Endourological surgeries for kidney, ureter and bladder stones

Bladder Sparing Surgeries

In the realm of medical advancements, bladder-sparing surgeries have emerged as a groundbreaking approach for treating bladder cancers. Traditional treatment options often involve complete removal of the bladder (cystectomy), which can significantly impact a patient's quality of life. Bladder-sparing surgeries offer a more conservative yet effective alternative, preserving the bladder whenever possible while still following principles of cancer control. 

Understanding Bladder Sparing Surgeries

Bladder cancer is a common urologic malignancy, often necessitating radical treatments like complete bladder removal (cystectomy). While cystectomy has been a gold standard in treating advanced bladder cancer, it comes with significant consequences, including the need for a urinary diversion and the potential impact on the patient's physical and emotional well-being. Bladder-sparing surgeries offer an alternative approach by focusing on removing only the cancerous tissue while preserving the functional capacity of the bladder.

Types of Bladder Sparing Surgeries

• Transurethral Resection: Transurethral resection (TUR) is a minimally invasive procedure that involves the removal of tumors from the bladder lining. It is particularly effective for non-invasive or superficial bladder cancers. TUR offers the advantage of preserving the bladder and allowing patients to maintain normal urinary function.
• Partial Cystectomy: In cases where the cancer is localized, a partial cystectomy may be performed. This procedure involves removing the tumor along with a portion of the bladder wall. While this technique aims to preserve bladder function, it is suitable for select patients with smaller tumors and favorable tumor characteristics.
• Trimodal Therapy: Trimodal therapy combines transurethral resection, radiation therapy, and chemotherapy. This approach offers a comprehensive treatment plan for certain bladder cancer cases, aiming to eradicate cancer cells while maintaining bladder integrity.

Benefits of Bladder Sparing Surgeries

• Improved Quality of Life: Bladder-sparing surgeries prioritize maintaining urinary function and reducing the need for external urinary appliances, thereby significantly improving patients' quality of life compared to radical cystectomy.
• Psychological Well-being: Preserving the bladder can have a positive impact on a patient's emotional and psychological well-being. The prospect of maintaining normal urinary habits can alleviate anxiety and depression commonly associated with radical treatments.
• Reduced Complications: Bladder-sparing surgeries often result in fewer complications compared to radical cystectomy, which can involve complex urinary diversions. Reduced complications contribute to faster recovery and decreased hospital stays.
• Functional Independence: Bladder-sparing surgeries allow patients to retain their independence and avoid long-term dependence on urinary appliances, contributing to a more active and fulfilling lifestyle.
• Oncological Outcomes: Studies have shown comparable oncological outcomes between bladder-sparing surgeries and radical cystectomy for select patients. This reinforces the viability of bladder-sparing techniques in treating bladder cancer without compromising long-term survival.

Risk Factors and Considerations

Bladder-sparing surgeries undoubtedly offer numerous benefits, but like any medical procedure, they come with their own set of challenges and considerations. It's important to be aware of these potential drawbacks before making decisions regarding treatment options. Here are a few bladder cancer risk factors and considerations associated with bladder-sparing surgeries:

Risk Factors:

• Risk of Recurrence: Bladder-sparing surgeries may not completely eliminate the risk of cancer recurrence. Residual cancer cells could remain in the bladder tissue, necessitating rigorous post-surgery surveillance to detect any signs of recurrence at an early stage.
• Long-Term Efficacy: The long-term effectiveness of bladder-sparing surgeries compared to more aggressive treatments like complete cystectomy is still being studied. For some patients, complete removal of the bladder might provide greater assurance against recurrence, especially for aggressive or advanced bladder cancers.
• Complexity of Surgery: Depending on the type of bladder-sparing surgery, the procedure can be technically complex and require a high level of skill and experience from the surgical team. This complexity can potentially increase the risk of surgical complications.
• Patient Selection: Identifying suitable candidates for bladder-sparing surgeries can be challenging. Factors such as tumor characteristics, patient health, and individual preferences must be carefully evaluated to ensure the best possible outcomes.
• Psychological Impact: While bladder-sparing surgeries aim to maintain quality of life, the psychological and emotional impact of living with the constant fear of cancer recurrence can be challenging for some patients.

Considerations:

• Close Monitoring: Patients who undergo bladder-sparing surgeries must commit to regular follow-up appointments, imaging studies, and potentially invasive procedures like cystoscopy. This level of monitoring is necessary to ensure early detection of any recurrence.
• Balancing Risks and Benefits: The decision to opt for a bladder-sparing surgery should involve a comprehensive discussion between the patient and their medical team. Balancing the potential benefits of preserving bladder function with the risks of recurrence and other complications is crucial.
• Patient Education: Patients need to be well-informed about the potential outcomes, risks, and challenges associated with bladder-sparing surgeries. Understanding these factors empowers patients to make informed decisions and actively participate in their treatment journey.
• Alternative Treatments: Bladder-sparing surgeries are not the only treatment option available. Patients should be aware of alternative approaches, such as complete cystectomy, which may be more suitable depending on the specific circumstances.
• Quality of Life vs. Risk: Patients must carefully weigh the potential impact on their quality of life against the risk of cancer recurrence. For some individuals, preserving bladder function may be a top priority, while others may prioritize minimizing the risk of recurrence.

