Genitourinary Care and Surgery in India

These are conditions usually caused by infections that can affect the genital area and urinary system. Some infections are caught from another person, usually during sex. Other cases are caused when organisms (bacteria or yeast), which are usually present in small numbers, overgrow and cause symptoms. Some genitourinary (GU) diseases are caused by bacteria that do not cause problems in their usual home in the body, but do if they get into another place.

Benign Prostatic Hyperplasia (BPH)

Hormonal changes that often begin at about age 40-45 years cause enlargement of prostate in almost all men. In medical terms this condition is referred to as Benign Prostatic Hyperplasia (BPH). This enlargement is a non-cancerous growth, not life threatening, but may lead to problems with urinating. Discomfort begins when this new prostatic tissue grows, squeezing the urethra like a clamp. Treatments available are:

Surgical Treatments

Most doctors recommend removal of the enlarged part of the prostate as the best long-range solution for patients with BPH. With surgery for BPH, only the enlarged tissue that is pressing against the urethra is removed; the rest of the inside tissue and the outside capsule are left intact. Surgery usually relieves the obstruction and incomplete emptying of the bladder caused by BPH. The following section describes the types of surgery that are used.

Trans urethral Surgery

In this type of surgery, no external incision is needed. After giving anesthesia, the surgeon reaches the prostate by inserting an instrument through the urethra.

A procedure called TURP (trans urethral resection of the prostate) is used for 90 percent of all prostate surgeries done for BPH. With TURP, an instrument called a resectoscope is inserted though the penis. The resectoscope, which is about 12 inches long and 1/2 inch in diameter, contains a light, valves for controlling irrigating fluid, and an electrical loop that cuts tissue and seals blood vessels.

During the 90-minute operation, the surgeon uses the resectoscope's wire loop to remove the obstructing tissue one piece at a time. The pieces of tissue are carried by the fluid into the bladder and then flushed out at the end of the operation.

Although this procedure is delicate and requires a skilled surgeon, most doctors suggest using TURP whenever possible. Trans urethral procedures are less traumatic than open forms of surgery and require a shorter recovery period.

Another surgical procedure is called trans urethral incision of the prostate (TUIP). Instead of removing tissue, as with TURP, this procedure widens the urethra by making a few small cuts in the bladder neck, where the urethra joins the bladder, and in the prostate gland itself. Although some people believe that TUIP gives the same relief as TURP with less risk of side effects such as retrograde ejaculation, its advantages and long-term side effects have not been clearly established.

Open Surgery

In the few cases when a trans urethral procedure cannot be used, open surgery, which requires an external incision, may be used. Open surgery is often done when the gland is greatly enlarged, when there are complicating factors, or when the bladder has been damaged and needs to be repaired. The location of the enlargement within the gland and the patient's general health help the surgeon decide which of the three open procedures to use.

With all the open procedures, anesthesia is given and an incision is made. Once the surgeon reaches the prostate capsule, he scoops out the enlarged tissue from inside the gland.

Laser Surgery

Some researchers are exploring the use of lasers to vaporize obstructing prostate tissue. Early studies suggest that this method may be as effective as conventional surgery.

Non-Surgical Treatments

Most doctors recommend removal of the enlarged part of the prostate as the best long-range solution for patients with BPH. With surgery for BPH, only the enlarged tissue that is pressing against the urethra is removed; the rest of the inside tissue and the outside capsule are left intact. Surgery usually relieves the obstruction and incomplete emptying of the bladder caused by BPH. The following section describes the types of surgery that are used.

Balloon Urethroplasty

In this procedure, a thin tube with a balloon is inserted into the opening of the penis and guided to the narrowed portion of the urethra, where the balloon is inflated. This action widens the urethra, easing the flow of urine.

Balloon urethroplasty is a simple procedure that can be done on an outpatient basis, so it may eventually offer men a safe alternative to surgery. Since the procedure doesn't actually remove the tissue causing the obstructions, more studies are needed to judge its long-range effectiveness.

Trans urethral Hyperthermia

Researchers are also investigating a procedure that uses heat to shrink the prostate. During a series of treatments spread over several weeks, a doctor inserts a catheter containing a heating antenna into the urethra and then applies concentrated heat to the enlarged tissue, gradually shrinking it and relieving the obstruction. However, the long-range effectiveness of hyperthermia is not clear, and studies have indicated that the frequent insertion of a catheter and the use of heat can cause side effects such as irritation of the urethra, bleeding, or painful bladder spasms.

Prostatic Stents: Doctors in Europe are studying the use of devices, or stents, which are inserted through the urethra to the narrowed area and allowed to expand, like a spring. The stent pushes back the prostatic tissue, widening the urethra.

Other common Genitourinary diseases and infections

• Chlamydia trachomatis
• Gonorrhoea
• Genital herpes
• Non-gonococcal (or non-specific) urethritis
• Pubic lice (Crabs)
• Pelvic inflammatory disease (PID)
• Trichomoniasis
• Genital warts
• Bacterial vaginosis
• Cystitis
• Scabies (Passed on through close contact, not necessarily sexual)
• Thrush (Candida)