My Urological journey of Five and a half decades

By Professor P. Venugopal

At the outset, let me register my indebtedness to The Youth Organization of USI (YOU) for the singular honor of asking me to document my journey through the specialty of Urology for the readers of this wing of USI. It has seen many ups along with some lows as life can never be perfect the way we want it to be.

For the purpose of chronicling, I would divide my tryst with Urology into two parts – my passage through Urology and the role I played in the Urological Society of India. There are bound to be overlaps in my narrative as these two are not watertight compartments.

My Urological voyage began in 1966 when I entered the portals of CMC Vellore in April for training in Urology which lead to the MCh (Genitourinary Surgery) degree. I had obtained the MS (Gen Surgery) degree in February of the same year. The MCh programme in Urology had been initiated by the Madras University in 1965 and I belonged to the 2nd batch in this center. Urology then was lot different from what it is today and the surgeries were predominantly open and endoscopic work was just about germinating. However, the work involved cystoscopy, retrograde studies of the upper tract by placement of catheters into the ureters and of course TUR-Prostate which set us apart from General Surgeons. The ability to access the lower urinary tract endoscopically gave us the edge and I would dare say, paved the path for all future developments giving us what we refer to as Endourology today!

The instruments were primitive and the vision through the scopes which used 3 Watts illumination was at best could have been called dim! I would not blame the present generation if it is amused when I make these remarks. It is not at all out of context to document here, that the perseverance of the pioneers who strove relentlessly for refinements has given us what we have today in the world of endoscopes. Today the instruments that we used have been relegated to history with the developments and advances in technology. I have had the ring side view these developments and the good fortune of incorporating them in my work.

The MCh programme of those days was of two years duration and I obtained my MCh in Genitourinary Surgery in April 1968. I continued at CMC Vellore after obtaining MCh, first as Lecturer in Urology and later was promoted as Reader in Urology.

I must admit that my greatest fortune was to be trained in the art and craft of Urology by the Doyen of Indian Urology, Prof. H S Bhat at whose feet I learnt the nuances my chosen line. No words can express my gratitude to my Guru who nurtured me throughout my career as an Urologist. What I have achieved today is entirely because of the blessings he showered on me.

It was still the time when many General Surgeons in position of strength ruled the roost of Urology and never missed an opportunity of voicing skeptical comments, casting doubts as to the prospect of Urology developing as a separate speciality. While some were overtly critical, many were silently obstructive. At this juncture, I must record that in 1956, Roger Barnes, a legendary figure of Urology in USA of his time, spent over a year at CMC Vellore and wrote the volume on ‘Endoscopy’ for ‘Encyclopedia of Urology’ with all pictures hand drawn by Mr Guiri, the medical artist of CMC Vellore. All Urologists of India should know that this volume had been dedicated ‘to the Urologists of India who are struggling to establish urology as a specialty’. Long have those days gone and Urology has become an established specialty with emergence of subspecialties under its wings.

In 1970, I was fortunate to get selected for Commonwealth Fellowship, offered through All India selection. I proceeded to UK to be mentored by Legendary John Swinney at Newcastle upon Tyne. Though I was selected to be trained in Paediatric Urology, I was posted with Prof Swinney, who in turn coordinated my training. After a brief 2 months under him I was posted with John ES Scott, a noted Paediatric Surgeon with special interest in Paediatric Urology, at Fleming Hospital to spend the rest of my time at UK. While at Newcastle, I participated in a Paediatric Urology Conference in April 1971, in which those with interest in this subspecialty participated from not only the UK but also from Europe, USA and Canada. I was fortunate to present our work at CMC Vellore on management of ‘Large Ureters’. Dr Boyd from Winnipeg, Canada who was one of the participants in this meeting met me and during our talk offered me a post to work with him. I received an appointment by August. Around the same time I received a letter from Kasturba Medical College Manipal appointing me as Reader and in charge of Urology. I was in quandary as to what I should do and which post to accept. I wrote to my guru for advice and I promptly received a reply in which he stated that ‘it is better to be a Donkey’s head than a Tiger’s tail’. I returned to India, to take up the assignment at Manipal and the rest is history. My farsighted mentor proved to be a guiding rudder which helped me sail into the harbor of success!

