NepMed Repository :: Browsing by Author "Sharma, Uttam K"

Browsing by Author "Sharma, Uttam K"

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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 R
ABSTRACT 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; urethroplasty
Comparison of Outcomes of Open versus Laparoscopic Living Donor Nephrectomy in Nepal
(Institute of Medicine, 2020) Sigdel, Prem R; Gnyawali, Diwas; Rai, Bipendra D K; Dhital, Pawan; Parajuli, Purushottam; Chudal, Sampanna; Dhakal, Niraj; Pradhan, Manish; Poudyal, Sujeet; Chapagain, Suman; Luitel, Bhoj R; Chalise, Pawan R; Sharma, Uttam K; Gyawali, Prem R
ABSTRACT Introduction: Laparoscopic donor nephrectomy is the gold standard for kidney retrieval in live donors. Until recently, donor nephrectomies were performed only by open technique in Nepal. There is no information on the experience and outcomes of laparoscopic donor nephrectomy in Nepal. The study was done to compare the outcomes among donors undergoing open and laparoscopic nephrectomies, and to compare the graft related outcomes between the two groups receiving these kidneys. Methods: In this retrospective study, 44 kidney donors from March 2019 to October 2019 were analyzed. Donors were divided into 2 groups: open donor nephrectomy (ODN) and laparoscopic donor nephrectomy (LDN). Parameters for analysis included demographic data, warm ischemia time, surgery time and length of hospital stay. Data on early graft function and complications in recipients till 30th post-operative day were compared. Results: There were 22 donors each in the ODN and LDN groups. Baseline characteristics of the donors were comparable between two groups. Mean surgery duration (183.55±43.31 minutes vs 117.73±18.75 minutes) and first warm ischemia time (11.22±4.34 minutes vs 2.3±0.8 minutes) was significantly high in LDN. Hemoglobin drop, post-operative complications in donors, creatinine of donors at discharge, mean hospital stay, graft function at one month and complications in recipients were comparable among ODN and LDN. Pain score in 1st post-operative day was comparable between two groups, however, pain was significantly less in second post-operative day in LDN. Conclusion: Laparoscopic donor nephrectomy is feasible in Nepal and associated with acceptable morbidity and graft function when compared to ODN. Keywords: Laparoscopic donor nephrectomy, open donor nephrectomy, renal transplantation
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, Ghanashyam
ABSTRACT 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 volume
Nephron Sparing Surgery for Small Renal Mass at a University Teaching Hospital: A Six Years Retrospective Review
(Institute of Medicine, 2019) Rai, Bipendra DK; Poudyal, Sujeet; Dhital, Pawan; Pradhan, Manish; Chapagain, Suman; Luitel, Bhoj R; Chalise, Pawan R; Sharma, Uttam K; Gyawali, Prem R
ABSTRACT Introduction Nephron-sparing surgery (NSS) is the standard of care for clinical T1 (cT1), renal mass less than 7 cm, whenever intervention is indicated. It has oncological outcome equivalent to radical nephrectomy in small renal masses and it also minimizes the progression to chronic kidney disease. However, there is paucity of data on outcomes of NSS in Nepalese population. Methods A six years retrospective review of medical records of patients undergoing partial nephrectomy from Jan 2012 to Dec 2017 in Department of Urology and Kidney Transplant Surgery at Tribhuvan University Teaching Hospital was done to determine its demographics and outcomes. Results Twenty eight patients underwent nephron sparing surgery for clinical T1 renal masses in the past six years. Complications occurred in three cases. Five of the lesions were benign and 23 malignant on final histology. Clear cell carcinoma was the commonest variant of renal cell cancer. Margin was positive in two cases and both were kept in close surveillance. There was no local recurrence and renal impairment during five to 60 months follow-up. Conclusion Nephron sparing surgery is a safe procedure with good oncological outcome for clinical T1 renal mass. It prevents unnecessary nephrectomy in benign lesions as well as chronic renal impairment at the same time. Keywords: Nephron sparing surgery, small renal mass
Retrospective Review of Adrenalectomy in a Tertiary Center in Nepal
(Institute of Medicine, 2019) Dhital, Pawan; Rai, Bipendra DK; Pradhan, Manish; Poudyal, Sujeet; Chapagain, Suman; Luitel, Bhoj R; Chalise, Pawan R; Sharma, Uttam K; Gyawali, Prem R
ABSTRACT Introduction Adrenal gland surgery is a challenging art as it encompasses diverse physiological derangements which are even life-threatening. Also, it remains a medical finesse to rightly identify the correct patient who will benefit from surgery which include strong biochemical and radiological resource. Soundly performed surgery will lead to oncologic and homeostatic correction leading to near normal course. Methods This is a retrospective analysis of adrenalectomy cohort over three years in a tertiary center in Nepal identifying diagnosis, perioperative management and postoperative course. The objective of this study is to review the presentation, histopathology and clinical outcomes of patients operated for adrenal mass in our center. Results There were 42 surgeries performed via open approach. The number of adenoma, phaeochromocytoma, carcinoma and non-functioning tumor were 13, 16, 12 and one respectively. In most of the hypertensive patients, control was achieved with minimal drug and recurrences were observed in 25% of carcinoma in postoperative follow up. Conclusion A large proportion of operative adrenal mass are observed clinically in our setup. The surgical outcome is satisfactory but judicious perioperative management is essential. Keywords: Adrenalectomy, adrenocortical carcinoma, phaeochromocytoma
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 R
ABSTRACT 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

Browsing by Author "Sharma, Uttam K"

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