Our Services
- DELIVERIES
- ABORTION AND FAMILY PLANNING
- OPERATIONS RELATED TO UTERUS LIKE HYSTERECTOMIES
- CONSERVATIVE SURGERIES FOR PROLAPSE UTERUS
- OVARIAN SURGERIES
- ANTE NATAL ADVICE AND CHECK UPS
- INFERTILITY ADVICE,TREATMENT AND BASIC PROCEDURES
- TREATMENT AND ADVICE REGARDING ABNORMAL VAGINAL DISCHARGE
- TREATMENT AND ADVICE REGARDING ABNORMAL UTERINE BLEEDING
- TREATMENT AND ADVICE FOR FIBROIDS,ADENOMYOSIS,ENDOMETRIOSIS
- TREATMENT AND ADVICE FOR PCOD
- CANCER SCREENING
- TREATMENT FOR STRESS URINARY INCONTINENCE OR INVOLUNTARY LEAKAGE OF URINE
NORMAL DELIVERIES
A Normal Delivery is the most natural birthing process. It is a preferred choice of most expectant moms. Once you give birth the vaginal way, your hospital stay is much shorter. The recovery time after a Normal Delivery is lesser than that after a cesarean delivery. It is also not very surgically invasive. The chances of developing the complications at the time of childbirth are lesser. Mothers who opt for a vaginal birth have a lower mortality risk. Normal Delivery has many benefits for the baby too. Baby and the body will start to prepare and progress naturally for Normal Delivery. As the baby passes through the vaginal opening, all the amniotic fluid in the baby’s lungs will expel naturally. During the vaginal birth, baby will get ingest some of the protective bacteria that will colonize in his intestines. These will boost his immune system.
In a Normal Delivery, the entire process depends on your body’s readiness and timing. Therefore, there is no way to schedule the birth as such. As you near your labor time, you may suffer from anxiety and stress. In some cases, Normal Delivery may increase your risk of incontinence.
CAESAREAN DELIVERIES
Caesarean section is a surgical procedure to deliver a baby.in this procedure, baby is delivered through an abdominal incision and not vaginally. The procedure can be emergency or elective.
Indications of emergency caesarean delivery:
CHILD RELATED REASONS:
FETAL DISTRESS BECAUSE OF:
- 1.meconium aspiration
- 2.cord around the neck
- 3.abnormal presentations like face, breech or transverse presentations
- 4.growth retarded babies
Mother related reasons:
- 1.cephalopelvic disproportion( small birth passage)L
- 2.previous caesarean delivery(due to increased risk of rupture of scar)
- 3.multiple pregnancies
- 4.hypertension in pregnancy(eclampsia)
- 5.maternal diseases like diabetes may lead to big babies requiring caesren delivery
- 6.active herpes in mother,HIV in mother —-caesarean is done to prevent transmission to the baby
PLACENTAL REASONS:
- 1.placenta preavia,placenta accreata 2.abruption of placenta
Muhurat c section . some people may want to plan their love ones in specific time and date. Advantages of caesarean delivery: A timely caesarean delivery in above mentioned indications may prevent trauma to the mother,both physical and mental ,and also life long disabilities in the baby Complications of caesarean delivery: A caesarean delivery should be performed by an expert who can anticipate difficulties and skillfully handle them. Otherwise mortality rates may increase due to excessive blood loss in the mother. also, blood bank facilities should be available in the vicinity. Other complications may include ,injury to the bladder, injury to the bowel, and wound infection and sepsis. What to expect on the day of surgery: As an obstetrician, I will ask the patient to come to the hospital empty stomach. once in the hospital, the nurse will check the vitals ,and an enema will be given to the patient .an IV line will be accessed ,and a catheter inserted. Once the anesthetist arrives, he will again perform a general examination , and after ensuring everything is alright, he will proceed with spinal anaesthesia most of the time. once the anaesthesia is in place, I’ll begin the procedure. The anesthetist maintains the anaesthesia till the end of the procedure, after which , the patient is shifted to the wards. On day 1, mild to moderate pain at the operation site is to be expected, in spite of the IV medications .the pain generally lessens in intensity within 24 hours. By day 3 to 4, the patient is able to walk slowly on her own ,and on day 5, the patient is generally sent home after ensuring she has passed stools. The patient will be called for suture removal on day 10 to day 12.
