Background: Despite the advances in technology in urology practice, and the surgical approach in dealing with iatrogenic vesicovaginal fistula repair, the most important is to achieve continent rate with minimum morbidity.Methods: From January 2006 to December 2017, the medical records and operative notes of 52 female (mean age 37 year) who had undergone transabdominal transvesical operative repair of their vesicovaginal fistula (VVF) at this institution were reviewed retrospectively. CT urography and diagnostic cystourethroscopy were the modalities of diagnostic tools. Trans-abdominal, transvesical repair with omental flap interposition were performed within 4-6 months in all cases. Patients were evaluated at two to three weeks initially, then at three months interval and later annually.Results: In present study, the most common presentation of VVF was urine leakage through vagina. In two third of the patients the etiology was due to hysterectomy procedure, regarding the location of the fistula, 94.2% of the fistulas located high in the posterior wall of the urinary bladder (supratrigonal), with the mean size of 2.2cm (range 5-25mm). 49 patients had single fistula (94.2%). The mean operative time was 110 minutes (range 60-130 minutes) and the mean post-operative urethral catheterization was 21 days (range 17-24 days). Almost all patients were continent after a mean of five months.Conclusions: Iatrogenic VVF is one of the distressing complications of gynecological procedure; delayed transabdominal transvesical approach with omental flap interposition is associated with excellent and durable results with minor morbidity. Standardization of the technique is a key success in the outcome of the repair.

<p class="BodyA"><strong>Background:</strong> Role of preoperative serum albumin on primary total knee arthroplasty.</p><p class="BodyA"><strong>Methods:</strong> A total of 1022 patients who underwent primary knee arthroplasty were collected. All patients were divided into the control group (preoperative serum albumin ≥3.5 g/dl) and case group (preoperative serum albumin &lt;3.5 g/dl). The risk factors of preoperative hypoalbuminemia and the postoperative complications were analyzed.</p><p class="BodyA"><strong>Results:</strong> Compared to controls, hypoalbuminemia patients were older (p&lt;0.05 ), had higher risk for any complication such as delayed wound healing, pleural effusion, and pneumonia, lower BMI and longer hospital stay (p&lt;0.001).</p><p class="BodyA"><strong>Conclusions:</strong> Preoperative hypoalbuminemia is more frequent in patients who are older, have poor nutritional condition, and have more than two concurrent disorders. Hypoalbuminemia before surgery is linked to a higher risk of postoperative problems.</p>

Background: Posterolateral knee dislocation rarely occur and might not reduce due to buttonholing of the Femoral condyle into the anteromedial knee joint capsule. These are complex injuries without any clear guidelines in terms of management. Case presentation: 40-year-old male presented with posterolateral knee dislocation due to a road traffic accident. Patient was having posterior cruciate ligament (PCL) injury along with posterolateral corner instability supported by clinical examination and confirmed with radiologic investigations. Management and Results: Patient was managed with single-stage arthroscopic reconstruction of PCL followed by open posterolateral corner ligaments reconstruction. Postoperatively patient had positive functional outcomes with satisfactory international knee documentation committee subjective knee form (IKDC) scores. Conclusion: Posterolateral Corner Injury (PLC) injury with associated PCL injury showed positive results when managed in a single-stage procedure.

Background: Total knee arthroplasty being the definite procedure in degenerative arthritis of the knee is associated with a high cost that includes the cost of implants & in-hospital length of stay (LOS). Incurring such high costs will put a burden on the patients economically, so the goal being the reduction of LOS yet improving the functional outcome with better patient satisfaction. The purpose of this study is to identify the perioperative risk factors increasing the LOS of patients, by quantifying them, efforts can be done to manage those risks providing better satisfaction to patients. Materials and Methods:The study design is a retrospective analysis of 1022 patients of primary elective total knee arthroplasty, performed in our institution. The potential factors recorded were: age, sex, hemoglobin levels, albumin levels, BMI calculated with patients height and weight, ASA grading, smoking alcohol status, diagnosis for which TKA was done and comorbids were analysed Results: We looked at 1022 patients and found the average length of stay is 6 days, with age, comorbids, BMI, ASA, Diagnosis, blood transfusion, hemoglobin and albumin all played a role to influence Length of stay Conclusion: Our study showed that LOS after TKA is multifactorial. Various risk factors are present at the time of presentation, some of which are modifiable and some non-modifiable. It is important to acknowledge all the factors that increase the in-hospital LOS & to do one's uttermost use of medical resources.