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Laparoscopic Vaginoplasty - With Absent Vagina, Can She Have Her Own Genetic Baby With MRKH Syndrome?

Dr.Pragnesh Shah 92% (197ratings)
MD, MBBS
Gynaecologist, Ahmedabad
Laparoscopic Vaginoplasty - With Absent Vagina, Can She Have Her Own Genetic Baby With MRKH Syndrome?

Patient’s parent’s visits to us when their daughter does not menstruate after the age of 15-17 years of age for her fertility concern & for planning surgery before her marriage. This operation is advised for Phenotype female i.e. normal secondary sexual characters & Genotype XX.

Objective:

In-patient with absent uterus is evaluated for associated renal malformations by USG & SOS IVP. As compared to commonly practiced method (skin graft from thigh & putting on neo vagina) patient’s on peritoneum is utilized for covering neo-vagina for Vaginoplasty. Vaginal space is dissected in usual way from below and laparoscopic access helps in avoiding injury to bladder & rectal injury.  This technique gives two cms wide vagina & 8-10 cms long vagina and good quality of sexual function and patient discharged on the next day with minimum postoperative care. This surgery requires lot of experience & expertise.

Benefits of Laparoscopy Surgery:

  1. Shorter Hospital stay,
  2. Earlier return to your routine work,
  3. Cosmetically vary small scar,
  4. Less pain after operation,
  5. Best fertility enhancement & Fertility results following Laparoscopy,
  6. Video-live operative file available in CD/DVD for future reference (Transparency about surgical procedure).
  7. The possibility of post-operative adhesion formation will be less, and the possibility of pain because of post-operative adhesions will also be less.  

The special advantages with our technique are:

    • Next day discharge,
    • No plastic surgery for skin graft so no post-operative dressings,
    • User friendly post-operative care by patient by using vaginal stent every night following operation till she starts actual sexual relation with her husband 6 weeks after laparoscopic Vaginoplasty.

Pre-operative Check Lists:

  • Lab. Investigation for Surgery (Urine complete & Blood complete, HbsAg, HIV, R.B.S.); Pelvic Trance vaginal USG report for renal malformation.
  • Operation planned at about 1.5 to 2 months prior to her proposed Marriage.
  • Enema & preparation/shaving of local parts.

No. Of Cuts on Abdomen:
Three cuts: all of 5 mm size.

Average Stay in Hospital:
24 hours. 

Average Duration of Surgery:
40-60 minutes

Average Blood loss during Surgery:
10-30 cc

Average time after operation to resume normal activities/work:
Within 24 hours.

Anesthesia:
General Anesthesia (Patient will not feel any pain in Operation Theatre during surgery)

Operative Procedure:

Inside the Umbilicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images - and sends them to a monitor so the surgeon can see what is going on inside. 


Performing laparoscopy usually only requires three tiny incisions less than one half inch, (about 5-10 millimeters) in length. One incision is made inside the navel, and another is usually made near the bikini line. The first incision allows a needle to be injected into the abdomen so carbon dioxide gas can be pumped inside the cavity of the abdomen, which helps to keep intestines & omentum up and away from organs. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable.

Vaginal space is dissected in usual way after putting Folly’s catheter in urethra and rectal probe in rectum by 3 cms long incision at labia minora.  Laparoscopic light & pnumo helps during vaginal dissection. Peritoneum is cathched with two artery forceps, opened from below under laparoscopic guidance and edges of the catched peritoneum is circumferentially mobilized down till we can take tension free stitch with dissected & pulled peritoneum & labia minora by few No1/0 Vicryl figure of ‘8” stiches. Then vagina is closed with mop to prevent leakage of pneumoperitoneum from below and laparoscopically neo fornices are created at the level of pelvic brim by purse string stitches taken to close vaginal upper end with No-1 Vicryl stitch & approximating with extra corporeal knot. This technique gives two cms wide vagina & 8-10 cms long vagina and good quality of sexual function and patient discharged on the next day & with minimum requirement of postoperative care.

Post-operative Course:

 

  • Patient remains drowsy/sedated for 2-3 hours after laparoscopy but conscious & pain free.
  • Patient can take fluids 3-4 hours after laparoscopy & light food after 4-6 hours.
  • She may feel little abdominal & shoulder pain after laparoscopy for 24 hours but it cam be relived with pain killer tabs.
  • Most of the patients can walk normally without support and can take normal diet 6-8 hours after the laparoscopy.
  • She can be discharged on the same day of the operation.
  • Few patients may feel nausea & vomiting after laparoscopy, which can be very well controlled with injection in post-operative room.
  • Folly’s catheter is removed on next day.
  • Patient is advised to prepare vaginal stent from 10/20 cc syringe with gauze pieces applied around it and then condom is applied on it and then xylocaine jelly with soframycin applied on stent –which is advised to put the same in vagina gently every night, till she starts actual sexual relation 45 days after operation.
  • Patient can do her normal activity within 24 hours after laparoscopy. Patient is advised to take antibiotics & analgesic tabs. for 5 days following laparoscopy.
  • Patient is advised to report to doctor for severe pain or bleeding or fever in postoperative period (Day-1 to Day-5) immediately.
  • Patient is advised to come for follow up 7 days after the Laparoscopy for dressing.

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

3742 people found this helpful

Causes And Types Of Bladder Tumor!

Dr.Shailendra Kumar Goel 89% (59ratings)
MBBS, MS - General Surgery, M. Ch. (Urology), DNB (General Surgery), MBA
Urologist, Noida
Causes And Types Of Bladder Tumor!

The urinary bladder is a hollow purse like storage organ which collects urine from the kidneys and stores it until it can be passed out of the body through the urethra during the process of micturition or urination. It has a thin inner lining of cells called urothelial cells and a thick muscular wall, which exerts pressure to push the urine out of the body. 

Causes of Bladder Tumors

In most cases, the bladder tumor develops on the inner layer due to a combination of some of the following factors.

