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Paediatric urology in the BJUI

September 29, 2014/1 Comment/by Mohan Gundeti

The BJUI and the Editorial team are committed to the publication of high-quality and highly citable articles concerning translational science for the International Paediatric Urology Community. We encourage authors to submit original and outstanding work for publication that can inﬂuence clinical practice or introduce innovative new care methods for children across the world.

In addition to valuable contributions, the reviewers’excellent review process ensures the best publications. Although, impact factor is an important attribute for a journal; the real true value resides with its ability to make paradigm shifts and bring innovative care to children’s lives.

On this note we have included the best three articles in the ‘Paediatrics’ section in this month’s issue.

Cundy et al. [1] from London (UK), have to be commended for the thoughtful meta-analysis of robot-assisted pyeloplasty (RAP).This is an early, but, timely analysis of our current practice of diﬀerent approaches to paediatric pyeloplasty. The primary outcomes were not signiﬁcantly diﬀerent for the open, robotic or laparoscopic approaches. This is not surprising ,as the surgeons that used these new approaches have been proﬁcient with their traditional approaches and have embraced the newer techniques with caution. RAP had a distinct advantage of reduced analgesia and length of hospital stay compared with the traditional open approaches, and this will probably drive the adoption of the newer approaches even at the expense of increased cost. Hopefully, the cost issue will be transient; as the new technology becomes increasingly widespread the cost should level out. Randomised clinical trials may be an answer to newer treatment adoption,but this may not be possible in all scenarios – hence a prospective comparative series may answer the question, with some human factor bias [2]. The advantage of ergonomic comfort and a reduced learning curve for surgeons performing these reconstructive procedures using the robotic approach,as mentioned by the authors,has the beneﬁt of reducing professional health hazards and saving on human capital. Unfortunately, this has never been considered or measured, although it is an important aspect.

Suer et al. [3] from Turkey, have analysed their anti-reﬂux surgery series in children using the open approach to predict complications in a multivariate analysis. The utmost factor is bladder dysfunction, e.g.bladder-bowel dysfunction, dysfunctional elimination syndrome or dysfunctional voiding. Over the years paediatric urologists have found this to be associated with VUR and poor outcomes after surgery. Extreme caution has to be taken when deciding to perform surgery in this group, as theVUR may be secondary and surgery may not be warranted at all.Ureteric tapering or tailoring of the dilated ureter is another factor for poor outcomes, which can be attributed to the poor vascularity of chronically dilated ureters. This practice has been based on the physics of Paquin’s law.Unfortunately, we do not have evidence of outcomes without this reduction plasty on these ureters. The authors have also emphasised the limitations of the current adult Clavien system of classiﬁcation used for grading [4], which has pitfalls and does not describe the complications well either in the paediatric population. It is an appeal to the paediatric urology community for further work to be done to produce a standardised grading system for use in paediatric cases.

Dangle et al. [5] from The University of Chicago have attempted to describe extravesical robotic ureteric re-implantation for VUR in children. The technique of re-implantation has not been described well to date, although there have been a few outcome reports with variable success rates. This explains the fact there may not be uniformity in this technique and/or the learning curve. The surgery itself is challenging because of the close proximity of important anatomical structures within a conﬁned space, and the risk of ureteric damage with improper handling is unforgiving. The video describes their current modiﬁed technique with important surgical steps for adoption. The success rate for resolution is still, not on a par with open surgery, but there were no complications. The ﬁne balance between success and complications needs to be deﬁned for incorporation into the paediatric urological armamentarium.

Moving forward:

‘With availability of advanced automated instruments to replace manual labour, if as a society we prefer this at an increased cost, then why not on the same philosophy adopt these new technologies in the surgical realm with proper training and safety to reduce the morbidity and achieve at par results?’.

and

‘The surgical dogma of practice needs to be challenged with evidence-based outcomes to move ahead’.

Editorial

Conflict of Interest

None declared.

