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News Letter



From the President’s Desk..........



Words from Honorary Secretary Dear Friends, Wish you all a very warm season's greetings. At present festive season is on. We just finished Ganesh utsav. Now we are celebrating Navratri. All these festivals will ultimately culminate into Diwali celebration. Diwali is a festival of joy, light, victory of good over evil & hence has a special place for all of us in India. Well, the year for west zone USI is also coming to an end. We had many events through out the year which will culminate into the annual meeting, the event members are always waiting for. Annual meeting - our mega event is not only an academic bonanza but a social gettogether as well. This year was quite exciting & rather eventful. After getting a mandate from AGM to go ahead for the first time ever out side the country west zone conference, we started working actively. Luckily everything went on as per plan. The response from the members was phenomenal. With co-operation of delegates, efforts from council members, & advise of seniors, DESERTCON 2010 at Dubai was a grand success. I am sure those who participated in this meet, will cherish the memories for years to come. Second grand event was UROFLEXICON at Thane. This was an academic feast. Live surgeries performed by world authority on Flex URS “ Michel Grasso� was a treat to watch. Delegates who attended were thoroughly impressed not only by his surgeries but were convinced that Flex URS is the thing of future. Credit must go to organizers for putting such a flawless event. A third event was our regular event of PG teaching activity. This we took as responsibility by west zone for last 4 years & without interruption, Pune group is organizing this event, which has become popular among the PG students of our zone. As every year many students attended this meet. I am giving a detailed report in this newsletter. I know that all of you are anxiously waiting for the SIlvasa conference. I am extremely thankful for the overwhelming response rather much more than expected. Organisers had booked rooms in 3 hotels but soon realized that number is going to exceed hence had to acquire rooms from other hotels. Organising committee under leadership of Jayantbhai Patel & Sumeet Mhaskar is giving last touches to the event. They are geared up to give us yet another flawless event like Khajuraho. I have no doubt that kind of venue treat resort is, kind of arrangements they have planned & kind of efforts they are taking to make your stay comfortable this conference is going to be a grand success. From council side, we have prepared an excellent scientific program good for all. This time scientific committee was formed to give us the guidelines for the program format. As per their recommendations, program is formulated & I have no doubt that everyone will like it. I am giving all the details of program in this newsletter. PG students have also sent lot papers for presentations. Dr. Pathak has taken lot of pains to review & tabulate them. I request all of you to participate actively in different sessions.

Speakers have taken lot of efforts to make presentation, take advantage of them to solve all your doubts, queries that you may have. This is my last message as secretary. I am coming to an end of my tenure. For last 4 years I enjoyed this post. It has been a completely different experience. The path was not nice & simple. There were lot of hurdles, lot of thorns & several potholes. For me as a person this has been a learning experience. These 4 years have made me strong, they have taught me how to sustain pressure, they have taught me that if you are clean & convinced about certain things, then never give up. Ultimate victory will always be of sincerity, hard work & truth. I was lucky to have excellent council members as my senior & junior colleagues. Their support & backing gave me boost to work more & more. I will always remain obliged to all of them. As secretary, I tried to get some new ideas in programs, tried to introduce new sessions, tried to tap new talent & give them opportunity to shine from the platform of west zone. However, I don't want to make tall claims about what I have done & what I have achieved. It is for you to assess. In these 4 years I met so many members who are interested in working for the zone. I had ample opportunity to speak to many people & developed rapport with many of them. One thing I have realized that members of our zone have such great potential & talent that we can outshine anyone. All of us have to work in cooperation & unitedly to make sure that west zone has leadership position in the country. At the end I apologize if I had hurt anyone unknowingly or for any lacunae that may have occurred. West zone was in my heart, it is in my heart & will always remain in my heart. Dr. Ravindra Sabnis Hon.Secretary. USIWZ

Council Members Details President Dr. Ajit Vaze


President elect Dr. Shailesh Shah


Past President Dr. S. W. Thatte


Hon.Secretary Dr. Ravindra Sabnis


Hon.Treasurer Dr. Umesh Oza


Council members : Dr. Hemant Pathak Dr. Hemant Tongaonkar Dr. Subodh Shivde Dr. Pradeep P. Rao Ex officio members Dr. Jaikishan Lalmalani Dr. Ravindra Sabnis


Mobile : 09821023637 Email :avaze@hotmail.com Mobile : 09824035673 E mail: kidneyline@gmail.com Mobile : 09820095112 Email : swthatte@vsnl.com Mobile : 09426422002 Email : rbsabnis@gmail.com Mobile : 09820058623 Email : uoza@bom3.vsnl.net.in Mobile : 09820364294 Email : goodurologist@gmail.com Mobile : 09820073911 Email : htongaonkar@gmail.com Mobile : 09822217380 Email : shivdes@yahoo.co.in Mobile : 09820336193 Email : pprao@mac.com Mobile : 09820071046 Email : lalmalani@hotmail.com Mobile : 09426422002 Email : rbsabnis@gmail.com

Introspection as an editor..........! This is my last writeup as editor, as I will be stepping down of this responsibility after the forthcoming Silvasa Conference. I have been editing these newsletters for last 3 years. Traditionally we come out with 3 issues per year in Feb, July & Oct. Thus I have been associated with 9 issues.

No Dr. Shirish Yande Vs Dr.Ravindra Sabnis I thank all the authors for their contribution. In Nadiad several urologists of international repute come for various courses. I took this opportunity to take their interview for the benefit of our members. In last 9 issues I have published 7 interviews 1) John Fitzpatrik Editor in chief BJU 2) Guido Barbagli Urethroplasty surgeon University Hospital Florance Italy 3) Arthur Smith Father of World Endourogy 4) Peter Alken Pioneer & Inventor of PCNL 5)Adrian Joyce Consultant urologist Leeds UK, past president of BAUS 6) Christian Chaussy - Inventor of ESWL 7)Olivier Traxer Consultant Endourologist University Hospital, France .

