Centres of Excellence

The Prostate  is a part of male reproductive system, is about the same size and shape as a walnut. It is located below the bladder and in front of the rectum and surround the urethra the tube like structure that carries urine from the bladder out through the penis. The main function of the prostate is to produce ejaculatory fluid.

Some common problem related to prostate are

• Prostatitis
• Benign prostatic hyperplasia, or BPH
• Prostate cancer

Benign Prostatic Hyperplasia (BPH) is the non-cancerous enlargement of the prostate; usually begin in the fifth decade of the life in men and which in many men may cause obstruction to urine flow.

Although the cause of (BPH) is poorly understood, the two major factors necessary for the onset of BHP in men are age and normal testicular function.

Since the prostate sound the urethra just below the bladder, its enlargement can result in symptoms that irritate or obstruct the bladder. A common symptom is the need to frequently empty the bladder, especially at night. Other symptoms include difficulty in starting the urine flow or dibbling after ends. Also, size and strength of the urine stream decrease.

Many men find that having to get up and go to the toilet at night is the most troublesome aspect of this condition, as it makes them tired during the day. Having to urinate frequently during the day, sometimes with a sense of urgency, can also be trying for patients, and can make traveling or attending events, such as the theatre or cinema, rather difficult. Incomplete emptying of the bladder can be progressive and eventually result in complete retention of urine. If this occurs a catheter (tube into the bladder) will be necessary as the bladder rapidly becomes over distended and painful.

No. It is possible to have both BPH and prostate cancer, having BPH does not increase your risk of having prostate cancer. However, because early symptoms of both conditions are similar, it is important to see your doctor if you are experiencing any symptoms associated with a urinary condition.

No, it is a common condition that can affect approximately 50 percent of men between the ages of 51 and 60 and up to 90 percent of men over the age of 80.

In order to help asses the severity of such symptoms, the American Urological Association (AUA) BPH Symptom Score Index was developed. The AUA diagnostic system includes a series of question that target the frequency of the urinary systems identified above, and as result, helps identify the severity of the BPH- ranging from mild to severe.

There are a number of diagnostic test procedures that can be used to confirm BPH. The tests vary from patient to patient, but the following are the most common:

Physical examination

• Digital rectal examination (DRE)

Laboratories Studies

• Prostate Specific Antigen (PSA) Blood Test
• Urinalysis
• Urine culture

Imaging Techniques

• Rectal Ultrasound
• Intravenous Pyelogram (IVP)

Urodynamic Testing

Watchful waiting: Is recommended as an important option for men who have mild symptoms and do not find them particularly bothersome.

Medical therapy: Today’s most common method for controlling moderate symptoms of BHP. Several medications are available to control moderate symptoms of BPH.

Minimally invasive treatments: Several minimally invasive therapies are available that allows the doctor to access the prostate through urethra and reduce the size of the prostate or decrease obstruction of the urethra.

Surgical treatment:  surgical intervention is necessary in patient in whom benign prostatic obstruction causes renal insufficiency, urinary retention, recurrent UTIs, bladder calculi, hydronephrosis, or large postvoid residual volume.
Surgical options for such patients include transurethral resection of the prostate, transurethral laser prostatectomy (which consists of resection, ablation, and vaporization), transurethral incision of the prostate, and open prostatectomy (usually when the prostate weight is >100g).

Stone Disease

What are Renal Calculi?
Kidney stone are also termed as Renal calculi. ( Nephrolithiasis) A kidney stone is a hard. Crystalline mineral material formed within the kidney or urinary tract.

What is the Prevalence of renal calculi?
Renal stone disease is common, with worldwide prevalence of between 2 and 20%. Lifetime prevalence is nearly 10% in men and 5% in women. Approximately 50 percent of patient with previous urinary calculi have a recurrence within 10 years.

What are the renal calculi?

• Dietary risk associated with increased stone risk:
  Low fluid intake, High intake of animal protein, High dietary sodium, Excessive intake of refined sugars, Foods rich in oxalate, High intake of grapefruit juice, apple juice and soft cola drinks.

• Family history of kidney stones ( increases risk by three times)
• History of hypertension
• Obesity
• Various other medical conditions.
  

Which is the most common type of renal calculi?
Calcium oxalate (alone or in combination) is the most common type of urinary stone.

