Dr. Sachin Pahade

Prostate cancer is a cancerous tumor in a man’s prostate gland, a small gland that is responsible for producing the seminal fluid which transports and nourishes the sperm. It is a very common type of cancer among men. A few cases of prostate cancer tend to develop slowly while others may progress very fast.

Symptoms

In the initial stages, prostate cancer may not show any symptom. However, in the latter stages, there may be symptoms such as:

1. Pain in the bones.

2. Erectile dysfunction.

3. Urination can get troublesome.

4. Presence of blood in the semen.

5. Pain and discomfort in the pelvic region.

Causes-

The exact causes of prostate cancer are not known. It starts to develop when certain cells in the prostate gland start to mutate. These mutations cause these cells to multiply at a very fast rate and thus, soon form tumors. Although the causes are not known, certain factors tend to aggravate this condition; them being:

1. Color: According to certain medical reports, a darker skin may mean increased chances of suffering from prostate cancer.

2. Age: The risk of developing prostate cancer tends to increase with age.

3. Genetics and Family History: Faulty genes could be another cause of this condition. Also, having some member in the family who is diagnosed with this type of cancer only increases the risks of you suffering from them.

4. Obesity: If you are obese, then you are more likely to develop prostate cancer.

Treatments-

The treatments for prostate cancer include:

1. Radiation Therapy: In this procedure, high energy rays are used to target and destroy cancer cells. Usually X-rays or protons are used to treat the cancer cells.

2. Hormone Therapy: Hormone therapy is a type of treatment wherein certain medications are administered to prevent your body from producing testosterone.

3. Surgery: If the other treatment methods do not produce desired results, then a surgery is carried out for the removal of the prostate gland. In addition to the prostate gland, some adjoining lymph nodes and tissues are also removed.

4. Chemotherapy: Chemotherapy is method of destroying cancer cells by injecting chemicals into the body. The medicines are injected into the veins in the arms.

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

Blood in urine, medically known as Hematuria is not usually a cause of concern, but it can translate into an adverse condition if left unevaluated. The kidneys and other structures in the urinary tracts such as urethra (tube connecting the bladder to the outer part of the body); bladder (that stores the urine) and ureters (tube joining the bladder to the kidney) are the sources of blood flow to the urine. Hematuria can be accompanied by symptoms such as discharge of tea-colored, brownish-red or pink colored urine due to the presence of red blood cells, traces of which can only be detected under the microscope.

Underlying causes behind this disorder might be

1. Urinary tract infection is where the bacteria enter the body through the urethra and begin to proliferate in the bladder.
2. Kidney infections (pyelonephritis) is when bacteria infiltrate into the kidneys from the bloodstream or travel up from the uterus to the kidneys.
3. A kidney or a bladder stone is marked by the minerals in the concentrated urine precipitating out and molding into crystals that deposit on the bladder or kidney walls.
4. Enlarged prostate is a condition in which the prostate gland, that is situated just below the bladder surrounding the upper part of the urethra, starts growing as males head towards their middle age.
5. Kidney disease such as glomerulonephritis causes swelling of the kidneys, thus disrupting the filtering system.
6. Bladder, kidney and prostate cancer are also possible causes.
7. Hereditary disorders such as sickle cell anemia (a hereditary disease of the red blood cells in the hemoglobin) can also pose as a cause behind this disorder.
8. Kidney injury as a result of heavy blows, accidents or injuries sustained while playing a spot can also contribute to this condition.
9. Medications such as penicillin or the anti-cancer drug ‘cyclophosphamide’
10. Strenuous physical exercises like intense workout or running may also result in Hematuria.

Treatments
There is no fixed cure for Hematuria; instead the doctor would work on treating the repressed conditions behind the symptoms, such as prescribing antibiotics to heal the urinary tract infection or a medicine to shrink and normalize the enlarged prostate or administer a shock wave therapy to destroy the kidney or bladder stones. If you wish to discuss about any specific problem, you can consult a Urologist.

Bladder cancer can be caused by a variety of factors, which include genetic factors, inheritance, drugs, chemicals, environment related factors and smoking. In fact, smoking tobacco is one of the major causes of bladder cancer around the world. The chemicals present in tobacco can irritate the bladder lining which ultimately leads to bladder cancer. Besides smoking other important environmental factors might be chemotherapy, exposure to chemicals from newspaper, dye, leather, paints industries.

