FAQ's - MITR

 What is Laparoscopy?
A laparoscope is pen-like instrument (one-half to one centimeter in diameter) inserted into the abdomen through the navel to view the interior of the peritoneal cavity.

The vision obtained is magnified onto high resolution TV monitors, the heightened visibility permits the laparoscopic surgeon to operate with precision and minimal trauma to the tissues.

Laparoscopic surgery has changed the practice of modern general surgery, urology and gynecology. Since 1990, advanced surgical procedures, including laparoscopic surgery, are routinely performed at specialized DEDICATED centers like MITR hospital at Kharghar.

The advantages of laparoscopic surgery are numerous, including the following:

1. Greater precision because of the magnification of the operative field.
2. Diminished blood loss.
3. Tiny incisions rather than opening the entire abdomen.
4. Less post-operative pain and discomfort.
5. Fewer complications.
6. Shorter hospital stay.
7. Quicker recovery time.

1) Is Laparoscopic surgery possible in children?
Yes, laparoscopic surgery is very much possible in children. For such surgeries in children, we use miniaturised equipment and telescopes. Laparoscopic surgery is possible even in small newborns for selected indications nowadays.

2) Is Laparoscopic Surgery safe in kids?
Yes, with good anesthesia, pediatric laparoscopic equipment and a trained surgeon, laparoscopic surgery is safe in children.

3) What are the common surgeries done laparoscopically in children?
◦ Appendicectomy
◦ Surgery for Undescended testis
◦ Pyeloplasty
◦ Diagnostic laparoscopy and Biopsy
◦ Hernia repair
◦ Nephrectomy
◦ Ovarian cystectomy / ovarian torsion management
◦ Cholecystectomy
◦ Gastro-esophageal reflux repair
◦ Many more surgeries are possible laparoscopically in kids.

4) What are the advantages of laparoscopic surgery in children?
◦ Shorter hospitalisation
◦ Smaller cuts- smaller scars- may be practically sutureless
◦ Faster recovery
◦ Less Pain
◦ Less chances of infection
◦ Less blood loss
◦ Less post-operative complications.

5) What are the disadvantages of laparoscopic surgery in children?
◦ May take more time in certain cases.
◦ Anesthesia required may be more for surgeries like hernia repair.
◦ All surgeries especially if a lot of suturing is required may not be possible laparoscopically.

6) What is the usual post-operative course?
◦ The child may have some pain post-operatively and also some bloating of the belly. This occurs as during laparoscopic surgery we put in carbon ◦ Dioxide gas to inflate the belly for creating a working space.
◦ Generally after most of the surgeries we allow feed in the evening after surgery.
◦ Most of the times the babies are discharged the day after surgery.

1) What are fibroids?
Uterine fibroids are non cancerous muscle growths in the uterus. They occur in about 50perrcent of womenin reproductive age group age. Many women who have fibroids are unaware of them because the growths can remain small and not cause a problem. Fibroids however can cause problems due to their size, number and location.them. The procedure is performed through a laparoscope and uses either a laser or electrical or cryo needle that is passed

2) What are its types?
Uterine fibroids are depending on the size, shape and location may occur inside the uterus, on its outer surface or within the walls. Fibroids can range in size from pea-sized growths to large melon sized growths. As fibroids grow they can disturb the inside as well as the outside of the uterus and can completely fill the pelvis and abdomen. Fibroids can occur singly or in multiples of varying sizes. Growth of the fibroid is unpredictable. They may remain very small for a long time, suddenly grow rapidly, or grow slowly over a number of years.

3) What causes of Fibroids?
Little is known about what causes them. Few theories put the responsibility on the ,female hormone estrogen

4) How do I know whether I have fibroids?
▹There may not be any symptoms at all.
▹Heavy flow,
▹long and frequent periods,
▹bleeding in between periods and
▹pain –lower abdomen

5) How do I know if my symptoms are due to fibroids?
Gynaecology routine pelvic examination. Other tests that can be used to obtain more information about the fibroid include the following,

▹Sonography.It can identify the site, size and number or fibroids.
▹Cmputed Tomography (CT) Scan and Magnetic Resonance Imaging (MRI)are special imaging techniques that may also be used to help visualize the fibroids but are rarely needed.

6) Complications of Fibroids ?
Bleeding related to it can get the heamoglobin of the pt .down and at times may need blood transfusion.

7) Can fibroids cause infertility?
Fibroids are not usually a cause of infertility. In order to cause infertility, fibroids must grow very close to and must actually obstruct the uterine openings of the Fallopian tubes, thereby blocking the passage of the egg as it enters the uterus. Both tubes must be blocked, since only one open tube is needed for pregnancy to occur.

8) Can fibroids be treated with medication?
Medication can temporarily reduce the size of the majority of fibroids and decrease the amount of menstrual bleeding, allowing a window time for some women to prepare physically and emotionally for surgery Fibroids may be removed with myomectomy or hysterectomy and the choice usually depends on patients wishes and desire to preserve fertility.

9) What is uterine artery embolization procedure for the treatment of fibroids?
Uterine artery embolization is a fairly new procedure developed to shrink fibroids without surgical removal of them. The procedure, performed by an interventional radiologist, involves injecting the embolizing agent to both uterine arteries (blocking the main blood supply to the uterus), because of which fibroids will die and eventually be absorbed by the body.

10) Which surgery best suits my fibroid?
The size, number & location of the fibroids and the first and foremost .

Technical skills of the operating surgeon are equally important deciding which surgery is best suited.

11) Can Fibroids turn into cancerous if untreated?
Uterine cancer caused by fibroids is extremely rare.

12) What is myoma coagulation (myolysis)?
Myoma coagulation, or sometimes called myolysis, is a laparoscopic procedure developed to shrink fibroids without removing directly into the fibroid to destroy both the fibroid tissue and the blood vessels feeding it.

1) What is endometriosis?
The tissue present inside the uterus is seen outside in endometriosis. Endometriosis is missed in 7% of normal people and understaged in 50%.

2) What are its Symptoms?
▹Pelvic pain.
▹Menstrual complaints.
▹Painful intercourse
▹Painful defecation.
▹Infertility.
▹Lower back pain which may radiate down the legs.

3) What causes Endometriosis?
▹The real cause of endometriosis remains unknown.
▹There is a theory that menstrual blood refluxed through the fallopian tubes gets deposited and grows on the pelvic peritoneum and pelvic organs.

4) How do I know wheather I have Endometriosis ?
Endometriosis is almost always diagnosed laparoscopically. Recognition of endometrioctic lesion is always hampered by excistence of coexisting microscopic lesions in normal looking abdomen.

5) What is the Treatment of Endometriosis
Endometriosis can be managed medically or ,surgically.

6) What is the Surgical Treatment?
There are are two surgical options radical and conservative.

Conservative surgery is rarely curative but is for those women who wishes to maintain her reproductive potential.

Radical surgery refers to the removal of uterus,ovaries and endometriotic lesion.

7) Does endometriosis recur after surgery ?
Recurrence of symptom rates of 13% and 40% has been seen after follow up of 3&5yrs respectively.Pregnancy to some extent can delay the onset of endometriosis.

8) What is the role of conservative surgery in endometriosis ?
The goal is to restore the normal anatomic relationship with view to increase the patients chances of conception and obtain pain relief.

9) Will I require further surgical intervention after conservative surgery?
There is 25% risk of redo surgery after conservative surgery and she is fortunate if she gets pregnant as this rate falls to 10%

10) Which organs other then reproductive organs are involved in endometriosis?
Endometriosis may affect the urinary system.gastrointestinal system and rarely seen on the under surface of diaphragm. Recently lot of cases are being diagnosed with abdominal wall endometriosis.

11) How does endometriosis cause infertility?
Distortion of normal anatomic relationship leads to infertility.

1) What is hysterectomy?
Surgical removal of the uterus is known as hysterectomy which is one of the most commonly performed gynecologic surgeries .

2) Why is uterus removed?
Few commonly performed reasons for hysterectomy include endometriosis, fibroids, adenomyosis non responding to medical management and cancer.

3) How is uterus removal surgery performed?
Inour country, the majority of hysterectomies are still done through a large abdominal incision known as an abdominal hysterectomy. When done through the vagina, the surgery is called a vaginal hysterectomy.

For patients with complicated pathologies including endometriosis, large uterine fibroids, ovarian cyst, extensive or dense adhesions secondary to previous abdominal pelvic surgeries, a vaginal hysterectomy becomes difficult or is contraindicated.A leap in technology brought in Minimally invasive technology for performing gynaecological operations with ease. And now Laparoscopically performed gynaecological surgeries are performed with Robotic assisted Laparoscopy.

4) Why is Minimally Invasive surgery safe?
Visualisation of pelvic cavity in great detail and enables him/her to get into the right surgical planes during surgery with minimal blood loss and tissue damage. As a result of this development, gynecologists now have an advantageous alternative to abdominal hysterectomy when vaginal hysterectomy is difficult, complicated, or deemed contraindicated.

5) Should ovaries be removed during hysterectomy?
Ovaries play protective role of releasing hormones in women and attempts should be made to conserve them.