Before I took over, release of newsletters was going through some problems. Members were not happy about the quality, contents & overall appearance of newsletters. We were getting it done through Pharma company & hence there were serious issues about sticking to time schedule. We had brain storming discussion in one of the council meetings. It was thought that newsletter is reflection of society & hence we should have high quality publication. It was that time in end of 2007, I accepted the responsibility & challenge to revamp the newsletters. There was a dilemma whether a newsletter should have a academic articles or not. I thought now-days people have so much access to academic material that it is pointless to fill newsletters with such contents. At the same time it was not proper to have only information booklet as our newsletter. Instead I thought that articles related to urology, debates, do-to-day advises, what is happening in zone, achievements would be interesting for people to read. I also decided to change the whole appearance. Appearance like a small 16 pages booklet was finalized. High quality glazy paper was used with lots of colour photographs. Cover page was finalized as map of states in zone. Thus I came out with first issue in Feb 2008. This was very much appreciated by members. Several people sent me very encouraging feedback. Since then I continued with same policy, keeping the basic format same but making some changes in cover page & color combination to avoid monotony.

It was a delightful experience for me to interview such icons of urology. I must tell that all these icons also enjoyed & asked for the copy of newsletter. I must make a mention of Mr. John Fitzpatrik who not only liked the idea & asked for the copy of newsletter of his interview but asked for all other newsletters to read. I also tried to put several articles of interest to urologists like Sterilization myths & realities ( S. Mishra) , Water & we (Sunil Joshi), Is pre-op HIV testing necessary in all cases, lasers in Urology (R. Kukreja), management thoughts, negotiation an art. (Palnitkar)‌etc In all more than 20 members have contributed their articles. Achievements of members, Forth coming events, Report of all the programs that were held, awards, minutes of AGM, details of scientific program & several photographs were integral part of newsletter.

You must have noticed that I have always put debate article of a subject, which is not academic but of interest to Urologists. All members have appreciated not only the topics but also contents of all debates. In last 9 issues, following debates have been written 1) Medical tourism in India hope or hype Anil Bradoo Vs Vinit Shah 2) Individual Nursing homes destined to Die Yes or No Pankaj Maheshwari vs Ajay Bhandarkar 3) Should we distance ourselves from Media Yes or No Makarand Khochikar vs Rasesh Desai 4) Are we ready for super-specialization in urology? Yes or No Rupin Shah Vs Brajesh Singhal 5) Short MBBS course is good or Bad Ashwin Limbasia Vs Mukund Anandankar 6) National Board has failed to deliver goods Yes or

One single person can't do the work of this kind. All council members gave backing & support time to time. All presidents always appreciated the work & that gave lot of encouragement. Friends, my only aim was to keep up the faith council had put on me & to fulfill promise that I gave to council & to the people of zone. After 3 years, when I am introspecting myself, I feel satisfied. I put my 100% & did maximum what I could do. This journey has been satisfying & enjoyable for me. But as I keep saying & believe that it is for you to decide whether I stood up to your test or not. Thanking you Dr. Ravindra Sabnis

Secretariat : Dr. Ravindra B. Sabnis Chairman, Dept. Of Urology, Muljibhai Patel Urological Hospital,Dr.Virendra Desai Road,NADIAD-387 001, Gujarat Tel.:0268 2520323 to 30, Fax : 0268 2520248,Mobile:09426422002 Email : rbsabnis@gmail.com


Scientific Program - WZUSICON 2010 Thursday - 28 October 2010 05.00 to 06.00 pm

Panel discussion - Talk Show BPH management lessons learnt Moderator : Umesh Oza Panelists : Madhav Kamat, Ajit Phadke, Mahesh Desai, Sharad Bapat

06.00 to 07.00 pm

Intra-op consultation from gynecologists Convener : Hemant Pathak, Panelists S.W.Thatte, Shailesh Shah, Suresh Patankar



Friday 29 October 2010 09.00 to 10.00

Recurrent UTI in females Convener: Anil Bradoo, Panelist : Kandarp Parikh, Ashish Jasani

10.00 to 10.30

Small fight - 1 cm stone in mid ureter Best energy source to be used with semirigid URS is Pnumatic lithotripsy : Piyush Varshney Laser lithotripsy : Jitendra Jagtap Chairpersons : Atul Shah, S. S. Joshi

10.30 to 11.00

Big fight- Partail nephrectomy for 3 cms upper pole RCC best approach is Laparoscopic : PP Rao Open : Makarand Khochikar, Chairpersons : S.V.Kotwal, Kim Mammen

11.00 to 11.30

Tea Break

11.30 to 12.00

Microscopic hematuria guidelines , Speakers : Subodh Shivde, S. K. Singh

12.00 to 01.30

Conference Symposium: Pediatric urolithiasis Convener : Prashant Pattnaik Panelists : Ashit Shah, Rajesh Kukreja, Pankaj Maheshwari, Vijay Raghoji, Prashant Mulawkar, Percy Chibber, Deepak Kirpekar

01.30 to 02.30

Lunch Hall A

02.30 to 03.00

Diagnosis of GU TB Speakers : Jayesh Dhabalia, Ulhas Sathye ,

03.00 to 03.30

OAB what is the systematic approach for management Speakers : Shirish Yande, Vivek Birla

03.30 to 04.30

Painful Bladder syndrome Case oriented discussion Convener : Nagendra Mishra, Panelists : Sharad Dodia, Kapil Thakkar Hall B

02.30 to 03.30

Pfizer panel discussion Ganesh Bakshi, Makarand Khochikar, Rishikesh Pandya


03.30 to 04.30

Cases discussion Uro-oncology Convener : HemantTongaonkar Panelists : J.N.kulkarni, Janak Desai, Bhalchandra Kashyapi,

04.30 to 05.00

Tea Break

05.00 to 06.00

Urology Quiz : Quiz master : Ajit Sawant, Anand Utture

06.00 to 06.30

Techniques in Urology ! Video demonstration : Ajit Vaze

06.30 to 07.00

Know your GURU Presenter : Janak Desai.

