Browsing by Author "Pradhan, Hema Kumari"
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Publication Clinical Profile of Patients Undergoing Total Laparoscopic Hysterectomy(Public Health Concern Trust-Nepal (phect-NEPAL), 2025) Shrestha, Sabita; Dangal, Ganesh; Karki, Aruna; Pradhan, Hema Kumari; Shrestha, Ranjana; Bhattachan, Kabin; Sah, SadhanaAbstract: Introduction: Total laparoscopic hysterectomy (TLH) has emerged as a preferred alternative to abdominal hysterectomy for benign gynaecological conditions owing to its well-known benefits. With increasing use of laparoscopic techniques, it is important to evaluate the clinical profile and surgical outcomes of the patients undergoing total laparoscopic hysterectomy. Methods: This descriptive study was conducted at Kathmandu Model Hospital- Institute of Health Sciences over 5 months period after taking ethical approval. All patients undergoing TLH for benign indication were included in the study. Sociodemographic and clinical characteristics, operative details and immediate postoperative complications were recorded in a predesigned proforma. Data were analysed using SPSS version 20. P-value of <0.05 was considered statistically significant. Results: A total of 73 patients underwent TLH during the study period. The mean age and bod mass index was 46±5.83 years and 28.07±3.94 kg/m2 respectively. The most common presenting symptom was heavy menstrual bleeding (63%, n=46). Fibroid uterus (52.1%, n= 38) was the leading indication for TLH. The mean operative time was 149.04±40.33 minutes. A statistically significant association was observed between increasing uterine weight and longer operative time (p=0.001). The overall complication rate was 23.28% with no bowel or urinary tract injuries. Conclusion: Total laparoscopic hysterectomy is a safe and feasible options for benign gynaecological conditions, even in patients with higher body mass index and larger uterine size. Despite longer operative time, it has favourable perioperative outcome with acceptable complication rates.Publication Clinical Profile of Women with Lower Urinary Tract Symptoms Visiting Kathmandu Model Hospital(Public Health Concern Trust-Nepal (phect-NEPAL), 2025) Tiwari, Kenusha Devi; Dangal, Ganesh; Shrestha, Ranjana; Karki, Aruna; Pradhan, Hema Kumari; Bhattachan, KabinAbstract: Background: Lower urinary tract symptoms (LUTS) are common among women and can significantly impair quality of life. Despite their high prevalence, LUTS often remain under-recognized and under-treated, particularly in low- and middle-income countries. This study aimed to determine the prevalence, severity, and associated factors of LUTS among women attending a tertiary care hospital in Kathmandu, Nepal. Methods: A hospital-based cross-sectional study was conducted from September 2025 to December 2025 at Kathmandu Model Hospital. A total of 385 women were assessed for any lower urinary tract symptoms were using a validated Bristol Female Lower Urinary Tract Symptoms questionnaire translated into Nepali. Symptoms were categorized into no/minimal, moderate, and severe LUTS based on total scores. Data were analyzed using SPSS version 25, and associations were assessed using the chi-square test, with statistical significance set at p < 0.05. Results: Among 385 participants mild, moderate, and severe LUTS were present in 40.7%(157), 27.0%(104), and 10.3%(40) of women, respectively. Storage symptoms, particularly urinary frequency, were the most common complaints among 76.60%(295). Moderate to severe LUTS were significantly more prevalent in women aged over 40 years and in those with increasing parity (p < 0.001). All women with diabetes mellitus and those with a history of hysterectomy reported LUTS, with the majority experiencing moderate to severe symptoms. No statistically significant association was observed between mode of delivery and LUTS severity. Conclusion: Lower urinary tract symptoms are highly prevalent among 79% women attending tertiary care in Kathmandu, with increasing age, higher parity, diabetes mellitus, and prior hysterectomy being significant associated factors. Early identification and targeted management strategies are essential to reduce symptom severity and improve quality of life among affected women.Publication Etiological Factors of Infertility among Couples Visiting Kathmandu Model Hospital: A Descriptive Cross-sectional Study(Public Health Concern Trust-Nepal (phect-NEPAL), 2024) Bhandari, Srijana; Dangal, Ganesh; Karki, Aruna; Pradhan, Hema Kumari; Shrestha, Ranjana; Bhattachan, KabinAbstract: Introduction: Infertility is one of the major health related concern in developing countries, affecting couples in various aspects of life such