6) What are types of Laparoscopic Hysterectomy ?
Part or complete use of laparoscopic technique to perform a hysterectomy is Laparoscopic Hysterectomy. Depending on the degree of laparoscopic technique used during the hysterectomy, the surgery may be classified as one of the following:

➢Laparoscopic Assisted Vaginal Hysterectomy (LAVH). Only a small portion of the hysterectomy is done with the laparoscope, with the rest of the procedure performed through the vagina. Laparoscopic assisted vaginal hysterectomy (LAVH) does not include occlusion and division of uterine arteries in the laparoscopic portion of hysterectomy.
➢Laparoscopic Hysterectomy (LH). Most of hysterectomy is done by laparoscopic technique, including theperform any portion of the procedure vaginally. The technique of total laparoscopic hysterectomy enables the gynecologic endoscopic surgeon to perform larger and more difficult hysterectomies. Total laparoscopic hysterectomy (TLH) requires advanced surgical skills on the part of gynecologist whose experience and proficiency are paramount in performing successful operative laparoscopy.
➢Total Laparoscopic Hysterectomy TLH). The entire hysterectomy is performed laparoscopically. The surgeon does not. perform any portion of the procedure vaginally. The technique of total laparoscopic hysterectomy enables the gynecologic endoscopic surgeon to perform larger and more difficult hysterectomies. Total laparoscopic hysterectomy (TLH) requires advanced surgical skills on the part of gynecologist whose experience and proficiency are paramount in performing successful operative laparoscopy. occlusion and division of both uterine arteries. The vaginal branch of uterine vessels are secured and divided vaginally and also the top of vagina is separated from the cervix vaginally.
➢At the MITR Healthcare all hysterectomies are totally done laparoscopically

7) Does Hysterectomy affect sex life in women ?
During hysterectomy uterus and cervix is removed but the vaginal passage is left intact to perform sexual act. What menopausal symptoms occur after surgical menopause/hysterectomy? Menopause symptoms have varied presentation and there is no chronological order. Hotflushes, anxiety, sweating, intolerance to extremes of temperature,dry skin, dry and itchy vagina,urinary symptoms, breast changes

1) What is a kidney stone?
The human kidneys are paired organs, which are positioned just in front of the 11th and 12th ribs. The kidneys are responsible for filtering water and other substances from the blood. The combination of these filtered substances and water is known as urine. Several of the substances commonly found in urine have the ability to crystallize. These crystals can then bind together to form a kidney stone.

2) What are the symptoms of a kidney stone?
The most common symptom from a kidney stone is the acute onset of severe flank pain due to the stone moving into a position in the kidney or ureter, which causes a blockage or obstruction of the flow of urine. Kidney stone pain is often associated with low back pain and abdominal pain. Kidney stones, especially those in the left kidney, can also cause significant amounts of nausea and even vomiting. As the stone moves further down the ureter toward the bladder, the pain often radiates in the groin and genital areas. In men, the pain may radiate to the scrotum. In women, the pain may radiate to the labia or even the vagina.

The pain associated with kidney stones often comes in waves. It has been said that kidney stone pain is the worst pain that a man can experience. Many women state that the pain is as bad or worse than labor pain. The amount of pain experienced does not correlate in any way with the size of the kidney stone.

Kidney stones can rub along the lining of the kidney and ureter, which can lead to blood in the urine. In addition, the stone may be associated with urinary frequency and irritation.

3) Are kidney stones common?
Kidney stones are a relatively common problem. Approximately 3 in 100 persons in Navi Mumbai have new stones each year.

4) Why do stones occur?
There are certain conditions in the urine including those caused by not drinking enough water, that make crystals which can tribute to stone formation. Some patients form stone because of anatomical malformations of the urinary tract, while other patient may have a genetic predisposition, environmental or nutritional risk factors.

5) What does a kidney stone look like?
Kidney stones can come in many different colors, shapes, textures, and sizes. The color depends on the composition of the stone. Most stones are yellow or brown, however, they can also appear tan, gold or black. The shape of the stone may be round, jagged or branch-like. The stone may be rough or smooth in texture. Finally the size of the stone may vary from specks of sand to pebbles to stones as large as golf balls.

6) What are the different types of kidney stones?
There are many different types of kidney stones. The vast majority of stones are composed of calcium. The most common types of stones are calcium oxalate (70%), calcium phosphate (5-10%), struvite (10%), uric acid (10%) and cystine (1%). It is not uncommon for a single stone to be made of more than one of these types. When this occurs, the stone is commonly referred to as a mixed stone. Less common types of kidney stones include Xanthine, matrix stones ,Indanavir stones.

7) Can kidney stones damage the kidney?
Kidney stones that block or obstruct the flow of urine within the urinary tract may be responsible for infection or even deterioration of renal function.

8) Who gets kidney stones?
Patients who are at risk for stone formation include inadequate hydration, dietary practices, stones that run in families, infections, anatomical factors within the urinary tract and metabolic conditions that may promote stone formation.

9) How do I know if I have a kidney stone?
The size, shape, and location of urinary calculi can cause many different symptoms. Many stones can cause sudden onset of severe pain, bloody urine, obstruction, or infection. Other stones can cause nausea, vomiting, fever or chills and burning with urination. You may experience a "renal colic" attack, which is flank (side) pain associated with a kidney stone.

10) Do kidney stones form in one or both kidneys?
The majority of renal stones are found in one kidney. However, bilateral renal calculi occur in 10 - 15% of patients. The CT scan, below, shows a stone in each kidney (red arrowheads).

11) Can you have more than one stone the kidney?
Yes. You can have multiple stones in a single kidney. The KUB, below, shows multiple stones in the right kidney (red arrowhead).

12) Do all stones require surgery?
No. There are several variables, which affect a person's ability to completely pass a kidney stone. Some stones can pass spontaneously without medical or surgical intervention. The size and the location of the stone are factors that may effect whether a stone will pass spontaneously. Stones that are smaller than 4 mm have a 40-fold greater chance of passing spontaneously than for stones larger than 6 mm, regardless of the location of the stone.

With regard to location, a stone in the distal ureter (close to bladder) compared to a proximal ureteral stone (close to kidney) will spontaneously pass 45% and 12%, respectively.

13) How do I treat a kidney stone?
There are various treatment options for managing kidney stones. Some stones may be treated with medication. Other stone types may require surgical intervention. Surgical management may include noninvasive surgery, minimally invasive surgery or infrequently, open surgery.

14) Can kidney stones reoccur?
Patients who have a kidney stone may have another kidney stone in the future. The risk of a patient having a recurrence of a stone can be up to 50% in 5-10 years and 80% in their lifetime.

15) What can I do to prevent a future kidney stone?
Depending on the type of stone that you have, your doctor may suggest a dietary modification or medication, which may reduce your risk for future stone formation. Speak with your physician

A very important aspect in the patient's evaluation is the analysis of the extracted or fragmented stone. Within 2 days of patients having symptoms related to stones, approximately 70-80% of stones will pass spontaneously in the urine. On the other hand, if patients underwent a procedure for stone treatment, their maybe stone fragments that broken up but not yet removed. Therefore, it is very important to collect any stone fragments that may pass in the urine. Patients are asked to urinate into a strainer, a cup with a mesh in the bottom, to retrieve the stone fragments. All stones fragments, no matter how large or small, should be collected and sent for stone analysis. This evaluation is essential and will shed light onto the etiology and pathogeneses of the renal stone so that therapy can be optimized.

16) 24-hour Urine Collection
Four to six weeks after a patient has passed his or her stone, or after it has been removed or disintegrated a 24-hour urine specimen will be obtained. It is important that the patient remain on his or her regular diet and life style during this period of urine collection. Urine is collected over a 24-hour period beginning with the second urine on the first day and ending with the first urine on the second day. This urine collection will be studied for chemicals in the urine that promote and inhibit stone formation. The specimen is analyzed for total urine volume, calcium, phosphorous, uric acid, creatinine, oxalate, magnesium, sodium and citrate.

17) Recommendations
Patients who had a history of kidney stones are prone to developing stones in the future. In fact, patients who develop stones, have a 50% risk of developing another stone within 5-10 years, and about 80% chance sometime in their life. To reduce a patient's risk of developing another stone, there are proactive measures that you and your urologist can take. Based on the stone analysis and the 24-hour urine collection, we can determine the type of stone and stone forming substances that may increase your risk for future stone formation. Therefore, we can determine if certain dietary changes and/or medications may reduce your risk for future stone formation. In addition, one of the most important factors for reducing all types of stones is by drinking large amounts of fluids. Patients who make kidney stones should drink of fluids to make 2 liters of urine or about ½ gallon of urine daily. Since the goal is to produce 2 liters of urine daily, you may find it necessary to drink more fluid in hot weather or if you perspire from athletic activity, etc. to replace the fluid lost by sweating.

1) What is UPJO?
ureteropelvic junction (UPJ) obstruction is a blockage which prevents fluid from draining out of the renal pelvis to the ureter, the tube which carries urine away to the bladder so that it can be expressed. The renal pelvis essentially acts like a funnel for urine, and when it is blocked, urine can back up into the kidney, causing kidney damage.

2) Does it occur in Adults?
This condition most commonly occurs as a congenital abnormality caused by malformations during fetal development, although it can also have extrinsic causes.It can be missed during childhood and is diagnosed in adults . People who have had kidney surgery are at increased risk for developing a UPJ obstruction, and they should seek the attention of a urologist if they develop any of the symptoms. The same holds true for patients with a history of kidney stones.

3) Are they associated with stones?
Stones are usually secondary effect of stagnation of urine inside kidney. They occur in 10% of all adult patients.

Pre-operative evaluation:
If a UPJ obstruction is mild, it may be left alone and allowed to resolve on itself. The patient may be given medications to eliminate infection or to break up a kidney stone, and the patient will be checked in a follow up appointment to see if the UPJ has cleared. More serious obstructions like total blockages and obstructions which do not resolve will require surgery. Surgery can include placement of a stentto temporarily drain the kidney until the site has healed.

Open pyeloplasty:
Surgery for a UPJ obstruction can take a number of forms, with some procedures being more invasive than others. The choice of surgery is usually dictated by the cause of the obstruction, the patient's general health, and the surgeon's preference. Recovery times vary, and generally include monitoring to check urinary output, and follow up care to confirm that the obstruction has been successfully removed.

Laparoscopic pyeloplasty:
Current trend is towards treating UPJO by minimally invasive techniques where laparoscopic technique is proving to be the best option.

4) Pre-operative evaluation
Open pyeloplasty

1) What and where is prostate gland?
The prostate is a small gland in the male reproductive system that is wrapped around the urethra, the tube that carries urine out of the body. The prostate makes part of the semen that carries sperm. During sex, muscles squeeze the prostate's fluid into the urethra. This fluid helps keep sperm active and alive in the vagina.

2) What is benign enlargement of prostate?
Benign prostatic hyperplasia, or BPH, is the medical term for what happens when a man's prostate gland grows larger and makes it difficult for him to urinate. BPH -­ a non-cancerous condition -­ is a normal part of growing older.

