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Urinary Tract Infection



General Info about Urinary Tract Infection


Infections of the urinary tract are common. Urinary tract infections (UTI’s) are caused by bacteria that invade the urinary system and multiply, leading to an infection. Women are affected more than men.

The urinary system consists of the kidneys, ureters, bladder, and urethra. The key elements in the system are the kidneys, a pair of purplish-brown organs located below the ribs toward the middle of the back. The kidneys remove liquid waste from the blood in the form of urine, keep a stable balance of salts and other substances in the blood, and produce a hormone that aids the formation of red blood cells. Narrow tubes called ureters carry urine from the kidneys to the bladder, a triangle-shaped chamber in the lower abdomen. Urine is stored in the bladder and emptied through the urethra.

There are three types of urinary tract infections:

  • Urethritis is infection of the urethra

  • Cystitis is infection of the bladder

  • Pyelonephritis occurs when bacteria ascend up the ureters and infect the kidneys


Phimosis / Tight Foreswkin



The male organ penis consists of a tubular cylindrical body called shaft of penis. It opens at its end and this area is called ‘Meatus’. The skin at the end can be pulled back to a short distance and this skin is often called the foreskin (or prepuce). The foreskin protects the more delicate ‘glans’ and ‘meatus’ (the hole or opening at the end of the penis). In people who have had ‘circumcision’ this foreskin is removed.

Q. What are the causes of Phimosis ?

Phimosis is congenital or acquired:-

  • In acquired phimosis there is chronic inflammation of the tip of the penis and prepuce (fore skin) or there are adhesions between Glans & prepuce or due to malignancy.

  • In congenital causes it is present since birth.

  • Phimosis is usually caused by thickening and repeated inflammation of the foreskin. Once this happens the foreskin fails to retract over the glans.

Q. What are the symptoms of Phimosis ?

  • Inability to retract foreskin.

  • Straining during urination.

  • Thin stream of urine.

  • Recurrent urinary infections.

  • Pus from penis – due to belanophosthitis.

Q. How can we diagnose Phimosis ?

From history & examination

On Examination

  • Pin hole opening of foreskin

  • Difficulty to push back the foreskin over the shaft of the penis.

  • Balooning of foreskin – A bulge in the tip of penis as urine accumulates under the foreskin.

  • The urine itself maybe cloudy or reddish if blood is present.

Q. How can Phimosis be treated ?

Circumcision is the only permanent cure. This refers to the surgical retraction of foreskin.

More Valuable information about Phimosis…

If untreated complications of phimosis can occur:

  • Infected foreskin leads to infection of glans also.

  • The tip of the foreskin acts like a ring and retracts over the shaft of the penis causing pain and discomfort (this condition is called paraphimosis).

  • Meatal Stenosis – narrowing of penile opening.

  • Sometimes a cancerous ulcer on glans can cause the adhesion to take place.

Frequently asked questions about Urinary Tract Infection…


Q. Which doctor should I meet for the complaint of tight foreskin?

You can meet a General physician or an Urologist.

Q. Is it true that following surgery (circumcision) adult males are made temporarily impotent?

This is untrue. After circumcision the glans is very sensitive to the atmosphere upto three months and during this period a person may not have erection.

Q. Does urine contain infectious organisms?

Urine is normally sterile.

Q. Can circumcision prevent cancer of penis?

It is true that if circumcision is done just after birth as in Jews, this can prevent cancer of penis in adults however if it is done in boyhood (as in muslims) there is no difference to cancer of penis.


Urinary Stone Diseases



History of Urinary Stone Disease

Urinary stones have affected mankind since time immemorial. It would be fascinating to know that the first evidence of urinary stones dates back to 4800 B.C., when a bladder stone was discovered in Egyptian mummy at E1 Amrah Egypt. Information about urinary stone disease can also be found in ancient Sanskrit literature in India.

