RESCUE UROLOGY HOSPITAL KENGERI

ANDROLOGY

UROLOGY CONDITIONS  TELE CONSULTATION


Infertility Management 

Personalised treatment plan is designed to overcome some of the most complex infertility problems. IVF treatment options are offered to help couples have a baby. Prenatal diagnostic testing - both invasive and non -invasive ways to determine the presence or absence of a chromosome abnormality and genetic disorders.

This procedure involves embryos that are frozen in a previous cycle and can be thawed and transferred in another cycle. Success rates for FET are better than fresh embryo transfers.

In IUI the semen is collected from the partner and is prepared in the lab and then inserted into the uterine cavity at the time of ovulation to facilitate fertilisation.

In IVF the egg and the sperm are extracted and allowed to fertilise under lab conditions in a petri dish, post which the embryos are transferred to the uterus.

In ICSI, fertilisation is achieved by injecting a sperm into the egg with the help of a micromanipulator. The resultant embryo is later transferred to the uterus for implantation.

Embryos are cultured in a lab until they reach the blastocyst stage (day-5) , post which, best quality blastocysts are transferred into the uterus for implantation. This process ensures only the best quality embryos are transferred to get better success rates.

Male infertility problems such as erectile dysfunction, ejaculatory problems, varicocele, low sperm count, azoospermia, oligospermia are treated using surgical techniques such as Percutaneous Epididymal Sperm Aspiration (PESA), Testicular Sperm Aspiration (TESA).

Sexual Dysfunction

● Occurs when a man can’t get or keep an erection firm enough for sexual intercourse.

● You may be advised to change your lifestyle, referred to a counselling session, diagnosis and treatment to help cure the situation.

● Doctor may advise you to indulge in exercise, quit smoking and drinking or suggest some therapies to be performed at home along with oral medicines. 

● Physical examination: This might include careful examination of your penis and testicles and checking your nerves for sensation.

● Blood test: A sample of your blood might be sent to the lab to check for signs of heart diseases, diabetes, low testosterone levels and other health conditions.

● Urine tests (urinalysis): Urine tests are used to look for signs of diabetes and other underlying conditions.

● Ultrasound: This test is performed by a specialist. He uses a device (transducer) held over the blood vessels that supply blood to the penis. This creates a video image to let your doctor see if you have blood flow problems.

● Psychological exam: Your doctor might ask you some questions to screen for depression and other possible psychological problems of erectile dysfunction. 

● Oral medications: Oral medications are a successful treatment for erectile dysfunction. Doctor will advise you on this.

● Alprostadil urethral suppository: Alprostadil intraurethral therapy involves placing a tiny alprostadil suppository inside the penis in the penile urethra. This method helps in getting erection.

● Testosterone replacement: Some men have low levels of the hormone testosterone which results in erectile dysfunction. In this case, testosterone replacement therapy might be recommended.

● Penis pumps: Battery powered penis pumps may be given for erectile dysfunction. This creates vacuum and pulls blood into your penis.

● Penile implants: This treatment involves surgically placing devices into both sides of the penis. These implants consist of bendable rods thus help to keep the penis firm and bend. 


External Genitalia 

The male reproductive organs form the external genitalia. This includes the penis and the scrotum. There could be some problems related to these organs. We now explore the different problems along with their remedies.

Penile Fracture
This is rupture of one or both of the tunica albuginea, the fibrous coverings that envelop the penis’s corpora cavernosa. It is caused by rapid blunt force to an erect penis, usually during vginal intercourse, or aggressive masturbation.


● Symptoms of penile fracture include : bleeding from penis, dark colored bruising to the penis, trouble urinating, hearing cracking sound, losing an erection suddenly, pain that aries from minimal to severe.


● Penile rupture can be diagnosed based solely on history and physical examination findings. Other methods are diagnostic cavernosography or MRI.


● An immediate surgical treatment is suggested if a patient hears a cracking or popping , followed by pain, discoloration and swelling of penile shaft.


● Some conservative management of penile fracture include splinting, cold compresses, and a combination of anti-inflammatory,analgesic medications and fibrinolytics. There could be some complications in these methods as curved or painful erections, arteriovenous fistula formation.

