Dr. Dan Spernat

MB BS MPH MEd AFRACMA AFACHSM FRACS (Urol)

Dan is a Urological Surgeon operating at Ashford, Flinders Private and Burnside Hospitals, South Australia.

Dan is a past Chair of the South Australian Section of the Urological Society of Australia and New Zealand, and was an Elected Member of the South Australian Regional Committee, Royal Australasian College of Surgeons, and the Director of Urology Training at The Queen Elizabeth Hospital. Dan is a Senior Lecturer in Surgery at the University of Adelaide and a member of the American Urological Association and European Association of Urology.

Dan has Bachelor of Medicine and Bachelor of Surgery degrees, a Masters degree in Public Health, a Masters degree with Distinction in Education, an Associate Fellowship with the Royal Australasian College of Medical Administration and an Associate Fellowship with the Australasian College of Health Service Management. Dan undertook specialist surgical training in Adelaide, Darwin, New Zealand, Melbourne and Sydney. Following core Urology training, he completed a Fellowship in Prosthetic Urology and Uro-Oncology at Melbourne's Monash Medical Centre.

His areas of special interest include Robotic Surgery, Prosthetic Urology, Uro-Oncology, Greenlight Laser Prostatectomy, Stone disease, and General Urology.

Appointments:

Your GP may write directly to Dan Spernat to arrange a clinic appointment. Alternatively, you may arrange an appointment yourself, as long as you have a referral letter from your GP.

Please Note: All patients need a current written referral to see a Specialist Surgeon. This is a Medicare requirement if you wish to access the rebate for your consultation and any other services. It is your GP (or another specialist) who will provide a letter of referral. A GP referral is valid for 12 months and a Specialist referral is valid for 3 months.

Your Consultation:

Please bring all copies of relevant investigations that have already been done, if you have them. This includes:

• X-rays/radiology images
• Blood results
• Urine results
• Pathology reports
• A list of your current medications
• A list of your other medical problems and previous surgery

Before Your Procedure:

Prior to an operation it is important to abstain from eating and drinking for 6 hours. If you are unsure of your operation time please contact 8244 4105 after 2pm the business day prior to your procedure.

On the day of your operation please bring all copies of relevant investigations that have already been done, if you have them. This includes:

• X-rays/radiology images
• Blood results
• Urine results
• Pathology reports
• A list of your current medications
• A list of your other medical problems and previous surgery

Financial Info:

Outpatient consultation fees are not paid by private health funds. A Medicare rebate is claimable, however you will be required to pay the balance on the day of your consultation.

The service fees cover the costs of running a modern medical practice. Fees vary according to procedure, and take into account the skill, experience, and training that have been required to be able to perform these procedures.

A quote for surgical fees will be provided pre-operatively.  

Frequently Asked Questions:

PSA

PSA is sensitive but not specific for prostate cancer. Furthermore, PSA levels may fluctuate due to many factors such as urinary retention, ejaculation and infection. In order to improve the efficiency of PSA screening I would recommend the following:

•      Prostate cancer case finding is appropriate in men, over the age of 40 and under the age of 75, who have a life expectancy above 10 years, are interested in preventative health care and are informed of the risks and benefits of PSA testing.
•   All men who have an abnormal digital rectal examination should be referred to an Urologist.
•    If a patient has a mildly elevated PSA then it would be appropriate to repeat the PSA four to six weeks later. A urine culture to ensure that infection is not present and treatment of a urinary tract infection prior to repeating the PSA is appropriate.

Patients with an abnormal digital rectal examination or PSA level will be offered a trans rectal ultrasound guided biopsy of the prostate. This procedure is undertaken as a day surgery procedure. It requires the passage of an ultrasound probe into the patient's rectum and at least 12 prostate biopsies are taken. The main risks of this procedure are bleeding and infection. This is minimised through the use of perioperative antibiotics. Patients should expect a small amount of blood in the urine, bowel motion, and semen post operatively.

Benign Prostatic Hyperplasia (BPH)

Lower Urinary Tract Symptoms (LUTS) are common. The symptoms may be either Obstructive or Over-active in nature.

Obstructive symptoms include:

• Incomplete emptying
• Poor flow
• Terminal dribbling
• Staccato flow

Over-active symptoms include:

• Urgency
• Frequency
• Nocturia

Routine investigations that may benefit patients include:

• Digital Rectal Exam (DRE)
• Urea, creatinine and electrolytes
• PSA (if indicated)
• Urine MC+S
• Ultrasound of the kidneys, bladder and ureters

Please Make Special Note of the Following:

• Any patient with microscopic or macroscopic hematuria should be referred to an Urologist.
• Any patient with primarily Over-active symptoms should be referred to a Urologist.
• Any patient who does not respond to initial medical therapy should be referred to a Urologist.

It is reasonable to empirically treat patients prior to referral to a Urologist. However, if significant abnormalities are revealed by the above investigations then referral to a urologist is appropriate. The following is a guideline and may help improve patient symptoms prior to urological intervention.

Lifestyle factors

• Decrease caffeine and alcohol
• Relaxed voiding and double voiding
• Urethral milking to prevent post-micturition dribble
• Distraction techniques to help control over active symptoms
• Bladder retraining aimed at increasing capacity

Complementary medicine

• There is no proven benefit of natural therapies over placebo

Alpha blockers – Prazosin or Tamsulosin

• This is the first line medical therapy in patients with predominantly obstructive symptoms.
• These agents may cause postural hypotension

5 Alpha Reductase Inhibitors – Finasteride or Dutasteride

• These medications are indicated in patients with large prostates and with predominantly obstructive symptoms.

PDE5 Inhibitors

• Cialis 5 mg per day is as effective as alpha blockers for obstructive lower urinary tract symptoms.

Renal Colic

Renal colic is common cause and many conditions can mimic renal colic. Therefore the following investigations are recommended prior to referral:

• Urea, creatinine and electrolytes
• Urine MC+S
• non-contrast CT of the Kidneys, Ureters and Bladder (plain CT KUB)
• Plain abdominal XRay to determine whether the stone can be followed with XRay or CT

Position: Urologist