Vesicovaginal fistula: repair by vaginal approach

To evaluate the outcome of transvaginal repair in vesicovaginal fistula even in cases having fistulous opening high in vagina or close to ureteric orifices. This study was carried out in Departments of Urology and Gynecology Lahore General Hospital from April 2004 to Oct 2007. Detailed history was taken; physical examination and relevant investigations were carried out. In extended lithotomy position, simultaneous cystoscopy and vaginal examination were performed in all cases. After identifying the fistula and ureteric orifices, trans-vaginal repair was done in all the cases. Thirty cases of urinary incontinence for 3 months to 12 years, with age range of 18 to 49 years and their parity ranged from 1 to 6. Sixty six percent fistulas were supra-trigonal and less than 2 cm [range1-4cm]. It was seen that obstetrical causes [59.4%] overruled the gynecological ones [33.3%]. Five patients had one or more previous fistula repair attempts; while one of the females had 4 deliveries even with the fistula. First repair attempt was successful in 27 [91.1%] cases, two of the remaining three were cured in 2[nd] repair and last one was cured in third trans-vaginal attempt. None of the repair compromised the ureteric orifice. The vaginal approach avoids laparotomy, splitting of the bladder and ureter re-implantation in the cases having fistulae closed to the ureteric orifice. Patient recovery is faster with less morbidity

study of perinatal mortality in lahore general hospital

This study was conducted at Obs/Gyae department of Lahore General Hospital, Lahore from 1[st] January 2004 to 31[st] December 2004. The aim of this study was to calculate the perinatal mortality rate and find out the various demographic and maternal risk factors leading to it. According to the results of the study the perinatal mortality rate was 91.9/1000 births [394 perinatal deaths /4287 total births]. Stillbirths accounted for 64% of perinatal deaths and 36% were early neonatal deaths. As a result of this study, major determinants of perinatal deaths are found to be increased maternal age, poor socioeconomic class, lack of antenatal care and complications arising from hypertensive disorder of pregnancy, mechanical factors [like obstructed labour and malpresentations] ante partum haemorrhage, bad obstetric history, induction of labour and operative delivery. Many of these factors are avoidable. Efforts must be oriented towards primary measures to improve the conditions at community level