Dr. Zaffar K. Sayed

Kidney stones can be as small as a grain of sand or as large–sometimes larger to an extent that it measures more than 5 cm in size. They can stay in your kidneys or travel through your ureters (the tubes that goes from your kidneys to the bladder and drains urine into the bladder normally), and out of your body with your urine. When a kidney stone moves through the ureters and out through urethra (tube that allows passage of urine from the bladder out of the body) with the urine, it is called passing a kidney stone. A kidney stone can also get stuck in your urinary tract and block urine from getting through. When you pass a stone or a large stone in the tube blocks the flow of your urine, it can cause unbearable pain and also other severe symptoms of kidney stones like fever, burning sensation or pain while passing urine, nausea, vomiting, blood in urine or inability to pass urine with complete blockage flow of urine. TYPES OF KIDNEY STONES Calcium stones are the most common type of kidney stones. They are usually made of calcium and oxalate (a natural chemical found in most foods), but are sometimes made of calcium and phosphate. Uric acid stones form when your urine is often too acidic. Uric acid can form stones by itself or with calcium. Struvite stones can happen when you have certain types of urinary tract infections in which bacteria make ammonia that builds up in your urine. Struvite stones are made of magnesium, ammonium and phosphate hexahydrate. Cystine stones are made of a chemical that your body makes naturally, called cystine. Cystine stones are rare, and happen in people who have a genetic disorder that causes cystine to leak from the kidneys into the urine WHAT ARE THE CAUSES AND RISK FACTORS OF KIDNEY STONES? Anyone can get a kidney stone, but some people are more likely than others to have them. Men get kidney stones more often than women do. Kidney stones are also more common in non-Hispanic white people than in people of other ethnicities. You may also be more likely to have kidney stones if: You have had kidney stones before. Someone in your family has had kidney stones. You don’t drink enough water. You follow a diet high in protein, sodium and/or sugar. You are overweight or obese. You have had gastric bypass surgery or another intestinal surgery. You have polycystic kidney disease or another cystic kidney disease. You have a certain condition that causes your urine to contain high levels of cystine, oxalate, uric acid or calcium. You have a condition that causes swelling or irritation in your bowel or your joints. You take certain medicines, such as diuretics (water pills) or calcium-based antacids. You have some structural (anatomical) problem in the urinary tract that is leading to sub-optimal urinary drainage out of the body WHAT ARE THE SYMPTOMS OF KIDNEY STONES? Sharp shooting episodic pain in your back or lower abdomen Pain while urinating Blood in your urine Nausea and vomiting Fever Why You Should Not Delay Kidney Stone Surgery? Can cause damage to the whole kidney or the urinary tract requiring additional corrective procedures Can cause blood loss through the urinary passage Can cause urinary tract infection Can cause of Chronic Kidney Disease (CKD) requiring Dialysis or Kidney transplant in the long run Treatment Option of Kidney Stones Extracorporeal Shockwave lithotripsy (ESWL) Ureteroscopy and treatment of stones (Commonly known as URS) PCNL (Percutaneous Nephrolithotomy) Flexible Nephro-ureteroscopy with LASER treatment of stones RIRS - Retrograde Intra Renal Surgery ECIRS - Endoscopic Combined Intra Renal Surgery Why Laser Surgery for Kidney Stone? Quick recovery Minimal pain Minimal bleeding Quick recovery Shortest possible hospitalisation Relatively higher stone free rate (clearance of stone)

Holmium laser enucleation of the prostate (HoLEP) is a type of laser surgery used to treat obstruction (blockage) of urine flow as a result of benign prostatic hyperplasia (BPH). In men with BPH, the prostate gland is not cancerous but has become enlarged. An enlarged prostate can result in a number of urinary tract symptoms such as frequent urination, getting up multiple times in night to pass urine, poor stream, straining or need to apply pass urine, difficulty in starting urination, or loss of bladder control. Holmium laser enucleation of the prostate (HoLEP) as more effective surgical procedure for urinary tract obstruction due to bph as compare to other surgical intervention such as Transurethral resection of the prostate (TURP (Monopalar/ Bipolar)), Transurethral resection of the vaporization prostate and potentially less costly surgery for urinary obstruction due to BPH, as compared to other surgical options such as laser vaporization and transurethral resection of the prostate. How does holmium laser enucleation of the prostate (HoLEP) work? The holmium laser is a surgical laser that has been found particularly effective in performing several types of urological surgeries. In the case of HoLEP, the laser is used to cut and remove the bulky prostate tissue that is blocking the flow of urine. Who needs to have holmium laser enucleation of the prostate (HoLEP)? BPH occurs in more than 40 percent of men over the age of 60 and is a leading cause of urination symptoms, including difficulty in passing urine. As men age, the symptoms of this condition can worsen. Although many cases of urinary obstruction from BPH can be treated without surgery, patients who do not benefit from such medical treatments may eventually need surgery to avoid or deal with long-term problems such as retention of urine, urinary tract infections, and bladder stones. Patients who are appropriate for HoLEP are typically symptomatic due to very large prostates. What are the advantages of holmium laser enucleation of the prostate (HoLEP)? Use of HoLEP in many different parts of the world has shown it to be a safe and effective procedure. Although there are many types of BPH surgeries available, HoLEP offers a unique advantage in being able to remove a large amount of tissue without any incisions on the body, even in very large prostates, while decreasing the risk of bleeding and providing tissue for pathology (to look for cancer). This decreases the need for blood transfusions during surgery, minimizes the time of stay in the hospital to one or two days, and reduces the risk of needing repeat treatment.

Laparoscopic surgery and hand-assisted laparoscopic surgery (HALS) are “minimally invasive” procedures commonly used to treat diseases of the urinary tract. Unlike traditional surgery on the intestines or any other organs of the abdomen where a long incision down the center of the abdomen is required at times, laparoscopic surgery requires only small “keyhole” incisions on the abdomen. In case of hand-assisted surgery, in addition to keyhole, a 3-4 inch incision is also used to allow the surgeons hand to gain access into the abdominal cavity for further manipulation/operative intervention. As a result, the person undergoing these laparoscopic procedures may experience less pain and scarring after surgery, and a more rapid recovery. It is a surgical procedure that employs fiber-optic instruments to inspect and operate on the organs inside the abdomen or the pelvic cavities.During laparoscopy, an instrument called a laparoscope is inserted into the abdomen through a very small incision in the abdominal wall. A laparoscope is a long, thin tube with a high-intensity light and a fibre-optic camera on the end which transmit images to an external video monitor and with the help of this visual assistance the operating surgeon completes his/her procedure, even the most difficult surgical interventions successfully with ease. Ablative Procedures Laparoscopic Nephrectomy Laparoscopic Radical nephrectomy Laparoscopic Parial nephrectomy Laparoscopic Nephroureterectomy Laparaoscopic Adrenalectomy Laparoscopic Prostatectomy Laparaoscopic Donor Nephrectomy Reconstructive Procedures Laparoscopic Pyeloplasty Laparoscopic Ureteric Reimplantataion Laparoscopic VVF repair SOME OF BENEFITS OF LAPAROSCOPIC SURGERY Lower risk of bleeding. Laparoscopic surgery can be a good option for men who take medication to thin their blood or who have a bleeding disorder that doesn't allow their blood to clot normally. Quicker recovery Accuracy Cost Effective Procedures More-immediate results. Improvements in urinary symptoms from Laparoscopic surgery are noticeable right away. It can take several weeks to months to see same level of noticeable improvement with medications

The prostate is a small organ normally about the size of a walnut. It lies below the bladder (where urine is stored) and surrounds the urethra (the tube that carries urine from the bladder to the exterior). Prostate gland makes a fluid that helps in nourishment of sperm as part of the semen (ejaculatory fluid). Prostate related problems are common in men of age 50 and older. An urologist is a specialist in diseases of the genitourinary system, including diagnosing and treating all the problems related to prostate gland for example age related increase in size of the prostate called as BPH to more complex and malignant condition like prostatic cancer as well. . What is Benign Prostatic Hyperplasia? Benign prostatic hyperplasia (BPH) is non-malignant (noncancerous) enlargement of the prostate gland, a common occurrence in older men. It generally evolves slowly, and commonly causes symptoms after age 50 though rarely a cause of symptoms in younger age group. Signs and symptoms of benign prostatic hyperplasia Frequent Urination Sensation of Incomplete emptying of bladder Nocturia (Getting up multiple times in night to pass urine