Later this month, the EAU comes to London for the 32nd Annual Congress and to mark the occasion Prof. Chris Chapple, EAU Secretary General, has written the issue’s lead editorial looking forward to the event.
The cover image reflects EAU17’s logo with a view along the river Thames of Tower Bridge, with the Shard in the background.
©istock.com/fotoVoyager
Click here for this issue’s Table of Contents
It is a great pleasure to write this editorial looking forward to the EAU hosting its 2017 meeting in London.
The EAU17 meeting promises to be outstanding, with a record-breaking number of abstracts for poster and video presentations submitted for the upcoming 32nd Annual EAU Congress (EAU17) in London. There were approximately 5000 abstracts submitted from 81 countries across the globe, the majority being from Europe and Asia. The overall acceptance rate of the submitted abstracts for both poster and video sessions was 25.37%; 1171 were selected from the 4625 abstracts submitted for the poster sessions and 89 video presentations were accepted from the 342 submitted for the 11 video sessions. This year the main Plenary Sessions were expanded from four to seven, providing not only theoretical perspectives but also focusing on best clinical practice. This is epitomised by the opening plenary session ‘Sleepless nights: Would you do the same again?’, which critically re-evaluates management decisions for kidney cancer cases from a medico-legal perspective. Undoubtedly, this session will trigger discussion on our practice and alert the audience to the implications of such clinical decisions, emphasising that ‘there is no such thing as brave surgeons just brave patients’.
There will be a strong focus on dynamic interaction, as evidenced by thematic Session 2, with a debate on robotic salvage prostatectomy between Declan Murphy and Axel Heidenreich. Another ‘not-to-miss’ event will include Plenary Session 5, with three debates alternating with three state-of-the-art lectures on the latest evidence-based developments in prostate cancer management. A highlight debate on prostate cancer screening will feature Jonas Hugosson and Gerald Andriole taking opposing views on the risks and benefits of prostate cancer screening. During this ‘head-to-head’ debate, both participants and the audience will re-visit this controversial subject, which has engendered opposing perspectives in Europe and North America.
Latest research will be highlighted, for example, two of the many lectures that will provide up-dates on the latest developments in urological research include: the PROstate MRI Imaging Study (PROMIS) trial results reviewed by Hashim Ahmed and the Prostate Testing for Cancer and Treatment (ProtecT) trial reviewed by Freddie Hamdy (both in Plenary Session 5). Visit https://eau17.uroweb.org/ regularly to stay informed about late breaking news sessions and remember that members of the EAU can reflect further on the meeting by watching all of the plenary sessions online at a later date.
It is clear that European urologists are very active in the fields of clinical and academic research, as evidenced by this edition of BJUI. Nielson et al. [1], review the data from 808 patients in a European registry study of renal cryoablation and comment on the oncological outcomes and complications after laparoscopy-assisted cryoablation. They conclude that the intermediate outcomes are satisfactory, in that 16 patients (3.1%) were diagnosed with residual unablated tumour after a median [interquartile range (IQR)] follow-up of 9.8 (6.0–12.8) months and local progression was diagnosed in 16 patients (3.1%) after a median (IQR) follow-up of 25.3 (18.7–55.8) months. However, they advise that it is important that patients are counselled about potential complications, as these included 47 Clavien–Dindo grade I, 61 grade II, 10 grade IIIa, nine grade IIIb, three grade IVa, one grade IVb, and three grade V complications. There were severe complications (grade ≥IIIa) in 26 patients (3.2%).
Ferro et al. [2] have prospectively evaluated 29 consecutive patients, followed-up for 36 months, after treatment with the Virtue® male sling (Coloplast, Humlebaek, Denmark) for post-radical prostatectomy (RP) stress urinary incontinence (SUI). At 36 months of follow-up, 58.6% used no pads/day. Patient satisfaction remained stable over time, with 25/29 patients reporting a Patient Global Impression of Improvement (PGI-I) score of 1 at 12 and 36 months. I concur with the authors that, whilst this series suggest that the Virtue® sling appears to be an effective treatment option for low-to-moderate post-RP SUI, as evidenced by both subjective (patient satisfaction) and objective measures, larger trials are needed to better evaluate the potential of this sling in real-life clinical practice and to compare it with similar devices, using a randomised comparative design. Furthermore, the introduction of prospective databases for all such implants into routine clinical practice is currently being considered and is long overdue.
Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, The Royal Hallamshire Hospital, Sheffield, UK
Ever since 2002, I have performed live surgery almost every year where it is transmitted to an audience eager to learn. This year I was invited by Markus Hohenfellner to the unique conference, Semi Live 2017 in Heidelberg. To say that it was an eye opener is perhaps stating the obvious. One look at the program will show you that the worlds most respected Urological surgeons had been invited to participate, but with a difference. There was no live surgery. Instead videos of operations – open, laparoscopic and robotic were shared with the attendees “warts and all” as a learning experience. These were not videos designed to show the best parts of an operation. There were plenty of difficult moments, do’s and don’ts and troubleshooting, but all this was achieved without causing harm or potential harm to a single patient.
My highlights were laparoscopic sacrocolpopexy (Gaston), robotic IVC thrombectomy up to the right atrium (Zhang) and reconstructive surgery for the buried penis (Santucci). The event takes place every 2 years and the videos are all available on the meeting app which can be downloaded here and is an outstanding educational resource.
We were treated to a heritage session which included the superstars Walsh, Hautmann, Clayman, Mundy, Schroder and Ghoneim. This was followed by our host Markus Hohenfellner comparing and contrasting the art of Cystectomy and reconstruction by Ghoneim, Stenzl and Studer.
Open surgery is certainly not dead yet. The session ended with Seven Pillars of Wisdom from Egypt which turned out to be a big hit on Twitter.
The editor’s choice session, a new innovation for 2017, allowed me to showcase the Best of BJUI Step by Step, a section that has now replaced Surgery Illustrated with fully indexed and citable HD videos and short papers.
Many on Twitter seemed to agree that in 20 years time we might look back and say that it was not the right thing to do.
Surgeons do not operate “live” every day. Most doctors in a survey, would not subject themselves or their families to be patients during live surgery. Talk about hypocrisy!! Why should it be any different for our patients? Live surgery is NOT a blood sport practised in Roman times….
The counterpoint is that patients often have the services of the best surgeons during live surgery, recorded, edited videos are not quite the same and that the whole affair has become safer thanks to patient advocates and strict guidelines from some organisations like the EAU. Others have banned the practice for good reason. While the debate continues, I for one came away feeling that Semi-Live was as educational, less stressful and much safer for our patients.
This year’s Annual RSM Urology Section Winter Meeting, hosted by Roger Kirby and Matt Bultitude, was held in Lake Tahoe, California.
A pre-conference trip to sunny Los Angeles provided a warm-up to the meeting for a group of delegates who flew out early to visit Professor Indy Gill at the Keck School of Medicine. We were treated to a diverse range of live open, endourological and robotic surgery; highlights included a salvage RARP with extended lymph node dissection and a robotic simple prostatectomy which was presented as an alternative option for units with a robot but no/limited HoLEP expertise.
On arrival to Northstar, Dr Stacy Loeb (NYU) officially opened the meeting by reviewing the social media urology highlights from 2016. Next up was Professor Joseph Smith (Nashville) who gave us a fascinating insight into the last 100 years of urology as seen through the Journal of Urology. Much like today, prostate cancer and BPH were areas of significant interest although, in contrast, early papers focused heavily on venereal disease, TB and the development of cystoscopy. Perhaps most interesting was a slightly hair-raising description of the management of IVC bleeding from 1927; the operating surgeon was advised to clamp as much tissue as possible, close and then return to theatre a week later in the hopes the bleeding had ceased!
With the promise of beautifully groomed pistes and stunning views of Lake Tahoe, it was hardly surprising that the meeting was attended by a record number of trainees. One of the highlights of the trainee session was the hilarious balloon debate which saw participants trying to convince the audience of how best to manage BPH in the newly inaugurated President Trump. Although strong arguments were put forward for finasteride, sildenafil, Urolift, PVP and HoLEP, TURP ultimately won the debate. A disclaimer: this was a fictional scenario and, to the best of my knowledge, Donald Trump does not have BPH.
The meeting also provided updates on prostate, renal and bladder cancer. A standout highlight was Professor Nick James’ presentation on STAMPEDE which summarized the trial’s key results and gave us a taste of the upcoming data we can expect to see in the next few years.
