Sunday, November 21, 2010
Saturday, November 6, 2010
Fast and convinient consultation system in Dr Ramayyas Hospital:
We have started a disciplined approach in reception centre at Dr Ramayyas hospital wherein the patient would be seen within 10 minutes of his/her arrival in the hospital.The tests also will be carried out as soon as possible so a pausible cause of the disease and the medications will be started without delay.Our centre has three fulltime urologist and one Urology Associate available for the round the clock.These doctors are specialised in different areas so the patients as per the complaints and the disease will be seen by the superspecialist immediately.
The emergency patient also would be immediately seen without any delay.The delay in consulation is most annoying for the patient and the dillydallying in investigations and the reports also adds to their woes.
We have equipped ourselves with all the posible surgical investigational armamentarium-blood tests,USG(transvaginal,trans-rectal,Follicular Monitoring,penile doppler test),Radiology,uroflowmetry.Recently we have added Urodynamic machine with the state of the art urodynamic chair also to our armamentarium.We carry out semen analysis,vibrator therapy,intracavernosal injection tests,cavernosographies,Vacuum Erection Device test,Nocturnal Penile Tumuscence Test here.We have also installed state of the art surgical microscope to complete the andrology Lab.These equipments will prevent to certain extent patients being referred again and again to different centres.
Dr Ramesh Ramayya-CEO and the Chairperson of the Institute will be looking into prostatic diseases and endourology.Dr Nath-Clinical Director will look into urological reconstructive field apart from endo-urology.Dr Naveen Acharya-Consultant Urologist will see andrology-impotence and infertility cases with assistance from Dr Mahesh Sable-Medical Suptd. and seminologist to complete any seminological requirements.Dr Santosh - Consultant Urologist will look after areas of laparoscopic Urology and Female Urological aspects.
The emergency patient also would be immediately seen without any delay.The delay in consulation is most annoying for the patient and the dillydallying in investigations and the reports also adds to their woes.
We have equipped ourselves with all the posible surgical investigational armamentarium-blood tests,USG(transvaginal,trans-rectal,Follicular Monitoring,penile doppler test),Radiology,uroflowmetry.Recently we have added Urodynamic machine with the state of the art urodynamic chair also to our armamentarium.We carry out semen analysis,vibrator therapy,intracavernosal injection tests,cavernosographies,Vacuum Erection Device test,Nocturnal Penile Tumuscence Test here.We have also installed state of the art surgical microscope to complete the andrology Lab.These equipments will prevent to certain extent patients being referred again and again to different centres.
Dr Ramesh Ramayya-CEO and the Chairperson of the Institute will be looking into prostatic diseases and endourology.Dr Nath-Clinical Director will look into urological reconstructive field apart from endo-urology.Dr Naveen Acharya-Consultant Urologist will see andrology-impotence and infertility cases with assistance from Dr Mahesh Sable-Medical Suptd. and seminologist to complete any seminological requirements.Dr Santosh - Consultant Urologist will look after areas of laparoscopic Urology and Female Urological aspects.
Friday, November 5, 2010
Alternative to Cranberry Juice in Recurrent UTI: D-Mannose and Proanthocyanidin scahet
Millions of women world wide suffer from recurrent urinary tract infections.The symptoms are usually burning urination,freqency of the urination and pain in genital region or lower back region.The physician usually sends urine for culture examination and starts antibiotics either for 5-7 days duration or gives low dose antibiotics for long time for suppression of the annoying bacterial flora.The recurrent infections if due to some causative factor like diabetes mellitus(altered immunity),stones,prolapse,dry vagina(due to post menopusal changes),pregnancy needs to be looke into.
The suppressive antibiotic administartion usually causes cure in 70% of the cases but as soon as the antibiotic is stopped some 30% of the women suffer from the recurrent UTI.
Some strategies like cranberry juice or lignonberry juice is being started for most of the patients but the effect of such preventive measures is not clear and diabetc patients are not suitable for these medications as the quantity to be taken could be 250 ml to 500 ml daily.
To prevent adherence of the bacteria to the urogenital mucosa D-mannose and proanthocyanidin can be taken regularly.Sachets available in the market like Ugiclean sachet can be dissolved in glassful of water and can be consumed 4-6 times a day.It is safer in diabetic patients also.
D-Mannose is a natrurally occuring simple sugar which without alteration is filtred by the kidneys and reach the bladder.On reaching the bladder it allows the fimbria of E-Coli to preferrentially attach to them rather than the bladder mucosa.This forms a slipper complex ; and can be voided easily.The proanthocyanidins helps to buid immunity as it is 50 times more powerful than Vit E and 20 times more potent.
In a study conducted by Dr Michael Blue,Oklahoma 66 % of the women with recuurent UTI had culture negativity.In a related study 80% of the painful bladder syndrome patients had relief.
The suppressive antibiotic administartion usually causes cure in 70% of the cases but as soon as the antibiotic is stopped some 30% of the women suffer from the recurrent UTI.
