Muljibhai Patel Urological Hospital

Nadiād, India

Muljibhai Patel Urological Hospital

Nadiād, India
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Proietti S.,IRCCS San Raffaele Hospital | Giusti G.,IRCCS San Raffaele Hospital | Desai M.,Muljibhai Patel Urological Hospital | Ganpule A.P.,Muljibhai Patel Urological Hospital
European Urology Focus | Year: 2017

Context: In an effort to reduce morbidity related to percutaneous nephrolithotomy (PCNL), some investigators have progressively introduced miniaturised approaches. The development of miniaturised nephroscopes facilitated widespread dissemination of these techniques and a significant expansion of the role of PCNL in endourology. Objective: To discuss the different techniques comprising modern PCNL and identify the pros and cons of each of them. Evidence acquisition: Data for this review were identified through a search of PubMed, including studies published in the last 20 yr in core clinical journals in English. The search terms included "urolithiasis", "nephrolithiasis", or "urinary stones" in combination with "miniaturised PCNL", "mini-PCNL", "micro-PCNL", "minimally invasive PCNL", and "ultra-mini PCNL". Publications relevant to the subject were retrieved and critically appraised. Evidence synthesis: The indications for miniaturised PCNL have not been standardised yet. Even though data in the literature reveal limitations and conflicting results, these techniques seem promising in terms of effectiveness and safety for the treatment of renal stones. The development of miniaturised scopes facilitated knowledge of the physics behind the vacuum cleaner effect generated during procedures, and greater efficacy of holmium laser generators and surgeon skill have led to progressive expansion of the indications for miniaturised techniques. Well-designed, randomised, multi-institutional studies are needed to better understand the indications for these miniaturised techniques before considering them a standard procedure for potential replacement of conventional PCNL. Conclusions: Miniaturised PCNL represents a valuable new tool in the armamentarium of modern endourologists, capable of offering good outcomes with lower complications rates compared to the standard technique and higher cost effectiveness compared to flexible ureteroscopy. Patient summary: Miniaturised percutaneous nephrolithotomy represents a safe and effective alternative to standard techniques for the treatment of renal stones. Each patient needs to be considered individually and tailored surgical treatment has to be offered. Miniaturized percutaneous nephrolithotomy represent a safe and effective alternative to standard techniques for the treatment of renal stones. Each patient needs to be considered individually and a tailored surgical approach has to be offered. © 2017.

Sabnis R.B.,Muljibhai Patel Urological Hospital | Ganesamoni R.,Muljibhai Patel Urological Hospital | Doshi A.,Muljibhai Patel Urological Hospital | Ganpule A.P.,Muljibhai Patel Urological Hospital | And 2 more authors.
BJU International | Year: 2013

Objective To compare micropercutaneous nephrolithotomy (microperc) and retrograde intrarenal surgery (RIRS) for the management of renal calculi <1.5 cm with regard to stone clearance rates and surgical characteristics, complications and postoperative recovery. Patients and Methods Seventy patients presenting with renal calculi <1.5 cm were equally randomized to a microperc or a RIRS group between February 2011 and August 2012 in this randomized controlled trial. Randomization was based on centralized computer-generated numbers. Patients and authors assessing the outcomes were not blinded to the procedure. Microperc was performed using a 4.85-F (16-gauge) needle with a 272-μm laser fibre. RIRS was performed using a uretero-renoscope. Variables studied were stone clearance rates, operating time, need for JJ stenting, intra-operative and postoperative complications (according to the Clavien-Dindo classification system), surgeon discomfort score, postoperative pain score, analgesic requirement and hospital stay. Stone clearance was assessed using ultrasonography and X-ray plain abdominal film of kidney, ureter and bladder at 3 months. Results There were 35 patients in each group. All the patients were included in the final analysis. The stone clearance rates in the microperc and RIRS groups were similar (97.1 vs 94.1%, P = 1.0). The mean [sd] operating time was similar between the groups (51.6 [18.5] vs 47.1 [17.5], P = 0.295). JJ stenting was required in a lower proportion of patients in the microperc group (20 vs 62.8%, P < 0.001). Intra-operative complications were a minor pelvic perforation in one patient and transient haematuria in two patients, all in the microperc group. One patient in each group required conversion to miniperc. One patient in the microperc group needed RIRS for small residual calculi 1 day after surgery. The decrease in haemoglobin was greater in the microperc group (0.96 vs 0.56 g/dL, P < 0.001). The incidence of postoperative fever (Clavien I) was similar in the two groups (8.6 vs 11.4%, P = 1.0). None of the patients in the study required blood transfusion. The mean [sd] postoperative pain score at 24 h was slightly higher in the microperc group (1.9 [1.2] vs 1.6 [0.8], P = 0.045). The mean [sd] analgesic requirement was higher in the microperc group (90 [72] vs 40 [41] mg tramadol, P < 0.001). The mean [sd] hospital stay was similar in the two groups (57 [22] vs 48 [18] h, P = 0.08). Conclusions Microperc is a safe and effective alternative to RIRS for the management of small renal calculi and has similar stone clearance and complication rates when compared to RIRS. Microperc is associated with higher haemoglobin loss, increased pain and higher analgesic requirements, while RIRS is associated with a higher requirement for JJ stenting. © 2013 BJU International.

