Simultaneous repair for complicated/ complex vesicovaginal fistula

To determine the outcomes of repair of complicated/complex vesicovaginal fistulae [VVF] by simultaneously abdominal and vaginal approach. Prospective descriptive study. This study was conducted at PUMHS, Nawabshah from Jan. 2008 to Dec. 2012. After routine clinical examination and investigation, patients having complicated/complex vesicovaginal fistulae were selected for repair. The patients having associated with colonic involvement or with preexisting malignant pelvic pathology were excluded from the study. Follow up was carried out weekly basis for 03 to 06 months. Our study comprises of only 12 cases having complicated/complex VVF. The mean age was 35 SD +/- 3.5 years. The mean size of fistula was 3.9 SD +/- 1.2 cm. The ureter and urethra were adjunct with fistula in 03 [25%] and 02[%] cases respectively. all cases were treated with aforementioned method and auto-cystoplasty was carried in 08 [66.5%] cases. The uni-lateral and bilateral ureteric re-implantation was attempted in 01 [8.5%] and 02 [16.5%] cases respectively and double J stent were kept in all these cases. The success was achieved in 09 [75%] cases. The short and long term complications like frequency/dysuia/urgency of micturation, urinary stress incontinence and dyspareunia that had occurred in 04 [33.5%], 02 [16.5%] and 05[41.5%] cases respectively. Simultaneously abdominal and vaginal approach should be considered as complementary add-on to improve the access in difficult instances from 02 sides. It authorizes the surgeon to excise the fistulous tract

Ureteroscopic lithotripsy: a day-surgery procedure

Objective: To ascertain patient's safety and efficacy of ureterolithotripsy as a day-surgery procedure

Study Design: An interventional study

Place And Duration: At Citi Medical Center Larkana, Ghulam Mohammed Mahar Medical College and Hospital Sukkur Peoples University of Medical and Health Sciences for Women Nawabshah between Dec: 2007 to Dec: 2012

Methodology: All the patients of either sex having ureteral stone less than 1.5 cm in diameter were selected on the basis of routine clinical examination, laboratory investigation like complete blood count and biochemistry, Ultra-sound and x-rays like intravenous urography [IVU] etc for ureteral lithotripsy. The Semi-rigid UreteroscopicG.O Fr with Swiss Lithoclast lithotripter was used

Results: Our study comprises 320 selected patients. Male to female ratio was 1.6:1. Average age of patients was 30.5 year. The mean stone diameter was 1.2 cm. The stones were successfully disintegrated and completely pulverized in 95% [n=304] cases. In remaining 5%[n=16] cases, the procedure was deferred. Among them, ureteric catheter or J J stent in 3% [n=9] and 2%[n=7] cases respectively had been left. Of them, former cases were due to failure of access to stone and ureteroscope did not negotiate at all and in later cases stone was presented in upper ureter and inadvertently floated up into the kidney [P< 0.05]. The operative complications like simple mucosal injury occurred in 11%[n=35] and minor bleeding which did not cloud the field of vision occurred only in 13%[n=42] cases. The Mean operating time was 27[ranged from 22 to 55] minutes. Postoperative complications like urinary tract infection [sepsis] with fever and persisting haematuria had occurs in 5.5%[n=18] cases 9%[n=29] respectfully. The hospital stay was merely a day in all except 15% [n=47] cases who developed post-operative complications [P< 0.05]. In 03 week follow-up, residual fragments were noted only in 6%[n=19] cases. These patients were managed conservatively except 2%[n=7] cases that underwent repeat ureteral catheterization for manipulation of fragments which were jammed together, remit

Conclusion: Although, our study has documented high success rate and low morbidity with merely a day hospital stay but is dependent on many potentially modifiable and process-related factors

