Dr. Sudhir Khanna

Kidney stones are one of the most common urinary tract disorders. These stones are the result of an abnormal concentration of urine. The stones might get unnoticed, till it moves around the kidney or passes into the ureter and causes obstruction. The stones are basically small deposits of calcium that can cause excruciating pain.

Here is a list of signs that can indicate that a person might be suffering from kidney stone disorder:

1. Back Pain: People suffering from kidney stones often suffer from localized back pain in the early stages. The pain initiates at the side and back, just near the kidney area. As the stone migrates down, the pain might spread to the groin, lower abdomen and lower back area. The waves of pain might last from a few minutes to few hours, depending on the number and size of the stone and the degree of obstruction. For men, the pain might also be felt in the testicles and scrotum area if the stone gets lodged at the UV junction.
2. Blood In Urine: Apart from pain and discoloration, visible signs of blood in the urine are seen in patients who have kidney stones. The color of urine might vary from brown, pink to slightly red with stains of blood. Blood along with urine is referred to as hematuria.
3. Vomiting and Nausea: People suffering from kidney stones often complain of nausea. It can become so severe that can lead to vomiting. Some other complications related to this condition include dehydration, nutritional deficiency etc. Another theory suggests that throwing up is the result of body’s endeavor of clearing the toxic material from the body.
4. Difficulty in Sitting: Once the kidney stones gain in size, it becomes increasingly difficult for a patient to sit or lie down for a longer duration. Sitting or lying down puts pressure in the kidney area thereby causing intense pain. People try to combat this condition, by frequently standing up or by having a small walk. Occasionally this can be a symptom of the stone disease.
5. Urinary tract infection: Sometimes there is obstruction in the kidney or ureter by the stone and patient develops infection in this obstructed system. Patient will present with high grade fever with chills and this is referred to Urinary Tract infection.

People may have a confusion about how many time should we go to the washroom? The right answer is 5-7 times a day. You should at least drink 8-10 glasses of water. But if you have any issue related to the kidney, you should seek help.

Male infertility is when the male is not able to get a fertile female pregnant. Though not openly admitted, it is an extremely common condition. For a man, it is highly hurting to the ego when it is identified. Given the discrete nature of the topic, it is difficult both for a man to admit that he could possibly be the reason the couple is not able to conceive. If that happens, the next challenge is to get them to undergo treatment.
With times, things are changing and more men are open to getting tested. The changed lifestyles are also contributing to male infertility, and the incidence has risen by a couple of percentages.

Causes: Male infertility is caused by a variety of issues leading to poor sperm quality and/or quantity, ranging from:

1. Sperm production, which can be reduced in numbers.
2. The quality of the sperm could be poor, with reduced mobility being extremely common. When this happens, they are not able to travel up the uterus and penetrate the egg.
3. Erectile dysfunction, where the erection is too soft or short for penetration into the female
4. Premature ejaculation, where the sperms are released very soon before they can enter the female.
5. In addition, lifestyle causes are another major cause of male infertility. These include smoking, increased stress levels, alcohol abuse, lack of exercise, poor dietary habits, and increased junk food.

Management: Male infertility is not as easily accepted as female fertility, though it is the cause for the couple’s inability to conceive in about 50% of the cases.
Once identified and accepted, treating male infertility is quite easy compared to female infertility. In order of progression, the treatment modes are listed below.

Counseling: In most cases, a sexual counseling session with the couple can help iron out performance anxiety and help build trust and frankness in the relationship. In many couples, this helps in overcoming the problem. Given the discrete nature of the topic, it takes time for a couple to get to know each other. There is also the male performance anxiety which can lead to poor performance. All this needs some time and some external help, which can improve the sexual compatibility and overall relationship.

Hormonal therapy: This is another simple and effective way to manage male infertility. Topical or systemic androgens can help in treating male infertility.

Surgery: In worse cases, where there are blocked sperm tubes, surgery may be required to unblock them. Surgery also required if there is varicocoele in the male.

In vitro fertilization: In couples whom none of the above work, IVF could be used to help in conception.

Male infertility needs to be accepted and then it becomes easier to treat.

