Nephrology and Urology
The Department of Nephrology and Urology at Sri Ramakrishna Hospital has a long and hallowed history.
The first haemodialysis unit was installed here way back in 1980. This was also the year we performed our first kidney transplant.
Thus, we have nearly four decades of experience and expertise in the field. Our surgeons are of the finest order and have performed literally thousands of procedures between them. We routinely carry out both living-donor and deceased-donor transplants with great success. The centre for dialysis is equipped with 20 of the latest haemodialysis machines, functioning around the clock. We also carry out continuous ambulatory peritoneal dialysis. For patients suffering from kidney stone disease, we have a host of treatments including the cutting-edge RIRS (Retrograde Intrarenal Surgery). Numerous patients have benefitted from our expertise at laparoscopic urologic surgery. Men suffering from erectile dysfunction can also explore penile prosthetic options in consultation with our surgeons.
The kidneys are located on either side of the spine. They perform the indispensable job of purifying the blood in the body and keeping the balance of minerals and salts in it. Without the kidneys, waste, chemicals and excess fluid would build up while the body’s salt and mineral balance would be unhinged. It is a fatal condition.
Chronic kidney disease is a condition where they have not been functioning properly for a while. While the onset of symptoms might seem sudden, the deterioration of the kidneys would have set in long before. This is because the healthy nephrons (millions of tiny filters in the kidneys) can take up the slack of the diseased and unhealthy ones. For a time that is. As more nephrons stop working though, the kidneys will begin to shut down. There are five stages of kidney disease ranging from kidney damage with normal GFR (glomular filtration rate) to kidney failure.
Some of the causes of chronic kidney disease are uncontrolled BP, high blood sugar, kidney diseases and infections (such as polycystic kidney disease, pyelonephritis and so on), narrow or blocked renal artery and long-term use of certain drugs. This damage can be slowed or even halted with medication and lifestyle changes. If not halted, dialysis will be required, as well as a renal transplant.
This is a condition where the kidneys have suddenly stopped working completely.
It is dangerous and potentially fatal so it requires immediate action. There are three major causes for acute kidney injury – blood loss, damage and blockage. A sudden blood loss to the kidneys can be the result of an injury, an infection (called sepsis) or heavy blood loss from the body itself. It can also be caused by sudden dehydration. Certain medicines, infections and even poisons can result in damage.
Some people with long-term health issues could suffer kidney problems from their medication. In the average person, this is rare. Sudden blockage can prevent urine from flowing out of the kidneys. This could be caused by a Tumour, Kidney Stones, an enlarged prostate or even an injury. There are a host of symptoms but sometimes they may be very slight until the condition progresses very far.
If you experience a reduction in urine (or no urine) when trying, swelling of the legs and feet, loss of appetite, nausea, vomiting, back pain below the rib cage and so on, please consult one of our physicians without delay.
The occurrence of kidney stones is an unfortunately common condition. Anybody who has experienced it can testify that it is excruciatingly painful. In fact, it is said that the pain caused by a kidney stone is only second to that of child birth.
Kidney stones are solid pieces of material which form when minerals in the kidneys become very concentrated. Often, patients might pass out small stones without even knowing it but the large ones can block the urinary tract and cause immense pain.
While they are common, nobody has been able to exactly pinpoint the cause of kidney stones. There are a host of conditions which seem to contribute to their formation ranging from genetic factors to low intake of water to urinary tract infections and so on. It is clear that diet and lifestyle also have an impact but the exact nature and correlation are not entirely clear. Treatments vary from vast intake of fluids to medications to lithotripsy (shock waves) to laparoscopic surgery.
This is the condition wherein a man is unable to attain and maintain an erection which is firm enough for sexual intercourse. While the occasional trouble with erection is not a cause for concern, it needs to be investigated if it is an ongoing problem. It can erode self-confidence, lead to relationship trouble, increase stress and, far worse, could be the indicator of a worse underlying health condition.
The process of male arousal is extremely complex, involving the brain, emotions, hormones, nervous system, muscles, blood vessels and so on. A problem with any of these may result in it. There are also psychological issues which can cause it. Some of the common causes of erectile dysfunction include heart disease, high cholesterol, diabetes, high blood pressure, obesity, alcoholism, use of tobacco, prescription medications, depression, anxiety and so on. Treatment can vary from medication to psychiatric therapy to injections, blood vessel surgery and surgical penile implants.
Treatments & Procedures
The kidneys are responsible for purifying the blood by removing excess fluid and waste from it. When they do not work properly or fail, it is a life-threatening condition. In these cases a machine is used to do the work of the kidneys. It purifies the blood through filtration and makes it viable for the body. The process is called dialysis. There are two kinds of dialysis – haemodialysis and peritoneal dialysis.
Haemodialysis is the more common form of dialysis. It makes use of an ‘artificial kidney’ or machine that is known as a haemodialyser to filter chemicals and waste from the blood. In order for the blood to flow to it, a ‘vascular access’ needs to be created. This is basically an entrance to a blood vessel which can be used to connect the machine to you. Depending on the patient’s condition, dialysis may need to be performed for a long or slightly shorter duration. And based on this, the access may be temporary or permanent. The access can be created through various ways.