Conclusion

Bladder-sparing surgeries have ushered in a new era of urological care, emphasizing patient-centered approaches that prioritize quality of life without compromising effective treatment. These innovative procedures represent a significant departure from traditional treatment methods and provide patients with greater choices and improved outcomes. 

As medical technology continues to advance in the city, we can expect even more refined and targeted approaches to bladder-sparing surgeries, further enhancing the lives of those who require personalized and effective bladder cancer treatment in Bangalore at Sakra World Hospital. It is evident that these surgeries are not just about saving bladders; they are about saving the essence of patients' lives. As these techniques continue to evolve, the journey toward personalized and effective bladder cancer treatment becomes all the more promising.

Kidney-sparing surgeries for small kidney tumours

Advancements in medical technology and surgical techniques have led to significant improvements in the treatment of kidney tumors. Kidney tumors, also known as renal tumors, can be benign or malignant growths that develop within the kidneys. Traditionally, the treatment approach for kidney tumors involved the complete removal of the affected kidney, known as a nephrectomy. However, with the advent of kidney-sparing surgeries, patients with small kidney tumors now have a more precise and conservative option that preserves kidney function while effectively treating the tumor.

Understanding Kidney Sparing Surgeries

Kidney-sparing surgeries also referred to as partial nephrectomies or nephron-sparing surgeries, have emerged as a groundbreaking alternative to traditional nephrectomies. These procedures are specifically designed for patients with small kidney tumors, typically measuring 4 centimeters or less in diameter. The primary goal of kidney-sparing surgeries is to remove the tumor while preserving as much healthy kidney tissue as possible.

Types of Kidney Sparing Surgeries

There are two main types of kidney-sparing surgeries commonly performed:

• Partial Nephrectomy: In this procedure, only the tumor and a small margin of healthy tissue surrounding it are removed, leaving the remaining kidney tissue intact. This is typically achieved through open surgery, laparoscopic techniques, or robotic-assisted procedures. Partial nephrectomies are highly effective for treating small kidney tumors and have been associated with better long-term kidney function outcomes.
• Radiofrequency Ablation (RFA) and Cryoablation: These minimally invasive techniques involve using either heat (RFA) or extreme cold (cryoablation) to destroy the tumor cells. During RFA, a special probe is inserted into the tumor, and high-frequency electrical currents are applied to heat and kill the cancerous tissue. In cryoablation, a probe is used to freeze and destroy the tumor. These procedures are especially useful for patients who are not candidates for surgical removal due to various factors.

Techniques of Kidney Sparing Surgeries

• Open Partial Nephrectomy: This traditional approach involves making a large incision in the abdomen to access the kidney. The surgeon carefully removes the tumor along with a margin of healthy tissue, and the incision is closed. While effective, this technique often involves a longer recovery period and a higher risk of complications.
• Laparoscopic Partial Nephrectomy: In this minimally invasive approach, small incisions are made in the abdomen through which specialized surgical instruments and a camera are inserted. The surgeon removes the tumor using these instruments while watching a video feed from the camera. This technique offers quicker recovery times and fewer complications compared to open surgery.
• Robotic-Assisted Partial Nephrectomy: Building on laparoscopic techniques, robotic-assisted surgeries employ a robotic system controlled by the surgeon to perform precise movements. This enhances the surgeon's dexterity and offers a 3D visualization of the surgical site, making tumor removal more precise and minimizing damage to healthy tissue.

Symptoms of a kidney tumor

Symptoms of a kidney tumor may include:

• Blood in Urine: Sometimes, blood can make the urine pink, red, or brown, which is called hematuria.
• Pain on the Side or Back: Feeling a dull ache or pain on your side or back, below the ribs, could be due to a kidney tumor.
• Lump or Swelling: You could feel a lump or notice a swelling in your belly or side.
• Feeling Tired: Unusual tiredness or weakness might be present, even without much activity.
• Weight Loss: Losing weight without trying could be a sign.
• Fever and Sweating: Fever that comes and goes, along with night sweats, could occur.
• Anemia: Anemia, which is when you don't have enough red blood cells, might make you look pale and feel weak.
• High Blood Pressure: If your blood pressure is consistently high and not responding to regular treatments, it might be linked to a kidney issue.
• Swelling in Legs and Ankles: Swelling in your legs or ankles, like they're puffy, might point to kidney issues.
• Loss of Appetite: You might not feel like eating as much as usual.

