These are the hardened mineral deposits which get formed in the kidney, and are also known as kidney stones (calculi).

They originate as microscopic particles and, over the course of time, gain in size and finally develop into stones. This condition is medically known as nephrolithiasis, or renal stone disease. These microscopic particles are the filtered waste products extracted from the blood by kidneys and added to the urine for evacuation from the body along with the urine in normal course of time. When this waste materials added to the urine does not dissolve completely and the kidney is unable to evacuate them from the body, crystals and kidney stones are likely to form. The stones that get lodged in the ureter (tube that carries urine from the kidney to the bladder) cause severe pain that starts from the lower back and radiates to the side or groin. A lodged stone can also block the flow of urine and build a backpressure in the affected ureter and kidney. This increased pressure results in stretching and spasm, which cause severe pain.

Signs & symptoms

Small and smooth kidney stones which remain in the kidney or pass smoothly with the urine, do not cause pain (called “silent” stones). However, stones that lodge in the ureter (tube that carries urine from the kidneys to the bladder) cause the urinary system to spasm and these produce pain. The pain is unrelated to the size of the stone and often radiates from the lower back to the side or groin.

Other symptoms of kidney stones may include the following:

Diagnosis

Laboratory Tests

Ultrasound

Whole Abdomen with Kidney, Ureter & Bladder Intravenous Pyelogram (IVP) X-Ray KUB

Treatment

Extracorporeal shock wave Lithotrispy (ESWL)

ESWL technique makes use of highly focused electro magnetic waves, projected from outside the body, to crush kidney stones anywhere in the urinary system, reducing them to sand-like particles that can then be passed through the patient's urine. Large stones may require more than one ESWL sessions. This procedure is not advisable for pregnant women. However, it can be safely used on patients of all age groups and even those who have heart and breathing problems. ESWL by 4th generation “SIEMENS LITHOTRIPTOR” with Ultrasound attachment helps to treat even Radioluscent stones, which are not visible in normal fluoroscopy Lithotriptors.

Percutaneous(through the skin) Nephrostolithotomy (PCNL)

This minimal invasive procedure is performed under local anesthesia. In this procedure, removal of kidney stones (lithotomy) is accomplished with the help of a telescope, which along with a mechanical lithotriptor, is inserted to break stone into fine particles to achieve stone-free status in large and complicated stones. This procedure usually requires hospitalization, and most patients resume normal activity within 2 weeks.

Percutaneous Nephrostolithotomy (PCNL)

Ureteroscopic Lithotrispy with Holmium Laser

This procedure is used to treat stones located in the middle and lower ureter and is performed under Epidural and Spinal anesthesia. In this procedure, a small, fiberoptic instrument (ureteroscope) is passed into the ureter. Large stones are fragmented using 100-Watts Coherent Holmium Laser. The laser fragments stone into sand like particles, which are then flushed out through the natural urinary passage. The advantage of Holmium Laser is its ability to fragment stones of all compositions and precision. So it is the most effective laser for the treatment of ureteric stones. Patients are generally admitted the same day of treatment and are discharged next day, which means only 24 hours hospitalization.</p>
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Enlarged Prostate

Overview

Benign Prostatic Hyperplasia (BPH) has no cure, and once prostate growth starts, it often continues, unless medical therapy is started.

Prostate grows in two different ways. In one type of growth, cells multiply around the urethra and squeeze it. The second type of growth is middle-lobe prostate growth in which cells grow into the urethra and the bladder outlet area. This type of growth typically requires surgery.

Acute Urinary Retention (inability to urinate) is also a severe type of BPH which causes severe pain and discomfort. Catheterization may be necessary to drain urine from the bladder to obtain relief.

Signs & Symptoms

Diagnosis

A physical examination and evaluation of symptoms provide the basis for a diagnosis of Benign Prostatic Hyperplasia. The physical examination includes a digital rectal examination (DRE), and symptom evaluation is obtained from the results of the AUA Symptom Index.

Digital Rectal Examination (DRE)

DRE typically takes less than a minute to perform. The doctor inserts a lubricated, gloved finger into the patient's rectum to feel the surface of the prostate gland through the rectal wall to assess its size, shape, and consistency. Healthy prostate tissue is soft, like the fleshy tissue of the hand where the thumb joins the palm. Malignant tissue is firm, hard, and often asymmetrical or stony, like the bridge of the nose. If the examination reveals the presence of unhealthy tissue, additional tests are performed to determine the nature of the abnormality.

AUA Symptom Index

The AUA (American Urological Association) Symptom Index is a questionnaire designed to determine the seriousness of a man's urinary problems and to help diagnose BPH. The patient answers seven questions related to common symptoms of benign prostatic hyperplasia. How frequently the patient experiences each symptom is rated on a scale of 1 to 5. These numbers added together provide a score that is used to evaluate the condition. An AUA score of 0 to 7 means the condition is mild; 8 to 19, moderate; and 20 to 35, severe.

