Tuesday, February 26, 2013

DR ABDUL FATAH SIDDIQUI - NEW CONSULTANT UROOGIST JOINS RAMAYYA PRAMILA UROLOGY HOSPITAL


Ramayya Pramila Urology Hospital is known for rendering Urology services for 24/7 .We have a team of Urologists micro specialising into different urological sub specialities.
Dr Ramesh Ramayya - LAER prostatectomy and HIFU for prostate cancer
Dr Vishwambhar Nath - Uro-oncology 
Dr Naveenchandra Acharya - Male infertility and impotence and Uro-oncology
Dr Vamshi Krishna - Laparoscopic Urology and Paediatric Urology
Dr Runa Kamat - Female Infertility


In addition we are honoured to have Dr Abdul Fatah Siddiqui - Specialist in Endo-urology (especially RIRS and microperc) as a team member. We are one of centres performing high number of Microperc and RIRS(probably the only centre in Hyderabad and Andhra Pradesh)

LASER TURBT


We use Thulium LASER routinely for bladder tumor-Trans Urethral Resection of Bladder Tumor(TURBT).

The settings we use are 30 W ..It has been proved that the LASER TURBT is safe; the obturator reflex, bleeding, catheterisation time and the perforation are less frequent as compared to routine monopolar TURBT.


This is one video to show the resection of small polyp with the Thulium LASER. 

Saturday, February 23, 2013

COMPLETE STONE CLEARANCE PACKAGE


We in Dr Ramayyas Pramila hospitals offer complete stone clearance package.Any stone burden howsoever it may be  is cleared with different modalities like PCNL/RIRS or ESWL.
We are equipped with Dornier lithotriptor which is supposed to be the best. The lithotripsy is carried out under effect of sedation so the procedure is completely painless and day care in most of the cases.

We have different instruments for doing PCNL like regular PCNL equipment by both Storz and Wolf,Mini Perc and Microperc(4.3 Fr sheath by Scholly--First time in Andhra Pradesh).
RIRS is done quite regularly here -both primary and secondary RIRS under general Anesthesia.(We are equipped with DUR-8 ELITE and Olympus scopes).

With these state of the art equipement we clear all the stone burden either with single modality or combination of all the above methods.We routinely get plain CT scan KUB or USG KUB after the procedures to rule out any residual fragments.




We did PCNL today and used olympus flexible scope to extyract the stones in lower calyx as there was a lot of torque while approaching the lower calyx with rigid nephroscope.The puncture was done through the upper calyx supracostal.The stones were cleared on both endoscopy and fluoroscopy.

Friday, February 22, 2013

ONE OF THE LARGEST SERIES OF RIRS IN 2012: FOR RENAL CALCULI


Laser lithotripsy is the fragmentation of calculi using the Holmium laser. The high absorption of the Holmium laser light (wavelength: 2.1 µm in the infrared) by the calculus leads to the ablation of the calculus material regardless of its chemical composition. Endoscopic imaging and controlled laser pulses ensure safe contact between the fiber tip and calculus. Thin fibers with a core diameter of 200 µm allow thinner endoscopes to be used to advance to the renal calyces.  Lithotripsy using the holmium laser is characterized by a high success rate and low complication rate for all types of calculi.
We have recently done 100 cases of RIRS last year(probably one of the largest series in hyderabad) sucessfully with Holmium laser and RIRS -olympus scope.

Tuesday, February 19, 2013

CME PROGRAMME ON PROSTATE CLINIC AND RENAL STONE DISEASE






The CME was held on 17-02-2013 Sunday at Hotel Sai Prakash by Dr Ramayyas Pramila Hospitals.The symposium was well attended by 30 Doctors from South Zone of Hyderabad,mostly from Old City.All of them are General Practitioners.
The CME was opened by a Welcome Speech by me  followed by the Hospital introduction Presentation  by Dr.Shiva Prasad,MD (Anest),Chief of Anesthesia.He spoke about the core values of the Hospital,committed and dedicated team and their availability round the clock,the achievements of the Hospital and the free consultation on every Sunday.


