MORNING MAIL CORRESPONDENT
NEW DELHI, MARCH 22: Challenged by three life-threatening problems, 17-year-old Ravi Tomar had almost given up hopes when doctors at BLK Super Speciality Hospital examined his case and took it up as a challenge. Ravi was born with a spinal cord defect which caused problems in his bladder and eventually led to his kidney failure. In a complex treatment protocol, doctors first recreated and enlarged Ravi’s bladder, trained him in emptying the bladed himself, and then transplanted a kidney. Today Ravi is keeping well.

Senior consultant, urology and renal transplantation, BLK Super Speciality Hospital, Dr Aditya Pradhan said, “Ravi’s case was complex. He was born with a spinal cord defect called Spina Bifida (Meningomyelocele). This condition weakened his bladder functions because the nerves supplying blood to the bladder were damaged by the defect of the spine. Eventually, as a result of the bladder dysfunction, kidney got progressively damaged and led to kidney failure.”

According to doctors, at the time the patient approached the hospital was in end stage kidney disease. His urinary bladder was very small – he could retain only 20 ml urine and remained wet most of the time. Doctors said that there were other associated problems. First the bladder needed reconstruction to increase its size to normal 400 ml, prior to the transplant. The child had to be trained to insert a catheter into the neobladder and empty it himself.

Doctors planned a special protocol and designed a three-stage intervention schedule. “The first stage involved reconstruction of the bladder from the bowel loops. In the second stage patient was trained to empty the bladder. And then in the third stage the Kidney transplant was done successfully,” said consultant, urology and renal transplantation at the hospital Dr Yajvender Pratap Singh Rana. Entire procedure from bladder reconstruction to training Ravi for evacuating his bladder to kidney transplant took over four months.