Autoantibody production is enhanced after mild SARS-CoV-2 infection despite vaccination in individuals with and without long COVID.

Long COVID patients who experienced severe acute SARS-CoV-2 infection can present with humoral autoimmunity. However, whether mild SARS-CoV-2 infection increases autoantibody responses and whether vaccination can decrease autoimmunity in long COVID patients is unknown. Here, we demonstrate that mild SARS-CoV-2 infection increases autoantibodies associated with systemic lupus erythematosus (SLE) and inflammatory myopathies in long COVID patients with persistent neurologic symptoms to a greater extent than COVID convalescent controls at 8 months post-infection. Furthermore, high titers of SLE-associated autoantibodies in long COVID patients are associated with impaired cognitive performance and greater symptom severity, and subsequent vaccination/booster does not decrease autoantibody titers. In summary, we found that mild SARS-CoV-2 infection can induce persistent humoral autoimmunity in both long COVID patients and healthy COVID convalescents, suggesting that a reappraisal of vaccination and mitigation strategies is warranted.

Genetic stress-reactivity, sex, and conditioning intensity affect stress-enhanced fear learning.

The Stress-Enhanced Fear Learning (SEFL) model of posttraumatic stress disorder (PTSD) reveals increased fear memory in animals exposed to stress prior to contextual fear conditioning (CFC), similar to the increased likelihood of developing PTSD in humans after prior stress. The present study utilized the SEFL model by exposing animals to restraint stress as the first stressor, followed by CFC using foot-shocks with 0.6 mA or 0.8 mA intensity. Adult males and females from the two nearly isogenic rat strains, the genetically more stress-reactive Wistar Kyoto (WKY) More Immobile (WMI), and the less stress-reactive WKY Less Immobile (WLI) were employed. Percent time spent freezing at acquisition and at recall differed between these strains in both prior stress and no stress conditions. The significant correlations between percent freezing at acquisition and at recall suggest that fear memory differences represent a true phenotype related to the stress-reactivity differences between the strains. This assumption is further substantiated by the lack of effect of either conditioning intensity on percent freezing in WLI males, while WMI males were affected by both intensities albeit with opposite directional changes after prior stress. Differences between the sexes in sensitivity to the two conditioning intensities became apparent by the opposite directional and inverse relationship between fear memory and the intensity of conditioning in WMI males and females. The present data also illustrate that although corticosterone (CORT) responses to prior stress are known to be necessary for SEFL, plasma CORT and percent freezing were positively correlated only in the stress less-reactive WLI strain. These differences in baseline fear acquisition, fear memory, and the percent freezing responses to the SEFL paradigm in the two genetically close inbred WMI and WLI strains provide a unique opportunity to study the genetic contribution to the variation in these phenotypes.

Hippocampus-dependent memory and allele-specific gene expression in adult offspring of alcohol-consuming dams after neonatal treatment with thyroxin or metformin.

Fetal alcohol spectrum disorder (FASD), the result of fetal alcohol exposure (FAE), affects 2-11% of children worldwide, with no effective treatments. Hippocampus-based learning and memory deficits are key symptoms of FASD. Our previous studies show hypothyroxinemia and hyperglycemia of the alcohol-consuming pregnant rat, which likely affects fetal neurodevelopment. We administered vehicle, thyroxine (T4) or metformin to neonatal rats post FAE and rats were tested in the hippocampus-dependent contextual fear-conditioning paradigm in adulthood. Both T4 and metformin alleviated contextual fear memory deficit induced by FAE, and reversed the hippocampal expression changes in the thyroid hormone-inactivating enzyme, deiodinase-III (Dio3) and insulin-like growth factor 2 (Igf2), genes that are known to modulate memory processes. Neonatal T4 restored maternal allelic expressions of the imprinted Dio3 and Igf2 in the adult male hippocampus, while metformin restored FAE-caused changes in Igf2 expression only. The decreased hippocampal expression of DNA methyltransferase 1 (Dnmt1) that maintains the imprinting of Dio3 and Igf2 during development was normalized by both treatments. Administering Dnmt1 inhibitor to control neonates resulted in FAE-like deficits in fear memory and hippocampal allele-specific expression of Igf2, which were reversed by metformin. We propose that neonatal administration of T4 and metformin post FAE affect memory via elevating Dnmt1 and consequently normalizing hippocampal Dio3 and Igf2 expressions in the adult offspring. The present results indicate that T4 and metformin, administered during the neonatal period that is equivalent to the third trimester of human pregnancy, are potential treatments for FASD and conceivably for other neurodevelopmental disorders with cognitive deficits.