● Home treatments include applying cloth-covered ice for 10 minutes at a time to reduce swelling, using a Foley catheter to empty bladder and reduce trauma on penis, taking anti-inflammatory medications, such as ibuprofen to reduce pain and swelling.


● Surgical repairs for penile fracture include getting rid of hematoma or buildup of blood due to the fracture, stopping bleeding of any damaged vessels, closing any cuts or lacerations to the penis that may have cause the bleeding.


● Aftercare and recovery: The recovery of penile fracture depends on the severity of the injury. The patient may be advised to go home after surgery but he will be asked to refrain from sexual activity for at least a month.


● Doctor may prescribe medications to reduce the likelihood of an erection during the recovery period, such as sedatives or hormones.


● Prompt treatment of penile fracture is vital to ensure a man to return to his full sexual and urinary function.


ANDROLOGY CLINIC

Penile Cancer

Penile Cancer Symptoms

Penile cancer is a disease in which cancer cells form in the tissues of the penis. Human papillomavirus (HPV) infection may increase the risk of penile cancer. Condom use and the HPV vaccine can help prevent infection with HPV.

● Fewer than 100 thousand cases per year in India.
● Treatable by a medical professional.
● Requires a medical diagnosis.
● Lab tests and imaging always required.

SYMPTOMS

  • An area of skin becoming thicker
  • Changes in the skin color
  • A reddish, velvety rash under the foreskin.
  • Small crusty bumps
  • Flat, bluish-brown growths.
  •  Discharge(fluid) or bleeding under foreskin.

Diagnosis of Penile Cancer

  • Doctor will take a small sample of tissue from a skin lesion on the penis.
  • Lab tests will check it for cancer cells .
  • Imaging tests like X-rays, CT scans, ultrasounds and magnetic resonance imaging (MRI).
  • These look inside your body for tumors or other signs that cancer could have spread.

Treatment of Penile Cancer

Various Treatment Options are listed below:

  • Surgery is the most common treatment for all stages of penile cancer. The doctor may remove the cancer using Mohs microsurgery, laser surgery, cryosurgery, circumcision, wide local excision, amputation of the penis.
  • Other options include radiation and chemotherapy.
  • Even if the doctor removes all cancer that can be seen at the time of surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left.
  • Mohs microsurgery is a procedure in which the tumor is cut from the skin in thin layers.Layers continue to be removed until no more cancer cells are seen. This type of surgery removes as little normal tissue as possible and is often used to remove cancer on the skin.
  • Laser surgery is a surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor.
  • Cryosurgery uses an instrument to freeze and destroy abnormal tissue. This type of treatment is also known as cryotherapy.
  • Circumcision is a surgery to remove part or the entire foreskin of the penis.
  • Wide local excision is a surgery to remove only cancer and normal tissue around it.
  • Amputation of the penis is a surgery to remove part or all of the penis. If part of the penis is removed , it is called partial penectomy. If all of the penis is removed, it is total penectomy.
  • Radiation therapy uses high energy X-rays or other types of radiation to kill cancer cells or keep them from growing. The two types of radiation are external radiation and internal radiation.
  • Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body.

Post Treatment Care

● Most penile cancer patients have some life-changing side effects.
● Urination: If the surgery removes part of the penis or entire penis, how a man urinates might change.
● In some cases a partial penectomy leaves enough of the penis to allow relatively normal urination.
● Sexuality: The surgery may affect the way a man thinks about sex because of the way the penis looks like after surgery.
● Mohs surgery may have little effect on sex and sexual pleasures once the person has recovered.
● After total penectomy, some people give up sex, but in some cases surgical reconstruction of the penis is possible.
● In some cases when men feel stressed and depressed, counseling could come of help. 

  • DO YOU HAVE QUESTIONS ABOUT PENILE CANCER?
  • TELE CONSULT WITH YOUR UROLOGIST

ANDROLOGY CLINIC

Ectopic Penile Testis

Ectopic Penile Testis Symptoms

Ectopic testis are found in the superficial inguinal scrotum, base of penis, perineum, or medial thigh. In case the testis crosses the midline, the cord structures may cross intra-abdominally or after exiting the inguinal canal.

SYMPTOMS

  • Palpable meaning that a doctor will be able to feel the undescended testicle during a physical examination.

