DORCHESTER 
UROLOGY
                  

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ROBOTIC SURGERY

Mr Afzal is a designated da Vinci Robotic Surgeon. He can be found on the da Vinci Surgeon locator website.

He and his team have pioneered Robotic Surgery in West Dorset. He has completed a recognized training programme under mentorship of top Robotic Surgeons from Germany and UK. He has a special interest in Nerve Sparing Robotic Prostatectomy. He offers Robotic Surgery to the West Dorset patients at Royal Bournemouth Hospital where he has a regular weekly operating slot.

Mr Afzal has presented a new technique of Robotic Prostatectomy without posterior mobilisation of the bladder
in Annual ERUS 16, EAU Robotic meeting in Milan, Italy, 14-16 September 2016. This video can be seen via clicking the following links:
https://youtu.be/hj18DhRMR8o
/download/f7bce378-97a1-11e6-b6b7-5b7c0cec1c65/
http://www.youtube.com/watch?v=tAr7xjKoM5A


(RARP) Robotically assisted radical Prostatectomy offers many potential benefits when compared to traditional open surgery, including: More precise removal of cancerous tissue.

  • Ability to perform nerve sparring surgery which enables:
  • Faster return of erectile (sexual) function: Studies show patients who are potent
  • prior to Robotic Surgery experience a faster return of erectile function than
  • previously potent patients who have open surgery.
  • Better chance for return of urinary continence: Recent studies show more
  • patients with Robotic Prostatectomy have full return of urinary continence within
  • 6 months as compared to patients having open surgery
  • Less blood loss
  • Less need for a blood transfusion
  • Less pain
  • Lower risk of complications
  • Lower risk of wound infection
  • Shorter hospital stay
  • Less chance of hospital readmission
  • Less chance of needing follow-up surgery
  • Fewer days with catheter
  • Less risk of deep vein thrombosis (life-threatening condition where a blood clot
  • forms deep in the body)
  • Faster recovery and return to normal activities

As a result of Robotic Prostatectomy offers the following potential benefits compared to traditional laparoscopy:

  • More patients return to pre-surgery erectile function at 12-month checkup1
  • Faster return of urinary continence
  • Lower risk of complications
  • Less blood loss and need for a transfusion
  • Less chance of nerve injury
  • Less chance of inuring the rectum
  • Shorter operation
  • Less risk of deep vein thrombosis (life-threatening condition where a blood clot
  • forms deep in the body
  • Shorter hospital stay
  • Less chance of hospital readmission​t

Please see the following links:

http://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Rad%20prost%20robot.pdf

TTB ,TRANSPERINEAL TEMPLATE BIOPSIES

Mr Afzal has developed Transperineal Template Biopsy service for Dorset. He has introduced a new technique where every 5 mm of the prostate gets biopsied. In patients where MRI scan shows an abnormal area at the anterior or apical part of the prostate, TTB is recommended by the MDT( Muti disciplinary team). TRUS BX fails to sample these areas. As compared with other centres where a sector, targeted or regional biopsies are performed, Mr Afzal technique involves sampling every bit of the prostate, minimizing the risk of false negative results.

Please see the following link:

http://www.tsft.nhs.uk/media/45770/TRUSP_saturation.pdf


TRUS Bx, TRANS RECTAL ULTRASOUND & BIOPSIES

TRUS bx are performed to diagnose prostate cancer in patients with raised age specific PSA, or abnormal prostate at rectal examination. Mr AfzaI has wide experience in TRUS Bx. He has performed more than 5000 TRUS biopsies in the last fifteen years. This day case procedure involves using an ultrasound probe, inserted via the back passage. Prostate is scanned in bi planner views, 12 biopsies are taken from the peripheral zones of prostate under local anesthetic with a needle inserted through the Ultrasound probe. Patients are given prophylactic antibiotics prior to the procedure.

