Here are basic tips of Kidney Transplantation (Renal transplantation)
Friends good after noon I am DR. Aditya Pradhan. I look after the department of urology and kidney transplant at the BL Kapoor hospital. In my department major activities are kidney transplant, kidney cancers we do the constructive urology we also do a lot of stone surgery and prostate surgery so literally, we cover the whole spectrum of urology practice as it is done today in most centers around the world to speak briefly about kidney transplant which is the focus of our activity so as you must be aware India has a large number of patients with kidney failure on an average in India about to lac patients are diagnosed with kidney failure every year. Unfortunately out of these two lac patients barely 3,000 patients get your kidney transplant done every year so there is a large number of patients who don’t get a kidney transplant done in spite of the facilities being available in most major cities in the country.
There are many reasons why a kidney transplant is not easily available-
The first and most forms, of course, is the availability of donor so there are stringent laws governing the rules of a kidney transplant and it is mandatory for every patient to get his own donor and these donors have to be live related which means first-degree blood relatives. They could be the patient’s parents they could be a sibling, could be his own children who are above 18 years of age or they could be his spouse so amongst these family members, he has to get a patient of the same blood group or of O blood group. Many families do not have relatives with these conditions and that is why there is a big problem for the patient to get a donor for him. So, this is one of the main problems that you have, that you don’t have an adequate number of donors.
The second problem is even when donors are available within the family they are not willing to donate their kidneys. There are some reasons which are their most of them are misconceptions that patient was donated his kidney may not be able to function normally after the operation. So, these are absolutely unfounded doubts every patient who is going to be tested for kidney donation. All his tests are done to confirm that he is healthy the operation is usually a very safe operation and after the surgery, the patient can lead absolutely normal life.
These misconceptions must be discarded by the donor. They must come to the transplant surgeon and once they counseled and I am pretty sure that they will understand that they are doing a life-saving deed for their near and dear ones. This is the second problem where donors are available but they are not willing to help their relatives because of this misconception about the operation now the third reason is that we don’t have many cadaver donations.
In India now some of you may be aware that there is a concept called brain stem death these are patients who died in the ICU. Before their patients are declared dead their relatives are counseled that they can help the community by donating organs. These are what other problems which are faced when we are doing kidney transplants today but the scenario in India is changing, we have become increasingly better in our techniques we have got good drugs available so in most instances, a kidney transplant is a successful operation in this hospital.
Our results are more than ninety-nine percent which is as good as world standards we are doing all kinds of transplants the kidney donor operation between laparoscopic ally so that the recovery is very quick and most donors can be discharged by the third day to go back home. we are also doing abo incompatible transplant which means that if the blood groups are not matching the donor can be still be taken up for the transplant.
so friends this was a brief about kidney transplant and if you would like any more details about any of the aspects which I talked about you can reach out to me at the lybrate.com website.
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Urinary incontinence refers to the inability to control bladder movements. While it does not affect the person’s health, it can be an embarrassing condition. The severity of this condition can range from passing small amounts of urine every time you sneeze or cough, to getting a sudden strong urge to urinate without the time to get to a toilet. Urinary incontinence is not a disease by itself but rather is a sign of another underlying condition. It may be caused as result of childbirth, age, menopause, prostate, or a neurological disorder.
Treatment for this condition can take many forms:
- Medication: Urinary incontinence may be treated by many different types of medications depending on the underlying cause. Anticholinergics may be prescribed to calm the bladder muscles and reduce the urge to urinate frequently. Alpha blockers are typically prescribed to men to help them relax the prostate and bladder neck muscles so as to be able to pass urine freely. For women suffering from incontinence due to hormone fluctuations, topical estrogen may be helpful.
- Behavioral techniques: The patient will also be taught techniques to help control the bladder. This includes scheduling toilet visits every few hours rather than waiting for the urge to urinate. To avoid overflow incontinence, the patient may be advised to follow a double voiding process. This involves urinating, waiting for a few minutes and urinating again. Cutting back on diuretics such as alcohol, caffeine, etc can also help. In addition, regular exercise and physical activity can help ease the issue.
- Pelvic Floor Exercises: Pelvic floor exercises or Kegel exercises can help strengthen the pelvic muscles and prevent leakage. This involves contracting the pelvic muscles, holding them for a few seconds and then releasing them. Ideally, the patient should be able to hold the contraction for 10 seconds. This exercise should be performed in three sets of 10 repetitions each. It is very effective in treating stress and urge incontinence.
