CARE Hospitals, Banjara Hills, Hyderabad

for Coronary Angioplasty

Coronary Angioplasty

Also known as percutaneous transluminal coronary angioplasty (PTCA) Thais is a procedure that is used to widen narrowed or blocked coronary arteries. The procedure is carried out by an interventional cardiologist. When combined with stenting, it is referred to as percutaneous coronary intervention. Is should be done within thirty minutes to 2 hours after a having a cardiac event.

Overview

Banjara Hills CARE Hospital, Hyderabad, is the flagship hospital of the CARE Group and was opened in 2000. It boasts India’s largest integrated outpatient center, which covers 185,000 square feet. Overall, CARE Hospital Banjara Hills has 435 patient beds and sees almost 200,000 patients per year, including hundreds of international patients. The Hospital offers private and deluxe patient rooms, a 24/7 pharmacy, a rehabilitation unit, and education and counseling services for heart patients to aid their recovery process. Other services on offer include airport and hotel transfers, free WiFi, religious facilities, and special discount rates for groups or for multiple procedures.

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Location

The Care Hospital at Banjara Hills is 30 km from Rajiv Gandhi International Airport and is accessible via public transport or hospital-organized transfer. The Hospital is located in the city of Hyderabad, in the state of Telangana in southern India. The city has a famous ancient quarter that contains the fortified citadel of Golconda (10 km away from the Hospital), a popular attraction with visitors. Nearby there is also the heart-shaped Hussain Sagar lake (4 km away), with an impressive large statue of the Gautama Buddha standing in the middle of the lake.

Languages spoken

English, Hindi, Arabic, Bengali (Bangla), Translators can be arranged for other Languages

Services

Medical records transfer

Rehabilitation

Airport pickup

Hotel booking

Special offer for group stays

Free Wifi

Phone in the room

TV in the room

Special dietary requests accepted

Private rooms for patients available

Parking available

Pharmacy

Laundry

Mobility accessible rooms

Online doctor consultation

Medical travel insurance

Translation services

Interpreter services

Car hire

Local transportation booking

Flight booking

Local tourism options

Family accommodation

Visa / Travel office

Religious facilities

Nursery / Nanny services

Dry cleaning

Entertainment options

International newspapers

Business centre services

Personal assistance / Concierge

Health insurance coordination

Restaurant

Procedures

Orthopedics 10 procedures

Hip Replacement

This is an orthopedic surgical procedure where a damaged hip is replaced with an implant, i.e., a prosthesis. This procedure can be performed either as hemi-replacement (only femoral head is replaced) or total replacement (i.e., total hip arthroplasty where both the femoral head and acetabulum are replaced).

Knee Replacement

Knee Replacement (arthroplasty) is an operation used to replace weight-bearing surfaces of the knee joint to relieve disability and pain. Especially in patients with osteoarthritis, psoriatic arthritis, and rheumatoid arthritis. Surgical techniques available include total knee replacement, partial knee replacement and femoral replacement.

Shoulder Replacement

Shoulder Replacement (arthroplasty) is an operation in which a prosthesis is used to replace part or all of the glenohumeral joint to relieve disability and pain. It is used to fix shoulder joint damage or relieve arthritic pain. We have the traditional shoulder total shoulder arthroplasty and the reverse total shoulder arthroplasty approach. The latter has two approaches, i.e., the deltopectoral approach and the transdeltoid approach.

Bone Fracture Treatment

Treatment depend on the severity of the fracture, patient choice and cost of treatment. Medically, reduction is done to fix a dislocated or Brocken bone. Devices available to fix fracture include orthopedic casts, splints, elastic bandages, and traction splint. Therapeutic physical therapy and joint manipulation can be done. Surgery included internal and external fixation.

Clubfoot Treatment

Club foot is also known as congenital talipes equinovarus. It is a combination of four thing in one i.e. cavus, adductus, varus and equinus. There are several types of clubfoot. It is a highly disabling condition if not managed early. The condition can be managed Non-operatively by Ponseti technique, Kite technique and French technique. Surgical options included: Posteromedial soft tissue release, Osteotomies, Triple arthrodesis, Achilles tenotomy and JESS.

Elbow Replacement

This s a procedure done to replace elbow joint that has been damaged by disease or trauma. It is indicated in severe loss of function, instability, joint destruction, severe pain or deformity. It is successful in relieving people of pain and improving the overall quality of life of the patient.