As the prostate grows, the capsule that surrounds it prevents the gland from expanding outward. As a result, the prostate presses against the urethra like a clamp on a water pipe and causes difficulty in urinating. The bladder wall thickens and becomes irritated. It may begin to contract when it holds even a small amount of urine, causing more frequent urination. As this strain continues, the bladder may eventually become unable to empty itself completely.

We still do not fully understand why BPH occurs. However, BPH does not seem to have to do with how sexually active a man is. Celibate priests experience BPH as often as all other men. Nothing seems to link BPH to impotence, prostate infections or sexually transmitted diseases.

Some men will begin to show some symptoms of BPH in their late 40s. About one-third of men develop BPH in their 50s. More than half of all men have it by the time they are in their 60s, and by age 85, nine out of 10 men develop BPH. While you can't prevent BPH, but you can have it and be among the over 50% of men who never experience any symptoms.

3) BPH Testing and Treatment
If you're having problems urinating we order some of the following tests to see if BPH has affected your bladder or kidneys and to rule out cancer as a cause of your symptoms.

Sonography or Ultrasound
Prostate Specific Antigen (PSA)
Creatinine
Because each man with BPH is different, you should discuss if this test is right for you. We may recommend additional procedures, depending upon your situation.

4) Do You Need Treatment?
If you have BPH, it doesn't necessarily need to be treated. You may have BPH and never experience any symptoms. If your symptoms are mild, you may not need treatment right away. And you may fall into the one-third of men whose mild symptoms go away without treatment.

Your BPH needs to be treated only if your urinary tract has been damaged, is in danger of being damaged, or your symptoms are severe enough to bother you.

When deciding whether you need treatment, you also need to ask yourself a few questions:
✓ Do my symptoms keep me from doing the things I enjoy?
✓ Do I want treatment now?
✓ What are the risks? Do I understand them? Am I willing to accept those risks in order to get rid of my symptoms?

Once you've decided to be treated for your BPH, you'll have a number of options available to you, including monitoring, medication or surgery.

Each treatment has its own benefits and risks. Know which treatment is best for you, and ask these questions:
✓ What is this treatment's success rate?
✓ How much better will I feel after this treatment?
✓ What are this treatment's risks? What are my chances of experiencing adverse side effects?
✓ How long will this treatment work?

1) What is Pediatric Urology?
Specialized medical science which deals with surgical disorders of genitourinary system (Kidneys, ureter, bladder and reproductive system) in children upto the age of 15 years.

2) Who is a Pediatric Urologist?
Pediatric Urologists are trained surgeons who treat such kids. Either they are Pediatric Surgeons who receive special training in Pediatric Urology or sometimes Adult Urologists who receive training in Pediatric Urology.

3) What is the scope of Pediatric Urology?
Pediatric Urology is a new and rapidly expanding field. In this era, parents want their kids to be treated by the best specialist possible and so such a specialty is the need of the hour. And with so much of progress being made in equipment and medicines, it would be impossible for a general surgeon to aware of everything new and latest.

4) How do I know that my child has a Pediatric Urology disorder?
We have listed a list of symptomswith which these disorderspresent. If any of these is present then please consult a Pediatric Urologist at the earliest. The other way is to consult a Pediatrician and then he will be able to guide you to an appropriate person.

5) How is Pediatric Urology different from adult urology?
Pediatric Urologists are experienced in handling small kids and can operate on these very soft and miniature tissues. They understand an unspoken language of the kids also and will be able to diagnose the problem in a young child better than an adult urologist who sees only adults.

6) What are the common symptoms of Pediatric Urology problems?
✔ Disorders diagnosed during pregnancy on ultrasonogram of mother
✔ Pain during passing urine- dysuria
✔ Thin stream
✔ Straining to pass urine
✔ Urinary retention or failure to pass urine
✔ Frequent passage of urine
✔ Hematuria or blood in urine
✔ Pyuria or pus in urine
✔ Bed wetting
✔ Incontinence of urine
✔ Urinary tract infection
✔ Fever
✔ Pain in belly
✔ Abnormal looking penis or genitalia
✔ Testisnot seen/ felt in scrotum
✔ Testicular swelling or pain

7) What are common Pediatric Urological disorders?
✔ Antenatally diagnosed renal anomalies
✔ Antenatal Hydronephrosis
✔ Undescended testis
✔ Testicular torsion
✔ Testicular cysts or tumours
✔ Labial Adhesions
✔ Tight foreskin or phimosis
✔ Hypospadias
✔ Episapdias
✔ Urinary tract infection Posterior urethral valves
✔ Vesico-ureteric reflux
✔ Pelviureteric junction obstruction
✔ Vesico-ureteric junction obstruction (primary megaureter)
✔ Intersex
✔ Neurogenic Bladder
✔ Dysfunctional Voiding/ Dysfunctional elimination syndrome
✔ Bladder diverticulum
✔ Duplex systems (or double ureters)
✔ Ectopic ureters
✔ Ureterocele
✔ Cystic kidney diseases
✔ Calculus disease
✔ Prune belly syndrome
✔ Stricture urethra
✔ Genital injuries
✔ Horseshoe kidney
✔ Absent kidney or renal agenesis

1) Hypospadias
In the course of last few years of my dedicated practice in Pediatric Urology and hypospadiology, I found that anxious parents have a lot of questions and they forget to ask many of them when they are consulting me in the clinic. Here I have put down some of these question/ answers and I hope it helps the parents in participating better in the care of their little one. All in all it’s a team effort.

2) What is hypospadias?
This is a condition where the urinary opening (pee hole) is not in the correct place but located on the underneath surface of the penis. The type of hypospadias is described by where the opening is. The mildest form (glanular) is where the opening is on the glans (see diagram). In moderate hypospadias, the opening comes where the glans meets the body of the penis (coronal and sub-coronal). Openings farther back (on the penis itself or at the base of the penis) are the severe varieties. In addition to the hole being in the wrong place, the foreskin is often incompletely formed on the undersurface and looks like a hood on the top. Sometimes the penis is bent downwards (chordee) usually due to tight skin but sometimes due to abnormality of the body of the penis.

3) Is it common?
Yes. It occurs to some degree in 1 in 150 to 200 boys. In India every year more than 75000 babies are born with hypospadias.

4) Is it associated with any other abnormalities?
Mild to moderate hypospadias are rarely associated with other abnormalities so no further tests are required. If the hypospadias is very severe or there is also an undescended testis or penile size is very small, then further testing is required.

5) Why does it happen?
The urinary pipe called urethra normally forms from a strip of special skin forming itself into a tube on the under side of the penis. It closes up rather like a zip fastener pulling closed from the back end to the tip of the penis. For some reason the end part of the tube fails to form and remains as a flat plate. The underlying cause is unknown in most cases. There are several theories including increased female hormone like substances in the environment causing mild forms of hypospadias. Very occasionally it seems to run in families.

6) Is surgery required?
Surgery may be required for 2 reasons:

1. To make everything work properly, i.e. to make the urine come out straight and to make the penis straight.
2. For cosmetic reasons.

If the boy can pass urine forwards then the operation is purely cosmetic. However, if it is not, there is a risk of your child becoming upset by the appearance as he gets older. Surgical results are best in the first year of life.

7) When should the surgery be done in ideal circumstances?
Ideal age for surgery in most of the hypospadias is between 6-12 months of age. If there are any co-existing problems, then surgery may be delayed till they are sorted out.

8) Why are the babies operated at such a young age? Why not wait till they are older?
Anesthesia is relatively safe after 6 months of age, that’s why we wait till that age. In infancy the babies are still in diapers, so managing them post surgery at home is very easy for the parents. The catheter can just drip into the diapers and baby can be sent home, the evening of surgery or maximum the next day. Further the skin and tissues are very pliable and heal very well at this age. Most importantly, erections and infections are also less of an issue at such a young age. Older kids have painful erections after surgery and also the success rates of surgery are lower in them.

9) Will there be any problem in the future regarding married life and children?
Most of isolated hypospadias once corrected do not have long-term sequences. Only cases where further investigation is warranted to look for fertility issues are where the hypospadias is very severe, there is associated undescended testis or the gender itself is in question. This can be ascertained by a set of certain investigations which your doctor will explain to you if required.

10) What are the usual precautions before surgery?
Babies are checked for fitness for anesthesia by a pediatrician / anesthetist. A couple of blood tests may be required. Any history of bleeding / blood disorder in the family should be asked. The baby should be free from any infection elsewhere (cold, cough, diarrhea, skin infections etc.). Generally babies are kept empty stomach for 4-6 hours before surgery as it is a requirement for anesthesia. Bathing is advisable in the morning of surgery.

11) How long does the surgery take?
Surgery time depends upon the severity of the hypospadias. Generally total time spent in the operation room (inclusive of anesthesia time) for a penile hypospadias is between 2-3 hours and more for severe hypospadias

12) What does surgery involve?
There are many types of operations designed to repair hypospadias. Essentially the operations we use, try to bring the hole up to the correct position on the 'head' of the penis (glans), make sure that the penis is straight and repair or remove the foreskin all in one operation. Many moderate hypospadias repair operations can be done as day care procedures (in and out of hospital the same day). Sometimes the child may need to stay in hospital overnight and have a tube (stent) draining the urine for a few days. Our doctor will explain the type of surgery planned for your child.

13) What is a stent?
The surgeon may decide to leave a tube (stent) into the bladder to drain the urine. This is left in place for 5 to 14 days depending on the details of the operation, and usually simply drains urine into the nappy. A bag can be attached for older children who no longer use nappies. If a stent is used for more than 2 days antibiotics are prescribed to prevent an infection in the urine.

The catheter is used to prevent urine running over the internal stitches so that in the first 24 hours there is not so much stinging. When it is removed the child may still find passing urine sore but this gets better in 24 hours. For bigger operations a catheter is used to keep urine from bursting through the stitches for a longer period to help healing. This catheter may irritate the bladder causing spasms in about 10% of cases. The baby cries out about every 30 minutes. If this happens it is easily treated by giving a medicine to stop the spasm.