Music as nursing intervention for pain in five Asian countries.

BACKGROUND: The use of music as intervention for relieving pain has increased in recent years, prompting its growing use among the people of the western world. However, among Asians, music has long been used for this purpose and continues to be so today. Despite this common knowledge, Asians have not generally written about the therapeutic effects of music. Consequently, most of the published research studies supporting this claim were conducted in western settings using western music. PURPOSE: To describe the use of music as intervention in painful conditions as experienced by people in five Asian countries: China, Thailand, Philippines, South Korea and Taiwan. METHOD: Descriptive survey of studies using music as intervention for painful conditions conducted in selected five Asian countries. FINDINGS: Twelve studies including theses and dissertations, published and unpublished, were found; however, only nine met the inclusion criteria. Data were categorized according to research design, sample size, gender, age, duration of music, frequency of music intervention, types of pain and instruments used to measure pain, conceptual or theoretical frameworks and statistical significance of the study. Five of the nine studies declared significant decrease in pain, while three reported mixed results. Fundamentally, the findings of the studies suggested that with music, relief of pain was possible. IMPLICATIONS: The mixed results imply the need for further investigation of the effects of music in painful conditions. Thus, the authors suggest continuing studies on the effects of music as intervention in painful conditions, and encourage increasing global dissemination of these studies, particularly in international journals.

Extracorporeal shockwave lithotripsy and intracorporeal lithotripsy for proximal ureteric calculi--a comparative assessment of efficacy and safety.

INTRODUCTION: Extracorporeal shockwave lithotripsy (ESWL) is the treatment modality of choice of many urologists for proximal ureteric calculi. In this study, we compared the efficacy and safety of ESWL versus ureteroscopy with holmium laser lithotripsy for the treatment of this group of stones. MATERIALS AND METHODS: Between May 1999 and October 2000, 50 patients had ESWL and another 51 patients underwent ureteroscopy with holmium laser lithotripsy for proximal ureteric calculi. The two groups were similar in age, sex ratio and stone size. ESWL was performed with the Dornier Compact lithotriptor whereas holmium laser lithotripsy was performed via retrograde ureteric access with a Wolf 7.5 Fr semirigid ureteroscope. RESULTS: Ureteroscopy with holmium laser lithotripsy was significantly better in terms of the mean procedure time (56 min in ESWL; 25 min in ureteroscopy; P < 0.001) and the 1-month stone free rate (50% in ESWL; 80% in ureteroscopy; P = 0.001). The 3-month stone free rate was also higher for ureteroscopy (78% in ESWL; 90% in ureteroscopy) but this difference was not statistically significant (P = 0.09). Minor complications of steinstrasse (6%) occurred in ESWL and proximal stone migration (8%) occurred during ureteroscopy. CONCLUSION: Ureteroscopy with holmium laser lithotripsy is a viable and safe alternative to ESWL for the management of proximal ureteric calculi.

Prevalence of overactive bladder in Asian men: an epidemiological survey.

OBJECTIVE: To study the epidemiology of overactive bladder (OAB) and the influence of demographic factors on its incidence in Asian men. SUBJECTS AND METHODS: A survey based on a self-administered questionnaire (locally translated in participating countries) was conducted between March 1998 and May 1998 to quantify the prevalence of OAB in a random sample of men (2369, aged 18-70+ years) visiting other than urology clinics in 26 centres in 11 Asian countries. The questionnaire was divided into two parts, i.e. social and demographic factors, and OAB symptoms. For OAB the questionnaire primarily focused on symptoms, degree of bother and treatment measures. The degree of bother was quantified by classifying it as mild, moderate and severe. The statistical relationship between demographics and OAB was assessed using the chi-square independent test. RESULTS: The prevalence of OAB was 29.9% (709 men); OAB was more common in professional workers (43%), the high-income group (26%, income of > US$ 800) and urban dwellers (64%). With increasing age the incidence of OAB increased, i.e. the prevalence was 53% in men aged > 70 years; the family history and type of toilets used had some relationship with OAB. Frequency (37%), urgency (34%), and frequency and urgency (10%) were the most common symptoms of OAB. Urge incontinence symptoms were reported by 13%. Some degree of bother was recorded in 32% of those with OAB, of whom only 5.9% received treatment for their OAB, with general practitioners and specialists being preferred equally. CONCLUSIONS: The prevalence of OAB in Asian men is high and more common in older patients. The treatment rate for the symptoms was much lower than in western countries, suggesting a need for better education of patients and more research for effectively managing the OAB.

