Bladder Pain Syndrome

Bladder Pain Syndrome is how the condition of Interstitial Cystitis is more popularly known. This is a condition which is characterised by the weakening of the tissues that form the lining of the bladder walls leading to the formation of lesions and ulcers over there. It is a condition which does not pose any threat to the longevity of an individual but it is one that causes a lot of discomfort and even prevents a person from leading a normal life.

The symptoms of Bladder Pain Syndrome are:
(i) Experiencing intensepain in the pelvic area.
(ii) Experiencing a burning sensation during urination.
(iii) Feeling a frequent need to urinate.
(iv) Weakening of bladder control abilities.
(v) Experiencing pain during intercourse.
Women are more prone to being afflicted by Interstitial Cystitis as compared to men.

While a lot of research is being conducted to ascertain what are the factors that actually lead to the development of Bladder Pain Syndrome, nothing concrete has been established by the researchers as yet. However, the possible causes which are assumed to lead to this condition have primarily been identified as under:

(i) The presence of some unknown substance in the urine of the patients that damages and prevents the regeneration of the epithelial cells which line the walls of the bladder.
(ii) The presence of Huner’s Ulcers (patches of broken skin) on the bladder walls in a large of number of patients with this condition.
(iii) The hyper-activation of sensory nerves in the bladder wall which give rise to this condition.
(iv) The presence of some unidentified micro-organism in the bladder which may be causing damage to the bladder walls.
Since the exact cause of Bladder Pain Syndrome is still unknown, the line of treatment that Doctors follow for patients afflicted with this condition is one which focuses on alleviating the symptoms to bring comfort to the patients. This calls for an element of experimentation on the part of the doctors as the intensity of symptoms vary from patient to patient along with the fact that the responses of the patients to the treatment also differs.

Doctors primarily rely on oral medication to help their patience manage this condition and resort to more complex processes such as Bladder Distension, Bladder Instillation, Bladder Augmentation and surgery only in the more severe cases.

The most interesting part about Bladder Pain Syndrome is the occurrence and intensity of the symptoms are not consistent all the time, they increase or decrease at different points of time and in a lot instances they disappear completely without recurring. Therefore doctors prefer using a course of oral medication accompanied with advice to their patients to follow a balanced diet with regular exercise.

Interstitial Cystitis Treatment

Interstitial Cystitis is the medical term to describe the chronic inflammation of the bladder wall which gives rise to the following symptoms:

1. The need to urinate frequently and urgently.
2. Experiencing a painful, burning sensation while urinating.
3. Decreased bladder control abilities.
4. Pain in the pelvic area
5. Intense Pain during intercourse.
Interstitial Cystitis is not a life-threatening condition but it severely impacts the patient’s ability to lead a normal life.

The reason for the development of Interstitial Cystitis is still unknown as a result of which the mode of Interstitial Cystitis Treatment is one of trial and error primarily aimed at controlling the symptoms in a patient.

The major methodologies of Interstitial Cystitis Treatment are given below:

1. Oral Medication: The heparinoid (heparin-like) drug, PentosanPolysulfate Sodium otherwise known as Elmiron is the most common oral medication which is used in Interstitial Cystitis Treatment. Pain alleviation medication or some anti-seizure drugs are also used to manage the pain experienced by patients in this condition.
Anti-Allergic drugs (antihistamines) may also be prescribed to control allergic symptoms that could be aggravating a patient’s condition.

2. Bladder Distension: This procedure is a temporary one which provides relief in terms of reducing the urination frequency and alleviation of pain to patients for periods ranging from three weeks to six months.
Bladder Distension is performed under general anaesthesia and basically involves stretching the bladder capacity.

3. Bladder Instillation: This procedure is more commonly known as a “Bladder Bath”. Under this, the bladder is filled with a solution known as Dimethyl Sulfoxide (DMSO) that is held in the bladder for durations ranging from 5 seconds to 15 minutes before being drained out through a catheter.
It is believed that as the medicated solution directly touches the bladder walls, it reaches the tissues more effectively to stem the inflammation and prevent the pain causing muscle spasms which also lead to the frequency and urgency in urination.

