Browsing by Author "Joshi, HN"

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    Outcomes of Extra Corporeal Shock Wave Lithotripsy in Renal and Ureteral Calculi
    (Kathmandu University, 2014) Joshi, HN; Karmacharya, RM; Shrestha, R; Shrestha, B; de Jong, IJ; Shrestha, RKM
    ABSTRACT Background Since the introduction in early 1980s, Extracorporeal Shockwave Lithotripsy (ESWL) became the accepted first line treatment modality for renal and upper ureteric stones. It is simple, safe and effective noninvasive procedure which can be performed without anaesthesia in outpatient basis. The objective of this study was to determine the efficacy of ESWL to achieve complete stone clearance in the patients with different sizes of renal and upper ureteric stones. Objective The aim of this study was to assess the outcome, efficacy and complications of ESWL in the treatment for renal and ureteric stones in terms of the site and the size of the stone in the patients presented at Dhulikhel Hospital Kathmandu University Hospital. Method In this prospective study a total of 430 (214 renal and 216 ureteric) cases of urinary stone disease in 257 male and 173 female patients treated by ESWL at Dhulikhel Hospital, Kathmandu University Teaching Hospital during time period of May 2010 to June 2012 were included. Data of patients with renal and ureteric stones were evaluated for stone site, size, and number of sessions. Data were analyzed using spss 13.0. Result Out of 430 cases, the overall stone free rate in after 1st session was 341 (79.3%) at one month and in three months follow up (3 sessions) it was increased up to 414 (96.3%). In 16 (3.7%) patients treatment was failed. Average size of the stone was 12.24 (SD± 3.65) mm. Stone free rate was 154 (72%) in the case of renal and 187 (86.6%) in the case of ureteric stones in first session. In three months follow up (three sessions) it was 204 (95.4%) and 210 (97.2%) respectively for renal and ureteric stones. In relation to size the stone free rate in <10mm, 10-15mm and > 15mm was 97%, 97% and 90%. Conclusion ESWL is the first line preferred choice for renal and upper ureteric stones which provides the maximum stone free rate in the case of stone size smaller than 1.5cm. KEY WORDS ESWL, outcome, renal stones, ureteric stones, urinary stone disease, urolithiasis
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    Outcomes of Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia Comparing Prostate Size of more than 80 Grams to Prostate Size less than 80 Grams
    (Kathmandu University, 2014) Joshi, HN; de Jong, IJ; Karmacharya, RM; Shrestha, B; Shrestha, R
    ABSTRACT Background Benign prostatic hyperplasia is a condition occurring in elderly men in which the prostate gland is enlarged, hence the condition also known as benign enlargement of prostate. Benign hyperplasia can lead to both obstructive and irritative symptoms. Transurethral resection of prostate (TURP) still remains the gold standard modality of surgical treatment of obstructive lower urinary tract symptoms due to Benign hyperplasia. Objectives The objective of this study was to evaluate the outcomes of TURP in large prostate (>80 grams) in comparison to small prostate (<80 grams) in terms of efficacy, safety and complications. Methods A total of 65 cases included in this prospective study, which were operated by a single surgeon with conventional monopolar TURP using standard technique. Intra -operative and post-operative complications, pre and post- operative quality of life (QoL) and international prostate symptom score (IPSS), operative time, time to removal of catheter and hospital stay were evaluated between small and large prostate gland volumes. Results Out of 65 cases, 30 were with large prostate size i.e. 80 grams or more (group 1), and 35 cases were with small prostate size than 80 grams size (group 2). Mean age was 71.8 SD ± 6.9 years in group 1 and 68.2 SD ± 12.7 years in group 2. The mean preoperative volume of prostate was 88.8 grams (range 80-115 grams) in group 1 and 40.3 (range 20-65 grams) in group 2. The mean preoperative post void residual volume of urine (PVRU) was 244 ml SD ± 190.8 ml in group 1 and 117 ml ± 70.3 ml in group 2. Mean resection time in group 1 was 110 (range 90-130) minutes and in group 2 it was 90 minutes (range 55-115) minutes. There were quite satisfactory improvements in IPSS and QoL. No significant complications were observed except TUR syndrome in 2 cases from group 2, which were managed well in postoperative period. Conclusion With meticulous resection and intra-operative haemostasis using continuous out flow resectoscope, conventional monopolar TURP is equally safe and effective in large size prostate as compare in small size. KEY WORDS Benign prostatic hyperplasia, obstructive lower urinary tract, prostate, transurethral resection of prostate.
