Pelvic organ support is provided by interaction between the pelvic floor muscle, ligaments and its connective tissues. Failure of anatomical support may result in pelvic organ prolapse. Therefore in managing anterior, posterior, or apical compartments prolapse, conceptual understanding of pelvic floor anatomy is essential for the surgeons. To appropriately treat these entities, comprehension of the various theories of the pathophysiology of pelvic organ prolapse is of paramount importance. DeLancey has described vaginal connective tissue support of the pelvis at three levels that has helped us to understand various clinical manifestations of pelvic organ support dysfunction. Pelvic floor disorder is frequently associated with etiological risk factors which include aging, parity, obesity, connective tissue disorder, increased intra-abdominal pressure and hysterectomy. A better understanding of pathophysiology of muscular, collagen, and neuronal components of the pelvic organs and their support would provide an insight of site specific defects and its prevention.

Objectives: To compare the effectiveness and complications of Burch colposuspension and Mid Urethral Slings (MUS) for the treatment of Stress Urinary Incontinence (SUI). Methods: We conducted a cross-sectional study of 162 patients who underwent surgery for SUI with Burch colposuspension (n=40), tension free vaginal tape (TVT) (n= 59) or transobturator tape (TOT) (n=63), from 2006 to 2014 at the Aga Khan University Hospital- Karachi. All three groups were assessed in terms of demographics, cure rates, intraoperative and postoperative complications at one and five years using incontinence impact questionnaire-short form-7 (IIQ-7) and urogenital distress inventory -short form-6 (UDI-6). Results: Mean age of the participants in Burch, TVT and TOT group was 44.1 ± 7.4, 48.3 ± 8.9, 53.0 ± 9.4 respectively. Majority of patients in TVT group were premenopausal (59.3%) and postmenopausal in TOT group (53.9%). Most abdominal hysterectomies were done in Burch group (40) while vaginal hysterectomies and anterior and posterior colporrhaphy in TOT group (55). All the procedures had both subjective and objective cure rate of more than 82% at one year, with TVT having the highest success rate of 96.61%. The objective cure rate in Burch, TVT and TOT group at five years was 74.19%, 90.30% and 81.25% respectively. Intraoperative complications included hemorrhage in one patient during Burch procedure and bladder perforation in two cases of TVT, with no significant difference in short or long-term complications with either procedure. Conclusions: All the three procedures have equal efficacy and complication rates. Even though TVT is the new gold standard but in view of current debate regarding mesh related complications, there is a need to readdress Burch colposuspension for treatment of SUI. doi: https://doi.org/10.12669/pjms.37.5.4017 How to cite this:Abrar S, Razzak L, Mohsin R. The practice of Burch Colposuspension versus Mid Urethral Slings for the treatment of Stress Urinary Incontinence in developing country. Pak J Med Sci. 2021;37(5):---------.  doi: https://doi.org/10.12669/pjms.37.5.4017 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Uterovaginal prolapse is the downward descent of the pelvic organ, resulting in protrusion of the vagina, uterus, bladder or rectum. The association between POP and hydronephrosis has been shown by various studies, but severe hydronephrosis leads to renal dysfunction are rarely seen. We report a case of 70 years old female with massive vaginal prolapse and chronic renal impairement. She presented with urinary tract infection (UTI) and raised creatinine levels of 4.5mg/dl. After correction of UTI, she surgically managed to relieve her obstructive symptoms. After surgery her creatinine levels drop to 2.0mg/dl but chronic renal failure persisted. Advance stage prolapsed may damage renal function if left untreated. Timely diagnosis and management may prevent irreversible damage to kidneys Continuous...

Abstract A 25-year-old female patient visited our clinic with complaint of cyclic haematuria. She had previous two Caesarean Sections at a secondary care hospital. Her complete urinalysis showed abundant red blood cells. Through computed tomography a fistula tract between the posterior wall of the bladder and the anterior wall of the lower uterine segment was diagnosed. The Cystoscopy revealed a fistulous opening with a diameter of nearly 1.5 cm localized between the bladder and uterine cavity. Fistulae was repaired by abdominal approach without transection of bladder. Surgery was performed by mobilization of bladder and wide anterior uterine dissection. A 2cm defect in the lower uterine segment was identified and was closed with 0 polyglycolic acid suture. Bladder defect was repaired in two layers. Then omental tissue flap was placed between the two surfaces. At 6 months follow the up patient was asymptomatic. Keywords: cyclic menouria; vesicouterine fistulas; Youssef’s syndrome. Continuous..

Aim: To evaluate the effect of lifestyle modification upon dysmenorrhea and pain severity in university students of Karachi. Methodology: This is a prospective cohort study, the sample size was 383 participants, and data was collected from the Karachi institute of health sciences. Participants were followed after lifestyle modifications, weight reduction, stress management, physical exercise, and nutrition. Menstruation pain severity was measured by pain visual analog scale score (VAS) score, after 4 weeks and 8 weeks of modification follow-up, participants were asked to fill a validated questionnaire including pain VAS score again to assess the difference in dysmenorrhea and its associated symptoms. Results: Out of 383 study participants, the mean age was 22.2±1.9 years while the mean weight was 72.9±4.7 years, mean age of menarche was 13.4±0.7 years. Pain VAS score was categorized within mild and tolerable, moderate and Uncomfortable, and severe with an immediate need for medical intervention, indicating 82(21.4%), 195(50.9%) and 106(27.6%) frequencies respectively. The effect of lifestyle modification afterthe first menstruation cycle questionnaire was filled again, and results indicated mild, moderate, and severe results as 277(72.3%), 90(23.4%) and 16(4.1%) while on the second cycle 343(89.5%), 34(8.8%) and 6(1.5%) were identified respectively. Conclusion: Lifestyle modification, maintaining a healthy weight, having proper nutrition, and managing stress can sufficiently reduce the chances of dysmenorrhea and decreases the severity of menstrual pain. Keywords:Dysmenorrhea, Pain-vas score, lifestyle modification