Overview
If something goes wrong with your urinary tract your body’s system for getting rid of your pee you may need to see a special doctor called a urologist. They’re experts who can treat problems that range from kidney stones to cancer.
Our Urologist are Dr. Hiren Sodha Dr. Amit Kolekar Dr. Abhinandan Sadalge Dr. Varun Gunavanthe Dr. Amit Khandkar |
Kidney Stones
Kidney stones are aggregation of chemical substances dissolved in urine. When the concentration level of these substances reaches a particular point, they crystallize into a permanent form and form stones. The most common type of stone contains calcium in combination with either oxalate or phosphate. Kidney stones vary in size; sometimes, these are too small to be felt or noticed in the urinary tract. Otherwise, these can be as large as a golf ball. When the stone obstructs the urine flow, the ureter dilates and stretches causing muscle spasms giving rise to immense gripping pain (renal colic); felt in flank, lower abdomen, groin or leg of affected side.
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In general, kidney stones show no symptoms until they move into the Ureter. Once these stones enter the Ureter, the following symptoms are usually seen.
- Sharp pain in the groin region and side areas
- Signs of blood while passing urine (hematuria)
- Frequent nausea and vomiting
- Pus observed in urine
- Passing less amount of urine
- Burning and itching sensation when passing urine
- The frequent feeling of urination
- Sometimes, the occurrence of fever/chills
- Blood Tests : These tests inform about the presence of too much calcium or uric acid in your blood. It helps doctors to check the health of your kidney.
- Urine Testing :Â Doctor may advise you to have two urine collections for two consecutive days to assess the amount of stone forming minerals present in your urine.
- Imaging : Imaging tests may include simple abdominal X-rays, CT Scan and ultrasound to reveal the presence of kidney stones in your urinary tract. One advanced test is intravenous urography where a dye is injected into an arm vein and x-rays or CT images are taken as dye travels through kidney and bladder.
- Analyzing passed Kidney Stones : You will pass urine through a strainer so kidney stones passing through urine can be collected and analyzed in a lab.
Retrograde Intrarenal Surgery (RIRS) for Kidney Stone
The advent of flexible ureteroscope has made intrarenal lithotripsy possible. Ureterorenoscopy using flexible ureteroscope is called Retrograde Intrarenal Surgery (RIRS). It can be easily used for stones anywhere in the tract. Its advantages include: no incision on the body, short hospital stay & early recovery. The procedure is expensive as the equipment is costly, even doctors need special training to perform it. It is a major leap in endourology in managing urinary stones and other problems in kidney.
Ureterorenoscopic (URS) Lithotripsy with Holmium Laser Treatment for Kidney Stone
In those instances when the stone is stuck within the bladder or Ureter, doctors use a device called Ureteroscope for its removal. It is a non-invasive method as there is no incision required. A rigid ureteroscope along with laser fiber is inserted through the Urethra into the Bladder and Ureter. The laser fiber is used to transmit the Holmium energy that breaks up the kidney stone and the surgeon removes the broken pieces through the urethra. Smaller pieces pass through urination. Sometimes, doctors insert a tube known as a stent between bladder and kidney to make it easy to pass kidney stones and improve healing.
Extracorporeal Shock Wave Lithotripsy (ESWL) for Kidney Stone
Lithotripsy can be understood as the extracorporeal shock waves (electromagnetic), which are the sound waves, mostly used for breaking down the stones into smaller particles, and the smaller particles smoothly pass into the bladder. It’s a complex process and often requires anesthesia. The person may feel strain around abdomen region and back. There may be chances of bleeding around the kidney regions as well.
Percutaneous Nephrostolithotomy (PCNL) Procedure for Kidney Stone
This method involves the removal of a stone through a tiny incision in the concerned person’s back. These methods are recommended when: The stone leads to hindrance causing infection or damages within the kidney. When the stone is too big to pass smoothly A person suffers from extreme pain.
ENLARGED PROSTATE (BPH)
Benign Prostate Hyperplasia (BPH) or enlarged prostate is a common condition that is often seen in older men. In this condition, the prostate grows more than its usual size. Prostrate is the organ that surrounds Urethra. The urethra is the tube that carries urine and semen. The larger prostate puts pressure on Urethra. It leads to frequent urination, which can eventually cause other serious urinary issues. Enlarged prostate gland may also adversely impact the kidney and urinary bladder.