A simple mechanism to understand stone formation

Imagine a glass of water containing little salt .If you add some more salt, it dissolves. When you add more and more salt, a stage is reached when the water is no longer able to dissolve the salt added to it. This is because the solution is supersaturated with the salt.Above this point , any little amount of salt added to the solution will start precipitating.

This is exactly the mechanism by which stones form except that the solution is urine and the chemical composition of the salt is different. There are 3 main ways by which stones form in the urinary tract. First a crystal has to form, then it has to grow and then a large number of such grown – up crystals has to aggregate to each other before it becomes large enough to block the urinary passage.

It would be comforting to know that nature has it own protective mechanisms to prevent stone formation. Yes ! there are certain substances in urine which interfere with the growth and aggregation of crystals which are responsible for stone formation.It is because of the presence of these substances in urine that most of us do not form stones. The stone forming substances are kept in a dissolved state in our urine.

Types of Renal Stones

There are various types of urinary stones, but the most common ones are calcium oxalate, uric acid, struvite and cystine stones.

Symptoms of stone in the kidney or ureter Stones in the kidney or ureter do not cause any symptoms until and unless they obstruct the urinary passage. The nature and the location of the pain can vary from person to person depending upon the size of the stone, the position of the stone within the urinary tract, and the damage it causes to the urinary system.

It should be however remembered that the size of the stone does not interfere with the severity of the pain. For example even very small stones in the ureter can cause lot of pain whereas large stones which develop in the kidney or urinary bladder may not produce pain at all, or may be associated with a dull ache only. Stones in the kidney may produce a deep, dull ache in the loin or back which might be mild, moderate or severe. Some stones may cause a dull or sharp pain in the abdomen below the ribs. It may be present throughtout the day and it is difficult to be ignored.

Stones which move down into the ureter (ie) the tube which carries urine away from the kidney cause lot of pain. The pain is usually sudden and might be so severe that the patient is not able to stay in one place for a short time. They move about from one place to another place in an attempt to feel comfortable. The pain may radiate from the loin to the groin. It might be associated with nausea or vomiting. The pain may also be felt in the testicle in males or vulva in females. Stones which are in the lower portion of the ureter may be associated with an increase in urinary frequency (ie) the patient has to visit the toilet to empty urine very frequently. It may also be associated with a sudden and intense desire to urinate where the patient has to rush to the toilet to pass urine. Burning sensation or pain accompanying urination is frequently present. If the stone is sharp, it might produce Haematuria (ie). blood in the urine . Most patients get alarmed by this and it is the reason why the patient comes for consultation to the doctor.

If urinary tract infection is present, there might be intermittent attacks of fever associated with pain.In some cases, the patient may not have any symptoms at all. They might be diagnosed to have a urinary stone when getting a routine health check up done.

Q.What are the tests to be done ?

A through physical examination is very important to understand the site and nature of the pain. It would also give the doctor an idea as to whether the pain is likely due to a stone within the urinary system or due to other reason.

A routine blood test and a urine test has to be done. The urine test will he helpful to know if there is blood in the urine, or if infection is present. It would be surprising to know that the doctor can make our if you are drinking adequate amount of fluids from the urine examination itself.

A special urine test in the form of urine culture has to be done to look for the presence of urinary tract infection . If it is present, it has to be treated with suitable anti-biotics for a specified time.

A blood test to measure the functioning of your kidney has to be done to know how your kidney is affected because of the urinary stone. Other metabolic tests may have to be done to look for any defects in your body which may be responsible for stone formation.This is very important as it is not only sufficient to treat for the stone but to find out why you formed the stone. So an appropriate treatment can be given so that you don’t form a stone again.

An ultra-sound examination is the first choice and it is very useful. It does not involve any intervention and is very safe. Even very small stones which cannot be seen on the X-Ray can be seen on an ultrasound. The presence of any abnormality in other organs in the abdomen can also be made out.

