Prasad Godbole

Sheffield Children's NHS Foundation Trust, Sheffield, England, United Kingdom

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Publications (29)41.89 Total impact

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    ABSTRACT: PURPOSE: Lower urinary tract symptoms (LUTS) are common in children. The aim of this study was to determine normal values for pelvic floor movement in asymptomatic controls to allow comparison with symptomatic children with dysfunctional voiding (DV) in the next phase of the study. MATERIAL AND METHODS: One hundred children between the ages of 5-17 years were recruited prospectively as controls. All were asked to perform a voluntary pelvic floor contraction manoeuvre with a full bladder. All scans were performed on a Vivid I GE ultrasound machine with a 4-9 MHz curvilinear probe. M Mode was used to determine the direction of pelvic floor (levator plate-LP) movement, the distance in cms and the endurance in seconds. Each measurement was taken 3 times. RESULTS: Six children were unable to understand and perform the manoeuvre and were excluded. The median age was 10 years (range 4-17). The median LP movement was 0.3 cm (range 0.1-1.6) and cranial in 86/94 (91%). The median endurance time was 5.8 s (range 2.3-15.5). For the (n = 59) younger children aged 4-11, the 95% normal reference range for LP movement was 0.1 cm-1.4 cm and for endurance was 2.5-13.5 s. For the (n = 33) older children aged 12-17, the 95% normal reference range for LP movement was 0.2 cm-1.2 cm and for endurance was 2.3-15.5 s. There was a significant correlation (Pearson r = 0.39, P = 0.001) between average LP movement and endurance. CONCLUSIONS: This study gives the normal reference ranges for the variables measured. A further study is currently underway examining the same variables in children with dysfunctional voiding (DV) and comparing these with the reference range.
    Journal of pediatric urology 03/2013; · 1.38 Impact Factor
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    Archives of Disease in Childhood - Fetal and Neonatal Edition 06/2012; 97(6):F463-4. · 3.45 Impact Factor
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    ABSTRACT: We previously reported our short-term experience of foreskin preputioplasty as an alternative to circumcision for the treatment of foreskin balanitis xerotica obliterans (BXO). In this study, we aimed to compare this technique with circumcision over a longer period. Between 2002 and 2007, boys requiring surgery for BXO were offered either foreskin preputioplasty or primary circumcision. The preputioplasty technique involved triradiate preputial incisions and injection of triamcinolone intralesionally. Retrospective case-note analysis was performed to identify patient demographics, symptoms, and outcomes. One hundred thirty-six boys underwent primary surgery for histologically confirmed BXO. One hundred four boys opted for foreskin preputioplasty, and 32, for circumcision. At a median follow-up of 14 months (interquartile range, 2.5-17.8), 84 (81%) of 104 in the preputioplasty group had a fully retractile and no macroscopic evidence of BXO. Of 104, 14 (13%) developed recurrent symptoms/BXO requiring circumcision or repeat foreskin preputioplasty. In the circumcision group, 23 (72%) of 32 had no macroscopic evidence of BXO. The incidence of meatal stenosis was significantly less in the foreskin preputioplasty group, 6 (6%) of 104 vs 6 (19%) of 32 (P = .034). Our results show a good outcome for most boys undergoing foreskin preputioplasty and intralesional triamcinolone for BXO. There is a small risk of recurrent BXO, but rates of meatal stenosis may be reduced.
    Journal of Pediatric Surgery 04/2012; 47(4):756-9. · 1.38 Impact Factor
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    ABSTRACT: To evaluate outcomes following laparoscopic heminephrectomy (LHN) in duplex kidneys in the pediatric population, focusing on the fate of the remnant moiety. 142 patients underwent laparoscopic heminephrectomy for duplex kidney across 4 different institutions in the U.S. and Europe. Median age at surgery was 11.4 months. A retroperitoneoscopic approach was used in all patients, with 82 (57.7%) patients placed in posterior prone position (PPR), and 60 (42.3%) in lateral retroperitoneal (LRP). Follow up included routine ultrasound, and DMSA was performed in the event of abnormalities in ultrasound or postoperative course. Median operative time was 120 min. 11 patients (7.7%) required open conversion, the majority of which (8/11) occurred prior to 2000. Median hospital stay was 2 days and no major complications were observed. 7 patients (4.9%) developed a postoperative urinoma, and 1 patient required ureterectomy for urinary tract infection. With a median follow-up of 4.5 years, 7 children (4.9%) experienced significant loss of function in the remaining moiety, with 3 patients requiring completion nephrectomy. Of patients losing their remaining moiety, median age at surgery was 9 months [4 - 42], and all except 1 (6/7) had an upper pole heminephrectomy. Three patients in this group (42%) experienced an immediate postoperative complication (hematoma, UTI, urinoma). No consistent preoperative or technical factors were consistent in the renal loss group. LHN for duplex kidney produces satisfactory outcomes in the pediatric population. With a median follow up of 4.5 years, we demonstrate a non-functioning renal moiety rate of 5%. We did not identify any clinical predictors of this outcome in our series, although upper pole heminephrectomy, patient age, and postoperative complications may be contributing factors.
