Surgical management of simple vesicovaginal fistulae

Vesicovaginal fistula is a fairly common occurrence in our country because of poor availability of obstetric care. The purpose of this study is to review our results in the surgical management of VVF.Design: Prospective study. Place and duration of the study: The study was conducted in the department of urology, Federal Government Services Hospital [F.G.S.H.]; Islamabad, from February 2002 to January 2004. Patients and Eleven patients were operated for vesicovaginal fistulae. Transvaginal repair was done in 8 [72.7%] patients while transabdominal repair was adopted in 3 [27.3%] patients only. Inclusion criteria: All patients presented with vesicovaginal fistulae only. Exclusion criteria: All patients presented with genitourinary fistulae other than VVFs. The majority of fistulae [10 [90.9%]] were caused by ischaemic necrosis of bladder and vaginal walls resulting from obstructed labour. One [9.1x] patient developed VVF after hysterectomy due to some gynaecological problem. Surgical repair proved to be successful through transabdominal route in all 3 [100%] cases of VVFs while in 6 [75x] of 8 [100%] cases through transvaginal route. To describe an overall result, 9 [81.8%] vesicovaginal fistulae were successfully repaired at first attempt. Vesicovaginal fistulae can be best managed following basic surgical principles like adequate exposure, identification of structures, wide mobilization, tension free closure, good haemostasis and uninterrupted bladder drainage

In situ piezoelectric ESWL for ureteric calculi

To assess in situ Piezoelectric ESWL for ureteric calculi, avoiding false positive results arising from the spontaneous passage of small stones and also to evaluate the efficiency of the EDAP LT02 Lithotriptor for insitu ESWL treatment of ureteric calculi. A prospective evaluation of patients with ureteric calculi treated with Piezoelectric ESWL using EDAP LT 02 Lithotriptor. patients with ureteric calculi treated with Piezoelectric ESWL using EDAP LT 02 Lithotriptor for a period of twelve months, coming to Urology department of Pakistan Institute of Medical Sciences [PIMS], Islamabad, as out door patients. A prospective evaluation of patients with ureteric calculi treated with Piezoelectric ESWL using EDAP LT 02 Lithotriptor for a period of twelve months, Seventy two patients, 60 males and 12 females, with mean age of 39.6 years, presenting with solitary ureteric calculus were treated using EDAP LT 02 Piezoelectric Lithotriptor, lo calization with fluoroscopy. No regional or general anesthesia given. After 3 months follow-up, of the 72 ureteric calculi cases, 60[83.3%] were successfully fragmented and ureter was stone free in 54 patients [75.1%] after insitu ESWL alone. The mean duration of stone clearance was 50 days [SD +11.58]. Sixteen patients required one session only, 28 patients required 2 sessions and twelve patients required three and more than three sessions. Stone location was 28 upper ureteric, 18 middle and 26 in lower ureter. Stone size varied from 7mm.to 17mm. in longest diameter. The average number of session, 1.5 for upper ureteric stone, 1.8 for mid and lower ureteric stones. Stone clearance for upper ureteric calculus was 85.7%, for mid ureteric 66.7% and for lower ureteric 69%, the overall stone clearance was 75%. In situ piezoelectric ESWL is safe, simple and effective technique for treating ureteric calculi. The site and size of the stone affects the success rate

Management of the lower urinary tract symptoms [LUTS] due to benign prostatic hyperplasia [BPH], with terazosin

This study was designed to assess the efficacy, safety and compliance of terazosin in the management of lower urinary tract symptoms due to benign prostatic hyperplasia. Study was conducted in the department of urology, DHQ Hospital Vehari, in about 1-year i-e from July 2004 to June 2005. Sixty patients with an age range of 45-85 years were included in the study. Data was collected prospectively. Patients were assessed according to the international prostate symptom score [I-PSS] at the start of study, during follow up and at the end of study. Out of sixty patients, fifty-two were able to complete the study. It was observed that most of the patients obtained a significant decrease in the prostate symptoms score and improvement in QoL score, with only a few side effects. Terazosin is a safe and effective treatment for BPH with good compliance