Malathi Manipal Hospital

Prostate Cancer is a form of cancer that affects men. The prostate is basically a small gland that sits in the male pelvic cavity and is responsible for producing seminal fluid or semen, from its position under the bladder, surrounding the urethra. The testosterone hormone controls this gland.

Prostate cancer refers to the growth of a malignant mass of cells which can also be called a tumour. More about this cancer:

• Risk Factors: The various risk factors involved in this kind of cancer are many. Advanced age, a family history of the same disease, obesity as well as genetic changes can lead to the development of this kind of tumour.
• Types: There are basically two types of prostate cancer, including fast growing or aggressive, and slow growing or non-aggressive. Yet, it is also important to remember that not every abnormal growth in this gland can be termed as a tumour, or is a sign of prostate cancer. A malignant growth signifies prostate cancer. This tumour can grow at a fast pace for aggressive prostate cancer, while it can grow and spread slowly for the non-aggressive type.
• Symptoms: It is possible to not have any kind of obvious symptoms when suffering from this kind of cancer. The symptoms usually begin to show up when the cancer has reached a more advanced stage. These include urinary problems, most significantly. The patient may go through pain and difficulty when it comes to urinating. This pain may also occur during ejaculation. The patient may also find blood discharge in the semen upon ejaculation and suffer from sexual dysfunction as well. Pain in the chest, pelvic area and back are also common symptoms of prostate cancer, which may gradually turn into numbness in the said areas as well.
• Diagnosis: The diagnosis of the issue will be done by a specialist from the urology department. After a physical examination where a diagnosis of the symptoms and other check ups will happen, the doctor may conduct lab tests to check the blood, urine and other samples. Further, imaging tests like MRI and CT scans will also be conducted. A digital rectal exam and prostate biopsy will also help in effective diagnosis.
• Treatment: The treatment of this kind of cancer usually depends on the severity of the symptoms and the spread of the tumour. Besides active observation, the doctor may also recommend radiation, chemotherapy and surgery based on the age and health condition of the patient. If you happen to find even subtle symptoms which could point towards this disease, do not hesitate to get in touch with the doctor.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Treatment for Kidney stones varies depending on the size and type of the stone or the symptoms caused by it. In case of small stones, medication and simple changes in lifestyle can be enough to treat it, but surgeries and extensive treatments are required if symptoms are severe. Following are treatment options for kidney stones:

Small stones with minimal symptoms:  

1. Drinking water: Drinking around 3 liters of water a day will regulate your urinary system and can effectively eliminate small stones. Unless your doctor advices otherwise, drinking ample amount of fluids, usually water, is one of the commonest way to get rid of small kidney stones. 
2. Pain relievers: There might be a considerable amount of pain and discomfort associated with passing the stone through urine. Your doctor may recommend pain killers like Ibuprofen, Naproxen sodium or acetaminophen. 
3. Medical therapy: In order to eliminate the kidney stone, your doctor may administer medical therapy. Medication like alpha blocker helps in passing the kidney stone with least pain and more quickly. It relaxes the muscles in the ureter and makes the process relatively easy. 

Large stones with severe symptoms: 

1. Using sound waves to break up stones: In this technique, a procedure called Extracorporeal Shock Wave Lithotripsy (ESWL), is employed. ESWL uses the help of sound waves to create vibrations which breaks the stones in smaller pieces. This procedure takes about an hour and can cause mild pain and discomfort. Your doctor may administer sedatives to reduce your sensitivity. ESWL has side effects like blood in urine or bruising in the abdomen. 
2. Surgical removal of kidney stones: Surgical removal of stones is done with the help of a procedure called nephrolithotomy. It uses small telescopes and other instruments which are inserted in your back through a small incision. It is generally done in case of large stones and when ESWL fails. 
3. Ureteric Calculi (Using a scope to remove stones): A thin illuminated tube called ureteroscope is used to remove a comparatively smaller stone in the kidney or ureter. The ureteroscope is equipped with a tiny camera which determines the location of the stone which is then broken into pieces with the help of other instruments. It may require general or regional anesthesia.

In case you have a concern or query you can always consult an expert & get answers to your questions!

The problem of an enlarged prostate or benign prostate hyperplasia is a very common occurrence as you grow older. It's known to strike men above the age of 50, with more than 50% of men after the age of 60, having this complaint.

