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S N Wadhwa

Publications and source records attributed to S N Wadhwa.

At least 19 recordsLinked to original sources
PubMed2003

[Transient compensatory hypertrophy and limited regeneration of the surgically removed rat ventral prostate].

OBJECTIVES: To confirm whether regeneration of prostate lobe indeed takes place on surgical lobectomy and if so, to what extent. Other issues studied are 1. whether the lobe regenerated is similar morphologically to that developing normally from neonatal origin to adulthood, and 2. the consequences of partial lobectomy on the contralateral lobe and the influence of sex steroid hormones on the regeneration process. METHODS: The effect of surgical removal of one of the ventral prostate lobes on the size of the contralateral lobe has been studied at various time intervals after lobectomy. RESULTS: The surgically extirpated ventral prostate lobe in rats regenerates attaining plateau size at 8-16 weeks post lobectomy. The regenerated lobe, however, remains significantly smaller than the original size. In early phase of post lobectomy (at 2 weeks) the contralateral lobe was significantly hypertrophied. It reverts to normal size on regeneration of the extirpated lobe with time. Orchiectomy carried out at the time of lobectomy caused a drastic reduction in the size of the remaining lobe, which was prevented by exogenous treatment with androgens. In animals receiving treatment with estrogens, the remaining lobe was partially but not fully atrophied. However, estrogens did not support the regeneration of the surgically removed lobe, which requires androgens. CONCLUSIONS: These studies demonstrate that surgical removal of one of the ventral prostate lobe leads to a process of regeneration. However, the regenerated lobe does not attain the normal size.

Animals↗
PubMed2001

Retroperitoneoscopic nephrectomy and nephroureterectomy for benign nonfunctioning kidneys: a single-center experience.

OBJECTIVES: To report our experience of 185 cases of retroperitoneoscopic nephrectomy and nephroureterectomy for benign nonfunctioning kidneys with various modified techniques for differing etiologies. The feasibility, complications, and long-term outcomes are discussed. METHODS: The present study comprised 185 patients who underwent retroperitoneoscopic nephrectomy or nephroureterectomy during a 57-month period beginning July 1995. All procedures were done using the retroperitoneoscopic approach. Thirty-two patients had a history of previous surgery, 20 patients had a percutaneous nephrostomy, and 12 patients had mild renal impairment. RESULTS: Retroperitoneoscopic nephrectomy and nephroureterectomy were completed successfully in 167 patients. Eighteen patients required conversion to open surgery, 4 on an emergent basis and 14 electively. The mean operating time was 100 minutes (range 45 to 240), mean blood loss was 133 mL (range 30 to 1200), and mean hospital stay was 3 days (range 2 to 8). A total of 37 complications (16.2% were minor and 3.78% were major) occurred. Re-intervention was needed in 1 patient. No mortality resulted. Previous surgery, percutaneous nephrostomy, and chronic renal impairment did not affect the outcome. Apart from one incisional hernia, no long-term complications occurred. CONCLUSIONS: Retroperitoneoscopic nephrectomy and nephroureterectomy can be performed safely and successfully with obvious advantages for benign nonfunctioning kidneys regardless of the etiology or pathogenesis, with modifications in the approach in very difficult cases. Patients with conditions often considered to be contraindications (ie, genitourinary tuberculosis, pyonephrosis, history of previous surgery, percutaneous nephrostomy, stone disease, chronic renal failure, and horseshoe kidney) can also be successfully treated by skillful dissection and modifications in the surgical technique.

Adolescent↗
PubMed1999

Primary obstructive megaureter in adults: need for an aggressive management strategy.

PURPOSE: Primary obstructive megaureter (POM) is an uncommon disease in adults. We reviewed our experience with this disease to determine the clinical profile, management and prognosis of this disease in adults. METHODS: We studied 37 adults with POM who presented from January 1989 to December 1998. Their clinical presentation, renal function, radiologic data, complications, treatment as well as the results and follow-up were studied. RESULTS: The patients' age ranged from 13 to 52 years. Male:female ratio was 27:10. Seven patients had bilateral disease. All patients were symptomatic excepting 2. Complications at presentation were loin pain (26 cases), urinary infection (15 cases), calculus disease (17 cases), azotaemia (5 cases), and obstructive jaundice (1 case). Associated congenital anomalies included contralateral renal agenesis (2 cases), posterior urethral valve (1 case) and exstrophy of bladder (1 case). Thirty-four patients required surgical intervention. Of these, 26 patients underwent ureteroneocystostomy (UNC) with ureteral tailoring in 18 patients; 4 patients were treated endoscopically by ureteric meatotomy and stenting, 2 patients with nonfunctioning kidney by nephroureterectomy, 2 patients in advanced renal failure by percutaneous nephrostomy alone. In 4 out of 5 patients uraemia did not improve despite adequate drainage. CONCLUSION: The majority of adults with POM are symptomatic, have complications and require surgical correction. Complications of stone formation (46%) and renal failure (13.5%) are unusually common in adults. Once renal failure is advanced, intervention appears futile, therefore, it is imperative to treat these patients as soon as possible. Surgical correction by ureteric re-implantation is effective and has low morbidity.