PSA Test

Blood test to check the levels of prostate specific antigen (PSA) in a patient who may have benign prostatic hyperplasia helps the Doctor to eliminate a diagnosis of prostate cancer.

Uroflowmetry Test

This is a simple test performed which records urine flow to determine how quickly and completely the bladder can be emptied and to evaluate obstruction. With a full bladder, the patient urinates into a device that measures the amount of urine, the time it takes for urination, and the rate of urine flow. Patients with stress or urge incontinence usually have a normal or increased urinary flow rate, unless there is an obstruction in the urinary tract. A reduced flow rate may indicate BPH.

Post-void residual (PVR)

This test measures the amount of urine that remains in the bladder after urination. The patient is asked to urinate immediately prior to the test and the residual urine is determined by ultrasound. PVR less than 50 ml generally indicates adequate bladder emptying and measurements of 100 to 200 ml or higher often indicate blockage.

Laser treatment

Holmium Laser Enucleation of Prostate (HOLEP)

It is the latest modality used in the management of Enlarged Prostate. In this procedure, a 550 Micron Fibre attached to a 100-Watts Holmium Laser machine is used to remove obstructive prostatic tissue and seal blood vessels. The enucleated gland is then pushed into the bladder, which is later sucked out with the help of an equipment called Morcellator. The whole procedure takes around 45-90 minutes, depending on the size of the gland. This procedure is nearly bloodless as the laser beam when cuts the gland also seals the blood vessels. In most of the cases there is no need for blood transfusion. At the end of surgery, a catheter is inserted to keep the bladder in place. It continuously drains the urine into a sterile collection bag. The catheter is usually kept for 24 to 48 hrs and the patient is discharged without catheter after giving a catheter free trial.

Kidney Cancer

Kidneys are a pair of organs located at the back of the abdomen. Their prime function is to filter the blood to remove waste products and extra water, converting them into urine. Thereafter, from the kidneys, the urine is carried to the bladder by a tube called the ureter. Finally, when the bladder is full, the urine passes out of the body through a tube called the urethra. The urethra other end opens immediately in front of the vagina in women and at the tip of the penis in men.

The kidneys also make substances that help control blood pressure and the production of red blood cells. Understanding cancer

The genesis of cancer lies in cells, the building blocks that make up tissues, which are the basic building block of the organs of the body. In normal course of time, cells grow and divide to form new cells as the body needs them. At the same time, when cells grow old, they die, and new cells take their place.

Sometimes this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can then form a mass of tissue called a growth or tumor.

Tumors can be of two types; benign or malignant:

Causes of kidney cancer

To see the enormity of the problem, each year, about 6200 people in UK alone, which is not very large demographically, are diagnosed with kidney cancer. Like in all other case of cancer, not much is known about the causes of cancer of the kidney. However, research has shown that cigarette smoking increases the risk of developing cancer of the kidney. This cancer has also been statistically linked to particular materials used in some industries, including cadmium, asbestos and lead (used in paints). Certain medical conditions, such as diabetes, obesity, chronic kidney failure or high blood pressure (hypertension), may also increase the risk of developing cancer of the kidney.

A small number of people who have an inherited condition known as 'von Hippel-Lindau syndrome' have also found to be at a slightly increased risk of developing this type of cancer. Occasionally, certain types of cancer of the kidney will affect two or more members of the same family. If this occurs, other family members may be at an increased risk themselves.

Cancer of the kidney affects men more than women and occurs mostly in middle-aged and older people, although there is an uncommon type ( Wilms' tumour, also known as nephroblastoma) that affects very young children.

Cancer of the kidney, like other cancers, is not infectious and so cannot be passed on to other people. Usually only one kidney is affected. It is very rare for cancer to occur in the other kidney.

Types of kidney cancer

Most cancers – approximately 90% – that occur in the kidneys are known as renal cell cancers (RCC). They are sometimes also called renal adenocarcinoma. There are different subtypes of renal cell cancer and these can be identified by looking at the cells under a microscope. The most common type is clear cell. Other, less common, types include papillary (or chromophilic), chromophobic, oncocytic, collecting duct and sarcomatoid.

Another type of cancer found, although rare in nature, is the transitional cell cancer (TCC), which starts in the cells lining the central area (pelvis) of the kidney. This section describes the tests and treatments for renal cell cancers. The tests and treatment for transitional cell cancer are very different.

Symptoms of kidney cancer

Although these symptoms can be caused by conditions other than cancer of the kidney, such as an infection or stones in the bladder or kidneys, it is important to get them checked by your doctor. Most people with any of the above symptoms will not have cancer of the kidney.

Sometimes cancer of the kidney may not cause any symptoms and is diagnosed following a scan carried out for a different reason.

Surgery is the main treatment for cancer of the kidney. In some people, hormonal treatment can be carried out either after surgery or when a cancer cannot be removed surgically. This is occasionally carried out. In rare cases, cancer of the kidney will spontaneously improve without any treatment.