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 Naproxen sodium or acetaminophen.
2. 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.

How to prevent kidney stones-

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.

Large stones with severe symptoms:

1. Surgical removal of kidney stones Surgical removal of stones is done with the help of a procedure called PCNL. 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 in the abdomen.

Urinary incontinence is a problem that can affect anyone. Urinary incontinence is the loss of bladder control or the ability of a person to control his/her urine output. It is an embarrassing problem as the urge to urinate and lack of bladder control can occur even when you are in the middle of something important. This condition is classified by its severity and ranges from the occasional urine leakage to the discharge of urine so suddenly that the person will not be able to make it to the toilet in time.

Symptoms and types:
The symptoms of urinary incontinence can be categorized by minor leaks of urine to moderate amounts. In some cases, the urine discharge can be sudden. This condition is more common among the elderly and females.

Types of urinary incontinence:

1. Stress incontinence: The leakage occurs when you are exerting pressure on your bladder, and can include instances of coughing, sneezing, exercising or even lifting something heavy.
2. Urge incontinence: There is an intense urge to urinate followed by an involuntary loss of urine before you reach the toilet. The sensation or urge to urinate will be often. This can occur throughout the night too and can cause discomfort both physically and mentally.
3. Overflow incontinence: This is experienced when your bladder does not empty completely. As a result, you would be experiencing constant dribbling of urine. No matter how many times you go to the toilet, the dribbling will continue.
4. Mixed incontinence: This happens when you experience more than one or two types of the above mentioned urinary incontinence.

Urinary incontinence is not a disease, but could be a symptom of an underlying condition. Do consult with your physician if you notice these symptoms and get treated for it. A simple urinalysis will help to determine and diagnose infections and other disorders causing this condition.

Prevention:
There are many factors that can put you at risk. Most involve everyday habits and the food that we eat. There are certain drinks such as alcohol, caffeine, aerated drinks, and chocolate drinks that can also stimulate your bladder and can increase the output of urine temporarily. Reducing your intake of these beverages particularly at night and limiting your intake of spicy foods could help you deal with this condition.

Making a few healthy lifestyle changes such as maintaining a healthy weight and regular exercises to strengthen the pelvic region can help to prevent conditions such as urinary incontinence. Watch what you eat and curb your intake of acidic and spicy foods. Also, limit or reduce your consumption of foods high in preservatives. Quit smoking and reducing the intake of alcohol will also be beneficial.

Coping with urinary incontinence can be embarrassing. Hence talk to your doctor about it and get medical attention immediately. Using adult diapers could help reduce the stress and embarrassment involved with this condition.

Namaskar! Mai Dr. Sudhir Khanna, chairman, senior consultant, department of urology, Sir Ganga Ram Hospital, New Delhi, mai pichle 29 saalon se kam kr rha hun.

Apko, public ko main urine problem ke baare mein awagat krana chahunga. Jo sabse common problem hai urine ki, usay BPH kehte hain. Ye normally 60 saal se upar vale logon ko affect karti hai or isme symptoms bahut kisam ke ho sakte hain. Sabse common symptom hota hai peshab jaldi jaldi aana. Next question ye hota hai ki logon ko ye nahi maloom ki normal kis ko kehte hain. 7 baar tak peshab karna din me, is normal. Or ratri me kisi bhi vayakti ko peshab karne ke lia uthna nahi chaiye. Agar vo ek baar se zyaada uth raha hai, to vo disease ka indication hai.

Or din mein 7 times se jyada agar peshab kar rha hai, to usko bhi problem ho sakti hai. Vyakti ko agar peshab karne jana hai to usko wait nahi karna chaiye. Agar usko wait karna pad raha hai or peshab ki dhaar patli hai, peshab me zor lagana pad raha hai ya peshab aant me boond boond kar ke aata hai ya peshab karne ke baad me usko tasli nahi ho or usko lage ki humein thoda peshab or aa jaata hai , to ye BPH ke symptoms hain. Kisi vyakti ko peshab mein jalan hona, peshab aaye to uska dood ke jana, ya jaate jaate kuch boond nikal jana, ye bhi isi bimari ke lakshanon me ata hai.