  1. Hereditary: A strong family history of cancer predisposes a person to cancer.
  2. Gender: Men are 3 times more prone for bladder cancer than women. 
  3. Ethnicity: White people are more prone for bladder cancer black people. 
  4. Smoking / Tobacco use: Smokers develop bladder cancer 2-6 times more frequently than non-smokers. Tobacco contain toxic, carcinogenic substances which reach the kidney and are stored in the bladder, leading to cancerous changes in bladder.
  5. Occupational hazards: Some workplaces have a higher likelihood of causing bladder cancers, especially dye and rubber industries. The effects can be damaging, and the person may develop cancers years after the exposure has happened.
  6. Recurrent bladder infections: In some people, this can also lead to bladder cancer in the long run. 

Types of Bladder Tumor Depending on the extent of the cancerous spread, it can be of two types: 

  1. Non-muscle-invasive bladder tumors: The tumor spread is limited to the inner part of the bladder (urothelial cells)
  2. Muscle-invasive bladder tumor: The tumor has spread to the thick muscular outer layer. 

This is more advanced and prognosis is poor compared to the noninvasive type. The most common and diagnostic symptom of bladder cancer is the presence of blood in the urine without pain in abdomen, known as painless hematuria. This is usually intermittent and stops on its own. Therefore any person who is more than 40 year old, has blood in urine, must be checked to rule out bladder tumor. If you miss these early warning symptoms by just thinking simple infection, you may miss the tumor and will be diagnosed later when tumor is advanced. Other symptoms include pain in the lower abdomen and frequent urination

Diagnosis 

From the most non-invasive to the most invasive diagnostic test, these include:

  1. Urine microscopy and cytology to detect blood and cancer cells in the urine 
  2. Ultrasound and CT Scan can define the bladder tumor, its size and spread. 
  3. Cystoscopy and biopsy is when a is tube inserted into the urethra to look into the inner wall of the bladder and biopsy is taken from lesion. It is highly diagnostic and confirmatory

Treatment TURBT

Once the tumor is diagnosed, first step of the treatment is endoscopic surgery known as transurethral resection of the bladder tumor (TURBT). The cancerous bladder lesion is resected and removed through a cystoscope. Muscle tissue from the base of tumor is also resected to check the spread of tumor in the muscle. The bladder is then flushed with chemotherapy agent to kill any residual cancer cells in the bladder.

  • Intravesical BCG Therapy: If muscle is not involved with tumor, this is called superficial tumor. As there is high chance that this tumor may recur or progress, bladder is treated with BCG injection therapy repeatedly for at least 6 weeks to many months. Check cystoscopy is usually done thereafter to check for any recurrence at frequent intervals.
  • Radical Cystectomy with Ileal conduit or Neo-Bladder: If tumor is involving muscle layer of bladder then whole urinary bladder is removed surgically and urine passage is made at abdominal wall using part of intestine called Ileal conduit. Patient has to wear a bag on abdomen to urine collection and discharge. Now-a-days, artificial bladder is made by patients own intestine which functions like normal bladder and patient passes urine per urethra.
  • Radical Radiotherapy: This is also an alternative treatment for muscle invasive bladder cancer where bladder is preserved and treated by radiotherapy. Repeated check cystoscopy is required thereafter to check for recurrence.
  • Chemotherpy: If tumor has advanced to lymph nodes and other body organs, then treatment is chemotherapy where anticancer drugs are injected into veins. In Summary, Bladder cancer is usually caused by Tobacco consumption. Blood in urine even if it stops on its own or by medications, in person over 40 years of age must be evaluated for bladder cancer. In early stage it can be treated by cystoscopy. If it involved muscle, bladder is removed and neo-bladder is made.

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

3409 people found this helpful

Homoeopathy for Infants and Growing Children

Dr.Noori Rizvi 89% (1298ratings)
BHMS
Homeopathy Doctor, Greater Noida
Homoeopathy for Infants and Growing Children

The homeopathic approach is gaining popularity as an alternative treatment for hyperactivity in children. Homeopathy is gaining recognition in the conventional field of medicine and has been subject to many clinical trials. Homeopathic treatment for children can be separated into two categories: self-limiting, acute conditions such as cold, sore throat, and stomach flu, or persistent, chronic conditions such as allergies and eczema. Homeopathy is successful in both categories.

Homeopathic medicine when given in proper manner can improve the immunity of your children, which in turn enable their body to deal with illness throughout their childhood. It can also help prevent illness and give support through difficult periods of their life. With Homeopathy children's health can improve and chronic conditions often clear up completely and never come back. It is safe with no harmful side effects. Homeopathy cures by looking at the whole individual and can be effective in unexpected ways. If you have tried everything else and are still not in wonderful good health why not give Homeopathy a chance to help you.

Homeopathic Medicines for Children and Infants

Ever since the science of homoeopathy was introduced 200 years ago by a German doctor, it has won praise especially for the treatment of little new-born, neo-nate, infants and children; of course for variety of reasons. Today, there are many paediatricians preferring homoeopathic treatment for their children and patients in various paediatric conditions. Essentially, any medicine administered to children must be free from harmful effects. Homoeopathic medicines are prepared mainly from herbs, vegetable kingdom, minerals and are given in very minute doses so that they are 100% non-toxic, having no adverse effects whatsoever.

Unlike antibiotics and other such medicine, homoeopathic pills do not hamper digestion; does not lower resistance power; does not produce allergy and does not harm even if taken for long-term. Homoeopathy pills being sweet in taste, is accepted with pleasure by children. Homoeopathic therapy is superior to traditional treatment of administering medicine through injections.

No injectables are required while you are on homeopathy. Even a comatose child may be administered homeopathic medicines without injections, that is the beauty of this science.

To name some prominent disorder in children, where homeopathy works very well are infant colic, fever, teething problem, vomiting, dysentery, nephrotic syndrome, kidney disease, growth related problems and convulsions (epilepsy), infantile eczema, jaundice, brain infections (meningitis), fungal infections, warts, hair-Loss (alopecia), growing pains, poor concentration, arthritis in children, psoriasis, leucoderma (white spots), pimples and thyroid problems. Various psychosomatic disorders such as bed-wetting, headaches, and gastritis also respond to homeopathy.

Whether children actually know or sense that homeopathic medicines are good for them for not, they deserve safe medicines. It is time that parents and physicians seek safe, natural and effective alternatives to conventional, potentially harmful drugs. Homeopathic medicine is one such alternative. If you wish to discuss about any specific problem, you can consult a homeopath and ask a free question.

