Vascular Surgery - Diabetic Foot Treatment in India

      Vascular Surgery - Diabetic Foot Treatment in India

Diabetes mellitus (DM) represents several diseases in which high blood glucose levels over time can damage the nerves, kidneys, eyes, and blood vessels. Diabetes can also decrease the body's ability to fight infection. When diabetes is not well controlled, damage to the organs and impairment of the immune system is likely. Foot problems commonly develop in people with diabetes and can quickly become serious.

• People with diabetes must be fully aware of how to prevent foot problems before they occur, to recognize problems early, and to seek the right treatment when problems do occur. Although treatment for diabetic foot problems has improved, prevention - including good control of blood sugar level - remains the best way to prevent diabetic complications.

• Damage to blood vessels and impairment of the immune system from diabetes make it difficult to heal these wounds. Bacterial infection of the skin, connective tissues, muscles, and bones can then occur. These infections can develop into gangrene. Because of the poor blood flow,antibiotics cannot get to the site of the infection easily. Often, the only treatment for this is amputation of the foot or leg. If the infection spreads to the bloodstream, this process can be life-threatening.

                                                Diabetic Foot Care Causes

• Footwear : Poorly fitting shoes are a common cause of diabetic foot problems.If the patient has red spots, sore spots, blisters, corns, calluses, or consistent pain associated with wearing shoes, new properly fitting footwear must be obtained as soon as possible.If the patient has common foot abnormalities such as flat feet,bunions, or hammertoes, prescription shoes or shoe inserts may be necessary.

• Nerve damage : People with long-standing or poorly controlled diabetes are at risk for having damage to the nerves in their feet. The medical term for this is peripheral neuropathy.

• Poor circulation : Especially when poorly controlled, diabetes can lead to accelerated hardening of the arteries or atherosclerosis. When blood flow to injured tissues is poor, healing does not occur properly.

• Trauma to the foot : Any trauma to the foot can increase the risk for a more serious problem to develop.

                          Diabetic Foot Treatment in India

 

Antibiotics : If the doctor determines that a wound or ulcer on the patient's feet or legs is infected, he or she may recommend for antibiotic therapy. Generally, the patient should see some improvement in the wound in two to three days and may see improvement on the first day itself. For limb-threatening or life-threatening infections, the patient will be admitted to the hospital and given IV antibiotics. Less serious infectionsmay be treated with pills as an outpatient.

Referral to Podiatrist or Orthopedic Surgeon : If the patient has bone-related problems, toenail problems, corns and calluses, hammertoes, bunions, flat feet, heel spurs, arthritis, or has difficulty with finding shoes that fit, a physician may refer you to one of these specialists. They create shoe inserts, prescribe shoes, remove calluses and have expertise in surgical solutions for bone problems. They can also be an excellent resource for how to care for the patient's feet routinely.

Varicose Veins Treatment in India

                    Varicose Veins Treatment in India

The word "varicose" comes from the Latin root "varix," which means "twisted." Any vein may become varicose, but the veins most commonly affected are those in your legs and feet. That's because standing and walking upright increases the pressure in the veins in your lower body.

The veins of the legs are divided into two systems - the deep veins (which run deep to the leathery layer of fascia surrounding the muscles) and the superficial veins (which run in the layer of fat just beneath the skin). The superficial veins are the ones that you can see (for example, on your foot or around the ankle) and they are the ones that can become varicose. It is essential to keep in mind these two different systems - deep and superficial - in order to understand varicose veins and their treatment. In a number of places in the leg, the superficial and deep veins are linked by perforating veins (or 'perforators'). They are called perforators because they perforate the leathery fascial layer surrounding the muscles of the legs. 

                          Varicose Vein Symptoms

Comfortable and sedentary life-style, modern fashion, special postures adopted while performing professional duties have contributed to increased incidence of a set of diseases unheard of in the past. Varicose vein disease is one of them and is a direct result of sedentary life-style. The problem has become very common during these days. According to one estimate, 15 to 20 per cent of the population in India is suffering from varicose vein disease these days. Women suffer from this disease four times more than men. 

• Pain (some time on & off).

• Swelling more prominent in end of day.

• Heaviness in leg.

• Fatigue.

• Prominent & dilated veins in leg veins.

• Pigmentation.

• Venous ulcer.

