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Nephrology And Renal Transplant Service

Prominent & Leading Nursing Homes / Clinics / Hospitals from New Delhi, we offer Nephrology And Renal Transplant Service, Benign Prostate Enlargement Treatment Services, Bladder Cancer Treatment Services, Urology Treatment Service, Kidney Transplant And Dialysis Treatment Service and Kidney Stone Treatment Services.

Nephrology And Renal Transplant Service
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Primus Nephrology, Kidney Transplant & Dialysis Center is a leading center for innovative treatments. Our center is dedicated to highest standards of patient care with human touch, offering pioneering procedures that minimize.

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Benign Prostate Enlargement Treatment Services
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What are lower urinary tract symptoms (LUTS)?

LUTS (lower urinary tract symptoms) refers to the conditions that define a wide range of symptoms or issues of the lower urinary tract that comprises of bladder, urethra and prostate gland. LUTS are widely categorized into voiding or obstructive symptoms or storage also called irritative symptoms. A person may have voiding symptoms, or storage symptoms, or a combination of both.

 
Obstructing Symptoms or Voiding                                            Storage or Irritative Symptoms

 

 

 

 

Poorly directed and weak stream of urine                               An urgent need to urinate

 

 

Strain while urinating                                                                   A shorter time between urination

 

 

Irregular stream or dribbling even after                                    Incontinence- that is followed by an

finishing urination                                                                         uncontrolled  flow of urine after

an intense urge to pee

Chronic urinary retention
Difficulty in starting Urination
Overflow or paradoxical incontinence –

 

urine overflows from a full bladder uncontrollably

even though normal urination can be difficult to start

How common are LUTS?

LUTS are very common amongst the ageing male population. These symptoms have notable effects on quality of life in aged men. About 30% of men between the age of 50 and older have LUTS ranging from moderate to severe. This is a very large group potentially requiring treatment. Although LUTS do not usually cause severe illness, they can considerably reduce patient’s quality of life and that may point towards severe pathology of the urogenital tract.

 

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  • Bladder Cancer Treatment Services
  • Bladder Cancer Treatment Services
Bladder Cancer Treatment Services
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Symptoms of Bladder Cancer

  • Appearance of blood or blood clots in the urine
  • An urge to urinate several times throughout the night(nocturia)
  • Feeling the need to urinate, unable to pass urine
  • Painful urination or burning sensation during urination
  • Frequent urination
  • Lower back pain on either side of the body

Bladder Cancer: Diagnosis
The following tests are done for diagnosing and learn more about

Bladder cancer:

  • Cytology, kit tests
  • Ultrasound
  • CAT scan or Computed tomography (CT scan)
  • Magnetic resonance imaging (MRI)
  • Positron emission tomography (PET) also known as PET-CT scan.

Bladder Cancer Treatment

  • The main diagnostic procedure for bladder cancer is cystoscopy.
  • This procedure helps the urologist to see inside the bladder with the help of thin, lightweight and a flexible tube called also known as a cystoscope.

Transurethral resection of bladder tumor (TURBT)

  • Transurethral resection of bladder tumor (TURBT). TURBT is also known as Transurethral resection of a bladder tumour. If an irregular or unusual tissue is found while performing a cystoscopy, the urologist usually recommends a biopsy. A biopsy refers to the removal of a small fragment of tissue for review under a microscope
  • A TURBT is helpful for the diagnosis of bladder cancer and finding out about the type of tumour, what are the extent of its depth and what layers of the bladder it has gone to, and identification of any further microscopic cancerous transformations, also known as carcinoma in situ (CIS)
  • A TURBT can also be used as a treatment for a non-muscle-invasive tumour.

FAQ’s For Bladder Cancer

What is urinary bladder?

The bladder is an elastic, hollow organ in the pelvic region that collects urine before it moves out from the body during urination, because of this role, it makes the bladder an essential part of the urinary tract.