3220 people found this helpful

Wrinkle Removal and Skin Tightening Treatments!

Dr.Pankaj Chaturvedi 86% (20ratings)
MD, MBBS
Dermatologist, Delhi
Wrinkle Removal and Skin Tightening Treatments!

The quality of a person’s skin says a lot about their age. As the years go by, your skin loses its elasticity and firmness and wrinkles and fine lines become increasingly prominent. Everyone wants to look younger and boast of the skin they once had but not everyone wants to undergo cosmetic surgery for the same. Thankfully, there are a number of noninvasive techniques that can help tighten skin and reduce wrinkles.

Botox Injections
Botox or botulinum injections are one of the most popular ways to erase fine line, crow’s feet, and wrinkles. This is extracted from botulinum bacteria and can be used on the forehead, around the eyes, cheeks, and neck. The injection is relatively pain-free and takes only a few minutes but its effects are temporary. The results become apparent 3 to 7 days after the injection and to maintain your look, you will need to take the injections every 3 to 6 months.

Chemical Peels
This involves the use of an acid solution that removes the top layer of dead cells from the skin. It can be used to address fine lines, wrinkles, sun spots etc. There are many different types of chemical peels that may be used depending on the extent of treatment required. Chemical peels should be only applied in a certified dermatologist’s clinic.

Microdermabrasion
Microdermabrasion is a non-surgical technique that exfoliates the top layer of skin with tiny crystals. In doing so, it helps treat fine lines, acne and tightens the skin. The effects of microdermabrasion are subtle and you may need up to ten sessions to see a noticeable difference.

INTRAgen

intragenic is a skin treatment method that utilizes the radio frequency device. This method works very well for the purposes of skin toning, tightening and rejuvenation. As it works on radio frequency method, it penetrates the deepest layer of the dermis and remodels the existing collagen. Moreover, it also stimulates neo-collagen and effectively tones and tightens the skin.

HiFu is a non-invasive method of skin treatment that uses the ultrasound to tighten, tone and also lift the sagging skin on the face. it is also called “non surgical facelift” or skin tightening by some experts and people. This method works best for aged people who are worried about their loosening and sagging skin due to age or any other reasons.

Nonablative Laser
This type of laser therapy is ideal for people who want to improve their skin tone and texture. It can also be used to treat brown patches on the skin. Without damaging the outer layer, it stimulates collagen production and makes the skin firmer and tighter. For the results to be visible, 4 to 6 sessions may be needed.

Light Therapy
Like lasers, intense pulsed light therapy can be used to address the dermis. This form of treatment involves directing short pulses of light at the dermis that destroy cells and aid in renewing the skin. Along with treating redness and patches, it also stimulates collagen to increase the skin’s elasticity. In case you have a concern or query you can always consult an expert & get answers to your questions!

4135 people found this helpful

Dengue Vaxia

MBBS,CCA,DCA,AASECT,FPA,AAD,F.H.R.SM.I.M.S
General Physician, Gorakhpur
Dengue Vaxia

Dengvaxia - first vaccine against dengue

Dengvaxia is a vaccine used to help protect adult or children against dengue disease caused by dengue virus serotypes 1, 2, 3 and 4. Dengvaxia is given to adults, adolescents and children 9 through 45 years of age living in endemic areas.

Read more:

Dengue symptoms and what to do if you think you have denguedengue fever - remedies using papaya leaf juice

Full prescribing info - dengvaxia

Contents

Dengue tetravalent vaccine (live, attenuated).

Indications / uses

Dengvaxia is a vaccine used to help protect adult or children against dengue disease caused by dengue virus serotypes 1, 2, 3 and 4. Dengvaxia is given to adults, adolescents and children 9 through 45 years of age living in endemic areas.

Dosage / direction for use

The patient will receive 3 injections of 0.5 ml each at 6-month intervals.

The first injection will occur at the chosen or scheduled date; the second injection, 6 months after the first injection; and the third injection, 6 months after the second injection. Dengvaxia should be used according to the local vaccination schedule.

If the patient forgot an injection of dengvaxia: if the patient missed a scheduled injection, the physician will decide when to give the missed injection.

It is important that the patient follows the instructions of the physician, pharmacist or nurse regarding return visits for the follow-up injection. If the patient forgets or is not able to go back to the physician, pharmacist or nurse at the scheduled time, ask the physician, pharmacist or nurse for advice.

Administration: dengvaxia is given by the physician or nurse as an injection underneath the skin (subcutaneous route) in the upper arm.

Contraindications

Do not use dengvaxia if the patient is allergic (hypertensive) to the active substances or any of the other ingredients of dengvaxia listed in description (see description); has developed an allergic reaction after prior administration of dengvaxia. Signs of an allergic reaction may include an itchy rash, shortness of breath and swelling of the face and tongue; is suffering from a disease with mild to high fever or acute disease. In this case, the physician will postpone the administration of dengvaxia until the patient has recovered; has a weakened immune system, for example due to a genetic defect, hiv infection or therapies that affect the immune system (for example, high-dose corticosteroids or chemotherapy); is pregnant; is breastfeeding.

Use in pregnancy lactation: dengvaxia must not be given to pregnant or breastfeeding women.

If the patient is of child-bearing stage, the patient should take the necessary precautions to avoid pregnancy for 1 month following administration of dengvaxia; is pregnant or breastfeeding, the patient thinks may be pregnant or is planning to have a baby, ask the physician, pharmacist or nurse for advice before receiving dengvaxia.

Special precautions

Inform the physician, pharmacist or nurse before receiving dengvaxia if the patient is taking an immunosuppressive treatment (prednisone or equivalent to 20 mg or 2 mg/kg for 2 weeks or more). The physician will postpone administration of dengvaxia until 4 weeks after the treatment is discontinued; has experienced any health problems after prior administration of any vaccines. The physician will carefully consider the risks and benefits of vaccination.

As with all vaccines, dengvaxia may not protect 100% of persons who have been vaccinated. Vaccination with dengvaxia is not a substitute for protection against mosquito bites. The patient should take appropriate precautions to prevent mosquito bites, including the use of repellents, adequate clothing, and mosquito nets.