14) When do we have to come again to the hospital after discharge?
First follow-up visit is generally arranged within 5-7 days after surgery for removal of dressing. After removal of dressing, an antibacterial ointment is applied 4-5 times a day and at each diaper change. Depending on the type of surgery done, second visit is arranged at 10 -14 days for removal of catheter. A further checkup is done after 3-4 weeks, 3 months and at one year.

15) What are common problems after surgery that we should know about?
➛ Most of the time, the babies are slightly cranky but manageable. They feel better at home that is why we try to send them to home as soon as possible. It is also easier for the parents to manage them at home. Further a pain killer syrup is prescribed to help in pain relief.
➛ Babies may have intermittent spasms due to irritation by the catheter. For this reason, a small dose of bladder relaxant is usually prescribed. The dose may need to be adjusted if cramps still happen.
➛ Blood spotting in the diaper / catheter may occur in the first few days. A few drops of the blood are acceptable. In case of continuing ooze, a hospital visit may be required but this is very infrequent.
➛ Dressing loosening up may occur in some babies, if it happens during first 2-3 days, then a new dressing is placed. After that the dressing is just removed.
➛ Infection may happen and is the most common cause of the failure of surgery. To prevent this, broad spectrum antibiotic syrup is usually prescribed for 7-10 days. It is vital to prevent stool smearing up the dressing in immediate post-operative period.

16) What is the usual post-operative course?
Babies are usually allowed feeds within 3-4 hours after surgery once they are fully awake and asking for feeds. Initially water and juices are started, if there is no vomiting, gradually milk and solids are introduced. Generally, babies are on their usual diet the morning after surgery. Diaper care is taught to the parents by myself and the nurses. Medications (syrups) are explained well and discharge to home happens by evening or morning after.

1) What is a hernia?
Commonly, a hernia develops over the abdomen. The abdominal wall consists of multiple layers – skin, fat under the skin, various muscles and fascia, fat and peritoneum.

Every hernia is characterised by a weakness or hole in the muscle layer. This allows the peritoneum to bulge through the muscle hole. This in turn allows the contents of the abdomen to protrude out and present as a bulge under the skin. This abnormal bulge is called a hernia.

2) What is an inguinal hernia?
Inguinal hernias account for about 80% of all hernias and are the most common surgical procedures done in infancy. These hernias appear more frequently in boys than in girls. An inguinal hernia is derived from persistence of all or part of the processus vaginalis, the tube of peritoneum that precedes the testicle into the scrotum during the eighth month of pregnancy. Following the dropping of the testicles into the scrotum, the processus vaginalis withers and closes forming the tunica vaginalis that lies below the testicles in the scrotum. When this fails to happen, fluid from the abdomen or an abdominal organ (usually the intestines) can be forced into it causing a bulging or mass that can be felt. The process vaginalis can extend only partly from the inguinal canal or extend completely into the scrotum.

Normal scrotum:
The processus vaginalis and tunica vaginalis are obliterated and contain no fluid or abdominal contents

Inguinal hernia:
The processus vaginalis has remained open allowing abdominal contents (fluid and loops of bowel) to enter into the scrotum

3) How is an inguinal hernia diagnosed?
There are usually no symptoms that a child has an inguinal hernia until abdominal organs are forced into the sac. Swelling can sometimes be seen in the groin area when a baby is crying or straining or when an older child coughs, strains or stands for a long time. If the bulging can be gently pressed back into the abdomen, the hernia is known as reducible. If a loop of the intestine is forced into the sac, the hernia is then known as incarcerated (irreducible). An infant or a child will show signs of irritability, loss of appetite, tenderness and swelling of the abdomen or have trouble having a bowel movement. With incarceration, the intestines have entered the sac and are being strangled. This portion of the intestines could die. This is life-threatening and you should call us immediately.

4) How is Inguinal hernia treated in kids?
Inguinal hernia once diagnosed clinically requires surgery. This should be done early as in pediatric age group, the chances of hernia getting stuck are relatively high and they are more for younger kids less than one year of age. Hernia repair is done through a small cut in the inguinal (groin) region as a Day Care surgery whereby the patient is admitted in the morning and goes home in the evening after surgery. All the stitches are absorbable and none need to be removed. In children less than two years, there are 10-20% of chances of hernia developing on the other side if there is hernia on one side and these children may be offered bilateral hernia repair at the onset.

5) Can inguinal hernia be repaired laparoscopically in children?
Yes, hernia can be operated laparoscopically easily even in small kids. For this purpose we use 3mm small equipment and telescope. We generally offer laparoscopic hernia repair to selected circumstances only after a detailed discussion with the family. Straightforward indications of Laparoscopic hernia repair are - bilateral hernia, recurrent hernia after a failed repair and a girl child with suspected internal organ problems.

1) What is hernia surgery?
Most hernia surgeries involve closure of the gap between the muscle using sutures. The hernia surgeon decides the need for adding a prosthetic material called mesh. Most mesh are made of polypropylene or polyester.

2) What is a mesh?
A mesh is a sheet of polyprolene or polyester and looks like a fishing net. It is a foreign body. When a mesh is introduced into the layers of the wall, it incites a foreign body. With ingrowth of cells, the body uses the mesh to strengthen the wall to prevent hernia recurrence.

3) What is conventional hernia surgery?
Open or conventional surgery involves an incision over the hernia site. The steps involved include

a) identify the hernia sac
b) reduce the contents
c) close the peritoneum
d) create space for mesh to overlap 3-5 cm beyond the defect
e) close the muscle gap / hernia defect
f) close the skin

1) What is an Undescended testis?
The testis (testicle) is responsible for the production of male hormone and also sperm. Before the child is born, the testicle migrates down from high in the abdomen and passes through abdominal wall and groin to take its normal position in the scrotum. Undescended testicles are quite common. They may be present in 4% of boys at birth, and there is an even higher incidence in premature infants. Three-fourths of these undescended testicles will descend to normal location within the first three months of life.

When a testicle is not in the normal scrotal location several possibilities exist:
➾ There may never have been a testicle (congenital absence).
➾ The testicle may have atrophied (withered away) before birth due to torsion (twist) or blockage of the testicular blood vessels.
➾ The testicle may have descended incompletely and may lie within the inguinal canal (just above the scrotum).
➾ The testicle may have not descended properly, but remains within the abdominal cavity.

In some children the testes may be found in the groin, but can be brought down into the scrotum during examination. These 'retractile' testicles also will be seen to descend when the child is in the bathtub. Retractile testicles are due to hyperactive muscles that temporarily pull the testicle into the groin. However, retractile testicles are not believed to injure the testicles and require no treatment.

2) Why should an Undescended testicle be treated?
In humans, the scrotal location of the testicles keeps them cooler than the core body temperature. This lower temperature is important for the development of the testicle as well as for production of normal sperm. Studies have shown that there is an increased risk of infertility in men with a history of undescended testicles. Relocating the testicle into the scrotum may decrease the risk of fertility problems, particularly if done at an early age.

There are other advantages to a location within the scrotum. There is a cosmetic advantage. The scrotal testicle may be less amenable to injury than a testicle outside the scrotum. Finally, and perhaps as important as any other reason, a testicle that has not made it into the scrotum is not accessible to physical examination. Undescended testicles are at increased risk for cancer. Testicular cancer may not occur until after age 40 years. Testicular carcinoma is highly curable, when detected early, and the best way to do this is monthly self-examination, which can only be done if the testicles are within the scrotum.

3) How is an undescended testicle treated?
We recommend treatment of the undescended testicle before one year of age, preferably by 6-7 months of age. There is evidence that early damage to the germ cells that produce sperm begins at this age. There are two options for treatment. Injections of a hormone, HCG, several times per week over several weeks can produce descent in some children. However, the success rates have been reported to be as low as10%. Also, the results of hormone treatment are less successful in children less than two years of age.

The most effective treatment is surgery, which can be performed as an outpatient. When a testis is felt in the groin area we usually explore the area through a small incision. Most undescended testes are associated with a hernia that must be repaired. After this is done, the testis is brought down into the scrotum and anchored in a space created in the scrotum (orchiopexy).

When a testis is not palpable on physical exam, its location must be determined. We have not found x-rays to be reliable in this regard. We place a laparoscope through a small incision below the 'belly button' to look in the abdomen at the time of surgery. Then the further course is decided upon the findings on Laparoscopy

Testis may be absent - This is confirmed by seeing blind ending blood vessels - Nothing further is done and parents are explained.
Testis may be small and abnormal - In such cases the testis are removed laparoscopically (orchiectomy). Most of these children probably had torsion or twisting of the testis on its blood supply prior to birth that led to the small testis.

Testis is present - In such cases, we assess if it is possible to bring the testis down in one stage or two stages. In those patients found to have testes very high in the abdomen, testis is brought down in two stages to preserve the blood supply.

1) Why is circumcision done?
Circumcision is one of the oldest operations performed. Sometimes it is done because a specific problem with the foreskin (prepuce) exists, and other times it is done for family, cultural, or religious reasons. Although routine circumcision was once advocated for all newborn males, the current feeling is that it is not necessary for all baby boys. Most boys will do fine later in life if their foreskins are not removed. A few may eventually need circumcision because of narrowing at the tip (phimosis), infections (posthitis), or irritation. The foreskin may be a source for urinary tract infections, and circumcision may be a good idea in boys with any underlying kidney abnormality.

2) How do you care for the uncircumcised penis?
Care of the uncircumcised infant is easy. We do not recommend pulling back on the foreskin to expose the tip of the penis (glans penis). As the boy gets older, the natural processes of erections and accumulation of old skin remnants between the inner foreskin and glans cause the foreskin to eventually separate from the tip of the penis. By age 5-6 years the foreskin should pull back easily, but and thereafter the foreskin should be cleaned daily.

3) Can phimosis be managed medically?
Yes, for selected cases with phimosis, medical treatment with ointments and daily cleaning may work and avoid a surgery. This can be decided only after a thorough history and clinical examination. We have personally treated more than 200 babies with phimosis successfully, with medical therapy.