Symptoms of bladder cancer are as follows:

Most often it occurs in people more than 50 years of age. It can present in different ways, but common symptoms being :

1. Painless hematuria - reddish or brownish colored urine with or without clots Increased frequency of urination Pain while passing urine .
2. Difficulty in passing urine

Diagnosis:

The diagnosis requires a proper imaging workup including ultrasound, CT scan and urine examinations. Following the initial imaging, a biopsy is required to confirm the diagnosis and stage the disease. This is done by cystoscopy under anesthesia.

Treatment Options:

Treatments for bladder cancer.depend on the stage of cancer. Broadly bladder cancers can be categorised into Non-invasive and Invasive cancers.

1. For non-invasive cancers: It requires recurrent cystoscopic surveillance and resection. For those with high risk of tumor recurrence or progression, intravesical chemotherapy or immunotherapy might be required.
2. For invasive cancers the various treatment choices are:
   1. Surgery: For localised tumor which are amenable to resection perhaps surgery is the best possible treatment. This is a major undertaking where in whole of bladder along with accessory organs is removed. The surgeon may offer choices for reconstruction between neobladder (refashioning bladder with patient's gut) or ileal conduit (fashioning a stoma over which bag can be worn to collect urine). Following surgery a regular follow up is required and the prognosis is good.
   2. Chemotherapy: This modality is reserved for patient's where surgery is not possible or they have metastatic disease (disease spread to other body parts).In this method, medications are used to target and destroy cancer cells.
   3. Radiation Therapy: This might be and option for patient's that are not suitable for surgery. Radiation therapy uses gamma rays to destroy cancer cells in the body The key to good prognosis in bladder cancers is early detection timely intervention and good follow up. If you wish to discuss about any specific problem, you can consult a Urologist.

One of the most common problems faced by ageing men is benign prostatic hypertrophy. Prostate is the gland at the base of the urethra near the bladder and when it enlarges it can lead to symptoms, mostly related to urination.

1. Frequent urge to pass urine
2. Prolonged urination
3. Frequent nocturnal visits to the toilet
4. Intermittent urination
5. Difficulty to start urinating
6. Inability to completely empty the bladder
7. Urinary tract infections

There are medications available to manage this, but offer only temporary relief. Many men therefore prefer to have the surgery undergone to manage these bothersome symptoms. However, like any surgery, the risks and benefits need to be considered along with other conditions like age, overall health status, other comorbid conditions, etc.

Surgical removal of the enlarged prostate gland is a more definitive approach to manage these symptoms. In addition to providing a quick cure, it also is used in the following cases:

1. Patients who do not respond to medications
2. Presence of blood in the urine
3. Associated bladder stones
4. Frequent infections of the urinary tract
5. Associated damage to the kidneys

Procedure of Surgery
During the procedure, a tube is passed through the tip of the penis into the urethra towards the bladder neck. Once it is in the desired position, laser is passed through it to deliver energy that acts on the prostate to either completely or partially destroy it. There are two methods by which laser acts on the enlarged prostate and making way for free flow of the urine.

1. Ablation: Excess prostate tissue is melted away by the laser by using photosensitive vaporization of the prostate. This is also known as Greenlight laser therapy or KTP laser vaporization. Alternately, Holmium can be used as the source of laser energy to ablate the prostate tissue.

2. Enucleation: Excess prostate tissue is cut and teased out through the urethra. Holmium laser is used to resect the prostate into smaller pieces, which are then removed out through a resectoscope. Another technique uses a tissue morcellator which grinds the enlarged prostate into smaller pieces to enable easy retrieval.

More men now opt for laser prostate removal as it has the following advantages:

1. Reduced risk of bleeding: This becomes essentially important in patients who are on blood thinners.
3. Immediate symptom relief: As compared to medications, the relief is felt almost immediately after the surgery
4. No catheter: With laser surgery, a catheter may be required for less than 24 hours unlike in open surgical cases.