Saturday 30 October 2010 08.30 to 09.00

Speaker's corner Chairpersons : Vivek Joshi, Anil Shrikhande

09.00 to 10.00

Sterilization of Urology equipments Symposium Pitfalls & practicality Convener : Ravindra Sabnis Panelists : Anup Ramani, Haresh Thummar, Ajay Kanbur

10.00 to 10.30

Dr. V. V. Desai Oration Topic : ESWL re-visited Speaker : S W Thatte Chairpersons : Ajit Vaze, Umesh Oza

10.30 to 11.00

A.N Gaikwad Oration Topic: New diagnostic modalities in diagnosing NMIBC Speaker : Theo de Reijke, Amsterdam Chairpersons : Shailesh Shah, Ravindra Sabnis

11.00 to 11.30

Tea Break

11.30 to 12.00

Flexible URS Which, & Why ‌??? Speakers: Jaydeep Date, Ajay Bhandarkar

12.00 to 01.00

Luminous Symposium - Use of lasers in urology Convener : Pankaj Maheshwari. Panelists : Ketan Shukla, Anil Varshney, Hemendra Shah Pankaj Maheshwari : HOLEP vs TURP Hemendra Shah : Tips & Tricks of HOLEP Ketan Shukla : Use of Holmium Lasers in Endourology Anil Varshney : What is new in Lasers for Surgical Therapy of BPH

01.00 to 02.00


02.00 to 04.00

Parallel sessions 3 halls podium, poster, video

04.00 to 05.00

What is the evidence, session Chairpersons: Sanjay Kulkarni, C.W.Thatte K citrate in prevention of stone recurrence : Sujata Patwardhan Medicines for atonic detrusor : Anita Patel Ca prostate prevention : Mukund Anandankar

05.00 to 06.00

Medico-legal implications in Urology Convener : Gaurang Shah, Panelists: Lalit Shah, Hemendra Shah




Free Papers 02.00 to 03.00 Podium I : Chairpersons: Dinesh Patel, Sadashiv Bhole Hall A 1. Laproscopic radical prostatectomy 5 yr MPUH experience Vikas Agarwal,S.Mishra,Naushad,Rajan,A.Kurien RB Sabnis, A.ganpule ,MuthuV, Desai MR Muljibhai Patel Urological Hospital, Nadiad 2. Laproscopic radical prostatectomy using low energy source- our experience Kalpesh Kapadia, Shrenik J. Shah, Civil Hospital, Ahmedabad 3. Laproscopic suturing of renal artery stump during retroperitoneal donor nephrectomy Vyas JB, Bipin pal, Raghubirbhardwaj,Pankajtrivedi , MitulParikh,Pranjalmodi Institute of kidney diseases and research civil Hospital Gujarat 4. Laproscopic management of fusion anomalies K.N Patel, Raghubirbhardwaj,Rizvi .JS,Pankajtrivedi , MitulParikh,Pranjalmodi, VyasJB,Patel.R IKDRC-ITS asrwa Ahmedabad 5. Laproscopictransabdominal VVF Repair our experience Shabbir Raja, Shrenik J Shah, Civil hospital Ahmedabad 6. Prevalence of overactive bladder in Mumbai an epidemiological study Poleboyina VK, RastogiM,Chowdry A, AlagappanC,SinghaniaP,AndankarMG,Pathak HR Nair hospital 03.00 to 04.00 Podium II Chairpersons: Sameer Joshi. Deepak Rajyaguru 7.

Retropubic radical prostatectomy clinicopathologicalobservations and outcome analysis of 428 patients Singh .DP, J.N.kulkarni, Valsangkar.R,Siddaiah,Chowdry .P.S, Gupta P., Bombay Hospital, Mumbai 8. Retroperitoneal radical cystectomy Chowdry PS, J.N.kulkarni,MallickS,Singh DP, Valsangkar.,Gupta.P., Bombay Hospital, Mumbai 9. Partial nephrectomy in large tumors is feasible, but is it worth doing it? Panchal PG, M.Ismail,SanjaySwain,S.K.Patwardhan, KEM hospital 10. High fidelity training models for flexible ureteroscopy .can we do away with virtual reality? Shashikantmishra, RB Sabnis, A.Kurien,A.ganpule ,MuthuV, Desai MR, Muljibhai Patel Urological Hosptial, Nadiad 11. Supine PCNL our experience Gupta P., Oza U.,Singh.DP, Valsangkar.R,Chowdry .P.S, Pattnaik PK., Bombay hospital, Mumbai 12. Flex URS& Lasers in teritiary care centre Ajit Sawant, Sion hospital POSTERS- MODERATED 02.00 to 03.00 Poster I Charpersons: Jayesh Kudchadkar, Rajendra Lahoti Hall C 1. Changing management of clinical T1 renal masses Shah Rupesh, Patnakar Suresh ,Oza Nimit, Amai trust ace Hospital, Pune 2. Non conventional renal malignancy in adult with IVC thrombosis report of 2 cases Sushantapadhay, Krishna Prasad,Bipin pal, Rizwi SJ, Pranjalmodi, IKDRC ITS Ahmedabad 3. A novel technique for large ureteric stone- antegrade flush and retrograde URS Hareshthummar, V.Joshi,S.Karia,S.Seth,S.Moteria, J.Amlani, B.T.Savani Kidney Hospital 4. Is DJ stenting necessary after uncomplicated URS?? Piyush Varshney, Jayesh Dabalia, Ajit Sawant,Vikash Kumar, Ujjwal Bansal, Avinash Badne Sion Hospital 5. A study of 231 cases of laproscopic retroperitoneal uretrolithotomy Kalpesh Kapadia, Shrenik J Shah, Civil hospital Ahmedabad 6. Laproscopicdiverticulectomy with antirefluxureteroneocystostomy Shah Rupesh, Patnakar Suresh ,Oza Nimit, Amai trust ace hospital Pune