Note: Incidental Detection- The majority of Kidney tumours are eligible for kidney-sparing surgeries are detected incidentally, during imaging done(Ultrasound, CT scan, MRI scan) for other clinical reasons. Hence these tumors may not manifest any of the above-mentioned symptoms. Those with a family history of cancers are encouraged to do ultrasound & other cancer screening tests for early detection of such tumors.

Benefits of Kidney Sparing Surgeries

• Preservation of Kidney Function: The most significant advantage of kidney-sparing surgeries is the preservation of kidney function. Since only the tumor and a minimal amount of healthy tissue are removed, the remaining kidney tissue continues to function effectively, reducing the risk of kidney-related complications.
• Reduced Risk of Chronic Kidney Disease: Patients who undergo kidney-sparing surgeries have a lower likelihood of developing chronic kidney disease, which can be a debilitating condition requiring ongoing medical management.
• Prevention of Kidney Failure: Kidney-sparing surgeries play a crucial role in preventing kidney failure, as the retained healthy tissue maintains the kidneys' ability to filter waste and regulate bodily functions.
• Faster Recovery: Minimally invasive techniques, such as laparoscopic and robotic-assisted surgeries, offer quicker recovery times compared to traditional open surgery. This allows patients to return to their normal activities sooner, improving their quality of life.
• Lower Risk of Cardiovascular Complications: Kidney health is closely linked to cardiovascular health. Preserving kidney function through kidney-sparing surgeries can contribute to a reduced risk of cardiovascular complications in the long run.
• Increased Treatment Options: Kidney-sparing surgeries expand treatment options for patients who might not be suitable candidates for complete kidney removal (nephrectomy), such as those with pre-existing kidney conditions.
• Long-Term Peace of Mind: Patients who undergo kidney-sparing surgeries can enjoy peace of mind knowing that they have received effective treatment for their kidney tumor while safeguarding their kidney function for the years to come.

Conclusion

Kidney-sparing surgeries have revolutionized the treatment of small kidney tumors, providing patients with an effective and less invasive alternative to complete kidney removal. With their ability to preserve kidney function, reduce the risk of chronic kidney disease, and offer quicker recovery times, these procedures have become a cornerstone of modern urological care. As medical advancements continue to evolve, kidney-sparing surgeries will likely play an even more significant role in enhancing patient outcomes and quality of life. If you are facing the prospect of kidney tumor treatment, it is crucial to consult with a qualified urologist, especially one experienced in nephron-sparing surgery in Bangalore at Sakra World Hospital, to determine the most appropriate approach based on individual circumstances.

Erectile Dysfunction - What is the Spectrum of Treatment?

Erectile dysfunction is a medical condition that involves the incapacity to attain or uphold an erection that is adequate for sexual intercourse. This condition can affect individuals of any age group, but it is frequently observed in men who are older.
It can have physical, psychological, or a combination of both causes, including factors such as high blood pressure, diabetes, heart disease, anxiety, depression, stress, and lifestyle choices such as smoking and excessive alcohol consumption. 

Treatment options include medications, psychotherapy, lifestyle changes, or surgery, depending on the underlying cause and severity of the condition. It is important to consult the best doctor for erectile dysfunction in Bangalore if you experience symptoms of this condition to identify and treat the underlying cause and improve your quality of life.

Causes of Erectile Dysfunction

Erectile dysfunction can have several causes, including physical, psychological, or a combination of both. A few common causes of the condition may include:

Physical factors: This condition can be caused by a variety of physical factors that affect blood flow to the penis or nerve function, such as:

• Cardiovascular disease or atherosclerosis
• Diabetes
• High blood pressure (hypertension)
• High cholesterol
• Obesity
• Multiple sclerosis (MS)
• Parkinson's disease
• Peyronie's disease (scar tissue inside the penis)
• Trauma or injury to the pelvic area
• Prostate surgery or radiation therapy
• Hormonal imbalances

Psychological factors: Erectile Dysfunction can also be caused by psychological factors, including:

• Anxiety or stress
• Depression
• Relationship problems
• Performance anxiety
• Sexual trauma or abuse

Lifestyle factors: Certain lifestyle factors can also contribute to Erectile Dysfunction, including:

• Smoking
• Excessive alcohol consumption
• Drug abuse
• Sedentary lifestyle
• Poor diet

It is important to identify the underlying cause of the condition in order to determine the appropriate treatment. A healthcare provider can perform a physical examination and run tests to identify any physical or psychological causes of the condition.
Diagnosis of Erectile Dysfunction

Diagnosing erectile dysfunction typically involves a physical exam, including medical history and blood tests to rule out any underlying medical conditions. Additional tests may be required, such as a urine test, a penile ultrasound, or a nocturnal penile tumescence test, which measures the number and strength of erections that occur during sleep.

