Testimonials

"First time to RG Hospital. Very good experience, helpful team and good assistance. My salute to your esteemed team. Keep it up.Thanks." Dr. Irania Rauanan KERALA

"International standard hospital. Worthy of recommendation, and excellent doctors' team." Dr. John Amadi 17, Jonathan Drive Rumueme, Piuibux 1890, Fed,
Sec. Portharcout, Rivers State, Nigeria

7 months old baby operated successfully with Holmium Laser

7 months old baby came to RG Stone hospital with complaint of excessive crying & probably pain in abdomen. There was strong family history of stone formation with father being a regular stone former. Another child of 8½ months in family was also treated at RG Stone for bilateral renal stone. On evaluation there were multiple stones in kidneys, right ureter & urinary bladder. Baby underwent right ureterorenoscopy with left PCNL. Now Baby is stone free & doing well.

Brief clinical details :

On Examination:-

Our faculty






Healthy child, weight. 7.5 kg, pulse 120/min regular, R/R 30/min, Temp 98.6° F. Lungs B/L clear, CVS - S1, S2 N. P/A soft, BS positive, nontender.

Investigations:-

Hb 11 gm %, TLC 13400/cumm, DLC P54 L35, platelet count 4.99 lacs/cumm, BT 1’59’’, CT 6’, B. urea 31 mg%, S. creatinine 0.81 mg%, RBS 70 mg%, S. calcium 9.75, S. sodium 139, S. potassium 4.5.

Urine Routine:-

Protein & Glucose nil. Microscopic:- RBC negative, P/C 10/HPF. Urine C/S:- E. Coli.

Stone Analysis:

100% cystine (brought 2-3 mm stones with him).

Ultrasound KUB revealed right kidney 8.1 mm calculus in inferior calyceal region, 12.8 mm calculus in pelvis, 2 calculi of 11.9 mm x 7.6 mm in right lower ureter and 1 small calculus at right V.U.J. Left kidney showed multiple calculi; 13.4 mm in renal pelvis, 1 in middle calyx of 8 mm, & at least 3 in lower calyces (6-7 mm). A mobile calculus 7.3 mm in urinary bladder.

X-ray KUB:

Bilateral renal calculi with right multiple ureteric and vesical calculus.

Intra Venous Pyelogram (IVP) showed adequate concentration and prompt excretion with multiple filling defects in PCS and ureter on right side; mild to moderate hydronephrosis with calculi in renal pelvis and lower calyces on left side. A vesical calculus.

Metabolic Screening (Urine):-

Reducing substances negative, Ferric Chloride test negative, Nitrosonapthol test negative, Nitro Prusside test positive. Aminoacids methionine & homocysteine increased (qualitative) suggestive of homocystinuria or cystinuria. Quantitative homocysteine 4.17 mol/lt. Parathyroid Hormone 9.7 pgm/ml.

Pediatric Nephrologist Consultation:-

Tab. D. Penicillamine 250 mg ½ BD (monitor blood counts), Tab. Pyridoxin 40 mg ½ OD, increased fluid intake (1 litre/day), sodium restriction, Uriliser 5 ml BD, surgical removal of calculi.

Procedures:-

Cystolithotripsy + Right Ureteroscopic Lithotripsy + Right Retrograde Intra Renal Surgery + JJ stenting under general anesthesia; light Percutaneous Nephrolithotony under general anaesthesia.

Followup:-

Ultrasound KUB showed B/L normal kidney, no calculus, no hydronephrosis.

82-year old hypertensive patient with IHD treated for 264 grams of enlarged prostate

82-year-old man suffering from prostatic symptoms, ischemic heart disease, high blood pressure and having recurrent urinary tract infections, was successfully treated at the RG Stone Urology and Laparoscopy Hospital, New Delhi.

According to Dr. Anil Varshney, Chief Urologist, who conducted the surgery,

"The patient was aware that he was suffering from Benign Prostatic Hyperplasia (BPH), with high residual urine of 300 cc, which was responsible for his problems and recurrent attacks of infection. He came to us looking for options, as in his own city, he was suggested & open surgery for enlarged prostate weighing 264 grams."