Fainting, sometimes accompanied by falling, can occur (mostly in adolescents) following, or even before, any injection with a needle. Therefore inform the physician, pharmacist or nurse if the patient fainted with a prior injection.

Adults above 45 years of age: adults above 45 years of age should not receive the vaccine.

Driving and using machines: no data are available on the effects of dengvaxia on the ability to drive or use machines.

Use in children: children less than 9 years of age should not receive the vaccine.

Side effects

Like all medicines, dengvaxia can cause side effects, although not all patients get them.

Serious allergic reactions: if any of these symptoms occur after leaving the place where the patient received an injection, consult a physician immediately: difficulty in breathing, blueness of the tongue or lips, a rash, swelling of the face or throat, low blood pressure causing dizziness or collapse.

When these signs and symptoms occur they usually develop quickly after the injection is given and while the patient is still in clinic or physician's surgery.

Serious allergic reactions are very rare (may affect up to 1 in 10, 000 people), after receiving any vaccine.

Other side effects: the following side effects were reported during clinical studies in children, adolescents and adults (from 9 to and including 60 years of age). Most of the reported side effects occurred within 3 days after the injection of the vaccine: very common (may affect more than 1 user in 10): headache, muscle pain (myalgia), generally feeling unwell (malaise), feeling of weakness (asthenia), injection site pain, fever.

Common (may affect up to 1 user in 10): injection site reactions: redness (erythema), bruising (hematoma), swelling, and itching (pruritus).

Uncommon (may affect up to 1 user in 100): infections of the upper respiratory tract, dizziness, sore throat (oropharyngeal pain), cough, runny nose (rhinorrhea), nausea, skin eruption (rash), neck pain, hardening of skin at the injection site (injection site induration).

Additional side effects in adults (from 18 to and including 60 years of age): uncommon (may affect up to 1 user in 100): swollen glands (lymphadenopathy), migraine, joint pain (arthralgia), flu-like symptoms (influenza-like illness).

Additional side effects in children and adolescents (from 9 to and including 17 years of age: uncommon (may affect up to 1 user in 100): itchy rash (urticaria).

Reporting of side effects or any suspected adverse event: if the patient experiences any side effects after vaccination, advised to seek immediate medical attention.

By reporting side effects, it can help provide more information on the safety of the vaccine.

Click to view adr monitoring form

Interactions

Using other medicines and dengvaxia: dengvaxia may not have an optimal effect if it used at the same time as medicines that suppress the immune system such as corticosteroids or chemotherapy.

Inform the physician, pharmacist or nurse if the patient is taking or has recently taken any other vaccines or any other medicines, including medicines obtained without a prescription.

Caution for usage

Before administering any biological, the person responsible for administration must take all precautions to prevent allergic or other reactions. As with all injectable vaccines, appropriate medical treatment and supervision must always be readily available in the event of an anaphylactic reaction following the administration of dengvaxia.

Epinephrine (1: 1000) and other appropriate agents used to control immediate allergic reactions must be available to treat unexpected events such as anaphylaxis.

Dengvaxia must not be mixed with other medicinal products in the same syringe.

Dengvaxia must not be administered by intravascular injection under any circumstances.

Syncope (fainting) can occur following, or even before, any vaccination as a psychogenic response to injection with a needle. Procedures should be in place to prevent injury from falling and to manage syncopal reactions.

Separate syringes and needles, separate injection sites and preferably separate limbs must be used if any other vaccine (s) or medicinal product (s) is/are concomitantly administered.

Dengvaxia is reconstituted by transferring all the solvent (0.4% sodium chloride solution) provided in the blue-labeled pre-filled syringe into the vial of freeze dried powder with a yellowish green flip off cap. The pre-filled syringe is fitted with a sterile needle for this transfer. The vial is then gently swirled. After complete dissolution, a 0.5 ml dose of reconstituted suspension is withdrawn into the same syringe. For injection, the syringe should be fitted with the new sterile needle.

The suspension should be visually inspected prior to administration. After reconstitution, dengvaxia is clear, colorless liquid with the possible presence of white to translucent particles (of endogenous nature).

After reconstitution with the solvent provided, dengvaxia must be used immediately.

Any unused dengvaxia or waste material should be disposed of, preferably by heat inactivation or incineration, in accordance with local regulations.

Do not throw away any medicines via wastewater or household waste. Ask a pharmacist on how to throw away medicines that no longer use. These measures will help to protect the environment.

Storage

Store in a refrigerator. Do not freeze. Keep the vaccine in the outer carton in order to protect it from light.

Description

After reconstitution, one dose (0.5 ml) contains 4.5-6.0 log10 ccid50* of each serotype of the cyd dengue virus** (1, 2, 3 and 4).

* ccid50: 50% cell culture infectious dose.

** produced in serum-free vero cells by recombinant dna technology.

The powder is a white, homogenous, freeze-dried powder with possible retraction at the base, and may form a ring-shaped cake.

The solvent (0.4% sodium chloride solution) is a clear, colorless liquid.

After reconstitution with the solvent provided, dengvaxia is a clear, colorless liquid with the possible presence of white to translucent particles.

Excipients/inactive ingredients: essential amino acids including l-phenylalanine, non-essential amino acids, l-arginine hydrochloride, sucrose, d-trehalose dihydrate, d-sorbitol, trometamol, urea, sodium chloride, water for injections.

Mechanism of action

Dengvaxia contains dengue virus serotypes 1, 2, 3 and 4 that have been weakened. Dengvaxia works by stimulating the body's natural defenses (immune system), which produces its own protection (antibodies) against the viruses that cause dengue disease.

Dengue is a viral infection transmitted to humans through the bite of an infected aedes mosquito. Dengue is not transmitted directly from person-to-person. Nevertheless the virus which replicates in an infected individual can be transmitted to other humans through mosquito bites for 4-5 days (maximum 12 days) after the first symptoms appear.

Dengue disease results in a wide range of symptoms including fever, headache, pain behind the eyes, muscle and joint pain, nausea, vomiting, swollen glands or skin rash. Symptoms usually last for 2-7 days. Dengue disease can also be asymptomatic.