as emotional, mental, social, and financial. Hence, knowing about the prevalence and its causative factors can help to estimate its burden in the society and provides insight for proper investigation and management of the infertile couples and to address the major burden of the society. Also knowing about various etiological factors of infertility helps to address them timely with close follow up during antenatal period for better perinatal outcomes. Methods: A cross-sectional study was carried out among 134 couples visiting Gynacelogy OPD of a tertiary hospital using pretested structured questionnaire. Non probability convenience sampling was done and the data was analysed using SPSS version 25.0. Descriptive statistical method was used for analysis. Results: Primary and secondary infertility was noted in 64.2% and 35.8% couples respectively. Among females, ovulatory disorder was the most common cause of infertility with polycystic ovarian syndrome found in 17.9% female along with unilateral fallopian tubal blockage seen in 17.9% followed by hypothyroidism found in 10.44%.Whereas in male, asthenospermia was the most common cause found in 32.25% followed by oligospermia found in 9.67% male. Conclusions: The study provides valuable insights into the etiological factors of infertility among both men and women. The identified causes underscore the complexity of reproductive health and emphasize the need for a holistic approach to fertility assessments and interventions to reduce the burden of society and also for good perinatal outcomes.Publication Fetomaternal Outcome of Pregnant Women at Term Undergoing Cesarean Section(Nepal Health Research Council, 2024) Bharati, Sonu; Dangal, Ganesh; Tiwari, Kenusha Devi; Maharjan, Sunita; Bhandari, Srijana; Karki, Aruna; Pradhan, Hema Kumari; Shrestha, Ranjana; Bhattachan, KabinBackground: Cesarean section is one of the most common procedures performed in obstetric practice today and is a lifesaving surgery for mother and fetus. Cesarean sections are classified traditionally, as elective cesarean section or emergency cesarean. The purpose of this study is to compare the maternal and neonatal outcomes in elective and emergency cesarean section so that measures can be taken to reduce maternal and neonatal morbidity and mortality. Methods: A descriptive study including 400 pregnant women who underwent caesarean section were included in this study. Patients were subjected to elective or emergency cesarean section as per the indication and protocol of institute. were included in the study. Results: During the study period there were total 1080 deliveries. The average age of the women was 29.21±4.07 years. Of the 400 cesarean section cases, only 2.8% had wound infection, 3.8% had fever, 4.8% urinary tract infection (UTI) whereas no women had observed with post-partum hemorrhages (PPH) and maternal death. Regarding fetal outcome, neonatal intensive care unit (NICU) admission was observed in 16%, birth asphyxia was 2.3% poor Apgar score 2.5% and neonatal death was not observed. Rate of fever, UTI, wound infection, need of resuscitation and poor Apgar score was significantly high in emergency section than elective caesarean section whereas NICU admission was not statistically significant. The most common indication of emergency cesarean section were fetal dress and for previous LSCS. Conclusions: Emergency cesarean was associated with increased maternal and perinatal complications than in elective cesarean section. Keywords: Caesarean section; elective caesarean section; emergency caesarean section; neonatal morbidity and mortality.Publication Laparoscopic Burch Colposuspension VersusTransobturator Tape Placement in Stress UrinaryIncontinence at Kathmandu Model Hospital(Public Health Concern Trust-Nepal (phect-NEPAL), 2024) Sah, Sadhana; Dangal, Ganesh; Karki, Aruna; Pradhan, Hema Kumari; Shrestha, Ranjana; Bhattachan, KabinAbstract: Introduction: Stress urinary incontinence is the involuntary leakage of urine due to increased intra-abdominal pressure. The pathological causes include urethral hypermobility and weakness of intrinsic urethral sphincter. Laparoscopic Burchcolposuspension is the valuable meshless alternative to transobturator tape placement and now is the current gold standard treatment for stress urinary incontinence. This study aimed to determine the efficacy of laparoscopic Burch colposuspension and transobturator tape placement in stress urinary incontinence. Methods: A retrospective study was carried out at the department of Obstetrics and Gynaecology at Kathmandu Model Hospital Institute of Health Sciences during the period of two year from December 2022 to November 2024 among all patients with stress