- Joining a vein to an artery in order to create a larger blood vessel. This is known as a fistula.
- Grafting an artery and a vein using a plastic tube which is soft.
- A thin plastic tube may be inserted into a large vein located in the groin or neck to create a temporary access.
During the session, the patient is connected to the machine. Blood flows into it where extra fluid and waste is removed from it while retaining minerals like sodium and potassium. When the cleaning is complete, the blood returns to the body. Depending on the condition of the patient, dialysis may have to be performed several times a week.
This is a less common form of dialysis. It utilises the lining of the abdominal region as a filter to clean blood. The advantages of it are that it can be carried out while the patient is asleep to at work or even during the course of daily activity. Prior to the first session, surgery is required to create access into the region. A small incision is made (usually to the side of the belly button) and a catheter is inserted into the peritoneal cavity. A cleaning solution, called dialysate, is passed through the catheter into the region. The excess fluid and waste which is in the blood passes through the lining of the peritoneal cavity and is drawn into the dialysate solution. This is allowed to happen to for about four to six hours, after which the solution is drained. Along with it, comes the waste and excess fluid.
For a person with kidney failure, a lifetime on dialysis is a painful and depressing course of action. However, a kidney transplant can give such people hope and a new lease on life. While typically people go on dialysis for while before getting a kidney transplant, some people actually benefit from a pre-emptive transplant. One kidney can do the work of two so only a single donated kidney is enough two to replace two which have failed. There are broadly two kinds of kidney transplant – living-donor and deceased-donor.
Living-donor Transplant the name implies, in this case the donated kidney comes from a living person. Since one kidney is enough to do the work of two, it is very common for family members to donate one of their kidneys. Close family relatives will also have a higher chance of compatibility. This constitutes about a third of all kidney transplants. Living donor transplants have certain advantages. A patient spends less time on a waiting list for dead donors. This prevents greater deterioration of health and pain experienced from it. It also has greater survival rates in the short and long term.
Deceased-donor Transplant This constitutes nearly two-thirds of all transplants. The donated kidney comes from a recently deceased person. It is usually harvested from the person immediately after death and stored either on ice or on a machine which maintains its functions. At Sri Ramakrishna Hospital we have extensive experience and great success with both forms of renal transplant. We also have the capability to perform ABO incompatible transplants. This is a form of transplant where the donor’s blood type is incompatible with the recipient. Through advances in modern medical technology, the usually incompatible antibodies are no longer an obstacle to a successful transplant.
Retrograde Intrarenal Surgery (RIRS)
Here at Sri Ramakrishna Hospital we are equipped to perform modern surgical procedures. One such procedure practised by the Department of Nephrology and Urology is RIRS (Retrograde Intrarenal Surgery). A fibreoptic endoscope is a thin, flexible device which allows the surgeon to view the inside of the body while performing surgery. In this case, the endoscope is passed through the urinary opening (urethra) and into the region of the kidney which collects urine.
The surgeon can then view the area and use a suitable method to deal with the condition. If it is a kidney stone, the surgeon might either evaporated the stone using a LASER or even held and removed using tipless basket. RIRS can only be performed by urologists with special training and expertise. The patient is usually placed under general anaesthesia or spinal anaesthesia. It is a quick and non-invasive procedure which allows much faster patient recovery times.
One possible treatment for men suffering from erectile dysfunction (ED) is the implantation of a penile prosthesis. A typical penile prosthesis is made up of two cylinders, a pump and a reservoir. These are surgically placed within the body. The two cylinders are placed within the penis. They are connected via a tube to the reservoir which contains fluid. The pump is connected to the system. It sits beneath the skin of the scrotal sac, between the testicles. The reservoir is placed beneath the muscles of the groin. In order to gain an erection, the man must press the pump. To ‘deflate’ he will press another valve at the base of the pump. There are different models of implants which different in levels of sophistication and mechanics.
Please consult our excellent team of Urologist & Andrologist at Sri Ramakrishna Hospital to determine which would be best for you.
This is more commonly known as ‘keyhole’ or ‘minimally invasive’ surgery. Laparoscopic surgery is a technique wherein surgery is performed through tiny incisions in the skin, rather than the more conventional ‘open’ methods which require large incisions. These tiny incisions are used to pass specialised instruments such as an endoscope (used to view the internals of the body) and microsurgical devices into the affected area. Using these, a surgeon gets a magnified view of the affected area and can make precise cuts and excisions exactly where required.
The advantages of this form of surgery as compared to open surgery are manifold – minimal blood loss, fast recovery, low pain inflicted and little to no scarring. At Sri Ramakrishna Hospital, the Department of Nephrology and Urology uses laparoscopic surgery to treat a number of conditions. Some of the laparoscopic procedures performed are as follows.
- Laparoscopic nephrectomy
- Laparoscopic partial nephrectomy
- Laparoscopic removal of kidney stones
- Laparoscopic adrenalectomy
- Laparoscopic pyeloplasty