Clinical safety profile of sildenafil in Singaporean men with erectile dysfunction: pre-marketing experience (ASSESS-I evaluation).

Safety and tolerability of sildenafil citrate was assessed in a population subset of 60 Singaporean men with erectile dysfunction taken from the Asian Sildenafil Efficacy and Safety Study (ASSESS-I), a double-blind, placebo-controlled, flexible-dose study. The men, from two centres, with > or = 6 months' history of erectile dysfunction, were randomized to two treatment arms for 12 weeks. One group (30 patients) received sildenafil (initial dose 50 mg taken 1 h before sexual activity for the first 2 weeks, increased to 100 mg or decreased to 25 mg, according to efficacy and/or tolerability). The remaining 30 patients received a matching placebo. Incidence and type of adverse effects were evaluated at 2, 4, 8 and 12 weeks. Nine patients (30.0%) on sildenafil (33.1% in the full ASSESS-I study) and one patient (3.3%) on placebo (22.8% in the full ASSESS-I study) experienced treatment-related adverse events, the most frequent being headache in the sildenafil group (reported by five patients [16.7%]; 11.0% in the full ASSESS-I study). Flushing, visual disturbance, dizziness, insomnia, myalgia and back pain each occurred in one patient in the sildenafil group (3.3%); in the placebo group, one patient (3.3%) had headache. Importantly, the incidence of cardiovascular and respiratory system adverse events were relatively less than in the full ASSESS-I population (cardiovascular 3.3% in the present study versus 10.2% in the full ASSESS-I population; respiratory 3.3% versus 5.5%). All adverse events were transient and mild, and did not lead to treatment withdrawal. There was no effect on sitting blood pressure, heart rate or standard laboratory parameters; more importantly, there was no incidence of myocardial infarction, stroke or priapism. These results should reassure Singaporean patients and their physicians of the safety of sildenafil for erectile dysfunction.

Penile colour duplex ultrasonography as a screening tool for venogenic erectile dysfunction.

INTRODUCTION: Vasculogenic impotence is one of the major causes of erectile dysfunction. Cavernosometry and cavernosography is traditionally the gold standard for evaluation of venogenic impotence. However, it is invasive and there are potentially significant complications. Penile colour flow Doppler imaging (PCDI) is non-invasive and can be used to assess venous incompetence. MATERIALS AND METHODS: One hundred and sixty-eight patients were referred for PCDI assessment from March 1998 to February 2001. Forty-three of these also had cavernosogram and cavernosometry done and were included in the study. RESULTS: The sensitivity was 93.9%, the specificity was 90.0%, the accuracy was 93.0% with a negative predictive value of 81.8% and a positive predictive value of 96.9%. Kappa value of 0.81 was obtained, indicating excellent agreement between PCDI and cavernosogram and cavernometry. CONCLUSIONS: Penile colour flow Doppler imaging is accurate in the assessment of venogenic erectile dysfunction. It can replace cavernometry and cavernosogram as a screening tool. Cavernometry and cavernosogram should only be done in cases when PCDI suggests venogenic impotence, and when surgery is contemplated.

The role of BTA stat in clinical practice.

OBJECTIVE: BTA stat is a rapid, urine-based test for bladder cancer that detects human complement factor H related protein (HCFHrp) by monoclonal assay. This aim of this study was to assess the efficacy of BTA stat as a diagnostic tool for bladder cancer in symptomatic patients suspected of bladder cancer and in the surveillance of patients with a history of treated bladder cancer. PATIENTS AND METHODS: One hundred and six patients presenting with haematuria (gross or microscopic) or irritative bladder symptoms presenting to the urology outpatient clinic of Changi General Hospital and 13 patients under bladder cancer surveillance were recruited for this prospective study. All underwent voided urine cytology (VUC), urine culture, urine BTA stat, intravenous urogram and cystoscopy. Sensitivity, specificity, positive and negative predictive values were calculated for both tests. The stage and grade of bladder tumours detected were also correlated with both test results. Causes of false positives and specificity in different patient groups were analysed. RESULTS: BTA stat is more sensitive than VUC in detecting primary and recurrent bladder tumours (85% versus 55%) but is less specific (62.6% versus 100%). Urinary tract infections and urinary calculi accounted for 62% of false positives with BTA stat. When patients with positive urine cultures and benign IVU abnormalities were excluded, specificity of BTA stat improved (93.9% cf. 62.6%). BTA stat was highly specific (100%) and more sensitive than VUC (75% versus 25%) in detecting recurrent tumours in asymptomatic patients on cancer surveillance. CONCLUSION: A high false positive rate and low predictive value limits the use BTA stat in screening symptomatic patients. However, it has a role in cancer surveillance and in the screening of high-risk asymptomatic individuals. Further prospective trials should be performed to better assess its role in this respect.