during sleep) Dribbling at the end of your urinary stream Incontinence, or leakage of urine A sudden strong desire to pass urine A slowed or delayed urinary stream Painful urination Blood in the urine Complications of benign prostatic hyperplasia Sudden inability to urinate (urinary retention). Urinary tract infections (UTIs). Bladder stones. Bladder damage. Kidney damage. The size of your prostate doesn't necessarily determine the severity of your symptoms. Some men with only slightly enlarged prostates can have significant symptoms, while other men with very enlarged prostates can have only minor or no urinary symptoms. Investigation for Prostate USG of KUB : Ultrasound of the Kidneys, ureters and urinary bladder along with prostate is a valuable basic screening scan that helps to understand the size of the prostate along with the status of other parts of urinary tract and it's abnormalities. Also, it helps in assessing prevoid and postvoid urine volumes. Urinalysis : Your urine is checked for blood, bacteria, sugar in case of Diabetics and Proteins in patients with longstanding kidney disease. Urodynamic test : This blood test is a marker which helps in detection of cancer of prostate gland. It's a organ specific marker and not disease specific so it can be deranged in other non cancerous conditions as well like Prostatic infections, Inability to pass urine (Urinary retention) due to various reasons, Foley catheter insertion (Tube put to drain urine), any instrumentation or interventions involving urinary tract. Uroflowmetry (UFR-PVR) test : While doing this test, when patient gets a normal desire to pass urine, he/she is asked to pass urine in a container which is connected to a machine, showing the urinary flow details and then immediately post void residue is also checked to assess the volume of urine left behind in the bladder after one has completed urination. Prostatic biopsy : A small amount of prostate tissue is removed under guidance with the help of a needle and it's examined under microscopy for abnormalities. Cystoscopy: This is an examination of meatus, urethra including prostate and bladder with a tiny lighted scope that is inserted into urinary passage leading to the interior of the bladder. This can be a diagnostic procedure for assessing the lower urinary tract or done at the time of therapeutic intervention like TURP. Intravenous pyelography or urography: This is an X-ray exam or CT scan that is done after a dye is injected into your body. The dye highlights your entire urinary system involving Kidney ureters and bladder on the images produced by the X-ray or CT. Assessing the impact of obstruction created by the prostate gland on the upper urinary tract comprising kidneys and ureters. Treatment Procedures of benign prostatic hyperplasia Transurethral resection of the prostate (TURP) can be used for patients for whom benign prostatic hyperplasia (BPH) severely affects day today life even on medical management. TURP is a commonly used endoscopic surgical treatment during which a surgeon inserts a instrument called resectoscope into the urethra. The resectoscope is a tool that allows a Uro-surgeon to remove the enlarged prostate gland part. It is actually done by passing an electrical current through the cutting loop which is attahced to the resectoscope it cuts off small pieces of the prostate gland in “chips.” After finishing cutting away the prostatic chips, the surgeon will flush the urethra and the bladder to remove the tissue that has been extracted from the prostate. Finally, a catheter is inserted to allow the passage of urine out of the body. When the catheter is removed a few weeks later, the body has a wider channel to pass urine out of the body. This wider passage alleviates severe symptoms of BPH. HOLEP Procedureare It's a minimally invasive surgical procedure used to treat BPH. HoLEP uses a laser to remove obstructive prostate tissue, providing relief from urinary symptoms associated with BPH. It's considered an effective treatment option with fewer complications compared to traditional surgical method like TURP. Thulium Laser Enucleation of the Prostate (ThuLEP) is also a minimally invasive surgical technique used to BPH. It involves using a thulium laser to precisely remove the obstructive prostate tissue. This procedure has gained popularity due to its effectiveness in relieving BPH symptoms while minimizing complications and recovery time. Transurethral incision of the Prostate (TUIP) is an endoscopic surgical procedure used to treat benign prostatic hyperplasia in men. It involves making small incisions in the prostate gland to relieve the compression on the urethra and improve the flow of urine. TUIP is often considered an an option for men with relatively smaller prostate glands or less severe symptoms compared to TURP or other more invasive procedures.