urinary incontinence undergoing transobturator tape placement and laparoscopic Burchcolposuspension. Results: Majority of the patients belonged to age group 40-50 years in both laparoscopic Burch colposuspension (58.5%) and transobturator tape (60%) groups. Majority of the patients were multiparous which was 90.2% in laparoscopic Burch colposuspension and 95%in transobturator tape groups. Majority of the patients were postmenopausal in both groups. Total blood loss was minimal in both groups. The success rate was 90.2% in laparoscopic Burch colposuspension and 95% in transobturator tape placement. Conclusion: Laparoscopic Burch colposuspension is safe and effective long-term treatment for patients with stress incontinence with low failure rates and minimal adverse outcomes. It has favorable outcome in terms of continence, cost, intraoperative and postoperative complications.Publication Laparoscopic Suture Cervicopexy in Young Lady with Cervical Elongation(Public Health Concern Trust-Nepal (phect-NEPAL), 2025) Sah, Sadhana; Dangal, Ganesh; Karki, Aruna; Pradhan, Hema Kumari; Shrestha, Ranjana; Bhattachan, Kabin; Shrestha, SabitaAbstract: Cervical elongation with apical prolapse in young women poses a surgical challenge when uterine preservation in required. We report a case of 25-years female, P1L1, with symptomatic cervical elongation. She underwent laparoscopic suture cervicopexy with plication of round ligaments and uterosacral ligaments and moschcowitz procedure under general anaesthesia. This surgery had led to a good anatomical correction with satisfactory apical support and the uterus remained centrally positioned with resolution of prolapse symptoms.Publication Management of a Transverse Upper Vaginal Septum with Hematometrocolpos: A Case Report(Public Health Concern Trust-Nepal (phect-NEPAL), 2024) Ghimire, Nitesh; Dangal, Ganesh; Karki, Aruna; Pradhan, Hema Kumari; Shrestha, Ranjana; Bhattachan, Kabin; Sah, SadhanaAbstract: The transverse vaginal septum is a rare congenital anomaly of the female genital tract caused by defective fusion or canalization of the urogenital sinus and Müllerian ducts. It can result in complete vaginal obstruction, leading to haematometrocolpos and cyclic pelvic pain, typically emerging after menarche in adolescents. Diagnosis involves thorough clinical examination and imaging like 3D ultrasound or MRI for complex cases. Early surgical treatment is crucial to ensure effective management and avoid complications. We report the case of a 14-year-old female treated for hematometrocolpos secondary to a complete transverse vaginal septum. A laparoscopic approach was used, involving a vertical incision in the cervix and upper vagina to drain the hematometrocolpos, exposing the upper septum. The septum was elevated, incised transversely, and extended laterally, with the edges sutured using 2-0 Polyglactin in a simple interrupted pattern. Postoperatively, a vaginal mold with an amnion graft was placed to prevent stenosis and removed three days later.Publication Persistent Mullerian Duct Syndrome in an Adult Infertile Male: A Case Report(Nepal Medical Association, 2024) Sedhain, Nesuma; Adhikari, Shree Prasad; Pradhan, Hema Kumari; Parajuli, RakshyaAbstract Persistent Müllerian duct syndrome is a rare autosomal recessive disorder of sex development characterized by the presence of Müllerian duct derived structures in a normally virilized, genotypical (46, XY) and phenotypical male. Here we describe a case of male partner of the couple who presented with primary subfertility and was diagnosed with persistent müllerian duct syndrome during investigations. Persistent Müllerian duct syndrome is a rare disease and in developing countries like Nepal, because of unaware of the disease condition and lack of proper health care facilities, such cases are diagnosed later in adult males. Therefore, this case highlights the importance of awareness and knowledge for early detection and treatment of such conditions to conserve fertility and prevent malignancy of testis and other remnant mullerian structures.Publication Posterior Vaginal Wall Fibrosis with Deviated Urethra Following Urethrovaginal Fistula Repair: A Case Report(Public Health Concern Trust-Nepal (phect-NEPAL), 2025) Yadav, Rosy; Tiwari, Kenusha Devi; Dangal, Ganesh; Karki, Aruna; Pradhan, Hema Kumari; Shrestha, Ranjana; Bhattachan, KabinAbstract: Urethrovaginal fistula (UVF) is an uncommon but distressing complication of gynecologic surgery. Surgical repair may result in scarring and posterior vaginal wall fibrosis, leading to dyspareunia, introital narrowing, and urethral deviation. Management of such sequelae remains surgically challenging. We present a 35-year-old woman with a