Effects of calcium, calmodulin, protein kinase C and protein tyrosine kinases on volume-activated taurine efflux in human erythroleukemia cells.

The effects of calcium, calmodulin, protein kinase C (PKC) and protein tyrosine kinase (PTK) modulators were examined on the volume-activated taurine efflux in the erythroleukemia cell line K562. Exposure to hypoosmotic solution significantly increased taurine efflux and intracellular calcium concentration ([Ca2+]i). The Ca2+ channel blockers La3+ (1 mM), verapamil (200 microM) and nifedipine (100 microM) inhibited the hypoosmotically-induced [Ca2+]i increase by more than 90%, while the volume-activated taurine efflux was inhibited by 61.3 +/- 9.5, 74.1 +/- 9.3 and 38.0 +/- 1.5%, respectively. Furthermore, the calmodulin inhibitors W7 (50 microM) and trifluoperazine (10 microM) and the Ca2+/calmodulin-dependent protein kinase II inhibitor KN-62 (2 microM) significantly blocked the volume-activated taurine efflux by 93.4 +/- 2.7, 77.9 +/- 3.5 and 61.3 +/- 15.8%, respectively. In contrast, the PKC inhibitor staurosporine (200 nM) or the PKC activator phorbol 12-myristate 13-acetate (100 nM) did not have significant effects on the volume-activated taurine efflux. However, pretreatment with PTK inhibitors genistein, tyrphostin A25, and tyrphostin A47 blocked the volume-activated taurine efflux. These results suggest that the volume-activated taurine efflux in K562 cells may not directly involve Ca2+, but may require the presence of calmodulin and/or PTK.

Holmium laser lithotripsy in the management of ureteric calculi.

INTRODUCTION: To evaluate the efficacy and safety of the holmium:YAG laser in retrograde ureteroscopic laser lithotripsy of ureteric calculi. METHODS: Three hundred and twenty-five patients (256 males and 69 females) with mean age of 45 years underwent 328 retrograde ureteroscopic laser lithotripsy as the primary therapy for ureteric calculi using semirigid mini-ureteroscopes and the holmium:YAG laser (Coherent, Palo Alto, California, USA). Four consultants and three registrars performed the procedures over a period of 31 months. RESULTS: The mean largest diameter of the calculi was 8.4 mm. The mean hospital stay was 1.8 days and the mean duration for the operation was 25 minutes. One hundred and twenty-two (37%) procedures were done as day surgery cases. Complete stone-free rates after single primary treatment using only the holmium:YAG laser were 75% and 91% at 4 weeks and 12 weeks of follow-up, respectively. Including 22 (7.6%) renal units which required additional procedures, the overall stone-free rate was 97%. Seventeen cases (5.2%) needed additional extracorporeal shock wave lithotripsy (ESWL) and 5 cases (1.5%) needed an additional repeat ureteroscopy and lithotripsy for complete stone clearance. Significant complications include 1 case of ureteric perforation. CONCLUSIONS: The holmium:YAG is a safe and effective intracorporeal lithotripter when deployed in a retrograde manner in conjunction with a mini-ureteroscope.

Liposarcoma of the spermatic cord.

A case of spermatic cord liposarcoma is reported in a 40-year-old man. The clinical presentation, pathogenesis and role of sonography in pre-operative diagnosis is reviewed. The role of radical orchiectomy, retroperitoneal lymph node dissection, radiation therapy and chemotherapy in treatment of spermatic cord liposarcomas is discussed.

Transurethral alprostadil for the treatment of erectile dysfunction: results of a multicentre trial.

