urethroplasties, inferior pubectomy, buccal mucusa dorsal onlay, full length nat urethral stricture, ventral onlay, perineal urethroplasty, good old 1st stage & 2nd stage were demonstrated. Surgeries were performed by Barbagli & Dr Sanjay Kulkarni. Dr. Barbagli delivered his lecture which was informative & entertaining as well. Various types of cases were discussed. Pros & cons of one procedure over another, role of VIU, ..etc were discussed. Delegates participated actively in the discussion. Total 112 delegates attending which included people form various parts of the country. Presence of Dr. Ajaykumar President USI, Dr. Ajit Phadke, Dr.S.S.bapat, gave the grace the occasion. At the end of workshop, all the delegates were happy to have seen all kinds of urethroplasties.

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Dr.Jaydeep Date, Dr. Subodh shivde, Dr. Kashyapi & Dr.Ajit sawant, All the students were happy & expressed their satisfaction about this teaching activity.

Uro-Raidology Teaching Activity, Pune

CME at Gwalior

We were discussing for long time that west zone should start some PG teaching activity. Dr. Jaydeep Date, Subodh Shivde & Bhalchandra Kashyapi took the lead & organisd first PG teaching activity under the banner of west zone. This programme was focused on uroradiology. 42 PG students from various teaching institutes (of M.Ch & DNB) of Maharashtra & Gujarat attended. This was conducted for 1 ½ days on 30 & 31 August. All the topics pertaining to uro-radiology were discussed. The programme was inaugurated at the hands of Hon. Secretary USIWZ Dr. Sabnis. Programme consisted of lectures, cases discussion, question answers, & quiz. All topics such as stone diseases, transplant, pediatrics, newer imaging modalities their pitfalls, GU trauma were covered. Faculty included eminent radiologists from Pune, Dr. Mukund Joshi, Dr.S.S.Joshi, Dr. Sabnis,

IMA Gwalior branch hosted state chapter annual conference IMA MPCON - on 11& 12 October. West zone USI was happy to get associated with Urology section of the conference. Dr.Sabnis & Dr. Mulawakr were invited faculty with Dr. J. Chhabra & Brajesh Singhal as local faculty. Two topics - Management of urolithiasis with the emphasis on recent trends & Overview of urinary tract infections were discussed. Lot of delegates actively participated in question answer session. Session was attended by more that 200 delegates who expressed their satisfaction.

Perspective Perspective is everything... One day a father of a very wealthy family took his son on a trip to the country with the firm purpose of showing his son how poor people live. They spent a couple of days and nights on the farm of what would be considered a very poor family. On their return from their trip, the father asked his son, "How was the trip?" "It was great, Dad." "Did you see how poor people live?" the father asked. "Oh yeah," said the son. "So, tell me, what you learned from the trip?" asked the father. The son answered: "I saw that we have one dog and they had four. We have a pool that reaches to the middle of our garden and they have a creek that has no end. We have imported lanterns in our garden and they have the stars at night. We have a small piece of land to live on and they have fields that go beyond our sight. We need servants to serve us, but they serve others. We buy our food, but they grow theirs. We have walls around our property to protect us; they have friends to protect them." The boy's father was speechless. Then his son added, "Thanks, Dad, for showing me how poor we are." Isn't perspective a wonderful thing? Makes you wonder what would happen if we all gave thanks for everything we have, instead of worrying about what We don't have. Appreciate every single thing you have, especially your friends! "Life is too short and friends are very few.�

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WZUSICON 2008 Solapur Scientific programme Day 1 Friday 09.00 - 09.30 09.30 - 10.00 10.00 - 11.30 11.30 - 11.45 11.45 - 12.45 12.45 - 01.15 01.15 - 02.00 02.00 - 03.00 03.00 - 03.30 03.30 - 04.15 04.15 - 04.45 04.45 - 05.15

Know your instrument - Rigid & Semi rigid URS Speakers - Milind Bapat, Mukund Adanakar Chairmen Harshad Punjani, Sushil Rathi Small fight Medical therapy Vs TURP for BPH Speakers - Hiren Sodha Vs Ismail Chairmen Rajesh Bhatt, Rahul Gune Symposium on urinary diversion Convener Hemant Tongaonkar Panelists Makarand Khochikar, Bhalchandra Kashyapi, Rishikesh Pandya Tea Break Trouble shooting in Urology Convener Pankaj Maheshwari. Panelist Suresh Patankar, Ajit vaze, Subodh shivde Talk show on drugs for Overactive bladder Speakers Suhas Salpekar, Brajesh Singhal Lunch “TRUS How I do it…!!” Mahesh Desai Discussion & Live demonstration of TRUS various cases, TRUS guided biopsy for Ca prostate. State of the art lecture “Pitfalls in uro-dynamics” Speaker Nitin Kekre Chairmen - Shirish Yande, Ashit Shah Meet the expert Convenor Hem ant Pathak, Experts Percy Chibber Percy, Shriram .Joshi Mock trial Ajit Sawant & his team Newer Drugs and More Trials - What do we have in store for Renal cell carcinoma ? Speakers - Rajesh Kukreja, Ulhas Sathye Moderator Makarand Khochikar

