Please wait...

Speciality

UROLOGY AND NEPHROLOGY


Urologists & Nephrologists at Ramesh Hospitals offer specialised nephrology and urology care to patients of all ages. We offer a wide range of therapeutic technology/ support including haemodialysis and peritoneal dialysis. What sets us apart is the outstanding team of doctors comprising of highly experienced nephrologists, urologists, renal transplant surgeons, anaesthetists and critical care experts. Multidisciplinary in approach, they provide optimal, evidence-based treatment to patients with the support of an award winning team of nurses, renal dieticians, rehabilitation experts and qualified technicians.


Urology Services

  • URO Oncology
  • URO-Gynecology
  • Endourology
  • Reconstructive Surgery
  • Voiding Dysfunction
  • Renal Replacement Therapy
URO Oncology

This field is dedicated to the diagnosis and treatments of tumors of urinary systems. Most importantly taking care of patients with prostate cancer, kidney, testicular and bladder cancer. Physicians that are trained in this field are called URO-Oncologists.

Dr. Mayank Mohan Agarwal got initial training of uro-oncology in premier central govt. institute Postgraduate Institute of Medical Education and Research, Chandigarh, India. It is a center of high repute and largest govt. run tertiary and quaternary care health-care organization north of Delhi. He then refined his skill-set and experience in this field through international awarded travel-fellowship in one of the best oncology centers in the world Memorial Sloan Kettering Cancer Center, New York, USA and then in Wake-Forest University Baptist Medical Center, Winston Salem, North Carolina, USA. He worked in PGIMER for 10 years as faculty and practiced and taught comprehensive urology, including uro-oncology. He introduced several minimally invasive uro-oncological procedures in the department namely –

  • Laparoscopic radical nephrectomy with or without IVC thrombectomy
  • Laparoscopic partial nephrectomy
  • Laparoscopic nephroureterectomy with excision of bladder cuff
  • Laparoscopic retroperitoneal node dissection
  • Laparoscopic pelvic node dissection
  • Laparoscopic radical cystoprostatectomy
  • Laparoscopic anterior exenteration
  • Laparoscopic radical prostatectomy
  • Videoendoscopic inguinal lymph node dissection

He also regularized orthotopic neobladder reconstruction, developed a novel technique for continent cutaneous urinary diversion (eponymed PGIMER Pouch) and regularized concept of Enhanced recovery after surgery (ERAS) concept after major oncological and other surgeries.

Onco-Urological Conditions

There are many urological conditions and diseases that may affect a person irrespective of their age and gender. Some of the most common urological cancers are listed below:

Bladder Cancer

It refers to cancer that starts from the tissues of the bladder. There will be uncontrollable growth in the cells and form tumors inside the organ. Most common symptom of bladder cancer is blood while urinating. Others include pain during urination, urgent need to urinate and increased frequency of urination.

Any blood while passing urine must not be ignored. Do contact your urologist for a complete evaluation. It may be caused by stones, infection, tumor, prostate enlargement and some kidney related medical disease.

Kidney Cancer

This type of cancer will begin in kidneys when there is an overproduction of abnormal cells also called renal cancer. Its symptoms may vary from person to person and include loss of appetite, blood in the urine, lump in the abdomen, fatigue, anemia among others. Nowadays, many asymptomatic cancers are picked up early during ultrasound abdomen done for other medical problems. If diagnosed at this stage the cancer is curable and many times kidney can be preserved.

Prostate Cancer

Prostate cancer affects prostate gland which is a small walnut-sized gland present just below bladder in line with urinary tract. It produces seminal fluid and it occurs only in men. Symptoms of prostate cancer may include difficulty in urination, blood in semen, erectile dysfunction, pain in bones, and discomfort in the pelvic region. With advent of screening of prostate cancer using a blood test named Prostate Specific Antigen (PSA) many such cancers can be detected in a early curable stage while they are not causing any symptoms.

Multidisciplinary team led by Dr. Mayank provides state-of-the-art facilities for accurate diagnosis and contemporary treatment of urological cancers.

URO-Gynecology

Uro-Gynecology also known as Female Pelvic Medicine and Reconstructive Surgery is a subspecialty within Obstetrics and Gynecology as well as Urology. It is devoted to the evaluation and treatment of disorders of the pelvic floor in women.

Women with a weakened pelvic muscles or ligaments may have trouble in controlling their bladder and bowels. They can suffer from leakage of urine, bowel gas or stool, difficulty emptying their bladder or having a bowel movement or overactive bladder. Some women can also face or see tissue coming out of the opening of their vagina. This can be a prolapsing uterus or vagina. It is also possible to experience several of these problems at the same time.

While physicians, general gynecologists and general urologists can begin the evaluation and initial treatment of Pelvic floor Dysfunction, if the diagnosis is not clear, if you experience several pelvic floor problems at the same time, if the initial approach has not helped or if a surgery is considered as treatment, you are recommended to be evaluated by an experienced Uro-gynecologist with dedicated interest in treating these diseases.

