Urology

Urology

Urology is the science which deals with the problems of the Urinary System. This includes simple Urinary Tract Infections, Kidney Stones, Prostate Diseases, Blood in the urine, Kidney Cancers, Urinary Incontinence etc. The entire gamut of any kind of diseases that affects kidney and adrenals, ureter, bladder, prostate, penis and testicles comes under the purview of an Urologist.

Urinary Tract Infection

Symptoms

The most common symptom of kidney cancer is the presence of blood in the urine. It may be present one day and not the next. Another symptom of kidney cancer is a lump or mass that can be felt in the kidney area. The tumor may cause a dull ache or pain in the back or side.

Investigation

 To diagnose kidney cancer, the patient's personal and family medical history is taken and a thorough physical examination is conducted. In addition to checking temperature, pulse, blood pressure, and other general signs of health, the doctor usually orders blood and urine tests and one or more of the below mentioned exams :

Ultrasound
Intravenous Urogram(IVU)
CT or CAT scan
Magnetic Resonance Imaging (MRI)
Arteriogram
Nephrotomogram

Hypervascular Mass in the right kidney as seen on a Renal Angiogram.

Treatment

If these tests suggest that a tumor is present, it is important to know the extent, or stage, of the disease. Because kidney cancer can spread to the bones, lungs, liver, or brain, staging procedures may include special x-rays and tests to check these organs.

Treatment for kidney cancer depends on the location and size of the tumor and whether the cancer has spread to other organs. Kidney cancer is treated with surgery, embolization, or hormone therapy, biological therapy, or chemotherapy, which are forms of systemic therapy and rarely Radiation therapy.

Surgery

Most kidney cancer patients have surgery, an operation called Radical Nephrectomy. In some cases, the surgeon removes the whole kidney(palliative Nephrectomy) or just the part of the kidney that contains the tumor(partial nephrectomy). More often, the surgeon removes the whole kidney along with the adrenal gland and the fat around the kidney. Also, nearby lymph nodes may be removed because they are one of the first places where kidney cancer spreads. Finding cancer cells in the lymph nodes means there may be cancer elsewhere in the body.

Radical Nephrectomy is major surgery. For a few days after the operation, most patients need medicine to relieve pain. Discomfort may make it difficult to breathe deeply, and patients have to do special coughing and breathing exercises to keep their lungs clear. Patients may need IV (intravenous) feedings and fluids for several days before and after the operation. Nurses will keep track of the amount of fluid the patient takes in and the amount of urine produced. The remaining kidney takes over the work of the one that was removed.

Dr. Dilip Raja Surgeon

Embolization

In embolization, a substance is injected to clog the renal blood vessels. The tumor shrinks because it does not get the blood supply it needs to grow. In some cases, embolization makes surgery easier. When surgery is not possible, this treatment may help reduce pain and bleeding.

Embolization can cause pain, fever, nausea, or vomiting. These problems are treated with medicine. Often, patients also require intravenous fluids.

Hormone Therapy

Some kidney cancers may be treated with hormones to control the growth of cancer cells. Some hormones are taken by mouth; others are given by injection. Patients do not need to be in the hospital for their treatment. This kind of treatment helps a small number of patients with advanced kidney cancer, especially when the disease has spread to the lungs.

The side effects of hormone therapy are usually mild. Progesterone is the hormone most often used to treat kidney cancer. Drugs containing progesterone generally cause few side effects, though some patients may retain fluid and gain weight.

Biological Therapy

Biological therapy is a new way of treating kidney cancer. This treatment attempts to improve the way the body's immune system fights disease. Interleukin-2 and interferon are two forms of biological therapy being studied to treat advanced kidney cancer. Doctors are also exploring the benefits of using biological therapy after surgery for early stage kidney cancer. This additional treatment is called adjuvant therapy. Doctors are trying to find out whether adjuvant biological therapy can prevent the cancer from recurring by killing undetected cancer cells that may remain in the body. Most patients having biological therapy must stay in the hospital so that the effects of their treatment can be monitored.

The side effects caused by biological therapies vary with the type of treatment. Often, these treatments cause flu-like symptoms such as chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea. Sometimes, patients develop a rash with dry, itching skin. Patients often feel very tired after treatment. In addition, interleukin-2 can cause the patient to retain fluid. These problems can be severe, and most patients need to stay in the hospital during treatment.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. Chemotherapy has not been very effective against kidney cancer, but researchers are studying new drugs and new drug combinations that may prove to be useful.