|Head of Department||YBrs. Dr. Susan Woo Yoke Yin|
a) To aim for an improved urologists: population ratio to provide better urological services to the people. At present this ratio is 1:1 000 000 and we hope that this will improve to 1:100 000 by the year 2020.
b) To aim for a local examination and accreditation in Urology and if possible, together with the Urological Associations in the surrounding ASEAN countries, to set up a regional Urological Examination committee under the wing of the FAUA (Federation of Asean Urological Associations)
a) To improve the standard of urological training in the country by setting up of an accredited urological training programme lasting for 3 years, of which the initial 2 years will be at the Institute of Urology, and the final year will be at a recognised overseas Urological centre. We also aim to train at least 2 Urologists a year.
b) To expand the urological services to other government general hospitals, either by monthly operative and clinic sessions, or full time resident urologists.
c) To improve the standard of urological services provided by better training and increase in the number of urologists in government hospitals.
d) To set up links with well known overseas urological centers to allow our trainees to acquire updated and advance urological knowledge and skills.
e) To provide basic urological skills to medical officers in post graduate surgical and gynecological training.
f) To contribute to urological education through: annual urological conference where prominent international urologists are invited. Improve urological skills through operative sessions and workshops conducted by expert urologists from overseas. Local combined radio-logical and clinical sessions together with the private urologists.
UROLOGY CLINIC SCHEDULE
|EVERY DAY EXCEPT
SUNDAY & PUBLIC HOLIDAY
a) General Urology
The services available are:
1. Management (medical and surgical) of prostatic diseases.
2. Uro-gynaecological services, especially in the area of female incontinence.
3. Uro-oncological expertise
4. Stone disease management including percutaneous nephrolithotripsy, uretero-renoscopy, and ESWL services.
5. Laparoscopic urological services
6. Management of male inhfertility(in conjunction with LPPKN) and also management of erectile dysfunction.
b) Paediatric Urology
i) Combine clinic with the paediatric nephrologist and paediatric neurologist. This allow better and improve care of the children especially those with impaired renal function and with neurological problems, like neurogenic bladders.
ii) The scope of work include endoscopic urology, reconstructive urology for congenital abnormality and neurogenic bladders, and surgery in renal failure patients.
c) Participate with the rehabilitation unit in managing urological problems and care of the bladder in spinal injured patients.
d) To provide urodynamic services including video-urodynamics. This has provided better understanding, assessment and improved bladder management in patients with urinary incontinence, spinal injured patients and patients with neurological disease like spina bifida and myelomeningocele.
e) In collaboration with the Department of Nephrology, we provide transplantation services. We also provide surgical and urological support to CAPD and Renal Dialysis programme by managing vascular access surgery and Tenchkoff catheter related surgery.
f) To provide expert urological consultation services to other referring units in the Hospital Kuala Lumpur, and to serve as the national referral centre for urology.
g) To provide urological services to Kuching, Kota Kinabalu and Ipoh with monthly visits by a Urologists from this centre
To do research in various urological disease such as bladder cancer, prostate cancer, urethral stricture and urinary calculi
ROBOTIC WORKSHOP MARCH 2006: A REVIEW
Azlin Azali, Sahabudin Raja Mohamed
Department of Urology, Hospital Kuala Lumpur
Robotic surgery was first started in the Department of Urology, Hospital Kuala Lumpur in April 2004. To date we have done 130 cases of robotic surgery. Majority of cases were radical prostatectomies. The experience with first fifty cases of robotic radical prostatectomy was published in the World Journal of Urology (Would J. Urol May 2006). In order to expand the robotic surgery to other areas of urologic surgery, we held a live-surgery workshop with the urologists from Vattikuti Institute headed by Professor Dr. Mani Menon.
The robotic workshop was held at the Urology and Nephrology Institute (IUN) from 15th to 31st of March 2006. It was a collaboration between IUN and Vattikuti Institute of Urology, Detroit. In the conjunction with this workshop, we also held an international conference from the 25th to 26th of March 2006. It was officiated by the Minister of Health, Dato' Chua Soi Lek on the 25th of March, 45 cases were performed during the two-week workshop, varying from stone surgery to hernia repair.