Dr. Mayank Mohan Agarwal got initial training of uro-gynecology (particularly in genitourinary fistulae) in premier central govt. institute Postgraduate Institute of Medical Education and Research, Chandigarh, India. It is a center of high repute and largest govt. run tertiary and quaternary care health-care organization north of Delhi. He then refined his skill-set and experience in this field through international awarded travel-fellowship with one of the most experienced and world-renowned uro-gynecologist Dr Shlomo Raz, at University of California, Los Angeles as well as in India with Dr N Rajamaheshwari. He practiced advanced uro-gynecology in PGIMER, Chandigarh and continued the same in Abu Dhabi as well as South India. He is experienced in the following uro-gynecological procedures and strives for excellent functional outcome –

  • Midurethral slings for stress urinary incontinence
  • Laparoscopic and open Burch Colposuspension
  • Pubovaginal Sling
  • Laparoscopic and transvaginal paravaginal cystocoele repair
  • Laparoscopic and transvaginal vault prolapse procedures (lap sacrocolpopexy, lap / vaginal uterosacral ligament fixation)
  • Laparoscopic and transvaginal hysterectomy
  • Colpoperineorrhaphy
  • Laparoscopic and transvaginal repair of simple and complex genitourinary fistulae
Endourology

Endourology is referred to a specific specialty area in urology in which small internal endoscopes and instrumentation are used to look into the urinary tract and perform surgery.

Procedures

What distinguishes endourology from traditional urology is that all procedures are performed internally, without any extensive incisions. Endourology is also called as minimally invasive urologic surgery or laparoscopic surgery.

Endourology, for example, can be used to locate and remove small kidney stones.

Stones may be taken out using tiny instruments inserted into the body through such areas like the urethra, bladder, and ureter. In addition to treatment, doctors can help determine what is causing the kidney stones and help in identifying the ways to prevent further stones from forming. Thin, flexible instruments that includes lasers, graspers, miniature stone retrieval baskets, special scalpels, and cautery, can be used to perform surgery without creating any incisions at all. Nearly all endoscopic procedures can be performed on an outpatient basis.

Endourological procedures include:

  • Urethroscopy: It is used to treat strictures or blockages of the urethra.
  • Cystoscopy: It is used to treat bladder stones and tumors. Obstructing prostate tissue can be removed with this approach as well (a procedure called “TURP”). Flexible plastic tubes called stents can be passed up the ureter using cystoscopy and x-rays to relieve blockage of the ureter.
  • Ureteroscopy: used to treat stones and tumors of the ureter.
  • Nephroscopy: used to treat stones and tumors of the kidney lining.
Reconstructive Surgery

Reconstructive surgery is a plastic surgery that is performed on body parts which are abnormal, either in terms of their shape (disfigured) or function (dysfunctional). Such abnormalities may occur because of:

  • Congenital defects /defects at birth;
  • Development abnormalities;
  • Trauma (e.g. burns);
  • Infectious disease; and
  • Tumours.

The aim of Reconstructive surgery is to improve the function of a body part. However, reconstructive surgery can improve functionality and the appearance of a body part at the same time. For example, blepharoplasty (eyelid surgery) is normally considered cosmetic, but can improve the function where eyelids droop severely and an individual’s vision can be obscured.

There are a numerous medical indications for reconstructive surgery. While these surgeries are undertaken with the aim of improving the function of the targeted body parts, in many cases they also change and normalise appearance as well.

Reconstructive surgery may be indicated in the following cases:

  • Breast surgery: May be medically indicated where disfigurations arise following mastectomy(breast removal);
  • Lip and palate surgery: Indicated in cases of congenital deformity, where an infant has a cleft lip or palate (partially formed lips or mouth). These conditions can cause impaired feeding, speech or abnormal dental development;
  • Ear surgery: May be indicated when abnormalities occur to one or both ears that impair hearing;
  • Hand surgery: May be medically indicated in correcting the function of deformed hands, removing the additional fingers or correct webbing;
  • Scar revision: Surgery may be medically indicated to correct scarring that causes restricted movement, including from burns;
  • Skin cancer treatment: To remove cancerous lesions affecting the skin and underlying tissues, with the aim to improve treatment outcomes. Individuals who are treated with reconstructive plastic surgery in removing skin lesions often also undergo radiotherapy.
Voiding Dysfunction

Voiding dysfunction is a broad term that is used to describe the condition where there is a poor coordination between the bladder muscle and the urethra. This will result in incomplete relaxation or over-activity of the pelvic floor muscles during voiding.