The bladder, just as the any other part of the urinary tract, is lined with a band of cells known as urothelium. This layer of cells is secluded from the bladder wall muscles called muscularis propria, by a thin, fibrous band known as lamina propria.

What is bladder cancer ?

Bladder cancer is the abnormal growth of healthy cells in the bladder lining that grows excessively and out of control, forming a mass called a tumour.

What are the tumour types?

  • A tumour is of two types malignant and benign.
  • A malignant or a cancerous tumour means it can grow and expand to join other body parts.

A benign tumour grows but does not spread to other body parts.

There are three main types of bladder cancers:

Urothelial carcinoma(most common). is the most common type of cancer that estimates for about 90% of all bladder cancers. This type of bladder cancer develops in the urothelial cells that are found in the lining of the urinary bladder. Earlier, this cancer was known as transitional cell carcinoma(TCC).

Squamous cell carcinoma. in response to irritation and inflammation squamous cells develop in the bladder lining (like patients on prolong catheterization). With time these cells become malignant. About 2-4% of all bladder cancers are squamous cell carcinoma.

Adenocarcinoma. About 2% of all bladder cancers are adenocarcinomas that develops from epithelial cells.

Bladder cancer is also defined as muscle-invasive, and non-muscle-invasive depending on whether it has spread into or through the muscle of the bladder wall.


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Urology Treatment Service
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We at Primus utilize the highly advanced and sophisticated diagnostic procedures and the latest treatment procedures to treat urology conditions. We deliver comprehensive, multi-disciplinary care for all kinds of urologic disorders, including cancers, kidney stones, incontinence, impotence, prostate problems, bladder issues and deformities. 

Our speciality services in Urology department include:

  • Laparoscopic procedures including nephrectomy
  • Bladder reconstruction
  • Brachytherapy (radioactive seed implantation)
  • Extracorporeal shock wave lithotripsy to destroy kidney stones
  • Endoscopic and percutaneous techniques
  • Genitourinary reconstruction
  • Medical and surgical treatment for sexual dysfunction and impotence
  • Minimally invasive techniques for benign prostatic hyperplasia and other conditions
  • Minimally invasive injection therapies and other procedures for incontinence
  • Penile reconstructive surgery
  • Percutaneous radiofrequency ablation of kidney tumours
  • Urodynamic evaluation

 Patient care Academic Program:

Patients and doctors interactive programs are held at regular intervals to educate about prevention and retardation of progression of renal failure in patients of pre dialysis and rehabilitation and counseling for patients on renal replacement therapy.

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Kidney Transplant And Dialysis Treatment Service
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General Information

Primus Nephrology, Kidney Transplant & Dialysis Center is a leading center for innovative treatments. Our center is dedicated to highest standards of patient care with human touch, offering pioneering procedures that minimize risk and hasten recovery. We provide clinical services in all areas of nephrology including: clinical nephrology, kidney transplantation , haemodialysis, hemodialfiltration, sustained low efficiency dialysis (SLED), CRRT, Plasmapheresis, peritoneal dialysis and critical care nephrology.

Our goal is to deliver the highest level patient care, consistent with our philosophy of keeping the patient at the highest priority. The scope of services the department offers includes

  • Clinical Nephrology – Regular Consultation
  • Critical Care Nephrology
  • Dialysis – Peritoneal Dialysis (Acute PD, CAPD, APD)
  • Haemodialysis – Maintenance HD and Hemodialfiltration
  • Emergency HD
  • SLED
  • CRRT – (CVVHD) for critical Patients

 Primus Offers full spectrum of renal solutions

Primus super-specialty hospital offers cutting edge care in all areas of nephrology with round the clock delivery of care for dialysis, transplant and chronic kidney problems.

