Aarogyam Superspeciality Hospital & Research Center

URINARY / KIDNEY STONE

Hardened mineral deposits formed in the kidney are called urinary or kidney stones (calculi). These originate as microscopic particles and over the course of time develop into stones. Medically this condition is known as nephrolithiasis or renal stone disease. The kidneys filter waste products from the blood and add them to the urine. When waste materials in the urine do not dissolve completely and the kidney is unable to evacuate them, crystals and kidney stones are likely to form. Some stones may pass out of the kidney or get lodged in the ureter (tube that carries urine from the kidney to the bladder) and cause severe pain that starts from the low back and radiates to the side or groin. A lodged stone can block the flow of urine and build a backpressure in the affected ureter and kidney. Increased pressure results in stretching and spasm causing severe pain.

Sign & Symptoms of Kidney and Ureteric stones (Urinary Stone)

Small and smooth kidney stones may remain in the kidney or pass without causing pain (called "silent" stones). Stones that lodge in the ureter (tube that carries urine from the kidneys to the bladder) cause spasm in the urinary system and produces pain. This pain is unrelated to the size of the stone.

Other symptoms of kidney stones may include the following:

Blood in the urine
Increased frequency of urination
Nausea and vomiting
Pain and burning during urination
Fever, chills, loss of appetite
Urinary tract infection

Diagnosis of Kidney Stone

Laboratory Tests

>Complete Blood Count
>Kidney Function Test
>Urine Routine & Microscopy

Ultrasound

>Whole Abdomen with Kidney, Ureter & Bladder (KUB)
>X-Ray KUB
>Intravenous Pyelogram (IVP)

Kidney Stone (Urinary Stone) Treatment

Extracorporeal Shock Wave Lithotrispy (ESWL)

uses highly focused electromagnetic or Electrohydraulic waves projected from outside the body to crush kidney stones anywhere in the urinary system. The stone is reduced to sand-like particles that can pass in the urine. Large stones may require more than one session. It can be used for patients of all age groups and those who have heart and breathing problems. However, the procedure is contraindicated for pregnant women.

Percutaneous Nephrostolithotomy (PCNL)

is performed under General or spinal anaesthesia. Percutaneous (through skin) removal of kidney stones (lithotomy) is accomplished through the most direct route. A telescope along with the mechanical lithotripter is inserted to break the stone into fine particles so as to achieve a stone-free status in large and complicated stones. This procedure usually requires hospitalization, and most patients resume normal activity within 2 weeks.

UreterorenoscopicLithotrispy with Holmium Laser

is performed under spinal anaesthesia to treat stones located in the kidney or ureter. A small, fibre optic instrument (ureteroscope) is passed into the ureter. Large stones are fragmented using 100-Watt Coherent Holmium Laser. The laser fragments the stone into sand like particles, which are then flushed out through the natural urinary passage. The advantage of Holmium Laser is its ability to fragment stones of all compositions with precision. Thus, it is the most effective laser for the treatment of urinary stones. Patients are generally admitted on the same day of the treatment and are discharged next day, which means only 24 hours of hospitalization is required.

ENALARGED PROSTATE (BPH)

Enlarged Prostate or Benign Prostatic Hyperplasia (BPH) is mistaken to be simply a case of too many prostate cells. But, in fact, there is no cure for BPH and once prostate growth starts, it often continues, unless medical therapy is started. The prostate gland grows in two different ways. In the first type of growth, the cells multiply around the urethra and squeeze it, much like you can squeeze a straw. The second type of growth is the middle-lobe prostate growth, in which the cells grow into the urethra and the bladder outlet area. This type of growth typically requires surgery.

Sign & Symptoms of Enlarged Prostate (BPH)

Straining to void
Blood in the urine (i.e. hematuria), Dribbling after voiding
Feeling that the bladder has not emptied completely even after urination
Frequent urination, particularly at night (nocturia)
Hesitant, interrupted or weak urine stream caused by decreased force
Leakage of urine (overflow incontinence)
Pushing or straining to begin urination
Recurrent, sudden, urgent need to urinate
In severe cases of BPH, Acute Urinary Retention (inability to urinate) may result. It causes severe pain and discomfort. Catheterization may be necessary to drain urine from the bladder to obtain relief.