Soon after joining KMC Manipal on 4th Oct 1971, I found that I had entered an empty department. It was surprising that, though there were no cystoscopes, there was a brand new ‘Nesbits Resectoscope’, bought by an error against an order for Rectoscope. No doubt I was thrilled by spotting it for it meant prospects for TURs! With the help of an ‘on the spot repaired’ Philips E2 Diathermy unit, I could perform the first TURP at Manipal on the 10th day of my joining and this not only boosted my confidence but earned me a distinct status. The Urology service began to blossom then onwards albeit a few pinpricks from General Surgery colleagues, which took some time to abate eventually. It is with great sense of pain, I record here that the first procedure I performed in Manipal ended fatally and I was shattered with my ego bruised. Once again, it was my guru who came to my rescue with suitable advice to bring me back from this remorse. This, once gain underscores the value of having a Guru, who guided me not only during my formative years, but throughout my active life as an Urologist.

It was customary in those days for any new entrant to meet the founder of KMC, late Dr. TMA Pai. On meeting him, he enquired what my plans were for my department. I had the bashfulness to tell him that I was interested in making the department as a teaching Department at as early a date as is permissible with my experience. I also informed him on the need for procuring the necessary equipments to develop Urology. He condescended to my requests and helped me procure all the equipments that I desired. Unlike today, it was not easy to obtain equipments in those days as these had to be imported adhering to many prevailing rules dampening the process of procurement. In 1974, we obtained the first complete set of most of Storz equipment that were available at that time and since then the department did not look back and progressed from strength to strength, not only in the number of patients but also in strength of faculty. I must give all credit to Dr. Snehal Patel who joined me and was pivotal in helping me towards commencing the MCh programme at KMC in 1977. In February 1977, the Department got inspected by Prof. BN Colabawalla, a tough task master of Urology in those days and the inspection was spread over two days. He recommended that we could commence MCh programme but only with one candidate and the first candidate was late Dr. Sitharaman.

I had always felt that 2 years training for Urology and other specialty courses were insufficient and I took this up with Mysore University to which KMC was affiliated to then. I began the course with the candidate being registered with the university only after 6 months of joining training. Mysore University granted my wish and introduced MCh Urology as a 3 years course. Fortunately, MCI also took note of this and made it mandatory that all specialty courses should be of 3 years and not two years as it used to be. Over the next few years of commencement of MCh programme, we were permitted to take two candidates annually. I selected one for the July commencement while the other joined in Jan, the coming year so that I had a gap of 6 months between taking up successive candidates which allowed me to build the new entrant on basics and expose the senior to advanced work.

The department continued to progress and we gradually developed most of the subspecialities that were surfacing in Urology and could obtain all the requisite equipments. Towards second half of 1980’s, we had an indoor census of around 250 patients at any time with an average of 40 to 50 patients undergoing various surgical procedures a day spread distributed in four operating rooms. We had an OR specifically for PCNLs and URS. In 1989, we obtained the Siemens ESWL unit and also we moved to a new facility for Urology with 146 beds. In the early 80’s we could obtain the first Ultrasound unit, which was the first in KMC Manipal as the Radiology Department did not have one and they were using our equipment till they obtained one for themselves. The first ‘C’ arm image Intensifier was also obtained by Urology before others. At the same time we also an obtained operating Microscope, much needed for a number of Andrological procedures.

I was fortunate in being able to train 26 candidates directly and many indirectly. The boys I trained were at one time known as ‘Venu’s Boys’ and I am proud of their achievements.

