Clinical Visit - Paediatric Urology in Paris

by Stephen Griffin FRCS Ed Urol, Urology Foundation Fellow

Urology trainee Stephen Griffin reports on his productive six week visit to Hopital Necker and Hopital Prive d'Anthony in Paris - including time spent with world-renowned pediatric urology  specialist, Dr Henri Lottmann.

As a urology trainee, I took an uncommon path into paediatric urology, spending 2 years in subspecialty training between Southampton General Hospital and Great Ormond Street Hospital, London. The award of the Urology Foundation’s travelling fellowship allowed me to spend 6 weeks in Paris at the Hôpital Necker and Hôpital Privé d’Antony.

The main aim of this visit was to gain experience in management of paediatric stone disease with extracorporeal shock-wave lithotripsy (ESWL) and to gain experience in operative decision-making and techniques for reconstructive paediatric urological procedures.

Learning from a world leader

My host, Dr Henri Lottmann, has particular interest in these areas and is well known within European paediatric urology. Highlights of the weekly programme included specialist neuropathic and adolescent clinics and the weekly operating lists at Necker and Antony. Before my arrival, I had discussed ideas for research projects and time was scheduled each week to allow this.

Dr Lottmann has a renowned name for treatment of stones in children and is referred patients from all over France.

Neuropathic clinics took place in rehabilitation centres in the greater Paris area. These were multidisciplinary clinics conducted with full-time rehabilitation doctors. These institutions are used for convalescence and training of patients who have undergone major reconstructive urological procedures such as bladder augmentation, Mitrofanoff procedure and ACE channel construction. Many patients are also followed up at these units. ESWL procedures were all undertaken at the Hôpital Privé d’Antony.

During my time in Paris I gained intimate knowledge of the patient selection process for ESWL in the treatment of paediatric stone disease. Dr Lottmann has a renowned name for treatment of stones in children and is referred patients from all over France. Therefore I encountered relatively high numbers of such patients over a short period.

I attended a number of ESWL sessions and had first-hand experience of Dr Lottmann’s protocols for antibiotic treatment and fluid management pre-, peri- and postoperatively. These strategies are aimed at optimising urine flow at the time of ESWL and minimising the bacterial load. Furthermore, I observed how he plays a very active role in positioning of the patient and targeting of the stone. Overall, this was a very different experience of ESWL from what I had previously encountered in the UK.

Attaining the Highest Standards

I picked up some subtle techniques that have enhanced my penile dissection for hypospadias surgery.”

In my research project, I investigated the safety and efficacy of ESWL for the treatment of paediatric urolithiasis. I had access to the files of treated patients, allowing me to make an unbiased judgement of the results of these treatments. It was clear that Dr Lottmann’s results match the best previously reported. This has taught me that repeating these results in my future practice will require not just a good lithotriptor, but development of a system that will encompass the overall process of management of these patients.

I also observed a number of hypospadias and reconstructive procedures while in Paris, and I picked up some subtle techniques that have enhanced my penile dissection for hypospadias surgery.

Lasting Links

Most importantly, I believe I have made a lasting link with a senior colleague who may act as a mentor in the future and is enthusiastic to collaborate in further research projects.

This experience would not have been possible without the aid of the Foundation’s grant, and for that I am very grateful.

It is most important that niche areas such as paediatric urology is supported in this way. This very positive experience will help patient care in the UK and allow me to pass my new found knowledge to my colleagues.

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