Centre of Excellence: Institute of Urology, University College Hospitals
City: London, United Kingdom
Director: Prof. A. R. Mundy
Urotour Coordinator: Mr David J. Ralph BSc MS FRCS (Urol)
Dates of visit: 03-10/10/2010
Trainees: Deirmetzoglou, Stavros (Kavala)
Pantazis, Thrasyvoulos (Alexandroupolis)
What the trainees said
Evaluation of the Center and Description of benefits gained
The truth is that everything starts with visitor reception and for this I must offer my congratulations to my colleague Evangelos Zacharakis for the interest he showed both during my initial contact with him at the clinic as well as throughout my stay in London.
I was given the opportunity to meet scientists from all academic levels and find answers to questions I raised on specialized subjects, such as Andrology and Paediatric Urology. I was particularly impressed by the attitude and, more specifically, the simplicity, politeness, interest and formality shown by the entire staff throughout my presence there, regardless of their capacity or hierarchical position. It was out of the question to be present in the room without first having been introduced and having met the entire surgical team. Naturally there was some dissonance, which, however, faded in the background of the general good impression. I observed a wide range of surgical procedures. From very simple procedures, which I had not had the chance to follow step-by-step and lege artis in the past, to more complicated ones, which this centre is famous for. Procedures by Professor Mundy were of particular interest and included revision of cysto-urethral anastomosis following stenosis in a case of surgically treated prostate Ca or vesico-vaginal fistulas. A unique experience was the HIFU for a prostate Ca case and standardized trans-perineal prostate biopsies in cases of prior repeatedly negative prostate biopsies. In charge of all this was Professor Eberton, who was also an excellent Teacher. Last but not least, I had the opportunity of observing Nesbit-type procedures or hypospadias plastic surgery on infants performed by Dr. David Ralph. I also observed a multitude of endoscopic procedures which –to be absolutely honest- affirmed my belief that there was nothing I had not been taught by my Professors at home. I was particularly fortunate to have observed these procedures performed by experienced surgeons, specialized in particular fields. I have always supported that in order to understand if surgeons know their business and are at the top of their field, they must give you the impression, that on the very following day of the demonstration, you will be able to carry out the same procedure on your own. For better or worse, I felt that I was ready to carry out almost all of the operations I observed and, of course, having a sense of things is one thing and being certain another.
Evaluation of the Center and description of benefits gained
First of all, I would like to express my gratitude for the opportunity you gave me to visit the Institute of Urology of London. As far as the Department I visited is concerned, I only have words of praise. The greatest part of my stay was spent in the operation theaters, observing everything from “day to day” Urology (TURP, TURBT), Endourology (URS, PCNL), to specialized Andrology procedures (penile prosthesis insertion, Nesbit, etc.) and Reconstruction. To be honest, I cannot say that I was impressed by the procedures, which we also perform here at Alexandroupolis Hospital. I believe that as far as Endourology and Intraurethral procedures are concerned standards are comparable. However, the clinic in question is an Andrology Reference Centre, and it was implied that other cases are not given the same serious attention. What is impressive is the incredible specialization in the sector of Andrology and Reconstruction. I saw operations carried out on a daily basis that, up until then, I thought were only described in books (e.g. phalloplasty) and others that were not performed at the hospitals were I had been trained or worked (insertion and removal of penile prostheses and sphincters, prosthesis insertion in priapism cases, etc), HIFU. Certainly, this was not the most impressive point. What truly impressed me was that Urologists of the calibre of Prof. Mandy, Prof. Woodhouse and Dr. Evans took the time to work with us, explain things to us, teach us. They were interested in finding out where we came from and what our jobs were at the centres were we work. At no point did I feel I was being snubbed or treated as an inferior. In many discussions, mainly concerning endourology, they listened to my opinion and asked me about our practices. The other impressive point is the way in which young Urologists are trained. I will not go into details, as I do not want to upset my younger Greek intern colleagues who are absolutely right in being upset by the practical part of their training; I will only mention that I trained at a “lithiasis centre”, which is what I consider Alexandroupolis Hospital to be, and was put to shame when I saw that URS were carried out by second year interns, while the registrar, who was younger than me, was capable of carrying out flexible URS and PCNL (four a day on average). Lastly, the way complications or failures are managed was also exceptionally impressive. Anything can happen and everything is discussed openly and without any taboos. Discussions on difficulties during surgery and complications are held on a daily basis. The working hours are, naturally, from 8am until 6pm, so there was no question of a tourist visit to London. The pace of work is quite relaxing and efficiency at least twice that at our hospitals. Hospital facilities were respectable but nothing outworldly. I feel that many hospitals in Greece have better facilities. We also had the opportunity, within the framework of the UROTOUR Program, to attend St. Peter's Course, an exceptional Andrology and Reconstruction seminar - which, in fact, offered a limited number of places - with theoretic training and live surgery. To recapitulate, I believe that this was an exceptional experience from which I have learnt much; I acquired both strictly urological knowledge, as well as a different way of thinking. I believe that the Center in question should be selected by any colleagues considering an internship in Andrology and Reconstruction, but not in other sectors.