  • Nephrology
  • Chronic Kidney Disease clinic
  • Kidney- Hypertension clinic
  • Transplant clinic – Pre transplant & post transplant
  • Comprehensive diabetic clinic
  • Patient education programmes & preventive nephrology

 Primus Kidney Transplant & Dialysis Center

The department of Nephrology at Primus provides comprehensive and high quality services. It has state of art Advanced Kidney Dialysis (AKD) unit. The department focuses to provide highest quality medical care with a human touch. The department is one of the first few centers in India to provide state of Art Renal Replacement Therapy.

 Dialysis Unit:

Latest generation, state of art fifteen bicarbonate haemodialysis machines with volumetric ultrafiltration and adjustable sodium facility, provide better patient safety profile.

We provide state of Art R.O.(Reverse Osmosis) water for the dialysis, to ensure patient safety and prevent long term complications on haemodialysis. Facility for continuous monitoring of sick patient on dialysis through highly sophisticated monitors throughout the dialysis procedure is available. Each haemodialysis session is for four hours duration. We make sure that adequate dialysis is given to the patients without compromising on duration of dialysis sessions. As, some of the hospitals are giving, only three hours of dialysis in each sessions, in which patients have to take more than twice or thrice weekly dialysis in order to get adequate dialysis.
Supported by highly trained Medical, Technical and Nursing staff, our dialysis unit provides the best quality care to all patients.

 Continuous Renal Replacement Therapy:

One of the few centers in India to provide highly sophisticated dialysis for critically ill patients in ICU/ICCU with multi-organ failure, where peritoneal or routine haemodialysis are not possible for various reasons Various procedures done with this technique are:-

  • SCUF (Slow Continuous Ultra filtration)
  • CVVH (Continuous Veno-Venous hemofiltration)
  • CVVHD (Continuous Veno-Venous haemodialysis)
  • CVVHDF (Continuous Veno-Venous hemodiafiltration)

 Plasmapheresis & Plasma Exchange:

These facilities of Plasmapheresis & Therapeutic Plasma Exchange (TPE) are available for renal and non-renal patients such as LGB syndrome and myasthenia gravis. Chronic Peritoneal Dialysis/Automated

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Kidney Stone Treatment Services
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Kidney Stone Treatment

PCNL/PNL refers to Percutaneous nephrolithotomy (PNL) which is a minimally-invasive technique of removing stones from the kidney with the help of making a small puncture (less than 1 cm) in size through the skin from the back (as shown). It is suitable for the removal of stones, which are greater than 2 cm in size. This is usually done under general anaesthesia or spinal anaesthesia.

Ureteroscopy is a technique of inspecting the upper urinary tract (ureter and kidney). This procedure is generally performed with a ureteroscope (semi-rigid or flexible)that is passed through the urethra and the bladder, that directly enters into the ureter & kidney.

URS(Ureteroscopy and stone removal) : The Kidney stones that are smaller in size and are present in the ureter as well can be removed successfully in one piece, and the bigger ones are generally fragmented by laser before removing it with the help of ureteroscopy.

RIRS or flexible ureteroscopy:

Retrograde intrarenal surgery (RIRS) is a relatively newer technique for the removal of stones. Retrograde intrarenal surgery (RIRS) is a method of removing kidney stone with the help of a fiberoptic endoscope. RIRS Surgery permits a surgeon to perform surgery inside the kidney without an incision. The RIRS has proved to be quite effective for cases that are difficult-to-treat such as bleeding disorders and the occurrence of stones in children.

Indications for RIRS

  • Tumours present in the upper urinary tract(TCC)
  • Occurrence of stones in children
  • Stones larger in size for ESWL (lithotripsy)/Lithotripsy failures
  • Extreme obesity with multiple co-morbidities.
  • Patients having bleeding disorders or on anticoagulants.

Procedure of RIRS

RIRS is a procedure that is performed by an experienced urologist in India with unique expertise in RIRS. The method is carried out under general or spinal anaesthesia.

Ureteric access sheath is passed on a guidewire under continuous fluoroscopy.

