Urology and Renal Transplantation

The Department of Urology at Amrita Hospital offers the best facilities for the diagnosis and treatment of genitourinary problems in adults and children. A highly qualified and experienced team of dedicated urologists and resident surgeons are available 24 hours a day. The latest state-of-the-art technology and equipment are available. The faculty subspecialises in the fields of Paediatric Urology, Uro-oncology, Laparoscopic Urology, Endourology, Andrology, Female Urology, Neuro-urology and Reconstructive Urology. Along with the support of the Nephrology services, more than 700 renal transplantation operations have been successfully performed.

Features

• Comprehensive Uro-oncology services
• Upper and Lower Tract Endourology
• Laboratory Services for Microbiology and Biochemistry
• Laparoscopic surgery
• Renal Transplantation and Access Surgery
• Urolithiasis - Medical and Surgical Management

Services Offered

Endourology

Endoscopic treatment of stones and diseases of the kidney, ureter, bladder, prostate and urethra is performed through natural openings in the body avoiding the pain associated with open operations.

Laparoscopic Urology

Key - hole surgery to remove and reconstruct urinary organs avoiding pain and long bed rest associated with open surgery. Nephrectomy, radical and partial nephrectomy, stone extraction, correction of hydronephrosis due to PUJ obstruction and re-implantation of the ureters are performed. More than 200 laparoscopic live donor nephrectomies and over 130 (the largest Indian experience) laparoscopic adrenalectomies have been successfully performed. We are one of the few centers in India who performs laparoscopic radical prostatectomy regularly for organ confined prostatic cancer.

Urological Oncology

The Department of Urology has a separate division for urological malignancies. The cancers of kidney, bladder, prostate, ureters, adrenals, testis and penis are taken care by this section. A subspecialty clinic in Uro-oncology is a unique venture in India. Being a research institute with state-of-the-art infrastructure, we have highly focused team for the care of urological cancers. In cases where multimodality treatment is required, our institution has medical oncologists, radiation oncologists, state-of-the-art radiology, pathology and nuclear medicine departments, all under one roof. There are facilities for brachytherapy, conformal radiotherapy, Intensity-Modulated Radiation Therapy (IMRT) and therapeutic nuclear medicine procedures. The Uro-oncologists, radiation oncologists, medical oncologists and Uro-pathologists discuss the cases and make combined decisions on the management of all the cases at the Tumour Board. Follow up and further management are done as per the current protocols.

Kidney Cancer

Surgeries like laparoscopic and open radical nephrectomies are the mainstay of treatment in kidney cancer. Complicated surgeries that require IVC exploration in locally extensive kidney cancers, open and laparoscopic partial nephrectomies (nephron sparing surgeries), and immunotherapy for advanced renal cancers are regularly done.

Prostate Cancers

Diagnosis of prostate cancer by TRUSS-guided multicore biopsy, and staging by bone scan, PET CT, 1.5 Tesla MRI, MD CT have greatly improved the detection of early disease and improved the outcome. Laparoscopic prostatectomy, conformal radiotherapy, IMRT (Image modulated radiotherapy) and brachytherapy all are routinely performed here.

Bladder Cancer

The gold standard for the treatment of advanced bladder cancer is radical cystectomy with orthotopic neobladder reconstruction. After removal of the diseased bladder, the bladder is reconstructed with a loop of intestine in the same sitting so that the patient is able to pass urine naturally. The quality of life is greatly improved as the patient is free from using a pouch to collect urine and the resultant social embarrassments. In a certain subset of patients, bladder preservation is done with the help of chemo radiation after endoscopic resection of the tumor.

Testicular Cancer

Survival after testicular cancer has recently improved after the use of multimodality approach. This requires individualized treatment decision and care involving chemotherapy, radiation, surgery and protocol based follow up. Reconstructions using prosthesis are also available to add to the quality of life.

