Adult Urology & Andrology

Urology is a specialty that deals with problems in male genitourinary system (kidneys, ureter, bladder, testis, penis, scrotum etc) and female urinary system. Andrology is a sub-specialty that deals with sexual health and emphasizes on the medical and surgical management of male infertility, erectile dysfunction, Peyronie’s disease and hypogonadism. 

It has been observed that out of 100 people coming to hospital for a surgical problem, 65 will be for a urological issue. Though most problems are resolved at the level of consultation room there are some that need surgical intervention that involves use of highly sophisticated machines (including robots) to harmlessly remove the problems without pain and discomfort.

Common disorders in Urology

• Kidney and Ureteral Stones: This is a condition in which a solid material is formed due to the presence of certain substances in higher proportion in urine. These can be extremely painful and can be found blocking the urine flow from kidneys to the urinary bladder. They are of various sizes and shapes; hence treatment is based on the aspects like- location of the stone, size, surface of stone and shape of stone.
• Bladder stones: They are stones found in urinary bladder.
• Urinary tract obstructions like PUJO (Pelvi-ureteric junction obstruction)
• Urinary Tract Infections: any infection that occurs in the urinary system is called as urinary tract infection. This infection could affect the kidneys, ureters, bladder or urethra.
• Urethral strictures
• Urinary Incontinence: A medical condition that leads to no control over the bladder.
• Neurogenic Bladder: The urinary bladder has nerves and muscles that work in synchronisation to allow urination to occur. But in cases of nerve injury due to an illness or trauma, the nerve endings to the bladder are damaged as well which hamper normal urination. Due to this miscommunication between the nerves and muscles of the bladder occur resulting in improper emptying of the bladder.
• Benign Prostatic Hyperplasia (BPH): Prostate is a gland present in males that is necessary for reproductive functioning. Usually in men this gland tends to grow in size. This enlarged growth of prostate is called as benign prostatic hyperplasia which affects the quality of life for them. It leads to displeasing symptoms like poor flow of urine or difficulty in urine leading to pain or incontinence.
• Hematuria: It is a condition in which blood is present in urine. It can arise in cases of infection, any trauma to the urinary system and due to certain viruses.
• Erectile Dysfunction: A sexual dysfunction that leads to the inability to maintain an erection of penis during sexual activity.
• Prostatitis: Infection of the prostate gland is called as prostatitis.
• Vasectomy Reversal
• Interstitial Cystitis: Interstitial cystitis is also called as bladder pain syndrome. It is a chronic inflammatory condition of the muscular layers of the bladder. The exact cause of Interstitial cystitis is not known as of yet
• Voiding Dysfunction
• Female Urology
• Prostate Cancer: Prostate gland is an essential part of a male reproductive system. It secretes an alkaline fluid that is part of the seminal fluid. This gland is around the urethra and still 
• Kidney Cancer: Kidney cancer usually occurs only in one kidney but it can affect both too. Surgery is carried out to remove a part of the kidney that has the tumor or in certain cases the whole kidney might need resection.
• Testicular Cancer: Cancer of testicles could either occur in either one or in both. Testicles are part of the male reproductive system that are necessary for production of male hormones and sperms. If detected early, it is treatable.
• Bladder Cancer: Bladder cancer is cancer of the urinary bladder. If caught in time it can be treated easily.
• Low Testosterone

Common Surgeries in Urology

• Endo-urology:
  1. Laser Stone surgery
  2. Extracorporeal Shock-Wave Lithotripsy (ESWL) for Kidney and ureteral stones
  3. Percutaneous Nephro-lithotomy (PCNL)- Treatment of large kidney stones (> 2 cm)
  4. Treatment of calyceal diverticula
  5. Ureteropyeloscopy /Ureterorenoscopy (URS)
  6. Treatment of ureteral and kidney stones
  7. Visual Internal urethrotomy (VIU) for urethral strictures
  8. Percutaneous Cysto-Lithotripsy for bladder Stones
  9. Cystoscopy and DJ Stenting
  10. Cystoscopy and RGP
  11. Cystoscopy and Biopsy
  12. Transurethral resection of bladder tumour (TURBT)
  13. Transurethral resection of Prostate (TURP)
  14. Bladder neck incision
• Laparoscopic surgery in Urology
  1. Laparoscopic Nephrectomy
  2. Laparoscopic Nephroureterectom
  3. Laparoscopic adrenalectomy
  4. Laparoscopic pyeloplast
  5. Laparoscopic kidney biopsy
  6. Laparoscopic drainage of renal cysts
  7. Laparoscopic ureterolithotomy for ureteric stones
• Orchiopexy for testicular torsion
• Ureteric re-implantation
• Pyeloplasty
• Sling surgeries for incontinence in Females like TVTO
• Management of Kidney trauma
• Management of injuries to ureter
• Radical prostatectomy
• Radical excision of bladder tumour
• Bladder augmentation
• Uretero-ureterostomy

FAQ's

Urinary stones

Do all stones need treatment?

