Prasad Godbole

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

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Publications (30)30.39 Total impact

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    ABSTRACT: This retrospective review was undertaken to identify the postoperative outcomes of children undergoing 'mini' percutaneous nephrolithotomy (MPCNL) at a single institution. Outcomes measured included: percentage of stone clearance, postoperative analgesia requirements, the need for intraoperative or postoperative blood transfusion, length of stay and morbidity. A total of 46 patients were reviewed over a two-and-a-half-year period; the mean age was 7.3 years (range: 1-16 years). The MPCNL was performed with a radiological-guided peripheral puncture, followed by dilatation of the nephrostomy tract to a maximum Amplatz sheath size of 16-French; an 11-French nephroscope was used. Stone disintegration was achieved either with pneumatic or laser lithotripsy. Complete stone clearance was achieved in 35/46 children (76%). The remaining 11 children had a stone clearance rate of over 80%. No patients required intraoperative/postoperative blood transfusion. A total of 39% of patients were managed on simple/non-opiate based analgesia, with 54% requiring opioid analgesia postoperatively for less than 24 h. There were no procedure-related complications and no mortalities. The mean length of stay was 2.24 days. The management of urolithiasis can be challenging in children. The use of percutaneous nephrolithotomy, is becoming increasingly popular in the treatment of paediatric urolithiasis. The stone clearance rate in children undergoing standard PCNL, has been reported to be 50-98% in the literature [1,2,3,4]. Samad et al. [2] in 2006, reported their experience in 188 consecutive PCNLs, using a 17Fr or 26Fr nephroscope. Their largest sub group included children aged >5-16 yrs. Within this group, 57% were treated with a 17Fr nephroscope and 43% with the 26Fr nephroscope, achieving stone clearance of only 47% with PCNL monotherapy. In this group the transfusion rate was 3% [2]. Badawy et al., reported their experience of 60 children in 1999, using a 26 or 28Fr Amplatz sheath. They reported an 83.3% stone clearance with single session PCNL, with only one procedure being abandoned due to intraoperative bleeding requiring blood transfusion [3]. In 2007, Bilen et al. reported their experience and compared the use of 26Fr, 20Fr and 14Fr (mini) PCNL. Stone size, previous surgery and the mean haemoglobin drop postoperatively did not change between the groups, however the blood transfusion rate was higher in the 26Fr and 20Fr Amplatz sheath groups. The stone clearance was highest in the 'mini PCNL' group at 90%, compared to 69.5% in the 26Fr and 80% in the 20Fr group [4]. MPCNL has become increasingly popular over recent years, with stone clearance reported as 80-85% [5-7] following a single session of MPCNL as monotherapy. In 2012, Yan et al. reported 85.2% stone clearance with mini PCNL monotherapy (tract size 14-16Fr), with no children requiring blood transfusion [6]. Zeng et al. reported their experience of 331 renal units in children, with stone clearance rates reaching 80.4% and a blood transfusion rate of 3.1% [8]. In our centre, we do not perform postoperative haemoglobin levels as a matter of routine and any investigations are performed on an intention to treat principle. Bilen et al. reported no blood transfusions being required in their cohort of patients undergoing MPCNL [4] and this is supported by Yan et al. [6]. Mini PCNL is an effective and safe procedure for the treatment of paediatric renal stones. In the present series, all children achieved greater than 80% stone clearance, none received a blood transfusion (intra/postoperatively) and there were no mortalities. Postoperative pain was managed with simple analgesia in 39%; however, the majority required opiate analgesia for less than 24 hours. Copyright © 2015. Published by Elsevier Ltd.
    No preview · Article · Mar 2015 · Journal of Pediatric Urology
  • Pauline Adiotomre · Edna Asumang · Prasad Godbole
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    ABSTRACT: A 7-week-old baby presented to a district general hospital with a history of pallor, lethargy, vomiting and high pitched cry. She had vomited three times at home. It was reported that the last vomitus had a greenish tinge to it. In hospital, she had a non-bilious vomit. There was no history of fever, constipation or diarrhoea. Her birth history and medical history were unremarkable. She was noted to be pale, lethargic and quiet on examination. Her vital signs were unremarkable. She had a soft scaphoid abdomen on examination. No masses were palpable. Investigations for sepsis were done and antibiotics started. Results of all the investigations were normal apart from mildly raised blood glucose and neutrophilia. Later on she passed a small amount of blood per rectum. Examination revealed a palpable mass in the epigastrium. An abdominal x-ray was suggestive of intestinal obstruction. Intussusception was confirmed on ultrasound. The intussusception was successfully reduced following surgery.
    No preview · Article · May 2013 · Case Reports
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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.
    No preview · Article · Mar 2013 · Journal of pediatric urology
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    Full-text · Article · Jun 2012 · Archives of Disease in Childhood - Fetal and Neonatal Edition
  • Prasad P. Godbole
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    ABSTRACT: Testicular problems in children may be both congenital and acquired. These problems are often difficult to diagnose and carry significant sequelae if untreated. Early surgical consultation is often needed for correction of the problem. This article reviews the pathophysiology of the most common pediatric testicular abnormalities with emphasis on the diagnostic modalities employed and current treatment alternatives.
    No preview · Article · Jun 2012 · Paediatrics and Child Health
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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.
    No preview · Article · Apr 2012 · Journal of Pediatric Surgery
  • Prasad P. Godbole · Duncan T. Wilcox
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    ABSTRACT: Understanding of the natural history of separation of the inner surface of the intact prepuce from the glans is paramount to the care of the uncircumcised penis. As emphasized by the authors, all too often, the child (and over anxious parent) is referred to specialists by even the most knowledgeable medical practitioner for circumcision due to inability to retract, residual adhesions, infection of cyst (almost always smegma). In Western countries like the USA, where historically circumcision has been the norm, educating the families about this natural process of prepucial separation right from birth, and essentially reassuring them that time and a hands-off approach for the foreskin is all that is necessary in the long run, should be reinforced. Whether families and referring physicians will concur, is conjecture.
    No preview · Chapter · Jan 2012
  • 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.
    No preview · Chapter · Dec 2010
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    S A Rehim · H Dagash · P P Godbole · A Raghavan · G V Murthi
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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.
    Full-text · Article · Dec 2010 · Case Reports in Medicine
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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.
    Full-text · Article · Sep 2010 · Pediatric Blood & Cancer
  • Prasad Godbole
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    ABSTRACT: Paediatric urological conditions range from those that are infrequent but severe and require referral to a specialist to those that may present to primary care physicians or adult urologists/general surgeons. The National Definitions Set No. 23 for Specialised Childrens' Services defines specialist paediatric urology. Adult general surgeons, adult urologists, general paediatric surgeons, general practitioners/primary care physicians, paediatricians and emergentologists will come across non-specialist or general paediatric urology which is referred to in this article. The management of paediatric urinary tract infection is beyond the scope of this article and readers are referred to recent guidelines issued by the National Institute for Health and Clinical Excellence. Management of common conditions and indications for specialist referral are addressed.
    No preview · Article · Jul 2010 · Surgery (Oxford)
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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.
    Full-text · Dataset · May 2010
  • Prasad Godbole · Julian Roberts · Ashok Raghavan

