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To review our experience in causes, diagnosis and basic principles of surgical treatment of urogenital fistulae.A retrospective study of 213 patients with different types of urogenital fistulae were reviewed between October 1995 to October 2008. They were analyzed with regard to age, parity, causal factor, mode of treatment and outcome. Patients were also evaluated at two or three weeks initially, three monthly and later depending upon symptoms.We reviewed our series of female urogenital fistulae treated over a 13 years period. Out of these 213 cases, 133 (62.44%) were Vesico vaginal fistulae, 54 (25.35%) Urethro vaginal fistulae and 26 (12.2%) were Uretero vaginal. Majority of the patients were young in child bearing age between 16 and 30 years of age, although age range was wide i.e., 11 to 50 years. The most common cause of urogenital fistulae were Obstetrical trauma due to obstructed labour in 50 (37.59%) and Gynaecological (hysterectomy 25 (18.79%) and caesarian section in 9 (6.77%). Patients of Uretero vaginal fistulae were mainly due to unrecognized ureteral injuries during Gynaecological procedures (hysterectomy in 17 cases and caesarian section in 5 cases). For repair of vesico vaginal fistulae, Transvaginal route for repair was used in 53 (39.84%) patients, while Trans abdominal route for repair was used in 70 (52.63%) patients. There were 16 (12.03%) failures in Vesico vaginal fistulae with a success rate of 88%. Mean Hospital stay was 15 +/- 3.5 days (range 4-30 days) and a mean follow-up of 8 +/- 3.2 months (range 4 months to 2 years).In this series, most of the female urogenital fistulae were vesico-vaginal with majority of the women being in the child bearing age. The most common cause was obstetrical trauma.

To evaluate the clinical presentation, therapeutic options and outcome of the treatment of penile fracture.Case series.The Department of Urology and Transplantation, Civil Hospital Quetta, between March 1995 and March 2009.One hundered and thirty seven patients of penile fracture were admitted. Detailed history was taken. Physical examination was done in order to get the extent of penile hematoma, sign of blood at the meatus and side of curvature. Patients with rupture of the superficial and deep dorsal vein of the penis were excluded from the study. The operative plan consisted of immediate exploration, debridement and primary repair of the tear in tunica albuginea and urethra via a degloving inscision. Data analysis was performed to obtain descriptive statistics.The mean age was 25 years (ranging from 14-50 years). Causes of fractures were manipulation in 56 (40.87%) cases, sexual maneuver in 39 (28.46%) cases, rolling or fall on bed in 18 (13.13%) and direct blow on erect penis in 11 (8.02%) patients. Injury involved unilateral corpora cavernosa in 126 (89.78%) and bilateral corpora cavernosa plus urethra in 11 (8.02%) respectively. The interval from time of injury to presentation was 4 hours to 45 days. All the patients presented with the typical clinical picture of a characteristic sound at the time of injury, pain, detumescence, and hematoma. In all the patients the tunical and urethral injuries were promptly repaired. Complication occurred in 7 (5.10%) patients.The mean hospital stay was 2 days. Eighty nine (64.96%) patients available for follow-up reported achieving adequate erection for intercourse without erectile or voiding dysfunction.Common clinical presentation were snapping or popping sound, sudden penile pain, detumescence and penile deviation. The aim of surgical repair was to avoid complications and preserve both sexual and voiding functions which was satisfactorily achieved in the majority.

To examine the relationship between clinical history and results of renal investigations in patients with xanthogranulomatous pyelonephritis.A retrospective review was conducted on 63 cases presenting with histopathological diagnosis of xanthogranulomatous pyelonephritis between 1995 to 2002, at the department of Urology, Bolan Medical College and Sandeman Provincial Teaching Hospital Quetta.There were 26 males and 37 females having an average follow up of two years. Positive findings on examination and investigations at presentation were fever and flank pain in 59 (93.6%) patients and pyuria in 34 (53.9%) patients. All the patients had renal and ureteric calculi with no or severe reduction in the function of the affected kidney on DTPA scan. Hypertrophy of the contra lateral kidney was seen in 56 (88.8%) patients.Xanthogranulomatous pyelonephritis is a common entity in this part of the world. Late referral leads to loss of the kidney. Pre-operative diagnosis of the condition is desirable and if surgery is mandatory then all infected tissues have to be removed.

To describe the mode of presentation of varicocele and to compare the low ligation (Inguinal approach/Ivanissevich's procedure) and high ligation (Retroperitoneal approach/modified Palomo's procedure) of varicocele repair regarding efficacy and postoperative complications.Institutional-based randomized comparative clinical trial.This study was conducted at the Urology Department, Bolan Medical College and Sandeman Provincial Teaching Hospital, Quetta from December 1996 to November 2001 (5 years).A total of 213 patients of varicocele who underwent treatment in the department and completed 6 months follow-up were included in the study. The mode of presentation of varicocele was recorded for all patients. For treatment purpose patients were randomly divided into two groups: in group I (n: 115) varicocele was ligated by inguinal approach (Ivanissevich's procedure) while in group II (n: 98) by retroperitoneal approach (modified Palomo's procedure). The efficacy and postoperative complications of the two procedures were carefully recorded and compared between the two groups.The mean age of the patients of group-I and group-II was 27.2 and 27.5 years respectively. More than 50% patients of both groups presented with feeling of heaviness/dragging sensation on ipsilateral side. Presentation with infertility/sub fertility in group-I and group-II was 16.5% and 15.3% respectively. Majority of patients of both groups had grade III varicocele with visible deformity. The rate of postoperative complications was very low in both groups of patients. Recurrence of varicocele and postoperative hydrocele formation were slightly more common in group-II as compared to group-I but the difference was statistically not significant (p0.05). An extremely significant improvement occurred postoperatively in both sperms density and motility in infertile/sub fertile patients of both groups.Both procedures of varicocele repair are equally effective and have a low rate of complications. There is no significant difference in postoperative complications. An extremely significant improvement occurs in semen parameters of infertile/sub fertile patients postoperatively, irrespective of method/technique of varicocelectomy

Two cases of retrocaval ureter are reported. A 22 years old male patient presented to us with the complaints of right flank pain and hematuria and a child of 2 years referred to us for evaluation of right side moderate hydronephrosis detected on ultrasound. The diagnosis was confirmed on intravenous urography and retrograde pyelography. Both the ends were transected and anastomosed above a JJ stent in front of the inferior vena cava. Postoperatively the patients remained asymptomatic and the hydronephrosis improved.