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Aims: Lack of compliance and unjustified antibiotic prescriptions has resulted in increasing bacterial resistance and is proving as a major challenge in the management of infections. Knowing the commonly isolated uropathogens and their antimicrobial susceptibility is beneficial in planning treatment protocols. Methods: A retrospective review of records of patients with urinary tract infection from January 2012 to December 2016 was conducted at Kathmandu Model Hospital. All patients who were diagnosed as having culture positive urinary tract infection in medical ward of Kathmandu Model Hospital during 5 years period were analyzed for demographic data, prevalence of organism and antibiotic susceptibility patterns. Results: A total of 315 samples were culture positive. The majority of bugs were gram negative E.coli (48.57%) followed by multi-drug resistant E.coli (28.89%). The other major pathogens were E. faecalis (6.03%), S. epidermidis (4.44%), K. pneumoniae (4.13%), respectively. The highest level of sensitivity in first line antibiotics was seen in nitrofurantoin (84.9%), whereas least sensitivity was shown by amoxicillin/clavulanic acid (21%). Similarly, in second line antibiotics, highest sensitivity was seen in tetracycline (100%), imipenem (91.9%) and least to meropenem (49.2%). Ceftazidime is mostly (93.3%) resistant antibiotics among uropathogens. All the third line antibiotics such as polymyxin B, tigecycline and colistin were 100% sensitive to all our isolates. Conclusions: Nitrofurantoin may be an appropriate choice for initial empirical therapy of urinary tract infection. Similarly, the multi-drug resistant E.coli is increasing but it can be tailored if antibiotics are used appropriately on the basis of susceptibility data. [ABSTRACT FROM AUTHOR]

Aims: Laparoscopy has become the most common procedure in recent set-ups. It is now a major diagnostic as well as therapeutic modality for infertility, endometriosis, extrauterine pregnancy and benign ovarian tumors.The aim of the study was to share the experience of gynecological laparoscopic surgeries performed at Kathmandu Model Hospital. Methods: A descriptive study was carried out at Kathmandu Model Hospital from 1st January 2011 to 1st May 2017. All the patients who underwent gynecological laparoscopic surgeries were analyzed for the indication, type of procedure and its complications. Results: Out of 217, majority 24.4 %(n=53) patients were in age group 26-30 years. There were 51.1% (111) cases of ovarian cyst, 12.44%(27) cases of ectopic pregnancy. Eight cases were done with surgeons for cholecystectomy and ovarian cystectomy or hysterectomy. There were 15% (n=32) cases of diagnostic laparoscopy. Total laparoscopic hysterectomy was done in 16% (n=33) cases. Conversion to laparotomy was done in 3%(8) cases. There was one case of vascular injury. Most common immediate post-operative complaint was variable degree of pain, managed with parenteral and oral analgesics. Oral diet started at 4-6th hour post-operatively, and mobilization started after 24 hours. 75% (164) cases had a hospital stay of 2 days and 25%(53) cases stayed for 3 days. Conclusions: Laparoscopic surgery at our hospital has been well demonstrated in terms of reducing postoperative pain and decreasing postoperative morbidity, short hospital stay, and less postoperative recovery time. However, adequate advanced training and devices are needed to perform skillful laparoscopic surgeries. [ABSTRACT FROM AUTHOR]

Aims: The study was done to analyze the epidemiology, diagnosis and treatment aspect of patients with ectopic pregnancy at Kathmandu Model Hospital. Methods: This was a retrospective study of patients with ectopic pregnancy who received treatment at Kathmandu Model Hospital from January 2008 to September 2015. Data were analyzed from patient records and discharge summary. Delivery number was obtained from maternity record. Results: There were 61 cases of ectopic pregnancy with the hospital incidence of 1.46%. Highest number of patients 20 (32.79%) were in the age range of 28-32 years. Most of the patients were nullipara 22 (36.06%) or with parity two 20 (32.79%). Some risk factors were found in 29 (47.54%) cases. The commonest risk factor was pelvic inflammatory disease in 12 (19.67%). All presented with pain abdomen, 48 (78.68%) had per vaginal bleeding, 17 (27.87%) presented in shock. Cervical excitation was present in 38 (62.29%). Urine for pregnancy test was positive in all and 37 (60.66%) had ultrasonography. Ten (16.39%) patients underwent emergency laparoscopic surgery and 40 (65.57%) had emergency laparotomy. Salpingectomy was required in 53 (86.89%) cases. The average hospital stay was 5 days. Conclusions: The study showed that ectopic pregnancy could occur at any reproductive age without obvious risk factors. Although not all patients gave history of amenorrhoea, pain abdomen was present in all. [ABSTRACT FROM AUTHOR]

