a consultant urologist at Shifa International Hospital Islamabad, in an interview with Samana Syed
SN: For a start, tell us who are urologists?
Urology is the study of kidney, bladder and male genital organs. And urologists are the “hardware” engineers of these organs as they prescribe medicines along with surgery. Basically urologists deal with the structure and form while working of these organs is checked by nephrologists.
SN: Which are the common diseases in Pakistan?
The most common disease in Pakistan are kidney stones in adults and genetic issues in infants.
SN: By genetic problems, do you mean having kidney stones by birth?
Though rare, it is possible to have a defective kidney with stones by birth.
SN: Are people aware about visiting urologist with such issues?
The dilemma is people commonly prefer going to hakeems, dais (midwives) or homeopaths for treatment especially in case of stones. This however, worsens the issue. People come to urologists when their stone size increases by the use of wrong medicines. The prescribed drugs act as diuretics and increase urine flow causing the body to dehydrate and therefore stone size starts to grow. It is easy to treat a small stone but treatment of a bigger stone is always difficult. Such people claim that their medicine can help remove the stone. However, in reality, majority of the stones get eliminated with time, particularly the small ones. And they take credit for its removal.
SN: Many believe that homeopathic or desi treatment is more effective in curing these problems? Do home remedies work? Your take on this.
Of course, everyone wishes for a treatment that is cost effective, easy and does not cause pain. And that is what homeopaths or hakeems claim and mislead people. They are unaware about the scientific mechanism of treatment as they do not have any scientific knowledge about the disease, its causes and ways of treatment. As far as home remedies are concerned, keep in mind that different stones require different treatments. So, never try a home remedy without knowing the stone type.
SN: Pain in the lower abdomen is only caused by kidney issues; is it so?
This is not so. There are many other organs in the lower part that could also cause pain. Therefore, it is necessary to get it diagnosed first. Do not start self-treatment. It can be harmful and never take any medicine to suppress your pain. Sometimes, if you ignore the kidney pain once, it will not alarm you again until the last stage when cure becomes impossible.
SN: Is contaminated water a reason for having kidney stones?
People generally think that most kidney issues occur due to contaminated water. But it is not the direct cause. However, contaminated water can cause loose motions and dehydrate the body eventually producing stones.
SN: Then what are the actual causes?
Pakistan is situated in the “stone belt” region where chances of stone formation are the highest in the world. It is due to the severity of weather conditions. Unfortunately, southern Punjab and northern Sindh have the highest number of cases as this disease has now become hereditary (whether they live in such places or not). Another reason is inadequate water intake.
SN: Fluid intake is a must for preventing kidney and urine related diseases. How much fluid is best for us?
Although it is difficult to tell the exact amount but three to five liters in winters and four to five liters in summers is a must. Moreover, urine should always be diluted and light in color in any season since concentrated, dark urine signifies an issue.
SN: Can diabetes and high blood pressure cause kidney issues?
Diabetes can cause stone formation but high blood pressure cannot. However, both conditions are highly dangerous for kidneys. Unfortunately, Pakistan and India are among the top countries to have blood pressure and diabetes incidence in the world. To prevent these diseases: avoid self-treatment and have regular checkups especially after a certain age or you have a family history. Get your weight, pulse, blood pressure and sugar level checked whenever you see doctor for any reason. Moreover, be alarmed if you feel unusually hungry or thirsty, have weight loss or an incurable wound or injury.
SN: What causes kidneys not to flush properly?
Balance of two things is important: water and the particles that dissolve in water. Stones are produced when this balance gets disturbed. If you suffer from dehydration, number of filterable particles will be increased in the kidneys. Similarly, if your water intake is good but your kidneys are excreting unusual amount of filterable particles then also the function gets disturbed. Therefore, maintaining the balance is highly important.
SN: Many times in old age, kidneys fail along with many other issues. Why is this so?
Aging is one of the factors. Part of our kidney weakens each year which we call glomerular filtration rate (GFR). Moreover, co-morbidity is common in old age which means a person can have more than one disease. Also, older people use more medicines or have enlarged prostrate which affects their kidneys.
