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1.What is Urology.

This division also includes ANDROLOGY, that deals with the issues related to male factors of infertility, erection problems in males and ejaculatory dysfunctions in younger and middle-aged males. Andrology, in liason with clinical psychology also deals with the psychological and sociological aspects of marriage related mental trauma and agony, where adequate counselling is being given for the problems that the newly married couple come to us with.

The scope of urology is big and various sub-specialities are being introduced by the Urological Society of India.

Pediatric Urology – urinary problems in children

Urologic Oncology – cancer of urinary tract

Kidney Transplantation – in patients with end stage kidney failure

Male Infertility – both erectile, ejaculatory and fertility related problems in males

Urinary tract stones – another upcoming speciality, where the entire treatment modality shifted from open stone surgery to endoscopic to minimally invasive key hole surgeries and now slowly drifting towards ultra-minimally invasive endoscopic surgeries once again.

Female Urology – deals with urinary problems in women.

Neurourology – urological complications of neurological diseases like urinary problems occurring after child birth, major pelvic radical surgeries and infective problems affecting the spinal cord.

6.Stone diseases

a.How are kidney stones formed?

Stones are heavier substances formed from diverse chemical substances from within the urine. Urine has diverse excreta dissolved in it. When there may be an excessive amount of waste into less liquid, crystals start to aggregate. The crystals aggregate and join together to develop into a hard and solid component that grows over time, gets heavier with an increase in size, descends from the kidney into the drainage portion of the kidney  and gets passed out in urine. Various chemicals like calcium, oxalate, cystine, xanthine, phosphates and antacids can form kidney stones. Not keeping one well-hydrated is one of the basic reasons why the patient develops kidney stones.

b.Are they always hereditary?

Not always, but yes, there are a few conditions that lead to stone formation in families. It is important to identify those conditions, treat the underlying cause and then treat the stones.

c.What are the common types of stones that we get affected with?

Common stones are calcium oxalate stones. These develop when urine contains low levels of citrate (that acts as a base to neutralize the acidicty of urine) and high levels of calcium and either oxalate or uric acid. Uric acid stones are seen in selected patients only.

Stones are associated with infections too. They are called as STRUVITE stones. Such ones are seen in chronic urinary tract infection (UTI) with bacterial (gram-negative bacteriae), organisms that split urea into ammonia, that subsequently combines with phosphate and magnesium to crystallize into a stone.

d.What are the symptoms of kidney stone?

Stones are of various sizes. They range from sand particles to larger pebbles. A few are as large as the size of the kidney itself! Though the generally accepted rule is that, the larger the stone, the more noticeable are the symptoms, smaller stones too can indeed be catastrophic. Occasionally, tiny stones of the size of a mustard seed can get trapped at the place of junction of the draining tube with the bladder and produce severe pain, infection and chills and rigor.

The symptoms could be one or more of the following:

• Intractable pain in the; loin region or upper back
• vague pain in upper back, that is too ill-localised
• fever and chills and rigor – suggest infections of kidney
• blood in the urine – can cause panic in patients’ mind.
• nausea or vomiting
• foul smelling urine or a turbid/cloudy urine.

Kidney stones produce pain, only when they obstruct the flow of urine. Urinary obstruction will lead on to the stretching of the coverings of the kidney. Sudden stretching of the coverings of the kidney produce severe pain, called as COLIC.

Please remember: Pain occurs only when the kidney makes efforts to push the stone out. Absence of pain in the presence of the stone only indicates that the kidney is too fatigued or not making efforts to push the stone out.

 e.What are the treatment options available for getting rid of kidney stones?

The best form of treatment is prevention. Patients are encouraged to take large quantities of water, sufficient enough to maintain a urine output of 1.5 litres per day. They are also encouraged to look at the clock and empty urine, so that urine stasis can largely be avoided.

Smaller stones, less than 4 mm are generally left untreated. They are clinically insignificant and usually pass out without much difficulty. Sometimes, smaller stones may get stuck at the lower end of the draining tube (ureter) and produce severe pain, necessitating early intervention.

Stones in the kidney, smaller than 1 cm are best treated by shock waves that are transmitted from external source (ESWL). Such stones are these days, being treated by flexible scopes that are passed into the kidney through the urinary passage. The advent of Laser has largely revolutionized such treatments using flexible scopes (RIRS). Larger stones in the kidney are best treated using a key hole surgery, where a small hole is made in the upper back, a scope is passed into the kidney directly and the stone is blasted and removed (PCNL). Stones that have dropped down into the ureter are best removed using ureteroscope and laser machine.

f.Do all kidney stones need to be intervened?

Not really. Various factors decide the need for intervention. Size of the stone, degree of infection, extent of kidney damage and the severity of symptoms decide the need for intervention.

g.How good is medical treatment for kidney stones?

Medical treatment is useful in two ways. One, to expel the stone that has descended down from the kidney into the draining tube (ureter) and two, to dissolve the small renal stones that form due to certain specific metabolic reasons.

h.What happens if a stone is left untreated?

Long term untreated stones in the kidney form a nidus for infection and damage the kidney over time. Stones that have descended into the ureter cause obstruction to the flow of urine, swell up the kidney ad result in reversible/irreversible damage to the kidney over a period of time.

i.What precautions are to be taken to prevent recurrent stone formation?

It is important to identify any specific reason for stone formation, identify the root cause and treat the cause accordingly. Addressing each case according to the root cause largely helps in prevention of stone recurrences.

j.Is it always useful to do a stone analysis?

Not always useful, as many a time, the report will show abundance of calcium, oxalates and phosphates. This is only confuse the patient regarding what diet to dfollow, what to take and what not to take. On the contrary, the stone analysis may be very useful in certain specific scenarios. Patients with stones in kidneys, young age stone formers and stone formers due to certain metabolic diseases are the best ones to get benefitted by such analysis.

k.Is milk restriction really helpful in stone recurrence?

Not really. As long as one is not used to taking many cups of milk in a day, daily ingestion of 3 to 4 small cups of coffee or tea or milk will not greatly influence stone formation.

l.Do children develop kidney stones?

Yes, children with stone disease need to be evaluated in greater detail to find out the reason for stone formation.

7.What is a prostate gland?

17.What is erectile dysfunction?

Here are the most common symptoms of ED:

• Difficulty getting an erection
• Difficulty maintaining an erection
• Reduced interest in sexual activity
• Low self-esteem

If these symptoms are present, a diagnosis of  ED is made. A doctor might also perform a physical exam and ask for a complete medical history. Sometimes, ED may be a warning sign of more serious underlying medical conditions like cardiovascular disease, so a doctor might order blood tests to check for other medical problems.