In 1993, I left KMC Manipal taking premature retirement and established new centres at two Hospitals with all the needed equipments including ESWL which was sought after in those days. But my passion for teaching made me take up an assignment at KLE Hospital at Belgavi and could commence MCh programme there in a short span of time. On reaching 60 years of my life, many in the family felt it was time that I am close to my kith and kin. I had to take the decision to join my son Dr. Anand who had joined KMC, Mangalore after his training and qualifying as a Radiologist. All through these changes, my better half, who herself was a noted Pathologist took up various assignments at centres where I parked sacrificing her ambitions. She left for heavenly abode in 2006 and that made me toy with the idea of retirement from active practice in Urology. In 2010, I finally decided to ‘hang up my gloves’. My interest in teaching continued and I commenced a group with yahoo as ‘Venugee’ in 2006. Soon thereafter Chandra Singh of Vellore along with Badrakumar and Anand Kumar commenced a group called Uroeducation’ and I felt it would be nice to dissolve my group and join Uroeducation group with all my members. Uroeducation group prospered to become a hub of education for many Urologists, Old and Young to participate. I had the privilege of contributing in Uroeducation which partially quenched my thirst for teaching. In 2012, KMC Hospital Mangalore commenced DipNB training and I was offered the post of Prof Emeritus, in which I am still continuing. The Uroeducation group with yahoo needed to be stopped but the next generation headed by Anil Takvani and his colleagues commenced a Group called ‘Uroacademy’ and I am active in that continuing to quench my thirst for teaching.

I vividly remember Prof BN Colabawala in his Presidential address in 1974 mentioning that Urology Section should be beware of the ‘young Turks’ in Urology. He was making an oblique reference to some of us who had the gumption of speaking for our qualified yet ‘struggling to stay afloat in Urology’ colleagues as General surgery was still lucrative.

In 1976, I mooted an idea that we should have a journal of our own, however small it may be and thus make it possible for our materials to be published. This was turned down at the 1976 Sectional Meet in Bangalore by the elders who ran Urology section with a rigid hand. Another burning issue was the need to be a Full member of ASI to be eligible for being a member of Urology Section. In 1976, at the ASI meeting in Delhi, after much debate at the General Body, it was decided that our sectional meeting will be called as the annual meeting of Urology Section and the Urology section was renamed as ‘Urological Society of India (USI)’. The first meeting of USI (though it was still and continued to be a section of ASI) was held at Pune organized by Shivdeo Bapat. It was at this meeting that I contested for Governing Council and won along with Ajit Phadke. Prof. A Venugopal was the president of USI and in the post conference Council meeting, the council scrapped the draconian rule which said that all members even with MCh degree had to be full time Urologists and this paved the way for many members pending to become full members to be upgraded. It was decided that anyone who had the necessary qualification, was eligible for full membership. It was also decided that the post of Secretary cum editor be separated to form separate offices. Our laws pertaining to various posts were not clear and in 1978 at Hyderabad conference, on culmination of Bapna’s term, Ajit Phadke took over as Secretary and I took over as the first Treasurer of USI. There was hardly any finance in our coffer as many members had not even paid the annual dues and that was Rs 50/-. The burning ambition to commence a Journal was still strong and at this time I got strong support from Mahendra Bhandari and both of us moved forward towards making it a reality. USI Council declined financial help which was understandable as there were no finances to talk about at that time. There was no financial sponsorship as we have today. In 1980, during the USI conference at Agra, I contested for the post of President elect and won. Mahendra and I joined hands and went begging for finances for the journal to various pharmaceuticals and were successful in obtaining assurances and this made us to go ahead. In 1984, at the USI Conference at Kolkata, the first issue of Indian Journal of Urology was released by the then Hon. Chief Minister of West Bengal, Jyoti Basu and I am proud that it was during my Presidentship.

