Browsing by Author "Neeraj K. Goyal"

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A decade's experience with vesicovaginal fistula in India
(Springer London, 2007) Neeraj K. Goyal; U.S. Dwivedi; N. Vyas; M.P. Rao; S. Trivedi; P.B. Singh
A retrospective analysis of 252 cases of vesicovaginal fistulae was done to analyse its etio-pathology and management in an Indian population. After a thorough evaluation, different techniques of fistula closure were used for repair and the results were listed. The main outcome measures were the etiology of the fistula, need for tissue interposition and cure rate per repair as well as the overall cure rate. We compared our results with literature and concluded that simple and small fistulae should be repaired with layered closure. All complicated fistulae should be repaired with tissue interposition or tissue graft. This is the first study from India compiling 10 years of experience on vesicovaginal fistula. © International Urogynecology Journal 2006.
Oral complications after lingual mucosal graft harvest for urethroplasty
(2007) Abhay Kumar; Neeraj K. Goyal; Suren K. Das; Sameer Trivedi; Udai S. Dwivedi; Pratap B. Singh
Background: The aim of this study was to assess the complications at donor site after lingual mucosal graft harvesting for urethroplasty. Methods: From March 2006 to December 2006, 30 patients of anterior urethral stricture underwent lingual mucosal graft urethroplasty. The site of the harvest graft was lateral mucosal lining of the tongue. Donor site complications, that is, pain, slurring of speech, pain during speech, salivatory changes and difficulty in protrusion of tongue were noted. Results: The mean (range) age of patients was 36.2 years (22-52 years). The mean (range) stricture length was 8.4 cm (4.8-16 cm) and graft length was 8.5 cm (4.2-16.2 cm). Mean duration of follow up was 3.8 months. At the first postoperative day, 90% of the patients experienced pain at donor site and 20% had slurring of speech. Pain was mild to discomforting in 80% and distressing to horrible in 13% of the patients. By third postoperative day, two-thirds were pain free, one-thirds had mild pain only and none had slurring of speech. By day 6 of surgery, all patients were pain free. Six per cent of the patients reported numbness over ventral aspect of anterior half of tongue, which persisted in the first follow up and subsided by second follow up. There was no bleeding, haematoma or infection at donor site. All patients were able to resume oral fluid within 24 h, eat soft solid diet in 48-72 h and return to normal diet after 4-5 days of surgery. No patient complained of difficulty in opening the mouth, salivation disturbances, perioral numbness or difficulty in protrusion of tongue. No long-term functional or aesthetic complications were reported. Conclusion: Lingual mucosal graft harvesting is feasible, provides a long graft, is easy to carry out and is the least morbid procedure. © 2007 Royal Australasian College of Surgeons.
Our experience with genitourinary fistulae
(2009) Abhay Kumar; Neeraj K. Goyal; Suren K. Das; Sameer Trivedi; Udai S. Dwivedi; Pratap B. Singh
Introduction: Our objective was to analyze the incidence, etiopathology, diagnosis and therapeutic aspects of the genitourinary fistula in an Indian population. Methods: This is a retrospective analysis of the genitourinary fistulae repaired at the Department of Urology, Institute of Medical Sciences, Banaras Hindu University, between January 1990 and December 2006. The surgical approach varied in each patient. Interposition grafts or flaps were used as and when required. The main outcomes analyzed were the incidence, etiology, surgical approaches, accessory procedure required, need for tissue interposition, cure rate per repair and overall success rate. Results: Out of 558 cases, 403 were vesicovaginal, 84 ureterovaginal, 43 urethrovaginal and 28 vesicouterine fistulae. The most common etiology was obstructed labor (72.2%), followed by hysterectomy. The transvaginal route was preferred for repair wherever possible. The transabdominal route was adopted for the repair of supratrigonal vesicovaginal, ureterovaginal and vesicouterine fistulae and if bladder augmentation was required. Conservative management was successful in 1.9% of the vesicovaginal fistulae and in 8 cases of ureterovaginal fistula. The remaining cases were managed surgically with excellent results. Conclusion: Genitourinary fistulae are not life-threatening but are socially debilitating. Surgical repair provides the definitive cure, but expectant treatment can be tried in selective patients. Copyright © 2009 S. Karger AG, Basel.
Prevention of bone mineral loss by zoledronic acid in men with prostate carcinoma receiving androgen deprivation therapy: A prospective randomized trial in an indian population
(2008) M.P. Rao; Abhay Kumar; Neeraj K. Goyal; Sameer Trivedi; Udai S. Dwivedi; Pratap B. Singh
Objective: To assess the efficacy of zoledronic acid in preventing bone mineral loss in locally advanced, non-metastatic prostate carcinoma in men receiving androgen deprivation therapy. Patients and Methods: Forty-one men with locally advanced, non-metastatic prostate carcinoma were randomly divided into 2 groups to receive zoledronic acid 4 mg intravenous infusion (n = 19) or a placebo (n = 22) every 3 months. The primary efficacy variables were measurement of bone mineral density (BMD) of the lumbar spine and urinary deoxypyridinoline at the baseline and at the end of treatment. The efficacy analysis was by mean and percent-age change of these variables from the baseline to the end of the treatment. Results: The mean BMD increased significantly to 1.18 g/cm 2 from a baseline value of 1.09 g/cm2 in the zoledronic acid group. In the placebo group, the mean BMD decreased to 0.99 g/cm 2 from a baseline value of 1.07 g/cm2. The percentage change of BMD of the lumbar spine from the baseline was an 8.15% increase in the zoledronic acid group and a 7.0% decrease in the placebo group. There was also a significant decrease of mean urinary deoxypyridi-noline values in the zoledronic acid group (p < 0.05) and a significant increase in the placebo group (p < 0.001). Conclusion: Long-term androgen deprivation therapy for prostate carcinoma patients leads to significant loss of bone density. Bisphosphonate treatment especially with the highly potent zoledronic acid should be considered in patients with a low BMD baseline because this drug not only prevents the decrease in BMD but also improves BMD. Copyright © 2008 S. Karger AG, Basel.
