Congenital vesicovaginal fistula in association with hypoplastic kidney and uterus didelphys

Impact of the surgical approach, considering Goh classification, on long-term results in patients with vesicovaginal fistula repair

Background

This study aims to present long-term results, preoperative classification, and surgical approach in the therapy of vesicovaginal fistulas (VVF) and neovesicovaginal fistulas (NVVF). Unlike developing countries, where fistulas are mainly the result of delivery trauma, in the modern world, the main causes are urogynecological surgery and irradiation therapy.

Methods

Data of 36 woman who underwent surgical treatment of VVF and NVVF were collected retrospectively. After clinical assessment, fistulas were categorized by the Goh classification system, which led to the choice of surgical approach: transvaginal or transabdominal. Follow-up period was 60 to 108 months.

Results

Out of 36 patients evaluated, 23 were operated transabdominal, and 13 were operated transvaginal. Patients selected for the transabdominal approach were mainly categorized as Goh 1 and 2, including patients after radiotherapy and patients with large fistulas. Patients selected for the transvaginal approach were mainly Goh 3 and 4. There were no statistical differences between groups regarding the success of the operation (83.3%) and complication rate. Complications included fistula recurrence (16.6%), stress urinary incontinence (22.2%), urinary tract infections (11.1%), overactive bladder (13.9%), and urosepsis (2.8%). There was a statistical difference in the duration of the hospital stay in favor of the transvaginal approach (12.00 ± 5.8 vs 16.27 ± 4.65).

Conclusions

Success in the surgical treatment of VVF and NVVF can be achieved by careful preoperative classification, selection of surgical approach, assessment of local tissue status, taking into consideration the characteristics of the fistulas, and adhering to the basic surgical principles. Regardless of the surgical approach, conducting such a preoperative stratification can achieve similar long-term outcomes. Most fistula recurrence (83.3%) appeared within 6 months after the surgery.

Approaches to Female Congenital Genital Tract Anomalies and Complications

Objective:

Female congenital genital tract anomalies may appear with quite confusing and deceptive complications. This study aims to evaluate the difficulties in diagnosis and treatment of female congenital genital tract anomalies that frequently present with complications.

Summary:

During a 10-year period, we evaluated 20 female patients with congenital genital tract anomalies aged between 3 days and 16 years. All patients were retrospectively analyzed in terms of the results of diagnostic studies, surgical intervention, and treatment.

Methods:

Ultrasonography and magnetic resonance imaging revealed hydromucocolpos or hematocolpometra, imperforate hymen, distal vaginal atresia, didelphys uterus, an obstructed right hemivagina, uterovaginal atresia, a unicornuate uterus with a noncommunicating rudimentary horn, a vesicovaginal fistula, a utero-rectal fistula, intraabdominal collection, and a vaginal calculus.

Results:

Two patients had Mayer-Rokitansky-Küster-Hauser syndrome and 6 patients had obstructed hemivagina and ipsilateral renal anomaly syndrome. Definitive surgical interventions were hymenotomy, vaginal pull-through, vaginovaginostomy, and vesicovaginal fistula repair using a transvesical approach. In conclusion, female congenital genital tract anomalies may appear with a wide range of complications.

Conclusions:

There is a potential to do significant harm, if the patient's anatomic problems are not understood using detailed imaging. Revealing the anatomy completely and defining the complications that have already developed are critical to tailor the optimal treatment strategies and surgical approaches.

Congenital vesicovaginal fistula: spontaneous or forced? Two cases and literature review

INTRODUCTION AND HYPOTHESIS

Congenital vesicovaginal fistula is an exceedingly rare entity. There is no consensus regarding the nature and origin of this condition. We report two cases with congenital vesicovaginal fistula and compile previously reported cases in the English literature. Theories behind the genesis of this anomaly will be briefly presented.

METHODS

We describe the presentation, diagnostic workup, and management of two patients with congenital vesicovaginal fistula. Previously reported cases were retrieved through an extensive English literature review using Medline and PubMed. Cases are tabulated based on the presence or absence of vaginal menstrual outflow obstruction.

RESULTS

Two women, aged 23 and 17, had had cyclic hematuria since puberty that was perceived as normal menstruation. One woman presented with an inability to have sexual intercourse, and the other with severe cyclic pelvic pain. Diagnostic workup unveiled congenital vesicovaginal fistula and distal vaginal agenesis in both. One had abnormal ureteric insertion, while the other had a history of anomalies unrelated to the urogenital system. Successful surgical correction of fistula was undertaken in both. An English literature review revealed 23 reported cases of congenital vesicovaginal fistula. While 74 % had concomitant menstrual outflow obstruction, the remaining had normal menstruation per vagina.

CONCLUSION

Congenital vesicovaginal fistula can present as an isolated anomaly, or associated with complex malformations of a wide spectrum. The presenting symptoms as well as the age at diagnosis vary widely. While the term "congenital" implies its genesis before birth, a congenital vesicovaginal fistula can be a manifestation of faulty embryological development, but also the result of outflow obstruction.

Cystic adnexal mass in a 16-year-old female: Ovarian pathology or complication of a Müllerian anomaly?

Patient: Female, 16

Final Diagnosis: Pelvic mass

Symptoms: None

Medication: None

Clinical Procedure: CT • MRI

Specialty: Diagnostic radiology • pediatrics

Congenital vesicovaginal fistula with transverse vaginal septum presenting as menouria-a rare case report and brief review

Menouria due to congenital vesicovaginal fistula is rare entity. We report a case of a 22-year-old female who presented with menouria. On evaluation, she had congenital vesicovaginal fistula and obstructing complete vaginal septum. McIndoe vaginoplasty and fistula repair through vaginal route was performed.

Menouria due to congenital vesicovaginal fistula associated with complex genitourinary malformation

Background:

Congenital vesicovaginal fistula (VVF) is a very uncommon condition rarely suspected at initial presentation. It is usually seen in association with complex malformations of the genitourinary tract.

Case:

A bifid insertion of the solitary ureter causing an uretero–VVF was associated with an obstructing transverse vaginal septum manifesting as menouria. Also seen were solitary crossed renal ectopia, bicornuate uterus and skeletal anomalies.

Conclusion:

In women with menouria without vaginal menstruation, pre-operative evaluation to detect an obstructive vaginal anomaly and unusual uretero–vesicovaginal fistulous communications is necessary before surgical intervention.

Congenital vesicovaginal fistula with transverse vaginal septum and ectopic ureter opening in proximal vagina: case report and brief review

Congenital vesicovaginal fistula is an extreme rarity. We report on a case of a 22-year-old lady who presented with menouria and infertility. On evaluation, she was found to have congenital vesicovaginal fistula, a nonfunctioning right kidney with ectopic ureter and transverse vaginal septum. Abdominal repair of the fistula, right nephroureterectomy, and excision of the vaginal septum was performed.