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DEPARTMENT OF UROLOGY
The Department of Urology at Tabba Kidney Institute offers a Total Care Program including comprehensive diagnostic facilities for all kidney stones and the below mentioned diseases. The patient is cared for by a professional team, which includes surgeons, nephrologists, nurses, radiologist, and other technical support staff.

Urology services offered at Tabba Kidney Institute include:

KIDNEY AND URETRAL STONES:

Kidney stones are very common in Pakistan, more so in the rural areas of the country. Now very effective ways are available to comprehensively treat these stones, with very little pain or discomfort. The complete approach to stone disease involves treatment of the existing stone and preventive measures against recurrences.

Three treatment options are currently available worldwide:

  • Extracorporeal Shock Wave Lithotripsy (ESWL).
  • Endoscopic Lithotripsy and extraction with the aid of telescopes.
  • Surgery.

Many stones can be removed without conventional surgery by introducing small telescopes into the body either through normal urinary passage or through a pencil size hole in the skin (the percutaneous approach).

Suitable stones within the ureter can be removed, pushed back to the kidney for subsequent ESWL or broken down by small portable lithotriptor under director vision and removed using forceps. This avoids the need for open surgery.

PCNL or Percutaneous Nephrolithotomy is minimally invasive surgery for large kidney stones. Stones in the kidney can be reached via a pencil sized skin hole and very large kidney stones can be broken down within the kidney and removed piecemeal. Consequently, the remaining small fragments become easily manageable with ESWL.

Not all stones are amenable to treatment by the modern methods. In certain circumstances, the kidney or urteric stones are still best managed by open surgery, however, this accounts for only a small fraction of all stone patients. The doctor can now utilize a wide variety of instruments and diagnostic aids to select the most appropriate treatment for the patient. A combination of ESWL and minimally invasive treatment may be suitable alternative of open surgery.

Kidney stones can occur in certain metabolic disorders or structural abnormalities of the genito-urinary system. Blood and urine chemistry along with an IVP are used to detect such abnormalities. Correction of the underlying disorder is the mainstay in prevention against recurrent disease. Additionally, the first degree relatives of stone patients have a higher risk of stone disease. It is advised that they should be screened with an ultrasound and KUB X-ray for asymptomatic disease. Many patients have no demonstrable abnormality on metabolic work-up. The best preventive measure is to increase water intake to ENSURE THAT 2 LITRES OF URINE is passed each day.

BPH: SURGICAL MANAGEMENT (BENIGN PROSTATIC HYPERPLASIA/ENLARGED PROSTATE)

Throughout a man’s life, his prostate may grow and start to cause problems as he ages. But what are some of those problems? Why are many urologists recommending surgery as a way to fix those problems? What are some of the surgical options available? The following should help answer those questions.

The prostate is part of the male reproductive system, is about the same size and shape as a walnut and weighs about an ounce. It is located below the bladder and in front of the rectumand surrounds the urethra, the tube-like structure that carries urine from the bladder out through the penis. The main function of the prostate is to produce ejaculatory fluid.

Benign prostatic hyperplasia (BPH), previously referred to as prostatism, is a common urological condition caused by the non-cancerous enlargement of the prostate gland in aging men.

Risk factors for developing BPH include increasing age, obesity, depression, and a family history of BPH.

  • Since the prostate surrounds the urethra just below the bladder, its enlargement can result in symptoms that irritate or obstruct the bladder. A common symptom is the need to frequently empty the bladder, especially at night. Other symptoms include difficulty in starting the urine flow or dribbling after urination ends. Also, size and strength of the urine stream may decrease.
  • Fill out the AUA Symptom Score and share the results with your health care provider.
  • In order to help assess the severity of such symptoms, the American Urological Association (AUA) BPH Symptom Score Index was developed. This diagnostic system includes a series of questions that target the frequency of the urinary systems identified above, and as a result, helps identify the severity of the BPH—ranging from mild to severe.
  • There are a number of diagnostic test procedures that can be used to confirm BPH. The tests vary from patient to patient, but the following are the most common: digital rectal examination (DRE), PSA test, rectal ultrasound, urine flow study and Cystoscopy.

When medical therapy fails, surgery is required to remove the obstructing tissue. Surgery is almost always recommended for men who are unable to urinate, have kidney damage, frequent urinary tract infections, significant bleeding or stones in the bladder.

Removal of the prostate can be accomplished in several different ways. The location of the enlargement within the prostate and the patient’s general health will help the urologist determine which of the three following procedures to use.

  • Transurethral resection of the prostate (TURP):
    Transurethral resection is the most common surgery for BPH. This can be done using electric current or with laser light. After the patient receivesanesthesia, the surgeon inserts an instrument called a resectoscope through the tip of the penis into the urethra. The resectoscope contains a light, valve for controlling irrigating fluid and an electrical loop that cuts tissue and seals blood vessels. The removed tissue pieces are carried by the irrigating fluid into the bladder and then flushed out and sent to a pathologist for examination under a microscope. At the end of the procedure, a catheter is placed in the bladder through the penis. The bladder is continuously irrigated with fluid through the catheter in order to monitor bleeding and prevent blood from clotting and obstructing the catheter. Since there are no surgical incisions with this procedure, patients normally stay in the hospital only one to two days. Depending on surgeon preference, the catheter may be removed while the patient is still in the hospital or the patient may be sent home with the catheter in place, attached to a leg bag for convenience and removed several days later as an outpatient procedure.
  • Transurethral incision of the prostate (TUIP):
    Transurethral incision is used for men with smaller prostate glands who suffer from significant obstructive symptoms. Instead of cutting and removing tissue to relieve the obstructed bladder, this procedure widens the urethra by making several small cuts in the bladder neck where the urethra joins the bladder and in the prostate itself. This reduces the pressure of the prostate on the urethra and makes urination easier. Patients normally stay in the hospital one to three days. A catheter is left in the bladder for one to three days after surgery.
  • Open prostatectomy:
    When a transurethral procedure cannot be done, open surgery may be required. Open prostatectomy for BPH is also performed for a prostate that is too large to remove through the penis. Other reasons for choosing an open prostatectomy include patients with large bladder diverticula, with large bladder stones and who cannot physically tolerate having their legs placed in stirrups for TURP/TUIP surgery.
  • An incision is made in the abdominal wall from below the belly button to the pubic bone. The prostate gland can then be removed in its entirety through either an incision in the fibrous capsule surrounding the prostate (retro pubic prostatectomy) or through an incision made in the bladder (suprapubic prostatectomy). Postoperative pain is mild to moderate. Patients usually stay in the hospital for several days and go home with a urinary catheter. In some cases a second catheter draining the bladder through the lower abdominal wall is used.
  • Postoperatively, patients typically experience significant improvement in their symptoms (table 1). As with any operative procedure, complications do exist. Some occur in the early postoperative period (table 2) while others may occur many years later (table 3).
  • Table 1: Overall improvement in patient symptoms