Adrenal Tumours

Key hole surgery has replaced open adrenelectomy as there is better visualisation and enhances early recovery. We have the largest series of laparoscopic adrenalectomies in India . Retroperitoneoscopic adrenelectomy is done only in a handful of centers in the world with Amrita Hospital being one.

Penile Cancer

Partial or total penectomy and radical lymph node dissection is the standard treatment in carcinoma of penis. Recent advances in the treatments have reduced the treatment morbidity considerably. With the help of plastic surgery team, penis can be reconstructed with forearm flap which makes the life of these unfortunate people comfortable. They can have a normal sexual life with the help of penile implants.

Laparoscopic surgeries in Uro-oncology

The laparoscopic surgery has changed the surgical concept in Uro-oncology. Most of the open surgeries like radical nephrectomy, nephro ureterectomy, radical prostectomy and radical cystectomy are now done more and more with minimum morbidity and early return to work.

Paediatric Urology

Expertise for the surgical reconstruction of congenital defects of the urinary tract either by open surgery or laparoscopy is available. Hypospadias, vesico ureteric reflux, hydronephrosis, stone disease, urethral valves, etc. are routinely corrected at Amrita Hospital. The neonatal anesthesia and ICU support facilities are excellent. We are the only centre in South India who has an active paediatric laparoscopic urology program.

Renal Transplantation and Access Surgery

Renal transplantation is routinely performed once or twice a week with a dedicated transplant ICU. Laparoscopic kidney retrieval, vascular access and fistula creation are also done routinely. The hospital is involved in cadaveric multiorgan retrieval and transplantation program in association with SORT (Society for Organ Retrieval and Transplantation), a voluntary NGO in Kerala.

Female Urology and Neuro-urology

Treatment of women with incontinence of urine and management of urinary problems in patients with neurological disease or injury is practiced as a sub-specialty. "Life tech Janus IV" urodynamic equipment available at the center correctly aids in managing these unfortunate patients. Expertise for sling operations, TVT (TransVaginal Tape), TOT (TransObturator Tape), SPARC (SupraPubic Arc sling) and augmentation and continent urinary diversion procedures are available.

Andrology

Evaluation methods for erectile dysfunction including pharmacocavernosometry, pharmacocavernosography and procedures like penile implantation surgery are done regularly.

General Urology

Stones in the kidney, ureter, bladder, common diseases of the urethra (stricture), prostate (cancer, enlargement) and bladder are routinely treated. All the advanced treatment options for stones in the kidney and other parts of the urinary tract are available. The latest "Dornier Compact Delta" ESWL machine is available for the most effective crushing of stones without surgery.

Ancillary Services

Advanced urological imaging, pathology, microbiology, nuclear medicine, anaesthesia, cardiology, nephrology, oncology and paediatric services contribute to complete team approach to our patients.

Facilities

Outpatient Procedures

The outpatient department has facilities to take care of all office urology procedures. It is supported by trained staff including two staff nurses, blood draw facilities, full-fledged procedure rooms, dedicated X-ray machines, ultrasound equipment, etc.

Uro Radiology

Ultra sound machine: The department has its own B-K ultrasound machine apart from the facility available in Radiology to do ultra sound guided procedures like TRUSS guided prostate biopsy, percutaneous nephrostomy, ultrasound guided aspirations, etc. It has a dedicated TRUSS probe for accurate prostate biopsy to diagnose prostate cancer. The department has a separate radiology suite for doing procedures like MCU (micturating cystourethrogram) and RGU (retrograde urethrogram). It is supported by a radiology department with all modern equipments including:

• CT: MD CT ( Seimens sensation 64) , Seimens CT scan
• MRI: GE HD xT, Magnotom symphony classic
• Most modern invasive radiology suite
• Ultra sound section having 4 ultra sound machine
• A mobile USG and X ray unit
• Image guided radiofrequency ablation equipment
• Seimens double head Gamma camera: Used for all procedures including diagnostic services like bone scan, DTPA scan, DMSA scan, MAG3 and therapeutic procedures in carcinoma prostate.