Methods of treatment

People with kidney cancer may have surgery, arterial embolization, biological therapy, or a combination of treatments and radiation therapy

At any stage of disease, people may resort to additional treatment / therapies to counter pain or to relieve the side effects of cancer treatment, and to also ease emotional and practical problems. This kind of treatment is called supportive care, symptom management, or palliative care.

Surgery

Surgery is the most common treatment for kidney cancer. It is a type of local therapy. It treats cancer in the kidney and the area close to the tumor.

An operation to remove the kidney is called a nephrectomy . There are several types of nephrectomies. The type depends mainly on the stage of the tumor. The doctor can explain each operation and discuss which is most suitable for the patient:

Arterial embolization

This is a type of local therapy used to shrinks the tumor. Sometimes it is done before an operation to make surgery easier. When surgery is not possible, embolization may be used to help relieve the symptoms of kidney cancer.

In this procedure, a narrow tube (catheter) is inserted into a blood vessel in the leg. The tube is passed up to the main blood vessel (renal artery) that supplies blood to the kidney. A substance is then injected into the blood vessel to block the flow of blood into the kidney. The blockage prevents the tumor from getting oxygen and other substances, thus stunting its growth

Radiation therapy

Radiation therapy (also called radiotherapy) is another type of local therapy. It uses high-energy rays to kill cancer cells only in the treated area. The patient has treatment at the hospital or clinic, 5 days a week for several weeks.

A small number of patients undergo radiation therapy before surgery to shrink the tumor. Some have it after surgery to kill cancer cells that may remain in the area. Also, patients who cannot have surgery may have radiation therapy to relieve pain and other problems caused by the cancer.

Biological therapy

Biological therapy is another type of systemic therapy. It uses substances that travel through the bloodstream, reaching and affecting cells all over the body. Biological therapy uses the body's natural ability (immune system) to fight cancer.

For patients with metastatic kidney cancer, interferon alpha or interleukin-2 (also called IL-2 or aldesleukin) medication may be used. The body normally produces these substances in small amounts in response to infections and other diseases. For cancer treatment, they are made in the laboratory in large amounts.

Chemotherapy

Chemotherapy is also another type of systemic therapy. Anticancer drugs are introduced into the bloodstream and travel throughout the body. Although useful for many other types of cancers, these drugs at presentnhave shown limited use against kidney cancer.

Benefits and disadvantages of treatment

A large number of people are frightened at the thought of undergoing cancer treatments, particularly because of the potential side effects of the various treatments on offer.

Although many of the treatments can cause side effects, these can often be well controlled with supportive medicines.

Treatment can be given for different reasons and the potential benefits will vary depending upon the individual situation.

Early-stage kidney cancer

Surgery is often the answer to combat early-stage kidney cancer. Occasionally, additional treatments are also given to help reduce the risks of it recurring.

Advanced-stage kidney cancer

If the cancer is at a more advanced stage, treatment may only be able to control it not cure it. However, for some people the treatment may have no effect upon the cancer and they may suffer from the side effects of the treatment as well, without any potential benefit. A choice may then have to be made about continuing the treatment.

Current legal Status of Kidney Transplant in India is as follows;

"As per the rules of our country, only a relative, who is compatible, can donate a kidney to the patient. Among the relatives, there is a category called the near relatives which is parents, siblings, children and spouse. People in this category can donate the kidney if they are medically compatible without the permission of the Government. Any other relative not belonging to this category in addition to being medically suitable, the permission from the government needs to be taken.

Prostate Cancer

Overview

Age Factor

Age is the strongest risk factor for prostate cancer. The disease is rare in men younger than 45, and the chance of getting it goes up sharply as a man ages.

Family history

Genetics plays an important role in development of prostate cancer. If a family member had been diagnosed with prostatic cancer, the chance of developing the same within the family goes up.

Race

Prostate cancer is more common in African American men. It is less common in Asian men.

Statistics

Every year over 232,090 men are diagnosed with prostate cancer, and about 30,350 die. If detected early, prostate cancer is often treatable. One in six or roughly 16 % men are at a lifetime risk of prostate cancer

A man with one close relative with the disease has double the risk. With two close relatives, his risk is five-fold. With three, the chance is 97%.
Every five minutes two men are diagnosed with prostate cancer.

Men with a body mass index over 32.5 have about a one-third greater risk of dying from prostate cancer than men who are not obese. Prostate cancer is mainly found in men age 55 or over with an average age of 70 at the time of diagnosis Majority of deaths from prostate cancer are related to advanced disease with metastasis

Signs & symptoms

It is not easy to detect early-stage prostate cancer as it is generally not be associated with any obvious signs or symptoms, or alternatively may show symptoms that can be mistaken for those of other disorders. Innfact, most cases of prostate cancer are not detected until they have spread out of the prostate and begin to cause noticeable symptoms.

The signs and symptoms of prostate cancer may include :

Diagnosis

Prostatic Specific Antigen (PSA)

This is a screening test for prostate cancer. This blood test is not the final diagnosis of cancer as it may be elevated in cases of chronic Prostate Enlargement and Prostatitits ( Infection of prostate)

Digital Rectal Examination :

A physical examination by Urologist may give a clue as to whether a person might be suffering from prostate cancer or not.

