Treatments and procedures

Dr Subodh Kamble offers and perform a variety of treatment and procedures to evaluate, diagnose and treat urologic conditions. Dr Subodh Kamble hold expertise in many types of urological conditions that includes, functional Urology, Female Urology, Andrology, Neuro-Urology, kidney stones, prostate surgery and all types of urological cancers. He has an extensive experience in managing urology patients. He acquired extensive experience and skills, and developed expertise in managing and operating patients with wide variety of urological conditions.

Dr Subodh Kamble is extensively trained in the super specialty of urology in UK and Australia. He offers all types of comprehensive care offering medical management and surgical management.

Diagnostic procedures

Trans perineal prostate biopsies

Dr Subodh Kamble holds expertise in all types of prostate biopsies. He has an expertise in performing precision point Trans perineal biopsy of the prostate both under Local Anaesthesia as well as General Anaesthesia. The Trans perineal biopsy of the prostate is far superior to the TRUS (trans rectal) biopsy of prostate in terms of diagnosing the prostate cancer.

*He is the only Urologist in the entire India to offer and do trans perineal precision point prostate biopsy under Local Anaesthesia*.

Dr Subodh Kamble also holds expertise in performing template biopsies for the prostate. Template/trans perineal biopsy of prostate is far superior to the conventional TRUS (trans rectal) biopsy of the prostate. Transrectal biopsies currently offered has only 60% yield in diagnosing the prostate cancers. Nearly 40% cancers are missed with this technique. Trans perineal prostate biopsies is the best method for diagnosing prostate cancers.

Flexible cystoscopy

Dr Subodh Kamble holds expertise in flexible cystoscopes which is performed under local anaesthesia and can be done in outpatient clinics as well. Flexible cystoscopy is used either in outpatient clinic or minor operative theatre to diagnose many conditions in investigation of multiple urological conditions, including cancers. Dr Subodh Kamble has performed well over 20,000 flexible cystoscopies and offers painless cystoscopies without having to put patients through general anaesthesia.

Flexible cystoscope is more commonly used, particularly for diagnosis and bladder tumour follow-up. It uses a fibreoptic instrument that bends easily to pass along the curves of the urethra, allowing the urologist to view the lining of the urethra, prostate and bladder.

Rigid Cystoscopy

A rigid cystoscopy is a procedure that uses a cystoscope, or lighted telescopic catheter, which allows a urologist to directly view the inside of the bladder and urethra. Rigid Cystoscopy evaluation is performed under general anaesthesia. Rigid cystoscopy can be performed both as diagnostic or to perform other procedures.

Rigid cystoscopy uses a solid, straight telescope and high intensity light. A separate channel allows the urologist to use a variety of instruments for biopsy or other procedures.

Digital rectal examination

A digital rectal examination (DRE) is performed to check for growths on, or enlargement of, the prostate in men or rectal lesions in men and women. During a digital rectum exam, a urologist inserts a gloved finger into the rectum to feel the condition of the prostate, which is in front of the rectal wall. Age related enlargement is not a particular concern, but if the gland feels unusually firm or hard, it may indicate an abnormal growth in the prostate gland and further testing can be performed.

Urodynamics

Urodynamic testing, also known as cystometrogram (CMG), assists in the diagnosis of urinary incontinence and other voiding conditions by evaluating the sensation and motor control, capacity and coordination of function of the bladder. While monitoring the storage and emptying functions of the bladder, a CMG allows for correlation of urinary flow rates, muscular and neural control of the bladder.

In urodynamic testing, small size catheters are inserted into the bladder and rectum. Fluid fills up the bladder and creates pressures that are monitored by computer to assess lower urinary function. This takes approximately 45 minutes, does not require the use of drugs and typically involves minimal discomfort.

Transrectal ultrasound guided prostate biopsies

If the blood test PSA (prostate-specific antigen) is abnormally high or the findings on examining the prostate through the back passage are abnormal, a transrectal ultrasound (TRUS) may be recommended. This is the most common way to image and biopsy the prostate.

An ultrasound scan is a test that uses sound waves to create an image of the inside of the body. To scan the prostate gland a small probe is passed into the rectum. This scan measures the prostate’s density and size. While scanning the prostate samples of cells (biopsy) can be taken for further examination under the microscope.

PSA (prostate-specific antigen) testing at a glance

PSA testing is a blood test for men that assesses levels of the prostate-specific antigen, a protein that can indicate the presence of prostate cancer. The PSA test has saved many lives due to early diagnosis of prostate cancer, the second leading cancer-related cause of death in men.

Urinary incontinence/Urinary Leak

InterStim Therapy

InterStim Therapy is a reversible therapy that uses an implantable device to send mild electrical pulses to stimulate the sacral nerves. Those nerves control the muscles of the pelvic floor, urinary and anal sphincters, lower urinary tract and colon. The sacral nerves are located just above the tailbone, near the spinal cord. InterStim Therapy, also known as sacral nerve stimulation or sacral neuromodulation.

