Mr Robert Ewing Urology Surgeon

Education l Qualifications l Awards l Present appointment l Previous appointments
Societies l Courses attended l Presentations l Publications

I was awarded the FRCS diploma in 1978 while I was training at Northwick Park Hospital. During my time at Northwick Park Hospital and St Thomas’ Hospital, London I gained considerable experience in general surgery. It was at this stage I was introduced to Urology. At St Thomas’ Hospital I mastered the more complex surgical procedures in both general surgery and urology.

I also enjoyed teaching the medical students which I did on each firm. I participated in the lecture programme for the nursing staff and operating department assistants.

The Urological department at St Thomas’ Hospital had a keen interest in the management of the neuropathic bladder through a link with the National Hospital for Nervous Diseases. In September 1981 I was awarded a Research Fellowship from the Research Committee of St Thomas’ Hospital. This allowed me to investigate a newly developed treatment for these patients called subtrigonal phenol injection. The technique was developed at St Thomas’ Hospital and modified by myself. I looked into the effects of the treatment on both the motor and sensory nerves to the bladder.

During my time at St Thomas’ I regularly attended the Chrysalis Club at the Institute of Urology. When I went to Yorkshire I started a similar club covering the North of England which I called the Sweet Pea Club. These clubs allowed senior registrars to present and discuss difficult and interesting urological cases.

I was appointed as a consultant urological surgeon in 1986 at Halton Hospital. For the first few years I was a single-handed Urologist. I established the urological service in an area where there was no urologist previously. In 1989 I introduced the “One Stop clinic”. Patients attending my clinic at Halton Hospital were assessed clinically. Any investigations were then performed at that first visit wherever possible. This included blood tests, flow rates, xrays and ultrasound scans.

My interests outside medicine include Modern art with a particular interest in the Impressionist artists. I enjoy pottering about in the garden. A few years ago I undertook a project using over 100 tons of buff sandstone and 700 tons of soil. The end result is a fantastic rockery with 14 waterfalls, 3 ponds, a scree garden and a bog garden. I am a keen golfer and skier. It helps to keep fit! I love playing bridge and doing crosswords.

I was educated at Enfield Grammar School, Enfield, North London from 1961 to 1968.
I attended Westminster Medical School from 1968 to 1973. The first 2 years were spent at Kings College London studying for my 2nd MB BS degree in basic Medical Sciences. The clinical years of training were at Westminster Hospital before gaining my medical degrees.

Qualifications

LRCP MRCS	January 1973	The Examining Board of England
MB BS	April 1973	University of London
Primary FRCS	May 1975	Royal College of Surgeons (Eng)
Final FRCS	May 1978	Royal College of Surgeons (Eng)

Awards

October 1981
Research Fellowship from the Research Committee of St Thomas’ Hospital, London

Present Appointment

Since May 1988
Consultant Urological Surgeon
at Spire Cheshire Hospital (formerly BUPA North Cheshire Hospital)

Previous Appointments

Jun 73 - Dec 73	House Surgeon Queen Mary's Hospital Roehampton	Mr D L Evans Mr B G Andrews Mr P M Aicroth
Jan 74 - Jul 74	House Physician St Stephen's Hospital Fulham	Dr M N Maini
Aug 74 - Feb 75	SHO St Stephen's Hospital Fulham	Dr L Martin
Mar 75 - Jun 75	Attended Primary Fellowship Course At the Royal College of Surgeons
Jul 75 - Sep 77	SHO Surgical Rotation Northwick Park Hospital Harrow
	Accident and Emergency	Mr T Welsh
	General Surgery/Gastroenterology	Mr A G Cox
	General Surgery/Vascular	Mr J D Lewis
	General Surgery/Oncology	Mr A E Kark
	General Surgery/Urology/Endocrines	Mr A Elton
Oct 77 - Feb 78	Attended Final Fellowship Courses
Oct 77 - May 79	Registrar in General Surgery Northwick Park Hospital Harrow	Mr A G Cox Mr A Elton
Jun 79 - Sep 79	Locums
Oct 79 - Sep 81	Registrar Surgical Rotation St Thomas’ Hospital London
	Urology	Mr K E D Shuttleworth Mr R W Lloyd-Davies Mr M I Bultitude
	General and Vascular	Mr C W Jamieson Mr F B Cockett
	G I Surgery	Sir Hugh Lockhart-Mummery Mr B T Jackson
	Professorial Surgical Unit	Prof J B Kinmonth Prof N L Browse
Oct 81 - Mar 83	Research Registrar in Urology	Mr K E D Shuttleworth
Apr 83 - Sep 86	Senior Registrar in Urology Yorkshire Regional Health Authority
	Bradford Royal Infirmary	Mr B K Gray Mr P A H Stewart
	General Infirmary at Leeds	Mr P B Clark Mr R E Williams
	St James Hospital Leeds Paediatric Urology	Mr P B Clark Mr R E Williams Mr P Whelan Mr P H Smith Mr D F M Thomas
	Bradford Royal Infirmary	Mr B K Gray Mr P A H Stewart
Sep 86 - Apr 07	Consultant Urological Surgeon Halton Hospital Runcorn