Prevalence of Ectopic Penile Testis

  • These conditions are present at birth sometimes or within two years. A definitive treatment is usually done in childhood itself. 

Diagnosis of Ureteral StonesEctopic Penile Testis

Learn about the investigations and the diagnosis

  • Diagnostic laparoscopy identified the cord structures exiting opposite the testis.

Treatment of Ectopic Penile Testis

● Hormonal treatment is an option to treat undescended testicles. The hormone used is hCG (human chorionic gonadotropin.

● If your child is 6 months old, the doctor will recommend surgery.

● Orchiopexy: This is a surgery if your child’s undescended testicle is low in the belly or in the groin. In this case the testicle can be moved to the scrotum.

● FS Orchiopexy: This is a surgery done if your child's undescended testicle is high in the belly, the blood vessels attached to the testicle may not be long enough to reach down into the scrotum. This surgery is a bit different and hence the name “Fowler-Stephens” orchiopexy.

● Open Surgery or Laparoscopic Surgery: The above mentioned methods of surgery can be done either as an open surgery or a laparoscopic surgery.

● Open surgery: The surgeon makes a cut in your child’s belly or groin and scrotum to do the surgery.

● Laparoscopic surgery: The surgeon uses a tool called a laparoscope for the surgery. It has a tiny camera that helps the surgeon during the surgery. There are no big cuts in this surgery. 

  • DO YOU HAVE QUESTIONS ABOUT CKD?
  • TELE CONSULT WITH YOUR UROLOGIST

Patient safety is our priority

  • Complications are quite rare in this type of surgery as the methods are quite safe.
  • Side effects could be plenty.
  • Bleeding.
  • Infection
  • Injury to blood vessels.
  • Injury to organs such as the testicles, the spermatic cords attached to each testicle, the bladder and others.
  • Risks of general anesthesia, such as pneumonia, heart attack, or stroke are quite rare.

What's important after discharge?

● Have your child avoid doing straddling activities , such as cycling (tricycle), sitting on a toy, for at least 3 to 4 weeks.
● Do not let your child do intense exercise, such as sports or physical education at school for nearly 4 to 6 weeks.
● Your child may have a shower or a sponge bath after surgery.
● The doctors use stitches that dissolve on their own in 2 to 3 weeks.
● The incision will ooze fluid for 2 to 3 days.
● Your child may have mild to moderate pain for several days after surgery. 

  • DO YOU HAVE QUESTIONS ABOUT Ectopic Penile Testis?
  • TELE CONSULT WITH YOUR UROLOGIST

ANDROLOGY CLINIC

Peyronie's Diseases

Peyronie's diseases and Symptoms

Peyronie’s disease is caused by repeated penile injury, typically during sex or physical activity. A fibrous scar tissue inside the penis that causes painful, curved erections.

SYMPTOMS

  • Usually self-diagnosable - In Peyronie’s disease, the bend in the penis is significant, and may occur along with pain or interfere in sexual function.
  • A physical exam by the doctor is sufficient to identify the presence of scar tissue in the penis.

Prevalence of Peyronie's diseases

  • More than 1 million cases per year in India are treated by medical professionals.
  • Chronic cases can last for years or be lifelong.

Diagnosis of Peyronie's diseases

Learn about the investigations and the diagnosis

  • Physical exam -- Your doctor will feel your penis when not erect,to identify the location and amount of scar tissue.
  • Other tests -- Your doctor might ask you to get an ultrasound done when your penis is erect.

Treatment of Peyronie's diseases

● Medication or surgery may be recommended if symptoms persist or worsen.
● Medications-- Dietary supplement and collagenase clostridium histolyticum.
● Medical procedure -- Penile traction
● Surgery -- Your doctor might suggest surgery if deformity of your penis is severe.
● Suturing the unaffected area -- suturing the longer side of the penis results in straightening of the penis.
● Incision and Excision and grafting -- In this surgery, the surgeon makes one or more cuts in the scar tissue, allowing the sheath to stretch out and the penis to straighten. The surgeon might remove some of the scar tissue. A piece of tissue (graft) is often sewn into place to cover the holes in the tunica albuginea.
● Penile implants -- Surgically inserted penile implants replace the spongy tissue that fills with blood during the erection.
● Depending upon the type of surgery you have, you might be able to go home the same day or you may need to stay overnight. 