Mishra S.,Muljibhai Patel Urological Hospital | Jagtap J.,Muljibhai Patel Urological Hospital | Sabnis R.B.,Muljibhai Patel Urological Hospital | Desai M.R.,Muljibhai Patel Urological Hospital
Current Opinion in Urology | Year: 2013

PURPOSE OF REVIEW: Training in percutaneous nephrolithotomy (PCNL) necessitates the trainee to climb the steep learning curve of this procedure sequentially. The initial steps of the process should be the acquisition of the necessary skills in a nonintimidating skills lab. We review the current scenario of the training in PCNL and advocate the means that may improve the overall patient care. RECENT FINDINGS: The training involves a comprehensive development of the trainee. Initial process starts with the cognitive skills update through conferences and observing peers do the procedure. Rapid prototyping could be useful for resident education. The benefits of three-dimensional stereolithographic biomodeling produced from computed tomography data may aid in achieving optimal access. Skills lab involving wet and dry lab reinforce the cognitive skills. The advantage of live anesthetized porcine model is it being a more realistic model and assessment tool. The specific advantage of the dry lab simulator is of repetitive tasking and easier setup feasibility. There is a lack of guideline for the lab setup and training. Funding, location, number of models installed, curriculum, a trained mentor, and instructor are the critical components that need to be planned in advance. SUMMARY: Training in PCNL starts with cognitive knowledge, reinforcement through repetitive nonpatient basic skills acquisition in wet and dry skills lab, prototyping the technique before the actual procedure, and finally supervised training under an able mentor.© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Desai M.,Muljibhai Patel Urological Hospital | Mishra S.,Muljibhai Patel Urological Hospital
Current Opinion in Urology | Year: 2012

Purpose of Review: Miniaturization of instruments in percutaneous nephrolithotomy (PCNL) has spawned an interest in so-called 'microperc' in which the procedure is carried out through 16-gauge needle. Recent Findings: The greatest limitation of extracorporeal shock wave lithotripsy is its unpredictable results. The main limitation of retrograde intrarenal surgery is high sustainable cost and poor durability. The main limitation of PCNL is its invasiveness and associated morbidity. The interest in reducing the tract size was to potentially reduce the invasiveness of the procedure, and, therefore, attending complications. In a historical study, postrenal biopsy bleeding was found to be significant only after the tract of the needle was less than 16 gauge. Microperc extended the concept of 'All-seeing needle' to perform PCNL through a 4.85-Fr (16 gauge) tract. The working hypothesis of the 'All-seeing needle' is that if the initial tract is perfect, then the tract-related morbidity could be reduced. The optical needle helps to avoid any traversing viscera and confirms the visual cues of a correct papilla. The other advantage of microperc is that it is a novel single-step renal access procedure, resulting in a shorter insertion to lithotripsy time. This may provide a new standard of obtaining renal access. Summary: Only a few published studies have documented efficacy and safety. Till further prospective and multicentric articles are published, it is still an experimental procedure requiring further research. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Sabnis R.B.,Muljibhai Patel Urological Hospital | Ganesamoni R.,Muljibhai Patel Urological Hospital | Sarpal R.,Muljibhai Patel Urological Hospital
Current Opinion in Urology | Year: 2012

