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Q&A with Joaquin Antonio Ramirez, Urology SHO at RLH

  • September 21, 2018

Hello, nice to meet you! What is your name, speciality and where do you work?

Hi! My name is Dr Ramirez and I work as an SHO in Urology at the Royal London Hospital.

Where is your home country?

I am originally from Costa Rica.

Why did you decide to relocate to the UK and what were your motivations?

I came to the UK with the hopes to specialise in Surgery and to learn about minimally invasive procedures which are more common in the UK than where I come from.

Relocating to the UK was very easy for me, I have been an expat for a long time and in my opinion, the UK is one of the easiest countries to relocate and find a job in, there are many people willing to help and everyone has been very welcoming since I arrived here.

What are your thoughts on living in London?

London can be a very hectic city to live in, as with any city it has its pros and cons, but I can assure you all that you will not be bored for a second if you decide to relocate here. The number of things to see and do is just amazing!

What are your thoughts on the NHS as a system?

I find it amazing how people in the UK respect and value the NHS as an institution and because of that support, doctors, can bring an amazing level of care to people for free.

Do you have any advice for junior doctors who are considering specialising in Urology?

I believe this is a great time to pursue Urology training in the UK, as it is a speciality that is suited for those interested in recent technological advances and research. I personally believe the most fascinating branch is urologic-oncology but there are many areas to specialise in, such as:

-Sexual health

-Infectious conditions

The main path for a doctor who aspires to become a Urologist is to complete the MRCS exam and then apply for a Registrar post, this can either be a training or a service post – both routes can lead to you becoming a Consultant.

I thoroughly enjoy working in Urology at the Royal London Hospital, it is a great speciality especially if you like video games. This is because now, everything is done through an endoscopic approach, so you are usually controlling instruments and see what you are doing via a TV screen.

We recently got a surgical robot in RHL that we use for benign procedures, as a result, it has shortened the patient’s stay at the hospital and they can leave with practically no visible scars. Plus, it is really easy and fun to use compared to traditional laparoscopy. I find this minimally invasive approach very exciting and I hope every day we will be able to offer this to more people in the UK and around the world.

Do you have any advice for Urology patients?

I am going to split my answer into to parts, for the two patients that I have treated:

A)Patients suffering from renal/ureteric stones

The cause of a patient suffering from stones can vary. The most common stones are calcium oxalate and they are caused by a combination of factors including genetics, dehydration and consuming a high quantity of oxalate in your diet. Foods that are high in oxalate and ones you should avoid if you suffer from this condition include spinach, bran flakes, rhubarb, beetroot, potatoes, chips, nuts, nut butter and many others.

Other types of stones can be caused by other factors such as recurrent urinary tract infections or gout, in this case, the main prevention is to treat the underlying medical condition as effectively as possible to prevent recurrence of calculi.

B)Patients suffering from BPH or more commonly known as an enlarged prostate

BPH stands for benign prostatic hypertrophy and it is a condition that affects up to 40% of men over the age of 65. It is an enlargement of the prostate gland that envelops the urethra making it difficult for the affected individual to pass urine, usually requiring them to depend on a urinary catheter to be able to empty their bladder.

BPH is typically caused by environmental factors that are still relatively unknown however, it has been theorised that it is caused by an increased conversion of testosterone to DHT or dihydrotestosterone, which is the hormone responsible for some changes in ageing males such as male pattern baldness. Theoretically, men who produce higher levels of testosterone have a higher chance of it developing BPH and just anecdotally I can confirm that many of my patients who suffered from this condition tend to be very muscular and ‘manly’ looking men, which is something I tell my patients which never fails to get a smile out of them.

It has been reported that aerobic exercise and a diet low in meat can prevent the incidence of BPH, but I believe the evidence is not yet conclusive on this matter. Currently, the best treatment available is for surgery and the most common procedure is called TURP (transurethral resection of the prostate) which involves passing a camera through the urethra and using an instrument called a resectoscope to ‘shave off’ a larger channel for the urine to pass through. This is done using an endoscopic cautery knife called a resectoscope. The surgery involves no cuts and is all done through this keyhole approach and it is currently the most effective way of treating this condition. There is a relatively high (5%) risk of causing erectile dysfunction which is why we are constantly looking for new ways to treat BDP which are safe and effective.

At Royal London Hospital, where I did my Urology placement, we are studying a new technique called Uro-Lift, which is a less invasive procedure which involves ‘clipping’ the prostate with two clips that open the urethra clearing the passage. This new technique has shown promising results, but it is still in its early stages and we require more patients to undergo this procedure to confirm its superiority to the traditional TURP.

Thank you for your advice, Dr Ramirez.

What are your plans for the future?

Eventually, I would like to go back to Costa Rica to help improve my home country with what I have learnt here. But for now, I have a lot of training ahead of me and so the UK is my current home.

 
 

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