Dr. Abhishek Kumar Singh

Surgeries provided by the doctor are:

Urinary Stone

Urinary stones also known as kidney stones are solid masses made of crystals and usually originated from kidneys. These stones cause unbearable pain and discomfort when they move in the urinary tract. Kidney stones vary in size. There are different kinds of kidney stones depending upon their composition. It is one of the most painful medical conditions.

• Calcium stones get formed because of the high intake of calcium oxalate in food (potato chips, peanuts, chocolate, beets and spinach). One should eat food with less oxalate and increase calcium intake to reduce the risk of stone formation.
• High concentration of uric acid in urine cause the formation of Uric acid stone. These kinds of stones are more common in males than females. Urine becomes acidic when the amount of purine increases in the body. Purine is a colourless substance found in animal proteins.
• Struvite is another kind of stone found in women with urinary tract infections. Treating UTIs can prevent the development of stones. These stones are large and cause urinary obstruction.
• Cystine stones occur both in men and women with cystinuria, a genetic disorder.

There are different stone removal procedures. The smaller stones can be easily disposed of while urination however, larger stones require surgery as they get stuck in the urinary tract.

One of the procedures used for treating kidney stone problems in the minimally invasive way is Laser Urinary Stone Surgery. This surgery involves the placing of a ureteroscope under the effect of anaesthesia into the urethra and urinary bladder. This instrument helps in the easy identification of stones in the kidney and ureter

CAUSES

There aren’t any definite or single cause for the occurrence of urinary stones. Some of the factors causing urinary stones are :

• Chronic Diarrhoea
• Family History
• Lack of water
• High Blood Sugar
• More crystal-forming content in urine

SYMPTOMS

Kidney stones don’t show any symptoms until they lack movements in the kidney or passes into the ureters. They block the flow of urine from the ureter and cause the swelling of the kidneys, which is very painful. Some of the common signs and symptoms experienced during urinary stones are:

• Severe and sharp pain in the side and back, below the ribs
• Burning sensation and pain while urinating
• Cloudy or foul-smelling urine
• Nausea and vomiting
• Fever and chills in case of infection
• Persistent need to urinate
• Pink, red and brown urine
• Pain comes in waves and fluctuates in intensity

PROCEDURE

Preparation of surgery

• Medicines such as Vitamin E, Mortin, Aspirin, etc. should be discontinued a week before surgery.
• Urine culture tests should be conducted one week prior to surgery.
• The patient has to maintain an empty stomach before the night of surgery.

During the surgery

• Anaesthesia is given to the patient and a small instrument known as the Ureteroscope is placed into the urethra and urinary bladder for easier visibility of the stones.
• Laser energy is passed through the instrument that breaks the stones into smaller pieces. A small basket is used for the removal of stones from the urethra and some pieces are passed through urine.

Post-operative surgery

• Pain will be experienced after laser surgery. Medications should be taken in such cases.
• Driving should be avoided for one or two days
• Prolonged lying and sitting is not advisable
• Stay hydrated
• Exercising should be avoided till not approved by the doctor.
• Burning sensation while urinating for few days.

The person who has developed urinary stones in their life are likely to develop them again. To prevent this, it is advisable to make required changes in lifestyle and diet.

Prostate Enlargement

Prostate enlargement, also known as benign prostatic hyperplasia (BPH), is a common urological condition among older men. It occurs when the prostate gland, which surrounds the urethra, grows and puts pressure on the bladder and urethra. This can lead to various urinary symptoms, such as frequent urination, difficulty starting or stopping urination, weak urine flow, and a feeling of incomplete bladder emptying.

While an enlarged prostate is not a life-threatening condition, it can significantly impact a person’s quality of life. In BPH, surgical intervention is necessary, however, medications and home remedies can relieve pain and discomfort associated with the enlarged prostate.

Renal Cell Cancer (RCC)

Kidney Cancer or Renal Cell Cancer is a disease in which the healthy cells in one or both kidneys become cancerous and grows out of control later forms a tumor. Almost all kidney cancers begin in the lining of tubules (tiny tubes) in the kidney. Renal tubules purify the blood and make urine. If the cancer is found earlier or before it spread to distant organs, it is easier to treat the cancer successfully, but the cancer may spreads to other organs like bones, lungs or brain.

Prostate Carcinoma

Prostate cancer is the type of cancer that affects the prostate. The prostate is a small nut-shaped gland in males that produces the seminal fluid that feeds and carries the semen.

