Publications by authors named "Nripesh Sadasukhi"

4 Publications

  • Page 1 of 1

A prospective longitudinal study to evaluate bone health, implication of FRAX tool and impact on quality of life (FACT-P) in advanced prostate cancer patients.

Am J Clin Exp Urol 2021 15;9(3):211-220. Epub 2021 Jun 15.

King George's Medical University Lucknow, India.

Background: Androgen-deprivation therapy (ADT) as a treatment modality in advanced prostate cancer has deleterious effect on bone mineral density (BMD) and quality of life (QOL). Using FRAX (Fracture Risk Assessment) model, candidates at high risk of fractures can be predicted and appropriate treatment can be initiated at early step to prevent skeletal-related events. Objectives of the present study were to evaluate bone health, implication of FRAX tool in advanced prostate cancer and to see the impact of ADT and Bone-directed therapy (BDT) on FRAX and FACT-P QOL scores.

Material & Method: We conducted a prospective longitudinal study of 83 localized and metastatic prostate cancer patients from March 2017 to Dec 2020. FRAX tool using BMD femoral neck (GE-Lunar) was used to compute the probability of 10-year Major osteoporotic fracture (MOF) and hip fracture risk %. Patients who received monthly Zolendronic acid with or without Vitamin-D/calcium supplementation were classified as BDT group. FRAX and FACT-P were measured at baseline and 12 months follow-up and compared between different therapeutic modalities to see the impact on clinical outcomes.

Results: Majority of patients had skeletal metastasis (78.3%) and high-grade disease at presentation. Secondary osteoporosis was the most commonly (82.05%) observed clinical risk factor (CRF) followed by smoking (19.23%). Hip fracture risk ≥3% accounted for larger proportion of patients than did MOF risk ≥20% (21.2% and 2.5%, respectively). Statistically significant reduction was observed in both MOF and hip fracture risk in BDT group, while worsening on ADT. ADT duration correlated positively with both MOF and hip fracture risk (R=0.148, P<0.001 and R=0.164, P<0.001, respectively). FRAX score accurately predict future fracture events in majority (80%) of high-risk patients. Statistically and clinically significant worsening in PWB, EWB, PCS, FACT-P Total, FACT-P TOI and FAPSI scores were observed in patients on ADT. Statistically and clinically significant improvement was noted in physical well-being in BDT group. However, other QOL domains and FACT-P total scores remained stable.

Conclusions: ADT caused duration depended worsening of FRAX and FACT-P score in these patients while improvements of FRAX were seen on BDT. FRAX tool is advantageous in identifying the patients who require early intervention or therapy to decrease skeletal-related events.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8303024PMC
June 2021

Renal transplant in a patient of severe hemophilia.

Indian J Urol 2021 Jan-Mar;37(1):87-89. Epub 2021 Jan 1.

Department of Urology and Renal Transplant, Mahatma Gandhi Medical College, Jaipur, Rajasthan, India.

Hemophilia is a rare disorder that is difficult to diagnose and manage. The prevalence of end-stage renal disease is increasing in hemophilic patients because of improved life expectancy. Renal transplant surgery in such patients is often complicated by adverse hematological events such as bleeding and intravesical thrombosis, both with a risk of renal allograft rejection. We report a case of a 46-year-old hemophilia A patient on hemodialysis who underwent renal transplant and show that although challenging, renal transplant in hemophilic patients is possible.
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http://dx.doi.org/10.4103/iju.IJU_194_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8033234PMC
January 2021

Robot assisted intra-corporeal ileocalicostomy ureteral substitution for complex uretero-pelvic junction obstruction: a novel and feasible innovation.

J Robot Surg 2019 Aug 31;13(4):589-593. Epub 2018 Oct 31.

Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.

A 33-year-old female presented to the emergency department of our hospital with urosepsis and hematuria with clot retention secondary to a complicated pyelolithotomy for left-sided pelvic calculus. A percutaneous nephrostomy was placed for drainage as a DJ stent could not be traversed into the left renal pelvis with retrograde pyelography demonstrating complete cut-off at L4-L5 level. After stabilization, she was found to have uretero-pelvic junction obstruction (UPJO) in left solitary functioning kidney with long-segment upper ureteric stricture and nadir serum creatinine 1.5 mg/dL. Nephrostogram and CT scan revealed an intra-renal pelvis with no passage of contrast into the ureter. Primary hyperparathyroidism secondary to parathyroid adenoma was also detected and she underwent excision of the same. The long-segment ureteric stricture and need for a wide drainage ruled out pyeloplasty and ureterocalicostomy as treatment options. A wide-bore communication between the lower calyx and bladder was necessary and robot assisted ileocalicostomy was performed in this case. A 20-cm-long segment of ileum was used to replace the ureter with a suprapubic 16 Fr Foley's catheter as splint. Postoperative course was uneventful with all tubes removed by third postoperative week. Nephrostogram demonstrated gravity-dependent drainage into the bladder with no leak or anastomotic narrowing. The patient is doing well at 6 months of follow-up with a stable renal function. Robot assisted ileocalicostomy is a safe and effective technique which provides wide gravity-dependent drainage in complex UPJO with long-segment ureteric stricture and intra-renal pelvis.
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http://dx.doi.org/10.1007/s11701-018-0885-3DOI Listing
August 2019

Robot-assisted boari flap calycovesicostomy for failed uretero-pelvic junction obstruction: a novel approach to a complex problem.

J Robot Surg 2019 Apr 22;13(2):345-349. Epub 2018 Aug 22.

Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.

Uretero-pelvic junction obstruction (UPJO) is a common condition, often presenting in adulthood in developing countries. These cases can pose significant problems owing to late presentation and complications such as infection, stones, and impaired renal function. We present the case of a 28-year-old female who presented to us with recurrent symptoms and impaired drainage following a failed open pyeloplasty and robot-assisted ureterocalycostomy for right UPJO. She was managed by robot-assisted boari flap calycovesicostomy, an innovation which helped in salvaging her kidney; ensuring good drainage in the involved kidney. To our knowledge, this is the first such case in the literature in the management of complex UPJO.
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http://dx.doi.org/10.1007/s11701-018-0863-9DOI Listing
April 2019
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