Late-night epiphanies to transformative medical solutions: Associate Professor Joseph Ischia on Ureteric Stone Treatment
The birth of JiffyStent: "With nothing to lose, I shared that I too had an idea for a medical device and this gentleman -who I’d met merely minutes ago -looked me in the eye and told me that he could help me develop it."
Associate Professor Joseph Ischia
November 15, 2023
Acute renal colic is severely painful condition caused by the presence of kidney stones. Although it can can be treated with a short procedure, the current process involves a median emergency-room hospital stay of 24hrs+, 1hr operating time and around $7,000 of costs to the Australian healthcare system per episode. I'm Associate Professor Joseph Ischia of the University of Melbourne's Department of Surgery, and I'm on a mission to change this for patients & doctors alike.
My name is Associate Professor Joseph Ischia with the University of Melbourne, Department of Surgery, Austin health. I am a surgeon scientist and surgical Oncologist. I completed a two-year uro-oncology fellowship in Vancouver at the Vancouver Prostate Centre. I specialise in the surgical and medical management of cancers of the kidney, bladder, prostate, and testicles. While I do robotics, I also specialise in the major open operations such as kidney cancers with IVC thrombus going into the heart, retroperitoneal lymph node dissections with very large masses, and bladder cancer surgery where I remove the bladder and create a neobladder using the patient’s own bowel. I have a PhD investigating regulatory peptides in kidney cancer and continue to do research with the University of Melbourne and a vibrant group of urological researchers. I supervise a number of PhDs, Doctor of Science, and Masters students.
The medical literature reveals that about 12,000 people per year will have an attack of acute renal colic, which is extremely painful. Around 80% of these patients are sent home in the hope that they’ll pass the stone themselves with ongoing minimal pain or only one or two more episodes of severe pain. Around 10% of people are representations to emergency or have large stones in the upper ureter that are unlikely to pass by themselves and we will stent these patients to relieve the obstruction. The remaining 10% will have primary treatment of the stone without the need for initial stenting.
Therefore, in the 3 billion people globally who have access to good healthcare, around 1.5 million stents are inserted each year with the vast majority of these performed in the operating room under general anaesthetic.
Currently, the emergency stenting of the ureter has a median hospital length of stay of more than 24 hours, uses an hour of operating time, and costs the Australian health system on average around $7,000 per episode.
I’m very keen to be able to treat the stone there and then in the emergency department without forcing the patient to have to wait for emergency operating room availability. Often, emergency slots only come up late at night, which can be extremely inconvenient for doctors (for example, we may be a long way from the hospital when the call comes in) and patients contend with extreme pain for longer than necessary.
It is my hope that our innovation, JiffyStent, will have a transformational change on the management of acute renal colic in people who cannot be managed with observation alone.
A very real annoyance for urologists is the management of acute renal colic. We’re often called back late at night to insert a stent to alleviate the patient’s pain – an operation that takes approximately 5 minutes and yet necessitates a general anaesthetic and takes up an hour of operating room time.
Around midnight one day, whilst waiting for my slot in the emergency operating room, I got to thinking there must be a better way. I sketched out an idea for a ureteric stent inserter that could be used in the emergency room, foregoing the need for general anaesthetic and use of the operating room. Whilst very pleased with myself, I had no idea what to do with the sketches nor with whom to speak about making them a reality and so they were relegated to my desk drawer. That is until several months later when I was in a consultation with an 83-year-old gentleman…
At the end of the consult, this gentleman sparked up that he’d ‘worked with my type before’. Amused, I asked him what he meant, and he went onto share that he’d worked alongside medico specialists, helping them design medical devices – an orthopaedic surgeon with whom he’d developed a hip alignment device, a neurosurgeon who was inventing ways to access the bodies of the vertebral spine.
With nothing to lose, I shared that I too had an idea for a medical device and this gentleman -who I’d met merely minutes ago -looked me in the eye and told me that he could help me develop it.