4. Surgery: Surgery is considered as an option in Interstitial Cystitis Treatment where the presence of Huner’s Ulcers is found on the bladder walls. There are two main types of surgery :

(i) Fulguration - This involves the burning of the ulcers with a laser.
(ii) Resection - This involves cutting around and removing the ulcers.

5. Bladder Augmentation: This is another surgical procedure where the damaged portions of the bladder are removed and a portion of the patient’s large intestine is re-shaped and attached to the remaining healthier portion of the bladder.

6. Transcutaneous Electrical Nerve Stimulation (TENS): Mild electrical pulses are made to enter the body for two or more times in a day. It is believed that the electrical pulses increase the blood flow to the bladder, strengthen the pelvic muscles that control the bladder and trigger the release of hormones that block pain. TENS is popularly used in Interstitial Cystitis Treatment morefor pain management.

7. Cystectomy:In extremely cases of Interstitial Cystitis, a Cystectomy may have to be carried out to remove the bladder completely with the diversion or re-routing of urine flow.

Having looked at the medical treatment of Interstitial Cystitis, it is imperative to mention here that for most patients, this condition involves some basic medication and more of lifestyle discipline and control in terms of:

(i) Diet Management by avoiding those foods which aggravate the symptoms in the patient. This again is variable as a set of food items which trigger off the symptoms in one person may not do so in another.
(ii) Avoiding smoking, alcohol and recreational drugs.
(iii) Exercise or Yoga to control and strengthen the bladder muscles and manage pain.
(iv) Bladder Training through counselling by using relaxation methods to control the frequency of urination.
The most interesting characteristic of Interstitial Cystitis is that the symptoms are not consistent in their intensity in many cases they even disappear completely without any form of Interstitial Cystitis Treatment.

Interstitial Cystitis

Interstitial Cystitis is more commonly known as the “Painful Bladder Syndrome (PBS)”. It is a physically debilitating condition but fortunately, it is not a life threatening one. This is found to occur more frequently in women between the ages of 30 and 40 than in men. The exact cause of Interstitial Cystitis is still unknown and many theories that have been propounded as to its exact causes are still under aggressive research. Some of these are:

(i) The presence of some unknown substance in the urine of the patients that damages and prevents the regeneration of the epithelial cells which line the walls of the bladder.

(ii) The presence of Huner’s Ulcers (patches of broken skin) on the bladder walls in a large of number of patients with this condition.

(iii) The hyper-activation of sensory nerves in the bladder wall which give rise to this condition.

(iv) The presence of some unidentified micro-organism in the bladder which may be causing damage to the bladder walls.

What actually occurs in “Painful Bladder Syndrome” is that ulcers or scars develop on the walls of the bladder which leads to the scarring and stiffness of the bladder and thereby hampering its normal function in the ejection of urine out of the body. Interstitial Cystitis is typically indicated by the following symptoms:

1. An excessive and frequent need to urinate.

2. The experiencing of a burning sensation during the act of urination.

3. A decrease in the ability to control the bladder.

4. Pain in the pelvic area

5. The experiencing of a burning sensation during intercourse

6. For men, the experiencing of pain in the penis and its immediate surroundings.

The diagnosis of Interstitial Cystitis is made after eliminating all other serious conditions that afflict the urinary tract. Some of the tests which a patient needs to undergo for the diagnosis of the “Painful Bladder Syndrome” are:

1. Bladder Biopsy

2. Cystoscopy (telescopic examination of the bladder)

3. Urinalysis

4. Urine culture

5. Urodynamics (shows how much urine must be in the bladder before you feel the need to urinate)

Congenital Malformations

The birth of a baby is an occasion of joy for the parents and their families. For many parents of new-borns, the pleasure of holding their child in their arms and dreaming of their happy future is marred when it is discovered that the little baby has some form or the other of what are known as congenital malformations.

The purpose of this blog post is to provide some information on the various congenital malformations from the urological perspective with the purpose of providing the mental peace and confidence to parents who are worried about their baby’s healthy life ahead.

