Department

Urology

The urinary and reproductive tracts are closely linked, and disorders of one often affect the other. Thus, a major spectrum of the conditions managed in urology exists under the domain of genitourinary disorders. Urology combines the management of medical (i.e., non-surgical) conditions, such as urinary tract infections and benign prostatic hyperplasia, with the management of surgical conditions such as bladder or prostate cancer, kidney stones, congenital abnormalities, traumatic injury, and stress incontinence.

Services
Doctors
Timetable

Kidney Stones

The Urology Department of Sree Lakshmi Hospital comprises a multi-service taskforce dedicated to the diagnosis, evaluation and treatment of urological disorders. It caters to both adults and children and includes intervention for chronic and acute conditions like renal failure. We have the combined benefits of rich medical expertise, advanced technology, up-to-date surgical facilities and a support staff dedicated to the welfare of patients. Our urologists have a wealth of experience in performing a range of minimally invasive procedures like laparoscopic surgeries for kidney and bladder complaints, laser endourology for kidney stones and prostate and uro-oncology surgeries for cancers of the cervix, bladder, prostate, kidney, testes, etc. We also treat male infertility and other problems related to reproductive organs. Our surgeons are also experts at reconstructive urology like renal transplants, etc.

Ailments & Treatments

Kidney Stone Treatment and Laser Stone Surgery

The Condition

Kidney stones or urinary stones, medically known as nephrolithiasis, are hardened mineral deposits that form in the kidney. Kidneys filter waste products of the blood into the urine. When the kidneys cannot discharge the waste particles, they accumulate within. Kidney stones first occur as microscopic particles, which grow into stones. Some stones may pass out from the kidney but get lodged in the ureter (the tube that carries urine to the bladder). This can interrupt urine flow and stretch the ureter. It can cause severe pain in the lower back, the sides and groin.
Symptoms of Kidney Stones:
  • Blood in the urine
  • Increased frequency of urination
  • Nausea and vomiting
  • Bladder neck incision
  • Pain and burning during urination
  • Fever, chills, loss of appetite
  • Urinary tract infection

Diagnosis

Laboratory Tests
  • Urine routine & microscopy
  • Kidney function test
  • Complete blood count
Ultrasound
  • Abdomen with Kidney, Ureter & Bladder (KUB)
  • X-Ray of KUB
  • Intravenous Pyelogram (IVP)

Extracorporeal Shock Wave Lithotripsy (ESWL)

In this procedure, concentrated electro-magnetic waves are used to disintegrate the kidney stones in the urinary system. The stone turns into small particles, which pass in the urine. Larger stones may require more than one session but ESWL can be used for all age groups, including patients with breathing and heart problems but may not be suitable for pregnant women. The 4th generation Siemens Lithotripter has an ultrasound attachment, which can detect radioluscent stones, which are not visible through fluoroscopy lithotripters.

Percutaneous Nephrostolithotomy (PCNL)

PCNL is performed under spinal or epidural anaesthesia. Percutaneous means “through the skin”; a telescope along with the lithotripter is inserted through the skin to neutralise the stone into fine particles, which can pass out with urine. The procedure usually requires hospitalization, but patients can return to normal activity within a fortnight.

Ureterorenoscopic Lithotripsy with Holmium Laser

This is also performed under spinal or epidural anaesthesia and is reserved for stones located in the ureter. A small fibre-optic instrument called a ureteroscope is inserted into the ureter along with a 100-watt Coherent Holmium Laser. The laser breaks up the stone into fine particles, which are then flushed out through the urinary tract. The Holmium Laser has the advantage of being able to target stones of all sizes with precision. Patients are generally discharged the next day after the procedure.

Enlarged Prostate (BPH)

The prostate is a gland, which produces the fluid that carries sperm. The prostate surrounds the urethra, through which urine passes out. An enlarged prostate is a prostate that has grown bigger. Also called Benign Prostatic Hyperplasia (BPH), prostate enlargement happens in almost all men as they grow older. Changes in the cells of the testicles may have a role in the growth. The prostate grows in two ways: In one type, the cells multiply around the urethra and squeeze it. The second type of growth occurs in the middle-lobe of the gland and the cells permeate the urethra and bladder outlet. The latter type typically requires surgery.