TURP

TUIP

Open

88%

80%

98%

Table 2: Immediate post-operative complications

TURP

TUIP

Open

Infection

15%

13%

13%

Bleeding requiring transfusion

5-10%

1%

8%

Impotence

14%

12%

17%

Retrograde ejaculation

73%

25%

77%

Incontinence

1%

<1%

<1%

Table 3: Late post-operative complications

TURP

TUIP

Open

Stricture and bladder neck contracture
(scar tissue causing obstruction)

4%

3%

4%

Additional surgery within 5 years

10%

9%

2%

  • Frequently asked questions:
  • Will surgery for BPH affect my ability to enjoy sex?
    Most urologists say that even though it takes a while for sexual function to return fully, most men are able to enjoy sex again. Most experts agree that if you were able to maintain an erection shortly before surgery, you will probably be able to do so after surgery. Most men find little or no difference in the sensation of orgasm although they may find themselves suffering from retrograde ejaculation.
  • Is BPH a rare condition?
    No, it is very common. It will affect approximately 50 percent of men between the ages of 51 and 60 and up to 90 percent of men over the age of 80.
  • Does BPH lead to prostate cancer?
    No, BPH is not cancer and cannot lead to cancer. Still, both problems can happen at the same time. There may not be any symptoms during the early stages of prostate cancer. So whether their prostate is enlarged or not, men should talk to their health care providers about whether prostate cancer screening is right for them.

KIDNEY CANCERS:Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving treatment. Learn more about making treatment decisions.
Kidney cancer is most often treated with surgery, targeted therapy, and/or immunotherapy. Radiation therapy and chemotherapy are occasionally used. Patients with kidney cancer that has spread (metastatic cancer, see below) often receive multiple lines of therapy, which are treatments given one after another. Descriptions of these treatment options are listed below.

In some cases, especially when the cancer is small and slow-growing, the doctor may recommend that the patient is monitored closely and wait to start active treatment until there is evidence that the disease is worsening. This approach is called active surveillance, watchful waiting, or watch-and-wait.

Surgery
Surgery is the removal of the tumor and surrounding tissue during an operation. If the cancer has not spread beyond the kidneys, surgery to remove the tumor, part or all of the kidney, and possibly nearby tissue and lymph nodes, may be the only treatment necessary. The types of surgery used for kidney cancer include the following procedures:

Radical nephrectomy.
Surgery to remove the tumor, the entire kidney, and surrounding tissue is called a radical nephrectomy. If nearby tissue and surrounding lymph nodes are also affected by the disease, a radical nephrectomy and lymph node dissection is performed. During a lymph node dissection, the lymph nodes affected by the cancer are removed. If the cancer has spread to the adrenal gland or nearby blood vessels, the surgeon may remove the adrenal gland during a procedure called an adrenalectomy and parts of the blood vessels.

Partial nephrectomy.
A partial nephrectomy is the surgical removal of a tumor while preserving kidney function and lowering the risk of kidney disease after surgery, called hyperfiltration injury. It is used most often for a small tumor, even when the other kidney is functioning normally.

Anyone experiencing the signs or symptoms of bladder cancer should be checked by a urologist, who can perform tests to diagnose bladder cancer even in its early stages.

The following are signs and symptoms of bladder cancer:
Blood in the urine: This is the most common symptom of bladder cancer and occurs in the vast majority of people with bladder cancer. Though it may have causes other than cancer, blood in the urine is never normal and should always be evaluated by a doctor.

  • Urinary urgency or pain on urination
  • Back or abdominal pain
  • Loss of appetite and weight

The initial treatment for bladder cancer is transurethral resection (TURBT), which removes the tumor from the bladder and provides information regarding stage and grade of the tumor.

Impotence refers to a man’s absolute inability to obtain a penile erection even after proper stimulation. If the condition is not absolute, i.e.; either erections are not complete or there is an inability to maintain them long enough, then the condition in general is called ‘penile dysfunction’.

Various Treatment options SEXUAL DYSFUNCTIONS are offered at ATKC.

A number of day cay surgeries are offered at ATKC such as:
prostate biopsy, Arteriovenous  Fistula Formation, Fistula Closure, Perm Cath Insertion,  IN&D, Circumcision, Bilateral orchidectomy, Uretheral Dilataion, cystoscopy, Ureteroscopy, Hydrocelectomy, PESA,Testicular Biopsy, Optical Urethrotomy and more.

For scheduling an appointment with the doctor, please call:
Aziz Tabba Kidney Centre, Karachi on +92 21 36311052: 36311118

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