We promptly set a date for a coffee catch up and this kicked off my working relationship with Mr.Donald Fry AO (Don), an engineer for over 60 years with 20 years’ involvement in medical research and the development of medical devices and named among theTop 100 Australia’s Most Influential Engineers in 2006.
Don’s initial prototype was comically simple but demonstrated his understanding of the concept. Just a few weeks later and by the third or fourth prototype, we were clearly onto something that might genuinely work. It transpired that Don still had a factory in Cairns owned and run by his son in which he could design and manufacture acetylene parts for the early iterations of our device. It was an extraordinarily impressive device and so the JiffyStent Inserter was born.
I think one of the most critical healthcare challenges today is the unequal access to good healthcare. Acute renal colic is an extremely painful condition which is treated in affluent healthcare settings that can ‘absorb’ the inefficient and expensive process of going to the operating room.
I think surgical entrepreneurs will look to develop new and innovative ways to solve surgical problems outside the cumbersome and expensive hospital systems. A program such as AUSCEP helps entrepreneurs like me to arm themselves with new skills - the skills that were never taught at university because we were too busy training to become doctors.
So many great ideas get bogged down at the idea phase and I can now see that 95% of a successful company is about the execution rather than the idea itself. Programs such as AUSCEP help fill in that 95% and, with greater awareness, it is my hope that more clinicians will be able to bring their ideas to fruition.
The AUSCEP program has been instrumental in guiding us through all the requirements of a medical device, which is far more than just the prototype. We have an excellent network and have made contacts through the program who are helping us to rapidly develop our device. Most importantly, it’s great to be inspired by the people giving the lectures as well as being surrounded by other individuals who possess an entrepreneurial spirit and a passion to develop medical devices.
After the initial excitement of coming up with a great idea, clinical entrepreneurship proved an isolating an arduous journey. Just when you think you’ve got the greatest idea of all time, most of your colleagues think you’re silly and ask why you don’t just stick to cutting out prostates!Furthermore, you face a myriad of obstacles on your journey, and this can prove very demotivating, especially when you possess hard-earned skills as a surgeon.Sometimes, you wonder why you bother. Programs such as AUSCEP connect you with other motivated and aspirational people. It has helped me find my clan.
It’s incredibly motivating to hear passionate people speak about their projects and the problems they’re trying to solve. The AUSCEP program provides wonderfully practical advice that has helped me to navigate the many moments of uncertainty. I particularly enjoy the accountability sessions in which you state what you’re going to do and six weeks later you’re asked to provide a progress report - did you achieve your intention? It’s amazing how quickly time can fly by when there’s no one looking over your shoulder!
My advice for clinicians interested in healthcare entrepreneurship is to:
Believe what everybody tells you – the very thing I initially tried to reject and ignore: your idea is worth almost nothing if you don’t have the requisite skills and resources to execute it.
Just get started.
Go chat to someone - anyone who has done it before - and they will introduce you to an exciting world you previously didn’t realise existed.
Even if you think you have the greatest idea ever, go ask ten of your colleagues how keen – on a scale of 1 to 10 – they would be to have access to your solution to the perceived problem (1 being not interested and 10 being extremely interested). Unless most people score it at least a 6, preferably 7, and ideally an 8-10, then give up now and save yourself a lot of pain and anguish. Alternatively, work out what the problem is that they truly want solved and reframe the question.
Associate Professor Joseph Ischia also runs TALKING UROLOGY with Melbourne-based Associate Professor Nathan Lawrentschuk, where the interview leading physicians, provide conference summaries and dive into the latest reports in the field. Check out the TU trailer below!
In this special series we continue to explore how medical entrepreneurship can transform healthcare and meet Associate Professor Fiona Brownfoot, a specialist obstetrician and a clinician-scientist based in Melbourne.
Securing part of this $3m grant program reflects the state's commitment to becoming a global centre of excellence in advanced therapeutics research, with a particular focus on microbiomics and its impact on human health.