Or agar bimari apki badh jayegi, to apko peshab me khoon bhi aa skta hai or fever bhi ho skta hai jisko hum UTI bolte hain or rya vayakti ka peshab bhi band ho skta hai. To in symptoms me se apko agar ek bhi symptom ho to aap apne urologist se mile. Investigation pe hum sabse pehle uske urine ka test krte hain ki usme infection to nhi hai. Urine culture test nhi krana hota hai, urine routien krana hota hai. Fir hum ek ultrasound krte hain jisme kidney, ureter or bladder ko dekhte hain, prostate ka size dekhte hain or sabse important chiz hai ki peshab krne ke baad me uske bladder me kitna urine ruk gya, isko hum ultrasound ke madhyam se pta lgate hain. Or teesra test hai uroflammatory. Ek machine hai jisme us vyyakti ko peshab karna hota hai or us se hum dekhte hain ki raaste me rukavat to nahi hai.

Quki ye ek mithya hai ki ultrasound thik hai to sab thik hai. Kareeb 60K marij hmare pas hai jisme ki 54K dawaiyon se hi kam kr rhe hain or pichle 30 saal se vo dawaiyon p acha perform kr rhen hain. To operation kewal 10% ka hi hota hai. Operation durbin se hota hai, koi tanka nhi lgta. Or usko hum behosh bhi nhi krte. Rid ki haddi me ek tikka lgate hain. Pain nhi hota or durbin se hum catheter daal dete hain. 3-4 din ke baad jab hum catheter nikalte hain, to uske bad pateint ki sari taklif thil ho jati hai or vo apna normal work pe ja skta hai. Isme patient ko ek or precaution lena hota hai ki usko kabzi nhi honi chaiye. Quki is s bleeding shuru ho skti hai. Isi me ek ciz or hoti hai, cancer prostate.

Jab hum rectal examination karte hain patient ka or hume aisa lagta hai ki prostate ki feeling normal nhi hai, to hum ek test karate hain PSA or agr PSA jyada hai to hume uska MRI krna pdta hai, or agar usme cancer milta hai to hume uski biopsy krni hoti hai. Cancer prostate me ghabrane ki avshakta nhi hoti hai. To main udeshaye ye hai ki agar apko zara bhi urine me koi symptom ho to aap apne urologist se milen, vo in tests ko krega or apko rai dega ki apko dawayi se thik kia ja skta hai ya agar operation krna hai to operation krenge. Or agar biopsy krni hai to vo ki jayegi. But kisi bhi trha se chinta nhi krni hai, ghabrana nhi hai quki agar aap ghabrayeinge to bimari badhegi. Or fir ilaj thoda advance ho jayega. Or ultimately apko suffer karna hoga. To ghabrane ki zarurat nhi hai. Doctor ko dikhayein or treatment len or shighar hi thik ho jayen. Thank You!

Be it frequent urination, painful urination, or change in color of urine, you must not hesitate to visit a urologist, especially when the symptoms persist for more than two days. Typically, an abnormal urge to urinate is directly affected by any infection in the bladder or due to any underlying medical condition. A urologist who is specialized in the study and treatment of disorders related to the urinary system is the right person to diagnose the problem and put you on the right treatment. Read on to have an insight into symptoms that would necessitate a urologist visit.

Inability to urinate: Many people tend to have calcium depositions in their urinary tract. This is what is known as a stone. When this stone grows big in dimension, it can block the ureters or the urethra. In both these situations, the total urine output reduces to a great extent or can stop completely. The first symptom, in this case, will be an intolerable pain in the back or lower abdomen. 

As the prostate grows in size, it pushes onto the bladder, thus again making it difficult to release urine.