Some strategies like cranberry juice or lignonberry juice is being started for most of the patients but the effect of such preventive measures is not clear and diabetc patients are not suitable for these medications as the quantity to be taken could be 250 ml to 500 ml daily.
To prevent adherence of the bacteria to the urogenital mucosa D-mannose and proanthocyanidin can be taken regularly.Sachets available in the market like Ugiclean sachet can be dissolved in glassful of water and can be consumed 4-6 times a day.It is safer in diabetic patients also.
D-Mannose is a natrurally occuring simple sugar which without alteration is filtred by the kidneys and reach the bladder.On reaching the bladder it allows the fimbria of E-Coli to preferrentially attach to them rather than the bladder mucosa.This forms a slipper complex ; and can be voided easily.The proanthocyanidins helps to buid immunity as it is 50 times more powerful than Vit E and 20 times more potent.
In a study conducted by Dr Michael Blue,Oklahoma 66 % of the women with recuurent UTI had culture negativity.In a related study 80% of the painful bladder syndrome patients had relief.
Naftoopidil in Benign Prostatic Hyperplasia
Naftopidil is one new moleculethat has evoked renewed interest in pharmacotherapy for benign prostatic hyperplasia.It is a alpha 1 d receptor antagonist and inhibits significantly cell proliferation dose dependently in all cell lines that expresses alpha (1 d)-AR mRNA .It is said to be effective in sexually active men and those with irritative voiding symptoms..
It has been seen to reduce the nocturnal urine volume and hence cause less disturbance in sleep pattern.
It has been seen to reduce the nocturnal urine volume and hence cause less disturbance in sleep pattern.
Wednesday, November 3, 2010
Penis Fracture:An andrological Emeregncy
A 25 year old gentleman married recently came to us with penile swelling after an episode of violent sexual activity.He presented with eggplant deformity of the penis with a large hematoma.
As a routine we performed retrograde urethrogram to see any urethral trauma.The urethral integrity was intact.He was immediately taken up for exploration;he underwent degloving incision of the penis and he underwent repair of the tunica with nonabsorbale sutures after evacuation of the hematoma.
He was discharged after 1 week and he regained his potency (as per the patient told on 8 week follow-up).
A penile fracture is an injury caused by the rupture of the tunica albuginea, which envelops the corpus cavernosum penis. It is most often caused by a blunt trauma to an erect penis.
Presentation
A popping or cracking sound, significant pain, immediate flaccidity, and skin hematoma of various sizes are commonly associated with the event. These symptoms are similar to a common bruising or contusion of the penis. If Bucks fascia is intact then ecchmosis is confined to penis and the penis may appear like eggplant and if the Bucks fascia is disrupted then “butterfly” hematoma may occur over the region of the perineum. Causes
In the western world the most common cause, accounting for about 30%-50% of cases, is intercourse. Of those, woman-on-top position resulting in impact against the male pelvis or perineum and bending laterally are most common.
The practice of taqaandan also puts men at risk of penile fracture. Taqaandan, which comes from a Kurdish word meaning "to click," involves bending the top part of the erect penis while holding the lower part of the shaft in place, until a click is heard and felt. Taqaandan is said to be painless and has been compared to cracking one's knuckles, but the practice of taqaandan has led to an increase in the prevalence of penile fractures in western Iran. Taqaandan is usually performed to achieve detumescence.
Diagnosis:
Penile fracture can be diagnosed by history or physical signs (a careful examination may reveal “Rolling sign”-palpation of blood clot over a break on tunica albugenia).In equivocal cases cavernosography or MRI may have to be performed. If urethral bleeding is also a presentation then retrograde urethrogram should be done to diagnose the urethral trauma.
Treatment and prognosis
Penile fracture is a medical emergency, and emergency surgical repair is the usual treatment. Delay in seeking treatment increases the complication rate. Non-surgical approaches result in 10%-50% complication rates including erectile dysfunction, permanent penile curvature, damage to the urethra and pain during sexual intercourse.
A circumferential degloving incision is given 1 cm proximal to the coronal sulcus then the trauma site is identified and the hematoma is evacuated. The defect in the tunica albugenia is repaired with inverting non-absorbale sutures.
Presentation
A popping or cracking sound, significant pain, immediate flaccidity, and skin hematoma of various sizes are commonly associated with the event. These symptoms are similar to a common bruising or contusion of the penis. If Bucks fascia is intact then ecchmosis is confined to penis and the penis may appear like eggplant and if the Bucks fascia is disrupted then “butterfly” hematoma may occur over the region of the perineum. Causes
In the western world the most common cause, accounting for about 30%-50% of cases, is intercourse. Of those, woman-on-top position resulting in impact against the male pelvis or perineum and bending laterally are most common.
The practice of taqaandan also puts men at risk of penile fracture. Taqaandan, which comes from a Kurdish word meaning "to click," involves bending the top part of the erect penis while holding the lower part of the shaft in place, until a click is heard and felt. Taqaandan is said to be painless and has been compared to cracking one's knuckles, but the practice of taqaandan has led to an increase in the prevalence of penile fractures in western Iran. Taqaandan is usually performed to achieve detumescence.