- Medical devices: Women suffering from severe urinary incontinence can consider the implantation of medical devices to help control the bladder. This includes a urethral insert to prevent leakage and a pessary or stiff ring to hold up the bladder muscles.
- Surgery: Surgery is usually considered only as a last resort. This could be in the form of a sling procedure, bladder neck suspension, prolapse surgery or inserting an artificial urinary sphincter. These procedures may be used to treat many different types of incontinence.
Gradual failure or slowing down in the functioning of the kidney is known as chronic kidney disease or chronic kidney failure. The basic function of the kidney is to filter the waste and also all the excess fluids in the blood which is eliminated through the urine. So, when this process does not happen in the way it should, then that stage is kidney failure.
When this problem reaches an extreme stage such as when it is not able to eliminate the waste and excess fluids, they get accumulated in the body. If the damage is bad, then the kidneys fail. If both the kidneys stop working, then you will need a kidney transplant or dialysis to survive. The treatment of chronic kidney failure involves slowing down the damage to the kidneys and that can be done by controlling what is causing the kidneys to stop functioning.
Here is the list of some causes of chronic kidney disease:
- Diabetes is one among the two main reasons for chronic kidney disease. The filters of your kidneys will get damaged due to too much sugar in the blood. As time passes, this will affect the kidneys as well and they will not be able to do their job properly. They will not be able to filter the waste from the body. The first sign of kidney damage is traces of albumin protein in your urine. Usually, when the kidneys are healthy, you will not have this problem.
- Another reason for chronic kidney disease is high blood pressure. The blood vessels in the kidneys will be damaged due to high blood pressure and that will damage the kidney functioning. That means, when the blood vessels are damaged, the waste and excess fluids from the body will not be filtered in the right way. Now, in turn, excess fluids will increase the blood pressure and that becomes a cycle.
- Any kind of genetic disorder can also cause chronic kidney disease. A cyst will grow inside the kidney and affect the functioning.
- Any kind of infection caused to the kidneys can also affect the functioning of the kidney and that in turn gets worse.
- Taking drugs which can be harmful to the kidneys can be a reason for chronic kidney disease.
- Lead poisoning or any heavy metal poisoning can be a reason for kidney failure.
- A family history of kidney diseases can also be a reason for chronic kidney disease.
- Age can also be a reason for kidney failure. People with age above 60 years are more prone to kidney failure.
Kidney disease or kidney failure is permanent and it cannot be undone. But through the right diet and following a few cautionary steps, one can keep the kidneys healthy for a long time.
The kidneys are two small organs located in the abdomen. The main function performed by these organs is filtering of the blood. Kidneys help remove waste from the blood which they turn into urine so that it may be excreted from the body. In doing this they also help regulate blood pressure, maintain the production of red blood cells, and sustain the electrolyte balance. When the kidneys do not function properly, the results could be fatal.
Hence, it is important to be able to recognize the early signs and symptoms of Kidney failure.
- Tiredness: A decrease in kidney functioning can cause toxins to build up in the body and blood. This can make a person feel more tired than usual and keep them from concentrating on simple tasks. Kidney failure is also associated with anemia which can also contribute to fatigue.
- Trouble sleeping: Chronic kidney disease has been linked to obesity and sleep apnea. Both these conditions can make it difficult for a person to fall asleep and stay asleep. The buildup of toxins in the blood can also contribute to insomnia.
- Dry skin: The skin is one of the first organs to show signs of internal organ failure. Thus, when the kidneys stop functioning as well as they are supposed to, the skin turns dry and itchy. This is because the production of red blood cells is reduced and the amount of minerals or nutrients in the body is unbalanced.
- Increased urge to urinate: An increased urge to urinate frequently especially at night could be a sign of kidney disease. This may also be a sign of a urinary infection.
- Blood in the urine: Urine should ideally be clear and pale yellow in color. Seeing blood mixed with urine should never be ignored. This is a sign that the kidneys have been damaged and blood is leaking into the urine. It could also be a sign of kidney stones, an infection, or a tumor in the kidney.
- Foamy urine: Excessive foam in the urine that does not go away even after flushing could be a sign of protein in the urine. This foam may look similar to a beaten egg white as it is produced by albumin; the same protein present in eggs.