Control of renal pedicle by ligasure for retroperitoneoscopicnephrectomy in children Kartik Shah, Rizwi SJ, Pranjal Modi, Civil hospital Ahmedabad 8. Role of day care VVF fulgration in small VVF Shabbir Raja, Shrenik J Shah, Civil hospital Ahmedabad 9. External iliac vein thrombosis in renal transplant receipient Panchal PG, M.Ismail, Sanjay Swain,S.K.Patwardhan, KEM Hospital 10. Penile gangrene in priapism Bushanpatil, VenketashwaraRao,SanjaySwain,S.K.Patwardhan, KEM Hospital 11. Xanthogranulomatousprostatitis rare presentation of rare disease Valsangkar R., Singh. D.P., D.D.Gaur, Bombay hospital 12. Management of chronic retention overcoming a dilemma Rajeev Sarpal, S. Mishra, Amit Bhattu,Rajan Sharma, R B Sabnis, A.Kurien, A.Ganpule, MuthuV,Desai MR Muljibhai Patel Urological Hospital, Nadiad 03.00 to 04.00 Poster II Charpersons: Rajesh Bhatt, Dhawal Naik 13. Non neurogenicneurogenic bladder a common diagnostic pitfall Madhuja Sawaiker, S.Mishra, R B Sabnis ,Muthu V, Desai MR Muljibhai Patel Urological Hospital, Nadiad 14. Post operative chylousascites a case report Patel A., S.Mishra, J.Jagtap, A.Ganpule,R B Sabnis ,Muthu V, Desai MR Muljibhai Patel Urological Hospital, Nadiad 15. A case of extra adrenal pheochromocytoma with rare presentation Sukantapadhy Krishna Prasad, Bipin Pal, Rizwi SJ., IKDRC-ITS Ahmedabad 16. Oral mucosal graft substitution urethroplasty Patel K.N, Bhardwaj R,Rizvi J.S., Pankaj Trivedi , Pal B., Pranjal Modi, Vyas J., Patel R. IKDRC-ITS Ahmedabad 17. A very rare case of bilateral renal cell sarcoma presenting with upper GI symptoms H.S. Deshmukh, Date Jaydeep, Shivde Subodh, Langarraja, Joshi Pankaj, Sadaverte Nilesh Deenanath Hospital, Pune 18. Bladder outlet obstruction due to isolated metastasis in prostate in a operated case of Ca rectum H.S. Deshmukh, Date Jaydeep, Shivde Subodh, Langarraja, Joshi Pankaj, Sadaverte Nilesh Deenanath Hospital , Pune 19. Laproscopic assisted percutaneouspyelolithotripsy in ectopic pelvic kidney Piyush Varshney, Jayesh Dabalia, Ajit Sawant,Vikash Kumar,Ujjwal Bansal, Avinash Badne Sion Hospital 20. Extensive urethral malignant melanoma requiring anterior exenteration Piyush Varshney, Jayesh Dabalia, Ajit Sawant, Vikash Kumar, Ujjwal Bansal, Avinash Badne Sion Hospital 21. Subcapsular renal hematoma unusual complication after URS Avinash Badne, Jayesh Dabalia, Ajit Sawant, Vikash Kumar, Ujjwal Bansal, Piyush Varshney Sion Hospital 22. Endoscopic treatment with DEFLUX for treatment of VUR our experience Bodhrajpasi, Shrenik J Shah, Civil hospital Ahmedabad 23. Conservative management of Grade 4 renal trauma H.S. Deshmukh, Date Jaydeep, Shivde Subodh, Langarraja, Joshi Pankaj, Sadaverte Nilesh Deenanath Hospital, Pune 24. Extra renal manipulations for RIRS using semirigid URS and pneumatic lithotripsy Haresh Thummar, V. Joshi, S. Karia, S.Seth, S. Moteria, J. Amlani, B. T. Savani Kidney Hospital


