The Necessity of Incorporating an Interposition Flap During Vesicovaginal Fistula Repair: Can Modifying the Method of Vaginal Repair Serve as a Substitute? A Randomized Clinical Trial.

PURPOSE: Traditionally, an omental flap is employed to reduce the risk of recurrence of vesicovaginal fistula (VVF) repair. In this study, we employed a modified surgical technique wherein the vaginal defect was closed using Connell sutures, without incorporation of an omental flap, aiming to mitigate potential complications. MATERIAL AND METHOD: Between 2010 to 2018, the current randomized clinical trial was conducted on 52 women who were candidates for open fistula repair. The patients were randomly allocated into two groups. In one group, the conventional method of fistula repair was performed involving an omental flap, while in the other group, we used a modified approach with a variation in the vaginal wall closure technique. In-hospital variables, including the length of surgery, hospital stay, and occurrences of ileus, were recorded. Patient follow-up extended for one year, with assessments conducted one, six, and twelve months postoperatively. These evaluations encompassed pad test to ascertain success rates and identify any potential complications. RESULTS: The final analysis comprised 49 patients, with an average age of 46.5 years. Baseline characteristics were comparable between the two groups (P-values > 0.05). The modified technique was associated with significantly reduced surgical duration (P = ˂ 0.001), and shorter hospital stays (P < 0.001). Ileus occurrence was reduced, but it was not significant(P = 0.856). However, the success rate showed no significant difference between the groups, with a success rate of 100% for the modified technique compared to 91.6% for the classic O'Conner method (P = 0.288). CONCLUSION: Based on the findings of this study, vaginal wall closure using Connell sutures during VVF repair demonstrates a success rate equivalent to the classic approach involving an omental flap. Moreover, this technique presents a reduced incidence of adverse effects, along with decreased surgical duration, hospital stay, and postoperative ileus.

Massive urethrorrhagia due to a blunt perineum injury; a report of a case with bulbar pseudoaneurysm.

Blunt perineum trauma rarely leads to massive urethrorrhagia due to the formation of a bulbar aneurysm. A 29-year-old man with unstable hemodynamic underwent a digital subtraction angiography (DSA), which revealed a pseudoaneurysm in the penile bulb supplied from both internal pudendal arteries fistulized to the urethral duct bulb. A catheter was inserted into the distal part of pudendal arteries at the pseudoaneurysm's proximity, and an intermittent embolizing agent (Gel-foam) was injected. The pseudoaneurysm was filled with Gel-foam. Despite the superiority of conservative management, urethrorrhagia's life-threatening nature calls for angiographic intervention, successfully embolized using gel-foam with negligible complications.

Percutaneous nephrolithotomy: Effect of unilateral procedure on contralateral kidney function.

BACKGROUND: Although long-term effects of percutaneous nephrolithotomy (PCNL) on renal function and structure have been evaluated, knowledge regarding the immediate effects of surgery on renal function is limited. We conducted this study to evaluate the impact of unilateral PCNL on bilateral renal function during immediate post-operative period. MATERIALS AND METHODS: From April to September 2012, 40 eligible patients were enrolled in this study and underwent unilateral PCNL. During the post-operative period, creatinine clearances (CrCl) of treated and untreated sides were estimated separately and pattern of changes in bilateral renal function following this procedure was evaluated. RESULTS: Following the operation, CrCl of both kidneys showed a similar pattern of changes, of course more dramatic on treated side. We observed progressive decline in CrCl of both sides followed by bilateral improvement in renal function toward pre-operative values. CONCLUSIONS: During the early post-operative period following unilateral PCNL, both kidneys experienced a temporary drop in function warranting more intensive post-operative care.

Efficacy of extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome: a randomized, controlled trial.

Objectives. To investigate the effectiveness of extracorporeal shock wave therapy (ESWT) for symptoms alleviation in chronic pelvic pain syndrome (CPPS). Materials and Methods. 40 patients with CPPS were randomly allocated into either the treatment or sham group. In the first group, patients were treated by ESWT once a week for 4 weeks by a defined protocol. In the sham group, the same protocol was applied but with the probe being turned off. The follow-up assessments were done at 1, 2, 3, and 12 weeks by Visual Analogue Scale (VAS) for pain and NIH-developed Chronic Prostatitis Symptom Index (NIH-CPSI). Results. Pain domain scores at follow-up points in both treatment and sham groups were reduced, more so in the treatment group, which were significant at weeks 2, 3, and 12. Urinary scores became significantly different at weeks 3 and 12. Also, quality of life (QOL) and total NIH-CPSI scores at all four follow-up time points reduced more significantly in the treatment group as compared to the sham group. Noticeably, at week 12 a slight deterioration in all variables was observed compared to the first 3 weeks of the treatment period. Conclusions. our findings confirmed ESWT therapy as a safe and effective method in CPPS in short term.