Advantages Of Non Surgical EVLT/RFA Varicose Veins Treatment

1. It is less risky as compared to surgery.

2. Needs no general anesthesia.

3. No Surgical scar on skin.

4. Done as a Day Care procedure with no overnight hospital stay necessary.

5. No blood loss or risk of blood transfusion.

6. The recovery is very fast as compared to traditional surgery.

7. The recurrence rate is very low as compared to conventional surgery.

8. Normal activities like long distance walking, running, standing can be resumed within 1-2 days.

Minimally invasive procedures like SEPS (Subfascial Endoscopic Perforator Surgery)

Subfacial Endoscopic Perforator Surgery (SEPS) is a minimally invasive surgical procedure which the doctors use to treat the underlying condition that causes venous ulcers. During the procedure they disconnect the abnormal perforator veins, which cause ulceration because of improperly functioning valves. By disconnecting these veins, they redirect the blood flow to healthy veins. Circulation in the leg is improved, and the ulcer is healed.

SEPS is usually performed with two ports of entry into the leg. A special instrument is inserted deep to the fascia of the leg and a large balloon is inflated with water to create a working space. The balloon is then emptied and the space is insufflated with air. The camera is inserted and the perforator veins can be seen in the space passing from superficial to deep layers. Another small incision is made in the calf for passage of another instrument. The perforator veins are carefully dissected, clips are applied and the veins are divided if necessary.

Most Advanced Laparoscopic Radical Nephrectomy at World Best Hospitals in India

             Laparoscopic Radical Nephrectomy in India

Nephrectomy (nephro = kidney, ectomy = removal) is the surgical removal of a kidney. The procedure is done to treat kidney cancer as well as other kidney diseases and injuries. Nephrectomy is also done to remove a healthy kidney from a donor (either living or deceased) for transplantation.

Advantages of Laparoscopic Radical Nephrectomy

• Improved visualization of surgical field

• Less blood loss

• Less pain

• Shorter hospital stay

• Quicker recovery

• Better cosmetic result

                                 Types of nephrectomy

There are two types of nephrectomy for a diseased kidney: partial and radical. In partial nephrectomy, only the diseased or injured portion of the kidney is removed. Radical nephrectomy involves removing the entire kidney, along with a section of the tube leading to the bladder (ureter), the gland that sits atop the kidney (adrenal gland), and the fatty tissue surrounding the kidney. When both kidneys are removed at the same time, the procedure is called bilateral nephrectomy.

The procedure used to remove a healthy kidney from a donor for the purpose of transplantation is called donor nephrectomy.

                 Laparoscopic Radical Nephrectomy in India

Laparoscopic radical nephrectomy uses a minimally invasive approach (laparoscopy) to perform exactly the same procedure that is done in open radical nephrectomy. In any radical nephrectomy (open or laparoscopic) the entire kidney including the kidney cancer is removed. The operation involves removal of the kidney along with the fat around the kidney. All of this tissue is contained in a leathery layer known as Gerota's fascia. 

The laparoscopic approach to partial nephrectomy means that no large incisions are required to perform the procedure. Instead of a large incision, three or four 1/2 cm to 1 cm incisions (less than 1/2 inch) are made. The spaces in the body are gently filled with gas to make working space and a small camera is placed into the body through one of the incisions. 

The entire kidney with the cancer within and with the surrounding fat and the layer known as Gerota’s fascia are removed. Once the entire specimen has been separated from the surrounding tissues, it is placed in a bag while still inside the body. The bag is then removed by making an incision.

Most Advanced Male Urinary Incontinence Treatment at World Best Hospitals in India

                 Male Urinary Incontinence Treatment in India

Urinary incontinence is the accidental laking of urine. It's not a disease. It's a symptom of a problem with a man's urinary tract . Urine is made by the kidneys and stored in a sac made of muscle, called the urinary bladder . A tube called the urethra leads from the bladder through the prostate and penis to the outside of the body. Around this tube is a ring of muscles called the urinary sphincter. As the bladder fills with urine, nerve signals tell the sphincter to stay squeezed shut while the bladder stays relaxed. The nerves and muscles work together to prevent urine from leaking out of the body.

Incontinence can happen for many reasons:

• If your bladder squeezes at the wrong time, or if it squeezes too hard, urine may leak out.

• If the muscles around the urethra are damaged or weak, urine can leak out even if you don't have a problem with your bladder squeezing at the wrong time.

• If your bladder doesn't empty when it should, you are left with too much urine in the bladder. If the bladder gets too full, urine will leak out when you don't want it to.

• If something is blocking your urethra, urine can build up in the bladder. This can cause leaking.

Urinary incontinence happens more often in older men than in young men. But it's not just a normal part of aging.

           Types and Symptoms of Urinary Incontinence

• Stress incontinence means that you leak urine when you sneeze, cough, laugh, lift something, change position, or do something that puts stress or strain on your bladder.

