One of the most common issues with old age in men is the enlarged prostate. Any difficulty with urination (no constant stream, difficulty initiating, or incomplete emptying of the bladder for instance), and the first suspect is an enlarged prostate. These symptoms are followed by a digital rectal exam to check for an enlarged prostate. Once confirmed, the next step is to check for levels of prostate-specific antigen (PSA). If both the exam and the PSA are positive, it could mean prostate cancer. As with any cancer, it is believed that sooner it is diagnosed and the treatment is started, the better.

Historically, the best way to rule out the prostate cancer had been to do a prostate biopsy. This is a minor invasive procedure, wherein biopsies are taken from various regions of the prostate which are known to develop cancer (about 12). A disadvantage of this procedure includes missing out on the front part of the prostate which can also develop cancer. Secondly, it is not a very pleasant experience and given a chance, most men would not want to have it done.

There is good news for these men who would like to avoid prostate biopsies. The first is the multiparametric MRI which uses no x-rays and is considered very safe with extremely accurate results. This MRI exam requires about an hour, and once the images are obtained, the doctor will analyse these images and check for several parameters to assess for prostate cancer. The absence of cancer can be confirmed with up to 90% accuracy, which is far greater than with usual biopsies. If there is a possibility of cancer, then a biopsy can be done to confirm it. 

Also, these images indicate the exact region where cancer likely is, and this guides the doctor to biopsy only where absolutely essential. The chances of false positive and false negative results are reduced drastically. The one disadvantage here is that MRI detected biopsies usually tend to be of a higher grade which requires immediate treatment.

Another way to reduce chances of the biopsy by 30% to 50% is by the 4K test. It helps detect a variety of prostate issues including cancer. It can be used once higher levels of PSA is identified and before going for a biopsy. It combined 4 prostate-specific biomarkers with clinical information to accurately provide men with a risk of developing prostate cancer. It can be used even after negative biopsies to confirm the diagnosis of prostate cancer.

These two measures can drastically reduce the incidence of prostate biopsies, which is neither pleasant for the patient nor very effective for the doctor.

Prostate Biopsies - Ways You Can Avoid It!

Glomerulonephritis is a disease that is caused due to inflammation of the small filters that are present within the kidneys or glomeruli. Glomeruli eliminate the excess waste, electrolytes and fluids from the blood, discharged through urine. A glomerular disease can be either acute or chronic. If the condition arises without a combination of any other disease, it is termed as primary glomerulonephritis. Secondary glomerulonephritis is characterized by diabetes or lupus (an auto-immune disorder) being at the root of the disease. Prolonged or severe inflammation can take a toll on the kidneys.


Causes-


Nephrotic syndrome can be primary, being a disease specific to the kidneys, or it can be secondary, being a renal manifestation of a systemic general illness. In all cases, injury to glomeruli is an essential feature. Kidney diseases that affect tubules and interstitium, such as interstitial nephritis, will not cause nephrotic syndrome.


Primary causes of nephrotic syndrome include the following, in approximate order of frequency:
Minimal -change nephropathy
Focal glomerulosclerosis
Membranous nephropathy
Hereditary nephropathies


Secondary causes include the following, again in order of approximate frequency:
Diabetes mellitus
Lupus erythematosus
Viral infections (e.g., hepatitis B, hepatitis C, human immunodeficiency virus [HIV] )
Amyloidosis and paraproteinemias
Preeclampsia
Allo-antibodies from enzyme replacement therapy


Nephrotic- range proteinuria may occur in other kidney diseases, such as IgA nephropathy. In that common glomerular disease, one third of patients may have nephrotic- range proteinuria.


Nephrotic syndrome may occur in persons with sickle cell disease and evolve to renal failure. From a therapeutic perspective, nephrotic syndrome may be classified as steroid sensitive, steroid resistant, steroid dependent, or frequently relapsing.


Treatment-
Whether one is suffering from acute or chronic nephrotic glomerular , with symptoms moderate or severe, the treatment lies in treating high blood pressure and other underlying conditions of the disease.
Water pills help control sweating, thus increasing the fluid flushed from the kidneys.
Statins reduce cholesterol level.
Blood thinners such as anticoagulants lower the risk of blood clots.
Corticosteroids regulate the immune system and ease the inflammation that results from kidney disorders.
Incorporating certain lifestyle changes such as opting for lean proteins, cutting on the intake of fat in the diet and consuming lesser amounts of salt can treat inflammation and swelling.
For kidney failure, dialysis can come to the aid in eliminating excess fluids and regulating hypertension.