In view of his medical condition and the size of his prostate, doctor advised Holmium Laser Enucleation of Prostate (HoLEP). "Traditional intervention like TURP can have disastrous complications in the given situation," he added. The Holmium Laser surgery was completed endoscopically in 2 hours and 30 minutes. The patient was discharged after two days, with absolutely no blood transfusion, he passed urine well post surgery. The need for open surgery had completely been avoided. This particular case of surgery of prostate gland is one of the largest done in India through Holmium Laser, at RG Stone Hospital, New Delhi.

Watermelon sized prostate (424 grams) treated through HOLEP

75-y/o male admitted with massive prostatic trilobar enlargement (424 grams) with lower urinary tract symptoms (LUTS), & chronic retention of urine x 3 years (on Foleys catheter). No history of diabetes, hypertension, CAD or asthma. Urine came out immediately after catheterization. No comorbidities. Large capacity grossly trabeculated bladder with pseudo-diverticulae & sacculations. TRUS biopsy negative twice for prostatitis & malignancy. S. PSA 35.52 ng/ml. 

         

Examination:

Pulse 68/min regular, BP 110/80 mm Hg, Temp 98.6° F, SPO2 96%. P/A:  Soft, BS positive. Chest, CVS, CNS – Grossly normal. PR: Grade IV firm, massive enlargement.

Investigations:

Hb 12.6 gm/dl, TLC 8100 cmm, DLC N-56/L-37/E-2/M-5, ESR 15 mm/1st hr, Platelet count 2.62 lakh/cmm, PCV 37.8%, BT 1’52’’, CT 5’45’’, B. group O+. RBS 89 mg/dl. B. Urea 38 mg/dl, S. Creat 1.4 mg/dl, S. Uric acid 6.0 mg/dl, S. Na+ 145 mmol/L, S. K+ 4.6 mmol/L, S. Chloride 101 mmol/L. S.PSA: 9.09 ng/ml.

Urine:
 

Pus cells 40-42/hpf, RBC full field, epithelial cells occassional.

HIV, HBS Ag and HCV negative. X-ray chest NAD.  Echo normal.

CECT Abdomen shows prostate grossly enlarged with median lobe bulge seen in urinary bladder. Urinary bladder is thick walled (? trabeculated).

Histology shows benign nodular hyperplasia of prostate.

Uroflowmetry:

7.4/2.6/185/72. PVR 220 cc (13/06/11), PVR 33 cc (14/06/11).

Ultrasound: Weight 408.82 cc/423.93 cc/424 cc. Median lobe ++ (218 gm), PVR 22 cc.

Diagnosis:-

LUTS with enlarged prostate with retention (recurrent), not on Foley’s catheter.

Advice: HOLEP under spinal anaesthesia (staged if required).                

Procedure:

Stage I:

Holmium laser two lobe enucleation under spinal anaesthesia on 07/06/11. 550 micron fibre/80 watts-100 watts. Due to bleeding & fall in haemoglobin levels, he was transfused with 2 units of compatible whole blood.

Stage II:

Morcellation under spinal anaesthesia on 10/06/11. Transfused another unit of whole blood.

Findings:

Stage I: 

Both ureteric orifices normal. Left lobe 284.35 KJ – 2 hours 20 min. Right lobe – 159.18 KJ – 1 hour 10 min.  Total energy 443.53 KJ. Adequate hemostasis achieved. Morcellation left. Continuous irrigation. 22 Fr three-way Foleys catheter placed.

Stage II: 

Enucleated lobes in bladder. Wide open prostatic fossa. Neglible residual tissue anteriorly. Tissue morcellated & retrieved. 20 Fr Foleys catheter placed.

Postoperative Parameters:

Doing well. Counts within normal limits. Epidural catheter & Foleys catheter removed on 09/06/11 & 10/06/11 respectively. Complained of dribbling of urine, which subsequently improved.

         
 Post-operative Ultrasound: 

Pre void volume 358 cc, PVR 15 cc. Prostatic fossa 5.6 x 5.4 cms.