Vaginal atresia is one of the common congenital anomalies of the female lower genital tract due to incomplete canalization of Mullerian ducts. It mostly presents as primary amenorrhoea with attacks of severe lower abdominal pain at monthly interval in presence of appropriate Tanner staging secondary sex characteristics. It is diagnosed by clinical presentation, examination and imaging, usually ultrasound scan and magnetic resonance imaging. There are conservative non-surgical as well as surgical methods to correct it. A 13 years pubertal girl presented at Kathmandu Model Hospital with complaints of cyclic severe lower abdominal pain since one year with presence of appropriate secondary sexual characteristics. Ultrasound showed features suggestive of hematometra. She underwent drainage of hematocolpos with neo-vaginoplasty followed by intravaginal mould placement. She also underwent dilatation of neovagina thrice under IVA to maintain the vaginal length and function. We present here a case of isolated vaginal atresia, who underwent Mc Indoe Vaginoplasty followed by serial dilatation. [ABSTRACT FROM AUTHOR]

The ectopic implantation is implantation of fertilized ovum outside the uterine cavity, ampulla of fallopian tube being the most common site. A cornual or interstitial pregnancy is an ectopic pregnancy that develops in the interstitial portion of the fallopian tube which is one of the most hazardous type of ectopic gestation. Treatment depends on the week of gestation at the time of diagnosis, level of serum β HCG, findings of ultrasonography, hemodynamic stability of the patient and the choice of future fertility. In this case report, we present a case which was previously misdiagnosed as a case of missed abortion at 8 weeks of gestation by transabdominal ultrasound and patient underwent medical abortion with mefipristione and misoprostolandafter 1 month presented with pain abdomen and was confirmed as extrauterine pregnancy by transabdominal ultrasound followed by surgical management. [ABSTRACT FROM AUTHOR]

Ovarian cysts are common findings in females of reproductive age. Mostly, they are non neoplastic and hormonally dependent as follicular, simple, and corpus luteum cysts. Ovarian cysts are rarely grown to reach huge size without raising any symptoms. Most of the cases that have huge cysts present with pressure symptoms over the genitourinary system leading to urinary complaints or the respiratory system lead to respiratory embarrassment. Dermoid cysts account for 10-20% of all ovarian neoplasms. They are common in young women, especially at the age of 30 years.In most of cases, they are asymptomatic and can be discovered accidentally on clinical examination or ultrasonographic scan. They are usually indolent tumors with very slow rate of growth about 1.8 mm per year. Giant dermoid cysts have been infrequently reported in the literature. This is a case report of huge dermoid cyst weighing 25 kgs in a 42-year old perimenopausal lady that remained relatively asymptomatic. She underwent Laparotomy with ovarian cystectomy. [ABSTRACT FROM AUTHOR]

Aim: The study was done to review the demography of urogenital fistulae including obstetric fistula (OF) and its surgical outcome in the early phase of fistula surgery and to create awareness about OF. Methods: This was a retrospective study of 47 patients who underwent fistula surgery during the period of January 2012 to May 2014 in Kathmandu Model Hospital, Helping Hand Community Hospital, Camp in Mid-wetern Regional Hospital Surkhet and Hamlin Hospital, Ethiopia. The primary outcome was in terms of urinary continence after 14 days of repair. Results: In the study 70% (n=33) of fistula were due to obstructed labour and 30% (n=14) were due to hysterectomy for gynecological indications. Ninety six percent (n=45) had successful closure of fistula. Seventy seven percent (n=36) were continent after surgery, and 17% (n=8) had some stress incontinence. Conclusions: The study showed obstructed labour was the major cause of OF, however iatrogenic fistula was also becoming common. The success of repair depended on the type, site, size of fistula and urethral length. Majority of our cases had successful closure of fistula with some degree of stress in some patients. [ABSTRACT FROM AUTHOR]