Ramayya pramila succesfully operated on 95yr old gentleman with urinary retention due to prostate enlargement using advanced thulium laser

A Gentleman aged 95 yrs presented to our emergency room with urinary retention for last 6hrs.He was immediately catheterised under strict aseptic precautions by our expert urologist and admitted for further evaluation and management.


The basic work up includes prostate diagnostic package and general cardio-respiratory screening to detect any other ailments possible at that age.He was put on appropriate antibiotic cover and after all investigations revealed his condition fit for the laser prostate surgery,the risk stratification was done by our intensivist,cardiologist and anaesthesiologist.


He had a prostate of 50gm size and counselled for laser prostatectomy with mild-moderate risk in view of age.He was shifted to OT and given spinal anaesthesia and made to settle in sitting position for 2 min to minimise the risks of cephalic spread of spinal anaesthesia.He was then put in lithotomy position and laser prostaectomy started using thulium laser with 70w as starting power for prostate vaporisation and enucleation was done at 30 w power.All the 3 lobes were enucleated succesfully without any bleeding.


The lobes were then morcellated with wolf morcellator and 2 way 20f catheter inserted.Normal saline was used as irrigation fluid throughout the procedure and this leaves no chance of any neurological complications seen with glycine used at the time of conventional TURP.



The patient was then shifted to post op care unit where he was monitored for 8 hrs before shifted to room to be with relatives.He was ambulated and after good recovery discharged on 3rd day without catheter.

With more technological advancements,it is possible to improve the quality of life irrespective of age.This happens at ramayya pramila often as we are in pursuit of perfection ALL THE TIME.

UROLOGY HEALTH CAMP BY RAMAYYA PRAMILA UROLOGISTS IN OLD CITY HYDERABAD

Ramayya pramila urology and laparoscopy hospital has conducted a urology health camp for men women and children of old city area of hyderabad on 7th december 2014.

There was excellent response to the camp which was well organised by our practice development manager in collaboration with neo-care diagnostics near high court.

Dr.Bhargava reddy patiently saw a good number of patients with urology and andrology problems and advised them with appropriate tests and medications.

Dr.Sarika, our expert uro-gynecologist examined and advised the women with urology ailments regarding medications and surgeries as needed.

With this over whelming response we got request from helping hand foundation to conduct a camp for their poor and needy patients which will be done in january 2015.

HERNIA:WHAT IS HERNIA?WHY AND WHEN SHOULD IT BE TREATED?

Hernia
A hernia is the protrusion of an organ or portion of an organ through the wall of the cavity that normally contains it. The inguinal canal is found in the groins of both men and women. In men, it is the area where the spermatic chord passes from the abdomen to the scrotum. This chord holds up the testicles. In women, the inguinal canal contains a ligament that helps to hold the uterus in place.


There are different kinds of hernias, each requiring a specific management. By far the most common hernias develop in the abdomen, when a weakness in the abdominal wall evolves into a localized hole, or "defect", through which omentum, or abdominal organs covered with peritoneum, may protrude in the form of hernia.


Hernias may or may not present with either pain at the site, a visible or palpable lump, or in some cases more vague symptoms resulting from pressure on an organ which has become "stuck" in the hernia, sometimes leading to organ dysfunction. Fatty tissue usually enters a hernia first, but it may be followed or accompanied by an organ. protrude.


Symptoms and signs vary depending on the type of hernia. Symptoms may or may not be present in some inguinal hernias. In the case of reducible hernias, a bulge in the groin or in another abdominal area can often be seen and felt. When standing, such a bulge becomes more obvious. Besides the bulge, other symptoms include pain in the groin that may also include a heavy or dragging sensation, and in men, there is sometimes pain and swelling in the scrotum around the testicular area.


Irreducible abdominal hernias or incarcerated hernias may be painful, but their most relevant symptom is that they cannot return to the abdominal cavity when pushed in. They may be chronic, although painless, and can lead to strangulation (loss of blood supply) and/or obstruction (kinking of intestine). Strangulated hernias are always painful and pain is followed by tenderness. 
  The conditions that increase the pressure of the abdominal cavity may also cause hernias or worsen the existing ones. Some examples would be: obesity, straining during a bowel movement or urination (constipation, enlarged prostate), chronic lung disease etc.

Also, if muscles are weakened due to old age,poor nutrition,multiple pregnancies,previous surgeries on abdomen etc. hernias are more likely to occur.

By far the most common hernias (up to 75% of all abdominal hernias) are the so-called inguinal hernias. Inguinal hernias are further divided into the more common indirect inguinal hernia (2/3, depicted here), in which the inguinal canal is entered via a congenital weakness at its entrance (the internal inguinal ring), and the direct inguinal hernia type (1/3), where the hernia contents push through a weak spot in the back wall of the inguinal canal.

UMBILICAL HERNIA:They involve protrusion of intraabdominal contents through a weakness at the site of umbilicus through the abdominal wall. Umbilical hernias in adults are largely acquired, and are more frequent in obese men and women. Abnormal decussation of fibers at the line alba  may contribute.Umbilical hernia occurs in babies under 6 months of age which becomes obvious when the baby cries.Typically, this hernia goes away on its own by 1 year of age.

