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Kidney stones are formed as a result of poor intake of water, infections in the urinary tract, obstruction to flow of urine or metabolic causes. In many cases, the causes of stone formation remain unknown.
Kidney stones mostly present with pain in the flank area which radiates forwards. The pain may be located on one or both sides depending upon the location of the stones. If the stone slips into the ureter, the pain starts radiating downwards towards the thighs or the genitals. Sometimes, there may be increased frequency of urine, burning sensation or even blood in the urine. Rarely, the stone may block the urine passage completely leading to retention of urine.
Kidney stones can be diagnosed with the help of imaging modalities like X-ray of the abdomen, ultrasound and CT scan of the abdomen. Of these, the CT scan is the most sensitive and specific investigation which provides an accurate assessment of the anatomy of the urinary tract.
The treatment of kidney stones can be with medical management or surgery. Small stones which are asymptomatic and not obstructing the urinary tract can be left alone without any treatment. Larger and obstructing stones require treatment to avoid long term kidney damage.
Medical treatment of kidney stones involves giving drugs which help in increasing the flow of urine and dilating the urinary passage so that the stone can pass out spontaneously. This is usually successful for smaller stones which have already come in the ureter or bladder.
Surgery for kidney stones can be done by open surgery or by endoscopic route. Open surgery is obsolete and now reserved for complicated cases like large staghorn calculi. Endoscopic surgery can bedone by direct puncture of the kidney (PCNL) or by laparoscopic route. Percutaneous nephrolithotomy (PCNL) is the preferred treatment option because it involves a single small skin incision with direct puncture of the kidney. The stone can be removed whole or after fragmentation with a lithotripter.
The patient is usually discharged within a day or two after undergoing Kidney stone surgery. The recovery time after this type of surgery is generally 7-10 days.
The cost of kidney stone surgery is generally between 50000 to 70000 INR but it can vary depending upon the complexity of the case and the patient characteristics.
Cystoscopy is a procedure to visualise the lower urinary tract including the urethra, urinary bladder and the ureteric orifices with the help of an endoscopic camera which is inserted through the urethral opening (pee hole).
People with the following problems may require a cystoscopy-
The diagnostic indications of cystoscopy include-
The therapeutic indication for cystoscopy include-
A diagnostic cystoscopy is usually performed under local anaesthesia which means that a numbing jelly is put inside the urethra before the procedure. This makes the procedure painless. In case of some therapeutic procedure, cystoscopy is done under spinal or general anaesthesia.
A diagnostic cystoscopy usually takes just 10-15 minutes to perform whereas a cystoscopic procedure may take longer depending upon the type of procedure being performed.
A person is usually allowed to go home after he/she has voided clear urine after a diagnostic cystoscopy. This can happen within 30 minutes to 1 hour after the procedure. In case of therapeutic cystoscopy, the person may be required to stay in the hospital for 1-2 days depending upon the type of procedure performed.
Ureteroscopy is a procedure to visualise the inside of the ureter and the upper urinary tract to diagnose and treat certain conditions. It is performed using an instrument known as a ureteroscope which is a long thin telescopic camera which can be inserted directly through the urethra into the ureteral opening. The ureteroscope can be semi-rigid or flexible and this procedure usually requires spinal or general anaesthesia to perform.
Ureters are paired hollow muscular tubes which connect the kidneys to the urinary bladder. Their function is to take the urine produced by the kidneys to the urinary bladder where it is collected before being voided outside.
The indications of ureteroscopy are-
Urethral dilation may be required in cases of narrowing of the urethra which can occur because of trauma or infections. Short segment strictures may be dilated with the help of metallic dilators under local anaesthesia. Longer segment or complex strictures may require an endoscopic urethrotomy or open surgery using a variety of flaps or grafts.
The prostate is a gland which is present only in males just at the base of urinary bladder and is responsible for producing secretions during sexual intercourse.
The prostate gland normally enlarges with increasing age and in some men, the gland’s enlargement starts to compress the urinary passage leading to obstruction of urine. The growth of this gland is related to male hormones and usually continues throughout the life of the person.
Prostate enlargement causes compression of the urethra leading to obstruction of urine outflow from the bladder. This leads to symptoms like urine hesitancy, poor flow, dribbling of urine and incontinence. There may be also increased frequency of urine and nocturia. In advanced cases, the urine flow can stop completely causing retention of urine which may necessitate placing a urine catheter.