Trans rectal Ultrasound :

Prostate Biopsy :

Treatment

Early Stage :

Prostaectomy means removal of the prostate gland and it can be done through Open Incision or closed method through Laser.

Advanced Stage

The bottom line is that early detection can lead to cure. This should be done before the cancer spreads to other organs

Erectile Dysfunction

Erectile dysfunction'( ED) or (male) impotence is a sexual dysfunction which is characterized by the inability to develop or maintain an erection of the penis. There are various underlying causes, such as cardiovascular leakage and diabetes or psychological, many of which are fortunately medically reversible.

The causes of erectile dysfunction may be physiological or psychological. Physiologically, erection is a hydraulic mechanism based upon blood entering and being retained in the penis, and there are various ways in which this can be impeded, most of which are amenable to treatment. Psychological impotence is where erection or penetration fails due to thoughts or feelings (psychological reasons) rather than physical impossibility; this can also often be helped. Notably in psychological impotence, there is a very strong placebo effect.

Erectile dysfunction, tied closely as it is to cultural notions of success and masculinity, can have devastating psychological consequences including feelings of shame, loss or inadequacy; often unnecessary since in most cases the matter can be helped. There is a strong culture of silence and inability to discuss the matter. In fact around 1 in 10 men will experience recurring impotence problems at some point in their lives.

Incidence and Prevalence

The term "erectile dysfunction" means the inability to achieve erection, an inconsistent ability to do so, or the ability to achieve only brief erections. These various definitions make estimating the incidence of erectile dysfunction difficult. According to the National Institutes of Health in 2002, an estimated 15 million to 30 million men in the United States alone experienced chronic erectile dysfunction.

According to the National Ambulatory Medical Care Survey (NAMCS), approximately 22 out of every 1000 men in the United States sought medical attention for ED in 1999.

As seems natural, incidence of this disorder increases with age. Chronic ED affects about 5% of men in their 40s and 15–25% of men by the age of 65. Transient ED and inadequate erection affect as many as 50% of men between the ages of 40 and 70.

Diseases (e.g., diabetes, kidney disease, alcoholism, atherosclerosis) account for as many as 70% of chronic ED cases and psychological factors (e.g., stress, anxiety, depression) may account for 10–20% of cases. Between 35 and 50% of men with diabetes experience ED.

Anatomy of the Penis

To understand D, one must understand the basics about the penis. The internal structure of the penis consists of two cylinder-shaped vascular tissue bodies (corpora cavernosa) that run throughout the penis; the urethra (tube for expelling urine and ejaculate); erectile tissue surrounding the urethra; two main arteries; and several veins and nerves. The longest part of the penis is the shaft, at the end of which is the head, or glans penis. The opening at the tip of the glans, which allows for urination and ejaculation, is the meatus.

Physiology of Erection

The physiological process of erection can be traced back to the brain to the nervous and vascular systems. Neurotransmitters in the brain (e.g., epinephrine, acetylcholine, nitric oxide) are some of the chemicals that initiate it. Physical or psychological stimulation (arousal) causes nerves to send messages to the vascular system, which results in significant additional blood flow to the penis. The two arteries in the penis supply blood to erectile tissue and the corpora cavernosa, which become engorged and expand as a result of increased blood flow and pressure.

To maintain rigidity, blood must stay in the penis. And for this, erectile tissue is enclosed by fibrous elastic sheathes (tunicae) that cinch to prevent blood from leaving the penis during erection. At the end of stimulation, or following ejaculation, pressure in the penis decreases, blood is released, and the penis resumes its normal shape.

Surgical Treatment

Penile implants

Penile implant, the simplest solution to ED, involves surgical insertion of malleable or inflatable rods or tubes into the penis. One type of penile implant, A semi-rigid prosthesis is a silicon-covered flexible metal rod. Once inserted, it provides the rigidity necessary for intercourse and can be curved slightly for concealment. Its main disadvantage however is that concealment can be difficult with certain types of clothing.

Another type of penile implant is the inflatable penile prosthesis consisting of two soft silicone or bioflex (plastic) tubes inserted in the penis, a small reservoir implanted in the abdomen, and a small pump implanted in the scrotum. It is a simple mechanical process. To produce an erection, a man pumps sterile liquid from the reservoir into the tubes by squeezing the pump in the scrotum. The tubes act as erectile tissue and expand to form an erection. When the erection is no longer desired, a valve allows the fluid to return to the reservoir. Inflatable prostheses are the most natural feeling of the penile implants and they allow for control of rigidity and size.

The surgical procedure to implant the inflatable prosthesis is slightly more complicated than for a semi-rigid implant. Also, because there are more mechanical parts, there is a higher risk for mechanical failure requiring repair or adjustment.

Another kind of penile implant is the self-contained inflatable prosthesis, which is similar to the one described before this, but has fewer parts. It consists of a pair of inflatable tubes in the penis with a pump attached directly to the end of the implant. The reservoir is also located in the shaft of the penis. Its compact design allows for simpler implantation, but because it takes up more space in the penis, there is less room for expansion.

