Browsing by Author "Gyawali, Prem Raj"
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Publication Defining Vascular Anatomy of Kidney and Variation among Potential Live Kidney Donors Using Spiral Computed Tomographic Angiography(Institute of Medicine, 2024) Chalise, Pawan Raj; Luitel, Bhojraj; Chapagain, Suman; Poudyal, Sujeet; Pradhan, Manish Man; Gyawali, Prem Raj; Shah, Dibya SinghABSTRACT IntroductionThis study measured the accuracy of spiral computed tomographic angiography (SCTA) in defining renal vascular anatomy and estimating the prevalence of renal vascular anomalies in live kidney donors.MethodsThis prospective clinical study included 400 live-related-donor nephrectomies from June 2017 to December 2023. Renal vascular anatomy was described after SCTA. Reporting included the number of renal arteries and veins. Analysis was done by considering intraoperative findings as “actual” findings and compared to preoperative SCTA images for their prediction. For donated side kidneys, the prevalence of vascular variations was calculated using surgical and SCTA findings. The non-donated side was evaluated using SCTA alone.ResultsFour-hundred live-donor nephrectomies were performed including 326 left and 74 right-sided cases. Of the 400 kidneys harvested, 429 renal arteries were detected out of which 414 arteries (96.5 %) were predicted by SCTA. Fifteen accessory renal arteries (1-2 mm) were identified at nephrectomy, which was not predicted. In two cases, SCTA was reported to have renal arterial stenosis (multiple in one and in mid-part in the other) which turned out to be normal intraoperatively. Similarly, 417 renal veins were detected in 400 harvested kidneys. Out of these, 408 renal veins (97.8 %) were predicted by SCTA. Two renal arteries were found in 161 Kidneys and three renal arteries were found in seven kidneys. In addition, two renal veins were found in 35 kidneys.ConclusionSpiral computed tomographic angiography provided a reliable and accurate assessment of renal vascular anatomy and its variations in live donor nephrectomy. Small accessory arteries were missed occasionally. KeywordsCT angiography; donor nephrectomy; renal vascular anatomy; renal transplantationPublication Periprocedural Antibiotic Prophylaxis Practice during Diagnostic Cystoscopy: An Observational Study(Institute of Medicine, Tribhuvan University, 2024) Phuyal, Anjit; Chapagain, Suman; Chalise, Pawan Raj; Luitel, Bhojraj; Poudyal, Sujeet; Gyawali, Prem RajAbstract: Introduction Both American and European guidelines recommend against routine use of antibiotics prophylaxis in routine cystoscopy. But studies have shown that antibiotics use during cystoscopy is discordant from available guideline recommendations even in Europe and America. This study aims to identify prophylactic antibiotic uses pattern of Nepalese Urologists and measure adherence to guidelines. Methods An online questionnaire based self-reported survey was conducted among the practicing urologists of Nepal, who were full members of Nepalese Association of Urologists. The questionnaires in Google Forms were sent via emails to 96 urologists of Nepal. Fully completed questionnaires were analyzed. Results Out of 96 emails 58 fully filled questionnaires were received and analyzed. Routine prophylactic antibiotics prescription before cystoscopy was reported by 43 (74.1%) urologists. Availability of Antibiotic Stewardship/Antimicrobial Stewardship team at their workplace was reported by 31 (53.4%) urologists and 19 (32.8%) urologists reported of having Standard Operating Procedure regarding peri-procedural antibiotic prophylaxis at their workplace. No verification of the answers were done and reported as received. Conclusion Peri-procedural antibiotic prophylaxis practice during cystoscopy was highly prevalent.Publication Renal Function Evaluation Following Donor Nephrectomy in Tertiary Kidney Transplant Center of Nepal(Institute of Medicine, Tribhuvan University, 2024) Gyawali, Milan; Luitel, Bhojraj; Pradhan, Manish Man; Chalise, Pawan Raj; Chapagain, Suman; Gyawali, Prem RajAbstract: Introduction Live kidney transplant is the standard of care for patients requiring renal replacement therapy. Donors with increasing age and comorbid conditions such as obesity and hypertension are now included for transplant. This study was performed to evaluate the change in renal function of kidney donors over a period of one year. Methods This was an analytical study of patient’s who underwent donor nephrectomy from January 2022 to June 2023 at Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Nepal. Renal function of donors in terms of serum creatinine, glomerular filtration rate, size of kidney and general physical examination including blood pressure pre-donation were compared with post donation period at three, six and twelve months. Results There were total of 76 cases available for analysis. Mean age of the donors was 44.6±10.1 years, ranging from 22 to 67 years, with male: female ratio of 1:2.45. There was no significant change in post donation blood pressure and kidney size. There was increase in serum creatinine level from baseline 70.47±14.96 to 93.20±17.61 (p<0.001) at three months follow up. Post donation glomerular filtration rate (GFR) of remnant kidney had increased significantly. Conclusion Post donation GFR of remnant kidney as well as serum creatinine level in live donor nephrectomy including the expanded criteria donors had increased significantly. Short-term deleterious effects in renal function post donation were not seen.