To begin at the very beginning, a congenital malformation is a physical defect that is inherent in the baby at the time of the birth; this defect may pertain to any part of the body or any organs of the body. In colloquial terms, we refer to this as a “birth defect”. The causes for a birth defect are not really very clear though some forms of these cases have been found to be genetic in nature.

Let us now look at the congenital malformations which may be present in the urinary system of a baby:

1. Pelvi-Ureteric Junction Obstruction (PUJ)

This condition typically describes the presence of an obstruction which prevents the proper drainage of the urine from the kidneys. Although this is a congenital abnormality, this condition may not show up at birth but may manifest itself in the later years.

2. Vesico Ureteric Reflux (VUR)

In a normal urinary system, the urine flows from the kidneys to the ureters and then into the bladder. The congenital malformation known as Vesico Ureteric Reflux (VUR) is said to occur, when it has been found that the urine in the body is flowing backwards from the bladder into the ureter and then towards the kidneys. This condition needs immediate intervention for correction as the bacteria and toxins present in the urine may cause permanent damage to the kidneys.

3. Megaureter

This is a birth defect when the ureters – the channel through which the urine flows from the kidneys into the bladder for expulsion are abnormally dilated.

4. Posterior Urethral Valves (PUV)

The urethra is the tube which carries the urine from the bladder to expel from the body. The urethra has these tissues present near the bladder which prevents the flow of urine from the bladder into the urethra and is known as Posterior Urethral Valves (PUV). This form birth-defect tends to occur amongst male children only.

5. Hypospadias

This is the most common form of congenital malformation occurring in boys. It is a condition in which the urethral opening does not form completely to the tip of the penis as is normal but is formed somewhere along the underside of the penis. This condition leads to discomfort in urinating for the child and may lead to complications in his later life.

6. Epispadias

In Epispadias, the urethra does not develop fully and ends abruptly prior to its normal location. This condition may occur in both girls as well as in boys.

7. Ectopia Vesicae (Bladder Exstrophy)

This is the most complex form of congenital malformation. The bladder here does not form inside the body but instead develops into a flat shaped structure and lies exposed outside the body. The urethra and the genital organs also do not form normally and completely and the pelvic bones are also found to be more spread out than normal. It may be very disturbing for parents of children to see this condition because it is not an appealing sight at all, but the cause for joy is that this is a very much correctible defect.

I would like to mention here, that all the birth anomalies that have been described here, need some form of surgical intervention or the other, and the extent of the intervention would vary with the severity of the condition. Therefore concerned parents should make sure that for correcting any of the congenital malformations, they should refer to a veteran doctor to take care of the child because the impact of these corrective measures would remain for the rest of the child’s life.

The Hype and Hope is Phalloplasty

Penis Reconstruction is a term which is used to refer to the various surgeries that are carried out on the male genitals to rectify some congenital defect, restore an organ lost to disease or accident or to augment the size. The correct medical term for this sort of surgery is Phalloplasty.

For centuries, across countries and cultures, the male organ has had special significance as the source of life and creation. In the Hindu tradition, the phallus of a god is openly worshipped and myriad temples dedicated to it exist everywhere. This emphasis on the male body has subsidized a mistaken belief, that the size of a man’s penis has a direct bearing of his sexual prowess and his ability to reproduce.

With spread of information technology and a change in the societal mindset where it is no longer taboo to discuss sex related matters, many men are coming forward to seek more information on penis augmentation and are often falling prey to unscrupulous medical practitioners or  quacks selling ” miracle remedies”.

As practicing urologist, who has successfully carried _____ surgeries for penis reconstruction, let me use this platform to inform those males who are having complexes about the size of their organs and their abilities to have fulfilling physical relationships with   their partners that, this type of surgery is one of the most complex surgeries to be carried out, unlike the regular plastic surgery procedures even with the improvement of the techniques used. The recovery of a patient from this surgery is very fragile and requires a lot of medical monitoring. Hence it is advisable to first develop some self-confidence and secondly to consult a genuine expert in men’s health for his opinion. In most cases, the expert would be able to reassure you that your body is in perfect order.