Societies

Member of the British Association of Urological Surgeons

Member of the Holyrood Urological Travelling Club

Member of the Northwich Medical Society

Honorary lecturer to the University of Liverpool

Member of the British Medical Association

Courses Attended

Primary Fellowship course (Royal College of Surgeons in London)	Spring 1975
Whipps Cross Final Fellowship course	1977
Pyrford Orthopaedic course	1977
Surgical Research Society	1977
Surgical Research Society	1978
British Association of Urological Surgeons Annual Conferences	1982-2007
International Continence Society Meeting in Aachen Germany	1983
2nd Paediatric Surgery Conference Manchester	1984
2nd Germ cell Tumour Conference Leeds	1985
Spinal injuries course Lodge moor Hospital Sheffield	1985
American Urological Association Conference Dallas Texas	1999
Holyrood Urological Society Meetings	1983-2007

Presentations

Subtrigonal phenol injection for urge incontinence secondary to detrusor instability in females
British Association of Urological Surgeons Annual Conference Newcastle June 1982

Subtrigonal phenol injection therapy for incontinence in female patients with multiple sclerosis
13th Meeting of the International Continence Society Aachen Germany 1983

Pelvic evoked responses
British Association of Urological Surgeons Annual Conference Harrogate June 1983

Salvage Surgery for advanced testicular tumours
2nd Germ cell Tumour Conference Leeds 1985

Scrotal ultrasonography
British Association of Urological Surgeons Annual Conference Eastbourne July 1985

Publications

Br J Urol 1982, 54 (6):689-92

Subtrigonal phenol injection for urge incontinence secondary to detrusor instability in females.

Ewing,R. , Bultitude,M.I. , Shuttleworth,K.E.

Thirty female patients with urge incontinence or bypassing an indwelling urethral catheter have been treated by subtrigonal phenol injection. All were proven to have detrusor instability. The injection method is described. Seventy-six per cent of patients were rendered dry. The urodynamic changes are recorded.

Lancet 1983, 1 (8337):1304-6

Subtrigonal phenol injection therapy for incontinence in female patients with multiple sclerosis.

Ewing, R. , Bultitude, M.I. , Shuttleworth, K.E.

24 female patients with multiple sclerosis presented with severe urge incontinence or leakage around an indwelling urethral catheter. All had failed to respond satisfactorily to drug therapy. After subtrigonal phenol injection 83% were dry.

Br J Urol 1983, 55 (6):639-41

Pelvic evoked responses.

Ewing, R. , Choa, B. , Shuttleworth, K.E.

An electrophysiological method to measure the sacral reflex arc has been developed and is described in detail. The latencies of 15 normal subjects are recorded. The electromyographic responses were abolished in seven multiple sclerotic patients with unstable bladders after subtrigonal phenol injection.

Eur Urol 1986, 12 (4):270-3

Evaluation of a double-monoclonal radioimmunoassay for the measurement of carcinoembryonic antigen in the urine of patients with bladder cancer.

Hetherington,J.W. , Ewing,R. , Cooper,E.H.

A double-monoclonal radioimmunoassay (RIA) has been used to detect urinary carcinoembryonic antigen (CEA) in 204 patients attending for diagnostic cystoscopy. Elevated levels of urinary CEA were found in 50% of patients with bladder tumours, and these levels correlated with both the grade and stage of the tumour. The sensitivity proved to be 58% and the specificity 74%, which compares with previous studies using polyclonal RIA kits. As a monitoring test, urinary CEA proves to be as useful as urine cytology. The use of a more specific assay does not increase the clinical value of the test which still lacks the sensitivity and specificity needed to allow it to be used to monitor recurrence of low grade tumours (Ta, Tis and T1).

Br J Urol 1986, 58 (4):368-70

Modified nephroureterectomy: a risk of tumour implantation.

Hetherington,J.W. , Ewing,R. , Philp,N.H.

The standard surgical management of patients presenting with transitional cell carcinoma of the upper urinary tract is nephroureterectomy with excision of a cuff of bladder around the ureteric orifice. Recently a modified technique of resecting the lower ureter endoscopically and completing the nephroureterectomy through a single loin incision has been advocated as a safe and simple procedure. We consider that this technique may have a risk of tumour implantation at the site of the resected lower ureter. We report our experience of this operation in five patients, two of whom developed invasive tumour at the site of the ureteric orifice after only a short follow-up.

Genitourin Med 1987, 63 (1):16-8

Prevalence of chlamydial infection in acute epididymo orchitis.

Mulcahy,F.M. , Bignell,C.J. , Rajakumar,R. , Waugh,M.A. , Hetherington,J.W. , Ewing,R. , Whelan,P.

