How did you start your work in India?
After completing my specialisation in urology, I returned from the UK in 1987 and started doing surgeries here. I started ‘Kulkarni Reconstructive Urology Centre’ in Pune in 1995. I had always kept in mind that I’ll offer treatment to all patients at an affordable cost and will not send any patient back even if the patient has no money. Along with offering services in Pune, I have performed the largest number of urethroplasty surgeries in the world.
Kindly explain ‘Kulkarni’s Technique for Urethral Reconstruction’.
I have invented this technique in 1998 for full-length stricture of the male urethra. The urethra is a tube that allows passage of urine from the urinary bladder. The average male urethra is 22 cm long. Narrowing of the urethra is called a urethral stricture. Full-length stricture of the urethra was traditionally treated by two-stage technique. For these difficult strictures, the ‘Kulkarni’s Technique’ has become the standard of care around the world. The narrow urethra is enlarged by using a patch of cheek mucosa.
Which techniques were in use before Kulkarni’s Technique? And how is your technique different?
Kulkarni’s Technique can also be used in Etiology Lichen Sclerosus. Lichen Sclerosus is a genital skin disease with white spots on the glans penis. Before Kulkarni’s Technique, there were two techniques in place.
First is Johanson’s two-stage urethroplasty, where the patient passes urine through a newly created hole in front of the anus. And the other is McAninch flap - in which the foreskin flap is used as a patch to enlarge narrow urethra. But both these techniques cannot be used in Lichen Sclerosus. Also, Kulkarni’s Technique has some distinguished advantages. First of all, it is a single stage procedure and does not require an incision on the penis. The success rate of this procedure is more than 85 per cent.
How has this technique helped patients?
It is now a standard of care around the world. I demonstrate and teach urethroplasty in more than 35 countries. Doctors from various countries have also come to Pune and work here for months learning this surgery.
Special instruments are not required for Kulkarni’s Urethroplasty. I have performed urethroplasty workshops in many government hospitals and will continue to do it so that a larger number of patients are helped.
Kindly elaborate how you came up with the idea to teach surgery to urologists for free at your school?
When I went to London in 1981 to learn urology, I had to pay 100 pounds as a fee for one month’s observer post at the Institute of Urology. I did not have that money at that time and had to run from pillar to post to make arrangements for the fees. At that time itself, I had decided that in future, I’ll teach the fellow urologists for free as far as possible.
How many patients undergo this surgery on an average in one month? And what is the cost of it?
The condition, ‘Urethral Strictures’ are common in India and around the world. As a result, we perform 500 urethroplasty surgeries every year in Pune. Out of these, 50 are pan-urethral strictures treated by Kulkarni’s Technique.
The same technique is used for penile and bulbar stricture in more than 200 patients every year. The cost of surgery varies and depends on many factors and co-morbidities.