Browsing by Author "Tiwari, Kenusha Devi"
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Publication Augmented Manchester Procedure with Right Sacrospinous Fixation in a young woman(Public Health Concern Trust-Nepal (phect-NEPAL), 2025) Tiwari, Kenusha Devi; Shrestha, Ranjana; Dangal, Ganesh; Pradhan, Hema; Bhattachan, Kabin; Shah, SadhanaAbstract: Severe cervical elongation in young multiparous women is a rare cause of pelvic organ prolapse. Achieving durable apical support while preserving the uterus presents a surgical challenge. A 26-year-old unmarried nullipara with 12 years history of pelvic organ prolapse with cervical elongation of 9cm. She underwent Manchester procedure combined with Right sacrospinous ligament fixation of the neo cervix under anesthesia. This combined approach addressed the anatomical defect and provided robust apical suspension. This case demonstrated the feasibility and rationale for this combined approach in a medically complex patient.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 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 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 Vaginoplasty with Amnion Graft: Management of Mayer-Rokitansky-Kuster-Hauser Syndrome(Nepal Health Research Council, 2023) Bhandari, Srijana; Dangal, Ganesh; Karki, Aruna; Pradhan, Hema; Shrestha, Ranjana; Bhattachan, Kabin; Tiwari, Kenusha Devi; Bharati, Sonu; Maharjan, SunitaAbstract Mayer-Rokitansky-Kuster-Hauser syndrome also known as mullerian agenesis is a rare congenital condition in which there is absence of uterus along with upper vagina. Patient usually presents with primary amenorrhea with or without cyclical lower abdominal pain but have normal secondary sexual characters. Modified McIndoe Vaginoplasty with amnion graft is the commonest surgery performed worldwide. A 23 year old girl with normal secondary sexual characters presented with primary amenorrhea with cyclical lower abdominal pain; on examination blind vagina was present. Vaginoplasty with amnion graft was done and vaginal mould was placed. Vaginal dilatation with Hegar’s dilator was done weekly until 6 weeks. She is under regular follow-up at present and advised for regular manual dilation at home. McIndoe Vaginoplasty with amnion graft is a simple yet rewarding procedure especially in low resource countries like ours, with good success rate and with minimal postoperative complications. Keywords: Amnion graft; Mayer-Rokitansky-Kuster-Hauser Syndrome; Modified McIndoe Vaginoplasty; Primary amenorrhea; Secondary sexual characters.