Early Detection of Cancer Bladder

Just like cancer on any other part of the body, when the lining cells of the bladder grow in  a disordered, uncontrolled way to form a mass, it is called bladder cancer. Bladder cancer can be successfully managed when detected early. Certain symptoms may be suggestive of bladder cancer like blood in the urine which may or may not be associated with pain. The urine will appear pink, red, or brownish in color depending upon the amount of blood discharge. Other symptoms that have to be noticed are urinary irritation, increased urge to urinate, pain or  burning sensation while urinating, or sometimes even difficulty passing urine.

In case you experience any such symptoms, it is important to have a detailed medical check up including urine analysis, urine cytology, cystoscopy, imaging tests like ultrasound, CT scan, MRI scan etc. as soon as possible. Treatment for bladder cancer depends on the stage of cancer, type and the overall health of the individual. Some options are:

•     Surgical removal of the tumor cells
•     Chemotherapy and Radiation therapy  to destroy cancer cells
•     Immunotherapy to boost the body’s ability to fight cancer

Later stages of bladder cancer may present greater challenges for the patient as well as the medical team. Thus, it is important to diagnose it at an early stage. It should also be remembered that bladder cancer has the risk of recurrence and should always be followed up at regular intervals to prevent remission.

Reviewed By: Dr Mahendra Jain

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Stress Urinary Incontinence (SUI)

 What is Stress Urinary Incontinence?

Sudden uncontrollable leak of urine with sudden increase in intra-abdominal pressure like coughing and sneezing.

A patient who complains of an involuntary or sudden passing of urine is said to be suffering from Urinary Incontinence. The sudden passing of urine could be due to any effort generated by sudden forceful bodily actions like coughing, sneezing, exercising and laughing, and is termed as Stress Urinary Incontinence. This disorder is the most common urinary incontinence in women.

What are the main causes of Stress Urinary Incontinence?

The main cause is weakness in pelvic floor muscles that support the pelvic organs. The factors primarily causing this condition could be due to various reasons or habits formed over a period of time, such as:

•     Increasing Age
•     Obesity
•     Prostate surgery
•     Smoking, as it causes cough
•     Prolapse
•     Hormonal deficiencies
•     Constipation
•     Pregnancy

How is Stress Urinary Incontinence treated?

The treatment that you need to undergo would depend on the causes of your problem. Your doctor will plan your treatment depending on the level or stage of your disease. You may be required to undergo a combination of lifestyle alterations and medication.

1. Behavioural Therapy

    By bringing small changes in your lifestyle, you may be able to reduce the stress incontinence episodes. Your doctor may advise you the following:

• Weight loss, if you are over weight
• Proper and sufficient Fluid Intake
• Physiotherapy - Pelvic Floor Exercises
• Cut back on smoking
• Reduce caffeine intake

    2.  Medication

    Though there still aren’t many options when it comes to medicines, many doctors recommend dulaxitin, however it must be kept in mind that no medicine should be taken without your doctor’s prescription/consultation.

    3. Surgery

 A severe case of stress incontinence that interferes with your everyday activities may be treated through surgery. A qualified surgeon would be able to explain to you the available options.

If you or someone you know is suffering from Stress Urinary Incontinence, immediate medical help must be sought so that timely diagnoses can be made and the best solution can be worked upon.

Reviewed By: Dr Mahendra Jain

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Retrograde ureteroscopic Intrarenal Surgery ( RIRS ) for kidney stone removal

Kidney stones are hard deposits of waste products of the human body like uric acid or minerals like calcium. Usually, they are very small and naturally flush out of the body, but some grow bigger as the minerals accumulate, and if they block the urinary tract, they can be very painful. They may then need to be surgically removed. 

Surgery would be advised when the stone is too large to flush out by itself; it is blocking the urine flow out of the kidney or is extremely painful and is causing urinary infections.

Retrograde ureteroscopic Intrarenal Surgery (RIRS) is one of the methods used these days. With advances in technology, RIRS has become a safe and efficient option. RIRS can be used as primary treatment for patients with stones smaller than 2 cm. It is also used for those with obesity; muscular and skeletal deformities and bleeding disorders.

This procedure, done under general anaesthesia, involves inserting a flexible endoscope called a ureteroscope through the urinary opening into the bladder, through the ureter into the kidney. This is ‘Retrograde’ as it moves up the urinary system and ‘Intrarenal’ as it enters the kidney. 

The stones are then viewed through the scope and either grabbed with an extremely tiny forcep, also inserted the same way, and then gently pulled out; or, vapourised using a laser probe.

RIRS should be performed by an endourologist, a urologist specialising in the diagnosis and treatment of diseases of the kidneys, ureter and bladder.

RIRS can be considered much superior to others, with its less complicated methods; causes fewer medical complications; has a good stone-free rate and the patient can leave the hospital in a day and restart normal life within two or three days.