SOME ESSENTIAL TIPS FOR PATIENTS
- Get plenty of rest. Rest is vital for recovery from any surgery
- Ask for help. Newborns are demanding
- Eat a well balanced diet
- Have plenty of oral fluids
- Process your emotions
- Take regular walks
- Manage pain
ABORTION AND FAMILY PLANNING OPERATIONS ( GOVT. RECOGNISED)
Family Planning is the method to limit one’s family. This not only helps in good mental and physical health of the family, but also improves the financial health of the family. The unmet need for family planning (to either limit family size or determine the intervals between children) results in unintended and unwanted pregnancies, which in turn lead to a broad range of maternal and child conditions that increase morbidity and mortality. Surgical procedures for family planning can help reduce this unmet need, particularly the need to limit childbirth. The demand for abortion is high in many LMICs, and the illegality of the procedure in most of these countries increases the likelihood of postabortion complications from clandestine, unsafe procedures Therefore, postabortion care is a significant health issue in LMICs. Timely, safe surgical interventions can reduce the morbidity and mortality associated with unsafe abortions.
FAMILY PLANNING PROCEDURES ARE AVAILABLE AT OUR PLACE AFTER PROPER COUNSELLING OF THE COUPLE AND KNOWING THEIR PARTICULAR NEEDS :
FAMILY PLANNING PROCEDURES INCLUDE :
- Contraceptive Pills.
- Insertion of Intrauterine device like Copper T.
- Family Planning Operation.
- Tubectomy, open as well as through Laproscopy approach.
Abortion Procedures in the form of Dilatation & Evacuation (D&E) are Available.
Abortion Procedures in the form of Pills are Available.
IMPORTANCE OF FAMILY PLANNING
- Reducing maternal mortality by reducing the number of times women are pregnant, including high-risk pregnancies associated with very young or older women
- Preventing high parity (among the potential factors leading to anemia in pregnancy)
- Decreasing the number of pregnancies that would have ended in induced, mostly unsafe, abortions in LMICs
The same surgical procedures used for abortion are also used to manage incomplete abortion, which is one of the most common postabortion complications and is often accompanied by other complications such as bleeding, sepsis, and genital injury. The surgical procedures used to manage such complications include laparotomy for sepsis and uterine injury and a wide range of minor procedures to repair injuries to the proximal birth canal
OPERATIONS RELATED TO UTERUS LIKE HYSTERECTOMIES(VAGINAL,ABDOMINAL,LAPROSCOPIC)
Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries, fallopian tubes and other surrounding structures. Usually performed by a gynecologist, hysterectomy may be total (removing the body, fundus, and cervix of the uterus; often called “complete”) or partial (removal of the uterine body while leaving the cervix intact; also called “supracervical”). It is the most commonly performed gynecological surgical procedure. Removal of the uterus renders the patient unable to bear children (as does removal of ovaries and fallopian tubes) and has surgical risks as well as long-term effects, so the surgery is normally recommended when other treatment options are not available or have failed. It is expected that the frequency of hysterectomies for non-malignant indications will fall as there are good alternatives in many cases. Oophorectomy (removal of ovaries) is frequently done together with hysterectomy to decrease the risk of ovarian cancer.
• For Uterine Prolapse (uterus coming out from the vaginal orifice) This Procedure is done vaginally. So there is no question of opening the abdomen, hence no Scar & easy recovery.
• In case of large sized uteri with fibroids, the same procedures has to be done abdominally, that is by making a cut through the abdomen.
• Also, in case of non-descent, Hysterectomies are performed Laproscopically, which is less painful & has a shorter hospital stay.
SOME ESSENTIAL TIPS FOR PATIENTS
- Get lots of rest. Aim for at least 8 hours sleep a night and more if fatigue is an issue.
- Keep up with a nutritious diet.
- Eat high-fiber foods
- Have plenty of oral fluids
A woman can usually go home within 24 hours of a vaginal hysterectomy. Surgeons can perform several types of hysterectomy, with each option dependent on a person’s specific condition. The options are:
VAGINAL HYSTERECTOMY:
An incision is made inside the vagina, and the uterus is removed through this incision.
LAPAROSCOPIC HYSTERECTOMY:
A thin, lighted tube and a small camera are inserted into very small cuts in the abdomen. The uterus is removed through the cuts.