Diagnosis:
Penile fracture can be diagnosed by history or physical signs (a careful examination may reveal “Rolling sign”-palpation of blood clot over a break on tunica albugenia).In equivocal cases cavernosography or MRI may have to be performed. If urethral bleeding is also a presentation then retrograde urethrogram should be done to diagnose the urethral trauma.
Treatment and prognosis
Penile fracture is a medical emergency, and emergency surgical repair is the usual treatment. Delay in seeking treatment increases the complication rate. Non-surgical approaches result in 10%-50% complication rates including erectile dysfunction, permanent penile curvature, damage to the urethra and pain during sexual intercourse.
A circumferential degloving incision is given 1 cm proximal to the coronal sulcus then the trauma site is identified and the hematoma is evacuated. The defect in the tunica albugenia is repaired with inverting non-absorbale sutures.
KORO:PENILE RETRACTION SYNDROME
A 35 year old patient came with the history of having gone through symptoms of penile retraction.He went through the turmoil for almost 4 hours.He says that he literally had to pull the penile shaft to prevent it from retracting into the body.
He had a particular misconception that if the penis would have totally involuted into the body then he would have died.He said that he heard a few people dying because of this condition.
Genital examination revealed no evidence of penile retraction.Although he was complaining about left testicular tenderness ;it appeared to be due to trauma sustained during the act of mechanical "pulling out".
First we thought the patient to be malingering but there two people with him who happened to be our patients in the past and vouched to have witnessed this condition.
We reassured the patient that such condition doenot exist and he is essentially normal.He was eduacted about his genital anatomy and explained that the penis cannot shrink inside the abdomen.
Later we did a dilgent search on the net.This condition appeared be akin to KORO (this word comes from the Malay-Indonesian word for tortoise) seemed to have been prevalent in China/South East Asia..
Most of the victims complain about episodes of acute attack of genital retraction or genital shrinkage, sometimes both. Each episode usually lasted several hours, though the duration can be as long as two days. There are cases in which koro symptoms persist for years with either chronic and continuous or recurrent history. On top of retraction, other symptoms include a perception of alteration of penis shape, loss of penile muscular tone.
Ideational components of koro include fear of impending death, penile dissolution and loss of sexual power. A man may perform manual or mechanical penile traction, or "anchoring" by a loop of string or some clamping device.
The treatment should be psychotherapy.
He had a particular misconception that if the penis would have totally involuted into the body then he would have died.He said that he heard a few people dying because of this condition.
Genital examination revealed no evidence of penile retraction.Although he was complaining about left testicular tenderness ;it appeared to be due to trauma sustained during the act of mechanical "pulling out".
First we thought the patient to be malingering but there two people with him who happened to be our patients in the past and vouched to have witnessed this condition.
We reassured the patient that such condition doenot exist and he is essentially normal.He was eduacted about his genital anatomy and explained that the penis cannot shrink inside the abdomen.
Later we did a dilgent search on the net.This condition appeared be akin to KORO (this word comes from the Malay-Indonesian word for tortoise) seemed to have been prevalent in China/South East Asia..
Most of the victims complain about episodes of acute attack of genital retraction or genital shrinkage, sometimes both. Each episode usually lasted several hours, though the duration can be as long as two days. There are cases in which koro symptoms persist for years with either chronic and continuous or recurrent history. On top of retraction, other symptoms include a perception of alteration of penis shape, loss of penile muscular tone.
Ideational components of koro include fear of impending death, penile dissolution and loss of sexual power. A man may perform manual or mechanical penile traction, or "anchoring" by a loop of string or some clamping device.
The treatment should be psychotherapy.
Penile Implant : A boon for erectile dysfunction
We recently operated a 56 -year old patient with erectile dysfunction.He was a known case of Coronary Artery Disease with hyperlipidemia and was on anti-platelet agents.He was a non-responder to PDE-5 inhibitors and Vacuum Erection Device so was taken up for Penile Implant.A three piece penile implant of Mentor Coloplast was implanted with a penoscrotal incision and the reservoir was implanted in retropubic space.
The whole surgery took 1 1/2 hours with minimal blood loss.The ecosprin medication was stopped 1 week prior to surgery.
The patient was started on prophylactic antibiotcs and as a routine scrubbing of the genital area with Betadine scrub was started 5 days prior to the surgery.
The post-operative period was uneventful and the patient was discharged 2 nd post-operative day.
The whole surgery took 1 1/2 hours with minimal blood loss.The ecosprin medication was stopped 1 week prior to surgery.
The patient was started on prophylactic antibiotcs and as a routine scrubbing of the genital area with Betadine scrub was started 5 days prior to the surgery.
The post-operative period was uneventful and the patient was discharged 2 nd post-operative day.
Urodynamic Facility at Dr Ramayyas Hospital
We launched Urodynamic facilities and have started doing Urodynamic studies regularly on patients of voiding dysfunction.
We have installed Urocomp 2000 EU machine manufactured by status medical equipments with a special chair especially for female patinets.
We have installed Urocomp 2000 EU machine manufactured by status medical equipments with a special chair especially for female patinets.