However, occasionally dengue can be severe and potentially lead to hospitalization and in rare cases to death. Severe dengue is characterized by high fever and any of the following symptoms: severe abdominal pain, persistent vomiting, rapid breathing, severe bleeding, bleeding in stomach, bleeding gums, fatigue, restlessness, coma, seizure and organ failure.

Source:- http://www.mims.com/philippines/drug/info/dengvaxia

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20 people found this helpful

Best Urologist in Delhi

Dr.Sanjeev Kumar Singh 92% (193ratings)
Bachelor of Ayurveda, Medicine and Surgery (BAMS)
Ayurvedic Doctor, Lakhimpur Kheri

Problems like prostate cancer and UTI are very common in males. They require special attention and need to be treated by a urologist. There are many best urologist in Delhi. A urologist specializes in the treatment of common diseases related to the male reproductive system. Here is a list of best urologists in Delhi you can get in touch with.

1. Dr. Shalabh Agrawal

DNB (Urology), MS, MBBS

Dr. Shalabh Agrawal in 17 years of his career is associated with some reputed hospitals like  Artemis & Metro hospital. He is known for his knowledge and efficiency as a urologist, urological surgeon and andrologist. He has handled many types of cases in his career and is particularly interested in endo-urology and laparoscopy. He also deals with treatment like cyst in kidney, hematuria, erectile dysfunction, HIV, and kidney transplant. He is currently associated with - One Health Urology Clinic, Gurgaon & Arcus Superspeciality Center- Delhi.

Consultation fees: ₹600

2. Dr. Sudhir Khanna

MBBS, MS - General Surgery, DNB - General Surgery, MCh - Urology, MNAMS - Urology

Dr. Sudhir Khanna is a famous urologist. He currently practices at Sir Ganga Ram Hospital and is the chairman of deptt of Urology. He is a member of the Delhi Medical Council. In 29 years of his practice, he has also performed various surgeries including cancer surgeries and kidney transplant. He is also known for his successful treatment of erectile dysfunction, infertility

Consultation fees: ₹1500- 2000

3. Dr. Kuldip Singh

Fellowship of the Royal College of Surgeons (FRCS), MS, MBBS

Dr. Kuldip Singh has 45 years of experience and is a popular Urologist in Delhi. He is affiliated with the National Heart institute and The Maples Medical Centre, Delhi. He is an expert in treating prostate, kidney and bladder tumors with robotic surgeries, neobladder for bladder cancers and Penile prosthesis surgery for erection problem. 

Consultation fees: ₹1000

4. Dr. Aditya Pradhan

DNB (Urology), MS - General Surgery, MBBS

Dr. Aditya Pradhan has 28 years of experience and is a reputed urologist in his profession. He specializes in Cystoscopy, hematuria, treatment of erectile dysfunction, H.I.V treatment, hydrocele treatment, Incontinence treatment, kidney transplant treatment, lithotripsy procedure, treatment of male sexual problems and Men’s health. He is currently associated with multiple hospitals and clinics like BLK Super specialty hospital.

Consultation fees: ₹600-1100

5. Dr. Nikhil Sharma

MBBS, MS - General Surgery, DNB (Urology)

With more than 16 years of experience,  Dr. Nikhil Sharma is a well-known name in the field of urology. He is currently practicing at Shanti Mukand Hospital Earch Centre and ClearMedi Hospital. He is known to treat all kinds of urology problems, including prostate and bladder cancer as well as erectile dysfunction.

Consultation fees: ₹600

6. Dr. Tanuj Paul Bhatia

DNB (Urology), MS (Gen Surgen), MBBS

Dr. Tanuj has 12 years of experience and is associated with Sarvodaya hospital and SCI Hospital. He has successfully conducted many scarless laser surgeries for removing kidney stones. He also specializes in prostate surgeries like RIRS (retrograde intrarenal surgery) and HOLEP (holmium laser enucleation of the prostate). 

Consultation fees: ₹450- 800

7. Dr. Saurabh Mishra 

MCH-Urology

Dr. Saurabh has more than 15 years of experience and is a leading urologist in Delhi. He has treated several cases in all kinds of urological diseases in his career. His areas of special interest are stone, prostate, genitor-urinary strictures, various urological cancers, erection and infertility problems. He was part of the team which did India’s first robotic urology surgery. He currently is associated with Moolchand Hospital and Dr. Saurabh’s clinic- Delhi.

Consultation fees: ₹800

8. Dr. Anirudh Kaushik

MBBS, MS - General Surgery, MCh - Urology

Dr. Anirudh Kaushik is an experienced Urologist and Andrologist with 25 years of experience. He is currently practicing at Holy Care Family Hospital. He holds a special interest and expertise in treating prostate-related problems, stone surgeries, and male infertility. He has conducted several open and endoscopic urological operations and surgery for malignancy and transurethral surgeries.

Consultation fees: ₹1000- 1200

9. Dr. Narmada Prasad Gupta

MBBS, MS - General Surgery, MCh - Urology, FAMS

Dr. Narmada Prasad Gupta is a reputed urologist in Delhi - NCR with 47 years of practice. He is a member of some of the famous and prestigious organizations like Indian Medical Association (IMA), Association of Surgeons of India (ASI), Indian Association Of Cosmetic Laser Surgeon (ACLS), Indian Society of Organ Transplantation (ISOT) and Urological Society of India (USI). in his career, he has successfully treated cases suffering from prostate cancer, enlargement, testicular cancer and other problems related to urology as well as cases of sexual dysfunction in males. He is currently practicing at Medenta.

Consultation fees: ₹1200

10. Dr. Abdul Munnon Durrani

MBBS, MS - General Surgery, DNB - Urology/Genito - Urinary Surgery

Dr. Durrani has close to 10 years of experience and is currently running his own clinic- DURRANI UROSURGERY HOME CLINIC and also visits as a consultant at Fortis Hospital He is known for his holistic approach and compassionate care, in his treatment. Some of the areas in which he specializes are conducting transurethral resection of the prostate also called TURP, lithotripsy, and cystoscopy. He is good at diagnosis and treating different problems related to the female and male urinary tract and male reproductive system

Consultation fees: ₹600-1000

Also, check Manipal Hospital Dwarka - Best Hospital in Delhi. Book Appointment, View Doctor List, Contact no, Address, Visiting Hours, Health Checkup Reviews, Lab Report Online.