A X-Ray film is usually needed. It should be taken after proper bowel preparation. You may be asked to take some medicines which help in the easy passage of stools so that proper information can be obtained.

Depending upon the X-Ray and the ultra-sound findings a I.V.P. test has to be done. It is a special X- Ray test and involves the injection of a contrast agent intra-venously and taking a series of X-Ray films. Some people might be allergic to this contrast if this the case, then this test cannot be done. This is a very useful test which gives a lot of information about the kidneys ,ureter and bladder. Since this test involves the use of X-Ray which are damaging to the fetus, you have to inform your doctor if you have missed your periods or if you are pregnant.

A CT scan may have to done in some cases. It is now being increasingly used by the doctors. It is done quickly and the cost is also is comparatively less.If adequate information cannot be obtained from the above mentioned tests, then additional interventional radiological tests may have to be done.

Treatment of Urinary Stones


1. CONSERVATIVE MANAGEMENT

It is usually the treatment of choice for small stones in the kidney and ureter. Most of such stones pass spontaneously in the urine without any need for intervention. The probability of a stone passing down spontaneously will depend upon the size of a stone, it�s location, shape etc. Such patients can be treated with anti-biotics and analgesics to feel symptomatically better. Oral dissolution agents can also be given for a considerable length of time. The patient is generally instructed to maintain a high fluid intake ranging from 2 to 3.5 litres/day.

If a patient has severe abdominal pain associated with vomiting and fever, then admission is usually required and intra-venous fluids may have to be given. If this does not help, then the stone may have to be removed by endoscopy. Some cases where the stone causes severe obstruction and infection then a procedure called DJ stenting has to be done to receiver obstruction. DJ stenting ie the process of inserting a synthetic tube between the kidney and the ureter. If this does not help a tube has to be passed directly into the kidney to drain the infected urine.

2. EXTRA CORPOREAL SHOCK WAVE LITHOTRIPSY

  • Extracorporeal Shock Wave Lithotripsy Advanced technique in stone removal Extracorporeal shock wave lithotripsy is recognized world wide as the most effective mode of treatment for kidney and ureteric stones.It is a highly scientific technique employing focused shock waves for breaking urinary stones into fine particles.This technique was introduced in 1980 by a German company. Ever since the introduction,of this technique,it has been successfully used by Doctors in USA,Europe and other areas of the world ,for the treatment of urinary stones.

  • It is a non operative technique with no necessity for anaesthesia and involves minimal pain.Unlike the earlier open operation treatment, ESWL does not involve any cutting of tissues and no scars are left after the procedure.

  • The ESWL procedure usually lasts for about 40 minutes.But depending on the size and number of stones,more than one session may be required for proper breaking of the stones.

  • Patients may be required to remain in the hospital for a day for observation. After the procedure the patient is advised to drink plenty of fluids.This helps in the passage of stone fragments in the urine.In some cases, certain other procedures may have to be adopted to facilitate full removal of the stone fragments.

3. URETEROSCOPIC STONE REMOVAL

It is ideally suited for stones in the lower portion of the ureter. It involves the passage of an instrument namely ureteroscope through your urinary passage. The instrument is as thick as a pen and is about 40 cm long. You may have to be admitted in the hospital for a few days (2-3 days) for this procedure and it has to be done under anesthesia.

A variety of other instruments can be passed in through the scope which can be used to break the stones and remove them. Very rarely it may so happen that the stone cannot be removed by this method in which case open surgery may be needed.

4. PERCUTANEOUS NEPHROLITHOTRIPSY

This procedure is ideally suited for very large calculi within the kidney and the upper ureter. In this procedure, a puncture is directly made on to the kidney, the stone is seen with a telescope, broken into fragments and the fragments removed. In some cases, it may not be possible to remove the entire stone. So a combination of other procedures like ESWL has to be done to ensure that the stone is completely removed.

