Objective To report the outcomes of operative management of traumatic posterior urethral distraction defect in boys at our Centre, as traumatic posterior urethral stricture in children is a rare condition that presents a major surgical challenge to the paediatric urologist and consensus on the optimal treatment of these strictures in children has not been reached. Patients and methods We retrospectively analysed our data from July 2013 to June 2018. All boys aged ≤16 years with traumatic posterior bulbo-prostatic obliteration (distraction defect) were included. Initial suprapubic cystostomy and delayed definite anastomotic urethroplasty was done in all the boys. The boys were evaluated preoperatively with a retrograde urethrogram and simultaneous voiding cystourethrogram, as well as cystourethroscopy. Results A total of 38 boys, with posterior urethral distraction defect, were divided into primary and redo surgery groups. The primary group comprised 34 boys who were operated upon for the first time. A perineal approach with development of an inter-crural space was done in 12 boys and along with an inferior pubectomy in 19 boys. Three boys in the primary group needed a transpubic approach due to a longer defect. In the redo group, there were six boys, of which four were operated initially outside our hospital, while two were our own unsuccessful urethroplasties. In the redo group, a perineal approach with inferior pubectomy was done in two boys and a transpubic urethroplasty in the remaining four boys. The success rate of anastomotic urethroplasty without any ancillary procedures was 81.5% (strict criterion), while the overall success rate was 94.7% (permissible criterion, which included boys who were managed later with direct vision internal urethrotomy and dilatation). Conclusion The ideal treatment of post-traumatic posterior urethral defect/strictures in boys is tension-free bulbo-prostatic anastomosis. This was done using a transperineal approach in most of the boys, but a few required a transpubic approach, with good results. Abbreviations DVIU: direct vision internal urethrotomy; SPC: suprapubic cystostomy; SUI: stress urinary incontinence

Background: Post Partum Hemorrhage (PPH) is a life threatening emergency that needs to be managed timely. Refractory PPH is treated surgically. Bilateral internal iliac artery ligation is one of the surgical procedures performed to control bleeding.Objective: We analyzed the effectiveness of Bilateral IIAL in controlling bleeding in PPHMethodology: It was a retrograde cross-sectional study conducted at Lady Aitchison hospital, Lahore from data during January 2018 to December 2020. After applying inclusion and exclusion criteria, data of patient including demographics, history, examination, ultrasound, procedure details and post-operative complications were recorded. All the data was analyzed using SPSS version 23.0.Results: All the patients (44) survived and success rate was 100 %. Uterine atony was present in 29 (65.9%) patients as a cause of PPH, placental abnormality, uterine rupture and coagulopathy in 7(15, 9), 4 (9.1%) and 4 (9.1%) patients respectively. 17 patients did not develop any complication. Most common Post-operative complication was wound infection (22.75%) followed by pneumonia (20.5%), paralytic ileus (9.1%) and DIC with renal failure (9.1%).Conclusion: Bilateral IIAL was found to be an effective and preferred life saving procedure, preserving fertility.