Mohan S. Gundeti, MD, MCh, FEBU, FRCS, FEAPU

BJUI Consulting Editor–Paediatrics, The University of Chicago Medicine, Chicago, IL, USA e-mail: [email protected]

References

1 Cundy TP, Harling L, Hughes-Hallett A et al. Meta-analysis of robot-assisted vs conventional laparoscopic and open pyeloplasty in children. BJU Int 2014; 114: 582–94

2 Orvieto MA, Large M, Gundeti MS. Robotic paediatric urology.BJU Int 2012; 110: 2–13

3 Suer E, Ozcan C, Mermerkaya M et al. Can factors aﬀecting complication rates for ureteric re-implantation be predicted? Use of the modiﬁed Clavien classiﬁcation system in a paediatric population. BJU Int 2014; 114: 595–600

4 Clavien PA, Barkun J, de Oliveira ML et al. The Clavien-Dindo classiﬁcation of surgical complications: ﬁve-year experience.Ann Surg 2009; 250: 187–96

5 Dangle PP, Shah A, Gundeti MS. Robot-assisted laparoscopic ureteric reimplantation:extravesical technique. BJU Int 2014; 114: 630–2

Highlights from the Irish Society of Urology 2014

September 29, 2014/2 Comments/by Greg Nason

Failte go Cill Airne (Welcome to Killarney, Co Kerry).
The urology community of Ireland descended on the picturesque town of Killarney in the south west of Ireland for its annual scientific meeting.

Mr David Quinlan (@daithiquinlan), President of the ISU, commenced proceedings with a tribute to the late Professor John Fitzpatrick and Mr Dermot O’Flynn. It is the first ISU following the sad passing of Professor Fitzpatrick in May of this year. Professor Fitzpatrick led a distinguished career and was a respected figure in world urology. The recent BJUI blog following his death demonstrated how highly regarded he was across the globe, with many sharing personal memories of him. Outside of his undoubted ability in the operating room, he was entertaining, had a special way with words and was a great story teller. He will be missed both here and afar.

Dermot O’Flynn, past President of the RCSI, also passed away this year aged 93. Mr O’Flynn was an established urologist in the Meath Hospital. He played a significant role in the formalisation of urological training in Great Britain and Ireland not only to the training programme but also the specialist exit examination.

Academic Program

The academic program commenced on Thursday morning with front line basic science presentations. Kieran Breen (@kjkibbles – who won the ISU Registrar’s Prize winner) from the Conway Institute (scientific laboratory set up by Professor Fitzpatrick) reported tissue microarrays following radical prostatectomy regarding immunohistochemistry staining for insulin receptors, IGF-1 receptor and PTEN as markers of predicting biochemical recurrence. Early data suggest these markers could identify potential patients at risk of biochemical recurrence. Tuzova et al. presented a multi-centre study led by the St James’ group that suggested urinary profiling of DNA hypermethylation can selectively detect high-risk prostate cancers with improved specificity over the traditional PSA test.
The afternoon podium session focused on prostate cancer and resulted in an expected heated debate – Daniel Good (@willbgood1) from Edinburgh, reported the use of a novel device in prostate cancer detection. The E-finger, is a probe that fits on the tip of a finger and attempts to differentiate significant from insignificant findings based upon prostate elasticity. The debate continued regarding the use of pre biopsy MRI as well as the role of transperineal biopsies as a standard. Rick Popert advocated the use of systematic transperineal biopsy based on an anatomical map of the prostate as opposed to the traditional ‘lucky dip’ that is the transrectal ultrasound biopsy.
Friday morning focused on urological training in Ireland – Elaine Redmond outlined the lack of urological exposure among primary care physicians and suggested a urological or men’s health module be incorporated in their curriculum. Matthew Burke, highlighted the need for dedicated paediatric urological training to meet the needs of the health service going forward – this echoed the thoughts of BAUS President Mark Speakman who highlighted the impending void in paediatric urology.
Other highlights included the suggestion of a national network for the management of penile cancer in Ireland, similar to this week’s BJUI article of the week. In a country with such low volumes, a supra-regional network may improve long-term morbidity and survival.
Finally, O’Kelly et al. (@fardodokelly), demonstrated the merits and quality of national urological meetings from the smaller European countries with a favourable final publication rate of 46%. The quality of presentations, in particular basic science demonstrated this will continue.

Guest Speakers

The ISU has continued to attract significant guest speakers from the world of urology and this year we were joined by Craig Peters (‘THE’ American Paediatric Urologist), Mike Leonard (Vice-President of the Canadian Urological Association), Mark Speakman (President of BAUS) and Prokar Dasgupta (@prokarurol – Editor of the BJUI).

