Dr Saurabh Clinic

Hello,

 I am doctor Saurabh Mishra. I am a senior consultant in the department of urology. Today I am going to discuss hematuria. Hematuria means blood in the urine. It's a common symptom and it can happen in young, middle-aged and elderly; all three categories of the patients can face these symptoms. Now, the haematuria is of two types: one is painful hematuria and the other one is the painless hematuria. As the name suggests, painful hematuria means the blood in urine is associated with painful urination also. This usually occurs in young patient or middle-aged patient and the most common reason for this is urinary tract infection. Painless hematuria usually occurs in the elderly males and the majority of the reason is malignancies. So, today we will be restricting ourselves to the painless hematuria. Painless hematuria in an elderly patient the commonest reason is urinary bladder cancer or urinary bladder tumour. This has been taken as the most common cause of continuous painless gross hematuria in more than 60 years age.

This is the second commonest urological cancer found in the males. So, males are more commonly involved compared with the female for the urinary bladder cancer and the ratio is usually 2:1 means every two males one female is involved. The common presentation of urinary bladder cancer as I told you is the hematuria. Most of the times the second most common cancer which can cause hematuria is the prostate cancer will be focusing more on CA bladder today not CA prostate. CA prostate will discuss in any other time so coming back to the urinary bladder cancer. The commonest age presentation I told is more than 60 years. It is the most common cause of hematuria as I told earlier is the commonest reason for hematuria in males. How we diagnose bladder cancer? The most common and the best modality to detect urinary bladder cancer is the endoscopy of the urinary bladder which is called cystoscopy.

The benefit of cystoscopy is that you can clearly visualise the tumour, you can take biopsy of the tumour, along with that if it is a superficial bladder cancer limited to one part of the urinary bladder you can completely remove the urinary bladder tumour. Urinary bladder tumour are divided in two categories: one is the superficial bladder tumour and the deep bladder tumours. The superficial and deep bladder tumours are divided on the basis of involvement of the cancer of the particular depth of the urinary bladder wall. So, as the name suggests superficial bladder cancer is the early-stage cancers and they can be very well treated by endoscopic pressure called TURBT means transurethral resection of the bladder tumour. It is similar to the TURP which is a common procedure done for prostate. So, if you see 70% of the patients are in the superficial category. So, 70% of the patient they very well get it treated by the endoscopic procedure without any cut or incision outside the body.

The rest 30% of the patients have deep bladder tumour and they need an extensive surgery in form of complete removal of the bladder, prostate, surrounding lymph nodes etc and the urinary bladder has to be urine has to be diverted and the commonest diversion is a hole is made in the abdomen at one quadrant and a part of the intestine is made in form of urinary bladder and one end is opened outside the abdominal wall and both the ureter means both the kidney are opened in one part of the newly made urinary bladder by the intestine. So, coming back to the superficial bladder cancer, the recurrence level in the superficial bladder cancer is very common but the progression of the cancer is not that common.

So, the possibility of recurrence is more than 70%. So, there has to be committed follow-up of these patients. So, there is a follow-up strategy made for CA bladder. This says that all the patient has to be followed up with endoscopy or the urethroscopy of the urinary bladder every three months for a period of one year, every 6 months after 1 year following the 2 years. And after that N1 cystourethroscopy is performed. Now, anytime in this time period if you come across recurrence, you remove it completely and it is again started as a fresh that means one every 3 monthly, 1 year every 6 monthly for another 2 years and N1 later on. So, anytime if there is progression then accordingly you treat the patients like I have already discussed in the deep invasive tumours and if it is just a recurrence you keep on treating like I have already told.

Thank you.

Hi,

I am Dr. Saurabh Mishra, Urologist. Today I will discuss prostate cancer from the general public point of view. This is common cancer a male can have a lifetime. Although the possibility of prostate cancer in our country is lesser than the western countries, still it is a significant one. I have come across with so many patients coming to my OPD with high PSA level and assuring themselves that they have prostate cancer and come to my OPD for the treatment of prostate cancer. But let me tell you the majority of these patients, they do not turn to have prostate cancer because of lack of awareness in the general public.

Any high PSA level is considered as prostate cancer. But that is not the truth. PSA is a tissue-specific marker, not a disease-specific marker. That means patients who have higher PSA, just show that there is a high tissue level whether it is malignant level or benign one is totally depends upon the relative value. If PSA is less than 4 nanogram per ml so there is no prostate cancer, which is absolutely incorrect. If a patient has less than 1 nanogram, there is a possibility of having prostate cancer. In case, a patient is having PSA more than 4 nanograms, doesn't mean he has prostate cancer. It is all relative. If a patient has 10 nanograms of prostate cancer, the possibility may be 20.

That means still 80% of the patients may have non-cancerous high PSA. It is our responsibility as a Dr to explain and reassure these patients about the fact and truth. With higher PSA also, there is a possibility of low prostate cancer. I am not talking about those patients who have a very high PSA and more than 100-200. If it is a very high PSA, then it is sure shot cancer. This discussion is basically for those patients to align between 4 nanograms per ml to say 30 nanograms or 35 nanograms. So, with higher PSA, do not make any conclusion. Rush to the urologist and discuss the things that how it has to go with high PSA. You urologist can advise for prostate biopsy also but do not assume by your own. Leave it on your urologist as he is going to treat you properly. Do not assume anything.

Thank You!

