Interview

Urologic Science Touching New Horizons

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Dr Rajeev Sood

Dr Rajeev SoodUrological disorders are becoming more frequent and they have a profound effect on the quality of life.

Dr Rajeev Sood, Professor & Head- Urology, Dr RML Hospital & PGI-MER, Delhi, Nominated Urologist to the President of India, Consultant Urologist to the Parliament of India and the Organising Secretary of USICON 2014, discusses with Shahid Akhter, ENN, the emerging frontiers in urology that will shape USICON 2014 (29 Jan 2 Feb, 2014)

After more than three decades USICON annual conference is being organized in New Delhi. What are the highlights of the 47th Conference?

USICON 2014 is poised to play a vital role in shaping public health perspective. It will focus on various causes that will impact the basic health issues, including those related to urology. This branch is closely related to and at times over laps with various other medical verticals like oncology, nephrology, andrology, endocrinology, gynecology, to name a few.

The four basic verticals envisioned by the conference are associated with breakthroughs and technological highlights, Organ donation, Oncology and Mens health.

The conference will have scientific programs and extensive training sessions, giving attendees a chance to sign up and master new skills. These are regularly updated on the website.

Please elaborate on advancements in urology that one may expect at the Conference under the theme of Basics to High tech?

Advancements in urology are multifold and can be classified into two broad groups – progress made by the pharmaceutical industry that has resulted in new drugs and the chain of technological innovations that have enriched the application in urology and oncology.

In the pharma domain, advanced molecules, nano technology, recumbent molecules and target therapies are the emerging frontiers that have hit the headlines.

Many firsts are scheduled to be launched at the conference, with target organ being prostate. This ranges from Mirabegron (by Astellas Pharma) to Degarelix ( by Ferring Pharma) and LHRH Antagonist for cancer.

OAB (overactive bladder) affects more than 400 million people worldwide. A new treatment, BETMIGA (Mirabegron) has received approval from the European Commission (EC) for the treatment of overactive bladder (OAB) symptoms in adults. Mirabegron represents the first new class of treatment in OAB.

Botulinum Toxin A, popularly known as Botox (by Allergan) and widely known for its use in facial rejuvenation, has been indicated for overactive bladder. It was approved by FDA in August 2011 for injection into the bladder muscle for treatment of leakage of urine (incontinence) in adults with overactive bladder due to neurologic disease.

Degarelix is a new form of hormone therapy that reversibly binds to the GnRH receptors, inhibiting the production of testosterone. By suppressing the production of testosterone, tumor growth is inhibited.

Abiraterone( by Johnson & Johnson), approved by FDA in 2011, is used in treatment of men with castration resistant prostate cancer.

LHRH antagonist is a Prostate Cancer Hormone Therapy. It is generally used for advanced prostate cancer with bone metastasis.

USICON 2014 Highlights

>>Live 3 D High Definition High
 
Luminosity Display

>>Live transmission of Robotic and Laparoscopic Surgeries from AIIMS

>>Internationally acclaimed faculty with extensive coverge of current changes and recommendations

>>Online integration of scientific content

>>Mobile Application and web portal

Emerging technologies are exciting and they hold the promise of changing urologic surgeries. Please outline USICON role in the technological advancements ?

Almost one third of surgical admissions are associated with urological disorders and they are getting more and more common. Medical care is becoming increasingly expensive as new advancements in diagnosis and ever expanding use of technology in treatment is becoming the standard of care.

Urological surgery was among the last surgical disciplines to gain recognition as a separate entity from general surgery in terms of medical training and practice. Today urologists may consider themselves lucky enough to be working in a very technological environment.

Robotic surgery is fast emerging as the standard of care for various urological conditions. It has gained recognition for its potential advantages to the surgeon as well as the patients.

With the advent of Minimally Invasive Surgery (MIS), there is a huge potential for endoscopic Intervention. For better vision 3D technology, USICON 2014 will be the launch pad for laparoscopic surgery by Olympus, Storz, Aesculap. Tookad Technology ( approved in Mexico) is being introduced for the first time as localised cancer prostate image guided targeting, HIFU ( high intensity focused ultrasound) for kidney and prostate tumours by EDAP and SONA BLADE.

The full range of lasers with advanced versions like Greenlight 180, Thulium 200, Holmium 200 are to be introduced at USICON 2014 for Indian surgeons. EIGEN technology of focused biopsies by fusion of ultrasound in imaging to target therapy to the localized early cancer. This will give 3D and 4D accurate image of the tumour.

Mens Health is a global issue. International Mens Health Week is observed universally but seems to be a non issue in India. As an urologist, how do you address this lack of concern ?

True, mens health month is celebrated across the globe. It is to spread the awareness of preventable health problems in men and to encourage early detection and follow up treatment of the disease. There are lots of awareness activities across the globe but we are lagging behind.

This has been a neglected domain and this concerns almost half of our population. Most of the government schemes and health programmes still focus on child, maternal health and communicable disease.

