Category: Uro-oncology

Uro-oncology, Urologist

Bladder cancer awareness month 2022

Dr Varinder Attri

‘ 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)
Uro-oncology, Urologist

Prostate cancer – Part I

Dr Varinder Attri

What is prostate ?

Prostate is a lemon sized reproductive gland, found only in men, below the bladder. Its function is to produce fluid which helps providing nourishment to sperms in semen. Urinary passage goes through prostate, before reaching the penis.

What all diseases can occur in prostate ?

BPH (BPH (Enlarged prostate) Symptoms), Prostatitis (Infection in prostate), Prostate cancer (Prostate cancer)are the most common diseases that originate from prostate.

What is prostate cancer ?

Like rest of the body cancers, prostate can harbour cancer in it. Malignant growth inside the prostate is called prostate cancer. Most of the prostate cancers are slow growing.

What are the risk factors for prostate cancer ?

Older age, African – American race, family history of ovarian/breast and prostate cancer increases the likelihood of a man being diagnosed with prostate cancer. As men increase in age, the risk of prostate cancer increases. About 60% of prostate cancers are diagnosed in men over the age of 65 years. Besides these, diet high in animal fat has been associated with risk of developing prostate cancer.

What are the symptoms of prostate cancer ?

Prostate cancer can be asymptomatic; meaning there can be no symptoms of cancer. If it does causes symptoms, these can be urinary symptoms or more generalised symptoms, depending upon the stage of prostate cancer. Most common symptoms include- urinary symptoms such as frequency or weak urinary stream, blood in urine (hematuria), erectile dysfunction (ED), Hematospermia (Blood in semen), urinary and bowel incontinence, pain in hips/back/legs etc.

Can we detect prostate cancer in patient who does not have symptoms ?

Prostate cancer can be easily screened with combination of Digital rectal examination (DRE), conducted by doctor and blood test called PSA (Prostate specific antigen). (Prostate cancer and PSA testing). These tests are recommended annually in men over 50 years of age. Combination of these tests can diagnose prostate cancer in men, in whom there are no symptoms of this disease.

What is PSA test ?

The PSA is a blood test which is commonly used to detect possible prostate cancer in a person. Elevated PSA levels may indicate the presence of prostate cancer, but it can be also elevated in certain conditions of prostate such as BPH, prostate infections (prostatitis), UTI (Urinary tract infection), retention urine etc.

If initial tests shows risk of prostate cancer, what happens next ?

The final diagnosis of prostate cancer is made after prostate biopsy done most commonly by ultrasound guidance called TRUS (Trans rectal Ultrasound). Sometimes doctor orders MRI called mpMRI (multiparametric MRI) prostate before undertaking biopsy. Once biopsy shows evidence of prostate cancer, the cancer is staged to look for the extent of cancer spread into the body. This is done by combination of various modalities such as CT scan, MRI , Bone scan and more recently PSMA PET scan.

Andrologist, Uro-oncology, Urologist

Ten tips to improve urological health

Dr Varinder Attri
  1. Consume fluid intake of 2.5-3.0 litre/day in regular interval to maintain constant hydration.
  2. Drink cranberry juice to help prevent UTIs.
  3. Maintain weight in healthy range.
  4. Avoid smoking.
  5. Limit the intake of salt and caffeinated products.
  6. Empty your bladder before going to bed.
  7. Limit fluid intake 2-3 hours prior to sleep at night.
  8. Avoid prolonged holding of urine.
  9. Regular Kegal exercises to strengthen the pelvic floor muscles.
  10. Front -to- back direction cleaning of genitals in women to prevent UTIs.

Andrologist, Uro-oncology, Urologist

Hydrocele – common cause of scrotal swelling

Dr Varinder Attri
  • Hydrocele is the accumulation of fluid inside the covering of the testis called tunica vaginalis and cause the swelling of scrotum.
  • Hydrocele is present in newborn and disappear at around one year of age.
  • Persistance of fluid inside the scrotum or development at later adult age due to various reasons cause this disease.

Symptoms

  • Painless scrotal swelling
  • Discomfort or heaviness in scrotum
  • Redness or severe pain if fluid inside gets infected

Causes

  • In children, the hydrocele may be due to the peristance of fluid normally present at birth.
  • In adult age, hydrocele is due to various reasons such as testis infection (orchitis), epididymis infection (epididymitis), testis tumor, trauma, after varicocele surgery or other testis surgery.

What are the risks of hydrocele

  • Hydrocele fluid can get infected.
  • Hydrocele can hamper sperm production or the quality of sperms.
  • Swelling can get increased to lead impairement of quality of life or pain in it.

Diagnosis

  • Diagnosis of hydrocele is mainly done by doctor after physical examination.
  • Ultrasound of the scrotum region is done to look for any infection inside or to look for underlying cause lead to the formation of hydrocele.
  • Blood or urine test may be required to rule out infection of other causes of hydrocele.

Treatment

  • In newborns, hydrocele may resolve of its own.
  • Opinion of the doctor for conservative management is required to rule out any underlying testicular cause.
  • In adult age or in baby boys where hydrocele fail to resolve and causing symptoms to the patient, doctor look for any cause that leading to fluid formation. If no such cause found, surgical evacuation of fluid along with removal of fluid forming covering of the testis so as to prevent re-accumulation of fluid. 
Uro-oncology, Urologist

Prostate cancer and PSA testing

Dr Varinder Attri
  • Prostate is a small walnut sized organ present in men and is the part of male reproductive organ. It helps in the male fertility. Normal prostate size varies from 15-20 gm.
  • Prostate cancer is the most common cancer in men after skin cancer.
  • PSA (Prostate specific antigen) is the blood test which is specific for the prostate.
  • Though PSA is organ specific, it is not disease specific.
  • PSA is raised in many conditions such as prostatitis (prostate infection), prostate cancer, prostate abscess, BPH (benign prostate hypertrophy), acute retention of urine, urine infection, hematuria, prostate surgery etc.
  • Normal PSA value range from 0-4 ng/ml for an average sized prostate and its upper range value corresponds to the advanced patient age.
  • PSA is used for screening of prostate cancer as it is raised in these patients.
  • Raised PSA need thorough evaluation to rule out any other cause of elevation of PSA other than prostate cancer. These tests include DRE (digital rectal examination), urine routine/culture.
  • Absence of urinary infection or in an asymptomatic men with no prior urologic surgery, raised PSA suggests the possibility of harbouring prostate cancer and need further workup for same. These tests include mpMRI (Multiparametric MRI) prostate if PSA is more than 4 ng/ml and less than 10 ng/ml.
  • Any patients with raised PSA and having prostate which is hard on DRE or harbouring nodule, need prostate biopsy directly. Also, patient with PSA more than 10 ng/ml or more than 4 ng/ml and MRI showing high suspicion for prostate cancer need biopsy of prostate.
  • Free PSA (fPSA) is often useful for patients having PSA in range between 4-10 ng/ml. This blood test tells about the risk of prostate cancer in such patients.
  • Final diagnosis is with prostate biopsy in men having raised PSA and is done by the TRUS (Transrectal Ultrasound) under local anaesthesia.