We were fortunate to be joined by prominent American faculty including Dr Trinity Bivalacqua (Johns Hopkins) and Dr Matt Cooperberg (UCSF) who provided state-of-the-art lectures on potential therapeutic targets and biomarkers in bladder and prostate cancer which promise to usher in a new era of personalized therapy.
A personal highlight was Tuesday’s session on learning from complications. It was great to hear some very senior and experienced surgeons speaking candidly about their worst complications. As a trainee, it served as a reminder that complications are inevitable in surgery and that it is not their absence which distinguishes a good surgeon but rather the ability to manage them well.
There was also plenty for those interested in benign disease, including topical discussions on how to best provide care to an increasingly ageing population with multiple co-morbidities. This was followed by some lively point-counterpoint sessions on robot-assisted versus open renal transplantation (Ravi Barod and Tim O’Brien), Urolift vs TURP (Tom McNicholas and Matt Bultitude) and HOLEP vs prostate artery embolization for BPH (Ben Challacombe and Rick Popert). Professor Culley Carson (University of North Carolina) concluded the session with a state-of-the art lecture on testosterone replacement.
In addition to the excellent academic programme, delegates enjoyed fantastic skiing with perfect weather and unparalleled views of the Sierra Nevada Mountains. For the more adventurous skiiers, there was also a trip to Squaw Valley, the home of the 1960 Winter Olympics. Another highlight was a Western-themed dinner on the shores of Lake Tahoe which culminated in almost all delegates trying their hand at line dancing to varying degrees of success! I have no doubt that next year’s meeting in Corvara, Italy will be equally successful and would especially encourage trainees to attend what promises to be another excellent week of skiing and urological education.
Miss Niyati Lobo
ST3 Urology Trainee, Brighton and Sussex University Hospitals NHS Trust
@niyatilobo
Major foci for clinically oriented specialty journals are systematic reviews and meta-analyses. Systematic reviews have a preeminent role in guiding the practice of evidence medicine by addressing focused clinical questions in a systematic, transparent and reproducible manner. Defining criteria of a high-quality systematic review include: an a priori registered protocol, a comprehensive search of multiple sources including unpublished studies (to avoid publication bias), an assessment of the quality of evidence that goes beyond study design alone, and a thoughtful interpretation of the findings. Systematic reviews inform clinicians and patients at the point of care, form the foundation of evidence-based clinical practice guidelines, and help shape health policy [3]. They also find frequent citation and can raise a journal’s impact factor. There is therefore more than one good reason for journals to care about the quality of systematic reviews.
Meanwhile, a study in this issue of the BJUI [4] shows that the methodological quality of systematic reviews published in the urological literature is modest, varies substantially, and has failed to improve over time. This contrasts to randomised controlled trials’ reporting quality that appears to have improved substantially over time, probably due to increased awareness among clinical researchers, urology readers and journal reviewers [4, 5]. The study [4] used the Assessment of Multiple Systematic Reviews (AMSTAR), a validated 11-item instrument, to measure the methodological quality of systematic reviews with higher scores reflecting better quality.
The authors [4] surveyed four major urological journals and compared the periods 2013–2015 to 2009–2012 and 1998–2008. Despite a dramatic increase in the number of systematic reviews published each year, methodological quality has stagnated with mean AMSTAR scores ± standard deviations of 4.8 ± 2.4 (2013–2015; n = 125), 5.4 ± 2.3 (2009–2012; n = 113) and 4.8 ± 2.0 (1998–2008; n = 57). The average systematic review therefore has deficits in over half the 11 AMSTAR criteria and is of only modest quality thereby undermining our confidence in their results. Although the mean AMSTAR score of 5.6 ± 2.9 for 25 systematic reviews published in the BJUI in 2013–2015 compared favourably to similar studies in other leading urology journals, the difference was not statistically significant.
What are we going to do about it? Inspired by these findings, the BJUI is launching a new initiative to raise awareness for the issue of methodological quality of systematic reviews among its readership and raise the bars for its contributors. Future systematic review authors will be asked to submit an AMSTAR-based checklist to provide enhanced transparency about its methods that will be reviewed as part of the editorial review process. These include documentation of an a priori written protocol and ideally, registration of the systematic review through the Cochrane Collaboration or the Prospective Register of Systematic Reviews (PROSPERO). Such a protocol should outline all important steps of the review process including the definition of outcomes, study inclusion and exclusion criteria, details about the literature search, study selection and data abstraction process, analytical approach including planned sensitivity and subgroup analyses. Authors should also rate the quality of evidence looking beyond study limitation alone by using an approach such as the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), which recognises such additional domains such as imprecision, inconsistency, indirectness and publication bias [6]. Critical steps of the systematic review process should be completed in duplicate to guard against random and systematic error and authors should provide readers with the information about who funded the studies included in the review, as well as their own potential conflicts of interests. To guard against publication bias, systematic review authors should also search for ongoing trials and unpublished studies through registries and abstract proceedings.