Knee Ligament Surgery (MCL)

The MCL is one of the four ligaments of the knee. A Knee Ligament Surgery is done to treat torn ligament as a result of injurer. As the MCL surgery is located outside the joint, no surgical key hole are usually necessary. The torn ligament can be reattached with staples, screws and screws through a small incision.

Knee Arthroscopy

These is a surgical procedure that is done to teat or diagnose knee joint problems like injuries and diseases. During the procedure, a small incision is made and an Arthroscope (tiny camera) inserted into the knees therapy allowing the examiner to see the inside of the joint on a live screen.

Ankle Fusion Surgery

Also known as ankle arthrodesis, is a surgical procedure done to fuse the different bones that make up the ankle joint into one piece. It is done when the joint become painful and worn out due to disease or previous trauma.

Ankle Replacement

The procedure is also known as total ankle arthroplasty. It is an orthopedic procedure done to replace the ankle joint articular surfaces that have been damaged by disease or injury with prosthetic components. It is done to treat ankle arthritis.

Cardiology 3 procedures

Coronary Angioplasty

Also known as percutaneous transluminal coronary angioplasty (PTCA) Thais is a procedure that is used to widen narrowed or blocked coronary arteries. The procedure is carried out by an interventional cardiologist. When combined with stenting, it is referred to as percutaneous coronary intervention. Is should be done within thirty minutes to 2 hours after a having a cardiac event.

Coronary Artery Bypass Graft (CABG) Surgery

Also referred to as colloquially heart bypass or bypass surgery or coronary artery bypass surgery. It is an operation done restore normal blood flow to obstructed coronary vessels hence used to manage coronary heart disease. The surgery has two main approaches, i.e., diversion of the internal thoracic artery to the left anterior descending artery in the left coronary vessel and using the great saphenous vein to create a connection between the aorta or its branch to the obstructed artery distance to the obstruction.

Aortopulmonary Window Repair

Aortopulmonary Window is a rare defect of the heart in which there is a hole connecting the aorta and the pulmonary artery abs a result failure of the conotructal ridges to fuse. As spontaneous closure does not occur, once a diagnosis is made, Aortopulmonary Window Repair surgery is the only solution.

Gastroenterology 5 procedures

Gallstones Treatment

Treatment of gallstones is based on one's symptoms and results of diagnostic procedures. The treatment options include cholecystectomy (surgery to remove the gallbladder) and drugs meant to dissolve the stones.

Liver Transplant (Living Related Donor)

This is the replacement of a diseased liver with a healthy one from a relative.it is recommended as a treatment for an end-stage liver disease or liver failure. The donor and recipient will have to undergo DNA analysis to ensure they are a close match before the procedure is done to minimize the risk of graft rejection.

Liver Biopsy

This is biopsy taken form the liver. It is a medical procedure that is done to diagnose, assess severity or monitor response to treatment of liver diseases.

Esophageal Cancer Surgery

This is a procedure done to treat cancer of the esophagus. The diseased area is resected. It is commonly done to manage earl stage (stage 1 and 2) esophageal cancer. It can be combine with chemotherapy and radiotherapy. Surgical options available included minimally invasive esophagectomy, open esophagectomy, and endoscopic mucosal resection.

Intra-Abdominal Adhesions Surgery

Adhesion are complications of radiation therapy, inflammatory processes and abdomino-pelvic surgeries. These adhesions can cause infertility, intestinal obstructions, chronic pelvic pain, and dyspareunia. These surgery is meat to manage these effects of adhesions so as to improve the patients overall quality of life.

General Surgery 2 procedures

Bone Marrow Transplant (Autologous)

This is a surgical procedure which involves a process where unhealthy bone marrow tissue is replaced with a healthy one. Bone marrow is the spongy soft tissue inside one's bones that contain blood-forming cells (hematopoietic or blood stem cells). The cell intern mature into platelets, white blood cells, and red blood cells. Before the transplant, radiation, chemotherapy or both may be given to destroy the diseased bone marrow tissue. This can be done in either of two ways, i.e., reduced intensive treatment or ablative treatment. The three types of bone marrow transplants are umbilical cord blood transplant, allogeneic bone marrow transplant or autologous bone marrow transplant. The donor cells are collected in two ways or leukapheresis or bone marrow harvest.

