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Afonina M, Waligora Lages S, Liori A, Botchorishvili R. Early approach for the iatrogenic vesico-vaginal fistula repair: a video case report. Facts Views Vis Obgyn 2024; 16:213-215. [PMID: 38950535 DOI: 10.52054/fvvo.16.2.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024] Open
Abstract
Background Vesico-vaginal fistula (VVF) is a rare but debilitating condition, characterised by an abnormal connection between the bladder and vagina. While obstetric-related cases prevail in developing countries, iatrogenic fistulas are more common in industrialised ones, often resulting from pelvic surgeries. Objectives The optimal timing for surgical correction of VVF remains debated, often leaning towards delayed intervention. Here we report a successful early laparoscopic repair of an iatrogenic VVF following hysterectomy. Materials and Methods The patient, a 54-year-old woman, presented with VVF after a hysterectomy. The laparoscopic repair was performed promptly upon diagnosis. Main outcome measures To assess the feasibility and effectiveness of an early repair of a gynaecological-related VVF. Results First, cystoscopy identified the bladder edge of the VVF. Second, laparoscopy was performed and the vesico-vaginal dissection was carried out. The excision of the previous stitches and of the fibrotic tissue was undertaken to create free flaps for suturing. The bladder was repaired in a double layer, and a single layer was applied to the vagina. Finally, the omentoplasty was done. The patient was discharged on postoperative day 5. No complications occurred. Conclusions This successful case demonstrates the feasibility and safety of early laparoscopic repair for gynaecological surgery-related vesico-vaginal fistulae. While acknowledging the need for further studies to standardise techniques, this report contributes to the evolving understanding of optimal management for this complex condition.
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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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Chen CS, Ibrahim A, Shin JH, Li HL, Moon HH, Chu HH, Kim JW. Embolization of Urinary Tract Fistulae Using an AMPLATZER Vascular Plug and Glue. J Vasc Interv Radiol 2020; 32:135-140. [PMID: 33223390 DOI: 10.1016/j.jvir.2020.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/30/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022] Open
Abstract
Six patients (mean age, 57.7 y ± 19.7) with persistent urinary fistulae underwent 7 urinary tract embolizations with AMPLATZER Vascular Plugs (AVPs) and glue: 5 with concomitant cavity obliteration with glue and 2 without. A single procedure was successful in resolving urinary leakage in 5 patients (71%) at a mean follow-up of 27.3 wk ± 31.5 (median, 9.7 wk; range, 4.9-80 wk). Repeat cavity embolization was required in 2 instances to achieve clinical success. Mean survival was 42.3 wk (median, 16.4 wk; range, 11.7-104 wk). Combined AVP and glue embolization may prove to be a primary approach in the control of persistent fistulae.
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Affiliation(s)
- Cheng Shi Chen
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Chin
| | - Alrashidi Ibrahim
- Department of Radiology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ji Hoon Shin
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Chin; Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43 gil 88, Songpa-Gu, Seoul 05505, Korea.
| | - Hai-Liang Li
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Chin
| | - Hye Hyeon Moon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43 gil 88, Songpa-Gu, Seoul 05505, Korea
| | - Hee Ho Chu
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43 gil 88, Songpa-Gu, Seoul 05505, Korea
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43 gil 88, Songpa-Gu, Seoul 05505, Korea
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Laparoscopic approach to vesicovaginal fistulae. Best Pract Res Clin Obstet Gynaecol 2019; 54:49-60. [DOI: 10.1016/j.bpobgyn.2018.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 04/18/2018] [Accepted: 06/12/2018] [Indexed: 11/18/2022]
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Robot-assisted vesicovaginal fistula repair via a transvesical approach. Int Urogynecol J 2018; 30:327-329. [PMID: 30564873 DOI: 10.1007/s00192-018-3843-8] [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: 09/11/2018] [Accepted: 11/28/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The objective of this video is to demonstrate a technique for robot-assisted vesicovaginal fistula (VVF) repair utilizing a mini cystotomy with a transvesical approach. METHODS A 53-year-old female developed a VVF after she underwent an abdominal hysterectomy for uterine fibroids at an outside facility. She was referred to us following two failed VVF repairs (one vaginal, one abdominal with bladder bivalving and omental flap). After discussing options, she underwent a robotic VVF repair via a transvesical approach. Following port placement, the space of Retzius was mobilized. An intentional cystotomy was made and the camera and working arms advanced into the bladder. The fistula was identified and circumferentially mobilized. The fistula was closed in three layers using absorbable sutures, and care was taken to avoid the ureters. RESULTS The patient's postoperative recovery was uncomplicated. Follow-up imaging was performed via cystogram at 4 weeks and showed resolution of the fistula. CONCLUSIONS A robot-assisted transvesical approach using a mini cystotomy to VVF repair is a useful technique especially when previous surgical planes have been used in prior repairs and failed. It maintains a minimally invasive approach and may avoid complications associated with an open abdominal approach.