It is understood that the methodological handiwork that goes into the planning, execution and reporting of a systematic review do not assure clinical relevance or newsworthiness, nor does it address any issues surrounding the limited quality of studies that the review may be summarising. However, it is nevertheless a sine quae no to assure readers that they can be confident of the results. The new BJUI initiative will raise awareness for the issue of systematic review quality by providing a summary AMSTAR score to accompany each article. We hope that with this initiative we will provide a beacon for other specialty journals to follow, with the goal of raising the bar for all published systematic reviews and ultimately leading to improved patient care.
Department of Urology, Minneapolis Veterans Administration Health Care System and University of Minnesota , Minneapolis, MN, USA
References
The other day, as the New York Times was getting excited about Nobel Laureate Bob Dylan new album ‘Triplicate’, I had the opportunity of remembering one of his classic songs. Let me explain. I turned up at the School of Surgery in central London for an academic committee meeting early that morning only to find that it had been cancelled. Due to a IT problem the email with this information never reached me! Rather than brave the London tube again, I decided to walk back to my hospital, which took me past my old hospital which sadly no longer exists.
The old hospital in question was The Middlesex Hospital in Mortimer Street, London (Fig.1). The original institution was built in 1745 at Windmill Street and moved in 1757 to Mortimer Street. I arrived there over 20 years ago to train at the Institute of Urology/St. Peter’s Hospital, a highly desirable post amongst surgical residents.
The Middlesex Hospital was closed in 2005 and sold to developers. It now houses swanky apartments and businesses around a beautiful Pearson Square, named after John Loughborough Pearson, who designed the Fitzrovia Chapel (Fig. 2) in 1890 inside the hospital. The Chapel survived the redevelopment as it is a protected building. So did one of the walls of the old hospital along Nassau Street which housed the radiotherapy building (Fig. 3). That facade has been preserved beautifully although there are no patients housed behind it anymore (Fig. 4).
So why I am telling you all this? Nostalgia you may say. But in fact much more. The 3 mile walk that morning allowed me to reflect on my own contribution to science and that of two friends who although slightly ahead of me in the training program at The Middlesex Hospital are gentlemen that I greatly admire.
One is Mark Emberton, now Professor at UCL, who has, through the PROMIS study, established the use of MRI prior to prostate biopsies rather than random TRUS biopsies for patients with a raised PSA. The other is David Ralph, an acclaimed Andrologist, who has just published our Priapism Guidelines, a must read for everyone managing this emergency. There is no doubt that both have made significant contributions to British Urology and patient care in the last 20 years during which so many things have changed.
As for me, I headed to Queen Square from The Middlesex Hospital, where many years of basic research in a Medical Research Council (MRC) funded lab led to the description of the so called “Dasgupta technique” of injecting Botox into overactive bladders. I was pleasantly surprised to hear that it had made its way into a number of texts including Smith’s Textbook of Endourology.
There are however certain things that do not change much. Next to the Middlesex Hospital, on Cleveland Street was the legendary Ragam’s (Fig. 5), which many would regard as THE go to South Indian restaurant. The masala dosa (pancake with spicy potatoes and hot lentil soup) used to cost £3.95 in 1994; 20 years later the price has gone up by only £2 to £5.95 (Fig. 6), while the quality remains as outstanding as ever.
Neurogenic urinary tract, sexual and bowel dysfunction is highly prevalent and affects the lives of millions of people worldwide. It has a major impact on quality of life and, besides the debilitating manifestations for patients, it also imposes a substantial economic burden on every healthcare system.
It was a great honour and pleasure to organize the 5th International Neuro-Urology Meeting (INUM), which took place from 25-28 January 2017, in Zürich, Switzerland. We are proud to announce that the International Neuro-Urology Meeting, organized under the umbrella of the Swiss Continence Foundation (www.swisscontinencefoundation.ch), has become the official annual congress of the International Neuro-Urology Society (INUS, www.neuro-uro.org), a charitable, non-profit organization aiming to promote all areas of Neuro-Urology at a global level and whose inauguration was inspired during the last INUMs.