Hernia Repair

A hernia is an abnormal protrusion in whole or part, through an OPENING, pathological or anatomically in the walls of its containing cavity, e.g., the abdominal cavity. Hernia Repair procedures involve returning this displaced tissue to their proper place. There are different types of Hernia Repair surgeries, i.e., Herniorrhaphy (tissue repair) and hernioplasty (mesh repair) where a mesh is usually sewn over weakened areas.

Ear, Nose and Throat (ENT) 1 procedures

Cochlear Implant

This is an electronic gadget (device) used to replace the functions of the inner ear when it is damaged. The implant does the work of the Cochlear by generating sound signals for the brain. It is thus useful in persons with profound or moderate hearing loss bilaterally. The device helps one to her better. Cochlear implant surgery is done by ENT Surgeon.

Gynecology 6 procedures

Gynecologic Laparoscopy

It is a new alternative technique to open surgeries. It allows a surgeon to look into one's pelvis. It can be sued to remove adhesions, manage ectopic pregnancies, manage ovarian cysts, hysterectomy, oophorectomy, and myomectomy, do female sterilization (tubal ligation), diagnose & treat endometriosis and cancer investigation and lymph node sampling in cancer treatment.

Myomectomy

This is the surgical removal of uterine fibroids especially symptomatic ones. The procedure aims to conserve the uterus for possible future deliveries.

Ectopic Pregnancy Surgery

This is an emergency exploratory laparotomy surgical procedure done to manage a raptured ectopic pregnancy. Ectopic pregnancies are extra uterine pregnancies.

Hysterectomy

This is the surgical removal of the uterus. It is a procedure done by gynecologists. It can either be total (where the entire uterus, fallopian tubes, cervix and upper third of vagina is resected) or partial. The option depend upon the patient choice and the indication for the operation.

Microdochectomy

This is a surgical procedure done to remove a portion of the lactiferous duct. It is the standard treatment for nipple discharges that arise from a single duct. The procedure can be done under guidance of a ductoscope.

Uterine Artery Embolization (UAE)

This is a procedure that is performed by interventional radiologist. A catheter is used to deliver small particles that then block uterine body blood supply. Common indications include adenomyosis and uterine fibroids.

Nephrology 1 procedures

Kidney Transplant (Living Related Donor)

This is the transplant of a healthy kidney to patients with an end-stage renal disease or no functional kidneys. Kidneys are important because they remove wastes and toxins from the body apart from producing important hormones in the body. The kidney can be taken from a live donor or deceased donor. There recipient and donor can be genetically related or non-related depending on whether a biological relationship existed between them. India has very nice centers where this can be done successfully.

Neurosurgery 4 procedures

Craniotomy

These are a surgical procedure where bone flaps are temporarily removed from the skull to give access to the brain. The bone flaps are created by specialized tools. Sometimes it’s done under the guidance of CT scans or MRI scans to localize the areas of treatment (stereotactic Craniotomy). A craniotomy is used in stereotactic biopsy of the brain, stereotactic radiosurgery & stereotactic aspiration of hematomas, cysts or abscesses. A craniotomy is also useful in aneurysmal clipping and removal of brain tumors. Are of various types, i.e., translabarynthine Craniotomy, retro-sigmoid Craniotomy, extended bifrontal Craniotomy and supra-orbital Craniotomy.

Epilepsy Surgery

This is a procedure done to treat epilepsy in order to reduce or stop the seizures. There are different types of epilepsy surgical procedure. This includes removal of the area in the brain causing this seizures or separating the part of the brain causing these tumors from the rest.

Deep Brain Stimulation (DBS) Surgery

This is a surgical procedure that is done to implant a device that send electrical stimulus signals to brain regions responsible for body movement. Electrode is placed deep in the brain and then connected to a stimulating device. DBS helps remove symptoms of slowness of movement, tremor, walking problems and stiffness that is caused by dystonia, essential tremor or Parkinsonism disease.

Skull Base Surgery

This is minimally invasive, highly specialized neurosurgical technique for diagnosis, evaluating and treating cancerous or benign growths located on the base of the skull, the upper vertebrae of the spine and the underside of the brain.

