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.

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.

Guide to chronic prostatitis: symptoms, diagnosis and treatment

What is prostate gland ?

Prostate is a walnut sized reproductive gland present below the bladder in all men. Urethra (urinary passage) passes through it. Its function is to provide nutrition to the sperms.

What is prostatitis ?

Prostatitis means that you have inflammation of your prostate gland. Prostatitis can present in short time duration with fever/chills (acute prostatitis) or can have persistent course (chronic prostatitis) and can have either infective or non-infective etiology.

What is meant by chronic prostatitis ?

Chronic prostatitis is the persistence of inflammation in the prostate for more than three months. It can be either infectious or non – infectious. Majority of patients have non infectious cause of chronic prostatitis and only 1 in 10 diagnosed having bacterial cause of infection. Read more about urinary tract infection at Urinary tract infection (UTI)

What are the symptoms of chronic prostatitis ?

Symptoms of chronic prostatitis are variable and include – Burning micturition (painful urination), pain in the penis, scrotum or suprapubic region, difficulty in initiating urinary stream, frequent urge of passing urine, poor urinary stream, sensation of having residual urine in bladder after passing urine, dribbling at the end of passing urine, pain while ejaculation or during orgasm etc. These symptoms may be very subtle in few patients but can be very annoying and bothersome in others, interfering in daily activities, work and sexual life. (Know the symptoms of enlarged prostate at BPH (Enlarged prostate) Symptoms)

How to make a diagnose of chronic prostatitis ?

Diagnosis of chronic prostatitis is made after detailed history and work up of the patient. Workup includes physical examination with digital rectal examination (DRE) to palpate the prostate and rule out any acute infection and laboratory tests such as urine examination and imaging with ultrasound to look for source of infection. EPS (Expressed prostatic secretions) which are drops of urethral discharge obtained after DRE and initial urine sample after DRE helps in ruling out any bacterial infection within prostate. Occasionally doctor may advice cystoscopy to look at urethra, prostate and bladder for any pathology. Read how to diagnose BPH at Prostate enlargement diagnosis

What is the treatment of chronic prostatitis ?

Lifestyle changes

Use of heating pad or sitz bath (soaking lower body half in warm water), limiting caffeinated products such as cold drinks, tea, coffee, cutting down alcohol intake, avoid spicy and acidic food, avoiding large amount of fluid intake at a time, avoid prolonged sitting, daily brisk walk for atleast 15 minutes, pelvic relaxation exercises etc helps in improving symptoms.

Medical treatment

  1. Alpha blocker – This medicine relax the bladder neck and prostate muscle fibers and helps in easing pain or voiding symptoms associated with chronic prostatitis.
  2. Antibiotics – Role of antibiotics are controversial when urine examination tests are normal, but use of antibiotics for 2-3 weeks (Doxycycline, fluoroquinolones) are often prescribed for any subclinical infection harboring in the prostate.
  3. Analgesics and Anti-inflammatory drugs – Painkillers and anti-inflammatory drugs (NSAIDs) helps reducing inflammation and reduces pain. Other neuropathic painkillers such as pregabalin helps in few patients.
  4. Muscle relaxants – These drugs helps in relaxing spasm of pelvic floor muscles.
  5. Prostatic massage – Prostatic massage helps reducing inflammation and reduces the symptoms of chronic prostatitis.

What is the prognosis of chronic prostatitis ?

Chronic prostatitis is poorly understood entity and its association with infection is subtle. Hence, this disease is very difficult to cure with many men do not respond to the therapy . Nonetheless, several potentially effective treatments are available. Your urologist may be able to help out in alleviation of symptoms associated with this disease.

Does chronic prostatitis increase the risk of prostate cancer ?

There is no evidence that chronic prostatitis increases the risk of developing prostate cancer. Read more about prostate cancer and its diagnosis at Prostate cancer

8 tips to prevent recurrent kidney stone formation

  1. Adequate fluid intake – Drinking plenty of oral liquids helps in reducing the chances of stone formation. It is estimated that nearly 50% of stone formations is due to less liquid intake. More concentrated urine leads to less dissolution of salts in it and thus leading to high chances of urinary stone formation. One should drink at least 2.5-3.0 litres of liquids per day so that the urine output remains nearly 2.0 litre/day. Citrate containing fluids such as orange and other citrus fruits decreases risks of stone formation.
  2. Calcium intake – Vitamin D deficiency often leads to excessive secretion of calcium in urine. Vitamin D supplementation along with calcium rich diet helps preventing renal stone formation. Calcium containing supplements should be taken along with the meals.
  3. Low salt intake – Avoiding excessive salt in the diet is beneficial and reduces the risk of calcium stone formation. Low salt in diet leads to less excretion of calcium in urine and hence less chances of calcium stone formation.
  4. Reduce body weight – Obesity with metabolic syndrome persons are prone to develop uric acid stones. Reducing body weight decreases the chances of uric acid stone formation.
  5. Avoid oxalate rich diet – Diet such as nuts, cashew, cocoa, chocolates, spinach, coffee, beet, rhubarb etc is rich in oxalate. Oxalate present in the food bind with the calcium in gut and does not get absorbed. Excessive oxalate gets reabsorbed in gut and get excreted in urine and increases chances of calcium oxalate stone formation. Avoiding such diet helps reducing the risk of these stone formation.
  6. Avoid excessive vitamin C intake – Excessive of vitamin C or its supplement increases the risk of stone formation. Other micronutrients such vitamin B6 helps reducing formation of stone.
  7. Get stone analysis – If someone has recently passed a stone or operated for stone disease, he/she should get the stone analysis done. It helps in knowing the composition of stone and hence doctor takes appropriate measures either with changes in food habits or starting some medicine, so as to decrease the chances of formation of stone disease.
  8. Prevent recurrent urinary tract infection – Recurrent urinary tract infection also leads to the formation of certain types of renal such as struvite stones. Preventing recurrent UTI helps decreasing the episodes of such types stone formation.
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