Vesico-vaginal fistula abdominal repair versus repair via vaginal route

To evaluate the outcome of Vesico-vaginal Fistulae [VVF] repair by abdominal and vaginal route. Interventional / clinical trial. Department of Urology, Chandka Medical College Teaching Hospital and Almas Medical Centre Larkana. Feb; 2005 to Nov; 2010. After routine clinical examination and investigation, patients having Vesico-vaginal Fistulae [VVF] were selected for repair. All patients had under gone examination those anesthesia [EUA] and cystoscopy. The patients having complex fistulae or associated with urethral, ureteric and colonic involvement or with preexisting malignant pelvic pathology were excluded from the study. Patients were divided in to 02 groups on the basis of the site of the fistula and the method of repair. Group-I comprised of those patients who had low type or uncomplicated fistulae and were operated by vaginal approach. Group-II consisted of those patients who had high type or large fistulae and were operated by abdominal approach. Postoperative follow up was carried out on weekly basis for 03 to 06 months. Our study included 32 cases. Group-I and II comprised of 18 and 14 patients respectively. The mean age was 34 years [ranged from 22 to 45 years]. The main cause of vesico-vaginal fistulae was obstetrical in 28[87.5%] and iatrogenic gynecological [hysterectomy] in 04 [12.5%] patients. No major difficulty was experienced except in 01[0.83%] case in group-1 who had a previous failure history of repair. The mean operative time was 95 minutes [range 80 to 125 minutes] and 145 minutes [range 110 to 175 minutes] in group-1 and group-2 respectively. Peroperative blood transfusion was required in 06 [33.33%] and 13 [93%] patients of group-1 and group-II respectively. Statistically significant difference was found between these two groups [P< 0.05]. Postoperative complications like wound infection occurred in 01[7.15%] of group- 1 and haematuria was present for few days in o4 [22.22%] and 05[35.5%] in group-1 and group-2 respectively. The mean hospital stay was 07 [range 5-10] days. Foleys catheter was removed at 02 week time in all cases. The success rate was achieved 15[83.33%] and in all 14 [100%] cases for group-1 and group-2 respectively and statistically no significant difference was found between two groups [P=NS]. All the patients were followed up regularly except 03 [16.5%] and 05 [35.5%] patients of group-1 and group-II respectively. Long term complications like urinary stress incontinence was observed in 2 [11.1%] patients of group-I, where as small capacity bladder and stone formation was observed in 02[14.3%] of group-11 cases. Birth trauma is still a major cause of vesico vaginal fistula in our region. Although, there is no significant difference in outcome of different technique but interposition of tissue between suture lines have a vital role to achieve a high success rate. Further more, best chance of success achieved with first attempt of repair. Strategic approach and proper training of medical and paramedical staff is recommended

Experience of upper urinary tract stones with dornier mpl 9000 lithotripter

To report our experience with Dornier MPL9000X Lithotripter in terms of safety, efficacy and complications in the management of upper urinary tract stones. Retrospective study. From 19[th] April 1998 to 15 August 2007 in the department of Nephrology, Chandka Medical College, Larkana. All patients who had renal calculi up to 2.5cm in size were selected for extra corporeal shock wave lithotripsy with Dornier MPL 9000 on the basis of clinical examination, laboratory investigations, X-Ray, intravenous urography and ultrasonography. Simple analgesics /sedation were used before the procedure, except in children where general anesthesia was used. A total of 1965 patients were treated with 3930 sessions [Average 4.1 sessions per patients]. Male to female ratio was 1.8:1. Average age of the patients was 35.3 years. The average stone burden was 1.8cm in diameter. Stone did not break in 3.3% cases, where as in 53 [2.69%] cases partial fragmentation had occurred. Over all success rate was 84%. About 10.2% cases were lost to follow up. Complications like colic pain, transient haematuria and stein Strasse was observed in 33%, 17% and 2.5% respectively. Extra corporeal shock wave lithotripsy for renal calculi was simple, safe and effective in selected group of patients

Pregnancy related acute renal failure; an experience at nephro-urology department Chandka medical college teaching hospital Larkana

Acute renal failure [ARF] during pregnancy is rare event and continues to be common in developing countries. 1998-2005. Nephro-urology unit at Chandka Medical College, Larkana. Retrospective study. 294 cases of Acute Renal Failure were treated. Among these cases, 72 [24.5%] were pregnancy related in origin. All of these patients were known to be previously healthy. Pregnancy related Acute Renal Failure was associated with, post partum hemorrhage was in 20 [27.7%], intra intiauterine death in 20 [27.7%] antipartum hemorrhage was 18 [25%], preeclampsia-eclampsia in 8 [11.11%] and septic abortion and puerperal sepsis in6 [8.3%]. Among these patients 65 [90.3%] required dialysis therapy because of moderate to severe azotemia. 35 [48.61%] patients recovered normal function. 30 [46.15%] developed irreversible renal function. Early reorganization of this disorder, improvement of health infra structure, antenatal health care and intensive supportive therapy, can reduce maternal and fetal mortality and morbidity