Surgical complications of radical retropubic prostatectomy: A single institutional experience of seven years
(Medknow Publications and Media Pvt. Ltd, 2007) Neeraj K. Goyal; Abhay Kumar; Sameer Trivedi; Udai Shanker Dwivedi; Pratap Bahadur Singh
Aim: To determine the surgical complications of open retropubic radical prostatectomy. Materials and Methods: Fifty-nine cases of localized prostate cancer underwent retropubic radical prostatectomy in our department in the last seven years. Standard technique of open retropubic radical prostatectomy as described by Walsh was used. During follow-up cancer control and quality of life indices (potency and urinary continence) were noted. Result: Postoperative recovery of all patients except one was excellent. This patient required cardio-respiratory support and nine units of blood transfusion. Forty-nine out of 52 patients were continent, two had stress incontinence and one was totally incontinent at one year. Bladder neck contracture was present in eight out of 52 patients at one year. Forty-five patients were impotent at one year with or without oral tablet sildenafil. Cancer control was present in 45 out of 52 cases. Seven cases had biochemical failure at one year. Conclusion: Though retropubic radical prostatectomy is the standard treatment for early prostate cancer it is not without complications. It has a steep learning curve. More number of cases and refinement in technique is required to achieve world-class results.
Urethral reconstruction in balanitis xerotica obliterans
(2008) Sameer Trivedi; Abhay Kumar; Neeraj K. Goyal; Udai S. Dwivedi; Pratap B. Singh
Objectives: To review the results of utilizing different grafts for substitution urethroplasty for anterior urethral stricture caused by balanitis xerotica obliterans (BXO). Methods: 153 patients who underwent substitution urethroplasty for anterior urethral strictures were included in this study. The stricture length varied from 3.8 to 16.4 cm (mean 10.2 cm). In 32% of the patients (49), local genital, penile (18), perineal (16) and scrotal (15) skin grafts were used. Over the 3 years our standard treatment policy has been to utilize a free mucosal graft from a non-genital area. Buccal mucosa was the most preferred, utilized in 74 (48.3%) patients and bladder mucosa in 12 (7.8%). Recently we have used lingual mucosal grafts in 18 (11.7%) patients for substitution urethroplasty. Results: The overall success rate for non-genital mucosal graft was 92.2%. The remaining 8 patients required more than one supplementary procedure postoperatively but none required a second urethroplasty. Of 49 patients who underwent substitution urethroplasty utilizing genital skin, the success rate was only 4%. 16.3% required one and 14.3% required multiple auxiliary procedures postoperatively. 34 patients (69.4%) required subsequent urethral reconstruction. Conclusions: A free graft urethroplasty using non-genital skin is recommended for anterior urethral stricture related to BXO. Copyright © 2008 S. Karger AG.
Xanthogranulomatous pyelonephritis: Our experience with review of published reports
(2006) Udai S. Dwivedi; Neeraj K. Goyal; Vaibhav Saxena; Rajiba L. Acharya; Sameer Trivedi; Pratap B. Singh; Nachiket Vyas; Biswajeet Datta; Abhay Kumar; Suren Das
Background: The aim of this study was to analyse the cases of xanthogranulomatous pyelonephritis with review of published reports. Methods: We retrospectively reviewed all nephrectomy specimens during February 1995 to January 2006. We found 26 cases of xanthogranulomatous pyelonephritis. We prepared a chart of these cases consisting of preoperative symptoms, laboratory findings, radiological imaging results and preoperative diagnosis. Open nephrectomy was carried out in all cases. Results: Age group of the patients was 6-65 years and male : female ratio was 1.6:1. Twenty-two patients presented to us with intermittent high-grade fever, 21 with flank pain, 18 with loin mass, 2 with haematuria and 1 was detected during screening of vague gastrointestinal symptoms. Twenty-five patients had pyuria and only 10 had sterile urine culture. In all patients, only one kidney was affected. All patients had renal calculi 10-42 mm in size with bilaterally enlarged kidneys. Ipsilateral kidney was enlarged because of hydronephrosis or pyonephrosis in all cases and contralateral kidney was enlarged because of compensatory hypertrophy in 13 cases. Ipsilateral kidney had severely compromised renal function in all cases. Associated psoas abscess was present in one and tuberculosis in another. Conclusion: Xanthogranulomatous pyelonephritis is a relatively rare entity that is associated with obstruction, stones and infection of the urinary tract. Late presentation leads to loss of renal parenchyma. It cannot be differentiated preoperatively with renal tumours (renal cell carcinoma and Wilms' tumour), pyonephrosis, infected hydronephrosis and renal lymphoma. Nephrectomy and antibiotics are the treatment of choice. © 2006 Royal Australasian College of Surgeons.