What are clinical features of renal calculi?
Pain – classic colicky loin to groin pain or renal pain

• Haematuria, gross or microscopic
• Dysuria and strangury

Systemic symptoms

• Restless patient, often writhing in distress
• Nausea, vomiting,
• Fever and chills (if associated with infection)

Asymptomatic

• Incidental stone

How is Renal Calculi diagnosed?

• History and physical examination
• Serum and blood testing

Calcium, parathyroid hormone, vitamin D, electroytes

• Urine dipstick and microscopic examination
• Urine culture
• 24-Hour urine collection
• Imagining Modalities

Plain Radiography, IVP, USG, CT Scans.

Can calculi pass spontaneously?
Yes, nearly all urethral stone are supposed to be expelled spontaneously when their diameters are smaller than 4mm. However, the spontaneous expulsion rate of distal ureter stones is about 25% if their sizes are between 4-6 mm and 5% if greater than 6 mm. And calculi over 8 mm are very rarely eliminated spontaneously. Therefore, active treatments are recommended for individuals with larger stones, especially are greater than 5 mm.

What are factors that can effect the management Renal calculi?
Management of a kidney stone depends on the size, location, and composition and the presence of anatomical malformation and complications. The presence of an immediate intervention, whereas uncomplicated stones can be managed conservatively with adequate fluid intake and analgesia. If a stone does not pass spontaneously then definitive treatment is needed to remove it. The goals of treatment are to control symptoms, render the patient stone free, and prevent recurrence.

What are the treatments available for Renal calculi?

• Conservative Management
• Drugs
  Analgesics
  Alkalizers
  Diuretics
  
  Can give the drugs that may increase the spontaneous passage of the stone like Tamsulosin

• Urologic interventions: Surgery is necessary when the pain is persistent and severe, in renal failure and when there is a kidney infection. It may also be advisable if the stone fails to pass or move after 30 days.

What are general measures that can be taken to prevent recurrent stone formation?

• Increase fluid intake to maintain urine output of 2-3 1/day.
• Decrease intake of animal protein (< 52 g/day)
• Restrict salt intake ( >50 mmol/day of sodium chloride)
• Normal calcium intake ( > 30 mmol/day)
• Decrease dietary oxalate
• Reduce the intake of food rich in
• Oxalate-spinach, rhubarb, chocolate, and nut.
• Cranberry juice.

OAB means overactive bladder in this the person feels urgent desire to go to the toilet, goes to the toilet frequently, and sometimes leaking of urine before reaching the toilet.
 

Overactive Bladder is a highly prevalent distressing medical condition. Despite the high prevalence of OAB and the availability of effective treatment options, OAB treatment remains suboptimal. The condition is under diagnosed, often because of patients’ reluctance to bring their urinary symptoms to the attention of their doctor. Many patients accept their symptoms as a “normal” part of aging or believe surgery is the only treatment available.

Large number of condition can cause OAB like

• Neurological disease
• Urinary Tract Infection
• Multiple Pregnancy
• BPH/Prostate cancer/ Prostatitis
• Diabetic Neuropathy.

• Urgency
• Frequency
• Nocturia
• Urge incontinence

OAB patients have a significantly poorer quality of life Patient who suffer from OAB focus on and may be preoccupied with such concerns as locating the closest bathroom, estimating the affects daily activities, such nocturnal bladder control, which can affect sleep.

• Hygienic protection
• Behavioral Therapy
• Medications
• Surgery

Behavioral therapies are considered the mainstay of treatment for urinary incontinence because they are noninvasive and can be initiated at the primary care level.
Behavioral interventions include pelvic floor muscle training (PFMT) bladder, training, self-monitoring with bladder or voiding diaries, and life modification.

Lifestyle modifications for the management of OAB include:

• Smoking cessation
• Caffeine reduction,
• Reduced alcohol consumption
• Weight loss
• Limiting fluid intake.

This daily diary allows to accurately recording the fluid intake (how much you drink) and the bladder activity each day. It helps the health care professional prescribe treatment for overactive bladder, the diary can also be used to help measure your progress.

Pelvic floor exercises are done to strengthen the pelvic floor muscles, which support the uterus, bladder and bowel. The exercise helps to control the leaking of urine.

Urinary tract infection (UTI) is one of the most common health problem for which patient seek medical care. It is a bacterial infection anywhere in the urinary tract. The urinary tract makes and stores urine and removes it from the body. Parts of the urinary tract include:

• Kidneys
• Ureters
• Bladder
• Urethra.