Kidney Cancer

WHAT IS KIDNEY CANCER

Kidney Cancer - also called renal cancer is a disease in which kidney cells become malignant (cancerous) and grow out of control, forming a tumor. Almost all kidney cancers first appear in the lining of tiny tubes (tubules) in the kidney. This type of kidney cancer is called renal cell carcinoma. The good news is that most of kidney cancers are found before they spread (metastasize) to distant organs. And cancers caught early are easier to treat successfully. However, these tumors can grow to be quite large before they are detected.

Kidney Cancer – Sign & Symptoms

Blood in the urine (urine slightly rusty to deep red)
Pain in the side that does not go away
A lump or mass in the side of abdomen
Weight loss
Fever
Feeling very tired or having a general feeling of poor health

Causes of Kidney Cancer

Smoking . If you smoke cigarettes, your risk for kidney cancer is twice that of nonsmokers. Smoking cigars may also increase your risk.
Being male. Men are about twice as likely as women to get kidney cancer.
Being obese. Extra weight may cause changes to hormones that increase your risk.
Using certain pain medications for a long time. This includes over-the-counter drugs in addition to prescription drugs.
Having advanced kidney disease or being on long-term dialysis, a treatment for people with kidneys that have stopped working Having certain genetic conditions, such as von Hippel-Lindau (VHL) disease or inherited papillary renal cell carcinoma Having a family history of kidney cancer. The risk is especially high in siblings.
Being exposed to certain chemicals, such as asbestos, cadmium, benzene, organic solvents, or certain herbicides Having high blood pressure. Doctors dont know whether high blood pressure or medication used to treat it is the source of the increased risk. Being black. The risk in blacks is slightly higher than in whites. No one knows why.
Having lymphoma. For an unknown reason, there is an increased risk of kidney cancer in patients with lymphoma.

PROSTATE CANCER

Adenocarcinoma of the prostate is the clinical term for a cancerous tumor on the prostate gland. As prostate cancer grows, it may spread to sac-like structures attached to the prostate (seminal vesicles), to tissues near the prostate, the interior of the gland, and to distant parts of the body (bones, liver, lungs, etc).
The prostate gland is located in the pelvis, below the bladder, above the urethral sphincter and penis, and in front of the rectum in men. It is made up of glandular tissue and muscle fibers that surround a portion of the urethra. The gland is covered by a membrane (called the prostate capsule).

Sign & Symptoms of Prostate Cancer

Blood in urine or semen
Frequent urination, especially at night
Inability to urinate
Nagging pain or stiffness in the back, hips, upper thighs, or pelvis
Painful ejaculation
Pain or burning during urination (dysuria)
Weak or interrupted urine flow

URINARY BLADDER CANCER

Urinary Bladder is a hollow bag located in the pelvis, that collects and stores the urine from kidneys. When the normal body cells multiply, they form an abnormal area of cells, called tumour.
Bladder cancer is classified by how deeply they invade the bladder wall. Superficial bladder cancer is limited to innermost lining of the bladder. Invasive bladder cancer is the one which has penetrated the muscular layer of the bladder wall.
Along with classification, the grade of the tumour is based on the degree of abnormality of the tumour. Low grade tumors are less aggressive whereas high grade tumours are dangerous. Stage CIS: Flat cancer limited to the innermost lining of the bladder. It is high grade. Stage T1: Cancer penetrated into the submucosal tissue.
Stage T2: Cancer penetrated the muscular bladder wall.
Stage T3: Cancer penetrated through muscular bladder wall into the surrounding fat. Stage T4: Cancer penetrated into the adjacent structures (prostate, uterus, or vagina). Regional lymph nodes not involved yet.
Stage T1-4N1-2M1-2: Cancer spread out of abdomen/pelvic wall to lymph nodes or distant organs like liver, lungs, or bones.

Symptoms of bladder cancer

Blood in urine
Pain and/or burning during urination (dysuria)
Frequency, urgency
These symptoms are non-specific and may be linked with other conditions that are unrelated to cancer. Urinary bladder cancer often causes no symptoms until it reaches an advanced stage. If you experience, any of these symptoms, you must see the doctor immediately.