Day 2 Saturday 08.00 - 09.00 Instruction course on Cadaver transplant Convenoer Pranjal Modi Panelists Jamal Ismail, Sharad Sagde 09.00 - 09.30 V.V.Desai Oration Orator Harshad Punjani Chairmen Deepak Kirpekar, Ravindra Sabnis 09.30 - 10.00 A.N.Gaikawad Oration “Challenges in management of RCC” Orator Roy Chally Chairmen Ajay Kumar, S.W.Thatte 10.00 - 10.30 Big fight small single Bladder tumour T1 G3 Cystectomy Vs Bladder Preservation procedures Spekers - Sameer Desai Vs T.B.Yuvaraj Chairmen Makarand Khochikar, Bhalchandra Kashyapi 10.30 - 10.45 Tea break 10.45 - 12.45 Video Symposium on lap Simple Nephrectomy Convener Anup Ramani, Panelists Arvind Ganpule, Ketan Shukla, PP Rao, Pranjal Modi 12.45 - 01.15 Know your Guru 01.15 - 02.00 Lunch 02.00 - 05.00 Free papers 05.15 AGM Day 3 - Sunday 08.00 - 09.00 Video Instructional course in Andrology Role of Andrologists in IVF unit Speakers Vijay Kulkarni, Rupin Shah, Sudhanshu Chitale 09.00 - 10.00 Quiz Jayesh Dhabalia & his team 10.00 - 11.30 Conference Symposium G.U.Trauma Convener - Sanjay Kulkarni Panelists Sujata Patwardhan, Rasesh Desai, Prashant Mulawkar, Gyanendra Sharma 11.30 - 12.30 Great discoveries in Urology Speaker Vasudeo Ridhorkar Chairmen Subodh Shivde, Sanjay Purohit

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Details of Free Paper Session PODIUM I (P - I) PCNL /UDM "Chairmen - Umesh Bhalerao, Abhay Khandekar" 1. Shah Hemendra N., A randomized control trial evaluating efficacy of nephrostomy tract infiltration with bupivacaine after tubeless PCNL 2. Tengse Shivraj M., Expanding indications of tubeless PCNL: Single centre experience with 454 patients over 3 year period 3. Tengse Shivraj M., Percutaneous Nephrolithotomy (PCNL) in patients on oral anti-coagulant therapy and bleeding disorders. 4. Bhati B. S., Urodynamic assessment of patients with acute retention of urine :is successful trail without catheter predictable? 5. Krishanu Das, Urodynamics in Traumatic Brain Injury- A prospective study 6. Kurien A., Percutaneous nephrolithotomy (PCNL) in patients with chronic kidney disease (CKD) PODIUM II ( P II ) - laparoscopy Chairpersons "Anjali Bhosle , Jaydeep Date" 7. Yuvaraja T.B., Laparoscopic Radical Prostatectomy- Our Initial Experience 8. Yuvaraja T.B., Positron emission tomography scans in the evaluation of post-chemotherapy residual masses in patients with metastatic testicular tumors- Prospective study 9. Modi Jayesh, Laparoscopic Dismembered Pyeloplasty in the presence of Crossing Vessels: Our Experience 10. Pandya R.R., Laparoscopic Partial Nephrectomy : Technique & Evolution in Linz 11. Rishikesh Pandya, Radioisotope guided laparoscopic sentinel lymph node dissection in staging of prostate cancer 12. Rizvi S.J., Retroperioneal Laparoscopic Nephrectomy In Children: Method Of Choice PODIUM III (P III) Reconstructive Urology Chairmen - "Devdatta palnitkar, Narendra Basarge" 13. Sharma G.R., Stepwise Approach to achieve a Normal Meatus in Tubularized Incised Plate Urethroplasty 14. KALE N.W., Dorsal patch urthroplasty for female stricture urethra. 15. Mahendra Singh Punia, Penile fracture - experience of tertiary care centre. 16. Modi Jayesh, Augmentation urethroplasty using buccal mucosa for long urethral strictures: our experience. 17. Attar Mohammad Ismail, Simultaneous bladder & vaginal reconstruction in complicated vesicovaginal fistula using ileum. 18. Chitale Vinayak, Cutaneous Ureterostomy 19. Attar Mohammad Ismail, Comparative study to assess the donor site morbidity after buccal and lingual mucosal graft harvest for urethroplasty PODIUM IV (P IV ) Miscellenious Chairmen "Prashant Mulawkar, C.W.Thatte" 20. Dassi V., A Prospective Randomized Study comparing Monopolar and Bipolar (saline) Transurethral Resection of Prostate 21. Joshi Pankaj, Plasma Kinetic TURP---Our Experience 22. Sharma G.R., "Usefulness of urology specific customized software ""URO Care"" in Day to Day Urology Practice" 23. Purohit S.P., A Peculiar Variety of Tropical Necrotizing ( Chikhal ) Hydrocele ? Mystery of the Missing Testis 24. Vyas Jigish, Exteriorization techniques: A good option for vascular access for hemodialysis in difficult situation 25. Shah Hemendra N., Outcome of Holmium Laser Enucleation for large (more than 100 g) symptomatic benign prostatic hyperplasia. VIDEO I ( V I ) Laparoscopy Chairmen - Anup Ramani, Anil Bandi 1. Dholaria P., Bilateral Laparoscopic Upper Moiety Heminephrectomy For Complete Duplex System With Ectopic Ureters: Surgical Technique 2. Yuvaraja T.B., Video Endoscopic Inguinal Lymphadenectomy (VEIL): Our initial experience 3. Dobhada Satyen, Laparoscopic nephrectomy for ectopic kidney 4. Patankar Suresh, Laparoscopic Pyeloplasty For Pelvic Kidney: Feasibility And Technique 5. Jain V., Laparoscopic pyeloplasty: How we do it! 6. Shivde Subodh, Laparoscopic assisted Nephrectomy in Xanthogranuolomatous Pyelonephritis-Our Experience. VIDEO II ( V II ) Endourology upper tract Chairmain Prashant Pattanaik, Milind Parikh 7. Shetty A.S., Simultanious twin tract PCNL