The First Keynote Speaker,Dr.Naveen Chandra Acharya,Chief of Urology,spoke in his presentation entitled "Prostate Cancer Detection and Treatment" about who are at risk,Scale of the problem,issues of Screening,Options of Treatment.Early detection of Prostate Cancer,Emerging Therapies like Laparoscopic Radical Prostatectomy,Robotic surgery and HIFU.

 Dr.Abdul Fatah,Consultant Urologist, the Second Keynote Speaker spoke  in his presentation entitled,"Renal Stones:  An Overview"about  Pathogenesis, Risk factors,Clinical features, Evaluation, Treatment, Role of stents,Metabolic Evaluation and Preventionfollowed by Question & Answer Session.

Dr.Shiva Prasad formally closed the program  by delivering a vote of Thanks to the speakers and the Sponsors.

Friday, February 15, 2013

DR RAMAYYAS PRAMILA HOSPITALS STARTS DOING MICRO-PCNL MOST MINIMALLY INVASIVE TECHNIQUE OF DOING PCNL FOR RENAL STONES FOR THE FIRST TIME IN ANDHRA PRADESH


Calyceal diverticular stones and residual fragments post PCNL and ESWL  are the difficult stones; various modalities have been employed by the urologists like RIRS, redo- PCNL etc. But we have started treating these stones with micro PCNL with tiny puncture and almost no complications. We did Micro PCNL in eight cases.
Procedure:




It was done with 4.3 Fr nephroscope. Initial puncture and dilatation was done till 8 Fr and with Holmium 30 W energy stone pulverization is done. A 6 Fr feeding tube is kept in the tract for 24 hours and then it is removed and the patient is discharged after 24-36 hours.

Dr Ramayya Pramila Hospitals consultant honoured as invited faulty at APSSM 2013 at Kanazawa,Japan



Erectile dysfunction(Ed) in 85% of cases can be attributed to atherosclerotic vascular disease, diabetes, or medications. Endothelial dysfunction(ED) is one of the earliest manifestations of atherosclerotic vascular disease and can be detected in damaged blood vessels at a much earlier stage. ED has also been suggested as clinical biomarker for the damaging effects of cardiovascular risk factors that may precede overt manifestations. With the hypothesis, we conducted a study of ED in Ed patients with no cardiovascular disease.

We found out that erectile dysfunction patients without CAD have underlying ED and its severity is related to severity of ED. 
This paper was accepted at APSSM 2013 and Dr Naveenchandra Acharya ,Chief Urologist has been invited as Faculty to talk on the subject of endothelial dysfunction and its effect on erectile dysfunction.The conference is to be held at Kanazawa,Japan on May 29 to June 2 ,2013.

Wednesday, February 13, 2013

PARAPHIMOSIS MANAGEMENT FOR GENERAL PRACTITIONERS


  • Paraphimosis is a condition where foreskin becomes trapped behind glans penis and cannot be reduced to normal position.
  • The foreskin may be retracted during penile examination, penile cleaning, urethral catheterization, or cystoscopy
  • If the foreskin is left retracted for a long period, some of the foreskin tissue may become edematous (swollen with fluid), which makes subsequent reduction of the foreskin difficult. Constricting ring initially impairs venous blood and lymphatic flow from the glans penis and prepuce, in turn causing edema of the glans. The ensuing tissue ischemia and vascular engorgement cause painful swelling of the glans and prepuce and may eventually lead to gangrene or auto amputation of the distal penis

Prevention and management:
  • Paraphimosis can be avoided by bringing the foreskin back into its reduced position after retraction is no longer necessary
  • Paraphimosis can often be effectively treated by manual manipulation of the swollen foreskin tissue. This involves compressing the glans and moving the foreskin back to its normal position, perhaps with the aid of a lubricant, cold compression, and local anesthesia as necessary
  • If this fails, the tight edematous band of tissue can be relieved surgically with a dorsal slit or circumcision.