Causes of enlarged prostate

A non-cancerous condition, enlarged prostate makes the passing of urine from the bladder through the urethra difficult. The multiplication of the prostate cells causes an enlargement of the gland, leading to a buildup of pressure on the urethra, affecting the discharge of urine from the body. The narrowing of the urethra, due to this benign condition, forces the bladder to contract more vigorously so as to push urine out of the body.

As time passes, the muscles of the bladder get significantly affected, causing them to become extremely sensitive, thicker and stronger. As a consequence, the bladder begins to contract, even if the amount of urine in the organ is negligible, causing episodes of frequent urination. Gradually, the bladder fails to completely empty itself of urine due to the constriction of the urethra. This can give rise to a number of health problems including the formation of bladder stones, urinary tract infections, blood in the urine and so on.

How can you identify the signs of the condition?

Signs of enlarged prostate are very easy to identify and include:

- A slow or weak urine flow
- Difficulty in initiating urination
- Instances of frequent urination
- A feeling of not completely emptying one's bladder
- Frequent urination during the night
- Exerting a lot to urinate
- Instances of dribbling
- Urgency to pass urine
- A feeling of urinating again minutes after doing so
- Urination that starts and stops. If you wish to discuss about any specific problem, you can consult a General Surgeon.

Reproductive medicine has gained a lot of attention recently with its increasing scope and opportunity. This branch of medicine is concerned with improving reproductive health, preventing reproductive disorders, diagnosis of infertility issues and allowing couples to have children when they choose to be parents. The scope of reproductive medicine is based on endocrinology, anatomy and physiology. Here are some things you need to know about reproductive medicine:

Scope

Reproductive medicine includes many aspects of human health and other factors. Sexual dysfunction, puberty, birth control, sex education, family planning are some of the factors that it is concerned with it. In women, issues such as ovulation, menstruation, menopause and pregnancy are of immense importance in reproductive medicine.

Methods and techniques

Methods to assess any reproductive abnormality include reproductive surgery, laboratory methods while methods of treatment are prescription of fertility medication, counseling and surgery. In vitro fertilization or ivf has become one of the most effective treatments to enable pregnancy. This treatment allows the examination of the embryo before implementation.

Training

Specialists in reproductive medicine are trained in gynecology and obstetrics which is followed by infertility and reproductive endocrinology. Some of them specialize in urology followed by andrology. Training is also provided for contraception specialization. Usually, specialists in this branch of medicine receive education in particular organizations that deal with only human reproductive disorders. If you wish to discuss about any specific problem, you can consult a Urologist.

Overactive bladder, also known as OAB, is a condition where sudden involuntary contractions of the urinary bladder's muscular walls cause bladder storage dysfunction. It leads to sudden and frequent urges to urinate (urinary urgency), as well as unintentional leakage or urine (urinary incontinence).

This is a condition that affects both men and women and causes tremendous discomfort in nearly every aspect of daily life. The specific causes of OAB vary from case to case but it is generally attributed to infection of the urinary tract or dysfunction of the nervous system. The symptoms are intensified by unhealthy lifestyle choices such as overindulging in caffeinated drinks, spicy foods, and alcohol.

There are several ways in which you can deal with the problem of OAB, depending on the nature of the case. It is necessary for you to consult a urologist for a detailed diagnosis to formulate the best treatment option.

Following are the most effective remedies to treat an overactive bladder:

1. Lifestyle Modifications - Also known as behavioral therapy, this is the first step in the treatment of OAB. It involves inculcating simple changes into everyday habits such as avoiding food and drinks that irritate the bladder, scheduling (and in some cases, practice delaying) bathroom visits, exercising the pelvic floor and bladder muscles, keeping a record of urinating habits in a 'bladder diary' for better understanding the problem, etc. You can incorporate these habits into everyday activities for an easy alleviation of the problem with absolutely no side effects.

2. Medication and Surgery - There are several different kinds of medicines and drugs that can treat the problem of OAB. The most common types are muscle relaxants that loosen the muscles of the urinary bladder to prevent involuntary contractions, and antibiotics and anti-inflammatory drugs that treat urinary tract infections. Many types of implants are surgically set into the pelvic area to act as electrical nerve stimulators for neuromodulation therapy. Reconstructive bladder surgery is another remedial option.