INTRODUCTION: The incidence of erectile dysfunction (ED) has been shown to increase significantly in Singaporean male population. Thus, this prospective study (no controls) assessed the clinical efficacy and safety of a medicated urethral system for erection (MUSE) in Singaporean male patients with a known history of ED. SUBJECTS AND METHOD: Eighty-six men with a mean age of 55.7 years with differential causes of ED were administered with MUSE in the clinic with a titration adjustment of 4 possible dose regimes (125, 250, 500 and 1000 mcg) till efficacy is achieved. Subsequently, patients were subjected to home treatment for a duration of 3 months. RESULTS: Sixty per cent of inclinic patients exhibited good responses and were given MUSE for home treatment. The efficacy rate for home treatment was 86%. Overall, the patients (n = 86) had a 51.2% success rate in achieving satisfactory sexual intercourse. Diabetic and psychogenic patients were noted to respond well to MUSE. No severe adverse events were found in this study. CONCLUSION: MUSE showed to be a safe, less invasive, well-tolerated and efficient alternative treatment for ED in Singaporean men.

Penile revascularisation for vascular impotence.

OBJECTIVE: Many methods of microscopic penile revascularisation procedures have been employed over the past 2 decades for the treatment of vasculogenic impotence, with varying success rates. The aim of our study was to evaluate the effectiveness and complications of deep dorsal vein arterialisation in the treatment of selected patients with arteriogenic and mixed arteriogenic/venogenic impotence. METHODS: This involved a retrospective analysis of 6 patients with vasculogenic impotence who presented to Toa Payoh Hospital from December 1991 to November 1994 and had penile revascularisation surgery performed. All patients underwent an extensive preoperative assessment, including dynamic infusion cavernosometry and cavernosography and selective pudendal arteriography. RESULTS: The 6 patients were aged between 27 and 51 years (mean 44 years). 2 (33%) patients had pure arteriogenic impotence, while 4 (66%) had mixed arteriogenic and venogenic impotence. Two patients (33%) had excellent surgical outcomes and 2 patients (33%) were considered improved. The mean follow-up period was 19.8 months (range 8 to 37). Complications were minimal. CONCLUSIONS: We conclude that although the results of penile revascularisation are promising in carefully selected patients, further studies with longer follow-up and more objective postoperative tests of hemodynamic and erectile function are needed to assess the true value of this mode of treatment.

Use of patient-controlled analgesia in extracorporeal shockwave lithotripsy.

OBJECTIVE: To assess the advantages of patient-controlled analgesia (PCA)-in patients undergoing extracorporeal shockwave lithotripsy (ESWL) for urinary stones. PATIENTS AND METHODS: Between December 1995 and May 1996, a prospective study was carried out on 100 patients who underwent ESWL for urinary stones. The patients were assigned to two equal groups, one receiving PCA and the other pethidine (control). Patients in the PCA group self-administered varying doses of intravenous alfentanil according to their pain tolerance, while those in the control group were given a single bolus dose of 1 mg/kg body weight intravenous pethidine by the attending urologist before the start of the procedure. The stone site, maximum energy level achieved, number of shock waves given, duration of procedure, pain scores, patient tolerance and acceptance were recorded to assess the efficacy of PCA compared with analgesia controlled by the physician. RESULTS: Both groups were matched for age, body weight, stone location and number of shocks given. The PCA group received a mean of 1.03 mg alfentanil while the control group received a mean of 62.5 mg pethidine. The maximum discharge voltage of 16 kV was achieved in all but one patient (98%) in the PCA group whereas only 21 patients (42%) in the control group attained this level. The mean treatment duration was less in the PCA group (32.8 min) than in the control group (44.5 min), the mean pain score lower (3.76 and 4.62, respectively) and the incidence of nausea and vomiting much less (22% and 60%, respectively). In addition, all 21 patients in the PCA group who had received intravenous pethidine during previous sessions of ESWL chose PCA as the better form of analgesia. There were no adverse effects in the PCA group except for one patient whose arterial oxygen saturation decreased transiently. CONCLUSION: PCA enables the urologist to achieve better patient compliance through better pain control; its application has maximized the use of lithotripsy and the patients' acceptability for this form of analgesia is confirmed. We recommend that this form of analgesia be used for ESWL.

Endoscopic injection of collagen for the treatment of female urinary stress incontinence.