02.00 to 03.00 Video I Charpersons: Sanjay Swain, B. K. Dastur (Hall B) 1. Laproscopic resection of extra adrenal pheochromocytoma in paediatric patient Shah Rupesh, Patnakar Suresh ,Oza Nimit, Amai trust ace hospital Pune 2. Thulium laser : platinum standard treatment for prostatic enlargement Dinesh Patel, Devasya Kidney Hospital , Ahmedabad 3. Laproscopy assisted ilealureter construction Arvind Ganpule, S.Mishra, A. Kurien, Muthu V., R B Sabnis, Desai MR Muljibhai Patel Urological Hospital, Nadiad 4. Intraoperative management of vascular injuries during laproscopic surgery Arvind Ganpule, S.Mishra, A.Kurien, Muthu V, R B Sabnis, Desai MR Muljibhai Patel Urological Hospital, Nadiad 5. Management of ureterovesical fistula with LESS approach Arvind Ganpule, P P. Rao, S.Mishra, A. Kurien, Muthu V., R B Sabnis, Desai MR Muljibhai Patel Urological Hospital, Nadiad 6. Laproscopic techniques in radical prostatectomy Anup Ramani, Lilavati hospital Mumbai Video II Chairpersons: Ajay Oswal, Jaikishan Lalmalani 7. PCNL in crossed fused ectopic kidney Haresh Thummar, V. Joshi, S. Karia, S. Seth, S. Moteria, J. Amlani, B.T.Savani Kidney Hospital 8. A simultaneous twin surgeon procedures in urolithiasis : Nadiad experience Shashikant Mishra, A. Kurien, A. Ganpule, Muthu V., R B Sabnis, Desai MR Muljibhai Patel Urological Hospital, Nadiad 9. Reducing morbidity of aggressive PCNL : multiple puncture wash technique with single tract Shashikant Mishra, A. Kurien, A. Ganpule, Muthu V., R B Sabnis, Desai MR Muljibhai Patel Urological Hospital, Nadiad 10. Micro PCNL feasibility and point of technique Patel A.,Sharma R. ,S. Mishra, Sawaiker M., Muthu V., R B Sabnis, Desai MR Muljibhai Patel Urological Hospital, Nadiad 11. Anterior urethral valve a case report Rastogi M., Poleboyina V. K.,Chowdry A., Alagappan C., Singhania P., Andankar M.G., Pathak HR Nair Hospitals POSTERS - UNMODERATED 1. Forgotten DJ Haresh Thummar, V.Joshi, S. Karia, S. Seth, S. Moteria, J.Amlani, B.T.Savani kidney hospital 2. PCNL under spinal( upper calyceal puncture) Haresh Thummar, V. Joshi, S. Karia, S. Seth, S. Moteria, J. Amlani, B T.Savani kidney hospital 3. Bone in stone- Three case reports C.S. Kurane, Patni L., A. V. Rawandale Patil, Institute of urology -Dhule 4. Prepubic urethral fistula in a case of stricture urethra- first case report. C.S.Kurane, Patni.L, A.V.Rawandale Patil, Institute of urology -Dhule 5. Posterior urethral valve, staghorn calculus and vesicoureteric reflux- a rare combination in adult C.S.Kurane, Patni.L, A.V.Rawandale Patil, Institute of urology -Dhule 6. Spear headed lithotripter a cheap alternative for hard stones C.S.Kurane, Patni.L, A.V.Rawandale Patil, Institute of urology -Dhule 7. A Case of Migrated Intra Uterine Contraceptive Device into the urinary bladder ParamneVV, Chaudhari HN, Sharma RM, Mulay AR, Sovani YB, Kshirsagar YB, Gadhikar R, Vartak K Bapat SS, Ratna Memorial Hospital, Pune 8. A Case of UretericFibroepithelial Polyp with Impacted calculus Chaudhari HN, ParamneVV, Sharma RM, Mulay AR, Sovani YB , Kshirsagar YB, Kashyapi BD, Bapat SS, Ratna Memorial Hospital, Pune


Debate All medical branches are growing fast. Technological advances have become part & parcel of our day-to-day practice. Urology is a classic example where most advances that we are having are technology or instrument driven. I still remember our prof in Surgery who would give so much importance to clinical signs & diagnose lot many things accurately. However that was the era 25 yrs back when ultrasound was not so common & CT scan & MRI was rarity. Now we have bedside ultrasound. CT scan is available in every small town. Times have changed. What is the relevance of relying on clinical signs in this era? Most of us have broken our heads in understanding whether it is mid diastolic or early systolic murmur? Does this understanding has any relevance when you have echo in your consulting. If you have lump in abdomen is your palpation, percussion, & other physical signs are going to decide whether it is kidney lump or spleen? Is it going to decide whether it is PUJ or solid tumor? The big question is “Has physical signs lost relevance in modern urology?” This is the topic for the debate today. Dr. Kandarp Parikh, Senior Consultant at Sterling Hospital, Ahmedabad & Dr. Ajit Sawant who is Associate Professor at L.T.M.MC & L.T.M.G.Hospital, Mumbai have put up their points. History & physical signs still have relevance in Modern Urology- Dr. Kandarp Parikh “ …..i will remember that I do not treat fever or cancerous growth but a sick human being, whose illness may affect the persons family and economic stability..” says the famous Hippocratic Oath. The ancient Indian medical practitioners diagnosed the diseases simply by Pulse examinations. These both emphasis that basic approach to the patient is still dependent on taking a complete history and executing a thorough physical examination . This basic dictate and guide the subsequent diagnostic evaluation. The Medical history is corner stone of the evaluation of urological patient and a well taken history will frequently elucidate the probable diagnosis. Urologist must be a detective and lead the patient through detailed and appropriate questioning to obtain accurate information. A complete history can be divided in to the chief complaint and history of present illness, the patient”s past medical history .Each segment provide significant positive and negative findings that will contribute to the overall evaluation and treatment of the patient. Most urology patient identify their symptoms as arising from the urinary tract e.g. Renal and ureteric colic. Family history gives important clues to identify genetic or familial disorders like APKD, tuberous sclerosis, RTA. 8 to 10% of men with Ca. prostate have familial form of the disease that tends to develop about a decade earlier that the common type of ca.prostate. This observation helps to screen vulnerable group at earliest. Patient with diabetes mellitus frequently present with autonomic dysfunction that may result in impaired urinary and sexual function. It is worthwhile obtaining information as much as possible about previous surgery before any intended surgery because most surprises that occur in the operating room are unhappy ones. Patient presenting with impotence should be questioned carefully to rule out other male sexual disorders including loss of libido, absence of emission and orgasm

