Stone surgery in Paris

Read about how Urologist, Niamh Smyth’s fellowship at Tenon Hospital, Paris, is helping her to set up her own stone clinic in Glasgow.

Throughout my urology training I always had the ambition to undertake a fellowship abroad. I first came to hear about Professor Olivier Traxer in my ST3 year from one of my first urology mentors Mr Bob Meddings and as I developed more of a fascination with endourology and stone surgery, the idea of a fellowship in Paris took hold. I finally realised this ambition in August 2019 just after completion of my training in the West of Scotland.

The

 is situated in the 20th arrondisement, a leafy, green suburb in the north west of Paris. The general urology department specialises in endourology and the team there lead by Professor Traxer undertake approximately 800 flexible urteroscopy procedures for stone disease as well as around 300 FURS for upper tract urothelial cancer per year. With an on-site lithotripter they can offer over 300 ESWL sessions per year as well as PCNL including mini perc. They have a dedicated team for metabolic work up of stone formers including dieticians, nephrologists and the world renowned biochemist Michelle Daudon who has dedicated a career to the identification and classification of kidney stones.

Learning from a world leader

Professor Traxer is an internationally renowned stone specialist.  Urology trainees and consultants visit from all over the world, and at any time Professor Traxer has two to three long term fellows with him, as well as between 2 and 5 visitors on short term visits of a few weeks who come and learn from his expertise. I was uniquely somewhere in between the two, spending a few months with the team.

As I have the advantage of speaking French, I was treated in a similar manner to his 12 month fellows and was afforded the honour of operating with him, helping with his regular formal teaching meetings and attending his outpatient clinics where I learned so much about the long-term management of stone patients. I soon discovered that as well as urologists travelling from far afield to learn from Professor Traxer, patients would also travel from north Africa or other parts of Europe to be treated by him. Given the Professor and his team’s reputation for stone surgery they have the benefit of being asked to trial the latest scopes, technology or toy available and I have never come across a more impressive “armamentarium”

I found it extremely interesting how Parisian patients are very engaged in their own health conditions and are expected to bring all of their own notes and scans with them to consultations. When a patient needs a scan or blood test for example, the clinician simply writes a prescription for the required blood test or scan and it is then the responsibility of the patient to go and arrange this scan and bring the results back to their specialist. The result of this is that all patients are very well informed and engaged in their own care, something I found to be incredibly positive.

Benefit to patients in the UK

Since returning to Glasgow to take up a consultant post at the University Hospital of Monklands I have been able to put in place and share many of the operative tips and tricks I learned. Through observing the passion Professor Traxer and his team have for the metabolic work up of stone formers I have also developed a keen interest in this aspect of stone management and am working on setting up my own metabolic clinic, and look forward to opportunities to share the skills and knowledge I acquired through this amazing experience.

I recently had the privilege of being invited to be one of the founding members of the newly formed Progressive Endourological Association for Research and Learning Solutions or “PEARLS” – an international research collaborative giving me the opportunity to share ideas with and engage in multicentre trials and research projects across the world.

Undertaking a post CCT fellowship is something I would strongly encourage others to do. It has not only broadened my horizons in terms of operative skills and clinical knowledge which will benefit my patients for years to come but I have also met colleagues from all over the world with whom I will remain friends for life.

I am grateful to Mr Dennis Cope for his incredibly generous sponsorship and to Professor Roger Kirby and The Urology Foundation without whom this amazing opportunity would not have been possible.

April 2021 

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