Please see the following link:

http://about-cancer.cancerresearchuk.org/about-cancer/prostate-cancer/getting-diagnosed/tests-diagnose/transrectal-ultrasound-guided-trus-biopsy



HIFU

Dorchester Urology offers HIFU ’’High Intensity focused Ultrasound’’ to patients with low grade prostate cancer where invasive radical treatments, surgery or radiotherapy is not indicated. In cases where patients choose not to stay on active surveillance, minimally invasive focal or whole gland HIFU could be an option. Salvage HIFU is also offered to patients where radiotherapy has failed to eradicate prostate cancer with PSA recurrence. HIFU uses high frequency ultrasound waves to heat and destroy cancer cells in the prostate. When high frequency sound waves are concentrated on body tissues, those tissues heat up and die. To use this as a cancer treatment, the specialist targets the area containing the cancer. Because the prostate is deep within the pelvis, you have HIFU for prostate cancer by putting an ultrasound probe into your back passage (rectum). Doctors call this a transrectal probe. From that position, the ultrasound can direct beams accurately at the prostate.

Please see the following link:

http://prostatecanceruk.org/prostate-information/choosing-a-treatment/hifu



PCNL (PERCUTANEOUS NEPHROLITHOTOMY)

Percutaneous nephrolithotomy (PCNL) is a surgical procedure to remove stones from the kidney by a small puncture wound (up to about 1 cm) through the skin. It is most suitable to remove stones of more than 2 cm in size. It is usually done under general anesthesia. PCNL is a type of 'keyhole surgery' where the stone in the kidney is broken up under vision using a endoscopic instrument called a nephroscope. The nephroscope gets to the kidney through an incision approximately 1 cm in length.Fragmentation may be needed to break the stone into small pieces using some type of energy probe (ultrasonic, electrohydraulic or laser). The stone fragments are then extracted with the nephroscope (see diagram below) through the small puncture in the back. PCNL usually also includes cystoscopy at the start of the procedure and x-ray screening. Alternatives to PCNL: External shock wave treatment, open surgical removal of stones, observation.

Please see the following links:

http://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/PCNL.pdf

http://www.nhs.uk/Conditions/Kidney-stones/Pages/Treatment.aspx


TURP

A TURP is usually carried out using a device called a resectoscope. A resectoscope is a thin metal tube that contains:a light,a camera,a loop of wire.The surgeon will insert the resectoscope into your urethra (the tube that carries urine from your bladder to your penis) before guiding it to the site of your prostate with the help of the light and the camera.An electric current is used to heat the loop of wire, and the heated wire is used to cut away the section of your prostate that is causing your symptoms. After the procedure, a catheter (a thin, flexible tube) is used to pump saline water into the bladder and flush away pieces of prostate that have been removed.A TURP can take up to an hour to perform, depending on how much of your prostate needs to be removed.Once the procedure has been completed, you will be moved back to your hospital ward so you can recover.

Please see the following links:

http://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/TURP%20for%20benign.pdf


TURBT
This procedure is usually performed under general or spinal anesthetic, using a telescope inserted into the bladder.The tumour is resected "piecemeal" using a wire loop which is connected to high-energy electric current to provide power for cutting. A lower energy current is used for cauterising any bleeding blood vessels.The tumour fragments wash forwards into the bladder and are evacuated by suction at the end of the procedure. All the fragments are then carefully examined under a microscope.

Please see the following links:

https://www.baus.org.uk/patients/information_leaflets/17/bladder_tumour_resection_procedure_information


CYSTOSCOPY
A cystoscopy is a medical procedure used to examine the inside of the bladder using an instrument called a cystoscope.A cystoscope is a thin, fibre-optic tube that has a light and a camera at one end. It is inserted into the urethra (the tube that carries urine out of the body) and moved up into the bladder.The camera relays images to a screen where they can be seen by the urologist (specialist in treating bladder conditions).

There are two types of cystoscope:
Flexible cystoscope – a thin, flexible tube used when the only purpose of a cystoscopy is to look inside your bladder
Rigid cystoscope – a thin, straight metal tube used for passing small surgical instruments down through the cystoscope to remove a tissue sample or carry out treatment. Most cystoscopies are performed as outpatient procedures, so you'll be able to go home on the same day.