Acute renal failure: An experience at nephro-urology department Chandka Medical College Hospital Larkana

To find out the various causes of acute renal failure [ARF] and its out come in our setting of tertiary Care Hospital in rural areas. A retrospective Study. Nephro-urology department Chandka Medical College teaching hospital Larkana. From March 1998 to March 2005. Review of 294 patients of acute renal failure admitted in Nephro-urology department Chandka Medical College teaching hospital Larkana. Detailed history, physical examination and laboratory data of 294 consecutive patients of acute renal failure were analyzed. 294 patients were included in this study. Among them 149 [51.7%] were in the younger age group [less than 40 years] with dominance of males [1.61 to 1.00 male to female ratio]. Major cause of ARF was pre renal, seen in 172 [66.6%] patients, 70 [23.8%] of all cases of acute renal failure had gynecological and obstetrical back ground. Other causes C.V.A in 24 [9.3%], HHD in 14[4.5%]. Glomerulonephritis in 22[8.5%],and obstructive uropathy in 16[6.2%]. 92 Patients [31.3%] improved on conservative treatment,166[56.5%] needed dialysis and 36[12.2%] left against medical advice. This data reveals that pre renal element is the single most important cause of acute renal failure, in which commonest cause was pregnancy related ARF followed by C.V.A,HHD, glomerulonephrits and obstructive urophathy. Early indentification, referral treatment of pre renal factors, good peri natal care and good therapeutic measures substantially bring down the incidence of acute renal failure. 12.2% patients left against medical advice due to heavy expenses on the treatment and needs NGOs and Government support for treatment of poor patients

Ultrasound guided percutaneous nephrostomy: 6 years experience

To assess the safety, success rate and complication of percutaneous nephrostomy tube [PNT] insertion for the relief of obstructive uropathy. From 1999 to 2005, 465 PNT insertions were performed at the Urology Department Chandka Medical College Teaching Hospital Larkana and Urology and Dialysis center Dadu. Among 430 patients, 300 men and 130 female, age ranged from 12 to 69 years. PNT placement was performed under local anesthesia during regular working hours. Early complications within 15 days of PNT insertion were recorded. Of the 430 procedures, successful PNT insertion was recorded in 400 [93%]. Follow-up data up to 15 days was available in 385 placements [96.2%] of which major immediate complications were encountered in 22 [5.7%] patients. and minor complications seen in 24[6.2%] cases. Ultrasound guided PNT insertion is safe with high success rate and should be procedure of choice for relief of obstructive Uropathy

Extra-corporeal shock wave lithotripsy; early experience with chinese lithotriptop at larkana

To evaluate the early Results of experience of ESWL to the effectiveness of Chinese lithotriptor. Period: From May 1999 to October 1999. Setting: Almas Medical Lithotripsy Center, Larkana. Fifty patients having renal and upper ureteric stones were treated with Chinese lithotriptor. Patients and The stone imaging and localization was done with the help of fluoroscope. The ages of the patients ranged from 10-52 years [average: 32 years]. 17[34%] were males and 33[66%] were females. Forty two patients had renal stones and 08 had upper ureteric stones. Simple analgesic and sedation was used before the procedure on 1st sitting. The over all stone free rate after 3 months of treatment was 78%. Five patients [10%] were dropped from the list because of failure of treatment. Remaining 6 patients [12%] showed partial fragmentation and residual stone in lower calyx. We noticed few transient complications including colic and haematuria which were managed easily. We conclude that the Chinese lithotriptor was as effective as other lithotriptors. It is also cost-effective

Transuretheral resection of prostate; Early experience in rural Sindh

Benign prostatic hyperplasia is common disorder affecting the men beyond middle age. Various modes of treatment e.g. watchful waiting, medical, conventional and endourological surgery are employed. Now a days various new minimal, invasive methods are getting popularity but TURP [Transuretheral Resection of Prostate] is still the gold standard method of treatment. From Oct 1994 to June 1998, Transuretheral Resection of Prostate [TURP] was performed in 100 patients to see the response rate and complications in our set up. Clinically all patients suffered from Benign Prostatic Hyperplasia and referred to us due to retention of urine and were already catheterized. Overall success response was seen in 96% of patients. Early and late complication rate observed was 23% and 13% respectively with 2% mortality rate. We concluded that TURP is the effective and safe endourological procedure with low morbidity