BACKGROUND: The objective of our study was to assess the efficacy and safety of glutaraldehyde cross-linked collagen injection in the treatment of female urinary stress incontinence. METHODS: We conducted a retrospective analysis of the records of 105 women who underwent collagen injection for urinary stress incontinence between March 1991 and April 1995. Preoperative assessment included uroflowmetry, residual urine determination, and urodynamic studies. RESULTS: Of the 105 women in our series, 95 patients (90.5%) had initial successful results at 3 months (61.0% cured, 29.5% significantly improved) while 4 patients (3.8%) had slight improvement and 6 (5.7%) failed surgical correction. One year after the procedure, the success rate dropped to 81.9% (86 patients) with 46.7% cured and 35.2% significantly improved. Nine patients (8.6%) had slight improvement and 10 patients (9.5%) failed surgical correction. Eight patients (7.6%) with initial unsatisfactory results underwent additional sessions of collagen injection and were subsequently either cured or had significant improvement. Twenty-three patients (21.9%) suffered a relapse. The mean time to relapse was 13.3 months, and 6 of those who relapsed underwent repeated injections with favorable results. Complications were minimal; 6 patients had temporary retention of urine, and 2 patients had urinary tract infections. CONCLUSIONS: We conclude that glutaraldehyde cross-linked collagen injection is a simple and safe method of treatment for urinary stress incontinence. A longer follow-up period is necessary to assess the long-term efficacy of this treatment.

Epidemiologic survey of lower urinary tract symptoms in Asia and Australia using the international prostate symptom score.

BACKGROUND: The prevalence of lower urinary tract symptoms was determined by survey as an initial step in estimating the significance of benign prostatic hyperplasia (BPH) in Asia and Australia. METHODS: The symptom index (0 to 35) and quality-of-life (QOL) index (0 to 6) of the international prostate symptom score were measured in 7588 men in 9 Asian countries and 146 men in Australia. RESULTS: The percentages of Asian men considered to be symptomatic (symptom index > or = 8) were 18%, 29%, 40%, and 56% in the age groups of 40 to 49, 50 to 59, 60 to 69, and 70 to 79 years, respectively. For Australian men, these figures were 36%, 33%, and 37% in the 50 to 59, 60 to 69, and 70 to 79 year age groups, respectively. CONCLUSIONS: Our estimates indicate that the prevalences of symptomatic men in Asia and Australia are similar to or greater than those in Europe and America, and suggest BPH is similarly common in these areas.

The ContiNet of the International Continence Society.

This is an account of the International Continence Society's ContiNet--the web server linking up continence organisations worldwide with provision to upload or download vast data stores of information on continence via e-mail, FTP, mailing lists, and special tools to seek information using "search engines." Special communication devices using internet voice/phone mail and real-time "text" or "voice" chats permit conversation globally over normal phone lines linked to the Net at local telephone rates. Special features of ContiNet include announcements of upcoming conventions, information for professionals and laypeople, and the capability to conduct research via the net and conduct consultations and discussions via newsgroups. In-built devices requiring special IDs and passwords permit privacy and security for users. Simple instructions are provided on how to get your PC up and running and get connected to fellow members of ICS, link up with national continence societies, or simply surf for professional enrichment and leisure. With the advent of advanced multimedia capabilities, the current poor quality videoconferencing on the Net will be replaced by excellent videophones by 1998.

Urological injuries in gynaecological practice--when is the optimal time for repair?

OBJECTIVE: This is a retrospective study to determine differences in outcome and prognosis between patients with urological injuries treated immediately within 30 days by definitive repair and those in whom definitive treatment was delayed. SUBJECTS: Patients who sustained urinary tract injuries after gynaecological surgery and who were subsequently referred to the Urological Department of (former) Toa Payoh Hospital during the period 1985-1991. RESULTS: There were nine injuries sustained in eight patients: six to the ureters and three to the bladder. One patient had a double injury: a vesico-vaginal fistula and a uretero-vaginal fistula. There were six patients whose injuries were repaired within 30 days of the primary gynaecological operation. They stayed an average of 10-14 days in hospital and were discharged well. They were well both clinically and radiologically on follow-up. Two patients had initial drainage before definitive surgery was undertaken. One patient recovered fully but had to endure the morbidity of a prolonged, 3-month hospital stay. The other patient treated by simple diathermy for her vesico-vaginal fistula, never fully recovered, and subsequently defaulted follow-up. CONCLUSION: The old dictum of waiting 3 to 6 months to allow oedema to subside, tissue planes to be re-established and the fistula to become smaller, before repair is attempted, should be reviewed. Recently acquired fistulae may be repaired definitively soon after diagnosis of the problem, with good results in competent hands, as supported in this series of patients studied. This shortens the length of hospital stay for the patients and alleviates much of the morbidity endured.