Symptoms of Enlarged Prostate

  • Blood in the urine (i.e. hematuria), caused by straining during urine passage
  • Dripping after urinating
  • Feeling that the bladder has not emptied completely after urination
  • Frequent urinating, particularly at night (nocturia)
  • Weak urine stream caused by decreased force
  • Leakage of urine (overflow incontinence)
  • Recurrent, sudden, urgent need to urinate
In severe cases of Acute Urinary Retention may cause severe pain, in which case a catheter may be used to drain the urine and procure relief.

Diagnosis of Enlarged Prostate (BPH)

Diagnosis includes clinical symptoms and physical examination. The former is obtained from findings of the AUA Symptoms Index and the latter includes a Digital Rectal Examination (DRE)

Digital Rectal Examination (DRE)

In DRE, the doctor inserts a gloved and lubricated finger into the rectum to feel the prostate gland through the rectal wall to evaluate its and size and shape. Healthy prostate tissue is soft while malignant tissue is hard and often asymmetrical. If DRE reveals the presence of unhealthy growth, further tests are performed to examine the nature of the growth.

American Urological Association (AUA) Symptom Index

The AUA Symptom Index is a questionnaire that helps determine the extent of a man’s urinary problems. It consists of seven questions concerning the common BPH symptoms. The frequency with which patients experience each symptom is rated on a scale of 1 to 5. The numbers add up to an individual score that reflects the true condition. An AUA score of 0-7 represents a mild condition; 8-19 is moderate; 20-35 reflects a severe condition.

PSA Test

This is a blood test to check the levels of Prostate-Specific Antigen (PSA) in a BPH patient to eliminate the possibility of prostate cancer.

Uroflowmetry Test

In this simple test, the patient with a full-bladder, urinates into a device that measures the amount of urine, the rate of urine flow and time taken to empty the bladder. A deceased flow rate may indicate an obstruction in the urinary tract and the presence of BPH.

Post-Void Residual (PVR) Test

A PVR test is conducted to determine the amount of residual urine in the bladder after urination. It is conducted after the patient urinates and the leftover urine is measured by ultrasound. A PVR result of less than 50 ml generally means adequate emptying of the bladder; a residue of more than 100 ml indicates blockage.

Holmium Laser Enucleation of Prostate (HoLEP)

HoLEP is currently the most advanced technique used in the treatment of enlarged prostate. The procedure involves the insertion of a telescopic camera and the Holmium laser to neutralize the excess prostate tissue and relieve pressure on the urethra. The enucleated prostate is then placed inside the bladder and later sucked out with a device called a Morcellator. The procedure is conducted under anaesthesia and lasts between 45 and 90 minutes depending on the size of the growth. It is also bloodless as the laser also seals the blood vessels. After the operation, a catheter is placed in the bladder for 24 to 49 hours to maintain its position and drain the urine into a collection bag.

Kidney Cancer

Symptoms of Kidney Cancer

  • Blood in the urine (slightly rusty to deep red urine)
  • Pain in the side that does not go away
  • A lump or mass in the side or the abdomen
  • Weight loss
  • Fever
  • Tiredness or general feeling of ill health
The mere occurrence of these symptoms do not necessarily indicate cancer; they can also be caused by infection or a cyst, etc. But the person should undergo an examination to either eliminate the possibility of cancer or get an early diagnosis.

Diagnosis of Kidney Cancer

If the doctor does suspect kidney cancer, he may conduct one or more of these following examinations: Physical Examination: Apart from a general check-up, he will feel the abdomen and side of the body for any lumps. Urine Tests: Urine is checked for blood pressure and other signs of kidney cancer. Blood Tests: The blood report will show how well the kidneys are functioning. It will include the levels of creatinine, urea and uric acid, etc. in the blood. Ultrasound: Ultrasound waves are bounced off the kidneys. The echoes, which are created, are captured by a computer. A solid tumour will show up in the resulting sonogram. CT Scan: An X-ray machine is attached to a computer and takes detailed pictures of the kidneys. The X-rays images will capture the tumour, if it exists. Biopsy: If a biopsy is required, the doctor inserts a thin needle into kidney to remove a small quantity of tissue. An X-ray or ultrasound machine may guide the needle. A pathologist examines the tissue sample in the laboratory to look for cancer cells.