Nephrotic Syndrome: Causes and Treatment

No Blood, No needle, No visit to hospital, you can do yourself at home with water. A thin layer of transparent screen like structure hangs in front of the abdominal muscles known as peritoneum. This peritoneum protects the abdominal structures and the muscle. This can also be used for performing dialysis which is carried out when the functioning of kidney gets affected. In peritoneal dialysis a thin and soft catheter is placed in the person s belly one week before performing the procedure.

The catheter has numerous holes in order to facilitate the transformation of fluids. Dialysis solution is prepared in a bag and the tubing is connected to the catheter placed in the abdomen thereby, the fluids absorb the waste materials from the body. The fluid is allowed to stay in your body for a particular period of time which is commonly referred as dwell time and later the fluid is drained out.

There are two types of peritoneal dialysis, continuous ambulatory peritoneal dialysis and automated peritoneal dialysis. This is the simple form of dialysis which anybody can perform after a short training period and this can be done anywhere in clean private place like hotels, home and even in office.

Procedure followed during Peritoneal Dialysis
All you need to perform a peritoneal dialysis is catheter and transfer set, cycler, dialysis solution and safety precautions materials to stay away from getting infections.
Step 1 - Perform a sterile aseptic technique. Wear a glove and surgical mask before connecting the catheters and transfer set. Clamp the tubing and remove the catheter once the dialysis solution enters your abdomen
Step 2 - Allow the solution to remain in your abdomen for a particular period of dwell time
Step 3 - Drain the fluid from the abdominal cavity into the drain bag. You may feel a mild tugging sensation when adequate amount of fluid is drained.
Step 4 - After drain close or clamp the transfer set and later flush a fresh solution directly to drain bag so as to remove the air from the tubing.
Step 5 - Close your drain bag and open your transfer set and refill your belly with fresh solution.

Make sure you perform without giving way for infection and excess fluid and dextrose absorption.

Peritoneal Dialysis - Procedure to be Followed!

Our kidneys act as filters which constantly flushes out toxins and excess minerals with water in form of urine. Urine contains lots of minerals which may precipitate and form stones. Urine has lots of pro-precipitating agents and anti-precipitating agents. When their balance disturbs due to some disease, stones start forming. These stones may often lead to abdominal pain which is referred to as renal colic. 

What exactly is renal colic? 

Renal or ureteric colic is the term used for typical pain in one side of abdomen in flank region starting from back and radiating forward towards lower abdomen up to scrotum. This is usually associated with nausea, vomiting and urinary discomfort. There may be blood in urine. 

How kidney stones are related to renal colic? 

Kidney stones usually form inside kidney and lies there without causing any pain. But whenever they are dislodged and stuck at mouth of kidney (pelvis) or anywhere in ureter, they block the passage of urine of that kidney. This causes swelling in kidney termed as hydronephrosis. This swelling in kidney causes renal / ureteric colic. This colic is protective phenomenon and tries to push out the stones. Small stones do come out in urine by this natural process. This spontaneous expulsion of small stones is common and many local practitioners used to get credit of it feigning benefit of their medicine. However large stones need some form of intervention to come out. Otherwise, they do harm to kidneys in long term. 

Symptoms of kidney stones along with renal /ureteric colic - 

Most stones which are lying in calyces of kidney are asymptomatic 
Nausea & vomiting 
Frequent urinary tract infections 
Fever with chills 
Foul smelling urine 
Hesitency, frequency and burning in urination 
Blood in urine (urine with a reddish, pink or brownish hue) 
Passage of small stones in urine 
Treatment of renal colic 

Treatment of ureteric/renal stones involves control of symptoms and stone removal. 

Expectant Treatment or Medical Expulsion Therapy: Small stones of less than 4 mm size usually pass on its own and some medicines like alpha-blockers and steroid hasten up their expulsion. Medium size stone (4-6 mm), sometimes passes with aid of these medications. But stones larger than 6 mm usually require intervention. 
Lithotripsy: This method involves breaking of stones by shock waves into small dusty particles which pass through urine on its own. This is usually suitable for stones upto 1.5 cm and lying in kidneys. This is non-operative treatment which can be done on OPD or Daycare basis. 
Ureteroscopy (URS): This method involves entry of very thin semirigid scope through urethra into ureter. Stone is broken by LASER and removed. This involves single day admission and spinal anaesthesia. 
RIRS- Retrograde Intra Renal Surgery: In this method very thin flexible scope in maneuvered through urethra into the upper ureter and pelvi-calyceal system of kidney. Stones in kidney or upper ureter are broken by LASER and removed. This is also done under anaesthesia and requires a day admission. 
Mini- PCNL: This method is suitable for large renal stones. In this technique, a small hole is made into the kidney through back and tiny scope is entered into the kidney. Stones are broken by LASER and removed. This is done under anaesthesia and require two to three days admission.

