Articles tagged with: ureteroscopy

19
November
2013

Aerospace Medicine and Urology

Aerospace Medicine and Urology

This week’s Guest Post is by Dr. Gordon Cable, a specialist in Aerospace Medicine, based in Adelaide. He discusses what this specialty involves and its relevance to Urology. He also talks about some of the big names at NASA he has met.


Gordon, can you explain what Aerospace Medicine involves?

Aerospace medicine is a specialty area of medicine that deals with the determination and maintenance of the health, safety and performance of all those who fly in the atmosphere or in space. It is an important specialty because those environments are so hostile to the anatomy, physiology and psychology of humans adapted to an earth-bound existence.


What sort of Urological problems do you encounter, and how do these affect pilots?

Pilots can of course develop any urological problem, just like any other member of the community, but the problem is how those conditions interact with the hostile aviation environment, and most importantly, how they affect a pilot’s performance and safety. Another important consideration is how any treatments for urological conditions might affect pilot performance, whether they be surgical or medications. The aerospace industry is still very heavily gender biased towards males, so mens’ health issues such as testicular cancer in younger males, prostatic hypertrophy and cancer in older males are common problems. Asymptomatic haematuria is a common finding at routine aviation medicals, which must be investigated thoroughly because the biggest showstopper of them all is the potential for renal calculus disease.


Kidney stones are a particular concern. Can you explain how the management of kidney stones in pilots differs from those in the general population?

The primary concern with renal calculi in pilots is the risk of sudden acute incapacitation due to renal colic. The presence of any calculi in the renal tract is bad news for pilots. Generally unrestricted medical certification is not possible, even if there is parenchymal calcification. When stones are present, even if asymptomatic, definitive treatment and proof of stone clearance is required before a pilot will be allowed to fly unrestricted. After an episode of renal colic, the risk of recurrence is also quite concerning, so careful management of stone-forming risk factors is particularly important, as is regular follow-up. Low-dose CT scanning is the preferred method of screening over ultrasound. Dehydration is common in many types of aviation operations, and some pilots are even known to intentionally dehydrate prior to flight so they don’t get caught short in the aircraft! This does not bode well for renal calculus risk.


What are the key areas of research in Aerospace Medicine?

Current hot topics and areas of ongoing work include fatigue management, especially as long haul flying now becomes commonplace with extended range aircraft. Aviation has always been a 24-hour a day industry, and combating the effects of shift work, long hours of “vigilant boredom”, and circadian dysrhythmia across multiple time zones are critical in maintaining pilot performance. The “ageing pilot” is an area of increasing interest with more and more pilots flying into their senior years beyond 60 years of age.

Cardiovascular risk, and determining the subtle effects of altered cognition are important areas of inquiry. Looking beyond earth, commercial space tourism is coming to a Spaceport near you – will you be fit to become an astronaut? This is a big question facing our specialty, and medically risk-managing a large cohort of the general public venturing into the near-vacuum microgravity conditions of suborbital flight is a topic we need to grapple with. Finally, maintaining the health of astronauts for long duration space flight will be essential if we ever intend to land humans on Mars, or travel beyond that on exploration class deep space missions to asteroids and beyond. Here radiation protection and the psychological aspects of isolation are important concerns.


You must have met some interesting people in your work. Who are the standouts?

Gordon Cable with Navy CAPT (Ret) Jim Lovell, Mission Commander of the famous but ill-fated Apollo 13.
Gordon with Navy CAPT (Ret) Jim Lovell, Mission Commander of the famous but ill-fated Apollo 13.

Attending international conferences in the field always affords the opportunity to meet some really interesting people, even some boyhood heros! I think the highlights have to be the NASA astronauts and flight surgeons I have met over the years. Last year I had the privilege to meet Jim Lovell, commander of the Apollo 13 mission, and Dr Charles “Chuck” Berry, NASA flight surgeon for the same mission. Previously I have met CAPT (Dr) Joe Kerwin, former USN Flight Surgeon and first US physician to fly in space as science-pilot aboard Skylab 2. Dr Story Musgrave, who flew on 6 Space Shuttle missions, attended one of our Australian conferences some years ago and in many ways was the most impressive individual I have ever met – physician, scientist, military and civilian pilot, astronaut – not sure how one can achieve so much in one lifetime!