The world’s leading experts in Neuro-Urology provided an overview on the latest advances in research and clinical practice of this rapidly developing and exciting discipline. This unique meeting combined state-of-the-art lectures, lively panel discussions, and hands-on workshops with emphasis placed on interactive components. There were many opportunities to exchange thoughts, experiences and ideas and also to make new friendship.
The Swiss Continence Foundation Award: To promote the next generation of outstanding young researchers and clinicians who represent the future of Neuro-Urology, the prestigious Swiss Continence Foundation Award of 10’000 Swiss francs was awarded to the best contribution from a young Neuro-Urology talent: Marc Schneider from Zürich, Switzerland, convinced the international jury with the presentation of his PhD project “Anti-Nogo-A antibodies as a potential causal treatment for neurogenic lower urinary tract dysfunction after spinal cord injury”. He demonstrated in an animal model that intrathecally applied antibodies against the central nervous system protein Nogo-A which inhibits nerve fibre growth had beneficial effects on lower urinary tract dysfunction in rats with incomplete spinal cord injury by re-establishing a physiological micturition and preventing detrusor sphincter dyssynergia. This effect presumably occurs due to neuronal re-wiring of descending micturition circuits facilitated by the anti-Nogo-A antibodies. Anti-Nogo-A immunotherapy enters currently clinical trials in humans and could become a unique causal treatment option for lower urinary tract dysfunction in patients with incomplete spinal cord injury.
One of many other highlights was the joint presentation of the EAU Secretary General Christopher R. Chapple and the BJUI Editor-in-Chief Prokar Dasgupta on the challenging topic “What should the neuro-urologist learn from the onco-urologist and vice-versa?”
Finally, we are delighted to announce the 6th International Neuro-Urology Meeting to be held in Zürich, 25 to 28 January 2018. Save the date! For details please visit: www.swisscontinencefoundation.ch. We are looking forward to seeing you in Zürich!
Thomas M. Kessler, SCF Chairman and INUS Vice-President
Ulrich Mehnert, SCF Vice-Chairman and INUS Treasurer
February’s Article of the Month, assessing the accuracy of 68Ga-PSMA PET/CT for lymph node staging in intermediate- and high-risk prostate cancer, comes from institutions in Sydney and Darlinghurst, Australia. The cover image shows the iconic Sydney Opera House, one of World’s most recognisable buildings, and Sydney Harbour Bridge
©istock.com/RugliG
Click here for this issue’s Table of Contents
Highlights from the Laparoscopy & Robotics subspecialty meeting at the 50th annual conference of the Urological Society of India (Mumbai, India)
It was like Australia and E
ngland playing a friendly cricket match in the middle of the Ashes tour…or perhaps Liverpool and Manchester United fans celebrating together in the spirit of bonhomie…
In an ably conducted sub specialty meeting during the golden jubilee annual conference of the Urological Society of India, Dr. Mallikarjuna Chiruvella from Hyderabad, the hub of the Indian software revolution, brought together traditional rivals, Laparoscopy and Robotics – not for comparisons and conflicts – but to find common ground in terms of improving outcomes and handling complications.
Undoubtedly, there is a lot in common when it comes to these two modalities. Indeed one is the progeny of the other. The anatomy, approach, indications, complications, and indeed, the ways of dealing with them have more similarities than differences. Experts from both sides of the fence highlighted these similarities and delved into the finer technical points of these modalities across the wide spectrum of urological ailments – urolithiasis, reconstructive urology and urologic oncology. An important component was the special emphasis on laparoscopic training and suturing techniques.
Our very own Editor In Chief, Prof. Prokar Dasgupta, was the show stopper with an exciting talk on the future of robotic surgery in which he explored advancements related to imaging integration, in vivo microscopy, automation, virtual reality and haptic feedback in the next gen robotic systems of the future.
Video clip of Prof Dasgupta’s slides (no audio).
Sub specialty convener, Dr Mallikarjuna and co conveners, Dr Arvind Ganpule from Nadiad, Gujarat and Dr. Gagan Gautam from New Delhi managed to raise some goosebumps in the 500+ attendees by presenting 3 ‘nightmares’ video sessions which took a keen look at intraoperative disasters and ways and means of preventing and managing them.
