Batra Department Of Urology

The Department of Urology is dedicated to providing state-of-the-art medical and surgical care in all aspects of Adult and Paediatric urology. The Department of Urology provides screening, staging and the most up-to-date treatment of all uro-genital tumors including kidney, ureter, bladder and prostate besides dealing with benign conditions like BPH, stone disease, incontinence, infertility & impotence. The Department of Urology has a complete range of facilities to provide comprehensive services in the management of urological conditions.

FACILITIES AND PROCEDURES PERFORMED :

  • Uroendoscopy - A device consisting of a tube and optical system for observing the inside of a hollow organ or cavity. This observation may be done through a natural body opening or a small incision. PCNL - Percutaneous Nephrolithotomy provides patients with a safe and effective way to remove kidney stones using a minimally invasive surgical procedure. It is a technique where Kidney stones are removed by a small puncture in the back (key-hole surgery) and the stone is removed through a telescope. A spinal or general anaesthesia is given for the procedure which makes the whole operation pain free for the patient. The hospitalization is usually 1-2 days. The patient can undertake international travel 3-4 days after the procedure.Recently, we have been doing miniture PWL using small size puncher (3-4mm). The advantagno bleeding and no requeirment of any stent or tube left for later date removal.One night stay is only required, well covered by TPA and other insurances.
  • Uretero-Renoscopy - Ureteric stones are removed by passing a ureteroscope (Rigid or flexible) through the urethra & bladder. The surgeon locates the stone, removes it with special instruments or fragments the stone by using the Swiss Lithoclast or laser lithotripsy (Luminous). A stent ( a special silicone tube) is placed in certain situations. The patient is discharged the next day. The stent (optional) can be removed after three to four weeks.
  • Laparoscopic Surgery - This is an option in certain cases depending on the size & location of stones and correction of any congenital problem like PUJ Obstruction.
  • Laparoscopic Nephrectomy - A minimally invasive surgical technique that provides patients with a safe and effective way to remove a diseased kidney (e.g. from cancer, blockage, or stone disease).
  • Laparoscopic Pyeloplasty is done for congenital PUJ Obstruction.
  • Laparoscopic ureterolithotomy is done for large imparted ureteric stones.
  • Laparoscopic diverticulectomy is done for large bladder diverticulum.
  • Uro-oncology - Treatment of patients with cancer disease in the urinary tract including major surgery on bladder, prostate, ureter, kidneys and genitalia.
  • TURBT – means trans urethral resection of bladder tumour endoscopically.

LAPAROSCOPIC RADICAL PROSTATECTOMY FOR CANCER PROSTATE

This surgery is done for Cancer Prostate. The entire prostate gland with the seminal vesicles are removed – we do a nerve sparing procedure to gaurd against impotence.

Prostate Disease (specialty clinic) - We have a specialty clinic within our hospital for the diagnosis and treatment of prostate diseases. The prostate is an accessory sex gland in men. It is about the size of a walnut, and surrounds the neck of the bladder and urethra - the tube that carries urine from the bladder. It is partly muscular and partly glandular, with ducts opening into the prostatic portion of the urethra. It is made up of three lobes: a center lobe with one lobe on each side. The prostate gland secretes a slightly alkaline fluid that forms part of the seminal fluid, a fluid that carries sperm.

TURP -Transuretheral Resection of the Prostate (TURP) is a surgical procedure to deal with patients with an enlarged, benign (non-cancerous) prostate, called Benign Prostate Hyperplasia or BPH.

KTP (GREEN LIGHT) LASER FOR PROSTATE

Benign enlargement for Prostate is treated by Green Light PVP laser (KTP Laser). There is no bleeding and the patients are discharged on the same day. The catheter may be kept for just a few hours. If the patient is on anticoagulants (blood thinning medicines) e.g. after coronary stenting; the KTP Laser procedure can be done without stopping anticoagulants.

Treatment of Incontinence - The loss of urinary control. Urinary incontinence (urinary leak) and other urinary problems like urgency (going to the toilet frequently) and stress incontinence (leaking of urine with cough and laughing or straining) can be investigated and treated with minimally invasive methods using TVT-O, Pro lift etc.In mates, incontinence resulting after prostate surgery can be taken care of by artificial sphincter (ANS-800) or ATOMS.