5. OPEN SURGERY

With the advent of new technologies to treat stone disease, the need for open surgery has been drastically reduced. But in some cases it might be required. The type of open surgery will depend upon the site and size of the stone within the urinary tract.


Undescended Testis

Undescended Testis

The testis is responsible for sperm production in men. The general body temperature is 36.9o C. But sperm production is best at a temperature 2o less than this level. This is the reason why the testes are located outside the body.

Treatment of Urinary Stones


Q. How common is Undescended Testis? Is it possible for the testis to descend by itself?

A: The most common cause of UTI is bacteria from the bowel that lives on the skin near the rectum or in the vagina which can spread and enter the urinary tract through the urethra. Once bacteria enters the urethra it travels upward causing infection in the bladder and sometimes other parts of the urinary tract.

Sexual intercourse is a common cause of urinary tract infections and the anatomy of women may make them more prone to infections since during sexual intercourse bacteria in the vaginal area could be massaged into the urethra by the motion of the penis.

Women who change sexual partners or begin having sexual intercourse more frequently may experience more frequent bladder infections.

Another cause of bladder infections or UTI is holding back urine. The bladder is a muscle that stretches to hold urine and contracts when the urine is released. Waiting long causes the bladder to stretch beyond its capacity which over a period of time can weaken the bladder muscle. When the bladder is weakened it may not empty completely and some urine is left in the bladder which may increase the risk of urinary tract infection or bladder infection.

Another common source of infection is caused by catheters or tubes placed in the bladder.

Q. How is it detected?

  • Some people are more prone to getting a UTI than others.

  • Studies have also shown that women who use diaphragms for birth control may be at higher risk.

  • People with diabetes have a higher risk of infection because of changes in the immune system secondary to the high sugar concentrations.

  • Any abnormality of the urinary tract that obstructs the flow of urine (a kidney stone) increases the risk for an infection.

  • UTIs may occur in infants who are born with abnormalities of the urinary tract, which sometimes need to be corrected with surgery.

Q. What happens when Undescended Testis is not corrected?

The most commonly occuring symptoms are:

  • A strong persistent urge to urinate.

  • Frequent urination, a painful, burning feeling in the urethra during urination.

  • Often, women feel an uncomfortable pressure above the pubic bone, and some men experience a fullness in the rectum.

  • The urine itself maybe cloudy or reddish if blood is present.

The most commonly occuring symptoms are:

  • Acute pyelonephritis may cause flank pain, high fever, severe chills and nausea or vomiting.

  • Cystitis may result in pressure in the lower abdomen and strong-smelling urine.

  • Urethritis may lead to pus in the urine. In men, urethritis may cause penile discharge.

Q. What is the right time to operate and bring down the testis (Orchidopexy)

A urinalysis, to look for ‘pus’ cells in the urine can be helpful in diagnosing UTI.

In some patients Ultrasound examination of the kidney maybe necessary to rule out any infection of the kidney.

A dip stick test is also available and it can give diagnosis within a short period.

Another test that may be performed is called a voiding cystorography (VCUG). It involves instilling a chemical into the bladder and taking serial X-rays as the patient urinates.This test is usually undertaken if the UTI keeps occuring repeatedly in children.

If the above tests are positive a urine culture can reveal the infectionand types of bacteria causing the infection.

Q. How can Phimosis be treated ?

UTI is treated with antibiotics. Treatment of patients with recurrent infections varies depending on the cause.

Postmenopausal women may receive hormone replacement therapy.

People with an obstructive cause (e.g., kidney stone or enlarged prostate) may require surgical correction.

More Valuable information about Urinary Tract Infection…

Preventive measures

Drink at least two to three litres of fluid depending on whether you live in cold or warm area.

Make sure you get enough vitamin C in your diet. It makes the urine acidic, which in turn decreases the number of bacteria.

Void urine at 2-3 hour intervals.

Void urine before bedtime and after intercourse.

Cleanse the genital area with water before sexual intercourse.