Adolescent↗
PubMed1999

Modified minimal cost retroperitoneoscopic nephrectomy, nephrectomy with isthumusectomy and nephroureterectomy in children: a pilot study.

OBJECTIVE: To assess the feasibility of retroperitoneoscopic nephrectomy, nephrectomy with isthmusectomy and nephroureterectomy in children with nonfunctioning kidneys and renal anomalies, at minimal cost using a modified technique. PATIENTS AND METHODS: Eleven children (aged 4-16 years) underwent retroperitoneoscopic nephrectomy, nephroureterectomy, or nephrectomy with isthmusectomy for nonfunctioning kidneys. Three patients had previously undergone percutaneous nephrostomy to evaluate whether the kidney could be salvaged, but this did not alter the success of technique, although adhesions and fibrosis required careful and precise dissection. RESULTS: All procedures were completed successfully with minor complications (peritoneal transgression via the port in two patients, with no consequences). The mean operative duration, blood loss and hospital stay were 109 min, 82 mL and 2.25 days, respectively. CONCLUSION: Retroperitoneoscopic procedures can be conducted safely, successfully and at minimal cost without compromising any principles of technique. It is not essential to prepare the bowel or use ureteric catheterization and renal artery embolization. Expensive balloon dissectors, trocar-sealing balloons, endostaplers and endobags, lap sacs or morcellators are not required. The direct approach to the kidney via retroperitoneoscopy is also quicker.

Adolescent↗
PubMed1999

The role of retroperitoneoscopy in the management of renal and adrenal pathology.

OBJECTIVES: To describe the technique, findings and results of retroperitoneoscopic ablation of recalcitrant renal, giant adrenal and complex peripelvic cysts, and nephrectomy for nonfunctioning congenital anomalous kidneys. PATIENTS AND METHODS: Nine patients (six men and three women, mean age 56 years, range 44-68, five with renal, two with adrenal and two with peripelvic cysts, diameter 6-14 cm) were treated by retroperitoneoscopic cyst ablation using three 10-mm ports. Six further patients (two male and four female, mean age 24 years, range 13-38) underwent retroperitoneoscopic nephrectomy using three or four ports for anomalous nonfunctioning kidneys; three patients had a pelvic kidney, two a horseshoe kidney and one an iliac kidney. Isthmusectomy was also performed in the patients with horseshoe kidneys. RESULTS: Retroperitoneoscopic cyst ablation was successful in all nine patients; the mean (range) operative duration was 69 (50-85) min in patients with simple renal and adrenal cysts, and 185 (160-210) min in patients with peripelvic cysts. The mean (range) blood loss was 130 (50-200) mL and hospital stay 2.33 (2-4) days. At the last follow-up, 15-39 months after the procedure, all patients were asymptomatic and satisfied with the outcome, with no recurrence of cysts. Retroperitoneoscopic nephrectomy with isthmusectomy (when applicable) was successful in the six patients with anomalous kidneys, with a mean (range) operative duration of 105 (85-120) min; the mean (range) blood loss was 116 (75-150) mL and the analgesic requirement 208 (150-250) mg of diclofenac sodium. The hospital stay was 2-3 days and the delay before return to preoperative activity 7-14 days. CONCLUSIONS: Retroperitoneoscopic cyst ablation is a safe and effective method to treat symptomatic cysts of the upper urinary tract which are refractory to other forms of management. Dissection is difficult in patients with peripelvic cysts. Retroperitoneoscopic nephrectomy for anomalous kidneys is a challenging procedure because of the abnormal location, anomalous vessels and presence of an isthmus. With advances in laparoscopy and increasing experience, open surgery for such conditions is likely to become obsolete.

Adolescent↗
PubMed1999

Retroperitoneoscopic nephrolympholysis and ureterolysis for management of intractable filarial chyluria.

