Role of urodynamic studies in evaluation of lower urinary tract symptoms

To emphasize the role of urodynamic studies in the evaluation of lower urinary tract symptoms and to describe the technique and report results of tracings from a urodynamic center in a tertiary care settings. Descriptive Study. This study was carried out at Armed Forces Institute of Urology, Rawalpindi, over thirty months from January 2003 to June 2005. sixty seven patients referred to the urodynamic centre of AFIU, Rawalpindi with complaints of urinary incontinence or voiding disorders were evaluated with conventional urodynamic tests. During cystometry, the detrusor activity, bladder sensation, bladder capacity and bladder compliance were measured with simultaneous urinary flow measurement in those who were able to void. Results were grouped into eight different types of urodynamic diagnoses. There were 51 females [76%] and 16 males [24%] patients. Majority of patients [48%] were in age group of 20-50 years. Ages ranged from 5-84 with a mean of 41.3 +/- 17.3 years. Majority of the patients found to have neuropathic bladder [25.3%] followed by patients with pure stress incontinence [23.9%]. In 38 female patients who presented with urinary incontinence, majority of them i.e. 16 [42.1%] were found to have pure stress incontinence on urodynamic evaluation while 11 [28.9%] patients had normal cystometric findings and 5 patients [13.1%] had hypersensitive cystometrogram signifying sensory urge incontinence while motor urge incontinence implying detrusor instability occurred in 1 patient [2.7%]. Urodynamic studies are useful in evaluation of lower urinary tract symptoms not responding to conventional medical treatment as they help clinician in identifying the underlying causes for the symptoms, and to quantify the related pathophysiological processes. Treatment of the underlying pathophysiology facilitates better treatment of symptoms

Recent trends in laproscopic myomectomy

Recently there is an increasing trend for minimal access surgery [MAS] for treatment of uterine myomas. Laparoscopic myomectomy has provided minimal invasive alternative to laparotomy for subserosa and intramural myomas. It is associated with faster postoperative recovery and potentially less postoperative adhesions. Main concerns are however subsequent fertility, reproductive outcome and long-term recurrence. Other alternatives are laparoscopic assisted myomectomy, laparoscopic ultraminilaparotomic embolised myomectomy, laparoscopically assisted transvaginal myomectomy, myolysis and cryosurgery. Hysteroscopic access is required for sub mucous myomas. The idea of this review is to analyse recent techniques which are used to treat uterine myomas. Recent evidence favours safety and reliability of laparoscopic myomectomy. Prospective randomised controlled trials comparing laparoscopic myomectomy with laparotomy myomectomy will clarify the status further

Maternal blood loss by expansion of uterine incision at caesarean section: a comparison between sharp and blunt techniques

In order to minimize intra operative blood loss during caesarean section, two techniques of expansion of uterine incision [sharp versus blunt] while performing lower segment transverse caesareans deliveries and their effect upon intraoperative blood loss were studied. Moreover, each method was also compared for its inadvertent extension of uterine incision laterally or into the broad ligament, into the cervix or vagina. Method: A quasi-experimental study with convenient sampling, involving two groups of women who underwent lower transverse segment Cesarean section. Both groups were studied for their demographic characteristics and clinical data. Standard surgical techniques were used in both groups except the expansion of uterine incision, either by sharp or blunt methods. Finally a comparison of two groups was made regarding blood loss, change in haematocrit, blood transfusion and uterine tears. The study was conducted at Combined Military Hospital Rawalpindi during May 2002 to April 2003. No significant difference was found between the two groups regarding their demographic characteristics and clinical data. Intraoperative blood loss and post-operative hematocrit drop were more significant in the patient group in which a blunt uterine incision was made. Besides, more patients in this group received blood transfusions. Unintended extension of uterine [tears] was also significantly higher in this group. Sharp expansion of uterine incision during low segment caesarean section is safer and precise based on these results

Leiomyoma of the vagina

An 18 year old unmarried girl presented with mass coming out of vagina for 3 months and with some vaginal discharge off and on. Menstrual cycle was 6 days every month with moderate flow. Single digit examination was suggestive of endocervical polyp. Laboratory investigations were non-significant except for a few pus cells in urine. Uterus and ovaries were normal on ultrasonography. Examination under anesthesia showed an anterior wall cystic mass 6'7 Cm in diameter, which had a well-defined capsule. The tumour was enucleated and the core contained some necrotic material. After enucleation the space was gently curetted. Histopathology and immunocytochemistry confirmed diagnosis of aggressive leiomyoma with 5'10 mitosis per high power field. Opinion of oncologist was taken for follow up of the case. An Enhanced CT scan of pelvis revealed a round hypodense shadow in right adnexal region that gave an impression of right ovarian cyst about 2.5 Cm in diameter without any radiologic evidence of malignancy. It was planned to be managed conservatively. Follow up over next one year [last check up being in Feb 2003] has not revealed any recurrence of leiomyoma/malignancy, whereas ovarian cyst has resolved

role of the anti-sperm autoantibodies in the management of patients with primary infertility

The role of antibody mediated infertility in patients with primary/secondary unexplained infertility is the subject of current interest worldwide. A prospective study was conducted to study the role of anti sperm antibodies in Pakistani patients with infertility. Patients reporting in the outpatient clinic of a local gynaecology department with problem of infertility were subjected to a detailed scrutiny by history and clinical examination including post-coital test and hysterosalpingography. Hormonal profile consisting of serum FSH, LH, Prolactin and Progesterone was assessed. Most of the ladies also underwent a pelviscopic examination. A total of 117 patients were selected where post-coital test was abnormal, semen analysis was not satisfactory or who had unexplained infertility. Tests were performed on the serum specimen from the husbands, wives and in some cases on the seminal plasma as well, for the measurement of the anti sperm agglutinating and anti-sperm immobilizing antibodies by the microagglutination technique. Fifteen of these patients were found positive for these antibodies, 7 were positive for the agglutinating antibody, 6 for the immobilizing antibody and two for both types. These results indicate that immunomodulation may be responsible for some cases of infertility in our population