Aamir Ali Shaikh, Fozia Shaikh, Muhammad Iqbal Soomro, Nisar Ahmed Shaikh, Kanta Ahuja, Malik Hussain Jalbani.
Use of anticholinergic in postoperative care of genitourinary fistula.
Rawal Med J Jan ;46(2):342-4.

Objective: To evaluate use of anticholinergic drug in postoperative care of genitourinary fistula. Methodology: This prospective study was conducted in Uro-gynecology ward at Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, Pakistan from January to October 2018. Detailed history regarding age, parity, mode of delivery, duration of incontinence, history of glaucoma, time of presentation, address and mode of referral were taken on predesigned performa. Detailed examination as well as local examination was done in good light in theater and fistula classified on Waaldejik classification. A total 31 patients were operated, 21 was obstetric whereas 9 were iatrogenic. 30 patients were operated with Latzko while only one case with O`Connor technique. All patients postoperatively were prescribed 10mg of oral anticholinergic (Solifenacin) tablet once a day after breakfast once orally. Folly`s catheter 14fr inserted per-operatively, bladder wash continued postoperatively along with antibiotics and anticholinergic started as soon when orally allowed. Bladder spasm pain was analyzed by using visual pain analogue score. Results: Out of 31 patients, 28 were of vesicovaginal WT I & II, 2 cases of uretherovaginal WT III, whereas one case of combine fistula (juxta cervical as well as vesicouterine WT I). One patient discontinued medication due to dry mouth and nausea, two were declared as failure, one due to recurrent UTI and one due to repeated surgery while rest of patient`s surgery was successful with fewer episodes of bladder spasm. Conclusion: Anticholinergic along with prolong catheterization was effective in increasing healing of suture line, decreasing bladder spasm, relaxing detrusor, thus increasing success rate and decreasing failure rate.

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