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8. Garg C.P., Virtual Technology to teach Endourology: Evolution of a new era. 9. Jain V., Video demonstration of ante grade manipulation incorporated with flexible ureteroscopy (combined approach) for removal of calculi in re-implanted ureters 10. Shivde Subodh, A Novel polymer to prevent backmigration of ureteric stones during intrcorporeal lithotripsy. 11. Shah Hemendra N., Holmium laser antegrade and retrograde endopyelotomy for pelviureteric junction obstruction: technical details from a trainee?s perspective. 12. Shah Hemendra N., A novel ureteric stent for tubeless PCNL: An initial clinical experience. VIDEO III ( V III ) Endo-Urology Lower Tract Chairmen "Umesh Oza, Raju Joshi" 13. Kulkarni Raghavendra V., Urogenital Ultrasound of the Unborn -- Realtime Experiences" 14. Joshi Pankaj, Urethral Leiomyoma ?A rare presentation. 15. Shah Hemendra N., Holmium laser Enucleation of prostate: technical details from a trainee?s perspective. 16. Shah Hemendra N., Holmium laser incision of bladder neck for post-prostatectomy bladder neck stenosis. 17. Sharma G.R., Antegrade Fulguration of Posterior Urethral Valves 18. Shah Hemendra N., Transurethral Holmium laser deroofing of prostatic abscess MPDERATED POSTER I ( MP I ) Chairmen "Sunil Joshi, Nitin Gadgil" 1. Joshi Pankaj, Ileo calicostomy with augmentation cystoplasty in a case of extensive renal tuberculosis. 2. Joshi Pankaj, Knotting of the guide wires - A rare complication during minimally invasive procedure on kidneyLessons learnt. 3. Joshi Pankaj, Testicular filariasis masquerading as a testicular tumor-Case report with review of literature. 4. Sharma Anshu, Vesicodiverticular Reflux as a Cause of Retention of Urine in an Adult Male 5. Chaudhari C.R., Orthotopic Ileal Neobladder In Female Patients After Radical Cystectomy 6. Tengse Shivraj M., Safety and efficacy of bilateral synchronous percutaneous nephrolithotomy: 4 year experience with 72 patients 7. Attar Mohammad Ismail, An unusual complication Of Shirodkar?s sling surgery for uterine prolapsed. 8. Attar Mohammad Ismail, Acquired urethral diverticulum following TURP: A case report. 9. Tengse Shivraj M., Management of renal matrix calculi: Single centre experience with 17 patients over 5 years. 10. Dholaria P., Malignancy Detected incidentally During Percutaneous Nephrolithotomy L-Shaped Crossed Fused Ectopic Kidney 11. Vyas Jigish, Is TURP necessary in all patient with bladder stone secondary to benign prostatic hyperplasia ? An outcome analysis 12. Shetty A.S., Management of non-neoplastic renal hemorrhage by transarterial embolisation. MODERATED POSTER II ( MP II) Chairmen - "Shailesh shah, Sanjeev Kanitkar" 13. Kurien A., Booster ESWL: A comparative study with delayed re-treatment 14. Krishanu Das, Adrenal Myelolipoma-a rare neoplasm 15. Yuvaraja T.B., Outcomes after laparoscopic partial cystectomy and bilateral pelvic lymph adenectomy in urachal adenocarcinoma of bladder 16. Aniruddha Gokhale, Pyelolithotomy to ileal ureter- sequelae of unusual complications! 17. Aniruddha Gokhale, Collecting duct carcinoma Kidney with Adenocarcinoma of colon - an unusual association ! 18. Abhijit Bapat, Laparoscopic versus Open Radical Nephrectomy for renal cell carcinoma of the kidney- Single Institute Experience 19. Narang Sanjeev, Morphological Evaluation Of Prepuce In Hypospadias Cases 20. Narang Sanjeev, Orthotopic Ureterocele Masquerading As A Bladder Tumor In A Woman With Pelvic Pain 21. Srinivas V. / Patil M. G., Metachronous Ipsilateral Transitional cell carcinoma and Contralateral Renal cell carcinoma-A Rare case 22. Srinivas V. / Patil M. G., Is prophylactic anticoagulant therapy required in urological oncology procedures in all cases? 23. Pandya R.R., Intermittant Androgen Therapy for Advance Prostate Cancer ? Feasibility. 24. Bhati B.S., Right sided Intrathoracic kidney with Bochdalek hernia

