Nachiket Vyas

Banaras Hindu University, Benares, Uttar Pradesh, India

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Publications (8)12.68 Total impact

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    ABSTRACT: 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 02/2007; 18(1):39-42. · 2.17 Impact Factor
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    ABSTRACT: The aim of this study was to analyse the cases of xanthogranulomatous pyelonephritis with review of published reports. 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. 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. 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.
    ANZ Journal of Surgery 12/2006; 76(11):1007-9. · 1.50 Impact Factor
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    ABSTRACT: To analyse the incidence, symptomatology, diagnosis and therapeutic aspects of Youssef syndrome (post caesarean vesicouterine fistula), and to review relevant published work. A retrospective study from the urosurgical unit of a tertiary care referral hospital was carried out. In a retrospective analysis of urogenital fistulae over 10 years, we identified 14 patients with uterovesical fistulae, resulting from caesarean section. All the patients were evaluated by history, physical examination, radiological tests and cystoscopy. All patients underwent transperitoneal repair of these fistulae with omental interposition. Results of surgery were evaluated by absence of cyclic haematuria, stoppage of urinary incontinence, and achievement of fertility. A total of 12 patients who had minimum follow up was included in the present study. The results showed that 50% of the fistulae resulted from emergency caesarean operation with 58% of patients presenting after their second caesarean section. The mean age of the patients was 19 years (range 15-29) and mean duration of symptoms was 7 months (range 3-16). Menouria and amenorrhoea were predominant presenting symptoms. The results of surgical treatment were excellent with good continence and resolution of the cyclic haematuria. Three pregnancies (37.5%) which resulted in elective caesarean section were recorded. Vesicouterine fistulae, despite being infrequent, are no longer a rare diagnosis and are most commonly secondary to lower segment caesarean section. With patient history and selected investigations diagnosis is relatively easy. The surgical repair of these fistulae is standard treatment, especially with delayed fistulae with achievement of total continence, and complete resolution of cyclic haematuria. Meticulous practice of obstetric and surgical principles during caesarean section can prevent the formation of these fistulae.
    ANZ Journal of Surgery 05/2006; 76(4):243-5. · 1.50 Impact Factor
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    ABSTRACT: To establish the safety and efficacy of ureteroscopic lithotripsy (URSL) under sedoanalgesia. This study was conducted at Department of Urology (Banaras Hindu University, India) among 124 patients with ureteral stones, between July 2000 and August 2003. Majority of the patients (59.68%) presented with lower ureteric calculi, 24.19% presented with upper ureteric calculi and 16.13% had middle ureteric calculi. All patients were given injection diclofenac sodium (75 mg) promethazine hydrochloride (12.5 mg) deep intramuscular 30 minutes the before procedure. Injection midazolam 0.03 mg/kg body weight slowly given intravenously immediately before the procedure for achieving sedation. Injection fentanyl 50 mcg intravenously given slowly just before introducing the ureteroscope into ureter for achieving intravenous analgesia. Patients were observed for few hours after completion of procedure and oral questions were asked as per proforma, which included tolerance, intensity of pain and percentage of pain experienced by the patients. Patients were discharged thereafter. 87.10% of patients opined that the procedure was acceptable. Only 4.84% opined this procedure was painful. According to present pain intensity score (PPI) in this study 79.03 patients experienced only mild pain, 11.29% cases rated procedure as discomforting, 6.45 rated procedure as distressing and only 3.23% rated as horrible procedure. As per visual analogue scale for assessment of pain 80.65 of cases rated only 20% pain score (in a scale of 0-100). 9.68% cases rated 30% and 6.45% rated 50%. Only two patients in middle ureteric group rated 100% pain. Overall success rate in fragmenting stone was 91.94, where as for lower ureteric calculi it was 97.30%; for upper and, middle ureteric calculi it was 86.66% and 80%, respectively. Ureteroscopic lithotripsy can be performed on day care basis under sedoanalgesia which is fairly tolerated by the patients with unremarkable complications and difficulty.
    International Urology and Nephrology 02/2005; 37(2):219-24. · 1.33 Impact Factor
