Browsing by Author "Pradhan, Manish Man"
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Publication 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 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 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 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.