Surgical treatment of vesicovaginal fistula; an audit of 69 cases

The aim of this study is to assess the outcome of patients undergoing repair of vesicovaginal fistula. This descriptive study which was conducted from May 2002 to March 2008 the Department of Urology Lady Reading Hospital Peshawar. A total of 69 patients with Vesicovaginal fistula were included in this study. A detailed history and physical examination with special emphasis on previous gynecological and obstetrical events was recorded. All these patients underwent routine investigations like HB%, CBC, Urianalysis, renal function test and viral profile with ultrasonography of the abdomen and pelvis. Intravenous Urography [IVU] was offered to those patients who had upper tract dilatation on ultrasonography. Preliminary cystoscopy and Vaginoscopy was performed in all patients to diagnose VVF and plan the surgical approach. The mean age was 39.07 [+10.031] years. Thirt eight [55%] patients developed fistula due to obstetrical reasons while 30 [43-47%] had gynaecological surgeries and only one patient developed fistula after radiotherapy. The average size of the fistula was 3.36 cm: Trans abdominal repair of fistula was done in 58 [84.1%] patients while 11 [15.9%] has transvaginal repair. Successful repair was achieved in 65 [93.7%] patients. Vesicovaginal fistula can be successfully managed surgically. Proper preoperative assessment of the patients is mandatory for selection of the surgical approach

Lecturing in medical education

Undergraduate medical students attend more lectures than they see patients. Lectures provide an entree into a difficult topic, different perspectives on subject, up to date resume of research and relevant clinical and laboratory experience. They also provide hints and guidelines on how to learn a topic or a procedure

Tubeless and stentless pyeloplasty

The aim of this study was to study cases of ureteroplevic junction obstruction undergoing open pyeloplasties without any stents and tubes.The techniques of operations designed in the present study were 88 Anderson Hyne's peyeloplasties, 22 Foley Y-V Plasty, 24 Culp, Deweered and the rest of the 16 cases Scardino- Prince flap pyeloplasties. 142 [95%] of cases had improvement in symptoms and renal functions while there was failure in 8[5%] of cases. It is concluded that stents and nehrostomy tubes are not needed in patients except in those undergoing secondary repairs or having inflammation