4) When is circumcision recommended?
⇒ Certain medical reasons: vesicoureteral reflux, kidney or bladder infections,
⇒ Posthitis (inflammation of the foreskin)
⇒ True phimosis (narrowing of the foreskin) which has not responded to medical therapy.
⇒ Parents for family, cultural, or religious reasons may request circumcision.

5) Where is circumcision done?
In very young babies circumcision can be performed in the clinic with local anesthesia and a clamp. In older infants and children Sedation and regional anesthesia is preferable.

6) How is the penis cared for after circumcision?
Initially a transparent cling wrap type of plastic dressing is applied which remains in place for 3-5 days. Once it falls off, we suggest antibiotic ointment or Vaseline be applied to the glans with every diaper change after circumcision. We like to see the patient 1-2 weeks after circumcision.

1) What is the appendix?
The appendix is a small hollow organ attached to the large intestine located in the right lower part of the abdomen. Like the tonsils and adenoids, it contains a large number of lymph glands. If the appendix becomes inflamed, a condition called appendicitis results and the organ will have to be removed. The appendix is not necessary for health and can be taken out at an early age without adverse effects.

Diagram of intestines, including appendix Close-up of the appendix, coming off the cecum (the portion of the colon located in the right lower side of the abdomen)

2) What are the signs and symptoms of appendicitis?
The most common signs and symptoms of appendicitis are abdominal pain, tenderness, vomiting and fever. The pain may be around the navel (belly button) but soon moves to the lower right portion of the abdomen. The most painful area is located halfway between the hip bone and the navel, but may vary. Vomiting, nausea, and fever refusal to eat and refusal to eat may be other symptoms of appendicitis. Diarrhea or constipation may be present.

3) How is appendicitis diagnosed?
When the patient is brought to the hospital, the doctor will do a complete physical examination looking for specific tender areas of the abdomen. Blood for lab tests will be drawn to check for signs of inflammation or infection. White blood count may be high if appendicitis is present. The patient will not be allowed to eat or drink while the diagnosis is being made. This is to prepare for surgery should it be necessary. The patient may have IV fluids started to make sure he/she has enough fluid intake to prevent dehydration. In some cases, other x-rays may be taken including an ultrasound scan. A laparoscopic surgeon will finally examine the patient if the doctor thinks he/she may have appendicitis.

4) How is appendicitis treated?
Uncomplicated Appendicitis

If the appendix has not burst open, surgery will be done to remove the inflamed appendix. This operation is either done through a small incision in the lower abdomen or using laparoscopic surgery. Laparoscopic surgery involves 3 small incisions in the abdomen large enough to insert a telescope-like device that finds the appendix and removes it. Pain and chances of wound infection are less with laparoscopic surgery. In doubtful cases laparoscopy allows examination of rest of the intestines to look for any other cause for symptoms.

The recovery from surgery is usually fast and the patient is often home in 2-3 days. The patient will be started on clear liquids and advanced to a regular diet as he/she tolerates it. Sitting in a chair and walking are very important. This may be difficult at first. Pain medication is available to relieve the pain. Please feel free to ask your nursing staff or the surgery team any questions that you may have.

Complicated Appendicitis

If the appendix is ruptured, a larger abdominal incision may be required to remove the appendix. Peritonitis (inflammation of the abdominal cavity caused by the release of stool into the abdomen) may occur and will be treated with antibiotics for up to 10 days following surgery. Your patient may come out of surgery with an NG (nasogastric tube) to empty the stomach of acids that are normally produced by the body to digest food. Your patient will be able to start on clear liquids and progress to a normal diet after the NG tube output is low, the patient has bowel sounds (gurgling sounds that signal the digestive tract is working) and the patient passes gas or stool. It is very important to breathe deeply, walk and sit in a chair as much as possible. If you need assistance, please ask your nurse or any member of the surgery team.

Sometimes, if the patient has been sick for days, an abscess may have formed inside the abdomen. This may be drained by ultrasound guidance and the patient will be treated with antibiotics until the infection has resolved. In most patients this treatment is successful and the appendix is then removed 6 to 8 weeks later. In the present era, laparoscopic surgeons are able to perform drainage of abscess with appendicectomy in the same sitting by laparoscopic surgery.

The patient can return to work within a few days of leaving the hospital but may not be able to participate in sports for one or two months.

1) What is Laparoscopic Appendectomy?
Appendicitis is one of the most common surgical problems. Approximately 6% of the population has an appendectomy sometime during their lifetime. Treatment requires an operation to remove the infected appendix. Traditionally, the appendix is removed through an incision in the right lower abdominal wall.

In most laparoscopic appendectomies, surgeons operate through 3 small incisions (each 0.5 to 1 cm) while watching an enlarged image of the patient’s internal organs on a monitor. In some complicated cases, one of the small openings may be lengthened to 2 or 3 inches to complete.

2) Are you a candidate for Laparoscopic Appendectomy?
Laparoscopic appendectomy has many benefits and is appropriate for most patients. Early, non-ruptured appendicitis usually can be removed laparoscopically. Laparoscopic appendectomy for advanced infection or when the appendix has ruptured is a more technically difficult surgery. With vast experience, laparoscopic surgeons can perform such complicated appendicitis by laparoscopic surgery. Very rarely, a traditional, open procedure using a larger incision may be required to safely remove the infected appendix in these patients.

3) Are you a candidate for Robotic Appendicectomy?
Robotic Appendicectomy has all the benefits of Laparoscopic Appendicectomy. It is also appropriate for most patients. The technique of robotic surgery makes a technically difficult Laparoscopic surgery, simple and easier. In addition, the benefits are exemplified and enables a faster recovery after a robotic appendicectomy.

1) Laparoscopis Cholecystectomy
Cholecystitis is the next most common surgical problem. Commonly, stones in the gallbladder may block the outflow of bile causing an inflammation.Treatment requires an operation to remove the gallbladder. Traditionally, the gallbladder is removed through an incision in the right upper abdominal wall.

In laparoscopic cholecystectomies, laparoscopic surgeons operate through 4 or 5 small incisions (each 0.5 to 1 cm) while watching an enlarged image of the patient’s internal organs on a monitor. In rare cases, one of the small openings may be lengthened to 4 or 5 inches to complete the procedure.

2) Are you a candidate for Laparoscopic Cholecystectomy?
Laparoscopic cholecystectomy has many benefits and is appropriate for most patients. Early, uncomplicated cholecystitis usually can be removed laparoscopically. Laparoscopic cholecystectomy for complicated infection like abscess or when the gallbladder has ruptured is a more technically difficult surgery. With vast experience, laparoscopic surgeons can perform such complicated cholecystitis by laparoscopic surgery. Very rarely, a traditional, open procedure using a larger incision may be required to safely remove the infected gallbladder in these patients. Another option in complicated cholecystitis is to drain the pus within the gallbladder using a tube, inserted under ultrasound guidance. Such patients may require a planned cholecystectomy later.

▸ May not be appropriate for some patients who have had previous upper abdominal surgery.
▸ May not be appropriate for some patients who have some pre-existing medical conditions, posing a risk for anasthesia.
▸ A thorough medical evaluation by your physician, in consultation with the surgeon trained in laparoscopy, can determine if laparoscopic gallbladder removal is an appropriate procedure for you.
▸ Sometimes, even during laparoscopic surgery, a decision can be taken by the surgeon to convert to an open surgery due to the gallbladder disease.

1) What is the Gall Bladder?
► A pear-shaped organ that rests beneath the right side of the liver.
► Its function is to collect and concentrate a digestive liquid (bile) produced by the liver. Bile is released from the gallbladder after eating, aiding digestion.
► Its removal is not associated with any impairment of digestion in most people as Liver continues to make bile even after gallbladder removal.

2) What causes Gall Bladder Problems?
► Gallbladder problems are usually caused by the presence of gallstones: small hard masses consisting primarily of undissolved cholesterol or black pigment.
► These stones may block the flow of bile out of the gallbladder, causing it to swell and resulting in sharp right upper or midline abdominal pain, vomiting, indigestion and, occasionally, fever.
► If the gallstone blocks the common bile duct, jaundice (a yellowing of the skin) can occur.
► If the gallstone blocks the pancreatic duct, pancreatitis (a swelling of the pancreas) can occur.

3) How are these problems found and treated?
Ultrasound is most used to find gallstones.

► In a few cases, MRI abdomen / MRCP tests may be used.
► Gallstones do not go away on their own. Some can be temporarily managed with drugs or by making dietary adjustments, such as reducing fat intake. This treatment has a low, short-term success rate. Symptoms will eventually continue unless the gallbladder is removed.
► Surgical removal of the gallbladder is the time tested and safest treatment of gallbladder disease.

4) Are you A Candidate for Laparoscopic Gallbladder removal?
Laparoscopic cholecystectomy or gallbladder removal has many benefits and is appropriate for most patients. Early, non-ruptured appendicitis usually can be removed laparoscopically. Laparoscopic appendectomy for advanced infection or when the appendix has ruptured is a more technically difficult surgery. With vast experience, laparoscopic surgeons can perform such complicated appendicitis by laparoscopic surgery. Very rarely, a traditional, open procedure using a larger incision may be required to safely remove the infected appendix in these patients.

► May not be appropriate for some patients who have had previous upper abdominal surgery.
► May not be appropriate for some patients who have some pre-existing medical conditions, posing a risk for anasthesia.
► A thorough medical evaluation by your physician, in consultation with the surgeon trained in laparoscopy, can determine if laparoscopic gallbladder removal is an appropriate procedure for you.
► Sometimes, even during laparoscopic surgery, a decision can be taken by the surgeon to convert to an open surgery due to the gallbladder disease.

5) Are you a candidate for Robotic Cholecystectomy?
Robotic Cholecystectomy has all the benefits of Laparoscopic Cholecystectomy. It is also appropriate for most patients. The technique of robotic surgery makes a technically difficult Laparoscopic surgery, simple and easier. Due to the three-dimensional vision of robotic camera enabling better depth perception, the biliary anatomy is better delineated. In addition, the benefits are exemplified and enables a faster recovery after a robotic Cholecystectomy.