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Management thoughts.. Small things that matter.. Mr Rao was advised that he

After completing the process of decision making and

needed TUR prostate for his

implementing it a patient often goes through what is

urinary symptoms. He went

known as 'Post Purchase Dissonance'. This is very

to his family physician who

common when the decision making process is complex,

referred him to a nearby

and the cost and risk involved is high. After discharge,

Urologist. Mr Rao went to

Mr Rao continued to have some burning micturition and

the Urologist's nursing

feeling of obstruction. He started wondering if after all,

home, was convinced about

his decision of getting operated and getting it done at the

the capability of the

'five star' hospital where some trainee nurse 'pulled out

Urologist, but ultimately decided to get operated at a

the catheter so forcefully' was correct. This Post

'five star' hospital.

Purchase Dissonance has the potential of converting an

How do patients assess the quality of service offered?

otherwise successful surgery on Mr Rao into a

How do they make a judgment on the WHEN and

'dissatisfied customer'.

WHERE of surgery?

A lot can be done to prevent this post purchase

A decision about the WHEN and WHERE of a major

dissonance. Prior counseling that such post operative

surgical operation is a complex process. It involves a lot

symptoms are commonly seen for the first few days

of information gathering, and opinion making, before

after surgery could quell the dissonance.

the ultimate decision is made and executed. There could

The one thing that I have found very effective in my

be a lot of influences that affect this decision making

practice is a simple phone call to the patient. An

process.

unwarranted phone call to your patient a day or two after

Services of a doctor are intangible. The patient can not

his discharge to enquire after his health reduces the

weigh them, smell them , taste them or feel them. The

dissonance level. The patient is almost overwhelmed by

patient is in no position to objectively assess the quality

this simple gesture of a phone call.

of the service. How does he then guage the quality? He

This principle is often followed by the consumer

then goes by the age old method of reputation of the

durable manufacturers. After installation of your next

service offerer ('Ya, I have got my TUR done there, and

Plasma TV don't be surprised if you get a call from the

feel that you must go there.' ) And of course the

dealer to ask if you are satisfied with the TV. Any small

educational background and the personality of the

dissatisfaction that has been caused by some voice

doctor would weigh in his favor.

quality problems or a slightly hazy image from an angle

But, very often, patients base their assessment of the

would no more trouble you!

quality of service (which is intangible) on the tangible

Attention to such 'small things that matter' could

things that are offered with the service. The tangible

convert potential customers into actual customers, and

things that a patient can perceive with his senses could

actual customers into satisfied customers.

be the grandeur of your premises, the attractive displays, your immaculate stationary, your attentive staff, and your own attire and personality. Mr Rao

Dr. Devdatt Palnitkar

probably felt that automatically the quality of medical

MS, MBA

service at the 'five star' hospital is going to be better. His

Aurangabad.

judgment was based on his assessment of the quality of ambience at that Institute.

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Interview Dr. Guido Barbagli is not a new name to us. His pioneering work in urethroplasty & “Barbagli technique� is well known to everyone in the world. Dr. Barbagli is engaged in private practice solely devoted to urethral reconstruction surgeries. He is attached as Hon Surgeon to University Hospital at Florence, Italy, where he studied & had held several posts before voluntarily retiring. Currently he is director of Centre for reconstructive urethral surgery & President of The society of Genito-urinary reconstructive surgeons. He has numerous publications in many international journals & has written chapters in many books. He is currently official reviewer of many journals like Journal of urology, European urology, BJUI, New England journal of medicine. He is extremely fond of teaching & conducts regular teaching courses at his centre in Arizzo. Recently he was in Pune to conduct a workshop on urethroplasty. We had opportunity to talk to him. These are some of the excerpts of his interview. Q- Sir thank you very much for giving us time for interview. Sir how many times have you visited India in past? Which places have you seen? A- This is my third visit to India since 2003. Every time I had very hectic schedule & hence could not really visit any tourists' places Q- What is your impression about India and Indian urology. Do you see nay change since 2003? A- India is a growing economy. I see changes in every field. When the economy is growing rapidly there is a great chance to improve in all fields of life. I feel Indian urologist are really good. I have watched them perform surgeries, I have read their papers. I feel they have the potentials to be the world leaders. I feel the problem is that Indians have an inferiority complex towards western world. If you can change your mindset you can be world leaders. You have the talent, the skills the technology and huge numbers. I do not see why this can not happen Q- When and how did you develop interest in urethral surgery? A- My teacher in Florence was the only person doing urethral surgery in Italy. So I started working in urethral surgery since 1979. I visited many places doing urethral reconstructive surgeries. I was part of team managing polytrauma. I did lot of surgeries in emergency for pelvic fractures & subsequently urethral surgeries. Thus my liking to urethral reconstruction kept on increasing & Since 1999 I started exclusively doing urethral surgery. Now in my own clinic, I am doing only urethral surgeries. We perform between 300-400 surgeries in a year