As noted above, as with any surgery, once enlarged prostate symptoms set in, have a detailed discussion with your doctor to identify if you are a suitable candidate for laser surgery. If you wish to discuss about any specific problem, you can consult a Urologist.

When we talk about health, the kidneys are rarely spoken of. These unsung heroes are responsible for filtering waste out of our bodies and ensuring that only clean blood flows through our system. The kidneys are a pair of small, bean-shaped organs located at the back of the abdomen. Along with removing waste from the blood, the kidneys also balance electrolytes and control the fluid balance in the body. Thus, keeping the kidneys healthy is as important as keeping the heart and lungs healthy.

Kidney stones are the most common condition that can affect these organs. Other conditions that can affect the kidneys include inflammation of the kidneys, renal failure, nephrotic syndrome and cysts. Thankfully, keeping the kidneys healthy is easy. Here are a few things you can do to improve the health of your kidneys.

1. Drink plenty of water: Keeping your body hydrated is crucial to kidney health. Ideally, a person should drink a minimum of 8-10 glasses of water a day. Water helps control the production of aldosterone- a hormone that regulates blood pressure- by the adrenal glands and helps the kidneys retain enough water and sodium to balance blood volume levels. If the kidneys do not get enough water, the adrenal glands are stressed into increasing blood pressure levels.
2. Limit consumption of caffeine: We drink caffeine in many ways- sodas, coffee, tea etc. While caffeine may act as a stimulant and keep you focused on what you are doing in the short run, in the long run, it dehydrates the body. Dehydration can also lead to the formation of kidney stones. Hence reduce your caffeine intake and instead drink more water and fresh juices.
3. Quit smoking: Smoking not only affects the lungs but also damages blood vessels thus decreasing blood flow to the kidneys thus preventing the optimal functioning of the kidneys. Smoking can also increase one’s risk of suffering from renal cancer.
4. Get regular exercise: Exercise benefits all parts of your body including the kidneys. Regular exercise reduces blood pressure and helps keep the blood moving. This can help prevent kidney diseases and a number of other conditions. Ideally, aim for half an hours exercise a day at the least.
5. Eat plenty of fresh fruits and vegetables: Fruits like grapes, apples and blueberries and vegetables like spinach, beets, garlic and red bell peppers help improve kidney functioning. Women should also include oestrogen boosting foods like chickpeas, fennel, tomatoes, cherries and carrots in their diet to protect themselves against kidney damage and fibrosis. Foods that are low in gluten, sugar and soy also help reduce the risk of kidney inflammation. If you wish to discuss about any specific problem, you can consult an urologist.

Overactive bladder, also known as OAB, is a condition where sudden involuntary contractions of the urinary bladder's muscular walls cause bladder storage dysfunction. It leads to sudden and frequent urges to urinate (urinary urgency), as well as unintentional leakage or urine (urinary incontinence).

This is a condition that affects both men and women and causes tremendous discomfort in nearly every aspect of daily life. The specific causes of OAB vary from case to case but it is generally attributed to infection of the urinary tract or dysfunction of the nervous system. The symptoms are intensified by unhealthy lifestyle choices such as overindulging in caffeinated drinks, spicy foods and alcohol.

There are several ways in which you can deal with the problem of OAB, depending on the nature of the case. It is necessary for you to consult a urologist for a detailed diagnosis to formulate the best treatment option.

Following are the most effective remedies to treat an overactive bladder:

1. Lifestyle Modifications: Also known as behavioral therapy, this is the first step in the treatment of OAB. It involves inculcating simple changes into everyday habits such as avoiding food and drinks that irritate the bladder, scheduling (and in some cases, practice delaying) bathroom visits, exercising the pelvic floor and bladder muscles, keeping a record of urinating habits in a 'bladder diary' for better understanding the problem, etc. You can incorporate these habits into everyday activities for an easy alleviation of the problem with absolutely no side effects.

2. Medication and Surgery: There are several different kinds of medicines and drugs that can treat the problem of OAB. The most common types are muscle relaxants that loosen the muscles of the urinary bladder to prevent involuntary contractions, and antibiotics and anti-inflammatory drugs that treat urinary tract infections. Many types of implants are surgically set into the pelvic area to act as electrical nerve stimulators for neuromodulation therapy. Reconstructive bladder surgery is another remedial option.