and most commonly premature ejeculation. It is important to identify precise problem before proceeding the further evaluation and treatment. A complete and thorough examination is an essential component of evaluation of patient, who present with urological disease. I still remember the famous Foot note in the text book of surgery, Love and Bailey.”if you do not put your finger in the rectum, you may put your foot in it”It is so relevant in day to day urology practice. It is not so infrequent to find prostatic abscess by per rectal examination and the sonologist has missed it. How many times urologist have found simple phimosis in elderly male presenting with LUTS and was advised TURP? Do we require any diagnostic tool other then history and physical examination in any patient with peyronies disease? Diagnosis like hypospadias, paraphimosis, hydrocele etc. are matter of spot diagnosis. Do you think for the diagnosis of torsion of testis we will wait and waste important time to confirm by imaging modalities. Modern day diagnostic tool are big boon to clinician to authenticate and confirm provisional diagnosis. Especially in oncology to stage the diseases but in a country like India where 80% of population lives in villages and small town, availability of fancy diagnostic tools is a big problem. Also the cost of investigations is far from the reach of majority. Most of the investigatory tools are operator dependent and so lot depends on the art of reporting. Use of all these diagnostic tool should be used judiciously and its use as per the requirement should be the balanced by clinician. Its better we remain good clinician rather than diagnostician. I would like to end my writing by quoting the famous statement by Bill Gates. “I am amazed by the fact that machines have taken over most of the human work but I am saddened by the fact that human beings are thinking like machines”


Physical signs have lost relevance in Modern Urology-Dr Ajit Sawant Physical examination is the process by which a physician analyses the body of a patient for sign of a disease. The aim is to reach correct diagnosis and plan appropriate management. Definition of Physical examination (PE) by National cancer Institute is “An examination of the body to check for the general signs of disease “. The traditional physical examination has been limited to use of eyes, ears & hands of examiner and has excluded the technological enhancement beyond the use of simple instruments. The value of physical examination in periodic health examination however has been called into question, except for a few specific segments of the head to toe examination; the evidence suggests that it does not detect enough conditions in time to have a favourable impact on the outcome of the patient's health. The US preventive service task force does not list the PE among the recommended interventions for the screening of the general or healthy population. One possible reason for the failure of physical examination exam to have positive impact as a screening examination is that it is not sensitive enough to detect many disease in there early stages , when intervention might have made some difference. We hypothesise that blending real time diagnostic technology into physical examination by the primary care physician can increase the diagnostic yield with some additional cost. We give undue importance on clinical examination to size, consistency etc which can be accurately determined by USG. We call this amalgamation of physical examination and ultrasound examination Ultrasound Assisted Physical Examination USA-PE. It can also help in determining the etiology of disease, whether it is hydronephrosis or tumour, which by physical examination one could have failed to

diagnose. Oshibuchi screened the abdomen of 715 Japanese workers and found gross abnormalities in 44.5 % of men and 34.2 % of women. Vallercess and Jayson found that many renal carcinomas are fortuitously discovered (37 % and 61 % respectively) and this group was likely to be at an early stage and hence better outcome than the group who presented with symptoms. For decades we have given importance to ballotability, bimanual examination, smooth surface etc as characterising features of renal lumps. These clinical signs become less important in present era where CT / MRI can increase the accuracy of detection & exact extent of disease. Even in detection of Ca prostate on per rectal examination, by the time the cancer is clinically felt digitally, most of the patients have locally advanced disease. The use of TRUS along with the serum PSA estimation will help us to detect early stage of Ca Prostate, which is in the state of cure. Hence, consideration should be given to low sensitivity and limited predictive value of digital rectal examination for detection of early Ca prostate. The use of USG has increased substantially due to its easy availability in all the hospitals, even in remote areas. There is increasing trend of urologist performing USG themselves as extension of physical examination. The decreasing cost of baseline USG machine has helped in this effect. Also with increased medicolegal litigations against doctors, no one can operate on a patient on the basis of only clinical examination and judgement as this could not stand in the court of law, hence investigations have become must prior to submission of the patient for invasive modalities of treatment. We therefore hypothesise that amalgamation of technology in physical examination will help us to reach early diagnosis and cure with some additional increase in the cost.

AGM Agenda All the members are informed that Annual general Body meeting will be held on Saturday 30 Oct 2010 at 6.00 pm in Hall A at Silvasa. 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) 13)

President's opening remarks Conduction of election Confirmation of minutes of last AGM held at Khajuraho Hon.Secretary's report Hon.Treasurer's report Report from organizing secretary of WZUSICON 2009 Dr. Brajesh Singhal & presentation of audited accounts Applications of new membership Full, Associate Presentation by Dr. Jayesh Kudchadkar orgnising chairman of WZUSICON 2011 Goa Proposal of venue for 22nd WZUSICON 2012 Decide the subject of for symposium WZUSICON 2011. Any matter with permission of chair Announcement of election results Vote of thanks by secretary