Q- That is really huge no indeed! From where do you get patients? With such high volume how do you organize yourself & how do you plan your day? A- Most patients are from Italy. However I get patients from Germany, France, Spain, Greece now Serbia also. I operate in my hospital and two other hospital which are University Hospital. I do private practice but I am visiting professor to University hospital. One week I operate from Monday to Friday 8am to 4pm. No visitors no phone calls disturb me when I am doing operations. Next week I do only out patient- new and follow up. I also do my paper writing, reading etc during that time. I also travel about three months in a year for conferences and workshops. So you see the schedule is very tight. Q- Urethral surgery is changing, how do you see the future A- Yes what I was doing 10 years ago I no longer do. I have changed. Urethral surgery is changing every day. For example, Repeated internal urethrotomies are out. I was doing dorsal onlay for bulbar srictures 5 years ago. I now prefer ventral onlay with spongioplasty. I feel erectile problems are less with this approach. I think the future is going to be smaller incision, less morbidity, less erectile problems, more stable graft material. At present buccal mucosa seems to be the best substitute. In future we may have a better substitute. Q- Tell us how did you start using buccal mucosa. A- Use of buccal mucosa was described by Belgian urologist in 1992. Larry Paskin from San Francisco popularized it. I immediately liked it and stared using. This is my favorite substitute. Q- What do you think we need to do in India to improve

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the outcomes of urethral surgery. A- USI should establish a permanent program for training in urethral surgery. They should identify 2-3 good centers with good work and have workshops, conferences, literature review in urethral surgery on permanent basis. Results of urethral surgery in Italy changed when in 1973 when italian society of urology came out with a book called urethral stricture disease and circulated to all members. This is the kind of activity USI needs to do. Pelvic trauma due to agricultural injuries was very common. Safety systems were evolved and we do not see this type of injury. Car safety has improved, speed controls are strict so pelvic fractures are less common. You need to spread this awareness to the society and the Government. Q- Sir, with such hectic schedule, how do you get time for other activities? Do you conduct any teaching activity at your clinic. A- I believe that if you decide particular thing, there is always plenty of time fo it. No time is always an excuse. Regarding teaching activity, we have a well drawn out teaching program. Urologists come not only from Italy, but also from many other countries. They stay in Arezzo for a month. They attend surgeries, OPDs, lectures , seminars. I give them copies of current and relevant

literature for their homework. I have urologists from India visit me regularly. Arezzo is a small town, Accommodation is cheap, food is good, and people are friendly. You can walk everywhere and do not need a car. It is my appeal for young urologists, interested in urethral surgeries to take the advantages Q- Where shall we get information & all the details? A- Please visit www.urethralcenter.it I have made this website which tells everything about urethral reconstruction. It gives you links, latest articles, courses & lots of other information Q- Sir, we know urethroplasty is your hobby but what are your other hobbies? A- Well, I like driving. That too I like fast cars; Whenever I get time, or rather I always take out time to go on speedy drive. I have my BMW M3, when I go back home I am buying Audi Q5. I also like Heavy metal Rock music like AC DC. Sir thank you very much for giving us time & sharing your views so frankly with us‌.! Dr Jaydeep Date Dr Ravindra Sabnis

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Debate This is the era of Computers, IT, tele-communication! Electronic media has penetrated into our life to the extent that we ourselves don't realize it. TV has almost become necessity. Surfing the channels is now biggest addiction. There is bombardment of information through various channels. It affects everyone's life irrespective whether it is true or false. Media is a double-edged weapon, whether we as urologists or doctors should remain away from it or we should embrace it is the key issue. Here are 2 views. Dr. Makarand Khochikar is practicing urologist for > 15 yrs. He has given lot many interviews, written health articles & has seen media from very close. Dr.Rasesh Desai is also a practicing urologist for >15 yrs. He has participated in shows on TV, written article in papers, magazines & has vast experience about media.