3. Devices and Products: Urinary urgency and incontinence can be managed through the external use of various devices and products which collect and hold urine or absorb leakages. These include indwelling catheters, condom catheters (for men), urine drainage bags, absorbent pads and adult diapers, and toilet substitutes such as bedpans and bedside urinals.

Prostatitis is a very common infection of the prostate. However, it is worth to note that prostatitis can also be an inflammation of the prostate without infection. Only 5 to 10 percent of prostatitis is caused by bacterial infection. Prostate cancer does not normally have its chances increased by prostatitis. There are several forms of prostatitis, including acute bacterial prostatitis, chronic bacterial prostatitis and chronic nonbacterial prostatitis (which is also known as chronic pelvic pain syndrome).

The exact cause for prostatitis is not known, but here are some factors which increase its risk, particularly acute bacterial prostatitis.

Possible causes:

1. Medical instrumentation: Putting an instrument like a urinary catheter may well cause prostatitis.
2. Rectal intercourse: This is basically another name for anal sex.
3. Abnormal urinary tract: The urinary tract comprises of the bladders, kidneys, ureters and urethra. If any one of these organs gets infected, then prostatitis is much more likely.
4. Bladder infection: A bladder infection may well spread to the prostate.

Symptoms
Prostatitis has a variety of symptoms. Here are the most common symptoms of prostatitis.

1. Constant need of urination: This is one of the most common symptoms of prostatitis.
2. Difficulty when urinating: Just like the constant need of urination, difficulty urinating is also a sign that you may have prostatitis.
3. Pain while urinating: This is because the prostate gland is a part of your urinary tract and if it does not work properly, there will be pain.
4. Chills and fever: This is a rarer symptom, but may indicate prostatitis if it is coupled with the other symptoms.
5. Pain in perineal area and genital organs: If you are experiencing pain in genital organs, than it may indicate prostatitis. 
6. Painful ejaculations or relief of perineal pain after ejaculations: If you are having painful ejaculation or the pain arises after ejaculation, then it may be due to prostatitis.
7. Hematospermia: Pinkish or brownish semen.

If these symptoms are persistent or bothersome, then a proper consultation is required. Evaluation includes physical examination along with few simple tests. This can be followed by proper treatment for cure or relief of symptoms. If you wish to discuss about any specific problem, you can consult an urologist and ask a free question.

Benign Prostrate Hyperplasia (BPH) is a condition which results in the enlargement of the prostate gland. The prostrate grand is situated near the Urethra (a tube which helps flush out the urine from the bladder). Generally, the chance of developing BPH increases after one crosses the age of 50. But it is yet unknown as to why some men experience more severe symptoms than others.

Causes of BPH
This condition generally occurs because of old age and affects almost all men above the age of 75. It occurs because of the various hormonal changes and changes in cell growth that the body goes through, as one becomes old. Sometimes BPH can set in due to genetics. If BPH sets in due to genetically reasons, it usually is quite severe and affects men before they reach 60.

Symptoms of BPH
Quite a few men who develop BPH, experience no symptoms at all. But when symptoms of BPH, known as lower urinary tract symptoms (LUT) start, they can be either mild or very severe. The severity of the symptoms is not related to the extent of the enlargement. Many a times men with only a mild enlargement complain about severe symptoms, while men with a highly enlarged prostate gland have not complained about any discomfort faced. 

Symptoms of BPH tend to worsen due to cold weather and also because of physical and emotional overexertion. There are certain medicines, which should be avoided if you suffer from BPH, as they have a tendency to worsen your symptoms, for example diphenhydramine, pseudoephedrine, oxymetazoline spray and other antidepressants.

The symptoms of BPH are related to bladder emptying and issues with bladder storage.

Symptoms related to the urine drainage from the bladder are:

1. Strain while urinating
2. Weak urine flow
3. Some dribbling after urination
4. Sudden urge to urinate
5. Pain while urinating

Symptoms related to storage of urine in the bladder are:

1. Waking during the night to urinate
2. Urinating frequently during the day and at night
3. Sudden urge to urinate, which may be hard to control

It however, has to be kept in mind that these symptoms may not primarily occur due to prostate enlargement, but are the result of other conditions like urinary tract infections, prostatitis, prostate cancer, neurological disorders and even diabetes. Thus, it is essential that you visit a doctor and get the cause for these symptoms diagnosed properly.

