CONDITIONS
Common Conditions
There are Certain Conditions common to both Men & Women
Urinary stones (calculi) are hardened mineral deposits that form in the kidney. They originate as microscopic particles and develop into stones over time.
Urinary stones may contain various combinations of chemicals. The most common type of stone contains calcium in combination with either oxalate or phosphate. A less common type of stone is caused by infection in the urinary tract. This type of stone is called a struvite or infection stone. Much less common are the uric acid stone and the rare cystine stone.
Cause
Urinary stones usually arise because of the breakdown of a delicate balance. The kidneys must conserve water, but they must excrete materials that have a low solubility. These two opposing requirements must be balanced during adaptation to diet, climate, and activity. The problem is mitigated to some extent by the fact that urine contains substances that inhibit crystallization of calcium salts and others that bind calcium in soluble complexes. These protective mechanisms are less than perfect. When the urine becomes supersaturated with insoluble materials, because excretion rates are excessive and/or because water conservation is extreme, crystal
Symptoms
The first symptom of a kidney stone is extreme pain. The pain often begins suddenly when a stone moves in the urinary tract, causing irritation or blockage. Typically, a person feels a sharp, cramping pain the back and side in the area of the kidney or in the lower abdomen. Sometimes nausea and vomiting occur with this pain. Later, the pain may spread to the groin.
If the stone is too large to pass easily, the pain continues as the muscles in the wall of the tiny ureter try to squeeze the stone along into the bladder. As a stone grows or moves, blood may be found in the urine. As the stone moves down the ureter closer to the bladder, a person may feel the need to urinate more often or feel a burning sensation during urination.
If fever and chills accompany any of these symptoms, an infection may be present. In this case, a doctor should be contacted immediately.
Diagnoses
The urologist will order laboratory tests, including urine and blood tests. He or she will also ask about the patient’s medical history, occupation and dietary habits. If a stone has been removed, or if the patient has passed a stone and saved it, the lab can analyse the stone to determine its composition.
CT and X-Ray are the chief methods used to diagnose kidney stones. Ultrasound can also be used to detect stones and urinary obstruction.
Your doctor might ask you to undertake a battery of tests to confirm that the stone disease is not the result of any primary disease.
Treatment
Conservative. In asymptomatic patients a wait-and-see course may be recommended by the doctor. Many stones will become symptomatic and produce acute renal colic while traveling down the ureter some time in the future. The stones may enlarge and then become more problematic and difficult to treat.
Pain control. The severe pain of renal colic needs to be controlled by potent pain killers. Don’t expect an aspirin to do the trick. Get yourself to a doctor or an emergency room. Also, the pain may be caused by some other problem needing immediate attention.
ESWL stands for “extracorporeal shock wave lithotripsy” (shattering a stone with a shock wave produced outside the human body). There are several methods for producing an acoustic or ultrasonic “big bang” which is then focused from outside into the kidney and the kidney stone.
Ureteroscopy or Pyeloscopy and Laser involves the insertion of a thin fibre-optic telescope into the kidney from the bladder via the urethra and the use of laser energy to fragment stones. Stone fragments can also be retrieved with the use of micro-baskets.
Percutaneous Nephrolitotomy (PCNL) is the preferred technique for treating large stones (over 2cm in diameter) within the kidney. It involves keyhole surgery performed through a 1cm incision in the skin overlying the kidney. A fibre-optic telescope is then inserted into kidney to enable stone fragmentation and retrieval.
A kidney tumour is Deadly cancer or Kidney.
They are most common after the age of 50 years.
In smokers, they can be seen at an early young age as well.
Symptoms
Unfortunately most kidney tumors have no symptoms untill very late when they can present as
1- Blood in Urine
2- Pain in Flank
3- Swelling in abdomen
4- Cyst in Kidney
Treatment
Kidney cancers are curable only by their Surgical removal.
Best treatment option
1- Laparoscopic Partial Nephrectomy for Upto 5 Cm can be removed without removing Kidney
It can be attempted in tumors upto 7 Cms
2- Laparoscopic Radical Nephrectomy for tumors larger than 7 cm. It needs removal of whole kidney.
3- Open Radical Nephrectomy for very large tumors which involve whole kidney can are attached to large Blood vessels or Surrounding organs.
