Faced with ever more efficient techniques and multidisciplinary care, prostate cancer is less and less often the death knell for sexuality. Explanations. It is the main cancer occurring in men over 65 years of age and one of the most controversial for its early detection, but prostate cancer is also being better and better managed and treated to limit “collateral” injuries when they are preventable. One of the challenges: preserving the integrity of the urethral sphincter, protecting patients from urinary loss, but also the erection nerves, directly attached to the prostate and extending into the penis to allow erection. “For purely anatomical reasons, the prostate cancer treatment in Delhi can have an impact on sexuality and affect patients beyond the disease itself,” emphasizes Dr. Shailendra Goel, urologist in Noida. Affected in their virility, some men fall into a situation of discomfort, which they very often keep silent. Taking into account the dimension of sexuality is therefore essential before, during and after treatment.” When should you consult? Early detection of prostate cancer is generally recommended in men between 50 and 70 years old and is mainly based on the so-called “PSA” test. Clearly, a blood test to measure a protein, PSA, secreted in excess in case of prostate tumor. In case of suspicion, which may need to be confirmed by an MRI, a biopsy may be necessary. Characterized by a generally slow evolution and often without incidence for many years, prostate cancer gives rise to some controversy as to too aggressive or early actions of radiotherapy or surgery. Among the dreaded facts: incontinence and erectile dysfunction. Radiotherapy or removal of the prostate The medical challenges? They are numerous and begin with the choice of prostate cancer treatment in Noida. Radiation therapy or total removal of the prostate: the option depends directly on the size of the tumor and on the decision taken between the best urologist in Noida and the patient. Non-invasive, radiotherapy has known progress such that it can intervene without causing damage to the erectile nerves, but it is only possible for minimally invasive tumors. For other situations, surgery is inevitable. “In the case of prostate cancer, the tumor generally nestles inside the gland by sticking to its wall,” explains urologist in Ghaziabad. The erector nerves, meanwhile, are attached to the outside of the prostate. Depending on the location of the tumor. Comprehensive care Two cases then emerge, depending on whether or not the erection nerves could be preserved. “In all cases, comprehensive care including sex therapy is advised,” said the best urologist in Ghaziabad. If nerves have been preserved, resumption of sexual activity is recommended as early as two weeks after the intervention, explains Professor Iselin. If an erection is no longer physiologically possible, ad hoc treatments are possible. The challenge remains real. “There is necessarily a before and after surgery on the prostate,” says Dr. Shailendra Goel, urologist and sexologist in Noida. Sexuality will have to reinvent itself. In extreme cases, you have to take into account that the section of nerves has definitively interrupted the nervous contact between the brain and the penis. And to recall: “In this process, several factors directly related to the patient’s life will make the difference, starting with his age – 50% of men already experience erectile dysfunction at 40 years -, but also his condition health and liveliness of his sex life. The more solid and sexually active the couple, the more likely they are to overcome the ordeal and find themselves.”
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In the last decades there has been an increase in the incidence of bladder tumors. However, there have been significant advances in bladder cancer treatment in Delhi, leading to increased survival. The bladder is an organ whose function is to store the urine produced by the kidneys, until it is eliminated by contraction of its muscles. Internally, the bladder resembles the interior of the oral cavity, being covered by a thin film, or mucosa, called urothelium. This same urothelium also lines the inside of the ureters, the pelves and the renal chalices, which transport the urine produced in the kidneys to the bladder. Under the bladder mucosa is an even thinner layer, called the lamina propria, and below this, the bladder musculature. Externally, the bladder musculature is surrounded by fatty tissue. Causes Not yet known are all the changes that lead to the development of bladder cancer. However, a number of substances have already been identified that are associated with a higher incidence of this type of tumor, especially those related to cigarettes and some chemical substances, such as hair dyes. Smoking is associated with 50% of all bladder tumors diagnosed in India as an isolated factor. Prolonged exposure to paints and dyes appears to be the cause of these tumors in 20% to 25% of patients, says urologist in Noida. More than 90% of malignant bladder tumors originate in the urothelium, most of which are confined to the mucosa and submucosa (superficial tumors), with no muscle involvement (infiltrative tumors). Symptoms According to the best urologist in Noida, the most frequent symptom is the presence of visible bleeding in the urine (hematuria), usually bright red and accompanied by coagulated blood. More rarely, this bleeding can only be seen through a urine test. The exclusive presence of hematuria, microscopic or not, is insufficient for the diagnosis of bladder cancer, as it can be a symptom of other diseases, or even be considered "normal" for some individuals. Therefore, further tests are needed to diagnose bladder tumors. Other symptoms associated with bladder cancer are very frequent urination and painful urination (dysuria). Again, these symptoms are also nonspecific and only suggest the possibility of a bladder tumor. Diagnosis Through clinical history and physical examination, the