Here are a few things you should know about Testicular Cancer (TC): 

1. Age: The commonest affected age group is 20-45 years with germ cell tumours. Half of all cases occur in men less than 35 years. Non-seminomatous germ cell tumours (NSGCT) are more common at ages 20-35, while seminoma is more common at age 35-45 years. Rarely, infants and boys below 10 years develop yolk sac tumours and 50% men above 60 years with TC have lymphoma.
2. Race: White Caucasian people living in Europe and the US have the highest risk. Whites are three times more likely to develop TC than blacks in the US. With the exception of the New Zealand Maoris, TC is rare in non-Caucasian races.
3. Previous TC: Confers a 12-fold increased risk of metachronous TC. Bilateral TC occurs in 1-2% of cases.
4. Cryptorchidism: 5-10% of TC patients have a history of cryptorchidism. Ultrastructural changes are present in these testes by age 3 years, although earlier orchidopexy does not completely eliminate the risk of developing TC. According to a large Swedish study, cryptorchidism is associated with a two-fold increased risk of TC in men who underwent orchiopexy less than 13 year, but risk is increased 5-fold in men who underwent orchiopexy aged above13 years. A meta-analysis showed risk of contralateral TC almost doubles while ipsilateral TC risk is increased 6-fold in men with unilateral cryptorchidism.
5. Intratubular germ cell neoplasia (testicular intraepithelial neoplasia, TIN): Synonymous with carcinoma in situ, although the disease arises from malignant change in spermatogonia; 50% of cases develop invasive germ cell TC within 5 years. The population incidence is 0.8%. Risk factors include cryptorchidism, extragonadal germ cell tumour, atrophic contralateral testis, 45XO karyotype, Klinefelter's syndrome, previous or contralateral TC (5%), and infertility.
6. Human immunodeficiency virus (HIV): Patients develop seminoma 35% more frequently than expected. Genetic factors: appear to play a role, given that first-degree relatives are at higher risk by 4-9-fold, but a defined familial inheritance pattern is not apparent.
7. Maternal oestrogen exposure: At higher than usual levels during pregnancy appears to increase risk of cryptorchidism, urethral anomalies, and TC in male offspring.

Trauma and viral-induced atrophy have not been convincingly implicated as risk factors for TC.

5 Reasons You Will See Blood in Urine

The condition in which blood appears in the urine is known as hematuria. The loss of blood in this condition could be gross or microscopic depending on the cause of the condition. There are several causes why blood may appear in the urine. Whatever the cause may be, hematuria is mostly indicative of a serious medical condition.

Here are 5 reasons that cause blood to appear in the urine.

1.Infection

Infections like urethritis, pyelonephritis, cystitis or infection in any other body organ along the urinary tract is one of the most common causes of hematuria. Such bacterial infection in the urethra can also infect the kidneys and the urinary bladder. It results in the urge to urinate frequently and also causes blood to appear in the urine.

2. Kidney stones and bladder stones

Another reason that can cause blood to appear in the urine is the presence of stones in the kidney or bladder. These stones are crystallized minerals that are formed in the kidney or the bladder but fail to pass through the urinary tract. They cause blockage and pain and result in hematuria.

3. An enlarged prostate

An enlarged prostate is a common cause of appearance of blood in the urine in men who are in their middle ages or older. Enlargement of the prostate gland causes the urethra to be compressed. This prevents the urethra from getting fully emptied while urination.

4. Polycystic Kidney Disease

PKD is a kidney disorder in which cysts filled with fluid form in the kidneys and impair the kidneys, causing them to fail entirely at times. It is an inherited disease and causes blood to appear in the urine.

In children who are between 6-10 years of age, kidney disorder after streptococcal glomerulonephritis can be a possible cause of hematuria.

5. Cancer

A cancerous kidney, bladder or prostate gland can also cause blood to appear in the urine. It is another major cause of hematuria but usually occurs in older patients.

'Consult'.