While the debates on laparoscopy versus robotics continue, the content and conduct of the meeting ensured that everyone could take away something practical and implementable from this session. Here’s to the new found common ground!
Gagan Gautam Head – Urologic Oncology & Robotic Surgery, Max Institute of Cancer Care, New Delhi, India. Twitter: @DrGaganGautam
Dr. Mallikarjuna Chiruvella Managing director, Asian Institute of Nephrology and Urology, Erramanzil colony, Hyderabad, India
Kabiguru Rabindranath Tagore is perpetually present in the Bengali memory and is a part and parcel of the Indian cultural fabric even after 75 years of his demise. The Bard of Bengal has retained his greatness through his songs, poetry, stories, progressive world view and love for his country.
The first Nobel Prize winner of Asia (1913), Tagore was knighted in 1915 and had the courage to return it as a mark of protest after the Jalianawala Bagh massacre in 1919. He is compared to the likes of William Shakespeare and Johann Wolfgang Goethe for his extraordinarily rich literature and sensitive understanding of human nature.
Rabindranath has been a hero, an idol and a father figure for the Bengali. That is why when it comes to his death there is a self-imposed oblivion among his followers because there is an aversion to accept that he too was human, he too had suffered in his last days.
The way the city cried and the huge congregation of people that came to pay him their last respects go on to show the place Tagore had in the heart of the Kolkatan. But very few people actually know that Kabiguru Rabindranath Tagore did not allow his deteriorating health to affect his spirit.
Seventy-five years after his death this is the first time Tagore’s illness has been revealed and his last days talked about. At an exhibition organised at Tagore’s home ‘Jorsanko Thakur Bari’ on his death anniversary on August 7, 2016 with the official approval of the Rabindra Bharati University Museum, the verandah of his home came alive with photographs and exposition of his last days when Tagore smiled through extreme pain and was surrounded by family and friends. The exhibition showed that despite his failing health he remained positive and at his creative best, and how doctors did their best to make him feel better. Rabindra Bharati University, that is housed in the premises of Tagore’s home, and Kolkata Prostate Cancer Foundation led by the author of this blog, organized this exhibition. It is evident that Tagore died from the complications of an enlarged prostate gland.
Tagore was a handsome man blessed with a good physique and an impressive personality. For the sake of building his body, he even learnt how to wrestle and lived a disciplined life. He learnt horse riding and had commendable stamina, which enabled him to swim across the Padma River. Despite this his health deteriorated at the age of 76 and unfortunately on 10th September, 1937 he lost consciousness and remained that way for two days. Kidney and prostate problems were diagnosed simultaneously. His health demanded immediate attention, which was duly given to him in Shantiniketan by a team of doctors headed by Dr Nilratan Sarkar from Kolkata.
He was also suffering from ailments like fever, headache, chest pains and a lack of appetite. Tagore strongly believed that his life had a meaning beyond these mortal diseases. That’s why the moment he could sit upright on his bed he took to his ink and paper. His love for nature was not only restricted to the stories he wrote, indeed he profoundly believed that he would feel much better if he spent his time in the lap of nature. That is why he kept visiting the hills of North-Eastern India.
He also ensured that his creativity did not suffer. Even in such trying times he wrote ‘Sejuti’, ‘Naba Jatak’ and ‘Shyama’. He also composed numerous songs and painted to his heart’s content. Tagore cared deeply for his country and despite his ill health he continued to have political discussions with Jawaharlal Nehru and Subhash Chandra Bose. He played host to Mahatma Gandhi and his wife Kasturba when they visited Shantiniketan. It seemed that his deteriorating health was the least of his worries.
On 15th September, 1940 when Tagore was in Kalimpong, due to a pain in his urinary bladder he lost consciousness again. He was unable to pass urine either. Despite the evident symptoms of uraemia, his grand-daughter, Pratima Debi wasn’t ready to accept that Tagore needed an operation. On 29th September, he was brought back to his Jorasanko House on the advice of Dr Prasanto Chandra Mohalanobis.
With the help of Dr Satyasabha Mitra, Dr Amiya Basu and Dr Mahalanobis he was moved to the marble room on the first floor where he spent most of his time. In the presence of his near and dear ones along with dutiful attendants and under the supervision of Sir Nilratan Sarkar and Dr Bidhan Chandra Roy he seemed to be on the path of recovery.
