Urology and Andrology Procedure

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

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