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Tag: Best Urologist in Dubai

Blood in the urine Have you ever noticed that the color of your urine is darker than normal?

Posted on by Dr. Ali Thwaini

Blood in the urine (hematuria) could manifest itself from a variety of conditions. This could be quite alarming finding when it happens. People would normally Google their symptoms and Dr. Google gives them the scare of their lives when going through the list of causes! First, red-colored urine doesn’t automatically mean that there’s blood in it.

There are various conditions that might lead to darker color urine, sometimes red, but aren’t associated with bleeding; these could be simply dehydration, excessive beetroot intake, some medicine ( e.g. Rifampicin), or excess intake of certain vitamins. When you have altered color urine, the best thing is to get it checked with the laboratory.

Urine is normally tested using a special dipstick test that contains chemicals able to detect blood constituents. This is a very fast test, cheap, and fairly reliable. Urine microscopy is another alternative. Both are non invasive and easily performed. If these tests confirm the present of blood, further assessments are required. These are in the form of radiological imaging ( ultrasound scan, or sometimes CT scan).

The other test is a direct visual inspection of the urethra and urinary bladder. This is carried out in the clinic using a flexible cystoscope under local anesthesia. It’s a very common, easy, and efficient procedure to confirm, or better, rule out urinary bladder pathology. Whilst hematuria is an alarming finding, mostly it’s due to non-sinister causes; these could range from urinary tract stones, infections, benign enlargement of the prostate. However, occasionally, there could be a significant underlying pathology, such as urinary tract cancer. There are some predisposing factors though; with the main being smoking. And yes, Shisha smoking, though the thought of as a benign social hobby, is by no means less harmful than cigarette smoking (one shisha smoking equals 70 cigarettes!).

Therefore, if you develop such a symptom, it is always better to visit your urologist to have the necessary tests carried out. All these tests are available at the Mediclinic City Hospital.

Renal cancer The silent killer

Posted on by Dr. Ali Thwaini

Renal Cancer is one of the come in urological counters affecting people are different stages of their lives. There are about 75,000 renal cancer new cases diagnose every year the United States Constitution saying about 5% of all other cancers and women are equally affected. While there are no definite predisposing factors to the development of renal cancers, There is a weak link between obesity and hypertension and, of course, smoking, to the development of real Cancers.

Most are diagnosed Anecdotally, however, some Are hereditary. Such as VHL disease. Before the advancements in medicine and surgery, kidney cancers were diagnosed rather late and patients were beyond the stage of cure. Due to the rightfully low thresholds and imaging, most of these cancers tend to be diagnosed incidentally and in early stages, Hence the name “incidentalomas”.

The benefits of early diagnosis of kidney cancer Are multifactorial; With early diagnosis, Tumors tend to be at a very early stage And patients are being offered kidney Sparing operations. This type of treatment has the potential of preventing The development of chronic kidney disease. Also, when the tumors are diagnosed at an early stage, especially in people who are high-risk surgical candidates, there is the option of minimally invasive treatment, in the form of the use of high or low temperatures to remove the cancer cells; this is in the form of radiofrequency ablation, Microwave ablation, And cryoablation. These methods have safe, proving their efficacy and safety.

The third benefit of diagnosing early kidney cancer is having a chance to follow them up closely In order to understand the biology of the disease. Several studies have shown that small kidney cancers tend to grow at a very slow pace the elderly and there is an option of active surveillance in this particular cohort of patients. Having said all the above, nephron-sparing surgery remains the gold standard in early localized kidney cancers, especially when technically feasible and safe. Surgery, on par with Medicine, has significantly progressed, and we have moved from open surgery to laparoscopic and then robotic surgery. While all options have proven their Efficacy in curing kidney cancer, the latter two surgical options have proven their safety and efficacy in providing an early return to normal function with less perioperative complications.

At Mediclinic and City Hospital, all the above modalities are available in treating kidney cancers and Patient’s are well managed by the multidisciplinary team to make their journey through illness and recovery as short and smooth as possible.

