Clinical Condition

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Common Urological disorders

These are diseases of kidneys, ureters, bladder, prostate or urethra.

Kidney , Ureter and bladder stones

The pain caused when a kidney stone becomes lodged in the ureter (the tube draining urine from the kidney to the bladder) – renal colic- regarded as the most painful event that could occur to a person, has been compared in intensity to that associated with childbirth. Kidney stones are made up of a variety of substances normally excreted in the urine. May be caused by a combination of disturbances in urine composition occurring due to diet, fluid intake or anatomical abnormalities of the urinary tract.

Prevention of kidney stones

Once a patient has formed a stone there is a possibility of forming another within ten years. This chance can be reduced in a number of ways. They are advised to undergo a 24 hour urine collection for metabolic evaluation and special blood tests. Then precise dietary and biochemical abnormalities can often be identified and corrected.

Prostate-related diseases (enlarged prostate)

Prostate problems are common over the age of fifty. The same symptoms can be caused by both benign enlargement of the prostate and prostate cancer, so it is important to seek an assessment. Symptoms are- Urinary frequency, Urgency- having to rush to the toilet, Poor urinary stream, Getting up at night to pass urine, Feeling of not emptying the bladder completely, Pain when passing urine.

If the cause of the symptoms is benign prostatic enlargement the treatment varies from a conservative approach with patient specific advice, various medications, and lastly prostate surgery.

Urinary Tract Infections

A urinary tract infection (UTI) is a bacterial infection that affects part of the urinary tract. Symptoms from a lower urinary tract include Burning & painful urination and either frequent urination. While those of pyelonephritis include fever and flank pain in addition to the symptoms of a lower UTI. Urinary tract infections occur more commonly in women than men. A urine culture is often necessary. In uncomplicated cases, UTI is easily treated with a course of appropriate antibiotics.

Genitourinary cancers

Include Prostate cancer, Bladder cancer, Kidney cancer, Testicular cancer, Penile cancer. Early and precise diagnosis and staging of GU cancer is crucial for successful treatment. Advanced techniques pinpoint the location and extent of the cancer. Diagnostic methods include: Transrectal ultrasound, High-resolution CT, PET (positron emission tomography) and MRI (magnetic resonance) scans. Highly skilled surgical techniques including laser and laparoscopic procedures. Advanced genitourinary cancer treatments include Radiotherapy, Proton therapy and Targeted therapies.

Voiding dysfunctions and incontinence

Voiding dysfunction and urinary incontinence are conditions in which the bladder is not able to store urine properly (incontinence) or conditions in which the bladder is not able to empty properly (voiding dysfunction). The incontinence is often categorized by the symptoms that are experienced. The accidental leakage of urine during activities such as coughing, laughing, sneezing, or lifting heavy objects is called stress urinary incontinence (SUI). Stress incontinence is not related to psychological stress.

TVT-O Transobturator Tape

This is a newer procedure for urinary stress incontinence. This procedure is performed under anaesthesia. A small incision is made in the vagina and the permanent tape is introduced via the vagina to sit under the urethra.

A sudden and strong feeling of the need to pass urine resulting in urine leakage is called urge urinary incontinence (UUI). Voiding dysfunction is often described by symptoms such as frequency (urinating more than 8 times per day), urgency (strong need to urinate) and urine retention (unable to empty your bladder). The problem can affect both women and men. In men, these symptoms can also be due to an enlarged prostate.

Diagnostic tools

Office Procedures-(Out Patient) – A review of patients’ medical history, examination and additional tests or scans (if needed) including- Departmental Ultrasound scanning, TRUS (Trans Rectal Ultra Sound), Uroflowmetry, Urodynamics study.

Radiology – including CT scan, MRI & Lab services round the clock.

After diagnosing the condition, various treatment options will be discussed with the patient and a personalized treatment modality to address particular symptoms and underlying causes will be planned.

Recent Trends in Urology

Endourology including minimally invasive urological surgery like laparoscopic procedures, closed transurethral procedures and a variety of laser surgeries are a few of the recent trends in urology.

Endourology is the sub-speciality of urology concerned with the investigation and treatment of urological symptoms and diseases using closed or minimally invasive surgical techniques. This involves passing highly specialised instruments through the urological tract or keyhole surgery through the abdomen for the treatment of kidney stones, tumours, and a wide range of other diseases of the urinary organs.

Endourology also encompasses laparoscopic (keyhole) surgery of the kidneys and ureters. These very advanced surgical techniques allow complete or partial removal of the kidney for benign diseases or cancer, removal of very large stones impacted in the ureter, and also reconstructive procedures for conditions such as pelviureteric junction (PUJ) obstruction in the form of laparoscopic pyeloplasty.

What is laparoscopy : This is a key hole procedure where is telescope is placed through the abdomen towards the target organ to be treated / removed . By this most of the urological tumors of the kidney, bladder and prostate can be removed with minimal scar and minimal hospital stay and less pain and early retrun to work. The following procedures are done through lapaproscopy at Columbia Asia

  1. Laparoscopic radical prostatectomy (LRP) ; For prostate cancer removal
  2. Laparoscopic Radical Nephrectomy : for Kidney cancer Removal
  3. Laproscopci partial Nephrectomy : Removal of the portion of the diseased kidney
  4. Laparoscopic Pyeloplasty : For PUJ obstruction – kidney blocks
  5. Laparoscopic cystectomy; removal of the bladder cancer
  6. Laproscopic Adrenalectomy

These are some of the major surgical procedure that can be tackled by keyhole method. At Columbia Asia referral hospital >500 laparoscopic procedures have been conducted for various diseases of the Genitourinary disorders.

Lasers-

Holmium Laser- 30 watt & 100 watt Lasers are available.

30 watt Holmium Laser- for Disintegration of Stones in the urinary tract. URS (Ureteroscopy) & RIRS (Retrograde Intra Renal Surgery). This technique involves passing very small instruments -semirigid or flexible ureteroscopes through the urinary tract to the stone, and fragmenting it using targeted laser energy without damaging the surrounding tissues.

100 watts Holmium Laser – Used for HoLEP- Holmium Laser Enucleation of Prostate- combined with mechanical morcellation represents the latest refinement of laser treatment for benign prostatic hyperplasia (BPH) which allows complete removal of intact lobes of the prostate. Utilizing this technique, even the largest of glands can be effectively treated with minimal morbidity. Worldwide experience with the HoLEP technique has shown the procedure to be safe and effective. Hospital stays are minimal as compared to the other treatment modalities.

Laser is also used in the surgery for Stricture Urethra

PVP (Photoselective Vaporization of prostate) laser ablation of the prostate – removes excess prostate tissue using a patented high-power Green Light Laser. The laser energy quickly vaporizes and precisely removes the enlarged prostate tissue which is a very safe & bloodless procedure

Other procedures :

TURP- Bipolar- using saline irrigation for Benign Prostatic Hypertrophy

TURBT- Trans Urethral Resection of Bladder Tumour.

TURED- Trans Urethral Resection of Ejaculatory Ducts – in Infertility.

Microscopic vaso-vasostomy (vasectomy reversal)

TVT-O Urinary sling, to treat female urinary stress incontinence

PCNL- Sometimes stones in the kidney are too large for URS & RIRS treatment, and these stones require removal through a specially made tract into the kidney through the back. This is called PerCutanious Nephro Lithotomy.