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Voskamp T, Khisa WW, Oosting RM, Wiggers T, Dankelman J. A training phantom for a vesicovaginal fistula repair with the transvaginal approach. Curr Probl Surg 2024; 61:101550. [PMID: 39098338 DOI: 10.1016/j.cpsurg.2024.101550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 06/12/2024] [Accepted: 06/24/2024] [Indexed: 08/06/2024]
Affiliation(s)
- Tink Voskamp
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | | | - Roos M Oosting
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | | | - Jenny Dankelman
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.
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2
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Jeon BJ, Tae BS, Yoo JW, Koo HY, Oh CY, Park JY, Bae JH. Pneumovesical vesicovaginal fistula repair: Lessons learned from an initial series of 25 patients. Int J Urol 2024. [PMID: 39039659 DOI: 10.1111/iju.15508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/22/2024] [Indexed: 07/24/2024]
Abstract
OBJECTIVES This study aims to share the experiences and outcomes of laparoscopic pneumovesical repair for vesicovaginal fistulas (VVF). MATERIALS AND METHODS A retrospective review of medical records from a single institution over 10 years was conducted. The focus was on patients who underwent VVF repair using a pneumovesical approach with three 5 mm laparoscopic ports. The study evaluated perioperative parameters, postoperative outcomes, and complication rates to assess the efficacy and safety of this surgical method. Cumulative sum (CUSUM) analysis was used to determine the learning curve based on operative time. RESULTS Of the 26 patients with VVF, 23 (88.5%) had successful fistula closure after the first surgery. One patient required open surgery conversion due to challenges in maintaining pneumovesicum, and two experienced recurrences, although successful repairs were achieved in subsequent surgeries. The average patient age was 47.4 years, with a mean operative time of 99.9 min. The postoperative hospital stay averaged 9.1 days, and catheterization lasted about 11 days. The CUSUM chart indicated a learning curve, with fluctuations until the 19th case, followed by a consistent upward pattern. CONCLUSION Laparoscopic pneumovesical VVF repair is an effective and safe technique, especially suitable for fistulas near the ureteral orifice or deep in the vaginal cavity. The method demonstrates favorable outcomes with minimal complications and allows for easy reoperation if necessary.
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Affiliation(s)
- Byeong Jo Jeon
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Bum Sik Tae
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jeong Wan Yoo
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Ho Young Koo
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Cheol Young Oh
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Gyeonggi-do, South Korea
| | - Jae Young Park
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jae Hyun Bae
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
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Medina LG, Lee RA, Celis V, Rodriguez V, Poncel J, Sayegh AS, Sotelo R. Robotic management of urinary fistula. Asian J Urol 2024; 11:357-365. [PMID: 39139533 PMCID: PMC11318412 DOI: 10.1016/j.ajur.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/13/2023] [Indexed: 08/15/2024] Open
Abstract
Objectives To highlight critical preoperative and intraoperative considerations in approaching fistula repair robotically. Methods A search of the literature was conducted to identify relevant articles pertaining to robotic management of urinary fistulae. Results Fistulae of the genitourinary tract can be a challenging dilemma for urologists, as definitive management may require surgical intervention. Pathogenesis of both enteric and non-enteric fistulae are multifactorial, and successful repair hinges on the meticulous perioperative evaluation, planning, and execution. Traditional open techniques can subject patients to increased morbidity and prolonged hospitalizations. Since its introduction, the robotic surgical platform has continued to expand its indications. Its three-dimensional visualization and tremor free wristed instrument movements have made the robotic platform an attractive option for genitourinary fistula reconstruction. Conclusion Robotic management of complex urinary fistulae is feasible in expert hands; more studies are needed to define its role in the treatment algorithm of this devastating conditions.
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Affiliation(s)
- Luis G. Medina
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Randall A. Lee
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Division of Urology, Department of Surgery, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Valeria Celis
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Veronica Rodriguez
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jaime Poncel
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Aref S. Sayegh
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rene Sotelo
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Vikram S, Om Kumar Y, Arjun Singh S, Mahendra S, Deepak Prakash B, Shashank T, Priyank B, Rahul J, Shivcharan N, Gautam Ram C. Genitourinary Fistula: epidemiology, changing trends in etiology and management: A tertiary care institute's perspective. Urologia 2024; 91:243-248. [PMID: 38497528 DOI: 10.1177/03915603241238597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Urogenital fistula is a physically, socially and psychologically devastating condition for the patient. In developed countries, these fistulae are typically related to gynecological surgery, pelvic pathology like malignancy or post radiation therapy. In contrast, classical teaching is that urogenital fistulae in the developing countries like India are usually associated with prolonged labor and obstetric complications. This retrospective study conducted at a tertiary care health Institute shows a paradigm shift in epidemiology, etiology and management of genitourinary fistulae in India in recent times. METHODS This retrospective study included patients undergoing surgical repair for various genitourinary fistulae at our institute from 2016 to 2022. Epidemiology, etiology, site, size and number of fistulae, clinical presentation, and management records of these patients were recorded and reviewed retrospectively. RESULTS In our study, the mean age of the patients was 38.4 ± 10.2 years. Vesicovaginal Fistula (VVF) was found to be most common fistula in the study population (87.5%) followed by vesicouterine (7.1%) and urethrovaginal fistula (5.4%). The causes of genitourinary fistula were iatrogenic (73.2%), carcinoma of cervix (16.1%), obstructed prolonged labor (7.1%), and genitourinary tuberculosis (3.57%). Among the 48 vesicovaginal fistulas that underwent surgery, 45.8% were treated using a transvaginal approach, 29.2% were managed through a laparoscopic transabdominal repair, and 25% were addressed using a robotic approach. Recurrence occurred in 7.1% of the operated patients. CONCLUSION Enhanced healthcare services in the country have contributed to a decrease in the incidence of obstructed labor, subsequently reducing related injuries. Iatrogenic injuries resulting from gynecological surgeries and carcinoma cervix have given rise to more complex fistulas, necessitating the implementation of advanced treatment strategies.
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Affiliation(s)
- Singh Vikram
- Department of Urology, AIIMS Jodhpur, Jodhpur, Rajasthan, India
| | - Yadav Om Kumar
- Department of Urology, AIIMS Jodhpur, Jodhpur, Rajasthan, India
| | - Sandhu Arjun Singh
- DnB Urology, Department of Urology, AIIMS Jodhpur, Jodhpur, Rajasthan, India
| | - Singh Mahendra
- DnB Urology, Department of Urology, AIIMS Jodhpur, Jodhpur, Rajasthan, India
| | | | | | | | - Jena Rahul
- Mch Urology, Department of Urology, AIIMS Jodhpur, Jodhpur, Rajasthan, India
| | - Navriya Shivcharan
- Mch Urology, Department of Urology, AIIMS Jodhpur, Jodhpur, Rajasthan, India
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Sharifiaghdas F, Emami M, Zargham M, Daneshpajooh A, Jahantabi E, Sharifimoghadam S, Mostafaei H, Salehi-Pourmehr H, Hajebrahimi S. Genitourinary Fistula: 5 Years' Experience of Five Referral Centers in Iran. Int Urogynecol J 2024; 35:893-900. [PMID: 38512606 DOI: 10.1007/s00192-024-05761-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/04/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Genitourinary fistula is a devastating ailment that has an impact on women's physical health, mental health, emotional health, and financial security. The management of genitourinary fistula depends on the type, size, and duration of fistula formation. The purpose of this study is to report the features of genitourinary fistula in Iranian women and our experience in the management of fistula. METHODS Retrospective chart reviews of 283 patients were performed to determine the cause of the fistula, prior repairs, tissue interposition, and the success rate. The operation was considered successful if the patient did not have any urine leakage during the observation time. RESULTS The mean (SD) age of women was 49.51 (19.39; range: 21-70) years, Of these, 137 (52.9%) had a history of previous genitourinary fistula surgery. The average fistula was 1.53 (0.041) cm in size. The median (interquartile range) operation lasted 70 (15) min. The success rate after fistula repair was 91.5%. The typical follow-up period lasted 13.26 (range: 1-88) months. Forty-three (15.2%) patients had a big fistula (>2.5 cm) and 4 patients (1.4%) had a history of pelvic radiation therapy, among other reasons for failure. After a second repair, all patients' initial failures were resolved. There were no significant complications, as classified by Clavien-Dindo class 2 or greater. Additionally, there were no bowel, ureteral, or nerve injuries. CONCLUSIONS Our patients with genitourinary fistula had a successful outcome following repair techniques, without any significant morbidity or mortality.
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Affiliation(s)
- Farzaneh Sharifiaghdas
- Department of Urology, Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Emami
- Department of Urology, Iran University of Medical Sciences, Tehran, Iran
| | - Mahtab Zargham
- Department of Urology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azar Daneshpajooh
- Department of Urology, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Elham Jahantabi
- Department of Urology, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Hanieh Salehi-Pourmehr
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sakineh Hajebrahimi
- Department of Urology, Tabriz University of Medical Sciences, Tabriz, Iran.
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
- Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
- Department of Urology, Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Imam Reza Teaching Hospital, Attar-E-Neishabouri Sqr., Tabriz, 51666, Iran.
