Dr Prashant Mulawkar

urologist and Andrologist, Ex-Hon Secretary Urological society of India (West zone). specialises in HOLEP, PCNL and URS and male infertility. Views my own.

[Dr Prashant Mulawkar @pmulawkar]

Using 3D CT for pre PCNL access planning

[Dr Prashant Mulawkar @pmulawkar]

@baoghbab @Guttajwala Why do you say so? The milk is donated to Govt hospitals. I appreciate @Guttajwala

[Dr Prashant Mulawkar @pmulawkar]

@DrVCMohan Well done

[Dr Prashant Mulawkar @pmulawkar]

No reply from @AshwiniVaishnaw @RailwaySeva despite sending details

[Dr Prashant Mulawkar @pmulawkar]

@AshwiniVaishnaw
Train reservation cancellations are to be done 72 hours. But trains are not running on time. This is impacting us badly. There is no accountability.

[Dr Prashant Mulawkar @pmulawkar]

There is no reply

[Dr Prashant Mulawkar @pmulawkar]

@RailwaySeva I have sent you a direct message

[Dr Prashant Mulawkar @pmulawkar]

@Shresthanyl @UrologyTiong @PEARLSendouro @asiaendouro @takatakaJinoue Congratulations

[Dr Prashant Mulawkar @pmulawkar]

@niveditajha30 @DrDhruvchauhan Did you face it personally?

[Dr Prashant Mulawkar @pmulawkar]

@amazon I ordered for coffee. But got a wrong product. And return is not available. What next?

[Dr Prashant Mulawkar @pmulawkar]

@RadiographyNG Ptosis of right kidney

[Dr Prashant Mulawkar @pmulawkar]

@anandmahindra Congratulations sir. Your R&D work is amazing

[Dr Prashant Mulawkar @pmulawkar]

@ShashiTharoor @ShobhaTharoor @X It would be a learning experience for everyone if we know how the account was hacked.

[Dr Prashant Mulawkar @pmulawkar]

@hemo_shk sigmoid volvulus

[Dr Prashant Mulawkar @pmulawkar]

@DrParimalGharia @OTRAXER @drnanjappa @drabhaymahajan @drkarthicknagan @iamdockarl @usiurolithiasis Good. Safety of the ureter is of paramount importance.

[Dr Prashant Mulawkar @pmulawkar]

Any guess which surgery is going on?

[Dr Prashant Mulawkar @pmulawkar]

@SudheerDevana difficult decision to make and dificult surgery to perform. Well done

[Dr Prashant Mulawkar @pmulawkar]

@RailMinIndia @AshwiniVaishnaw @IRCTCofficial No refund for cancellations within 8 hr. If train is delayed for 2:59 hours, no refund. Better allow full refund if a train is delated for >1 hour. This will allow passengers to file TDR and will improve punctuality of trains.

[Utpala Mulawkar @MulawkarUtpala]

@Dev_Fadnavis @mieknathshinde @SunetraA_Pawar @mrhasanmushrif @CMOMaharashtra
जरा बारकाईने वाचा ही बातमी आणि महाराष्ट्रातील वैद्यकीय क्षेत्र नष्ट करणे बंद करा. लहान दवाखाने बंद झाले तर ते समाजहिताचे नाही ह्याचे भान ठेवा.

[Dr. Chacón-Lozsán F .'. @franciscojlk]

🩻Contrast-induced AKI:
one of the biggest myths still shaping clinical decisions

For decades we were taught:

👉 “Contrast damages the kidneys”
👉 “Avoid CT with contrast in CKD”
👉 “Hydrate, protect, delay imaging if needed”

But what if… most of this is wrong?🤔

->The uncomfortable reality

Modern evidence shows:

👉 Low-osmolar contrast rarely causes true nephrotoxicity
👉 Even in CKD, AKI, and ICU patients
👉 The risk is often overestimated—or nonexistent

So where did the fear come from?

📍 1950s high-osmolar contrast (actually toxic)
📍 Poorly controlled observational studies
📍 “Creatinine rise = contrast injury” assumption

👉 Correlation became causation
👉 And the dogma stayed

⚠️What recent data tells us

✔ No difference in AKI rates with vs without contrast
✔ No benefit from bicarbonate, NAC, or aggressive hydration
✔ Even ICU and AKI patients show no worsening outcomes

->Translation to real life

👉 The patient was going to develop AKI anyway...Not because of contrast!!

->The real problem: “Renalism”

👉 Avoiding necessary imaging
👉 Delaying diagnosis
👉 Choosing inferior tests

And that leads to:

❌ Missed PE
❌ Delayed sepsis source control
❌ Worse outcomes

->Clinical mindset shift

Instead of asking:

👉 “Will contrast harm the kidneys?”

We should ask:

👉 “Will NOT doing the scan harm the patient?”

->Who still deserves caution?

✔ eGFR <30
✔ Severe hemodynamic instability
✔ Multiple nephrotoxins

Even then:

👉 Optimize volume
👉 Minimize dose
👉 Don’t delay critical imaging

🤓Bottom line

✔ Contrast nephrotoxicity exists… but is rare
✔ The fear is bigger than the risk
✔ The harm of NOT imaging is often greater

In critical care

👉 We don’t treat creatinine
👉 We treat patients

And sometimes…

👉 The most dangerous thing is NOT the contrast

👉 It’s hesitation.

📃Reference
Florens N, Demiselle J.
Kidney360 7: 445–449, 2026. doi: https://t.co/CWzi7WC9Wx

[Dr Prashant Mulawkar @pmulawkar]

@DrBora_Urol Buccal mucosa ureteroplasty would be needed