Uro-oncology, Urologist

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)
Uro-oncology, Urologist

Prostate cancer – Part I

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.


Know about symptoms, diagnosis and treatment of kidney stones/calculi

  • Kidney stones or otherwise called renal calculi or nephrolithiasis are deposits of combination of various minerals inside the kidney.
  • The constituents of these stones are normally excreted into the urine.
  • Excess concentration of these minerals in the urine leads its crystallization and further stone formation.
  • Various reasons of stone formation include less water intake, dietary factors, excessive calcium level in blood due to Vitamin D deficiency or hormonal imbalance, excess body weight, urinary infections, certain drugs intake etc.
  • Kidney stones are often diagnosed with ultrasound or CT scan test and its management depends on various factors.


  • Dull aching Flank or back pain
  • Radiating pain to lower abdomen
  • Pain while passing urine
  • Colicky pain (pain that comes and go in intervals or waves)
  • Blood in urine
  • Passing cloudy urine
  • Fever
  • Nausea/vomiting


  • Combination of various tests are done.
  • Blood tests – Tests to look for elevated calcium or uric acid, Vitamin D deficiency, Parathyroid hormone.
  • Urine tests- Urine tests are done to look for active infection. Recurrent infections lead to stone formation. Also 24 hour urine test is done to find the cause of recurrent stone formation.
  • Imaging – Imaging in form of Ultrasound, IVP or CT scan is often used to look for the exact number of stones, its size, location inside kidney, hardness of stone. It also helps the doctor in deciding the treatment to be undertaken for stones.


  • Small kidney stones do not require any surgical treatment and kept on surveillance. General mesures such as plenty of oral fluids, painkillers and alkalizers are often used.
  • Large kidney stones are treated with one or other surgical therapy. These include-
  • ESWL – Extracorporeal shock wave therapy uses various kind of shock waves to break the stone by vibration. Doctor chooses which stone to be treated with this therapy. Patient is placed on machine and stone is focused on machine and sound waves then break the stone. Procedure last for about 30-40 min. Small broken stones then passes in urine in following days.
ESWL set up
  • PCNL (Per – cutaneous Nephro-lithotomy) – In this surgery used for large stone, small endoscope is passed through the the cut (<1cm) given in back of the patient. Small instruments passes through this endoscope such as laser and other to break the stone and then these small broken pieces are removed with other instrument. Surgeon may also stent at the end of surgery.  
PCNL procedure
  • RIRS (Retrograde Intra Renal Surgery) – This surgery involves passing the small endoscope (ureteroscope) is passed through the urethra up into the kidney and subsequently the stone is broken with laser machine. This laser breaks and convert the stone into sand particles which gets flushed in urine in following days. Doctor may place a stent in this surgery.  
RIRS procedure
  • Parathyroid gland/adenoma removal – Sometimes the cause of recurrent stone formation lies in parathyroid gland which becomes overactive. It is situated in the front of neck behind thyroid gland. This involves either complete removal of parathyroid gland removal or removal of a small part of it. 

Prevention of stone disease

  • Drink plenty of oral fluids to maintain urine output of about 1.5-2.0 litre/day.
  • Take low salt diet.
  • Cut down the animal protein intake.
  • Cut down oxalate rich diet such as rhubarb, beets, okra, spinach, sweet potatoes, nuts, tea, chocolate and soy products. Calcium rich diet can be safely taken and not avoided.
  • Recurrent calcium stone formers may be prescribed by doctor with certain medicines such as thiazide or potassium citrate.
  • Uric acid stone formers may be given with Allopurinol or oral alkalizer is given.
  • Infection stone former may be treated with antibiotic to keep the urine free of infection.

Bladder cancer

What is bladder cancer?

It is the cancer of tissues in bladder, an organ that holds urine. It occurs in both sex but most commonly in elderly men after age 60 years.

What are the symptoms of bladder cancer?

Visible painless presence of blood in urine with clots is most common presentation of bladder cancer. Besides this other causes may include burning and painful micturition, frequent urination, retention urine etc. More advanced cancer can present with weight loss, fatigue, backache, loss of appetite etc.

What are the risk factors of developing bladder cancer?

Tobacco smoking is most common factor associated with future development of bladder cancer. Persons working in industries which process paint, dye, metal and petroleum products are more prone. Chronic bladder infection, radiation therapy, bladder stone disease are other risk factors. Family and genetic history also pose a risk to its development.

How to diagnose bladder cancer?

Ultrasound Abdomen or CT scan is most frequently used for its diagnosis. Final diagnosis is made with biopsy after bladder tumor resection with endoscopy.

What are treatment of bladder cancer ?

Sometimes TURBT (biopsy for diagnosis) is sufficient for the treatment of bladder tumor in early stage. In more high risk cases, drug therapy into the bladder may be required at periodical intervals. In cases where tumor has spread into muscle layes, cystectomy (complete bladder removal) is required. In metastatic cases chemotherapy is used.    

Whom to consult for bladder cancer ?

Initial visit to Urologist is required for the management of bladder cancer. Further need of medical oncologist, radiotherapist is required if necessary.



•Hematuria is passing blood in urine.

•Can be Gross (visibly red urine) or microscopic hematuria (blood present in urine examination).

•Even single episode of hematuria warrants investigation as upto 50% patients with gross hematuria and 33% with microscopic hematuria show some underlying cause. 

•Various causes leading to hematuria include BPH (enlarged prostate), urinary tract infections, stone disease, cancer of urinary tract etc.

•Initial panel of tests required for evaluation of hematuria include urine examination and culture, Ultrasound/CT scan kUB, urine cytology, PSA (men>40 yrs), cystoscopy etc.  

  • Management is mainly disease specific, such as prostate surgery for BPH, antibiotics for UTI, stone management, endoscopic biopsy for bladder mass, prostate biopsy for suspicious prostate cancer.