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| Dr Narasimhan Subramanian |
Recently, some experts from Apollo Hospital, New Delhi, India were in Nigeria to train our doctors on specialized surgeries. One of them, Dr Narasimhan Subramanian, a consultant urologist, spoke to WINIFRED OGBEBO and VICTOR OKEKE on the urology specialty and everything relating to it.
What is urology?
Urology is a branch of medicine which primarily deals with all urine, kidney and reproductive organs-related problems. It is a surgical specialty which deals with diseases of the male and female urinary tract, the male reproductive organs and the kidney. It is a surgical branch where we, surgeons treat these conditions.
Developments have continuously happened in urology over the last hundred years. We are trying to highlight those segments of development in urology which would make patient care easier either in terms of diagnosing the condition early or introducing treatments which are less invasive so that we reduce the pain, the duration of hospitalisation, ensure they return to work early and the amount of pain and the amount of deformity on the scalp becomes negligible.
Similarly, when you look at various cancers, some cancers can be prevented. For instance, you can prevent lung cancers if people reduce smoking and start breathing better. Whereas many other cancers you can’t stop them but what you can do is to diagnose them early. When you diagnose them early, you are catching at a stage where they are curable. The new advances in terms of the blood tests and scans we do make us diagnose these much earlier than you would otherwise understand.
Is such knowledge transferable? Is it something you can transfer to a hospital like the Abuja University Teaching Hospital?
Majority of the knowledge which we have in medicine today is something which we can transfer both by interactions like what we are doing today. What we are doing today is that our own experience of newer techniques and methodologies is being shared with our colleagues in this part of the world.
Some of them may require newer technologies to be available physically here; some of them on the other hand can be done by satellite models.
Let us assume that I have operated a patient from Nigeria in India, I don’t need him to come and see me every time in India. There are the telemedicine systems whereby he can be at anywhere with an access to Skype or Teleconferencing and I can see his medical condition and offer medication as required.
Similarly today, what you find is that the surgical operations which I’m doing in India can be easily viewed through the satellite by colleagues in this part of the world.
So, almost all the knowledge and procedures are transferable but to get one’s hands on experience, one obviously needs to be present in those centres which require a large volume of work because when the volumes are high, you end up needing much longer time to acquire that level of skill.
Urologic disorder especially kidney problems are very common in Nigeria as we imagine they would be in India as well. Did you study the urological landscape of Nigeria in the course of preparing your material for this CME? What are the common kidney problems in Nigeria?
The common kidney problems which relate to stone disease formation, cancers, infections and others, wider studies would indicate that there are no specific regions in Nigeria where kidney related problems are likely to be higher. But across the country, what happens is, because of the number of patients with high blood pressure or diabetes which are inadequately controlled, there is a higher incidence of kidney failure and of people requiring dialysis and kidney transplants.
The second is prostate cancer. Incidences of prostate cancer are much higher in certain races than the other. Among the Caucasians in the United States it’s quiet high, among the Chinese it’s the lowest. We the Indians and the Sothern Asians come somewhere near the Chinese.
People from Africa and the Caribbean will not only have higher rates of prostate cancer compared to the Indians but there tends to be a larger volume of cancers and seem to occur in relatively younger people as well. So understanding these diseases and the need for more aggressive treatment becomes more important.
What preventive measures can Nigerians take to prevent kidney diseases?
When you look at kidney diseases, you would take about four common conditions. One is kidney stones, second is infections in the kidneys, third is the kidney failures and fourth is the cancers of the kidneys.
Talking of stones, one of the most important single steps is that we must all drink a lot of water. If you drink three or more litres of water every day, then you reduce your chances of stone formation.
Similarly, once you have formed the stone, there are different types of stones which may require different dietary restrictions and some of them may even require certain medications to reduce the formation of stones. Coming to infections in the kidney, again, many of the urine infections do not necessarily affect the kidneys but if these infections are untreated or are associated with medical conditions which are not recognised, then they can affect the kidney.
Coming to the issue of kidney failure, what you would need is that early diagnosis and recognition of infections in the kidney- high blood pressure and conditions associated, diabetes and associated conditions, and use of pain killers in an unregulated fashion. When you address all these, you will certainly reduce the incidences of kidney related medical problems.
The basic mechanisms by which stones are formed, there are salts that are present in the body and when the concentration of the salts becomes more in the kidney, that is when stones are formed. So if you dilute these by forming more urine it gets washed off the system and reduce this stone formation. [Leadership.ng]
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