A considerable amount of attention was given to his diet, medicines and cleanliness in order to ensure complete recovery. The poet continued to have his biochemic medicines, which he felt would also give him relief. Dr Dakhshinaranjan Roy visited him regularly and advised him.
On his return to Shantiniketan it seemed, Tagore had come to terms with his failing health and was determined to win this battle without dampening his spirits. He narrated a sea of stories every now and then and his imagination took on the colour of his palette. What emerged were timeless paintings. Around this time he also welcomed the Chinese missionary Tai-Chi-Tao with open arms.
It was the Poush Utsav in December that year, actually the last one that Tagore witnessed, when it dawned on him that time plays the most crucial role in one’s life. The harder he tried to hold on to time, it slipped away from him. Despite the mental and physical struggle, he managed to stand by his beliefs and played an active part in some major protests demanding independence for India. His works ‘Golpo Solpo’ and ‘Teen Sangee’ reflected these precise thoughts in his last days.
Despite this positivity his illness persisted. Because of the constant persuasion of doctors, both, allopathic and ayurvedic treatments were started in a desperate attempt to revive him. On 16th July, 1941, his doctors advised him to undergo surgery.
The operation was scheduled for 30th July. But he was not informed about it for fear that he would not accept it. On the day of the operation after making all arrangements, Dr Lalit Bandopadhyay finally broke the news to Tagore that he would be operated upon. The poet was shocked and not very happy; however, he was taken to the verandah of his house where a special operation theatre had been created for him. A Suprapubic Cystotomy was performed where the doctors aimed to insert a tube into his bladder to relieve his urinary retention. The operation was done by Dr Lalit Bandopadhyay, assisted by Dr Satysakha Maitra and Dr Amiya Sen.
After the operation, he often complained of a burning sensation but thankfully remained unconscious most of the time. To everyone’s dismay, his condition worsened and his pain was evident even while he was unconscious. On 4th August his kidneys stopped working and uremia had set in. Saline was administered to him and oxygen was kept handy. On the night of 6th August, his condition had hit rock bottom and people started gathering in the premises of Jorasanko.
Slowly oxygen tubes were removed and Tagore’s spirit freed itself from the shackles of a human body, at 12.10 pm. The news spread like wildfire and thousands of people rushed to Jorasanko to pay their last respects. The deafening silence of the crowd was broken by the blowing of conch shells. Flowers carpeted his path to the crematorium on the banks of the Ganges.
The echo of his words from “The Postmaster” keep coming to my mind. He said: “So, the traveller, borne on the breast of the swift-flowing river, consoled himself with philosophical reflections on the numerous meetings and partings going on in the world – on death, the great parting, from which none returns.”
A line from his famous song sums up his last days:
Exists Sorrows, Exists Death, Separation Chars,
Yet Exists Peace, Yet Exists Happiness, Yet The Infinite Stirs.
Dr. Amit Ghose, Kolkata, India
IN THE MEDIA:
“Finally, when his condition worsened and he had almost stopped passing urine, doctors diagnosed him with severe uremia and other complications. It was then decided that surgery could not be postponed any further and the poet was brought back to Jorasanko. It was here that a sterilized OT was created for the surgery conducted by Lalit Bandyopadhyay and overseen by BC Roy and Nil Ratan Sircar. They did not operate on the enlarged prostrate, but did a bypass surgery to take out accumulated urine. The prostate had to be left untouched,” said urologist Amit Ghose, who has been supervising the installation of the exhibition – Published in the Times Of India, August 7, 2016
“Not many people know that Kabiguru Rabindranath Tagore suffered from a disease of the Prostate Gland (not cancer). At that time he was given the best medical treatment possible. With the advancement of technology in India we are well-equipped to detect and handle diseases related to the prostate. Also, we wanted to create an awareness through this initiative that with regular check-ups it is possible to have an early detection of prostate-related issues and prostate cancer as well,” said the person behind this initiative, Dr. Amit Ghose, Director, Prostrate Cancer Foundation. – Published in BusinessWire India, August 9, 2016
The kind of love and care Rabindranath Tagore had got from everyone around him also is something to talk about. The doctors treating him tried their level best and they often sat by his bedside holding his hand hoping the pain and the discomfort would subside,” said Dr Ghose. – Published in Asia Times, August 21, 2016