Treatment for Erectile Dysfunction

There are several treatments available for erectile dysfunction (ED), depending on the underlying cause and severity of the condition. 

Here are some common treatment options for this condition:

Lifestyle changes: Making lifestyle changes such as quitting smoking, limiting alcohol consumption, maintaining a healthy weight, exercising regularly, and eating a healthy diet can improve overall health and help alleviate ED.

Oral medications: Medications like sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) are commonly prescribed. These drugs work by increasing blood flow to the penis, helping to achieve and maintain an erection.

Injections and suppositories: Alprostadil is a medication that can be injected directly into the penis or inserted as a suppository in the urethra to help achieve an erection.

Vacuum devices: A vacuum device or penis pump can be used to create an erection by placing a tube over the penis and using a hand pump to create a vacuum, which pulls blood into the penis.

Surgery: Surgery may be recommended in cases where ED is caused by a physical problem, such as a blockage in the blood vessels supplying the penis. A penile implant can also be surgically inserted to help achieve an erection.
Psychotherapy: In cases where ED is caused by psychological factors such as anxiety or depression, psychotherapy or counseling may be recommended to address the underlying issues.

Erectile dysfunction is a prevalent health condition that can significantly affect the overall well-being of a man. While it is often associated with older men, it can affect men of all ages. Understanding the causes and symptoms of this condition is essential for proper diagnosis and treatment. If you are experiencing symptoms, you can visit Sakra World Hospital which provides erectile dysfunction treatment in Bangalore to determine the underlying cause and appropriate treatment options.

Renal Transplantation - Why It’s Better than Dialysis

Renal transplantation is a medical procedure that involves transplanting a healthy kidney from a donor to a patient whose kidneys have failed due to chronic kidney disease or other medical conditions. This procedure has proven to be much better than dialysis for patients with end-stage renal disease for a variety of reasons.

Dialysis is a life-sustaining treatment for patients with end-stage renal disease that removes waste and excess fluid from the blood when the kidneys can no longer perform this function. While dialysis can prolong life, it is not a cure for end-stage renal disease and requires frequent, time-consuming sessions that can impact a patient’s quality of life. On the other hand, renal
transplantation is a one-time procedure that can provide patients with a new kidney that functions like a normal kidney, eliminating the need for dialysis altogether.

Who Needs to Undergo Renal Transplantation?

Renal transplantation is recommended for individuals who have lost most of their kidney function and are unable to maintain adequate blood filtration and fluid balance in the body. Renal transplantation is typically considered for patients with end-stage renal disease who are under the age of 70 and who are healthy enough to undergo surgery. 

The most common causes of end-stage renal disease include:

Diabetes: Diabetes is a chronic condition that can cause kidney damage over time. When diabetes is not well-controlled, high levels of blood sugar can damage the tiny blood vessels in the kidneys, which can lead to end-stage renal disease.

High Blood Pressure: High blood pressure can damage the blood vessels in the kidneys, leading to renal disease. People with high blood pressure should have regular kidney function tests to monitor for any signs of kidney damage.

Chronic Glomerulonephritis: This is a group of diseases that cause inflammation and damage to the kidney & filtering units (glomeruli). Over a period of time, this can cause kidney damage.

Polycystic Kidney Disease: This is an inherited condition that causes cysts to form in the kidneys, which can eventually lead to end-stage kidney disease. Autoimmune Diseases: Certain autoimmune diseases, such as lupus, can cause inflammation and damage to the kidneys, leading to renal disease. Untreated Kidney Stones: Left untreated, kidney stones can block the ureters or make them narrower. This increases the risk of infection, or urine may build up and put added strain on the kidneys. These problems are rare because most kidney stones are treated before they can cause complications.

Chronic Recurrent Kidney Infections: Some people develop a chronic infection of the kidney that is very stubborn and hard to get rid of. A continuing problem with a kidney infection is called chronic pyelonephritis. Having a severe kidney infection or repeated kidney infections can damage the kidneys. They can lead to chronic kidney disease.

Dialysis vs Kidney Transplant: Why Renal Transplantation is Better Than Dialysis?

Here are a few reasons why renal transplantation is better than dialysis:

Better Quality of Life: Patients who undergo renal transplantation have a better quality of life than those who are on dialysis. They can resume normal activities and can eat and drink without restriction. Additionally, patients who undergo renal transplantation do not have to worry about scheduling dialysis treatments around their work, school, or social lives.

Long-Term Health Benefits: Renal transplantation has long-term health benefits that dialysis does not. Patients who undergo renal transplantation have a lower risk of developing cardiovascular disease, infections, and other complications associated with end-stage renal disease.

Cost-Effective: Although renal transplantation is initially more expensive than dialysis, it is a cost-effective long-term solution. Patients who undergo renal transplantation have a lower risk of developing complications, which can result in fewer hospitalizations and lower healthcare costs over time.