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Top 10 urologist in Bangalore

Dr.Sanjeev Kumar Singh 92% (193ratings)
Bachelor of Ayurveda, Medicine and Surgery (BAMS)
Ayurvedic Doctor, Lakhimpur Kheri
Top 10 urologist in Bangalore

Pain or a burning sensation when passing urine? Or the urine has blood or is cloudy? These could be sign of UTI or urinary tract infection. You need to visit a urologist. There are so many urologist in Bangalore, so how to choose whom to consult. Here is a list of top 10 urologist in Bangalore, you can refer to:

1.  Dr. K.S Shiva Kumar

MBBS, MS - General Surgery, M.Ch - Urology

Dr. K. S. Shiva Kumar is amongst the top urologist & uro oncologist in Bangalore, with 20 years of experience. He is associated with many clinics and hospitals like Shree Srinivasa Uro Care, MVJ Medical College, Manipal Hospital, CMH Hospital and Sri Sathya Sai Super Specialty Hospital. He is not only an expert in urology but also an expert Laparoscopic Surgeries. He specialises in wide range of disorders and surgeries such as treatment for urinary tract infection (UTI), pediatric urology, andrology, laparoscopy, neurourology, Uro-oncology & radiology, laser & robotic urology, and infertility

Consultation fees: ₹500

2. Dr. Shrinivas R.P

MBBS, MS - General Surgery, DNB

Dr. Shrinivas R.P has 8 years of experience and  is a popular Urologist in Bangalore. He currently practices at Manipal Hospital, Bangalore. with an experience of 8 years. He specializes in child surgeries. He also provides treatment for wide range of urinary conditions like hematuria, hydrocele, and problems related to reproductive organs like H.I.V and Erectile Dysfunction. He has conducted many surgeries, using different procedures like vasectomy, reconstructive urology and minimally invasive urology surgery etc. 

Consultation fees: ₹700

3. Dr. N Nagarajaiah

MCh - Urology, MS - General Surgery , MBBS

Dr. Nagarajaiah Narayanaswamy is a well-reputed urologist in Bangalore who has more than 23 years of experience. He has performed over 20,000 surgeries in his career, one of them being removing one of the largest kidney stones. He has also performed various surgeries including cancer surgeries and Laser (TURP). He is also known for his successful treatment of erectile dysfunction, infertility. He is currently working at the Shushrutha Urology and Andrology Clinic, Rajajinagar

Consultation fees: ₹500

4. Dr. Udaybhaskar M

MBBS, MS - General Surgery, M.Ch - Urology

Dr. Uday Bhaskar M is amongst the most recognized doctor in urology and has 14 years of experience. He has received an award of Best Poster in American Urological Association and is a member of national and international associations. He is associated with PES Medical College as the Assistant Professor and practices as a consultant urologist at Fortis Hospital, hcg hospital for cancer related problems, Malathi Manipal hospital , excel care hospital and Arunodaya hospital. He has performed over 4000 varied surgeries including some very rare and complicated cases like removing a 10 kg renal Tumor from pregnant lady. He is an expert in treating prostate , kidney and bladder tumors with robotic surgeries,  neo bladder for bladder cancers and Penile prosthesis surgery for erection problem. 

Consultation fees: ₹500- 670

5. Dr. Srinivas Rao

MBBS, MS - General Surgery, MCh - Urology

Dr. Srinivas Rao is a renowned urologist with 20 years of experience and  practices as consultant urologist at Manipal hospital Whitefield, Aaxis hospital Kadugodi and Aaxis kidney stone center Bhattarahalli, KR puram. He has several years of experience in performing advanced endoscopic and laparoscopic procedures to treat different kind of urological disorders like  kidney stones and cancer, PUJ obstruction, benign prostatic enlargement, bladder cancer and prostate cancer etc.

 Consultation fees: ₹500

6. Dr. Chandrashekar.B.V

MBBS, MS - General Surgery, DNB - Urology/Genito - Urinary Surgery

Withmore than 20 years of experience, Dr. Chandrashekar is a well known name in the field of urology. He is currently practicing at Sree Venkateshwara Speciality Hospital, Bangalore. He is known to treat all kind of urology problems, including prostate and bladder cancer as well as erectile dysfunction.

Consultation fees: ₹500

7.  Dr. Ninan Thomas Panickeranicker

M.Ch - Urology/Genito-Urinary Surgery, MS - General Surgery, MBBS

Dr. Nainan Thomas is an experienced Urologist and Andrologist with 35 years of experience. He is  currently practicing at G M Health Care. He holds a special interest and e7. Dr. Ninan Thomas P7. Dr. Ninan Thomas Panickeranickerxpertise in treating prostate related problems, stone surgeries and male infertility. He has conducted several open and endoscopic urological operations and surgery for malignancy and transurethral surgeries.

Consultation fees: ₹500

8. Dr. Chandrashekar S Ratkal

M.Ch - Urology/Genito-Urinary Surgery, MS - General Surgery, MBBS

Dr. Chandrashekar has 4 decades of experience as a Urologist, Andrologist and Urological Surgeon He is a member of many eminent associations  like Karnataka Medical Council, Indian Medical Association (IMA), Medical Council of India (MCI), Urological Society of India (USI), American Urological Association (AUA) and Bangalore Urological Society. He is known for his treatments and procedures like frenuloplasty, circumcision, vasovasostomy and TESA.

Consultation fees: ₹750

9. Dr. Premkumar Krishnappa

MBBS, MS - General Surgery, DNB - Urology/Genito - Urinary Surgery

Dr. Premkumar Krishnappa is a reputed urologist, uro-oncologist, andrologist and renal transplant surgeon. In 13 years of his career, he has performed over 1000 laser enabled transurethral prostate procedures (LASER TURP), over 500 laser fragmentation of kidney (RIRS) and Ureteric stones(URS) and over 50 kidney transplants. He has also contributed in many articles in various peer reviewed journals with a special interest in urethral surgeries and reconstructive urological procedures. He is currently associated with Fortis group of hospitals. 

