Biomedical subjects
Publications and source records attributed to Pranjal Modi.
We report an extensive form of emphysematous pyelonephritis (EPN) in the right kidney extending from the anterior abdominal wall to the scrotum in a patient with renal calculi with obstructive uropathy and describe the progression route of infection from retroperitoneum to scrotum. Such an extensive occurrence of EPN is very rare. The patient succumbed after 48 h despite aggressive treatment.
An 8-year-old boy with right flank pain was found on ultrasonography and intravenous urography to have hydronephrosis secondary to ureteropelvic junction obstruction with calculi in the lower pole of the right kidney and a fusion anomaly. Transperitoneal laparoscopic dismembered pyeloplasty and removal of calculi was carried out. The patient had uneventful recovery and is doing well at 6 months' follow-up. To our knowledge, this is the first reported case of laparoscopic pyeloplasty with pyelolithotomy in crossed fused ectopic kidneys in the pediatric population.
Laparoscopic removal of the pyonephrotic moiety of a horseshoe kidney is challenging because of inflammation, aberrant vasculature, abnormal kidney location, and the renal isthmus. We herein report retroperitoneoscopic nephrectomy of the nonfunctioning pyonephrotic right moiety of a horseshoe kidney.
A Boari flap may be required to bridge long defects of the middle and lower ureter to the bladder. Laparoscopic construction of a Boari flap was performed in a patient with a ureteral stricture secondary to iatrogenic injury. The salient steps performed were spatulation of the transected ureteral end, fashioning of a Boari flap from the bladder, end-to-side anastomosis of the ureter to the flap, placement of a stent with the aid of a suction cannula, and closure of the flap over the stent. A Boari flap can be accomplished laparoscopically with minimal morbidity.
AIMS: Laparoscopic nephrectomy has become a standardized procedure for removal of benign non-functioning kidneys. We present our experience of retroperitoneoscopic pre-transplant native kidneys nephrectomy. METHODS: Comparison of 40 patients who underwent retroperitoneoscopy with 40 open simple pre-transplant nephrectomy patients was done. RESULTS: Forty retroperitoneoscopic nephrectomies were done between June 2003 and April 2005. The mean operative time was similar in the two groups; however, the mean blood loss, postoperative analgesic requirement, complication rate, hospital stay and convalescence period were significantly less in the retroperitoneoscopic group. CONCLUSION: Retroperitoneoscopic nephrectomy should be offered as the primary treatment modality to patients requiring pre-transplant native kidney nephrectomy, except in patients where it is contraindicated.
Vesicovaginal fistula (VVF) may be a complication of prolonged repair or urogynecologic surgery. Failing conservative management, it may be repaired using an abdominal or vaginal approach. We herein report laparoscopic repair of VVF following vaginal hysterectomy and detail the operative steps.
OBJECTIVES: To present our initial experience with laparoscopic ureteroneocystostomy in patients with traumatic disruption of the distal ureter owing to gynecologic procedures. Reconstructive laparoscopic procedures are still evolving. METHODS: Six patients with ureterovaginal fistula in whom endoscopic management had failed underwent laparoscopic ureteroneocystostomy with a psoas hitch between July 2003 and December 2004. RESULTS: All procedures were completed successfully. No intraoperative or postoperative complications were noted. Postoperative intravenous urography did not reveal any evidence of obstruction. No reflux was seen in 5 of the 6 patients during micturating cystography. CONCLUSIONS: Laparoscopic ureteroneocystostomy is a safe and feasible minimally invasive option for patients with gynecologic distal ureteral injury.
BACKGROUND: Retroperitoneoscopic surgery has become an established armamentarium in the hands of urologist. We present a simple and cost-effective technique that aids in the maintenance of pneumoretroperitoneum. METHODS: Between June 2003 and December 2004, 150 retroperitoneal nephrectomies were performed with maintenance of the pneumoretroperitoneum using our technique. RESULTS: The retroperitoneal space was maintained in all patients with minimal or no leakage of carbon dioxide from the port site. CONCLUSION: Our simple, cost-effective technique is highly reliable for the maintenance of pneumoretroperitoneum.