Improved Survival Rates: Renal transplantation has a higher survival rate than dialysis. Studies have shown that patients who undergo renal transplantation have a longer lifespan than those who remain on dialysis.

Increased Independence: Patients who undergo renal transplantation are more independent than those on dialysis. They do not have to rely on machines to filter their blood or schedule appointments with a dialysis centre. Additionally, renal transplantation provides patients with a sense of normalcy, allowing them to return to their healthy lives.

In conclusion, renal transplantation is a better option than dialysis for patients with end-stage renal disease at Sakra wold hospital which is the best dialysis hospitals in Bangalore. It provides patients with a better quality of life, long-term health benefits, and higher survival rates. While not all patients are eligible for renal transplantation, those who are should consider this life-changing procedure as a viable option.

Prostate Cancer - Who Needs Treatment?

Prostate cancer refers to a form of cancer that develops within the male reproductive system's prostate gland. This cancer is the second most common cancer in men worldwide and is usually diagnosed in men who are over 60 years of age. However, the decision to undergo treatment for prostate cancer can be complex and depends on various factors, hence it is crucial to consult with the best doctors for prostate cancer treatment. In this article, we will explore who needs treatment for prostate cancer.

Prostate cancer is generally slow-growing, and many men may live with the disease for years without experiencing any symptoms or complications. However, in some cases, prostate cancer can grow and spread to other parts of the body, leading to more severe symptoms and life-threatening complications.

Symptoms of Prostate Cancer

In some cases, prostate cancer may not cause any symptoms, but some common signs and symptoms include:

• Difficulty urinating: One of the most common symptoms of prostate cancer is difficulty urinating or a weak urine stream. This can be caused by the cancer pressing on the urethra, the tube that carries urine from the bladder out of the body.
• Frequent urination: Men with prostate cancer may need to urinate more often, especially at night. This symptom can be caused by the cancer irritating the bladder or by the prostate gland becoming enlarged.
• Blood in the urine or semen: Prostate cancer may cause blood to appear in the urine or semen. This symptom can be alarming, but it is not always a sign of cancer.
• Pain or discomfort during ejaculation: Men with prostate cancer may experience pain or discomfort during ejaculation. This symptom can be caused by the cancer affecting the nerves or muscles that control ejaculation.
• Pain in the back, hips, or pelvis: Prostate cancer can spread to other parts of the body, including the bones. This can cause pain or discomfort in the back, hips, or pelvis.

It is important to note that these symptoms can also be caused by other conditions, such as an enlarged prostate or a urinary tract infection. However, if you experience any of these symptoms, it is essential to see a doctor for evaluation and diagnosis. Early detection and treatment of prostate cancer can improve the chances of successful treatment and recovery.

Treatment for Prostate Cancer

The treatment for prostate cancer depends on various factors such as the stage and aggressiveness of the cancer, the patient's age and overall health, and personal preferences. Some of the treatment options available for prostate cancer include:

Active Surveillance: This approach involves monitoring the cancer closely with regular PSA blood tests, digital rectal exams, and sometimes imaging tests like MRI or biopsy. If the cancer starts to grow, the treatment plan may be changed accordingly.

Surgery: Surgery involves removing the entire prostate gland and sometimes nearby lymph nodes. The two main types of surgery are robotic-assisted laparoscopic prostatectomy and open prostatectomy. Laparoscopic surgery is less invasive than open surgery and has a faster recovery time.

Radiation Therapy: High-energy radiation is utilized in radiation therapy to destroy cancerous cells, and it involves two forms: external beam radiation therapy and brachytherapy. External beam radiation therapy involves delivering radiation from outside the body, while brachytherapy involves placing small radioactive seeds inside the prostate gland.

Hormone Therapy: Prostate cancer cells need male hormones (androgens) to grow. Hormone therapy involves blocking the production or action of androgens.

Chemotherapy: Chemotherapy uses drugs to kill cancer cells. Chemotherapy is usually used for advanced prostate cancer that has spread to other parts of the body.

Immunotherapy: Immunotherapy uses drugs that stimulate the immune system to fight cancer cells. 

Targeted Therapy: Targeted therapy involves using drugs that specifically target the cancer cells.

Focal Therapy: Focal therapy is a newer treatment option that targets only the cancerous area of the prostate gland. Focal therapy includes several options like cryotherapy, high-intensity focused ultrasound, and laser ablation.

The treatment plan for prostate cancer may involve a combination of these treatments, depending on the stage and severity of the cancer. The treatment plan will be determined by a team of specialists, including a urologist, radiation oncologist, and medical oncologist. It is important to discuss the potential benefits and side effects of each treatment option with your doctor before deciding on a treatment plan.

In conclusion, the decision to undergo treatment for prostate cancer depends on several factors, including the stage of the cancer, the age and overall health of the patient, the potential side effects of treatment, and the patient's personal preferences. You can visit Sakra World Hospital which provides prostate cancer treatment in Bangalore. It is essential to discuss the options with our specialists and make an informed decision based on individual circumstances.