Kidney Cancer Stages

Doctors need to know the stage or spread of the cancer in the body to formulate the best treatment plan. The stage is determined by the size of the tumour and how far it has spread and to which parts of the body. Staging may involve further tests including ultrasound, CT scan or even MRI. Stage I: This is the earliest stage of the cancer. The tumour is about 2.75 inches or 7 cms. The cancerous cells are contained within the kidney. Stage II: This is also an early stage of the cancer but the tumour is bigger in size, though the cancerous cells are still within the kidney. Stage III: This can involve one or more of the following scenarios:
  • Though the tumour is still in the kidney some cancer cells have spread through the nearby lymphatic system and infected one lymph node.
  • The tumour has spread to the adrenal gland or the layers of tissue that surround the kidney. Cancer cells may also be found in a neighbouring lymph node.
  • Cancer cells have spread from the kidney and invaded a large blood vessel close by. The diseased cells may also be found in a lymph node nearby.
Stage IV: At this stage, one or more of the following may be happening:
  • The tumour has spread beyond the fibrous tissue that envelops the kidney
  • Cancer cells are found in more than one lymph node in the vicinity
  • The cancer has spread to other organs in the body.

Kidney Cancer Stages

Doctors need to know the stage or spread of the cancer in the body to formulate the best treatment plan. The stage is determined by the size of the tumour and how far it has spread and to which parts of the body. Staging may involve further tests including ultrasound, CT scan or even MRI. Stage I: This is the earliest stage of the cancer. The tumour is about 2.75 inches or 7 cms. The cancerous cells are contained within the kidney. Stage II: This is also an early stage of the cancer but the tumour is bigger in size, though the cancerous cells are still within the kidney. Stage III: This can involve one or more of the following scenarios:
  • Though the tumour is still in the kidney some cancer cells have spread through the nearby lymphatic system and infected one lymph node.
  • The tumour has spread to the adrenal gland or the layers of tissue that surround the kidney. Cancer cells may also be found in a neighbouring lymph node.
  • Cancer cells have spread from the kidney and invaded a large blood vessel close by. The diseased cells may also be found in a lymph node nearby.
Stage IV: At this stage, one or more of the following may be happening:
  • The tumour has spread beyond the fibrous tissue that envelops the kidney
  • Cancer cells are found in more than one lymph node in the vicinity
  • The cancer has spread to other organs in the body.
Treatment depends mainly on the stage of the disease, the age and overall health of the patient. Doctors usually work out the optimal treatment plan in consultation with the patient during which they also discuss the expected results. Surgery: Based on the results of the various tests, doctors many decide to remove all or parts of the kidney. Surgery may also be complemented with chemotherapy and/or radiation therapy. Recurrent Cancer: The cancer can come back or other cells may become cancerous after treatment. The cancer can recur in the kidney or another part of the body.

Prostate Cancer

The prostate gland sits in the pelvis, below the bladder and above the penis. In men, it is located in front of the rectum. The prostate itself is made up of muscle fibres and glandular tissue. A membrane called the prostate capsule surrounds the gland and produces the Prostate-Specific Antigen (PSA). Clinically termed adecarcinoma of the prostate, the cancerous tumour may grow and spread to the sac-like appendages on the gland (seminal vesicles), to the lymph nodes and tissues surrounding the prostate and even the interior of the gland. In the later stages of the disease, the tumour may also spread to distant parts of the body.
The symptoms of the disease are similar to those of an enlarged prostate. Though they may not necessarily related to cancer, the following symptoms should be immediately investigated by a physician.
  • Blood in semen or urine
  • Frequent urination, particularly at night
  • Inability to urinate
  • Stiffness or nagging pain in the back, pelvis, hips or upper thighs
  • Pain during ejaculation
  • Pain or burning sensation during urination (dysuria)
  • Weak or interrupted flow of urine
Early stage prostate cancer is generally diagnosed upon a routine Digital Rectal Examination (DRE).
The treatment for adecarcinoma of the prostate depends on the stage of the disease, the age of the patient and his overall health. Watchful waiting is the best course for action for elderly patients and those in poor health, especially if it is in the early stages. Prostate cancer, even if untreated, can take years till it becomes a major problem. The patient is monitored by the physician for any marked progression of the cancer. When this happens, the patient will need aggressive treatment.