Urethral stricture refers to any narrowing of the urethra for any reason whether or not it actually impacts the flow of urine out of the bladder. Any inflammation of urethra can result in scarring, which then can lead to a stricture or a narrowing of the urethra. Trauma, infection, tumors, surgeries, or any other cause of scarring may lead to urethral narrowing or stricture. Mechanical narrowing of the urethra without scar formation (developmental causes or prostate enlargement) can also cause urethral stricture. Urethral stricture is significantly more common in men and boys compared to women and girls. This condition is considered rare in females. Injury or damage to the urethra can heal with scar tissue that may cause a stricture. There are various types of injury that can damage the urethra. For example, an injury may occur during surgical procedures to look into your bladder via your urethra; radiotherapy treatment may damage your urethra; a fall astride on to the frame of a bike can cause damage. Infection of your urethra is another cause - for examples Sexually transmitted infections such as gonorrhoea or chlamydia. Infection as a complication of the long-term use of a tube (catheter to drain your bladder.Infection may cause inflammation in the tissues in and around your urethra. Common Causes of Stricture Urethra Trauma from injury or accidents (for example, falling on a frame of a bicycle between the legs, or a car accident) Pelvic injury or trauma Previous procedures involving the urethra (urinary catheters, surgeries, cystoscopy) Previous prostate surgery (TURP or transurethral resection of the prostate) Prostate enlargement Cancer of the urethra (rare) Infections of the urethra (sexually transmitted diseases or STDs, urethritis, gonorrhea, chlamydia) Prostate infection or inflammation (prostatitis) Previous hypospadias surgery (a congenital birth defect in which the opening of the urethra is on the underside of the penis instead of the tip) Congenital malformations of the urethra, which rarely can cause urethral stricture in children Treatment Option of Urethral Stricture VISUAL Internal Urethretomy (VIU) Laser Endoscopic Urethretomy (OIU) End to End Urethroplasty Subtituation Urethroplasty (Buccal Mucosa Graft - Urethroplasty)

Erectile dysfunction (ED) is the inability of a man to achieve or maintain an erection sufficient for his or his partners sexual needs. Most men experience this at some point in their lives, usually by the age of 40, and are not psychologically affected by it. Causes of Erectile Dysfunction Erectile dysfunction is characterized by the regular or repeated inability to obtain or maintain an erection. There are several ways that erectile dysfunction is analyzed: Obtaining full erections at some times, such as when asleep (when the mind and psychological issues, if any, are less present), tends to suggest the physical structures are functionally working. Other factors leading to erectile dysfunction are diabetes mellitus (causing neuropathy). Causes of Erectile Dysfunction Drugs: Anti-depressants (SSRIs) and nicotine are most common Neurogenic disorders: Spinal cord and brain injuries, nerve disorders such as Parkinson’s disease, Alzheimer disease, multiple sclerosis, and stroke Psychological causes: Performance anxiety, stress, mental disorders, clinical depression, schizophrenia, substance abuse, panic disorder, generalized anxiety disorder, personality disorders or traits psychological problems, negative feelings. Surgery: Radiation therapy, surgery of the colon, prostate, bladder, or rectum may damage the nerves and blood vessels involved in erection. Prostate and bladder cancer surgery often require removing tissue and nerves surrounding a tumor, which increases the risk for impotence Ageing: It is four times higher in men in their 60s than in men in their 40s. Lifestyle: Smoking is a key cause of erectile dysfunction. Smoking causes impotence because it promotes arterial narrowing. Treatments of Erectile Dysfunction Vacuum devices: Vacuum erection devices, also known as vacuum constriction devices have been utilized for improving erectile rigidity for over a century. A vacuum constriction device (VCD) is an external pump with a band on it that a man with erectile dysfunction can use to get and maintain an erection. Penile Prosthesis: Penile prostheses are devices that are implanted completely within the body. They produce an erection-like state that enables the man who has one of these implants to have normal sexual intercourse. Alprostadil intraurethral (Muse) therapy involves placing a tiny alprostadil suppository inside your penis in the penile urethra Testosterone replacement therapy can be delivered via injection, patch, gel, gum and cheek (buccal cavity), intranasal, subcutaneous pellet, or oral PDE5 inhibitors as standard line of treatment in most cases