Prostate cancer is one of the more prevalent types of cancer. Many prostate cancers develop slowly and limit themselves to the prostate gland, where they may not cause severe damage. However, in some cases, prostate cancer becomes aggressive and spreads quickly to other neighboring body parts.

Prostate cancer in its initial stages, confined to the prostate gland, and the patient has the best chance of success with minimal treatment and complications.

Types of cancer that may occur in the prostate are

• Adenocarcinoma: Most prostate cancers are adenocarcinoma. These cancers develop from the cells of the gland (the cells that form the liquid in the prostate that is added to the sperm).
• Sarcomas: Soft tissue sarcomas are cancers that develop in the connective and supporting tissues of the body. Muscle, nerves, fat, fibrous tissue, and blood vessels are among these tissues.
• Neuroendocrine tumors (except small cell carcinomas): Neuroendocrine tumors (NETs) are rare tumors that begin in the cells of the nervous system. NETs come in a variety of shapes and sizes. The type you have is determined by the type of cell in which cancer began.
• Small cell carcinoma: Small round cells are responsible for small cell prostate cancer. It’s a type of cancer that affects the neuroendocrine system.
• Transition cell carcinoma: Prostate transitional cell cancer begins in the cells that line the tube that transports urine to the outside of the body (the urethra). This cancer typically begins in the bladder and progresses to the prostate. It can, however, start in the prostate and spread to the bladder entrance and nearby tissues in rare cases.
• There are a few other types of prostate cancer. If you are told that you have prostate cancer, it is quite certain that it is adenocarcinoma. In some cases, prostate cancers develop and spread rapidly, but in most cases, it develops slowly.

If you experience any of the following symptoms, Please does consult your urologist immediately.

• Difficulty in beginning urination.
• Poor or discontinued urinary flow.
• Frequently urinating, particularly at night.
• Difficult to empty the bladder.
• Painful or burning while urinating.
• Blood from urine or semen.
• Back, hip, or pelvic pain that does not go away.
• Painful ejaculation.

If you are having one or more of these symptoms, don’t conclude on your own that you have cancer. However, don’t take these symptoms lightly as well. Meet the urologist and follow his advice with respect to further investigations.

Female Urology

Urology focuses on conditions related to the urinary tract system, including the kidneys, adrenal glands, ureters, urinary bladder, urethra, and the male reproductive organs that include the penis, testes, scrotum, prostate, etc.

There are some urological conditions that are more common in women than in men, such as urinary incontinence and urinary tract infection. This is where female urology comes into play. Female urology concentrates solely on the diagnosis and treatment of urologic conditions that are most prevalent in females. The urologists that deal specifically with the urological problems in females are known as urogynecologists.

How Do You Know It’s Time To Visit A Female Urologist?

There are certain signs and symptoms that hint towards a building urological condition that may pose a threat to your health. These include,

• Spotting blood in the urine
• Immediate urination urges
• Leakage of urine
• Pain in back and sides
• Abdominal pain
• Cloudy pain
• Burning sensation while urinating
• Having Urinary Tract Infections on a more frequent basis

If you are experiencing any of these symptoms, it is advised that you immediately visit a urologist as it is extremely common in females to develop frequent urologic conditions.

Types of Urologic Conditions Seen In Women

• Urinary Tract Infections (UTIs) - These are infections in the urinary tract caused by bacteria. It results in painful urination, blood in urine, excessive cramps, and even nausea. These infections can be recurring.
• Urinary Incontinence - A person with UI experiences leakage of urine by accident. It is more common in women. There are two types of Urinary Incontinence.
• Stress Incontinence - This usually happens when an individual is either laughing, sneezing, coughing, or lifting heavy objects. Weakening of the pelvic floor is what causes stress incontinence.
• Overactive Incontinence - This is caused by excessive contraction of bladder muscles and results in a frequent or urgent need to urinate.
• Urinary Fistula - In this condition, the kidney, bladder, urethra, colon, and vagina are in an unusual connection. This results in the leakage of feces and urine. It is a rare condition and needs to be checked immediately.
• Pelvic Organ Prolapse - This happens when pelvic organs such as the bladder have fallen off of their normal position. This is caused by the weakening of the woman’s muscles, skin, ligaments, and other supporting structures around her vagina. Age, genetics, or excessive straining are some factors that may cause this weakening.
• Pelvic Floor Pain - This is usually caused by childbirth, surgery, or sexual trauma and results in chronic pelvic pain
• Kidney Stones - When minerals and salts in urine clump together, it causes kidney stones that can vary from the size of a grain to a golf ball. While some stones can be passed with urine, some may require surgery.
• Polycystic Kidney Disease - Growth of multiple cysts in one or both kidneys.

