Miss Trishna Thapa, 11 years female resident of Tamakoshi -6, Khimti was operated in Pediatric Urology department of Ishan Children and Women’s Hospital , Tokha – 5 on 22-04-2024). She underwent the complex and rare Urosurgical procedure with 4 operation at a time (Augmentation illeocystoplasty with B/L ureteric reimplantation with Bladder neck closure with Mitrofanoff procedure).
Probably this kind of Pediatric Urology Surgery has been successfully treated in Nepal for the first time. We would like to send sincere gratitude to Miss Trishna Thapa & her parents and wish her good health. This rare & complex surgery has been operated by Professor Dr. Ramnandan Prasad Chaudhary & Team ( Dr. Shirish Silwal, Dr. Ranjit Mahato, Fellow Dr. Dhan Bahadur Shrestha).
We had taken well informed written consent from parents for this rare procedure. We explained possible complications including life threating risks during intraoperative and postoperative period to parents. This complex Uro-surgical procedure took 10 hours. The anesthesia team was led by Professor Dr. Shyam Krishna Maharjan and team. After surgery we successfully managed the patient in surgical ICU and post-operative ward & recovery was uneventful. She was discharged on 14th postoperative day.
She was delivered 11 years back in maternity hospital, Thapathali. Since birth only she was born with this rare & complex Genitourinary abnormality (Extrophy Epispadias Complex) in which there is no lower abdominal, no umbilicus. Urinary bladder is open, urine flows from both kidney through long abdomen & the urethral pipe also absent.
She underwent 1st surgery with Bladder & Bladder neck repair (closing of urinary bladder) on day 9 by the team lead by Prof. Dr. RP Chaudhary then at Kanti Children Hospital. At the age of 4 years of age she again underwent 2nd surgery urethroplasty( making of urethral pipe).
The patient was in regular follow up with Prof. Dr. RP Chaudhary. The patient was kept observation upto 5 years with hope that her urinary leaking will improve but it didn’t. Her urinary bladder remained small for her ageand urinary incontinence with urine going back upto both kidneys (Reflux of Urine). She was under Diaper during daily activities including schooling upto 11 years. As a consequence she had risk of Renal Failure. Thus this rare and complex Uro surgical procedure was advised & parents agreed to go for it for better quality of life & to save both kidneys.
Prof Dr. RP Chaudhary was involved to Kanti Children Hospital for 23 years. During his tenure also, this type of rare complex Uro surgery wasn’t performed by any pediatric surgeons there but due to his expertise, experience and multidisciplinary facilities with expert team quality & nursing care, this surgery was successfully performed here in Ishan Children & Women’s Hospital .
She is completely healthy now. She is doing continuous intermittent self-catheterization (CISC) i.e. self-passage of urine through artificial passage in abdominal wall made with appendix.
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