Areas of Expertise
Prostate Cancer
PROSTATE CANCER
Bladder cancer is a type of cancer that begins in the cells of the bladder, the organ that stores urine. It’s one of the most common cancers, affecting both men and women, but it’s more common in men. There are several types of bladder cancer, but the most common type is transitional cell carcinoma, which begins in the cells that line the inside of the bladder.The exact cause of bladder cancer isn’t always clear, but some risk factors include smoking, exposure to certain chemicals, chronic bladder inflammation, and a family history of bladder cancer. Symptoms of bladder cancer may include blood in the urine, frequent urination, pain during urination, and lower back pain. Treatment for bladder cancer depends on the stage and type of cancer but may include surgery, chemotherapy, radiation therapy, immunotherapy, or a combination of these treatments. Early detection and treatment are crucial for improving outcomes and prognosis. Advanced metastatic disease may present with bony pains, cough, breathlessness and blood in sputum. Initial diagnosis is made with the help of a Ultrasound scan which can be easily done nowadays. Confirmation of the size and location of the tumor is done with the help of a dedicated CT scan. What follows next is an endoscopic surgery called Trans Urethral Resection of Bladder Tumor (TURBT) which removes all of the tumor from the bladder and provides tissue for histopathological examination and biopsy, which establishes the type, grade and stage of tumor. This surgery is done under anaesthesia and is done through the natural orifice of urine, and does not require any cuts or incisions. Patients are generally sent home one to two days after the surgery. Further treatment depends on the stage of the disease as determined by the biopsy report. A PET scan is done (for muscle invasive disease) to assess if there are any distant metastases or if the tumor is just localized to the bladder. Initial stages, which is the non muscle invasive stage, require instillation of BCG or a chemotherapeutic agent in the bladder along with cystoscopic surveillance. This intravesical therapy prevents the tumor from recurring and progressing. The drug is initially instilled weekly for 6 weeks, which is the induction course, followed by monthly instillations, which is the maintenance regimen. The more advanced stage, which is the muscle invasive, stage requires a radical surgery which involves removal of the whole bladder, besides the prostate in the males and uterus, cervix and fallopian tubes in females. The bladder is replaced by a replica bladder made from the intestines called a neobladder or a loop to facilitate collection of urine outside the body called an ileal conduit. The gold standard for bladder removal has always been a surgery called a radical cystectomy but sometimes bladder preservation is also possible for advanced bladder cancers. Patients not fit for anaesthesia and surgery are offered radiotherapy and chemotherapy with a curative intent. Follow up after surgery involves regular visits to your doctor for physical examination, routine blood tests and a cross sectional imaging such as a CT scan. Patients with metastatic disease are treated with systemic chemotherapy and immunotherapy. Treatment plans are often individualized based on the patient’s specific situation, and multidisciplinary teams consisting of urologists, medical oncologists, radiation oncologists, and other specialists work together to determine the most appropriate treatment approach. It’s essential for patients to discuss their treatment options thoroughly with their healthcare team to make informed decisions about their care.