Other urological conditions that are fairly common in women include painful bladder syndrome, hydronephrosis, chronic kidney disease, and several urologic cancers.

Urinary Blood Cancer

Bladder cancer is a type of cancer that develops in the cells of the bladder, which is the organ responsible for storing urine. It is essential to have a comprehensive understanding of bladder cancer, including its causes, risk factors, diagnosis, and treatment options.

Early detection plays a crucial role in the successful treatment of bladder cancer. The following signs and symptoms may indicate the presence of bladder cancer:

• Hematuria (blood in urine): The most common symptom of bladder cancer is blood in the urine. The urine may appear pink, red, or dark brown. Although hematuria can be caused by other conditions, it should always be investigated by a healthcare professional.
• Frequent urination: Individuals with bladder cancer may experience an increased frequency of urination. This can be accompanied by urgency and a feeling of incomplete bladder emptying.
• Pain during urination: Some individuals with bladder cancer may experience pain or a burning sensation while urinating.
• Pelvic or back pain: Advanced bladder cancer can cause pain in the pelvic area or lower back.
• Urinary tract infections (UTIs): Recurrent UTIs that do not respond to treatment may be a warning sign of bladder cancer.

If bladder cancer is suspected, a healthcare professional will perform various diagnostic tests, including:

• Urine tests: Analysis of urine samples can detect abnormal cells or blood.
• Imaging tests: Imaging techniques such as ultrasound, CT scan, or MRI can provide detailed images of the bladder and surrounding structures.
• Cystoscopy: A thin tube with a camera is inserted into the bladder through the urethra to examine the bladder lining and potentially collect tissue samples for further testing (biopsy).

Treatment options for bladder cancer depend on several factors, including the stage and grade of the cancer. They may include:

• Surgery: The removal of cancerous tissue from the bladder may involve transurethral resection, partial cystectomy, or radical cystectomy.
• Radiation therapy: High-energy rays are used to target and destroy cancer cells.
• Chemotherapy: Medications are administered to kill cancer cells or stop their growth. Chemotherapy may be given before or after surgery or used in combination with radiation therapy.
• Immunotherapy: These treatments help stimulate the body’s immune system to fight against cancer cells.

Male Infertility

Erectile Dysfunction

Percutaneous Nephrolithotomy (PCNL)

Percutaneous nephrolithotomy or PCNL is a minimally invasive inpatient procedure performed under general anesthesia to remove kidney stones. Generally, these stones are large and complex. For the PCNL procedure, a small incision is made in the flank (side of the back), underneath the rib cage. Through that incision, the urologist uses scopes to go directly into the kidney, locate the kidney stone, and then break it up using an energy device such as a laser or ultrasound.

Usually, a temporary device (ureteral stent or nephrostomy tube) for urinary drainage is needed after a PCNL. A stent in internal and goes from the kidney to the bladder while a nephrostomy tube directly drains urine from the kidney to an external bag

Ureteroscopy (URS)

Ureteroscopy (URS) is a preferred method for the treatment of small- to medium-sized kidney stones located in any part of the urinary tract.

The procedure

• The procedure is typically performed with the patient under general anaesthesia (asleep).
• During this procedure, a ureteroscope is inserted through the urethra and bladder into the ureter (a tube that carries urine from the kidneys to the bladder) or kidney.
• X-ray images with a contrast agent (dye) in the ureters may be used to allow the urologist to see where the stone is located and to rule out other abnormalities.
• The ureteroscope is long and thin with a tiny fibre optic camera at the end that is used to see beyond the bladder into the ureters.
• Once the stone is located, it is pulled out directly with a “stone basket” or a laser is used to break the stone into smaller pieces before they are extracted using the basket.

Some ureteroscopes are flexible like a thin, long straw. Others are more rigid and firm.

Transurethral Resection of Prostate (TURP)

A TURP (Transurethral Resection of the Prostate) or Prostatectomy is surgery to remove parts of the enlarged prostate to treat benign prostatic hyperplasia.