• Urge incontinence is an urge to urinate that's so strong that you can't make it to the toilet in time. It also happens when your bladder squeezes when it shouldn't. This can happen even when you have only a small amount of urine in your bladder. Overactive bladder is a kind of urge incontinence. But not everyone with an overactive bladder leaks urine.

• Overflow incontinence means that you have the urge to urinate, but you can release only a small amount. Since your bladder doesn't empty as it should, it then leaks urine later.

• Total incontinence means that you are always leaking urine. It happens when the sphincter muscle no longer works.

• Functional incontinence means that you can't make it to the bathroom in time to urinate. This is usually because something got in your way or you were not able to walk there on your own.

         Treatment for Male Urinary Incontinence in India

Artificial Sphineter:

Urinary leakage in the male candidates can be treated with the artificial sphineter. This device is an implanted device helps keeping the urethra be closed, until the candidate gets ready for urination. The artificial sphineter device is helpful for the urinary incontinence that is caused from nerve damage interfering the function of the sphincter muscle or weakened muscle function. If the inconsistency is because of the uncontrolled bladder contractions, it does not solve the problem.

Urinary Diversion

Urinary diversion surgery is considered if the function of the bladder is lost because of the damage of the nerve or the bladder has to be removed. The surgery provides a urinary diversion. During the surgery, a reservoir is created after removing a small intestine piece and the ureter is directed to this reservoir. A stoma is also created as an opening for the lower abdomen so that the urine can be drained towards the bag through a catheter.

Male Sling

Male sling surgery procedure provides the support by wrapping a strip over the urethra. The ends of the strip are then attached to pelvic bone ends. The sling continues to keep the pressure over the urethra until the urine is released consciously by the candidate.

Most Advanced Male Hypospadias Treatment at World Best Hospitals in India

    Most Advanced Male Hypospadias Treatment in India

Hypospadias is a male birth defect in which the opening of the tube that carries urine from the body (urethra) develops abnormally, usually on the underside of the penis. The opening can occur anywhere from just below the end of the penis to the scrotum. In most cases, the cause of this birth defect is not fully understood Treatment with hormones such as progesterone during pregnancy may increase the risk of hypospadias. Certain hormonal fluctuations, such as failure of the fetal testes to produce enough testosterone or the failure of the body to respond to testosterone, increase the risk of hypospadias and other genetic problems.

Mild hypospadias usually does not cause symptoms, especially in newborns and young children. If it's more severe, a male may have problems such as spraying urine, having difficulty directing the urine stream, and having erections that are not straight. In some cases, this defect may make it impossible to urinate while standing.

                     Diagnosis Of Male Hypospadias 

Hypospadias is usually diagnosed in males at birth. Upon examination, the foreskin is usually incomplete and the urethral opening is misplaced. Mild hypospadias may not be diagnosed unless removal of the foreskin (circumcision) is performed.

Some pediatricians perform ‘partial circumcisions’. In this situation the pediatrician begins the circumcision procedure, and, after exposure of the glans, identifies a hypospadias.

Due to swelling after the procedure, the consequences of a partial circumcision may look bothersome at first, but after several days or weeks the inflammation reduces and the penis appears much better over time.

              Treatment for Male Hypospadias in India

Male hypospadias is treated for several reasons and is conducted in full term or healthy boys, who are in between 3 months to 18 months. However, the repair can be performed also in childhood and sometimes possibly in the adulthood. Sometimes treatment for testosterone hormone is done before the surgery in case the opening is proximal.

The surgery is done to make the penis to straight to normal position having urinary channel at the head tip ends of the penis. The surgery is performed in four steps.

• Straightening the shaft

• Creation of the urinary channel

• Positioning the opening of the urethral in the head

• Reconstruction or circumcision of the foreskin

The surgery for hypospadias repair takes 90 minutes to 3 hours. It is done usually in stages. The surgery is usually performed with spinal anesthesia or general anesthesia. Urologists perform certain tasks during the surgery. They straighten the shaft separately before the urinary channel is constructed.

Most Advanced Laser Lithotripsy Surgery at World Best Hospitals in India

                                Laser Lithotripsy Surgery in India

Kidney stones are also known as calculi (plural), or calculus (singular). When it is in the kidney, it is a renal calculus. The tube draining the kidney to the bladder is the ureter, and a stone in the ureter is a urethral calculus. Passing a stone is usually very painful. However, many patients can pass a stone with only a "muscle ache" sensation in the back, and they may not be aware the pain was from a stone until it "pops out."

