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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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Seitz V, Davidson ERW. Retained Tampon Fragment as an Unusual Cause of Vesicovaginal Fistula. Obstet Gynecol 2024; 144:e1-e3. [PMID: 38772038 DOI: 10.1097/aog.0000000000005608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/11/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Vesicovaginal fistula (VVF) is an uncommon cause of urinary incontinence (UI). Iatrogenic etiologies, especially abdominal hysterectomy, are most common; however, a minority of VVFs are caused by retained foreign bodies. Objects associated with VVF include intrauterine devices, gauze, pessaries, bottle caps, and sexual aids, but retained tampons or other menstrual products have not been commonly reported. CASE We present the case of a 53-year-old woman, gravida 0, with no prior pelvic surgery, with 2 months of intermittent UI and hematuria. Although initial diagnostic test results were negative, cystoscopy and vaginoscopy eventually confirmed the diagnosis of VVF associated with a retained foreign body. In the operating room, all debris was removed using vaginoscopy, and the VVF was repaired using a modified Latzko technique. At the patient's 9-week follow-up appointment, she was found to have complete healing of the VVF and resolution of associated symptoms. CONCLUSION This is a case of VVF secondary to a retained tampon fragment. In addition to this uncommon etiology, our patient's presenting symptoms were atypical, leading to a delay in diagnosis and treatment for which vaginoscopy was critical.
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Affiliation(s)
- Vienne Seitz
- Department of Obstetrics & Gynecology, Medical College of Wisconsin, and the Medical College of Wisconsin, Milwaukee, Wisconsin
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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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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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Paluku JL, Aksanti BK, Clemmer WC, Furaha CM, Kamabu EM, Kasereka JML, Kalole BK, Mukuku O, Tsongo ZK, Wembonyama SO, Mpoy CW, Juakali JS. Determinants and predictive model of failure of surgical repair of obstetric vesico-vaginal fistula in the Democratic Republic of the Congo. Reprod Health 2024; 21:42. [PMID: 38561789 PMCID: PMC10986004 DOI: 10.1186/s12978-024-01779-0] [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: 10/30/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Surgical repair of obstetric fistula aims to restore the anatomical and functional integrity of the urinary tract, enabling affected women to regain their dignity and quality of life. However, such repairs can end in a failure. The aim of this study is to develop a predictive score to identify factors influencing failure of surgical repair of obstetric vesico-vaginal fistula (FSROVVF) in the Democratic Republic of the Congo. METHODS This was an analytical cross-sectional study of 318 women with obstetric vesico-vaginal fistula (OVVF) who had undergone surgical management. A bivariate and then a multivariate analysis were performed. Score discrimination was assessed using the ROC curve and C-index, and score calibration using the Hosmer-Lemeshow test. RESULTS Surgical repair of OVVF was unsuccessful in 16.98% of cases (54/318). After logistic modeling, six criteria emerged as predictive factors for FSROVVF: the presence of fibrosis (AOR = 5.01; 95% CI:1.73-14.49), the presence of 2 or more fistulas (AOR = 9.04; 95% CI:3.01-27.13), the association of OVVF with another anatomoclinical entity of fistula (AOR = 3.16; 95% CI:1.09-9.13), the fistula size > 3 cm (AOR = 3.65; 95% CI:1.36-9.76), the peri-operative hemorrhage (AOR = 7.01; 95% CI:2.33-21.03), and the post-operative infection (AOR = 178.89; 95% CI:26.09-1226.64). A score ranging from 0 to 13 points was obtained, of which a value ≤ 5 points defines a low risk of FSROVVF, a value between 6 and 8 points defines a moderate risk and value ≥ 9 points corresponds to a high risk of FSROVVF. The area under the ROC curve of the score is 0.925 with a sensitivity of 61.11%, a specificity of 96.59%, a positive predictive value of 78.57% and a negative predictive value of 92.39%. CONCLUSION This study demonstrated that the number of fistulas ≥ 2, fistula size > 3 cm, fibrosis, association of OVVF with other types of fistulas, peri-operative hemorrhage, and post-operative infection are factors predictive of FSROVVF. These six factors are key contributors to the score used to predict FSROVVF. Once validated, this score will inform and enable preoperative counseling regarding the prognosis and the chances of a successful outcome of surgical repair of OVVF.
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Affiliation(s)
- Justin Lussy Paluku
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Goma, Goma, Democratic Republic of the Congo.
- Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, Democratic Republic of the Congo.
| | - Barthelemy Kasi Aksanti
- Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | - William C Clemmer
- Department of Family Medicine, American Academy of Family Physicians, Orono, USA
| | - Cathy Mufungizi Furaha
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Goma, Goma, Democratic Republic of the Congo
- Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | - Eugénie Mukekulu Kamabu
- Department of Internal Medicine, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | - Jonathan M L Kasereka
- Department of Orthopedics and Trauma, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | - Benjamin Kambale Kalole
- Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | - Olivier Mukuku
- Department of Maternal and Child Health, Institut Supérieur des Techniques Médicales, Lubumbashi, Democratic Republic of the Congo
| | - Zacharie Kibendelwa Tsongo
- Department of Internal Medicine, Faculty of Medicine, University of Kisangani, Kisangani, Democratic Republic of the Congo
| | - Stanis Okitotsho Wembonyama
- Departments of Pediatrics and Public Health, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Charles Wembonyama Mpoy
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Jeannot Sihalikyolo Juakali
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Kisangani, Kisangani, Democratic Republic of the Congo
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Tadesse S, Mekete D, Negese S, Belachew DZ, Namara GT. Urinary incontinence following successful closure of obstetric vesicovaginal fistula repair in Southern Ethiopia. BMC Womens Health 2024; 24:164. [PMID: 38454367 PMCID: PMC10919033 DOI: 10.1186/s12905-024-02979-3] [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: 08/24/2023] [Accepted: 02/17/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Urinary incontinence (UI) after successful closure of obstetric vesicovaginal fistula (VVF) repair is a widely recognized public health problem. However, there is insufficient research evaluating the factors associated with UI after successful obstetric VVF repair in Ethiopia. OBJECTIVES The main aim of this study was to assess the magnitude and associated factors of UI following the successful closure of obstetric VVF repair at the Yirgalem Hamlin Fistula Center in the Sidama region of southern Ethiopia. METHODS A retrospective cross-sectional analytical study was performed on patients who underwent obstetric VVF repair at the Yirgalem Hamlin Fistula Center between 2016 and 2020. The data were collected from September to October 2021. EPI Data Version 3.1 and SPSS Version 25.0 were used for data entry and analysis. A multivariable binary logistic regression model was used for all variables significant in the bivariate binary logistic analysis to determine the association between the independent variables and outcome variables. The data are presented in tables and figures. Variables with a p-value < 0.05 were considered to be statistically associated with the study outcome. RESULTS In total, 499 study subjects were included. The magnitude of UI after successful closure of obstetric VVF repair was 23.25%. A Goh type 4 fistula (AOR = 4.289; 95% CI 1.431, 12.852), a fistula size > 3 cm (AOR = 8.855; 95% CI 4.786, 16.382), a partially damaged urethra (AOR = 2.810; 95% CI 1.441, 5.479), and a completely destroyed urethra (AOR = 5.829; 95% CI 2.094, 16.228) were found to be significantly associated factors with the outcome variable. CONCLUSIONS Nearly one in four patients who had successful closure of obstetric VVF repair at the Yirgalem Hamlin fistula center had UI, which is above the WHO recommendations. The presence of a Goh type 4 fistula, large fistula size, and damaged urethral status significantly affect the presence of UI. Therefore, interventions are necessary to prevent and manage UI among patients who underwent obstetric VVF repair and had a closed fistula.
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Affiliation(s)
- Shimelis Tadesse
- Department of Midwifery, College of Health Science, Mattu University, P. O. Box 318, Mattu, Ethiopia.
| | - Desta Mekete
- Department of Midwifery, College of Health Science, Mattu University, P. O. Box 318, Mattu, Ethiopia
| | - Shambel Negese
- Department of Midwifery, College of Health Science, Mattu University, P. O. Box 318, Mattu, Ethiopia
| | - Dereje Zeleke Belachew
- Department of Midwifery, College of Medicine and Health Science, Mizan Tepi University, Mizan Tefere, Ethiopia
| | - Galana Takele Namara
- Department of Midwifery, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
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Degge HM, Laurenson M, Dumbili EW, Saxby H, Hayter M. Journey for a cure: Illness narratives of obstetric fistula survivors in North Central Nigeria. SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:437-456. [PMID: 37786367 DOI: 10.1111/1467-9566.13715] [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: 12/06/2021] [Accepted: 08/25/2023] [Indexed: 10/04/2023]
Abstract
Obstetric fistula is a life transforming event resulting in embodied biographical disruption. Survivors suffer myriad long-term physical and emotional consequences. This paper is an account of a narrative inquiry, conducted with 15 fistula survivors in North-central, Nigeria, who described how their identities had been transformed by their condition. A narrative therapeutic approach, using Frank's 'chaos, restitution and quest' typology, was used to map their recovery narratives. 'Chaos', described by Frank as the opposite of restitution, dominated, with women losing hope of recovery. Women's shift towards 'restitution' began with treatment, but inadequate health-care access often delayed this process. In their quest narratives, women's life and identify changes enabled them to derive meaning from their experience of obstetric fistula within the context of their own lives. The findings highlight socio-structural factors raising the risk of obstetric fistula, which in turn causes biographical disruption and hampers sufferers' treatment and recovery. Rehabilitation should include income-generating skills to bring succour to survivors, particularly those whose incontinence persists after repairs.