Reviewed By: Dr Mahendra Jain

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Radical Perineal prostatectomy: What You Should Know?

Radical perineal prostatectomy is a surgical procedure performed to completely remove the prostate gland through a small incision in the perineum, the area between the anus and the scrotum. This procedure is typically carried out on men with prostate cancer that has not spread and involved other organs of the body. 

Radical perineal prostatectomy is rarely used than other surgery such as the open radical retropubic prostatectomy or the robot-assisted laparoscopic radical retropubic prostatectomy. Just like the retropubic approach, a radical perineal prostatectomy achieves the same rate of cure when the cancer is small and confined to the prostate. However, less blood is lost and provides quick recovery. One downside to the perineal approach is an increased risk of fecal incontinence.

Advantages of radical perineal prostatectomy

RPP provides patients with several benefits, including:

•     Shorter operating time 
•     Short hospital stay 
•     Low blood loss
•     Equally low rate of surgical complications
•     Short recovery period
•     Lower rates of urinary incontinence
•     Preservation of erectile function

Who is not suitable for radical perineal prostatectomy?

Radical perineal prostatectomy is not suitable for men with conditions that limit correct positioning during the procedure. These conditions are:

•     Ankylosis,
•     Unstable artificial hip replacement, 
•     Severe arthritis of the joints in the pelvis

Having very large prostates is also a technical challenge. However, the size can be reduced to aid surgical removal by hormone therapy before surgery.  

Lympg node sampling can not be done in radical perineal prostatectomy, which can be considered as a drawback of this procedure.

A discussion with expert professionals can help you to choose the right method. Factors, such as a man’s life expectancy and other comorbidities, are also taken into account while considering the procedure

Reviewed By: Dr Mahendra Jain

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Renal calculus/ kidney stones

Kidney stones are deposits of crystals of oxallates, calcium or uric acid that form inside the kidneys. It is also known as a renal calculus. Kidney stones could be either small or big. These are classified based on their location in the kidney, ureter, or bladder. Kidney stones are mainly caused due to less intake of fluids and high dietary intake of animal protein, sodium, refined sugars, and related products.

Kidney stones can be quite painful, but usually, the stones will not cause permanent damage if identified and treated on time. Small stones can be treated by certain medications and drinking a lot of water will pass a kidney stone. For larger stones , doctors would suggest surgery.

Medical care
Treatment for kidney stones depends on the size of the stone and the cause of it. Medical management is mainly by increasing water intake, dietary restrictions of animal protein and food rich  in calcium and oxallates , reduction of carbonated soft drinks.

The various procedures to break down the kidney stone would be as follows:

Extracorporeal Shock Wave Lithotripsy (ESWL) - This is one of the most common treatments recommended by the doctor to break kidney stones. Shockwaves are used to break the kidney stone so that it can easily pass through the urinary tract. It is a opd procedure. No anaesthesia is required for the procedure.  All the people will be able to return to their routine activities on the same day.

Percutaneous Nephrolithotomy (PCNL) - This is a procedure where a tiny tube known as nephrostomy is placed trough the kidney from the small incisions made from the back. The kidney stones are removed with the help of other instruments passed from the nephrostomy tube. Doctors suggest PCNL for large, complex  large stones or for patients who have the presence of nephrostomy or unique anatomic problems in their urinary tract .

Ureterorenoscopic Lithotripsy - URS or ureteroscopy is a versatile form of stone therapy. Doctors use special laser fibers, or machanical lithotripter which can be deployed through the ureteroscope to break the stone. If there are any stone fragments, then the doctor would use special baskets that will be deployed through the ureteroscope to retrieve the stones. URS is usually used to remove the stones from the ureter, especially the lower ureter.

Retrograde Intrarenal Surgery with Holmium Laser (RIRS) - without any incisions, doctors could perform the surgery inside the kidney. Doctors would put the RIRS instruments through the body’s natural opening, through the bladder and the ureter, and finally into the kidney. Then stones are fragmented by LASER . RIRS can be used to remove kidney stones, kidney tumors, and strictures.

Open nephro/pyelolithotomy - this was one of the procedures to remove the stones within the renal pelvis. When ESWL and PCNL are not feasible, like in very large stones doctors used to perform pyelolithotomy to break the stones.

For complex or large stones, doctors would suggest URS, ESWL, and PCNL. At times certain stones would require a combination of two or more treatment modalities.

Reviewed By: Dr Mahendra Jain

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What can I expect after a laser prostate surgery?

Before asking what to expect after, one should know what the surgery is. 

The doctor inserts a tube through the patient's urinary tube (urethra), the prostrate surrounds the urethra. A laser is passed through this tube, to deliver concentrated light energy to generate precise and intense heat. It is this intense heat that shrinks and removes the excess tissue that is preventing the flow of urine. This is called Laser Transurethral Resection of the Prostate or LASER TURP.

