Conventional abdominal operations for urinary bladder fistula have limitations like increased morbidity, more hemorrhage, more postoperative pain, and longer hospital stay. Laparoscopic repair of bladder fistula was done to explore the potential role of laparoscopic surgery in this field. Twelve women with vesicovaginal (11) and vesicouterine (one) fistula, of both gynecological (seven) and obstetric (five) origins, were treated by laparoscopic intraperitoneal repair between 1991 and 2004. The bladder wall was mobilized and repaired by interrupted stitches in single-layer followed by omental interposition. All cases were completed laparoscopically without any significant intra- or postoperative complication. Gynecological cases were discharged on the fourth day. Urinary catheters of all women were removed on the 14th day, and all but one obstetric fistula (91% success) were closed. Long-term follow-up confirmed the cure. Laparoscopic repair is an excellent method of repairing urinary bladder fistula located near the vaginal apex.
Objective: To study effects of levonorgestrel intra-uterine system (LNG-IUS) on adenomyosis with and without endometriosis. Design: Fifty-eight women with a confirmed diagnosis of adenomyosis after exclusion of confounding factors, and detection or exclusion of endometriosis were selected. They were categorized into group A (only adenomyosis, n=44) and group B (adenomyosis plus endometriosis, pre-treated by laparoscopic surgery, n=14) received LNG-IUS between July 2004 and January 2006 and were followed up on five different parameters. Results: Analysis of three years' follow up shows mean reduction of different variables in groups A and B as dysmenorrhoea (visual analogue scale) 98.2±3.9% and 98.3±3.7% (p<0.0001) menstrual bleeding (blood-loss assessment chart) 92.2±11.2% and 85.0±17.5% (p<0.0001), chronic pelvic pain (pain-calendar) 98.8±2.7% and 96.4±4.9% (p<0.0001); uterine volume 27.8±9.0% and 28.7±9.6% (p<0.0005) maximum endo-myometrial junctional-zone thickness 30.2±7.9% and 26.0±4.8% (p<0.0005). Effects on groups A and B were comparable. Other observations were-amenorrhoea-27.5%, intermenstrual bleeding-37.3% and expulsion-6.9%. Conclusion: LNG-IUS is equally effective for long-term conservative management of both adenomyosis alone and with co-existent endometriosis.
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