Dr Pristyn Care

Chronic Suppurative Otitis Media causes recurrent or persistent discharge through a perforation in the tympanic membrane, and can lead to thickening of the middle ear mucosa and mucosal polyps. It is a common cause of hearing impairment, disability, and poor scholastic performance.

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. Vivek Kumar Pathak, MBBS MS ENT. I am an ENT specialist. Today I am going to discuss about the medical condition which is called Adenoid tonsillitis. So what are tonsils? Tonsils are nothing but they are a connection of lymphatic tissues which are present in the palatine, they are called as Palatine tonsils. There are certain tonsils which are present in the nasopharynx, they are known as the Adenoids. So these tonsils sometimes become hypertrophic, they increase in size. So whenever they increase in size, there are certain symptoms with which the patient comes in the OPD or the casualty. The symptoms are difficulty in swallowing, fever, sleep apnea, difficulty in breathing at the bedtime and similar condition with the adenoids.

Adenoid are more common in children. Normally they regress by the age of 12 to 13 years. Sometimes the adenoids are very much hypertrophic, then they cause difficulty in breathing, recurrent sinusitis, sometimes the child sleeps with mouth open. Whenever the patient develops all these symptoms, these tonsils and the adenoids we have to remove them. First of all we go for medical treatment. If the patient doesn't get treated we go for the surgery. The surgery for these hypertrophic tonsils and adenoid is removal. Nowadays we use a precise instrument like Coblation and laser to remove these adenoid and tonsil. By this technique, the blood loss is very less so you can say one drop or two drop of blood loss is there. The post-of period is painless. Nowadays we use the coblation method. If you are having these symptoms or your child is having these symptoms of tonsillitis and chronic adenoid hypertrophy then you can come to us and get relieved.

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!

Hi!

I am Dr. Vivek Kumar Pathak. Today I am going to discuss with you regarding a medical condition of your underline throat that is called as Vocal Polyp. It is a type of voice disorder. So what happens? There is a formation of a polyp over the vocal cords. So vocal cords are the structures which are responsible for speech production. So because of this polyps, the patient develops hoarseness of voice. So the main symptoms in case of vocal cord polyp is a hoarseness of voice. So, there are various types of voice disorders. So, number 1, whenever there is a structural abnormality over the vocal cord like vocal polyp, vocal nodule, Reinke's edema or there are certain functional disorder like dysphonia. So in case of, whenever a patient of hoarseness of voice comes in OPD, first of all we do certain investigations or examination. Number 1 is laryngoscopy examination.

This can be done like OPD basis or in operation theatre. So first of all we look at the movement of vocal cord or any structural abnormality or any functional abnormality of the vocal cords. So the patient is having vocal polyp, we suggest certain type of surgery that is called as microlaryngeal surgery. So basically microlaryngeal surgery is a surgery to remove the vocal polyp with minimal damage to the vocal cords. So, with fine instruments we excise the polyp and the patient can gain a normal voice after the surgery or with other disorders we can treat accordingly like if a patient is having a dysphonia, we can give certain type of speech therapy or certain medical treatment is also there, we can give proton pump inhibitors also. So basically the management of a patient of hoarseness of voice depends upon the cause which has caused hoarseness of voice. So if a patient is having vocal polyp, we can excise the polyp by microlaryngeal surgery.

If the patient is having functional disorder, we can treat it accordingly. If a patient is having the goats over the vocal cord, we can excise the tissue and send it for histopathological examination to rule out any malignancies especially for patient is above 60 years and patient is chronic smoker. So, the management is medical or surgical. That's much. So in our centre we are doing this microlaryngeal surgery. Anybody can come and go for consultation if the patient is having hoarseness of voice especially if a patient is above 60 years.

Thank you!

Hi,

I am Dr. Kundan Kharde so, today I will be discussing laser and laparoscopy in general surgery. So, both topics fall under minimal access surgery. Laparoscopy is basically surgery of the abdomen with the help of some optic fiber. In this, we make very small incisions. And through these buttonholes, we insert some cameras and optic fiber. We get a better and magnified view of internal organs on a big screen.

With the help of an instrument, we can operate many abdominal surgeries like appendix, gallbladder stones, and even hernia can be treated with laparoscopy. So, what are the advantages of laparoscopy surgery? As I said that the wound and the cut will be very small. So, there will be less pain, recovery will be faster. Hospital admission will be very less. Apart from this, we also do laser. Laser in general surgery is mostly used for varicose veins. We use laser for piles, fistula, and fissures. With the help of the laser, we can correct all those problems. The laser enables us to operate these cases in a minimal way. It gives fewer wounds, faster recovery, less pain, and lesser hospital stay.

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 everyone!

I am Dr. Vivek Kumar Pathak, MBBS MS - ENT specialist. Today I am going to discuss about deviated nasal septum. So what is deviated nasal septum? First of all we have to know that what is nasal septum? Nasal septum is a partition between the nasal cavity which divides the left nasal cavity and the right nasal cavity. Nasal septum comprises of the cartilage part and the bony part. The cartilage is called as the septal cartilage or quadrilateral cartilage. Sometimes during the development of the body and face, the nasal septum becomes deviated specially at the time of 17 to 18 years and the patient develop certain symptoms. The symptoms can be nasal obstruction, there can be recurrent episodes of sinusitis, there can be bleeding from the nose. So asymptomatic deviated nasal septum has to be corrected. The treatment of deviated nasal septum can be done by operation called as septoplasty, Septoplasty is the correction of the deviated part of the nasal septum.

It can be done endoscopically or it can be done by open surgery. Nowadays we are preferring endoscopy surgery for the nasal septum deviation. Any patient who is having all these symptoms with deviated nasal septum, the septoplasty can be done. It is done in our centre. Anyone who is having the symptoms, is having deviated nasal septum can get corrected by septoplasty which is simple procedure which can be done under local anaesthesia and if the patient is apprehensive, it can be done under general anaesthesia.

Thanks!

Hi! Myself Dr. Vivek Kumar Pathak. I am ENT specialist. Today I am going to talk about nasal polyps. Nasal polyp is a condition of the polypoidal nasal mucosa or the diseased nasal mucosa. The polyps can be allergic or they can be antrochoanal polyps. The allergic polyps are ethmoidal polyps. Regarding the management of antrochoanal polyps we have to give antibiotics and following that we have to go for Polypectomy. In case of allergic polyps, first of all we need to go for medical management, we have to give anti-allergic, antihistamine nasal steroid and if the patient doesn't get improved by the medication then we have to go for a surgery that is functional endoscopic sinus surgery.

This functional endoscopic sinus surgery is basically a surgery which is done by the endoscope. We have to remove the diseased nasal sinusoidal mucosa. With that the patient get improved. The main symptom in case of polyps is the nasal obstruction, anosmia. The patient gets very much relief from these symptoms. The surgery is very much beneficial in case of patients with polyps. Regarding the surgery, there are few complications but they can be managed.

I want to conclude that polypoidal nasal mucosal is a diseased mucosa which can be managed medically or surgically. If the patient doesn't get improved by medication then we have to go for functional endoscopic sinus surgery. It is done in our centre. We have affiliated centre for the surgery and anybody can consult for the surgery and can get relief from the symptoms. Regarding the functional endoscopic sinus surgery which is done at our centre, you can consult me at my clinic. In both the centres, we have this facility for operating the patient.