Things to know about ‘Dhat’ syndrome (Nocturnal emission/Nightfall)

What is meant by nightfall or nocturnal emission or wet dreams?

Spontaneous involuntary loss of semen while the person is in sleep is called as nightfall or nocturnal emission. It is most common in young boys (adolescent age group).

Is there any side effects of night fall ?

There is no evidence that nightfall (wet dreams/nocturnal emission) cause any bodily side effect in men.

What is Dhat disease or Dhat Syndrome ?

Dhat syndrome is the clinical entity seen primarily in Indian subcontinent and present with a features of depression, anxiety, multiple nonspecific body symptoms, sexual dysfunction, fatigability, and impairment of concentration, which are attributable to semen loss. Loss of semen irrespective of the mechanism (during urination, defecation, masturbation, nightfall or nocturnal emission, and even sexual intercourse) is considered worrisome by patients suffering from Dhat syndrome.  

Which age group are mainly affected with Dhat syndrome ?

Patients with Dhat syndrome are often young males in second to third decade of life. Majority of the patients belong to south east Asia continent and belong to low socio-economic groups with orthodox culture. Families with poor education have higher chances of having this entity.

What are the symptoms of Dhat syndrome ?  

The most common presenting symptoms in patients with Dhat syndrome are weakness of the body, tiredness, low energy, low mood and mental stress. It can also be described as the abnormal illness behavior and bodily symptoms due to semen loss, as well as heightened emotional (depression and anxiety) response. These symptoms often get amplified with the stress.

How the symptoms of Dhat syndrome develop ?

At the time of onset of Dhat syndrome, these people get excessively worried with having nightfall or semen discharge and gives lot of significance to this semen loss. Every time they loss semen, they experience stress (as it is not acceptable in their culture). This abnormal thinking leads to stress response which further gets amplified with each time person have semen loss and hence this vicious cycle goes on. Further exaggeration of this stress response leads to the symptoms of anxiety, depression and other body (somatic) symptoms. This anxiety feature can lead to sexual dysfunction seen in few men with Dhat syndrome. Nearly 20% of patients diagnosed with Dhat syndrome do harbour some underlying depression, anxiety disorder.

How to treat Dhat syndrome ?

The patient with Dhat syndrome approach a variety of medical practitioners and specialists with their complaints. Since this culture originated disease entity is rare in western countries, the presentation and management knowledge is deficient in western medical practitioners. Patients with Dhat syndrome require comprehensive assessment to assess clinical severity. Integration of various medical specialities such as Urology, Psychiatry, Psychologists, general medicine, psychiatric nurses, alternative medicine (Ayurvedic/Siddha) can lead to better patient management. Psychosocial therapy, cognitive behavior therapy (imparting sex education and resolving sexual myths is very important), antianxiety and antidepressant therapy are helpful. Educating the traditional healers may help in resolving the sexual myths that they carry and dissipate to the people in the society.

5 tips for healthy prostate

1. Do not let your bladder to overfill than its capacity. Go to washroom when you get first urge to void. Make sure you go once in 2-3 hours in daytime.

2. Do not take excessive caffeinated products and alcohol. These can irritate your bladder and can cause frequent urination.

3. Restrict fluid intake after evening and do not take any fluid atleast 2 hours prior to sleep, so as to avoid getting up in night for passing urine. Avoid taking large quantity of water at a time.

4. Certain anti hypertensive drugs increase urine production. Such drugs to be taken in morning time. Certain medicines for cough and cold can also aggravate urination problem. Consult your doctor before starting such medicines.

5. Make a habit of doing daily exercise for 30 minutes. Sedentary lifestyle increases urinary symptoms.

Erectile dysfunction – causes, diagnosis and treatment

What is erectile dysfunction?

Erectile dysfunction or otherwise called impotence, is the inability of achieving or maintaining hard enough erection of penis, that is required for sexual act. Persons with erectile dysfunction have either looseness of erection or have complete lack of erection. Read how it is different from premature ejaculation Premature ejaculation- causes, diagnosis and treatment

What are the causes of erectile dysfunction?

There are numerous causes of erectile dysfunction. It can be broadly divided into – Organic and non-organic causes. Organic causes are those where there is some underlying cause which leads to erectile dysfunction and non organic causes include those where no underlying cause is found.

Organic causes – Uncontrolled long term diabetes or hypertension, heart diseases, low testosterone levels, obesity, hypothyroidism, certain blood pressure medications, hyperlipidemia, prostate enlargement, chronic kidney disease, peyronie’s disease etc.

Non-organic causes- These includes stress, anxiety, relationship problems, depression etc.

Erectile dysfunction can be caused by any one of above factors or these factors can be present together in some patients. ED patients usually also suffer from premature ejaculation.

How to diagnose erectile dysfunction?

History and examination is most important parameter in diagnosis of ED. It include detailed questionnaire pertaining to erection After history, if required doctor may order few investigations in search of underlying causes leading to erectile dysfunction. Blood tests to check for diabetes, kidney disease, hypothyroidism, hypogonadism (Testosterone and Testosterone deficiency syndrome), PSA (PSA testing) etc are done. Doctor may do oral phosphodiesterase test after giving either sildenafil or tadalafil orally and checking the erection achieved. Sometimes your doctor may order penile doppler ultrasound after applying injection in penis to check penile vessels and hardness of penis.

