NEWS AND ANNOUNCEMENTS



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St Andrew’s doctors and staff attended a clinical lecture from its new Urologist, Dr Devang Desai about the innovative new surgery he is introducing in Toowoomba. Dr Desai has trained extensively overseas and obtained skills in assisting patients with urology problems, particularly following cancer treatment or trauma to the pelvic area.


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The following article was published in the Chronicle on June 3, 2017. The weblink to the article is https://goo.gl/FHWX6z. We are immensely proud of our specialist Dr Devang Desai on this accomplishment.

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Surgery performed for first time in Toowoomba

A NEW surgery is being offered in Toowoomba for the first time, with a city surgeon learning the procedure from a world-class expert.

Dr Devang Desai performed the first urethroplasty on a patient at St Vincent’s Private Hospital on Thursday, with another operation scheduled at Toowoomba Hospital next week.

The surgery, for men, is where the urethra is reconstructed to cure problems like urethral stricture.

Dr Desai said it was the first time the procedure had been performed outside of Brisbane. Previously patients would have to travel to Brisbane, were faced with having a lifelong catheter or had their stricture dilated and hoped it would not come back.

“In the past, because we didn’t offer these surgeries, a lot of people in the west would just have long-term catheters,” Dr Desai said.

“What I have done, is take a graph from the inside of the check, the inside lining, and essentially patch the urethra, widen the urethra out.

“The aim is they don’t need any further intervention.”

Dr Desai has been back in Toowoomba only a couple of weeks after having completed a genitourinary reconstructive urology one-year fellowship in India with world renowned expert Dr Sanjay Kulkarni.

He said there was a lot of work out there in relation to the surgery, having quickly booked in two procedures since returning. The procedure generally takes about two hours.

The surgery, performed on a man in his 80s on Thursday, came as a relief for the patient who had undergone other surgeries including prostrate surgery for endoscopic resection and dilation.

“It is a complicated procedure. I have done medicine, surgery, urology and I went overseas and did this for a year – it is not something everyone can do,” he said.

Dr Desai said he was the only surgeon in and around Toowoomba able to perform the operation, joining about 200 others around the world.

“I was in Toowoomba before I went on my fellowship, I thought why not go overseas and learn this type of thing,” he said.

“Then patients don’t have to go travelling. It’s nice to offer to the community.

“The biggest thing is, I’m happy to do this service publicly and privately. We can do much more complex things here now, rather than going to Brisbane.”

For more go to toowoombaurology.com.au



Dr Desai has recently completed comprehensive overseas training, gaining expertise in reconstructive and robotic urology.

Reconstructive urology involves treating patients who have suffered urinary tract injuries, usually from trauma. However, other conditions such as cancer treatments, complications from other surgeries, congenital malformations and infections can result in the need for reconstructive surgery.

Dr Desai will also be utilizing the St Andrew’s Hospital Robotic Assisted Surgery system for kidney and the prostate procedures.

General urology procedures for treating urinary stones are also performed by Dr Desai.

For an appointment to see Dr Desai, please see your GP for a referral. Toowoomba Urology can be contacted on telephone 4632 8481.


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INTRODUCTION AND OBJECTIVES: Urethral stricture is a prevalent and challenging urological condition. Management has evolved over the last century, specifically with the advent of oral mucosal grafts for urethroplasty. We review the history of urethral stricture treatment.

METHODS: A literature search of medical texts, journal articles and historical texts was performed pertaining to history of urethral strictures.

  • Urethra ~ greek word ourein = to urinate
  • Urethral stricture – Hindoo scriptures 6th century BC
  • Ayurveda – urethral dilatation using metal / wood dilators
  • Ambrose Pare’s description – ‘A silver weir, sharp at the upper end, is to be passed in as far as the obstruction, then by oft thrusting it in and out, it may wear and make plain the resisting caruncles‘. 1894 Sapezho – first described oral mucosa in urethroplasty
  • Anterior urethra –
    • 1953 Staged repair Johanson
    • 1996 Dorsal onlay Barbagli
    • 1996 Ventral onlay Morey McAnnich
    • 1999 Dorsal inlay penile Hayes & Malone
    • 2000 Panurethral Kulkarni
    • 2001 Dorsal inlay bulbar Asopa
    • 2008 Muscle and nerve sparing Barbagli
    • 2010 Enterourethroplasty Mundy
    • 2015 NTAU Mundy

     

  • Oral mucosal grafts still remains one of the greatest advancements in urethral stricture management.

In the future urethroplasty may have a limited role once we establish how to halt the process of fibrosis

Posterior urethral injuries (PFUI) have been traditionally managed by Anastomotic Urethroplasty

Posterior Urethra –

  • 1962 Pierce. Total abdominal pubectomy
  • 1968 Paine & Coombs Abdominal approach
  • 1973 Waterhouse Abdominoperinal approach
  • 1976 Turner-Warwick Transpubic approach with omental wrap
  • 1986 Webster & Goldwasser Perineal approach
  • 2010 Kulkarni Etiology and management of PFUI

Future directions –

Anterior urethra

  • Liquid mucosal grafts
  • Tissue engineering

Posterior urethra

  • Stepwise perineal approach

 


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