Flexible Ureteroscope scope is then passed through the urethra (the urinary opening) in the bladder and then into the ureter and kidney.

The stone can be then seen through the Ureteroscope and fragmented with Holmium laser.

Small fragments are grasped by baskets (Nitinol Baskets) and taken out.

After the completion of RIRS Procedure, Double J stent is placed to facilitate the smooth drainage from kidney and avoid blocking in the ureter.

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Renal cell cancer refers to the condition where there is a growth of cancer cells form in the tubules of the kidney. The most common type of renal cancer appears in the renal (kidney) tissue that helps in filtering the blood and produces the urine. This condition is commonly known as renal cell cancer (or renal cell carcinoma). Another kind of adult kidney tumour grows in the renal pelvis where the urine collects and this type of renal cancer is called transitional cell carcinoma.

What are the signs of kidney cancer?

In most of the cases renal cancer is accidentally found on imaging (USG or CT) done for any other disease or on routine checkup.

  • Most of the people accidentally find out about cancer on routine ultrasounds indicative of renal mass. Other signs might be
  • (hematuria) blood in the urine
  • Lower back pain on either side
  • A lump on the side or on the lower back.
  • Tiredness
  • Loss of appetite.
  • Weight loss
  • Fever that does not occur due to an infection and that doesn’t go away(FUO)

What are the risk factors for renal cancer?

Following are the risk factors for renal cell cancer:

  • Smoking
  • Abuse of certain pain medicines, including over-the-counter pain medicines, for a prolonged period
  • Obesity
  • High blood pressure
  • Hereditary renal cell cancer
  • Presence of certain genetic disorders like hereditary papillary renal cell carcinoma or von Hippel-Lindau disease.

What are the ways to find whether one has a renal tumor?

The following tests and procedures may be used to detect renal cancer:

  • Physical exam and history
  • Ultrasound exam : It is the most popular primary test to diagnose a renal mass/cancer.
  • Blood Test : Certain blood tests like LFT, KFT and Serum Calcium are done for finding any abnormality.
  • Urinalysis : This analysis is done for checking the colour of urine and its components, like red blood cells,sugar, protein, and white blood cells.
  • Liver function test : Liver Function test or LFT is a diagnostic measure by which a sample of blood is examined for measuring the amounts of enzymes released into the bloodstream by the liver. An elevated amount of an enzyme can be a sign of cancer that has spread to the liver. Certain conditions that might not be cancerous can also increase liver enzyme levels.
  • CT scan (CAT scan) |Modality of choice : In this technique, the computer-generated pictures that are linked to an x-ray machine are taken. In this technique, a dye is injected into a vein to help the organs or tissues show up more clearly in the CAT scan. This procedure is known by various names like computed tomography, computerized tomography, or computerized axial tomography.
  • MRI (magnetic resonance imaging): This technique makes uses a magnet, a computer and the radio waves for making detailed pictures of areas present inside the body. This procedure is also known as nuclear magnetic resonance imaging (NMRI).
  • Biopsy : Biopsy refers to the extraction of cells or tissues so that they can be viewed under a microscope by a pathologist for finding any signs of cancer. For performing biopsy for renal cell cancer, a fine needle is inserted into a tumour and a sample of tissue is extracted.

What are the Stages of Renal Cell Cancer

  • After the diagnosis of renal cell cancer tests are performed for finding out if cancer cells have spread within the kidney or to any other regions of the body.

 

 

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What is Urethral Stricture?

A urethral stricture is a process of scarring in or nearby the urethra (which is a tube connecting the urinary bladder to the urinary meatus for the elimination of urine from the body), which results in the narrowing or blocking of the urinary passage. It occurs more commonly in men as compared to women

What are the common causes of urethral stricture?

Any infection, inflammation or urethral injury that occurs due to any instrumentation or foley’s catheterization or trauma can result in urethral stricture.

