Ureteroscopic Surgery – A safe solution

Ureteroscopic Surgery is a very safe surgery performed with minimal invasion to treat stone formation diseases in the ureter and kidneys of the human body. Doctors use this surgery for primary treatment as well as subsidiary treatment after having tried out other options. This surgery has high chances of success but often results in the patient having to stay longer in the hospital and suffering from complications. Ureteroscopic surgery is also an effective way of treating pregnant ladies and paediatric patients. The doctors in Jehangir Hospital, Pune are very experienced in performing surgeries like this. The hospital also provides efficient clinical examination facilities.

Types of Uteroscopy

1. Diagnostic endoscopy
In diagnostic endoscopy the image of the ureter is taken with the help of an ureteroscope and a guidewire without putting the upper urinary tract under trauma.

2. Therapeutic treatment
Therapeutic treatment is used for a variety of complications like stricture disease, treating stones and urothelialtumours.

Pre-operative details:
• Before the ureteroscopic examination of the patient, the surgeon needs to have all the required instruments ready.
• The instruments include – accessories, endoscopes, sources of energy and fluoroscopy.
• The energy sources can be any of the following – Electrocautery, Mechanical impactor and electrohydraulic lithotripsy.
• The doctor administers a dose of broad spectrum antibiotic which is parenteral in nature, prior to the operation.
• In most cases fluoroquinolone or cephalosporin is utilized as the antibiotic.

Intra-operative details:
• During the ureteroscopy a guide wire is essential for safety purposes.
• This guide wire helps in passing the ureteroscope several times into the ureter during the surgery.
• A gasper with multiple prongs is required to collect the fragments during the several times the endoscope is passed.
• In such cases, a ureteral sheath is used to give a protective covering to the intra-mural ureter and the ureteral meatus. This prevents trauma in those parts of the body.

Post-operative details:
• At the end of the ureteroscopic surgery, doctors place stents inside the ureter so that the healing process takes place faster and to make sure that proper drainage takes place, in case a lot of manoeuvres had taken place during the operation.
• The stents might cause an increase in the frequency of urination and may also cause hematuria.
• The stents maybe removed after a few weeks or 6-8 weeks depending upon the degree of healing that takes place.
• The patients are discharged the very same day on which the operations are performed.
• The patients are given analgesics and antibiotics to prevent infection.
• Proper positioning and careful selection of the stents make sure that the unpleasant side-effects do not take place.

Follow-up procedure:
• After the surgery is performed successfully, the patients need to visit the doctor to remove their stents.
• The imaging process needs to be repeated at intervals for a number of months after the operation to see the progress of the surgery.

Complications:
• Minor complications –Some of the minor complications that take place are colic pain, false passage, fever and hematuria.  These complications are found in a very small percentage of patients and are not serious.
• Major complications - Some of the major complications taking place are perforation, avulsion, stricture, Urinoma, urosepsis, deep vein thrombosis and cardiovascular accidents. These are also found in a handful of patients but require serious treatment.

Prognosis:
• In case of diagnostic ureteroscopy, if the source of bleeding is found or if the nature of defect is ascertained, then the treatment is brought to an end.
• In case of therapeutic ureteroscopy, the obstruction in the ureter must be resolved and the burden of the stone must be decreased. The drainage should be improved by endoscopic stricture.

All the processes related to ureteroscopic surgery are performed with expertise at Jehangir Hospital, Pune.

Endometrial Cancer – What you need to know

Endometrial Cancer is one of the most common types of cancer related to gynaecology. The endometrium is a part of the uterus of the female body. Malignancy of the endometrium or the lining of it causes this type of cancer. This illness is normally found in women who have entered their menopause, usually within a decade of having done so. It commonly occurs on endometrial hyperplasia and shows symptoms of vaginal bleeding. The most common way of treating it is to conduct a hysterectomy, which is the complete removal of the uterus. This also helps in stemming the spread of the malignancy. The doctors in Jehangir Hospital, Pune are well equipped to do the needful.

The symptoms and signs of endometrial cancer are the following:

• Bleeding occurs in the vagina after menopause.

• Bleeding might occur between periods.

• The patient might suffer from pelvic pain.

• An abnormal discharge might take place from the vagina which might be watery or might have a tinge of blood.

• The patient might feel pain while having intercourse.

The patient must consult or visit a doctor when they undergo any of the above mentioned symptoms. The faster the cancer is detected the better the chances for survival of the patient.

Causes

• Hormonal changes in the female body - In case a fluctuation occurs in the balance of the two main hormones of the female body, progesterone and oestrogen, there might be changes in the wall of the endometrium. Diseases or conditions like diabetes, obesity or polycystic ovary syndrome which increase the levels of oestrogen but not progesterone are very likely to cause endometrial cancer.

• Longer period of menstruation – In case of an early incidence of menstruation or a delay in the start of menopause, the endometrium is exposed to oestrogen for a longer period of time. This is more likely to cause endometrial cancer.

• Never being pregnant – Women with no experience of pregnancy are more likely to suffer from endometrial cancer than women who have been pregnant.

• Old age – The chances of endometrial cancer increases with age, more so after menopause.

• Obesity – As the body fat increases, so does the hormonal imbalance in the body. Obese people are more likely to have endometrial cancer.

• Breast cancer hormonal cancer – Women having breast cancer are treated with hormonal therapy drug tamoxifen. This drug increases the probability of having endometrial cancer.
Diagnosis

• Examination of the pelvis – The doctor examines the vagina and uterus to search for abnormalities.

• Ultrasonography – Ultrasound waves are used to get an image of the patient’s uterus and test it for any abnormalities on the lining of the uterus.

• Biopsy – The doctor scrapes a part of the uterus lining and tests it for malignancy.

Stages

• Stage 1 – The cancer is found only in the patient’s uterus.

• Stage 2 – It spreads to the cervix apart from the uterus.

• Stage 3 – The cancer spreads beyond the uterus of the patient during this stage.

• Stage 4 – In this stage the cancer spreads to the rectum, urinary bladder and other parts of the body.

Treatment of endometrial cancer:

• Surgery: The uterus can be removed by performing hysterectomy. This will prevent the cancer from spreading. The ovary and the fallopian tubes can also be removed.

• Radiation: Powerful X-rays are used to kill the cells affected by cancer. This can be used to shrink the tumour as well.

• Hormonal therapy: Two types of therapies can be done; the doctors may either increase the levels of progesterone or decrease the levels of oestrogen.

• Chemotherapy: Chemicals are administered to kill the cancer cells. This treatment is done in the advanced stages of cancer.

The team of Oncologists at Jehangir Hospital, Pune are well experienced and can assist in quick diagnosis and complete cure of this daunting disease as well.