Then again there are those who have a genuine need for penis reconstruction so that they may get back a physiologically complete body and a normal life. As I have mentioned earlier, these are men who may have been born with some form of a defect or have lost their organs due to an accident ( or a violent domestic attack as in the sensational case of ____Bobbit) or due to some serious disease like cancer or for those instances where a sex-change surgery is essential. These are men for whom the complex invasive surgeries of Phalloplasty should be carried out because it is about giving these men a chance to lead a regular life.

There are different surgical techniques for penis reconstruction but all of them involve taking a graft of tissue from a part of the patient‘s body and using it to extend the urethra to “create a penis”.

Before signing off, I would once again like to address those males who are having body image issues to please consult an urologist and have your questions addressed. At the same time, to those men out there who have genuine need for a penis reconstruction, I would like to offer them the hope of getting back their bodies and their lives with the help of medical science.

Important Facts About Penis Enlargement

“Male enhancement” is the polite term used for the process of penis enlargement which involves the techniques, medical or otherwise to increase the girth, length or hardness of the human penis. Just as women obsess over their appearance and body contours; there are men too, who are severely worried about the shape and size of their male organ and this anxiety often reach such proportions that these men are unable to enjoy normal relationships.

There are several fly-by-night companies and unscrupulous medical professionals who play on the insecurities of these men and offer them promises of penis enlargement through medicines and exercises.  Some of the most common types of these remedies are:

1.       Specialized weights for increasing the length.

2.       Vacuum Developers which are to be attached to the male organ.

3.       Magnetic rays to stimulate the penis growth.

4.       Various types of pills and potions.

5.       “Hormone” Therapy

Let it be clarified here, that none of the medicines, exercises or devices have been proven to have the desired effect permanently. Surgical intervention is the only true option.

Before proceeding further, let me clarify to any anxious male who is having complexes about his body and his ability to have normal sexual relations with his partner that there are reams of scientific evidence to prove that the size of the penis has absolutely no bearing on the pleasures derived by both partners from the act of intercourse. So please do not spend too much of time worrying about it and do not let your self-esteem suffer because of this. If you do still have some anxieties and insecurities, please do consult an andrologist and take his guidance to clear off your doubts.

Of course, there are men who are born with a congenital condition where the size of their penises are much smaller than normal and they have difficulty in performing the basic bodily functions who benefit from a penis enlargement surgery.

Please be very clear that such a surgery is not an easy one and is fraught with risks if it is not conducted by a properly trained and experienced surgeon. There are several cosmetic clinics who claim to offer this type of surgery and they are best avoided at all costs. Should you feel that there is absolute need for you to undergo this penis enlargement surgery as your physical and mental wellbeing is dependent on it. Then please seek out a surgeon who is affiliated with a renowned medical institution and who has the proven credentials and experience of conducting this type of surgery. A good surgeon will first counsel you and only when convinced will allow you to go ahead with this surgery , not only that he will also ensure that the pre and post operative care provided will be such that you recover well and enjoy the pleasure of your penis enlargement. 

Understanding HOLEP (Holmium Laser Enucleation of Prostate)

As on date there are very few urologists who are well versed in the use of the HOLEP (Holmium Laser Enucleation of Prostate) in Delhi for the treatment of Benign Prostate Hyperplasia (BPH) or enlarged prostate as it is commonly known. The methodology is quite complex and calls for a lot of time and attention in order to learn, that is the reason why the widespread adoption of this technique has still not occurred even though it offers far more advantages over the other alternative treatment methods.

Benign Prostate Hyperplasia (BPH) or enlarged prostate is a non-malignant condition where the tissues of the prostate gland in males increase in size over the years and weigh down on the urethra (the channel through which the urine is carried out of the body), constricting its size and thereby causing obstruction in the smooth expelling of urine from the body.

In order to ease the discomfort caused by this condition, the prostate tissues which cause the obstruction need to be removed so that the urethra regains its original dimensions and the smooth flow of urine from the body resumes. Urologists, who have the know-how, use HOLEP (Holmium Laser Enucleation of Prostate) in Delhi to either vaporize or completely remove the disruptive tissue.