ABDOMINAL HYSTERECTOMY:
A larger incision is made in the abdomen to remove the uterus.
CONSERVATIVE SURGERIES FOR PROLAPSE UTERUS
In India, nulliparous prolapse cases constitute 1.5–2 % of genital prolapse; the incidence is even higher (5–8 %) for young women who have just delivered one or two children making it one of the highest in the world. The prevalence is very high in India because Indian women, especially those with poor socioeconomic status, are anemic and malnourished (‘maternal depletion syndrome’) with poorly developed pelvic floor tissues and the additional insult of one or more vaginal deliveries at home is sure to bring down the cervix and uterus. Gynecology is already replete with many and varied conservative operations for prolapse.
Conservative Surgeries are performed by the ways are :
- • Manchester Fothergill Operations
- • Shirodkar’s Sling Operations.
- • Purandare’s cervicopexy
- • And many more depending upon the age of the patient, presentation of symptoms and future child being.
PREVENTION
- • Avoid lifting heavy weights
- • Treat chronic constipation ,so as to avoid straining
- • Treat chronic cough
- • Maintain proper nutrition
- • Report at the earliest to your gynaecologist.
Cystocele Anterior vaginal wall prolapse is defined as the descent of the anterior vagina such that the urethro-vesical junction (a point 3-cm proximal to the external urethral meatus) or any anterior point proximal to this is less than 3 cm above the plane of the hymen. Cystocele is classified as a paravaginal defect (lateral, displacement), midline defect (central, distention), or transverse defect (apical) when the pubocervical fascia separates from the vaginal cuff or uterosacral ligaments or a combination of these defects
TREATMENT: Surgical repair is required in this case.
OVARIAN SURGERIES (FOR CYSTS,TORSION ETC)
Elective surgery is performed for large ovarian cysts, which may be simple ,cystic cysts,or,complex ovarian cysts. Simple functional cysts may be treated by medications.
Emergency surgery is needed when a cyst has burst and bled into the abdomen or there is ovarian torsion. Cystectomy: This is the most common form of treatment. The cyst is removed without removing the ovary. Cystectomy can be done by laparoscopy or by making a larger incision in the abdomen (laparotomy).Ovarian torsion refers to the complete or partial rotation of the ovary on its ligamentous supports, often resulting in impedance of its blood supply. It is one of the most common gynecologic emergencies and may affect females of all ages . The fallopian tube often twists along with the ovary; when this occurs, it is referred to as adnexal torsion. Prompt diagnosis is important to preserve ovarian and/or tubal function and to prevent other associated morbidity. However, making the diagnosis can be challenging because the symptoms are relatively nonspecific. Isolated torsion of the fallopian tube is less common, but may also occur and adversely impact tubal function. Tubal torsion may occur either in the mid-portion of the tube itself or around the ligamentous supports of the tube. Torsion of paratubal or paraovarian cysts may also occur.
Treatment also available in the form of medicines for smaller functional cysts.
Surgical removal of cysts – Laproscopically or open Surgery is done.
When an ovarian growth or cyst needs to be closely looked at, a surgeon can do so through a small incision using laparoscopy or through a larger abdominal incision (laparotomy). Either type of surgery can be used to diagnose problems such as ovarian cysts, adhesions, fibroids, and pelvic infection. But if there is any concern about cancer, you may have a laparotomy. It gives the best view of the abdominal organs and the female pelvic organs. Then, if the doctor finds ovarian cancer, he or she can safely remove it. During surgery, a non-cancerous cyst that is causing symptoms can be removed (cystectomy), leaving the ovary intact. In some cases, the entire ovary or both ovaries are removed, particularly when cancer is found.
ANTE NATAL ADVICE AND CHECK UPS
Antenatal is not only about medicine and tests. It includes counselling and providing information. It also includes advice on your general health about taking exercise, eating well and stopping smoking.
Ante natal visit will include Weight check, BP check and Abdominal Examination each visit, which is 3-4 weeks apart.
Any Blood test, Sonographies or Injections will be advised accordingly after Examination.
Partner or any other family member ,preferably an elderly lady , accompanying the pregnant woman is beneficial.
SOME ESSENTIAL TIPS
- See your doctor or midwife as soon as possible
- Eat well.
