Webinar with Dr Percy Jal Chibber on kidney and prostate care

On Saturday, September 5, Dr Percy Jal Chibber, Director-Department of Urology & Renal Transplantation Surgery, at the H N Reliance Foundation Hospital and Senior Consultant Urologist at the Jaslok and Breach Candy Hospitals addressed Seniors Today readers on kidney and prostate care.

On Saturday, September 5, Dr Percy Jal Chibber, Director of Urology and Renal Transplantation at the Sir H N Reliance Foundation Hospital and Research Centre,  spoke with Seniors Today readers on kidney and prostate care. Dr Chibber  is also Senior Consultant Urologist at the Jaslok and Breach Candy Hospitals in Mumbai.

Dr Chibber has been Honorary Visiting Urological Laparoscopy Specialist to the Tata Memorial Cancer Centre. Although he practises all aspects of urology, his special interests are Endourology, Urologic Laparoscopy/ Robotic Surgery and Renal Transplantation.

Dr Percy Jal Chibber took his undergraduate medical education (MBBS) in Mumbai at the B Y L Nair Hospital. He did his MS in general surgery standing first in the university and was awarded four gold medals.

He did his specialist training in Urology at the University of Edinburgh and also obtained his fellowship of the Royal College (FRCS). He returned to Mumbai and started his urological practice in 1981, and was soon appointed Honorary Assistant Professor of Urology at the Grant Medical College and the Sir J J Group of Hospitals, where he was later to hold the position of Professor and Head of Urology and Renal Transplantation between 1995 and 2007.

In 1983, Dr Chibber trained in the techniques of Percutaneous Renal Surgery, in UK, and the USA, with Mr J E A Wickham and Dr Arthur Smith, respectively, both of whom have been described as pioneers of Minimally Invasive Urological Surgery.

Since 1983, he has developed and pioneered the techniques of Percutaneous Renal Surgery and Radiology in India, and has one of the largest personal series of the procedure in the world. Since January, 2000, he has been performing and training students in the techniques of Laparoscopic Urological Surgery. Dr Chibber was invited by the Cleveland Clinic to spend six weeks as an International Scholar in the department of Laparoscopic Urology in May 2001.  He trained in Robotic Urology at the OLV Institute, Alst, Belgium in 2011. He was the President of the Urological Society of India for 2015-2016.

Dr Chibber has published numerous papers in peer-reviewed national and international journals, and has authored chapters in books.

Takeaways from Health Live @ Seniors Today with Dr Percy Chibber

1. Prostate gland – The shape of the prostate gland is of a walnut with a leathery texture. Urine is passed through the centre of this gland. It is an important gland for reproduction. Prostate produces fluid that contains 0.1ml of sperms which fertilises the egg for child production. This gland has muscles in it that contracts while ejaculating to empty the prostates. Ejaculating is the best way to empty the fluid than massaging it. 

2. Prostate ailments – The conditions that commonly people suffer from, benign prostatic enlargement, prostatitis, and cancer prostate. 

Benign prostatic enlargement is a condition that is part of growing old. After the age of 60 the prostate invariably grows – just like grey hair. 

Prostatitis is an infection of prostates that can occur in any age but general occur between the age of 40-60.

Cancer of the prostate, the most sinister of all prostate ailments.

3. Prostate and bladder – Enlarged prostate causes blockage of the bladder, it thickens over time causing discomfort while urinating. As the bladder becomes thicker it becomes weaker, and due to increases bladder contraction the person may experience frequent/urgent/nocturnal urination.  

4. Size does not matter – Every individual experience symptom that are independent of their prostate size. One with a small prostate may experience various symptoms while another with a large prostate may experience no symptoms at all.  The size of the prostate as nothing to do with the symptoms. 

5. Rectal examination and sonography – A rectal examination is performed to check the hardness, nodules and asymmetry of the prostate while a sonography detects the emptiness of the prostate and kidney stones if any. 

