What is urology?
Urology is a sub division of medicine that deals with the surgically correctable diseases that affect the urinary tract and the male and female genitalia. The importance of this sub division gains further momentum, as the diseases of the urinary tract and genitalia are so common in clinical practice.
This division also includes ANDROLOGY, that deals with the issues related to male factors of infertility, erection problems in males and ejaculatory dysfunctions in younger and middle-aged males. Andrology, in liason with clinical psychology also deals with the psychological and sociological aspects of marriage related mental trauma and agony, where adequate counselling is being given for the problems that the newly married couple come to us with.
The scope of urology is big and various sub-specialities are being introduced by the Urological Society of India.
Pediatric Urology – urinary problems in children
Urologic Oncology – cancer of urinary tract
Kidney Transplantation – in patients with end stage kidney failure
Male Infertility – both erectile, ejaculatory and fertility related problems in males
Urinary tract stones – another upcoming speciality, where the entire treatment modality shifted from open stone surgery to endoscopic to minimally invasive key hole surgeries and now slowly drifting towards ultra-minimally invasive endoscopic surgeries once again.
Female Urology – deals with urinary problems in women.
Neurourology – urological complications of neurological diseases like urinary problems occurring after child birth, major pelvic radical surgeries and infective problems affecting the spinal cord.
What is nephrology?
Nephrology is a branch of medical science that deals with medically treatable kidney problems. One who treats kidney problems mainly with medicines and hemodialysis is a Nephrologist.
Who is a urologist?
Urologist is a surgeon who, after the MS general surgery qualification, sub-specializes further in the field of problems related to male and female urinary tract. A urologist also treats patients with kidney failure, by performing peritoneal dialysis and kidney transplantation.
What is the difference between urologist & nephrologist?
As mentioned earlier, both nephrologists and urologists treat patients with kidney disorders. While the nephrologists treat them medically, urologists treat these patients surgically.
What are the facilities available in NAURO KIDNEY SPECIALITY CLINIC?
NAURO offers a complete package for all forms of urological and Andrological illnesses. Its a ONE STOP SOLUTION for all kidney related issues. Patients with kidney stones, prostate related old age problems, erection problems, ejaculation related issues, male factors of infertility are being evaluated, adequately counselled and treated at this centre. Though NAURO is only an out-patient clinic, we direct them to the nearby hospitals according to the situations that the patients are in and offer surgical treatment at those nearby centres.
II. STONE DISEASES
Kidney stones send about 10% of Indians to the emergency room every year, but there are many definite ways to decrease the risk of developing stone disease. To help you learn about symptoms, prevention tips and treatment, this month, the NAURO KIDNEY SPECIALITY CLINIC answers the top 12 questions about kidney stones.
How are kidney stones formed?
Stones are heavier substances formed from diverse chemical substances from within the urine. Urine has diverse excreta dissolved in it. When there may be an excessive amount of waste into less liquid, crystals start to aggregate. The crystals aggregate and join together to develop into a hard and solid component that grows over time, gets heavier with an increase in size, descends from the kidney into the drainage portion of the kidney and gets passed out in urine. Various chemicals like calcium, oxalate, cystine, xanthine, phosphates and antacids can form kidney stones. Not keeping one well-hydrated is one of the basic reasons why the patient develops kidney stones.
Are they always hereditary?
Not always, but yes, there are a few conditions that lead to stone formation in families. It is important to identify those conditions, treat the underlying cause and then treat the stones.
What are the common types of stones that we get affected with?
Common stones are calcium oxalate stones. These develop when urine contains low levels of citrate (that acts as a base to neutralize the acidicty of urine) and high levels of calcium and either oxalate or uric acid. Uric acid stones are seen in selected patients only.
Stones are associated with infections too. They are called as STRUVITE stones. Such ones are seen in chronic urinary tract infection (UTI) with bacterial (gram-negative bacteriae), organisms that split urea into ammonia, that subsequently combines with phosphate and magnesium to crystallize into a stone.
What are the symptoms of kidney stone?
Stones are of various sizes. They range from sand particles to larger pebbles. A few are as large as the size of the kidney itself! Though the generally accepted rule is that, the larger the stone, the more noticeable are the symptoms, smaller stones too can indeed be catastrophic. Occasionally, tiny stones of the size of a mustard seed can get trapped at the place of junction of the draining tube with the bladder and produce severe pain, infection and chills and rigor.