Purpose of Review: To review the recently published literature related to miniperc. Recent Findings: Miniperc has generated lot of enthusiasm in the last few years. Miniperc utilizes tract size of 20 F or less, hence the complication rates are much less. Hematocrit drop is significantly reduced and blood transfusion rates have gone down. Reduced pain and hospital stay without affecting success rate is the remarkable achievement of this procedure. Although initially it was supposed to be for small sized stones, many authors have utilized miniperc even for large and complex stones with good clearance rate. Summary: Miniperc has several advantages over standard percutaneous nephrolithotomy. In comparison with retrograde intrarenal surgery and shock wave lithotripsy, it offers better clearance rate. Hemorrhagic complications of miniperc are significantly less, making it an attractive procedure for treating renal stones. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Mishra S.,Muljibhai Patel Urological Hospital | Sabnis R.B.,Muljibhai Patel Urological Hospital | Desai M.,Muljibhai Patel Urological Hospital
Journal of Endourology | Year: 2012

Background and Purpose: Staghorn stone volume and its distribution within the collecting system, "staghorn morphometry," predicts the requirement of tract and stage for percutaneous nephrolithotomy (PCNL) monotherapy. The purpose of the study was to develop a CT urography staghorn morphometry-based prediction algorithm to predict tract(s) and stage(s) for PCNL monotherapy and classify staghorn accordingly. Material and Methods: A retrospective case-control design of 94 units was used. CT software calculated the total stone volume (TSV) with absolute volume and percentile volume in the pelvis, planned entry calix, favorable and unfavorable calix. Entry calix was the optimum calix chosen, keeping the relations of the ribs and adjoining viscera that could clear maximum stone volume. Unfavorable calix was defined as having an acute angle from the entry calix and infundibular width of ≤8mm. A prediction model with odds ratio (OR) (95% confidence interval) was constructed on univariate and multivariate regression factors. Results: On univariate analysis, TSV (P=0.013), unfavorable calix stone volume (0.007), and percentile distribution of stone in pelvis (0.026), pelvis and entry calix (<0.001), and unfavorable calix (0.001) predicted tracts while total stone (<0.001), pelvic stone (0.0046), and unfavorable calix stone (<0.001) volume and percentile volume in pelvis (0.04), pelvis and entry calix (0.005) and unfavorable calix (P<0.001) predicted stage. Multivariate analysis showed that unfavorable calix stone percentile volume predicted tract (area under the curve [AUC] - 0.91) while TSV and unfavorable calix stone percentile volume (AUC - 0.846) predicted stage. The OR-based prediction model suggested a need for single tract and stage PCNL vs multiple tract and stage PCNL for TSV and unfavorable calix percentile stone volume of (<5,000mm 3 and 5%) and (>20,000mm 3 and 10%), respectively. Conclusion: The model predicts the tract and stage for PCNL monotherapy. Staghorn morphometry differentiates staghorn into type 1 (single tract and stage); type 2 (single tract-single/multiple stage, or multiple tract-single stage), and type 3 (multiple tract and stage). © 2012, Mary Ann Liebert, Inc.

Sabnis R.B.,Muljibhai Patel Urological Hospital | Bhattu A.,Muljibhai Patel Urological Hospital | Mohankumar V.,Muljibhai Patel Urological Hospital
Current Opinion in Urology | Year: 2014

PURPOSE OF REVIEW: Sterilization of endoscopic instruments is an important but often ignored topic. The purpose of this article is to review the current literature on the sterilization of endoscopic instruments and elaborate on the appropriate sterilization practices. RECENT FINDING: Autoclaving is an economic and excellent method of sterilizing the instruments that are not heat sensitive. Heat sensitive instruments may get damaged with hot sterilization methods. Several new endoscopic instruments such as flexible ureteroscopes, chip on tip endoscopes, are added in urologists armamentarium. Many of these instruments are heat sensitive and hence alternative efficacious methods of sterilization are necessary. Although ethylene oxide and hydrogen peroxide are excellent methods of sterilization, they have some drawbacks. Gamma irradiation is mainly for disposable items. Various chemical agents are widely used even though they achieve high-level disinfection rather than sterilization. This article reviews various methods of endoscopic instrument sterilization with their advantages and drawbacks. SUMMARY: If appropriate sterilization methods are adopted, then it not only will protect patients from procedure-related infections but prevent hypersensitive allergic reactions. It will also protect instruments from damage and increase its longevity. © 2014 Wolters Kluwer Health.