Two years ago, Dato' Dr Sahabudin and Professor Mani Menon conceived the idea of robotic stone surgery during a meeting in Egypt. Since then both parties have been working towards making it a reality. 70 cases were initially selected; these cases were then presented to Professor Ashok Hemal during his brief visit to KL prior to the workshop. Renal stone which were large and confined to the renal pelvis were selected. Most of the cases were seen in the HKL clinic and a few others were referred from other hospitals.
For the first time in Asia, the surgeons also performed robotic nephrectomy for donor kidneys, non-functioning kidneys and renal cell carcinoma. Eight patients underwent robotic nephrectomy; three patients were donor for renal transplant and five more had non-functioning kidneys. There were two renal cell carcinoma cases, one patient underwent nephroureterectomy while the other underwent partial nephrectomy. The average duration of surgery was about four hours. All the patients had uneventful recovery.
There were challenges in gathering enough cases for the workshop, specifically for stone surgery. For stone surgery patients required investigations, such as urine culture, CT urography and DTPA scan. As they came from all over the country, it was time-consuming to get these investigations for them. Among those who had had these investigations done, there was a few candidates who were deemed unsuitable for the robotic stone surgery due to the unfavourable stone location (calyceal stones) were not included for robotic surgery instead were given an option for PCNL.
The workshop was run by a team of 12 surgeons and anesthesiologist from Detroit as well as the local consultants, specialists and anaesthesiologists. Cases were predetermined by the operating surgeons. The progress was monitored on a daily basis when the patients were still hospitalized. Patients were discharged on the 2nd or 3rd post operations day. Depending on the type of robotic surgery performed, the follow-up ranged from 10 to 14 days after patients were discharged.
The pre and post operative protocol contained pre-emptive analgesia, instructions on bowel preparation and diet on the two days preceding the surgery, pre-operative antibiotics, intravenous fluid regime and investigations (blood and urine). Post-operative protocol includes deep vein thrombosis prophylaxis, urinary catheter care and routine blood investigations. Meanwhile, for other cases (stone surgery, hernia and vesico-vaginal fistula repairs, etc.), some adjustments had to be made to accommodate the pre- and post-operative care (e.g. choice of antibiotic).
Post-operative pain control was achieved mostly with patient-controlled analgesia(PCA). Pre-emptive analgesia using COX-2 inhibitor helped to reduce post-operative pain. Patients were encouraged to use incentive spirometry and saline nebuliser to minimise atelactasis.
Patients who underwent robotic stone surgery and pyeloplasty had their ureteric stents removed 2 weeks after their respective surgeries. Patients with vesico-vaginal fistula and prostate cancer had to undergo pericathetogram to ensure there was no anstomotic leak.
Most cases had uneventful recovery. In one particular case, a patient developed fever and abdominal distension secondary to transperitoneal urinary leak from stone surgery. Retrograde Pyelogram showed blocked stent with urinary leak from lacerated lower pole calyx. The blocked ureteric stent was changed and she was treated with intravenuous antibiotic. She recovered fully from the surgery. One other patient who underwent stone surgery also developed abdominal distension and fever from prolonged ileus. One radical prostatectomy case had persistent urinary leak on pericathetogram up to one month after the surgery.
The 45 cases of robotic surgery performed during the workshop are listed below:
1. Nephrectomy (5)
2. Partial nephrectomy (1)
3. Nephroureterectomy (2)
4. Pyeloplasty (3)
5. Pyelolithotomy (14)
6. Ureterolithotomy (1)
7. Donor nephrectomy (3)
8. Prostatectomy (11)
9. VVF repair (1)
10. Hernia repair (1)
11. Cystectomy (3)
Patients who underwent robotic stone surgery will be followed-up with intravenous urography to be performed six months after their surgery to rule out pelvic stricture. With the good outcome of robotic pyeloplasty we recommend that a randomised study to compare the advantages of robotic pyelolithotomy over percutaneous nephrolithotripsy has been proposed. we hope to undertake this project in February 2007.