Avoid using feminine hygiene sprays and scented douches, which may irritate the urethra.

Wipe from front to back to prevent bacteria around the anus from entering the vagina or urethra.

Avoid bubble baths and other chemicals in bath water.

Having good vaginal muscle tone is beneficial and may be achieved by doing Kegel exercises.

Q. What are the complications of Orchidopexy?

Accordion Content

Q. What are the chances of fertility after operation?

Accordion Content

Q. What is a retractile testis?

Accordion Content

Q. Can a normally descended testis go back up?

Accordion Content


Drugs In Importance




Drugs In Importance


Q. Do many people use viagra?

Viagra (sildenafil citrate) is by far the most widely used treatment for erectile dysfunction. In the United States, more than 5 million men have used it to improve their sexual function. Doctors in the United States have prescribed it more than 16 million times. And it is available in more than 90 countries worldwide.

Q. What are the precautions to be taken if I want to use viagra?

  • Sildenafil citrate is a prescription medication, so you’ll need to talk to your health care provider to find out if it’s right for you. Be sure to ask your health care provider if your heart is healthy enough to handle the extra strain of sexual activity. If you have chest pains, dizziness, or nausea during sex, stop and immediately tell your health care provider. Remember to protect yourself and your partner from sexually transmitted diseases.

Q. What are the side effects of viagra?

With viagra, the most common side effects are headache, facial flushing, and upset stomach. It may also briefly cause bluish or blurred vision, or sensitivity to light. In the rare event of an erection lasting more than 4 hours, seek immediate medical help. Remember to protect yourself and your partner from sexually transmitted diseases.

Q. How does viagra help in improving the performance?

Viagra, chemically known as sildenafil citrate is useful in producing erections by the following mechanism. When there is sexual stimulation, viagra causes smooth muscle relaxation and inflow of blood to the penis. This results in an erection and improves performance.

Q. Who should not use these drugs?

People who take nitrates for relief of chest pain should NOT take viagra because it can cause dangerous and life-threatening fall in blood pressure levels. Also if patients have hypersensitivity to any of the ingredients of the drug, they should avoid it.

Q. Who should take sildenafil citrate with caution?

Patients who have suffered a heart attack (myocardial infarction), patients having blood pressure less than 90/50 or more than 170/110, cardiac failure patients, people with deformities of penis, leukemics, patients suffering from sickle cell anemia and multiple myeloma

Q. What is erectile dysfunction?

This is the consistent disability to obtain or maintain an erection for satisfactory sexual reactions. This has replaced the earlier term impotence, which was in use.

Q. What is the stepwise treatment for erectile dysfunction?

Step one stabilize general condition of the patient. Step two treat correctable causes Step three initiate specific therapy oral sildenafil, transurethral alprostadil, injectable alprostadil, and use of vacuum devices. Step four penile implants or vascular reconstruction


Prostate Cancer



Introduction

As the name suggests, prostate cancer develops from cells of the prostate gland. The prostate gland is about the size of a walnut and is located in front of the rectum, behind the base of the penis, under the bladder. It is found only in men, and produces same of the seminal fluid, which protects and nourishes sperm cells. The prostate surrounds the upper part of the urethra, the tube that carries urine and semen out of the penis. Nerves located next to the prostate take part in causing an erection of the penis. When a person is affected by prostate cancer, the cancer cells may spread outside the gland to other parts of the body. Most prostate cancers grow very slowly and never cause symptoms or spread. Autopsy studies show that many elderly men who died of other disease also had a prostate cancer which neither they nor their doctor were aware of. But some prostate cancers can grow and spread quickly. The people most likely to get prostate cancer are men over age 50. Prostate cancer is the second leading cause of cancer death in men, exceeded only by lung cancer. It accounts for about 13 per cent of male cancer-related deaths. The cause of prostate cancer is not known. In the early stagers of prostate cancer usually there are no symptoms. Most prostate cancers are discovered during a routine rectal examination. In the later stages urinary obstruction may be observed accompanied by pain in the low back or pelvis from spread of cancer. Eighty-nine percent of men diagnosed with prostate cancer survive at least 5 years, and 63 per cent survive at least 10 years. Fifty-eight per cent of all prostate cancers are found while they are still confirmed to the prostate. Thirty-one per cent of prostate cancers have already spread locally (to tissues near the prostate) at the time of diagnosis. Treatments that remove or damage nerves located next to the prostate nerves can cause erectile dysfunction, also known as impotence. Although early diagnosis and treatment of prostate cancer may help some men to live longer, it has no impact on the life span of other men.

