MULJIBHAI PATEL UROLOGICAL HOSPITAL, NADIAD
JAYARAMDAS PATEL ACADEMIC CENTRE


NO STONE LEFT UNTURNED – INSTRUCTION COURSE ON PCNL

'German Doctor praises Nadiad Kidney Hospital for pioneering work'

Jayaramdas Patel Academic Centre (JPAC) at the Muljibhai Patel Urological Hospital (MPUH), Nadiad organised yet another Instruction Course on PCNL (Percutaneous nephrolithotripsy) during 2 -4 July, 2009.

Stone management occupies a major portion of our clinical practice. Basically most of the stone cases are either neglected or diagnosed late. Very often they complicate other health problems like diabetes, hypertension, obesity, pregnancy, neurological diseases, CRF, Bleeding Diathesis, etc. This increases complication or failure to clear all stones. Though PCNL (Percutaneous nephrolithotripsy), URS (Ureteroscopic lithotripsy) and ESWL (Extracorporeal shock wave lithotripsy) are still indicated, their applications have been modified. It requires special attention.

International faculty who participated in the Course included Peter Alken from Germany and Adrian Joyce from UK, while Samir Rai and Anil Bradoo will be among the National faculty members. Mahesh Desai, Director, JPAC and Chairman, Dept. of Urology; and R.B. Sabnis, Vice Chairman, Dept. of Urology will also be present, among others, from MPUH.

Dr. Peter Alken told DNA "I invented the PCNL technique in 1980s, but the doctors here (in MPUH Nadiad) perfected it. I am really very glad to see good use of the technique here. I admire the hospital and its doctors for making a great success of the technique".

The main aim of the Course was to focus on complicated situations. There will be ‘hands on’ facilities to increase the skill. Around 50 Urologists participated in the programme.

Muljibhai Patel Urological Hospital, who are the pioneers in the field of nephro-urology in India, has handled more than 16000 stone cases so far.

Kidney Stones Overview
The kidney acts as a filter for blood, removing waste products from the body and helping regulate the levels of chemicals important for body function. The urine drains from the kidney into the bladder through a narrow tube called the ureter. When the bladder fills and there is an urge to urinate, the bladder empties through the urethra, a much wider tube than the ureter.
In some people, the urine chemicals crystallize and form the beginning, or a nidus, of a kidney stone. These stones are very tiny when they form, smaller than a grain of sand, but gradually they can grow to a quarter inch or larger. The size of the stone doesn't matter as much as where it is located.
When the stone sits in the kidney, it rarely causes problems, but should it fall into the ureter, it acts like a dam. The kidney continues to function and make urine, which backs up behind the stone, stretching the kidney. This pressure build up causes the pain of a kidney stone, but it also helps push the stone along the course of the ureter. When the stone enters the bladder, the obstruction in the ureter is relieved and the symptoms of a kidney stone are resolved.

Kidney Stones Causes
There is no consensus as to why kidney stones form.
Heredity: Some people are more susceptible to forming kidney stones, and heredity certainly plays a role. The majority of kidney stones are made of calcium, and hypercalciuria (high levels of calcium in the urine), is a risk factor. The predisposition to high levels of calcium in the urine may be passed on from generation to generation. Some rare hereditary diseases also predispose some people to form kidney stones. Examples include people with renal tubular acidosis and people with problems metabolizing a variety of chemicals including cystine (an amino acid), oxalate, (a type of salt), and uric acid (as in gout).
Geographical location: There is also a geographic predisposition in some people who form kidney stones. There are regional "stone belts," with people living in the stone belts having an increased risk. This is likely because of the hot climate, since these people can get dehydrated, and their urine becomes more concentrated, allowing chemicals to come in closer contact and begin forming the nidus of a stone.
Diet: Diet may or may not be an issue. If a person is susceptible to forming stones, then foods high in calcium may increase the risk, however if a person isn't susceptible to forming stones, nothing in the diet will change that risk.
OTC products: People taking diuretics (or "water pills") and those who consume excess calcium-containing antacids can increase the amount of calcium in their urine and increase their risk of forming stones. Patients with HIV who take the medication indinavir (Crixivan) can form indinavir stones.
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‘Every life deserves world class care’