- Swollen ankles: Swollen ankles are a sign of sodium retention. This is caused by the improper filtration of blood by the kidneys. The patient may also notice his or her feet getting swollen.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Urine is the body’s way of removing toxins from the bloodstream. This should be a painless procedure but many people complain of painful urination. This pain could stem from issues with the urethra, bladder or perineum. It may be caused by a number of factors.
- Urinary Tract Infection (UTI): UTI could be caused by an inflammation of the urethra or a bacterial infection. In either case, painful urination is one of the first signs that can be identified. Women have a higher risk of UTIs as they have a shorter urethra as compared to men. This allows bacteria to travel through the urethra easily to reach the bladder.
- Sexually Transmitted Infection (STI): A sexually transmitted infection such as gonorrhea, genital herpes or chlamydia could also cause painful urination. These diseases may not have other visible symptoms and hence it is important to get yourself checked out by a doctor. Simple sexual practices such as engaging in safe sex and abstaining from sexual intercourse with multiple partners can help prevent STIs.
- Prostatitis: This is a condition in which the prostate gland gets inflamed. This affects only men and is a common cause of painful urination and a stinging sensation while passing urine.
- Cystitis: Cystitis can be described as an inflammation of the lining of the bladder. It can make a person want to urinate more frequently, cause urinary incontinence and painful urination. The most common type of cystitis is known as Interstitial cystitis (IC).
- Kidney Stones: Mineral deposits in the kidneys are known as kidney stones. The size of these stones can range from a few mm to be as big as a golf ball. The larger the kidney stone, the more painful it will be. Small kidney stones may be passed out of the body along with urine while medical intervention may be required for larger kidney stones.
- Urethral Stricture: This is a condition where the urethra is narrowed by the development of scar tissue around it. It may be the result of a previous surgery, trauma to the abdomen, cancer, radiation etc. as the urethra is narrowed, the amount of urine that can pass through it is reduced thereby causing pain and difficulty urinating.
- Allergy: An allergic reaction to soaps, lotions, creams and other such personal hygiene products used in the genital area can also contribute to painful urination. Sometimes the dyes in laundry and detergents can also cause irritation in your private parts.
Bedwetting is a common problem among children who are yet to learn how to control their bladder but bedwetting can also be a problem for adults. Adult bedwetting is known as secondary enuresis. It is a condition that develops at least six months or much later after a person has learnt to control over their bladder.
Adult bedwetting can happen occur due to several reasons that are listed below:
- Sleeping problems can be a major reason for bedwetting at night. Sometimes one might be in a deep slumber to and wakes up to the sensation of a full bladder and the urge to urinate. Also, many suffer from another sleeping disorder- night terror. One wakes up partially from their sleep frightened which may cause them to lose control on of their nerves and wet the bed.
- Stress and anxiety is another major cause for adult bedwetting. Adults have busy schedules these days and the stress and anxiety levels are high in them. Extreme stress and frustration can make one nervous as a result the person may find it difficult to control his nerves and thus lose control over the bladder.
- Medical conditions in a person or a person who suffers from neurological disorders are prone to lose the control over their bladder. Patients who have suffered a stroke often face difficulties to in responding to signals send sent by the body and the sensation of a full bladder is one of them. Often as a side effect of medication one may face this problem.
- One may have a small bladder that may not be able to hold the large volume of urine that the body produces. Maybe during the day, the person may not face a problem but at night this can be a reason for bedwetting. A person's bladder can also become hyperactive during the night which leads to the inability to hold the urine in during sleep.
- Diabetes is a very common reason for bedwetting among adults especially among the elderly people. In case of type 1 diabetes, the extra glucose that is stored in the liver and muscle tissues are released between meals or during exercise or at night during sleep.
- Urinary tract infection caused by microbes can cause one to lose control over the infectionbladder. Infection in the bladder or the kidneys or ureters and the urethra are termed as UTI.
- An obstruction in part of the urinary tract, such as from a bladder stone or kidney stone can cause a person to face this the problem of bedwetting.
Other than these major reasons, a few others can be an enlarged prostate, obstructive sleep apnea, hormonal problems or genetics can contribute to the problem of bedwetting. Bedwetting may not stay the entire life but in adults, it causes other problems like such as embarrassment or lack of confidence. Bedwetting, however, should not be neglected and one should visit a doctor lest it should lead to other health problems.
