Surgical treatment of vesicovaginal fistula; an audit of 69 cases

The aim of this study is to assess the outcome of patients undergoing repair of vesicovaginal fistula. This descriptive study which was conducted from May 2002 to March 2008 the Department of Urology Lady Reading Hospital Peshawar. A total of 69 patients with Vesicovaginal fistula were included in this study. A detailed history and physical examination with special emphasis on previous gynecological and obstetrical events was recorded. All these patients underwent routine investigations like HB%, CBC, Urianalysis, renal function test and viral profile with ultrasonography of the abdomen and pelvis. Intravenous Urography [IVU] was offered to those patients who had upper tract dilatation on ultrasonography. Preliminary cystoscopy and Vaginoscopy was performed in all patients to diagnose VVF and plan the surgical approach. The mean age was 39.07 [+10.031] years. Thirt eight [55%] patients developed fistula due to obstetrical reasons while 30 [43-47%] had gynaecological surgeries and only one patient developed fistula after radiotherapy. The average size of the fistula was 3.36 cm: Trans abdominal repair of fistula was done in 58 [84.1%] patients while 11 [15.9%] has transvaginal repair. Successful repair was achieved in 65 [93.7%] patients. Vesicovaginal fistula can be successfully managed surgically. Proper preoperative assessment of the patients is mandatory for selection of the surgical approach

Percutaneous nephrostomy for the relief of upper urinary tract obstruction: an experience with 200 cases

To assess the role of Percutaneous Nephrostomy in upper obstructive uropathy. This was a descriptive study, conducted at Department of Urology, Lady Reading Hospital and Institute of Kidney Diseases, Hayatabad Medical Complex Peshawar from January 2006 to December 2008 on 200 patients of upper obstructive uropathy undergoing Percutaneous Nephrostomy. Fluoroscopy and Ultrasonography were used as guiding tools for accurate puncture of the renal tract. The patients were kept in the ward and their renal function tests were checked daily. All the data was collected on a structured proforma and analysis was done on SPSSv 10. A total of 200 Percutaneous Nephrostomy were attempted in 200 patients. The mean age of the sample was 41.6 +/- 12.68 years. Male to female ratio was 2.3:1. The causes included Stone disease in 104 [52%], Pyonephrosis in 52 [26%], Malignancy in 20 [10%], Renal tract tuberculosis in 12 [6%], Obstetrical trauma in 8 [4%] and Ureteric Injury due to Fire Arm in 4 [2%] patients. It was successful in 192 patients, while there was a failure in 8 cases [4%]. Considerable relief in terms of symptoms and renal biochemistry was observed with in a week. The mean blood urea level of 265 mg/dl before PCN dropped to 37 mg/dl and mean serum creatinine of 10.5 mg/dl dropped to 1.2 mg/dl respectively in all patients except 12 who were declared to have End Stage Renal Disease [ESRD]. Percutaneous Nephrostomy improves the patient's condition both in terms of urinary output and renal parameters

Transurethral resection versus transurethral incision of the prostate: a subjective and objective analysis

To assess and compare the outcome and complications of transurethral prostatectomy [TURP] versus transurethral incision of the prostate [TUIP] in patients having bladder outlet obstruction. Fifty patients suffering form benign prostatic hyperplasia [BPH] with prostate size of <30 gms were included in this study. Group a [25 patients] underwent TURP while in group B [25 patients] TUIP was performed. The patients were assessed using International Prostatic Symptoms Scoring System [IPSS], uroflownetry, TRUS and postvoid residual urine volume. Follow up was done at 1,3,6 and 9 months intervals. There was no statistically significant difference in the mean age among the two groups. IPSS score dropped by 81.55% for group A and 85.71% for group B at 9 months postoperatively from baseline. The overall improvement in maximum flow rates as recorded for both groups was 172.60% and 249% respectively while it was 182.8% and 279% for group A and B in average flow rates. The mean drop in postvoid residual urine volume for group A was -88.50% and -99.02% for group B. Overall 84% of patients in group A and 92% of patients in group B were well satisfied with the outcome of procedures. TUIP is an effective and comparable treatment modality for BPH with gland size of < 30 grams. Results of TURP and TUIP were comparable, but TUIP was simple and easier to perform, with less morbidity and shorter operation time than TURP