PURPOSE: To evaluate the feasibility of retroperitoneoscopic lymphatic disconnection in patients with intractable filarial chyluria with the aim of reducing the morbidity of the surgery. PATIENTS AND METHODS: Two patients presented to us with intractable chyluria. They did not respond to conservative measures and endoscopic sclerotherapy. In view of the severe lipid and protein loss associated with recurrent bouts of chyluria, they merited surgical correction by lymphatic disconnection. Because this operation requires extensive mobilization within the retroperitoneum over a large area, it necessitates a large flank or midline incision. In order to reduce the incision-related morbidity, it was decided to undertake the procedure laparoscopically. The retroperitoneal route was chosen for its obvious advantages. RESULTS: Surgery was carried out uneventfully in both patients, with a mean operating time of 2 hours. The patients stayed in the hospital for an average of 2.5 days. Chyluria resolved in the immediate postoperative period, and they have been asymptomatic over a follow-up of 30 and 18 months. One patient had drainage of lymph for 5 days, which resolved spontaneously. CONCLUSIONS: The objectives of open surgery can be achieved by the minimally invasive approach of retroperitoneoscopy. The new approach significantly reduces the incision-related morbidity without compromising the principles of open surgery. We propose five important steps necessary to avoid recurrence and reduce postoperative morbidity.

Adult↗
PubMed1999

Transperitoneal and retroperitoneal laparoscopic nephrectomy for giant hydronephrosis.

PURPOSE: We evaluate laparoscopic nephrectomy for giant hydronephrosis with an emphasis on the operative technique of retroperitoneoscopic surgery. MATERIALS AND METHODS: During the last 2 years 13 men and 5 women underwent laparoscopic nephrectomy for giant hydronephrosis via a transperitoneal (6) or retroperitoneal (12) approach. The etiology was congenital ureteropelvic junction obstruction in 17 patients and hydronephrosis caused by stone disease in 1. Three patients had a contralateral obstructed kidney. Renal parameters were normal in all patients. RESULTS: All procedures were successfully completed without the need for conversion to open surgery. Mean operating time was 113.8 minutes (range 70 to 165) and average blood loss was 260 ml. (range 40 to 600). No patient required a blood transfusion. Postoperative recovery was uneventful with an average postoperative hospital stay of only 3.2 days (range 2 to 5). CONCLUSIONS: Laparoscopic nephrectomy is a good alternative to open surgery for giant hydronephrosis and significantly reduced the morbidity of surgery. A retroperitoneal approach is feasible, despite the large amount of retroperitoneal space occupied by these hugely dilated kidneys. Modifications of our technique have been invaluable to the successful outcome in this series.

Adolescent↗
PubMed1998

Management of obliterative posttraumatic posterior urethral strictures after failed initial urethroplasty.

PURPOSE: We evaluate the problems encountered during surgery and assess the results of different endoscopic and open surgical methods following failed urethroplasty for posttraumatic posterior urethral stricture. MATERIALS AND METHODS: Since 1992 we have treated 23 patients in whom urethroplasty for posterior urethral strictures failed. Of these patients, 3 had undergone 2 previous repairs and 6 had additional complicating factors, such as fistula, periurethral cavity and false passage. End-to-end anastomosis was done in 14 patients via a transperineal (7) or transpubic (7) approach. In 1 patient substitution urethroplasty using a radial artery based forearm free flap was performed. In 3 patients a 2-stage urethroplasty was done, 4 underwent core-through optical internal urethrotomy and 1 underwent endoscopic marsupialization of a false passage. RESULTS: At 1 to 5-year followup 3 of the 23 patients had restenoses (13%), including 2 in whom previous treatment failed. The remaining 87% of the patients void well and are continent, and there is no worsening of the preexisting potency status. CONCLUSIONS: Previous failed urethral stricture repair complicates management due to fibrosis, impaired vascularity and limited urethra available for mobilization. Recurrent strictures less than 1.5 cm. can be managed successfully with core-through internal urethrotomy. End-to-end anastomosis is possible in the majority with generous use of inferior pubectomy or the transpubic approach with certain modifications. When residual inflammation or long strictures are present a 2-stage procedure is a safer option. Overall, reoperation can offer a successful outcome for the majority of these complex strictures.

Adult↗
PubMed1998

Intralesional sclerotherapy in the management of hemangiomas of the glans penis.

PURPOSE: We studied the role of sclerotherapy in the management of glans penis hemangiomas. MATERIALS AND METHODS: Four patients with hemangiomas of the glans penis were treated on an outpatient basis with intralesional injections of 30% hypertonic saline. RESULTS: In all 4 patients the lesions regressed and all were satisfied with the outcome. CONCLUSIONS: Intralesional sclerotherapy is a cost-effective modality for the treatment of glans penis hemangiomas, especially in developing countries and at peripheral hospitals where expensive laser equipment may not be available.

Adolescent↗
PubMed1998

Nephroplication and nephropexy as an adjunct to primary surgery in the management of giant hydronephrosis.