Guest Speakers – Mr John Thornhill (incoming ISU President), Mr Roger Plail (President of the Section on Urology, Royal Society of Medicine), Mr David Quinlan (outgoing ISU President), Professor Prokar Dasgupta (BJUI Editor), Professor Craig Peters (University of Virginia), Mr Mark Speakman (President of BAUS), Professor Mike Leonard (Vice-President Canadian Urological Association)

Professor Peters lecture on Robotic Surgery in Paediatric Urology ‘Reflections on emerging technologies’ was an eye opener in to what can be achieved if we push the boundaries. His strive for excellence and improved patient outcomes in the face of ‘robot-scepticism’ have led to advances in paediatric robotics. Outside of the robotic pyeloplasty – they have pioneered and tested the use of robotics in hypospadiology due to the undoubted improved optics as well the management of congenital abnormalities.
In one of the highlights of the meeting, Professor Peters was pitted against Professor Mike Leonard (Vice-President of the Canadian Urological Association) in a debate ‘Robotics are alien in paediatric urology’ panelled by Professor Dasgupta and Mark Speakman. ‘Robocop’ versus the sensible Canadian approach duelled in a fascinating debate – detailing clinical efficacy, cost effectiveness, quality control. Professor Peters offered Professor Leonard his card for redo pyeloplasty ‘in which the robot works quite well’.
Professor Dasgupta, (the man who still carries a diary) engaged the audience in a tour de force regarding immunotherapy in prostate cancer as well as detailing his future vision for the BJUI. This was the first year the abstracts were published in the BJUI, the Official Journal of the ISU. This is a most welcome addition and adds to the standing of our annual meeting.

Professor Prokar Dasgupta – the Editor of the ‘journal that never sleeps’ – with his pocket diary.

Mark Speakman, gave an impressive demonstration in the art of oratory at the gala dinner regarding delivering a service and the impending need to publish surgeon-specific outcomes. He continued to speak to trainees and the need to add a ‘second string to your bow’ highlighting the areas which will require urologists in the future – paediatrics, andrology and female urology – warning that we cannot all be robotic pelvic oncological urologists.

Social Media Presence

The #ISU14 hashtag gathered momentum in the past few days. Again an inaugural addition to our meeting and something we will endeavour to promote in years to come. Any attendee at the EAU, AUA, BAUS will attest to the quality of social media presence and this is something we can learn from. By the end of the meeting we had followers across the globe, in the United States and Australia.

ISU Social Media Team ( Mr Rustom Manecksha – @dr_rpm, Mr David Bouchier-Hayes – @dbh44, Mr Garrett Durkan – @gcd67, Professor Prokar Dasgupta – @prokarurol, Mr Greg Nason – @nason_greg, Mr David Quinlan – @daithiquinlan,
Mr Fardod O’Kelly – @fardodokelly)

The now standard selfie – Mr John Thornhill, Mr Roger Plail, Mr David Quinlan, Professor Prokar Dasgupta, Professor Craig Peters, Mr Mark Speakman, Professor Mike Leonard)

Symplur #ISU14 analytics

Moving forward

The annual meeting also ended Mr David Quinlan’s tenure as the President of the Irish Society of Urology. The ISU has moved from strength to strength under his watchful eye, incoming President John Thornhill applauded Mr Quinlan as ‘a rock who sailed a steady ship’. We look forward to welcoming all to next year in Limerick for hopefully a bigger annual conference with a wider global audience.

Mr David Quinlan (outgoing President of ISU), Professor Prokar Dasgupta (BJUI Editor), Mr John Thornhill (incoming ISU President)

Greg Nason is a Specialist Registrar in Urology in Ireland.
ISU Social Media Team (David Quinlan, Rustom Manecksha, David Bouchier-Hayes, Fardod O’Kelly, Greg Nason)

What’s the diagnosis?

September 26, 2014/1 Comment/by admin Z.9

Test yourself against our experts with our weekly quiz. You can type your answers here if you want to compare with our answers, or just click the ‘submit’ button below.

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sLND for Prostate Cancer Nodal Recurrence: #urojc September 2014 summary

September 22, 2014/by admin Z.9

The September 2014 edition of the International Urology Journal Club (#urojc) returned to familiar territory – prostate cancer. In particular, the discussion focused on salvage lymph node dissection following radical prostatectomy. For the second time (first in July 2014), two journal articles were selected. Both were kindly made available to open access by The Journal of Urology (@JUrology).

