URUOLOGY DEVELOPMENT IN PATIENT CARE BY Dr. NARASIMHAN SUBRAMANIAN

Urology is a branch of medicine which primarily deals with all urine, kidney and reproductive organs-related problems. It is a surgicalspecialty which deals with diseases of the male and female urinarytract, the male reproductive organs and the kidney. It is a surgicalbranch where we surgeons that treat these conditions.

Developments have continuously happened in urology over the lasthundred years. We are trying to highlight those segments ofdevelopment in urology which would make patient care easier either in
terms of diagnosing the condition early or introducing treatmentswhich are less invasive so that we reduce the pain, the duration ofhospitalisation, ensure they return to work early and the amount of
pain and the amount deformity on the scalp becomes negligible.

Similarly, when you look at various cancers, some cancers can beprevented. For instance, you can prevent lung cancers if people reducesmoking and start breathing better. Whereas many other cancers youcan’t stop them but what you can do is to diagnose them early. When you diagnose them early, you are catching at a stage where they are curable.

The new advances in terms of the blood tests and scans we do, make us diagnose these tumours much earlier than you would otherwise understand.

Majority of the knowledge which we have in medicine today is something which we can transfer both by interactions like what we are doing today. What we are doing today is that our own experience of newer

Techniques and methodologies is been shared with our colleagues in this part of the world. Some of them may require newer technologies to be available physically here; some of them on the other hand can be done by satellite models.

Let us assume that I have operated a patient from Nigeria in India, I don’t need him to come and see me every time in India. There are the telemedicine systems whereby he can be at anywhere with an access to Skype or Teleconferencing and I can see his medical condition and offer medication as required.

Similarly today, what you find is that the surgical operations which I’m doing in India can be easily viewed through the satellite by colleagues in this part of the world. So, almost of the knowledge and procedures are transferable but to get ones hands on experience, one obviously needs needs to be present in those centres which requires a large volume of work because when the volumes are high, you end up needing much longer time to acquire that level of skill.

The common kidney problems which relate to stone disease formation, cancers, infections and others, wider studies would indicate that there are no specific regions in Nigeria where kidney related problems
are likely to be higher. But across the country, what happens is, because the number of patients with high blood pressure or diabetes which are inadequately controlled, there is a higher incidence of kidney failure and of people requiring dialysis and kidney transplants.

The second is prostate cancer. Incidences of prostate cancer are much higher in certain races than the other. Among the Caucasians in the United States it’s quiet high, among the Chinese it’s the lowest. We
the Indians and the Sothern Asians come somewhere near the Chinese.

People from the African and the Carribbean, we not only have higher rates of prostate cancer compared to the Indians but they tend be of a larger volume of cancers and seem to occur in relatively younger
people as well. So understanding these diseases and the need for more aggressive treatment becomes more important.

Preventive Measures for Kidney Diseases

When look at kidney diseases, you would take about four common conditions. One is kidney stones, second is infections in the kidneys, third is the kidney failures and fourth is the cancers of the kidneys.
Talking of stones, one of the most important single step is that we must all drink a lot of water. If you drink three or more litres of water every day, then you reduce your chances of stone formation.

Similarly, once you have formed the stone, there are different types of stones which may require different dietary restrictions and some of them may even require certain medications to reduce the formation of stones. Coming to infections in the kidney, again, many of the urine infections do not necessarily affect the kidneys but if these infections are untreated or are associated with medical conditions which are not recognised, then they can affect the kidney.

Coming to the issue of kidney failure, what you would need is that early diagnosis and recognition of infections in the kidney- high blood pressure and conditions associated, diabetes and associated
conditions, and use of pain killers in an unregulated fashion. When you address all these, you will certainly reduce the incidences of kidney related medical problems.

The basic mechanisms by which stones are formed, there are salts that are present in the body and when the concentration of the salts becomes more in the kidney that is when stones are formed. So if you dilute these by forming more urine it gets washed off the system and reducing this stone formation.

Dr. NARASIMHAN SUBRAMANIAN

Consultant Urologist, Indraprastha Apollo Hospitals, New Delhi