Types of Voiding Dysfunction and their Symptoms:

  • Overactive Bladder (OAB) : Children with OAB may feel an urgent need to urinate even when their bladder may not be full, and may use the bathroom more than 10 times per day or about every hour. Most children with OAB will have urinary tract infections (UTIs) and urinary incontinence, and sometimes these symptoms will be continued even after the UTI is treated. Some children may (unsuccessfully) try to “hold it” by crossing their legs or using other physical maneuvers. OAB is the most common type of voiding dysfunction and occurs in about 22% of children between the ages of 5 – 7 years old.
  • Dysfunctional Voiding : With this type of dysfunction, the muscles which control the flow of urine out of the body don’t relax completely, and the bladder never fully empties. This may cause a range of symptoms such as daytime wetting, night wetting, a feeling that the bladder is always full, urgency, and straining to urinate. With severe cases of dysfunctional voiding, children may develop symptoms similar to those of a neurogenic bladder and be at higher risk for complications such as kidney infection and disease.
  • Underactive Bladder : Children with an underactive bladder will urinate less than 3 times a day, or will be able to go for more than 12 hours without urinating. These children have to strain to urinate because the bladder muscle itself will be “weak” and doesn’t respond to the brain’s signal that it is time to go. Accidental wetting with underactive bladder is caused by the bladder becoming too full and overflowing.

Void Dysfunction treatment

  • Overactive Bladder (OAB) : The first step in treating OAB is to put the child on a schedule where they use the bathroom every 2-3 hours while they are awake. Children are encouraged to urinate before the sense of urgency develops to help “retrain” the bladder. After a few months on the voiding schedule, physicians may prescribe medications that can help them reduce the frequency and feeling of urgency.
  • Dysfunctional Voiding : Most treatments for dysfunctional voiding emphasize on retraining the brain and helping the bladder relax. Children are taught that normal urination does not involve squeezing the abdominal muscles, but instead, relaxing muscles in the pelvis and bladder. A timed voiding schedule is the important part of bladder retraining. Biofeedback and Kegel exercises (pelvic floor relaxation and contraction) may also effectively help manage dysfunctional voiding. The physician may also be prescribed medicine that will help the bladder relax.
  • Underactive Bladder : Treatment for underactive bladder is primarily behavioral. Children are allowed on a timed bathroom schedule to go whether or not they feel the urge to urinate. Medications that relax the bladder can also be helpful. Children with very large capacity bladders who aren’t able to urinate may need short term catheterization.
Renal Replacement Therapy

Renal replacement therapy (RRT) replaces nonendocrine kidney function in patients with renal failure and is occasionally used for some forms of poisoning.

There are three main modalities that is used to replace the renal function: dialysis (either hemodialysis or peritoneal dialysis), hemofiltration, and kidney transplant.

Dialysis focuses on the diffusion of molecules across a semipermeable membrane, which separates blood on one side and the dialysate on the other.

Hemofiltration is based upon the principles of filtration and convection, (as opposed to diffusion) and mimics the function of the glomerular system. An ultrafiltrate is excreted, and the replacement of electrolytes with a specific solution is essential.

Kidney transplantation is indicated for patients with end-stage renal disease (ESRD). In such cases, it associates with a greater long-term survival rate and a better quality of life than dialysis.

Hemodialysis

Molecules diffuse across a semipermeable membrane down their concentration gradient and are removed from the blood.

Superior at removing low-weight molecules (e.g., urea, protein-bound drugs, ammonia).

Requires either a catheter (short-term option) or the creation and maturation of a fistula (long-term option)

Hemofiltration

Molecules are filtered out by a semipermeable membrane, whereas fluid passes through freely and re-enters the body (as “ultrafiltrate”).

Superior at removing middle-weight molecules (e.g., TNF, IL-8, IL-6) Replacement fluid is needed due to significant amounts of fluid are wasted in this process (“effluent”).

Our Department

DOCTORS


Sr Consultant – Urology

Dr KSN Chary

Consultant, Urology..


Consultant – Nephorology and Transplant Physician

Dr M Surendra Babu

Ledipasvir and Sofosbuvir for Untreated Hcv Genotype 1 Infection in End Stage Renal..


Consultant – Urology

Dr Durga Prasad

Singla N, Bendapudi DP, Chhabra R, Malhotra P, Prakash M, Gupta SK. A Prospective Randomized..


Consultant – Nephrology

Dr Ch Nageswara Rao

Consultant, Nephrology



Consultant – Nephrology

Dr DLP Sai Kumar

Worked as junior resident in the department of general medicine in Katuri medical college..


Consultant – Urology

Dr D Sridhar

Consultant, Urology


Consultant – Urology

Dr MVSN Gupta

Consultant, Urology


Consultant – Urology

Dr K Lalith Sagar

Consultant, Urology



Registrar

Dr Vinod Parimi

Registrar

Appointments for Call

Vijayawada – 0866 2463 463
Guntur – 0863 2377 777
Ongole – 0859 2234 599

Timings: Sunday – Saturday 24/7

?

Health Packages

?

Make an Enquiry

?

Book An Appointment