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Introduction: Vesicovaginal fistula (VVF) is well recognized complication of prolonged labor or urogynecologic surgery. Failing conservative management, it may be repaired with abdominal or vaginal approach. We herein share our initial experience of VVF repair done laparoscopically through transperitoneal approach. Materials and Methods: From January 2005 to January 2007, we treated 4 cases of VVF developed following vaginal hysterectomy. All except one had fistula recognized in post operative period. In one case, bladder injury was recognized intraoperative, repaired primarily but developed VVF immediately after removal of urethral catheter. All cases underwent successful laparoscopic VVF repair (O'Conor's) by standard transperitoneal approach. Results: The mean operative time was 176 minutes. The estimated blood loss was 40 cc. The mean hospital stay was 2.7 days. The urethral catheter was removed at 2 weeks after visualizing no extravasation on cystogram. In follow up, all patients are asymptomatic with normal voiding. Conclusion: Laparoscopic VVF repair is feasible and efficacious approach for VVF repair. [ABSTRACT FROM AUTHOR]

Introduction: Laparoscopic right sided donor nephrectomy is associated with technical problems of short renal vein length of the right kidney and retro-caval location of the renal artery. We present our experience of overcoming both these challenges during retr operitoneoscopic donor nephrectomy on right side. Materials and Methods: Between September 2004 and August 2007, total 210 retroperitoneoscopic donor nephrectomy was performed. 53 cases were on right side. Four ports were used for right sided donor nephrectomy. Hem-o-lok clip was used for control of renal artery and Endo TA stapler was used for control of renal vein. All procedures were completed without conversion to open surgery. Kidney was retrieved by inguinal incision. Results: Mean operative time, mean blood loss and mean warm ischemia time were 120 min, 98 ml, and 4.7 minutes respectively. Five cases had two or more renal veins. Five cases had two and one had three renal arteries. Mean value of serum creatinine at 1 month and 3 months post transplantation was 1.28 mg% and 1.26 mg% respectively. Three grafts were lost due to rejection and none due to technical problems at mean follow up of 19 months. Conclusion: Right sided retroperitoneoscopic donor nephrectomy is safe and effective with immediate and intermediate term results. [ABSTRACT FROM AUTHOR]

Introduction: Open pyeloplasty has been the gold standard for surgical treatment of ureteropelvic junction (UPJ) obstruction, enjoying a long-term success rate exceeding 90%. This procedure requires a muscle incision that entails some degree of morbidity. Laparoscopic dismembered pyeloplasty is an acceptable option for UPJ obstruction. We report our experience with this approach. Materials and Methods: From November 2005 to January 2007, 51 patients underwent laparoscopic dismembered pyeloplasty for the treatment of UPJ obstruction. Mean age of adult patient was 29.60 years (18-64 years). Mean age of pediatric patients was 10 years (7 months-15 years). 43 patients underwent transperitoneal approach and 8 retroperitoneal approaches. 29 cases were of right side and 22 cases of left side UPJ obstruction. Five patients underwent simultaneous pyelolithotomy. Three ports were used in all cases.48 patients had primary UPJ obstruction, one patient had pelvic kidney with UPJ obstruction and two cases had secondary UPJ obstruction. Patients were followed at regular intervals for symptomatic improvement and further assessed with imaging studies. Data collected included operative time, length of hospital stay, and resolution of obstruction by ultrasonography, renal scan or intravenous urography. Failure was defined as inability to complete the intended procedure, persistent symptoms, and radiographic evidence of obstruction. Results: Mean operating time was 161 minutes (range 100-240). The procedure was completed successfully in all cases except in one case. Crossing vessels were noted in 21 of 51 ureters (50.0%). Mean blood loss 70 ml (25-200 ml). Mean hospital stay was 3.5 days. Postoperative complications were noted in 4 patients. Of the two patients with poorly functioning unit, one required baloon dilatation of anastomosis site and the other required nephrectomy. One patient required ureterocalicostomy for restricure. One patients had immediate urinoma in the post operative period requiring percutaneous drainge. 48 of 51 ureters (94.1%) demonstrated a patent UPJ on excretory urography and/or improvement of renal function on diuretic renography at a minimum follow up of 6 months. Conclusion: Although the procedure requires advanced laparoscopic skills, it can be safely and successfully completed as frequently as the conventional open procedure. [ABSTRACT FROM AUTHOR]