The first paper from the Mayo Clinic by Karnes et al., titled ‘Salvage Lymph Node Dissection (sLND) for Prostate Cancer Nodal Recurrence Detected by ¹¹C-Choline Positron Emission Tomography/Computed Tomography (PET/CT)’, reported on a retrospective single-surgeon series of 52 men who underwent salvage lymph node dissection for nodal recurrence post radical prostatectomy. Median follow-up was 20 months. Three-year Biochemical recurrence (BCR)-free survival rate was 45.5% (PSA <0.2). Metastatic/systemic progression-free and cancer-specific survival rates were 46.9% and 92.5% respectively. They concluded that sLND may delay further progression of disease but highlighted the need for randomised controlled trials.

The second paper from German group Tilki et al., titled ‘Salvage Lymph Node Dissection for nodal recurrence of prostate cancer after Radical Prostatectomy’, also reported on a retrospective series of 58 patients who underwent sLND for nodal recurrence on PET/CT post radical prostatectomy. Median follow-up was 39 months. All but 1 patient had BCR. Five-year clinical recurrence-free and cancer-specific survival rates were 35.9% and 71% respectively. Tilki et al. concluded that while most patients had BCR, sLND may delay ADT and clinical recurrence in selected cases.

A common sentiment shared during the discussion related to the lack of randomised evidence for sLND:

There were some serious concerns about the methodology and results from the two articles:

Discussions quickly shifted away from the two articles to the actual clinical question of sLND in oligometastatic disease and delay to ADT. Matthew Katz provided useful links to the use of stereotactic radiation therapy.

Issues surrounding sLND training and the paradigm shift in recent years were also highlighted:

Opinions were divided on the question of surgical morbidity versus the potential increase in time to ADT:

Pop culture references were in vogue this month. An article by the Mayo Clinic on the ¹¹C-Choline PET scan sparked the linked exchange:

Some take home messages pertained to the uncertainty regarding patient selection and the role of sLND in the broader multidisciplinary arena of prostate cancer treatment:

The winner of the Best Tweet Prize is Brian Chapin (@ChapinMD) for his tweet above. We thank the Journal of Clinical Urology for supporting this month’s prize by way of a one year electronic subscription to their journal. We also thank the Journal of Urology for supporting this month’s discussion by way of allowing time limited open access of both articles.

Staying true to form, this month’s edition of #urojc provided a forum for lively international discussion. We look forward to next month’s installment and especially encourage trainees to make use of this excellent educational opportunity.

Isaac Thangasamy is a second year Urology Trainee currently working at the Royal Brisbane and Women’s Hospital, Brisbane, Australia. He is passionate about education and social media. Follow him on Twitter @iThangasamy

What’s the diagnosis?

September 19, 2014/by admin Z.9

Test yourself against our experts with our weekly quiz. You can type your answers here if you want to compare with our answers, or just click the ‘submit’ button below.

Image from Sathianathen et al. BJUI 2014

No such quiz/survey/poll

Editorial: Perioperative aspirin: To give or not to give?

September 17, 2014/by Akshay Sood and Quoc-Dien Trinh

As the population ages and life expectancy increases, one may safely assume that more men will be diagnosed with diseases of the elderly such as prostate cancer. In the USA, it is estimated that the number of older adults (≥65 years old) will double between 2010 and 2030, contributing to a 45% increase in cancer incidence [1]. Also, it is likely that these older patients will present with multiple comorbidities, commonly described as ‘multimorbidity’ in the contemporary medical literature, including chronic cardiac and pulmonary conditions requiring multidisciplinary medical management.

Hence, the present study by Leyh-Bannurah et al. [2] examining the peri-operative use of aspirin in patients undergoing radical prostatectomy (RP) is a timely and important contribution, and may very well influence our clinical decision-making regarding the perioperative management of the anti-coagulated patient. Their results show that perioperative continuation of aspirin made no difference in peri and postoperative outcomes following RP. Previous studies have assessed the effect of aspirin continuation in patients undergoing minimally invasive RP, but the present study is the first to evaluate the effect of aspirin continuation in patients undergoing minimally invasive and open RP at a high-volume tertiary centre. Studies from other surgical specialties evaluating the role of anti-platelet therapy and its timing before surgery have shown conflicting results. The study by Park et al. [3], looking at discontinuation of aspirin for ≥7 days vs <7 days before surgery in patients undergoing lumbar spinal fusion, found that aspirin discontinued only 3–7 days before surgery significantly increased the risk of intraoperative bleeding. Alghamdi et al. [4] found similar results in patients undergoing coronary artery bypass grafting. In contrast, the study by Wolf et al. [5] showed that continuation of aspirin up to the day of the surgery did not increase the risk of bleeding, transfusion or other adverse outcomes in patients undergoing pancreatectomy. Similarly, Khudairy et al. [6] assessed the use of clopidogrel and its discontinuation time in hip fracture repair, and found that whether it was stopped ≥1 week or <1 week before surgery did not make any difference to the risk of bleeding or peri-operative complications. Nonetheless, the evidence provided by the present study by Leyh-Bannurah et al. is important, as the risk of bleeding seems to be procedure-specific, depending on the nature and source of potential bleeding (primarily arterial vs primarily venous). The lack of information, however, regarding cardiovascular morbidities in their patient population is an important limitation of their study; as such factors may influence perioperative decision-making, including the threshold for transfusion.