The symptoms could be one or more of the following:
· Intractable pain in the; loin region or upper back
· vague pain in upper back, that is too ill-localised
· fever and chills and rigor – suggest infections of kidney
· blood in the urine – can cause panic in patients’ mind.
· nausea or vomiting
· foul smelling urine or a turbid/cloudy urine.
Kidney stones produce pain, only when they obstruct the flow of urine. Urinary obstruction will lead on to the stretching of the coverings of the kidney. Sudden stretching of the coverings of the kidney produce severe pain, called as COLIC.
Please remember: Pain occurs only when the kidney makes efforts to push the stone out. Absence of pain in the presence of the stone only indicates that the kidney is too fatigued or not making efforts to push the stone out.
What are the treatment options available for getting rid of kidney stones?
The best form of treatment is prevention. Patients are encouraged to take large quantities of water, sufficient enough to maintain a urine output of 1.5 litres per day. They are also encouraged to look at the clock and empty urine, so that urine stasis can largely be avoided.
Smaller stones, less than 4 mm are generally left untreated. They are clinically insignificant and usually pass out without much difficulty. Sometimes, smaller stones may get stuck at the lower end of the draining tube (ureter) and produce severe pain, necessitating early intervention.
Stones in the kidney, smaller than 1 cm are best treated by shock waves that are transmitted from external source (ESWL). Such stones are these days, being treated by flexible scopes that are passed into the kidney through the urinary passage. The advent of Laser has largely revolutionized such treatments using flexible scopes (RIRS). Larger stones in the kidney are best treated using a key hole surgery, where a small hole is made in the upper back, a scope is passed into the kidney directly and the stone is blasted and removed (PCNL). Stones that have dropped down into the ureter are best removed using ureteroscope and laser machine.
Do all kidney stones need to be intervened?
Not really. Various factors decide the need for intervention. Size of the stone, degree of infection, extent of kidney damage and the severity of symptoms decide the need for intervention.
How good is medical treatment for kidney stones?
Medical treatment is useful in two ways. One, to expel the stone that has descended down from the kidney into the draining tube (ureter) and two, to dissolve the small renal stones that form due to certain specific metabolic reasons.
What happens if a stone is left untreated?
Long term untreated stones in the kidney form a nidus for infection and damage the kidney over time. Stones that have descended into the ureter cause obstruction to the flow of urine, swell up the kidney ad result in reversible/irreversible damage to the kidney over a period of time.
What precautions are to be taken to prevent recurrent stone formation?
It is important to identify any specific reason for stone formation, identify the root cause and treat the cause accordingly. Addressing each case according to the root cause largely helps in prevention of stone recurrence.
Is it always useful to do a stone analysis?
Not always useful, as many a time, the report will show abundance of calcium, oxalates and phosphates. This is only confuse the patient regarding what diet to dfollow, what to take and what not to take. On the contrary, the stone analysis may be very useful in certain specific scenarios. Patients with stones in kidneys, young age stone formers and stone formers due to certain metabolic diseases are the best ones to get benefitted by such analysis.
Is milk restriction really helpful in stone recurrence?
Not really. As long as one is not used to taking many cups of milk in a day, daily ingestion of 3 to 4 small cups of coffee or tea or milk will not greatly influence stone formation.
Do children develop kidney stones?
Yes, children with stone disease need to be evaluated in greater detail to find out the reason for stone formation.
III. PROSTATE DISEASES
What is a prostate gland?
The prostate gland is a walnut-sized gland located just below the bladder in men and surrounds the top portion of the tube that drains urine from the bladder (urethra). The prostate's primary function is to produce the fluid that nourishes and transports sperm (seminal fluid).
What is the actual use of prostate in males?
An accessory reproductive organ that is present only in males. It secretes a fluid that aids in nourishment of sperm. One of its main roles is to squeeze fluid into the urethra as sperm move through during sexual climax. This fluid, which helps make up semen, energizes the sperm and makes the vaginal canal less acidic.
The prostate's most significant capacity is the development of a liquid that, along with sperm cells from the testeicles and liquids from different organs, makes up semen. The muscles of the prostate likewise guarantee that the semen is strongly squeezed into the urethra and afterward removed outwards during discharge.