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Chinthakanan O, Sirisreetreerux P, Saraluck A. Vesicovaginal Fistulas: Prevalence, Impact, and Management Challenges. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1947. [PMID: 38003996 PMCID: PMC10672783 DOI: 10.3390/medicina59111947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/21/2023] [Accepted: 10/29/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Vesicovaginal fistulas (VVFs) are an abnormal communication between the vagina and bladder and the most common type of acquired genital fistulas. This review will address the prevalence, impact, and management challenges of VVFs. Materials and Methods: Epidemiologic studies examining VVFs are considered. In addition, publications addressing the treatment of VVFs are reviewed. Results: VVFs in developing countries are often caused by obstructed labor, while most VVFs in developed countries have iatrogenic causes, such as hysterectomy, radiation therapy, and infection. The reported prevalence of VVFs is approximately 1 in 1000 post-hysterectomy patients and 1 in 1000 deliveries. VVFs affect every aspect of quality of life, including physical, mental, social, and sexual aspects. Prevention of VVFs is essential. Early diagnosis is necessary to reduce morbidity. Nutrition, infection control, and malignancy detection are important considerations during evaluation and treatment. Conservative and surgical treatment options are available; however, these approaches should be customized to the individual patient. The success rate of combined conservative and surgical treatments exceeds 90%. Conclusions: VVFs are considered debilitating and devastating. However, they are preventable and treatable; key factors include the avoidance of prolonged labor, careful performance of gynecologic surgery, and early detection.
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Affiliation(s)
- Orawee Chinthakanan
- Female Pelvic Medicine and Reconstructive Surgery Division, Department of Obstetrics & Gynecology, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Pokket Sirisreetreerux
- Urology Division, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
| | - Apisith Saraluck
- Female Pelvic Medicine and Reconstructive Surgery Division, Department of Obstetrics & Gynecology, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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Wang X, Gao Z, Li L, Tian D, Zhou H, Shen J. Clinical efficacy of flap transfer coverage in the treatment of vesicovaginal fistula. Int Urogynecol J 2023; 34:1797-1802. [PMID: 36738313 PMCID: PMC10415502 DOI: 10.1007/s00192-023-05465-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/31/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Vesicovaginal fistula (VVF) brings severe psychological, physiological, and social stress to patients, which seriously affects the quality of their sexual life. Traditional transvaginal repair surgery can cause vaginal shortening. Transferring the lateral free flap can maintain vaginal length. This study was carried out to investigate the clinical efficacy of the surgery of flap transfer coverage for treating VVF. METHODS A retrospective analysis was performed on 37 patients diagnosed with VVF and repaired by flap transfer coverage in the Urogynecology department of the First Affiliated Hospital of Kunming Medical University from January 2018 to June 2021. All patients took a prone split leg position to repair VVF with the flap transfer covering method and a chart review was performed. RESULTS Among the 37 patients, there were 34 cases of primary complete healing, and the success rate reached 91.89% without recurrence and complications. Three cases recurred with leakage of urine; cystoscopy showed that the fistula was significantly reduced, and all patients were cured after secondary repair by the same surgical method without complications. CONCLUSIONS Flap transfer coverage is a safe and effective surgical method for repairing VVF. The prone split leg position can better increase exposure. The fistula being away from the incision suture is the key to the success of the operation. Transferring the fistula can effectively improve the cure rate of VVF. Transferring the lateral free flap can maintain vaginal length.
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Affiliation(s)
- Xingqi Wang
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
- Yunnan Province Clinical Research Center for Chronic Kidney Disease, Kunming, 650032, China
| | - Zhenhua Gao
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
- Yunnan Province Clinical Research Center for Chronic Kidney Disease, Kunming, 650032, China
| | - Ling Li
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
- Yunnan Province Clinical Research Center for Chronic Kidney Disease, Kunming, 650032, China
| | - Daoming Tian
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
- Yunnan Province Clinical Research Center for Chronic Kidney Disease, Kunming, 650032, China
| | - Hang Zhou
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
- Yunnan Province Clinical Research Center for Chronic Kidney Disease, Kunming, 650032, China
| | - Jihong Shen
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China.
- Yunnan Province Clinical Research Center for Chronic Kidney Disease, Kunming, 650032, China.
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Tsakos E, Xydias EM, Ziogas AC, Bimpa K, Doumouchtsis SK, Karydas G, Moros V, Poulakis V. Surgical and Quality of Life Outcomes Following Robotic-Assisted (da Vinci) Laparoscopic Repair of Vesicovaginal Fistula: A Case Report and Video Demonstration. Cureus 2023; 15:e42171. [PMID: 37484789 PMCID: PMC10361450 DOI: 10.7759/cureus.42171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 07/25/2023] Open
Abstract
This report presents the case of a 63-year-old woman who developed a vesicovaginal fistula as a complication of a previous total hysterectomy. The fistula was treated with the use of the da Vinci X surgical system by a multi-disciplinary operating team, including senior Robotic Urological and Gynecological Surgeons at St. Luke's Hospital in Thessaloniki, Greece. The patient was monitored up to 12 months post-op at the time of writing and she was asked to evaluate post-op quality of life using the SF-36 and ICIQ-SF-UI questionnaires. The robotic surgical procedure was completed successfully. The total operation duration was 105 minutes, without any intra-operative complications. The patient was hospitalized for two days and made a swift, uneventful recovery. Regarding the quality of life, the patient reported satisfactory improvement in almost every domain assessed compared to her pre-op assessment; an improvement that was maintained throughout the reported follow-up period. At the time of writing, the patient reports no long-term complications and satisfactory urinary continence. Robotic-assisted laparoscopic vesicovaginal fistula repair is an effective and safe treatment option for this rare complication, as indicated by both post-operative data and the patient's own self-evaluation in this report. Further research is warranted, focusing on refining the surgical technique and comparing this to other alternative methods aiming to further improve patient outcomes.
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Affiliation(s)
- Elias Tsakos
- Department of Obstetrics and Gynaecology, EmbryoClinic IVF, Thessaloniki, GRC
- Department of Robotic Gynaecological Surgery, St. Luke's Hospital, Thessaloniki, GRC
| | - Emmanouil M Xydias
- Department of Obstetrics and Gynaecology, EmbryoClinic IVF, Thessaloniki, GRC
- Department of Medicine, University of Thessaly, School of Health Sciences, Larissa, GRC
| | - Apostolos C Ziogas
- Department of Medicine, University of Thessaly, School of Health Sciences, Larissa, GRC
| | - Kanelina Bimpa
- Department of Breast Surgery, EmbryoClinic IVF, Thessaloniki, GRC
| | - Stergios K Doumouchtsis
- Department of Obstetrics and Gynaecology, Epsom and St. Helier University Hospitals, Epsom, GBR
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Kurokawa I, Nomura Y, Nakagawa C, Okada Y, Fuji K, Yoshimura Y. Transvaginal vesicovaginal fistula closure: A retrospective study of 28 cases at a single facility in Japan. Int J Urol 2023; 30:586-591. [PMID: 36946367 DOI: 10.1111/iju.15181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/12/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVES We aimed to report the background of patients with vesicovaginal fistulas (VVFs) at our center, which has treated a relatively large number of such patients in Japan, as well as the ingenuity and outcomes of vesicovaginal fistula closure (VVFC). We also investigated the causes of VVFs. METHODS A retrospective review was performed for 28 patients with VVFs treated at our center. Age, body mass index, etiology, site of fistula, and postoperative outcomes were investigated. RESULTS Twenty-one (75%) fistulas occurred following hysterectomy. The overall success rate of VVFC was 85.7%, and the success rate limited to the first attempt was 89.5%. In 68% of cases, no bladder injury suspected as the cause of VVF was noticed during the surgery. Energy devices were used in all 12 patients for whom information on the type of device used for hysterectomy was confirmed. CONCLUSIONS To our knowledge, this is the first report to evaluate a relatively large number of VVFCs in Japan. Although VVF is thought to be caused by bladder injury during hysterectomy, delayed thermal damage might also result in this pathology, even if there is no apparent intraoperative bladder injury.
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Affiliation(s)
- Ippei Kurokawa
- Department of Female Pelvic Health Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
- Department of Urology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Yukiko Nomura
- Department of Female Pelvic Health Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
- Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Chie Nakagawa
- Department of Female Pelvic Health Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
- Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Yoshiyuki Okada
- Department of Female Pelvic Health Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
- Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Kohzo Fuji
- Department of Urology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Yasukuni Yoshimura
- Department of Female Pelvic Health Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
- Department of Urology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
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10
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Sandhu RS, Cheung F. Robotic-Assisted Surgery-a Highly Effective Modality for Vesicovaginal Fistula Repairs. Curr Urol Rep 2023; 24:117-120. [PMID: 36626078 DOI: 10.1007/s11934-022-01140-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW To summarize recent experience with robotic vesicovaginal fistula repair and describe the contemporary technique. RECENT FINDINGS Robotic vesicovaginal repair has been tested at multiple centers, with similar outcomes to open surgery. It has benefits including decreased hospital stay, less blood loss, and similar long-term outcomes. As long as the surgeon is experienced in robotic surgery, this technique appears to be promising. Robotic vesicovaginal repair results in similar outcomes to open surgery with decreased morbidity.
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Affiliation(s)
- Rajan S Sandhu
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Felix Cheung
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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11
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Tozzi R, Spagnol G, Marchetti M, Montan G, Saccardi C, Noventa M. Vaginal-Laparoscopic Repair (VLR) of Primary and Persistent Vesico-Vaginal Fistula: Description of a New Technique and Surgical Outcomes. J Clin Med 2023; 12:jcm12051760. [PMID: 36902546 PMCID: PMC10003712 DOI: 10.3390/jcm12051760] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023] Open
Abstract
The main aim of our study was to describe the surgical technique and evaluate the feasibility, efficacy and safety of a vaginal-laparoscopic repair (VLR) of iatrogenic vesico-vaginal fistulae (VVF). Between April-2009 and November-2017, we retrospectively reviewed all clinical, radiological and surgical details of surgery for benign or malignant disease and ended up with VVF. All patients were diagnosed by CT urogram, cystogram and clinical test. The surgical technique was standardised and is described here. Eighteen patients developed VVF after hysterectomy, three after caesarean section and three after hysterectomy and pelvic lymphadenectomy. Twenty-two patients had an average 3 (range 1-5) attempts at fistula repair in other hospitals. In one patient, five attempts were made. The mean size of the fistula was 2.4 cm (range 0.7-3.1 cm). A median 8 weeks (6-16) conservative management with Foley catheter failed in all patients. No conversion to laparotomy and no complication occurred at VLR. Median hospitalisation was 1.4 days (range 1-3). The latter confirmed all patients were dry and tested negative at a repeated filling test. At 36 months follow-up, all patients remained dry. In conclusion, VLR successfully repaired VVF in all patients with primary and persistent VVF. The technique was safe and effective.
