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ΣΥΝΈΝΤΈΥΞΗ
to meet the real icons of Urology. For example, in London, I met John Wickham, Richard Turner- Warwick and Tony Mundy. At that time, these were the popes of Urology, those who concepted and revolutionized reconstructive and minimally- invasive Urology. Of course, you can’t only mention these! Then in Barcelona, I had so many inspiring experiences, regarding general Urology but also orthotopic kidney transplantation. Can you imagine that you put a kidney in the renal fossa instead of putting it in the pelvis? What is really important, in my opinion, is that this choice that I have made, to travel around Europe, was in accordance with my educators in Leuven, so as to fill the gaps of what we were not doing in Leuven. I strongly believe that an honest trainer should advise their residents, after they have finished their education to go and see other professionals that they are impressed by. Fortunately, that is what I did. I went to Mainz, because they had at that time the first ESWL machine. This is also where I saw the percutaneous nephrolithotomy with doctor Alken and saw the construction of Mainz pouch I and II by professor Hohenfellner. We were not yet doing these things in Leuven. Then, I went to Denmark to Herlev Hospital, where Hans-Henrik Holm did the first seed implantations for prostate cancer and I saw my first artificial sphincter implantation by Tage Hald. These were the pioneers of doing this! And finally, I went to the great Fritz Schröder in Rotterdam, who introduced radical prostatectomy in Europe.
So, this is what I would advise to all young urologists, to travel around and to see things that they have not been offered during their regular education. This is the way to be better than your colleagues, who immediately after training just go to practice and start to reproduce what they have learned.
T.S.: You have developed the original surgical technique for many operations such as the prepubic urethrectomy, the percutaneous gastrostomy, the lumbal splenectomy during orthotopic kidney transplantation, and of the Leuven “N” pouch for bladder substitution. What is the driving force that guides you to differentiate from already existing techniques and to try something new?
H.vP.: Well, I have to admit that the most successful and original one is the prepubic urethrectomy. And I will tell you the story behind it: one of my chiefs of Urology performed a cystectomy and did the
diversion, which was a Bricker ileocutaneostomy. And then he told me: “I’m going to have lunch and you have to finish the case. You close it up and do the urethrectomy.” Unfortunately, this meant that we had to reinstall the patient and make a perineal incision, which would take another hour of surgery and even more. I remember back then that it was already afternoon. So, I started wondering whether we could not do this through the same incision. And this is how the prepubic urethrectomy, avoiding a perineal incision was born. If you have seen the technique, you can understand that in the prepubic space you can invert the penis completely and bring it in the operative field, so you don’t need a perineal incision. As a result, patients suffer less pain, because they can sit up after the surgery, and it’s much faster. I mostly did it because I was not willing to spend another hour and a half doing the urethrectomy, so this technique took only twenty minutes. In the beginning I had some bleedings, but then I further developed the technique and I presented it. Interestingly, when I did my visit with Rudolf Hohenfellner in Mainz, who did a cystectomy with a Mainz pouch II, I told him that I did the urethrectomy in another way and then I showed it there. Because he was an editor for a book of surgery, he made me publish my technique in his book. I have also published the technique in the Journal of Urology in the USA and it became worldwide known. Surprisingly, I have seen papers in China of people who used the technique and published their results. Moreover, there were urologists from the UK who were surprised by the technique and visited me to come and see how we did it. I am glad to see that the prepubic urethrectomy is now a well-established technique and it can be still found in the regular textbooks of Urology.
The percutaneous gastrostomy is a different story. You know at that time, patients undergoing Bricker diversion or substitute bladder needed full bowel preparation and where not allowed to eat or drink after surgery. A naso-gastric tube was inserted which stayed in place for three or four days, which was associated with important patient discomfort. I thought that we could do this in another way. And so, I started doing this with a Cystofix ® catheter inserted straight in the stomach through the abdominal wall. In that way once bowel transit had recovered, you could clamp the gastrostomy and remove it. The patient could start drinking early and didn’t suffer from the tube in his nose. It was a matter of quality of life.
Tεύχος 25 | Σεπτέμβριος – Οκτώβριος 2023
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