We lose control over the physiological, psychic and other aspects of the body as we age, to a certain extent. While we may be exercising regularly, consuming a nutritious diet and also have a lifestyle devoid of bad habits, still certain conditions may develop as we age. Benign Prostate Hyperplasia (BPH) or Enlarged Prostate is one of these conditions. The urethra or the tube which carries the semen and urine out of the body through the penis is surrounded by the prostate gland. The enlargement of the prostate gland with aging to a certain extent is normal and does not cause any abnormalities. But when the enlargement exceeds these limits, the urethra gets squeezed. This particular condition is termed as Benign Prostate Hyperplasia. The squeezing of the urethra does not allow the normal evacuation of the urine. You may have to go to the bathroom multiple times for excreting small amounts of urine and there may also be other bothersome or inconvenient impacts of the condition. Enlarged prostate gland may also adversely impact the kidney and urinary bladder.
There are a number of symptoms related to the enlargement of the prostate gland which clearly indicate the presence of the condition. These symptoms may also worsen gradually over a period of time if the disease is not treated early.
Some of the Symptoms of BPH (Enlarged Prostate)Â Include :
- Nocturia or increased urination frequency during the night
- Frequent and urgent need of urination during the day
- Difficulty in starting urination
- A urine stream that starts and stops abruptly
- A weak stream of urine
- Difficult incomplete urination or thorough emptying of the bladder
- Dribbling at the end of urination
As said earlier, the enlargement of the prostate gland may also pose problems to other organs including the kidneys. There are also certain other symptoms of BPH (Enlarged Prostate) but these are less common and include:
- An Infection in the urinary tract
- Urine containing blood
- A complete inability towards urination
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There is no clear link between the size of the prostate and the symptoms. Some men having smaller prostate enlargements have more severe symptoms and vice versa. In some cases, it has been found that the symptoms of BPH (Enlarged Prostate) stabilize or may even get more improved over a period of time conditions. Enlargement of the prostate is not cancer but only a doctor can diagnose the real cause of the symptoms
The doctor will try to know your family history and other aspects of your physical condition. He may ask you questions directly about your condition or you may be required to fill a survey form, which will have questions pertaining to urination and other aspects of the condition.
The doctor will also try to examine the shape and size of your prostate gland through the digital rectal examination. During the examination, he will wear the gloves and insert a finger gently into the rectum area for the examination.
Prostate Specific Antigen or PSA test, blood test, and urine test are also carried out. Apart from detecting the condition of the prostate, these tests also aim to find out the presence of any infection or adverse impact on the kidney.
Advanced tests including ultrasound, biopsy (for ruling out the presence of cancer), and urodynamics test (for evaluating the functioning of the bladder).
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Lifestyle Changes :
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Medications :
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Surgical Procedure and Techniques :
TUMT (TransUrethral Microwave Therapy)Â – Use of cold and heat for killing excess prostate cells and tissues. A catheter is entered inside the prostate and has instruments for generating and delivering microwave heat/energy.
TUNA (TransUrethral Needle Ablation)Â – A Cystoscope (a surgical and visual instrument is inserted via the penis into the urethra. Tiny radio-frequency (RF) needles are also passed through the Cystoscope and these deliver heat and cause necrosis, thereby shrinking the prostate issues.Â
Procedures including Laser Therapy and TransUrethral Resection of Prostate (TURP) are more involved surgical procedures and are carried out to remove a part of the prostate gland.Â
Laser Therapy – A scope is inserted via the penis tip into the urethra. As the urethra is surrounded by the prostate gland, the heat/energy (passed through the scope subsequently) cuts the excessive tissues of the prostate or melts them.Â
TUIP (Transurethral Incision of Prostate)Â – The method involves making some small incision on the prostate so that the pressure on urethra can be released.
A Robotic Surgery or an Open Surgery may also be performed if all these measures are incapable of treating the enlarged prostate condition.
Open Surgery – Open surgery for enlarged prostate treatment (or open prostatectomy) is usually carried out if the prostate is excessively large, or when TURP cannot be done because of some reason. It may also be carried out if bladder stones are there, or the bladder wall has pouches (bladder diverticula).