Spinal Surgery 3 procedures

Spine Surgery

This is a surgery done on the spine to treat back pain, or other damages are done on the spine by trauma or disease scoliosis, spinal stenosis, and disc herniation. It is recommended when conservative treatments are unsuccessful. It can either be done as an open or minimally invasive procedure. Common surgical approaches are lateral, posterior and anterior. Spinal surgical techniques included laminotomy, laminectomy, microdiscectomy, disc replacement, spinal fusion, and foraminotomy.

Scoliosis Treatment

Scoliosis is a condition where ones spine bend LATERALLY (sideways). It arises commonly before pubertal growth spurts. It can be caused by muscular dystrophy, cerebral palsy or idiopathic. Surgery is the main modality of treatment. Surgical options include scoliosis fusion surgery and anterior scoliosis corrective surgery (VBT).

Spinal Fusion Surgery

Sometimes also called spondylosyndesis or spondylodesis. It is an operation done to stop motion in segments of the spine (thoracic, lumber or cervical) that are causing a patient pain. It helps to stabilizes and decompress the spine. The procedure involves the use of bone grafts which can either be allografts, autografts or artificial substitutes.

Colorectal Medicine 2 procedures

Hemorrhoidectomy

This is a surgical procedure done to treat hemorrhoids. Patient is given either spinal or general anesthesia and then incisions are made around the hemorrhoid tissue. The swollen veins are then used to prevent bleeding and the entire hemorrhoid removed.

Rectocele Surgery

Rectocele is a posterior vaginal wall prolapse that occurs when the wall that separates the rectum from the vagina weakens thus allowing the vaginal wall to bulge. It can be managed conservatively by physiotherapy and using vaginal pessaries. Surgical options included colporrrhaphy and rectocele repair. Surgery is the definitive management of this condition.

Diagnostic Imaging 1 procedures

Renal Angiogram

This is an imaging test that is done to examine the blood vessels in ones kidneys. It helps reveal blockages aneurysms or stenosis in the kidneys. Radiologist inject a contrast agent into arteries that bring blood to the kidney and X-rays used to monitor the flow. Fluoroscopy can also be used.

Oncology 5 procedures

Whipple Procedure

Whipple Procedure also known as kaush-Whipple Procedure, pancretoduodectopmy, pancreaticoduodenectomy is a major surgical procedure dome to remove cancer of head of pancreas. It involves the removal of the common bile duct, the gallbladder, the duodenum and portions of the stomach.

Chronic Leukemia Treatment

The treatment of chronic leukemia depend on a person’s age, reason for treatment, disease risk group, stage of cancer, signs and symptoms of disease, patient preference and overall health. Treatment options included targeted drug therapy, chemotherapy, bone marrow transplant, and immunotherapy.

Glioblastoma Treatment

Glioblastoma (Glioblastoma multiform) is a malignant tumor that affects the spinal cord and the brain. It is usually quite aggressive hence can spread quickly and grow fast. Treatment includes radiotherapy, chemotherapy and surgery (craniotomy and radiosurgery).

Laryngeal Cancer Treatment

Laryngeal Cancer is a condition which cancerous cells form from larynx tissues. The most common presentation include ear pain and sore throat. Laryngectomy (total) in addition to thyroidectomy and nodal removal followed by radiotherapy is the most common mode of treatment.

Cancer Staging

Staging is the process used to find out the amount of cancer in the body and their locations. The information is used by doctors to formulate the patient treatment plan and to determine their prognosis. There are four different ways staging is done i.e. pathological staging, post-neoadjuvanat or post-therapy staging, clinical staging and restaging (done when cancer recurs after treatment). The four factors used in staging include: site of primary tumor, the tumor size, the involvement of lymph nodes and metastases. Tests done to enable staging process include imaging tests, pathological tests, surgical reports, laboratory tests and physical examination.

Urology 2 procedures

Kidney Stones Treatment

The treatment of renal stones included taking a lot of water to help pass these stones and use of painkiller to relive renal colonic pain. Drug used included NSAIDs, diuretics narcotics and urinary retention drugs. Medical procedures that can be done to remove the stones include laser lithotripsy, uteroscopic stone removal and extracorporeal shockwave therapy.