Let us elaborate on this novel surgical procedure further. HOLEP (Holmium Laser Enucleation of Prostate)is the use of laser to remove the obstructing prostate tissue and push it in to the bladder. An endoscope is then used to remove these tissues from the bladder. A catheter is normally left to drain the bladder at the end of the procedure. The operation on an average takes between forty-five to ninety minutes depending upon the size of the prostate.

The main reason as to why HOLEP(Holmium Laser Enucleation of Prostate) scoresother surgical procedures such as TURP (Transurethral Resection of the Prostate) and TUIP (Transurethral Incision of the Prostrate) is that there is minimal bleeding in this procedure and the recovery time is much, much shorter. The duration of hospital stay for undergoing the HOLEP surgery also does not exceed more than twenty four hours. The best part is that the positive impacts of this laser surgery are noticeable right away and the possible recurrence of the prostate enlargement is delayed by a considerable amount of time.

Although there are only a few options for HOLEP(Holmium Laser Enucleation of Prostate)in Delhi, it is advisable for those having to undergo surgical intervention for their enlarged prostates to consider this option as it not only provides quick relief from the symptoms but also ensures complete resumption of normalcy in life within the shortest possible duration.

Successful Removal of the Largest Kidney Tumour by Dr. Rajesh Taneja

Dr. Rajesh Taneja is an established urologist who is rated as one of the best in the country. He has over twenty years of practice in this field of urology and handling cases of kidney tumour. Any disease which has the effect of debilitating our major organs is traumatic and stressful for both the afflicted person as well as his or her family members. That is the reason why it is important to be able to undergo treatment with a reliable physician who engages with the patient and the family members and gives them the much needed support through their difficult days.

The kidneys in the human body perform the critical functions of processing and excreting body wastes and water, manufacturing red blood cells, producing Vitamin D and releasing hormones essential for other body functions. The kidneys also play a part in regulating the blood pressure and maintaining a balance of chemicals in the body. So it is but natural to infer that any damage to the kidneys would have far reaching consequences on the functioning of the entire body.

Kidney tumour occurs when the cells of the kidneys start growing excessively and begin to form clusters known as tumours. The tumours may be harmless (benign) or cancerous (malignant). The cause of kidney tumours is still not known but certain trends have been noted. Instances of this condition have been found to be higher if a combination of the following factors is present:

1. A habit of smoking
2. Being Obese
3. Males over the age of forty
4. Having had a prolonged exposure to certain medications – especially pain killers.
5. Having a history of high blood pressure.
6. Prolonged exposure to certain toxic chemicals.
Today it is very easy to detect the presence of tumours in the kidneys quickly and the good news is that early detection helps in curing this condition to a very large extent. It is advisable that to consult an urologist such as Dr. Rajesh Taneja at the earliest if any of the symptoms are experienced:

1. Passing of blood in the urine.
2. Pain in the back and in the flanks.
3. Rapid and unexplained weight loss.
4. Regular occurrence of fever which is not flu or common cold.
5. Experiencing fatigue and lethargy.
While smaller sized tumours may be treated through medicines, larger tumours need to be removed through surgical intervention. Dr. Rajesh Taneja, Senior Consultant Urologist and Andrologist , New Delhi has the distinction of having removed the largest kidney tumour ever from a human body. The tumour measured 39 centimetres in length, 25 centimetres in width, and 9centimetres in height and weighed 7500 grams; about the size of a medium water melon.

The landmark surgery was conducted by Dr. Rajesh Taneja on 7th February 2004 at the Pushpawati Singhania Research Institute for Liver, Renal and Digestive Diseases at New Delhi. The highlight of this surgery was that no blood transfusion was needed and it was conducted under general anaesthesia. The total duration of this surgery was three hours and twenty minutes.

Post this record achievement, Dr. Rajesh Taneja kept the patient under close observation for five days before discharging her from the hospital. The patient from whose body the heaviest kidney tumour was removed now leads a normal life albeit with some precautions.