The prevalence of sexually transmitted infection was studied in 40 men presenting with acute epididymo-orchitis in Leeds. Chlamydia trachomatis infection was identified in 13 of 29 men (45%) aged less than 35 years. Neisseria gonorrhoeae was isolated from four of these 13 men with chlamydial urethritis. C trachomatis was isolated from the urethra of only one of 11 men (9%) aged over 35. Appreciable bacteriuria was found in six of these 11 men (55%). Noting details of sexual history and screening for sexually acquired pathogens is advocated in younger men with acute epididymo-orchitis.

Br J Urol 1987, 59 (1):53-8

Urinary fibrin/fibrinogen degradation products in transitional cell carcinoma of the bladder.

Ewing,R. , Tate,G.M. , Hetherington,J.W.

Urinary fibrin/fibrinogen degradation products (FDPs) were measured in 210 specimens from 174 patients with newly or previously diagnosed transitional cell carcinoma of the bladder. They were detected in 94% of patients with deeply invasive bladder tumours (pT2-4) compared with 17% of superficial tumours. Microalbuminuria (greater than 50 micrograms/g creatinine) was also found in 80% of patients with pT2-4 lesions. Both were compared with urine cytology. Urinary FDPs are markers of bladder tumour invasion. Our results suggest that urinary FDPs are not of value in screening for the presence of bladder neoplasia but their role may be in following patients with superficial bladder tumours to detect those tumours which become invasive. The mode of excretion of the FDPs in the urine is discussed.

Br J Urol 1987, 59 (1):76-80

Surgical salvage of advanced testicular tumours

Ewing,R. , Hetherington,J.W. , Jones,W.G. , Williams,R.E.

After combination chemotherapy, 19 patients underwent salvage surgery for testicular neoplasia. Active malignancy was found in nine patients, three of whom have died of the disease. Those with benign residual disease have had a good prognosis without further treatment. Biopsy alone of the residual masses proved reliable in determining which patients were to be simply followed or given further chemotherapy. If active malignancy was not resected fully, the prognosis was very poor. Our policy continues to be to attempt complete excision of residual masses after induction chemotherapy and to give salvage chemotherapy to patients with residual active malignancy.

Also published in Germ Cell Tumours (edited by J Price Pergamon Press Ltd Oxford)

Br J Radiol 1987, 60 (715):649-54

Scrotal ultrasonography: a clinical evaluation.

Fowler,R.C. , Chennells,P.M. , Ewing,R.

Two hundred and thirty patients had scrotal ultrasonography over an 18-month period. We report the ultrasound findings, correlation with the clinical diagnosis and, where possible, with the pathological diagnosis. The results show the value of scrotal ultrasonography in clinical practice. Of particular interest is the ultrasonic examination of the clinically normal or impalpable testis and the correct ultrasound diagnosis of testicular tumour in five cases (2% of all cases, 28% of tumours detected) thought clinically to be benign. A brief review of abnormal appearances is included.

Br J Urol 1987, 60 (4):345-8

Double-blind study comparing aztreonam with placebo for prophylaxis of infection following prostatic surgery.

Millar,M.R. , Inglis,T. , Ewing,R. , Clark,P. , Williams,R.E. , Lacey,R.W.

Department of Medical Microbiology, University of Leeds.

In a prospective, randomised, double-blind study, 179 patients undergoing retropubic or transurethral prostatectomy were given pre-operatively either 1 g aztreonam or a placebo. In patients treated with aztreonam there was a significant reduction in the number with post-operative bacteriuria and in the number requiring treatment of post-operative bacteriuria. Other differences were not significant. The mean duration of post-operative hospital stay for patients receiving aztreonam was 7.1 days compared with 6.9 days for those receiving placebo. In patients treated with aztreonam there was no increase in the frequency of infections due to Gram-positive bacterial species.

Br J Urol 1987, 60 (5):433-5

Extra-urethral ectopic prostate.

Ewing,R. , Harnden-Mayor,P. , Mason,M.K. , Anderson,C.K.

Department of Urology, General Infirmary, Leeds.

Extra-urethral ectopic prostatic tissue is a distinct entity which has been identified in the bladder of seven patients and may be more common than previously thought. Such tissue probably derives from the subtrigonal glands of Lowsley.

Eur Urol 1989, 16 (1):63-6

New method of postprostatectomy bladder irrigation.

MacDermott,J.P. , Ewing,R. , Gray,B.K.

Urology Department, Bradford Royal Infirmary, UK.

Bacterial filters have been used to sterilise the hospital water supply in order to provide irrigant for postprostatectomy irrigation. This method was compared retrospectively to bladder irrigation derived from a still on the ward. Postoperative bacteriuria was similar in both groups of 75 patients, occurring in 23.7% of patients irrigated from the still and in 20% of patients irrigated via the filters. The bacterial filter proved reliable and as safe as using water from the still.

Br J Urol 1997, 80 (3):497

Fibroepithelial polyp of the calyx

Hamm,R.S. , Ewing,R.

Halton General Hospital NHS Trust, Runcorn, Cheshire, UK.

This paper reports a case of fibroepithelial polyp uniquely occurring in the calyx of the kidney.

Curriculum Vitae of Mr Robert Ewing