Overactive bladder: A multicenter study in Pakistan.

OBJECTIVE: To determine the overall prevalence of overactive bladder in Pakistan, and to determine the difference in prevalence in relation to gender. METHODS: The multicenter study was conducted from February 2017 to October 2018 at 11 institutions across the country, and comprised randomly selected healthy subjects of either gender who were assessed on the basis of symptoms defined by the International Continence Society for overactive bladder. Data was collected using a questionnaire based on the symptoms which was filled for the respondent by designated health workers. Data was analysed using SPSS 23. RESULTS: Of the 1291 respondents, 632(49%) were males with a mean age of 37.8±14.4 years, and 659(51%) were females with a mean age of 38.3±13.7 years. The overall prevalence of overactive bladder was 82(6.4%). Among the males, it was 15(2.4%) and among the females 67(10.2%) (p=0.001). Urgency, frequency and nocturia were reported by 82(6.4%) respondents; 15(1.2%) males and 67(5.2%) females (p=0.001). CONCLUSIONS: The prevalence of overactive bladder was found to be low when assessed with strict application.

A CASE OF COMPLEX HEMATOMA FORMATION AFTER INSTITUTION OF ACS PROTOCOL IN A PATIENT WITH UNTREATED PRIMARY HYPOPARATHYROIDISM.

OBJECTIVE: We report an unusual case of untreated hypoparathyroidism in which the patient presented with a prolonged QT interval and unusual bleeding after the institution of acute coronary syndrome (ACS) protocol. METHODS: A 53-year-old female presented with sudden pain and diffuse tightness in the abdomen/limbs and profuse sweating for a few hours. Patient was admitted under cardiology services and ACS protocol was instituted. RESULTS: After 2 days of admission, she developed severe abdominal pain and distention, which was due to large hematomas in the bladder wall, rectus sheath, and retroperitoneal area. These hematomas were surgically drained, but the abdominal wall could not be closed due to gut distention and stiffness of the abdominal wall; a Bogota bag was applied for closure. The patient was shifted to oral calcium after 12 days of intravenous calcium and vitamin D replacement. Abdominal closure was done several weeks later as a follow-up procedure. CONCLUSION: This case illustrates the neglected areas of the impact of hypoparathyroidism; the effects of chronic hypocalcemia on the cardiovascular system and coagulation cascade.

Surgical management of genitourinary fistula.

OBJECTIVE: To determine the commonest cause of genitourinary fistulae and evaluate the experience of the surgical management. The study was carried out at the Urology Department, Jinnah Postgraduate Medical Centre (JPMC), Karachi. METHODS: Twenty two patients were operated including 14 of Vesicovaginal Fistula (WF), and 8 of Ureterovaginal Fistula (UVF). In one patient of WF fistula was extending up to proximal urethra. Out of 14 WF cases, 9 patients underwent transvaginal repairs, 1 extraperitoneal transvesical repair and 1 transperitoneal repair. Three urinary diversions including 1 Mitrofanoff and 2 ileal conduits were also made. Ureteroneocystostomy was done in cases of UVF with adjuvant procedures in 3 cases including Psoas Hitch in 1 and Boari's flap in 2 patients. RESULTS: The mean age was 35 (range 21-50) years. WF due to obstetric causes was seen in 71.4% patients while 28.6% developed WF secondary to gynaecological procedures. Majority of (91%) WF were repaired successfully in the first attempt in patients subjected to the procedure (78.6% cases of WF). There was only one recurrence in transvaginal repair, which was successfully treated with extraperitoneal transvesical approach in second attempt, thus augmenting the success rate to 100%. However 3 (21.4%) cases of WF required urinary diversion as there was complete loss of sphincter mechanism in one case, in which fistula was extending up to the urethra, and in two cases of complex WF with complete loss of posterior bladder wall surrounded by extensive scarring. All cases of UVF were successfully treated with ureteroneocystostomy alone or with adjuvant procedure in 37.5% cases. CONCLUSION: Uncomplicated WF can be successful repaired transvaginally by refreshing the fistulous edges without excising it. Transabdominal route should be reserved for complicated WF. Ureteroneocystostomy with antireflux mechanism with or without adjuvant procedure is the treatment of choice for UVF resulting from complete transaction or ligation of ureter.