13-year-old boy unable to voluntarily control his urination goes through a unique surgery and gets a fresh lease of life

Imagine the misery, a 13-year-old boy has to go through, if he is unable to control his urination in front of his friends, family and in a social gathering and helplessly wets his pants and smells pungent every time he has to urinate with the fear of getting mocked, bullied and laughed at. He was getting repeated urinary tract infections and constant suffering for which regular medications were required. That’s exactly what had happened with Bangalore - based Harsh (name changed), a teenager whose self-esteem got shattered and social life went haywire. The reason, a congenital disease that he was born with - Myelo Meningocele (MMC), a birth defect in which a developing baby's spinal cord fails to develop properly.

A newborn with Myelo Meningocele (MMC) is usually presented with swelling at the lower back and Harsh was no exception. He underwent surgery to remove the swelling containing nerves at the age of one year. According to Dr. Anil Kumar, Senior Consultant and HOD- Paediatric Surgery, Sakra World Hospital,  if the swelling is removed then over a period there is a risk that the nerves attached to this site start having a pulling effect and the child may start developing weakness in both legs and lose control over the bladder and bowel movements. 

The first 9 years after the removal of swelling was not that difficult for the child, but from the last year, he was not in a good position. He almost lost control over his urinary bladder and was not able to urinate properly. He kept on storing the urine in the bladder and suffered from a repeated urinary infection, urine leaking & swelling of the kidney and ureter which was threatening to damage his kidneys. Long-term urinary infection was not good for Harsh and also there was a risk of kidney damage and other health complications. 

Dr. Anil Kumar, best pediatric urology surgeon Bangalore says, “It was at this point of time when he was brought to us and our team of efficient doctors worked on his condition till we decided to conduct a unique procedure on him - Laparoscopic Appendicovesicostomy, a procedure where the appendix is used to connect the urinary bladder to the umbilicus (navel).”

How was the procedure conducted?

Dr. Anil Kumar performed surgery laparoscopically where keyholes were made on the patient’s body. He used the appendix and connected it to the patient’s bladder through the umbilicus. All Harsh has to do now is to go to the restroom at regular intervals, use the tube to empty the urine.

No big cut was made on the abdomen, hence, the cosmetic appearance is good. Also, post-operative recovery has been faster. Besides, the clinical outcome has been excellent. The child is no longer facing any difficulty in passing out urine and is able to empty his urinary bladder at frequent intervals. There is no risk of repeated urinary tract infection and no pressure effect on kidneys anymore, thereby no risk of damage to his kidneys., Harsh is healthy and fit.  

Post the surgery, Harsh is doing absolutely fine and has been able to come out of the long trauma that he was suffering from being able to safeguard his social image like any other teenager. He has begun with his regular schooling, attending classes and social functions, making new friends, and leading a normal life like never before. 

Sakra World Hospital is one of the best child hospital in Bangalore, offering state-of-the-art tertiary care in various pediatric specialities. The center has an outstanding team of pediatric surgeon in Bangalore covering all subspecialties in pediatrics to provide comprehensive management of problems of neonates and children.

What You Need to Know About Kidney Transplant

The kidneys are parts of your body whose function is to filter and remove excess waste, minerals and fluid and regulate blood pressure. However, there are situations when your kidney is unable to perform this filtering ability and that is considered a kidney failure. When the kidneys fail to perform their functions, it needs prompt treatment and potentially transplantation. There are 2 options – dialysis or a kidney transplant. Dialysis is a procedure that uses an artificial kidney to remove waste and excess fluids from the body when your own kidney fails to do so.

A kidney transplant, on the other hand, is a surgical procedure performed to treat kidney failure. Many opt for this procedure as it offers more freedom and a better quality of life. A kidney transplant is done by placing a healthy kidney into your body to perform its functions when your own kidney doesn’t function normally anymore.

Who Needs A Kidney Transplant?

Kidney transplants are usually considered when a person has End-Stage Renal Disease (ESRD). This is a permanent condition suggesting kidney failure. People who get transplants tend to live longer compared to those undergoing dialysis treatment. Along with this, a better quality of life, fewer restrictions on diet, fewer long-term health issues and a guaranteed more energetic body are some of the reasons people prefer a kidney transplant over dialysis.

The kidney transplant could happen from a living donor or a deceased donor. The main reason as to why living donor transplantations are preferred more over deceased donors is because the former transplant has a lower risk of complications and lower time on a waiting list for a patient.

What Are The Risks Of Kidney Transplants?

Like any other surgery, there are some risks associated with this procedure. These include:

1. Kidney rejection – Sometimes the body rejects the new kidney placed into the body of the patient. However, with healthcare development now, there are new medicines to help the patient to cope with such situations.

