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Holep ( Holmium laser enucleation of the prostate).
This is a modality in use for the last 15 years. This involves the use of Holmium laser to remove the enlarged portion of the prostate. This procedure is also done endoscopically. The main advantage of this procedure is that it can be done for high-risk cardiac patients. Another advantage is that the size of the prostate is not a limitation for this procedure.
This is the most promising technique among the newer modalities for the treatment of enlarged prostate.
What we do
Holmium laser over TURP
TURP is a conventional treatment for enlarged prostate. This is also done endoscopically. The prostate is removed by cutting it into chips using electrocautery. It is difficult to determine the endpoint of the operation
The advantages of holmium laser treatment are many:
- There is minimal blood loss thus the need for blood transfusion is practically nil. Holmium laser surgery can be performed even in patients who are on anticoagulants.
- High-risk cardiac patients, patients with respiratory problems can be dealt with holmium laser.
- Patients with cardiac pacemaker are very difficult to operate with traditional TURP due to
- Any size of the prostate gland can be treated. The upper limit of TURP is 75-80 gms
- The medium used in holmium laser surgery is normal saline thus there are no chances of electrolyte imbalance.
- The side effects of TURP like bladder neck contracture impotence are less with laser surgery
- Tissue removed with the laser is equivalent to that removed by open surgery thus holmium laser surgery gives long-lasting results
HoLEP
How is HoLEP better?
HoLEP offers a quick, effective return to normal urinary function. Compared to the other surgical treatment modality, HoLEP provides many benefits:
- No incisions
- 1-2 day hospital stay
- 2 week recovery
- Less than 24-hour catheter use in most patients
- Minimal pain and swelling
- Fewer complications
- Protects surrounding healthy tissue
- Long-term relief: least retreatment rate amongst all surgical procedures for BPH
- Lower risk of erectile dysfunction
- Can be performed on any size prostate gland: It is now considered new size-independent Gold Standard.
RIRS
Retrograde Intrarenal Surgery
This is a minimally invasive treatment for ureteric and renal stones. This form of treatment does not involve making a cut on the patient. A flexible scope is passed through patient’s urinary system through the natural orifice. The entire urinary system is visualised with a high definition camera system attached to the scope.
Stones located in any part of the urinary system can be broken by using the holmium laser and extracted using miniature baskets.
Stones upto 3 cm can be removed by this procedure.
Can be performed as a day care procedure and patients can resume their routine activity next day.
Less risk / practically no chances of bleedimg in contrast to other minimally invasive stone removal procedures
Even small tumors in the urinary system can be diagnosed by flexible ureterorenoscopy and treated by holmium laser.
URS
Ureterorenoscopy
This is a treatment for ureteric stones. Here a rigid fine instrument is introduced into the urinary system of the patient through the natural orifice. The stone can be visualized in the ureter and can be broken by holmium laser. The small pieces of the stone can be removed by means of forceps or left to be passed on their own. Sometimes a fine plastic tube which is called as a stent is placed after the surgery and requires removal at a later date.
(MINI PCNL)
PCNL
In this procedure, stones within the kidney are removed by making a small key hole in the back region. Then a tract from the skin into the kidney is established, through which rigid straight instruments are passed inside and the stone is broken into smaller pieces using ho;mium and removed. It can be used for stones of any size. The incision used for making these tracts is around 5 mm, and does not require stitches usually.
Hospitalization is usually required for 1 or 2 days and the patient can resume normal work in a weeks time. The only major risk of this operation is bleeding which is unpredictable and can occur in 1% of the patients requiring blood transfusion.
SURGERY
LASER PROSTATE SURGERY
This is the most promising technique among the newer modalities for the treatment of enlarged prostate The treatment involves the use of Holmium laser to remove the enlarged portion of the prostate. This provides long lasting relief for urinary problems from BPH. HoLEP is also safer and easier on the patients who have failed prior traditional BPH treatment, transurethral resection of the prostate (TURP). The main advantage of this procedure is that it can be done for high-risk cardiac patients. Another advantage is that the size of the prostate is not a limitation for this procedure.