What are the symptoms of Urethral strictures?

slow urine stream, spraying a stream of urine, Painful urination, reduction in the urine output, inadequate emptying of the bladder and recurrent urinary tract infections.

What is the treatment for Urethral Stricture?

Urethral stricture treatment can only be done by surgical intervention as medicines are not effective

Diagnosis: RGU and MCU (retrograde and antegrade urethrogram are imaging techniques that can help in pinpointing the length, severity and the location, of the stricture.

Treatment: The selection of treatment of urethral stricture depends upon on the length and severity of the stricture.

Short strictures: for strictures that are short dilation or cutting the stricture (urethrotomy) with the help of a laser or knife under the guidance of specially designed video cystoscope.

 Long / recurrent strictures: these strictures involves surgically removing the stricture after which the reconstruction of the area with grafts (buccal /lingual mucosal urethroplasty) or a flaps is done.

Hypospadias

Hypospadias is the term given to an inborn disorder of the urethra where the urinary opening lies on the underside of the penis instead of being at the tip. It is, in fact, the second most common birth abnormality of the reproductive system present in males that affects about one out of every 250 males at birth.


Dr. Ashish Kumar Saini (HOD)

Director & Unit Head Dr. Ashish Kumar Saini is a Urologist with expertise in Endourology, Laparoscop ...

Read more Dr. Ajay Kher

Dr. Ajay Kher is a Senior Consultant- Nephrology and Kidney Transplant Medicine with above 15 years ...

Read more Dr. Harbinder Singh

Dr. Harbinder Singh is an associate consultant in the department of urology at Primus. He has done h ...

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The number of exchanges per day and length of time per exchange varies by person to person. Usually, CAPD is performed four times a day. Each solution exchanges last about half an hour. Assistants help people with problems using their hands to do CAPD.

Automated Peritoneal Dialysis (APD)

The second type of peritoneal dialysis, automated peritoneal dialysis (APD) involves a machine. You attach the tubing and solution bags to the machine. Before going to sleep, you connect the tubing to the peritoneal catheter. During the night the machine performs the dialysis. For extra therapy, dialysis solution remains in the peritoneal cavity during the day. The peritoneal cavity of most adults can hold two to three liters of fluid.

 Kidney Transplant:

If you are nearing the need for dialysis and would like to explore getting a transplant, start the discussion with your nephrologist. Your doctor will discuss the transplant process with you, which generally starts with being referred to a transplant center for further evaluation. While transplant requirements vary between centers, you’ll most likely undergo comprehensive medical tests to determine if you are a viable candidate. If you are, then the search for a donor can begin.

Finding a match:

There are two types of organ donors: a living donor and a non-living, or cadaver, donor. Compatibility between a patient and the donor reduces the chances of organ rejection and can contribute to a more successful transplant. Additionally, because medication to help prevent organ rejection is so effective, donors don’t always have to be genetically similar to the recipient.

If you don’t have a potential living donor, you will be placed on the waiting list for a cadaver organ and will need to register for the national transplant waiting list at United Network of Organ Sharing (UNOS). The wait for a transplant can vary greatly depending on the type of donation you receive, your geographic location and current health.

Going in for surgery:

You will be scheduled for surgery as soon as an appropriate organ match has been identified. In most cases, your surgeon will leave your kidneys in place and simply place the new, healthy kidney in a different location in your abdomen. You will remain in the hospital for several days after the surgery and be monitored for any complications.

Common transplant concerns:

While your age and health conditions prior to the transplant surgery can affect the risk of complications, there are three common post-transplant concerns.

  • Rejection: Medication will be prescribed to help ensure your body accepts the new kidney.
  • Functionality: In some cases, the newly transplanted kidney begins working right away, while in others it may require dialysis for a few days before it starts functioning normally.
  • Organ lifespan: The average life span for a donated kidney is 10 to 15 years. When a transplant fails, a patient may opt for a second transplant or return to dialysis.

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