Consultation fees: ₹400-1000

10. Dr. Venkateshwara Rao K

M.Ch-Urology, MS, MBBS

Dr. Rao has close to 10 years of experience and is associated with Apollo hospitals. He is known for his holistic approach and a compassionate care, in his treatment. Some of the areas in which he specializes are conducting transurethral resection of the prostate also called as TURP, lithotripsy and cystoscopy. He is good at diagnosis and treating different problems related to the female and male urinary tract and male reproductive system.

Consultation fees: ₹400

6 people found this helpful

Is Breast Lump Signal To Breast Cancer?

Dr.Swarup Kumar Ghosh 88% (89ratings)
MF Homeo (London), DHMS (Diploma in Homeopathic Medicine and Surgery), Biochemistry M.D.( PG) (Kol), CMS Ed, Affilied by UGC & MCI., Electro - Homoeopathy Pledge (Certifict No.11244)., Electro Homoeopathy Certficate., BEMS; MDEH(MP).
Homeopathy Doctor, Kolkata
Is Breast Lump Signal To Breast Cancer?

Most lumps are not cancer,  A breast lump is a growth of tissue that develops within your breast. Different types of breast lumps can vary in the way they look and feel. You may perceive a lump as a mass, growth, swelling, thickness, or fullness.

Symptoms and Signs of Breast Lumps

  • A distinct lump with definite borders
  • A firm, hard area within your breast
  • A thickened, slightly more prominent area in your breast that's different from surrounding breast tissue
  • Other breast changes, such as redness, dimpling or pitting of the skin
  • One breast that's noticeably larger than the other
  • Nipple changes, such as a nipple that's pulled inward or spontaneous fluid discharge from your nipple
  • Persistent breast pain or tenderness, which might increase during your menstrual period

Sometimes, a breast lump is a sign of breast cancer. That's why you should seek prompt medical evaluation. Fortunately, however, most breast lumps result from Noncancerous (benign) conditions.

Causes of Breast lumps

  • Breast cancer.
  • Breast cysts — fluid-filled sacs in your breast that are usually benign
  • Fibroadenoma— a solid, benign mass most common in young women
  • Fibrocystic breast.
  • Injury or trauma to the breast
  • Intraductal papilloma — a benign, wartlike growth in a milk duct
  • Lipoma— a slow-growing, doughy mass that's usually harmless
  • Mastitis-— an infection in breast tissue that most commonly affects women who are breast-feeding
  • Milk cyst (galactocele) — a milk-filled cyst that's usually harmless

Homeopathic Remedies of Breast Cancer

Well-selected homeopathic remedies are effective for breast lump and cure the condition without further complications

Bryonia alba 1m - Bryonia alba is indicated when breast lump with stitching pain is present. The breast is hard and painful. Pain in breast at menstrual period. The breast pain aggravates during movement.

Calcarea carb 30- An excellent remedy for breast lump. Breasts are hot and swollen. Chronic cystic mastitis. Blunt duct adenosis; best remedy for fibroadenoma. Lump in breast is hard, nodular, and tender to touch in the beginning. Then the pains are reduced and the lump turns to be hard due to calcification. Calcarea acts best when the tumours are calcified. These breasts are swollen and tender before menses. Deficient lactation. The breasts are distended in lymphatic women. The patient complains of profuse sweating around the genitalia with dirty smell. Inflammatory condition of the breast. With breast condition patient has the mental symptoms due to suffering. The patient is anxious, tired, and weak, both mentally and physically.

Calcarea flour 30 - Calcareaflour. It is another top remedy for lump in the breast. Lump in the breast which is hard, movable with clear margins which are sharp in nature, or their edges is sharply defined. Most commonly they are solitary, very rarely multiple. Occurs in young patients usually unmarried. Nodules are in the upper right quadrants. The patient is sad and depressed due to financial conditions. Confused due to melancholic condition of mind. The patient is chilly, and she is very sensitive to cold air, cold wind and cold atmosphere in general. Genitals are sore. Urine is copious and offensive. Pain at the tip of the urethra while urinating and after the act. Pain in back extending to sacrum.

Conium maculatum 30 -  Conium maculatum is one of the top remedies for breast lump. Here the mammary glands are hard and sore. A typical carcinoma of the breast, that is, scirrhous adenocarcinoma, which begins in the ducts and ends in the parenchyma. As the stage advances, the cooper's ligament shortens and thus it produces the notch. Sometimes the condition is associated with the inflammation of the breast tissue. The region is hard and nodular, tender to touch. Burning and stinging pains in the breast. The skin over the tumor is adherent. Occasionally there is the discharge of pus from the nipple. The lesion is hard, almost cartilaginous. The edges are distinct, serrated, and irregular; associated with productive fibrosis.

Baryta carb 30 - Baryta carb is very effective for breast lump. Inflammation, insulation, and enlargement are the fundamental pathogeneses of this drug. The mammary gland is enlarged and there is a lump, which is hard. There is very sensitive to touch. The glands which are enlarged are tender with infiltration. The women of the late twenties are affected. These patients present with hard but not serrated mass with a firm rubbery consistency. Their edges are sharply defined. Most commonly the tumours solitary. Or occasionally are multiple. They are differentiated from cancer by smooth rather than irregular lobulations. A bloody discharge from nipple is an indication of this drug. All the glands of the body are very sensitive to cold and they are worse by taking cold. The skin over the gland becomes ulcerated. It is seen that this remedy works better in Paget's disease of nipple which is supposed to be primary carcinoma of the mammary gland.

Bellis perennis 30 - Bellis perennis is prescribed when the lump is caused by a trauma that causes injury to deeper tissues of the breast. The main indication is sore, bruised feeling in breast. Breasts engorged. 

Chimaphilia Umbellata 30 - Chimaphilia is indicated for a painful tumor of mammae in women of large breasts. There is sharp pain through the breast.

Hydrastis Canadensis 30 - Hydrastis is prescribed to those patients who have the tendency to indurated glands. Swelling of the mammary glands. Fat necrosis and glandular cell myoblastoma are common in this remedy. Fat necrosis tumor is probably post-traumatic. The patient complains of pain and tenderness. The lesion is fixed to the breast tissue, which sometimes causes dimpling of the overlying skin. Engorged nipples, cracks, and discharges of watery fluid or there is serosanguinous discharge. The patient is weak and emaciated, fainting due to improper assimilation or defective assimilation. All-gone sensation or empty feeling in the stomach, not relieved by eating. Chronic catarrhal condition of the membrane of the stomach. The patient is thirstless. Obstinate constipation, colicky, and crampy pain in the abdomen. The liver is enlarged and tender.