What are the Symptoms of Kidney Stone?

A kidney stone may or may not cause signs and symptoms until it has moved into the ureter the tube connecting the kidney and bladder. At that point, these signs and symptoms may occur:

• Severe pain in the side and back, below the ribs

• Pain that spreads to the lower abdomen and groin

• Pain on urination

• Pink, red or brown urine

• Nausea and vomiting

• Persistent urge to urinate

• Fever and chills if an infection is present

   Kidney Stones removal Laser Lithotripsy Surgery in India

• Laser lithotripsy is a procedure to treat kidney stones. It uses a laser to break the stones into very small pieces. These pieces can be removed during the procedure. Or they may pass out of the body in the urine. You may be awake for the procedure. Or you may have medicine to make you sleep. Either way, you will not feel pain. The doctor may use an X-ray to find the stone.

• First, the doctor puts a thin viewing scope with small tools, a camera, and a laser into your urethra. The urethra is the tube that carries urine from your bladder to the outside of your body. Then the doctor moves the scope and tools through your urethra and bladder into your ureter. Ureters are the tubes that carry urine from your kidneys to your bladder. If needed, your doctor moves the scope into your kidney.

• If the stone is large or is in your kidney, your doctor may need to make a small cut (incision) in your back and put a hollow tube into your kidney. In this case, the doctor uses the laser to break up the stone. Then he or she removes the pieces of the stone through the hollow tube.

• Your doctor may also place a small, flexible tube inside one of your ureters. This tube is called a stent. It helps the pieces of the stone pass through your body. If you get a stent, your doctor will usually remove it in a few weeks.Most people are able to go home the same day of the procedure.              

                         Advantages for Laser Lithotripsy

• Non-invasive, does not require surgery

• Immediate relief of symptoms

• No blood loss

• Faster recovery and shorter hospital stay

• Lesser chances of infection

Most Advanced Laparoscopic Urology Treatment at World Best Hospitals in India

                 Laparoscopic Urology Treatment in India

Laparoscopy also known as keyhole surgery is the art of performing surgeries through the smaller incisions using tiny instruments or telescopic instruments. Laparoscope is a narrow tube with a camera and lens attached to it. The advantages of laparoscopic surgery over the traditional open incision surgery are minimal postoperative pain and bleeding, a short hospital stay, faster recovery, and fewer complications.

Laparoscopic urology involves treating the conditions of genitor-urinary tract using minimally invasive technique, the laparoscopy. The urology conditions may include the conditions affecting kidneys, ureter, bladder, penis & testes.

Advances in the field of medicine and technology enabled the physicians to perform laparoscopic surgeries to treat a wide range of urological conditions with better outcomes and minimal adverse events.

                             Advantages Of Laparoscopy

• Blood loss is minimal.

• The pain is very much reduced than the traditional surgery.

• Gives improvised clarity and accuracy.

• Catheter removal is quick.

• The cancerous tissues are removed totally with minimum recurrence.

     Types of Procedures for Laparoscopic Urology in India

Laparoscopic removal of stones in the ureter, kidney and bladder : 3-4 keyhole incisions are made through which the laparoscope is introduced to visualize the size and location of the stones. Special probes are inserted through the instrument which powder the stones and suck them out or direct them to the bladder from where they can be flushed out.

Laparoscopic simple or radical nephrectomy: A simple nephrectomy is the removal of one kidney whereas a radical nephrectomy also involves the removal of one kidney together with the neighboring adrenal gland and lymph nodes.

Laparoscopic repair of Vesico - vaginal repair : Usually the vaginal wall and the bladder wall are distinct but at times due to injury, disease or prolonged labor an abnormal connection forms between them. This causes urinary incontinence. Through 4 keyholes during laparoscopic surgery, the organ walls are repaired and a layer of fat obtained from the abdomen is placed between the walls.

Laparoscopic donor nephrectomy: It is the surgical removal of kidney for donation. This procedure is performed for the purpose of kidney donation. The most serious donor complications that occur during laparoscopic donor nephrectomy include renal vessel injury, bowel injuries, bleeding or hematoma, and incisional hernias. 

Laparoscopic nephroureterectomy: It is a surgical procedure in which the surgeon removes the kidney and the ueter, the tube that carries urine from the kidney to the bladder. Laparoscopic nephroureterectomy is used to treat patients who have transitional cell carcinoma of the ureter or kidney.

Laparoscopic partial nephrectomy: It is a surgery to remove a diseased or damaged part of kidney. Laparoscopic partial nephrectomy is performed in patients with a solid renal mass in a solitary kidney or compromised contralateral kidney, bilateral renal tumours, and in patients with a normal contralateral kidney with small localized renal tumours.