First to start TURis technology for prostate vaporization in Hyderabad

The TURis plasma vaporization electrode does not cut off tissue with a loop, but energetically vaporizes the tissue with a small button electrode. With the help of the latest plasma technology, cells can be removed by merely gliding the electrode over the prostate tissue. A smooth tissue surface is left behind - no healthy tissue is irritated or injured by plasma vaporization as the plasma corona reduces the depth of the energy. Vaporization of the tissue is performed by the plasma corona utilizing a controlled high-frequency energy peak of approximately 300 Watts.  Bleeds during and after this minimally invasive surgery can be avoided with this technique and quick healing of the wound stimulated.


Plasma vaporization represents an innovative surgical treatment option that can remove the cause of BPH safely, gently and with high efficiency. It can be done safely in patient on anticoagulants and anti platelet agents
The resectoscope used was an Olympus 26F in continuous flow-type Iglesias with continuous aspiration. The loops were all disposable/single use. We did 13 cases till now for prostate gland from 30 gm to 75 gm in size and 3 cases of bladder tumor resection. Till now there was no incidence of unwanted stimulation of the obturator reflex, TUR syndrome, thermal skin lesion, blood transfusion, urethral strictures, and bladder neck contractures. 

Establishment of Exclusive prostate clinic


Ramayya  Pramila  Process Driven HealthCare  Urology Hospital,  a  division of  Ramayya Pramila HealthCare  Pvt Ltd.has launched an exclusive prostate clinic.  The  journey of Ramayya Pramila began in 1970 and in the journey of the last four decades of Specialized Health Care  Services its core values  of Care, Commitment , Compassion and Collaboration  has made us a premier Uro-Surgical Centre  in  State of Andhra Pradesh.Our Hospital is a AAA Hospital for all our patients – Affordable- Transparent, all inclusive packages, Available- 24/7 full time Urologist Consultants, Affable- warm and friendly environment for both patients and attendants .
It created history by being one of the  first specialty surgical center worldwide and the first  in the State of Andhra Pradesh.  The Center is now Managed by his son Dr. Ramesh Ramayya. We offer technology intensive and State of the Art Urology Service.  We have four highly qualified, experienced and committed full time urologists offering a 24/7 Urology service.
 We recently launched an exclusive Prostate Clinic. In addition we are in the process of launching a series of specialty clinics like UTI (Urinary Tract Infection) , Urine leak , Stone Clinic , Infertility and Sexual Desire Clinics which will benefit the patient.  These clinics will concentrate on preventive aspects which will therefore avoid surgery as timely medical attention will be given, We are also one of the few centers in the country working in a paperless clinical environment thus allowing transparent audited practice.
Our team of dedicated urologists armed with technology intensive equipment offer a 24/7 State of the Art Urology Services. They conduct health camps, specialized clinics, workshops and Continuing Medical Education Programs. 
The recent launch of the prostate clinic was an attempt to provide all the facilities for prostatic ailments like- clinical consultation,urodynamic assessment,Laser prostatectomy(Thulium LASER- which is all  set to become the new platinum standard for prostate surgery),Laproscopic and open radical prostatectomy,TURis for prostate vaporisation without blood loss, and HIFU(the only centre treating prostate cancer with noninvsaive ultrasonic technology delivered on a robotic arm).

