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Urology FAQs - Dr. Nitin Shrivastava Answers Common Questions
Kidney Stones
Kidney stone FAQs
The classic symptom is sudden, severe pain in the loin or lower back that radiates to the groin - often described as worse than childbirth. Nausea, vomiting, and blood in the urine commonly accompany it. However, many stones are discovered incidentally on ultrasound. A non-contrast CT KUB is the gold-standard investigation and confirms a stone within minutes of the scan being reported.
Stones smaller than 5mm pass spontaneously in up to 80% of cases with fluid intake and a drug called an alpha-blocker (Tamsulosin). Stones between 5–10mm pass in about 50% of cases. Stones above 10mm rarely pass without treatment and usually need RIRS or PCNL. A CT KUB tells us the size and location precisely, which determines the recommendation.
RIRS (Retrograde Intrarenal Surgery) is a day-care procedure where a flexible scope is passed through the natural urinary tract - no external cuts - and a holmium laser fragments the stone. Most patients are discharged the next morning. Return to desk work: 3–4 days. Full activity: 2 weeks. A temporary DJ stent is placed for 1–2 weeks, then removed in an OPD visit.
PCNL (Percutaneous Nephrolithotomy) is used for large stones (above 20mm), staghorn stones, or stones RIRS cannot access. A small puncture (under 1cm) in the flank accesses the kidney directly. Hospital stay is 2–3 days. It is more invasive than RIRS but achieves better stone-free rates for large stones.
Prostate & BPH
Prostate FAQs
A weak or interrupted urinary stream, difficulty starting to urinate, a feeling of incomplete emptying, needing to rush to the bathroom (urgency), frequent urination - especially at night (nocturia) - and, in severe cases, inability to pass urine at all (acute urinary retention). Symptoms are graded using the International Prostate Symptom Score (IPSS). Treatment depends on symptom severity and the degree of obstruction on flow studies.
TURP (Transurethral Resection of the Prostate) uses electrical current to chip away prostate tissue through the urethra - no external cuts. It is the gold standard for moderate-sized prostates. HoLEP (Holmium Laser Enucleation) removes the entire inner prostate using a laser and works for prostates of any size, including very large ones. HoLEP has lower recurrence rates. Both are highly effective. Dr. Nitin will recommend the appropriate technique based on your prostate size and anatomy.
PSA (Prostate-Specific Antigen) is produced by the prostate gland - not just by cancer. BPH, prostatitis, and even vigorous cycling can raise it. A PSA above 4 ng/mL, or one that is rising rapidly (PSA velocity), warrants assessment. The modern approach is a prostate MRI (mpMRI) first, then a targeted biopsy of any suspicious area - rather than a blind biopsy. This finds more significant cancer and avoids over-investigation of insignificant lesions.
No. The treatment for prostate cancer depends on the risk level (Gleason score, PSA, staging) and the patient's age and preferences. Low-risk prostate cancer can be safely observed on active surveillance - with regular PSA, MRI, and biopsy checks. Intermediate and high-risk localised disease is treated with surgery (robotic prostatectomy) or radiotherapy. Advanced disease is managed with hormone therapy and newer agents. Dr. Nitin explains all options and helps you decide.
Urological Cancer
Cancer surgery FAQs
Blood in the urine - even once, even painless, even if it went away - is the cardinal warning sign. Bladder cancer should be excluded before it is attributed to a UTI or other cause. Urinary urgency and frequency that does not respond to antibiotics, or weight loss combined with urinary symptoms, are also concerning. Investigation is a flexible cystoscopy (camera into the bladder under local anaesthetic) - a 10-minute procedure.
Small kidney tumours (under 4cm) can sometimes be observed or ablated rather than surgically removed - this decision is made based on your age, overall health, and tumour characteristics. Tumours larger than 4cm are usually treated surgically. Robotic partial nephrectomy (removing only the tumour, preserving the kidney) is preferred when technically feasible. Larger tumours, or those in central locations, may require radical nephrectomy (complete kidney removal). All are performed robotically at Apollo Hospital Gurugram.
Male Infertility & Sexual Health
Male health FAQs
Zero sperm in the ejaculate is called azoospermia. It affects about 1% of men. There are two types: obstructive azoospermia (sperm are produced but cannot get out due to a blockage) and non-obstructive azoospermia (the testes are not producing sperm adequately). This distinction is made by FSH hormone level and testicular biopsy/TESA. Obstructive azoospermia is treated with PESA or TESA sperm retrieval + IVF-ICSI. Non-obstructive azoospermia may be treated with hormones or microTESE surgical exploration.
Yes - varicocele is the most commonly identified correctable cause of male infertility. It affects 15% of all men and up to 40% of infertile men. By raising scrotal temperature, it impairs sperm production. Microsurgical varicocelectomy (repair through a small groin incision) improves semen parameters in 60–70% of men, with natural pregnancy rates improving significantly within 6–12 months of repair.
Female Urology
Female urology FAQs
Recurrent UTI (2+ episodes in 6 months) deserves a urological assessment - not just repeated antibiotic courses. A urologist investigates the underlying reason: incomplete bladder emptying, anatomical factors, antibiotic resistance, post-menopausal oestrogen deficiency, or bladder pathology. A prevention strategy includes adequate fluid intake, post-coital precautions, potentially low-dose prophylactic antibiotics, and - for post-menopausal women - vaginal oestrogen, which is highly effective at reducing recurrence.
Yes - most cases of urinary incontinence are treated successfully without surgery. For stress incontinence (leaking on coughing or exercise), pelvic floor physiotherapy is the first-line treatment and is effective in 60–70% of cases. For urgency incontinence (leaking before reaching the toilet), bladder training and medication (anticholinergics or beta-3 agonists) resolve or significantly improve the problem for most patients. Surgery (sling or Botox) is reserved for cases not responding to conservative treatment.
General
General urology FAQs
Haematuria means blood in the urine - it can be visible (frank haematuria, where the urine looks pink, red, or cola-coloured) or microscopic (detected on urine dipstick or microscopy only). Visible haematuria should always be investigated promptly. It is not always cancer, but bladder cancer, kidney cancer, and kidney tumours can present this way. Haematuria with fever and loin pain (suggesting infection/obstruction) is a medical emergency - attend hospital immediately.
At Six Sigma Clinics, Sector 50, Dr. Nitin sees patients both with and without a GP referral. A referral letter is helpful context but is not required for a consultation. At Apollo Hospital Gurugram, you can book directly via the hospital's OPD system or WhatsApp the team (+91 78382 86336) for direct booking. Insurance pre-authorisation for surgery typically requires a specialist's written recommendation, which Dr. Nitin provides after consultation.
Routine appointments are usually available within 3–7 working days. Urgent cases (blood in the urine, acute retention, severe pain, rapidly rising PSA, suspected cancer) are prioritised - WhatsApp +91 78382 86336 and mention urgency; the team will accommodate within 24–48 hours in most cases. Evening appointments are available at Six Sigma Clinics, Sector 50 (Mon–Sat, 6–8:30 PM).
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