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Affiliation(s)
- Roberto Tozzi
- Division of Women and Children’s Health, Department of Gynaecology and Obstetrics, University of Padua, 35122 Padua, Italy
- Nuffield Department of Women and Reproductive Health, University of Oxford, Oxford OX3 9DU, UK
- Correspondence:
| | - Giulia Spagnol
- Division of Women and Children’s Health, Department of Gynaecology and Obstetrics, University of Padua, 35122 Padua, Italy
| | - Matteo Marchetti
- Division of Women and Children’s Health, Department of Gynaecology and Obstetrics, University of Padua, 35122 Padua, Italy
| | - Giulia Montan
- Division of Women and Children’s Health, Department of Gynaecology and Obstetrics, University of Padua, 35122 Padua, Italy
| | - Carlo Saccardi
- Division of Women and Children’s Health, Department of Gynaecology and Obstetrics, University of Padua, 35122 Padua, Italy
| | - Marco Noventa
- Division of Women and Children’s Health, Department of Gynaecology and Obstetrics, University of Padua, 35122 Padua, Italy
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Tang M, Li P, Wang C, Zhang Q, Meng X. Clinical application of single-layer annular vaginal flap in transvaginal repair for vesicovaginal fistula. World J Urol 2023; 41:249-255. [PMID: 36394596 DOI: 10.1007/s00345-022-04222-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To compare the first-time success rate and prognosis of repairing vesicovaginal fistula (VVF) by transvaginal and transvesical approaches, and to highlight a modified transvaginal repair technique which only require single layer closure of an annular vaginal flap. METHODS Retrospective analysis of 57 consecutive patients who underwent VVF repair between 2007 and 2021. Fistula characteristics, operative factors, post-surgical complications and outcomes were analyzed. RESULTS A total of 57 women with a median age of 50.4 (27-75) years were included. The history ranged from 7 days to 8 years, with an average of 20 months. 56 cases (98.2%) of VVFs were caused by pelvic surgery, and only one resulted from difficult labour. 11 cases (19.3%) had a history of surgical repair failure. All 57 cases of surgery were smoothly completed. Among them, 17 patients underwent transvaginal repair, whereas 40 (70.2%) women had transvesical repair. Transvaginal approach had a significantly shorter operative time, less intraoperative blood loss, reduced postoperative hospital stay, less hospitalization cost and lower minor complication rates than transvesical group (p < 0.05). No serious complications occurred in the two groups. No cystostomy was performed in the transvaginal group, but 12 cases (30%) in the transvesical group. The average follow-up time was 18.5 (3-48) months. The first-time success rates of transvaginal and transvesical techniques were 82.3 and 75%, respectively. CONCLUSION VVF repair with single layer closure of an annular vaginal flap is a technically feasible, simple and successful approach with significantly better operative parameters and lower complications rates.
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Affiliation(s)
- Min Tang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210000, Jiangsu, China
| | - Pu Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210000, Jiangsu, China
| | - Chengming Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210000, Jiangsu, China
| | - Qian Zhang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210000, Jiangsu, China
| | - Xiaoxin Meng
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210000, Jiangsu, China.
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Duan XH, Li FY, Han XW, Wu G, Zhang JH, Tian YD, Zhang YC. Clinical Observation of Double Percutaneous Nephrostomy Combined with Ureter Occlusion Stent for Treating Cervical Cancer Complicated with Vesicovaginal Fistula. Cancer Biother Radiopharm 2022; 37:759-765. [PMID: 33016777 DOI: 10.1089/cbr.2020.4016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: To evaluate the efficacy of double percutaneous nephrostomy (PCN) combined with ureter occlusion stent for treating cervical cancer complicated with vesicovaginal fistula (VVF). Materials and Methods: A retrospective analysis was performed for 12 patients with cervical cancer complicated with VVF. Regardless of surgical resection, radiotherapy alone or combined chemoradiotherapy were carried out in all patients. After VVF was diagnosed by gynecological examination, imaging, and cystoscopy, concurrent double PCN and ureter occlusion stent implantation were performed for all patients. Results: All patients successfully received ureter occlusion stent implantation after nephrostomy. The success rate of nephrostomy and stent placement was 100% (12/12). After intervention, urinary fistula immediately disappeared in all patients. One week post-surgery, bilateral hydronephrosis disappeared in 4 patients, and their renal insufficiency and renal function returned to normal. One month after operation, 6 patients with genital eczema or ulcer and 5 patients with urinary tract infection were cured. During follow-up, there were no recurrence in urinary fistula, renal dysfunction, and other complications. Conclusion: Double PCN combined with ureter occlusion stent could effectively treat cervical cancer complicated with VVF hydronephrosis, urinary tract infection, and renal insufficiency and contribute to alleviate all kinds of clinical discomfort.
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Affiliation(s)
- Xu-Hua Duan
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Feng-Yao Li
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Xin-Wei Han
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Gang Wu
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Jian-Hao Zhang
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yu-Dong Tian
- Department of Urology Surgery, and The First Affiliated Hospital, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yan-Cang Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, People's Republic of China
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Kim S, Jeong H, Cho W. A novel technique for transurethral vesicovaginal fistula tract resection followed by transvaginal fistula repair: a two-step procedure. KOSIN MEDICAL JOURNAL 2022. [DOI: 10.7180/kmj.22.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: The principle of treatment for a vesicovaginal fistula (VVF) tract is complete removal of the fistula tract and surrounding scar tissue, followed by anastomosis without tension from surrounding healthy tissue. We present our novel two-step procedure for VVF repair. Methods: We retrospectively analyzed 12 women, aged 14 to 67 years, who were treated between 2011 and December 2018. Conservative treatments failed, as these patients had complex VVFs. This technique consisted of two steps: first, transurethral resection of the fistula tract and surrounding scar tissue; second, transvaginal repair of the bladder mucosa, bladder muscle, and vaginal mucosa with tensionless anastomosis. If an interposition flap was needed, we used a Martius flap.Results: The mean operation time was 186.3 minutes (range, 145–320 minutes), and the mean urethral catheter indwelling time was 10 days. Ten patients successfully underwent surgery through a transvaginal approach with no intraoperative or postoperative complications. However, one patient developed peritoneal perforation during transurethral resection of the fistula due to severe granulation tissue formation around the fistula, which prompted conversion to an abdominal approach. In two cases, we used a Martius flap because of the poor tissue condition due to previous radiation therapy and an inflammatory reaction. At a mean follow-up of 37 months (range, 16–51 months), no recurrence of VVF was observed in any patients.Conclusions: This novel technique for transurethral VVF tract resection followed by transvaginal fistula repair was very safe and effective technique, and this straightforward technique is expected to reduce surgeons’ burden.
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15
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Dejanovic D, Specht L, Czyzewska D, Kiil Berthelsen A, Loft A. Response Evaluation Following Radiation Therapy With 18F-FDG PET/CT: Common Variants of Radiation-Induced Changes and Potential Pitfalls. Semin Nucl Med 2022; 52:681-706. [PMID: 35835618 DOI: 10.1053/j.semnuclmed.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 11/11/2022]
Abstract
Radiation therapy (RT) is one of the cornerstones in cancer treatment and approximately half of all patients will receive some form of RT during the course of their cancer management. Response evaluation after RT and follow-up imaging with 18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) can be complicated by RT-induced acute, chronic or consequential effects. There is a general consensus that 18F-FDG PET/CT for response evaluation should be delayed for 12 weeks after completing RT to minimize the risk of false-positive findings. Radiation-induced late side effects in normal tissue can take years to develop and eventually cause symptoms that on imaging can potentially mimic recurrent disease. Imaging findings in radiation induced injuries depend on the normal tissue included in the irradiated volume and the radiation therapy regime including the total dose delivered, dose per fraction and treatment schedule. The intent for radiation therapy should be taken in consideration when evaluating the response on imaging, that is palliative vs curative or neoadjuvant vs adjuvant RT. Imaging findings can further be distorted by altered anatomy and sequelae following surgery within the radiation field. An awareness of common PET/CT-induced changes/injuries is essential when interpreting 18F-FDG PET/CT as well as obtaining a complete medical history, as patients are occasionally scanned for an unrelated cause to previously RT treated malignancy. In addition, secondary malignancies due to carcinogenic effects of radiation exposure in long-term cancer survivors should not be overlooked. 18F-FDG PET/CT can be very useful in response evaluation and follow-up in patients treated with RT, however, variants and pitfalls are common and it is important to remember that radiation-induced injury is often a diagnosis of exclusion.
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Affiliation(s)
- Danijela Dejanovic
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Lena Specht
- Department of Oncology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Dorota Czyzewska
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Kiil Berthelsen
- Department of Oncology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Annika Loft
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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16
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Sayegh AS, La Riva A, Perez LC, Rangel E, Medina LG, Adamic B, Sotelo R. Robotic-assisted vesicovaginal fistula repair using a vaginal cuff flap. Int Urogynecol J 2022; 33:2581-2585. [DOI: 10.1007/s00192-022-05144-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/24/2022] [Indexed: 10/18/2022]
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17
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Bellini MI, Lauro A, D'Andrea V, Marino IR. Benign Hepatic Tumors and Liver Transplantation: A Literature Review. EXP CLIN TRANSPLANT 2022; 20:231-236. [PMID: 34981714 DOI: 10.6002/ect.2021.0447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Management of benign liver tumors represents still an open debate, with no clear guidelines for patient selection, treatment options, and indications to surgical intervention. Usually, most of these diseases are conservatively treated, in view of their low potential malignancy and incidental diagnosis. However, when the lesions are symptomatic, with a major hepatic parenchyma involvement or life-threatening complications, liver transplant represents the only curative option. The scope of this review is to present an up-to-date state of the art of transplantable benign hepatic neoplasms.