Hello friends! I am Dr. Saurav Mishra. I am working in senior consultant in the department of Urology Moolchand MedCity Lajpat Nagar.

Friends today I am going to discuss about the stone disease. This will be more of the point of view of the general public. So coming to the topic. The Stone disease is a common disease and mostly involve the young patients. The commonest factor of the stone disease there are multiple factors in fact but dehydration has been seen as to be the most consistent factor. The risk of recurrences are as high as 50%. There are various kinds of stones but oxalate stones are the commonest one.

How are they present? Most of the stones present as a pain – pain in both the sides of the abdomen is the commonest pain. How to detect these stones. Best investigation is the CT scan. The accuracy to detect these stone of the CT is more than 99%. How to treat these stones. The treatment depends on the location and the size of the stone. The size even it may be very small but according to the location it may be a dangerous stone. For example a stone of 5mm 6mm in the ureter may be dangerous whereas a stone of 2cm versus 10mm may not be dangerous in the kidney. Because a very small stone can block a kidney completely and knock out the kidney. Even a large stone if it occupies one corner of the kidney not going to cause a problem.

Come to the treatment. The medical treatment although discussed commonly but it has a role in the ureter stone. In our practice we see approximately 60% of the small stones. They pass spontaneously under the effect of medical treatment. As such there is not a single entity or a medication which can dissolve the stone and reduce the size of the stone and cause spontaneous passage. There is no existence of such thing but it has been seen there are few drugs which relaxes the ureter and facilitate the process of passage by the tune of 10%. So if someone is claiming that I am giving a particular tablet you can get rid of stone its wrong. Its total the size of the stone which is going to decide and the passage.

If the ureter is wide enough it can allow the stone to pass off. Now if the stone does not pass then the options are the surgical intervention or procedures. In urine stone it is surgeries are almost non existent. Now almost all the procedures are minimally. Majority are done through urine passage. The commonest procedure done is the ureteroscopy. The stones which are more than 5mm in diameter the possibilities are that the urine passage is low. These are stones they need the surgical procedures for their removal. Now the commonest procedure is the ureteroscopy. And the most common ureteroscopy is the semi-rigid ureteroscopy. If the stone is lying in the kidney and a small stone, for example, less than 10mm then the flexible ureteroscope can be used and be removed the same way as the ureter stone. If the stone size is large more than 1cm in that case the capacity of RIRS is not that much. So either it will not be able to fragment that amount of stone. So the PCNL has a upper hand in such patient. PCNL is there is the hole made in the back and through that a camera incepted and the stone is broken down and the pieces are removed so for larger stone in kidney the best modality is PCNL. The stones in the ureter or even the kidney stones which are small size the best modality is the ureter uterescopy. So these procedures they carry out 80% procedures found for urolithiasis. Thank you so much.

Hello everyone!

I am Dr. Saurabh Mishra. Today I will discuss the myths and facts about BPH. There is a common myth that if the size is small than treatment will be by medications and if the size is large then it may need surgical treatment. But in fact, it may happen vice versa. Now the second myth is about the BPH versus prostate cancer. There is a common myth that prostate patient may develop prostate cancer. So, BPH patients do not have a high risk of prostate cancer. The third myth is that all patients can be treated with surgical treatment. But in fact, few patients need surgical treatment.

Fourth myth: Leakage of urine after prostate surgery. This rate has gone down in the recent time. Fifth myth: Small prostate has a small problem and large prostate has a large problem. But in fact, size does not matter in this problem at all.

Thank You!

Hello friends. I am Dr Saurabh Mishra. I am a senior consultant in Urology in Lajpat Nagar, New Delhi. Now I am going to discuss something about Prostate. As you know prostate is a very common problem and it is not only seen by the urologist but so many other colleagues in the medical specialities, specially the physician. There are lot of myths and confusions about the Prostate in patients as well as the health care professionals. So, I would like to simplify the treatment methods for the prostate specially from the patient's point of view.

For the treatment protocol, we keep the patients into three categories;

• Those patients who are asymptomatic and incidently been detected an emlarged prostate. Anything above 20g prostate, we call it as enlarged prostate. So, suppose a patient have some symptoms, he has undergone ultarsound and enlarged prostate was picked up. Such patients lie in Group-1. They do not need any treatment and kept under observation. Once they face any problem, they are given appropriate treatment.
• Group-2 are those patients who suffer some urinary problems. Most commonly, they face frequent urine at night. In this category, they can have some obstructive features also. For example, they take long time to pass urine, the last part of the utine comes slowly that is called dribbling of urine. If these symptoms are present, the patient goes to the doctor and doctor evaluates and if no complicated factors are found then the medical treatment is started. So many medicines are available for the medical treatment of the Prostate. But unfortunately, most of them belong to same family. Due to this, if one drug fails to work then the options are least.
• Group-3 patients are those who have complications. The complication may include the recurrent urinary tract infection, recurrent blood in urine, either of the kidney or both the kidneys are enlarged, bladder stones etc. If these symptoms are present, then it becomes the complicated factor. If any of tehse factors or all of these are present in the patient, then these patients may directly be planned for the surgery and no medical treatment is incorporated in such patients.

Few things we come to know. I have never dicussed about the size of the prostate. That means the size of the prostate will not tell about the treatment. There are so many patients who took treatment from the physician also. So, to such patients, I want to clarify the thing that the treatment is not that complicated but the treatment should be incorporated. The patient should be clarifies about the problem and the treatment and the group should be evaluated for the patient.

Thank you so much.