Ask The Urologist: Interview With Dr Sudhir Kumar Rawal

This week, we interviewed Dr Sudhir Kumar Rawal, Director Surgical Oncology, Rajiv Gandhi Cancer Institute to learn everything we can about the urinary system, common urology problems, and how robotic-assisted surgeries making complex surgeries simpler.

Dr Sudhir Rawal, Medical Director and Chief of GenitoUro- Oncology Services, Rajiv Gandhi Cancer Institute, Delhi

The aim of the Urology week is to raise awareness of the importance of urological care and its relation to improving Quality of Life.

Urology treats surgical procedures for bladder dysfunctions, prostate cancer, and removal of kidney stones, congenital abnormalities, traumatic injury, and stress incontinence.

They also treat medical conditions affecting urinary tract such as infections, management and treatment of prostate.

This week, we interviewed Dr Sudhir Kumar Rawal, Director Surgical Oncology, Rajiv Gandhi Cancer Institute to learn everything we can about the urinary system, common urology problems, and the treatments to resolve them and how robotic-assisted surgeries making complex surgeries simpler.

When should one consult a urologist?

The urologist can help with pelvic pain, bladder issues in men and women, as well as sexual dysfunction in men and infertility in women.

Urological problems like blood in your urine (hematuria), experiencing consistent pain or burning while urinating, could indicate a urinary tract infection (UTI).

Conditions exclusive to men include problems with getting or keeping an erection; anything related to fertility; an elevation or change in your prostate-specific antigen (PSA); an abnormal prostate exam; or a testicular mass or persistent pain. Prostate cancer is the most common cancer among American men, yet in its early stages, prostate cancer often has no symptoms.

Women experience urological problems differently. Usually they face urinary incontinence and urinary tract infections. They also may have a urinary fistula, pelvic organ prolapse and voiding dysfunction.

What are the early symptoms of bladder cancer? 

Painless visible haematuria (VH) is the commonest presentation of bladder cancer. “Hematuria” means that enough blood is present in the urine that the patient can see it. There are small amounts of blood called “microscopic hematuria,” and it can only be found with a urine test. Bloody urine looks different, but you might not be able to tell the difference. It’s best to see your doctor soon after you see blood in your urine.

What are the warning signs of prostate cancer? 

Among the first signs of prostate cancer are change in urination or defecation habits. Depending on the tumour’s size and location, it could cause difficulty in starting and stopping the urinary stream, increase in the frequency of urination, rectal pain, erectile dysfunction, lower back, hips or pelvic pain, decrease in semen ejaculated or pressure and pain while urinating.

If the formation of pus in the prostate of a patient is an indication of cancer?

No, It is rather not an indication of cancer. Serious complications can arise if an infection isn’t properly treated. Complications include- an inability to urinate, rectal pain, prostate abscess, which is a collection of pus that causes inflammation. This condition is very treatable and if you have any of these symptoms, you can follow-up appointments with your doctor so that they can make sure your treatments are effective.

What are the treatment options available to patients with Urological cancers?

There are many types of urological cancer, it can be experienced by both men and women, such as bladder and kidney cancer, and gender-specific cancer such as testicular cancer for men and vaginal cancer for women-

  • Bladder cancer grows mainly in the lining of the bladder. Fortunately, most bladder cancer is found early because it tends to cause blood in the urine. When it is found early, it is highly treatable. Many times, the best option might include more than one of type of treatment. Surgery, alone or with other treatments, is used to treat most bladder cancers.
  • Kidney cancer is abnormal cell growth in the kidney. Cancer cells may grow in the tissues or tubes within the kidney. Treatment options and recommendations depend on several factors. Kidney cancer is most often treated with surgery, targeted therapy, immunotherapy, or a combination of these treatments. Radiation therapy and chemotherapy are occasionally used. Partial nephrectomy (kidney-sparing surgery) is mostly done by robots because of its special advantage.
  • Prostate cancer is common cancer among men that develops within the prostate gland. Symptoms usually appear when the tumour causes some degree of urinary blockage at the bladder neck or the urethra. The usual symptoms include difficulty in starting and stopping the urinary stream, increase in the frequency of urination, and pain while urinating. Advanced prostate cancer may be treated with external-beam radiation therapy, testosterone suppression therapy, or surgery. Treatments may be given in different combinations to stop cancer from growing and spreading.
  • Testicular cancer starts in the male gland known as a testicle or testis (two are called testicles, or testes). If you find any lump, swelling or firm part of the testicle, you should see a doctor find out if it is a tumour. They are mainly treated by chemotherapy and residuals is treated by robotic surgery for testicular cancer using robotic devices to remove cancerous tissue from the lymph nodes or to remove the lymph nodes themselves, where testicular cancer generally first spreads.

How robotic-assisted surgeries are proving to be a boon for urologists as well as patients.

Robotic tools, technologies and techniques can now enable a surgical operation to be performed with better visualisation of the anatomy than was possible in laparoscopic surgery. Earlier surgeries involve a large team of doctors that have to operate for long hours and use hundreds of instruments for the completion of one surgery.

YOU MAY LIKE TO READ: Robotic-Assisted Surgery Will Be New Normal During And Beyond COVID-19 Pandemic, Explains Expert

Improved visualisation helps in the preservation of nerves and other critical structures. This is particularly important for complex gynecologic, rectal and prostate cancer surgeries.

Robotic arms are controlled by a doctor sitting at a remote console and enable a surgical operation to be performed with better visualisation so it avoids invasive cutting of the wound and excessive bleeding and risk of post-surgery infections.

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