ABSTRACT
Background: Urological disorders like stone disease, pyonephrosis secondary to obstruction and trauma are common during pregnancy with global incidence of 1 in 250 to 1 in 3000. These diseases can complicate any pregnancy and timely diagnosis and management is of utmost importance for safety of the mother and fetus. Managing these cases entails morbidity and minimally invasive procedures avoiding anesthesia have definite advantage.Methods: It was an observational study. Pregnant patients with nephrolithiasis, pyonephrosis, complicated post-traumatic ureteropelvic junction (PUJ) obstruction (PUJO) and trauma were included in the study.Results: Out of total 84 cases, 45 required intervention. Percutaneous nephrostomy (PCN) for pyonephrosis secondary to PUJO and obstructed PUJ calculus was done in 11 and 14 cases respectively. Bilateral PCN for bilateral nephrolithiasis was done in 7 cases. Silicon double-J stenting for ureteric calculus was done in 13 cases. One case of spontaneous fornicial rupture of kidney without stone disease was managed conservatively as were 4 cases of trauma with concomitant renal injury, 18 cases of non-obstructive renal stones and 16 cases of pyelonephritis. Seven patients lost follow-up. One case each of pyonephrosis and polytrauma had fetal death at term unrelated to urological cause. In rest 75 patients, primary pathology was tackled after 6-8 weeks of delivery.Conclusions: Urological diseases during pregnancy are not an uncommon entity and can pose risk to both mother and fetus. With good clinical vigil, use of minimally invasive procedures, close monitoring and follow up, these patients can be safely managed without any adverse events to the fetus and mother.
ABSTRACT
To assess the role of TOT sling procedure in current surgical management of female Stress Urinary Incontinence [SUI] in terms of post-operative results, cost effectiveness, pt acceptance and complications. From June 2006 to September 2008, 30 patients of SUI were treated surgically by TOT-sling procedure. Pre-operatively the patients were evaluated by thorough history taking, clinical examination and different diagnostic test depending upon the individual clinical scenario. Patients were explained in their own language the nature of procedure and the principle behind it. Any complication[s] [intra/postoperative] were noted. After discharging the patients they were followed up by at least 3 visits [follow-up visits] at 1,3 and 6 month interval. Any complications of the procedure and patient acceptance were evaluated at each follow-up. The mean age of the total patients [n=30] was 39.5 yrs and 28 [93.33%] were multiparous. Involuntary loss of urine on straining was the most common complaint present in 25 [83.33%] patients and 22 [73.33] patients were having duration of symptoms less than 3 yrs. 9 [30%] patients were having mild cystocele pre-operatively which resolved after surgery. All the 30 [100%] patients were continent post-operatively while 7 [23.33%] were having lower urinary tract symptoms [LUTS]. No major intra/post-operative complication was seen but, urgency, dysuria, fever and haematuria was seen post-operatively which resolved after few days. The operative time was 24 +/- 3.8 months and catheter was removed on 2.7 +/- 1.7 days post-operatively. Hospital stay was 6 +/- 2.4 days [3-11] and app. Cost of the treatment was Rs 3253 +/- 360 [2700,3900]. TOT Sling procedure is currently the Gold Standard for management of female SUI. It is very important to diagnose SUI and rule out other causes of incontinence because only the former one [Genuine SUI] is improved by TOT sling and other types may be even worsened by this procedure