Yes, as they can potentially reduce kidney functioning capacity and be a cause for pain and infection. Hence all stones need treatment.

Do all stones need surgery?

No. 70% of all urinary stones pass out of body naturally. They just need assistance to painlessly pass out through natural urinary outlet.

Is kidney swelling (hydronephrosis) harmful?

Yes. Whenever the urinary passage is blocked by stone or any other reason kidney swelling –also called hydronephrosis occurs. If this hydronephrosis persists for a longer period deterioration of kidney function starts.

Does everyone get same type of of symptoms?

No.  Some people don’t get any symptoms and thus miss the disease detection at an early stage. Others, who present with symptoms will have pain as the common symptom. Some will have only blood in urine or infection in urine or a mix of all these symptoms.

How do I know if I have a stone?

If you suspect or are diagnosed with a stone disease, the best thing is to get an ultrasound. Sometimes ultrasound can miss stones in ureter, wherein an X-ray is more helpful.

Can I go to work if I have a stone?

Yes, if you are pain free with the ongoing medications you can go to work. But it is not advisable to travel long distances or overseas during treatment.

Does everybody get same kind of stones?

No. Some stones are as hard as building stones and some are as brittle as biscuits. Some are as soft as cheese and some as fluffy as cotton.

When is the surgical treatment recommended?

Whenever the stone becomes a reason for intractable pain or persistent infection the surgical option is used. Any hydronephrosis persisting for longer periods will prompt a surgical modality of treatment.

Which surgical method is the best for me?

Looking at all your data- right from onset of problems and the tests like X-ray, CT scan etc - a plan is made. It is either one procedure or a mix and match of 2 or more procedures. The aim is to safely remove the stone without much pain. Safety comes first.

Which is the commonly used method in your clinic?

Lithotripsy is the most common used method. Because it is safe, effective and natural.

Prostate enlargement and Prostate cancers

Why is my prostate enlarged?

As age advances enlargement of the prostate gland occurs as a natural process. It is very similar to ageing process, and nobody knows why people age. Some enlargement will occur in all men above age of 45 years.

Is it a problem if I have no discomfort whatsoever in my urination?

No, it is not a problem. An exception is when the obstruction of urine is silent where the man does not appreciate symptoms due to decompensated obstruction.

Are all enlargement of prostate potentially cancerous?

No they usually are benign or non-cancerous. But enlargement of prostrate in specific zones inside the prostate gland are potentially cancerous.

How do I know if my enlargement is cancerous?

Examination of your prostate gland by the finger inserted through back-passage is the mainstay of detecting early cancers. Blood tests like PSA and biopsy of gland help in confirming or excluding the diagnosis.

Is biopsy of prostate gland compulsory?

In cases of suspicion for prostate cancer after clinical examination and blood tests; a biopsy is ordered.

Is biopsy painful?

Yes it is but it is be easily anageable with mild pain killers.

If prostate surgery is needed, how much time I need to be away from my daily routine?

One can resume their daily activities in 3 days. But exercises like running or playing badminton etc can be started after 3 weeks.

If I don’t get operated, what is the risk I carry?

By not opting for surgery, the symptoms worsen. Therefore you carry the risk of sudden blockage of urine which becomes a painful situation. It predisposes to infection, stone formation and can also lead to bleeding and kidney damage.

Is the catheter harmful to my body?

No it isn’t. The sole purpose of catheter is to drain the urine from your bladder and give it rest. This allows the bladder to heal as well.

Catheters are known to cause infection. Is that true?

Yes. That is why they are kept in the body only till the time their purpose is served. If they are needed for prolonged use they are changed at regular intervals to prevent infection.

Bladder Cancer

Is cigarette smoking that important in causing cancer of bladder?

