Saturday, June 6, 2015

B R A N D of Urethroplasty.

B . R . A . N . D . of Urethroplasty

Benefits of Urethroplasty
Urethroplasty relieves pain and discomfort during voiding, decrease in urine flow rate, frequent urination due to urethral stricture. Urethroplasty can also reduce your risk of getting orchitis, prostatitis or recurrent urinary tract infection. Recurrence of urethral stricture is rare after Urethroplasty.

Risks of Urethroplasty

  • Recurrence of urethral stricture
  • Infection - Wound infection or urinary tract infection
  • Fistula
  • Allergic reaction to anesthesia
Alternatives to Urethroplasty

  • Urethral Dilatation - The goal of urethral dilatation is to stretch the scar tissue of the stricture without producing any additional scarring. This method may be effective in some very small strictures.
  • Urethral Stents - In this technique, a short tube is placed inside the urethra that holds the strictured portion of the urethra open as it heals after surgery, thus preventing the normal scar formation of healing from causing the stricture to recur. The lining of the urethra eventually covers the stent, and it remains in place permanently.
  • Internal Urethrotomy - Internal Urethrotomy, also known as Direct Vision Internal Urethrotomy (DVIU) is a surgical procedure used to treat urethral strictures (narrowing) due to scarring. Internal Urethrotomy can be categorized as Reconstructive Urology procedure where the normal anatomy and function of the urethra is restored by dilatation of the urethra.
Now or Never

  • Besides having to bear the pain and discomfort during urinating, urethral stricture can cause urinary tract infection and sometimes in infection of your testes, stone formation in bladder, retrograde pressure on the kidney to cause kidney failure. Urine may stop completely creating an emergency situation called acute urinary retention. Urethroplasty is a safe procedure used worldwide with good success rate.

Friday, October 7, 2011

“What a Urologist Goes Through on Starting Private Practice”

Being a urologist I am very well aware of the problems he has to face to establish himself
Urology is a very technology intensive branch. If you have to stand out from the crowd and beat the competition you have to put the latest gadgetry. Only this can give you a head start in this fiercely competitive market.

Let’s go step wise how a young urologist goes about -

1. If he has the financial backing – good for him (majority don’t)
2. Then he approaches big – corporate! Hospitals or glorified ‘lale ki dukan’.
    a. Some say get you part equipment. Some say we will give everything
    b. You become a bonded labourer with the level of bonds varying.
    c. These managers rule over docs, or the lala’s dictate terms to fill up beds. How long can you ward off  the pressure of unethical practice to fill up beds. Up goes the no of cystoscopies, URS’s, etc but quality work is compromised.
   d. You enter the rat race. Academics gone with the wind. Urologists of institutes rule over PP urologists & look down upon them as greedy money spinning machines.
   e. You also ‘…do as Romans do.’ Become a roaming urologist. Who does not like the lure of extra money?
   f. Little rift starts with your management/lalas terming it as ‘clash of interest’. They start looking for alternatives. This time they have better bargaining power as they have an already established dept of  urology – thanks to your hard work. Another ‘bakra’ falls prey to their tall promises.
  g. You, maintaining your self-respect gradually increase your roaming and set off to start another dept. of  urology but with a better bargaining power. Initially they will agree to most of your points but gradually the whole cycle repeats.

3. Some having tasted blood initially or later (after having burnt their fingers) – resort to extensive roaming  practice, thus -
   a. You are exposing yourself to unnecessary risks of travelling hazards, with your wife having sleepless nights.You have only 24 hrs, and a majority of it is spent on travelling.
   b. You are at the mercy of the calling docs. Case not fully worked up, patient counseling not done, as a result chances of litigation increase and you are pushed to the forefront, the calling doctor conveniently washing his hands off.
   c. Again you have established that good urology work is being done at X place. Another young urologist approaches him and the owner has a choice at a cheaper rate.

4. Frustrated with all this you start your own OPD somewhere. So starting from scratch again to build your own enterprise. You have got older, god forbid, any health problems, the bank balance built up  for your own house goes into your own setup. And you have lost out on 3-4 yrs of the incubation period that any setup requires.

SO What is the best option? CONFUSED!!! It was same here till I had clarity of thought.

The best option is have your own permanent consulting address, however small. Gradually add OPD procedures, then day care, then indoor. Initially you will have time so can choose the roaming places wisely according to your terms and conditions.

Now all this is also not so easy. You require funds and your own place. This is where you can learn from our life. I had undergone all what I have enumerated.

Then one fine day I floated the idea of group practice. Started talks with 5 young urologists. At the end of 4 months only 3 were left who has equality in majority of spheres. Took a place on rent & started ‘Kidney Centre’. Never had to look back since then, now 5 yrs. We have futher subspecialized in various aspects of urology. Thus we are masters of one or two not jack of all like majority of urologists who practice alone. Infact you can’t afford to restrict yourself to few areas in urology at the beginning of your practice if you are alone.

So now comes the golden offer :-

We have come out with a unique business model wherein the local urologists have been given partial ownership of these centres. We plan to open a chain of ‘Kidney Centres’ across India with the local urologists’ initials prefixing it. This also helps in portrayal of his ownership.

The local urologist can invest up to 30 per cent in the centre. Rest 70 per cent stays with the management. This gives the empanelled doctors a sense of ownership.

Why 30:70? If you start your own 10 bedded hosp your net profit is around 30 % only
You operate in any corporate setup, out of the total package you don’t get more than 30% or even less in some places.

Our USP shall be ‘Specialized Advanced Urology Centres’.

You will have all the advantages of being in a group practice. Further we can extend the offer of joining to fresh urologists who enter the city/town. Then you as a group can outsource various urology depts. in your city/town at your terms. There are endless advantages of group practice. You can also publisize ‘Day Care Specialized Surgery Centre’.

Original thoughts as penned down by
Dr Rajesh Gulia
Senior Consultant Urologist
KIDNEY CENTRE-34, SCO No - 332-334, Sec 34 - A
Chandigarh- 160022. Tele : 0172-3013245, Fax :0172-3912246
Cell :+91-9814466026
E-mail :
Web : ,
Blog :

Tuesday, December 29, 2009

I have started a special website on Stricture Urethra – . Almost all my patients X-rays (RGU’s & MCU’s) both pre-op, post-op, & follow up results have been uploaded. Once it is fully constructed it will be a unique one with the following attributes :

1. Patients will be able to see their own data, X-rays, & follow up Investigations etc after they log in with a unique ID.

2. A person suffering from stricture urethra will be able to identify himself with all such patients who have the same type of stricture as himself & see their surgical outcome(anonymity being maintained).

3. Any patient/doctor can post/upload the RGU & MCU Images and get expert opinion as to the type of management/surgery required.

With Warm regards,

Dr Rajesh Gulia

Senior Consultant Urologist

KIDNEY CENTRE-34, SCO No - 332-334, Sec 34 - A

Chandigarh- 160022. Tele : 0172-3013245, Fax :0172-3912246

Cell :+91-9814466026

E-mail :

Web : ,

Blog :