  • DO YOU HAVE QUESTIONS ABOUT Peyronie's Diseases?
  • TELE CONSULT WITH YOUR UROLOGIST

ANDROLOGY CLINIC

Testicular Cancer

Testicular Cancer and Symptoms

Cancer in the male organs that make male hormones and sperm (testicles).
The testicles are located inside a loose bag of skin(scrotum) underneath the penis.

SYMPTOMS

  • Pain areas: in lower back
  • Whole body: cancer- related fatigue
  • Painless testicular lump, swelling of scrotum, swollen lymph nodes, or weight loss
  • Feeling of heaviness in the scrotum
  • Dull ache in the lower abdomen or groin
  • Sudden buildup of fluid in the scrotum
  • Breast tenderness or growth
  • Swelling in one or both legs or shortness of breath, chest pain, and bloody sputum or phlegm.
  • Shortness of breath could be from a blood clot in a large vein often known as deep vein thrombosis. A blood clot in an artery in the lung is known as pulmonary embolism.

Prevalence of Testicular Cancer

  • Fewer than 100 thousand cases per year in India. Treatable by a medical professional

Diagnosis of Testicular Cancer

Learn about the investigations and the diagnosis

  • Physical examination: The doctor will feel the testicles for any sign of swelling, tenderness, or hardening. The doctor will also feel the abdomen, neck, upper chest, armpits and groin for evidence of enlarged lymph nodes. The breasts and nipples will be examined for swelling. Leg swelling could be from blood clots in veins,in the leg, pelvis,or abdomen.
  • Ultrasound: An ultrasound uses sound waves to create a picture of the internal organs. If there is a tumor large enough to be seen on an ultrasound, then the sonogram will show the size, location, and solidness of the tumor.
  • Blood tests/tumor markers: The levels of serum tumor markers are measured before surgery to remove a testicle. High levels of these tumor markers may indicate testicular cancer or another type of cancer.
  • X-rays: An x-ray is a way to create a picture of the structure inside the body thus helps to know whether the cancer has spread and if so how much.
  • CT scan: A CT scan can help doctors find any abnormalities or tumors. It can also measure the size of the tumor.
  • MRI scan: An MRI scan uses magnetic fields to create a 3-dimensional image of the inside of the body. MRI can be used to measure the size of the tumor.
  • Biopsy: A biopsy is the removal of a small amount of tissue for examination under microscope.

Treamment of Testicular Cancer

● Surgery: Surgery for cancer involves the removal of the tumor and sometimes some surrounding healthy tissue during an operation.

● Radical orchiectomy or inguinal orchiectomy is the first treatment for testicular cancer. Here the testicle with cancer is removed. This operation is done through an incision done in the groin along the beltline. This surgery involves the removal of entire testicle and most of the spermatic cord.

● Chemotherapy: This is a non-surgical procedure which uses drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells. Chemotherapy is given by a medical oncologist.

● Radiation therapy: Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A radiation therapy regimen , or schedule, usually consists of a specific number of treatment sessions given over a set period of time. For testicular cancer, the radiation is generally directed at lymph nodes in the abdomen for men. 

  • DO YOU HAVE QUESTIONS ABOUT CKD?
  • TELE CONSULT WITH YOUR UROLOGIST

Patient safety is our priority

● In orchiectomy, the removal of 1 testicletypically does not affect a man's testosterone level if he still has the other testicle and it is normal in size. If a man’s testosterone levels are decreased , symptoms may include depression, fatigue, decreased sex drive, inability to achieve erection, hot flashes, as well as loss of muscle and bone mass in the long term. In this case, the man can still become a father.

● In case the surgery involves the removal of both the testicles, the man will no longer produce sperm or testosterone and will not be able to biologically produce children.

● Common side effects of chemotherapy are fatigue, nausea and vomiting,numbness and tingling in the hands and feet, high pitch hearing loss and ringing in the ears. There is also a risk of severe infections. Some drugs are linked to dangerous swelling in the lungs,shortness of breath, difficulty in breathing, or a persistent cough. Some men have a higher risk of blood clots, chest pain, or swelling in 1 or both arms or legs.