Iodum 30 - This remedy predominantly acts on the enlargement of the mammary glands which may be either neoplastic or malignant. The mucous membranes of the glands and the breast tissue are inflamed. The breast tissues are hypertrophied, enlarged, hard, and nodular. Emaciation of the patient due to malabsorption. The tumours are well differentiated. They have a discrete capsule. Small lesions present leaf-like intracanalicular protrusions and large lesions have cystic space. Inflammation of the lesions, ulceration occasionally, excoriating, and acrid discharge from the nipple or from the lesion. Oedematous swelling of the affected breast.

Lapis Albus 30 - The main action of this remedy is on the glands of the mammary region. These glands have the tendency to turn malignant. Remarkable results are observed in scrofulous condition of the glands. Fibroid tumors, intense burning pains in the parts. The tumors have pliability and a kind of softness rather than hardness. The margins are clear. The glands are elasticity, exactly the reverse of calc. Fluorica.

Phytolacca dec. 30 - Phytolacca is another remedy effective for lump in the breast. Mammae hard an very sensitive. Tumors of the breast with enlargement of axillary glands. When child nurses' pain goes from the nipple all over the body. Irritable breast before and during menses.

Plumbum iodide 30 - Plumbum iodide is another effective remedy for breast lump. There are indurations of breast, especially when a tendency to become inflamed, appears sore and painful. Indurations of great hardness and associated with very dry skin.

Scrophularia nodosa q - Scrophularia has a specific affinity for the breast. It is very useful in the dissipation of breast tumors.

Thyroidinum 1m - An intercurrent remedy


Breast cancer is cancer that forms in the cells of the breasts.

After skin cancer, breast cancer is the most common cancer diagnosed in women in the united states. Breast cancer can occur in both men and women, but it's far more common in women.

Substantial support for breast cancer awareness and research funding has helped create advances in the diagnosis and treatment of breast cancer. Breast cancer survival rates have increased, and the number of deaths associated with this disease is steadily declining, largely due to factors such as earlier detection, a new personalized approach to treatment, and a better understanding of the disease.

Symptoms of Breast Cancer

  • Nipple changes 
  • Nipple changes

Signs and Symptoms of Breast Cancer

  • A breast lump or thickening that feels different from the surrounding tissue
  • Change in the size, shape or appearance of a breast
  • Changes to the skin over the breast, such as dimpling
  • A newly inverted nipple
  • Peeling, scaling, crusting or flaking of the pigmented area of skin surrounding the nipple (areola) or breast skin
  • Redness or pitting of the skin over your breast, like the skin of an orange

Cause of Breast Cancer

  • Doctors know that breast cancer occurs when some breast cells begin to grow abnormally. These cells divide more rapidly than healthy cells do and continue to accumulate, forming a lump or mass. Cells may spread (metastasize) through your breast to your lymph nodes or to other parts of your body.
  • Breast cancer most often begins with cells in the milk-producing ducts (invasive ductal carcinoma). Breast cancer may also begin in the glandular tissue called lobules (invasive lobular carcinoma) or in other cells or tissue within the breast.
  • Researchers have identified hormonal, lifestyle, and environmental factors that may increase your risk of breast cancer. But it's not clear why some people who have no risk factors develop cancer, yet other people with risk factors never do. It's likely that breast cancer is caused by a complex interaction of your genetic makeup and your environment.

Inherited Breast Cancer

  • Doctors estimate that about 5 to 10 percent of breast cancers are linked to gene mutations passed through generations of a family.
  • A number of inherited mutated genes that can increase the likelihood of breast cancer have been identified. The most well-known are breast cancer gene 1 (brca1) and breast cancer gene 2 (brca2), both of which significantly increase the risk of both breast and ovarian cancer.
  • If you have a strong family history of breast cancer or other cancers, your doctor may recommend a blood test to help identify specific mutations in brca or other genes that are being passed through your family.
  • Consider asking your doctor for a referral to a genetic counselor, who can review your family health history. A genetic counselor can also discuss the benefits, risks, and limitations of genetic testing to assist you with shared decision-making.

Risk Factors of Breast Cancer

A breast cancer risk factor is anything that makes it more likely you'll get breast cancer. But having one or even several breast cancer risk factors doesn't necessarily mean you'll develop breast cancer. Many women who develop breast cancer have no known risk factors other than simply being women.

Factors that are associated with an increased risk of breast cancer include:

  • Being female. Women are much more likely than men are to develop breast cancer.
  • Increasing age. Your risk of breast cancer increases as you age.
  • A personal history of breast conditions. If you've had a breast biopsy that found lobular carcinoma in situ (lcis) or atypical hyperplasia of the breast, you have an increased risk of breast cancer.
  • A personal history of breast cancer. If you've had breast cancer in one breast, you have an increased risk of developing cancer in the other breast.
  • A family history of breast cancer. If your mother, sister or daughter was diagnosed with breast cancer, particularly at a young age, your risk of breast cancer is increased. Still, the majority of people diagnosed with breast cancer have no family history of the disease.

Inherited genes that increase cancer risk. Certain gene mutations that increase the risk of breast cancer can be passed from parents to children. The most well-known gene mutations are referred to as brca1 and brca2. These genes can greatly increase your risk of breast cancer and other cancers, but they don't make cancer inevitable.
Radiation exposure. If you received radiation treatments to your chest as a child or young adult, your risk of breast cancer is increased.

Obesity.

  • Being obese increases your risk of breast cancer.
  • Beginning your period at a younger age. Beginning your period before age 12 increases your risk of breast cancer.
  • Beginning menopause at an older age. If you began menopause at an older age, you're more likely to develop breast cancer.
  • Having your first child at an older age. Women who give birth to their first child after age 30 may have an increased risk of breast cancer.

Having never been pregnant

  • . Women who have never been pregnant have a greater risk of breast cancer than do women who have had one or more pregnancies.
  • Postmenopausal hormone therapy. Women who take hormone therapy breast lump. 

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