- Maintain Proper Hydration
- Be careful about food hygiene
- Exercise regularly
- Meditation for 10min Per day Will help
Pregnancy is a special and crucial period for any woman. During this time she needs every possible care so that her health and the health of her baby are perfect and that she is able to deliver properly. Antenatal care forms an important part of pregnancy care. It is the systemic medical care of the pregnant woman and foetus to endure overall health and to rule out the possibility of any probable complication. Once you have confirmed your pregnancy, the next logical option for you is to find a good gynaecologist/obstetrician so that s/he can take charge of your antenatal care
INFERTILITY ADVICE,TREATMENT AND BASIC PROCEDURES
Infertility is typically defined as the inability to become pregnant after one year of sexual intercourse without contraception. For women over age 35, this condition is diagnosed after 6 months of an inability to conceive. … In a lifetime, 10-15% of couples will experience infertility.Infertility is the inability of a person, animal or plant to reproduce by natural means. It is usually not the natural state of a healthy adult, except notably among certain eusocial species (mostly haplodiploid insects). In humans, infertility is the inability to become pregnant/impregnate or carry a pregnancy to full term. There are many causes of infertility, including some that medical intervention can treat. Estimates from 1997 suggest that worldwide about five percent of all heterosexual couples have an unresolved problem with infertility. Many more couples, however, experience involuntary childlessness for at least one year: estimates range from 12% to 28%.” 20-30% of infertility cases are due to male infertility, 20-35% are due to female infertility, and 25-40% are due to combined problems in both parts. In 10-20% of cases, no cause is found.
The most common cause of female infertility is ovulatory problems which generally manifest themselves by sparse or absent menstrual periods.[5] Male infertility is most commonly due to deficiencies in the semen, and semen quality is used as a surrogate measure of male fecundity. Women who are fertile experience a natural period of fertility before and during ovulation, and they are naturally infertile for the rest of the menstrual cycle. Fertility awareness methods are used to discern when these changes occur by tracking changes in cervical mucus or basal body temperature.
SOME ESSENTIAL TIPS FOR PATIENTS
- Maintain a normal body weight. Weighing too much or too little can not only put your health at risk, but also can diminish your fertility .
- When you’re ready to have children, don’t delay. The age of the female partner is the number one determinant of successful fertility treatment for couples. The duration of infertility is the second most important factor
- Don’t smoke. Smoking lowers your chances for pregnancy and increases the risk of miscarriage. Smokers also tend to go through menopause two years earlier than non-smokers
- Exercise Regularly
TREATMENT AVAILABLE AT OUR CLINIC
- Infertility consultation
- Treatment with oral medications in mild cases
- Intra uterine insemination
Most couples will conceive with “first level” infertility treatments such as fertility drugs, lifestyle changes or intrauterine insemination (IUI). The vast majority will not require advanced technologies such as in vitro fertilization (IVF).The type of infertility treatment depends upon the cause(s) of infertility including the presence of male infertility, the couple’s infertility treatment history, and many other factors such as female age
TREATMENT AND ADVICE REGARDING ABNORMAL VAGINAL DISCHARGE
Vaginal discharge is a common presenting symptom seen by doctors in many services (primary care, gynaecology, family planning, and departments of genitourinary medicine). Vaginal discharge may be physiological or pathological. Although abnormal vaginal discharge often prompts women to seek screening for sexually transmitted infections (STIs), vaginal discharge is poorly predictive of the presence of an STI. Normal vaginal flora (lactobacilli) colonise the vaginal epithelium and may have a role in defence against infection. They maintain the normal vaginal pH between 3.8 and 4.4. The quality and quantity of vaginal discharge may alter in the same woman in cycles and over time; each woman has her own sense of normality and what is acceptable or excessive for her
Vaginal discharge can be of fungal origin,bacterial cause ,but most of the times , it is of mixed origin.
SOME ESSENTIAL TIPS FOR PATIENTS
- If you are being treated for a vaginal infection, use all the medication as directed, even if you think you are better
- Avoid vaginal contact with products that can irritate the vagina, such as feminine hygiene products, perfumed or deodorant soaps, powders, lotions, and bubble baths.