Yes. Tobacco use in any form is known to cause transitional cell carcinoma of bladder. Stoppage of tobacco use is known to benefit these patients as the recurrence of this cancer is reduced.

Are all cancers of bladder incurable?

No.  A variety of cancer called superficial TCC is curable if monitored and treated on time. It involves a lot of commitment from the patient to regularly get checked by cystoscopy.

Do all bladder cancer need chemotherapy?

No. Many superficial cancers and favourable deep cancers do not need chemotherapy. They might need immunotherapy to boost body resistance against the cancer.

When is the decision to remove bladder taken?

Whenever there is a deep cancer seen on the biopsy or whenever the type of cancer is high grade this decision is taken.

Do I need an external bag all my life after the natural bag is removed?

In case you undergo surgery called ileostomy then you need to carry and change external bag all your life. In case you undergo a surgery called neo-bladder then an external appliance is not needed. You may have to drain the urine yourself by use of a catheter.

How much time it takes to learn to change the bag?

One or two training sessions by stoma nurse is enough to learn the technique.

Endoscopy in urology (Endourology)

What is a cystoscopy?

It is a method of examining the urinary passage internally from bladder to the external opening of urine. It is usually done in conjunction with treating the suspected problem in this area, like Biopsy, stricture removal, stone removal, cancer removal or prostate removal.

Is it painful?

It is always done under anaesthesia. There are 3 ways how it can be administered local anaesthesia, regional anaesthesia or general anaesthesia.

When do I go home after cystoscopy?

It depends on why the cystoscopy has been done in the first place. A purely diagnostic cystoscopy will allow you to go home in 3 hours.

What should I expect when I go to hospital for cystoscopy?

On being admitted to hospital, an i.v line is placed through which antibiotics are given first. The patient is explained the whole procedure once again and consent forms are given to sign.

What is PCNL? Is it endoscopy?

Yes, PCNL or Percutaneous Nephrolithotomy is a form of endoscopy. The kidney is entered directly from a small hole made on the back overlying the kidney area. Stones are broken or removed through a telescope called nephroscope. On an average you stay in the hospital for 48 to 72 hours depending upon various stone related factors.

What should I expect if I have been advised URS?

URS or Ureterorenoscopy is usually a day care procedure or a stay of 24 hours may be advised. It involves the same pre procedure planning as cystoscopy. A tiny bore telescope called ureteroscope is inserted inside the lumen of ureter up to stone or the obstruction. After the end of scopy a stent may be inserted called DJ stent. This DJ stent needs to be removed within 8 weeks as per needs.

Does DJ stent cause problems?

DJ stents are inserted to protect kidney. But they can be a cause for discomfort in some people. Bladder pain or blood in urine may be seen in some. But they are never a major cause for concern.

Laparoscopy in urology

How is Laparoscopy different from endoscopy? Is it more painful?

Both are ways of dealing with problems in minimally invasive technique. Both are minimally painful. Endoscopy involves use of natural tracts in body, whereas laparoscopy involves entry into tummy directly without entering lumen and seeing organs on their surface level. Both have their own indications and cannot replace each other.

After laparoscopy I have heard that there are scars. Is that true?

Yes, unlike endoscopy there are scars which are size of button hole. They are not seen clearly later when healed.

When is laparoscopy used in kidney diseases?

Cancers and non-cancerous enlargements of kidney are treated with laparoscopy. A disease called PUJ obstruction is repaired by laparoscopy. Large stones in ureters are sometimes removed by laparoscopy. Whenever possible, endoscopy is preferred over laparoscopy.

Lithotripsy

What precautions I should take before coming for the lithotripsy session?

Nothing special is required. You can have light snacks at home before reporting for lithotripsy. Be there atleast 15 minutes prior to ensure that you change the dress and have done necessary paperwork. Tell your doctor if you are taking blood thinners or have some bleeding tendencies.

How does stone break? Does it break in one go?

The shock waves delivered to the stone are actually modified sound waves. They are focussed precisely on the stone using an ultrasound machine. Not all stones break in one go. The harder ones need more sessions which are given after 7-10 days. Stones need to be smaller in size to enable them to pass out of body naturally.

How do I know if stones are passing out?

You may see them in your urine, or sometimes they are mixed with blood. A stone catcher is sometimes given to you to ensure that you can catch them while urinating.

Do I get pain during or after lithotripsy?