2. General surgical procedure risks - Just like most surgeries have risks that come with it, some complications like bleeding and infections could occur.

3. Side effects from anti-rejection medicines – After the procedure, a patient takes medicines in order to help the body accept the new kidney. These medicines could bring about side effects like acne, diabetes, weight gain, excessive hair growth or loss, high blood pressure or cholesterol.

Eligibility

A kidney transplant is a serious medical procedure and the first thing that the patient needs to do is to choose the right transplant centre or hospital for the procedure. A person with heart conditions, infections that can’t be treated, cancer, and other serious conditions that cannot be rectified will not be eligible for a kidney transplant. The centre will consider the following factors in the patient before adding them to the donor waiting list.

1. Mental health evaluation – The patient’s mental state plays a major role in deciding their situation for a kidney transplant. Factors like stress, financial situation and family support are evaluated before deeming the patient fit for a transplant.

2. Blood tests – One of the major steps before finalizing a transplant is to find a matching donor and ensure that the kidney will not be rejected. For this purpose, few blood tests are conducted on the patient.

3. Other tests – Basic physical tests to check your kidneys, X-rays and other body scans will be conducted to have an overall health evaluation for the patient.

Post - Surgery & Recovery.

There are certain things you need to expect before and after the procedure. All the above factors based on the patient and their donor’s mental and physical health evaluation will be done. Post the surgical procedure, the patient will be taken to the recovery room for close monitoring until their body functionalities like heart rate, blood pressure and breathing become stable. The patient will spend a day or two in the ICU as well under observation during this period.

Ideally, the recovery period requires the patient to spend a few days or a week at the hospital depending on their recovery speed. Blood samples will be taken often from the patient in order to check the status of the new kidney. Urine content will also be checked to test the kidney functionality in the new body. Anti-rejection medicines will be provided to the patient in order to help the body accept the new kidney. The patient will move slowly from liquid food to more solid food. Specialists will guide the patient on post-surgery care that needs to be followed at the hospital as well as on returning back home. Once the patient becomes stable, they will be discharged.

Obesity and Kidney Diseases

Kidney Disease is often thought to be a rare occurrence and one can really not see it coming as in most of the cases 90% of the kidney function is already lost by the time any significant symptoms appear. It is also assumed that kidney disease manifests primarily in old age. It is important to know that these are serious myths about kidney disease that need to be addressed. Especially when one has a pre-existing condition that increases the risk of developing kidney disease. Some of the major risk factor to look out for include:

1.     Diabetes

2.     Hypertension

3.     Obesity and overweight

4.     Family history of kidney diseases

5.     Habits like cigarette smoking

6.     Other kidney problems like – recurrent urinary tract infections, stones and tumors, etc.

Overweight/Obesity & Kidney Disease

• 600 million people worldwide are affected by obesity

• Individuals affected by obesity have 83% higher risk of developing kidney disease.

• 24.9% of CKD in women is associated with obesity and overweight.

• 13.8% of CKD in men is associated with obesity and overweight.

CLEARLY, obesity contributes to be one of the major risk factors in the occurrence of kidney disease. Obesity itself can directly lead to CKD because in obese people the BMI being high, the kidneys have to work harder to meet the higher metabolic demands of the body by filtering beyond the normal values – hyperfilteration. Indirectly obesity contributes to the development of diabetes, hypertension and dyslipidemia that is altered lipid metabolism which in turn lead to kidney diseases.

Obesity and Overweight

Both Obesity and overweight can be defined as an excessive or abnormal accumulation of fat that affects the overall health of the body.
Body mass index (BMI) is an index of weight-for-height that is used to classify overweight and obesity in adults. It is defined as a person's weight in kilograms divided by the square of his height in meters (kg/m2).
In Adults

1. BMI greater than or equal to 25 is categorized as Overweight and

2. BMI greater than or equal to 30 as Obesity

What causes obesity and overweight?

One of the fundamental causes of obesity and overweight is an energy imbalance between calories consumed and calories expended which are often due to some the following factors:

1. An increased intake of energy-dense foods that are high in fat

2. An increase in physical inactivity due to the increasingly sedentary nature of   many forms of work, changing modes of transportation and increasing urbanization

3. Genetic and endocrine conditions

4.  Sometimes medication

Why is CKD awareness important for a person who is overweight or obese?

Obesity or excess weight are both preventable with a few lifestyle changes and weight reduction. These changes not only provide prevention and reduce the risks, but also in some cases cure chronic diseases like diabetes, high blood pressure, cardiovascular disease and CKD. Therefore, all individuals with obesity especially those with diabetes and high blood pressure should regularly monitor their – blood sugar, blood pressure, serum creatinine levels and urine tests for protein leak.

How can obesity and overweight be managed to prevent or reduce the risk of CKD?

The integration of a healthy diet, physical activity and refreshing sleep is the focus of management of obese and overweight people.