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18
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Fan X, Ma X, Lai Y, Li Z, Huang J, Huang H. Suprapubic Transvesical Repair of Vesicovaginal Fistula Using a Homemade Laparoscopic Single-Port Device: Experience of 42 Patients. Front Surg 2021; 8:744226. [PMID: 34805259 PMCID: PMC8595089 DOI: 10.3389/fsurg.2021.744226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/11/2021] [Indexed: 01/09/2023] Open
Abstract
Aim: Vesicovaginal fistula (VVF) is the most common urogenital acquired fistula, and has remained a scourge and of public health importance. VVF can be repaired by transvaginal approach, transabdominal approach or transvesical approach, but the optimal management is still debated. Methods: To demonstrate a suprapubic transvesical approach to repair VVFs using a homemade laparoscopic single-port device. A retrospective review of the medical records of 42 consecutive patients who underwent fistula repair for VVF at our center from January 2012 to March 2018 was performed. VVFs were repaired by a suprapubic transvesical approach using a homemade laparoscopic single-port device. Clinical data, perioperative data and outcomes were collected. The primary outcome was VVF successful closure rate, and secondary outcome was perioperative complications. Results: The mean age of the patients was 44.6 (27–58) yr. The mean follow-up time was 65.6 (32–118) mo. The VVFs were successfully closed in 37 (88.1%) patients after the first surgery, and failure was observed in five patients. Initial failures of all the five patients were cured after a second repair. No major complication occurred as defined by Clavien-Dindo class 2 or greater. Conclusions: Suprapubic transvesical approach to repair VVFs using a homemade laparoscopic single-port device is a simple, effective, and feasible approach offering ideal results without major complications.
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Affiliation(s)
- Xinxiang Fan
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Clinical Research Center for Urological Diseases, Guangzhou, China
| | - Xiaoming Ma
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yiming Lai
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zean Li
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jian Huang
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Clinical Research Center for Urological Diseases, Guangzhou, China
| | - Hai Huang
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Clinical Research Center for Urological Diseases, Guangzhou, China
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Rasic D, Zenko Sever A, Rasic F, Strbe S, Rasic Z, Djuzel A, Duplancic B, Boban Blagaic A, Skrtic A, Seiwerth S, Sikiric P, Sever M. Stable Gastric Pentadecapeptide BPC 157 Heals Established Vesicovaginal Fistula and Counteracts Stone Formation in Rats. Biomedicines 2021; 9:biomedicines9091206. [PMID: 34572392 PMCID: PMC8465604 DOI: 10.3390/biomedicines9091206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/05/2021] [Accepted: 09/07/2021] [Indexed: 12/18/2022] Open
Abstract
With the stable gastric pentadecapeptide BPC 157 therapy known to heal various both external and internal rat fistulas, we attempt to approach vesicovaginal fistula, continuous urine leaking through vagina, bladder stones, and a possible therapy solution among rats with well-formed 2 week-fistulas (vaginal/vesical 4 mm large defects) started with delayed therapy. Subsequent control fistula course (the subsequent 1, 2, 4, and 6 weeks) since beginning revealed the failed healing, fistula leaking, adhesions, urinary leaking through vagina, failed epithelization, collagenization, granulation tissue and neovascularization, increased inflammation, and necrosis. Thereby, the later intervals revealed the persistent inability to sustain even minimal volume, vesical, and vaginal defects and stone formation at the end of the experiment (fistula-time day 56). BPC 157 therapy (10 µg/kg, 10 ng/kg, intraperitoneally once time daily or perorally in drinking water until sacrifice) was initiated with a considerable delay (at 2 weeks after fistula formation). Already within 1 week therapy, all BPC 157 regimens stopped urinary leaking through vagina, reversed the otherwise resistant poor healing course to the increased epithelization, collagenization, granulation tissue and neovascularization, decreased inflammation, and decreased necrosis. Thereby, at later intervals, all BPC 157 rats exhibited a five times larger volume that can be sustained before leaking as in healthy, vesical, and vaginal defects completely closed and no stone formation. Thus, macro/microscopic and functional recovery, and counteracted stone formation. Concluding, BPC 157 therapy’s beneficial effects resulted in healing and no stone formation, with µg- and ng-regimens, either given daily perorally in drinking water or intraperitoneally.
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Affiliation(s)
- Domagoj Rasic
- Department of Urology, School of Medicine, University of Zagreb, Salata 3b, 10000 Zagreb, Croatia;
| | - Anita Zenko Sever
- Department of Pathology, School of Medicine, University of Zagreb, Salata 9, 10000 Zagreb, Croatia; (A.Z.S.); (S.S.)
| | - Fran Rasic
- Department of Pharmacology, School of Medicine, University of Zagreb, POB 916, Salata 11, 10000 Zagreb, Croatia; (F.R.); (S.S.); (A.D.); (A.B.B.)
| | - Sanja Strbe
- Department of Pharmacology, School of Medicine, University of Zagreb, POB 916, Salata 11, 10000 Zagreb, Croatia; (F.R.); (S.S.); (A.D.); (A.B.B.)
| | - Zarko Rasic
- Department of Surgery, School of Medicine, University of Zagreb, Salata 3b, 10000 Zagreb, Croatia; (Z.R.); (M.S.)
| | - Antonija Djuzel
- Department of Pharmacology, School of Medicine, University of Zagreb, POB 916, Salata 11, 10000 Zagreb, Croatia; (F.R.); (S.S.); (A.D.); (A.B.B.)
| | - Bozidar Duplancic
- Department of Anaesthesia, School of Medicine, 21000 Split, Croatia;
| | - Alenka Boban Blagaic
- Department of Pharmacology, School of Medicine, University of Zagreb, POB 916, Salata 11, 10000 Zagreb, Croatia; (F.R.); (S.S.); (A.D.); (A.B.B.)
| | - Anita Skrtic
- Department of Pathology, School of Medicine, University of Zagreb, Salata 9, 10000 Zagreb, Croatia; (A.Z.S.); (S.S.)
- Correspondence: (A.S.); (P.S.); Tel.: +385-1-4566-980 (A.S.); +385-1-4566-833 (P.S.); Fax: +385-1-492-0050 (A.S. & P.S.)
| | - Sven Seiwerth
- Department of Pathology, School of Medicine, University of Zagreb, Salata 9, 10000 Zagreb, Croatia; (A.Z.S.); (S.S.)
| | - Predrag Sikiric
- Department of Pharmacology, School of Medicine, University of Zagreb, POB 916, Salata 11, 10000 Zagreb, Croatia; (F.R.); (S.S.); (A.D.); (A.B.B.)
- Correspondence: (A.S.); (P.S.); Tel.: +385-1-4566-980 (A.S.); +385-1-4566-833 (P.S.); Fax: +385-1-492-0050 (A.S. & P.S.)
| | - Marko Sever
- Department of Surgery, School of Medicine, University of Zagreb, Salata 3b, 10000 Zagreb, Croatia; (Z.R.); (M.S.)
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Jang W, Song JS. [Uterine Cervical Cancer: Emphasis on Revised FIGO Staging 2018 and MRI]. TAEHAN YONGSANG UIHAKHOE CHI 2021; 82:1083-1102. [PMID: 36238389 PMCID: PMC9432380 DOI: 10.3348/jksr.2021.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/05/2021] [Accepted: 09/17/2021] [Indexed: 11/15/2022]
Abstract
Uterine cervical cancer is a common gynecological cancer prevalent in Korea. Early detection, precise diagnosis, and appropriate treatment can affect its prognosis. Imaging approaches play an important role in staging, treatment planning, and follow-up. MRI specifically provides the advantage of assessing tumor size and disease severity with high soft tissue contrast. The revised version of the International Federation of Gynecology and Obstetrics (FIGO) staging system has been introduced in 2018, which incorporates subdivided primary tumor size and lymph node metastasis. In this review, the staging of uterine cervical cancer based on previous studies, the recently revised FIGO staging, and various post-treatment images are primarily described using MRI.
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21
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Evaluation and Management of Genitourinary Emergencies in Patients with Cancer. Emerg Med Int 2021; 2021:4511968. [PMID: 34367695 PMCID: PMC8337163 DOI: 10.1155/2021/4511968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/10/2021] [Accepted: 07/17/2021] [Indexed: 02/03/2023] Open
Abstract
Background Genitourinary emergencies in cancer patients are common. Most cancer treatments are administered in the outpatient setting, and patients with complications often visit the emergency department. However, there is no recent emergency medicine literature review focusing on genitourinary emergencies in the oncologic population. Objective of the review. To increase awareness of common genitourinary emergencies in patients with cancer and enable the prompt recognition and appropriate management of these conditions. Discussion. Genitourinary emergencies in patients with cancer require a multidisciplinary approach to treatment. The most common genitourinary emergencies in patients with cancer are related to infection, obstructive uropathy, hemorrhagic cystitis, and complications associated with urinary diversions. The treatment approach in patients with infections, including viral infections, is similar to those without cancer. Understanding the changes in the anatomy of patients with urinary diversions or fistulas can help with the management of genitourinary emergencies. Conclusions Familiarization with the uniqueness of genitourinary emergencies in patients with cancer is important for emergency physicians.