Diet for Stone Formers

Posted on by Dr. Ali Thwaini

Once a stone former. always a stone former!!

Urinary tract stones are the most common encounters in the field of urology. “Doctor, I’d rather give birth to 10 children than going through the pain of passing a stone!” Says many of my female stone patients.

Ureteric colic is an uninvited guest that barges in at any time. It is so severe at times that pilots, divers, and those operating heavy machinery, when suffering from a ureteric stone, aren’t allowed to resume their work until the stone has passed, for the fear of their lives and others.

Prevention is better than cure, and there are many, inexpensive and easily adaptable lifestyle modifications that wild help minimizing the chances of stone recurrence rate.

Below are some advice Preventing the Stone Formation

Water

60% of our bodies are made of it. It makes absolute sense to maintain a healthy water intake.

Drinking plenty of fluid is the most effective way of preventing the stone formation and reduces your risk of stone formation by almost one-third (30 to 40%). Not drinking enough can cause your urine to become concentrated, making stones more likely to form.

Try to drink two to three liters (four to six pints) of fluid (water or squash) each day. You should aim to keep your urine colourless throughout the day. This should give you a urine output of at least two liters (four pints)per day.

What about other fluids?

I, like many people, am addicted to caffeine. Whilst it has some benefits, it has its implications in stone formation, mainly increasing the Oxalate component of stones. Not to mention the fact that these fluids would actually deprive the body of water due to their diuretic effects.

Kidney Stone Diet Tips that may help:

  • Drink a large glass of water at specific times each day (e.g. when you get up, when you arrive at work, after using the toilet, etc);
  • Keep a bottle or jug of water by your side all day; you can flavour it with fruit squash;
  • Try to drink one glass of water every hour;
  • Add slices of lemon, lime or orange to cold water; this gives it a pleasant flavour and helps to make your urine less acidic;
  • Eat more fruit & vegetables because they contain a lot of water. Finally
  • Include moist/liquid foods in your diet (e.g. soup, stew & jelly).

Calcium:

Opposite to the traditional belief, reducing the amount of calcium in your diet can increase the risk of stone formation, by raising oxalate levels in your urine. A daily intake of up to 1000 mg per day is safe for calcium stone formers.

Most dietary calcium is found in dairy products (milk, yogurt, cream and cheese). A normal, varied diet will give you about 500 mg of calcium each day. The approximate calcium contents of dairy produce are:
• milk and yoghurt – 120 mg per 100 g
• soft cheese – 400 mg per 100 g
• hard cheeses – up to 1000 mg per 100 g

They were the numbers that will hopefully help you identify the right quantity of dairy products for daily consumption

If you have too much calcium excreted in your urine, the restriction might be of benefit here, but better consult your doctor

What about the other culprit? Oxalate

The majority of urinary tract stones are composed of calcium and oxalate. The latter is present and vast quantities of the following food items:

rhubarb, celery, spinach, beetroot and sesame seeds, all of which have large amounts of oxalate in them.

Black tea, chocolate, nuts (including peanut butter), cocoa and carob are all moderately high in oxalate.

Eating those items in moderation is the recommendation as most of them have lots of beneficial nutritional items.

Uric Acid Stones.

These are the second most common type of kidney stones. Historically they are related to large amounts of red meat consumption that could lead to gout, Hence the name Kings’ disease.

In addition to red meat the following items contain a large amount of uric acid and are butter taken in moderation by normal people and then matchless amounts by uric acid stone farmers:

• meat – all meats, including liver, heart, kidney, sweetbreads & meat extracts (e.g. Oxo)
• fish – especially anchovies, crab, fish roe, herring, mackerel, sardines, shrimps & whitebait
• others – yeast extracts (e.g. Bovril), beer, asparagus, cauliflower, mushrooms, peas, beans & spinach.

In summary

Urinary tract stones are one of the most common presentations and Urology and emergency. Stone attacks are very painful and cuddly to potentially serious illness and lots of work and activity.

