Dr Himesh Gandhi is a Senior Urologist and Director, Robotic Surgery, Ruby Hall Clinic, Pune
Dr Himesh Gandhi has made significant contributions to the fields of robotic surgery, UroLift, and Rezum therapy, particularly within urology.
In robotic surgery, Dr Gandhi has been at the forefront of utilizing advanced robotic systems to perform minimally invasive procedures with enhanced precision and control. His expertise in this area has led to improved patient outcomes, reduced recovery times, and minimized surgical risks.
Dr Gandhi’s work with UroLift, a minimally invasive procedure for treating benign prostatic hyperplasia (BPH), has helped many patients experience relief from symptoms without the need for more invasive surgery. By employing this innovative technique, he has improved the quality of life for numerous individuals suffering from BPH.
In the realm of Rezum Therapy, which uses steam to reduce prostate tissue and alleviate symptoms of BPH, Dr Gandhi has been a pioneer in adopting and promoting this effective treatment. His contributions have been instrumental in establishing Rezum as a viable option for patients seeking a less invasive alternative to traditional surgical methods.
Prostate cancer is one of the leading cancers in males in the current times.
Every year around 40- 60 thousand males are freshly diagnosed with prostate cancer.
Prostate cancer is the 8th most common cause for mortality in males, in India and is often neglected. It accounts for 26% of all cancerous diseases in males.
September is known as Prostate Cancer Awareness month.
Risk factors for development of prostate cancer:
- Increasing age
- More common in people of Afro- American descent
- Family hoister of prostate cancer
- History of chronic prostatitis or sexually transmitted diseases
Prevention of prostate cancer:
Prevention is not very effective for prostate cancer but prevention of chronic prostatitis can be done, thereby reducing the risk of prostate cancer. This can be achieved by:
- Frequent ejaculation
- Lifestyle and nutrition
- Drugs
Early detection of prostate cancer:
These investigations should be done by males over the age of 50 years:
- PSA screening, free PSA
- PHI (Prostate Health Index) test: it is a crucial marker which helps differentiate between chronic prostatitis and elevated PSA levels due to malignancy
- Digital Rectal Examination (DRE)
Clinical features and presentation:
Symptoms do not exist in the early stages of the disease.
In patients with local disease, the clinical presentation is similar to that of Benign Prostatic Hypertrophy.
Signs of local disease are:
- LUTS symptoms
- Erectile dysfunction
- Perineal pressure
- Blood in urine (hematuria)
- Blood in semen (hematospermia)
General symptoms of an advanced disease are:
- Unintentional weight loss
- Generalised body weakness
- Anemia
- Paraneoplastic syndromes, for example- tendency to develop venous thromboembolism
- Bone pain, pathological fractures
- Lymphatic oedema
- Neurological symptoms
- Cough and dyspnoea
- Jaundice
- Hepatic insufficiency
Initial assessment and investigations include:
- Digital Rectal Examination
- Quantitative PSA levels
- MRI
- PET scan to localise the area
- Biopsy- trans rectal/ trans perineal biopsy is considered if the undermentioned conditions are fulfilled:
- Suspicious lesion at DRE and/ or
- Verified PSA value of >/=4 ng/ ml or
- PSA rise >/= 0.75 ng/ ml/ year
Trans rectal biopsy is preferred due to ease of doing the procedure under local anaesthesia, less painful procedure and its low risk of post op infections.
Staging of prostate cancer:
- Stage 1: only in the right lobe
- Stage 2: involves both lobes
- Stage 3: the cancer breeches the capsule and spreads to the seminal vesicles
- Stage 4: comes out of the prostate and spreads to the surrounding organs and lymph nodes
Gleason’s scoring system is used to grade the biopsy, where:
Gleason 4 and 5: high risk factor
Gleason 3: low risk factor
Management of prostate cancer:
The management of the disease is done based on the spread of the disease.
- Localised disease: this can further be divided into:
- Low risk: active surveillance
- Intermediate risk: radical prostatectomy in combination with Radiation therapy and hormone treatment
- High risk: radical prostatectomy in combination with Radiation therapy and hormone treatment
- Locally advanced disease: radical prostatectomy in addition to radiation and hormone therapy
- Metastatically advanced disease: multimodal approach which includes radical prostatectomy in addition to radiation and hormone therapy
Minimally Invasive Surgical Treatment (MIST) for BPH (Benign Prostate Hyperplasia) includes Rezum Therapy which is a newer advancement in the field of minimally invasive surgery for the treatment of BPH.
Another surgical procedure for surgical treatment of BPH is Urolift wherein the prostate is lifted like a curtain. The advantage of this procedure is that few few staples only the surgeon is able to open up the urethra without compromising the sexual function.
It is a one- day procedure
Can be done for any individual with or without any associated comorbidities.
Side effects of Urolift last for 1-3 days (post op), these are:
- blood in urine
- Increased urinary frequency
- Burning senator while micturition
- Pelvic pain
- Urinary urgency
These symptoms resolve within 7- 14 days.