What are the treatment options for ED?

There are various treatment options for ED. The underlying cause need to be addressed along with the ED treatment.

Psychological counselling- Psychological counselling is done in patients with anxiety, stress or depression or patients having relationship tension.

Oral therapy – There are multiple drugs in market which are used for ED such as Sildenafil, tadalafil, avenafil etc which are usually prescribed by andrologist for ED treatment.

Intra penile injections- Sometimes doctor may prescribe you with intra-penile injection (also called Intracavernous injection). These injection therapy is more beneficial in patients which are primarily having psychogenic erectile dysfunction with failed response to oral therapy.

Vacuum erection device – These devices help in achieving erection with the help of pump action. These can be particularly useful for elderly people or patients in whom other therapies are contraindicated.

Penile prosthesis (Penile implant) – Penile implant placement is the last resort for patients with erectile dysfunction who do not respond to oral or intra cavernous injections. There are variety of penile prosthesis in market (malleable, 2 piece, 3 piece implant). These implants are placed if patient has failed other therapies mentioned above. After implant surgery, the ED patient usually have high satisfaction rate.

Which doctor to meet for treatment of ED?

You should meet your nearby andrologist for treatment of erectile dysfunction.

Minimal invasive laser treatment for kidney stones

Kidney stones are most common urological disease. Over the course of years, treatment for kidney stones has drastically improved. Open surgery for kidney stone is nearly obsolete these days after the introduction of minimal invasive surgery (PCNL).

With the recent advancement in technology, the armamentarium of the kidney stone removal have become more sophisticated and kidney stone removal can be done with minimal invasive approaches. Laser treatment in stone disease has shifted the paradigm of stone treatment. The patients experience much better outcome in terms of post operative pain, minimal risk of bleeding with early recovery and resumption to work.

RIRS (retro grade intrarenal surgery) and mini PCNL are being performed regular basis at our Sacred Heart Hospital, Maqsudan, Jalandhar. Currently we are using Holmium laser for the stone fragmentation and dusting. Here are few of the kidney stones done recently with mini PCNL and RIRS laser lithotripsy with complete stone free rates.

Book your appointment today or visit us if looking for laser treatment of stone disease.

Bladder cancer awareness month 2022

‘ Blood in urine is ominous sign.’

Bladder cancer is 10th most commonly diagnosed cancer. Nearly 570,000 cases of bladder cancer are diagnosed annually worldwide. Majority of these patients present with blood in urine at the initial presentation. Smokers have higher risk of being diagnosed with bladder cancer than non- smokers.

Gross, Painless passage of blood along with clots in urine could be early symptom of bladder cancer.

Bladder cancer awareness month is a global campaign and is held every year in month of May to create attention regarding the bladder cancer, its symptoms and signs, to underline the importance of early detection and treatment, share the treatment stories of patients and to improve the quality of life of patients.

Smoking is the single most common preventable cause of bladder cancer.

Any person passing blood in urine should immediately get him/herself tested to a urologist. Early detection of bladder cancer or any other urological cancer leads to better survival and outcome.

Bladder cancer awareness month (1st-31st May)

Painful ejaculation or painful orgasm- causes, diagnosis and treatment

What is painful ejaculation or painful orgasm ?

Pain before onset of ejaculation or during ejaculation is termed as painful ejaculation. It can be dull or sharp pain and can involve the scrotum, penis root or shaft or perineal region. Pain can persist for few minutes to hours and person can have pain with urination also.

What are the causes of painful ejaculation ?

Various reason for painful ejaculation include – Prostatitis (infection/inflammation of the prostate), urinary tract infection, history of prostate surgery, sexually transmitted infections (STDs), use of medications such as antidepressants, prostate cancer, ejaculatory duct calculi etc. are the most common causes of painful ejaculation.

How to diagnose this condition and its causes ?

Painful ejaculation diagnosis is based on history provided by the patient. Causes leading to painful ejaculation can be assessed with the physical examination including digital rectal examination to palpate the prostate for any infection, urine examination with microscopy and culture, urethral discharge (if any), Trans rectal ultrasound (TRUS), serum PSA test. Additional tests are usually advised based on these initial tests.

What is the treatment for painful ejaculation ?

Treatment depends on the underlying cause. When it is caused by infection with either prostatitis or sexually transmitted infection, treatment is prescribing antibiotics to the patient along with analgesics. When its secondary to prostate surgery, it usually subside with time. Treatment for prostatic duct or ejaculatory duct calculi need endoscopic surgery for ejaculatory duct resection. Change of medicines for antidepressant induced painful ejaculation may be necessary. When painful ejaculation occurs due to prostate cancer, its treatment is done after more elaborate investigations and depending upon stage, type, patients age etc.

Whom to consult if you are having symptoms of painful ejaculation ?

Meet your local Urologist or Andrologist for best treatment.

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