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22
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Ting NS, Lee HC, Ke JY, Li PC, Ding DC. Total uterine prolapse complicated with vesicovaginal fistula: A case report. Medicine (Baltimore) 2021; 100:e26386. [PMID: 34128901 PMCID: PMC8213252 DOI: 10.1097/md.0000000000026386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/26/2021] [Accepted: 06/02/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Vesicovaginal fistula (VVF) most commonly occurs due to iatrogenic injury during surgery or obstructed labor. We report a rare case of a patient with severe pelvic organ prolapse who developed VVF even though pessary had not been used. PATIENT CONCERNS A 63-year-old postmenopausal woman, para 3 (all spontaneous vaginal deliveries), complained of vaginal bulging sensation and involuntary urinary leakage for 3 years. DIAGNOSIS Stage IV uterine prolapse with VVF. INTERVENTIONS She underwent transvaginal VVF repair combined with total vaginal hysterectomy and sacrospinous ligament fixation. The postoperative course was uncomplicated. OUTCOMES The patient remained free of complications during the 1-year follow-up. LESSONS This case illustrates the point that patients with pelvic organ prolapse (POP) should be treated promptly and careful follow-up should be conducted. Clinicians should be aware of the symptoms of VVF to ensure its early diagnosis and treatment.
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Affiliation(s)
- Ning-Shiuan Ting
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
| | - Hsiang-Chen Lee
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
| | | | - Pei-Chen Li
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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23
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Milani R, D'Alessandro G, Barba M, Cola A, Volontè S, Frigerio M. Transvaginal primary layered repair of postsurgical urethrovaginal fistula. Int Urogynecol J 2021; 32:1941-1943. [PMID: 33950308 DOI: 10.1007/s00192-021-04819-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 04/18/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Urethrovaginal fistula (UVF) is a rare disorder, which implies the presence of an abnormal communication between the urethra and the vagina. METHODS Surgical repair options include transurethral, transabdominal and transvaginal procedures, either with or without tissue interposition. The vaginal route is considered a safe and effective option to correct UVF. This video is aimed to present a case of direct transvaginal layered repair of urethrovaginal fistula, without the use of tissue interposition. The featured patient is a 66-year-old woman who developed a symptomatic UVF after a complicated laparoscopic hysterectomy for endometrial cancer 3 years before. Cystoscopy demonstrated the presence of a 7 mm urethral orifice a few millimeters caudal from the bladder neck. After proper informed consent, the patient was admitted to transvaginal primary layered repair, according to the technique demonstrated in the video. The featured procedure was completed in 60 min and blood loss was < 100 ml. No surgical complications were observed. RESULTS The procedure was successful in restoring the anatomy and relieving the symptoms. CONCLUSION Transvaginal layered repair without tissue interposition represents a safe and effective procedure for the surgical management of postsurgical urethrovaginal fistula.
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Affiliation(s)
- Rodolfo Milani
- University of Milano-Bicocca, Monza, Italy
- ASST Monza, Ospedale San Gerardo, via G.B. Pergolesi, 33 20900, Monza, Italy
| | - Gloria D'Alessandro
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marta Barba
- University of Milano-Bicocca, Monza, Italy.
- ASST Monza, Ospedale San Gerardo, via G.B. Pergolesi, 33 20900, Monza, Italy.
| | - Alice Cola
- University of Milano-Bicocca, Monza, Italy
| | | | - Matteo Frigerio
- ASST Monza, Ospedale San Gerardo, via G.B. Pergolesi, 33 20900, Monza, Italy
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Glaser SM, Mohindra P, Mahantshetty U, Beriwal S. Complications of intracavitary brachytherapy for gynecologic cancers and their management: A comprehensive review. Brachytherapy 2021; 20:984-994. [PMID: 33478905 DOI: 10.1016/j.brachy.2020.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 11/21/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
Intracavitary gynecologic brachytherapy in the form of tandem-based brachytherapy and vaginal cylinder-based brachytherapy represents a fundamental component of the treatment of women with cervical or uterine cancer due to the ability to deliver a therapeutic dose of radiation with sharp dose falloff. This results in highly effective treatment in terms of oncologic outcomes with an overall favorable toxicity profile. Still, complications and side effects of brachytherapy do exist. While advances in brachytherapy techniques have led to a significant decrease in the rates of toxicity, a thorough understanding of the potential complications is crucial to ensuring optimal outcomes for women with gynecologic cancer undergoing brachytherapy. Use of equivalent dose at 2 Gy per fraction (EQD2) models has allowed incorporation of external beam radiotherapy dose to the brachytherapy dose leading to development of consolidated dose constraints for organs-at-risk in the modern era. This manuscript offers a comprehensive review of potential complications associated with intracavitary brachytherapy for gynecologic cancer including predictive factors, mitigation tactics, and management strategies.
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Affiliation(s)
- Scott M Glaser
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA.
| | - Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | | | - Sushil Beriwal
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA
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Özkaya F, Cinislioğlu AE, Aksoy Y, Adanur Ş, Topdağı Yılmaz EP, Polat Ö, Demirdöğen ŞO, Özbey İ. Vesicovaginal fistula repair experiences in a single center high volume of 33 years and necessity of cystostomy. Turk J Urol 2021; 47:66-72. [PMID: 32833621 PMCID: PMC7815243 DOI: 10.5152/tud.2020.20080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/27/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to retrospectively examine the patients who underwent surgical treatment for vesicovaginal fistula (VVF) repair in our clinic, to evaluate our surgical preferences, success, and treatment results, to compare these with the literature, and firstly to reveal the necessity of cystostomy and its effect on treatment success. MATERIAL AND METHODS Between 1985 and 2018, a retrospective evaluation was performed on the records of 102 patients who underwent surgical treatment for VVF repair. All cases underwent a detailed physical examination and had their routine laboratory tests and imaging methods. In obese patients, a Foley catheter was moved into the bladder through the fistula tract, then inflated in order to push the vagina and bladder wall upwards. A transurethral catheter was used in all cases, and cystostomy was used in 58 (56.9%). RESULTS The most common cause was prior hysterectomy for benign diseases in 35 (34.31%) cases. Among a total of 102 cases with for VVF, 95 (93.1%) were primary, 5 (4.9%) secondary, and 2 (1.9%) tertiary. The transvesical and O'Connor approaches (transabdominal) were performed in 61 (59.8%) and 41 (40.2%) cases, respectively. Transvaginal approach was not used in any of the cases. Cystostomy was applied in 58 (56.9%) of cases and not applied in 44 (43.1%). CONCLUSION Complete excision of the fistula tract and sealing of the layers separately using the water-tight technique are extremely crucial factors to increase the success rate of VVF repair. In cases where good transurethral drainage is ensured, cystostomy is unnecessary and may increase the risk of infection.
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Affiliation(s)
- Fatih Özkaya
- Department of Urology, Atatürk University Faculty of Medicine, Erzurum, Turkey
- Anesthesiology Clinical Research Office, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Ahmet Emre Cinislioğlu
- Department of Urology, Health Science University, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Yılmaz Aksoy
- Department of Urology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Şenol Adanur
- Department of Urology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | | | - Özkan Polat
- Department of Urology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Şaban Oğuz Demirdöğen
- Department of Urology, Health Science University, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - İsa Özbey
- Department of Urology, Atatürk University Faculty of Medicine, Erzurum, Turkey
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Mörgeli C, Tunn R. Vaginal repair of nonradiogenic urogenital fistulas. Int Urogynecol J 2020; 32:2449-2454. [PMID: 32897458 DOI: 10.1007/s00192-020-04496-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 08/13/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS In developed countries urogenital fistulas are rare and usually a complication of surgery or radiation therapy. Surgical repair can be accomplished transvaginally or by laparotomy, laparoscopy, robotic-assisted laparoscopy, or transurethral endoscopy. Closure can be achieved with or without tissue interposition. The vaginal approach is the least invasive and a variety of techniques with or without tissue interpositions and flaps have been described. This study reviews surgical approaches and techniques for the repair of nonradiogenic urogenital fistulas. METHODS We identified and reviewed records from all patients treated for urogenital fistulas at our unit between 2008 and 2018. We analyzed fistula location, etiology, type and duration of corrective surgery, length of hospitalization, as well as complication and success rates. RESULTS Fifty patients (mean age 52 years) were identified. 49 fistulas were related to previous gynecological surgery, 3 were related to obstetric trauma. Thirty-four patients had vesicovaginal, 11 urethrovaginal, 3 ureterovaginal, and 2 neobladder-vaginal fistulas. Forty-eight patients (96%) were operated on using a vaginal approach; a modified Sims-Simon repair was used in 47 cases (94%). No flaps or tissue interpositions were used. In 48 patients (96%) successful closure was achieved with one operation; the modified Sims-Simon technique was successful in all 47 cases. The median operation time was 40 min (range, 20-100 min); the complication rate was 14%. CONCLUSIONS This series demonstrates the feasibility and advantages of vaginal repair of benign gynecological fistulas. The success rate was high and extensive procedures were avoided.
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Affiliation(s)
- Claudia Mörgeli
- Department of Urogynecology, Alexianer St. Hedwig Hospital, Berlin, Germany.
| | - Ralf Tunn
- Department of Urogynecology, Alexianer St. Hedwig Hospital, Berlin, Germany
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Marina T, Lago V, Padilla P, Matute L, Domingo S. Vesicovaginal Fistula Repair by Modified Martius Flap: A Step-by-Step Surgical Technique Video. Ann Surg Oncol 2020; 28:1002-1006. [PMID: 32797377 DOI: 10.1245/s10434-020-09020-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/25/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Fistula repair in the perineal region represents a major challenge for surgeons. It is important for the medical community to facilitate and disclose these techniques. OBJECTIVE The aim of this article was to show a stepwise approach for a direct repair and use of a Martius flap for a vesicovaginal fistula. METHODS We show a single case performed in a patient who presented with a vesicovaginal fistula diagnosed after surgery, which did not respond to conservative management. The procedure consists of the following steps: intraoperative cystoscopy, anatomical direct repair of the fistulous tract between the bladder and vagina, and modified Martius flap. CONCLUSIONS Martius flap is a repair technique used for complex fistula in the perineal region. It is a simple, safe, and reproducible procedure with good long-term functional and esthetic results.