Prevention is better than cure. Modification of lifestyle has amends beneficial results. For any further information and treatment visit your local urologist for further information and advice

Pelvi-Ureteric Junction (PUJ) Obstruction

Posted on by Dr. Ali Thwaini

What is PUJ obstruction?

PUJ obstruction results from narrowing of the junction between the pelvis of the kidney and ureter, resulting in impedance to the flow of the urine from the kidney to the ureter.

The condition affects approximately one person in every 1000 adults and tends to occur more in men.

Most people have two kidneys, that filter the blood to remove waste products, which they excrete into the urine. Urine is carried from each kidney, through the ureter, to the bladder where it is stored.

As well as removing waste products, the kidney performs many vital functions, such as controlling fluid balance (how to dilute the blood is), regulating various salts or electrolytes in the bloodstream (eg: sodium, potassium, calcium, magnesium), maintaining the correct acidity of the blood, and regulating blood pressure.

Many different conditions can affect the kidney; one of which is PUJ obstruction that causes no symptoms or problems and is only discovered by chance when the patient is having a scan for another condition. Alternatively, it can cause:

• Recurrent episodes of loin pain which tends to worsen after drinking especially alcohol.

• Kidney infection (pyelonephritis).

• Kidney stones.

• Lump or swelling in the kidney area.

• Damage to the kidney as a result of either high pressure in the renal pelvis, kidney infection, or formation of kidney stones.

How is Diagnosis of PUJ Obstruction?

PUJ Obstruction

This includes blood tests, urine test,s and scans. CT scan is commonly used to assess the anatomy and the structure of the renal pelvis and a special nuclear medicine scan called MAG3 scan is used to confirm the obstruction and also to assess the function of the kidney.

If there is severe kidney infection as a result of the obstruction, then the kidney must be drained as a matter of urgency with insertion of a temporary ureteric stent or nephrostomy tube before any definitive treatment.

There are several treatment options for PUJ obstruction and these will be discussed with you; these include:

Active surveillance with careful observation with repeated scans.

Treatments for PUJ obstruction

The PUJ is the portion of the collecting system that connects the renal pelvis to the ureter. The standard treatment for pelvic ureteric junction obstruction is pyeloplasty.

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There are different ways to approach the kidney to perform the operation. These include via a flank incision, subcostal (under the rib) incision, transabdominal approach, or even sometimes through an incision in the back. 

Most commonly, however, this procedure is done using laparoscopy, or keyhole surgery.

Laparoscopy is a technique of performing a surgical operation using instruments inserted through narrow hollow tubes (‘ports’) rather than through a larger incision, as in traditional surgery. 

The result is shorter hospitalization and convalescence, often less bleeding and post-operative pain, and fewer wound complications.

Chronic prostatitis Symptoms

There’s a reason behind naming chronic prostatitis as chronic pelvic pain syndrome. This is usually due to the vague presentation and different manifestations in different men. This could be ranging in the form of penile tip pain or scrotal discomfort. Others could present with chronic low back pain and pain during ejaculation. This could be well associated with storage lower urinary tract symptoms.


Non-surgical methods for Penile Enhancement

Posted on by Dr. Ali Thwaini

Non surgical methods for penile enhancement There are several conservative measures that if used properly, might help in gaining some length and possibly strength during erection.

Penis stretching?

Penis stretching refers to using own hands or a device to increase the length or girth of the penis.
Although there’s evidence to suggest that stretching can increase penile size, the results are usually minimal. In some cases, they may even be temporary.

It’s important to remember that much of the evidence around penis stretching is anecdotal, as there are no randomized trials with its effects to draw a valuable conclusion.

Manual stretching exercises involve using own hand to massage the tissues along the length of the penis. This is intended to stretch the skin and create “micro-tears” in the tissue.
The tissues may appear engorged as they heal, making the penis look longer.
Some exercises also claim to increase girth. Girth exercises, such as jelqing, are also centered around tissue massage.
Consistency is key to maintaining either of these purported effects. However, excessive use of such exercises might lead to more tissue damage leading to harmful outcomes.


