ObjectiveVesicovaginal fistula (VVF) causes detrimental psychosomatic effects on a woman. It is repaired using open abdominal as well as laparoscopic approach. Here we compare a series of open versus laparoscopic VVF repairs done at a single centre.MethodsRetrospectively data of patients undergoing VVF repair in our department between January 2011 to December 2014 was analyzed. Patients who had a single, primary, simple VVF following a gynaecological surgery were included in the study. 26 patients met all the criteria. Out of these, thirteen patients had undergone a laparoscopic VVF repair (group 1) while thirteen had undergone an open transabdominal VVF repair (group 2).ResultsMean fistula size was 2.14±0.23 cm in group 1 and 2.18±0.30 cm in group 2, which was comparable. Mean blood loss was 58.69±6.48 mL in group 1 and 147.30±19.24 mL in group 2, which is statistically significant (P<0.0001). Mean hospital stay was 4 days in group 1 and 13 days in group 2 which is statistically significant (P<0.0001). The analgesic requirement (diclofenac) was 261.53±29.95 mg in group 1 and 617.30±34.43 mg in group 2, which is statistically significant (P<0.0001). Fistula repair was successful in all the patients in both the groups.ConclusionThe present study shows that laparoscopic VVF repair results in reduced patient morbidity and shorter hospital stay without compromising the results. So laparoscopic repair may be a more attractive treatment option for patients with post gynecology surgery VVF.
Introduction:Urinary tract injuries are a known complication of obstetrical and gynecological surgeries because of their anatomical proximity. Delayed diagnosis and improper management leads to high morbidity and even mortality. This is our three year's experience of urological complications after obstetric and gynecological surgery, their treatment and follows up.Materials and Methods:We reviewed all cases of urological injuries managed in our department that were deemed to be of obstetric and gynecological origins.Results:Thirty seven women were treated in the department for urological complications secondary to obstetric and gynecological procedures from January 2012 to December 2014. The most common organ involved was urinary bladder, occurring in 54% patients followed by ureter in 35.13%. Vesicovaginal fistula (VVF) was the most common injury involving the bladder occurring in nineteen patients. Ureterovaginal fistula (UVF) occurred in nine patients and acute ureteric injury in three. Hysterectomy was the most common etiology occurring in 60% cases followed by obstetrical causes in 40% cases. All cases were successfully managed both with open surgery or laparoscopic surgery.Conclusion:Although obstetrical causes are still important in developing countries, gynecological procedures especially laparoscopic surgeries are on the rise. In these procedures the suspicion of urological injuries should be kept in mind and intra-operative detection and early repair should be attempted. Delayed diagnosis and improper treatment leads to severe complications.
Prophylactic insertion of Double-J(DJ) stent remains controversial in renal transplantation. Recent studies regarding DJ stenting concluded that their routine use improved outcomes. But they also lead to adverse complications, leading to advocation of stenting in selected situations. The objective is to analyze the potential benefit and drawbacks of selective DJ stenting across a ureteroneocystostomy in renal transplant recipients at a single centre. A total of 81 patients were operated and followed up in our study. 39 patients (Group 1) had a Double-J stent placed because of various factors while it was not placed in 42 patients (Group 2). Urological complications like leaks, obstruction, urinary tract infection were compared between these 2 groups. In group 1, 14 out of 39 (35.89%) and in group 2, 6 out of 42 (14.28%) developed urinary tract infection, which is statistically significant (P=0.024). There was no occurrence of urinary leaks or collecting system obstruction in either group. The mean serum creatinine at discharge was 1.14±0.26 mg% and 1.05±0.22 mg% in groups 1 and 2, respectively (P=0.94). There was one case of forgotten Double-J stent, which was later removed. Our results demonstrate that many patients can be successfully transplanted without the use of Double-J stent. Double-J stent insertion increases the incidence of urinary tract infection. So routine Double-J stenting should be avoided as much as possible unless otherwise indicated.
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