Single stage primary closure of bladder exostrophy vs two stage closure: experience of 18 patients

To study the outcome and complications of single primary repair of Bladder Exostrophy and compare it with two stage repair. Descriptive study. The study was carried out at Paediatric Urology Dept, Children Hospital Complex and Institute of Child Health, Multan from 1[st] January 2008 to 30 December 2009. We retrospectively reviewed the records of all patients operated for primary single stage and two stage repair of Bladder Exostrophy. Patients were divided into two groups based on the type of surgery performed. Group I consist of patients with single stage complete repair and group II consist of patients with two stage repair. Data of both groups was entered on a proforma and surgical outcome, complications and urinary continence was noted. There were total 18 patients 13 male, 3 female, Group I [3 male 5 female] and Group II [10 male]. Age ranges from two days to one year in group one with mean age of four months and in group two age ranges from four days to one year with mean age of six months. Average surgery time, bloodloss and anesthesia recovery time was slightly higher in Group I but the complications like wound infection, wound dehience and reoperation rate was also more in Group I as compared to Group II. Long term outcome like VUR, continence interval was similar in both groups. Single stage primary repair offers the advantage to correct the defect in one sitting and psychologically comfortable for the parents but it needs greater experience and complications are higher in male patients. In our current setup single stage complete repair is suitable in female patients but in males two stage repair is more appropriate with satisfactory results

Efficacy of transcutaneous electric nerve stimulation [TENS] therapy in overactive non-neurogenic neurogenic bladder [Hinman's Syndrome]

To compare the outcome of the patients of overactive non-neurogenic neurogenic Bladder Syndrome with traditional treatment alone and traditional treatment plus Transcutaneous electrical nerve stimulation [TENS] therapy. Twenty eight patients of Hinmans syndrome [all below 12 years] were recruited for the study at The Children's Hospital and The Institute of Child Health Multan, from August 2008 to November 2010. It was a randomized controlled trial and individual patients were categorized as having mild moderate or severe disease, on the basis of Overactive Non-neurogenic neurogenic bladder symptom score [OABSS] scoring system. The patients with equal grades of severity were placed in control and study groups each comprising 14 patients. Group A was given traditional treatment while group B was treated with TENS therapy in addition to traditional treatment. Improvement was observed by OABSS and voiding diaries. After 12 weeks of treatment, the patients were re-evaluated for their symptoms and grade of severity of disease, t-test was applied to compare outcome between two groups and p < 0.05 was considered to be statistically significant. At the start of treatment, dribbling and increased frequency was observed in all 28 patients and urgency was noted in 22 patients [11 patients in each group]. At the completion of treatment after 12 weeks, dribbling was observed in 11[78.51%] vs. 3[21.4%] children in group A and B respectively. Frequency was reduced to 8[57.14%] in group A and 5[35.7%] in group B patients. Urgency was also reduced to 8[72.7%] in group A while 3[27.3%] in group B patients. No marked side affect were noted, except local skin irritation in some patients. Transcutaneous electrical nerve stimulation [TENS] Therapy is an effective and safe tool to improve the symptoms and quality of life of the patients with Hinman syndrome but still large scale studies with longer follow up are required

Role of alpha blockers in the management of lower ureteric stones

To study the role of Alpha-blockers in the management of patients with lower ureteric stones. Single blind experimental study. Department of Urology Nishtar Hospital and Medical College, Multan from 1st January 2002 to 30 December 2003. Eighty patients of lower ureteric stones were included in the study. They patients were divided into two equal groups. Basic data of all patients was collected including history, examination, age, sex, stone size, location, number and duration of symptoms. In group I forty patients [Experimental group], Doxazocin 4mg was given OD for four weeks, along with routine analgesics while the group II were performed weekly for eight weeks. The results were collected regarding stone passage rate, time, analgesic use, hospitalization and endoscopical intervention if needed. Statistical analysis was performed. In all paitents the mean size of stones was 5.68mm [range 5-8mm], average number one [range 1-3] and located in the lower five centimeters of ureter. In experimental group, 36 patients [90%] passed their stones in average three weeks; rest of the four patients [10%] needed ureterorenoscopy. While in Control group, only eighteen patients [45%] passed their stones spontaneously in average five weeks, eighteen patients [45%] needed ureterorenoscopy and in four patients [10%] ureterolithotomy was done. Alpha-blockers when, used as a spasmolytic drug for treatment of lower ureteric stones of size less than one centimeter, increased the stone expulsion rate and decreased expulsion time. It also decreased the need for hospitalization and endoscopic intervention, and provided particularly good control of colic pain

Role of Peritoneum as interposition tissue in the management of vesico vaginal fistula

To study the relative efficacy and results of the use of peritoneum as interposition tissue between vesical and vaginal repair in the management of VVF and compare the results with omentum pedicle flap. Design: It is a comparative study. Place and Duration: The study included twenty patient of VVF, who were operated in the Dept of Urology Nishtar Hospital Multan, from 301 June 2003 to 30, July 2004. Subject And In 10 patients [Group I], omentum was used as interposition tissue between the vesical and vaginal suture lines and in 10 patients; [Group II] peritoneum was used as interposition tissue between the two repairs. The study included 20 patients of VVF with mean age of 27 years. The leading cause of hysterectomy was the dysfunctional uterine bleeding in 8 patients [40%]. Fifteen patients [75%] came from rural areas and 5 patients [25%] were referred from gynecological units of Nishtar Hospital Multan. In group I patients, with omentum as interposition tissue, two patients [20%] developed high-grade fever three patients [30%] developed persistent vomiting, two patients [20%] needed blood transfusion, four patients [40%0] developed UTI. One patient [10%] developed leakage of urine per vagina on 18t postoperative day and one patient [10%] developed intestinal obstruction. In group II patients, one patient [10%] developed high-grade fever one patient [10%] developed persistent vomiting, three patients [30%] needed blood transfusion, three patients [30%] developed UTI. None of the patients developed any leakage of urine or intestinal obstruction. The study showed that peritoneum is equally good as omentum for use as interposition tissue in transabdominal repair of VVE It is also easy to mobilize with a comparable complication rate