NepMed Repository :: Browsing by Author "Chalise, Pawan R"

Browsing by Author "Chalise, Pawan R"

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Buccal Mucosal Graft Urethroplasty for Complex Urethral Strictures: A Single Center Study
(Institute of Medicine, 2023) Chalise, Pawan R; Luitel, Bhojraj; Chapagain, Suman; Poudyal, Sujeet; Pradhan, Manish M; Parajuli, Purushottam; Sharma, Uttam K; Gyawali, Prem R
ABSTRACT Introduction: Urethral strictures have been a surgical challenge for the reconstruction urologists. Lichen sclerosus is the most common cause of urethral stricture in the developing world. There are different free graft tissues for urethroplasty but buccal mucosal graft (BMG) urethroplasty is an effective and versatile procedure for inflammatory and long segment urethral strictures. Methods: A total of 64 cases who had complex urethral strictures underwent dorsal onlay BMG urethroplasty. BMG was harvested from cheeks or sublingual mucosa depending upon the length of the stricture. The catheter was removed after 3 weeks and patients were evaluated with uroflowmetry. The surgery was considered successful if subjective and objective parameters were satisfactory. Results: Average length of the harvested graft was 14.5 cm (10-18 cm) in 42 panurethral, eight distal penile, four proximal penile and bulbar, and 10 bulbar urethral strictures. Postoperative period was uneventful except in four, of which two developed urethral fistulas and the other two developed periurethral abscess which resolved after treatment. After catheter removal, all voided with satisfaction. All patients, reassessed after mean period of 21 months, had satisfactory voiding. Two patients underwent visual internal urethrotomy for stricture at proximal site of BMG placement. There were no complications observed in the donor site with complete healing in all. Conclusion: Dorsal onlay BMG Urethroplasty is an effective and versatile procedure for anterior urethral strictures with excellent results and with minimal donor site morbidity. Keywords: Buccal mucosal graft; Lichen sclerosus; panurethral; urethroplasty
Correlation of Differential Function and Glomerular Filtration Rate Estimated from Computed Tomography based Renal Volume and Diuretic Renogram in Living Renal Donor
(Institute of Medicine, 2022) Rai, Bipendra DK; Gnyawali, Diwas; Poudyal, Sujeet; Pradhan, Manish; Chapagain, Suman; Luitel, Bhoj R; Chalise, Pawan R; Gyawali, Prem R; Sharma, Uttam K; Nepali, Rabin; Gurung, Ghanashyam
ABSTRACT Introduction: In renal transplant, serum creatinine and isotope studies are used for determination of donor glomerular filtration rate (GFR). Studies have shown computed tomography measured renal volume can also be used. Our main objective was to assess the accuracy of volume based estimated GFR (vGFR) with diethylene triamine penta acetic acid (DTPA) measured GFR in living kidney donors. Methods: An observational analytical study was conducted from July 2018 to June 2019 in Department of Urology and Kidney Transplant Surgery and Department of Radiodiagnosis in Tribhuvan University Teaching Hospital where a total of 38 eligible potential donors were evaluated and serum creatinine level, computed tomography with contrast and DTPA renogram were used to measure GFR and differential function. Results: The mean age of the donors were 42.8±10.9 years with 70% of donors being females. Renal volume was not statistically different between male and female donors. There was moderate correlation between volume based and DTPA based GFR (r=0.76) and differential function (r=0.71). Compared to creatinine, volume based GFR estimate showed better correlation to DTPA renogram. There was no significant difference in differential function estimated by DTPA and volume based estimates (p = 0.96). The upper and lower limit of agreement between the volume based and DTPA based differential function was –4.7 and 4.6 respectively. Conclusion: GFR measurement by CT volume overestimates total GFR compared to DTPA renogram but it has better correlation than creatinine based estimates. It can be used to estimate the differential function of the donor kidney. Keywords: Computed tomography, DTPA, glomerular filtration rate, renal transplant, renal volume