Dr. Ravindra B. Sabnis Hon. Secretary, WZUSI


Interview - Olivier Traxer Oliver Traxer is Working as professor, University of Pierre et Marie Curie, Paris. He currently holds many prestigious positions such as President of French Urolithiasis committee, Member of International consultation on urolithiasis, Member of European guidelines committee…etc. He has more than 130 scientific publications in peer reviewed journals. & more than 200 oral presentations in National & International conferences. He has extensively traveled all across the globe & conducted live operative workshops. ŸQ: How many times have you visited India? ŸA: This is my third visit. My first visit was 14 years back when I was a resident & I had come on a holiday here. That time I visited places in Rajasthan & Agra. I liked Rajasthan. Tajmahal is one of the most beautiful structures in the world. My second visit was during world congress in Mumbai, but that time did not go anywhere else. ŸQ:Where are you working at present? ŸA:Well I am in a teaching hospital in France. It is a university hospital. I like to be in academics & teaching. ŸQ:How is the residency system in France? How many years they have to spend? ŸA:In France, after medical school, there is a national exam. According to merit you have a choice to select the subject. So person can go to urology, gen surgery, cardiology after medical school. You have to work for 6 yrs. Of which 5 yrs are of residency of that also first 2 yrs in gen surgery & last year is equivalent to assistant urologist. Usually after 6 yrs also students prefer to stay on for another 2-3 yrs to get experience. So it is 8-9 yrs before you come out. ŸQ: Do you have exam at the end of residency for passing or failing? ŸYes we have exam but it is not much complicated. We have continuous evaluation program for all 5 yrs of residency, which carries lot of weightage. ŸQ: How is health care system works in France? ŸA: We have public & private system. Public system is fully supported by GOVT, whereas if you opt for private then you have to pay only the difference. This difference, patients can pay form their pocket or from private insurance. However this difference is not so high, therefore almost 70% work is done in private. So we have lot private practicing people. Most urology trainee after completion will go in private practice. ŸQ: You are working in a big University hospital. Have you separated sub specialties or they are still

part of urology? ŸA: There is still no official division, but we have several sub-specialties . As you know urology has become vast & one person can't do everything. So we have people who have selected sub specialties like female urology, oncology, endourology, Andrology …etc. If you have to form a big team then you need different people doing different things. ŸQ: What is the disease pattern prevalent in France. Why I am asking this to you because Dr. Peter Alken & many others told me that stone incidence has gone down. Staghorn stones are disappearing from western world. Do you have same experience? ŸA: First number would be of oncology & that too mainly prostate cancer. Second would be female urology & third will be endourology. Incidence of stone disease in France would be around 10%. In whole of France on an average only 2000 PCNL’s are done in 1 year. Our 80% stones cases are less than 30 mm. That means we have only 20% stones, which are big. Average stone size treated in France is 9 mm. That is the reason ESWL & Flex URS are very popular in France. ŸQ: What do you think are the reasons for decrease in stone incidence? ŸA: Actually prevalence of stones is increasing. We see smaller stones. They are uric acid, Ca, Mainly related to diet. The reason big stones are going down is because chronic infections are less, pick up rate is high, and migrant population is less. ŸQ: Is Ca prostate common? ŸA: Yes. It is commonest urology disease as of today. ŸQ: How is your screening program works? Do you screen every individual? ŸA: In France almost every individual more than 50 yrs. is screened for Ca P. It is not a national program but it works at individual level. Any person going to GP or any doctor would advise PSA & do DRE. Even general


public is well aware of PSA & CaP. This is how it works. ŸQ: Which is most sought after subspecialty in France? ŸA: Without any doubt it is Uro-oncology. It is all because of Radical prostatectomy done in such a large number. ŸQ: How you developed interest in endo-urology when only 10% incidence of stone disease. ŸA: Well when I finished my residency, my chairman asked me whether you want to stay back as faculty? I was interested in teaching & academics so I said “yes”. He said then you have to develop endo-urology. I was bit surprised because of I was interested in oncology. But then in the bigger interest I accepted. They organized my fellowship at Texas. I spent 2 yrs there & came back to develop stone centre. Now it is quite exciting. ŸQ: How you developed mastery in Flex urology? ŸA: When I started in yr 2000, that time not many people were doing Flex URS. So I struggled & pursued to develop expertise & I succeeded. Now we do quite a lot of cases. This year in our department we did 800 stone cases. That is quite a lot. ŸQ: It is not easy to develop any department. What problems did you face? ŸA: I was lucky not to have many problems because not many were interested in endourology. So I had space. Others were happy that a new urologist is doing something different. They all helped me. I developed contact with different companies & slowly got established. ŸQ: So do you think now many more students are attracted to endourology? ŸA: Not really. Since I joined, none have opted for endourology so far.

ŸQ: I see that you have so many publications to your credit. How do you manage that? What is your advise to us? ŸA: For any publication, you need excellent database. In US they have people to do that. We have same problem like yours. We don't have specific people for this purpose. So we try to get it done through our residents or fellows. But still so may times I myself have to do data entry. I make sure that all entries are done on daily basis & this is the key for having more publications. ŸQ: What is your advise to young urologists? ŸA: My advise to residents is not get impressed or carried away by any subspeciality during residency. You have to work well in all departments. I also feel that residents should not be too much after publications during residency. Your interest should be in clinical work, you should work maximum in ward. Focus on technique, understanding right indication, understanding complications…etc. Once you finish training then focus on some subspeciality & work for 23 yrs. ŸQ: What is trend in France? students remain in university hospital or go to private practice? ŸA: In France most people go in private practice & nowa-days trend is to form a group & practice together. ŸQ: Apart from Urology what are your other hobbies? ŸA: I like sports especially Tennis & Ski. I go very often for Skiing in east France & enjoy. ŸQ: How do spend free time? Do you watch movies? ŸA: No, No. I am not fond of movies at all. I have 3 sons. They are young 6,9 & 11 yrs old. So in my free time I am always with family & spend really quality time together. Sir, on behalf of west zone I thank you very much for spending time & sharing some of your thoughts with us.