Radical Prostatectomy

Radical Prostatectomy surgically removes the prostate and surrounding parts like the seminal vessels and lymph nodes of the pelvis. The operation may involve one of two techniques: In retropubic prostatectomy a cut is in the lower abdomen provides better access to the gland, the pelvic lymph nodes and seminal vesicles. In perineal prostatectomy, the incision is made in the perineum, the space between the scrotum and the rectum. With the latter procedure, an additional lymphadenectomy is required to remove the lymph nodes.

Urinary Bladder Cancer

The urinary bladder is a bag located in the pelvis, which collects the urine from the kidneys and stores it. The severity of the cancer is determined by how deep the tumour has infested the bladder wall. If the cancerous cells are limited to the innermost bladder lining, it is termed as superficial bladder cancer. Invasive bladder cancer penetrates the muscular layer of the bladder wall.

Stages of Urinary Bladder Cancer

The tumour is also classified as low or high grade. High grade tumours are more aggressive.
  • Stage CIS: Though limited to the innermost lining of the bladder, it is a high grade tumour.
  • Stage T1: Cancer has infested the submucosal tissue
  • Stage T2: Cancer has penetrated the muscular bladder wall
  • Stage T3: Cancer spread through the muscular bladder wall into the surrounding fat
  • Stage T4: Cancer has spread to nearby body parts (prostate, uterus, or vagina) but the regional lymph nodes are not involved yet.
  • Stage T1-4N1-2M1-2: Cancer has spread out of the abdomen/pelvic wall to the lymph nodes or to distant organs like liver, lungs or bones
  • Blood in the urine
  • Pain and/or burning sensation during urination (dysuria)
  • Frequency or urgency of urination
The above symptoms are not specific to cancer and may have other causes. However, urinary bladder cancer usually shows no signs until it progresses to an advanced stage. Hence, if any of these symptoms do occur, please see a doctor immediately to either rule out the cancer or get an early diagnosis.

Diagnosis

The detection of cancer of the urinary bladder involves the following investigations:
  • Physical examination
  • Urine analysis
  • Urine cytology
  • Cystoscopy
  • CT Scan
  • Pyelography
  • Biopsy
  • Ultrasound
Treatment of urinary bladder cancer also depends on the stage of the disease and type of tumour. Most common treatment options involve surgery, chemotherapy and radiation therapy, either alone or in combinations. Some patients at stage CIS and T1 may undergo immunotherapy or biological therapy.

Ureteric Stricture

The lumen of the ureter is the duct that carries urine from the kidneys to the urinary bladder. Ureteric stricture occurs when the lumen narrows, resulting in obstruction of the urine flow. Depending on nature of the stricture, are categorized as anastomotic or non-anastomotic. Ureteric strictures may be benign or malignant.

Causes of Ureteric Stricture

There are a number of causes for the condition. The stricture may be the result of external trauma or may occur after the above mentioned treatments. Gonorrhea may cause the ureteric stricture to become inflammatory. Other types of the condition are tuberculous uretitis and schistosomiasis. The stricture may also be a rare complication in cancer. Patients undergoing treatments like ureterescopy, ureteric stone intervention or urinary diversion are at great risk for being inflicted with this condition. The last could result in anastomotic ureteric stricture. Non-anastomotic strictures may be the result of stones, endoscopy of the upper urinary tract, pelvic radiation and a host of open and laparoscopic surgeries.

Treatment of Ureteric Stricture

A variety of minimally invasive treatment options are available this condition. Balloon dilation may be the first treatment, particularly for patients with non-anastomotic strictures. If the stricture does respond positively to dilation, endoscopic incision may the preferred procedure. For this, a laser may be used along with a ureteroscope; a stent is left in place for about 6 weeks to keep the ducts open. Holmium Laser Endoureterotomy is a new technique for long-term relief if conventional treatments not effective.

Male Infertility

Male infertility is the inability of a male to impregnate a fertile female. It is usually caused by semen deficiencies. The factors behind the causes are classified as pre-testicular, testicular or post-testicular:
  • Pre-testicular: Drugs, alcohol, smoking or medications affecting the birth of sperm (spironolactone, chemotherapy)
  • Testicular: Age, genetic disorders, carcinoma, varicocele, hydrocele, mumps or other trauma
  • Post-testicular: These defects include malfunctions in the genital tract and ejaculation problems
Male infertility can be easily diagnosed by the patient’s medical history and physical examination, supplemented with semen analysis. A blood test may also be conducted to rule out hormonal imbalances or genetic causes. The partner of the patient may also be interviewed. Her fertility may also be investigated.
Treatment options depend on the underlying cause and the extent of the malady. Pre-testicular infertility can be treated with medication bur testicular infertility cannot be treated my medicines alone. Post-testicular infertility may require surgery.