3. Devices and Products - Urinary urgency and incontinence can be managed through the external use of various devices and products which collect and hold urine or absorb leakages. These include indwelling catheters, condom catheters (for men), urine drainage bags, absorbent pads and adult diapers, and toilet substitutes such as bedpans and bedside urinals. If you wish to discuss about any specific problem, you can ask a free question.

Here are a few things you should know about Testicular Cancer (TC): 

1. Age: The commonest affected age group is 20-45 years with germ cell tumours. Half of all cases occur in men less than 35 years. Non-seminomatous germ cell tumours (NSGCT) are more common at ages 20-35, while seminoma is more common at age 35-45 years. Rarely, infants and boys below 10 years develop yolk sac tumours and 50% men above 60 years with TC have lymphoma.
2. Race: White Caucasian people living in Europe and the US have the highest risk. Whites are three times more likely to develop TC than blacks in the US. With the exception of the New Zealand Maoris, TC is rare in non-Caucasian races.
3. Previous TC: Confers a 12-fold increased risk of metachronous TC. Bilateral TC occurs in 1-2% of cases.
4. Cryptorchidism: 5-10% of TC patients have a history of cryptorchidism. Ultrastructural changes are present in these testes by age 3 years, although earlier orchidopexy does not completely eliminate the risk of developing TC. According to a large Swedish study, cryptorchidism is associated with a two-fold increased risk of TC in men who underwent orchiopexy less than 13 year, but risk is increased 5-fold in men who underwent orchiopexy aged above13 years. A meta-analysis showed risk of contralateral TC almost doubles while ipsilateral TC risk is increased 6-fold in men with unilateral cryptorchidism.
5. Intratubular germ cell neoplasia (testicular intraepithelial neoplasia, TIN): Synonymous with carcinoma in situ, although the disease arises from malignant change in spermatogonia; 50% of cases develop invasive germ cell TC within 5 years. The population incidence is 0.8%. Risk factors include cryptorchidism, extragonadal germ cell tumour, atrophic contralateral testis, 45XO karyotype, Klinefelter's syndrome, previous or contralateral TC (5%), and infertility.
6. Human immunodeficiency virus (HIV): Patients develop seminoma 35% more frequently than expected. Genetic factors: appear to play a role, given that first-degree relatives are at higher risk by 4-9-fold, but a defined familial inheritance pattern is not apparent.
7. Maternal oestrogen exposure: At higher than usual levels during pregnancy appears to increase risk of cryptorchidism, urethral anomalies, and TC in male offspring.

Trauma and viral-induced atrophy have not been convincingly implicated as risk factors for TC. If you wish to discuss about any specific problem, you can consult a Urologist.

Benign Prostate Hyperplasia (BPH) is a condition which results in the enlargement of the prostate gland. The Prostate gland is situated near the Urethra (a tube which helps flush out the urine from the bladder). Generally, the chance of developing BPH increases after one crosses the age of 50. But it is yet unknown as to why some men experience more severe symptoms than others.

Causes of BPH
This condition generally occurs because of old age and affects almost all men above the age of 75. It occurs because of the various hormonal changes and changes in cell growth that the body goes through, as one becomes old. Sometimes BPH can set in due to genetics. If BPH sets in due to genetically reasons, it usually is quite severe and affects men before they reach 60.

Symptoms of BPH
Quite a few men who develop BPH, experience no symptoms at all. But when symptoms of BPH, known as lower urinary tract symptoms (LUT) start, they can be either mild or very severe. The severity of the symptoms is not related to the extent of the enlargement. Many a times men with only a mild enlargement complain about severe symptoms, while men with a highly enlarged prostate gland have not complained about any discomfort faced. 

Symptoms of BPH tend to worsen due to cold weather and also because of physical and emotional overexertion. There are certain medicines, which should be avoided if you suffer from BPH, as they have a tendency to worsen your symptoms, for example diphenhydramine, pseudoephedrine, oxymetazoline spray and other antidepressants.

The symptoms of BPH are related to bladder emptying and issues with bladder storage.

Symptoms related to the urine drainage from the bladder are:

1. Strain while urinating
2. Weak urine flow
3. Some dribbling after urination
4. Sudden urge to urinate
5. Pain while urinating

Symptoms related to storage of urine in the bladder are:

1. Waking during the night to urinate
2. Urinating frequently during the day and at night
3. Sudden urge to urinate, which may be hard to control

It however, has to be kept in mind that these symptoms may not primarily occur due to prostate enlargement, but are the result of other conditions like urinary tract infections, prostatitis, prostate cancer, neurological disorders and even diabetes. Thus, it is essential that you visit a doctor and get the cause for these symptoms diagnosed properly.

