Center of Excellence: Universidad de La Laguna/Hospital Universitario de Canarias
City: Tenerife, Spain
Director: Prof. David Manuel Castro Díaz
Visit dates: 24/11-01/12/2013
Trainees: Mitrakas Lambros (Larisa)
Moustakas Giorgos (Athens)
What the Trainees said
Description & Evaluation of the Center
The Clinic of the Hospital Universitario de Canarias in Tenerife is a fully developed and modern Urology clinic. It is located on the 8th floor of the central building with a capacity of 30 beds. The building and accommodation facilities (beds, chairs, waiting rooms etc) are quite old but absolutely functional. All premises are incredibly neat and perfectly clean. The administrative, nursing, paramedical and medical staff was more than ‘abundant’. The new modern building is connected with the old one, and that is where the daily briefing meeting about the on-call shift program, patients and clinical lessons take place). I was impressed with the fixed scheduled discussion meeting with the Oncologists. There is electronic access to all patients’ files (data base). Following the meeting, we, with almost all physicians, including Professor Castro, would go to the great hospital staff café at about 9:30, for an express (~15 minute) coffee (barraquito!!!). Then everybody would go to their posts.
On day 1 in the morning, we accompanied Professor at the outpatient clinic visits with about 15-18 outpatients. In the beginning, he showed us around the autonomous outpatient clinic, where there are separate rooms for prostate transrectal biopsies, cystoscopies, ESWL, urological imaging, neurourological –urodynamic studies, 2 small reception areas and rooms for the patients’ preparation and, of course, rooms for the staff. Every morning there are 4 medical offices receiving patients at the same time. After lunch, we attended a living donor kidney transplantation performed by the Professor (laparoscopic live donor nephrectomy). The Clinic has outpatient clinics and surgeries scheduled on a daily basis. Our day was completed at 8:30 p.m.
On day 2, after our meeting and café, we attended a urethroplasty (stricture relapse of traumatic aetiology), with implantation of buccal mucosal or preputial grafts due to the large extent of the stricture. The procedure was completed within 6 hours.
On day 3, I actively participated in a transperitoneal nephrectomy of a right multicystic kidney. The same patient was scheduled to undergo a LAP nephrectomy of the left kindey and ureteroileodermostomy (Bruecker) one week later, with the ultimate goal to have kidney transplantation in the right iliac fossa. Tenerife is Number One worldwide in transplantations per 1.000.000 population!!!
On day 4, we attended a surgery for placement of artificial sphincter performed by the Professor in a patient with post-prostatectomy urinary incontinence.
On day 5, we attended scheduled videourodynamic studies and ESWL sessions. It is important to note out that both procedures are conducted by trained nursing staff. The physician’s contribution is necessary only to treat a potentially occuring uncommon difficulty or complication, that occurs very rarely. In the evening, we attended a Urology seminar related to the interaction and relationship between Primary Healthcare and Urology. Although all presentations were in Spanish, we were able to understand most data given that the medical terminology mostly derives from the Greek language.
All laparoscopic and endourological procedures are performed there. In transurethral procedures, a monopolar system is used to limit costs. In my opinion, this is a very useful lesson for us, Greeks.
I also consider highly important and beneficial the fact that the Professor is not himself the Director of the Clinic, for I personally believe that a Professor’s tasks are so numerous that do not allow him to adequately fulfill the Director’s heavy responsibilities and demanding requirements.
The Residents are given an important and active role in surgeries by Specialist Surgeons, including the Professor. Given that in every surgical procedure there are 2 surgeons, very often we would see the Professor “holding the retractor΄΄ during the operation, so as to allow for the Resident to gain surgical experience and improve their skills.
At this point I would like to underline that Professor.Castro-Diaz was incredibly friendly with us, and made us feel really at home. He dedicated to us lots of his professional time, so as to explain things and convey his knowledge, as well as lots of his personal time, so that we could get to know him better and enjoy his warm hospitality. Having met him has been a real honor to me!
Last but not least, I should say that all colleagues, both Urology Specialists and Residents, “embraced” us as if we had known each other from long before, and even those who did not speak English well did their best to share their experience and knowledge with us.
I would like to warmly thank ISUD, Professor Chatzichristou, the Urology Clinic of the Hospital Universitario de Canarias in Tenerife and Professor Castro-Diaz for selecting me to participate in UROTOUR 2013.
The Urology Clinic of Hospital Universitario de Canarias in Tenerife is a fully developed and modern Urology Department providing ideal training. Our colleagues there deal intensively with kidney transplantations (as a surgical procedure, for all other relevant issues are settled by Nephrologists), and this is undoubtedly something unique for us who have been educated and trained in Greece. For sure, it is well worth for every young Urologist not only to visit the Clinic as an observer, but also to attend there a more integrated post-training program.
Description & Evaluation of the Center
Within the context of Urotour 2013, I had the opportunity to visit the Urology Clinic of the Hopital Universitario de Canarias, for the period 23-30 November 2013. The hospital is located in San Cristóbal de La Laguna in Tenerife. It was founded in 1971 and is hosted in an 8-storey building which has been expanded with a second building during the last years.
Dr. David Castro-Diaz is a worldwide famous Urology Professor with main interest focusing mainly on the field of Neurourology and urinary disorders.
Besides the patient wards, the Urology Clinic also has an independent wing with exclusive nursing staff, which comprises the Extracorporeal Lithotripsy department, the Urodynamic department with radioscopic equipment and videourodynamic control devices, room for endoscopies, room for ultrasound screening and transrectal biopsies, as well as a Care Unit for urological patients.
The clinic daily routine starts at 8:00 with briefing and discussion upon patient cases. Then follow the outpatient clinics, endoscopies, biopsies, extracorporeal shock wave lithotripsies (ESWL) and surgeries. There are both morning and evening surgery sessions scheduled with a few-hour lunch break inbetween.
From the very few first hours, one can realize that it is an optimally organized department offering high level healthcare services. There is always online access to the patients’ data base and paraclinical examinations. Everybody –even the Professor- participates in outpatient clinics. It should be pointed out that the organization and smooth clinic operation is within the competence of the Director of the Department (and not of the Professor), so that there is allocation of responsibilities, facilitating thus the organizational structure, optimal performance and educational & training work of the University.
Surgeries are scheduled many days in advance, so that everybody is always aware of the exact program. We had the opportunity to attend and participate in a wide range of surgical procedures. Indicatively, I am mentioning various laparoscopic and open nephrectomies, laparoscopic radical prostatectomies, artificial urinary sphincter placement almost on a daily basis, implantation of lip mucosal or preputial grafts to treat extensive urethral strictures and, of course, kidney transplantations.
It is worth mentioning that the Urology Clinic has a long tradition in kidney transplantations -with a history of 2.500 transplantations and about 2 transplantations per week. In one of such procedures, we had the opportunity to attend a live donor nephrectomy and immediate implantation in the recipient. There was smooth flow of surgeries and excellent time management thanks to the additional evening surgery sessions and the great number of functional operating theaters.
The nursing staff in the Urology Clinic was perfectly trained and their contribution was substantial in conducting videourodynamic studies and extracorporeal lithotripsies.
I would like to thank the whole nursing and medical staff of the Urology Clinic and particularly Professor David Castro-Diaz for their collaboration, warmth and hospitality that made us feel part of their group from the very first moment.
I believe that my visit to the Urology clinic of the Hopital Universitario de Canariasότι was an extraordinary experience in an organized Center of Excellence in Spain. I strongly recommend my colleagues to visit it.
