Browsing by Author "Parajuli, Purushottam"
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Publication 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 RABSTRACT 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; urethroplastyPublication Clinicopathological Outcome of Early and Late Onset Renal Cell Carcinoma: An Observational Study(Institute of Medicine, Tribhuvan University, 2024) Pandit, Durga; Phuyal, Anjit; Gyawali, Milan; Guragain, Bipin; Parajuli, Purushottam; Pradhan, Manish Man; Poudyal, Sujeet; Chapagain, Suman; Luitel, Bhojraj; Chalise, Pawan Raj; Sharma, Uttam Kumar; Gyawali, PremAbstract: Introduction Renal cell carcinoma (RCC) is considered a disease of old age and is typically found in the 6th-8th decade of life. The diagnosis of RCC is increasing more rapidly in younger age patients. This study was conducted to evaluate the clinicopathological pattern and outcome of early onset RCC and compare them with the older age group patients. Methods This was a single center observational study. All the patients undergoing radical or partial nephrectomy during the period of November 2019 to October 2022 for renal masses and whose final histopathology report showed RCC were included in the study. Clinicopathological patterns and outcome were compared between the two age groups. Results Among 47 patients, 17 (36.2%) patients were at or below the age of ≤46 years and 30 (63.8%) patients in older age group. There was significant difference in male (29): female (18) ratio between the two age groups (p < 0.005). Younger age patients (≤46 yrs) had higher stage of disease at presentation compared with the older age (>46 yrs) patients [tumor extension into major veins and perinephric tissue (T3) and above 26 vs 21] and they had significantly higher mortality rate (29.4% vs 3.3%, p =0.01). Conclusion Patients aged ≤46 years of age were more frequently affected by RCC with female predominance. Younger age group had higher stage of disease at presentation with higher mortality in comparison to older age group.