1. Symptoms of LUTS: A patient shows symptoms of lower urinary tract symptoms in form of poor urine flow, overflow incontinence, terminal dribbing, feeling of incomplete evacuation are some of the signs.
2. Pain in the lower abdomen: Pain in the lower abdomen is also a symptom of various kinds of urinary problems. If the pain is accompanied by urinary frequency or a burning sensation during urination, it inevitably prompts a visit to the urologist to check for bladder cancer or prostate.
3. Blood in urine: Irrespective of the gender of the sufferer, blood in the urine is never a good sign. An immediate visit to the urologist is suggested as he can order tests which can highlight an infection or a disease or in extreme cases, even the early signs of cancer in kidney or bladder.
4. Repeated urinary tract infections: Cases might arise, when a particular person is suffering from two or more infections in a span of 6 months. This situation should never be ignored, and immediately a doctor should be visited as this can be a serious health problem in both men and women. Prophylactic or some antibiotic treatments will be prescribed in this case and cause of infection has to be identified and then treated. 
5. Increased frequency: This is again another urinary condition which can affect both sexes. This condition is characterized by increased frequency of urination and nocturia and pain in the lower abdomen are also reported. Nocturia is severe nighttime urination. Nocturia is when someone has to get up at night to pass urine. The treatment for this condition depends on the reason. A series of tests and examinations have to be carried out to find out the reason, and accordingly, a treatment plan has to be charted out. If a person has to pass urine more at night than in the day or is getting up at night even once till the age of 60 then it is an abnormal condition and he must visit a urologist. 

Apart from the symptoms mentioned above, if you experience uncontrolled urine leakage or any sediments in urine or if you sense any abnormality concerning the lower abdominal area a urologist visit is warranted. No need to shy away from reporting even such minor discomfort as it could help avoid dire consequences. In case you have a concern or query you can always consult an expert & get answers to your questions!

Urological problems such as urinary tract infection, urinary incontinence, and kidney stones are highly prevalent across gender and age groups. But there are several simple measures you may undertake to improve urological health and prevent such problems.

Read on to know how to go about it.

1. Drinking adequate amount of fluids: Waste products are mostly eliminated through urine, and when you drink more water, you will be able to remove more toxins from the body. The general recommendation is having 8 glasses of water in a day even though this varies on an individual basis. You must also consider drinking cranberry juice which offers protection from various types of infections of the urinary tract. And you should drink an extra amount of water while exercising and when you are spending a lot of time outside as you might excrete more water through perspiration.
2. Cutting down the intake of caffeine and alcohol: Both alcohol and caffeine act as a diuretic and they irritate the lining of the urinary bladder. This causes frequent urge to urinate.
3. Avoid holding urine: You should never practice holding the urine for a long span of time but try going to the toilet whenever you feel the urge.
4. Controlling the daily intake of salt: When you consume too much of salt, the sodium in the body increases and it causes retention of fluids in the body. This is invariably linked with high blood pressure which can cause damage to the kidneys and formation of kidney stones. Thus, it is essential to reduce the intake of canned foods, fried stuff, and processed foods.
5. Keeping the genital area clean: You should always aim to keep the genital area clean by washing it with plain water or some mild cleanser once in a day. Also, while indulging in sexual intercourse, bacteria along with other micro-organisms can enter into the urinary tract causing infection. Women are at a higher risk of developing urinary tract infections since they have a shorter urethra. Male groins and female vaginas are considered breeding grounds for different pathogens which can transfer from one partner to another during intercourse hence care should be taken.
6. Preventing urological problems in women: Once you use the washroom, you should wipe the genital area from the front part to back. You should not use perfumed soaps and cleansers in the vaginal areas. Wearing cotton panties is always a healthier option than other fabrics. One should also avoid using vaginal deodorants and spermicidal creams to prevent infections.

Though numerous treatment options are available for these disorders since prevention is always better than cure, adopt these practices to steer clear of these common problems. Further, incorporating lifestyle changes such as eating a balanced diet coupled with exercise and leading a stress-free routine can pave the way for general good health.

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

The kidneys may be a pair of small organs but they perform a very important function. Without the kidneys, it is impossible to filter blood and remove toxins from the body. One of the common problems associated with kidneys is the development of a kidney stone. This can be described as a hard, pebble like substance that is formed when urine contains high levels of certain minerals. Kidney stones vary in size and shape. Small stones may pass through the ureter into the bladder and out of the body with minimal discomfort. However, in some cases, a kidney stone can be as large as a golf ball. In such cases, it can block the urine flow and cause extreme amounts of pain as well as bleeding. In such cases, a doctor needs to be consulted as early as possible.

