Browsing by Author "Baidya, JL"
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Publication Morbidity and early outcome of transurethral resection of prostate: A prospective single-institute evaluation of 100 patients(Kathmandu Unversity, 2010) Shrestha, B; Baidya, JLAbstract Background: Transurethral resection of the prostate underwent significant technical improvements during the last decades, with major impact on the incidence of intra and postoperative complications. Objectives: teh objective of teh study was to analyse the early complications and to predict immediate outcomes of transurethral resection of prostate (TURP) in a single tertiary care institute. Materials and methods: We prospectively evaluated 100 patients undergoing transurethral resection of prostate at B and B Hospital, Gwarko, Lalitpur, Nepal, from August 2008 till April 2009. Case records containing 32 variables concerning preoperative status, operative details, complications and immediate outcome were recorded for each patient. Results: The cumulative short-term postoperative significant morbidity was 10% and the peroperative morbidity was 6%. The most relevant postoperative complication was failure to void (24%). Among significant postoperative morbidities, surgical revision had to be performed in two patients (2%), open prostatectomy in one patient, transurethral resection (TUR) syndrome in 5% and significant urinary tract infection in 2%. Among significant intra operative morbidity, we had one case with bladder perforation, significant cardiac arrhythmia requiring prompt attention in 4% and TUR syndrome during resection in 1%. We did not have any mortality related to the procedure during the study period. The resected tissue averaged 25.67gm. Incidental carcinoma of the prostate was diagnosed by histological examination in 4% of patients. Urine peak flow rate (Q-max) increased to 12.88ml per second from 9.24ml per second and average flow rate increased to 7.36 ml per second from 5.03 ml per second. The postoperative mean residual urine measured by ultrasound decreased to 28.46ml from preoperative 86.59 ml. Conclusions: TURP has, for decades, been the standard surgical therapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia though significant morbidities can be associated with the procedure. Meticulous preoperative workup and proper selection of the patients for the procedure significantly improve the outcome after transurethral resection of the prostate. Key words: TURP ( Transurethral resection of prostate), LUTS ( Lower urinary tract symptoms), BOO (Bladder outlet obstruction)Publication The outcome of pneumatic lithotripsy for the management of ureteric calculi(Kathmandu University, 2008) Shrestha, B; Karki, DV; Baidya, JLAbstract Background: Various methods have been adopted for the removal of ureteric calculi around the world. Ureteroscopic pneumatic lithotripsy has been used to treat ureteric calculi for more than a decade. Owing to its low price and high degree of effectiveness, it has become the most popular ureteroscopic device amongst many others. Moreover, ureteroscopy has become the method of choice for the quickest way of rendering patients stone-free. Objectives: To determine successful stone fragmentation by ureteroscopic pneumatic lithotripsy in the management of ureteric calculi as well as intra-operative and post-operative complications related to it. Study design: A prospective and descriptive study. The study was conducted in Section of Urology, Department of Surgery, B&B Teaching Hospital, Kathmandu University. The data was collected from April 2005 to April 2006. Materials and methods: Ninety-two consecutive patients having ninety- ve ureteric stones were treated with intracorporeal pneumatic lithotripsy over a period of one year. The size, side, number and site of stones along with the results of preoperative routine investigations were noted in the patients. The pneumatic lithotripter was introduced through a 10 or 8 Fr rigid ureteroscope (Karl Storz) to break the stone/s. Successful stone fragmentation, lithotripsy time, intra-operative and post-operative complications and duration of hospital stay were recorded. Results: Complete stone fragmentation was achieved in about 80 % of cases. The mean lithotripsy time was 17.66 minutes. About 76% of patients were stone-free at one week follow-up after the procedure, 92% by the end of eight weeks while 100% stone-free status was achieved by the end of 12 weeks. The mean hospital stay was 1.82 days and complications (both signi cant and minor) occurred in 51 % of cases. However, majority of them were minor and successfully managed. Conclusion: Intra-operative pneumatic lithotripsy is a minimally invasive, effective and rapid procedure for the management of ureteric calculi. Though it can give rise to considerable complications, they are mainly minor. Moreover, both complications and failure rates can be reduced if patients with ureteric calculi are properly selected. It seems to be a good alternative in patients where extracorporeal shockwave lithotripsy is unsuccessful or not indicated and in patients who need early stone removal. Key words: SIRS- Systemic In ammatory Response Syndrome, ESWL- Extra corporeal shockwave lithotripsy, JJ stent: Double J stent, URS: Ureterorenoscope, Steinstrasse.Publication Unresolved abdominal mass(Kathmandu University, 2009) Shrestha, B; Baidya, JLAbstract A case of huge enhancing solid mass in the abdomen observed in 30 years old gentlemen is reported. Patient was worked up and managed conservatively outside valley with the provisional diagnosis of an appendicular lump. When examined, he was found to have huge intra abdominal mass. Interestingly when the genitalia was examined he was found to have underdeveloped empty scrotum without testes in it which he was yet not bothered. This simple examination gave us a straight clue to come up with the diagnosis of malignancy in undescended testes. Laparotomy was performed and the mass was excised. After 6 weeks postoperatively he was subjected for the chemotherapy. After3 cycles of chemotherapy CT scan showed complete disappearance of retroperitoneal lymphadenopathy and serum tumor markers have come down to normal level. Key words: Germ cell tumor (GCT), Seminoma, Non seminomatous germ cell tumor, (NSGCT), Cryptorchidism, Alpha fetoprotein (AFP), Beta human chorionic gonadotrophin (BHCG), Lactate dehydrogenase (LDH)