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Sabnis R.B.,Muljibhai Patel Urological Hospital | Bhattu A.,DNB Urology | Mohankumar V.,DNB General Surgery
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. Source


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. Source


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. Source


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. Source


Ganpule A.,Muljibhai Patel Urological Hospital | Chhabra J.S.,Muljibhai Patel Urological Hospital | Desai M.,Muljibhai Patel Urological Hospital
Current Opinion in Urology | Year: 2015

To review the most recent literature and contemporary role of the use of porcine and chicken models in laparoscopic and robotic simulation exercises, for training and skill assessment. RECENT FINDINGS: There are multiple types of the simulators which include mechanical, virtual reality, hybrid simulators and animal models. The recent literature has seen insurgence of several of such simulators, specifically the animate ones comprising porcine and chicken models. The different training models reported have evolved from generalized and simpler, to a more task dedicated and complex versions. Unlike in the past, the recent publications include analysis of these models incorporating different measures of validity assessment. SUMMARY: On account of the natural tissue properties inherent to these porcine and chicken models, they are proving to be instrumental in acquisition of higher surgical skills such as dissection, suturing and use of energy sources, all of which are required in real-time clinical scenarios be it laparoscopy or robotic-assisted procedures. In-vivo training in the animal model continues to be, perhaps, the most sophisticated training method before resorting to real-time surgery. © 2015 Wolters Kluwer Health, Inc. Source

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