There are four different types of kidney stones.

1. Calcium Stones: This is the most common type of kidney stones. It is caused by excess calcium that is not flushed out with the urine.
2. Uric acid stones: Highly acidic urine can trigger the development of such stones. This may be caused by excessive consumption of meat, fish and shell fish.
3. Struvite stones: This is often formed as a side effect of Urinary tract infections. These stones may develop and grow rapidly.
4. Cystine stones: These stones are formed as a result of a genetic disorder known as cystinuria. This disorder causes an amino acid known as cysteine to leak into the urine.

Kidney stones are a fairly common occurrence. It affects both men and women but men have a higher risk of developing kidney stones as compared to women. Other risk factors that can influence kidney stones are:

1. Family history of kidney stones
2. Not drinking enough water
3. Obesity
4. Digestive problems
5. Recurrent UTIs
6. Gout
7. Bowel inflammation
8. Disease that causes blockage of the urinary tract
9. Certain medications such as diuretics or calcium based antacids

Once a person has been diagnosed with a kidney stone, this issue can recur. Treatment for kidney stones depends on the type of stones, size and location. In most cases, medication is prescribed to help break the stone down into smaller parts so that it can pass through urine. In extreme cases, surgery may be required. If not treated in time, it can cause severe pain, bloody urine, UTIs that can further lead to kidney failure and reduced kidney functioning.

Kidney stones can be prevented by drinking plenty of fluids and making a few dietary changes. Ideally, a person should have a minimum of 8-10 glasses of water a day. If you have a high risk of developing any type of kidney stones, reduce your sodium consumption and the amount of meat eaten.

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

If a survey is done for the most common male sexual problem, the outcome would be erectile dysfunction. Commonly referred to as ED, it is a major problem for the male but it can be treated in simple ways.
By definition, ED is the repeated inability of a male to achieve and/or maintain an erection for a healthy and satisfying sexual relationship. The key word here is “repeated” as a quicker erection or softer erection is very common in many men, which could be a one-off instance and caused by transient factors like stress or lack of sleep. When this happens repeatedly, then it needs attention.

Symtoms: Erectile dysfunction is when:

1. Erection is too soft, not allowing for sufficient penetration and prolonged intercourse
2. Erection duration is very short
3. There is difficulty in arousal

Risk factors: ED has been noted to be commonly seen in people, who have following behaviours:

1. Smoking
2. Obesity
3. Advanced age (>60 years)
4. Excessive alcohol abuse
5. Sedentary lifestyle with no exercise
6. History of diabetes
7. Hypertension
8. Atherosclerosis
9. History of groin surgical procedures for prostate, bladder, etc.

Causes: ED has both physiological and psychological reasons.

• Most common psychological reasons are strained relationships, performance anxiety, and other life stressors.
• Physical causes include reduced hormone levels and other chronic medical conditions like obesity, diabetes, and hypertension.

Diagnosis: While ED is easy to diagnose medically, the truth is that not many would be forthcoming for a diagnosis. Given that this issue could be a jolt to the “manhood,” it is often not brought out in the open for discussion. Once that is done, the following steps can help in diagnosis.

1. Medical history and specifically sexual history
2. Check for genital abnormalities
3. Blood testosterone levels
4. Other vitals including blood pressure, sugar, and cholesterol levels to identify overall health

Management:

1. Sexual counseling involving the couple. Once they open up and get comfortable, the problem vanishes. Performance anxiety which is a major cause is taken care of, and ED is no longer an issue. Aligning the couple’s expectations also is very essential.
2. Hormone supplements, both locally applied and taken into the system, help to a great extent
3. Lifestyle changes like quitting smoking, moderating alcohol abuse, healthy eating habits, and moving away from sedentary lifestyle helps treat ED
4. Medicines like Viagra are very useful for occasional cases of erectile dysfunction

As a last resort, there are advanced options like pumps, vacuum devices, implants, and surgical options, and implants. These are often not required, as in most cases, sexual counseling and hormone therapy help in managing ED.

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