HOLEP is performed under either general or regional anaesthesia. In this procedurea, a thin tube is inserted into the urethra through which holmium laser fibre is passed. Using high laser energy settings, enlarged prostatic tissue is separated from the capsule. Using morcellator, enucleated prostatic lobes are extracted. The entire procedure is performed without any incision, and minimal invasiveness.
STAPLER CIRCUMCISION
ZSR CIRCUMCISION
Disposable circumcision anastomat (ZSR) is a surgical instrument for circumcision and suturing surgery in Male Urology.
This Disposable circumcision stapler is a sterile, hand-held, manual surgical instrument preloaded with non-bioabsorbable skin staples intended to be used to perform a circumcision. It is designed to cut the foreskin and apply a circular row(s) of staples proximal to the cut line. The stapler portion typically consists of a dome intended to be inserted under the foreskin over the glans penis, and a circular cutting stapler mechanism with a manual lever intended to connect over the outside of the foreskin
Advantages of Stapler Circumcision:
- Shorter operative time
- Suitable for all age groups
- Efficient healing process
- Painless postoperative period
- Excellent cosmetic result
- Disposable instrument levelling the possibility of any infection.
Traditional circumcision and suturing surgery approaches have shortcomings such as long duration, painful, rare neat incision and postoperative hematoma. ZSR disposable circumcision anastomat can solve all problems.
STAPLER CIRCUMCISION
LAPARASCOPIC UROLOGIC SURGERY
Many traditional urologic surgical procedures require large incisions with lengthy hospitalization and recovery. Laparoscopic Surgery is a minimally invasive modern surgical technique in which operations in the abdomen are performed through small key hole incisions (usually 0.5–1.5 cm) in the abdomen. Patients who have undergone these procedures have enjoyed not only the same therapeutic benefits of traditional open surgery but also greatly reduced postoperative pain, shorter hospitalisation, faster recovery and better cosmetic results.
Laparoscopic Nephrectomy: This procedure involves removal of the kidney by means of only 3 -4 small holes (ranging from 5-12 mm). The indications for this operation are non-functioning kidney, tumours of the kidney, donor nephrectomy for the purpose of kidney transplant. Even small portions of the kidney can be removed by this procedure which is called as partial nephrectomy.
Laparoscopic Reconstructive Surgery: congenital obstruction in the kidney, where it connects to the ureter (the tube connecting the kidney to the bladder) is called a ureteropelvic junction obstruction, or UPJ obstruction. Repair of a UPJ obstruction is necessary to prevent kidney damage. Such problems can also be repaired by means of minimally invasive surgery.
Common examples of Reconstructive Surgery done laparoscopically are pyeloplasty, Ureteric Reimplant, ureterolysis.
KIDNEY TRANSPLANTATION
Kidney transplantation is the treatment of choice for people with kidney failure. This allows patients to stop dialysis, decrease their fluid and diet restrictions, and enjoy a much better quality of life.
DONOR SURGERY
Donors for kidney transplant is usually a living donor, and the other source is from a non-living donor. Patients who have had kidneys donated from living donors usually enjoy higher success rates than those who receive organs from non-living donors, since there is less chance for rejection.
A living donor must be in good health and free from diabetes, high blood pressure, cancer, kidney or heart disease. Living donors usually are between 18 and 60 years old. The living donor must undergo a series of tests to determine if they are truly compatible with the recipient. This procedure is performed by laparoscopic method, through small keyhole incisions in the abdomen, and the kidney is delivered via a lower abdominal incision. Advantages of this laparoscopic method – faster recovery, minimal postoperative pain and early discharge from the hospital
RECIPIENT SURGERY
Kidney transplant surgery lasts about three to four hours. During surgery, the transplanted kidney is placed in the pelvis near one of your hip bones. The surgeon connects the blood vessels from the transplanted kidney to the blood vessels in the pelvis.
