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Lithotripter for the treatment of kidney stones

The use of botulinum toxin in Ophthalmology

Service request: Cancer

Service request: Pathology

Library and Knowledge Services


Welcome to ...

Success at the Paediatric Spotlight Seminar

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June 2010

Lithotripter for the treatment of kidney stones

A New Service from the Urology Department

The department of Urology is proud to announce a new service which is due to start from mid June. A new fixed Siemens Lithotripter is being installed in St Peterís Hospital, Chertsey.

The Siemens Lithoskop in situ

The Siemens Lithoskop in situ

Lithotripsy Ė the shock-wave treatment of kidney stones - was developed in Germany in the early eighties and has become the standard treatment of kidney stones today.

The original device required patients to be immersed in a water bath and treated under a general anaesthetic. Technology has moved on somewhat and the modern machines allow us to treat patients while they remain awake. Patients can even walk home within an hour of treatment making it very user-friendly and convenient. The treatment can be repeated easily if necessary.

All types of stones can be treated effectively using the lithotripter

All types of stones can be treated effectively using the lithotripter

The Siemens Lithoskop equipment being installed in St Peterís Hospital is the most modern version of the lithotripters. It can treat patients with all types of stones in any location using x-rays or ultrasound localisation. This will be the first Lithoskop lithotripter in the UK.

Our new service

Beginning in mid-June, we will be able to offer treatment to patients with no delay as it will be available on site and will be run by our experienced team of consultants and junior doctors.

Our department

All of the urology consultants are offering this treatment. The urologists, Robin Cole and Ravi Kulkarni, Krishna Patil and Justin Collins will be joined by Bill Dunsmuir later this year. They have between them extensive experience of stone management, several having been trained in renowned stone centres in London and in Bristol. Whilst the majority of stones can be treated with the lithotripter they also have the expertise to offer alternative treatments for stones when required.

The Urology Consultants and the team of registrars

The Urology Consultants and the team of registrars

The benefits

This machine will expand and enhance our stone service. We anticipate treating local patients and those further a field.. This will provide a unique opportunity for patients to be treated close to home rather than go to London.

Referral information

Either via letter to any named consultant or if using Choose and Book under the specialty of íUrologyí, clinic type 'Not otherwise specified' and select the íUrological stone serviceí.

Contact: 01932 722053

The use of botulinum toxin in Ophthalmology

Known primarily for use in cosmetic surgery, botulinum toxin, better known as Botox or Dysport, enjoys growing popularity in eye care as a therapeutic agent. The toxinís ability to cause denervation in unwanted muscle function makes it an intriguing option in cases of squints and other ophthalmic disorders in which traditional therapies are of limited benefit.

Botulinum toxin is produced by the bacteria Clostridium botulinum. The toxin induces paralysis by blocking the release of acetylcholine. Thus, it inhibits the transmission of nerve impulses across the synaptic junction to the motor end plate.

The botulinum toxinís effect is usually seen two or three days following injection, with maximal effect occurring at approximately two weeks. Recovery takes six to 14 weeks with the proliferation of new axonal nerve buds to the denervated muscle and the regeneration of muscle end plates.

In 1973, botulinum toxin was first shown to be effective and safe when used to weaken extraocular muscles. It is beneficial in patients who have horizontal or vertical strabismus, thyroid ophthalmopathy, nystagmus, diplopia, and postsurgical over- and undercorrections and to assess the postoperative double vision.

The advantages of using botulinum toxin to treat strabismus: its ease of administration in the outpatient clinic, the use of a topical anaesthetic, little or no postinjection discomfort, and the absence of postoperative recovery time. Recovery is unnecessary, since no surgical incision or residual scarring occurs. Instead, the technique used in electromyography is employed to position the needle precisely into the belly of the extraocular muscle.

In addition to the uses in squints, this therapy is popular for dystonias of the face and neck e.g. benign essential blepharospasm and hemifacial spasm. Additional uses include: induction of a protective ptosis in cases of corneal compromise or ulceration in patients who have fifth or seventh cranial nerve palsies, upper lid retraction associated with thyroid eye disease and spastic entropion.

Referral Process

The Botox Clinic takes place on the first Friday each month at St.Peterís. You can refer through the adult general ophthalmology service on C&B or via letter.

Namir Kafil-Hussain FRCS, Consultant Ophthalmic Surgeon Ashford and St. Peterís Hospital

Contact : 01784 884172.

Cancer Service Request

Where cancer is suspected please continue to refer via the Two Week Rule (TWR) fax number (0800 9234668).

As you are aware all urgent GP cancer referrals will be responded to under the "Two Week Response StandardĒ. All patients referred using the Two Week Rule (TWR) for suspected cancer will be offered a date for their first appointment within two weeks and therefore it is important to stress to your patients the need for them to be able take up their appointments immediately.

We ask practices to use the dedicated TWR forms appropriate for the specialty they are referring to (available at with all referrals. Like all Surrey Hospital Trusts please do not send suspected cancer / TWR referrals through Choose and Book or manually through the post.