    No preview · Article · Apr 2010 · Journal of Pediatric Urology
  • Giampiero Soccorso · Gail Moss · Julian Roberts · Prasad Godbole
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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.
    No preview · Article · Feb 2010 · Journal of pediatric urology
  • Prasad P. Godbole · Mark D. Stringer

    No preview · Chapter · Jan 2010
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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.
    No preview · Article · Aug 2009 · Journal of pediatric urology
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    Prasad P. Godbole
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    ABSTRACT: IntroductionSurgical techniquesOutcomesComplicationsPrevention of complicationsManagement of complicationsConclusion References
    Preview · Chapter · May 2009
  • Giampierro Soccorso · Gail Moss · Julian Roberts · Prasad Godbole
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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.
    No preview · Article · Apr 2009 · Journal of Pediatric Urology
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    Preview · Article · Feb 2009 · Cerebrospinal Fluid Research
  • Max Pachl · Dave Wilkinson · Julian Roberts · Prasad Godbole
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    ABSTRACT: PurposeAlpha adrenergic blockade using medications such as doxazosin, prazosin and terazosin have been recognized to be successful in select children with voiding dysfunction and incomplete bladder emptying. We report our prospective experience of the use of doxazosin in the management of voiding dysfunction and incomplete voiding of non-neuropathic origin.Material and Methods Data on 19 children with voiding dysfunction, diurnal enuresis and significant residuals was collected prospectively and analysed. All children had a non-invasive urodynamic assessment including a detailed history, examination, frequency volume chart completion and uroflowmetry. The expected bladder capacity (EBC) was calculated using the formula (age in yrs. + 2) x 30 (ml) and a residual volume of greater than 10% was considered significant. Doxazosin was prescribed in a dose of 500micrograms – 2 g/day depending on side effects and response. The criteria of a successful outcome were complete resolution of symptoms and improved uroflow parameters where repeated.ResultsOf the 19 children prescribed Doxazosin 13 showed symptomatic improvement and improvement in residual volumes of which 4 were completely dry and 9 showed improvement in voiding dysfunction and incomplete voiding. One child discontinued doxazosin due to headaches. Six had no improvement in symptoms or residual volumes.Conclusions Doxazosin resulted in complete resolution of symptoms in only 4/19(20%) of children while 33% had no improvement. Parents should be informed about the realistic prognosis of this treatment option as in this study the ‘success’ rate was much lower than previously published.
    No preview · Article · Apr 2008 · Journal of Pediatric Urology