Vascular Reconstructive Surgery

A small percentage of men also prefer to undergo vascular reconstructive surgery to improve blood flow to the penis. Revascularization involves bypassing blocked veins or arteries, for which a vein is transferred from the leg for creates a path to the penis that bypasses the area of blockage. Young men with only local arterial blockage are the best candidates for this procedure. It may restore function in 50% to 75% of men.

Venous ligation is performed to prevent venous leak. Problematic veins are bound (ligated) or removed, which allows an adequate amount of blood to remain in the penis. It may improve function in 40% to 50% of men, but some men may experience problems over the long term.

Vascular surgery for erectile dysfunction is rarely performed and is generally considered experimental. Risks include nerve damage and the creation of scar tissue, both of which are causes of impotence. Surgeons experienced with these procedures may be difficult to find.

Non Surgical Treatments

Sex Therapy

This is a much maligned treatment, primarily due to a number of quacks practicing it and fooling gullible people. It has been accepted that a significant number of men develop impotence from psychological causes that can be overcome. When a physiological cause is treated, subsequent self-esteem problems may continue to impair normal function and performance. Qualified therapists (e.g., sex counselors, psychotherapists) work with couples to reduce tension, improve sexual communication, and create realistic expectations for sex, all of which can improve erectile function. Psychological therapy may be effective in conjunction with medical or surgical treatment. Sex therapists emphasize the need for men and their partners to be motivated and willing to adapt to psychological and behavioral modifications, including those that result from medical or surgical treatment.

Medical Treatment

Oral Medications

Oral medications used to treat erectile dysfunction include selective enzyme inhibitors (e.g., sildenafil [ Viagra, vardenafil HCl [Levitra], tadalafil [ Cialis]) and yohimbine (Yohimbine, Yocon).

Selective enzyme inhibitors are available by prescription and may be taken up to once a day to treat ED. They improve partial erections by inhibiting the enzyme that facilitates their reduction and increase levels of cyclic guanosine monophosphate (cGMP, a chemical factor in metabolism), which causes the smooth muscles of the penis to relax, enabling blood to flow into the corpora cavernosa.

Patients taking nitrate drugs (used to treat chest pain) and those taking alpha-blockers (used to treatigh blood pressure and benign prostatic hyperplasia) should not take selective enzyme inhibitors.

Men who have had a heart attack or stroke within the past 6 months and those with certain medical conditions (e.g., uncontrolled high blood pressure, severe low blood pressure or liver disease, unstable angina) that make sexual activity inadvisable should not take Cialis®. Dosages of the drug should be limited in patients with kidney or liver disorders.

Viagra is absorbed and processed rapidly by the body and is usually taken 30 minutes to 1 hour before intercourse. Results vary depending on the cause of erectile dysfunction, but studies have shown that Viagra is effective in 75% of cases. It helps men with erectile dysfunction associated with diabetes mellitus (57%), spinal cord injuries (83%), and radical prostatectomy (43%).

Levitra in clinical studies has been shown to work quickly, provide consistent results, and improve sexual function in most men the first time they take the drug. It also has shown to be effective in men of all ages, in patients with diabetes mellitus, and in men who have undergone radical prostatectomy.

Cialis has ben shown in clinical trials to stay in the body longer than the other selective enzyme inhibitors. It promotes erection within 30 minutes and enhances the ability to achieve erection for up to 36 hours.

Common side effects of selective enzyme inhibitors include headache, reddening of the face and neck (flushing), indigestion, and nasal congestion. Cialis may cause muscle aches and back pain, which usually resolve on their own within 48 hours.

Yohimbine improves erections for a small percentage of men. It stimulates the parasympathetic nervous system, which is linked to erection, and may increase libido. It is necessary to take the medication for 6 to 8 weeks before determining whether it will work or not.

Yohimbine has a stimulatory effect and side effects include elevated heart rate and blood pressure, mild dizziness, nervousness, and irritability. Yohimbine's effects have not been studied thoroughly, but some studies suggest that 10% to 20% of men respond to treatment with the drug.

Ease of administration makes oral medication advantageous. Some drugs, however, are suitable for only a relatively small group of men, and in many cases, oral medications may by less effective than other treatments.

Self-Injection

Self-injection involves using a short needle to inject medication through the side of the penis directly into the corpus cavernosum, which produces an erection that lasts from 30 minutes to several hours. Prostaglandin (alprostadil, Caverject®, Edex®), and phentolamine (Regitine®) produce results similar to Viagra but are localized in the penis after injection. They cause vascular dilation and a relaxation of smooth muscle. Prostaglandin is the only substance currently approved for erectile dysfunction treatment. Phentolamine is a heart medication with similar effects used by some physicians to treat impotence.