- Avoid wearing tight-fitting clothing, such as bathing suits, exercise wear, or pantyhose, for prolonged periods of time
TREATMENT
Treatment generally consists of oral and local medications, sometimes for both partners, for better results. Personal hygiene plays an important role in this treatment. Possibility of STDs have to be kept in mind at all times , and required tests are to be performed accordingly.
Vaginal discharge is a common reason for women to seek help from their general practice, gynaecologist, family planning service or genito-urinary clinic. The exact prevalence is unknown, as vaginal discharge is often self-diagnosed and self-treated.
TREATMENT AND ADVICE REGARDING ABNORMAL UTERINE BLEEDING
Abnormal bleeding can occur at any age. However, at certain times in a woman’s life it is common for periods to be somewhat irregular. Periods may not occur regularly when a girl first starts having them (around age 9–14 years). During perimenopause (beginning in the mid–40s), the number of days between periods may change. It also is normal to skip periods or for bleeding to get lighter or heavier during perimenopause.Your ob-gyn or other health care professional will ask about your health history and your menstrual cycle. It may be helpful to keep track of your menstrual cycle before your visit. Note the dates, length, and type (light, medium, heavy, or spotting) of your bleeding on a calendar. You also can use a smartphone app designed to track menstrual cycles. You will have a physical exam. You also may have blood tests. These tests check your blood count and hormone levels and rule out some diseases of the blood. You also may have a pregnancy test and tests for sexually transmitted infections (STIs)
COMMON CAUSES OF ABNORMAL UTERINE BLEEDING(AUB)
1. Hormonal imbalance, specially in teenagers and women in child-bearing age group.
2. Conditions like adenomyosis, intra mural fibroids,endometrial or cervical polyps
3. Cervical erosions can sometimes lead to AUB
4. Endometriosis can rarely lead to AUB
5. Retained products of conception ,may lead to AUB
TREATMENT
Treatment of AUB depends on the cause of abnormal bleeding, and as per various causes, the treatment will differ.
Up to 13% of women with heavy menstrual bleeding have some variant of von Willebrand disease and up to 20% of women may have an underlying coagulation disorder (2–4). Other coagulation factor deficiencies, hemophilia, and platelet function disorders may be associated with AUB in any age group. Additionally, systemic diseases, such as leukemia and liver failure, and medications, such as anticoagulants or chemotherapeutic agents, can impair coagulation and be associated with AUB..
TREATMENT AND ADVICE FOR FIBROIDS,ADENOMYOSIS,ENDOMETRIOSIS
Adenomyosis is a condition in which the inner lining of the uterus (the endometrium) breaks through the muscle wall of the uterus (the myometrium). Adenomyosis can cause menstrual cramps, lower abdominal pressure, and bloating before menstrual periods and can result in heavy periods. The condition can be located throughout the entire uterus or localized in one spot. Though adenomyosis is considered a benign (not life-threatening) condition, the frequent pain and heavy bleeding associated with it can have a negative impact on a woman’s quality of life
Treatment available in the form of Laproscopic as well as open Surgery.
Fibroids are benign (non-cancerous) growths of the uterus (womb). They are also known as uterine fibroids or leiomyomas. The most common symptoms associated with fibroids are heavy or irregular periods, but often there are no symptoms. Fibroids most commonly affect women aged in their 30s and 40s. They tend to shrink in women who have passed menopause. It’s possible to have one or several fibroids, which can vary in size from 1 mm to more than 20 cm in width. Not all fibroids need to be treated, but for those that do there are various treatments available. The most suitable treatment for you will depend on factors such as the size of the fibroid(s), your symptoms, your age and whether you may be planning future pregnancies
SOME ESSENTIAL TIPS FOR PATIENTS
- Eat Plenty of Fruits, Vegetables and Whole Grains
- Limit Caffeine and Alcohol
- Try a Gluten-Free or Low-FODMAP Diet
- Processed foods are low in important nutrients and fiber, and they often contain unhealthy fats and added sugars, both of which promote inflammation and pain
- Trans fats, which are found in some processed foods, increase the risk of heart disease. Some evidence has also shown that they may increase the risk of endometriosis.