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Affiliation(s)
- Tiermes Marina
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain.
| | - Víctor Lago
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
| | - Pablo Padilla
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
| | - Luis Matute
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
| | - Santiago Domingo
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
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Akpak YK, Yenidede I, Kilicci C. Evaluation of etiology, characteristics, and treatment of patients with vesicovaginal fistula observed in rural Africa. J Gynecol Obstet Hum Reprod 2020; 50:101879. [PMID: 32712179 DOI: 10.1016/j.jogoh.2020.101879] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In this study, we aimed to evaluate the etiology, characteristics, and treatment of patients with diagnosis of vesicovaginal fistula (VVF) due to labor in rural Africa following surgery in a hospital with western standards according to the current literature. METHODS In this retrospective large case series, 56 patients undergoing surgery due to prediagnosis of VVF and then followed-up regularly in Nyala-Sudan Turkey Training and Research Hospital between December 2018 and February 2019 were evaluated. The information related to the ages, mode, and the number of deliveries, previous histories of fistula repair surgery, postoperative success and complication rates were gathered. RESULTS The absence of urine from the vagina during the examination with methylene blue was defined as success. The overall success rate was 84.3 %. The vaginal route was most commonly preferred for fistula repair surgery and its success rate and efficiency were found to be higher. In addition, a low complication rate was observed as 3.9 %. A higher rate of association was observed between Female Genital Mutilation/Cutting (FMG/C) and fistula. Especially FGM/C type 3 was frequently seen with a rate of 61.7 %. This type of FGM/C was observed in all patients undergoing reoperation. The main causes of recurrence of fistula were vaginal delivery within 6 months of repair or presence of multiple fistulas at diagnosis. CONCLUSIONS The surgery and follow-up process should be individualized after this examination based on the condition, clinical picture of the patient and surgeon's experience. Additionally worldwide steps should be taken to prevent FGM/C as it is associated with many undesired outcomes including VVF.
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Affiliation(s)
- Yasam Kemal Akpak
- University of Health Science, Tepecik Training and Research Hospital, Department of Obstetrics and Gynaecology, Izmir, Turkey; University of Health Science, Nyala Sudan-Turkey Training and Research Hospital, Department Obstetrics and Gynaecology, Nyala, Sudan.
| | - Ilter Yenidede
- Zeynep Kamil Women and Children's Disease Training and Research Hospital, Department Obstetrics and Gynaecology, Istanbul, Turkey
| | - Cetin Kilicci
- Zeynep Kamil Women and Children's Disease Training and Research Hospital, Department Obstetrics and Gynaecology, Istanbul, Turkey
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Randazzo M, Lengauer L, Rochat CH, Ploumidis A, Kröpfl D, Rassweiler J, Buffi NM, Wiklund P, Mottrie A, John H. Best Practices in Robotic-assisted Repair of Vesicovaginal Fistula: A Consensus Report from the European Association of Urology Robotic Urology Section Scientific Working Group for Reconstructive Urology. Eur Urol 2020; 78:432-442. [PMID: 32653322 DOI: 10.1016/j.eururo.2020.06.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/10/2020] [Indexed: 10/23/2022]
Abstract
CONTEXT Surgical repair of a vesicovaginal fistula (VVF) has been described extensively in the literature for several decades. Advances in robotic repair have been adopted since 2005. OBJECTIVE A consensus review of existing data based on published case series, expert opinion, and a survey monkey. EVIDENCE ACQUISITION This document summarizes the consensus group meeting and survey monkey results convened by the European Association of Urology Robotic Urology Section (ERUS) relating to the robotic management of VVF. EVIDENCE SYNTHESIS Current data underline the successful robotic repair of supratrigonal nonobstetric VVF. The panel recommends preoperative marking of the fistula by a guidewire or ureteral catheter, and placement of a protective ureteral JJ stent. An extravesical robotic approach usually provides a good anatomic view for adequate and wide dissection of the vesicovaginal space, as well as bladder and vaginal mobilization. Careful sharp dissection of fistula edges should be performed. Tension-free closure of the bladder is of utmost importance. Tissue interposition seems to be beneficial. The success rate of published series often reaches near 100%. An indwelling bladder catheter should be placed for about 10 d postoperatively. CONCLUSIONS When considering robotic repair for VVF, it is essential to establish the size, number, location, and etiology of the VVF. Robotic assistance facilitates dissection of the vesicovaginal space, harvesting of a well-vascularized tissue flap, and a tension-free closure of the bladder with low morbidity for the patient being operated in the deep pelvis with delicate anatomical structures. PATIENT SUMMARY Robotic repair of a vesicovaginal fistula can be applied safely with an excellent success rate and very low morbidity. This confirms the use of robotic surgery for vesicovaginal fistula repair, which is recommended in a consensus by the European Association of Urology Robotic Section Scientific Working Group for reconstructive urology.
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Affiliation(s)
- Marco Randazzo
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Linda Lengauer
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | | | | | - Darko Kröpfl
- Department of Urology, Klinik Essen Mitte, Essen, Germany
| | - Jens Rassweiler
- Department of Urology, SLK Kliniken Heilbronn, Heilbronn, Germany
| | | | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai Health System, New York, NY, USA
| | | | - Hubert John
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland.
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Outcomes of Urinary Diversion for Late Adverse Effects of Gynecologic Radiotherapy. Urology 2020; 144:214-219. [PMID: 32634446 DOI: 10.1016/j.urology.2020.06.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/19/2020] [Accepted: 06/24/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To describe the risks of urinary diversion performed to address adverse effects of gynecologic radiation, with the hypothesis that high grade complications would be more common in sarcopenic women and in those undergoing continent diversion (vs noncontinent) or concomitant cystectomy (vs bladder-sparing diversion). METHODS A retrospective review was performed of patient records of women who underwent urinary diversion for urinary adverse effects of gynecologic radiotherapy during the period of 2008-2018 from 3 tertiary centers. Skeletal muscle index was calculated to assess for sarcopenia based on preoperative computed tomography scans. Outcomes include high-grade postoperative complications within 90 days of surgery, 30-day readmission rate, and long-term (>90 days) outcomes. RESULTS Among 34 women who met the inclusion criteria, the majority were white/Caucasian (73.5%). Twenty-six of 34 (76.5%) underwent noncontinent diversion. Seventy nine percent (27/34) (79.4%) of women experienced complications within 90 days; 9 of 34 (26.5%) experienced high-grade (Clavien grade ≥3) complications. Thirty-two percent (11/34) were readmitted within 30 days. Rates of high-grade complications were not significantly impacted by diversion type (P = .49), concurrent cystectomy (P = .70), or sarcopenia (P = 1.0). CONCLUSIONS Urinary diversion for late adverse effects of gynecologic radiotherapy is associated with high peri-operative risk, even in skilled hands. In this series, neither sarcopenia, nor continent diversion, nor cystectomy were associated with increased complications. Patients and surgeons should consider risks and benefits when deciding to proceed with urinary diversion, however further study is needed to elucidate significant preoperative markers which may predispose patients to significant complications.
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Transvaginal Repair of Apical Vesicovaginal Fistula: A Modified Latzko Technique—Outcomes at a High-volume Referral Center. Eur Urol 2019; 76:84-88. [DOI: 10.1016/j.eururo.2019.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/11/2019] [Indexed: 01/09/2023]
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Abstract
Vesicovaginal fistula (VVF) is an abnormal communication between the bladder and the vagina. Prompt diagnosis and timely repair are essential for successful management of these cases. As the clinical scenario is variable, it is difficult to frame uniform guidelines for the management of VVF. Hence, the management protocol is dependent on the treating surgeon and the available resources. Conservative methods should be used in carefully selected patients. Delayed repair is better than the early repair of VVF. Transvaginal route for repair is preferred as it has low morbidity, higher success rates, and minimal complications. Anticholinergics should be used in the postoperative period for better chance of bladder healing. When facilities are available, all the patients may be referred to a tertiary care center where expertise and advanced resources are available. Trained surgeons adapting the new trends should refine the art of VVF repair.
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Affiliation(s)
| | | | - Arabind Panda
- Department of Urology, KIMS Hospitals, Secunderabad, Telangana, India
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Lobo N, Kulkarni M, Hughes S, Nair R, Khan MS, Thurairaja R. Urologic Complications Following Pelvic Radiotherapy. Urology 2018; 122:1-9. [DOI: 10.1016/j.urology.2018.07.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 06/17/2018] [Accepted: 07/07/2018] [Indexed: 11/28/2022]
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Breen M, Ingber M. Controversies in the management of vesicovaginal fistula. Best Pract Res Clin Obstet Gynaecol 2018; 54:61-72. [PMID: 30037532 DOI: 10.1016/j.bpobgyn.2018.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 04/24/2018] [Accepted: 06/12/2018] [Indexed: 10/28/2022]
Abstract
Achieving 100% closure and continence rate in the management of vesicovaginal fistulas remains a challenge. There is still debate about several aspects of the care including the following.
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Affiliation(s)
- Michael Breen
- Centre de Soins des Fistules, Centre Hospitalier Universitaire Toamasina, Hospital Be Toamasina, Boite Postale, 501 Toamasina, Madagascar.
| | - Michael Ingber
- The Center for Specialized Women's Health, Garden State Urology, Atlantic Health System, 3155 State Route 10E, Suite 100, Denville, NJ, 07834, USA.