Bladder Cancer It is cancerous tumor of Urinary Bladder. It is more common after age of 40 years although it can happen in younger individuals as well in case of family history or Smoking.
Symptoms Most common symptoms is Blood in urine which can be even so less that it is not visible to eyes and rather appears in Urine report in the form of RBC. Even single episode of Hematuria is dangerous and should require evaluation to rule out urinary tract cancer.
Tests Urine Cytology for malignant cells. CECT KUB region Cystoscopy for visualization of bladder from inside for any growth.
Treatment Superficial tumors Can be removed by endoscopic TURBT.
New laser modalities offer better results with lesser bleeding.
Deep Muscle invasive tumors. Require removal of Urinary Bladder which can be done by Laparoscopy After removal of bladder new bladder can be created from intestine segment Bladder Cancer is curable if treated early
The adrenal glands are located above the kidneys and have two parts, the adrenal cortex and the adrenal medulla. The adrenal cortex secretes hormones including cortisol and aldosterone. The adrenal medulla produces dopamine, epinephrine and norepinephrine.
Adrenal tumors are cancerous or noncancerous growths on the adrenal glands.
The cause of most adrenal tumors is unknown. Risk factors for adrenal tumors can include Carney complex, Li-Fraumeni syndrome, multiple endocrine neoplasia type 2 and neurofibromatosis type 1. Adrenal tumors may be removed surgically.
Cause & Risk factors
Several signs and symptoms may be seen, including:
- Bruising
- High blood pressure
- Weakness
- High blood sugar levels or diabetes
- Low potassium levels
- Excessive hair growth
- Sweating
- Increased weight or weight loss
- Stretch marks on the abdomen
- Depressed mood
- Nervousness
- Anxiety/panic attacks
- Osteoporosis
- Fat deposits on the neck
- Heart palpitation
Diagnosis & Treatment
The vast majority of adrenal tumors are benign. Most often, they do not cause any symptoms and are discovered as incidental findings on either a CT or MRI done for completely unrelated reasons, such as for evaluation of abdominal pain. As such, they are referred to as adrenal incidentalomas. Aside from categorizing them as noncancerous (benign) or cancerous (malignant), they are categorized as functioning or nonfunctioning. Functioning tumors lead to overproduction of one or more of the normal adrenal hormones.
If you see blood in your urine, with or without symptoms of cystitis, you should contact your Doctor immediately for further advice
Your Doctor will normally investigate blood in the urine urgently.
You may be started on antibiotics to treat a presumed infection. However, if the urine test result comes back showing no evidence of infection, you must consult a urologist for more detailed investigations.
What are the facts about blood in the urine?
the commonest cause of blood in the urine is infection (cystitis)
Hematuria can be visible to naked eyes or can be seen as microscopic in urine analysis
Both forms should always be investigated no matter what.
any blood in urine after the age of 40 in both male or female and at any age in smokers should be evaluated to rule out urinary tract cancer.
1 in 5 adults with visible blood in the urine and 1 in 12 adults with non-visible blood in the urine are subsequently discovered to have bladder cancer
children with blood in the urine rarely have cancer – they usually have an infection in the bladder or inflammation of their kidneys (nephritis)
some drugs (e.g. rifampicin, nitrofurantoin) and foodstuffs (e.g. beetroot) can turn the urine red; therefore a proper history of drug intake is important in evaluation.
Causes
What could have caused the blood in my urine?
50% (half) of patients with visible blood in the urine will have an underlying cause identified but, with non-visible blood in the urine, only 10% will have a cause identified
Although there are many potential causes for blood in the urine, those most often identified are:
bladder infection
cancers of the bladder (pictured), kidney or prostate
stones in the kidneys or bladder
inflammation of the kidneys (nephritis)
urinary tract injuries
blood disorders (e.g. sickle cell disease, clotting disorders, anticoagulant and anti-platelet drugs)
other causes, including less common infections (e,g. TB, schistosomiasis)
Evaluation
The usual tests performed are:
a. General blood tests
CBC
KFT
RBS
PSA in Men
b. Urine Analysis
this may show the presence of RBCs in urine along with pus cells if the infection is present.
c. Other specific tests
Urine Cytology for Malignant cells
ultrasound scan KUB Region
CT scan of your abdomen
Specialized evaluation:
Examination under anaesthesia
I have been detected with Cysts in my Kidney. Is it dangerous?