● Some long lasting effects from chemotherapy are fatigue, heart problems, and secondary cancers.

● Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, loose bowel movements and peptic ulcers.

● Radiation therapy may cause problems with sperm production but newer techniques can help men to preserve fertility.

● Radiation therapy increases the risk of secondary cancers many years after treatment and may increase the risk of heart problems and gastrointestinal disease. 

  • DO YOU HAVE QUESTIONS ABOUT Testicular Cancer?
  • TELE CONSULT WITH YOUR UROLOGIST

ANDROLOGY CLINIC

Orchiectomy

Orchiectomy

Orchiectomy is a surgical procedure in which one or both testicles are removed. The surgery is typically performed as treatment for testicular cancer, in some cases of testicular torsion, and is sometimes used in management of prostate cancer. There are 2 types of orchiectomy done:

a) Simple orchiectomy -- One or both testicles removed through a small cut in your scrotum. This may be done to treat prostate cancer if your doctor wants to limit the amount of testosterone that your body makes.

b) Radical inguinal orchiectomy -- One or both testicles is removed through a small cut in the lower part of your abdominal area instead of your scrotum. This may be done if you’ve found a lump in your testicle and your doctor wants to test your testicular tissue for cancer. Doctors may prefer to test for cancer using this surgery because a regular tissue sample or biopsy, can make cancer cells more likely to spread.

c) Subcapsular orchiectomy -- The tissues around the testicles are removed from the scrotum. This allows you to keep your scrotum intact so that there is no outward sign that anything has been removed. 

  • DO YOU HAVE QUESTIONS ABOUT Orchiectomy?
  • TELE CONSULT WITH YOUR UROLOGIST

What to expect before Surgery

  • A physical examination is done before the surgery.
  • A blood test is taken to ensure good health before undergoing the procedure.
  • Inform your doctor about any medications you are taking.
  • Arrange in advance for a ride home after the procedure as you will not be able to drive or operate machinery.
  • The type of anaesthesia that may be used during an orchiectomy include either a general type anaesthesia or a spinal block in which case the patient does not have sensation waist down during the procedure.

Surgery

The surgery usually takes about an hour. 


  • The surgery will not affect your penis or scrotum, the sac that covers your testicles.
  • In simple orchiectomy, the surgeon starts the procedure by taping the penis to the abdomen, Next ,a small incision is made in the scrotum and one or both testicles are removed.
  • In radical inguinal orchiectomy, an incision is made in the abdomen instead of the scrotum.

Instructions

● It can take up to two months for complete recovery.
● You will be going home just a few hour after the procedure, but you will return the next day for a follow-up appointment.
● Expect to take a few days off work to recuperate.
● You also need to limit physical activity such as exercise, sex, sports and running for a month.
● Wearing a scrotum support garment for the first two days after surgery.
● Avoid lifting upto 10 pounds for the first two weeks after surgery.
● Avoiding straining during bowel movement by eating fiber. 

  • DO YOU HAVE QUESTIONS ABOUT Orchiectomy?
  • TELE CONSULT WITH YOUR UROLOGIST

Patient safety is our priority

● Redness, pus or bleeding from the incision site.
● Severe pain or loss of feeling around the scrotum.
● Fever over 100 degree F.
● If you notice hematoma (a large purple area on the scrotum which indicates there is blood in that area).
● Inability to urinate.
● Contact doctor if you notice any of the above complications. 

  • DO YOU HAVE QUESTIONS ABOUT Orchiectomy?
  • TELE CONSULT WITH YOUR UROLOGIST

What's important after discharge?

● Loss of muscle strength.
● Osteoporosis (a condition in which the bone tissue becomes fragile as a result of hormonal changes).
● Low level of fertility (or perhaps loss of fertility).
● Loss of sex drive and inability to get or maintain an erection.
● Hot flashes.
● Weight gain.
● Depression or low mood.
● Erectile dysfunction.
● Increased risk of cardiovascular disease. 

  • DO YOU HAVE QUESTIONS ABOUT Orchiectomy?
  • TELE CONSULT WITH YOUR UROLOGIST

© Copyright 2020 Ratkal Speciality Hospitals Pvt. Ltd. - All Rights Reserved. Created by PNJXN