Introduction: Vesicovaginal Fistula (VVF) is the most common acquired fistula of the urinary tract in women. Robotic surgery is recently introduced for VVF repair and has benefits over conventional methods. Aim: To describe experience with robot-assisted laparoscopic repair of VVF in patients. Materials and Methods: This was a retrospective observational study conducted from February 2014 to February 2018, at Department of Urology, Apollo Main Hospital, Chennai, Tamil Nadu, India. The study included 24 patients who underwent robot-assisted laparoscopic VVF repair. After cystoscopy ureteric catheter was passed through the fistula and retrieved through vagina. Bilateral ureteric catheters were placed simultaneously with vaginal packing. Da Vinci Si robot was docked with patient in trendelenburg position. After trocar placement transperitoneally the fistula was approached. Through vertical or transverse cystotomy, fistula was identified. With the circumferential incision around the fistula, both the bladder and vagina was separated and the fistulous tract was excised. Bladder was closed vertically and vaginal opening was closed transversely interposing the Omentum. Statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) version 20.0. Results: The mean age of participants was 40.33 years. Elective hysterectomy done for benign conditions (91.67%) was the major cause of VVF in patients followed by emergency hysterectomy (8.33%). All of the patients underwent adhesiolysis while two patients performed right ureteric re-implantation additionally. The median operative time was 127.50 minutes. The median duration of drain and hospital stay was three days each. Urethral Foley’s catheter removal done at 2-3 weeks based on operating surgeon’s preference and the mean duration of follow-up was 26 months. Conclusion: Robot-assisted laparoscopic VVF repair is convenient and an effective approach in the successful management of VVF in complex fistulas and recurrent cases.

Utero-vaginal prolapse (UV) is a common condition affecting millions of women worldwide, and a major cause of gynecological surgery. Although it is not life threatening but, it can have a severe impact on quality of life. Prolapse is a protrusion of a pelvic organs beyond its normal anatomical confines and it represents the failure of fibromuscular support to maintain normal position. Urodynamic Study (UDS) is the dynamic study of the transport, storage and evacuation of urine. The ultimate goal of urodynamics is to aid in the correct diagnosis of urinary incontinence based on pathophysiology. Urodynamic studies assess both the filling storage phase and the voiding phase of the bladder and urethral function. AIM: of this study is to assess the role of urodynamic measures in pelvic organ prolapse (POP) patients for identifying the urinary problems concomitant with prolapse for proper management. The use of urodynamic tests are for diagnosis, prognosis, guidance of clinical management and decision for type of surgery that results in improvement of patient outcomes with various urological conditions. KEYWORDS: With Pelvic Organ Prolapse (POP) Urodynamic Study Urinary Incontinence. INTRODUCTION:Utero-vaginal prolapse (UV) is a common condition affecting millions of women worldwide, and a major cause of gynecological surgery. Although it is not life threatening but, it can have a severe impact on quality of life.Prolapse is a protrusion of a pelvic organs beyond its normal anatomical confines and it represents the failure of fibromuscular support to maintain normal position. (1) Two third of affected women have concominent cystocele and/or rectocele. Cystocele is primarily the result of weakened pubocervical fascia. (2) Women with UV prolapse may present with a wide range of lower urinary tract symptoms. The prolapse may mechanically obstruct the urethra, leading to bladder outlet obstruction, impede voiding and mask urinary incontinence. (3) The pathophysiology of Stress Urinary Incontinence (SUI) and Pelvic Organ Prolapse (POP) are related and can be considered multifactorial. These factors may be divided into intrinsic (Genetic, age, postmenopausal status, ethinicity) and extrinsic components (Parity, history of previous delivery, co-morbidities and patient's occupation). Overall, irrespective of the inciting factor, the end result is the same: an anatomical defect in the endopelvicfascial layer leads to prolapse. The clinical factors involved in prolapse are damage of the soft tissues sustained during pregnancy and weakening of pelvic floor tissue during menopause. (4) Prolapse and urinary incontinence often occur concomitantly. Anterior vaginal wall prolapse may present as stress incontinence. A large cystocele may cause uretheral kinking and overflow incontinence. Uterine descent can cause lower back and sacral pain. Enterocele may cause only vague symptoms of vaginal discomfort. A rectocele can lead to incomplete evacuation of stool. Stress incontinence is described as the involuntary leakage of urin...