6. Symptoms of the bladder – There are two types of symptoms that one may experience, one – irritative and two – obstructive. Irritative symptoms consists of frequent, urgent and nocturnal urination. While obstructive symptoms consist of weak urine stream, interrupted urination, staining your pants, and bladder not empty.  

7. Medical treatment – There are plenty of medicines available in the market that are used to treat symptoms of prostate discomfort. Below are the class of drug used for treating prostate medically.

For obstructive symptoms 

Alpha blockers help relax the muscle at the outlet, but this drug is effective only when it is used – 24 hours. Hormone Antagonist helps regress the prostate, to experience its effectiveness one has to use it for longer – 2-3 years.

For bladder overactivity

When a person experiences urgency to rush to the washroom, that’s a sign of an overactive bladder, drugs such as Mirabegron and Solifenacin are used to treat this symptom as long as it persists.

For erectile problem

As you grow older you may experience erectile dysfunction. Sometimes urinary medication is combined so improve erectile function. A low dose of Tadalafil can be used for ED.

8. Prostate surgery – If you are not doing well with the medication then you will need a surgery to recuse you. If the symptoms persist even after using medication – frequent urination, have to stop a conversation and rush to the bathroom, or staining your pants, then you have to get yourself checked.

9. Transurethral resection of the prostate (TURP) – This is a surgical procedure to treat enlarged prostates. A resectoscope is inserted to take out the excessive growth of prostate. 

10. Green light laser – For people who are on blood thinner can opt for a green light laser to chisel out excessive prostate. It is a safe procedure.

11. Holmium laser – For people with humongous prostates, 200-250 grams they require a little extra procedure to reduce the size of the enlarged prostate.

12. Robotic simple prostatectomy (RSP) – This is a minimal invasive surgery performed using a robot to extract big sized prostates. 

13. Prostate cancer – When the cells in the prostate begin to mutate in the peripheral zone. This happens due to growth and multiplication of testosterone in the body. These cells produce PSA – prostate-specific antigen, this reveals whether the PSA levels are fine or no. Symptoms of prostate cancer are similar to enlarged prostates hence making a prognosis based on the symptoms are not recommended. 

14. Diagnosis of prostate cancer – Early diagnosis of prostate cancer is possible. Cancer of the prostate is diagnosed in people with genetic history or people with higher risk by digital rectal examine (DRE) to examine the hardness of the nodule, followed by a PSA test to check the levels if they are higher or lower. If the PSA level is higher, then a biopsy is performed to examine and grade the risk of cancer, and in some cases, to get better clarity of the condition an MRI is required.

15. PSMA PET CT – This test gives you an idea of whether the cancer has spread to other parts of the body.

16. Treatment for prostate cancer – Cancer levels differ from person to person – low, intermediate and high. The primary intent of the treatment is performed with curative intent, to help you get rid of the cancer. Treatments include, radical surgery – where the prostates with cancer are removed. The other procedure is radiation treatment when the cancer cells are burnt using radiation. 

17. Surgery for prostate cancer – There are three methods of surgery, one is open method of surgery, radiation and robotic surgery. Open method is an old method where the surgery is performed with hands. Whereas with robotic surgery is performed remotely. The advantages of robot surgery are that it provides 3D imaging, 10-fold magnification, the moments are of 6 DOF (degree of freedom – like a wrist), its steady and precise. Radiation surgery is performed if the patient is old or has some complications.

18. CSPC – Castrate-sensitive prostate cancer (CSPC). If you remove the testosterones from the patient the cancer will immediately shrink. This is usually performed in the beginning.

19. CRPC – Castrate-resistant prostate cancer (CRPC). If the cancer comes back after the treatment the patient falls under CRPC domain. With various medication hormones are manipulated and then on the basis of severity of the patient various medication and hormones are given.

20. PSA index – Prostate-specific antigen give an overview of protein secreted by the prostates. The parameters of PSA – 

• 4 ng/dl is considered normal
• 4-10 ng/dl is considered borderline
• More than 10 ng/dl is considered as a concern.