    Journal of pediatric urology 06/2011; 7(3):272-5. · 1.38 Impact Factor
  • Prasad P. Godbole
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    ABSTRACT: The management of foreskin conditions varies amongst medical practitioners from observation to circumcision. A number of conditions may affect the foreskin and may lead to a specialist referral. This chapter deals with common foreskin problems, their etiology and management in primary/emergency care. Indications for referral will be highlighted. Circumcision will be dealt with in another chapter.
    12/2010: pages 55-60;
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    ABSTRACT: The treatment of prostatic rhabdomyosarcoma (RMS) depends on tumour stratification based on site and histology. An increasing range of cytogenetic, molecular, and immunohistochemistry studies are required. This is difficult to achieve using standard cystoscopic biopsies alone. We present a 5-year-old male, diagnosed with a pro-static RMS. He underwent cystoscopy to confirm the diagnosis and at the same time tissue was obtained for histology using laparoscopic graspers via a STEP TM Port inserted percutaneously into the apex of his bladder. Histology and cytogenetics confirmed an embryonal botryoid RMS for which he received chemotherapy followed by a radical prostatectomy for residual disease. Pediatr Blood Cancer. 2010;55:583–585.
    Pediatric Blood & Cancer 10/2010; 55:583-585. · 2.35 Impact Factor
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    ABSTRACT: The treatment of prostatic rhabdomyosarcoma (RMS) depends on tumour stratification based on site and histology. An increasing range of cytogenetic, molecular, and immunohistochemistry studies are required. This is difficult to achieve using standard cystoscopic biopsies alone. We present a 5-year-old male, diagnosed with a pro-static RMS. He underwent cystoscopy to confirm the diagnosis and at the same time tissue was obtained for histology using laparoscopic graspers via a STEP TM Port inserted percutaneously into the apex of his bladder. Histology and cytogenetics confirmed an embryonal botryoid RMS for which he received chemotherapy followed by a radical prostatectomy for residual disease. Pediatr Blood Cancer. 2010;55:583–585.
    · 2.35 Impact Factor
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    ABSTRACT: The investigation of infantile febrile urinary tract infection (UTI) is still a subject of debate and controversy. To evaluate for vesicoureteric reflux (VUR) most authorities recommend a micturating cystourethrogram (MCUG) to be performed at least 4 weeks after UTI to avoid false positive. At a tertiary centre for paediatric specialities, information on 427 infants who had undergone MCUG following a first febrile UTI was prospectively recorded and their case notes reviewed. The infants were divided into two groups: Group A (117) with MCUG performed less than 4 weeks from UTI diagnosis and Group B (310) with MCUG after at least 8 weeks from diagnosis. Of the 427 children, VUR was detected in 33% of those for whom MCUG was performed less than 4 weeks after UTI diagnosis and in 24% of those for whom it was performed at least 8 weeks after diagnosis. Neither the prevalence nor the grade of VUR in infants with a first episode of UTI is influenced by the timing of the MCUG following diagnosis. We therefore suggest that it is better to perform an MCUG as soon as possible, provided inflammation has subsided.
