A visit to the Endourology and Stone Service at St. Bartholomew’s Hospital (Barts), London, UK

Abstract

I was pleased to have been accepted to visit the Endourology and Stone Service at Barts by the director of the service, Mr. Noor Buchholz. This 1-month visit from June to July 2011 turned out to be one of my most valued professional experiences. St. Bartholomew’s Hospital is part of the Barts and The London NHS Trust, a tertiary university hospital trust caring for an often underprivileged population of >600,000 people in the east of London. The Endourology and Stone Service has gained a national and international reputation, and was recently accredited by the European Board of Urology (EBU) as a sub-speciality centre of excellence. Its director, Mr. Buchholz, is on the board of the urolithiasis section of the European Association of Urology-EULIS, an organisation which strives to foster research and education within the field of urolithiasis in Europe and beyond. Under his guidance, I found myself in an environment of high medical professionalism, close collegiate co-operation and open intellectual exchange. On the first day, Mr. Buchholz cordially welcomed and introduced me to the whole team of specialist nurses, junior doctors, residents and consultants. The team is truly multi-national and multi-cultural, so that I was immediately made to feel ‘at home’. I was attached to a German doctor, Dr. Christian Bach, who is currently following a 2-year EBU-accredited fellowship programme in the service. He guided and assisted me throughout my time at Barts, in a highly competent and friendly manner. I had the chance to observe all activities and procedures undertaken by the service, such as morning ward rounds led by consultants and senior residents, outpatient clinics, lithotripsy, clinical conferences, interventional radiology lists, day-case procedures and main theatre lists, with state-of-the-art and sometimes highly complex endourological procedures. I took careful notes of all interesting details, which I intend to implement later into my work. Typically, on an operating day, patients arrive at the hospital at 07:00 h, are seen by the surgeons and the anaesthetists, and the first operation starts at 08.30 h. This is an efficient time-saving way of scheduling operations, enabling the team to perform many cases every day. Of particular interest to me was the way my British colleagues performed the operations. I was impressed by the wide range of surgical procedures and the variety of instruments and disposables at the surgeon’s disposal. Although here too, the main asset of the surgeons is their manual skills, experience, and the tactical solutions they are able to apply in each individual case. I had the chance to observe several special endourological procedures, like prone and supine percutaneous nephrolithotomy, retrograde intrarenal surgery with the latest digital flexible ureteroscopes, insertion of metal ureteric stents, end-to-end urethroplasty (‘rail-roading’) and various other surgery and techniques from which I learned much that will help my in my practise. Of special interest for me was permanent ureteric stenting with metallic ureteric stents, in which this centre has a leading role worldwide, and for which Mr. Buchholz is probably the most experienced expert. Of note was that each operating list, performed under the guidance of the consultants Mr. Buchholz, Mr. Junaid Masood and Mr. Islam Junaid, was taken as an opportunity for learning and teaching. Residents and Fellows typically assisted each other, under the close observation of the consultants, who would assist only when and where needed. This culture of education was apparent throughout my time at Barts. Fortuitously, I also had the chance to participate during my time at Barts in one of the post-graduate surgical simulation workshops, as they are conducted regularly and frequently. My visit to Barts gave me not only the chance to observe and learn from very many open and endoscopic procedures, but I was also warmly welcomed into the social life of the department, which furthers team-bonding and friendships between team members, who all are enthusiastic professionals and talented instructors. I have returned home with new surgical skills and insights, and the enthusiasm to perform some of the procedures and tricks I have seen during my visit; and of course made new friends.