What are the benefits?

1. It is a blood less surgery. That is an immediate advantage over conventional surgery. Cardiac patients who are on blood thinners like Ecosprin and clopidogrel can also undergo it safely.
2. LASER TURP is done with normal saline. Thus problems of excessive water absorption and complications of normal TURP is completely avoided.
3. Foleys catheter can be removed a day earlier than conventional TURP and thus less hospital stay.
4. Regrowth of the prostate tissue is very minimal with Laser TURP and thus low recurrence rates.
5. Post-surgery irritation in the prostate area is more in LASER TURP but it is only for short time.
The surgery may be expensive, but, it’s worth the obvious advantages.

What to expect afterwards?

1. Rarely Because of the swelling that may be block the urine flow, the patient may have to wear an urinary catheter for few days
2. There may be blood in the urine. This, however, is normal for the first few   days only
3. The patient may have irritating urinary symptoms like a need to urinate frequently for some time  only 
4. Urge Incontinence or difficulty holding urine.  This, however, improves in few weeks
5. The patient should avoid lifting weights for month
6. The doctor would also recommend against the patient engaging in sexual activities, at least, for several weeks.

Reviewed By: Dr Mahendra Jain
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Link Between Varicoceles and Male Infertility

Infertility in men is a result of multiple reasons such as endocrine diseases, infections, testicular tumor or damage, congenital causes, seminal abnormality, varicocele, and many unexplained factors. Among this varicocele is considered the most common correctable cause of male infertility. However,   varicocele doesn't require treatment in all men  and for some men with varicoceles can father children, even without intervention. Here, in this article, we are discussing the link between varicocele and male infertility.

 What are varicoceles?

 A varicocele occurs when one or more veins in the scrotum bulge, allowing blood to pool inside the scrotum. These veins are known as pampiniform plexus. This is similar to varicose veins that typically seen in the legs. In some men, varicoceles are identified as a bag of worms.

 Most often, men with varicoceles have no signs or symptoms. However, some may experience discomfort  or pain in the testes when they stand for long  or sit for an extended period. It is common among people who work standing like guards, post man, police man, military personals, and sales people. It is also very common in  men who work hard like machine tool workers, athletes, sportsmen, and men who work in hot areas like smithy foundry bakery and cooks.

 Varicoceles in men is quite common and usually doesn't require treatment. How ever if they cause pain in  the testes or interfere with fertility then treatment is required.

How are varicoceles diagnosed?
Varicoceles are often diagnosed through self-exam of the scrotum. The patient will be asked to stand for a while so that the urologist can check the scrotum, varicocele is felt as ‘bag of worms’ just above the testes. Cough impulse can be felt in these veins.

A urologist may suggest for a scrotal ultrasound Doppler test. This is to get an exact picture of your scrotum. An ultrasound reveals the images of those veins that are wider than 3 millimeters with blood flowing the apposit way. The ultrasound can also show the size of the testicles. These are useful in deciding the severity and the treatments needed.

How can varicoceles affect fertility?

• Varicoceles can occur in 15% of all men, and 40% of men seeking treatment for infertility have the condition. Many men often don't know that they have varicoceles until they approach for infertility treatment.
• A varicocele can contribute to infertility as the pooled blood caused by the varicocele raises the temperature in the scrotum and decreases sperm production and affects the quality of sperms. This high temperature in the testicles can damage the sperm and cause decreased sperm count, decreased motility of sperm, and an increase in the number of deformed sperms.
• Varicocele's effect on testicles over time will  reduce fertility. Men with prolonged cases of varicoceles may experience a condition known as testicular atrophy. A condition in which the testicles shrink and stop effectively producing healthy sperms.

What are the treatments for varicocele?

Most often, varicoceles don't require treatment. Treatment is offered when varicoceles cause

• Fertility problems
• Pain
• Abnormal semen analysis

After a thorough examination, your doctor will decide the treatment methods to reverse your varicocele. Your doctor may suggest both surgical procedures and nonsurgical treatment options. Microscopic Varicocelectomy is the surgical procedure that is recommended to treat varicose. That is the “Gold slandered” of varicocele treatment. This is a surgical procedure that involves tying off the veins that are causing the varicocele. Laparoscopic Varicocelectomy, minimally invasive option, and varicocele embolization are the other types of surgical procedures. All these methods can alleviate the varicocele and lead to improvements in sperm count and quality. Earlier the treatment better is  the recovery of the sperm quality. Thus it is prudent to get it treated atb the earliest.

If you are concerned about varicoceles or suspect that the reason behind your infertility issue is varicoceles feel free to contact Urology Hospital, Bangalore. Our expert Urologists help you to detect the severity of your varicoceles more precisely and determine the appropriate treatments.

Reviewed By: Dr Mahendra Jain
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