Healthy Diet

1. Rather than opting for extreme diets opt for small portion meals

2. Substitute water or fresh fruit juices for sugary aerated drinks

3. Limit energy intake from total fats and sugars;

4. Limit protein and sodium intake

5. Salt consumption should be limited especially in people with high blood pressure

6. Increase consumption of fruit and vegetables, as well as legumes, whole grains and nuts

Physical activity

Physical activity is crucial to successful healthy weight reduction. Exercise increases energy expenditure, promotes weight-loss and helps sustain a healthy weight.

1. Inactivity is unhealthy and should be avoided

2. Engage in regular physical activity (60 minutes a day for children and 150 minutes spread through the week for adults)

Sleep

Adequate sleep promotes the maintenance of a healthy weight.

1. Most individuals require about seven hours of sleep each night

2. Prevent irregular sleep patterns

3. Avoid eating before going to sleep

Dr. Sushma Rani Raju
Consultant - Nephrology
MD (Internal Medicine), DM (Nephrology)
Institute of Renal Sciences

8 Golden Rules To Keep Your Kidneys Healthy

The kidneys are bean-shaped organs, each roughly the size of a fist. They are two in number and located one on each side of the backbone deep in the abdominal cavity, beneath the rib cage.

Kidneys do many functions to keep us healthy. 

Their main job is to remove toxins and excess water from the blood. They also help to control the blood pressure, to produce red blood cells and to keep the bones healthy.

Kidneys also control blood levels of many minerals and salts including sodium and potassium, and help to control blood acidity. Every day they carefully control salt and water level in the body so that the blood pressure remains in the normal range.

How do we keep our kidneys healthy?

Kidney diseases are silent killers, which will largely affect the quality of life. There are however several easy ways to reduce the risk of developing kidney disease.

1. Keep fit and active

Keeping fit helps to reduce blood pressure and therefore reduces the risk of Chronic Kidney Disease.

2. Keeping the blood sugars under good control

About half of people who have diabetes develop kidney damage, so it is important for people with diabetes to have regular tests to check their kidney functions. Blood test Serum creatinine and eGFR (estimated Glomerular filtration rate) will tell us about the total kidney function. The presence of excess protein or albumin in the urine is also a marker of kidney damage.

Kidney damage from diabetes can be reduced or prevented if detected early. It is important to keep the blood sugars under control with the help of doctors, with regular medicine intake, good dietary practices and regular exercises.

3. Regular monitoring of blood pressure

Although many people may be aware that high blood pressure can lead to a stroke or heart attack, few know that it is also the most common cause of kidney damage.

The normal blood pressure level is less than 140/80 mmHg. One should adopt lifestyle and dietary changes at 140/90 and above. They should discuss the risks with the doctor and monitor the blood pressure level regularly. High blood pressure is especially likely to cause kidney damage when associated with other factors like diabetes, high cholesterol and heart diseases.

4. Eat healthy and maintain optimal weight 

This can help prevent diabetes, heart disease and other conditions associated with Chronic Kidney Disease.

Reduce the salt intake. The recommended sodium intake is 5-6 grams of salt per day (around a teaspoon). In order to reduce salt intake, try and limit the amount of processed and restaurant food and do not add extra salt to the food.

5. Maintain a sufficient fluid intake

Drinking 2 liters of water per day should be sufficient to maintain good health.

Consuming adequate fluids will help the kidneys clear sodium, urea and toxins from the body which, in turn, results in a “significantly lower risk” of developing chronic kidney disease. However  “aggressive fluid loading”, which can cause side effects, is not recommended. It’s important to keep in mind that the right level of fluid intake for any individual depends on many factors including gender, exercise, climate, health conditions, pregnancy and breastfeeding. In addition, people who have already had a kidney stone are advised to drink 2 to 3 liters of water daily to lessen the risk of forming a new stone.

6. Do not smoke

Smoking accelerates the process of atherosclerosis, which is the hardening of the blood vessels and thereby slows the blood flow to the kidneys. When less blood reaches the kidneys, it impairs their ability to function properly. Smoking also increases the risk of kidney cancer by about 50 percent.

7. Do not take over-the-counter pills/ pain killers on a regular basis

Common pain killer medicines also called non-steroidal anti-inflammatory drugs like brufen, combiflam and voveran are known to cause kidney damage if taken regularly.

Such medications probably do not pose significant danger if the kidneys are relatively healthy and when one uses them only during emergencies. However in situations of chronic pain like, arthritis or backache, one has to consult a doctor to find a way to control the pain without putting ones kidneys at risk.

8. People with ‘high risk’-Get your kidney function checked 

1. Those Who have Diabetes

2. Those Who have hypertension or high blood pressure

3. Those who are obese

4. If one of the parents or other family members are suffering from kidney disease

5. Those who are of Asian, African or Aboriginal origin