• People with kidney stones.
• People with medicals condition that cause incomplete bladder emptying (For example, spinal cord injury)
• Immunocompromised people: AIDS and diabetes
• Women who are sexually active Infection
• Women who use a diaphragm for birth control
• Men with enlarged prostate
• Catheterized patients.

If you have a UTI Infection, you might notice:

• You urinate a lot but only a little bit each time.
• It burn when you urinate.
• You have to urinate suddenly.
• There is blood in your urine.
• Your urine is not clear.
• Your urine smells bed.

Yes, Women tend to get urinary tract infections more often than men because bacteria can reach the bladder more easily in women. The urethra is shorter in women than in men, so bacteria have a shorter distance to travel.

A doctor can confirm if you have aw urinary tract infection by testing a simple of your urine.

Urine Test we can do: Urinalysis, Urine Culture

Ultrasound
X-Rays, Like

• Voiding Cystourethrogram
• IVP.

Doctor thinks you have urinary tract infection; he or she will probably test a sample of your urine to find out if there are bacteria in it. If you have an infection, doctor will then prescribe an antibiotic. Usually, symptoms of the infection go away 1 to 2 day after you start taking medicine.

You should see your doctor if you have any of these sings or symptoms:

• Burning feeling when you urinate
• Frequent or intense urges to urinate, even when you have little urine to pass
• Pain in your back and lower abdomen
• Cloudy, dark, bloody or unusual-smelling urine
• Fever or chills.

• Drink lots of water every day.
• Don’t resist the urge of urinate. Do so when you feel the need.
• Urinate before and after you have sex.
• Wipe from the front to the back after going to the bathroom.
• For women, using a diaphragm or spermicide for birth control can lead to UTI’s by increasing bacteria growth.
• Do not douche.
• Take showers instead of tub baths.

Infertility is defined as inability of a couple to conceive naturally after one year of regular unprotected sexual intercourse.

It remains a major clinical and social problem, affecting perhaps one couple in six. It affects 13% to 15% of couple worldwide. Male infertility plays a key role in conception difficulties of up to 40% infertile couples.

Factors relating to male infertility include

• Pre-testicular causes
  Pre-testicular factors refer to conditions that impede adequate support of the testes & include situations of poor hormonal & poor general health like Hypogonadism due to various causes, Drugs, Alcohol, Smoking, Medications etc.

• Testicular causes
  Testicular factors refer to conditions where the testes produce semen of low quantity and or poor quality, despite adequate hormonal support & include: Age, Genetic Defects on the Y chromosome etc.

• Post-testicular causes
  Post-testicular factors decrease male fertility due to condition that affect the male genital system after testicular sperm production and include defects of the general tract as well as problems in ejaculation.

No, Impotency is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis sufficient for satisfactory sexual performance.
Impotency can lead to Infertility.

The number and quality of a man’s sperm can be affected by his overall health & lifestyle. Some factors that may increase the risk of male infertility are:

• Alcohol
• Drugs
• Smoking Cigarettes
• Environmental Toxins, including Pesticides & Lead
• Health Problems
• Medicines
• Radiation Treatment & Chemotherapy for Cancer
• Age.

The diagnosis of infertility begins with a medical history & physical exam. The provider may order blood tests to look for hormone imbalance or disease. A semen sample may be needed. The volume of the semen is measured, as well as the number of sperm in the sample. How well the sperm move is also assessed.

Male infertility can create major tension and the problem has caused many once healthy relationships to break up. It does not affect the couples’ life only, but it also affects the healthcare services & social environment. The feelings experienced by the infertile couples include depression, grief, guilt, shame and inadequately with social isolation.

In Semen Analysis we evaluate certain characteristics of a Male’s Semen like Sperm Count, Total Sperm Count, Motility, Morphology, Volume etc.

Infertility can be treated with Medicines, Surgery, Artificial Insemination or Assisted Reproductive Technology. Many times these treatments are combined. About 2/3 rd of Couples who are treated for infertility are able to have a baby. In most cases infertility is treated with Drugs or Surgery.

In many cases, neither Medicines nor Operations are of help. In such cases, an attempt is made in the reproductive laboratory to improve semen quality and facilitate the penetration of the sperm into the ovum. This includes Sperm Washing /capacitation, Intra-Uterine Insemination (IUI), Gamete Intra-Fallopian Transfer (GIFT), In Vitro Fertilization (IVF) & Micro-Manipulation (ICSI).