Penile Enhancement Exercises

Penile Enhancement Exercises


1. Stretching


This is carried out by grasping the penis just behind its head. Don’t hold it too firmly or too loose. The penis is then gently stretched initially downwards for 20-30 seconds followed by upwards stretch for another 20-30 seconds


2. Rotational stretch


This is achieved by grasping the penis just below its head and pulling it outwards firmly. It is normal to feel a stretch in the shaft but not any pain. Then the penis is moved in circular motion maintaining the stretch and grip. Each rotation should take around 30 seconds. For each direction, at least three rotations are to be performed.


3. Jelqing

Jelqing-penile enhancement


With the penis being partially erect and using a lubricant, the penis is held at the base with the thumb and index finger. Slow movement of the hand up the penis maintaining the pressure.This is one jelq and it should take you 2 to 3 seconds to do 1 jelq. This help in pushing the blood towards tip of the penis and will not cause any pain. Repeat this process.


4. Kegel


The key is to identify the Pubococcygeus muscle by stopping the flow of urine. Once recognized, the muscle is held in contraction for about five seconds and then released. This method is then repeated as many times as desired, ideally for about 30 minutes every day to see an improvement in erection.

5. Opposite stretch

After folding the tip and base of the Leno’s with each hand respectively, both hands are then pulled in opposite direction, without causing any pain. This position is held for about 30 seconds and then relax. This method is repeated as required and after enough number of stretches let your penis relax.


Research on penis stretching techniques is limited. None of the studies that have been done point to any one technique as an effective way to permanently lengthen the penis. However, a temporary increase in size may be possible.One 2010 review reported that men who used the Andropenis stretching device saw an increase in size with extended daily use. Participants used the device for six hours per day over the course of four months. They gained anywhere from 1.8 to 3.1 centimeters (cm) in length.
Stretching with a device

To use a penis pump:

  • Place your penis inside the air-filled chamber.
  • Use the pump mechanism to suck the air out of the chamber. This pulls blood into your penis, causing it to become erect.
  • Attach the included ring or clamp to your penis to keep it erect for up to 30 minutes. It’s safe to have sex or masturbate during this time.
  • Remove the ring.

To use a traction device:

  • Insert your penis into the base end of the device.
  • Secure the head of your penis within the two notches at the opposite end.
  • Fasten the silicone tube around the shaft of the penis.
  • Grip the ends of the silicone tube on the bottom of the device and slowly pull your penis outward. Stop pulling if it starts to feel painful or uncomfortable.
  • Leave the penis in the stretched position for 4 to 6 hours a day.

Potential risks and complications

Being too rough with your penis can cause large tears in the tissues or damage to the ligaments that connect your penis to your body. These injuries can potentially hinder your ability to get or maintain an erection. When wearing a traction device, follow your doctor’s instructions for how long to wear it. Wearing it any longer can cause injuries that affect the penis function. After using a pump, don’t let the blood stay in your penis for more than 30 minutes. Having an erection for more than a few hours can permanently damage your penis. Stretching exercises or devices may cause:

  • itching
  • minor bruising or discoloration
  • red spots along the penile shaft
  • numbness
  • vein rupture

See your doctor if your symptoms last for more than a couple of days or are severe. Your doctor can assess your symptoms and advise you on any next steps.

Your results will depend on the approach you take and how consistent you are with use. Traction devices, for example, must be used daily — often for months at a time — in order to achieve any noticeable effects. Anecdotal reports suggest that using a penis pump can produce much faster results, but there isn’t any research to support this.It’s also unclear how much time will pass before you see results from manual stretching exercises.

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The bottom line

If you have questions or concerns about your penis size, talk to your doctor. They can discuss your options for lengthening and explain how to do so safely.Learning how your penis responds to stretching and other forms of stimulation may help you feel more comfortable with your body. You may also notice changes in appearance or performance over time.Be sure to follow any product directions or guidelines provided by your doctor. If performed incorrectly, stretching can result in injury or erectile dysfunction.Seek immediate medical attention if you experience pain or discomfort while stretching, or if you notice any change in your erectile function.

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