Read the full article

Akshay Sood and Quoc-Dien Trinh*
VUI Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI, and *Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA

References

Lamb A. Fast Facts: prostate cancer, seventh edition. BJU Int 2012; 110: E157
Leyh-Bannurah S-R, Hansen J, Isbarn H et al. Open and robotic assisted radical retropubic prostatectomy in men with ongoing low-dose aspirin medication: revisiting old paradigm? BJU Int 2014; 114: 396–403
Park JH, Ahn Y, Choi BS et al. Antithrombotic effects of aspirin on 1- or 2-level lumbar spinal fusion surgery: a comparison between 2 groups discontinuing aspirin use before and after 7 days prior to surgery. Spine 2013; 38: 1561–1565
Alghamdi AA, Moussa F, Fremes SE. Does the use of preoperative aspirin increase the risk of bleeding in patients undergoing coronary artery bypass grafting surgery? Systematic review and meta-analysis. J Cardiac Surg 2007; 22: 247–256
Wolf AM, Pucci MJ, Gabale SD et al. Safety of perioperative aspirin therapy in pancreatic operations. Surgery 2014; 155: 39–46
Al Khudairy A, Al-Hadeedi O, Sayana MK, Galvin R, Quinlan JF. Withholding clopidogrel for 3 to 6 versus 7 days or more before surgery in hip fracture patients. J Orthop Surg 2013; 21: 146–150

15th Asia-Pacific Prostate Cancer Conference 2014

September 15, 2014/by Sarah Wilkinson

Blog author Dr Sarah Wilkinson enjoys lunchtime entertainment at APCC in Melbourne.

The 15^th Asia-Pacific Prostate Cancer Conference 2014 (#apcc14; prostatecancerconference.org.au/) is the largest prostate cancer educational event in the region and attracts over 800 multidisciplinary delegates every year. The world’s leading experts in prostate cancer have featured on the Faculty at this conference in recent year’s and this year’s Faculty was again a great team-sheet for leaders in this field:

The Confernece kicked off on Sun 31^st August with a series of Masterclasses including the very popular da Vinci© Prostatectomy Masterclass (featuring Dr Henk Van Der Poel, Dr John Davis, Dr Markus Graefen and Dr Paul Cathcart), along with new master classes focusing on Prostate MRI scanning (led by Dr Jelle Barentsz), and LDR Brachytherapy (led by Dr Juanita Crook).

MRI Prostate Masterclass led by Jelle Barentsz was a sell-out

The Nursing & Allied Health streams also opened their plenary sessions to a busy auditorium. The official Poster and Welcome Session was held on Sunday evening on what was an unseasonally warm and to Winter in Australia. Whilst enjoying the range of lovely canapés and beverages on offer via Melbourne’s premier conference and catering venue (https://mcec.com.au/), delegates caught up with their long lost urology colleagues and perused the high quality posters on display. Poster prizes were awarded for each of the three conference streams; Clinical Urology, Nursing & Allied Health, and Translational Science, as judged by experts in the respective fields. The task of picking just one winner for the Clinical Urology category proved too difficult for judges A/Prof Henry Woo (@DrHWoo) and Dr Phil Dundee (@phildundee), so a dual prize was awarded to both Dr Fairleigh Reeves (@DrFairleighR) and A/Prof Jeremy Millar (@jeremymillar). Rob McDowell took out the poster prize for the Nursing & Allied Health stream with his poster on baseline characteristics of participants in a telephone-delivered mindfulness intervention for men with advanced prostate cancer. The Translational Science winner was Saeid Alinezhad, who presented; ACSM1, CACNA1D and LMNB1 as three novel prostate cancer biomarker candidates.