Prostate Biopsy

This is a procedure done to take a sample from the prostate for histological analysis. It is dome to detect or diagnose cancer of the prostate especially after blood PSA level; rises to the level of prostate cancer. There are several options that can be used to take the sample i.e. MRI-guided biopsy, ultrasound guided biopsy, Transrectal biopsy and transurethral biopsy.

Dermatology 1 procedures

Mesotherapy

This is a non-surgical cosmetic medical procedure.it involves the multiple injections of homeopathic and pharmaceutical drugs , vitamins , plant extracts and various other ingredients into the skin subcutaneous fat layer. The procedure helps remove excess fat, tighten the skin thus rejuvenating it.

Rheumatology 1 procedures

Rheumatology Consultation

This is a review of a patient suspected or diagnosed with Rheumatologic disorders such as Rheumatoid arthritis. The patient will undergo a clinical examination and relevant investigations ordered so as to check the patient’s general medical condition. The patient’s medications will also be reviewed and if failing, they will be changed. The consult is done by a consultant Rheumatologist.

Cosmetology 1 procedures

Laser Hair Removal

This is the process of removing unwanted hair by exposing them to a beam of pulses of light that will destroy the hair follicles. The intense heat of the laser will damage these hair follicle inhibiting any future growth.

Tropical medicine 1 procedures

Malaria Treatment

Malarial is the leading killer in many part of Asia and Africa. A patient can present with specific or non-specific symptoms. History of residency or travel to malarial infected regions is important. The management offered will depend on whether it is complicated or uncomplicated. The type of drug used will also be influenced by pregnancy and allergy to some antimalarial.

Vascular Medicine 1 procedures

Aortic Arch Surgery

It a complex cardiothoracic operation done to manage aortic arch aneurysms. The procedure is often needed once the aneurism enlarges to a certain size, or when there is aortic dissection or when it ruptures. During the surgery, concomitant repair of other defects in the heart can be performed e.g. coronary artery blockage.

Neonatology 1 procedures

Neonatology Consultation

A neonatologist is a pediatric subspecialist in the medical care of newer bone infants particularly the premature and ill new bones. The do most of their work in neonatal ICU. The consolation will enable the specialist to review the infant and prepare and appropriate treatment plan to ensure the baby turns out healthy.

Physical Medicine and Rehabilitation 1 procedures

Knee Brace

This is a medical devices that is fitted into the knee joint to give it support, especially when the person has pain that is emanating from the knee. They are used to provide support to the knee ligaments and the patella while one recovers from injury, to prevent injury, play sports, or to relieve pain in the knee. There are four categories of knee braces available i.e. functional, unloader, prophylactic and rehabilitative braces.

Neurology 1 procedures

Neurology Consultation

This is an appointment with a neurologist (physician that has subspecialized in neurology) for treatment, diagnosis or management of disorders that affect the nervous system.

Ophthalmology 1 procedures

Chalazion Treatment

A Chalazion is a painless benign nodule or bulge in the lower or upper eyelids. Conservatively, it is managed by lid hygiene and warm compress. Medically, topical or intralesional steroids can be used to minimize inflammation. This can cause regression of the lesion in few weeks. An ophthalmologist best performs surgery to remove the lesion.

Specialists

Specialists working with CARE Hospitals, Banjara Hills, Hyderabad

Dr. B. Soma Raju Cardiology

  • Chairman and Managing Director at the hospital
  • Specializes in cardiology
  • Particular expertise in emergency cardiac care, primary coronary angioplasty, stent implantation, and peripheral angiography and angioplasty
  • Fellow of the National Academy of Medical Sciences (2002)

Dr. C. Narasimhan Cardiology

  • Specializes in cardiology
  • Graduated with a DM degree (doctorate) in cardiology from CMC Hospital (1989)
  • Completed fellowship in clinical electrophysiology at the University of Wisconsin, Milwaukee (1995-1997)
  • Completed fellowship in clinical cardiology/vascular disease at Michael Reese Hospital, Chicago (1997-1998)

Dr. K. Nageswara Rao Cardiology

  • Specializes in pediatric cardiology
  • Graduated with a master's degree in pediatrics from Kurnool Medical College, Andhra Pradesh
  • Graduated with a DM degree (doctorate) in cardiology from the Sri Chitra Tirunal Institute, Trivandrum, Kerala
  • Completed a fellowship in pediatric cardiology at the Children's Hospital at Westmead, Sydney
  • Member of the Cardiology Society of India, the Indian Echocardiographs Society, and Pediatric Cardiology Society of India
  • Awarded the Highest Innovation ranking award from the American College of Cardiology