Achievments ·Dr. Makarand Khochikar- was invited as a faculty for the teaching course at Singapore during 30th Sept -5th Oct

2010., organised by Sigapore Urological Association (SUA) and Urological Association of Asia (UAA), where he delivered lectures & gave hands on training. He was also invited as an external examiner for the exit examination in urology (FAMS) by the Singapore University , Singapore. ·Dr Mahesh Desai , Dr Makarand Khochikar & Dr Deepak Kirpekar were invited as a faculty for the pre AUA live

operative workshop at University of Sothern California , LA (USA) in May-June 2010 ·Dr. Hemendra Shah Won 2 awards for best poster & 1 for best video at WCE held at Chicago 2010 ·Dr. Ajit Vaze was invited as a faculty to Barcelona for 25th silver jubilee conference of EUA where he delivered a

lecture on Evaluation of incontinent females in India. He is again Invited as a faculty at Berlin on 5th November for Master class in Female urology ,organised by EAU. Hearty Congratulations on behalf of west zone USI…!


Report PG Teaching Program - Pune WEST ZONE USI TEACHING PROGRAM - PUNE 20TH AND 21 ST AUGUST 2010 A brief report Venue - Deenanath Mangeshkar Hospital & Research Center, Pune The main theme of the course was exposure of the trainees to number of areas in urological practice such as use of drugs in transplantation, bladder disorders, use of drugs and medical evaluation in renal stone disorders, drug treatment in erectile dysfunction. A special lecture was conducted on the urological effects of non-urological drugs in practice. There were lectures on use of chemotherapy drugs in uro-oncology and reconstructive principles after major extirpative cancer surgery. A lecture was conducted demonstrating the skin and genital problems in day-today practice. Two special problem based symposia were conducted on paediatric urology and uro-oncology. In keeping with the needs of trainees for writing the theory papers a practice exam was conducted and a lecture was specially arranged for giving model answers. A separate lecture was given about the art of presentation in the examination. There were 34 registrations for the course, which included trainees from urology, surgery and gynecology. The faculty list included the following invited faculty Dr.Vineet Shah, Dr. Dhananjay Bokare, Dr.Ravindra Sabnis, Dr.Vinay Kulkarni, Dr.Ajit Vaze ;Dr.Shirish Bhave, Dr.Atul Muley, Dr.Chandrashekhar Phansalkar, Dr.Hemant Tongaonkar, Dr.Ganesh Baxi, Dr. Sameer Desai, Dr.Bhalchandra Kashyapi, Dr.Kumar Prabhash, Dr.Prabha Yadav, Dr Nitin Gadgil, Prof Dr. Suresh Patankar,Dr. Gyanendra Sharma, Dr Shirish Yande. Dr. Jaideep Date, Dr. Subodh Shivde, Dr.Bhalchandra Kashyapi were the co-coordinators for the event.

Discounted registration of WZUSICON 2011 Don't miss….!! ·WZUSICON 2011 Goa ·Dates - 15 to 18 Sept 2011 ·Venue Hotel Holiday Inn. ·Residential conference ·Attractive all inclusive packages ·Discounted registration to those who register at Silvasa. ·Get your cheque book or pay cash. ·Visit WZUSI stall or meet Dr. Jayesh Kudchadkar at Silvassa.


Uro-oncology meeting - Miraj Have you registered , if not Hurry up !

Uro-oncology conference at Siddhi Vinayak Ganapati Cancer Hospital, Miraj ( Maharashtra) 19th, 20th and 21st Nov 2010

Siddhivinyak Ganapati Cancer Hospital is organising a two and half day program on uro-oncology on the eve of completion of successful 12 years. The department of uro-oncology was established under the leadership of Dr Makarand Khochikar in 1998 , the time when Dr Khochikar returned to Miraj after his training in uro-oncology at London and Cambridge ( 1992-1998) . Over the period of time the department has grown from strength to strength and has its presence felt nationally and internationally. The hospital has organised a very good program on this occasion in the third week of November. The program has been supported by the Urological Society of India-West Zone and University of Southern California , Los Angeles. The details of the program have been already sent out. Over the two and half days there is going to be a feast of excellent lectures, case based discussions, debates and video demonstrations. The main highlight of the program is case based discussions. There are going to be six such sessions on ever aspect of uro-oncology i.e kidney tumours, bladder tumours, prostate cancer and cancers of testis and genitalia. The main attraction of this conference is these case based studies , that we don't get to see that many in our conventional conferences. The real life cases are really exciting ones and are the ones that teach you a lot . Therefore do not miss this great opportunity. Every attempt would be made to have as much participation as possible from the audience for these sessions. Dr Mark Soloway , Chairman Emeritus from Miami (USA) ,a giant in the field of Uro-oncology does not need any introduction. He s going to be the star attraction. His lectures on 'Has anything changed in urological oncology in last two decades? ' , Who's who in uro-oncology and a two and half hour master class in bladder and prostate cancer are going to be really a treat. So make sure you do not loose such a grand opportunity to interact with the master ! Dr Krishna Patil from UK is going to convince us that Robotic Surgery is the future ad your transition from open to Robotic Surgery is very much possible based on his own experience. Our own faculty Dr Mahesh Desai , Dr Srinivas Desai , Dr Srinivas, Dr J N Kulkarni , Dr Murali Kamat , Dr Anil Mandhani , Dr Deepak Dubey , Dr Nitin Kekre, Dr R B Sabnis and many others are going to be there to share their experience. A session on cyberknief ( Dr Kumar Swami ), MR guided therapies for prostate cancer ( Dr Srinivas Desai), histoscanning ( Dr Mahesh Desai) the new entrants on the horizon are also going to take us to this exciting field. Of course , there are going to be breathtaking video session on various oncological procedures to watch the Masters at their best and also an opportunity how experts do the reconstruction after cystectomy. So , please hurry up and register at the earliest. The organizers expect you in large numbers and every arrangement has ben made to make you comfortable. For further enquiries please contact: Dr Makarand Khochikar at khochikar@gmail.com or urooncoconference2010@gmail.com


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USIWZ Newsletter 2010 Oct  

USIWZ Newsletter 2010 Oct