With better medical care the mortality and morbidity associated with spina bifida are improving and more such patients are reaching reproductive age. Significant problems may be encountered in the management of pregnancy in spina bifida, especially in patients with previous abdominal operations for the management of neuropathic bladder dysfunction. We report successful pregnancy outcomes in 2 such patients, both with urinary diversions, with combined obstetric and urological care. We also review the existing literature on the subject.

A 16-year-old boy presented to our tertiary care centre in puducherry in the month of October 2014 with high grade, intermittent fever for 10 days duration. He had double vision involving left eye and headache for two days duration. He had multiple erythematous lesion all over the body on 3 rd day of fever. At home his skin rash was assumed as chicken pox by mother; he was kept at home and treated conservatively with antipyretics.As he developed double vision he was referred to our hospital. There was no vomiting. On admission, his vitals were normal. There was no skin rashes. His fundus showed-bilateral papilloedema, left eye restricted abduction. There was no neck stiffness. Other system examination was normal.His investigation revealed thrombocytopenia with platelet count 45000 /cumm, total count-7100/cumm Hb-13gm%, PCV -39.4, elevated liver enzymes SGOT-82u/L SGPT-187U/L. Dengue infection can present as febrile illness with thrombocytopenia, dengue shock syndrome and dengue haemorrhagic fever. Neurological manifestation of dengue infection is more predominant in endemic region. Here, we report a case with unusual neurological presentation of dengue infection. A 16-year-old boy presented with fever for two week duration, headache and double vision involving left eye for two days. He had multiple erythematous rashes all over the body on 3 rd day and treated conservatively. On examination he had bilateral papilloedema, left eye restricted abduction. His investigation revealed thrombocytopenia and positive dengue serology. His MRI brain with venogram showed bilateral transverse sinus thrombosis. Hence he was diagnosed as cerebral venous thrombosis due to dehydration with underlying dengue infection. He was hydrated and managed conservatively. On 3 rd day his double vision started improving. His repeat MR Venogram was done after two week duration, which revealed recanalisation of bilateral transverse sinus.He was diagnosed as cerebral venous thrombosis due to severe dehydration with underlying dengue infection. As main treatment option in dengue fever is proper hydration, he was hydrated well and serial platelet count was monitored. His initial CSF analysis showed total count-81 with lymphocytic predominance 88%, elevated protein-321mg/dl sugar-65 mg/dl.On 3 rd day his double vision started improving. On 5 th day it disappeared. As CVT is due to severe dehydration with underlying viral infection, and there was improvement in vision, anticoagulation was not started. He was treated conservatively with antipyretics and parenteral fluid replacement. After two week his repeat MRI brain with venogram [Table/ Fig-2] was done which revealed recanalisation of bilateral transverse sinus.

Urinary incontinence is a common condition affecting up to 50% of the female population, but only a third seek medical help. Although the majority of these are satisfactorily managed with conservative or conventional surgical treatment, 10%-15% continue to remain incontinent despite intervention. Urinary diversion is a management option for this group. The different techniques of urinary diversion, their results, complications and long-term sequelae are discussed, with a review of the literature.

Our results suggest that, while simultaneous augmentation cystoplasty and artificial urinary sphincter implantation lead to an initial increase in prosthesis infection, this difference disappears after 3 years.