These drugs have been successfull in producing erections in 80% of men. Most of them claim that they produce erections that feel natural and improve sex. The injections are relatively painless and support an erection that begins about 5 to 15 minutes after the injection. It is recommended that self-injection be performed no more than once every 4 to 7 days. Side effects include infection, bleeding, and bruising at the injection site, dizziness, heart palpitations, and flushing. There is a small risk for priapism (an erection that lasts for more than 6 hours and requires medical relief). Repeated injection may cause scarring of erectile tissue, which can further impair erection.

Urethral suppositories containing prostaglandin (aprostadil), like Muse® (Medicated Urethral System for Erections), may be an alternative to injection. Using a hand-held delivery device, a man inserts a prostaglandin pellet through the meatus (penis opening) into the urethra. Prostaglandin is absorbed through the urethral mucosa and into the surrounding erectile tissue. It is available with a prescription, is well tolerated, and may improve erections in 60% of men who use it.

In addition to the side effects associated with injecting aprostadil, pain in the penis and perineum (area between scrotum and rectum) may occur with suppository use.

Vacuum Devices

Vacuum devices are simplistic in nature and work by manually creating an erection. The penis is inserted into a plastic tube, which is pressed against the body to form a seal. A hand pump attached to the tube is used to create a vacuum that draws blood into the penis, causing the penis to become engorged. After 1 to 3 minutes in the vacuum, an adequate erection is created. The penis is removed from the tube and a soft rubber O-ring is placed around the base of the penis to trap blood and maintain the erection until removed. The ring can be left in place for 25 to 30 minutes.

Vacuum devices work best in men who are able to achieve partial erections on their own. They are easy to use at home, require no other procedure, and typically improve erections regardless of the cause of impotence. Some men experience a numbing feeling after placing the O-ring. Since the penis is flaccid between the ring and the body, the erection may be somewhat limpid.

Male Infertility

Infertility is the inability to conceive after at least one year of unprotected intercourse. Since most people are able to conceive within this time, physicians recommend that couples unable to do so be assessed for fertility problems.

In men, hormone disorders, illness, reproductive anatomy trauma and obstruction, and sexual dysfunction can temporarily or permanently affect sperm and prevent conception. Some disorders become more difficult to treat the longer they exist without treatment.

Sperm development takes place in the ducts (seminiferous tubules) of the testes. Cell division produces mature sperm cells (spermatozoa) that contain one-half of a man's genetic code. Each spermatogenesis cycle consists of six stages and takes about 16 days to complete. Approximately five cycles are needed to produce one mature sperm. Energy-generating organelles (mitochondria) inside each sperm powers its tail (flagellum) so that it can swim to the female egg once inside the vagina. Sperm development is ultimately controlled by the endocrine (hormonal) system that comprises the hypothalamic-pituitary-gonadal axis

Because sperm development takes over 2 months, illness that was present during the first cycle may affect mature sperm, regardless of a man's health at the time of examination.

Incidence and Prevalence

According to the National Institutes of Health, male infertility is involved in approximately 40% of the 2.6 million infertile married couples in the United States. One-half of these men experience irreversible infertility and cannot father children, and a small number of these cases are caused by a treatable medical condition.

Treatment

At least one-half of male fertility problems can be treated so that conception is possible. There are three categories of treatment for male infertility:

Assisted reproduction

Thistherapy includes methods to improve erectile dysfunction, induce ejaculation, obtain sperm, and inseminate an egg

Electroejaculation-

This procedure can be used to produce ejaculation when neurological dysfunction prevents it. An electrical rectal probe generates a current that stimulates nerves and induces ejaculation; semen dribbles out through the urethra and is collected. Retrograde ejaculation is associated with the procedure and sodium bicarbonate is usually taken the day before to make the urine alkaline (nonacidic) and nondetrimental to sperm. Candidates for electroejaculation include men who have undergone testis removal (orchiectomy), retroperitoneal lymph node dissection (RPLND), and those with spinal cord injuries.

Sperm retrieval

This technique is used to obtain sperm from the testes or epididymis when obstruction, congenital absence of the vas deferens, failed vasectomy reversal, or inadequate sperm production causes azoospermia. A technique called micro epididymal sperm aspiration (MESA) is used in which an incision is made in the scrotum to gather sperm from the epididymis, the elongated, coiled duct that provides for the maturation, storage, and passage of sperm from the testes. Percutaneous epididymal sperm aspiration (PESA, or fine needle aspiration) is similar to MESA but does not involve microsurgery. In this. a needle is used to penetrate the scrotum and epididymis and draws sperm into a syringe. Testicular sperm extraction (TESE), the removal of a small amount of testicular tissue, is used to retrieve sperm from men with impaired sperm production, or when MESA fails. (see also Testis Biopsy)

These procedures are done under local anesthesia, usually take about 30 minutes, and may cause pain and swelling.

Sperm washing

This procedure isolates and prepares the healthiest sperm for insemination. Sperm and washing medium are combined and spun rigorously (centrifuged) and the process is repeated if necessary. The process separates sperm from white blood cells and fatty acids (prostaglandins) in the semen that may hinder sperm motility. It also concentrates sperm, which increases the chance for conception.