SN: Which foods to avoid in kidney problem?
Kidney’s culprit is salt which is used excessively in Pakistan. It can increase blood pressure, weaken bones and promote kidney stone formation. So, reduce its intake.
SN: How can kidney problems be diagnosed?
An ultrasound is the basic test that can help in diagnosis. It can tell the shape of kidneys, if there are obstacles, stone type, form, size and its location.
SN: Can stones recur?
Yes, there are around 35 to 50 percent chances for stone reformation. Stone removal does not guarantee that new stones will not appear. It is necessary to identify the cause for treatment and eventually gett rid of the problem.
SN: Are kidney and bladder stones different?
Bladder stones are of two kinds: stones that pass to the bladder from kidney and stones that are formed in the bladder. The latter are formed when there is an obstacle in the urinary tract. But in Pakistani children, protein deficiency can also be the cause of bladder stones.
SN: How can bladder stones be treated?
Sadly, majority doctors opt to operate it which is an unfair practice in this advanced era. Urologists can treat it without operation, with the help of endoscopy. Surgery should only be done when the stone size is extremely big. Therefore, always prefer consulting an urologist over a general surgeon or quack.
SN: What causes burning in bladder?
Urine infection causes burning in urine. Sometimes burning can also be caused by excessive excretion of calcium through urine or eating acidic food.
SN: Why does the kidney excrete excess calcium?
Overuse of calcium, kidney dysfunction in which it starts excreting more calcium than usual without any reason, disturbance of acidic balance or parathyroid hormones (hormones responsible for maintaining calcium) and excessive intake of vitamin D can cause excess calcium.
SN: What is Urinary Tract Infection (UTI)? It is more in women and old age?
It is infection of the urine and arises from the bladder. If it stays only in the bladder, it will be called lower UTI; otherwise it is called Upper UTI. It is seven percent more common in baby boys, in their first year of life. Otherwise women are more prone to this disease because bladder tube is smaller in them. Also, in old age, the chances of UTI increase as prostate issues are common in this age and it is associated to the problem.
SN: What are the causes of pain in urination?
Pain in urination is caused by infection, stone or obstruction in the bladder.
SN: Is there more than one thing that obstructs urine flow?
There can be many reasons for instance, stones in bladder or kidneys, birth defects or any injury or external compression, for instance tumor etcetera .
SN: Why does frequent urination occur?
Frequent urination is also called polyuria. There are many causes to it for instance; infection in the bladder, stones, bladder weakness or unstable bladder , drinking excess water and in some cases a smaller-sized bladder.
SN: People who experience polyuria usually avoid drinking water. Is it alright?
You should never avoid water intake as it can cause dehydration.
SN: Why do some people feel the need to void during the night? How can this be prevented?
This mostly starts after a certain age. However, youngsters could also experience the problem. It is caused when the natural biological clock in our bodies fails to work properly. The main purpose of this clock is to sense timings for urine production. Older women with weak bladder and older men with prostate issue are more prone to this defect.
SN: What does blood in urine mean?
It is a common problem and can have many causes. Most common among them are stones, several kidney issues or cancer. Immediately consult your urologist if you find blood in urine with or without pain as it can be cancerous.
SN: How is kidney and bladder cancer treated?
Kidney and bladder cancers are different and their treatments also differ depending on their type and stage. For instance, if cancer is localized in the bladder, it is burned through endoscopy. But organ removal becomes essential if it is spread. If kidney cancer is small and residing only at a side, we just remove half the kidney. The entire kidney is removed incase the cancer is spread to the whole organ.
SN: Is kidney removal important? People even sell it for money?
A kidney should only be removed if it is dysfunctional, otherwise removing it for the sake of money is unethical and unhealthy. Removal of kidney does not remove the problem. It rather intensifies it.
SN: Anything left that you would like to add at the end?
Never go to homeopaths and hakeems for kidney treatment. They do not have the required knowledge, skills and proficiency. In reality, even they come to us when they undergo such problems. Always consult a credible urologist when required.