Uro Dynamics

Two uroflow meters and Labourie Janus urodynamics machines are used for assessing the urine flow and evaluating neurogenic bladder

Flexible Cystoscopy

Two Karl Storz flexible cystoscopes are used in the evaluation of hematuria to rule out bladder malignancies and in the follow up of bladder cancer to diagnose early recurrence. They help to avoid anesthesia during routine cystoscopy as the procedure is painless.

Extracorporeal Shock Wave Lithotripsy (ESWL):

A Dornier compact sigma lithotripter is used for extra corporeal lithotripsy.

Procedures Performed

Laparoscopic Urology

The department is recognized as one of the apex centers in laparoscopic urology. Both laparoscopic and retroperitoneoscopic surgeries including:

• Laparoscopic and retroperitoneoscopic adrenalectomy
• Laparoscopic and retroperitoneoscopic nephrectomy and radical nephrectomy, laparoscopic nephron sparing surgeries
• Laparoscopic pyeloplasty
• Laparoscopic radical prostatectomy
• Laparoscopic donor nephrectomy

Endo Urology

• Percutaneous nephrolithotomy PCNL
• Ureteroscopy
• Flexible ureteroscopy and laser lithotripsy
• Transurethral Resection of the Prostate TURP
• Transurethral Resection of Bladder Tumour TURBT
• Endopyelotomy and retrograde endopyelotomy

Onco Urology

Prostate Cancer

• Open and laparoscopic radical prostatectomy
• Intensity Modulated Radiation Therapy (IMRT) and Conformal RadioTherapy
• Hormonal treatment
• Chemotherapy
• Radio isotope treatment

Kidney Tumors

• Radical nephrectomy: open and laparoscopic
• Nephron sparing surgeries: open and laparoscopic
• Radiofrequency Ablation (RFA)
• Immunotherapy

Testicular Tumors

• Inguinal orchiectomy
• Retroperitoneal lymph node dissection
• Chemotherapy and radiotherapy

Bladder Cancer

• Radical cystectomy and conduit
• Orthotopic neobladder
• Bladder preservation

Penile Cancer

• Penectomy and penile reconstruction

Reconstructive Urology

• Vescico ureteric reflux : STING therapy, laparoscopic and open ureteric reimplanation.
• Urethral stricture : Perineal urethroplasty, Buccal mucosal graft urethroplasty, Transpubic urethroplasty.
• Pelvi uretric obstruction : Laparoscopic and open pyeloplasty Endopyelotomy.
• Female urology : TVT (TransVaginal Tape), TOT (TransObturator Tape), SPARC (SupraPubic Arc sling)  surgery, Reconstructive surgery for Vesicovaginal fistula (VVF) and Urovaginal fistula (UVF).

Andrology

• Pharmaco cavernosography and cavernosometry
• Penile prosthesis implantation
• Penile vascular reconstruction
• Surgeries for Peyronie's Disease

Paediatric Urology

• Paediatric pyeloplasty: Lap/open
• Paediatric adrenalectomy: Lap/open
• PUV fulgration
• Ureteric reimplanation: ( Lap/open) and STING surgery
• Hypospadias repair

Specialty Clinics

Regular Out Patient Clinics

Monday to Saturday (8.30 AM -5:30 PM)

All patients undergo comprehensive evaluation and every effort is made to complete the evaluation process to have a diagnosis and to plan the treatment.

Specialty Clinic

• Paediatric Urology
• Uro-Oncology Clinic

Outreach Program

Prostate Cancer Detection Camp

We have started periodic prostate cancer detection camps in places near to the hospital. They are conducted free of cost including the investigations for cancer detection.

CONTACT US

Phone : 0484 - 6681320 / 0484 - 2851320
Email :urology@aims.amrita.edu