Treatment of Haematuria - Haematuria is the presence of red blood cells (RBCs) in the urine. The urine appears normal to the naked eye, but examination under a microscope shows a high number of RBCs. We effectively evaluate and treat all types of urinary incontinence and haematuria.

Varicocele - Are enlargements of the veins that drain the testicles. A varicocele affects fertility due to the decrease in circulation of blood in the testicular area. Once a varicocele has been diagnosed, a surgical procedure can be done to correct the problem. This improves motability of sperms and fertility index.
Infertility -We offer a complete range of facilities for investigation of male infertility. Female infertility investigation by gynaecologists with special training in infertility is also provided. Treatment is coordinated with the assisted conception unit and an IVF laboratory.

Pediatric Urology - Pediatric Urology involves the diagnosis and treatment of all kinds of congenital urological problems encountered in children.

Clinical Expertise
The department has nationally and internationally renowned urological surgeons and physicians, offering uniquely comprehensive range of innovative care for all urological disorders.

HOLMIUM LASER

enucleation of prostate (HoLEP) for BPH>

Transurethral resection of the prostate (TURP) is still considered the gold standard treatment for benign prostatic hyperplasia (BPH). However, its current use is limited to small and medium-sized prostates due to an overall morbidity rate of 15-20% and blood transfusion rate ranging from 5% to 11%. Patients currently undergoing treatment for BPH are progressively older with more comorbidities; thus, there is an increased need for more minimally invasive procedures in the current treatment era. In an attempt to limit the morbidity associated with standard TURP several laser therapies have been introduced for the treatment of BPH, including neodymium:yttrium aluminium garnet (Nd:YAG), the holmium:YAG, and the potassium-titanyl-phosphate (KTP) lasers. These lasers have been used to coagulate, vaporize and cut prostatic tissue overgrowth using a variety of techniques. The holmium laser has been further developed to allow for actual prostatic lobe enucleation with subsequent tissue removal.

Holmium laser enucleation of the prostate (HoLEP) has emerged as an effective transurethral treatment option for patients suffering from symptomatic BPH of any size. A multitude of publications have supported the safety and efficacy of HoLEP for small and large gland BPH, even in the presence of bleeding diatheses and anticoagulation. HoLEP has been found to be as effective as TURP and open suprapubic prostatectomy for the treatment of obstructive BPH, with the benefit of less morbidity. Long-term studies of patients undergoing HoLEP demonstrate sustained relief from BPH symptoms from 4 to 7 years postoperative, with very low retreatment rates, ranging from 0 to 4%.
The efficacy of HoLEP lies in its excellent tissue debulking capabilities. Large case series have shown that HoLEP produces a prostate volume and prostate-specific antigen reduction of 60-90%. Another benefit of HoLEP is the potential to be performed as an outpatient procedure with catheter removal within 24 hours of surgery. When compared to contemporary ablative procedures, HoLEP has the advantage of actual tissue removal for pathologic specimen examination, greater prostate volume reduction, and durable long-term results, while maintaining low morbidity.

Since HoLEP is a laser based procedure it is performed using normal saline irrigant, thus eliminating the risk of dilutional hyponatremia, also known as TUR syndrome. Furthermore, since the laser can perform pin-point coagulation of bleeding vessels as they enter the capsule of the prostate the need for blood transfusion has nearly been eliminated in patients without bleeding diathesis. Evidence demonstrates the feasibility of radical prostatectomy after HoLEP; the concomitant treatment of bladder, ureteral and renal stones at time of HoLEP; and the limited impact of HoLEP on erectile function. Investigators have reported that once the initial investment for the laser is factored out HoLEP is more cost-effective compared with TURP and open prostatectomy due to a shorter length of hospitalization and decreased need for ancillary interventions (i.e. blood transfusion, and continuous bladder irrigation). 

 

Dr. P. Gulati
 

Sr. Consultant, Urology

Urology

 

 

Dr. Manoj Talwar

Sr. Consultant, Urology

Urology