In case you have a concern or query you can always consult an expert & get answers to your questions!
My dad was diagnosed with renal cell carcinoma. But there were no symptoms. They removed half kidney by surgery. Will there be any chances of spreading cancer cells to other body parts or will the cancer be back? What are the precautions to be taken?
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:
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.
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.
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.
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.
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.
Bladder Tumors: The are mostly characterized by blood in urine. Sometimes there might be blood clots that obstruct the urine flow.
Phimosis: Phimosis is another major reason behind urinary tract obstructions.
In case you have a concern or query you can always consult an expert & get answers to your questions!
The prostate gland in males surrounds the urethra, through which urine and sperm are passed out of the body. Its function is to secrete a fluid, which provides nourishment to the sperm. It is about the shape of a walnut and is present between the pubic bone and the rectum.
As a man crosses 40, the prostate gland begins to increase in size due to an increase in the number of cells. This is known as hyperplasia. The condition is usually benign and therefore the name benign prostate hyperplasia (BPH). As it continues to grow, there is an increased pressure on the urethra. Therefore, there can be problems with urination. The bladder, being a muscular organ, compensates to some extent and so the problems with urination are mostly managed. If left untreated, this can continue to be a major problem and the bladder may not be able to compensate. In men who are 60-plus, BPH is very common.
Signs and symptoms
- One of the initial symptoms of BPH is when the urine stream begins to grow weak.
- There could also be a reduced speed of passing urine.
- Men with BPH never have a feeling of complete emptying of the bladder.
- On the other hand, there is also a constant difficulty in initiating a urine stream. There could be intermittent breaks in the urine stream.
- The person may feel the need to strain to initiate the stream and to ensure complete emptying.
- There could be dribbling of urine after passing urine.
- The duration between two bathroom visits can constantly reduce, with the constant urge to urinate.
- There is a constant urge to visit the bathroom, which is more common in the night. One of the most annoying features of BPH is the walking up at night to urinate, but with an inability to initiate a stream and an inability to completely empty the bladder, it leaves the person very irritated and frustrated.
- There could be blood in the urine. In fact, blood in the urine accompanied by fever, chills, nausea and vomiting are indications of an emergency.
- There could be blockage of urine completely, if the enlargement is quite severe.
If you are having any of these symptoms, then the doctor will first test for an enlarged prostate through a digital rectal exam. Then a test is done to check a chemical called prostate specific antigen. Increased levels of this chemical is almost always indicative of BPH. In addition, X-rays and scanning may be used to confirm diagnosis.
Blood test cancer prostate is PSA. It is done only if there is a suspicion of cancer. Most cases can be managed by medication. Surgical removal procedure needs a minimum of 2 to 3 days. If you wish to discuss about any specific problem, you can consult a Urologist.
The prostate gland is a male reproductive organ at the base of the urinary bladder and urethra is a thin tube that carries urine out of the penis. It runs through the prostate gland. A fluid produced by this gland helps to carry sperms produced by the testes outside during intercourse.
Cause of urinary problems in men:
Men experience urinary symptoms either due to inflammation of the prostate gland or prostatitis or symptoms may be the result of a blockage of the passage due to enlargement of the prostate gland.
Symptoms of urinary problems:
1. The need to urinate frequently during the night.
2. Urinating more often during the day.
3. Urinary urgency is the urge to urinate can be so strong and sudden that one may not reach the toilet in time.
4. The urine stream is slow to start.
5. Urine dribbling for some time after finishing urination.
6. A sensation that the bladder is not fully emptied after urination.
7. A lack of force to the urine flow, which makes directing the stream difficult.
8. The sensation of needing to go again soon after urinating
1. A long course of antibacterial medication (for bacterial prostatitis) is prescribed, because infection is difficult to get rid of, the antibacterial medication will need to be taken for many weeks.
2. Medication to improve urine flow and other symptoms (for obstruction caused by an enlarged prostate).
3. Surgical procedures (for blockage caused by an enlarged prostate), such as Transurethral Resection of the prostate(TURP), Laser Resection of prostate, Transurethral Incision of the prostate(TUIP).
UroLift: A new method of treatment for men, where medication has not been successful, but their prostates are not so enlarged that they need more invasive surgery. It involves the Transurethral Insertion of staples to separate the lobes of the prostate. It has minimal side effects and preserves ejaculatory and erectile function.
