Urology is a surgical speciality which deals with diseases of the urinary/reproductive tracts in men and with urinary disease in women. The urinary tract includes kidney, ureter, bladder and prostate in men.
The various diseases of the urinary tract that are treated by a urologist:
As we all know Kidney removes waste product from the blood in the form of urine. Kidney stones or calculi get formed when chemicals in the urine become concentrated to the point that they form solid crystals. Smaller stones pass out on their own however larger stones might become lodged in the urinary tract causing severe pain, blockage or infection.
There are various kinds of kidney stones, caused due to accumulation of calcium, ammonia(struvite stone), uric acid or cystine(cystinuria). Some of the common risk factors associated with these are as follows:
- Drinking less water
- Genetic factors esp cystinuria (runs in the families)
- Urinary tract infections esp struvite stone
- Gout or chemotherapy esp in the case of uric acid stones
- Some kinds of medications
Mostly associated with a severe cramping pain in the lower back or side. The pain usually moves down towards the abdomen, groin or genitals as the stone moves down the urinary tract. Some of the other symptoms may include:
• Nausea and vomiting
• Cloudy or bloody urine
• Increased urinary frequency
- Physical examination
- Abdominal CT scan/ultrasound
- Blood tests to check calcium, phosphorus, uric acid, and electrolyte levels
- Kidney function tests
• Being located in the geographic stone belt of the world, large population in North India is suffering from urinary stone disease. Stones are usually formed in kidneys but may migrate in ureter or bladder and cause symptoms like pain, blood in urine or burning during urination.
• For Kidney stone PCNL (Per Cutaneous Nephro Lithotripsy) is a minimally invasive urological procedure where through a small key hole Puncture in the Lumber region the kidney is approached and a telescope of pen size is inserted into the kidney and the stone is broken under direct vision using Holmium Laser. These broken stone fragments are then removed through the same passage. Now a days PCNL in the form of 5mm, miniperc is also being done.
• For the stones in ureter or bladder, the telescope is inserted through urethra (URS / FLEXIBLE URS) and stones are broken with Holmium Laser and then removed.
• Small stones upto 1.5cm in the kidney now can be removed without any puncture by RIRS (Retrograde Intrarenal Surgery)
Enlargement of Prostate gland (BPH)
• Almost 60% of men at the age of 60 years and almost all the men at the age of 90 years would have some degree of prostatic enlargement. However, only about two thirds of these, would have any symptoms pertaining to enlarged prostate. These symptoms comprise of increased frequency of urination, hesitancy in passing urine, sense of incomplete evacuation of urine, poor urinary flow, as well as retention of urine.
• 10 to 20% of symtomatic BPH patients who do not get relief with medicine need surgical removal of prostate. For the last half a century, Trans Urethral Resection of Prostate, popularly known as TURP is minimally invasive surgical method for the treatment of the enlarged prostate gland. Since last decade, Laser Prostatectomy is a novel innovation and is rapidly replacing TURP operations at most advanced urological centres worldwide. Laser prostatectomy using 100 watts Holmium Laser is called HOLEP (Holmium Laser Enucleation of Prostate). Laser treatment of prostate cancer has several advantages over TURP in the form of less blood loss, shorter hospital stay.
o The procedure is almost blood less when compared to the TURP; hence there is no need for blood transfusion even during treatment of very large prostate glands.
• The post-operative duration of indwelling catheter is much less than that required for conventional TURP and hence the patient may be sent home much earlier.
o Early discharge from hospital further facilitates quicker recovery and earlier resumption of usual productive work.
Tumours (Prostate Cancer) of the various organs of urinary tract:
• Cancers affecting the urinary organs are fairly common. The common cancer of urogenital tract includes
o Kidneys & ureters
o Urinary Bladder
• Most of these cancers require a well planned and executed surgical extirpation as this forms the primary determinant of outcome for the patient. At PSRI we offer laparoscopic advanced Prostate Cancer Treatment in Delhi. PSRI Hospital happens to be the proud record holder for removal of world’s heaviest kidney tumour (Limca book of records).
• Few patients of cancer may require CHEMOTHERAPY in post-operative period or early if detected in advanced stage. This is also available and done under supervision of Medical Oncologist
Infections of the urinary tract
• Urinary tract infections are very common especially in women and Diabetes. If this is not adequately treated, can become chronic, and then it is very disturbing for the patient as this severely hamper their quality of life. Detailed investigation and treatment of these patients can give them back to the normal healthy life that they deserve.
• Neglected cases of urinary tract infections could lead to sepsis or permanent damage to kidneys causing ‘kidney failure’ (Renal failure).
• Prostatic infection in men can also become chronic if not adequately treated and then require prolonged specialized treatment and care.
Urogynaecology: Urinary diseases of women
• A range of urinary symptoms like increased frequency of urination, urgency, incontinence or leakage of urine unnoticed or on coughing and straining, painful urination etc. need to be evaluated in detail, to arrive at a definitive diagnosis. There is a facility at PSRI hospital where a team of urologist and gynaecologist evaluate the urinary symptoms of female patients in the ‘Urogynaecology clinic’ and most of the time these patients do better with the medicines only.
• Cases of injury to the urinary tract of women during childbirth or gynecological operation (vesicovaginal fistula, Ureterovaginal Fistula) need surgical repair. Women with Stress incontinence need various sling operations to save them of the misery of urinary incontinence.
Congenital anomalies (Birth defects) of organs of urinary tract
• Some children are born with the structural or functional abnormalities of the urinary tract organs. Common congenital urological disorders are UPJ obstruction, vesico ureteric reflux posterior urethral valve, exstrophy, epispadias and Hypospadias. These children need careful evaluation and planning of surgical correction of such abnormalities.
Neurogenic bladder in patients of spinal cord injury
Damage to the nerves carrying sensation from the urinary organs to the brain could result in difficulty in controlling the act of urination voluntarily. Such situations frequently occur in patients with spinal cord injuries. These patients deserve special attention to their urinary tracts so as to make the process of urination under better control and protect the kidneys from any damage
• It is now well known that overall in about half the number of infertile couples, males are equally responsible for the failure to reproduce. Therefore, more and more men are being diagnosed with a cause of infertility and they need to be seen by an appropriate specialist, the andrologist. There are some surgically correctable disorders which can restore fertility in males.
Male sexual dysfunction
• A good andrologist, by conducting a few tests, can arrive at a precise diagnosis in each case and thus plan a proper treatment. The treatment consists of medication and counselling sessions. However, in resistant and difficult cases, surgical implantation of silicone devices (penile implant) may be necessary .These devises can be inflated to provide rigidity of the male organ, enabling it for performance of the sexual act.
Andropause- Male menopause
• Ageing in men and its sequelae vary greatly among different individuals. One major problems that are faced by aging men is sexual dysfunction most commonly loss of interest or decreased libido. This clinical condition though not uncommon, is often missed in the practice. High index of clinical suspicion, which should arise out of the various causes, is the key to diagnosing Andropause.
• Assessment and treatment (replacement of testosterone hormone in form of injection or gel/patches/tablets) of these individuals helps in the improving the quality of life and reduce the effects of aging process