urologist in Ghaziabad may suspect this disease. As the presence of bleeding in the urine can result from other diseases in the kidneys, in the collecting systems (goblets and renal pelves), in the excretory pathways (ureters) and in the bladder, the best urologist in Ghaziabad may order some imaging tests (computed tomography, ultrasound, resonance) magnetic, excretory urography) to assess these structures. The analysis of urine may also include the analysis of urothelial cells that are released and carried by the passage of urine (urinary cytology), as well as some substances dissolved in it and that may be related to urothelial tumors. The most important diagnostic test for bladder tumors is endoscopy (cystoscopy), which allows the urologist in Delhi to view the inside of the bladder. This examination can usually be performed without the need for hospitalization and under mild sedation, or even under local anesthesia through the introduction of an anesthetic jelly in the urine channel (urethra). If the urologist in Greater Noida diagnoses the presence of a tumor, or if they have already been diagnosed through imaging tests, there will be a need for hospitalization to perform an endoscopic surgery. This surgery takes place under general or epidural anesthesia / spinal anesthesia, in which we will try to "scrape" (transurethral resection - TURP) the entire visible tumor, which will allow the study of its microscopic characteristics (anatomopathological study), fundamental data for defining the prognosis and bladder cancer treatment in Noida. The anatomopathological study will allow the pathologist to examine tumor cells and compare them with normal cells in the same tissue. With this, the best urologist in Greater Noida will be able to conclude how much the tumor cells differ from the normal ones and classify the tumor in "low grade" and "high grade". The tumor grade reflects the aggressiveness of the tumor, that is, the probability of becoming infiltrative, if it is a superficial tumor, or of spreading through the body (developing metastases). The pathologist will also define how deep the tumor has invaded the bladder, whether it has compromised only the mucosa and submucosa (superficial tumors), or whether there has already been involvement of the bladder muscles (infiltrative tumors). Through radiological exams, the urologist in Vaishali will check for possible involvement of other structures in the body, especially the lungs, liver and lymph nodes (lymph nodes) located inside the belly (abdominal cavity). All of this information constitutes tumor staging and it is this that will define the most appropriate form of treatment, as well as the prognosis. Staged tumors such as Ta, Tis and T1 are considered superficial tumors. Most Ta tumors are low grade tumors and rarely progress to infiltrative tumors. However, they are often recurrent. T1 stage tumors, on the other hand, often evolve with involvement of the bladder muscles. The Tis stage features a type of high-grade tumor called "in situ" carcinoma (CIS). These tumors are difficult to remove and are treated by bladder instillation of substances, such as BCG. When left untreated, they end up evolving to infiltrative tumors. Treatment Removal of stage Ta and T1 tumors - Performed through endoscopic scraping (resection) by transurethral approach (RTU), which allows material to be obtained for anatomopathological study. Chemotherapy and intravesical immunotherapy - After removal of the tumor by endoscopic route, depending on the case, and particularly in the CIS, the best urologist in Delhi may opt for intravesical instillation of immuno or chemotherapy in order to reduce the incidence of recurrences. Intravesical instillation is performed through a catheter (probe) inserted into the bladder through the urethra. The procedure is done on an outpatient basis, requiring only local anesthesia obtained with the introduction of an anesthetic jelly in the urethra. The instilled substance is retained in the bladder for approximately 1 hour, and then eliminated through urination. After instillation, the patient is expected to experience a little burning sensation when urinating, which may persist for 24 to 48 hours. The most frequently used immunotherapeutic drug is BCG. Among chemotherapeutic agents, thiotepa, doxorubicin, and mitomycin-C may be used. Cystectomy - Partial or complete removal of the bladder may be necessary in patients with CIS or high-grade T1 stage, who do not respond to intravesical chemotherapy and immunotherapy. In these situations, the risk of developing infiltrative disease is greater, which requires more aggressive treatments in order to reduce the possibility of metastasis. Cystectomy is also the most appropriate way to treat infiltrative tumors (which affect the bladder muscles). It may be preceded by systemic chemotherapy (intravenous injection of chemotherapeutic drugs) in special situations. Exceptionally, infiltrative tumors can be treated only with endoscopic resection associated with chemotherapy and radiotherapy. With the complete removal of the bladder, it becomes necessary to create an alternative for the elimination of urine produced by the kidneys (urinary diversion). The preferred way, whenever it is possible to use it, is to make a "new" bladder with a segment of the intestine. This surgery allows the urine produced to be stored in this intestinal reservoir (neo-bladder ileal) to be eliminated by the urethra, allowing the patient to live with a very good quality of life. However, some tumors may make this form of urinary diversion impossible, requiring the use of urinary collection bags attached to the skin, or that a drainage of the urine into the intestine be created. Understanding the prostate The prostate is a gland and is part of the human reproductive system. It is below the bladder and above the rectum, encompassing the entire back of the first portion of the urethra. The prostate contributes to the production of seminal fluid that