Bladder Cancer
BLADDER CANCER
- Bladder cancer generally presents in the ageing male, but in the last two decades, the incidence in young adults including ladies has risen alarmingly. Bladder cancer is one of the most lethal of all urological malignancies, second only to kidney cancer in terms of mortality. Smoking constitutes one of the most important risk factors for developing this cancer. Other risk factors include exposure to industrial chemicals, specially those involved in the petrochemical and plastics industry. The most common symptom is blood in urine, scientifically known as hematuria. Other symptoms can be of increased frequency of urination, pain while passing urine, and loss of appetite and weight. Advanced metastatic disease may present with bony pains, cough, breathlessness and blood in sputum. Initial diagnosis is made with the help of a Ultrasound scan which can be easily done nowadays. Confirmation of the size and location of the tumor is done with the help of a dedicated CT scan. What follows next is an endoscopic surgery called Trans Urethral Resection of Bladder Tumor (TURBT) which removes all of the tumor from the bladder and provides tissue for histopathological examination and biopsy, which establishes the type, grade and stage of tumor. This surgery is done under anaesthesia and is done through the natural orifice of urine, and does not require any cuts or incisions. Patients are generally sent home one to two days after the surgery. Further treatment depends on the stage of the disease as determined by the biopsy report. A PET scan is done (for muscle invasive disease) to assess if there are any distant metastases or if the tumor is just localized to the bladder. Initial stages, which is the non muscle invasive stage, require instillation of BCG or a chemotherapeutic agent in the bladder along with cystoscopic surveillance. This intravesical therapy prevents the tumor from recurring and progressing. The drug is initially instilled weekly for 6 weeks, which is the induction course, followed by monthly instillations, which is the maintenance regimen. The maintenance regimen goes on The more advanced stage, which is the muscle invasive, stage requires a radical surgery which involves removal of the whole bladder, besides the prostate in the males and uterus, cervix and fallopian tubes in females. The bladder is replaced by an orthotopic neo bladder or an ileal conduit which is made from the small intestine. Robotic surgery allows a minimally invasive approach for this major surgery wherein the patient does not have any big incisions on his abdomen and gets up and walks about the next day of the surgery as opposed to a traditional open approach which involves a large incision prolonging patient recovery. Patients not fit for anaesthesia and surgery are offered radiotherapy and chemotherapy with a curative intent. Follow up after surgery involves regular visits to your doctor for physical examination, routine blood tests and a cross sectional imaging such as a CT scan. Patients with metastatic disease are treated with systemic chemotherapy and immunotherapy.
Kidney Cancer
KIDNEY CANCER
Kidney cancers arise in patients generally aged beyond 60, both in males and females and commonly present with blood in urine, pain in abdomen, or a lump in abdomen which is seen in more advanced stages. However about 60 % of the patients diagnosed with renal cancer are asymptomatic, and detected to have the lesion on an abdominal ultrasound done for an unrelated reason. The major risk factor for development of renal cancer is tobacco exposure, mainly in the form of smoking. The risk almost doubles with every 10 years of smoking. Other risk factors include obesity, hypertension, chronic NSAID painkiller use and some industrial chemical exposure. Kidney tumours are diagnosed and characterised by abdominal CT scans. The mainstay of treatment of these tumours are surgical removal, either removal of the whole kidney, known as radical nephrectomy, or just removal of the tumour while preserving the rest of the kidney in the case of small masses, known as partial nephrectomy. Kidney tumours do not respond to radiotherapy or chemotherapy and they should never be used as first line treatment options. Minimally invasive approach in the form of robotic surgery or laparoscopic surgery is the preferred form of surgery and avoids the morbidity of a large incision of an open surgery. Patients with metastatic and advanced disease are treated with targeted therapy with Tyrosine Kinase inhibitors or with the newer immunotherapeutic agents.
Testicular Cancer
TESTICULAR CANCER
Testicular cancer usually presents with painless enlargement of the testis. Most patients notice it on their own while in the shower. Attention is drawn towards an enlarging testes usually after a trivial trauma. There is an associated decrease in sensation of the afflicted testes. The age of presentation, prognosis and treatment modalities differ for these two types of tumor. Distinction amongst these two types of tumor is made initially by the blood levels of Alpha feto protein (AFP), Beta Human Chorionic Gonadotropin (B-HCG) levels and Lactate dehydrogenase (LDH) levels. The first step of treatment is to do a procedure called a high inguinal orchiectomy whereby the affected testes is removed through an incision in the groin. Scrotal orchiectomy or biopsy before removal of the testes should never be done. Final diagnosis is made by histopathological examination. Staging is done using CT scans of the chest and the abdomen to detect spread to the abdominal nodes. Treatment depends on the stage of the disease and the type of tumor (Seminoma vs Non Seminoma) and levels of blood markers. Initial stages are managed with high inguinal orchidectomy followed by surveillance while the more advanced stages need chemotherapy and surgery (Retroperitoneal Lymph Node Dissection (RPLND)) or radiotherapy depending upon the tumor subtype. RPLND can be done using open, laparoscopic or robotic approach. It is important to understand that testicular cancer has excellent cure rates if detected and treated early and appropriately.
