Anaesthesia, Intensive Care and Pain Medicine - St Vincent's ...

Department of Uro l o g y
St.Vincent’s Healthcare Group
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and atmosphere in the clinics. Also, the check-in process occurs
just once – in the specific outpatient clinic the patient is being
seen in. No longer do patients need to go to a separate
central check in area. Both patients and staff have responded
well to this structure. Furthermore, patients with outflow
symptoms are being seen at their initial appointment with
urodynamic assessment and other appropriate investigations
completed by Siobhan Gardner, the Urodynamics Nurse.This
has greatly facilitated therapeutic decision-making and has
significantly reduced the need for return appointments.
Surgically 2003 has seen the development of laparoscopic
nephrectomy on the SVUH campus under the direction of Mr
David Mulvin and in conjunction with Mr Justin Geoghegan.
This provides an interesting option for patients requiring
nephrectomy for certain benign and malignant renal conditions
with faster postoperative recovery and earlier return to work.
A further development has been a significant improvement in
the provision of transrectal ultrasound prostate biopsy via the
Annexe in St Michael's Hospital. This will greatly add to the
availability of TRUS biopsy already provided by our radiological
colleagues on the SVUH campus. TRUS biopsy is likely in the
future to require further increases in the provision of service as
the awareness and demands on the early diagnosis of prostate
cancer escalates.
A significant amount of effort from everyone in the department
was focused in 2003 on the Accreditation process. Not only
has this provided documentation of what was happening
already, but it has galvanized the unit even further. It has also
resulted in improvements in the delivery of patient care and in
improving the patient information available for those patients
undergoing urological procedures.
On a sad note, Sinead Farrell left us as Urology Cancer Nurse
to pursue new challenges. She had developed a significant
expertise in counselling patients with early prostate cancer and
she will be greatly missed for her kind patient-focussed work.
To our delight,she has been replaced by Angela Kissane who
comes to us with a significant clinical oncology background. She
has already proved extremely valuable in counselling Urology
cancer patients with regard to their diagnosis,management
options and prognosis.
Departmental Statistics
During 2003 there were 12,337 patient presentations which
included:
Outpatients: A total of 5,235 outpatients were seen by the
Urology Department. Three Urological outpatients clinics occur
per week on the St Vincent's Campus with over 4,399
outpatient attendances. Of these 1,102 were new patient
attendances.There were 836 outpatient attendances in St
Michael's Hospital seen in the once weekly outpatients clinic of
which 194 were new patient attendances.
Admissions: Total admissions were 3,049 patients. There were
2,244 admissions in the year 2003 on the St Vincent's Campus
with an additional 451 in St Michael's Hospital and 354 waiting
list initiative/5-day patients through the St Michael's Annexe.
Theatre: Surgical procedures totalled 2,704 with 1,803 surgical
procedures performed on the St Vincent's Campus, 495
performed at St Michael's Hospital and a further 406
procedures performed in the St Michael's Annexe.
Consults: 475 inpatient consultations in 2003.
Monthly meetings occur as below:
•Multi-Disciplinary Team Meeting (Monthly, Monday 8:15 AM)
•University College Dublin Urology Conference (Monthly on
Wednesdays 6:30PM between the Mater Misericordiae
Hospital and SVUH)
Ongoing Clinical Trials
•Casodex 150mg for non metastatic prostate
cancer (Zeneca)
•Atrasentan for prostate cancer (Abbott)
Presentations
•Thromboprophylaxis for radical prostatectomy: a
comparative analysis of present practice between the USA,
the UK, and Ireland.Galvin DJ, Mulvin D, Quinlan DM. Irish
Society of Urology, Killarney, 10/10/03.
•Feasibility of open simple prostatectomy with early vascular
control. Connolly, S and Quinlan DM. Irish Society of
Urology, Killarney, 10/10/03.
•Quinlan, DM: Urological Trauma Course. British Association
of Urology Annual Meeting,Manchester, 25/06/03.
Publications
•Oral-activated charcoal in the diagnosis of enterovesical
fistulae. Kavanagh DO, Neary P, Bouchier-Hayes DJ, Mulvin
DW, Quinlan DM. Ir J Med Sci.2003 Jul-Sep;172(3):157,
2003.
Future Plans
The plans for 2004 will focus around continued improvements
in the outpatient arena as we plan to move into the new
development. The focus in Urology has been to constantly
improve the outpatient setting to provide a seamless transition
into the new Ambulatory Day Care Unit. Improvements are
now needed for referring consultants,general practitioners and
patients regarding access and information on waiting times for
both outpatient appointments and inpatient treatments.
Information technology and secretarial infrastructures will need
to be improved to provide a better interface with both
referring doctors and their patients. Office space and
associated infrastructure will be required for both Urological
secretaries and consultants.
For inpatients,St Charles’Ward will require development
regarding patient accommodation and particularly toilets and
showers. In the space available, this will require some
imaginative architectural thinking.
It is now time to consider the application for a fourth
Urological Consultant with an emphasis on reconstructive work
to improve the provision of services for those patients needing
urethral surgery, bladder augmentation,continent urinary
diversion and penile surgery.
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A very proud moment for the Department of Urology was the
start in 2003 of a Urology Nurse Diploma programme at
University College Dublin and St Vincent's University Hospital.
This is the only programme of its type in the country and a
most coveted development by the Department of Urology.
The diploma nurses rotate through clinical attachments on the
Urology Wards,Theatre, Urodynamics,Lithotripsy and
Outpatients. Lectures are provided in the Department of
Nurse Education and supported at consultant level by the
urologists and associated disciplines. Urology continues to enjoy
a tremendous calibre of nursing care at St Vincent's University
Hospital. This will be improved further by the Urology Nurse
Diploma programme. This will provide for postgraduate
education and tuition in the major areas of Urology and
improve the attractiveness of the unit to potential nursing
candidates. It is hoped that this may also lead to the provision
of a small number of urology nurse practitioners and nurse-led
urology pre-assessment clinics.
Urodynamics:There were 874 urodynamic procedures
performed.
Teaching
For the urological trainees there remains a major emphasis
placed on academic conferences,teaching in the operating
room and research endeavours. Each day starts with an
organised teaching session with weekly conferences on:
•Research Conference (Monday 8:15AM)
•Irish Society of Urology Teaching Conference
(Monday 7:00PM)
•Uroradiology Conference (Tuesday 8:15AM),
•Surgical Conference (Wednesday 8:15AM),
•Uropathology Conference (Thursday 8:15AM)
•Audit (Friday 8:15AM)