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Chandra Shekhar Biyani

Publications and source records attributed to Chandra Shekhar Biyani.

12 recordsLinked to original sources
PubMed2006

The detour extra-anatomic stent--a permanent solution for benign and malignant ureteric obstruction?

OBJECTIVES: We describe our experience of the Detour extra-anatomic stent (EAS) (Mentor-Porgés, UK) for permanent bypass of complete upper urinary tract obstruction. The self-retaining expanded polytetrafluoroethylene-silicone tube, placed in the kidney using a percutaneous route, is tunnelled under the skin and sutured into the bladder to establish extra-anatomical urinary drainage. METHODS: From April 2002 to November 2005, a total of nine Detour stents were inserted into eight patients; one patient needed bilateral stent insertions. The causes for ureteric obstruction were persistent malignant disease in three and complicated benign disease in five patients. RESULTS: To date, four of five patients with benign disease are alive; one died unexpectedly of metastatic malignancy. The only stent-related complications were infection and haematuria. The two patients with malignancy have subsequently died, but there were no urinary drainage problems for their second and third years of life, respectively. CONCLUSIONS: The preliminary data presented here suggest that the Detour EAS offers a permanent and minimally invasive method to establish internalisation of urinary drainage to bypass complete ureteric obstructions for which conventional stenting has failed, open surgery has been tried and failed or was not considered feasible, and long-term nephrostomy drainage was not favoured.

Adult↗
PubMed2006

A survey of follow-up practice of urologists across Britain and Ireland following nephrectomy for renal cell carcinoma.

AIM: To determine the follow-up protocol for interval assessment of patients following radical nephrectomy for renal cell cancer and to compare them with the recommendations proposed in the literature. METHODS: Consultant urologists across Britain and Ireland completed a postal questionnaire. One follow-up mailing was used to encourage non-responders. The responses were analysed in the light of the recommendations from European Association of Urology and American guidelines. Also information was collected from the respondents on the choice of follow-up investigations for renal cell cancer and the total duration of follow-up. RESULTS: Of the 480 urologists surveyed 292 (60.8%) responded. Most respondents recommended regular follow-up with chest radiography (CR), ultrasound and computed tomography (CT). For T1 disease CR was requested by 28, 62 and 55%; for T2 disease by 30, 66 and 51%; for T3 disease by 39, 63, and 48% at 3, 6 and 12 months, respectively. For T1 disease US was requested by 5, 23 and 30%; for T2 disease 6, 27 and 30%; for T3 disease 8, 25, and 26% at 3, 6 and 12 months, respectively. For T1 disease an abdominal CT was requested by 2, 17 and 21%; for T2 disease 3.7, 19.5 and 26%; for T3 disease 10, 31, and 33% at 3, 6 and 12 months, respectively. Only one respondent followed the guidelines suggested in the literature. Further follow-up after 12 months for 5 and 10 years was suggested by 58.2 and 21.3% for T1, 53 and 24.73% for T2, and 45.5 and 25.5% for T3, respectively. There is appreciable variation in the frequency of use and timing of imaging. CONCLUSIONS: Most respondents perform follow-up after radical nephrectomy in patients with renal cancer, with considerable variability in their practices. In the current increasingly cost-conscious healthcare industry a scientifically justified follow-up should be considered.

Carcinoma, Renal Cell↗
PubMed2006

Challenge of percutaneous nephrolithotomy in patients with spinal neuropathy.

OBJECTIVE: To assess the technical difficulties, associated complications and stone clearance rates in patients with spinal neuropathy undergoing percutaneous nephrolithotomy. METHODS: Twenty-nine patients with spinal neuropathy underwent percutaneous nephrolithotomy in the two centers studied between October 1995 and January 2002. They were nine patients with traumatic spinal cord injury, 10 patients with spina bifida and 10 with other heterogeneous causes for their spinal neuropathy. The group included 12 men and 17 women, with an average age of 44 years (14-80). Patients' medical records were reviewed retrospectively for data relating to their renal lithiasis. RESULTS: A total of 39 percutaneous nephrolithotomy procedures were undertaken on 32 kidneys. Thirteen procedures were for staghorn calculi. Preoperatively, eight kidneys required nephrostomy and 5 J stent decompression. The average American Society of Anesthesiologists (ASA) score was 3, and one patient had percutaneous nephrolithotomy performed under local anaesthetic as the risk of general anaesthetic was felt to be too high. The associated morbidity and mortality in this group is significant. There were two postoperative deaths. Major complications were associated with three procedures, and consisted of seizures, aspiration pneumonia and pressure necrosis. Nine patients experienced minor complications including fever, hypotension and nephrostomy site leakage. Nine patients required intensive therapy unit care postoperatively and the average hospital stay for the group was 13.32 days. Only 18 (62%) patients were rendered stone-free from their initial percutaneous nephrolithotomy. Seven patients required a further procedure for stone clearance: four underwent extracorporeal shock-wave lithotripsy, two ureteroscopy and one nephrectomy. CONCLUSIONS: Patients with spinal neuropathy and renal lithiasis pose a significant operative challenge. Technical difficulties and potential complications should be considered carefully before undertaking percutaneous nephrolithotomy in these patients.

Adolescent↗
PubMed2005

Laparoscopic approaches in urology.

The use of laparoscopy was one of the most important steps in the progress of medicine, and has developed through the 20th century. Gynaecologists took the initial lead in introducing this technology, followed by general surgeons. Since the first laparoscopic nephrectomy in 1990, most ablative and reconstructive urological surgery has been attempted laparoscopically. Laparoscopic urological surgical approaches include conventional transperitoneal and extraperitoneal; in this review the different approaches, with the relevant anatomical considerations, are discussed.

Humans↗
PubMed2005

Varicocele.

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Embolization, Therapeutic↗
PubMed2004

Varicocele.

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Embolization, Therapeutic↗
PubMed2003

Ligation of the renal vein during laparoscopic nephrectomy: an effective and reliable method to replace vascular staplers.

PURPOSE: Application of the endovascular gastrointestinal anastomosis stapler has become a standard procedure to control renal vein during laparoscopic nephrectomy. However, device malfunction resulting in significant complications has been reported. We present a safe and cost-effective technique for renal vein ligation during laparoscopic nephrectomy. MATERIALS AND METHODS: From October 2002 to April 2003 we applied our new technique of renal vein ligation in 20 cases. After renal pedicle dissection the renal artery was secured with Hem-o-lok (Weck Closure Systems, Research Triangle Park, North Carolina) clips. The renal vein was encircled with a suture, which was knotted extracorporeally and pushed down by a knot pusher to shrivel a vein of any size. Subsequently 10 mm Hem-o-lok clips were applied to the vein to occlude it completely. RESULTS: All procedures were successfully completed. The operative costs of vein ligation were decreased. There was no significant increase in mean operative time. CONCLUSIONS: Our approach is a safe, reliable, rapid and inexpensive method to ligate the renal vein during laparoscopic nephrectomy. Therefore, this technique has replaced endovascular gastrointestinal anastomosis stapler use at our center.

Humans↗