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Giusti G, Lucci Chiarissi M, Abate D, De Vita G, Angioni S, De Lisa A. Early Repair of Post-hysterectomy Vesicovaginal Fistulae Through a Laparoscopic Transperitoneal Extravesical Approach. Experience of a Single Center. Urology 2018; 119:44-48. [PMID: 29885331 DOI: 10.1016/j.urology.2018.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/05/2018] [Accepted: 05/16/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To verify the feasibility and effectiveness of the correction of vesicovaginal fistulae (VVF) through a laparoscopic transperitoneal extravesical approach and TachoSil application as interposition tissue. VVF are the most common fistulae of the urinary tract and even today there is no agreement over the preferred approach to treat this kind of pathologic condition. METHODS We retrospectively analyzed the data of women who, from July 2010 to July 2017, underwent early laparoscopic transperitoneal extravesical VVF repair. Patients were placed in the lithotomy position. Five operating ports were placed. After the resection of the VVF, the vesical and vaginal edges were closed in two layers. Finally two layers of TachoSil (4 cm x 4 cm) were placed between the sutures. Several variables were considered in the perioperative period. Patients were re-evaluated at 1 and 3 months after surgery. RESULTS Sixteen patients underwent VVF repair. Mean duration of the surgery was 106 minutes, mean length of stay was 3.2 days. No high grade complications according to Clavien-Dindo were reported. At 1 month all patients showed complete continence and at 3 months they reported a good quality of life. CONCLUSION The laparoscopic approach described enables adequate repair of VVF. The use of Tachosil is straightforward and atraumatic, and may be considered as an alternative to tissue flap interposition. Finally, we confirm that the early approach is not a hazard in such a disabling disease and can be adopted to restore as soon as possible the good quality of life for patients.
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Affiliation(s)
- Giuseppe Giusti
- Department of Urology, University of Cagliari, Cagliari, Italy.
| | | | - Danilo Abate
- Department of Urology, University of Cagliari, Cagliari, Italy
| | | | - Stefano Angioni
- Division of Gynecology and Obstetrics, University of Cagliari, Monserrato, Italy
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Abstract
Female voiding dysfunction and incontinence are common in the general population and symptoms have been shown to have a significant negative impact on health-related quality of life. This article highlights the epidemiology, evaluation, diagnosis, pharmacologic therapies, and surgical treatment for overactive bladder, stress urinary incontinence, and urogenital fistulas.
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Affiliation(s)
- Amanda Vo
- Department of Urology, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Tarry 16-703, Chicago, IL 60611, USA
| | - Stephanie J Kielb
- Department of Urology, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Tarry 16-703, Chicago, IL 60611, USA.
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Ureterovaginal fistula: A complication of a vaginal foreign body. Taiwan J Obstet Gynecol 2018; 57:150-152. [PMID: 29458888 DOI: 10.1016/j.tjog.2017.12.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To know the diagnostic tools and proper management of ureterovaginal fistula following neglected vaginal foreign body in order to achieve optimal outcome. CASE REPORT A case of ureterovaginal fistula associated with a neglected vaginal foreign body. The patient was complaining of a foul-smelling vaginal discharge and lower abdominal pain. On vaginal examination, a hard and large foreign body was found. Examination under anesthesia was performed, and an aerosol cap was removed from her vagina. The patient developed urinary incontinence after removal of the foreign body. Subsequent work-up demonstrated the presence of a right ureterovaginal fistula. The patient underwent an abdominal ureteroneocystostomy. At one year follow up, the patient had fully recovered. CONCLUSION Ureterovaginal fistula following neglected vaginal foreign body is a serious condition. Early diagnosis, treatment of infection and proper surgical management can improve the outcome and decrease complications.
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Abstract
BACKGROUND Vesico-vaginal fistulae (VVF) remain the most prevalent genitourinary fistula detrimentally impacting quality of life. PURPOSE OF THE REVIEW The purpose of this review is to examine relevant literature on management of VVF. RECENT FINDINGS Obstructed labor is the leading cause of VVF in the developing world with most repairs performed via the transvaginal approach. Conversely, the predominate etiology in industrialized nations is iatrogenic injury with an increasing trend towards abdominal repair via a minimally invasive (laparoscopic and robotic) approach. No studies have compared transvaginal repair to minimally invasive transabdominal approaches. Further, an increasing number of authors have developed algorithms to determine optimum surgical approaches and risk factors for persistent incontinence. As surgeons become more facile with laparoscopic and robotic skills, there is a growing trend for minimally invasive surgical management of VVF in developed countries, perhaps widening the disparity gap between developing nations where transvaginal approaches predominate with good success. Further studies are needed to compare transvaginal to minimally invasive transabdominal approaches.
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[VESICOVAGINAL FISTULA CAUSED BY CYSTOCELE: A CASE REPORT]. Nihon Hinyokika Gakkai Zasshi 2018; 109:229-232. [PMID: 31631088 DOI: 10.5980/jpnjurol.109.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Typical etiologies of vesicovaginal fistula (VVF) include obstructed labor, iatrogenic surgical injury, pelvic irradiation and cancer invasion. VVF caused by cystocele are very rare. To date, there are no documented cases in Japanese literature.A 74-year-old woman presented with near total incontinence. On physical examination, she was found to have severe cystocele and pressure necrosis of anterior vaginal wall, which caused partial breakdown of vaginal mucosa and VVF. She underwent vesicovaginal fistula repair using transvaginal and transabdominal approaches. Catheter drainage was performed for 10 days and postoperative cystogram showed no sign of leakage. She is currently symptom-free at 55 months.
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Mikami T, Yamaguchi K, Sawayama S, Abiko K, Kondoh E, Baba T, Konishi I, Mandai M, Matsumura N. Two cases of recurrent uterine cervical cancer with arterio-enteric fistula treated by femoro-femoral artery bypass in hybrid operation room. Int Cancer Conf J 2017; 7:26-29. [PMID: 31149508 DOI: 10.1007/s13691-017-0312-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 10/23/2017] [Indexed: 10/18/2022] Open
Abstract
Little has been reported regarding aortic-enteric fistula (AEF) as a complication of gynecologic cancers because of its rarity. However, since it is lethal if left untreated, medical practitioners involved with gynecologic diseases should be aware of this deadly condition. In our hospital, we encountered two cases of cervical cancer complicated by AEF. In both cases, contrast computed tomography (CT) revealed leakage of the contrast material from an artery into the small intestine, indicating AEF. Endovascular procedures with complete embolization of the affected arteries and femoro-femoral artery bypass (f-f bypass) were performed in the hybrid operation room. The activities of daily living improved dramatically for both patients, and they survived for 3 months before dying from cervical cancer. While embolization by endovascular methods and f-f bypass performed in a hybrid operation room is, therefore, an available option for treating AEF, literature is lacking and more research is required to improve long-term outcomes for this disease.
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Affiliation(s)
- Teppei Mikami
- 1Department of Gynecology and Obstetrics, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Ken Yamaguchi
- 1Department of Gynecology and Obstetrics, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507 Japan.,2National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Saki Sawayama
- 1Department of Gynecology and Obstetrics, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Kaoru Abiko
- 1Department of Gynecology and Obstetrics, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Eiji Kondoh
- 1Department of Gynecology and Obstetrics, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Tsukasa Baba
- 1Department of Gynecology and Obstetrics, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Ikuo Konishi
- 1Department of Gynecology and Obstetrics, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507 Japan.,2National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Masaki Mandai
- 1Department of Gynecology and Obstetrics, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Noriomi Matsumura
- 1Department of Gynecology and Obstetrics, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507 Japan.,3Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
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Tatar B, Oksay T, Selcen Cebe F, Soyupek S, Erdemoğlu E. Management of vesicovaginal fistulas after gynecologic surgery. Turk J Obstet Gynecol 2017; 14:45-51. [PMID: 28913134 PMCID: PMC5558317 DOI: 10.4274/tjod.46656] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 02/14/2017] [Indexed: 12/01/2022] Open
Abstract
Objective: In developed nations, surgery, especially gynecologic procedures, is the major cause of vesicovaginal fistulas (VVFs). We retrospectively evaluated our treatment modalities for VVF repair caused by a gynecologic surgery, and discussed the reasons of selecting certain surgical techniques and their outcomes. Materials and Methods: We compared the surgical procedure preferences of surgeons and their results with patient and surgeon characteristics for the management of VVFs after an inciting gynecologic surgery in Süleyman Demirel University Hospital, Isparta over a 10-year period. The surgical procedures were undertaken in departments of urology and obstetrics and gynecology. Results: Abdominal repair was chosen for 65%, vaginal repair for 25%, and laparoscopic repair for 10% of patients. For the 75% of the patients that urologists operated, they chose the abdominal route. The mean parity number of patients who underwent abdominal repair was lower than that for vaginal repairs (p<0.05). For the patients managed with the vaginal route, 20% had a Martius flap, and 80% had a simple excision and repair. For patients operated via the abdominal route, 18% needed omental flap; no tissue interposition was used for the rest. The mean hospitalization time was less in patients managed with transvaginal repair (3.4 days) compared with transabdominal repair (9.2 days) (p<0.05). Conclusion: The choice of repair method depends on surgeon’s training (gynecology vs. urology). The vaginal route should be the first choice because it does not compromise the success rate and the mean hospitalization time is less. For the transvaginal approach, access to the lesion is the most important factor for the success of the procedure. No flap is needed for tissues that appear well vascularized.