PRESS RELEASE – 18th JANUARY, 2009

ROBOTIC HIFU Ablatherm – FIRST TIME IN INDIA


Muljibhai Patel Urological Hospital (MPUH), popularly known as Nadiad Kidney Hospital, has procured and commissioned the state-of-the-art Robotic HIFU Ablatherm – High Intensity Focused Ultrasound - for treatment of Prostate Cancer. MPUH has become the first hospital in the country to have this state-of-the-art Robotic equipment.

During the Press Conference, well known Urologist and an expert on Robotic HIFU, Dr. Stefan Thuroff from Munich, Germany, explained the stages of prostate cancer; the reasons why prostate cancer is not generally detected early enough to treat it more efficaciously and cost-effectively; the need to build awareness leading to timely preventive check-ups, etc. He emphasized the fact that the earlier the cancer is detected, faster it becomes to cure prostate cancer. He also explained the advantages of using Robotic HIFU for the treatment of prostate cancer. Others present at the press conference included Dr. Mahesh R. Desai, Managing Trustee and Head of Urology, and Dr. M M Rajapurkar, Medical Director and Head of Nephrology.

Early prostate cancer can be cured by surgery or HIFU, but the reality in India is that by the time patient becomes symptomatic, prostate cancer is advanced where nothing much can be done by way of treatment. We have taken the lead to acquire this new technology for the first time in India which will give more options to treat various stages of prostate cancer from ‘early’ to ‘advanced’. The beauty of this technology is that it is non-invasive, state-of-the-art technology which is truly robotic. Robotic means, it designs, acts and re-acts; it has the highest degree of safety and efficacy.

What is HIFU?

HIFU, which is short for High Intensity Focused Ultrasound, is a state-of-the-art technology acoustic ablation technique that utilizes the power of ultrasound to destroy deep-seated tissue with pinpoint accuracy for treatment of prostate cancer. HIFU focuses sound waves in a targeted area which rapidly increases the temperature in the focal zone causing tissue destruction.

In most cases, HIFU is a 1 – 2.5 hour, one-time procedure performed under spinal anesthesia. Unlike radiation, HIFU is non-ionizing; this means that HIFU may also be used as a salvage technique if other prostate cancer treatments fail, like Radiation or Surgery, both of which are painful and requires hospitalization for 4-5 days.

How Does HIFU Work Against Prostate Cancer?

In order to understand the basic concept of how HIFU works, an analogy can be drawn between HIFU ablating the prostate and sunrays entering a magnifying glass to burn a leaf. When a magnifying glass is held above a leaf in the correct position on a sunny day the sunrays intersect below the lens and cause the leaf to burn at the point of intersection. If you insert your hand into the path of either one of the sun rays individually, away from the point of intersection, there is no significant heat felt or harm caused. Alternatively, if you place your hand at the point of intersection you will be burned.

The scientific principles at work in this example are the same as those with HIFU. Instead of light as the energy source, HIFU utilizes sound. Instead of a magnifying glass HIFU uses a transducer. Just as the individual sunray is harmless to the hand, and individual sound wave is harmless to the healthy tissue it travels through.

During HIFU, the physician uses continuously updated real-time images of the prostate to map out and execute the entire treatment plan. These images show treatment progression and permit the physician to customize treatment for maximum safety and effectiveness.

The Benefits

• Non-invasive treatment
• Destruction of the cancerous tissue with minimal effect to the surrounding organs
• Treatment does not use radiation
• Treatment can be performed under spinal anesthesia
• Treatment can be repeated
• Other therapeutic alternatives can be considered if results are unsatisfactory.
• Ablatherm HIFU can be used for all tumor stages as for the treatment of local recurrences (i.e. after external beam radiotherapy).