During TURP Procedure, an instrument is inserted up the urethra to remove the section of the prostate that is blocking urine flow. It is often used to treat prostate enlargement (benign prostate hyperplasia).

Transurethral resection of bladder tumour (TURBT)

This surgical procedure is used in both the diagnosis and treatment of bladder cancer. Transurethral resection of bladder tumor (TURBT) allows the surgeon to biopsy your tumor, or remove an entire small tumor from the inside of your bladder, while leaving the bladder intact. TURBT is essential to obtain a biopsy to confirm the cancer diagnosis and determine the stage and grade of the cancer.

Direct vision internal urethrotomy (DVIU)

This is a surgery done to repair a narrowed section of the urethra. This is referred to as a stricture. The urethra is the tube through which urine passes from the bladder to the outside of the body.

Vesicovaginal fistula repair (VVF REPAIR)

A VVF repair is a standard surgical procedure for patients with a fistula between the urinary bladder and vaginal vault. A fistula is a pathological opening or connection between two parts of your body. VVF is a type of female urogenital fistula that opens between the vagina and urinary bladder. This can lead to irregular urinal flow in the vaginal area and affect the patient’s psychological well-being.

NEPHRECOTOMY LAP/OPEN

A laparoscopic nephrectomy is an operation to remove one of the two kidneys that sit at the back of the abdominal cavity. The kidneys make urine by filtering waste products and excess fluid from the blood. Urine drains from the kidneys, through the ureters into the bladder where it is stored until the person is ready to go to the toilet. A laparoscopic nephrectomy involves removing an entire kidney through keyhole incisions in the flank, the side of the body between the ribs and the hip.

Nephrectomy (nephro = kidney, ectomy = removal) is the surgical removal of a kidney. The procedure is done to treat kidney cancer as well as other kidney diseases and injuries. Nephrectomy is also done to remove a healthy kidney from a donor (either living or deceased) for transplantation.

URETEROLITHOTOMY LAP/OPEN

Laparoscopic ureterolithotomy is a minimally invasive option to treat large ureteric stones not amenable to ureteroscopy. There are a very few small case series describing laparoscopic ureterolithotomy for lower ureteric stone.

Open Ureterolithotomy is the removal of a stone in the ureter (the tube connecting the kidney to the bladder), through an open surgical incision in the side or abdomen

This operation involves using an incision (surgical cut) in the abdomen or the side (loin), along the line of the ribs. A cut is made into the ureter and the stone is removed. An internal drainage tube (stent) will be inserted into the ureter at the time of the procedure to ensure the kidney can drain urine freely and aid healing

BOARI FLAP URETERIC REIMPLANT

The incidence of ureteral stricture is showing a rising trend due to increased use of laparoscopic and upper urinary tract endoscopic procedures. Boari flap is the preferred method of repairing long- segment ureteral defects of 8–12 cm. The procedure has undergone change from classical open (transperitoneal and retroperitoneal) method to laparoscopic surgery and recently robotic surgery. Laparoscopic approach is cosmetically appealing, less morbid and with shorter hospital stay. Laparoscopic ureteral reimplantation with Boari flap is safe, feasible and has excellent long term results. However, the procedure is technically challenging, requires extensive experience of intracorporeal suturing.

STAPLER CIRCUMCISION

Circumcision is the surgical removal of the foreskin of the penis. The procedure can be performed in many ways such as laser circumcision, stapler circumcision, open surgery, etc.

Stapler circumcision is performed using a stapler device known as an Anastomat. The procedure is painless, ensures minimum blood loss, and involves no stitches. Stapler Circumcision is definitely better and safer than traditional surgery and offers fast healing after the circumcision. The stapler removes the foreskin in one quick motion and places a silicone ring in its place to stem the bleeding and aid recovery.

TRUS GUIDED PROSTATE BIOPSY

Transrectal ultrasound (TRUS) guided biopsy of the prostate has been a standard diagnostic approach for prostate cancer over the past thirty years. Today, the role of TRUS biopsy is being challenged by transperineal (TP) prostate biopsy due to concerns over the safety and diagnostic yield of TRUS biopsy. TRUS biopsy still offers a convenient, reliable and accessible tool for diagnosing prostate cancer in the majority of patients. It continues to play a role in prostate cancer diagnosis, especially where hospital resource allocation is limited, including the public sector. TRUS biopsy has low rates of severe complications, although there remains room for improvement in current practice to improve the tolerability and reduce the incidence of post-biopsy infec tion.