In 1982, at the Manipal Conference of USI, I took over the reins of USI. In 1980, it was decided that the constitution be reframed to fill in the various lacunae that existed. Under the Chairmanship of BN Colabawala, the constitution was revised and it got the approval of the Charity Commissioner in April 1982. Though there was another reframing of Constitution in 1985, it was not submitted to the Charity commissioner for reasons not clear. The same constitution of 1982 continued as USI constitution till the recently held 2018 Jaipur Conference as USI went on defaulting in submission of its changes to the Charity Commissioner.

There was considerable murmuring going on that a USI member had to pay once to USI and a bigger amount to ASI to maintain membership of USI. The younger generation then which is now the ruling generation, felt that this was unjust and wanted a separation from ASI.

In 1981, I could become the spearhead for commencing Karnataka State Chapter of ASI and took up the assignment of as the founder secretary. Through that Organization, I progressed to become the state president and moved ahead to become the Governing Council member of ASI in 1987. It was during this time that I pleaded with ASI that we should be granted Independence from ASI and go on our merry way to progress. This was turned down repeatedly though by then Orthopedics had separated from ASI. At that time many of the present leaders of USI were younger and were not keen on paying dual membership to maintain membership of USI. The epoch making meeting was at Ahmadabad in 1989 where the decision to cut the umbilical cord with ASI was finally made. There was considerable debate and an Extraordinary General body was called with this one point agenda the next day and amidst considerable turmoil and voting, many of the then younger Urologists supported me and voted in favour of separation. Though this decision was not to the liking of many elders of USI at that time, it had to be accepted and now is part of the history which enabled USI to progress and reach the level it has.

I had the privilege to institute few awards in USI. In 1980, USI implemented the (now late) Prof. CKP Menon award and the first award was received by Dr. Devanathan from KMC Manipal in the Annual Conference of USI at Mumbai in 1981. This has since then remained a coveted award for the younger generation to aspire for. Late Dr. Sitharaman award for the ‘best essay’ was instituted in 1984. This also was meant for the younger generation of Urologists to exhibit their skills at writing. Reliance Industries gave a grant of Rs 2.5 Lakhs in 1984 to enable USI to commence Research Activities but unfortunately, though we received the amount, USI could not commence any research activities. In 1986, at the USICON in Vijayawada, I received the coveted Presidents Gold medal and also delivered the (Late) Himadri Sarkar Oration on my experience in managing Large Ureters.

I am proud that I could serve both Urology and USI and could see its progress from close quarters. We are at the threshold of change with an entirely new generation taking over. Changes are a must and a need of any organization. New blood from time to time will take Urology and USI to greater heights from where it is today.

During my journey spanning over five decades, I have seen the rise of Urology and USI from infancy to where it is today. I am proud that I could play a small role in its development over these years. But the specialty and USI should not rest on existing glory but should continuously strive to progress. Even when we are on the right track, any apathy on our part will halt the progress of the specialty.

Urology is no longer a subspecialty of General Surgery as it was. It has gained the status of being a ‘Broad specialty’ with its own subspecialties emerging. USI should have the wisdom to nurture these subspecialties to grow to their fullest potential. All in Urology and USI should work towards achieving this. We should not repeat what ASI did and forfeited all the subspecialties it had once which included Urology as well. USI should have the vision to permit these subspecialties to nurture under the umbrella of USI. No doubt a time will come when many of these subspecialties would like to spread its wings by forming separate organizations of their own. This should be welcomed by USI and should be a part of nurturing them. We should give enough space for them in our scientific programmes so that hopefully they will continue to be under the umbrella of USI. For this to happen, the Young Turks of today should come forward with a vision of how this could be achieved. Handing over the baton at the right time without holding on is the need of the day. Progress should be like a relay run. A runner runs at his best for a while to hand over the baton to the next and he runs as fast as he can and this should continue forever. This timely exchange will no doubt take Urology and USI to glorious heights.

While I pray for the continued growth and evolution of Urology, I wish USI Godspeed in all its endeavors for furtherance of Urology in India.

Long live Urology and USI.

My Urological journey of Five and a half decades
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