Male infertility is a man inability to cause pregnancy in a fertile female, commonly due to deficiency of sperm cells in the semen. Sexual dysfunction, also called erectile dysfunction, is an inability to maintain an erection sufficient for sexual intercourse. Both conditions may be treatable through medication or hormone therapy. Male infertility is due to low sperm production, abnormal sperm function or blockages that prevent the delivery of sperm. Illnesses, injuries, chronic health problems, lifestyle choices and other factors can play a role in causing male infertility. Common Symptoms of Male Infertility The main sign of male infertility is the inability to conceive a child. There may be no other obvious signs or symptoms. In some cases, however, an underlying problem such as an inherited disorder, hormonal imbalance, dilated veins around the testicle, or a condition that blocks the passage of sperm causes signs and symptoms. Problems with sexual function — for example, difficulty with ejaculation or small volumes of fluid ejaculated, reduced sexual desire or difficulty maintaining an erection (erectile dysfunction) Pain, swelling or a lump in the testicle area Recurrent respiratory infections Inability to smell Abnormal breast growth (gynecomastia) Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality Having a lower than normal sperm count (fewer than 15 million sperm per milliliter of semen or a total sperm count of less than 39 million per ejaculate) Common surgical procedure for Male Infertility Micro Surgical Varicocelectomy: When abnormal semen parameter is because of testicular vein varicosities, this need ligation of testicular varicose vein. In microsurgical technique, ligation of venous channel in done under operating microscope thus reducing risk of post operative scrotal oedema and no risk of injury to testicular artery. Testicular Biopsy: when sperm are nor seen in semen, then directly a small tissue is collected from testis by needle biopsy and the tissue is examined under a microscope to see either presence of sperm or to retrieve sperm for IVF.

Urologic oncology is the field of medicine concerned with the research and treatment of cancers of the urinary system for both genders, as well as those affecting the male sexual organs. Most often, these include cancers of the kidneys and bladder, as well as the prostate and testes. Women's cancers or cancers of the female reproductive systems are seen by gynecologic oncologists. Symptoms Blood in the urine, painful or burning sensation during urination and needing to urinate frequently, particularly during the night, are all symptoms common to bladder, kidney and prostate cancers. Kidney cancer may also result in symptoms of fever, unexplained weight loss, fatigue and a pain in the side of the abdomen that does not subside. Prostate cancer will affect the flow of urine; patients may experience difficulty starting or stopping urination; as well as difficulty in achieving an erection rarely. Testicular cancer often presents as an enlargement or swelling of the testicle, mild pain in the scrotum and/or pain in the groin, back or lower abdomen. Causes Smoking, certain bacterial infections and occupational chemical exposure are among the risk factors for bladder cancer. For kidney cancer, the risk factors include smoking, obesity, high blood pressure and heavy metal exposure. The odds of developing prostate cancer are raised by age and family history, while testicular cancer risk factors include family history and congenital abnormalities or birth defects of the testes, kidneys and penis. Different Types of Urological Cancer Prostate Cancer This is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing, however, there are cases of aggressive prostate cancers. The cancer cells may metastasize (local and distant spread of cancer to other parts of the body) from the prostate to other parts of the body, particularly the bones and lymph nodes. Prostate cancer may cause pain, difficulty in urinating, problems during sexual intercourse or erectile dysfunction. Other symptoms can potentially develop during later stages of the disease. Prostate cancer tends to develop in men over the age of fifty. Globally