Prajwal Paudyal

Urologist, Kathmandu Medical College

[Prajwal Paudyal @PrajwalPaudyal]

Double face urethroplasty contd….

[Prajwal Paudyal @PrajwalPaudyal]

In near-obliterative bulbar urethral strictures, double-face BMG urethroplasty involves a small ventral inlay graft combined with a larger dorsal onlay graft to achieve adequate urethral lumen augmentation.

[Prajwal Paudyal @PrajwalPaudyal]

An inferiorly and medially directed calyx poses a significant technical challenge for percutaneous access during supine PCNL..this is a pyelogram after stone clearance in inferior medial calyceal stone

[Prajwal Paudyal @PrajwalPaudyal]

During Pelvic Fracture Urethral Injury (PFUI) reconstruction, using an antegrade flexible cystoscope is a critical technique to precisely localize the proximal limit of a completely obliterated or severely strictured urethra.

[Prajwal Paudyal @PrajwalPaudyal]

Meticulous identification and preservation of the dorsal vessels is paramount during crural separation.

[Prajwal Paudyal @PrajwalPaudyal]

PPU - Bulbar mobilization → Excision of stricture urethral segment → Crural separation → Parachuting of sutures and Tension-free end-to-end anastomosis

[Prajwal Paudyal @PrajwalPaudyal]

Laparoscpic nephrectomy for giant hydronephrotic kidney : 20 cm kidney extracted out from just 4 cm incision

[Prajwal Paudyal @PrajwalPaudyal]

Giant hydronephrosis: Immediate preoperative percutaneous suction aspiration appears to be an effective strategy for rapid decompression before laparoscopic nephrectomy, providing minimal morbidity and simultaneous decompression and nephrectomy

[Prajwal Paudyal @PrajwalPaudyal]

Lap assisted PCNL contd…

[Prajwal Paudyal @PrajwalPaudyal]

A challenging pelvic ectopic kidney, a large stone burden, yet complete clearance in a single session—achieved with laparoscopy-assisted PCNL.

[Prajwal Paudyal @PrajwalPaudyal]

Anastomotic urethroplasty…tension-free, watertight urethral anastomosis with six interrupted sutures

[Prajwal Paudyal @PrajwalPaudyal]

Female BMG urethroplasty contd…

[Prajwal Paudyal @PrajwalPaudyal]

BMG anterior onlay urethroplasty for female urethral stricture

[Prajwal Paudyal @PrajwalPaudyal]

Today’s laparoscopic nephroureterctomy specimen for midureteric UTUC

[Prajwal Paudyal @PrajwalPaudyal]

Dorsal inlay ( Asopa technique ) BMG urethroplasty for fossa navicularis stricture

[Prajwal Paudyal @PrajwalPaudyal]

Antegrade flexible nephroscopy in supine PCNL: A valuable adjunct for accessing difficult calyces, minimizing the need for additional tracts, and maximizing stone-free rates.

[Prajwal Paudyal @PrajwalPaudyal]

Intra-operative ultrasound is a very useful tool during supine PCNL in case of retro-renal colon

[Prajwal Paudyal @PrajwalPaudyal]

Retro-renal colon # Pre-operative CT guided surface marking of possible site of puncture in supine PCNL to avoid colon

[Prajwal Paudyal @PrajwalPaudyal]

Replaced an intraperitoneal nephrostomy tube that had perforated the renal pelvis with a correctly positioned PCN.

[Prajwal Paudyal @PrajwalPaudyal]

Modified Supine PCNL isn’t just for stone clearance—it’s an excellent position for managing PCNL complications. A referred case with a perforated renal pelvis, nephrostomy tube, and intra-abdominal drain highlights its versatility.