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Abstract
PURPOSE OF REVIEW Urological fistulas are an underestimated problem worldwide and have devastating consequences for patients. Many urological fistulas result from surgical complications and/or inadequate perinatal obstetric healthcare. Surgical correction is the standard treatment. This article reviews minimally invasive surgical approaches to manage urological fistulas with a particular emphasis on the robotic techniques of fistula correction. RECENT FINDINGS In recent years, many surgeons have explored a minimally invasive approach for the management of urological fistulas. Several studies have demonstrated the feasibility of laparoscopic surgery and the reproducibility of reconstructive surgery techniques. Introduction of the robotic platform has provided significant advantages given the improved dexterity and exceptional vision that it confers. SUMMARY Fistulas are a concern worldwide. Laparoscopic surgery correction has been developed through the efforts of several authors, and difficulties such as the increased learning curve have been overcome with innovations, including the robotic platform. Although minimally invasive surgery offers numerous advantages, the most successful approach remains the one with the surgeon is most familiar.
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Cirocchi R, Cochetti G, Randolph J, Listorti C, Castellani E, Renzi C, Mearini E, Fingerhut A. Laparoscopic treatment of colovesical fistulas due to complicated colonic diverticular disease: a systematic review. Tech Coloproctol 2014; 18:873-85. [PMID: 24848529 DOI: 10.1007/s10151-014-1157-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 04/13/2014] [Indexed: 12/19/2022]
Abstract
Colovesical fistulas originating from complicated sigmoid diverticular disease are rare. The primary aim of this review was to evaluate the role of laparoscopic surgery in the treatment of this complication. The secondary aim was to determine the best surgical treatment for this disease. A systematic search was conducted for studies published between 1992 and 2012 in PubMed, the Cochrane Register of Controlled Clinical Trials, Scopus, and Publish or Perish. Studies enrolling adults undergoing fully laparoscopic, laparoscopic-assisted, or hand-assisted laparoscopic surgery for colovesical fistula secondary to complicated sigmoid diverticular disease were considered. Data extracted concerned the surgical technique, intraoperative outcomes, and postoperative outcomes based on the Cochrane Consumers and Communication Review Group's template. Descriptive statistics were reported according to the PRISMA statement. In all, 202 patients from 25 studies were included in this review. The standard treatment was laparoscopic colonic resection and primary anastomosis or temporary colostomy with or without resection of the bladder wall. Operative time ranged from 150 to 321 min. It was not possible to evaluate the conversion rate to open surgery because colovesical fistulas were not distinguished from other types of enteric fistulas in most of the studies. One anastomotic leak after bowel anastomosis was reported. There was zero mortality. Few studies conducted follow-up longer than 12 months. One patient required two reoperations. Laparoscopic treatment of colovesical fistulas secondary to sigmoid diverticular disease appears to be a feasible and safe approach. However, further studies are needed to establish whether laparoscopy is preferable to other surgical approaches.
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Affiliation(s)
- R Cirocchi
- Department of General and Oncologic Surgery, St. Maria Hospital, University of Perugia, Località Sant'Andrea delle Fratte, Via Gambuli n.1, 06156, Perugia, Italy
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Gómez RG, Mundy T, Dubey D, El-Kassaby AW, Firdaoessaleh, Kodama R, Santucci R. SIU/ICUD Consultation on Urethral Strictures: Pelvic fracture urethral injuries. Urology 2013; 83:S48-58. [PMID: 24210734 DOI: 10.1016/j.urology.2013.09.023] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 09/08/2013] [Accepted: 09/20/2013] [Indexed: 10/26/2022]
Abstract
The posterior urethra pierces the perineal diaphragm in close relationship to the pubic arc elements of the bony pelvis to which it is tethered by attachments to the puboprostatic ligaments and the perineal membrane. Because of these relationships, it is not surprising that fracture disruptions of the pelvic ring can be associated with injuries to the urethra at this level. Although the relationship between pelvic fracture and posterior urethral injury has been recognized for >1 century, considerable controversy exists on almost any aspect of these injuries, from the anatomy and classification of the injuries to the strategies for acute management, reconstruction, and treatment of complications, to mention just a few. What it is not controversial and well known is that these injuries can result in significant morbidity in the long run--mainly strictures, erectile dysfunction, and urinary incontinence--which can cause lifelong disability. It also well known that, just as in many other areas of trauma, the severity and duration of the complications can be reduced considerably if the injury is diagnosed and treated promptly and efficiently. This chapter summarizes the most relevant published evidence about the management of pelvic fracture urethral injuries. This comprehensive review, performed by an international panel of experts, will provide valuable information and recommendations to help urologists worldwide improve the treatment and outcomes of their injured patients.
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Affiliation(s)
| | - Tony Mundy
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Deepak Dubey
- Manipal Institute of Urology and Nephrology, Manipal Hospital, Bangalore, India
| | | | - Firdaoessaleh
- School of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Ron Kodama
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Demirci U, Fall M, Göthe S, Stranne J, Peeker R. Urovaginal fistula formation after gynaecological and obstetric surgical procedures: Clinical experiences in a Scandinavian series. Scand J Urol 2012; 47:140-4. [DOI: 10.3109/00365599.2012.711772] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mahmoud B, Sataa S. Post-cesarean Vesicouterine Fistulae: A Report on a Case and an Update of the Literature. ACTA ACUST UNITED AC 2012. [DOI: 10.3834/uij.1944-5784.2012.08.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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