Efficacy of pubovaginal sling using fascia lata for treatment of urodynamic stress incontinence in females

To evaluate results of pubovaginal sling surgery for the treatment of urodynamic stress incontinence in females. Descriptive study. This study was carried out in Pakistan Naval Services Shifa, Karachi and Armed Forces Institute of Urology, Rawalpindi from February 1997 to February 2004. Thirty two Pubovaginal sling operations using fascia lata were performed at Pakistan Naval Ship Shifa, Karachi and Armed Forces Institute of Urology, Rawalpindi in females having severe urodynamic stress incontinence. The inclusion criteria was women with stable bladder, having post void residual urine [PVRU] <100 ml and P det 720 cm of water. Patients with detrusor overactivity, impaired detrusor function and marked cystocele were excluded from the study. The procedure involves placing a band of sling material using fascia lata directly under the bladder neck, which acts as a physical support to prevent bladder neck and urethral descent during physical activity. All patients were evaluated postoperatively by clinical examination, PVRU, Peak flow rate on uroflowmetry and urodynamic assessment. Mean patients age was 46.5 years [range 27-68] and mean parity was 6 [range 0-10]. Follow up was completed in all 32 patients over a mean follow-up period of 26 months [range 3-38]. Overall success rate [completely cured and partially cured] was 84%. De. novo detrusor over activity was observed in 25% patients, while 2 patients underwent undo operation for urinary obstruction. Pubovaginal sling surgery is the first line surgical treatment for all types of urodynamic stress incontinence

Obturator nerve block; transurethral resection of lateral bladder wall tumours [TUR-BT]

To evaluate the efficacy of obturator nerve block combined with spinal anaesthesia for prevention of adductor muscle spasm and its associated complications during transurethral resection of bladder tumours located at its lateral and inferolateral wall. A prospective study. At AFIU Rawalpindi. From January 2005 to December 2006. Material and method Fifty patients who had tumours at their lateral / inferolateral bladder wall of physical status ASA I - IV received spinal anaesthesia at 3rd or 4th lumbar space followed by obturator nerve block with a view to preventing adductor jerk during resection of tumour. There was complete suppression of adductor jerk in 45 [90%] patients and surgery was completed smoothly. Two patients [4%] had mild adductor jerk and additional sedation was required. The block failed to work in 3 [6%] cases and required conversion to general anaesthesia. Thus the procedure was successful in 94% [complete and partial suppression of jerk. We conclude that spinal anaesthesia combined with obturator nerve block is an effective technique for preventing adductor jerk during TUR-BT, thus avoiding intra-operative and post operative complication

Mayer Rokitansky Kuster Hauser syndrome with urogenital sinus anomaly

Mayer Rokitansky Kuster Hauser [MRKH] syndrome is a rare disorder, characterized by the congenital absence of uterus and associated renal tract anomalies. The case presented with primary amenorrhea and primary infertility, despite development of normal female secondary sexual characteristics. CT scan revealed absent uterus, a solitary left sided pelvic kidney and a vesicovaginal communication that, on cystoscopy, revealed urogenital sinus anomaly manifesting as a common channel formed due to absent anterior wall of vagina and posterior wall of urethra. The urogenital sinus anomaly in MRKH syndrome has not been reported earlier

Tubularized incised plate urethroplasty for various types of hypospadias

To report out short term results of hypospadias repair using Tubularised Incised Plate [TIP] Urethroplasty as described by Snodgrass for various types of hypospadias. A cohort of 62 patients comprising various types of hypospadias [62% distal penile, 30% mid penile and 8% proximal penile] underwent Snodgrass repair by one surgeon [F.A.] from June 2001 to November 2005. Age of the patients ranged from 1 to 20 years, the modal age being 3.2 years. There was no chordee in 90% of the cases whereas mild to moderate chordee was present in the remaining 10%. Urethroplasty was done by tubularization of the incised urethral plate as described by Snodgrass with coverage of the suture line by vasclarized dartos layer for water proofing. Chordee, if persisted after degloving of the penis, was corrected by dorsal placation. Patients were followed postoperatively on day 5, one month and subsequently on three monthly basis for a year. On the mean follow up of six months 46 patients [74%] achieved good functional and cosmetic results, with normal looking penis and ability to void urine with good forwardly directed stream. Complications were observed in 16 patients [26%]. The most common complication was urethrocutaneous fistula in 14 [22%]. Out of these 8 patients had minor leak which closed without requiring any further surgical intervention by regular urethral dilatation. The remaining 6 patients required re-operation for closure of the fistula. 2 patients had glans dehiscence which required re-operation 6 months later. Another 2 patients developed meatal stenosis which settled with regular post-op dilatation. So, the complications requiring surgical intervention was seen in 8 patients only. TIP Urethroplasty is a simple single stage procedure applicable for the majority of the hypospadias including mid and proximal hypospadias and redo cases where urethral plate is intact. It provides excellent functional neo-urethra, cosmetically normal looking glans and vertically oriented slit like meatus with lesser complication as compared to other single stage procedures