Prevention and risk factors

Although some factors increase a person’s risk of getting cancer, they do not always cause the disease. Many people with one or more risk factors never develop cancer, while others with this disease have no known risk factors.

While the causes of prostate cancer are not yet completely understood, researchers have found several factors that are consistently associated with an increased risk of developing this disease. Prostate cancer seems to run in some families, suggesting an inherited or genetic factor. Having a father or brother with prostate cancer usually doubles a man’s risk of developing this disease. The risk is even higher for men with several affected relatives, particularly if they were young at the time of diagnosis.

The chance of having prostate cancer increases rapidly after age 50. More than 80 per cent of all prostate cancers are diagnosed in men over the age of 65.

Some studies suggest that men who eat a lot of fat have a greater chance of developing prostate cancer. Other research indicates that men with a high-fat diet ten to cat fewer fruits and vegetables and more dairy products, and that these factors may be responsible for increasing risk rather than the amount of fat itself. Lycopenes, which are found in especially high levels in some fruits and vegetables (such as cooked or raw tomatoes and watermelon) also seem to lower prostate cancer risk. These vitamin-like substances are antioxidants that help prevent damage to DNA and may help lower prostate cancer risk. The mineral selenium also seems to lower the risk of prostate cancer. Recent research also suggests that a diet high in calcium and low in fructose (fruit sugar) increases the risk of prostate cancer.

Regular physical activity and maintaining a healthy weight may help reduce prostate cancer risk.

Men who have had a vasectomy may have an increased risk for prostate cancer. Some studies have found that prostate cancer develops one to two times more often in these men, but other studies found no difference in prostate cancer risk. Some studies that noticed an increase in risk found that this risk is highest in men who were younger than 35 when they has a vasectomy.

The role of vitamin supplements in reducing prostate cancer risk is not entirely certain, but some studies suggest that taking 50 mg of vitamin E daily can lower risk by 32 per cent. Although other studies found vitamin E to be of no benefit, reasonable doses of this vitamin have no significant side effects.

Some other studies suggest that taking vitamin A supplements may actually increase prostate cancer risk. As always, vitamin supplements should be used with the consent of a doctor. What causes prostate cancer

What causes prostate cancer is still not known exactly but, researchers have found some risk factors and are making progress toward understanding how these factors cause cells in the prostate gland to become cancerous.

During the past few years, scientists have made great progress in understanding how certain changes in DNA can cause normal prostate cells to grow abnormally and form cancers. DNA is the chemical that carries the instructions for nearly everything our cells do. We usually resemble our parents because they are the source of our DNA. However, DNA affects more than our outward appearance. Some genes (parts of our DNA) contain instructions for controlling when cells grow and divide.

Certain genes that promote cell division are called oncogenes. Others that slow down cell division or cause cells to die at the appropriate time are called tumour suppressor genes. It is known that cancers can be caused by DNA mutations (defects) that turn on oncogenes or turn off tumour suppressor genes. Some people with certain types of cancer have DNA mutations they inherited from a parent. Researchers have recently found that inherited DNA changes in certain genes make them more likely to develop prostate cancer. These genetic changes appear to be responsible for about 10 per of prostate cancers.

DNA mutations related to prostate caner usually develop during a man’s life rather than having been inherited before birth.