Dr. Thomas Cherian Gastroenterology

  • Specializes in heptatobiliary surgery and liver transplants
  • Graduated with a bachelor degree in medicine from Bangalore University (1995)
  • Completed fellowships in general surgery and hepato-pancreaticobiliary and UGI surgery at the RCS and Physicians of Glasgow (2000 and 2007)
  • Member of the British Medical Association, the Association of Surgeons in Training, the British Transplantation Society, the Carrel Club (UK Transplant Trainees Club), the Medical Defence Unit of Scotland, the International Hepato-Pancreatico-Biliary Association, and the International Liver Transplantation Society

Dr. J. Murthy Neurology

  • Specializes in neurology
  • Graduated with a DM degree (doctorate) at the Post Graduate Institute of Medical Education and Research, Chandigarh (1979)
  • Particular expertise in neuro-vascular disorder treatments

Dr. Rama Krishna Murthy Neurosurgery

  • Specializes in neurosurgery
  • Graduated with a bachelor degree in medicine from Osmania Medical College, Hyderabad
  • Graduated with a master's degree (MCh) in Neurosurgery from Nizam’s Institute of Medical Sciences, Hyderabad
  • Member of the American Association of Neurological Surgeons, the Congress of Neurological Surgeons, the Neurological Society of India, the Andhra Pradesh Neuroscientist’s Association, the Indian Society of Stereotactic and Functional Neurosurgery, and the Twin Cities Neurological Society

Dr. Syed Ameer Basha Neurosurgery

  • Specializes in neurosurgery
  • Graduated with a bachelor degree in medicine from Kurnool Medical College, Andhra Pradesh
  • Graduated with a master's degree (MCh) in neurosurgery from Nizam’s Institute of Medical Sciences, Hyderabad
  • Particular expertise in skull base surgery, neurovascular surgery, epilepsy surgery, and neural transplantation
  • Member of the Neurosurgical Society of India (NSI), the Andhra Pradesh Neuro Scientists Association (APNSA), the Skull Base Society of India, the Cerebro Vascular Surgical Society of India, the Neurosurgical Society of India (NSSI), the American Neural Cell Transplantation Society, the American Association of Neurological Surgeons (AANS), the Congress of Neurological Surgeons (CNS), and the Walter E. Dandy Neurosurgical Society (WEDNS)

Dr. Pinnamareddy Vikranth Reddy Nephrology

  • Specializes in nephrology
  • Graduated with a master's degree in internal medicine from Jawaharlal Nehru Medical College, Rajiv Gandhi University, Belgaum, Karnatakan (2002)
  • Completed fellowships in nephrology at the University of California, San Diego (2009) and V U University Medical Center, Amsterdam (2011)
  • Member of the International Society of Nephrology (ISN), National Academy of Medical Sciences, India (NAMS), Indian Society of Nephrology (ISN), Indian Academy of Nephrology (IAN), Peritoneal Dialysis Society of India (PDSI), Association of Physicians of India (API), and the Research Society for the Study of Diabetes in India (RSSDI)

Dr. Praveen Mereddy Orthopedics

  • Specializes in orthopedics
  • Graduated with a master's degree in orthopedics at Manipal University, Karnataka
  • Graduated with a postgraduate degree (DNB) in orthopedics at the National Board of Examinations, New Delhi
  • Member of the American Academy of Orthopedic Surgeons (AAOS), the Indian Orthopedic Association (IOA), and the Indian Medical Association (IMA)

Dr. Prem Chand Gupta Vascular Medicine

  • Specializes in vascular surgery
  • Graduated with a bachelor degree in medicine from the Armed Forces Medical College (AFMC), Pune
  • Graduated with a master's degree in surgery from the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh
  • Particular expertise in varicose veins and leg ulcers treatment, laser ablation (EVLT), and radio frequency ablation (RFA)

Dr. K. Prasad Raju Urology

  • Specializes in urology
  • Graduated with a bachelor degree in medicine from Madras University
  • Graduated with a master's degree in general surgery from Gulbarga University
  • Graduated with a master's degree (MCh) in urology from the NTR University of Health Sciences

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