When health for all by 2020 is the goal, mens health comes to the centre stage and concerned urologists are following the global initiatives. This will help the policy makers, fellow academicians and clinicians to understand the importance and implications of such health related moves and measures.

India is to host the World Congress on Mens Health in 2015. We recently won the bid, with myself as the Congress Chair, in the recently held World Congress in Washington where other bidders from Australia, New Zealand, Japan and Malaysia too participated.

How will aging impact the society?

It is all the more important because the aging population of new India is exposed to disease burden and the young generation is equally vulnerable due to social role and mental stress of the male. This leads to men being more vulnerable in our Indian society and the result is that mans life span is shorter than the womens by 5 years.

Lifespan of an average Indian has increased but the quality of life should also have improved. There is lack of awareness and access to medical facilities are limited. This leads to more suffering as the aged are even discarded by their families as destitutes and untouchables. Imagine an elderly suffering from overactive or unstable bladder, leading to frequent bed wetting or nocturnal enuresis.

Suicides, renal stones, malignancies, accidents and trauma are two to four times more in men. Work place stress, computerization, electronic towers, array of gadgets have added to the infertility and sexual dysfunction. Contrary to the belief female sexual dysfunction is more prent than male sexual dysfunction.

How do you co relate the life style disorders vis-i-vis mens health?

India had launched a new national health programme in 2011. For the first year, thirty target districts were identified but goals remained far from being fulfilled. This needs intervention of professional bodies and social organisations. Polity needs to be sentisized and bureaucracy to be stimulated to understand the otherwise disastrous outcome.
India is acknowledged as world capital for diabetes the major killer cause of kidney failures; sexual health is worse in India due to diabetic hypertension and we are leading in global tobacco consumption.


During USICON 2014, we intend to create new incentive for public awareness where clinicians and other stake holders will be donating their bodies in unprecedented numbers which will go a long way in educating and encouraging the people to come forward for organ donation


Why are we so lax in prostate cancer awareness ?

Prostate cancer in Indias aging population is sharply increasing. At one point of time, we were seventh in male cancers but today we have become the leading nation in male cancer and so is the case of other malignancies. Like female screening programmes in breast cancer or cervical cancer, there is no well defined strategy for males who are more prone to oral cancer, tuberculosis, etc Morbidity and mortality due to these disparities is on the increase at a glaring pace. Urologists and oncologists are disproportionately in small numbers, access to medical facilities to diagnose and treat are few and far.

USICON in 2007 started prostate disease awareness programme which was piloted in Delhi, yet other than Delhi, no other state adopted it as health programme. Globally, it started in the US in 2003 when Col Powell himself suffered from prostate cancer which resulted in awareness drives and presidential proclamation declaring prostate day and gradually it was emulated by other nations. We were not too far in 2007 but pace got hindered due to lack of understanding of the long term effects of the drive. USICON 2014 is determined to address this and implement strategies to bridge the gap.

How do you visualize the pace and progress of technology and research in Indian healthcare?

We are not far behind the new advances, technologies and skills yet we are adopting rather than innovating and researching. It is ironical that a major chunk of service providers and doctors of fame in countries like US are of Indian origin. We need to address this question and ensure that our talent gains global recognition.

It is our responsibility to ensure that major institutions, professional bodies, academic institutions, research organisations, public sector, social organisations come forward to provide and accelerate research facilities and opportunities in addition to awareness drives. Add to this the political vision and will.

Globally, organ transplantation has made dramatic progress over the last few decades. How do you uate the Indian scenario and your road map by way of USICON 2014 ?

Organ and tissue transplant are steadily improving almost everywhere but we in India are lagging behind. It is not just about the lack of awareness among people but what about facilities, man power, acceptance of cadaver donation procedures, legislation, etc.. There are so many empty spaces.

The number of patients who die due to kidney failure is in lakhs but kidneys available as organ are only in thousands and that too by close relatives who relent after much persuasion.

India needs to emulate Spain, Belgium and Norway where the law presumes it as consent where individuals are automatically considered an organ donor unless they choose to opt out. Spain is a world leader due to its measures and implementation. Their success is attributed mainly to the sensitive way transplant coordinators approach the bereaved families. Spanish Model has been recommended by the WHO.

One body can give or improve life to at least 31 people. In India, one lakh patients enter renal replacement programs annually. The Indian government has brought about a new legislation on organ transplant and has constituted various boards in institutions like AIIMS and RML to promote and encourage organ donation.

Time to bridge the gap
Way back in 1994. President Clinton had signed a bill establishing National Mens Health Week in the United States. 20 years have passed by and we have not moved beyond the pink ribbon ! It is time now to focus on mens health which is not about exclusive male issues but it impacts the society at large. It is more of a family issue that touches the life of wife, mother, sister, etc.!

Liver transplant has picked up in few institutions but why other organs are still in infancy?

During USICON 2014, we intend to create new incentive for public awareness where clinicians and other stake holders will be donating their bodies in unprecedented numbers which will go a long way in educating and encouraging the people to come forward for organ donation.

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