Tuesday, February 12, 2013

Launch of exclusive prostate clinic


Launch of ISD clinic


MAJOR ISSUES IN SEXUAL MEDICINE THESE DAYS IN INDIA



Female sexual dysfunction and unconsummated marriages:
Despite the land of Kama sutra; the Indian society is still largely conservative about sexual issues. There is lack of proper sex education in Indian High schools and adolescents. The sex word is supposed to be a taboo in both urban and rural society. Although the concept of swayamvara (girl choosing her own groom) existed in Indian Vedic Literature some 4000 years ago; the arranged marriages are still prevalent in the Indian subcontinent. The Institution of arranged   marriages in India has been proved to be immune to the social, economic and educational progress what India has achieved. In rural background many a times the arranged marriages are forced on girls on the basis of caste and financial reasons.
Only 1.1% of marriages in India result in a divorce compared with over 45.8% in the United States, though the Indian figure appears to be rising. The remarkably low rate of divorce can also be because of female partner silently suffering in the forced marriages without voicing any discontent about physical/verbal abuse. They are also less likely to complain about dissatisfaction about sexual life.
The main problem with arranged marriage many a times is that there is no proper communication between the couple especially on the issues of sexual needs and preferences. This lack of sexual communication in the immediate post marriage life can lead to marital malaise and unconsummated marriage. Lack of privacy, system of combined family; orthodox society, and lack of sexual education during adolescence leads to a lot of sexual problems in newlywed couples. In Indian society that premarital relationship is not accepted so most of the girls are virgins till the marriage. So there is lot of fear and anxiety amongst the females after the marriage regarding the coital act.
Unconsummated marriages are the most commonly seen problem in sexology clinic. This is prevalent among 5 to 10 per cent of the marriage population in India. In most cases, the female partner does not allow the male to have an intercourse due to fear of pain.Vaginismus is the commonest reason; anxiety being the common reason. The vaginal muscles contract because of panic reaction leading to severe pain during insertion. Proper sexual counseling and dilatation is the answer for this problem.
In India there are very few systematic sex surveys conducted; so proper information about sexual dysfunction is not available. Female sexual dysfunction is highly prevalent to the extent of around 2/3 rd of married woman suffering from it. Singh et al presented one interesting paper regarding this problem and have highlighted the high prevalence of sexual problems in Indian women.
Average Indian woman has a tendency to neglect the body predisposition after marriage. Multiple child births most often by Dayas (synonym: midwifery in rural Indian set up), sedentary life style, lack of  exercise leads to problems like putting on weight and loose vagina.The lack of self esteem and culture of silence further aggravates the sexual dysfunction in them. Frigidity is common and many a times they just indulge in coital act for fear of verbal/physical abuse upon refusing it.
Male sexual dysfunction:
Khurana et al have shown in their study shown that around 1/3 rd of Indian men have metabolic syndrome in the form of dyslipidemia, and diabetes. The pandemic of diabetes in India has also led to increase in incidence of sexual dysfunction. As metabolic syndrome and endothelial dysfunction (hence erectile dysfunction) go hand in hand; the erectile dysfunction may be higher in India than the other countries in the world. In urban India with the advent of software and BPO companies, night duties and long stressful working hours have contributed to increased incidence of sexual dysfunction. Of late there has been increased awareness about sexual problems in Indian men due to mass media, newspapers, late night programs in TV channels and various web marketing programs. The proportion of couples seeking an appointment with the sexologist is on the rise. One of the welcome changes that is happening now-a-days is the couple coming together and visiting the doctors. The female counterparts are also forthcoming in their complaints especially in urban India. The general myths like Dhat syndrome (losing semen and hence energy) and guilt/misconceptions about the masturbation still continues to haunt the adolescents in India. The age old misconception about losing one drop of semen is equal to 40 drops of semen is still surprisingly high in adults because of lack of sex education. In certain rural areas, there is a general misconception that the sex with the virgins gives relief from venereal diseases. This only underscores the urgent need of starting sex education right at the high school age on a warfooting.   
Various sexual practices and problems with sexual orientation in India:
Different sexual practices in India are influenced by the social and religious laws (sexual morality).Anything other than conventional sexual practices are not encouraged and viewed with disgust. In fact, oral sex is listed as 'illegal' under Section 377 of the Indian Penal Code, stated as being 'carnal intercourse against the order of nature', which does not carry the potential for procreation. But with the exposure to internet and pornographic literature more and more young adults and couples are engaging in alternative sexual practices. Common trends what we see in sexology clinic is more and more couples are engaging in foreplay, oral sex and other sexual positions other than the routine missionary position.
The prevalence of lesbian, gay, bisexual and transgender life styles (LGBT) is not known but logically it must be the same as in any other countries. There is general reluctance on the part of people to talk and express their views about it. The Delhi High Court struck down the provision of Section 377 of the Indian Penal Code which criminalized consensual sexual acts of adults in private, holding that it violated the fundamental right of life and liberty and the right to equality as guaranteed in the Constitution. But there has not been any positive response from the Government on this issue; it remains to be ambivalent about this problem.
The last area of concern is HIV endemic in India. The National AIDS Control Program, with its focus on educating the general population about responsible sexual behavior, safer sex and condom use has had a significant impact. The reduction in the rate of HIV transmission in the country suggests success.