Urologists uses InterStim Therapy to treat the following conditions:

  • Urinary incontinence: the involuntary leaking of urine due to the loss of bladder control

  • Overactive bladder (OAB): the sudden urge to urinate that cannot be controlled

  • Urinary retention: the inability to empty the bladder; patients will often feel full but cannot urinate or only release a small amount of urine

  • Faecal incontinence: the inability to control bowel movements causing stool to leak unexpectedly from the rectum.

InterStim Therapy is available for patients, most often women, who have not had success with more conservative options like Kegels, pessaries and physical therapy. InterStim is not intended for patients with stress incontinence, urinary blockage, patients with a pacemaker or diabetic patients. Dr Kamble has expertise in this procedure.

Intravesical Botulinum Toxin in Bladder

Botulinum Toxin is a drug prepared from the bacterial toxin botulin, used medically to treat certain muscular conditions and cosmetically to remove wrinkles by temporarily paralyzing muscles. Botox is an approved treatment for overactive bladder, urinary incontinence and spastic bladders caused by neurologic diseases. Dr Subodh Kamble probably has the highest number of these operations done and highest success rate in India.

Intra Sphincteric Botulinum Toxin in Sphincter

Botulinum Toxin can also be used to treat lack of coordination between the bladder muscles and the sphincter muscles. This can be caused due to spinal cord trauma or the neurologic diseases. Dr Subodh Kamble offers this surgery to his patients and probably the only urologist to perform this surgery successfully in India. Patients travel from overseas to him to get this surgery done.

Intra Urethral Bulking agents

Intra urethral bulking procedure is to add synthetic material to tissues around the urethra to help support it and treat urinary leakage due to weak sphincter muscles or the pelvic floor muscles. Dr Subodh Kamble has performed many of these surgeries successfully for the treatment of urine leakage.

Sling procedure for women

One of the commonest type of surgery to correct stress incontinence is a sling procedure. During this procedure, surgeons use body tissue, mesh or synthetic materials to create a sling or ribbon that acts as a hammock to support the urethra. The sling ensures the urethra remains closed during non-urinating actions like laughing, coughing, sneezing or lifting. There are a few different types of sling procedures. The most common is a mid-urethral sling surgery. During a mid-urethral sling procedure, a surgeon will use a narrow piece of synthetic mesh placed under the urethra to support it and the neck of the bladder. Having been trained as a fellow in female urology, Dr Kamble has expertise in performing this surgery.

Retropubic suspension/urethropexy

Dr Kamble is expert in performing open as well as laparoscopic Burch colposuspension, also known as a Burch urethropexy or colposuspension. Many Urologists use the Burch colposuspension as the primary urethropexy for certain group of patients.

In many countries the sling procedures are banned owing to the high complication rates hence a laparoscopic Burch is an alternative for those who wish to avoid procedures that use synthetic mesh. Dr Kamble offers both urethral bulking agent surgery as well as Burch colposuspension to his patients with urine leak due to weakness of muscles.

Sling procedure for men

Certain males, especially following the radical prostatectomy surgery for prostate cancer, develops intractable urine leakage. Dr Kamble performs urethral bulking agent surgery as well as male advance urethral sling operation for the treatment of the urine leak following their prostate surgery. Sling is used to lift the urethra to stop the urine leak.

Artificial urinary sphincter for men

For extensive urinary incontinence in male patients, an artificial urinary sphincter may be recommended. This is a small ring filled with fluid that is surgically placed around the bladder. When the patient would like to empty his bladder, he presses a valve placed under the skin that will cause the ring to deflate and allow urine to flow from the bladder. Dr Kamble performs this surgery on some of his patients with urine leak who opts for this type of surgery.

Prostate and Bladder cancer

Hormone therapy

Hormone therapy cuts off the supply of the male hormone testosterone. Prostate cancer cells can’t grow without testosterone. In men whose prostate cancer is advanced, hormone therapy can shrink the cancer and make tumours grow more slowly. For some organ confined prostate cancer, urologist and the oncologist may use hormone therapy to shrink tumours before treating them with radiation therapy. Hormone therapy is then continued for 3 years post radiotherapy as per the guidelines.

Blue light cystoscopy

Dr Subodh Kamble holds expertise in blue light cystoscopy technique, which is another innovative diagnostic as well as therapeutic procedure increasing yield of diagnosing the bladder cancers. In comparison to normal white light cystoscopy 65% more chances of diagnosing bladder cancer, specially carcinoma in situ (CIS), which is high grade cancer of bladder. This procedure is rarely performed in India.

Benign enlargement of prostate (BEP)

Presenting complaints are straining to pass urine, slow or weak flow of the urine, starting and stopping of urine (hesitancy) and incomplete emptying of the bladder. There is constant feeling that they haven’t emptied their bladder. Anyone with above complaints may need medical or surgical treatment for their benign enlargement of the prostate. Males with prostatic enlargement should also have PSA (simple blood test for prostate) checked.

  • Dr Subodh Kamble offers expert treatment both medical and surgical for the BEP

  • TURP (trans urethral resection of prostate) (monopolar as well as bipolar)>

  • • HoLEP (Holmium laser enucleation of prostate) and Green laser evaporation of prostate