The ureter (urine drainage tube) from the transplanted kidney is connected to your bladder so urine can be excreted. A stent (a flexible, narrow tube) is inserted into the ureter going into the bladder to keep the connection open. This stent will be removed six weeks after surgery by a procedure called a cystoscopy. This procedure is done as an outpatient procedure in the transplant clinic.
Seven to ten days after surgery, the staples are removed in the outpatient clinic. Patient is advised regular follow-up with the transplant team.
Dr. A.K.JAYARAJ Urologist
Best Patient Care!
Prostate Cancer
Prostate cancer is the second most frequent type of cancer in males, and it affects the prostate gland.
Bladder Cancer
Overactive bladder is a condition in which your bladder begins urinating at an inopportune time.
Infertility
Male infertility is defined as a man’s inability to conceive a child. Male infertility can be caused by sperm motility issues, sperm production issues, or sperm delivery bottlenecks.
Erectile Dysfunction
Erectile dysfunction, often known as impotence, is the inability to obtain or maintain an erection during sexual activity.
Enlarged prostate/ BPH
The expansion of the prostate gland in men is known as benign prostatic hyperplasia (BPH).
Urinary tract infection
A urinary tract infection (UTI) occurs when bacteria enters your urethra and travels up into your bladder causing painful urination.
Kidney stones
Kidney stones are a buildup of minerals and salts that harden inside your kidneys.
Vasectomy
Vasectomy, often known as male sterilisation, is a minor procedure that prevents sperm from reaching the ejaculated semen. A vasectomy is a long-term method of preventing pregnancy. The vas deferens tubes are cut or stopped during a vasectomy to prevent sperm from leaving the testicles. The sperm remain in the testicles and are absorbed by the body naturally.
Vasectomies have no effect on the ability to ejaculate and have no effect on the semen.
Urologists at Urology Clinics of North Texas will go over the vasectomy surgery with you in detail to ensure your comfort.
What to Expect
A vasectomy is a minor surgical operation that can be completed in the comfort of your own home. The operation, which takes around 20 minutes and takes place in our office, should take about 20 minutes. You should not experience much discomfort throughout the treatment because your testicles will be anaesthetized.
After a vasectomy, you should relax for at least one day, but you should be OK in a few days. It’s possible that your testicles are sore or swollen. You can have intercourse three days after a vasectomy, depending on how soon you heal. Because the operation may not be effective right away, you should continue to use another form of birth control until your urologist confirms that there are no sperm in your sperm. After you’ve had roughly 20 ejaculations after the vasectomy, your doctor will perform a semen assay to ensure there are no sperm present.
Vasectomy Reversal
The goal of vasectomy reversal surgery is to reintroduce sperm flow into a man’s reproductive tract. Unlike a vasectomy, this surgery will require the patient to undergo general anaesthesia. It is possible to reverse vasectomies, although success is not assured.
Your urologist will either reattach the vas deferens or link the vas deferens directly to the epididymis during a vasectomy reversal. At the time of the operation, your urologist will determine which procedure is required. The procedure of joining the two severed ends of the vas deferens will be performed on the majority of men.
A vasectomy reversal can take up to ten days to recover from, and intercourse can be resumed after a few weeks. Sperm levels may take 3-12 months to return to normal. Vasectomy reversals have a higher success rate depending on how long it has been since the vasectomy. When the vasectomy was performed less than three years ago, they are the most successful. The longer a guy waits to get his vasectomy reversed, the more difficult it will be for him to conceive naturally.
PENILE PROSTHESIS
It is an effective solution for organic erectile dysfunction (ED) in patients who do not respond to conservative (non-surgical) therapies. Patient satisfaction rates with penile prostheses are over 90%.
Types of penile prosthesis:
Three piece inflatable Penile implant:
This is the most popular inflatable prosthesis because it is designed to most closely mimic a natural erection, provide rigidity when inflated and a natural, flaccid appearance when deflated. The prosthesis includes a pair of cylinders implanted in the penis, a pump placed inside the scrotum and a reservoir of saline placed in the lower abdomen. Squeezing and releasing the pump moves fluid into the cylinders, creating an erection. Deflate the device by pressing the deflate button on the pump. The penis then returns to a soft, flaccid and natural-looking state.