Sperm retrieved by MESA, PESA, or TESE may be used in invitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). IVF involves combining eggs with sperm in a laboratory, providing proper fertilization conditions, and transferring the resulting embryos to the uterus. To retrieve an egg, a specialist uses ultrasound to guide a fine needle through the vaginal wall and into the ovary or makes an incision in the abdomen to get to the ovary (laparoscopy). Once the eggs are retrieved, they are combined with prepared sperm in a sterile dish for 2 to 4 days. After fertilization, the embryos are transferred to the uterus. IVF is used most commonly for infertility caused by female reproductive abnormalities.

Intracytoplasmic sperm injection(ICSI)

may be used with immotile sperm during in vitro fertilization. Using a tiny glass needle, one sperm is injected directly into a retrieved mature egg. The egg is incubated and transferred to the uterus.

Fertilization occurs in 50% to 80% of cases and approximately 30% result in a live birth. The egg may fail to divide or the embryo may arrest at an early stage of development. Younger patients achieve more favorable results and poor egg quality and advanced maternal age result in lower success rates.

ICSI does not increase the incidence of multiple pregnancies. Long-term information about the health and fertility of children conceived through this procedure is not available because it was first performed in 1992.

While excess sperm from MESA or PESA can usually be frozen for future use, most TESE-derived sperm are not of sufficient quality or quantity for frozen storage (cryopreservation). Multiple MESA or PESA procedures are not recommended, since repetition can lead to scarring.

Gamete intrafallopian transfer

This procedure is recommended for couples with unexplained fertility problems and normal reproductive anatomy. Mature eggs and prepared sperm are combined in a syringe and injected into the fallopian tube using laparascopy. Embryos that result from this procedure naturally descend into the uterus for implantation.

Drug therapyfor male infertility includes medications to improve sperm production, treat hormonal dysfunction, cure infections that compromise sperm, and fight sperm antibodies. The administration of testosterone is similar to that used to treat tulate estosterone deficiency. Tamoxifen (Nolvadex®), an antiestrogen agent, may be used to stimgonadotropin (a male hormone) release, which leads to testosterone production. Antibiotics, like levofloxacin (Levaquin®) and doxycycline (Periostat®), are used to treat fertility-impairing infections of the urinary tract, testes, and prostate, and STDs.

Surgery or male infertility is performed to treat reproductive tract obstruction and varicocele. Vasoepididymostomy is a microsurgical procedure that corrects obstruction in the coiled tube that connects the testes with the vas deferens (epididymis). Obstructions commonly result from STDs and also include cysts and tubal closure (atresia), which is usually genetic. Vericocelectomy, the removal of a varicocele from the testes, often results in increased sperm count

Female Urinary Incontinence

Urinary incontinence is the medical term used to describe the condition of not being able to control the flow of urine from your body. It usually happens because the urethra cannot close tightly enough to hold urine in the bladder. The two commonest causes of urinary incontinence in women are stress incontinence and urge incontinence.

Stress Incontinence- This is an involuntary leakage of small amounts of urine with exertion such as coughing and sneezing, lifting or playing sports in the absence of any desire to go to the toilet.

Urge Incontinence

his is an urgent, sudden, overwhelming urge to pass urine and get to the toilet in time.

An estimated 51million women (17 million of them in the U.S. alone) suffer from urinary incontinence. Between the ages of 18 and 44, approximately 24% of women experience incontinence. For women over age 60, approximately 23% deal with incontinence, and the problem more common in women than men.

Treatment

Treatment can range from simple managing treatment methods (behavioral therapy) like maintaining a strict schedule of avoiding and monitoring fluid intake to reduce the occurrence of incontinence and using absorbent products such as pads, liners, undergarments and diapers to manage their problem to controlling treatment options that vary in invasiveness and effectiveness, depending on the cause and the severity of the incontinence.

It is important that you understand all the options available to you before selecting the correct option.

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Gall bladder Stone

Overview

It is a pear shaped accessory digestive organ located under the liver in the right upper abdomen. The function of the Gall Bladder is to primarily store a small amount of bile juice to help in digestion. For example, when we eat fatty food, the gall bladder squeezes this bile through the common bile duct into the intestine for breaking down and digesting this fatty food.

However, when the concentration of cholesterol or fats increase in the bile juice it precipitates as a stone. It can occur in all age groups and in both males and females, though commonly in females. The five F’s of Gall Bladder stone diseases are “A Fat, Flatulent, Fair, Female of Forty is more likely to have gall stones”.

Signs & symptoms

The common symptoms of Gall Bladder stone disease or cholelithiasis are:
Gaseous distension or bloating
Flatulent Dyspepsia
Acute upper abdominal pain along with vomiting and fever. This occurs when a gall stone gets impacted at the neck of the gall bladder.

Jaundice

This occurs when a gall stone just drops down from the gall bladder into the common bile duct resulting in obstruction to the flow of bile and hence causing jaundice.

Pancreatitis

This occurs when the slipped gall stone in the common bile duct irritates the duct of the pancreas gland leading to inflammation of the gland. This is an emergency situation and patient requires admission into the intensive care unit most times.

