Thursday 20 December 2018

Treatment of chronic testicular pain


Treatment of chronic testicular pain

As a best urologist in Palam, West Delhi, I have decided to write this post after having treated in my practice, in recent weeks, several patients who had this problem and had long been going around trying to solve without success. In general, the patients I see in the kidney hospital in Palam, West Delhi have been evaluated by a multitude of specialists, they have undergone all kinds of tests, they have undergone multiple treatments ... without solving chronic pain.
The first thing we should do with a patient who is consulting for chronic testicular pain is a good clinical history in which we value:
  • Analysis of pain and its circumstances: from when you have it; possible causes (previous surgeries in the linguino-scrotal, abdominal or retroperitoneal area, traumatisms, infections or inflammations in these areas, etc.); characteristics and intensity of pain; irradiation thereof; triggering factors (when sitting, when urinating, when having an erection, when making a bowel movement, when the testicle is palpated, etc.); associated symptomatology (urinary frequency, urgency, nocturia, rectal or urinary tenesmus); etc.
  • Physical examination:  of the testicle, epididymis, deferent, spermatic cord, inguinal canal (hernias), abdomen, fist, renal percussion, etc.
  • Essential tests:  fractionated urine and semen culture, testicular eco-Doppler, abdominal and urological ultrasound. In some cases, it may be useful to perform Magnetic Nuclear Resonance of the pelvis.
With respect to treatment, our approach is as follows:
  • First, treatment of any process that could have caused the pain: torsion of testicular appendix, varicocele, epididymitis, orchitis, inguinal hernia, testicular tumour, tension hydrocele, etc. One should not lose sight of the so-called referred pain, that is, when the pain is caused by problems in other abdominal viscera but the patient locates it in the testicle (for example, kidney or ureter stones, appendicitis, etc.).
  • Second, use of analgesics. We use Paracetamol, Tramadol or the combination of both, depending on the intensity of the pain. In some cases, it is necessary to resort to specific treatments for what we call neuropathic pain (pain caused by disease or direct problem of the somatosensory nervous system). Among these neuropathic pain treatments, we have: carbamazepine, gabapentin, pregabalin, tricyclic antidepressants, etc.
  • In many patients, especially if the pain is of moderate or severe intensity, very constant, long evolution, etc. it is advisable to resort to psychological or psychiatric support to avoid anxiety, depression, stress, etc. associated with this situation.
  • If the pain does not remit with medication, we can resort to infiltration of the spermatic cord with anaesthetics and corticosteroids; radiofrequency; etc.
But in a high percentage of cases (possibly in more than 50% of patients) none of the above solves the problem. In these patients the only solution is surgery of denervation of the testicle. This is a technique that consists in sectioning all the nervous branches that collect the sensitivity of the testicle, thus avoiding the transmission of the painful sensation to the central nervous system. As a preliminary step, we should perform a cord block with local anaesthetics to confirm the possible efficacy of the subsequent surgical intervention. If the aesthetic block is effective, we will have a guarantee that the surgery will solve the pain. The surgical procedure must be performed by the best urologist in Janakpuri, West Delhi with the help of a surgical microscope that allows us to identify the arteries (testicular and deference); the veins; the lymphatics and the vas deferens, which will be the only structures that will be respected.

Monday 17 December 2018

Urinary Incontinence in Male & Child


URINARY INCONTINENCE

IN THE MALE
Urinary incontinence in men occurs, in most cases, as a consequence of surgery on the prostate, urethra or bladder, says urologist in Palam.
The therapeutic options are multiple. The most common procedure performed by urologist in Janakpuri are the following:
  • Rehabilitation of the perineal and pelvic muscles: Sometimes it is enough to resort to a good rehabilitation of the perineal and pelvic muscles to solve this problem. This is possible when the patient has residual muscle in the sphincter. On other occasions, rehabilitation should be used as a treatment associated with any of the surgical techniques described below. The results obtained with this type of treatment in our unit have been very satisfactory. The experience accumulated in this sense is broad and conclusive, being a reference centre for other urologist in West Delhi, who refer us to patients with this problem. In our unit, we recommend starting rehabilitation 4-6 weeks after having undergone radical prostate or bladder surgery.
  • Injection of bulking substances: It is a very simple and effective technique in about 50% of cases. When we associate the injection of bulking substances with Rehabilitation, the percentage of improvements and cures exceeds 75%.
  • Mesh placement: In males, meshes can also be used to correct certain forms of UI. The technique is not very complex and the results achieved can reach 70% cure / improvement says urologist in Dwarka.
  • Incontinence prosthesis placement: The results obtained with its implantation are very satisfactory.
IN THE CHILD
The causes of urinary incontinence in children can be very numerous. However, it is usually a problem of uncontrolled urination.
Children usually acquire daytime urinary continence around 2-3 years and nocturnal continence around 3-5 years. These ages are indicative and will depend, to a great extent, on the global maturity of each one.
Therefore, if a child is not able to contain urine during the day after 3 years or during the night after 5, he should consult with the specialist. Currently, most of the urologist in West Delhi think that it is better to value and treat these children from that age than to wait for their spontaneous evolution until they are older.
We, as a team of urologist in Hari Nagar, speak of enuresis when the child presents involuntary urine losses at an age when he should have already acquired control of urination. There are many different types of enuresis:
  • Primary or secondary: depending on whether the child has had control over the pee on occasion or not
  • Diurnal, nocturnal or mixed, depending on the time in which the enuresis occurs
  • Monosymptomatic or complex
  • Etc.
The most common form of presentation is usually monosymptomatic nocturnal enuresis. This clinical picture can appear as a consequence of multiple factors, such as:
  • Neurological factors
  • Psychic factors, critical emotional situations, etc.
  • Sleep problems
  • Hereditary factors
  • Etc.
Although this problem usually resolves spontaneously with the passage of time, it is not advisable to ignore it for two fundamental reasons: firstly, because it can be a more serious problem that starts manifesting in this way; and, secondly, because of the possible psychological effects that this situation could cause the child.
The therapeutic options are numerous. It is usually convenient and necessary to associate several of them to achieve satisfactory results. The available treatments at the hospital of urologist in Uttam Nagar are:
  • Behavioural measures: reduce the fluid intake before going to bed, urinate before going to bed, lift the child to urinate at night, motivate the child, not ridicule, etc.
  • Medical treatments
  • Use of alarms
  • Rehabilitation and voiding re-education.