Happy Clients

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Minimal invasive surgery for giant adrenal myelolipoma

A 49 years old lady presented to the Urology clinic in KIMS PBMH with dull aching left flank pain and dyspepsia for the last 3 months. She was attended by Dr. Sumanta Mishra, an expert urology specialist She was diabetic for 2 years on oral hypoglycemic and hypertensive for the last 5 years on medications. She had LSCS 16 years back and attained menopause 2 years back. She doesn’t have palpitation, headache, dizziness, pedal edema, or any recent weight loss or weight gain.  She had central obesity with a BMI of 37. On examination, her systemic blood pressure was 160/90 mm of Hg, pulse 80/min, and no abdominal mass palpable. 


Her ultrasound abdomen showed a well-defined brightly echogenic lesion measuring 82x92x117mm is seen in the left adrenal region. Her blood investigations including serum electrolytes were normal. Contrast-enhanced CT scan with adrenal protocol showed a Large retroperitoneal mixed density lesion of size 9.8x 7.3x 9.5 cm noted in the anatomical side of left adrenal gland displacing left kidney downwards. The lesion contains a gross fat density area with some soft tissue density area suggestive of adrenal myelolipoma. The right adrenal was normal. Her endocrine evaluation was done to rule out secreting tumors including pheochromocytoma. All hormonal evaluations including 24 hours urinary metanephrines and normetanephrine, serum cortisol, DHEA, serum aldosterone, and renin levels were within normal limits.


Based on radiological features and hormonal evaluation she was diagnosed with left adrenal myelolipoma. After proper counseling, the patient about the treatment plan laparoscopic left adrenalectomy was planned. 


Standard three-port was placed by Hasson’s technique in the right lateral decubitus position and adrenal approached by the transperitoneal route. The key steps of surgery were identifying and controlling the adrenal vein while safeguarding the renal hilar vessels along with the spleen and pancreatic tail. The adrenal mass of 11 x 9 x 9 cm was excised and retrieved by a Pfannenstiel incision. The patient was discharged on 3rd post-operative day.


Our patient had such a giant AML and presented with features of pressure effect due to mass. Her hypertensive status and central obesity warranted hormonal evaluation which was normal and helped confirm the diagnosis. Although this is a benign lesion, surgery is needed in large symptomatic cases and suspicion of malignancy. AMLs doesn’t recur after surgical excision with recurrence-free survival rate up to 12 years being reported [

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A large 13 cm renal cell carcinoma was removed successfully by laparoscopic surgery

A 51 years patient was referred to KIMS was diagnosed with a large left kidney malignant lesion with enlarged para-aortic lymph nodes on CT scan. After a complete evaluation and counselling, the patient underwent laparoscopic left radical nephrectomy and lymph node dissection by Dr. Sumanta Kumar Mishra, a skilled urologist in Bhubaneswar, under the guidance and assistance of Dr. J B Jagdeb. 


A large renal cell carcinoma sized 13 x 10 x 9 cm was effectively removed with laparoscopic surgery. The patient was released without issue on the third post-operative day. His biopsy revealed clean margins and no evidence of malignancy in his lymph nodes. 


Large kidney cancers with enlargement of lymph nodes are difficult to operate on with laparoscopy and are performed only in a few centres. The Department of Urology, KIMS, and PBMH have been performing such complicated procedures. The Department of Urology is grateful to our founder Dr. Achyuta Samanta for the trust and support.

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Hemi-nephrectomy for Non-functioning Upper Pole Moiety of Duplex Kidney

A duplex kidney, also known as duplicated ureters, is a urinary system condition in which two ureters drain urine from a single kidney. This is caused by a partial fusion of the upper and lower poles of the kidney, resulting in two distinct renal drainage channels. It is more frequent in women than in men, and it is an unavoidable birth defect.


A 21-year-old woman presented with pain in her left flank area. After a complete evaluation, she was diagnosed with left-sided “duplex kidney." It is a duplication of the left kidney with two ureters flowing into the urinary bladder. 


On examination, the upper moiety of the duplex kidney was highly hydronephrotic and non-functional. The lower pole of a duplex kidney is usually poorly functioning. But our patient's upper moiety was non-functional. After obtaining proper consent, she underwent an open hemi-nephrectomy with a ureterectomy. 


Dr. Sumanta Kumar Mishra, a renowned urologist in Bhubaneswar and Assistant Professor of Urology, performed the surgery successfully with Dr. Sumit Kumar Panda and Dr. J.B Jagdeb. Following surgery, the patient was in good health and recovered within a few weeks. 

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