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General UrologyGeneral Urology

 

 

Male Infertility

 

Failure to conceive for a couple after 1 year of trial is defined as infertility. About 10-15% couples are infertile. Males and females are usually equal contributors to infertility problems suggesting 50% female factors, 30% male factors and remaining 20% contributed by both females and males causes.

  • Apart from duration of infertility, the history of prior pregnancy from present or previous partner as well as any previous evaluations or treatments done is important. Frequency and time of sexual intercourse, use of any lubricant as well as history of erectile dysfunction are important points.
  • Childhood and developmental history including bladder and urethral reconstruction, undescended testis, testicular torsion, testicular trauma and onset of puberty are other things which helps in evaluation of male infertility problems.
  • If a person has received chemotherapy or radiotherapy and also history of mumps or sexually transmitted disease in the past may contribute to infertility.
  • If a person has undergone previous operations over scrotum, prostate, retroperitoneum, pelvis or previous hernia operation, then these may be the obstructive cause of infertility.
  • Various substances are gonadotoxins for examples marijuana, chemotherapy, radiotherapy, various recreational drugs, tobacco, alcohol, anabolic steroids, regular hot bath and pesticides and their use may affect fertility.

Testis size, consistency, their locations, presence of dilated veins in groin called varicocele and presence or absence of vas deference which carry the sperm are some of the things to look for during examination. Orchidometer helps in the measurement of testis size. Absence of vas deference may suggest cystic fibrosis which necessitates further genetic test evaluation like CFTR testing for any mutation. Karyotyping and Y-chromosome analysis are other genetic testing needed if sperm counts are less than 5-10 millions/ml. Semen analysis should be done on atleast 2 occasions for initial evaluation. Semen volume, sperm count, motility and morphology are the components of semen analysis. Blood testing of hormones including LH, FSH and testosterone are needed. In primary testicular failure these hormones (LH & FSH) are usually elevated and testis size may be smaller than normal

 

Varicocele is one of the commonest cause of male infertility and usually evident on clinical examination and may be confirmed on Doppler ultrasound examination. Its correction by microsurgery usually has good outcome in improving the semen parameters like count and motility. Various assisted reproductive techniques like Intra Uterine insemination (IUI), In-Vitro Fertilization (IVF) and Intra Cytoplasmic Sperm Injection (ICSI) are very popular and help in most cases of infertility. ICSI is a form of micromanipulation which involves the injection of single sperm directly in the cytoplasm of a mature egg using glass needle or pipette. For obstructive azospermia due to previous vasectomy operation, the vasectomy reversal surgeries usually have good success in expert hands. Both ends of vas deference are connected (Vasovasostomy) microsurgically with the help of a operating microscope. Occasionally end of vas and side of epididymis is connected (Vasoepididymostomy) if there is epididydimal obstruction. With expert hands specially fellowship trained urologist these surgeries have higher success rates.

 

Kidney Transplantation

 

Kidney transplantation is one of the treatments for End Stage Renal Disease (ESRD) where non functioning kidney is replaced with healthy kidney from another person (live or cadaveric). Diabetes is one of the common cause of ESRD. Various investigations including blood tests, x-rays, blood type, tissue type etc. are performed before the transplant to make sure that a person is good candidate for transplant. During the operation, the new kidney is placed in the lower abdomen with the anastomosis of artery, vein and ureter (tube that carries the urine). Old kidneys are usually left in place in the body unless they cause problems (like infection etc.) in that case they need to be removed. After the transplant, patient has to be on long term immunosuppresive medications like cyclosporine, corticosteroids, mycophenolate mofetil, tacrolimus etc. The outcome of renal transplantation has improved significantly over the years specially due to advancement and development of immunosuppressive medications. The common complications after kidney transplantation are rejection, infection, cancer and relapse of original disease etc. and that is why these patients need to be followed by physicians for the rest of their life. Kidney transplantation involves the dedicated team of physicians (nephrologists), surgeons, transplant coordinators, nurses, psychologist, social workers and pharmacist etc.

 

General Urology Problems

 

In Urology, illness related to kidney, ureter, bladder, prostate and male genital organs are evaluated and treated. Kidney stones are common and nowadays most of the kidney stones can be treated by extra corporeal shock wave lithotripsy (ESWL). Sometimes, if the stones in the ureter (a tube carying the urine from kidney to bladder) block the kidney then temporary stenting may be needed. Most of the Bladder cancer are superficial and can be managed by endoscopy which is performed through urine passage. Difficulty in voiding due to Prostate enlargement is a common urological problem . Initiallly, this is treated by medications but if they do not work then surgery is usually needed . Prostate surgery including laser surgery is usually done through urine passage with good success rate. Passage of blood in urine (Hematuria) can be a symptoms of serious illness and it should be evaluated in detail. Collection of watery liquid arround the testis is called as Hydrocele which requires surgical treatment.