    Journal of pediatric urology 02/2010; 6(6):582-4. · 1.38 Impact Factor
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    ABSTRACT: Splenic trauma in children following blunt abdominal injury is usually treated by nonoperative management (NOM). Splenectomy following abdominal trauma is rare in children. NOM is successful as in the majority of instances the injury to the spleen is contained within its capsule or a localised haematoma. Rarely, the spleen may suffer from an avulsion injury that causes severe uncontrollable bleeding and necessitates an emergency laparotomy and splenectomy. We report two cases of children requiring splenectomy following severe blunt abdominal injury. In both instances emergency laparotomy was undertaken for uncontrollable bleeding despite resuscitation. The operating team was unaware of the precise source of bleeding preoperatively. Retrospective review of the computed tomography (CT) scans revealed subtle radiological features that indicate splenic avulsion. We wish to highlight these radiological features of splenic avulsion as they can help to focus management decisions regarding the need/timing for a laparotomy following blunt abdominal trauma in children.
    Case Reports in Medicine 01/2010; 2010:762493.
  • Prasad Godbole, Julian Roberts, Ashok Raghavan
    Journal of Pediatric Urology. 01/2010; 6.
  • Archives De Pediatrie - ARCHIVES PEDIATRIE. 01/2010; 17(6):35-35.
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    ABSTRACT: Current imaging recommendations for investigating any infantile febrile urinary tract infection (UTI) are ultrasound scan (US), micturating cystourethrogram (MCUG) and dimercaptosuccinic acid (DMSA) scan. The aim of this retrospective cohort study was to determine the need and indications for MCUG in the investigation of a first febrile infantile UTI, as doubts have been raised over its benefit. Information on 427 infants who had undergone US, MCUG and DMSA following a first febrile UTI was prospectively recorded. The infants were divided into two groups: A (354) with normal renal US and B (73) with abnormal US. DMSA findings were correlated with findings on MCUG. Main outcome measures were incidence of recurrent UTIs, change in management or intervention as a result of MCUG, and outcome at discharge. Only 21/354 (6%) infants in Group A had both scarring on DMSA and vesicoureteric reflux (VUR), predominantly low-grade on MCUG. In Group B (abnormal US), 23/73 (32%) had scarring on DMSA and vesicoureteric reflux, predominantly high grade on MCUG. Of the infants with non-scarred kidneys, 73% had dilating reflux. Successful conservative treatment was performed in 423 infants, and 4 infants in Group B required surgery. We recommend US and DMSA in all infantile febrile UTI cases. Where US is normal, MCUG should be reserved for those cases with abnormal DMSA. Where US is abnormal, MCUG should be performed irrespective of findings on DMSA scan. A randomized prospective study is necessary to evaluate this further.
    Journal of pediatric urology 08/2009; 6(2):148-52. · 1.38 Impact Factor
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    ABSTRACT: Purpose The investigation of infantile febrile urinary tract infection (UTI) is still a subject of debate and controversy. To evaluate for ureterovesical reflux (VUR) most authorities recommend a micturating cystourethrogram (MCUG) to be performed at least 4 weeks after the UTI to avoid false positive results. We reviewed our 10 year experience to determine whether the timing of MCUG affected the detection of ureterovesical reflux in this patient population. Material and Methods Information on 427 infants under 1 year of age who had undergone MCUG following a first febrile UTI was reviewed. The infants were divided in two groups: Group A (117) with MCUG performed within 4 weeks from UTI diagnosis and Group B (310) with MCUG at least 8 weeks from diagnosis. Results Of the 427 children, there were 258 boys (60%) and 169 girls (40%) with a median age of 5.2 months (1-12). VUR was detected in 33% of those for whom MCUG was performed 4 weeks after UTI diagnosis and in 24% of those for whom it was performed at least 8 weeks after diagnosis (p = 0.07). The grade of VUR in these two groups was not statistically significant (p = 0.3) Conclusions Neither the prevalence nor the grade of VUR in infants with a first episode of UTI is influenced by the timing of the MCUG. Following treatment of the acute episode and complete resolution of symptoms the MCUG can be performed as soon as is convenient.
    Journal of Pediatric Urology. 01/2009; 5.
