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D Dalela

Publications and source records attributed to D Dalela.

At least 19 recordsLinked to original sources
PubMed1998

The single ectopic ureter.

UNLABELLED: OBJECTIVES To correlate renal function with the site of the ectopic orifice in patients with a single ectopic ureter and to evaluate the role of ureteric reimplantation in the preservation of renal function. PATIENTS AND METHODS: Forty-four patients (41 female, age 1.5 months to 20 years) with a single ectopic ureter have been managed in our institution in the last 21 years. The classical symptom of continuous wetting with intermittent normal micturition was reported in most of the female patients. The investigative evaluation included intravenous urography (i.v.U), cysto-urethroscopy, vaginoscopy with retrograde ureteric catheterization, micturating cysto-urethrography (MCU) and ultrasonography. Diuretic renography was carried out in four patients after it became available in 1992. Renal function was assessed in relation to urinary tract anomalies and with outcome after ureteric re-implantation. RESULTS: Thirty-eight patients (two males) had a unilateral ectopic ureter; the ectopic orifice was vaginal in 12, vestibular in 11, urethral in nine, at the bladder neck in two, the seminal vesicle in one and undetermined in three. Twenty-one patients had renal and/or ureteric abnormalities, with reflux detected on MCU in three ureters. Associated anomalies included hypospadias (two, one female), skeletal anomalies (two), anorectal malformations (three), cryptorchidism (two), and unilateral cystic ovary (one). Two patients had preoperative hypertension. In 15 patients, renal function was considered sufficient to justify ureteric reimplantation, 14 of whom regained continence. One girl had suprapubic leakage from the bladder and died during secondary nephroureterectomy. Another girl had persistent incontinence; she was found to have contralateral duplex ureters with a vestibular ectopic orifice and was cured after upper polar heminephroureterectomy. i.v.U and renography carried out in two patients each within 4 weeks of surgery showed a moderate improvement in renal function. Eight patients reported for follow-up after ureteric reimplantation (mean duration 11 months); none had hypertension or urinary infection. Twenty-three patients with rudimentary kidneys underwent nephroureterectomy. Histopathological examination of the excised kidneys showed moderate to severe dysplasia with chronic pyelonephritis. Six patients (one male) had bilateral single ectopic ureters, with normal renal function in the five females. Unilateral reimplantation in the boy resolved the symptoms; one girl died before surgery and the other four underwent bilateral ureteric reimplantation, after which one was dry for up to 3 h while the other three were incontinent, one of whom subsequently underwent urinary diversion. CONCLUSIONS: There was no clear correlation of renal function with the site of the ectopic ureteric orifice, as most of the patients with a vaginal ectopic ureter had sufficient renal function to justify renal preservation. Ureteric reimplantation preserved renal function, although the improvement after surgery was determined by the degree of renal dysplasia.

Adolescent↗
PubMed1995

Bilateral simultaneous percutaneous nephrolithotomy. A prospective feasibility study.

A prospective study was undertaken to assess the feasibility and safety of bilateral simultaneous percutaneous nephrolithotomy (BPNL) under single anesthesia. BPNL was attempted in 16 consecutive patients with upper tract urolithiasis suitable for percutaneous treatment bilaterally. Bilateral simultaneous PNL could be accomplished in 14 of 16 cases; the opposite side was abandoned in 2 due to technical reasons. The operating sides could be switched within a short period (15 min) by rotating the patient table by 180 degrees. The average total operating time and irrigation time was 83 and 43 min, respectively. A total of 29 tracts and 18 sessions were required for endourologic treatment of 28 units in 14 patients. There was no significant morbidity. Complete clearance was achieved in 11 of 14 patients; there was insignificant residue in 1, while 2 with major residue required adjunct JJ stenting and extra-corporeal shockwave lithotripsy. The average hospital stay was 5.4 days. After initial proficiency with endourology, preparedness for BPNL is advisable in all such cases.

Adult↗
PubMed1994

Endopyelotomy and pyeloplasty: face to face.

46 symptomatic adult patients with documented ureteropelvic junction obstruction were treated with pyeloplasty (n = 23) or endopyelotomy (n = 23). Basic characteristics in both the groups were comparable. The technical aspects, complications and outcome, in the form of improvement in function and drainage patterns, were compared in both the groups. Endopyelotomy enjoyed the significant advantages of a shorter operating time and hospital stay, and obviously better cosmetic acceptance. The major complications in the endopyelotomy groups were related to external drainage and secondary infection in the form of fever, secondary hemorrhage and slippage of tubes in 44, 9 and 13% of cases, respectively. Complications associated with pyeloplasty were prolonged urinary leak, wound infection and urinary tract infection in 12, 17 and 22% of cases, respectively. Using 99Tc-DTPA diuretic scan, an improvement of more than 10% in split renal function could not be documented for any case from either group. In none of the patients did the function deteriorate either. Of all evaluable cases, only 1 in the pyeloplasty group showed a persistent obstructive pattern. The rest all demonstrated adequate drainage across the ureteropelvic junction. Overall in 12 cases (8 pyeloplasty, 4 endopyelotomy) drainage could not be determined postoperatively due to poor radionuclide uptake. A nephrostogram and/or pressure flow study, however, demonstrated a nonobstructive pattern in all these patients. It is concluded that endopyelotomy scores over pyeloplasty with a shorter operating time and hospital stay. The complication rate and outcome following surgery, however, are comparable in both the groups. Using external drainage following endopyelotomy, early resumption of work, however, could not be obtained.

Adolescent↗
PubMed1992

Routine radio-imaging in filarial chyluria--is it necessary in developing countries?

Chyluria is a common presentation of filariasis in developing countries and mostly affects economically poor classes. The judicious use of investigations is mandatory to keep the cost of treatment acceptable. A modified plan is suggested for managing such patients without using retrograde pyelography or lymphangiography. A total of 54 patients were studied at 2 separate institutions, with retrograde pyelography being carried out at one institution but not at the other. All patients were treated primarily by the instillation of 1% silver nitrate, with an initial success rate of 70%. Eight patients who failed to respond underwent pyelolymphatic disconnection, the success rate being 88%. The omission of retrograde pyelography and lymphangiography had no effect on either treatment or outcome. The value of these radio-imaging techniques is discussed.

Adult↗