Browsing by Author "Poudyal, Sujeet"
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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.Publication Correlation Between Early Postoperative Urine Output and One-Year Graft Function after Living Donor Kidney Transplantation: A Prospective Observational Study(Institute of Medicine, 2025) Tamang, Rabindra; Chalise, Pawan Raj; Chapagain, Suman; Poudyal, Sujeet; Pradhan, Manish Man; Luitel, BhojrajABSTRACT Introduction: The prognostic value of early postoperative urine output after kidney transplantation remains uncertain. This study evaluates its association with one-year graft function and examines additional clinical predictors. Methods: A prospective observational study was conducted at a tertiary transplant center in 90 renal transplant recipients; 82 completed one-year follow-up. Primary outcome was one year estimated glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration 2021. Exposures included urine output on postoperative days 1 to 3, donor age, warm and cold ischemia times, discharge creatinine, dialysis duration, human leukocyte antigen mismatch, and early surgical complications within 30 days. Primary analysis used linear regression with prespecified covariates. Secondary analysis used logistic regression for eGFR less than 60 mL per minute per 1.73 m2. Results: Urine output on postoperative days 1, 2 and 3 did not correlate with one year estimated glomerular filtration rate. Complications occurred in 8.5 % (7/82). Body mass index showed no association with one year estimated glomerular filtration rate. In the multivariable model, older donor age and higher discharge creatinine independently associated with lower one year estimated glomerular filtration rate (donor age B = -0.595, p = 0.02; discharge creatinine B = -0.219, p = 0.03). Single-marker receiver operating characteristic analysis showed poor discrimination. Conclusion: Early post-operative urine output did not correlate with one-year graft function. Future research should focus on additional markers and strategies to improve graft function prediction. Keywords: Chronic kidney disease; estimated glomerular filtration rate; living kidney donors; renal transplantationPublication 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, GhanashyamABSTRACT 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 volumePublication 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 Influence of Ureteric Orifice Configuration on Effective Insertion of Ureteral Access Sheath during Flexible Ureteroscopy(Institute of Medicine, 2025) Jha, Amit Kumar; Luitel, Bhojraj; Chapagain, Suman; Poudyal, Sujeet; Pradhan, Manish Man; Chalise, Pawan RajABSTRACT Introduction: Retrograde Intrarenal surgeries are facilitated by the use of ureteral access sheaths (UAS) but it is not always possible to insert the sheath on the first attempt. The aim of the study was to determine the possible predictive factors enabling insertion of UAS during flexible ureteroscopy (fURS). Methods: All consecutive patients undergoing fURS/RIRS who were not pre-stented were studied and data collected. The study parameters were the demographics of the patients, characteristics of the stones, and perioperative data, including the ureteric orifice (UO) configuration over introductory guidewire. Multivariate logistic regression analysis was used to detect the possible predictors of successful UAS insertion. Results: In total, 78 patients who underwent primary fURS were included, with a mean age of 38.9±14.68 years and a male: female ratio of 2.25:1 with an average stone burden of 11.4 mm. There was successful primary insertion of UAS in 47(60.26%) patients. Out of them, 44 of the patients had rounded configuration of the ureteric orifice with a successful primary insertion of UAS in 17 (38%) patients whereas 30 (88%) patients had successful insertion in those with tented configuration of the ureteric orifice over a guidewire with a significant p value (<0.001). In multivariate regression analysis, a tent-shaped UO after guidewire insertion was the only significant predictor (OR:13.70 95% CI:3.76-50.10 with p-value<0.0001) for primary successful UAS insertion into virgin ureters. Conclusion: Patients with tent-shaped UOs after insertion of a guidewire were more likely to have an UAS insertion on the first attempt in a virgin ureter. Keywords: Flexible ureteroscopy; ureteric access sheath; ureteric orifice configuration; virgin uretersPublication Outcome of ABO-Incompatible Living Donor Kidney Transplantation: A Single Center Observational Study from Nepal(Institute of Medicine, 2023) Hamal, Saurav S; Nepali, Rabin; Poudyal, Sujeet; Shah, Dibya SABSTRACT Introduction: Kidney transplantation is the most effective treatment for end-stage renal disease (ESRD) patients. However, the increasing number of ESRD patients and the limited availability of living and cadaveric donors has led to a growing waiting list for kidney transplantation. ABO-incompatible transplantation has emerged as an alternative for these patients in Nepal. Methods: This was an observational study of all the patients who underwent kidney transplantation from March 2017-Feb 2019. Data on demography of recipients and donor, blood group, human leukocyte antigen mismatch, induction agent, post-operative complications and creatinine clearance at discharge and one-year post-transplant were collected and analysed. Then we compared patient and kidney graft survival at one year between ABO incompatible and ABO compatible recipients. Results: During the study