Pathology Service Request

When sending private blood group samples please ensure that a cheque of £20 is made payable to Ashford & St Peterís NHS Trust and sent with the sample to Blood Transfusion Department.

Sometimes, the cheque is sent a few days after the sample has arrived, but this will cause a delay as the lab cannot process the sample until payment is received.

Library and Knowledge Services

Are you aware of our services?

We have libraries at Ashford and St Peterís Hospitals, located next to the Education Centres on both sites.

You can use our website to order journal articles, make literature search requests and set up an Athens account. An Athens password will give you access to electronic journals and resources including the Map of Medicine.

You can also join our General Practice mailing list to keep up-to-date with new books and other useful documents.

A membership form is available on the website or via the following contact details: Tel: 01932 723213 or Email:



Audiology services in the Trust are provided at both St Peterís and Ashford hospitals.

Both sites offer a range of services such as seeing potential and experienced hearing aid users referred from GPs and ENT clinics.

We also provide diagnostic facilities for ENT clinics, carry out hearing aid repairs and maintenance and offer general advice on a range of topics such as assistive devices and communication strategies. When needed we can signpost our patients to other helpful organisations.

We are always looking at additional ways in which we can assist our service users and improve their experience.

An exciting new project we have Ďin the pipelineí is to set up a volunteer service. This will provide additional help to patients with things like mould insertion and cleaning. It will help them to overcome difficulties they may struggle with and which can significantly affect their aid use and experience. Watch this space for further information when this is launched!

Batteries - Every day we issue hundreds of hearing aid batteries and we know that some health centres also provide this service for their patients. Patients usually prefer to go to their surgery, which is often closer to home and easier to access.

Currently, we donít know which practices offer this service, and we would very much like to tell patients if there is a more convenient centre for them to collect their batteries - so please let us know if this is something you offer, or if it something you would like to provide (see email address).

Did you know?

The most common cause of a hearing aid not working is the mould being blocked.

Patients can make an appointment at a repair clinic without a GP referral if they are already under our care and have had a hearing test within the last three years.

We also provide a postal repair service.


Welcome to...

Mr Samer Humadi
Consultant General, Upper Gastrointestinal and Bariatric Surgeon


Appointed In January 2010 to consultant surgeon in general surgery with special interest in bariatric surgery at Ashford and St. Peterís Hospitals NHS Trust.

During his training he did a core of general surgical training, which involved a two years of colorectal surgery, one year of breast surgery, six months of vascular surgery and one year of general surgery. After finishing core training, Mr Humadi chose upper gastrointestinal surgery as his sub-speciality of interest.

In upper gastrointestinal surgery, he has done sixteen months of training in oesophago-gastric cancer surgery between Gloucestershire Royal Hospital and Bristol Royal Infirmary. He completed a further year of Bariatric Surgery training at Musgrove Park Hospital in Taunton, which is a centre of excellence and a recognised international centre for bariatric surgery.

Mr Humadi provides upper gastrointestinal and full bariatric surgery (gastric balloons, gastric bands, gastric sleeve and gastric bypass surgery) for the South Thames Bariatric Service (STBS), which includes both ASPH and St Georges Health Trust.

Mr. Humadi is married with two children. His wife works as a GP in Southall.


To provide a full bariatric service at Ashford & St. Peterís Hospitals NHS Trust.

Key Services

Upper GI & Bariatric clinics at Ashford, St. Peterís and St Georgeís Hospitals.

Theatres at Ashford, St. Peterís and St Georgeís Health Trust

Endoscopy at Ashford Hospital

Participating in the general surgery, GI bleeding on call rota at ASPH.

How to refer

General surgery - by letter or choose and book

Bariatric surgery- by letter only

Contact Number

01784 884313

Success at the Paediatric Spotlight Seminar

Consultants from the paediatric team gave three presentations on Thursday 20th May at the Brooklands Hotel.

Over twenty GPs were present to hear Clinical Director Paul Crawshaw discuss new developments in paediatric care at the trust, and launch the specialist paediatric surgery which will take place at the trust from June 18th. Consultant Bozhena Zoritch discussed ADHD and shared care protocols and Consultant Diab Haddad covered the growth of allergies in children and treatments available. To download your own copy of the presentations please visit and click on clinical events.

Would you or a colleague like to be on our invitation list? If so please email or phone 01932 723716

For more details about the pilot to change visiting times at the trust from 1st June 2010 please see the website

Diary Dates

Clinical Interface Meeting - the trust's clinical directors and medical director meet with local GPs once a quarter to discuss current issues. All GPs welcome.

Location: Foxhills, 12.30pm-2pm.

Dates: 8th June, 14th September and 14th December.

Spotlight Seminar: 26th August

Spotlight Seminar: 21st October on Womenís Services.

Your Contacts:

ASPH queries in general -

Joanna Matthews,
GP Liaison Manager.
Tel: 01932 723716

ASPH queries related to CAB only -

Michael Hooker,
CAB Manager
Tel: 01932 723511

For queries related to Ashford & St. Peterís appointments please call 01932 723831 or 01784 884351