Urology, Then….AND Now

surgical wards emanating a urinary smell due to open suprapubic wounds wetting
the bulky suprapubic dressing.
At a later date, Foley indwelling catheters were available although quality of the
balloon was very poor and leaks and rupture of the balloon was quite common.
Bladder neck ligatures and adjustment of balloon of Foleys catheter into the bladder
into the prostatic cavity and circular bladder neck sutures were tried to reduce the
bleeding during surgery and post operative period. However, placement of Foley’s
balloon inside the bladder and traction, to reduce the bleeding from the bladder
neck area was found to be most effective. Post operative irrigation with normal
saline reduced the chances of clot retention.
Despite all attempts, mortality due to blood loss and septicaemia was common. It
was mandatory to keep two units of blood available in the operation theatre before
starting the surgery. Morbidity and prolonged hospital stay (10-14 days) was
common. Only basic antibiotics like Ampicillin and Gentamin were available to treat
septicaemia.
In the late seventies, Retropubic Millins prostatectomy with angular ligatures of
prostatic vascular pedicle was started. It reduced the requirements of blood and no
SPC was used. Urethral catheter was removed after 5 days. However, problems of
septicaemia continued to haunt. Hospital stay was also reduced to 5 days to 6 days.
During my posting at Pathankot MH, I had an opportunity to use this technique on
BPH patients. Results of Millins Prostatectomy(about 100 cases), encouraged me to
pursue my career in Urology, and gave me the courage to proceed for MCh. Urology
even at an age of 42 years! I joined PGI, Chandigarh in MCh (Urol) in the year 1981.
In subsequent issues, I shall chronicle my journey as a urologist over the last 3
decades.
I joined PGI at the age of 41, and was again a student in the company of three young
doctors, 14 to 15 years younger, and was popularly addressed as ‘Father’. This was
an era of learning scientific and methodical urological problems and all urological
investigations i.e RGU, MCU, Nephrostograms, Urodynamic studies. These were done
by us(Senior Residents). We had exposure to all major urological open surgical
procedures …. Recurrent kidney stones, hydronephrosis, radical nephrectomies,
replacement of ureter by long Boari’s flaps, ileal loop and Psoas hitch etc. Repair of
recurrent urethral strictures by transpubic operations was commonly done. Repair of
vesicovaginal fistulae, vesico rectal and uretero vaginal fistulae used to be
challenging problems.