OBJECTIVE: To study the role of nephroplication and nephropexy as an adjunct to primary surgery in the management of giant hydronephrosis, with an aim to reduce stasis and improve drainage, thus preventing consequent complications. PATIENTS AND METHODS: Adjunctive nephroplication and nephropexy were performed in 20 renal units of 16 patients with giant hydronephrosis treated between January 1992 and March 1997. Twelve patients had unilateral and four had bilateral pelvi-ureteric junction obstruction. Four patients had elevated serum creatinine levels. All patients were treated with definitive surgery for the underlying disease and an adjunctive nephroplication and nephropexy was performed at the same time. RESULTS: Eighteen of the 20 renal units with giant hydronephrosis showed an improvement in function and drainage as well as in pelvicalyceal system dilatation, while one remained unchanged and one deteriorated. None of the patients developed renal stones or pyelonephritis. Of the four patients with azotaemia, three showed definite improvement to normal levels while one stabilized. CONCLUSIONS: Nephroplication and nephropexy of giant hydronephrotic kidneys are useful adjunctive procedures to reduce pelvicalyceal system stasis and to improve drainage, thereby preventing subsequent stone formation, infection and deterioration in renal function.

Adolescent↗
PubMed1998

Obstructive jaundice: a unique presentation of primary obstructive megaureter.

A case of giant hydronephrosis leading to obstructive jaundice due to primary obstructive megaureter in an adult is the subject of this presentation. Giant hydronephrosis due to primary obstructive megaureter in adults is uncommon. This is also the first case of obstructive jaundice due to primary obstructive megaureter reported in the literature. The patient was initially treated with a percutaneous nephrostomy till the jaundice resolved. This was followed by definitive surgery in the form of ureteral tailoring and reimplantation along with nephroplication and nephropexy, with a successful outcome.

Adult↗
PubMed1997

Androgen receptor transcript level in benign hypertrophy and carcinoma of the human prostate.

OBJECTIVE: Current reports suggest the presence of androgen receptor (AR) defects in prostate cancer. We have detected the AR mRNA in normal, benign hypertrophied (BPH) and carcinomatous (CaP) prostate tissues and evaluated the difference in the level of AR transcript in these groups. MATERIALS AND METHODS: Cytoplasmic dot hybridization assay was used to measure the levels of AR mRNA in 21 normal, 45 BPH and 30 CaP specimens. Tissue samples of 14 CaP patients receiving endocrine treatment were also analyzed. Blots were autoradiographed and the intensity of the signal was measured by densitometry. RESULTS AND CONCLUSIONS: The majority of cases in all the 3 groups were positive for the AR mRNA. All the patients who had received endocrine treatment were also positive for the AR mRNA. The level of the AR mRNA was significantly higher in BPH and treated CaP cases as compared to normal cases (p < 0.05). Among the CaP cases the level of AR transcript was significantly higher in the treated group as compared to the untreated group.

Adult↗
PubMed1996

Carcinoma penis in a young boy. A case report.

Carcinoma of the penis below the age of fifteen years is a rarity. A 14 year old boy presenting with advanced carcinoma penis with bilateral fungating inguinal lymphadenopathy is the subject of this case report.

Adolescent↗
PubMed1995

Immunohistochemical localization of transforming growth factor-alpha, epidermal growth factor receptor and c-erbB-2 protein in hyperplastic human prostates.

Transforming growth factor-alpha (TGF-alpha) is a potent mitogenic factor which acts by binding to the epidermal growth factor (EGF). c-erbB-2 is a member of the EGF receptor family and is known to be associated with cellular growth and differentiation. The roles played by these factors in benign prostatic hyperplasia (BPH) are not clearly known. In the present study, expression of these factors was investigated immunohistochemically in frozen and formalin fixed prostate tissues from subjects suffering from BPH. Intracytoplasmic localization of TGF-alpha was observed in the epithelium of nine out of 39 (23.07%) cases. Twenty-six out of 36 (72.22%) frozen BPH tissues exhibited moderate to strong staining for immunoreactive EGF-receptor in the cell membrane. c-erbB-2 oncoprotein was localized in 35 out of 39 cases (89.74%) with the intensity of staining being variable. All nine cases positive for TGF-alpha were also positive for both EGF-receptor and c-erbB-2 protein. Staining reaction had no correlation with the serum testosterone, prostate specific acid phosphatase and prostate specific antigen levels. Immunohistochemical studies indicate the expression of TGF-alpha, EGF receptor and c-erbB-2 protein in BPH tissues. Further study is required to elucidate the precise roles played by these factors in benign growth of prostates.

Adult↗
PubMed1995

Giant staghorn ureteral calculus.

We are reporting a young female who presented with a history of right flank pain and urinary tract infection off and on. On investigation, she was found to have a giant fork-shaped ureteral calculus in a bifid ureter. Since her ipsilateral renal unit was nonfunctioning, nephroureterectomy was performed. Such a case of giant staghorn ureteral calculus in a bifid ureter has never been reported in the world literature.

Adult↗