1) What is PCOS?
PCOS or Polycystic ovary syndrome is a condition in which there is polycystic ovarian morphology on ultrasound, menstrual irregularity and signs of hyperandrogenism like acne, and hirsuitism.

2) Do adolescents present with PCOS?
PCOM polycystic ovarian morphology on ultrasound should not be used alone to diagnose PCOS in adolescents who are within eight years of menarche. A defined irregularity in menstrual cycle post menarche along with signs of acne and or hirsutism are the 2 essential criterion for pcos.

3) What is adult PCOS?
In an adult menstrual irregularity ,signs of acne,hirsutism and pcom on ultrasound all of the three are essential findings to diagnose pcos.

4) How does Cosmetic treatment help in PCOS?
Cosmetic treatment for acne and hirsutism helps achieve visible results over a period of time.And it is a very promising factor to build up self confidence.

5) Can acne and hirsutism in PCOS be cured with cosmetic treatment?
Cosmetic treatment cures acne and hirsutism but it needs maintenance treatment at regular intervals to achieve desired benefit.

6) Can Cosmetic treatment permanently cure acne,hirsutism?
For desirable results cosmetic treatment should be done at regular time intervals.Since PCOS is there to stay and hence there is a need for supportive cos.

7) Can sonography diagnose PCOS?
Polycystic ovarian morphology PCOM, is a sonography finding and is not diagnostic of PCOS. In healthy adolescent post menarcheal girls PCOM is not the only criteria to diagnose PCOS until eight years post menarche.

8) How does lifestyle influence PCOS? Is it seen in thin women?
An adolescent with rapidly increasing BMI and weight gain are at potential risk to develop pcos. PCOS is a lifestyle acquired disease, undisciplined eating and sleeping habits, lack of physical activity disturb the balance in reproductive hormones.

Yes it is seen in thin women also and it is a challenge to treat them.

9) Is there a cure for PCOS?
PCOS is lifestyle disease and there is a need for continuous change in the lifestyle to manage the symptoms.

10) What is postmenopausal bleeding?
After one year of menopause during which menstrual blood loss stops when menstrual blood loss restarts it is labelled as postmenopausal bleeding

11) Why do women experience postmenopausal bleeding?
Causes include thickened endometrium,endometrial polyp,vaginal bleeding

12) Is it normal to experience postmenopausal bleeding?
It is not normal to have bleeding once menopause is achieved.

13) What tests need to be performed for postmenopausal bleeding?
Ultrasound is the first test to be performed in post menopausal bleeding.

14) Does post menopausal bleeding mean you have uterine cancer?
Post menopausal bleeding needs to be investigated further to rule out uterine cancer.

15) How do you treat postmenopausal bleeding?
Hysteroscopic Endometrial biopsy is a procedure done to diagnose and treat bleeding.

16) Is it worrisome to bleed after menopause?
It is not normal to bleed after menopause except if you are on certain medications.

17) Is post menopausal bleeding benign?
It can be benign but one has to do necessary investigation to confirm the cause of the bleeding.

18) Is it curable?
It can be cured after a workup after the cause is diagnosed.

19) Does post menopausal bleeding stop on its own?
It is quite common for postmenopausal bleeding to stop on its own.

1) What is the main cause of getting kidney stones?
The main cause of developing kidney stones is “IDIOPATHIC”. The Condition of having Kidney stones is also referred as nephrolithiasis or urolithiasis. The medical terminology for kidney stone is ‘RENAL CALCULUS’. These stones are made up of salts and minerals from our body. Some of the known factors which led to the formation of kidney stones are less water drinking i.e., dehydration, heat exposure, obesity, diabetes, cardiovascular diseases and CKD (chronic kidney disease). Usually, men are more prone for urinary stone disease than women. Also, study has proved that there is higher prevalence of stone disease in hot, arid or dry climates.

2) How do you know if I have kidney stones?
The typical presentation of kidney stones is called as renal colic or ureteric colic. Renal colic means symptom complex arising due to urinary stone in kidney like one sided back pain associated with nausea or vomiting and sometimes haematuria i.e., blood in urine. This symptomatology is so diagnostic of kidney stone that it is called as “triad of renal stone”.

Similarly, there is a term called Ureteric colic, which means the symptom complex arising due to stone in ureteric region. Ureter is the thin or narrow lumen tube which connects kidney to urinary bladder. When the stone gets stuck in the ureter and causes obstruction to the flow of urine, it leads to ureteric colic. Ureteric colic is constellation of one sided back or flank region pain radiating to front side along the site of ureter and coming to groin/ testis/ tip of penis or vagina/ mid-thigh region alongwith nausea and vomiting.

The most common, simplest and radiation free way to know whether one has kidney stone or not is ULTRASOUND or SONOGRAPHY (also known as USG-KUB). Usually, USG is the first and most commonly done investigation for urinary stones or kidney stones. There are few stones smaller stones which can be missed on sonography but the after effects is clearly visible on USG.

CT-SCAN (plain) is the standard recommended investigation of choice for diagnosing urinary stones. It gives lot of information about the stone like size, site, number, density. Also, it will show the status of kidney, ureter, bladder. Even 1mm stone cannot be missed on CT-SCAN, but the drawback is radiation exposure. Hence only when the urologist feels that there is a need for CT scan, it should be done. Otherwise, USG-KUB/ sonography itself provide lot of information.

3) How do you clear out kidney stones?
Treatment of kidney stones depend upon the size of stone, location of the stone, condition of the patient, comorbidities in the patient, after effects of the stone or you can say complication caused due to the stone.
Broadly tiny and smaller stones like less than 5mm stone usually passed out on its own or with the help of medical therapy in whom it is not passing on its own.

Hydration is the chief and most important treatment for urinary stones. Drinking water is the remedy for kidney stones. Adequate fluid intake (2.5-3.5 litres) has been recommended daily to clear out the smaller stones. This also helps in avoiding the formation of the stone into the kidney.
Calcium supplements has been recommended to lower the formation of oxalate stones as it reduces the level of oxalate in urine.

Avoid non-dairy animal protein to reduce uric acid stone formation.
Alkalisation of urine too helps in decreasing formation of urinary stones.
Increase fruits and vegetables in meal to avoid urinary stones.

4) Is a kidney stone serious?
When there is a stone in kidney, it does not obstruct the flow of urine, hence it doesn’t cause any symptoms. This leads to the kidney stone remain undetected. When the kidney stone start obstructing the flow of urine, the symptoms will appear in the form of pain or blood in urine and this usually makes patient to visit urologist or doctor.

Then the set of investigations identify the presence of renal stone. Early diagnosis with early treatment doesn’t lead to serious condition. But sometimes pain is not so severe enough or pain remains absent even in presence of large kidney stone/ staghorn calculus or if mild back pain is ignored, then it leads to some serious complications which may require ICU admission, sepsis, or kidney failure/ renal failure.

To avoid such serious condition, health check-up is advisable with USG/sonography or ultrasound as one of the investigations.

5) What are 5 symptoms of having kidney stones
The typical presentation of kidney stones is called as renal colic or ureteric colic. Renal colic means symptom complex arising due to urinary stone in kidney like one sided back pain associated with nausea or vomiting and sometimes hematuria i.e., blood in urine. This symptomatology is so diagnostic of kidney stone that it is called as “triad of renal stone”.

Similarly, there is a term called Ureteric colic, which means the symptom complex arising due to stone in ureteric region. Ureter is the thin or narrow lumen tube which connects kidney to urinary bladder. When the stone gets stuck in the ureter and causes obstruction to the flow of urine, it leads to ureteric colic. Ureteric colic is constellation of one sided back or flank region pain radiating to front side along the site of ureter and coming to groin/ testis/ tip of penis or vagina/ mid-thigh region alongwith nausea and vomiting.

In case of complication like infection, fornicial rupture; there will be fever with chills, burning during urination, weakness, loss of appetite, etc.

6) What foods causes kidney stones? Or What Drinks causes kidney stones?
The main cause of renal /kidney stones is IDIOPATHIC. But there are few factors which are responsible for the formation of kidney stones and diet constitutes one of the important factors.
► Consumption of sugar-sweetened soda and punch are associated with increased risk of stone formation.
► Intake of Non-dairy animal proteins like meat, fish, poultry, eggs also increase risk of renal stone formation.
► Restriction in calcium rich diet increases kidney stone formation
► Increased consumption of salt results in increased formation of urinary stones
► Oxalate rich diet also increases stone formation, like black tea, cocoa, spinach, mustard greens, pokeweed, Swiss chard, beets, rhubarb, okra, chocolate, nuts, wheat germ, soy crackers, pepper.

7) How can I avoid getting kidney stones?
The factors which lead to increase formation of urinary stones needs to be avoided and it forms the mainstay to avoid getting kidney stones.
Factors which decrease the urinary stone formation are:
· High fluid intake: it has been proved that to avoid urinary stone formation or to wash out urinary stone from the body, the minimum amount of urine produced per day is 2.5 litres. To achieve this urine output, one healthy adult needs to drink atleast 3.5 litres of water per day. So, intake of more fluids lead to decrease stone formation.
· Grape fruit juices is more effective in preventing stone formation followed by lemon and orange juices due to high content of citrus.
· Other juices which may help in decreasing urinary stone formation are lime, cranberry, black currant and even tomato.
· Beverages like coffee, tea, beer and wine prevent stone formation to some extent.
· Diets high in potassium and lower in animal protein may prevent kidney stone formation
· Diets high in fruits and vegetables have been associated with a reduced risk of stone formation.
· Calcium supplementation with meal is the recommended dietary habit associated with a reduced risk of urinary stone formation
· Alkalizer like potassium citrate

8) What is the fastest way to dissolve a kidney stone?
There is no way to dissolve a kidney stone or urinary stones. Small stones in kidney need to be flushed out from the body. There are natural remedies which can help in flushing out the urinary stones or the other method is medical or surgical. The fastest way to get rid of the stone is “SURGERY” but it is needed only in large stones like greater than 5 mm stones. Nowadays urinary stone removal has been achieved without making any cut into the body and as a day care procedure and patient can go to office directly from the urology hospital / centre.