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    Sonography in Acute Ureteric Colic: An Experience in Dhulikhel Hospital
    (Kathmandu University, 2014) Joshi, KS; Karki, S; Regmi, S; Joshi, HN; Adhikari, SP
    ABSTRACT Background Computed tomography is considered as an imaging modality of choice in acute ureteric colic. However due to concerns regarding radiation exposure, sonograms are re-emerging as imaging methods in such situations. Objectives To evaluate the role of sonography in detection of calculus in acute ureteric colic. Methods Total 384 patients were enrolled. Hydronephrosis was graded as mild, moderate or severe. Calculus was detected as an intraluminal echogenic focus with distal shadowing with twinkling artifact. Number, size and position of the calculi were assessed. Patients were categorized into four groups:I. ureteric colic only II. ureteric colic with hematuria III. ureteric colic with hydronephrosis and IV. ureteric colic with hematuria and hydronephrosis and then the possibility of detection of calculi has been compared among these groups. Results Out of 384 patients, 254 were found to have calculi ranging between 2.7-27mm. Nineteen had in the pelvis/ pelviureteric junction, 64 in proximal ureter, 125 in distal ureter, 6 at iliac crossing and 40 at vesicoureteric junction. Two hundred forty one had single and 14 had multiple calculi. Calculus detection is easier in category III and IV patients. The sensitivity and specificity of ultrasonography were 87.98% and 93.07%. Degree of hydronephrosis is strongly correlated with the number of calculi but weakly correlated with the size of the calculus. Conclusion Sonogram can be used in all cases of acute ureteric colic. Hydronephrosis is the most important finding because it paves the way out for the detection of calculus. KEY WORDS Calculus, hydronephrosis, sonography, ureteric colic
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    The Predictive Value of Pre-Operative Symptoms Including Upper Gastrointestinal Endoscopy Before Laparoscopic Cholecystectomy for Elective Symptomatic Cholecystolithiasis
    (Kathmandu University, 2013) Karmacharya, A; Malla, BR; Joshi, HN; Gurung, RB; Rajbhandari, M
    ABSTRACT Background It has always been a challenge to distinguish between upper gastrointestinal symptoms due to gall stones or any other causes. The persistence of abdominal symptoms even after cholecystectomy is highly discouraging for surgeons. Objective To evaluate the value of preoperative (UGE) as a routine investigative tool in patients with gall stone disease and to assess the outcome of cholecystectomy in patients with gallstones on preoperative abdominal symptoms. Methods This is a prospective study conducted on 96 cases at the Department of Surgery, Dhulikhel Hospital among ultrasonographically proven gall bladder stones irrespective of age and sex. After the examination, all the patients were subjected to UGE, and biopsy were obtained for histopathology if required. The statistical analysis were performed using spss version 16. Results Out of total patients, 84(87.5%) were females and 12(12.5%) were males with a M: F ratio of 1:7. Both the sexes were comparable in age groups. Out of total 96 patients, 53(55.2%) presented with typical pain and 43(44.8%) presented with atypical pain. All the patients were subjected to upper gastrointestinal endoscopy (UGE) and 53(55.2%) had normal findings and 43(44.8%) had various lesions. Patients with typical pattern of pain had normal endoscopic findings and those with atypical pain had pathology in upper gastroendoscopy (p<0.001). Serious pathology resulting to change of the planned treatment was found in three cases (3.12%). Among them two had gastric carcinoma and one had active peptic ulcer disease. The relief rate after the cholecystectomy was significant in patients with typical pain than among those with atypical pain (p<0.001). The commenest post cholecystectomy symptoms were heart burn (10%), abdominal discomfort (9%) and dyspepsia (7%). Conclusion Presence of atypical pain in patients with gall stones is highly likely to have other coexisting upper gastrointestinal pathologies. Hence, upper gastrointestinal endoscopy prior to elective cholecystectomy in patients with gall stones can be clinically helpful. KEY WORDS Biliary colic, cholelithiasis, upper gastrointestinal endoscopy
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    Urinary Bladder Carcinoma: Impact of Smoking, Age and its Clinico-Pathological Spectrum
    (Kathmandu University, 2013) Joshi, HN; Makaju, R; Karmacharya, A; Karmacharya, RM; Shrestha, B; Shrestha, R; de Jong, IJ; Shrestha, RKM
    ABSTRACT Background Urinary bladder carcinoma is common urological malignancy. Although epidemiological evidence favors role of occupational exposure to chemical carcinogen as the aetiological factor of bladder carcinoma, many cases arise with no obvious occupational exposure to chemical carcinogen. Tobacco and cigarette smoking is common in both rural and urban areas of Nepal. Objective The objective of this study was to determine the impact of smoking and age in urinary bladder carcinoma with related clinicopathological correlations. Method A total of 56 (44 males and 12 females) cases of urinary bladder cancer treated at Dhulikhel Hospital, Kathmandu University Teaching Hospital during time period of January 2004 to December 2013 were included in the study. Data of patients with Urinary bladder cancer were obtained from hospital records and evaluated for age, sex, history of smoking, clinical presentations, cystoscopic findings and histopathological characteristics. Results Out of 56 cases, 51 (91.1%) of the patients had hematuria. History of smoking was found in 44 patients. Smoking was found much higher in males (88%) than females (41.66%). Transitional cell carcinoma (TCC) was the most common histological variety, which was seen in 51 (91.07%) patients. The significant impact of smoking was found in terms of grade of TCC. Conclusion The incidence of bladder carcinoma is higher in male and TCC is the most common variety of Urinary bladder malignancy. History of smoking correlated with grade. KEY WORDS Bladder cancer, bladder carcinoma, smoking, transitional cell carcinoma

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