history of total abdominal hysterectomy (TAH) for choriocarcinoma followed by chemotherapy developed a urethrovaginal fistula, which was repaired successfully. She later presented with posterior vaginal wall pain and discomfort due to fibrosis and urethral deviation. She underwent Fenton’s procedure with posterior vaginal wall fibrosis was released.Publication Prevalence of Thyroid Disorders in First Trimester of Pregnancy at Kathmandu Model Hospital(Public Health Concern Trust-Nepal (phect-NEPAL), 2024) Pradhan, Hema Kumari; Dangal, Ganesh; Karki, Aruna; Shrestha, Ranjana; Bhattachan, KabinAbstract: Introduction: Thyroid disorder is a common endocrine disorder in pregnancy. The reference range of thyroid function is lower in pregnancy. Optimum thyroid function is required to prevent complications in mother and fetus. Pregnant ladies without symptoms of thyroid disorder may have abnormal value. This study was done to find the prevalence of thyroid disorder in pregnant ladies attending Kathmandu Model Hospital in first trimester. Methods: This was an observational study of pregnant ladies who attended Obstetrics and Gynecology Department of Kathmandu Model Hospital from September 2021 to February 2022. Pregnant ladies in first trimester with singleton pregnancy without history of thyroid disorder were included in the study. Thyroid function test (TFT) was done after obtaining consent. Data were collected and analyzed. Results: A total of 488 pregnant ladies were included in the study. Thirty-seven (7.58%) pregnant ladies had abnormal result, out of which 34 (6.96%) had subclinical hypothyroidism (SCH). Conclusion: Subclinical hypothyroidism was high in the present study and BMI was not associated as risk factor.Publication Repair of Iatrogenic Urethrovaginal Fistula Using Labial Fat: A Case Report(Public Health Concern Trust-Nepal (phect-NEPAL), 2024) Bajracharya, Kalpana; Dangal, Ganesh; Karki, Aruna; Pradhan, Hema Kumari; Shrestha, Ranjana; Bhattachan, Kabin; Sah, Sadhana; Bhandari, SrijanaAbstract: Urethrovaginal fistula is abnormal communication between female urethra and vagina leading to continuous leakage of urine. Though it is rare in practice, it is most commonly the result of iatrogenic injuries, obstetric trauma, malignancy or infections. About 98% of these fistulae are secondary to iatrogenic injury.1 There are many repair procedures. However it appears that the martius operation with labial fat pad interposition between the repaired urethra and vagina is satisfactory.2 We present our experience in repairing iatrogenic urethrovaginal fistula using martius operation with labial fat pad.Publication The Impact of Body Mass Index on Semen Parameters: A cross sectional study(Rapti Academy of Health Sciences (RAHS), 2024) Sedhain, Nesuma; Adhikari, Shree Prasad; Pradhan, Hema Kumari; Thapa, Jwala; Parajuli, RakshyaAbstract Introduction: Infertility is an emerging health issue across the world/. Obesity is another growing health concern, which is seen associated with adverse health outcomes. Several people had investigated the effects of obesity on male infertility, with inconclusive findings. Hence the present study aimed to assess the relationship between Body Mass Index (BMI) and the various parameters of semen (volume, sperm count, vitality, motility and morphology). Methods: This was a cross-sectional study involving 272 men aged 20 – 52 years. The participants were categorized into four BMI groups as underweight, normal weight, overweight, and obese. Semen samples were analyzed. In the correlation study, Spearman’s correlation was used. Independent variables were tested on the dependent variables using Analysis of Variance (ANOVA) and Multivariate Analysis of Variance (MANOVA) to find out the effects of BMI on semen parameters while controlling effects of various covariates (age, smoking and alcohol consumption, occupation, ethnicity and education). Results: Correlation analysis showed no statistically significant correlations between BMI and semen parameters. However, comparing the BMI groups revealed statistically significant differences in semen parameter (p<0.05). The normal weight, overweight and obese groups had better semen quality than underweight. Underweight men had sperm count(16±20.78 million/ml), vitality(13.6±7.09%), progressive motility(4.33±4.93%) and morphology(1.33±0.57%). The effect of BMI on semen parameters was further confirmed by MANOVA study with Wilks’ Lambda=0.802, F=3.273, p<0.05. Conclusions: Semen quality was adversely affected in underweight groups compared to other groups. Thus emphasizing importance of keeping healthy BMI in order to have a better reproductive health. Keywords: BMI, Semen parameters, Underweight.