it is the sixth leading cause of cancer-related death in men. Prostate cancer is most common in the developed world with increasing rates in the developing world. However, many men with prostate cancer never have symptoms, undergo no therapy and eventually die of other unrelated causes. Many factors, including genetics and diet, have been implicated in the development of prostate cancer. The presence of prostate cancer may be indicated by symptoms, physical examination along with Digital Rectal Examination (DRE), Prostate-Specific Antigen (PSA) or Prostatic biopsy. PSA testing increases cancer detection but does not decrease mortality. Management strategies for prostate cancer should be guided by the severity of the disease. Many low-risk tumours can be safely followed with active surveillance. Curative treatment generally involves surgery, various forms of radiation therapy or less commonly, cryosurgery; hormonal therapy and chemotherapy are generally reserved for cases of advanced disease (although hormonal therapy may be given with radiation in some cases). The age and underlying health of the man, the extent of metastasis, appearance under the microscope and response of the cancer to initial treatment are important in determining the outcome of the disease. The decision whether or not to treat localised prostate cancer (a tumour that is contained within the prostate) with curative intent is a patient trade-off between the expected beneficial and harmful effects in terms of patient survival and quality of life. Kidney Cancer It is a type of cancer that starts in the cells in the kidney.The two most common types of kidney cancer are Renal Cell Carcinoma (RCC) and Urothelial Cell Carcinoma (UCC) of the renal pelvis. These names reflect the type of cell from which the cancer developed. The different types of kidney cancer (such as RCC and UCC) develop in different ways, meaning that the diseases have different outlooks (or prognosis), and need to be staged and treated in different ways. RCC is responsible for approximately 80% of primary renal cancers, and UCC accounts for the majority of the remainder. Bladder Cancer This includes any of the several types of malignancy arising from the epithelial lining (i.e. the urothelium) of the urinary bladder. Rarely the bladder is involved by non-epithelial cancers, such as lymphoma or sarcoma, but these are not ordinarily included in the colloquial term 'bladder cancer'. It is a disease in which abnormal cells multiply without control in the bladder. The bladder is a hollow, muscular organ that stores urine and is located in the pelvis. The most common type of bladder cancer recapitulates the normal histology of the urothelium and is known as transitional cell carcinoma or more properly urothelial cell carcinoma. Treatment There are three main categories of urologic cancer treatments: surgery, radiation and chemotherapy. A fourth option sometimes applied in the treatment of prostate cancer is termed active surveillance or watchful waiting. In this case, a prostate tumour that is determined to be of very small size and of slow growing in nature not actively treated until such a time that it is determined to be of greater risk to the patient.

Urological surgeries are surgeries which are associated with diseases that affect the male or female urinary tract & the male reproductive tract. The organs that fall under this field are kidneys, ureters, urethra, adrenal glands, urinary bladder and the male reproductive system (penis, testes, vas deferens, epididymis, seminal vesicles, prostate) Robotics in the field of urological surgery has been an exciting development. In urology, robots have been applied in two areas: Endourology and Laparoscopy. Some of Benefits of Robotic Surgery Precision Three D natural vision Better hand-eye coordination Enhanced depth perception Seven degrees of freedom movements Ergonomic design Reduced chances of surgeon fatigue. Robotic urological surgery is slowly becoming the gold standard for certain procedures. In cases of cancer of the prostate wherever indicated, a Da Vinci Robot used for Radical Robotic Prostatectomy (RRP) is the preferred plan of treatment. Benefits of robotic prostatectomy over open prostatectomy & laparoscopic prostatectomy are as follows: Faster return of sexual function (erectile function) Increased chance of return of urinary continence within 6 months of surgery Less loss of blood Lower risk of wound infections & complications Shorter hospital stay & recovery time Better nerve sparing rate