During lithotripsy there is no pain. After lithotripsy there may be pain which can be easily managed by pain killers. If the stone is large a decision to insert DJ stent may be taken to reduce pain of stone passage.

How much time does each session take? Can I go to work on same day?

Each session takes 45 to 60 minutes. You can go to work after the session.

Does Lithotripsy damage my kidney?

No it doesn’t damage the kidney. It is considered to be the safest mode of stone treatment as the stone selectively is broken.

Laser treatment in Urology

I am confused between laser,laparoscopy,lithotripsy and endoscopy? Please explain.

Lasers are energy sources which are inserted through endoscopy or laparoscopy to treat the disease. Laser machines alone cannot do anything unless they are directed through endoscopes. Lithotripsy is another energy source (sound waves) which can pass through skin surface to reach the stone without use of endoscopes.

How does Laser make difference in my treatment?

As lasers are light energy they can be carried in optical fibres which can be bent. Thus this energy can be delivered practically in all corners of kidney, ureter and bladder. They are powerful and disintegrate stones to the smallest size possible. Lasers used for removal of prostate cut prostate in a bloodless fashion thus reducing the need to transfuse blood. Some lasers can vapourise prostate gland thus avoiding any bleeding and use of catheters.

Are Lasers harmful to me in any way?

No they aren’t. They are precisely delivered to the organ in question to get maximum benefits. These lasers have very poor depth of penetration, hence they cannot damage the adjacent organs.

MITR Hospital offers cutting edge “Urology and Andrology” treatments.

Urology Department at MITR Hospital is managed by:

Dr. Manish Dubey

MBBS, M.Ch , DNB (Urology)

• About Dr Manish Dubey

• Detailed CV of Dr Manish Dubey

• Media Coverage of Dr Dubey

• Beyond  Urology

Special Clinics:

• Bladder cancer screening clinic

• Prostate cancer screening clinic

• Lithotripsy and stone Clinic

• LUTS Clinic

• Incontinence clinic

OPD Timings at MITR Hospital

• Mon/ Wed/ Friday:       6pm to 8pm

• Tue/Thur/Saturday:      11am to 12 noon

About Dr. Manish Dubey:

M.S., DNB, M.Ch

Consultant Urologist and Andrologist

As a degree holder of Masters in Genito-urinary surgery and Diplomate of National board certified urologist, Dr. Manish Dubey is highly trained to treat disorders of the male and female urinary tract (bladder, ureter, kidney, and urethra) and the male reproductive system. Urology is classified as a surgical subspecialty, but since a wide variety of clinical problems are encountered when treating urological conditions, knowledge of internal medicine, pediatrics, gynecology, and other specialties is required.

After completing an undergraduate degree at Seth G.S.Medical college and KEM Hospital ,Mumbai ,he pursued postgraduate education at LTMG Hospital , Sion, Mumbai (Popularly called Sion Hospital ) in1996.The surgical residency included one year of Urology internship which ultimately made him to choose urology as the ulimate career. A three-year Urology residency at the Bombay Hospital Institute of Medical Sciences under guidance of Dr. A.G.Phadke gave him ample opportunities to see vast variety of Urological diseases. The team at Bombay Hospital reads like the Who's who is the field of Urology with Dr.D.D.Gaur heading the Laparoscopy-Urology unit, Dr.H.M.Punjani heading the Pediatric Urology Unit., Dr.J.N.Kulkarni heading Onco-urology unit, P.K.Pattnaik heading Endo-urology unit and Dr.R.K.Garg, Dr.U.G.Oza and Dr.S.W.Thatte heading the transplant unit.

At the end of training he spent the following years practicing general urology in Navi Mumbai. In addition, he accepted a position as Lecturer in faculty for the nearby Deemed University of Dr. D.Y.Patil Medical School. Presently in private practice, Dr. Dubey continues his volunteer for various health camps in remote health centers in Raigad district.

Interested in the field of urological research, Dr. Dubey has published his findings in the British Journal of UrologyDr. Dubey is fluent in English, Hindi and Marathi. He is an enthusiastic Harmonica player and tennis amateur.

Dr. Manish Dubey and MITR Healthcare members are dedicated to serving the urological needs of Navi Mumbai , Mumbai, Thane, Raigad district. We treat each patient as a partner in his or her medical care and make patient education a central component of our care. Because many urological conditions are accompanied by social discomfort or embarrassment, we emphasize sensitivity and discretion when dealing with all of our patients' concerns.