Why does a man get Prostate enlargement?
The actual reason for prostate development is obscure. Variables connected to maturing and changes in the testicular cells might play a part in the growth and development of the organ. Testosterone levels and hormone levels within the prostatic cells also play a major role. Men who have had their gonads taken out at a youthful age (for instance, because of testicular malignant growth) don't foster BPH.
What are the symptoms of prostate gland enlargement?
Patients may have any of the following symptom:
· Thin stream of urine
· Poor force
· Straining ot pass urine
· Prolonged duration to pass urine
· Sense of incomplete evacuation
· Delayed initiation of passing urine
· Frequency of urination duing both day and night
· Urgency to urinate
· Difficulty in control with involuntary leakage of urine.
· Getting up frequently at night to urinate.
· A urinary stream that starts and stops – interrupted stream of urine
Does an enlarged prostate always indicate an underlying cancer?
No. Not at all. Both are two independent entities. Each one is to be treated on its own merit.
How does one diagnose prostate enlargement?
A simple clinical examination could diagnose the condition in most patients. By putting the index finger into the patient’s rectum, one can diagnose both benign and cancerous enlargement of prostate in most individuals. However, a few blood tests and ultrasound scan can give additional information regarding finer details of the two types of glandular enlargement. Further evaluation using MRI scan and PET CT scans give additional information regarding cancer prostate. However, a biopsy of the prostate would give the final confirmation on the type of enlargement that we deal with.
Do all prostate enlargements need treatment?
No not at all. Only if the patient has bothersome symptoms or if the uroflowmeter shows a poor flow, one needs intervention.
When will one need a surgical intervention for prostate enlargement?
When medical treatment fails, or if the patient develops retention of urine, recurrent infections, blood in urine or if kidney damage sets in, one needs to get it surgically corrected.
How does one get prostate cancer diagnosed?
As mentioned earlier, rectal examination may give some idea about the nature of illness. Blood tests like Serum PSA may be very helpful in picking up the diagnosis earlier. Multi planar MRI scans and PET CT scans are very helpful tools to diagnose the disease. Biopsy is the final confirmation of malignancy.
What are the options available for treatment of cancer of prostate gland?
Varied options are available, including watchful waiting. Radical prostatectomy (open/laparoscopic/robotic) that results in surgical removal of the entire prostate gland and adjacent structures, Radiotherapy and Cryotherapy are other useful modalities while we aim at cure of the disease. Hormonal treatment is suggested in advanced diseases.
IV. ERECTILE DYSFUNCTION
What is erectile dysfunction?
Erectile dysfunction (ED) is the inability to achieve and sustain an erection that’s firm enough for sexual intercourse. Men who experience ED have decreased blood flow to the penis, which could be caused by many things from drug side effects to stress or high blood pressure.
Here are the most common symptoms of ED:
· Difficulty getting an erection
· Difficulty maintaining an erection
· Reduced interest in sexual activity
· Low self-esteem
If these symptoms are present, a diagnosis of ED is made. A doctor might also perform a physical exam and ask for a complete medical history. Sometimes, ED may be a warning sign of more serious underlying medical conditions like cardiovascular disease, so a doctor might order blood tests to check for other medical problems.
How common is impotence?
ED is very commonly encountered in clinical practice. With increasing age, associated comorbid illnesses, changes in lifestyle habits and better diagnostic modalities, more number of ED patients are being diagnosed these days. Statistics reveal that more than 300 million men would be affected by ED by 2025.
What are the reasons for impotence?
The fundamental understanding of ED arises from the fact that erections mainly involve the blood vessels. Conditions that reduce the blood flow to the penis also result in ED. These include hardening of the arteries (atherosclerosis) and diabetes. Another cause may be a faulty vein that lets blood drain too quickly from the penis.
How does one get treated for impotence?
As smoking is one of the strongest factors causing ED, one should stop smoking with immediate effect.
Obesity and overweight may cause ED. Weight reduction greatly helps recover from ED
Regular physical activity indirectly helps in ED
Abstinence from alcohol also helps.
Appropriate counselling for marital disharmony, infedility and relationship issues greatly helps overcome the psychological barrier and facilitates a good erection.