Simple Cysts:
Simple Kidney cysts can form at all ages ranging from the foetal stage when the mother is still pregnant to childhood, young and older age.
1- Foetal stage: Cysts form due to genetic disorders. some like MCDK and ARPKD are dangerous to the survival of newborn due to early renal failure.
2- Childhood stage: Cysts are rare in this age and can be sometimes delayed presentation of a genetic disorder.
3- Young adulthood: Upto 1-2 simple cysts can normally form and are of no consequence. except for Genetic disorder cases like ADPKD where they are associated with cysts in other organs like Liver and Pancreas.
4- Middle age: In cases of ADPKD number of cysts increase in all organs with age and can result in renal failure by the age of 50s.
5- Elderly age: Half of the population above age of 50 can have a few simple cyst in kidneys and are of no consequence
Complex renal Cyst
Complex cysts are dangerous and are usually seen in adults at any age. they can be a precursor of cancer or can be cancerous depending upon the complexity of cysts.
Evaluation:
Ultrasound Abdomen: Good enough to detect simple cysts in Kidney liver& Pancreas.
CECT KUB: A CT Scan is needed in cases where ultrasound suspects a complex renal cyst.
Management:
1- Simple cysts: most cases need no treatment unless symptomatic. can be treated for an infection or in case they are very large and causing pain, then they can be managed by Laparoscopic cyst deroofing.
2- Cystic disease like ADPKD need control of Diabetes, Infection and hypertension in order to delay renal failure. once the failure has happened patient will need renal replacement therapy in the form of dialysis or a kidney transplant. rarely if kidneys re very large then they might need to be removed in order to make space for transplant kidney.
3- Complex cyst treatment is based on complexity and up to type 2 cysts can be simply observed. while cysts which have complexity level 3-5 will need to be considered cancerous hence need to be tackled accordingly with Surgery.
I have been detected with Kidney infection. Should i worry?
Pyelonephritis is inflammation of the kidney, typically due to a bacterial infection. Symptoms most often include fever and flank tenderness. Other symptoms may include nausea, burning with urination, and frequent urination. Complications may include pus around the kidney, sepsis, or kidney failure.
It is common in diabetics and can be caused by Urine tract infection. It is twice as common in women compared to men.
it can present with variable severity and can be self-limiting to life-threatening.
Causes and symptoms
Causes
Usually caused by variety of Bacterial infections of Urinary tract. few factors predispose certain individuals to this
Diabetes
Anatomical abnormality of Urinary tract like PUJ obstruction
Stones in Kidney
Neurogenic Bladder
Vesico ureteric reflux
Immunocompromised state
Symptoms & Signs
1- Fever with Chills
2- urinary symptoms; Burning, pain, blood in urine
3- Abdominal pain
4- Fall in blood pressure or Shock-like state in advanced cases.
3- Deranged renal function and high TLC
Diagnosis & Treatment
Diagnosis is done based on blood investigations (like CBC, KFT), Urine Test (Urine Analysis, Urine culture), Imaging (Ultrasound & CT Scan).
Based of Findings it can be simple or Complicated Pyelonephritis.
Simple Pyelonephritis: Usually doesn’t require admission to hospital can be treated by Oral/ intravenous antibiotics course of 14 days.
Complicated Pyelonephritis: Needs Hospitalization and sometimes may need Intensive care in very sick patients.
Some patients may need Dialysis in case of severe renal dysfunction.
Cases with obstruction or dilatation of the kidney will need some sort of drainage in the form of Stenting or Percutaneous nephrostomy.
Rare severe cases of Pyelonephritis with gas (Emphysematous) in the Renal system may require removal of kidney by open or laparoscopic method. this can be life-saving in such situation.
Conditions in Men
BPH
Prostate when it is your friend no more
is common as men get older—about half of men over age 60 experience it, and 90% of men age 80 or over have BPH symptoms. When symptoms for BPH worsen, such as urinating more often at night or experiencing a complete blockage of urine, surgery becomes an option.
The gold standard surgical treatment for BPH traditionally has been transurethral resection of the prostate (TURP). During TURP, the section of the prostate that blocks urine flow is removed. Although effective, TURP has its side effects. The procedure is limited to prostates of about 100 grams in size; erectile dysfunction also is possible.