Ganpule A.P.,Muljibhai Patel Urological Hospital | Desai M.R.,Muljibhai Patel Urological Hospital
Current Opinion in Urology | Year: 2011

Purpose of Review: The treatment options in urolithiasis in kidneys with abnormalities of form and location can be challenging due to abnormal anatomy (calyceal and renal orientation), relative immobility interfering with movement of equipment, and abnormal relation with other visceral organs. Recent Findings: In this review, we focus on the different techniques and results of various treatment modalities. The approach to managing these stones should be individualized. We also allude to the results of a few recent series and emphasize various treatment options. Summary: Ultrasound helps in gaining access in ectopic kidneys, in addition to being a diagnostic tool. Computerized tomography is pivotal in helping to decide the management and choosing the method of treatment in anomalous kidneys. Flexible ureteroscopy can be a useful tool in stones less than 2 cm in size with the availability of smaller flexible ureteroscopes and access sheaths. However the surgeon should consider complete 'on table' clearance in these patients as the drainage is likely to be impaired. Ultrasound guided percutaneous approaches for ectopic kidneys should be performed by surgeons well versed with it. Laparoscopic assisted percutaneous nephrolithotomy has shown good clearance rates with minimal morbidity and less likelihood of ancillary procedures. Although adequate fragmentation can be achieved with extracorporeal shock wave lithotripsy, the drainage of fragments might be impaired due to the anatomical abnormalities. The choice of shock wave lithotripsy as a treatment option should be made prudently. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Bader M.J.,Ludwig Maximilians University of Munich | Gratzke C.,Ludwig Maximilians University of Munich | Seitz M.,Ludwig Maximilians University of Munich | Sharma R.,Muljibhai Patel Urological Hospital | And 2 more authors.
European Urology | Year: 2011

Background: In percutaneous nephrolithotomy (PNL), the best possible way to access the collecting system is still a matter of debate. There is little possibility of correcting a suboptimal access. Objective: To describe our initial experience using a micro-optical system through a specific puncture needle to confirm the quality of the chosen access prior to dilatation of the operating tract. Design, setting and participants: Micro-optics of 0.9- and 0.6-mm diameter were used. The micro-optic with integrated light lead was inserted through the working sheath of the puncture needle. The modified needle had a 1.6-mm (4.85-Fr) outer diameter. The optical fiber was connected via a zoom ocular and light adapter to a standard endoscopic camera system. For sufficient intraoperative sight, an irrigation system was connected. Intervention: The optical puncture needle was used in 15 patients for renal access prior to standard PNL procedures. Measurements: The optical assessment included determination of the distortion, resolution, angle, and field of view. The irrigation flow was assessed in an ex vivo setting, with the puncture stylet or the needle shaft either empty or with a 0.018-in guidewire inserted. Results and limitations: In all cases, visualization of the punctured kidney calyces was successful and the presence of the target calculi could be confirmed prior to guidewire placement and tract dilation. The 0.9-mm optic was found to be significantly superior in all optical parameters in contrast to the 0.6-mm optic. No significant complications were observed. Conclusions: The optical puncture needle for PNL appears to be most helpful for confirming the optimal percutaneous access to the kidney prior to dilation of the nephrostomy tract, improving the safety of the technique. © 2011 European Association of Urology.

Rajapurkar M.,Muljibhai Patel Urological Hospital | Dabhi M.,Muljibhai Patel Urological Hospital
Clinical Nephrology | Year: 2010

Chronic Kidney Disease (CKD) burden is increasing worldwide. In developing countries like India, limited financial resources and lack of infrastructure put a severe strain on existing health policies in the light of the increasing burden of CKD. The exact prevalence of CKD in India is not known due to lack of adequate data recording systems both in the Government and insurance sectors. Recently with the support of the Indian society of Nephrology, a CKD registry has been formed with the hope of generating adequate information about CKD patients in India. Here we have reviewed various published studies on the magnitude ofCKDin India. Three studies which have been carried out in different parts of India have been reviewed to examine the prevalence of CKD, which ranges from 0.79% to 1.4%. The incidence of End Stage Renal Disease was estimated to be 181 per million population in 2005 in central India. Many more such efforts are needed across our country in order to determine the exact burden of CKD. © 2010 dustro Verlaf Dr. KJ. Feistle.

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