Aims:  The aim was to determine the incidence and association of urinary problems post successful fistula repair. Methods: The retrospective analysis was conducted at Maternal Child Health Pakistan Institute of Medical Sciences, Islamabad, and comprised data related to patients having undergone vesicovaginal fistula repair from January 2008 to June 2018. Various modalities were used to determine the underlying cause of these symptoms including patient’s history, examination, ultrasound, urine examination and urodynamic studies. Statistical analysis of the record was done using SPSS 21 software. Results:  Among total 318 successful fistulas repair patients, 78 (24.5%) had urinary problems post operatively. Out of these 78, 56.4% had stress incontinence, 41% infection and 2.6% urge incontinence.13.6% of the stress incontinence was due to sphincter weakness. Urge incontinence was found to be due to detrusor instability. These post-operative urinary complaints were significantly associated with the repair of vesicovaginal (31.3%), urethral (23.1%) and vesicouterine (15.7%) fistula compared to those involving ureter(p 0.04). No significant association was found between the incidence of post-operative urinary complaints and previous history of surgical repair, parity, fistula size and duration of fistula. Conclusions: Urinary incontinence after fistula repair requires careful evaluation as the successful repair of a urogenital fistula can correct the fistula defect, but it might not make the patient dry. Moreover, performing further continence surgery may exacerbate the condition in some cases.

Laparoscopic appendicectomy is a safe procedure with low morbidity. It is advantageous in obese patients, patients with other pathology, and patients with an unusual position of the appendix, and it has a low infection rate.

Aims: To evaluate the association of various predictive factors with the outcome of surgical repair of vesicovaginal fistula. Methods: The retrospective analysis was conducted at Maternal and Child Health, Pakistan Institute of Medical Sciences, Islamabad, and it comprised data related to patients having undergone vesicovaginal fistula repair from January 2008 to June 2018. Statistical analysis of the record was done using SPSS 21 software. Results: A total of 364 patients of urogenital fistula repair were reviewed, with an overall success in 318 (87.4%) cases. There were no significant differences in fistula duration (p0.4), size of fistula (p 0.34) and accessibility (p0.5) between successful and unsuccessful group. However, we found the association between the type of fistula and history of previous repair attempts with the success of fistula repair. Primary surgical repair of vesicovaginal (90.0%), vesicouterine (86%), ureteric (100%) and ureterovaginal (98%) were more successful as compared to repair with the history of 1 previous attempt (90.3%, 83.3%, 66.6% and 75% respectively). Success rate was found to further decrease with the history of more than one repair attempt of vesicovaginal (71.4%) and vesicouterine (66.5%) fistula. Further, successful fistula repair in women was also found to be significantly associated with parity less than 4 (p 0.038). Conclusion: Despite the higher success rate of urogenital fistula repair, it’s important to refer the urogenital fistula patients timely to specialized fistula centres in order to achieve best results.