Penile Cancer
PENILE CANCER
Penile cancer presents with a growth, usually involving the head or the foreskin of the penis. Uncircumcised males with poor hygiene are at high risk of developing a lesion, and circumcision is protective against penile cancers. The Human Papilloma Virus, responsible for cervical cancers in females, are also a causative factor for development of penile cancer. A warty growth on the glans is the most common presentation, while earlier stages might present with discolouration or a patch on the glans and the more advanced stages present with a cauliflower like growth replacing a part or the whole of the penis. Some patients also have swelling and ulcers in the inguinal region on one or both sides at presentation, representing more advanced stages of the disease. Diagnosis is based on clinical examination and a CT scan of the chest, abdomen and pelvis to detect metastases. A wedge biopsy of the lesion confirms the diagnosis and the final treatment depends on the stage of the disease. Smaller lesions can be treated with partial excision of the glans or partial amputation of the penis. Larger growths require a radical penectomy or removal of the whole penis and creation of perineal urethrostomy. Most of the patients also require a bilateral inguinal and pelvic lymph node dissection which is done by open approach or a minimally invasive approach called VEIL (Video Endoscopic Inguinal Lymphadenectomy). VEIL can be done laparoscopically or robotically and has added benefits over open surgery. Larger inoperable tumors can be treated with radiotherapy and metastatic disease is treated with systemic cytotoxic chemotherapy.
Adrenal Cancer
ADRENAL CANCER
Adrenal tumours can either be benign tumors, adrenal cortical cancers or paraganglioma arising from the adrenal medulla known as pheochromocytomas. Tumors arising from the cortex of the adrenal, whether benign or adrenal cortical carcinoma, are usually asymptomatic, but may present with abdominal pain or a lump in cases of large masses. Some of these tumors also produce excess steroids and sex hormones and patients may present with symptoms arising from these excess production of the hormones. Patients with pheochromocytomas present with symptoms of catecholamine excess, the classical triad being headache, palpitation and excessive sweating. Hypertension and deranged glucose metabolism also results for excess production of catecholamine. Diagnosis is made based on CT scan of the abdomen and measurement of plasma metanephrine and nor metanephrine levels. Surgery is the mainstay of treatment for adrenal masses, for both cortical tumors and of pheochromocytomas, albeit pheochromocytomas require medical counteraction of the effects of excessive catecholamine before surgery. Robotic and laparoscopic approach provide a minimally invasive means of removal of the tumor with minimal morbidity as against an open approach.
Adv. Laparoscopic Urology
ADVANCED LAPAROSCOPIC UROLOGY
Advanced laparoscopy is transforming urology, offering minimally invasive surgery for complex conditions. Tiny incisions house a camera and surgical tools, allowing magnified visualization and precise procedures. Patients benefit from faster recovery, less pain, and improved cosmetic outcomes.
This technique tackles various urological concerns, including kidney and adrenal tumors, ureteropelvic junction obstruction, and prostate cancer. Advanced laparoscopy even incorporates robotic assistance for enhanced dexterity and control. While minimally invasive, it requires specialized training and expertise. Talk to your urologist to see if advanced laparoscopy is right for you.
Robotic Surgery
ENDOUROLOGY
GENERAL UROLOGY
Robotic urology refers to the application of robotic technology in the field of urology, which focuses on the diagnosis and treatment of diseases related to the male and female urinary tract and the male reproductive organs. Robotic systems, such as the da Vinci Surgical System, have revolutionized urological surgeries by offering enhanced precision, dexterity, and visualization to surgeons.
In robotic urology, procedures like prostatectomy (removal of the prostate gland), nephrectomy (removal of a kidney), cystectomy (removal of the bladder), pyeloplasty (surgery to correct a blockage in the ureteropelvic junction), and even reconstructive surgeries are performed using robotic assistance. The surgeon controls robotic arms equipped with surgical instruments and a camera from a console, allowing for minimally invasive surgery with smaller incisions, reduced blood loss, shorter hospital stays, and faster recovery times compared to traditional open surgery.
Robotic urology has become increasingly popular due to its benefits for both patients and surgeons, offering improved outcomes and a higher quality of care for various urological conditions.