Prostate enlargement is diagnosed by a combination of clinical history, physical examination and a number of tests. An ultrasound scan of the abdomen helps to objectively quantify the volume of the prostate gland. A transrectal ultrasound (TRUS) is more accurate in determining the volume and even detecting small nodules in the prostate gland. A cystoscopy can help in better assessment of the degree of outflow obstruction and is usually performed before surgical intervention.
Medication is usually the first line of treatment for an enlarged prostate gland. The medication is usually effective in improving the flow of urine and arrests the further growth of the prostate gland. The medication needs to be continued for long term to prevent the recurrence of symptoms.
The surgical treatment of an enlarged prostate is by endoscopic surgery which is known as TURP (Transurethral resection of prostate). The prostate is chipped off piece by piece using an endoscopic instrument known as a resectoscope which is passed inside the body from the natural urinary passage. The channel for the urine is created by this surgery which leads to resolution of symptoms and normalisation of urinary flow. This surgery was earlier performed by an open approach but rarely done so now. Endoscopic surgery can also be done using a variety of LASERs which burn or vaporise the prostate gland.
TURP surgery is usually performed within 30-90 minutes and the patient is discharged from the hospital within a day or two. A urinary catheter is required to be placed for 5-7 days after which it can be removed.
The cost of Prostate surgery in Delhi varies between 50000 to 80000 INR dpending upon the size of the gland and the medical condition of the patient.
Circumcision procedure involves complete removal of the foreskin covering the glans penis surgically. This may be done on religious grounds or for medical reasons the most common being tightening of the foreskin which prevents its retraction.
The benefits of circumcision include-
Circumcision in adults is usually performed under local anaesthesia as a day care procedure. In young children, it requires a short general anaesthesia as they are more apprehensive for the procedure.
The recovery time after a circumcision is short with patients being sent home the same day and resuming their daily activities within a day or two. They are advise to avoid sexual intercourse for at least 2-3 weeks to allow for complete healing.
Hydrocoele refers to collection of fluid within the scrotal sac in the space between the testis and its covering layers. It can occur on one or both sides and presents as a painless enlargement of the scrotum.
Most causes of primary Hydrocoele are idiopathic which means that no cause is identified. Many patients report a history of trauma but that may be coincidental. Hydrocoele mat develop secondarily due to infections or tumours of the testes.
Hydrocoele presents as a slow and painless enlargement of the scrotum. It may be present on one or both sides. Pain may be encountered when the fluid gets secondarily infected which is rare.
Hydrocoele is diagnosed by clinical examination alone but can be confirmed by an ultrasound scan which shows the presence of fluid around a normal testis.
Hydrocoele is treated by surgically removing the fluid and plicating the layers around the testis to prevent the further reaccumulation of fluid. There is medical treatment for Hydrocoele.
Hydrocoele surgery is usually done under local anaesthesia in a day care setting. The patient is discharged on the same day and can resume normal activities within 5-7 days.
The cost of Hydrocoele surgery in Delhi varies from 10000 to 15000 INR depending upon the patient characteristics and the individual case.
An undescended testis is a surgical condition in which one or both testis of a boy are not present in the scrotum at the time of birth. The testis may descend with time but the condition usually fails to show improvement after 1 year of age and requires surgical correction.
The causes of undescended testis may be hereditary, hormonal, genetic abnormality and in many cases the cause remains unknown.
The patient usually doesn’t have any symptoms except failure to feel the testis on one or both sides in the scrotum. In many cases, the scrotum also looks small and under developed.
Undescended testis is diagnosed by clinical examination by the failure to feel the testis in the scrotum. The position of the testis can be confirmed by an ultrasound scan but sometime it may require a CT scan or an MRI.
In infants younger than one year of age, this condition requires watchful waiting. In older children, the treatment is by surgical correction. The surgery involves mobilising the testis and its blood vessels to lengthen them so that the testis can be brought down into the scrotum where it is anchored to prevent its ascent. In cases where the testis has been damaged and in adults, an undescended testis may harbour hidden cancer and needs to be removed.
Surgery for undescended testis may be complicated by damage to the testicular blood vessels or the vas which may affect the future performance of the testis.
The recovery time after this surgery is 5-7 days though heavy exertion is to avoided for 3-4 weeks.
The cost of this surgery in Delhi is between 30000 to 50000 INR.
Orchidectomy refers to surgical removal of the testis. It is a procedure done to remove a permanently damaged or diseased testis or it can be done as form of hormone ablation therapy. The indications for orchidectomy include-
Pyeloplasty is a surgery for removal of obstruction in the urinary tract because of a narrow renal pelvis (PUJ obstruction). It can be done by open surgery or the laparoscopic route. The renal pelvis is reconstructed to allow free passage of urine.
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