Surgical Management of Pediatric Urolithiasis: Descriptive Study from a Tertiary Care Center in Nepal
(Institute of Medicine, 2023) Guragain, Bipin; Phuyal, Anjit; Gyawali, Milan; Pandit, Durga; Parajuli, Purushottam; Pradhan, Manish M; Poudyal, Sujeet; Chapagain, Suman; Luitel, Bhojraj; Chalise, Pawan R; Sharma, Uttam K; Gyawali, Prem R
ABSTRACT Introduction: Urolithiasis is common in the pediatric population in low-resource countries but appropriate management is not available in all parts of the country. This study aimed to identify demographic parameters, clinical characteristics, and surgical management of pediatric urolithiasis in a tertiary care center in Nepal. Methods: This was a retrospective and descriptive study of pediatric patients (≤18 years) who underwent surgical management of urolithiasis in the Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital from January 2021 to December 2022. Results: Total 64 patients with Male: Female ratio 1.78:1 and mean age of 8.63±5.56 years presented mostly with pain abdomen (93.8%) followed by lower urinary tract symptoms (26.6%), hematuria (20.3%), and fever (14.1%). The mean number of calculi was 2.2±1.47 and the mean size was 13.97±8.30 mm. Most of the calculi (39.1%) were in the right system and 90.62% were in the upper tract. Only 15.62% of patients had calculi in the lower tract. Open surgeries were performed in only 10.93% and the rest were managed by minimally invasive procedures. Percutaneous nephrostomy tube insertion was done in 6 (9.37%) of patients and 1 (1.56%) underwent nephrectomy for nonfunctioning kidney. Conclusion: Pediatric urolithiasis patients presented with pain abdomen, lower urinary tract symptoms, or hematuria. Surgical management has shifted from open surgeries in the past to minimally invasive surgeries at present. Keywords: Minimally invasive surgery; pediatric; urolithiasis
Transplant Renal Artery Stenosis in Living Donor Kidney Transplant Recipients: A Single Center Experience from Nepal
(Institute of Medicine, 2022) Dhakal, Niraj; Sigdel, Mahesh R; Chalise, Pawan R; Bhurtyal, Nishan; Shah, Dibya S
ABSTRACT Introduction: Transplant renal artery stenosis (TRAS) is the most common preventable vascular complication in kidney transplantation with significant rates of graft loss and mortality. We aimed to study the demographics, prevalence, clinical presentation, and outcome of TRAS. Methods: We retrospectively reviewed medical records of all living donor kidney transplant recipients at Tribhuvan University Teaching Hospital from August 2008 to May 2021. Cases diagnosed with TRAS by ultrasound Doppler and/or renal CT angiogram were included. Data on demographics, clinical presentation, management, and outcomes were collected and analyzed. Among patients who underwent revascularization, pre and post-procedure creatinine, blood pressure (BP), and antihypertensive medicine burden were compared. Results: Among 620 living donor kidney transplantation, TRAS was present in 17 recipients (Male:Female = 16:1) (2.6%); mean age was 35.47±12.71 years. The median duration at diagnosis was one-month post-transplant (range: 5 days-9 months). The most common clinical features of TRAS were graft dysfunction and uncontrolled hypertension. Diagnosis of TRAS was confirmed with CT angiography in 13 patients. Ten patients underwent revascularization. Pre and post-revascularization mean serum creatinine was 356±210.49 μmol/L and 122.8±30.48 μmol/L (p=0.007) respectively, mean systolic BP was 200±12.47 mmHg and 133±13.38 mmHg (p=0.005) respectively and mean diastolic BP was 105±15.09 mmHg and 80±9.43 mmHg(p=0.005) respectively. Significant reduction in anti-hypertensive pill burden was achieved. Conclusion: Prevalence of TRAS was 2.6%. Most cases presented early with hypertension and graft dysfunction. Revascularization of significant stenosis had a favorable outcome in terms of BP control, antihypertensive pill burden, and preservation of renal function. Keywords: Renal allograft outcome, revascularization, TRAS

Browsing by Author "Chalise, Pawan R"

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