Should we distance ourselves from Media..? Of course, yes!- Dr. Makarand Khochikar I don't think many people will disagree with me with I have to say. The reasons to agree with me are plenty and sufficient enough to make a case for keeping a distance with the electronic media in India in particular.

fact that the electronic media in India has got their priorities wrong. Education has been the least priority of the current electronic media barring very few exceptional channels. What about the information? We did expect the information to be apt, close to the reality and keeping a peripheral awareness. The information has to be balanced also especially in our society. Ours is a diverse society with varied level of maturity and education and prosperity. Large spectrum of the society believes what it comes their way and therefore it's a very important thing to offer balanced information with what I call is a 'peripheral awareness'. This may synonym with 'responsible journalism', and that is what is expected from the electronic media. After all don't we all as a medical professional are supposed to keep this 'peripheral awareness' in mind while passing on the information or educating the patient? I strongly feel that the current electronic media has completely forgotten about this very basic issue. Result of this, a complete chaos and utter confusion that has led to much disbelief about medical illnesses and medical fraternity.

Let us see what electronic media is all about and what are its aims and objectives. Television entered our living rooms gently in early eighties and with liberlisation and globalization went on to occupy our lives over next two decades, to the extent that now they have encroached our lives to a larger extent. Television came with the clear idea of offering information, education and entertainment to the society. We all welcomed this medium, which we thought was a step forward from the print media. As the time has gone by, what we have witnessed is the electronic media muddling and messing with their aims and objectives. They have moved far away from what they aimed at, the result of which have a damning effect on the society.

I would have been happy if they would have understood this fault of theirs over the period of time with self assessment and peer review, but I think they are heading towards more disaster, by aiming at only entertainment. Entertainment in any form be an art, music, sport, creativity is welcome, but what this current media is doing is using the medical illnesses and medical fraternity to 'entertain' people rather than using them for a 'healthy' (noble) cause. For example, what does this news mean to you interview of a doctor outside the operation theatre after treating a VIP? A panel of doctors sitting in the studio commenting on what possibly could go wrong in that case with some funny pictures and information given about the human anatomy? There is a filmy touch to all this aiming at 'entertaining' people and increasing what is being called as TRP rating.

We as a medical fraternity thought this electronic media is a tool to educate people about health issues. Issues such as keeping healthy life style, preventing the communicable diseases, ill effects of the pollution on the health and how to improve on our average life expectancy. This does not mean that electronic media would be doing this job, but we as a medical fraternity could use this medium for the betterment of the health of the society. Cardiac illness and cancer disease are the two important threats to Indian subcontinent and we still see many patients presenting at an advanced stage. Loosing the brain and skill (human resources) of our society with these two major threats is a sheer waste and a national loss and we as a medical fraternity would have loved to spread awareness amongst the society of these illnesses so that we can prevent, if not, detect and treat early. Could we achieve that? , Unfortunately the answer is negative and the main reason behind this is the

They would go to any extent to improve their TRP rating and some of the examples of the latest fad 'breaking

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witnessed many people flocking the clinics with 'fear' of same disease that was discussed on the channel on the other night. Surfing on the Internet on the next day following the show makes matters even worse. We are seeing many people with this 'phobia', thanks to the media for not understanding the 'pulse' of the people.

news' are really shocking. Media constantly going about a VIPs illness and giving information far from reality. Issues such as knee replacement of a Prime minister or a liver transplant after gunshot injury of another political leader are the recent examples.

We as a medical fraternity should also be partly blamed for this. Why do we get succumbed to the cheap popularity of 'appearing' on television for the sake of publicity and personal glory, especially when we know what the channels are aiming at? Are they interested in presenting vital information or issues those would help towards a betterment of society, if the answer is positive then one should, but if you analyze their performance over last few years, the answer would be negative.

Doctors claiming this being the 'World's first� case, or first time in India or first time in this rural area how close are they to the reality? An important breakthrough in the cancer treatment in reality it would be a just a phase I, II study in the laboratory. Magic cure in cancer field would be arrival of some new drug still under trial. A new technology that we change the human life it would be some development in that field, if we believe that we all would have been immortals!

What can we do at this stage? I think we have to be very careful with this current electronic media. We ourselves are the best judges to decide what is the reality and what is 'filmy'. Should we be helping those who take active part in real mass education on health issues and care or should we be party to the 'entertainment' channels? Should we boldly say no to the 'managed interviews' or be part of them for our personal gains and popularity.

Routinely conducted operations shown as 'heroics' treating a polytrauma, repairing the amputed limbs, limb salvage surgery etc. Blaming medical fraternity for a death in the hospital Highlighting some issues from the hospital without checking the facts and figures and many more ‌‌.

If you think you are over smart and can 'use' this medium cleverly, you are wrong, you are getting 'used' and not the other way around. After all you have witnessed what happens if you follow this path with glaring examples of important personalities who have been victims of media, who at times though they are using them.

So, the current electronic media has lost all its value as they have drifted away from the basic aim and objective they had in mind. They have forgotten about their first aim 'education', information is always far from truth and full of spices to sell themselves and perhaps they see 'entertainment' in that and that is what keeps them going.