Female Urology

1- Urinary Incontinence

One in 10 women experience Urinary incontinence and is the inability to even hold urine till the patient reaches the toilet Women experience Urinary incontinence two times more than man and usually it often temporary. Some of the reason is because of pregnancy, child birth, structure of female urinary tract or menopause. But some of the common reason for Urinary incontinence which is common for both men and women can be because of neurological injury, birth defect, multiple sclerosis, stroke or some physical problem because of age Younger women experience less incontinence compared to older women. Urinary incontinence can be treated and can be cured There is a problem in muscle which helps to holds or release the urine resulting into Urinary incontinence Urine is stored into bladder and bladder is connected to Urethra (tube through which urine leaves the body). The muscle of the bladder contact which push urine out of bladder into urethra while sphincter muscles relax and urine flow out of body But if the bladder muscle contract suddenly or the sphincter muscles relax suddenly, it will Couse condition called Urinary incontinence

2-Interstitial Cystitis

Symptoms of Interstitial Cystitis There is a continuous pain and it increases as the bladder fills.Patient will experience pain to lower parts of body (abdomen, lower back) Urine Frequency The frequency of urination increases because of interstitial cystitis. The frequency remains same in day and night The most common symptoms is urgency to urinate. Patient even feel to urinate though he has urinate immediately Some of the patient with urinary incontinence ,even complain of problem of leakage of urine even during sexual intercourse Interstitial Cystitis Causes Urinary incontinence is more in women than men, and it increase with age. It cn be due to following reasons
  • Autoimmune conditions
  • Defect in urinary bladder
  • Damages the bladder (substance in urine)

3-Urinary Tract Infections

Urinary Tract Infection. Microorganism infects urinary tract. This microorganism comes in contact with urethra and then the bladder and causes UTI Risk factors – UTIs
  • Past Kidney or bladder infection
  • Diabetes
  • Frequent sex with new sex partner
Types of Urinary
  • urethra Infection – Urethritis
  • Bladder Infection – Cystitis
  • Kidney Infection – Pyelonephritis
  • Frequent urination
  • Burning sensation during urination
  • Dark urine or blood in urine
  • Lower back pain
  • Pain in abdomen bladder and Muscle aches
  • Nausea and Vomiting
  • Chills with High fever
  • Fatigue
Note: If the infection reaches into kidney it is dangerous A person having Kidney infection can experience:
  • Chills and Fever
  • Lower abdominal pain
  • Back Pain
How to preventing urinary tract infections
  • Drink lots of water (8 to 10 glass/day)
  • Urinate as soon as you get the sensation
  • Take shower
  • Females after urination should wipe from front to back
  • Wear Loose cloth
At Sree Lakshmi Hospital provide you the best treatment for urinary tract infections .We have experienced UTI specialist & surgeons.

4-Cystoscopy

What Is a Cystoscopy?

Cystoscopy is done to view the urinary tract. It is done with the help of instrument called cystoscopy. It contains thin tube and cameras and is inserted to capture the view the urinary tract. The camera capture the magnified images which help the doctors for proper diagnosis

Why Cystoscopy?

Following symptoms
  • Long term urinary problems
  • Painful urination and continues need to urinate
  • Blood in urine
  • Urinary Tract Infection
  • Urinary Incontinence
  • Urinary Retention
  • Bladder stones
  • Enlarged prostate gland
  • Noncancerous growths
  • Problems with the ureters
  • Bladder Cancer
  • Urinary tract injury

5-Female Sexual Dysfunction

  • Loose perineum – (Can cause sexual problems)
  • Tight perineum – Can cause difficulty in intercourse
  • Vaginismus – vaginal muscles spasm difficulty in intercourse
  • Genital Mutilation syndrome – Abnormal genitalia
  • Post Delivery Sexual problems – decrease in sexual interest, painful intercourse
  • Atrophic vaginitis – Age related changes of vagina

6-Non-surgical Conservative Treatment

At Sree Lakshmi Hospital we create awareness about Non-surgical conservative treatments. We educate on good bladder habits, pelvic muscle training and postural techniques to help micturition