Gordon Cable: Biography

A graduate of the University of Sydney, Gordon is a specialist in aerospace medicine, and a designated aviation medical examiner for CASA and CAD Hong Kong. His professional affiliations include:

  • Fellow of the Australasian College of Aerospace Medicine
  • Clinical Senior Lecturer, Discipline of Public Health, University of Adelaide
  • Past President/Honorary Member of the Australasian Society of Aerospace Medicine
  • Member of the International Academy of Aviation and Space Medicine
  • Fellow of the Aerospace Medical Association
  • Fellow of the Royal Aeronautical Society

Gordon is a Senior Aviation Medical Officer for the ADF, and has been a consultant to the RAAF Institute of Aviation Medicine since 1996. He has worked part time as a medical officer for CASA's aviation medicine section in aeromedical certification and complex case management. He holds a Postgraduate Diploma in Aviation Medicine from the University of Otago (NZ), and a Graduate Diploma of Occupational Health and Safety Management from the University of Adelaide. The author of many scientific publications, his professional interests include:

  • Altitude physiology of hypoxia and hypobaric decompression illness
  • Hypoxia awareness training of military and civilian aircrew
  • Postgraduate education in aerospace medicine for medical professionals

In his civilian clinical practice Gordon takes a particular interest in the management and certification of complex aeromedical cases, and education of aircrew in health, safety and performance issues.


Categories: Other

12
November
2013

Kidney stones - prevention and treatment

Kidney stones - prevention and treatment

Matthew Bultitude is a consultant urological surgeon practising at Guy's and St. Thomas' Hospital in London. He has a subspecialist interest in stone disease, and in this article he answers questions about the common problem of kidney stones.


Matt, how did you become interested in urological stone disease?

I was fortunate to work as a junior doctor in the stone unit at Guy's and St. Thomas' Hospital and following on from that I was offered a research position which I gladly took up. I undertook a number of clinical projects during that period including an MSc thesis assessing the safety of flexible ureteroscopy. I really enjoyed the challenges that stone disease creates and this has carried on throughout my career.


Do you see an increasing rate of stone disease in the UK, and what is the cause of this?

There is no doubt that there has been a steady increase in the number of stone cases in the western world and the UK is no exception. The lifetime risk may now be as high as 12% (American data) and although more common in men, they are becoming increasingly prevalent in women. This is essentially due to a combination of increasing obesity with poor diets (high in animal protein, fizzy drinks, processed foods, salt etc) and low fluid intake.


What have been the major developments in surgery for stone disease in the last few years?

I remember (as a boy with a urological father) when the first public lithotripter arrived in the UK (St. Thomas' Hospital) in the 1980's. This revolutionised stone treatment and continues to be a common treatment. What has changed over the last decade has been the development of smaller (diameter) and more robust instruments allowing us to pass telescopes up the urinary tract to the kidney to treat stones (flexible ureteroscopy). For large stones percutaneous surgery (PCNL) remains the standard and recent developments have seen some interesting changes to how this is done with smaller and smaller instruments and also in new surgical positions with many surgeons now choosing the supine position (so lying on side) rather than prone (lying on front).


Does shock wave therapy have an ongoing role in stone management?

There is no doubt that shock wave lithotripsy has been on the decline but in my opinion it is still a useful treatment for many patients. Choosing the correct stone for this treatment is important and as it works better in a thin patient with a smaller stone, rather than trying it in everyone. However I increasingly find patients prefer the more definitive choice of surgery with ureteroscopy to fragment the stone with a laser as although it is more invasive, the outcomes are more predictable.


Calcium oxalate stones are the most common kind of kidney stones. What is your advice to someone who has had a stone like this, to prevent future stone formation?

I often give quite detailed advice about stone prevention, although the summary of this is a normal healthy diet with lots of fluid (which is what we should all be doing!). In principal we should aim for a diet with:

- Enough fluid to produce at least 2 litres of urine per day. The actual amount will be different for everyone but usually a minimum of 2.5 litres in per day is required. This is the most important advice.

- Limited animal protein (meat and fish)

- Low salt

- Plenty of fruit and vegetables

- High fibre

- A normal calcium intake - so cutting back is often the wrong thing to do.

For calcium oxalate stone formers there are some foods high in oxalate and limiting intake of these may also help.


What developments do you see on the horizon for kidney stone treatment?

I think surgery will continue to improve with better quality and smaller instruments becoming available. Shockwave lithotripsy will probably continue to decline (as discussed above). What would be a game changer is the development of effective medication that could reduce the chance of stones growing in urine although I suspect we are many years away from this!


You can read more about Matt Bultitude by following these links to the Guy's and St. Thomas' Hospital website and the London Bridge Hospital website.

Click here for a link to his personal website.

You can also follow Matt Bultitude on twitter


Categories: Kidney Stones

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