helps to load sperm during ejaculation. One of the most common prostate problems is its benign growth, which, over time, can compress the urethra and cause difficulty urinating, explains the best urologist in Noida. Prostate cancer No one knows exactly what causes prostate cancer. However, it is known that it is not a contagious disease and that some risk factors make certain men more likely than others to develop it. Prostate cancer is the most common malignant tumor in men and it is estimated that on average one in six men will develop the disease, says the urologist in Noida. Age – Age is the most important factor, being uncommon before age 45 and most common after age 60. Family history – If a first-degree relative (father or brother) has already developed the disease, the risk is greater. Race – It is believed that the racial issue may be important in the development of prostate cancer. In the United States, the disease is more common among blacks. But this is not necessarily repeated in other countries, in which there are groups descended from African tribes of different ethnicities. In the East, in general, it is less frequent. However, this low incidence may not have exclusively the racial factor as a justification, since Orientals who migrate to the West and acquire local habits, present a progressively higher risk of prostate cancer in subsequent generations. Diet – Some studies suggest that prostate cancer is related to a diet rich in meat and animal fat, while a diet rich in fruits and vegetables could be a protective factor. Conditions such as benign prostate growth, obesity, smoking, having undergone a vasectomy, a viral infection of the prostate and a lack of physical exercise are not considered risk factors, explains the urologist in Greater Noida. Early detection– Since localized or early stage prostate cancer usually does not cause symptoms, you should try to discover the disease before the symptoms appear. For that, it is recommended to perform the examination of the prostate by digital rectal examination. The collection of a blood test, PSA (acronym in English for prostate specific antigen) is a controversial topic in the medical field, although the dosage of this substance is an important marker for prostate cancer. On the one hand, the risk of false positives may be associated with invasive and unnecessary interventions. But, on the other hand, early detection is linked to a better prospect of total tumor elimination. American guidelines suggest that men as young as 50 years of age go to the urologist in Ghaziabad to investigate the health of the gland.
Symptoms – Mostly prostate cancer have no symptoms. The discomfort to urinate or the presence of blood in the urine or sperm are more related to the benign growth of the prostate or prostatitis. A urological evaluation is often necessary to clarify the real source of these symptoms, says the best urologist in Ghaziabad. Diagnosis – Localized prostate cancer does not appear in most imaging tests such as ultrasound, tomography, MRI and PET-SCAN. Therefore, the diagnosis is made through biopsy (removal of small fragments by a fine needle inserted through the rectum) guided by ultrasound and made with sedation. The removed fragments are analyzed by a pathologist who evidences the existence or not of the problem. This exam has become standardized and routinely performed in the best institutions, with a low risk of serious complications and with a quick return of the individual to his normal activities. A biopsy exam performed does not completely exclude the presence of the disease and other biopsies may be necessary depending on the analysis of several risk factors. Disease stages – When the diagnosis is confirmed by biopsy, it is necessary to perform a series of tests that will determine whether the disease is located in the prostate, whether it is just beyond the limits of the prostate, or whether malignant cells have already spread to other organs. . Treatment Options
Kidney cancer is the third in frequency among malignant tumors of the uro-genital apparatus, after those of the prostate and bladder. They are, in their great majority, originated in the kidney itself, although exceptionally they can be an extension of tumors from other locations. If not treated in a timely manner, it can be fatal. If it is diagnosed in a localized stage (before it has expanded outside the kidney), the probability of 10-year survival is greater than 90%, and it decreases depending on the extent of the tumor, says urologist in Noida. What is the cause of this disease? As in other malignant diseases, it is believed that damage to DNA (the substance within the cell that determines its biological activity) generates a cascade of events that ultimately translate into unregulated and aggressive cell growth and reproduction that make up a tumor. A type of cancer is the family kidney, which occurs when some mutations (changes in DNA) are passed from one generation to the next. Corresponds to 3-4% of all cases of the disease. If there is a family history of kidney cancer, the person must be strictly controlled. Another form of cancer is sporadic kidney cancer, which corresponds to the vast majority of cases and is caused by changes in the cells after birth, probably due to external factors that cause DNA damage, explains urologist in Ghaziabad. Some of these factors are: Smoking habit It increases the probability of developing kidney cancer by 40%, making it the highest risk factor for this disease. Many of the chemicals inhaled by smoking are believed to be absorbed into the bloodstream and concentrated in large quantities, where they can cause DNA damage and tumor formation. By quitting smoking the risk decreases, but it can take many years to reach the risk of a non-smoker. Occupation Studies indicate that people exposed to some chemical agents like asbestos, cadmium, some herbicides and organic solvents like trichlorethylene, have a higher risk than people who do not have this contact. Obesity Some scientists believe that it is a factor in 20% of cases. It can alter the balance of hormones in the body, which affects the normal growth of kidney tissue. Sedentary lifestyle Several studies indicate that inactive people are more likely to develop kidney cancer than those who exercise regularly. Hypertension Statistics suggest that, added to excess weight, they can triple the risk of kidney cancer. What are the symptoms of the disease? According to the best urologist in Noida in its early stages, it is rare to cause symptoms. A significant proportion of cases are detected as a finding in a routine checkup or for an unrelated problem. There is no blood test that allows investigating kidney cancer in its early stages; therefore, it can reach a significant volume before being found. Some of the symptoms that can be experienced are:
It should be noted that in the vast majority of cases these symptoms are not caused by cancer, but by benign conditions such as cysts or infections. However, a study is necessary, as tumors diagnosed in a timely manner can be successfully treated, suggests the best urologist in Ghaziabad. How do you make the diagnostic? In addition to the physical exam, one or more of the following studies are done to confirm the diagnosis:
Staging Once the diagnosis of kidney cancer has been established, other laboratory and radiological examinations are used to determine if the tumor is confined to the kidney or presents evidence of local or distant extension. This information is extremely valuable for planning the best kidney cancer treatment in Delhi. Treatment Kidney cancer treatment in Noida will depend on two factors: the degree of extension and the general health condition of the patient. Nephrectomy (surgical removal of the kidney) is the standard therapy for “localized” tumors, that is, confined to the kidney, its adjacent tissue, or peri-renal lymph nodes, says urologist in Greater Noida. Radical nephrectomy It is the most commonly performed surgical procedure for this type of cancer. It consists of the removal of the kidney, adrenal gland, lymph nodes, and perirenal fatty tissue. The remaining kidney allows the patient to lead a normal life. Partial nephrectomy It is the removal of only the part of the kidney that includes the tumor. It allows preserving a greater reserve of kidney tissue. It has been used more commonly in recent years, especially for small tumors (4 cm or less), in which a radical nephrectomy may be unnecessary. It is the preferred strategy in patients who have only one kidney or, having both kidneys, their overall function is impaired. Laparoscopic surgery Both total and partial removal of the kidney can be performed laparoscopically. The surgery is performed using small instruments and a camera that are inserted through three to four holes of approximately 1 cm. on the abdominal wall. It meets the objectives with the same efficiency as open or traditional surgery, providing the advantages of less pain in the postoperative period and a faster recovery. Advanced tumors Treatment of advanced tumors is gradually improving, but an optimal strategy does not yet exist. Some patients may benefit from kidney removal. Alternatives include immunotherapy, which is the use of drugs that stimulate the patient’s immune system to try to control the tumor. More recently, other drugs have been incorporated that can attack the tumor, reducing its vascularity and other targets. The latter appear to be more promising, but there are no long-term follow-ups yet. Chemotherapy and radiotherapy do not play a role in the management of kidney cancer, except in very rare cases. Tracing Like all malignant tumors, even when the tumor has been completely removed, it requires regular monitoring, since malignant cells can appear in other parts of the body. Control includes physical examination, laboratory and radiological examinations. A change in lifestyle is recommended that includes a balanced diet with high fiber intake and low animal fat, regular exercise and smoking cessation. Urethral stenosis is a narrowing of a segment of the urethra, which can result in a decrease or even complete interruption of the urinary flow, resulting in a series of complications, explains the best urologist in Noida. The urethra is a tubular organ through which urine flows out of the bladder. In men, the urethra is longer. In its innermost part, just at the exit of the bladder, the urethra crosses the prostate. Near the exit of the bladder is the urinary sphincter, which controls the voluntary elimination of urine (continence). Any part of the urethra can be affected, and the extent of the narrowing can vary from a few millimetres or even affect the urethra throughout its length. In general, there is deposition of scar tissue (fibrosis) in the region of the stenosis. This type of problem is more common and more complex in men, says the urologist in Noida. Causes
Symptoms
Complications When you have a urethral narrowing, the bladder muscle starts to work, making more effort to generate a urinary flow that can overcome the region of stenosis. Even so, depending on the degree of the stenosis, part of the urine may be retained inside the bladder (residual urine). This residue can result in recurrent urinary infections, prostatitis, orchitis (infection of the testicles) and pyelonephritis (infection of the kidneys). An abscess near the site of the stenosis can further aggravate the obstructive condition. Rarely, some patients with chronic inflammation due to urethral strictures can develop cancer, states the best urologist in Greater Noida. Tests for detection of urethral stenosis
Treatment
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AuthorDr Shailendra Goel is consultant urologist at Max Hospital, Noida. He is one of the leading urologist in Noida. He performs all type of uro-onco surgery including kidney cancer, kidney transplant in Delhi, Noida. Archives
November 2020
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