For prostates larger than 100 grams, the other common option is an open prostatectomy, which involves opening the bladder and enucleating the BPH tissue. However, these patients often need a catheter for up to 5 days, and there’s more bleeding as well as a longer recovery period.
For men with an enlarged prostate, the holmium laser enucleation of the prostate (HoLEP) is a minimally invasive treatment option now available at University Hospitals Cleveland Medical Center. In this procedure, a holmium laser is used to separate the prostate gland tissue from the prostate capsule, which allows for complete resection of the benign tissue.
With HoLEP, you go through the urethra without an incision. Performing HoLEP is technically demanding, which has limited the number of surgeons who perform the procedure.
Prostatitis is an Inflammatory condition of Prostate
Symptoms
1- Burning in Urine पेशाब में जलन
2- Heaviness in lower abdomen and perenium
शरीर के निचले भाग में भारीपन
3 – इरेक्शन से सम्बंधित दिक्कतें Erectile dysfunction
4 – शीघ्र स्खलन Premature Ejaculation
5 – सेक्सुअल पावर में कमीं Low Sexual power
Causes
1- unknown
2- Smoking धुम्रपान
3- गुटखा Tobacco
4- prostate infection
Diagnosis
Specialist andrologrst urologist
Treatment
1- Acute Cases – Symptoms 3 महीने से कम समय
सही Diagosis और उपचार से Curable हैं
2- Chronic Cases – 3 महीने से अधिक समय होने पर
अगर शुरुवाती इलाज् ठीक से ना हो
ऐसे केस में इलाज् multi modlality होता है।
Blood In Semen
Blood in the Semen may be due to various reasons including Cancer. Do not neglect it. Consult a doctor immediately.
Testicular Biopsy
Painless testicular Biopsy facility is available.
Varicocele Surgeons
We are trained, experienced and reliable surgeons. We specialize in Varicocele surgery.
Sperm Retrieval
by PESA TESA TESE and Micro-TESE
Prostate cancer is curable if detected early.
Do annual serum PSA.
Prostate cancer is second most common cancer in males Prostate cancer is generally seen after the age of 50 years but in smokers and with family history it can be seen as early as at the age of 40 years.
Symptoms Unfortunately in the early stage of prostate cancer there are no symptoms most patient sometimes experience some urinary difficulty or sometimes blood in the urine.
Most early prostate cancer cases are detected on testing of serum PSA Which is a very reliable test if the values are more than 4ng/dl.
Diagnosis
Apart from serum PSA cancer prostate diagnosis involves a digital rectal examination by a urologist.
An MRI for the prostate and a bone scan to check for the spread of prostate cancer.
In newer modalities, PSMA PET CT Is found to be very effective in terms of identifying the spread of prostate cancer.
Definitive diagnosis requires biopsy of the prostate which is safe and does not cause any risk or spread of disease.
Premature ejaculation: ejaculation occurs sooner than desired, either before or shortly after penetration.
Up to 30% of patients may report concomitant erectile dysfunction.
Along with Erectile dysfunction, premature ejaculation makes up for 90% of sexual dysfunction in Men
Causes & Diagnosis
reason for PME is complex and multifactorial
Any painful focus over the penis (tight frenulum) and Prostatitis can result in PME.
Detailed history taking and examination by Urologist/ Andrologies is must.
Treatment of PME
1- Reducing stimulation: Usage of condoms, local anaesthetic sprays and Circumcision and in extreme cases dorsal neurectomy is helpful.
2- Correction of erectile dysfunction
3- Medical therapy with selective serotonin reuptake inhibitors (SSRI) & tricyclic antidepressant
4- Specialized delay techniques
Conditions in Women
- UTI (Urinary Tract Infection)
- Urinary incontinence
- Pelvic Organ Prolapse
- Vesico Vaginal Fistula (VVF)
- Interstitial Cystitis (Bladder Pain)
- Urethral Stenosis
- Vaginal Discharge
- Sexual Issues
Conditions in Children
- Phimosis
- VUR (Vesico Ureteric Reflux)
- Bedwetting
- Undescended Testis
- Hypospadias
- PJU Obstruction
- Kidney Diseases
- Posterior urethral Valve