IMH’S second opinion saves man’s bladder

dubai — Simon (name changed for privacy), a Kenyan citizen, was diagnosed in Kenya with a large bladder and left kidney pipe tumour. He was advised to go for bladder removal as well as left kidney removal.

Bladder removal meant that he might have an external urine pouch for the rest of his life which would affect his quality of life as well. This radical approach was advised without carrying out initial biopsy of the bladder tumour according to internationally accepted protocols.

Fortunately Simon met doctors from International Modern Hospital (IMH), who were participating in Medic East Africa. After speaking with Dr Hafeez Rahman (Chairman, IMH) and Dr Rohit Kumar (head of Surgery, IMH) who were at the camp in Kenya, Simon had a telephonic

Patient was out of the hospital in 4 days following his major laparoscopic left kidney removal surgery and was fit to travel back to Kenya after a week

consultation with Dr Vinod P Abraham, Consultant Urologist at IMH and plans were put in place for initial biopsy of his bladder and ureteric tumour rather than proceeding straight away with removal of his bladder and left kidney.

An initial consultation was held with Dr Vinod at the Urology department of IMH followed by excision biopsies of the bladder tumour along with sampling of tumour from the left kidney pipe to ascertain the course of treatment. Biopsies showed that the tumour in the bladder had not spread to the underlying bladder muscle, which as per protocol meant that bladder removal was not required. The kidney, on the other hand would have to be removed, which would be carried out through keyhole surgery. Initial surgery was done endoscopically on the second day of arrival and he was discharged from the ward the next day following surgery.

In the course of evaluation prior to surgery, Simon was assessed with a cardiac condition which posed a fatal risk since the kidney removal surgery would be performed under general anesthesia (the first bladder tumour surgery was performed under spinal anesthesia). With the support of the cardiology unit, Simon’s cardiac condition was optimised to mitigate the risk involved. A decision to go ahead with the high risk procedure was taken weighing important factors such as the risk of the tumour spreading. Dr Arun Kumar, head of Anaesthesia at IMH provided smooth general anaesthesia keeping the patient stable throughout surgery, while Dr Sundar, head of Cardiology provided crucial peri-operative management of the patient. The kidney removal surgery was done laparoscopically which meant smaller incisions, lesser blood loss, faster recovery, and a lesser chance of morbidity. Patient was out of the hospital in 4 days following his major laparoscopic left kidney removal surgery and was fit to travel back to Kenya after a week.