9) How long do kidney stone surgery take?
There are multiple surgeries for kidney stone. Which surgery is best for the kidney stone depends upon the location of the stone, size of the stone, kidney status and comorbidity of the stone. The major factor which decides the type of surgery is patients’ choice. Broadly, there are three procedures done for kidney stone. They are:

ESWL: it stands for extra-corporeal shock wave lithotripsy. This procedure is done for small kidney stones in selected patients. This is OPD based procedure and it takes 30-60 min. Multiple sittings can be required for the same stone.

PCNL: it stands for Per-Cutaneous Nephro-Lithotomy. In this surgery a small hole is made into the kidney, stone was fragmented with laser/ pneumatic lithoclast and removed in pieces. This surgery usually takes 1hr to 2 hrs depending upon the size of the stone and hardness of the stone. There are varieties of PCNL done nowadays.

RIRS: it stands for Retrograde Intra-Renal Surgery. This is the most advanced form of kidney stone surgery. In this, kidney stone was fragmented into powder form also called as dusting. In this surgery, there is absolutely no cut on the body. Stone is broken down from the natural hole or orifices given by God. This surgery takes 1hr to 2hrs as well depending upon the hardness and size of the stone. In few cases, multiple sittings are required.

10) Is kidney stone removal a major surgery?
Kidney stone surgery varies from mild to major surgery depending upon the size of the stone, complication due to the stone, age of the patient, comorbidities of the patient and status of the patient. Usually, PCNL and RIRS surgery are major surgeries in aged patients and in patients with multiple comorbidities and when stone size is greater than 2cm.

11) Is kidney stone surgery removal painful?
Kidney stone surgeries are least painful of most of the surgeries. In fact, if we consider the pain due to stone as 100%, post-surgery the pain will be between 10-25%, it means the pain decreases after the surgery. One of the indications for the surgery is intractable pain. During the surgery, the patient remains in anaesthesia so there won’t be a pain during surgery.

12) What is the best procedure to remove kidney stones?
There are various surgeries/ procedures for removal of kidney stones depending the location of the stone, size of the stone, comorbidities of the patient, age, complication due to stone and kidney position and anatomical orientation. So best procedure differs from patient to patient. Urologist can guide the patient which surgery will be best suitable for him/her after thorough investigation and clinical examination.

But if we consider the scenario, where PCNL and RIRS both are possible options so most likely patient tend to choose RIRS as it doesn’t involve any cut into the body. But its best to discuss with the urologist regarding the pros and cons in that patient for that particular stone.
13) What is RIRS surgery? or What is the meaning of RIRS?
RIRS stands for Retrograde Intra-Renal Surgery. This is the most advanced and modern form of kidney stone surgery. This surgery involves the use of the most modern technique of stone breaking/ fragmentation and it is LASER. Around a decade ago, the best approach to reach kidney stone was making a hole into the kidney and reach it to fragment it as there was no flexible instrument available. But with the introduction of flexible scope or we can say flexible viewing optical instrument, RIRS came into existence. Urine is formed into kidney and then was excreted out of the body after passing through various channels/tunnels/pipe/holes. As this natural passage already exists in body, with the invent of flexible scope, it was possible to reach inside the kidney through these naturally existed passages without making any hole or cut into the body. In this, kidney stone was fragmented into powder form by using LASER (like holmium or thulium). In this surgery, there is absolutely no cut on the body. Stone is broken down from the natural hole or orifices given by God. This surgery takes 1hr to 2hrs depending upon the hardness and size of the stone. In few cases, multiple sittings are required. (PLZ click on the link to see RIRS surgery).

14) What is PCNL and RIRS?
PCNL: PCNL stands for Per-Cutaneous Nephro-Lithotomy. In this surgery a small hole is made into the kidney to reach the kidney stone, stone was fragmented with laser/ pneumatic lithoclast and removed in pieces. This surgery usually takes 1hr to 2 hrs depending upon the size of the stone and hardness of the stone. There are varieties of PCNL done nowadays viz. Prone PCNL or Supine PCNL depending upon position of patient. PCNL depending upon the size of hole viz., standard PCNL, MINI-PCNL, ultra mini PCNL, , micro-PCNL.

The major complication of PCNL is Bleeding/haemorrhage. Other less common complications are infection, sepsis, urinary leak, perinephric collection, AV malformation, pseudoaneurysm, etc.
RIRS: RIRS stands for Retrograde Intra-Renal Surgery. This is the most advanced and modern form of kidney stone surgery. This surgery involves the use of the most modern technique of stone breaking/ fragmentation and it is

LASER : Around a decade ago, the best approach to reach kidney stone was making a hole into the kidney and reach it to fragment it as there was no flexible instrument available. But with the introduction of flexible scope or we can say flexible viewing optical instrument, RIRS came into existence. Urine is formed into kidney and then was excreted out of the body after passing through various channels/tunnels/pipe/holes. As this natural passage already exists in body, with the invent of flexible scope, it was possible to reach inside the kidney through these naturally existed passages without making any hole or cut into the body. In this, kidney stone was fragmented into powder form by using LASER (like holmium or thulium). In this surgery, there is absolutely no cut on the body. Stone is broken down from the natural hole or orifices given by God. This surgery takes 1hr to 2hrs depending upon the hardness and size of the stone. In few cases, multiple sittings are required. As such RIRS is a very safe procedure. The most common complication of RIRS is Infection and it accounts from 2% to 16%. (PLZ click on the link to see RIRS surgery).

15) How many days rest after RIRS?
RIRS is a very safe and most minimal invasive surgery for kidney stone removal. Nowadays it is being performed as day care surgery as there is no cut involved. Usually, no rest is required after RIRS surgery. Only exercises were advised to be avoided till stent is there into the ureter.

16) Does RIRS damage kidney?
RIRS surgery is done for kidney stone removal. It involves the use of most advanced fragmentation technique for stone breakage i.e., LASER fragmentation. Also, there is continuous water irrigation taking place during the RIRS surgery into the kidney. As there is no hole created, it acts as closed environment system inside the kidney and this led to minimal kidney damage. In expert hands, this damage gets minimised to large extent or we can say it gets nullified. Out of the three procedures for kidney stone removal, RIRS causes least damage to kidney.

17) Is stent necessary after RIRS?
During the initial days of the introduction of RIRS, the flexible scopes were thicker or broader in diameter. The normal ureter usually has narrow lumen as compared to the diameter of flexible scopes, so during those days RIRS was 2-step procedure – 1st step being to put DJ stent in the ureter on the side of the surgery and this ureter used to get dilated in 5 days to 10 days. So, after 5-10 days 2nd step of surgery used to be done i.e., RIRS and then again DJ stent used to be put.
Nowadays due to available of smaller flexible scopes, this 1st step of DJ stenting is now no longer required in majority of the patients. Post-RIRS surgery, whether DJ stent is required or not is decided by the urologist depending upon the character of the stone, consistency of the stone, size of the stone and condition of the patient and ureter.

18) Why stent is placed after RIRS?
There are multiple reasons for stent placement in ureter after RIRS surgery. RIRS is done for the kidney stone removal. In this surgery, stone was fragmented into very minute pieces or made into powder form with the help of LASER. This stone powder/ fragments comes out from the narrow lumen ureter after the surgery slowly over few days. DJ stent was placed into ureter in order to prevent ureteric obstruction due to this stone powder or fragments. DJ stent is actually a thin lumen tube. Also, DJ stent leads to the dilatation of the ureter over few days which expediate the process of powder removal. Thirdly stone causes injury to the ureter where the stone was stuck, DJ stent helps in early healing of the area by preventing obstruction and good drainage of urine. Fourth, usually after RIRS there is mild injury happens to the mucosa of the kidney due to stone movement or infection or due to LASER which leads to mild bleeding from the injured surface. This blood changes its state from liquid to solid and forms clot in few seconds and this clot will block the ureter which has very narrow lumen and will lead to ureteric obstruction which will cause very severe pain also called as clot colic. So, in order to prevent clot colic, DJ stent was put after RIRS.

19) Which is better PCNL or RIRS?
There are various surgeries/ procedures for removal of kidney stones depending the location of the stone, size of the stone, comorbidities of the patient, age, complication due to stone and kidney position and anatomical orientation. So best procedure differs from patient to patient. Urologist can guide the patient which surgery will be best suitable for him/her after thorough investigation and clinical examination.

But if we consider the scenario, where PCNL and RIRS both are possible options so most likely patient tend to choose RIRS as it doesn’t involve any cut into the body, early discharge from the hospital, early resumption of normal activity. But its best to discuss with the urologist regarding the pros and cons in that patient for that particular stone.

20) What are the complications of RIRS?
RIRS is a very safe and most minimal invasive surgery for kidney stone removal. Nowadays it is being performed as day care surgery as there is no cut involved. Usually, no rest is required after RIRS surgery. Only exercises were advised to be avoided till stent is there into the ureter. Still there are few complications of RIRS which is seen in few patients. They are pain, fever, infection, minimal transient bleeding leading to hematuria (blood in urine), urine extravasation, urinoma, forniceal rupture, etc. Ureteric avulsion, sepsis, bleeding requiring transfusion are the rare complications after RIRS.

21) Is stent removal painful?
DJ stent is removed in the similar fashion as it is put. Stent removal if not done under anaesthesia is mildly painful. At MITR Hospital, DJ stent was removed under anaesthesia only and by using flexible scope which doesn’t cause any pain to the patient.

1) What is Laparoscopic Hernia surgery?
Minimal invasive surgery or key hole surgery can be performed by standard two dimensional laparoscopic surgery or three dimensional robotic surgery at MITR hospital, Kharghar.