Surgery is usually recommended for most types of hernias to prevent complications like obstruction of the bowel or strangulation of the tissue,Muscle reinforcement techniques often involve synthetic materials like mesh. The mesh is placed either over the defect (anterior repair) or under the defect (posterior repair). At times staples are used to keep the mesh in place. 

Laparoscopic surgery is also referred to as "minimally invasive" surgery, which requires one or more small incisions for the camera and instruments to be inserted, as opposed to traditional "open" or "microscopic" surgery, which requires an incision.Many patients are managed through day surgery centers, and are able to return to work within a week or two, while intense activities are prohibited for a longer period. 

OVERACTIVE BLADDER:A CURSE FOR CHILDREN,MIDDLE AGED MEN AND WOMEN,

The hallmark symptom of overactive bladder is urgency, but the diagnosis also includes frequent urination, frequent interruptions of sleep because of the need to urinate -nocturia, and urinating unintentionally followed by an urge to continue urge incontinence.

Overactive bladder has many causes which can include diseases such as diabetes, medications such as diuretics, or lifestyle choices such as excessive consumption of caffeine or alcohol Bothersome urinary symptoms that are related to neurological such as multiple sclerosis are generally treated differently from overactive bladder in people who do not have neurological problems

People with the condition often have the symptoms for a long time before seeking medical care. Pain while urinating suggests that there is a problem other than overactive bladder.Management of overactive bladder is addressed in terms of quality of life since it is not a life-threatening problem.Overactive bladder is characterized by a group of four symptoms: urgency, urinary frequency, nocturia, and urge incontinence. Urge incontinence is not present in the "dry" classification.


The causes  of OAB is unclear, and indeed there may be multiple causes. It is often associated with overactivity of the detrusor muscle, a pattern of bladder muscle contraction observed during uro-dynamic study. It is also possible that the increased contractile nature originates from within the urothelium and lamina propria, and abnormal contractions in this tissue could stimulate dysfunction in the detrusor or whole bladder. Treatments for OAB are usually synonymous with treatments for detrusor overactivity. OAB is distinct from stress incontinence, but when they occur together, the condition is usually known as mixed incontinence.
Diagnosis of OAB is made primarily by ruling out other causes of overactivity of the bladder such as an infection or bladder tumor.  Additionally, urine culture may be done to rule out infection. The frequency/volume chart may be maintained and cystoscopy may be done to exclude tumor and stones. If there is an underlying metabolic or pathologic condition that explains the symptoms, the symptoms may be considered part of that disease and not OAB.


Treatment for OAB includes nonpharmacologic methods such as lifestyle modification (fluid restriction, avoidance of caffeine), bladder retraining or may involve the use of pharmaceutical agents such as anti muscarinic drugs.

Studies have shown that few people get complete relief from overactive bladder drugs and that all available drugs are no more than moderately effective. A typical person with overactive bladder may urinate 12 times per day. Medication may reduce this number by 2-3 and reduce incontinence events by 1-2 per day.

ADVANCES IN LAPAROSCOPY TECHNIQUES AND TECHNOLOGIES

Since the early 1990s, laparoscopic urologic surgeries have evolved from experimental techniques to commonly accepted procedures. Early pioneers in the field used instrumentation and optics that are primitive by today’s standards, but technological advances have made the operations more efficacious and easier to perform. Various devices, including energy sources, vascular staplers, 3-chip cameras, and robotic assistance, have allowed surgeons to perform complex operations with improved confidence.

Conventional laparoscopic camera consists of a 2-Dimensional (2D) system and although there is improvement in graphics from high definition (HD) system, there is still a lack of depth and spatial perception. There is much training needed to master laparoscopic techniques as there is a need to interpret secondary spatial cues such as shadow and motion parallax.

 3-Dimensional (3D) systems may potentially improve laparoscopic training by eliminating the need to overcome the loss of stereoscopic vision.

(Laparoscopy), a modern technique in which an operation in the abdomen is performed through small incisions as compared to larger incisions needed in traditional surgical procedures. This surgical approach addresses the key requirements of Healthcare Reform:

• Increased Quality of Care – Minimally invasive surgery provides better clinical outcomes than traditional "open" surgery.
• Decreased Costs – Numerous industry and clinical studies have demonstrated that minimally invasive surgery provides significant cost savings when compared to a robotic surgical approach.

• Enhanced Patient Satisfaction – Minimally invasive surgery provides less scarring, shorter hospital stays and faster recovery than traditional "open" surgery.

Da Vinci is a computer-assisted robotic system that expands a surgeon's capability to operate within the abdomen in a less invasive way during laparoscopic surgery. This

system allows greater precision and better visualization compared to standard laparoscopic surgery.

The operations with the Da Vinci System are performed with no direct mechanical connection between the surgeon and the patient. The surgeon is remote from the patient, working a few feet from the operating table while seated at a computer console with a three-dimensional view of the operating field.

The physician operates two masters (similar to joysticks) that control the two mechanical arms on the robot. The mechanical arms are armed with specialized instruments with hand-like movements which carry out the surgery through tiny holes in the patient’s abdomen. The arms eliminate any hand tremor by the surgeon and offer motion scaling – allowing extremely precise movements within the patient.