Diagnosis of bladder cancer

physical examination
urinalysis
urine cytology
Ultrasonography
Cystoscopy and Biopsy
CT scan


Treatment depends upon the cancer type and stage.
Most widely used therapies are surgery, radiation therapy, chemotherapy, alone or in combination.
Immunotherapy or biological therapy is used in some patients at stage CIS and T1.

URETHRAL STRICTURE

Urethral stricture is the abnormal narrowing of the urethra (tube that releases urine from the body).
Urethral stricture may be caused by inflammation or scar tissue from surgery, disease, or injury. It may also be caused by external pressure from an enlarging tumor near the urethra, although this is rare.

Risk Factors: Increased risk is associated with men who have a history of sexually transmitted disease (STD), repeated episodes of urethritis. There is also an increased risk of urethral stricture after an injury or trauma to the pelvic region. Any instrument inserted into the urethra (catheter or cystoscope) increases the chance of developing urethral strictures.

Sign & Symptoms of Urethral Stricture

Dysuria (painful urination)
Difficulty in urinating
Spraying of urine stream
Decreased urinary output
Increased urinary frequency or urgency
Incontinence
Lower abdominal pain
Bloody or dark urine
Discharge from urethra
Swelling of penis, testes, scrotum
Urinary retention
Recurrent infections of urinary tract
Physical examination may reveal the following:
Redness or swelling of penis, scrotum, testis
Urethral discharge
Enlarged or tender prostate
Distended bladder
Hardness (induration) on the under surface of penis
However, sometimes the exam may reveal no abnormality.

Diagnosis of Urethral Stricture

Blood in urine
Pain and/or burning during urination (dysuria)
Frequency, urgency
These symptoms are non-specific and may be linked with other conditions that are unrelated to cancer. Urinary bladder cancer often causes no symptoms until it reaches an advanced stage. If you experience, any of these symptoms, you must see the doctor immediately.

Treatment of Urethral Stricture

The treatment comprises of the placement of a suprapubic catheter, which allows the bladder to drain urine through the abdomen. It may be necessary to reduce acute problems such as urinary retention and infection.
Surgical options vary depending on the location and length of the stricture.
Visual internal urethrotomy may be all that is needed for small stricture. A urethral catheter is left in place after the procedure.
Open urethroplasty may be performed for long strictures by removing the affected portion or replacing it with another tissue. The results vary depending on the size and location of stricture, prior therapies and the experience of the surgeon.
There are no drug regimes currently available for urethral strictures. If all other treatment choices fail, urinary diversion -appendicovesicostomy (Mitrofanoff procedure) - may be performed to allow the patient to perform self-catheterization of the bladder through the abdominal wall.
The results of the treatment depend upon the characteristics of the stricture viz. its length, degree of fibres, associated infection, and previous surgeries. Urethral stricture may totally block the urine flow, causing acute urinary retention, a condition that must be relieved quickly.
Bladder Stones, infections of genitourinary tract, rarely malignancies. Practicing safe-sex behavior may decrease the risk of contracting sexually transmitted diseases and subsequent urethral stricture.
Early treatment of urethral stricture may prevent complications such as kidney or bladder infection or damage.

MALE SEXUAL DYSFUNCTION

Sexual dysfunction refers to a problem during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity. The sexual response cycle has four phases: excitement, plateau, orgasm and resolution.

Sign & Symptoms of Male Sexual Dysfunction

Lack of sexual desire, sexual fantasies, or interest in sexual contact
Inability to have or maintain any erection
Inability to have or maintain an erection sufficient for sexual functioning
Inability to reach an orgasm despite adequate sexual stimulation and signs of arousal
Ability to achieve orgasm only during masturbation or during oral sex
Difficulty controlling the timing of orgasm and ejaculation, so that it occurs very early in sexual contact, leaving the other partner dissatisfied
Lack of ejaculation
Persistent erection unassociated with sexual desire

Treatment of Male Sexual Dysfunction

Treatment of Male Sexual Dysfunction

MALE INFERTILITY

Male infertility refers to the inability of a male to make a fertile female pregnant. It is usually due to semen deficiencies.
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.


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