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    Cerebrospinal Fluid Research 01/2009; · 1.81 Impact Factor
  • Nordeen Bouhadiba, Prasad Godbole, Sean Marven
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    ABSTRACT: Abdominoscrotal hydrocele (ASH) is reported with increasing frequency and is recognized to be responsible for complications not only related to the pressure effect on the contiguous structures, but a wide a variety of conditions, including hemorrhage and malignant transformation. Although there are only two reports in the literature of spontaneous resolution, the actual accepted consensus for treatment is complete excision. The surgical approaches are abdominal, scrotal or combined. There is no report in the literature of a laparoscopic excision of ASH. In this paper, we report on the first case to be treated with this approach and highlight the new advantages and simplicity in using this recommended technique.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 11/2007; 17(5):701-3. · 1.07 Impact Factor
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    P Godbole, A Wade, I Mushtaq, D T Wilcox
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    ABSTRACT: A vesicostomy is believed to have a detrimental effect in boys with posterior urethral valves compared to primary valve ablation. We compared the outcomes of boys managed by initial vesicostomy with those undergoing primary fulguration. The outcomes of 54 boys (23 vesicostomy, 31 primary valve fulguration) over 1 year of age who had not undergone renal transplant were considered. Outcome parameters identified were ultrasound findings, continence status, glomerular filtration rate (GFR) and 1-year creatinine. Dryness was defined as completely dry both day and night with no need to wear pads. Results are presented with 95% confidence intervals. Ultrasound examinations were normal in 9/19 (47.4%) of the vesicostomy group and 11/24 (45.8%) of the fulguration group. Graded ultrasound results were not significantly different (p=0.24). The vesicostomy patients were more often dry (79% vs 64%, p=0.43). The vesicostomy group had on average higher GFR (95.26 vs 85.79) and lower 1-year creatinine (49.58 vs 52.46) values. After accounting for age differences between groups, there was no significant difference in the GFR and 1-year creatinine values (p=0.16 and p=0.87, respectively). There was a tendency for the major outcomes to be more favourable in the vesicostomy group. Although trends were non-significant, confidence intervals were wide and potential differences of clinical importance could not be discounted.
    Journal of pediatric urology 09/2007; 3(4):273-5. · 1.38 Impact Factor
  • Sean S. Marven, Prasad P. Godbole
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    ABSTRACT: Minimal access surgery (MAS) in children is advancing, and the use of a video endoscope has entered all the surgical disciplines for children. Refinements of instrumentation have empowered surgeons, so that size and weight are no longer considered contraindications to an MAS approach. The pioneering era has passed, and virtually all procedures that could possibly be performed by an MAS technique in children have been accomplished. Further refinements will make the majority of these procedures the gold standard, but much work remains to be done and the evidence base needs consolidating.
    12/2006: pages 3-10;
  • Mohan S Gundeti, Prasad P Godbole, Duncan T Wilcox
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    ABSTRACT: We evaluated whether bowel preparation is required before augmentation cystoplasty in children. A total of 46 consecutive children underwent cystoplasty using detubularized ileum between 1998 and 2004. Group 1 (24 patients) underwent standard mechanical bowel preparation with sodium picosulfate, a bowel enema (sodium phosphate) if required and clear fluids for 24 hours preoperatively. Group 2 (22 patients) received no bowel preparation and was on a normal diet preoperatively. One dose of parenteral triple antibiotics was administered at induction of anesthesia in both groups. The surgical technique was similar in both groups. Postoperatively, group 1 had a nasogastric tube in situ, while group 2 had no nasogastric tube. The main outcome measures were hospital stay (days), time to commencing fluids postoperatively (hours), incidence of urinary tract infection during hospitalization and incidence of wound infection. Median postoperative stay was 5 days (range 4 to 7) in group 1 and 4 days (3 to 6) in group 2. Median time to intake of oral fluids was 48 hours (range 24 to 72) in group 1 and 24 hours (12 to 48) in group 2. Three patients in group 1 and 2 in group 2 had a symptomatic urinary tract infection during the postoperative course. One patient in each group had a superficial wound infection. There were no significant differences in hospital stay or postoperative complications between the 2 groups. This series suggests that bowel preparation is unnecessary for children undergoing cystoplasty.