Monday morning saw the Official Conference Opening given by conference President Prof Tony Costello (@proftcostello) who announced the opening of a new Royal Men’s Hospital to specifically address the needs of men’s health in Australia. The life expectancy of Australian males is currently 5 yrs less than women, and cancer mortality is a third higher for prostate cancer compared to breast. Rates of alcohol, tobacco and drug abuse, as well as suicide, are all 4x higher in men compared to women. 66% Australian men are overweight or obese, and men are also far less likely to visit their GP for a check-up. Next we were lucky enough to have Federal Minister for Health and Sport, the Hon. Peter Dutton MP (@PeterDutton_MP), take leave from Parliament to give the Ministerial Address. Mr Dutton expressed his support for the conference and the forthcoming opening of the new “Royal Men’s Hospital”, a clinic focussed on Men’s Health in Australia’s premier health science precinct, and spoke of how he hopes the recently proposed $20 billion Medical Research Future Fund will further help advances in this area.

Conference President Prof Tony Costello with Australia’s Minister for Health, Hon Peter Dutton MP

The 2^nd Patrick C Walsh Lecture was given by Dr Peter Carroll from the Department of Urology, UCSF, USA. Dr Carroll discussed how we can refine current risk assessments for patients with prostate cancer, and in the process give them refined treatment options. Dr Caroll and his team (including Dr Matthew Cooperberg who was also present), have led the way in risk stratification for men with localised prostate cancer and continue to find ways to best select men at higher risk of adverse outcomes.

This year’s point-counter point debate focused on the preferred method of prostate cancer biopsy. In the left side of the ring we had Mr Jeremy Grummet (@jgrummet) who argued the case for a transperineal biopsy due to multi-drug resistant rectal flora. On the right side we had Mr Shomik Sengupta (@shomik_s) who was in favour of sticking with the well-established TRUS. Following a very close audience vote, session chair A/Prof Nathan Lawrentschuk (@lawrentschuk) declared the winner, “Close, but transfecal by an organism.”

The Conference dinner was held on Monday evening at the Mural Hall, Myer Building. 18^th century style mirrored commodes and Parisian inspired parquet flooring transported guests to another world, whilst some fine whisky and entertainment was enjoyed.

And for those who hadn’t partied too hard, the Clinical Urology and Translational Science Breakfast sessions were back by popular demand beginning promptly at 6:45 am the next morning. Both sessions focused on genomics and its implications in diagnosis and treatment planning in what is now coined ‘The Genomic Era’.

Later in the morning we remembered renowned British urologist Prof John Fitzpatrick, who sadly passed away aged 65 on May 14^th 2014, suffering from a massive subarachnoid haemorrhage. His close colleague and friend, Prof Roger Kirby, delivered the remembrance speech “Life in the Fast Lane”, along with a musically accompanied slide show. Prof Kirby’s tribute can also be read here at Blogs@BJUI (https://www.bjuinternational.com/bjui-blog/professor-john-fitzpatrick-1948-2014/).

The urology Twitterati were again out in full force at #apcc14. During peri-conference period (including the 5 day lead up period, the actual conference dates, and 2 days post-conference), almost 400,000 impressions were generated in cyperspace from 424 tweets, by 111 participants. There was an average of 2 tweets per hr over the peri-conference period and each participant averaged 4 tweets each.

The conference ended with the exciting news of a 2^nd Prostate Cancer World Congress, to be held August 18-21^st 2015 in beautiful Cairns, Queensland Australia. See you there!

Sarah Wilkinson completed her PhD in prostate cancer research and is now working as a Medical Science Liaison for Oncology and Haematology at GSK. Twitter: @wilko3040

Richard Turner-Warwick

September 12, 2014/79 Comments/by Roger Kirby and Christopher Chapple

Richard Turner-Warwick CBE MSc, MCh (Oxon), DM.(Oxon), DSc.(Hon NY), FRCP, FRCS, FRCOG, FACS, FRACS (Hon), FACS (Hon)

Richard Turner-Warwick, now retired, but in good health, was one of the giants of British urology and is, quite literally, the Father of reconstructive urology, both nationally and internationally. A brilliant surgeon, teacher and writer, he managed to inspire a great many urologists around the world. He also restored quality of life to countless patients from many continents who had suffered traumatic or neoplastic injury to their genitals or lower urinary tract. In his honour we have organized a meeting on reconstructive urology, kindly supported by The Urology Foundation (TUF), in Glasgow on Saturday 12^th October 2014, immediately in advance of the SIU meeting in the same city. This blog is designed to publicise this meeting, and also provide an opportunity for those that worked with and for Richard to post their memories and reminiscences of the great man. Please do post a comment, and also join us in Glasgow at what will certainly be an exceptional day.