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    ABSTRACT: Twenty-two women with primary and secondary (five patients) vesicovaginal fistula attending a tertiary level urological unit in India were treated by repair of the fistula using bladder mucosal autografts. The fistula was approached transabdominally or via a combined abdominal and vaginal approach (for those involving the trigone). After closure of the vaginal layer, bladder mucosa was harvested from the dome of the bladder and laid over the fistula with sutures at each corner to fix it in place. Patients were catheterised for 12-14 days. At follow up after 3 to 12 months, 20 out of 22 patients were continent, with no other symptoms. The two failures had undergone two previous repairs each. This series is the first from India, and demonstrates the efficacy of bladder mucosal autografts for managing large fistulae, those where a previous repair has failed and fistulae adjacent to the ureteric orifice without the need for uretero-neocystostomy.
    BJOG An International Journal of Obstetrics & Gynaecology 02/2005; 112(1):112-4. · 3.76 Impact Factor
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    ABSTRACT: To evaluate the effectiveness of combination (povidone iodine and 50% dextrose) renal pelvic instillation sclerotherapy (RPIS) as a minimally invasive therapy for chyluria resistant to conservative treatment. A total of 50 patients with chyluria and hematochyluria (28 men and 22 women) were included in the study. Initially, all were offered conservative antifilarial drug therapy and dietary fat restriction. Intravenous urography was done in all cases to document normal renal functional status. In the patients in whom chyluria persisted after 3 weeks of conservative therapy, cystoscopic lateralization was done and a 5F open-ended ureteral catheter was positioned under local anesthesia. The same was left attached to a 16F Foley catheter for 3 days of RPIS. A solution of 5 mL of 5% povidone iodine and 5 mL of 50% dextrose was instilled twice a day with the patient in the Trendelenburg position for 3 days. In cases of bilateral efflux, the dominant side was treated first. The opposite side was subjected to a similar instillation sclerotherapy schedule after 6 weeks if chyluria persisted. Of the 50 patients, only 4 responded to conservative therapy. The remaining 46 patients underwent combination RPIS. The mean follow-up was 24 months. Complete remission of chyluria or hematochyluria occurred in 40 (87%) and persisted in 6 patients (13%). Of the 6 patients in whom symptoms persisted, 2 developed chyluria on the side opposite the one treated with RPIS. Another 2 patients developed recurrence on the same side after remaining asymptomatic for 6 months after RPIS. All four of these patients subsequently underwent chylolymphatic disconnection and nephropexy (two open and two laparoscopic) with a successful outcome. The final 2 patients with persistent symptoms were lost to follow-up. Combination sclerotherapy using a 5% povidone iodine and 50% dextrose solution is a safe and cost-effective minimally invasive therapy for chyluria refractory to conservative treatment.
    Urology 01/2005; 64(6):1107-9; discussion 1110. · 2.42 Impact Factor
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    ABSTRACT: Objective: To show the efficacy and ease of our modified technique of constructing orthotopic neo-bladder after radical cystectomy for carcinoma bladder.Materials and methods: A total number of 76 patients with invasive carcinoma of bladder underwent radical cystectomy and orthotopic neo-bladder construction at this tertiary care hospital. We modified the conventional Hautman's technique. In this we constructed the ileal pouch first on the abdominal surface after making a neo-urethra utilizing a "U" shaped flap of dependent ileal segment. Then at the end of the procedure, anastomosis is performed between the neo-urethra and the membranous urethra. These cases are followed up at regular intervals with usual protocols with special stress on uroflowmetry and complete urodynamic assessment in selected patients.Results: Out of 76 patients who had a follow up of more than 10 years, only 1 patient developed total incontinence, which developed early local recurrence. Day and night time continence rates were achieved in 95 and 90%, respectively. All patients have shown good urodynamic characteristics and normal upper tracts without vesicoureteral reflex.Conclusion: This new modified technique of making the pouch first on the surface with urethral anastomosis as a last step avoids accidental disruption, offers technical simplicity and substantially shorterns the operative time. This makes the procedure safer even in the hands of less experienced urologists without compromising continence rates.
    UroOncology 02/2004; 4(1):35-37.
  • UroOncology 01/2004; 4:139-143.