RESUMO
Objectives: To assess the causative factors and outcome of surgical management of Vesicovaginal fistula [VVF] in our set up
Duration and Design of Study: Retrospective descriptional study from January 2008 to June 2012 conducted at Department of Urology PMC/Allied Hospital Faisalabad
Methodology: All patients with VVF who presented in our out patient department and underwent surgical repair in our department were included in this study. The records of patients were reviewed and data was entered in a structured proforma and analyzed. After history, physical examination, relevant investigations, IVU, Cystoscopy and vaginoscopy, patients were divided into two groups. Patients with supratrigonal fistula were operated through abdominal approach and those with infratrigonal fistula were operated through vaginal approach. The outcome of surgical procedures and post operative complications were noted
Results: This study included 68 patients. In 42 [61.76%] patients, cause of VVF was iatrogenic injury during hysterectomy, and 26 [38.24%] patients developed VVF due to obstetric causes. Fifty patients [73.53%] had supratrigonal fistula and eighteen patients [26.47%] were having trigonal or subtrigonal fistula. We achieved 90% and 83.33% success rate with abdominal and vaginal repair respectively
Conclusion: The most common cause of VVF is iatrogenic injury during hysterectomy. Both approaches of surgical repair had almost equally good results
RESUMO
Congenital ureteropelvic junction obstruction is an important and treatable cause of neonatal hydronephrosis. It may be due to congenital absence of nerves leading to adynamic segment causing functional obstruction. It may also be due to defective muscular arrangement and replacement of muscles by fibrosis leading to anatomical obstruction or it may be caused by extrinsic compression by aberrant lower polar vessel. The aim of the present study is to define the etiological determinants of congenital PUJ obstruction
Objectives: To study the macroscopic abnormalities of congenital PUJ obstruction and correlating theses abnormalities with the microscopic and immunohistological findings
Material and Methods: It was a cross sectional observational study and patients presenting to outpatients department, irrespective of age and sex, with the diagnosis of PUJ obstruction and needing surgery were included in the study. Anderson Hynes Pyeloplasty was done in all cases and resected portion of redundant pelvis and narrow segment was submitted for histopathological and immunohistological examination
Results: Congenital PUJ obstruction was more common in males with a male to female ratio of 2:1 and it was common on left side in 55.55% cases. Presentation was in wide age range patients [2-40 years]. In 33.33% patients it was structural abnormality where we were unable to pass feeding tube and in 66.66% patients it was functional abnormality where it was distensible PUJ. Predominantly circular muscle arrangement was seen in 15[57.69%] cases. Varying degree of replacement of muscle fibers with fibrous tissue was seen in all cases and total replacement in those where kidney was nonfunctional due to PUJ obstruction. Nerves were present in 5/26 [19.23%] cases. In 4/5 [80%] cases of crossing vessels, nerves were present
Conclusion: Most cases of congenital PUJ obstruction are due to functional obstruction but anatomical obstruction also has a significant contribution [33.33%].Predominant circular muscle arrangement is the abnormality leading to impaired peristalsis. Absence of nerves leading to functional obstruction is the major defect in congenital PUJ obstruction. Crossing vessel is the real cause of PUJ obstruction mechanically compressing the PUJ in vascular tangle cases