Diagnosis

Laboratory Tests

Complete Blood Count
Liver Function Test
Blood Sugar
Urine Routine & Microscopy
Lipid profile
Ultrasound
Whole Abdomen scan

Treatment

Presently the Gold standard for the treatment of gall stone disease is – Mini Laparoscopic Cholecystectomy (Key hole surgery). This procedure is done under General Anaesthesia. In this procedure, small 3-4 holes (5mm) are made in the abdomen through which telescope and other specialized instruments are inserted into the abdomen and surgery is carried out watching a TV Monitor. The gall bladder along with the stones is removed. Patient is subsequently discharged from the hospital within 24 hours.

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Hernia

Overview

Hernia is a defect in the sheath or muscle of the abdominal wall, due to which abdominal contents protrude into the superficial space of the abdomen. It occurs either through the natural openings like Inguinal Canal / Femoral canal or it occurs due to the weakness of the sheath or the abdominal musculature. Eg. Ventral Hernia.

Hernia may either be present in a person from the time of his birth or a person may acquire it due to certain living or working conditions.

Types of hernia

Some of the common hernias are:
Inguinal hernia, also known as Groin Hernia - commonly occurs in males.
Congenital hernia -Hernia which occurs from birth.
Acquired Hernia– Hernia acquired during the lifetime. The common conditions leading to this Hernia are–
Lifting of heavy weights.
Doing strenuous exercises.
With aging, when the abdominal musculature becomes weak.
In certain pre-existing medical conditions like, Bronchial Asthma, Chronic
Constipation and Urinary Bladder outlet obstruction.

Femoral Hernia:

This type of hernia occurs below the inguinal ligament and through the femoral canal. This commonly occurs in females.

Ventral Hernia :

This hernia occurs through the anterior abdominal wall. They are either congenital (mostly umbilical hernia through the umbilicus) or acquired. The causes for which are:

Obese patients :

Increased amount of fat acts as a pile driver, which leads to a defect in the sheath and thus leading to Hernia Formation.

Surgery after effects :

After the surgery (also known as Incisional Hernia) – This can occur due to a faulty technique of closure of the abdomen by the surgeon.

Poor musculature of the patient.
Wound infection after the surgery.

Treatment

Through the ages the treatment of Hernia has gone through various changes and modifications. Significant changes that have taken place in the treatment of Hernia are:

Open Surgery with suturing technique – now obsolete.

Open Surgery with Mesh technique. This is practiced worldwide and in most Centres.
Laparoscopic surgery (Key hole surgery) with mesh. This is being done in advanced Centres with excellent results.

Most of the hernias can be treated by Laparoscopy. In this procedure, small 3-4 holes are made in the abdomen depending on the site and size of hernia. A telescope is inserted through one of the holes and very specialized Laparoscopic instruments through the other holes. Watching on a TV monitor the surgery is carried out and a mesh is placed at the site.

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Some of the treatments available are

Urinary Stone

Overview

Signs & symptoms

Other symptoms of kidney stones may include the following:

Diagnosis

Laboratory Tests

Ultrasound

Treatment

Extracorporeal shock wave Lithotrispy (ESWL)

Percutaneous(through the skin) Nephrostolithotomy (PCNL)

Percutaneous Nephrostolithotomy (PCNL)

Ureteroscopic Lithotrispy with Holmium Laser

Enlarged Prostate

Overview

Signs & Symptoms

Diagnosis

Digital Rectal Examination (DRE)

AUA Symptom Index

PSA Test

Uroflowmetry Test

Post-void residual (PVR)

Laser treatment

Holmium Laser Enucleation of Prostate (HOLEP)

Kidney Cancer

Tumors can be of two types; benign or malignant:

Causes of kidney cancer

Types of kidney cancer

Symptoms of kidney cancer

Methods of treatment

Surgery

Arterial embolization

Radiation therapy

Biological therapy

Chemotherapy

Benefits and disadvantages of treatment

Early-stage kidney cancer

Advanced-stage kidney cancer

Current legal Status of Kidney Transplant in India is as follows;

Prostate Cancer

Overview

Age Factor

Family history

Race

Statistics

Signs & symptoms

The signs and symptoms of prostate cancer may include :

Diagnosis

Prostatic Specific Antigen (PSA)

Digital Rectal Examination :

Trans rectal Ultrasound :

Prostate Biopsy :

Treatment

Early Stage :

Advanced Stage

Erectile Dysfunction

Incidence and Prevalence

Anatomy of the Penis

Physiology of Erection

Surgical Treatment

Penile implants

Vascular Reconstructive Surgery

Non Surgical Treatments

Sex Therapy

Medical Treatment

Oral Medications

Self-Injection

Vacuum Devices

Male Infertility

Incidence and Prevalence

Treatment

Assisted reproduction

Electroejaculation-

Sperm retrieval

Sperm washing

Intracytoplasmic sperm injection(ICSI)

Gamete intrafallopian transfer

Female Urinary Incontinence

Urge Incontinence

Treatment