Please see the following link:

http://www.nhs.uk/conditions/cystoscopy/pages/introduction.aspx

URETERO-RENOSCOPY + HOLMIUM LASE FRAGMENTATION & REMOVAL OF URETERIC/ KIDNEY STONES
The surgeon will insert a telescope into the bladder through the water pipe (urethra). Under X-ray guidance, a flexible guidewire will be inserted into the tube that runs to the kidney (ureter), on the affected side. A longer telescope (rigid, pictured below, or flexible, pictured above) will then be inserted over the wire and passed up to the kidney to locate the stone(s). The stone(s) will be disintegrated using a mechanical probe or laser and the fragments extracted with special retrieval devices. A ureteric stent is normally left in place, together with a bladder catheter, after the procedure.

Please see the following link:

https://www.baus.org.uk/patients/information_leaflets/185/rigid_ureteroscopy_for_stones



ESWL (LITHOTRIPSY FOR SMALL KIDNEYS/ URETERIC STONES)

Firing shockwaves through the skin to break kidney stones into small enough fragments to pass naturally; this involves either xray or ultrasound to target the stone(s). What are the alternatives to this procedure? Alternatives to this procedure include telescopic surgery, open surgery and observation to allow stones to pass on their own.

Please see the following link:

http://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/ESWL.pdf



LAPAROSCOPIC NEPHRECTOMY

Its a keyhole surgery to remove kidney cancer. A full general anaesthetic is normally used and you will be asleep throughout the procedure. You will usually be given an injection of antibiotics before the procedure, after you have been checked for any allergies. The anaesthetist may also use an epidural or spinal anaesthetic to reduce the level of pain afterwards. The surgeon will free the kidney and its surrounding fat through several keyhole incisions and will put into a bag which will be removed by enlarging one of the keyhole incisions. A bladder catheter is normally inserted during the operation to monitor urine output and a drainage tube may be placed down to bed of the kidney.

Please see the following link:


http://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Radical%20nephrectomy%20lap.pdf

LAPAROSCOPIC ADRENELECTOMY

The operation is performed under general anaesthetic (you will be asleep). The surgeon will usually make 3-4 small cuts on the abdomen. Through one of these wounds a telescopic camera is passed to allow the surgeon to see the kidney/adrenal glands and surrounding organs. Through the other wounds instruments are passed which can cut, diathermy (cauterise) and stitch the blood vessels and organs inside. Once the adrenal gland has been isolated a slightly larger wound is made to allow the gland to be removed. This is then sent away for analysis in the laboratory. At the end of the operation a catheter tube is often placed into the bladder through your urethra (water pipe). A wound drain will sometimes be inserted into one of the abdominal wounds. The operation takes approximately 1 – 2 hours.

Please see the following link:
http://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Adrenalectomy_lap.pdf



LAPAROSCOPIC PYELOPLASTY

After exposing the kidney through “keyhole” incisions, the surgeon will divide or remove the blockage at the junction between kidney and ureter. The kidney will then be joined to the ureter again so that drainage can occur (pictured). Occasionally, a flap of tissue from the kidney may be folded down to widen the narrowing. A ureteric stent is normally put in to allow healing of the suture line in the pelvis of the kidney. You will have a bladder catheter put in during the operation to monitor urine output and a drainage tube near the newly-formed join.

Please see the following link:
http://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Pyeloplasty_lap.pdf


CIRCUMCISION

Its the operation performed to surgically remove the foreskin. A full general anesthetic is normally used and you will be asleep throughout the procedure. A spinal anaesthetic (where you are unable to feel anything from the waist down) or a local anaesthetic injection around the penis may also be used. Your anaesthetist will explain the pros and cons of each type of anaesthetic to you. Local anaesthetic is injected into the base of the penis to relieve discomfort after the operation. This can be used as the sole form of anaesthesia in some patients. All methods minimise postoperative pain. The entire foreskin will be removed using an incision just behind the head of the penis (pictured). This leaves the head of the penis completely exposed with no redundant skin.


Please see the following link:

http://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Circumcision.pdf