The implant procedure is usually done on an outpatient basis. A small incision is made in the scrotum or above the pubic bone and all components are inserted through this small opening. The procedure is performed under anesthesia. It generally takes a few days to return to your regular routine of light activity and need to wait 4 to 6 weeks before using the implant for sexual intercourse.
A penile implant may provide a permanent option for men who have tried other treatments without success or satisfaction. Compared with other treatment options, the implant provides spontaneity — it allows you to have sex when the mood strikes and the erection can last as long as you want it to last. The implant is discreet and entirely contained inside your body — there are no visible components so it would be difficult for someone to know you had this device.
MALLEABLE PROSTHESIS
This is a flexible penile implant that consists of two firm but flexible rods that are placed into the shaft of the penis. There are no other parts to this implant. To have an erection, patient need to simply hold the penis and move it into the desired position. Post orgasm / ejaculation, the implant is bent down to conceal it. The malleable penile implant can be a good option for men with limited dexterity. The advantages are easy insertion, easy handling, avoids abdominal incision and low failure rate.
MICROSCOPIC VARICOCELECTOMY
varicocele is an enlarged vein that’s similar to a varicose vein.
In this case, the vein is in the scrotum, the sac of loose skin that contains the testicles. However, varicoceles can be more than just cosmetic. These enlarged veins sometimes contribute to a reduction in sperm count and issues with male infertility. Enlarged scrotal veins may also cause problems with testicle development and size.
- Some varicoceles are harmless and require no treatment.
- But if testosterone production is affected, a urologist might recommend microscopic varicocele surgery.
What Is Microscopic Varicocele Surgery?
A varicocelectomy is the most common procedure performed to correct issues with varicoceles. With microscopic varicocele surgery, a high-powered surgical microscope is used to perform the operation. This type of surgery allows for a better view of the affected area. Microscopic surgical techniques have also been linked to fewer complications and lower risks for patients. Such procedures are often done with local anesthesia.
What Are Inguinal and Subinguinal Surgical Approaches?
Microscopic varicocele surgery can be done with an inguinal or subinguinal approach, referring to the location where the incision is made. An inguinal approach is typically used if the purpose for the procedure is to ease pain caused by varicoceles. Doing so allows for direct access to the ilioinguinal nerve, which can be cut to relieve pain caused by enlarged veins. With a subinguinal approach, the incision is made just above the top of the penis. It’s sometimes necessary to make two incisions in the same area, which is where the spermatic cord leaves the abdominal wall.
What Happens During Surgery?
Both surgical approaches involve a cut that’s made to access the spermatic cord to reach the abnormal veins. The problem veins are then cut and tied to take accumulated blood away from the testicles. During microscopic surgery, the special microscope is above the patient. The surgeon or urologist is then able to view all veins that need to be severed. Other structures, including the vas deferens and arteries, can also be viewed and avoided. Lymphatic drainage also remains intact. Unintentional damage to the vas deferens or arteries can affect sperm flow and cause issues with the testicles. Lymphatic damage can cause the scrotum to fill with fluid. With microscopic varicocele surgery, these risks are significantly reduced.
What Happens After Surgery?
Microscopic varicocele surgery is usually an outpatient procedure. Most patients recover fairly quickly and experience little discomfort while healing. There may be some minor swelling and bruises in the scrotum, although it’s usually minor and manageable with medication. Most men resume normal activities within a few weeks. Men with sedentary occupations can usually get back to work in a day or so. The procedure normally takes about an hour to perform.
It’s believed varicoceles may be caused by a reduced blood flow in the spermatic cord, the tiny tube that transports blood to and from the testicles. This reduction in blood flow results in wider veins. The condition often develops during puberty. However, it’s usually not until later in life that varicoceles require attention if sperm quality and fertility are affected. For times when issues related to varicoceles are mild, men may benefit from over-the-counter pain medications or wearing athletic supporters to ease pressure on the scrotum.