Surgery for treating BPH may also have certain complications and side effects. Erectile dysfunction, incontinence, stricture/ narrowing of the urinary tube, and bleeding may be some of the side effects of a surgery. While some of the conditions may heal themselves naturally, others may require medical intervention.
A number of treatment methods are available for the treatment of the disease BPH. But it is important for the patient to reach out to the doctor early so that the symptoms do not aggravate and worsen over a period of time and cause damage to other vital organs of the body. A prompt medical intervention will avoid the complications and may improve the condition easily.
URETHRAL STRICTURE
The urethra is one of the organs of the urinary tract that carries urine from the bladder so that it can be released from the body. The urethra tube is usually wide enough for the urine to flow easily through it. However, when the urethra tube gets contracted, it deliberately blocks down or restricts the urinary flow. This condition is known as the urethral stricture.
→ Frequent and sudden urge to urinate
→ Reduction in urine volume or weak urine flow
→ Feeling the bladder is still full after urination
→ Frequent stopping and starting of urine stream
→ Burning sensation or pain while urinating
→ Incontinence (lack of control over urination)
→ Pain in the lower abdominal area or pelvic
→ Urethral discharge
→ Penile pain and swelling
→ Presence of blood in urine or semen
→ Darker urine color
The doctors will only prescribe the treatment option considering the severity of the condition.
Nonsurgical: The doctor will use a medical instrument known as the dilator for making the urethra wider. It is done by inserting a wire into the urethra to the bladder and dilates it. Another nonsurgical treatment option is permanent urinary catheter placement. But it has side effects as it causes urinary tract infections and bladder irritation.
Surgery: Open urethroplasty is a preferred surgical option for the doctors for urethral strictures. This process involves removing the contracted tissue and reconstructing the urethra.Â
Urine Flow Diversion: Â In some cases, the doctors follow urinary diversion procedures to treat the strictures. This surgery leads to the flow of urine permanently rerouted towards a small opening in the abdomen.
URETERIC STRICTURE
Ureteral stricture is a narrowing of the lumen of the ureter, the duct that carries urine from the kidneys to the bladder, resulting in an obstruction. Ureteral stricture may arise from a variety of causes and is characterized as either anastomotic or nonanastomotic, depending on how they develop. They may be benign or malignant. Who get it? Any individual undergoing treatment such as an ureteroscopy for kidney, ureteric stone management or urinary diversion is at great risk for developing ureteral stricture.
Symptoms of ureteral stricture may include pain, loin lump , flank tenderness, and/or urinary tract infection.
There are a variety of minimally invasive treatments for patients with ureteral strictures. A doctor may perform balloon dilation as a first step in treatment, particularly in patients who have nonanastomotic strictures.
For ureteral strictures that do not respond favorably to dilation alone, endoscopic incision is the procedure of choice for most patients. Endoscopic incision of the stricture can be performed or a laser may be used with a rigid or flexible ureteroscope. A stent may be left in place to keep the ducts open for approximately 6 weeks.
New technique called Holmium Laser Endoureterotomy is now available that may allow long-term relief from ureteral stricture if other techniques are unsuccessful.
Erectile Dysfunction
Erectile Dysfunction (ED) is the inability of a man to achieve or maintain an erection sufficient for his or his partner’s sexual needs. Most men experience this at some point in their lives, usually by the age of 40, and are not psychologically affected by it.
The factors may be pre-testicular, testicular or post-testicular.
- Pre-testicular: Drugs, smoking, alcohol, medications affecting spermatogenesis (spironolactone, chemotherapy).
- Testicular: Age, genetic defects, carcinoma, varicocele, trauma, hydrocele, mumps, idiopathic.
- Post-testicular: These defects include the defects in the genital tract and ejaculation problems.
Diagnostic tools include medical history, physical examination, semen analysis, blood analysis to rule out hormonal imbalances or genetic issues. Patient’s partner can also be interviewed.
The treatment modalities depend upon the underlying disease and extent of impairment. Pre-testicular issues can be rectified by medicines. Testicular based infertility is usually medication resistant. Post-testicular infertility can be overcome by surgery.
In infertility condition, the female fertility should also be checked.
Male Infertility
Male infertility refers to the inability of a male to make a fertile female pregnant. It is usually due to semen deficiencies.