A number of other procedures that have been developed to reduce urinary symptoms.
Medication for urinary problems:
1. Medications to reduce the tone of the muscles of the urethra and prostate to minimize any obstruction to urine flow caused when these muscles contract.
2. Medication to reduce the size of the prostate gland. These drugs work by blocking the action of male hormones produced by the prostate gland.
3. Medications to relax the bladder, making unwanted contractions less likely and reducing the symptoms of urgency and frequency of urination.
4. Over-the-counter medicine 'Saw Palmetto' (Serenoa repens) is used sometimes. This may help some men, especially if frequent urination at night is a problem. However, recent reviews of the evidence for using Saw Palmetto as a treatment for mild or moderate urinary symptoms did not show any improvement compared to no treatment, in men with BPH. If you wish to discuss about any specific problem, you can consult a Urologist.
Urinary incontinence, commonly known as loss of bladder control can really cause embarrassment. The severity of this condition may range from once in a while leaky urine to the sudden and forceful urge to urinate, due to which you end up urinating before reaching the toilet.
Types of Urinary Incontinence:
1. Stress incontinence- When you feel the urge to urinate due to sneezing, coughing, laughing or while doing physical exercise
2. Urge incontinence- When you feel the urge to urinate, suddenly. This may occur during the day and even at night.
3. Functional incontinence- When you cannot reach the toilet on time because of a physical or mental impairment.
4. Mixed incontinence- When you involuntarily urinate due to more than one incontinence
Stress incontinence is the most common type in women. The activities which increase your risk, are:
1. You have had more than one pregnancy and vaginal delivery.
2. You have pelvic prolapse. This is when your bladder, urethra, or rectum slide into the vagina. Delivering a baby can cause nerve or tissue damage in the pelvic area. This can lead to pelvic prolapse months or years after delivery.
Female urinary stress incontinence is the involuntary release of urine during any physical activity that puts pressure on your bladder. This potentially embarrassing condition differs from general incontinence in that it happens when the body is under immediate physical stress. Activities that can put stress on your bladder include coughing, sneezing, laughing, lifting heavy objects, or bending over. This condition is particular to women, many of whom experience symptoms after muscles have been weakened due to a vaginal childbirth, following menopause, or during pregnancy.
Ensure that you consult a doctor:
1. If this condition hinders your day to day activities
2. If the urinary incontinence is the result of a serious underlying problem
Urinary incontinence may be temporary or permanent.
Causes of temporary incontinence are:
2. Caffeine and caffeinated drinks
3. Decaffeinated tea or coffee
4. Spicy and sugary foods
5. High intake of Vitamin B or C
6. Urinary tract infection (UTI)
Chronic urinary incontinence can lead to certain complications like
1. Skin problems- Skin rashes and infections can develop around the vaginal area, because of the constant wetness one feels. It may also cause sores.
2. Urinary Tract Infections- Urinary incontinence can also result in UTI
3. Impact on personal and social life- Urinary incontinence can lead to great embarrassment, thus affecting the social and personal life of an individual.
Treatment for Female Stress Urinary Incontinence:
There are several types of treatment available. Treatment options include lifestyle changes, medications, nonsurgical treatments, and surgeries.
Make regular trips to the restroom to reduce the chance of urine leakage. Drink fewer fluids and avoid activities such as jumping and running.
Medications that reduce bladder contractions.
Kegel exercises strengthen your pelvic muscles. Done regularly, these exercises can strengthen your muscles, allowing you to control when urine is released from your body.
If other treatments fail, you will have to go for surgical treatment. Types of surgery include:
Injectable therapy, in which collagen is injected into your urethra to reduce incontinence.
Tension-free vaginal tape (TVT) surgery, in which mesh is placed around the urethra to give it support.
Vaginal sling surgery, in which a sling is placed around the urethra to support it
anterior or paravaginal vaginal repair surgery to repair a bladder that is bulging into the vaginal canal.
Retropubic suspension surgery to move the bladder and urethra back into their normal positions.
Some doctors even try electrical stimulation and medication. When the condition is highly advanced interventional therapies and surgery is recommended.
Some interventional therapies are:
1. Bulking material injections
2. Botulinum toxin type A
3. Nerve stimulators