Singh Urology

Secretary: Natalie Roome: 01332 783423
Derby Private Health: 01332 785200
Nuffield Health, Derby Hospital: 0300 790 6192


  • Anaesthetist v Surgeon – Positive or Negative?

    Today I am going to take a semi-serious look at the, sometimes fractious, relationship between anaesthetists and surgeons, one of the key professional partnerships in medicine. As a surgeon myself, specialising in Urological cancers, I have to say that some of my best friends are anaesthetists and their contribution to successful patient outcomes is vital.

    Nonetheless, much is made of the supposed rivalry between these two specialisms. It is perhaps heightened by the fact that they are the key players in a surgical team and neither can work without the other. Both are used to working under pressure in often stressful situations, very likely to be Type A personalities and be obsessive about detail. Conflict at some level is to be expected.

    Recently research into conflict situations between surgeons and anaesthetists was carried out by the Department of Anaesthesia at Vall d’Hebron Hospital in Barcelona. The objective was to identify the main situations that lead to conflict and their causes.  After surveying all anaesthetist departments in Catalonia the key findings were:

    • 60.7% of anaesthetists had had arguments with surgeons
    • 33.3% averaged an argument a month
    • 21.4% averaged one a week

    The most frequent cause was exceedingly long surgical programmes. 95.8% of anaesthetists considered that surgeons try to operate elective cases in the Emergency operating theatre on the day when they are on call. The third most common cause of arguments was due to constant complaints by surgeons that the patient was not relaxed enough. The fourth was whether or not to go ahead and operate. Across the board conflict was found to be most common in emergency situations.

    Given the source of the research the emphasis is understandable but does illustrate how vital it is to maintain great team work in the operating theatre, to let opinion be heard but not to let ego’s impact patient care.

    Common medical stereotypes would picture the anaesthetist as the brains of the operating theatre with the surgeon as the brawn – hence the suggestion that Orthopaedic surgeons are “as strong as an ox and almost twice as clever”. The British Medical Journal did some research into this view in 2011, comparing the intelligence test scores and grip strength of 36 orthopaedic surgeons and 40 anaesthetists, both male, at three UK district hospitals. The results showed that both mean grip strength and intelligence test scores for the surgeons were higher than the anaesthetists who should now find new ways to make fun of their friends,

    It is often said that if you want to find a good surgeon ask an anaesthetist. My feeling is that professional rivalry, points of view clearly expressed and sharing a common objective are what make for high performing surgical teams and that is what we all want – surgeon anaesthetist and patient.

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  • Robotic Surgery – Managing the costs of Modern Healthcare solutions

    In August 2014 the Royal Derby hospital, where I have a practice, installed a Da Vinci Robotic surgery system. It’s considerable acquisition and running costs were funded by a generous private benefactor. There is no doubt that this is a marvel of modern medical technology. It allows a surgeon to carry out minimally invasive procedures with major benefits to the patient of significantly less pain, a shorter hospital stay and faster rehabilitation.

    From the surgeon’s point of view it offers greater surgical precision, increased range of motion, improved dexterity and improved access when compared with traditional Laparoscopic (Keyhole) surgery. I have carried out procedures using this system myself and the results are impressive.

    There is though a conflict that this kind of progress presents to our healthcare system. There is no doubt that this equipment can make a surgeon’s job more effective with the promise of better outcomes for patients. It is also much more ergonomic than traditional open or laparoscopic surgery thus resulting in less fatigue for the operating surgeon. When the capital cost of “the robot” along with its maintenance contract and the cost of disposable items required is factored in it is much more expensive than traditional surgery

    More expensive technology means more expensive procedures for which money has to come from budgets already under intense pressure. It is difficult to envisage us retreating from this progress but equally we have to accept that the funding for the NHS is finite. This is a very good example of how, in my view, the cost of treatment is increasing at a rate far greater than the current model for the NHS can sustain.

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  • Vasectomy & Prostate Cancer

    For many years the association between Vasectomy and an increased risk of Prostate Cancer in otherwise healthy men has waxed and waned in medical opinion.

    A study recently published in the Journal of Clinical Oncology (Vasectomy and the Risk of Aggressive Prostate Cancer. A 24-Year Follow-Up Study July 2014 by Siddiqui MM, Wilson KM, Epstein MM et al) seems to provide the strongest evidence yet that such a link exists. Lethal, Advanced and High Grade prostate cancers were 20% higher in men with vasectomy versus those without. Interestingly the association with low-grade tumours was not significant. Although a link with immunity has been implicated the factors causing the increased risk have not been identified.

    Having said this the decision on whether or not to have a Vasectomy should not be unduly influenced by these findings as the absolute risk of lethal prostate cancer identified in this study is relatively small at just 1.6%.

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  • The Deadly Effect of Delay

    Delay in seeking medical attention is generally agreed to be a major factor in success or failure in the discovery and treatment of cancers in both men and women. In my experience it is more often men who will put off seeing their GP and getting a timely referral but I understand that, statistically, there is little difference in the part that gender plays in health related procrastination.

    A very thorough study of the reason for and effects of delay was published in the International Journal of Public Health in May 2010 and can be found here. In brief the study suggests that fear, unsurprisingly, plays a major role in delaying access to medical help in both acute and slow progressive diagnoses. Mitigating the effect of fear by communicating the benefits of early diagnosis, in addition to the more usual awareness of symptoms, is key to improving the rate of success in reducing mortality from cancers in particular.

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  • New Website

    Welcome to the new Singh Urology website! I’ve included lots of information about the conditions that I can treat, as well as the various treatments that are available – see the ‘Patient Information‘ section for details.

    There’s also an extensive Glossary of urological terms, if you’d like to get a better understanding of any terminology used on the website, as well as information for GPs.

    Please do get in touch if there’s anything I can do to help you.

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