The kidneys perform the vital function of filtering the blood and removing wastes and toxins from the system. If both the kidneys stop working, the subsequent build up of wastes and toxins in the body can cause other complications. Renal or kidney transplantation is usually only done in patients who are suffering from end stage kidney disease who are dependent on dialysis for their excretory function. During the procedure the kidney which is retrieved either from a living donor or a deceased (brain dead) donor is implanted into the patient’s abdomen. The patient’s diseased kidneys are not usually removed.
The kidney for the transplantation may be donated by a deceased donor or a living donor, such as a family member. The donor kidney is carefully chosen based on the patient’s blood type and human leukocyte antigen type (HLA). This helps to minimise the chances of the body rejecting the donor organ. Rejection occurs when the body’s immune system identifies the donor kidney as a foreign body and starts to produce an immune response to attack it. The patient is prescribed immune suppressant medications after the surgery to lower the risk of organ rejection.
Uro-oncology is one of the areas or sub-specialities in urology concerned with the diagnosis and treatment of cancers of the urinary tract. Uro-oncology also deals with cancers of the male reproductive organs. Kidney, bladder and prostate cancer are the most common urologic cancers. Our uro-oncologists treat malignant growths in the urinary tract with a variety of tools at our disposal including surgical intervention, radiation therapy and chemotherapy. Surgical intervention may be laparoscopic or open. The Uro-oncologist with the collaboration of the medical oncologist tailors the treatment according to the individual patient to deliver the highest standard of care.
Endo-urology is a sub-specialty within the field of urology which uses minimally invasive surgical techniques used to treat diseases of the urinary tract. It is commonly used in the diagnosis and treatment of stone diseases of the urinary tract. During the procedure, a highly sophisticated endoscope is passed into the patient’s natural urinary passage to access the stone. The stones are then fragmented using a laser. Some of the common endo-urological procedures performed are URS (uretero-renoscopy), RIRS (Retrograde Intra-Renal Surgery). Large kidney stones can be removed by a procedure called as PCNL (Per-Cutaneous Nephro Lithotomy) wherein the kidney stones are accessed by a small keyhole incision through the back. Endo-urology is a real boon to the patients as it eliminates the need for a large surgical incision and allows the patient to recover faster.
Reconstructive urology is another area in urology which aims to restore normal anatomy and function to the genitourinary tract. This includes bladder reconstruction, urethral reconstruction for strictures, pelvic floor reconstruction. Traumatic injuries to the genitourinary tract or congenital defects may also require reconstructive surgery. Reconstructive surgeries are unique because they require a high degree of customisation to match the patient’ needs.
Laparoscopic procedures for cancers of the urinary tract
Traditional open procedures to remove tumours of the urinary tract require large incisions and lengthy hospital stay. With advances in medical science and the evolution of laparoscopic techniques, it is possible to treat these diseases through keyhole incisions. During a laparoscopic procedure, the surgeon inserts a laparoscope (a small tube with a camera) and specialised instruments through small incisions in the abdomen. The camera provides enhanced visualisation of the tumour, which enables the surgeon to remove the tumour without much blood loss. Post operative pain and scar are less in laparoscopic procedures compared to open procedures. Even large tumours can be removed safely using laparoscopic techniques.
Female urology is a sub-specialty of urology that deals with treatment of urological conditions affecting women. A female urologist deals with problems like female urinary incontinence, pelvic organ prolapse, over-active bladder, under-active bladder, interstitial cystitis etc. Most of these procedures are done by minimally invasive techniques.
Paediatric Urology is another sub-specialty focussing on diseases of the genito-urinary system of children. It is a highly specialised field. Some of the problems dealt in this sub-speciality are Pelvi-ureteric junction obstruction (PUJO), Hypospadias, kidney stones in children, phimosis, neurogenic bladder, undescended testis, wilms tumour, bladder exstrophy etc.
Male infertility and Erectile Dysfunction (Andrology)
Intracytoplasmic sperm injection (ICSI) is an In-vitro fertilisation (IVF) procedure in which a single sperm is injected into an ovum. This procedure is most effective for couples with severe male infertility. Typically, men with severe infertility do not have many sperms in their ejaculate, so sperm retrieval is done directly from the epididymis or the testes. Depending on the cause of the male infertility, different methods may be chosen to extract the sperm like testicular sperm aspiration (TESA), percutaneous epididymal sperm aspiration (PESA), testicular sperm extraction (TESE) or micro-epididymal sperm aspiration (MESA).
Erectile Dysfunction is another common problem dealt by an urologist. The patient is subjected to a comprehensive evaluation with the help of blood tests including hormonal assays and imaging studies like penile Doppler. Penile prosthesis is typically recommended for severe cases of erectile dysfunction where all other options have failed.
Neurological conditions affecting bladder can cause problems like difficulty in voiding (under-active bladder) or leakage of urine (overactive bladder). Patients suffering from spinal cord injuries, Parkinsons disease, stroke, Alzheimer’s disease, diabetes will have variable degrees of neurogenic bladder. Complete evaluation including urodynamic study is performed and appropriate treatment instituted.