Objectives: To assess the effect of pelvic organ prolapse (POP) and/or stress urinary incontinence (SUI) on various domains of female sexual functions in patients before and after reconstructive surgery for these pelvic floor disorders. Methods: We conducted a quasi-experimental study of 126 women aged 25-65 years, presenting with POP / SUI, from January 1st 2019 to December 31st 2019 at Aga Khan University Hospital. POP surgery was performed only in patients with symptomatic POP ≥ stage 2 according to POP-Q (quantification). Sexual functions were assessed using Female Sexual Function Index (FSFI) questionnaire, among sexually active women at baseline and 18 months after surgery. Results: Mean age of the participants was 51.6, with a mean parity of four. Out of 126 patients, 31 patients underwent vaginal hysterectomy, pelvic floor repair and mid-urethral sling (MUS), 55 had vaginal hysterectomy with pelvic floor repair, 12 women had only pelvic floor repair and 10 patients had uterine suspension surgery for prolapse, while 18 patients underwent MUS operation alone for SUI. There was a statistically significant difference in female sexual functions after surgery for POP and/or SUI (p<0.01). This improvement was observed in both total and individual scores of each domain of FSFI with an overall improvement in sexual function from a mean of 18.5 pre-surgery to 20.8 post-surgery. Conclusions: This study reveals that women sexual functions are affected by POP and SUI and improve remarkably after reconstructive surgeries for these pelvic floor disorders. doi: https://doi.org/10.12669/pjms.37.4.3892 How to cite this:Abrar S, Mohsin R, Saleem H. Surgery for pelvic organ prolapse and stress urinary incontinence and female sexual functions: A quasi-experimental study. Pak J Med Sci. 2021;37(4):---------. doi: https://doi.org/10.12669/pjms.37.4.3892 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.
Congenital Urethrovaginal fistula with vaginal agenesis is a rare variant of vaginal agenesis. It is difficult to diagnose, classify and treat because of late clinical presentation at menarche. Management is usually challenging, and it involves vaginal reconstruction. A 22 years female presented with cyclical menouria since age of 12 years. Clinical examination revealed the absence of a vagina with developed secondary sexual characters such as axillary and pubic hair, breast development. Abdominal USG showed normal uterus and ovaries, urinary bladder with left kidney. MRI revealed functioning left kidney along with vaginal agenesis and an abnormal communication between uterus and urethra. The surgical treatment consisted in repairing the urethrovaginal fistula and vaginoplasty. In this case, the diagnosis of congenital urethrovaginal fistula was delayed until adulthood because of vaginal agenesis. A concomitant surgery can be performed with good outcome.
Aims: To evaluate use of diary for teaching patient with overactive bladder and see its therapeutic effects in terms of reduction in their symptoms Methods: A single-blind randomized clinical trial, regarding “Effects of Bladder Training and behavioral intervention in Female Patients with Over active Bladder syndrome, attending Urogynecology clinic at The Aga Khan University Hospital Karachi, Pakistan: A Randomized Controlled Trial (OAB) trial” We here present the additional conclusions drawn from results of ARM-1.Arm-1 patients were managed by behavioral intervention only and were asked to fill 7 days diary in 12 weeks .By using WHO software a minimum of 114 women needed to meet the study objectives. We recruited 50 women in each group (150 totals) as there was a possibility of drop out.We calculated the mean difference in fluid intake and reduction in urinary frequency, urgency, nocturia before and after educating the patient using the paired-T Test. Results: A total of 47 women completed follow up visits for overactive bladder treatment ARM-A. (Mean ± SD) Mean fluid intake on first diary was 2392.9 ml while on last diary fluid intake was reduced to 177.1ml with mean fluid intake difference of 621.8ml+622.2(p<0.00).The mean reduction in frequency of micturition during day and nocturia was 2.9+2.7(P<0.00) and 0.59+ 0.99(p<0.00) respectively. The mean decrease in urgency score and reduction in leak accident was 1.19+1.2(p<0.00) and 0.9+0.95(p<0.00) respectively. Conclusions: The bladder diary for women with OAB has both diagnostic and therapeutic effect. In developing countries it is an easy least expensive but time consuming method of treatment for simple cases of OAB.
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