period, there were total of 124 kidney transplant recipients among them 12 were ABO incompatible and 112 were ABO compatible recipients. The study showed slightly lower patient and graft survival in ABO-incompatible recipients than ABO compatible recipients (83.3% vs 99.2%, p<0.001). However, death-censored graft survival were similar in both groups (100%,p<0.001). The graft function at one year measured by creatinine clearance was better in ABO-incompatible recipients than ABO-compatible recipients (67.1±11.75 vs 61.87±12.82, p<0.001). Postoperative complications were slightly higher, however, complications at one year were lower in ABO-incompatible recipients. Conclusion: The study showed that living donor ABO-incompatible kidney transplant recipients have a good outcome at one year but is associated with greater risks of patient and graft loss at early transplant period compared to ABO-compatible recipients. Keywords: ABO incompatible; graft survival; infection; kidney transplantation; patient survival; rejectionPublication 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 Prediction of Urosepsis after Percutaneous Nephrolithotomy using Neutrophil-Lymphocyte Ratio(Institute of Medicine, Tribhuvan University, 2025) Lacoul, Robal; Luitel, Bhojraj; Chapagain, Suman; Poudyal, Sujeet; Pradhan, Manish Man; Chalise, Pawan RajAbstract: Introduction: Percutaneous nephrolithotomy (PCNL) is the preferred modality treatment for kidney stones >2 cm. Prediction of postoperative infection remains a major concern. The neutrophil-to-lymphocyte ratio (NLR) is an inexpensive and readily available marker of systemic inflammation and has shown potential in predicting infection and sepsis. This study aims to investigate the utility of preoperative NLR in predicting urosepsis following PCNL. Methods: A prospective observational study was conducted on 86 patients undergoing PCNL at Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Nepal. Preoperative NLR was calculated from complete blood counts. Postoperative infectious outcomes were analyzed, logistic regression and receiver operating characteristic (ROC) curve analyses were performed to assess NLR’s predictive value. Results: Post-PCNL fever occurred in 43 patients (50%) and sepsis in 16 patients (18.6%). Patients with sepsis had significantly higher preoperative NLR (3.55 ± 2.25 vs. 1.82 ± 0.68, p < 0.001). An NLR cut-off of 1.86 predicted sepsis with area under curve (AUC) 0.829, 93.8% sensitivity and 68.6% specificity (p < 0.001). Higher risk of sepsis was seen in patients with chronic kidney disease (37.5%), preoperative percutaneous nephrostomy (46.7%), prior UTI admission (30.3%), staghorn stones (50%), longer operative time (99.69 ± 31.12 vs 78.26 ± 34.23 minutes). Conclusion: Preoperative NLR may be a useful marker for identifying patients at increased risk of sepsis after PCNL, particularly in patients with complex stones and value >1.86. Further large-scale studies are needed to validate its role and compare it with other established biomarkers.Publication Prevalence and Antimicrobial Susceptibility of Multi-Drug Resistant Uropathogens in a Tertiary Hospital in Nepal: A One-Year Audit(Nepal Medical Association, 2025) Pradhan, Manish Man; Sharma, Sangita; Poudyal, Sujeet; Gnyawali, Diwas; Adhikari, Suman; Chapagain, Suman; Luitel, Bhojraj; Kattel, Hari Prasad; Chalise, Pawan RajAbstract Introduction: Antibiotic resistance, especially multidrug resistance, poses a global public health threat. It complicates the treatment of infections like urinary tract infections, leading to treatment failure, extended hospital stays, and increased healthcare costs. Empirical antibiotic therapy, guided by local resistance patterns, is crucial for patient outcomes and infection prevention. This study analyzes urine cultures from TU-Teaching Hospital from January to December 2024 to investigate the prevalence and antimicrobial susceptibility of multidrug-resistant uropathogens. Methods: This was a retrospective, observational hospital-based study conducted in a tertiary care center after obtaining the ethical approval from Institutional Review Committee (IRC), (Approval reference: 470 (6-11) E2). All samples tested fromJanuary 1, 2024, to December 31, 2024 the period included in the study. Data were collected from the Electronic health records of the Microbiology department and analyzed using Microsoft Excel 16.0.0 and SPSS 30.0.0 software to determine the urine culture positivity rate, the prevalence of multidrug-resistant uropathogens, and their antimicrobial susceptibility patterns with a specific focus on resistance to commonly prescribed antibiotics. Results: A total of 25,315 urine samples were collected for urine culture and sensitivity testing during the study period. Significant bacterial growth was seen in 4,557 (18%). Multidrug resistance was seen in 3,448 (75.66%). The most frequently isolated organisms were Escherichia coli 1724 (50%), Klebsiella 154 (17.7%). E. coli, Klebsiella, Enterococcus, Citrobacter, Pseudomonas, and Acinetobacter showed resistance to Ceftriaxone (74.61–92.20%), Amoxycillin+Clavulanate (67.58–97%), and Nitrofurantoin (52.29–89.55%) across selectively tested isolates. Conclusions: Urine samples demonstrated a high prevalence of multidrug resistance to routinely prescribed antibiotics, even among second-line parenterally administered antibiotics. Only costly third-line antibiotics exhibited low resistance.Publication 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 RABSTRACT 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