Our country and society at large is the 'transitional phase', our electronic media is no exception to this. They have yet to achieve the maturity and have lost their way somewhere in the middle. Till then for all the reasons I gave you keep a distance from electronic media, at least for now.

Another important illness that is borne out of the programmes run on these channels is the 'phobia'in the masses due to incomplete , superfluous and irresponsible talks or telephonic shows. We have

Should we distance ourselves from Media..? Why, of course, Not! - Dr.Rasesh Desai important role in medical communication with the public. All over the world, including India, television news channels have health programmes and health news flashes; newspapers and health magazines have health columns written by medical journalists.

Medicine (doctors) and the media, whether television, newspapers and health magazines, h a v e b e c o m e inseparably linked. Each has something to say, complimentary or otherwise, about the other. Each has to give and take medical information, good or bad, from each other. Media also play a very

For both doctors and public, medical communication can be educational, informative or entertaining. TV channels and medical journalists have a special responsibility in covering health and medical news as viewers and readers may take important health care decisions based on the information provided in their

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stories. TV channels have an educational role. Health reporting does involve “telling a story”. When a public health situation is involved, health writers & the media play a role in quickly delivering important messages to the public. Role in AIDS awareness, anti-smoking, maternal and child health with family planning, immunization, female foeticide, concept of brain death and organ donation, breast cancer, eradication of polio & prevention of heart disease are important health education material. TV channels and newspaper health columns along with doctors present these in such a way that they evoke a positive response in the public and make a huge contribution in success of national health programmes and thereby improving public health. For this the medical journalists and producers have to ensure that they get the content right. They have themselves to be well informed and they should depend on suppliers of authentic information & that means more collaboration with doctors rather than less. One of the top rated health TV programmes was “Good Medicine” which was aired on the Australian Nine Network from 1997 to 2001. The programme was a viewer's guide to health care, patient rights, international breakthroughs &cutting edge technology. The show included tips on how to look after you & create the body beautiful, information on common conditions that affect everyone, personal stories of courage & hope against medical diversity. Indian TV serial “Kalyani”, a weekly health programme on Doordarshan being broadcast for the last seven years, has won an award for best communication strategy on HIV/AIDS. In addition health messages were printed on ration cards for the benefit of housewives in villages. “Kalyani” has also created health awareness about malaria, TB, tobacco and alcohol, sanitation and hygiene. Given that, most people do not interact with their doctors on a regular basis, the media is probably the most significant source of health information for the general public. But health information in the media cannot substitute for personal medical advice.

These audio and video presentations enable far more doctors and public to understand, assimilate and retain the essential message of material that may seem daunting in its full form on the printed page or lectures. Regulatory mechanisms may be lax in some developing countries. India has had a long history of unethical or illegal clinical trials, sale of spurious drugs and illegal kidney transplants. This opens up opportunities for investigative health journalism, an opportunity for reporters and TV channels to take up the traditional watchdog role of the press to find & report wrongdoing. The recent exposure of illegal kidney transplants earlier this year in guest houses and residential neighbourhood in flats in Gurgaon by TV channels and press where kidneys were removed from up to 500 labourers and sold to wealthy patients will go a long way in discouraging organ trade and promoting cadaver kidney transplants. The news also ignited a national discussion of organ transplant law with the need for legislation to make transplants easier. Repeated articles in newspapers and TV news about unethical and illegal drug trials in oncology and contraception in India forced Indian Council of Medical Research to establish a registry and audit clinical trials. Drug regulators had to scrutinize trials to ensure compliance with ethical guidelines and good clinical practice. Journalists and TV channels meet their responsibilities when they cover certain key issues when writing stories about new medical treatment. These include the accurate reporting of the comparative benefits, harms and costs of the treatment & the extent to which their informants have ties with the manufacturers. TV channels must refer to medicines by their non-proprietary generic names, reveal funding source and emphasize the limitations of new therapies. Thus working together, doctors and media can reduce commercial influences and result in better informed clinical decision making. There are black sheep in every profession and when the media accuse these doctors of complacency, authoritarianism, self-interest, negligence and being unscrupulous, they are doing the society good. Only such doctors will see the media professionals as irresponsible, sensationalising, trivialising & superficial. And only such doctors will have to run away from media.

For the medical profession, major and minor surgical procedures, examination techniques, specialized diagnostic and imaging techniques that require showing of movement, nonverbal communication, doctor patient relationship, medical history taking....these need to be seen to be believed. I am sure most medical students and postgraduates would have used these media publications not only for preparing for their exams but also subsequently for regular CMEs.

As the realm of medicine inevitably pervades our lives, its coverage in the media will increase. Thus doctors should never distant themselves from the media..