Hernia surgery is one of the common surgeries performed at MITR hospital. Laparoscopic surgery involves similar steps as open surgery without the need of a single large incision. Most laparoscopic hernia surgeries are performed using three to four small incisions commonly one incision measuring 1 cm and the rest measuring 0.5 cm. In an abdominal wall hernia, the telescope provides an enlarged image of the abdominal contents along-with the hernia defect and its contents. The steps involved are

a) The first step of any laparoscopic hernia surgery is making a small incision and insufflating carbon dioxide gas to create a working space near the hernia site.
b) The hernia contents are separated and reduced back into the abdominal cavity.
c) The hole in the muscle is sutured using a non-absorbable suture.
d) lastly, a mesh is placed to cover the sutured hole with a three to five cm overlay, circumferentially.

In some complicated cases, one of the small openings may be lengthened to 2 or more inches to complete the procedure in a hybrid fashion.

2) Are you a candidate for Laparoscopic hernia surgery?
Laparoscopic hernia surgery has many benefits over the open surgery and is appropriate for most patients.
In uncomplicated hernia and complicated hernia with only fat without vascular compromise are two common conditions in which laparoscopic surgery is offered.
Very rarely, a traditional, open procedure using a larger incision may be required to safely perform a hernia surgery or a hybrid technique is opted based on the technical challenges during the surgery.

3) Are you a candidate for Robotic hernia surgery?
Robotic hernia surgery has all the benefits of Laparoscopic hernia repair surgery. It is also appropriate for most patients. The technique of robotic surgery makes a technically difficult hernia surgery, simple and easier. Procedure related discomfort is minimised following robotic hernia surgery.

Total Knee Replacemen
1) How long does it take to recover from TKR?
◈ Most patients are able to return to activities and walk without the need for assistive devices between 3 to 6 weeks after surgery.
◈ Overall it takes 2 to 3 months to make a complete recovery post TKR.

2) How painful is a total knee replacement?
◈ There will definitely be some pain after your operation but your surgery team will do everything possible to keep it manageable and minimal.
◈ You may receive a nerve block prior to your operation and your surgeon may also use a long-acting local anaesthetic during the procedure to help with pain relief after the procedure.
◈ Your doctor will prescribe medication to help you manage the pain. You may receive this intravenously (IV) immediately after surgery.
◈ When you leave the hospital, the doctor will give you pain relief medication as pills or tablets.

3) Is total knee replacement considered major surgery?
◈ A knee replacement is a major surgery, it is only recommended if other treatments, such as anti-inflammatory medications, physiotherapy, lifestyle modifications and intra-articular injections have not reduced pain or improved mobility.

4) What is the most commonly reported problem after knee replacement surgery?
◈ One of the most common problems people experience after total knee replacement is Knee stiffness. This can cause difficulty with activities that require a lot of bending, including going down stairs, sitting in a chair, or getting out of a car.

5) What is the best age to have a Total knee Arthroplasty?
◈ The age bracket of 50 to 70 years is the most common age group for Knee Arthroplasty.

6) How many hours is total knee replacement surgery?
◈ The procedure takes 1 to 3 hours.

7) What percentage of knee replacements are successful?
◈ Knee replacement surgery has an extremely high success rate. About 90% of knee replacements last 10 years and 80% last 20 years.

8) What is the number one reason for knee replacement?
◈ The most common reason for knee replacement surgery is to ease pain caused by arthritis.

2) Total Hip Replacement

1)Why should someone need Total hip replacement?
Total hip replacement is often necessary after the cartilage between the femoral head and acetabulum wears out. Arthritis leaves patients with severe pain and immobility. Typically, a hip replacement is not performed unless non-surgical methods fail to relieve hip pain.

2)How long does it take to recover from a total hip replacement surgery?
On an average, Hip replacement recovery can take around 2 to 4 weeks, but it depends on a few factors, including how active you were before surgery, your age, nutrition, pre-existing conditions, and other health and lifestyle factors.

3)What is the most frequent complication after a hip Arthroplasty?
One of the most common serious medical complication related to hip Arthroplasty is blood clots.

4)Do you ever feel normal after hip replacement?
Studies show that 90 percent of people who undergo hip replacement feel better and can get back to normal activities within few weeks.

5)How long should I use a walker after hip replacement?
In most cases, you will need to use a walker or crutches for 2 to 4 weeks after surgery. You may be advised to use a cane for few days after you have stopped using walker.

6)Can I walk up stairs after hip replacement?
Yes, one can use stairs 3 to 5 days post-surgery. You should lead with your stronger leg that still has your original hip to walk up the stairway and your weaker leg to walk down it.

7)How much physical therapy is needed after hip replacement?
Everybody is different and everyone’s joints recover at a different rate, but in general one requires 4 to 6 weeks of physiotherapy post-surgery.

1) What is the best test to diagnose gallstones?
Ultrasound or sonography of abdomen is the gold standard for diagnosis of all types of gallbladder ailments including gallstones, medically known as gallbladder calculi or cholelithiasis. Apart from being safe, relatively cheaper and easily accessible, ultrasound can show the gallstones really well. Ultrasound shows the stone as highly reflective echogenic focus against the background of bile in the lumen of gallbladder. It can accurately detect the number as well as sizes of the stones. Ultrasound is done in real time and hence can also help to detect mobility of stones with change in position of the patient. Moreover, it can show the various complications of gallstone disease like impaction at neck of gallbladder, gallbladder wall thickening and fluid collection around the gallbladder due to inflammation. Ultrasound can also reveal signs of blockage of bile flow due to the stones. Many studies have shown that ultrasound is more sensitive and specific than CT scan to detect gallstones with an accuracy of about 90 to 95%. Since it uses sound waves instead of radiation its absolutely safe to be performed in cases of gallstones during pregnancy as well.
At MITR hospital Kharghar, along with the presence of a dedicated medical and surgical GI team, there is availability of latest five probe 4D sonography machine with experienced radiologist

2) What is Liver Elastography?
Ultrasound based Liver Elastography is a special type of ultrasound test which uses sound waves to measure stiffness of liver. It is advisable to refrain from eating or drinking for three hours before the scan. Elastography is a quick, non-invasive and painless test which is done by scanning in the right upper abdomen. The results are recorded and an overall stiffness score is generated. Stiffness of liver is a sign of liver fibrosis and some chronic liver diseases like fatty liver and hepatitis can cause the liver to lose its elasticity and become stiffer. Elastography helps the doctor to assess the severity of liver fibrosis in patients with chronic liver disease. The doctors can plan treatment protocols like need for antiviral therapy or liver cancer surveillance based on the reports. Elastography can also be used to monitor the progression of disease over a period of time. At MITR hospital kharghar, Point Shearwave Elastography is available which is performed under imaging guidance on an ultrasound machine.

3) What is transvaginal ultrasound? When is it necessary? Is it safe?
Transvaginal ultrasound (TVS) is a type of intracavitary ultrasound done in females to visualize the pelvic organs like uterus, ovaries, fallopian tubes, endometrium and other pelvic organs well. It is done with the help of special high frequency transducer (probe) which appears like a wand. Before inserting it into the vagina, the probe is covered with a gel and condom, hence making it sterile and safe. Transvaginal ultrasound remarkably improves the resolution and image quality while scanning due to the reduced distance between the probe and pelvic structures. Use of higher frequencies in TVS probes also leads to better image quality. In addition, patient does not need to keep the bladder full for scanning, which reduces discomfort. Transvaginal ultrasound is indicated in pregnancy as well as in number of pelvic conditions. It is the chosen method of scanning in early pregnancy to diagnose intrauterine pregnancy and rule out ectopic/tubal pregnancy. Fibroids, endometrial polyps, ovarian cysts, polycystic ovaries and tubal lesions etc are some of the conditions which can be very well diagnosed using TVS. TVS is also used in infertility treatments for follicular monitoring and oocyte retrieval.
At MITR hospital kharghar, you have the advantage of getting scanned by senior experienced female radiologist thus avoiding any discomfort or hesitation you may feel before the procedure.

4) What is KUB ultrasound? How are kidney stones diagnosed?
KUB ultrasound is the ultrasound of the urinary tract, namely the kidneys, ureters and urinary bladder. It also includes evaluation of the prostate gland. It is a very common investigation prescribed by doctors in cases of flank pain, hematuria and urinary problems like retention or urinary infection. Ultrasound/ sonography is usually the first investigation done nowadays to diagnose kidneys stones. It can not only detect calculi within the kidneys and ureters but also show the degree of swelling in the kidneys called as hydronephrosis caused by blockage of urine due to stone.
Ultrasound is easily available, cheaper and radiation free as compared to CT scans. It can be repeated multiple times to look for progression of stone in the urinary tract. A KUB scan will also give information regarding the prostate gland like the size and volume of the gland. Along with it post void residual urine can be assessed which will give an idea about the amount of urine retained in the bladder after voluntary void.
At MITR hospital Kharghar, along with a dedicated Adult and Pediatric Urology team, there is availability of high-end ultrasound machine with an experienced radiologist who work as a team and provide uro-radiology services to scores of patients.

5) What is colour Doppler? In which conditions is it done?
A colour doppler scan is an imaging test done on an ultrasound machine to check the direction and speed of blood moving through blood vessels (arteries and veins). It is a non-invasive test done using a special high frequency transducer, moved on the surface of the body following the course of blood vessels. Based on the flow velocity and direction, arbitrary colour coding is done. It is used commonly to study arteries in both arms and legs in order to identify clots or narrowed arteries.
A potentially life-threatening condition called the deep vein thrombosis (DVT) is detected using colour doppler. Varicosities of legs is a condition which frequently requires doppler evaluation to visualize the extent and severity of the problem. Not only the limbs, colour doppler is also routinely done to evaluate neck and renal vessels which provide blood supply to critical parts of body such as brain and kidneys respectively.
In males, a scrotal doppler, is performed to identify blood supply inside scrotum. This study can identify cases of testicular torsion and few other conditions such as varicocele and epididymo-orchitis. Similarly in females, a pelvic doppler is often required in cases of ovarian torsion. In addition, colour doppler is used during pregnancy to evaluate blood circulation in the baby, uterus and placenta.
At MITR Hospital Kharghar, all types of Doppler studies are done.