LINK TO REGISTER: https://tinyurl.com/RTWmeeting

Biography

Born in 1925, Richard Turner-Warwick was educated at Bedales School – at Oxford University and at The Middlesex Hospital Medical School in London. At Oxford he took an honours degree in Natural Science.

He was captain of the Oriel College Boat Club, rowed in the 1944, 1945 Oxford Crews and won the Oxford and Cambridge Boat Race in 1946 when he was President of the OUBC. His MSc thesis was on Neuro-Anatomy.

During his pre-clinical training at The Middlesex Hospital he obtained the Senior Broderip Scholarship and a number of other Medals and Prizes – qualifying in 1949. From 1949 until 1960, mostly at The Middlesex Hospital, he had an unusually extensive specialist training in internal medicine and pathology – and then in abdominal, thoracic, gynecological, and plastic surgery. He trained in urological surgery with Sir Eric Riches and with Sir David Innes Williams at the Institute of Urology in London.

He obtained his FRCS in 1954, his MRCP in 1955, his Oxford Doctorate of Medicine in 1957 and his Oxford Mastership of Surgery in 1962. He was able to visit many urological centres in America as the Comyns Berkley Travelling Fellow – becoming a Senior Resident in Urology at the Columbia-Presbyterian Medical Centre in New York. He was appointed a Consultant General Surgeon to The Middlesex Hospital in 1960 – one of six, with additional charge of the Thyroid Clinic. His outpatient assistant at this time was Deborah Doniach, the pioneer of clinical auto-immunity – her treatment of Hashimoto’s lymphadenoid goitre with thyroxine led to its shrinkage so that decompression-thyroidectomy no longer provided the control histological material she needed – it was for this purpose that he developed his trephine biopsy instrument.

He took over the Urological Department at The Middlesex Hospital when Sir Eric retired in 1963. He created a pioneering urodynamic unit as an integral part of his routine clinical service – synchonously combining video-cysto-urethrography with measurement of pressure and flow voiding dynamics.

Since about 1975 he confined his personal surgical interest and practise to Functional Reconstruction – he was additionally appointed to the staff of St Peter’s Urological Hospitals in London and also an Honorary Visiting Urological Surgeon to the Royal Prince Alfred Hospital in Sydney in 1978 where he operated for three weeks each year until 1987. His main interest and reputation at that time was in reconstruction of the male urethra.

He was elected a Hunterian Professor of the Royal College of Surgeons in 1977, later serving on the Council of this and also that of the Royal College of Obstetricians and Gynaecologists. He was President of the British Association of Urological Surgeons 1982-1984. Among his many distinctions he was given the Victor Bonney prize of the RCOG; in 1987, the Valentine Gold Medal of the New York Academy of Medicine in 1991, the Gordon Watson Medal of the RCS in 1992, the Spence Medal of the American Association of Genito-Urinary Surgeons in 1997 and the William Didusch award of the for medical art in 2002.

He was elected to FACS (Hon). in 1997, to FRACS (Hon) in 1981, to elite Fellowship of the Urological Society of Australia in 1988 the Honorary Fellowship of the American Association of Genito-Urinary Surgeons in 2002. He was awarded an Honorary Doctorate of Science in New York in 1988. During the 40 years between 1965 and 2005 he undertook more than 300 operating surgical teaching visits – mostly in America, Australia, New Zealand but also in Europe and the UK.

The Genesis of Urethral Reconstructive Surgery over the Last 50 Years

In Honour of Richard Turner-Warwick

Friday 10^th – Saturday 11^th October 2014

Royal College of Physicians and Surgeons, Glasgow

LINK TO REGISTER: https://tinyurl.com/RTWmeeting

Friday 10^th October

Afternoon Arrival

19:00 Dinner – with reflections by attendees

Royal College of Surgeons & Physicians, Glasgow

Saturday 11^th October

09:00 Welcome and Introduction

Christopher Chapple & Roger Kirby

09.05 A Lifetime’s Experience of Urethral Surgery

Richard Turner-Warwick

09:15 Genesis of Anterior Urethral Surgery: From Scrotum to Oral Mucosa

Jack McAninch