umbilical and one supra pubic scar marks. Liver and spleen were not palpable. Per speculum examination revealed that the vagina and vault were wet with urine. A 0.5 x 0.5 cm fistula was visualized at the vault in the center. On per vaginal examination the vault was supple with no palpable mass. On investigation, complete haemogram, urine routine examination, serum electrolytes, renal function tests, ultrasound (abdomen and pelvis) were within normal limits. A three-swab test done confirmed the fistula to be vesicovaginal. Intravenous pyelogram (IVP) showed normally functioning kidney with normal ureteric outline.The patient was taken up for cystoscopy, which revealed a scarred area on the posterior wall of the bladder above the trigone with a fistulous opening. A probe was passed through the fistulous opening in the vagina and the fistulous opening in the bladder was localized by cystoscopy being done at the same time. In view of the prolonged history of the patient, multiple surgeries and small size of the fistula, a decision was taken to attempt sealing of the fistula with fibrin sealant .Under cystoscopic guidance and local anaesthesia, a probe was passed through the fistulous opening in the vagina and margins of the fistula traumatized, in an attempt to freshen the margins. The cystoscope was removed and 2ml of reconstituted fibrin glue (Tissucol) was injected into the fistulous opening in the vagina using a Duploject syringe. The patient was then put on a continuous Foley's catheter for seven days. The patient had no leakage of urine in the postoperative period. The patient had no incontinence of urine after catheter removal and she was voiding satisfactorily. The patient was followed up at three months, when she was found to be asymptomatic and extremely satisfied with the procedure.

Objectives: Palmoplantar warts are a challenge to treat. Standard treatment methods include electrocautery, radiofrequency ablation and cryosurgery, carbon dioxide laser, and Erbium-doped Yttrium Aluminum Garnet laser, which are ablative, invasive, and have downtime. Non-ablative lasers like pulsed dye laser and long-pulsed Neodymium: Yttrium-Aluminum-Garnet (Nd: YAG) have been tried earlier for the treatment of warts to overcome these deficiencies. The aim of the study was to assess the efficacy and safety of long-pulsed 1064 nm Nd: YAG laser in the treatment of palmoplantar warts. Material and Methods: Eleven adult subjects with a total of 58 hand and foot warts were enrolled in the clinical trial from January 2016 to January 2017 to receive treatment with long-pulsed 1064 nm Nd: YAG laser. The thick hyperkeratotic part of the wart was removed by paring and then the lesion was treated, at monthly intervals for four sessions or until the clearance of the warts. Response was assessed at the beginning, before each treatment session and after the final treatment. Results: A total of 8 subjects with 52 warts completed the study. Forty (76.9%) warts showed complete clearance of lesion and 2 (3.8%) warts showed marked improvement. Ten (19.2%) warts did not get cleared. The average number of sessions was 2.2. Mild pain was noticed during the procedure. There was no wound, no infection and no bandages were required after the procedure. Post-inflammatory pigmentation or scarring was not observed in any case. Conclusion: Long-pulsed 1064 nm Nd: YAG laser is safe, effective, non-destructive, and relatively painless for the treatment of palmoplantar warts.