Renal Colic - Ways it Can Be Treated?

Colorectal surgery is the broad term for surgical procedures performed on the colon, the rectum and the anus. There are various different surgical procedures which fall under colorectal surgery and these are used to treat a vast array of disorders, such as:
1. Anal cancer
2. Colorectal cancer
3. Severe complications related to constipation
4. Anal injuries
5. Inflammatory conditions of the gastrointestinal tract
6. Congenital defects

Procedures
The surgeries under colorectal surgery are performed after diagnostic tests such as proctoscopy, sigmoidoscopy and defecating proctography. The most common diagnostic test is colonoscopy. These help to identify the origin and nature of the problem and decide which surgical procedure is to be followed. The procedures under colorectal surgery are as follows:

Colectomy
This procedure involves removal of a section of the large intestine. This is known as partial colectomy. In extreme cases, such as advanced cancer or severe gastrointestinal infection, the entire colon is removed and this is called total colectomy. Sometimes, the rectum is also taken out along with the colon and this is called proctocolectomy.

Colonic polypectomy
An abnormal growth of tissues in the inner lining of an organ is known as a polyp. Colonic polypectomy is done to eliminate polyps from the colon and rectum before they become malignant. This can be done endoscopically. Surgery is required in case of large polyps.

Strictureplasty
Chronic or repeated bowel inflammation causes scar tissue to accumulate in the large intestine. This results in the narrowing of the colon. Stricturoplasty removes the scar tissue so that proper flow of digestive contents is resumed.

Colostomy or ileostomy
A damaged section of the colon is removed and the shortened intestine is then attached to another opening (stoma) in the anterior wall of the abdomen.

Hemorrhoidectomy
This surgical process is used for swollen hemorrhoids or blood vessels, which form in the anal canal. Hemorrhoidectomy is extremely effective in removing hemorrhoids, but the surgery also involves a number of complications.

Anoplasty
Anoplasty or imperforate anus correction is done to correct birth defects in the rectum and the anus. The structural flaw does not allow the stool to pass properly from the rectum and so it is repaired through surgery.

All About Colorectal Surgery

The general perception that hereditary diseases cannot be prevented is changing. Polycystic kidney disease (PKD) is one such hereditary condition. The kidneys are the body's detox machine, which remove all impurities and flush it out of the system through urine. PKD is a condition where there are multiple, fluid-filled cysts which develop in the kidneys. These can vary in size and though noncancerous, can grow to a very large extent, producing severe symptoms including extremely high blood pressures and kidney failure.

In the recent past, however, there have been various theories that put forth how a modified and healthy lifestyle can prevent PKD. A child with a parent who suffers from PKD has 50% likelihood to develop the same. That cannot be prevented; however, changes can be made which can delay the onset and reduce the severity of symptoms of PKD, most notably high blood pressure and kidney failure which may require lifelong dialysis.

Symptoms and complications: The most common symptoms include high blood pressure, kidney pain (behind the back above the buttocks), infections of the kidneys or the bladder, bloody urine, kidney failure, headache, bloated abdomen due to the fluid-filled cysts, frequent urination, and kidney stones. There could be impact on pregnancy plans, with high blood pressure complicating the pregnancy. This needs extra care in management and is not life-threatening in most cases.

Prevention: The kidneys take the brunt of all the toxins that a body is subjected to. It is therefore, very important to reduce the exposure of body, especially kidneys to toxins. One of the best ways to keep the kidneys in good health is to control blood pressure. Some of the ways to do this include:

    Following a low-sodium diet with a good amount of hydration
    Reduce fat in the diet as much as possible
    Include a lot of berries, broccoli and apples
    Be diligent in taking your blood pressure medications as directed
    Ensure that your weight is within the prescribed limits for you
    Quit smoking and drinking
    At least 30 minutes of moderate physical activity should be included in your daily regimen

Read up on symptoms of PKD and keep an eye on them. If you are having a bloated feeling or pain in the kidneys or blood in the urine, consult a doctor. If you are planning on having a baby, genetic counseling may be useful to see if there is a risk of passing on the genes to the baby. Keep a positive outlook and have a frank discussion with family and friends on your overall condition. So, as much as PKD is a hereditary disease, there are ways to manage it and improve the quality of life.

Is Polycystic Kidney Disease Preventable?

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