The subject of ‘Urology’ deals with the surgical diseases of urinary tract and kidneys which result in the obstruction, stasis or aberration in the flow of urine from kidneys to the urinary bladder and its final exit from the body.

The various diseases in the urinary tract which are treated by a urologist are:

1. Kidney stone disease. Being located in the geographic stone belt of the world, there is a large population in North India suffering from urinary stone disease. PCNL (Per Cutaneous Nephro Lithotripsy) is a minimally invasive end urological procedure for removing the kidney stone through a small key hole (5 mm, Miniperc) in the flank. A telescope of the size of pen is inserted into the kidney and the stone is physically broken under direct vision using Holmium Laser. The stone fragments are then removed through the same passage.
2. Enlargement of Prostate gland (BPH). Almost 60% of men at the age of 60 years and all men at the age of 90 years would have some degree of prostatic enlargement. However, only about two thirds of these would have any symptoms pertaining to enlarged prostate. These symptoms comprise of increased frequency of urination, hesitancy in passing urine, sense of incomplete evacuation of urinary. For the last half a century, minimally invasive surgical method of treatment of the enlarged prostate gland has been Trans Urethral Resection of Prostate, popularly known as TURP. Laser Prostatectomy is a novel invention and is rapidly replacing TURP operations worldwide Laser prostatectomy using 100 watts Holmium Laser is called HoLEP (Holmium Laser Enucleation of Prostate).Laser treatment of prostate has several advantages.
1. The procedure is almost blood less when compared to the existing TURP; hence there is no need for blood transfusion even during treatment of very large glands.
2. The period for which the patient needs indwelling catheter is much less than that required for conventional TURP and hence the patient may be sent home much faster.
3. Early discharge from hospital is an indicator of quicker recovery and earlier resumption of usual productive work.

This technology is in use since Aug 2005 at Pushpawati Singhania Research Institute Hospital in New Delhi.

3. Tumours ( Cancers) of the various organs of urinary tract:
1. Kidneys
2. Prostate
3. Urinary Bladder
4. Testicles
5. Penis
   Cancers affecting the urinary organs are fairly common. Most of these cancers require a well planned and executed surgical extirpation as this forms the primary determinant of outcome for the patient. PSRI Hospital happens to be the proud record holder for removal of world’s heaviest kidney tumour (Limca book of records).
4. Infections of the urinary tract like Tuberculosis
   Urinary tract infections can be very disabling entity, especially for women, who sometimes learn to live with this disorder as part of life. Detailed investigation and treatment of these patients can give them back the quality of life that they deserve. Neglected cases of urinary tract infections could lead to permanent damage to kidneys causing ‘kidney failure’. Some confusable diseases like interstitial cystitis need special attention
5. Urogynecology: Urinary diseases of women
   Urinary symptoms in women could be confusing for any doctor. A range of urinary symptoms e.g. increased frequency of urination urgency of urination, incontinence, leakage of urine on coughing and straining, painful urination etc need to be evaluated in detail to arrive at a definitive diagnosis .There is a facility at PSRI hospital where a team of urologist and gynaecologist evaluate the urinary symptoms of female patients in the ‘Urogynecology clinic’. Cases of injury to the urinary tract of women during childbirth or an unrelated operation (vesicovaginal fistula:VVF, Ureterovaginal Fistula) need surgical repair. Women with Stress incontinence need sling operations to save them of the misery of urinary incontinence.
6. Neurogenic bladder as occurs in patients of spinal cord injury
   Damage to the nerves carrying sensation from the urinary organs to the brain could result in difficulty in controlling the act of urination voluntarily. Such situations frequently occur in patients with spinal injuries. These patients deserve special attention to their urinary tracts so as to make the process of urination under better control and protect the kidneys from any back pressure changes.
7. Congenital anomalies (Birth defects) of organs of urinary tract
   Some unfortunate children are born with abnormalities of the structure and function of the urinary tract organs. These children need careful evaluation and planning of surgical correction of such abnormalities.
8. Male sexual dysfunction
   A good andrologist, by conducting a few tests, can arrive at a pin point diagnosis in each case and thus plan a proper treatment. The treatment consists of medication and counselling sessions. However in resistant cases, surgical implantation of silicone devices can be done .These devises can be inflated to provide rigidity of the male organ, enabling it for performance of the sexual act.
9. Male Infertility
   It is now well known that overall in about half the number of infertile couples, males are equally responsible for the failure to reproduce. Therefore, more and more men are being diagnosed with a cause of infertility and they need to be seen by an appropriate specialist, the andrologist. There are some surgically correctable disorders which can restore fertility in males.
10. Andropause- Male menopause
    Aging and its attendant sequelae vary greatly among different individuals. One of the various problems that are faced by aging men is sexual dysfunction, which is multidimensional as well as multifactorial in origin. This clinical condition though not uncommon, is often missed in the practice. High index of clinical suspicion, which should arise out of the following, is the key to diagnosing Andropause.
    
    1. Men above 40 years of age, who have recent onset erectile dysfunction
    2. Decreased libido
    3. Loss of ejaculation
    4. Reduction in muscle mass and strength
    5. Increased abdominal fat distribution
    6. Mood disturbance, dysphasia, irritability
    7. Decreased attention span
    8. Memory loss
    9. Reduced ability to handle stress
    10. Reduced bone mineral densit
    11. Vasomotor instability/hot flushes
    12. Reduced pubic and axillary hair
    13. Depression
    Assessment and treatment of these individuals helps in the improving the quality of life and reduce the effects of aging process.