Laparoscopic Pyeloplasty: It is a surgical procedure which relieves the obstruction between the ureter and the kidney at the ureteropelvic junction. Laparoscopic pyeloplasty is indicated in patients with obstruction of ureteropelvic junction, junction where the ureter attaches to the kidney.

Laparoscopic Radical Prostatectomy: It is a surgical procedure to remove all of the prostate gland and some of the tissue around it. This procedure is effective in treating prostate cancer that has not spread beyond the prostate gland. This is called localized prostate cancer.

Laparoscopic Radical Cystectomy: It is a surgical procedure that is used to remove the bladder. Laparoscopic radical cystectomy is the treatment of choice for patients with muscle-invasive bladder cancer.

Most Advanced Non-Surgical Treatment for Urinary Stones at World Best Hospitals in India

Most Advanced Non-Surgical Treatment for Urinary Stones at World Best Hospitals in India

Kidney stones are small pebbles initially and become stones later, after growing in the size. These are formed by crystal aggregation of the dietary mineral present in the urine. They are formed in different locations in the kidney. These might be present in bladder or ureter. These are also classified on the basis of the chemical composition, like having uric acid, struvite or calcium. After the stones are grown more than 3 mm size, they cannot be passed through the urine and start causing the symptom. Mostly men are affected from the kidney stone problems.

The kidney stones lead to dehydration, by developing the body fluids to lose gradually. The acid content in the body will be increased when high protein food is consumed.

                                 Types of Kidney Stones

Calcium

Calcium stones are the most common. They can be made of calcium oxalate (most common), phosphate, or maleate. Vitamin C and spinach contain oxalate. Calcium-based kidney stones are most commonly seen in young men between the ages of 20 and 30.

Uric Acid

This type of kidney stone is more common in men than in women. They can occur in people with gout or those going through chemotherapy.

Struvite

This type of stone is found mostly in women with urinary tract infection. These stones can be quite large and cause urinary obstruction.

Cystine

Cystine stones are rare. They occur in both men and women who have the genetic disorder cystinuria.

                        How are kidney stones diagnosed?

• Laser prostatectomy or Laser for prostatic surgery is recently developed minimally invasive treatment modalities for patients having BPH i.e benign prostatic hyperplasia or benign prostatic hypertrophy. The term Benign prostatic hyperplasia or benign prostatic hypertrophy means increase in size of the prostate gland in the men above 50 years of age.

• Extracorporeal shock wave lithotripsy (ESWL) is the most frequently used procedure for the treatment of kidney stones. In ESWL, shock waves that are created outside the body travel through the skin and body tissues until they hit the denser stones. The stones break down into small particles and are easily passed through the urinary tract in the urine.

• Several types of ESWL devices exist. Most devices use either x-rays or ultrasound to help the surgeon pinpoint the stone during treatment. For most types of ESWL procedures, anesthesia is needed.

• Prostatectomy is used mainly to remove the prostate gland when there is no cancer in it but its size enlarges due to which it creates problem in the urinary tract. Laser prostatectomy is a short and easy procedure, usually after which the patient can return to their home on the day of operation itself.

        Non-Surgical Treatment for Urinary Stones in India

Percutaneous Nephrolithotomy (PCNL) is a procedure to remove medium-sized or large stones from the kidney by means of a nephroscope passed into the kidney through a small puncture created in the patient's back. A nephroscope uses an ultrasonic or laser probe to break up large kidney stones and suction it out. This procedure is usually done under general anaesthesia or spinal anaesthesia.

Extracorporeal shock wave lithotripsy (ESWL)

Extracorporeal Shock wave lithotripsy uses shock waves to break stone smaller than 2 cm into small fragments that can more easily flushed out of the urinary tract and pass out from the body.

After identification of the position of the stone with X-ray or ultrasound, shockwaves are applied to fragment the stones. 

Ureteroscopy (URS)

Renal stones that do not respond to lithotripsy (ESWL), that are very hard or located in areas where ESWL does not work well can be treated by flexible ureteroscopy. Many men and women who have contraindication to ESWL or for whom ESWL is unlikely to work (such as morbid obesity) may do well with ureteroscopy. 

Holmium Laser:

During the procedure, holmium laser is used to break up the stones in the kidney, ureter or bladder through a small endoscopic camera. A small scope (ureteroscope) is passed through the urethra into the bladder, and from there up into the ureter to reach stones in the ureter and the kidneys.