TREATMENT AND ADVICE FOR PCOD
PCOS is a problem with hormones that affects women during their childbearing years (ages 15 to 44). Between 2.2 and 26.7 percent of women in this age group have PCOS. Many women have PCOS but don’t know it. In one study, up to 70 percent of women with PCOS hadn’t been diagnosed . PCOS affects a woman’s ovaries, the reproductive organs that produce estrogen and progesterone — hormones that regulate the menstrual cycle. The ovaries also produce a small amount of male hormones called androgens. The ovaries release eggs to be fertilized by a man’s sperm. The release of an egg each month is called ovulation. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) control ovulation. FSH stimulates the ovary to produce a follicle — a sac that contains an egg — and then LH triggers the ovary to release a mature egg. PCOS is a “syndrome,” or group of symptoms that affects the ovaries and ovulation. Its three main features are: cysts in the ovaries high levels of male hormones irregular or skipped periods In PCOS, many small, fluid-filled sacs grow inside the ovaries. The word “polycystic” means “many cysts.” These sacs are actually follicles, each one containing an immature egg. The eggs never mature enough to trigger ovulation. The lack of ovulation alters levels of estrogen, progesterone, FSH, and LH. Estrogen and progesterone levels are lower than usual, while androgen levels are higher than usual. Extra male hormones disrupt the menstrual cycle, so women with PCOS get fewer periods than usual.
CANCER SCREENING
Cancer screening aims to detect cancer before symptoms appear.This may involve blood tests, urine tests, DNA tests other tests, or medical imaging. The benefits of screening in terms of cancer prevention, early detection and subsequent treatment must be weighed against any harms. Universal screening, also known as mass screening or population screening, involves screening everyone, usually within a specific age group. Selective screening identifies people who are known to be at higher risk of developing cancer, such as people with a family history of cancer. Screening tests must be effective, safe, well-tolerated with acceptably low rates of false positive and false negative results. If signs of cancer are detected, more definitive and invasive follow-up tests are performed to reach a diagnosis. Screening for cancer can lead to cancer prevention and earlier diagnosis. Early diagnosis may lead to higher rates of successful treatment and extended life. However, it may also falsely appear to increase the time to death through lead time bias or length time bias.
Cancer Screening is available at our place in the form of
1. Pap Smear
2. Hysteroscopy guided dilatation & curettage with Histopathology
3. Cervical Biopsy.
4. Basics Breast Cancer Screening
Pap smear screening is an easy and simple way of detecting cervical cancer in early stages .Ideally, it should be done from 20 years of age,if results are negative,pap smear is to be repeated after every 5 years upto the age of 30years. From 30 years onwards, if a pap smear is negative, it is to be repeated every 3 years.
A hysteroscopic guided dilatation and curettage, with histopathology ,is a simple way of diagnosing endometrial cancer, in suspicious cases.
The goal of cancer screening is to provide useful health information which can guide medical treatment.[medical citation needed] A good cancer screening is one which would detect when a person has cancer so that the person could seek treatment to protect their health.Good cancer screening would not be more likely to cause harm than to provide useful information. Good tests come with a patient explanation of why that person has high enough risk of cancer to justify the test. Part of the testing experience is for the health care provider to explain how common false positive results are so that the patient can understand the context of their results.
TREATMENT FOR STRESS URINARY INCONTINENCE OR INVOLUNTARY LEAKAGE OF URINE
Stress urinary incontinence( SUI) is defined as involuntary leakage of urine in a woman, during episodes of increased intra abdominal pressure , like coughing ,sneezing ,laughing, straining at stools.
Women who suffer from stress urinary incontinence (SUI) worry about coughing, sneezing, even laughing in public for fear of having an accident. For some the fear of embarrassment is so great that they become virtual recluses, staying at home and avoiding any social contact. Even with this anxiety, however, 62% of women sufferers wait a year or longer before discussing the condition with their doctor, reports a new Multi-sponsor Surveys’ Gallup Study of women with SUI. It’s usually when something really embarrassing happens to them in public that they finally seek help. Most women cope with SUI by wearing pads, because they don’t know that SUI can now be easily treated with a simple surgical procedure.
SOME ESSENTIAL TIPS FOR PATIENTS
1. Don’t ignore the symptoms of SUI in early stages, do visit your gynaecologist regarding the same.
2. According to the degree of symptoms, treatment is available in the form of oral medications, or various surgeries ,like TOVT,TOVT etc.
TREATMENT
Treatment of SUI is in the form of medications ,in early stages.
Various surgeries , like TOVT,TVT etc ,depending upon individual cases are available.