    The Journal of Urology 11/2006; 176(4 Pt 1):1574-6; discussion 1576-7. · 3.70 Impact Factor
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    ABSTRACT: Posttreatment genitourinary embryonal rhabdomyosarcoma often shows well differentiated rhabdomyoblasts, which are detectable on routine histological staining. Definite areas of residual undifferentiated rhabdomyosarcoma indicate residual/recurrent disease. However, the recent use of immunohistochemical staining with desmin and myogenin in resected specimens and surveillance biopsies following adjuvant therapy may demonstrate scant positive staining cells that appear undifferentiated on light microscopy. To our knowledge the clinical significance of this finding is currently unknown. Therefore, we reviewed our retrospective experience with genitourinary embryonal rhabdomyosarcoma to examine the relationship between immunostain positive undifferentiated cells and subsequent clinical outcome. A total of 14 children with a median age of 2.75 years (range 8 months to 7 years) with genitourinary embryonal rhabdomyosarcoma were identified in the histopathology database. All had biopsy confirmation of the diagnosis, followed by multi-agent chemotherapy. Two children in whom there was obvious residual active tumor at the resection margins were excluded from further analysis. Histopathological findings in all patients on the resection/posttreatment biopsy were reviewed. All specimens were immunostained with desmin and myogenin to detect residual undifferentiated rhabdomyoblasts. The relation between histopathological findings and outcome was determined. There were 14 cases of genitourinary embryonal rhabdomyosarcoma. In 2 cases (14%) residual embryonal tumor was pathologically confirmed following initial treatment. In 12 cases no obvious residual tumor was present following initial therapy. Rhabdomyosarcoma affected the bladder in 10 cases and the vagina in 2. There were no distant metastases in any child. Ten patients underwent local resection following chemotherapy and 2 underwent followup biopsies only without resection. A total of 11 cases showed well differentiated, posttreatment rhabdomyoblasts that was identifiable on routine hematoxylin and eosin staining with margins apparently free of tumor and 1 showed no morphological evidence of residual rhabdomyosarcoma. However, all cases demonstrated at least scant abnormal desmin and myogenin positive cells in the specimens. Four patients had no further treatment and none had clinical recurrence. All were well 10 years (range 8 to 13) after treatment. Eight patients received further treatment (chemotherapy and/or radiotherapy) based on clinical and pathological findings, followed by further resection in 3. One patient died of disease but 7 were well a median of 7.2 years (range 8 months to 13 years) after treatment. The significance of undifferentiated myogenin/desmin positive cells in genitourinary embryonal rhabdomyosarcoma in the absence of morphological residual/recurrent embryonal rhabdomyosarcoma remains unclear since such cells can be detected in all cases of posttreatment embryonal rhabdomyosarcoma. In some cases findings are associated with clinical disease recurrence, while others with identical histopathological findings following initial treatment have no clinical sequelae even in the absence of further treatment. In genitourinary embryonal rhabdomyosarcoma close and regular clinical surveillance is essential. Desmin/myogenin immunohistochemistry to detect scattered undifferentiated cells does not appear to provide useful prognostic information.
    The Journal of Urology 11/2006; 176(4 Pt 2):1751-4. · 3.70 Impact Factor
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    ABSTRACT: Dismembered pyeloplasty is the traditional technique in the management of ureterovascular pelvi-ureteric junction obstruction (PUJO) in children. Controversy remains regarding the role of lower pole vessels as the sole aetiology for PUJO. Endopyelotomy and concomitant laparoscopic transposition of lower pole vessels for PUJO has been described in adults. We describe our technique of laparoscopic transposition of lower pole vessels in children with PUJO, leaving the PUJ intact. Thirteen patients (seven boys and six girls) with a mean age of 10.2 years (range 7-16 years) underwent laparoscopic transposition of lower pole vessels. Surgery was indicated on the basis of intermittent pain and ultrasound/MAG3 appearance of obstruction with or without reduced function. The technique involved laparoscopic transperitoneal mobilization of the lower pole vessels from the region of the PUJ thereby freeing the junction and transposing them superiorly onto the anterior wall of the pelvis. The main outcome measures were relief of pain and improvement in ultrasound appearance or drainage parameters on a postoperative MAG3 renogram performed within 4-6 weeks of surgery. Median operating time was 92 min. All patients were discharged within 36 h of surgery. All patients remain pain free at a median of 6 months (range 3-18 months). Twelve patients showed good drainage on the postoperative MAG3 renogram and improvement in ultrasound appearance. One patient had recurrent symptoms requiring insertion of a JJ stent. She has undergone further laparoscopic exploration. The vessels were in their transposed position and there was a kink at the PUJ which was released. She had a vertical pyelotomy and transverse closure over the JJ stent with good results. This technique is simple and requires less operating time. No anastomosis or temporary JJ stent is required. Our early results are very encouraging with no serious complications.
    Journal of pediatric urology 09/2006; 2(4):285-9. · 1.38 Impact Factor