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Affiliation(s)
- Burak Tatar
- Süleyman Demirel University Faculty of Medicine, Department of Gynecologic Oncology, Isparta, Turkey
| | - Taylan Oksay
- Süleyman Demirel University Faculty of Medicine, Department of Urology, Isparta, Turkey
| | - Fatma Selcen Cebe
- Süleyman Demirel University Faculty of Medicine, Department of Obstetrics and Gynecology, Isparta, Turkey
| | - Sedat Soyupek
- Süleyman Demirel University Faculty of Medicine, Department of Urology, Isparta, Turkey
| | - Evrim Erdemoğlu
- Süleyman Demirel University Faculty of Medicine, Department of Gynecologic Oncology, Isparta, Turkey
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Cardenas-Trowers O, Heusinkveld J, Hatch K. Simple and effective: transvaginal vesico-vaginal fistula repair with a modified Latzko technique. Int Urogynecol J 2017; 29:767-769. [PMID: 28884350 DOI: 10.1007/s00192-017-3471-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 08/21/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The incidence of vesico-vaginal fistulas after hysterectomies for benign indications in developed countries is less than one percent. The objective of this video is to demonstrate an easy-to-follow, step-by-step approach to repairing a small, uncomplicated vesico-vaginal fistula transvaginally using a modified Latzko technique. METHODS In this video, we present a case of a 46-year-old woman who developed a simple, uncomplicated vesico-vaginal fistula after a total abdominal hysterectomy. To correct her fistula, we used a modified Latzko technique, which is a transvaginal approach to vesico-vaginal fistula repair that involves mobilizing the vaginal mucosa around the fistula and then closing the pubo-vesical fascia and vaginal mucosa in layers. RESULTS The patient had successful surgical correction of her vesico-vaginal fistula without recurrence of the fistula. CONCLUSIONS For small, uncomplicated vesico-vaginal fistulas, a transvaginal approach has an equivalent success rate to that of other approaches with less invasiveness and faster recovery times. Therefore, it is reasonable to use a modified Latzko technique to help restore the quality of life to women affected by small, uncomplicated vesico-vaginal fistulas.
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Affiliation(s)
- Olivia Cardenas-Trowers
- Department of Obstetrics and Gynecology, University of Arizona, 1501 North Campbell Avenue, PO Box 245078, Tucson, AZ, 85724, USA.
| | - John Heusinkveld
- Department of Obstetrics and Gynecology, University of Arizona, 1501 North Campbell Avenue, PO Box 245078, Tucson, AZ, 85724, USA
| | - Kenneth Hatch
- Department of Obstetrics and Gynecology, University of Arizona, 1501 North Campbell Avenue, PO Box 245078, Tucson, AZ, 85724, USA
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Malik MA, Sohail M, Malik MTB, Khalid N, Akram A. Changing trends in the etiology and management of vesicovaginal fistula. Int J Urol 2017; 25:25-29. [DOI: 10.1111/iju.13419] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/13/2017] [Indexed: 01/09/2023]
Affiliation(s)
- Muhammad A Malik
- Department of Urology; Madina Teaching Hospital; University Medical and Dental College; Faisalabad Punjab Pakistan
| | - Muhammad Sohail
- Department of Urology; Madina Teaching Hospital; University Medical and Dental College; Faisalabad Punjab Pakistan
| | - Muhammad TB Malik
- Department of Urology; Madina Teaching Hospital; University Medical and Dental College; Faisalabad Punjab Pakistan
| | - Nauman Khalid
- Department of Urology; Madina Teaching Hospital; University Medical and Dental College; Faisalabad Punjab Pakistan
| | - Adeen Akram
- Department of Gynecology; Allied Hospital; Punjab Medical College; Faisalabad Punjab Pakistan
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Bodner-Adler B, Hanzal E, Pablik E, Koelbl H, Bodner K. Management of vesicovaginal fistulas (VVFs) in women following benign gynaecologic surgery: A systematic review and meta-analysis. PLoS One 2017; 12:e0171554. [PMID: 28225769 PMCID: PMC5321457 DOI: 10.1371/journal.pone.0171554] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 01/22/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Vesicovaginal fistulas (VVF) are the most commonly acquired fistulas of the urinary tract, but we lack a standardized algorithm for their management. Surgery is the most commonly preferred approach to treat women with primary VVF following benign gynaecologic surgery. OBJECTIVE To carry out a systematic review and meta-analysis on the effectiveness of operative techniques or conservative treatment for patients with postsurgical VVF. Our secondary objective was to define the surgical time and determine the types of study designs. METHODS PubMed, Old Medline, Embase and Cochrane Central Register of Controlled Trials were used as data sources. This systematic review was modelled on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, including a registration number (CRD42012002097). RESULTS We reviewed 282 full text articles to identify 124 studies for inclusion. In all, 1379/1430 (96.4%) patients were treated surgically. Overall, the transvaginal approach was performed in the majority of patients (39%), followed by a transabdominal/transvesical route (36%), a laparoscopic/robotic approach (15%) and a combined transabdominal-transvaginal approach in 3% of cases. Success rate of conservative treatment was 92.86% (95%CI: 79.54-99.89), 97.98% in surgical cases (95% CI: 96.13-99.29) and 91.63% (95% CI: 87.68-97.03) in patients with prolonged catheter drainage followed by surgery. 79/124 studies (63.7%) provided information for the length of follow-up, but showed a poor reporting standard regarding prognosis. Complications were studied only selectively. Due to the inconsistency of these data it was impossible to analyse them collectively. CONCLUSIONS Although the literature is imprecise and inconsistent, existing studies indicate that operation, mainly through a transvaginal approach, is the most commonly preferred treatment strategy in females with postsurgical VVF. Our data showed no clear odds-on favorite regarding disease management as well as surgical approach and current evidence on the surgical management of VVF does not allow any accurate estimation of success and complication rates. Standardisation of the terminology is required so that VVF can be managed with a proper surgical treatment algorithm based on characteristics of the fistula.
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Affiliation(s)
- Barbara Bodner-Adler
- Department of General Gynaecology and Gynaecologic Oncology, Medical University of Vienna, Vienna, Austria
| | - Engelbert Hanzal
- Department of General Gynaecology and Gynaecologic Oncology, Medical University of Vienna, Vienna, Austria
| | - Eleonore Pablik
- Section for Medical Statistics, Medical University of Vienna, Vienna, Austria
| | - Heinz Koelbl
- Department of General Gynaecology and Gynaecologic Oncology, Medical University of Vienna, Vienna, Austria
| | - Klaus Bodner
- Department of General Gynaecology and Gynaecologic Oncology, Medical University of Vienna, Vienna, Austria
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Abstract
BACKGROUND Radiotherapy plays a substantial role in the treatment of malignancies. More than 2/3 of all oncologic patients undergo radiotherapy during their specific treatment. Besides manifold side effects of radiotherapy, radiogenic fistulas of the urogenital tract are a potential severe complication. These fistulas might affect the female genital tract and the urinary tract. THERAPY Potential manifold variety of radiogenic urogenital fistulas requires a specific therapy. Radiation tissue damage includes severely disturbed local blood supply. Consequently, in some cases extremely complex reconstructive techniques are necessary to restore the functionality of the urinary tract. CONCLUSION The treatment of radiogenic urogenital fistulas is challenging. A successful therapy can only be achieved by local improvement of the blood supply in the damaged area.
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Affiliation(s)
- A Kocot
- Klinik und Poliklinik für Urologie und Kinderurologie, Julius Maximilians Universität Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
| | - H Riedmiller
- Klinik und Poliklinik für Urologie und Kinderurologie, Julius Maximilians Universität Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
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Takagi C, Baba H, Yamafuji K, Asami A, Takeshima K, Okamoto N, Takahashi H, Kubochi K. Simultaneously Diagnosed and Successfully Treated Rectovaginal and Vesicovaginal Fistulae after Low Anterior Resection with Concomitant Resection of Female Genitalia. Case Rep Gastroenterol 2017; 11:17-22. [PMID: 28203133 PMCID: PMC5301109 DOI: 10.1159/000455187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 12/15/2016] [Indexed: 11/27/2022] Open
Abstract
Rectovaginal fistula (RVF) and vesicovaginal fistula (VVF) are infrequent but distressing complications after pelvic surgery. However, their adequate treatment is not well described. Here, we simultaneously encountered and successfully treated RVF and VVF after radical surgery for rectal cancer. A 70-year-old woman underwent low anterior resection (LAR) combined with resection of the uterus, the bilateral adnexa, and the upper side of the vagina, as well as diverted ileostomy for rectal cancer. A month after the surgery, she developed urinary incontinence and underwent medical treatment, but her symptoms did not improve. Evaluation with contrast enema before stoma closure revealed the presence of RVF and VVF. We repaired the VVF and RVF via transabdominal and transperineal approaches. After 6 months, ileostomy was closed and the patient had no recurrence of cancer and fistula. In LAR with hysterectomy and resection of the vaginal wall, there is a risk of RVF and VVF. The excision and closure of the fistula tract and omental flap can be effective to treat both fistulae.
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Affiliation(s)
- Chisato Takagi
- Department of Surgery, Saitama City Hospital, Saitama City, Japan
| | - Hideo Baba
- Department of Surgery, Saitama City Hospital, Saitama City, Japan
| | - Kazuo Yamafuji
- Department of Surgery, Saitama City Hospital, Saitama City, Japan
| | - Atsunori Asami
- Department of Surgery, Saitama City Hospital, Saitama City, Japan
| | - Kaoru Takeshima
- Department of Surgery, Saitama City Hospital, Saitama City, Japan
| | - Nobuhiko Okamoto
- Department of Surgery, Saitama City Hospital, Saitama City, Japan
| | - Hidena Takahashi
- Department of Surgery, Saitama City Hospital, Saitama City, Japan
| | - Kiyoshi Kubochi
- Department of Surgery, Saitama City Hospital, Saitama City, Japan
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