There is evidence that development of prostate cancer is linked to increased levels of certain hormones. High levels of androgens (male hormones) may contribute to prostate cancer risk in some men. Researchers have recently noted that men with high levels of another hormone, insulin-like growth factor-1 (IGF1), are more likely to develop prostate cancer.

Detection and symptoms

Some prostate cancers may be found because of symptoms such as slowing or weakening of the urinary stream or the need to urinate more often. These symptoms, however, can also be caused by benign diseases of the prostate. Symptoms of advanced prostate cancer include blood in the urine, impotence, and pain in the pelvis, spine, hips, or ribs. These symptoms, again, may also be present with other diseases.

SOME TESTS FOR PROSTATE CANCER


1. CONSERVATIVE MANAGEMENT

It is usually the treatment of choice for small stones in the kidney and ureter. Most of such stones pass spontaneously in the urine without any need for intervention. The probability of a stone passing down spontaneously will depend upon the size of a stone, it�s location, shape etc. Such patients can be treated with anti-biotics and analgesics to feel symptomatically better. Oral dissolution agents can also be given for a considerable length of time. The patient is generally instructed to maintain a high fluid intake ranging from 2 to 3.5 litres/day.

If a patient has severe abdominal pain associated with vomiting and fever, then admission is usually required and intra-venous fluids may have to be given. If this does not help, then the stone may have to be removed by endoscopy. Some cases where the stone causes severe obstruction and infection then a procedure called DJ stenting has to be done to receiver obstruction. DJ stenting ie the process of inserting a synthetic tube between the kidney and the ureter. If this does not help a tube has to be passed directly into the kidney to drain the infected urine.

2. EXTRA CORPOREAL SHOCK WAVE LITHOTRIPSY

  • Extracorporeal Shock Wave Lithotripsy Advanced technique in stone removal Extracorporeal shock wave lithotripsy is recognized world wide as the most effective mode of treatment for kidney and ureteric stones.It is a highly scientific technique employing focused shock waves for breaking urinary stones into fine particles.This technique was introduced in 1980 by a German company. Ever since the introduction,of this technique,it has been successfully used by Doctors in USA,Europe and other areas of the world ,for the treatment of urinary stones.

  • It is a non operative technique with no necessity for anaesthesia and involves minimal pain.Unlike the earlier open operation treatment, ESWL does not involve any cutting of tissues and no scars are left after the procedure.

  • The ESWL procedure usually lasts for about 40 minutes.But depending on the size and number of stones,more than one session may be required for proper breaking of the stones.

  • Patients may be required to remain in the hospital for a day for observation. After the procedure the patient is advised to drink plenty of fluids.This helps in the passage of stone fragments in the urine.In some cases, certain other procedures may have to be adopted to facilitate full removal of the stone fragments.

3. URETEROSCOPIC STONE REMOVAL

It is ideally suited for stones in the lower portion of the ureter. It involves the passage of an instrument namely ureteroscope through your urinary passage. The instrument is as thick as a pen and is about 40 cm long. You may have to be admitted in the hospital for a few days (2-3 days) for this procedure and it has to be done under anesthesia.

A variety of other instruments can be passed in through the scope which can be used to break the stones and remove them. Very rarely it may so happen that the stone cannot be removed by this method in which case open surgery may be needed.

4. PERCUTANEOUS NEPHROLITHOTRIPSY

This procedure is ideally suited for very large calculi within the kidney and the upper ureter. In this procedure, a puncture is directly made on to the kidney, the stone is seen with a telescope, broken into fragments and the fragments removed. In some cases, it may not be possible to remove the entire stone. So a combination of other procedures like ESWL has to be done to ensure that the stone is completely removed.

5. OPEN SURGERY

With the advent of new technologies to treat stone disease, the need for open surgery has been drastically reduced. But in some cases it might be required. The type of open surgery will depend upon the site and size of the stone within the urinary tract.