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Announcements ]AGM will be held at 5.15 pm on Saturday 15 th Nov. 2008 at Solapur in hall A. All full members are requested to attend

]It is absolutely mandatory that person who is presenting a paper in the conference (not enough to have one of the authors of paper as member) is a member of USIWZ or at least has applied for membership. All those who are presenting papers & are still not members are requested to apply for membership immediately. All the consultants in the teaching institutes are requested to inform their residents to become member to avoid last moment disappointment of not allowing to present papers Procedure to apply for membership: Please download application form from our website. www.wz-usi.org , go to constitution last 2 pages are the membership form. Fill up all the details. Make DD or at par cheque of Rs 1600 payable at Mumbai in the name of “Urology Society of India west zone” send it to following address: Dr. Umesh Oza, Oza Urology Clinic, 410, Soni shopping centre, L.T.Road, Borivali west, Mumbai 400092.

]All post graduate students of M.Ch & DNB urology are requested to participate in Urology quiz which will be held on Sunday 16 Nov. bet 9.00 to 10.00 am. First 2 winners will get Eagle traveling fellowship with cash prize of Rs 5000 & Rs. 3000 retrospectively. Please note that you have to be a member or should have applied for membership of USIWZ to participate in the quiz.

]Applications are invited for venue for WZUSICON 2010. It is Gujarat's turn for hosting the conference. Requirements / Guidelines: It should be hosted by some society (like surgical society, local IMA..etc), Venue should be easily accessible by road / rail from most places in the zone It should have an A/C auditorium of at least 350 capacity & other 2 halls of 50-100 capacity Organizing Chairman & Secretary should be decided while bidding.

]Applications are invited to decide a venue for hosting USICON 2013. Now-a-days USICON venues are decided 4 yrs in advance. In yr 2013, it is west zone's turn. In Solapur AGM, we shall have to decide about the venue & inform USI council for taking decision at Indore. .

Hearty Congratulations!! vDr R.C. Shah from Ahmedabad, Ex-council member of USIWZ, has become President Elect of “International College of Surgeons- Indian Section”. vDr, Nagendra Mishra from Ahmedabad was invited to attend the Interstitial cystitis definations meeting as a member of consensus group. This meeting was held at Miami, USA. He was one of the 21 International experts who were invited to decided various nomenclatures and definations to be used in Interstitial Cystitis.

West zone USI feels proud of their achievements!! 15


90/10 Principle B) Did your daughter cause it? C) Did the policeman cause it? D) Did you cause it?

Author: Stephen Covey Discover the 90/10 Principle. - It will change your life (at least the way you react to situations). What is this principle? 10% of life is made up of what happens to you. 90% of life is decided by how you react. What does this mean? We really have no control over 10% of what happens to us.

The answer is “D". You had no control over what happened with the coffee. How you reacted in those 5 seconds is what caused your bad day. Here is what could have and should have happened.

We cannot stop the car from breaking down. The plane will be late arriving, which throws our whole schedule off. A driver may cut us off in traffic. We have no control over this 10%. The other 90% is different. You determine the other 90%. How? ………. By your reaction.

Coffee splashes over you. Your daughter is about to cry. You gently say, "Its ok honey, you just need to be more careful next time". Grabbing a towel you rush upstairs. After grabbing a new shirt and your briefcase, you come back down in time to look through the window and see your child getting on the bus. She turns and waves. You arrive 5 minutes early and cheerfully greet the staff. Your boss comments on how good the day you are having.

Let's use an example. You are eating breakfast with your family. Your daughter knocks over a cup of coffee onto your business shirt. You have no control over what just happened. What happens next will be determined by how you react.

Noticed the difference? Two different scenarios. Both started the same. Both ended different. Why?

You curse. You harshly scold your daughter for knocking the cup over. She breaks down in tears. After scolding her, you turn to your spouse and criticize her for placing the cup too close to the edge of the table. A short verbal battle follows. You storm upstairs and change your shirt. Back downstairs, you find your daughter has been too busy crying to finish breakfast and get ready for school. She misses the bus. Your spouse must leave immediately for work. You rush to the car and drive your daughter to school. Because you are late, you drive 40 miles an hour in a 30 mph speed limit. After a 15-minute delay and throwing $60 traffic fine away, you arrive at school. Your daughter runs into the building without saying goodbye. After arriving at the office 20 minutes late, you find you forgot your briefcase. Your day has started terrible. As it continues, it seems to get worse and worse. You look forward to coming home. When you arrive home, you find small wedge in your relationship with your spouse and daughter.

Because of how you REACTED. You really do not have any control over 10% of what happens. The other 90% was determined by your reaction. React properly and it will not ruin your day. A wrong reaction could result in losing a friend, being fired, getting stressed out etc. Here is a way to apply the 90/10 principles. If someone says something negative about you, don't be a sponge. Let the attack roll off like water on glass. You don't have to let the negative comment affect you….!! Recently I read this article & immediately thought of sharing this with you. Our society & many members are undergoing agonizing accusations, allegations. This is a testing time. This principle of 90/10 so aptly describes how to react. We should not be like sponge but like a glass from where water will roll off. I am sure life will be much better if this principle is adopted.

Why? …. Because of how you reacted in the morning. Why did you have a bad day? A) Did the coffee cause it?

Editor 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 Oct  

USIWZ Newsletter 2008 Oct  

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