A kidney stone may not be as big as the stones in your garden, but can be quite a pain. Kidney stones are actually mineral crystals that are usually a combination of calcium and phosphates. The size of a kidney stone ranges from the size of a sugar crystal to a ping pong ball.

Following are treatment options for kidney stones:

1. Pain relievers - There might be a considerable amount of pain and discomfort associated with passing the stone through urine. Your doctor may recommend pain killers like Ibuprofen, Naproxen sodium or acetaminophen.
2. Drinking water - Drinking around 3 liters of water a day will regulate your urinary system and can effectively eliminate small stones. Unless your doctor advices otherwise, drinking ample amount of fluids, usually water, is one of the commonest way to get rid of small kidney stones.
3. Medical therapy - In order to eliminate the kidney stone, your doctor may administer medical therapy. Medication like alpha blocker helps in passing the kidney stone with least pain and more quickly. It relaxes the muscles in the ureter and makes the process relatively easy.

Large stones with severe symptoms:

1. Surgical removal of kidney stones Surgical removal of stones is done with the help of a procedure called nephrolithotomy. It uses small telescopes and other instruments which are inserted in your back through a small incision. It is generally done in case of large stones and when ESWL fails.
2. Using sound waves to break up stones In this technique, a procedure called Extracorporeal Shock Wave Lithotripsy (ESWL), is employed. ESWL uses the help of sound waves to create vibrations which breaks the stones in smaller pieces. This procedure takes about an hour and can cause mild pain and discomfort. Your doctor may administer sedatives to reduce your sensitivity. ESWL has side effects like blood in urine or bruising in the abdomen. If you wish to discuss about any specific problem, you can consult an urologist.

Lower Urinary tract obstruction refers to a condition of hindrance to urinary flow from bladder outwards. This can occur in all the age groups and affect either sex. The symptoms can be poor urine flow, intermittent flow, straining to pass urine or empty bladder, sense of incomplete emptying of bladder, difficulty in starting urination. Other problems can be increased urine frequency and difficulty to hold on with or without occasional urine leak in clothes. The cause and treatment vary in different age groups.

Few common reasons behind Lower urinary Tract Obstruction:

1. Congenital urethral stricture and PUV: These defects can be detected either before or after birth and need correction at earliest to avoid long-term complications. It is usually brought to attention by parents who observe abnormal urine flow pattern of their child OR found out during evaluation for repeated urinary tract infections.

2. Neurogenic bladder: This is caused due to defects of nerves that are responsible for controlling bladder function. This can be due to diseases of brain, spinal cord or peripheral nerves. These defects can occur by birth or later in life. It is very important to take early consult to avoid long-term complications and progression to renal failure.

3. Urethral stricture: This is narrowing in a long tube that starts from bladder to the external urinary opening. It can be idiopathic, post-traumatic, or due to urethral infections. Usually, a person is able to recognise poor urine flow and bring it to the attention of urologist. Treatment for stricture depends on various factors and range from simple endoscopic surgery to open surgeries.

4. Bladder neck obstruction: Bladder neck is a network or a group of muscles that connect the bladder to the urethra. The muscles tighten to hold urine in the bladder, and relax as they release it through the urethra. Urinary tract obstruction occurs when there are abnormalities blocking the bladder neck that restricts its opening during urination.

5. BPH: This occurs due to enlarged prostate obstruction urine flow out of bladder. Prostate enlargement is mostly age-related and rarely due to prostatic tumors. Urinary stones. This can be usually recognized by sudden obstruction to urine flow in person who was voiding normally. These episodes might be recurrent due to movement of stone in between bladder and urethra.

6. Bladder tumors: The are mostly characterized by blood in urine. Sometimes there might be blood clots that obstruct the urine flow. Phimosis: Usually occurring post-puberty, it is referred to as the inability to retract the glans (the sensitive structure at the end of the penis). It is a condition in which the distal foreskin, which was previously retractable, is unable to retract anymore.

7. Phimosis: Phimosis is another major reason behind urinary tract obstructions.