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Affiliation(s)
- Hannah M Degge
- Department of Health and Education, Coventry University, Scarborough, UK
| | - Mary Laurenson
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Emeka W Dumbili
- School of Sociology, University College Dublin, College of Social Sciences and Law, Dublin, Ireland
| | - Heidi Saxby
- Department of Health and Education, Coventry University, Scarborough, UK
| | - Mark Hayter
- Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
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Paluku JL, Bartels SA, Kasereka JM, Aksanti BK, Kamabu EM, Mukuku O, Tsongo ZK, Wembonyama SO, Mpoy CW, Juakali JS. HEAL Africa score to predict failure of surgical repair of obstetric urethro-vaginal fistula in the Democratic Republic of the Congo. BMC Womens Health 2024; 24:111. [PMID: 38341554 PMCID: PMC10858488 DOI: 10.1186/s12905-024-02948-w] [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: 10/13/2023] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Obstetric fistula (OF) repair surgery aims to restore the anatomical and functional integrity of the urinary tract, allowing affected women to regain their dignity and quality of life. However, in some cases, this surgical repair may fail. The objective of this study was to develop a predictive score to identify factors associated with the failure of surgical repair of obstetric urethro-vaginal fistula (FSROUVF) in the Democratic Republic of the Congo (DRC). METHODS This is an analytical cross-sectional study of 358 patients with obstetric urethro-vaginal fistula (OUVF) who received surgical repair. We conducted bivariate and multivariate analyses. Score discrimination was assessed using the receiver operating characteristic (ROC) curve, C-index, and score calibration according to the Hosmer-Lemeshow test. RESULTS Surgical repair of OUVF failed in 24.86% of cases (89/358). After logistic modelling, 6 criteria predicted FSROUVF: the use of intravaginal indigenous products (AOR = 3.59; 95% CI: 1.51-8.53), the presence of fibrosis (AOR = 6.37; 95% CI: 1.70-23.82), the presence of 2 or more fistulas in the same patient (AOR = 7.03; 95% CI: 3.14-15.72), the total urethral damage (AOR = 3.29; 95% CI: 1.36-7.95), the fistula size > 3 cm (AOR = 5.65; 95% CI: 2.12-15.01), and the postoperative infection (AOR = 351.10; 95% CI: 51.15-2409.81). A score of 0 to 14 was obtained, with a value ≤5 points indicating a low risk of FSROUVF, a value between 6 and 8 indicating a moderate risk, and a value ≥9 points corresponding to a high risk of FSROUVF. The area under the ROC curve of the score is 0.938 with a sensitivity of 60.67%, a specificity of 96.28%, a positive predictive value of 84.38%, and a negative predictive value of 88.10%. CONCLUSION We report a FSROUVF rate in the DRC approaching a quarter of operative patients. Predictors of failure included fibrosis, presence of 2 or more fistulas, total urethral involvement, fistula size greater than 3 cm, postoperative infection, and use of intravaginal indigenous products. These factors are constitutive of the HEAL Africa score, which once validated, may have value in pre-operative counselling of patients. This study could be valuable for policy and strategies to address the problem of OUVF in the DRC and in resource limited settings more generally.
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Affiliation(s)
- Justin Lussy Paluku
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Goma, Goma, Democratic Republic of the Congo.
- Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, Democratic Republic of the Congo.
| | - Susan A Bartels
- Departments of Emergency Medicine and Public Health Sciences, Queen's University, Kingston, Canada
| | - Jonathan Ml Kasereka
- Department of Orthopedics and Trauma, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | - Barthelemy Kasi Aksanti
- Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | - Eugénie Mukekulu Kamabu
- Department of Internal Medicine, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | - Olivier Mukuku
- Institut Supérieur des Techniques Médicales, Lubumbashi, Democratic Republic of the Congo
| | - Zacharie Kibendelwa Tsongo
- Department of Internal Medicine, Faculty of Medicine, University of Kisangani, Kisangani, Democratic Republic of the Congo
| | - Stanis Okitotsho Wembonyama
- Department of Pediatrics, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
- Department of Public Health, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Charles Wembonyama Mpoy
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Jeannot Sihalikyolo Juakali
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Kisangani, Kisangani, Democratic Republic of the Congo
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Yang JM, Huang WC. Ultrasound in Female Urinary Incontinence. J Med Ultrasound 2024; 32:14-20. [PMID: 38665347 PMCID: PMC11040483 DOI: 10.4103/jmu.jmu_25_23] [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: 03/11/2023] [Revised: 03/19/2023] [Accepted: 03/22/2023] [Indexed: 04/28/2024] Open
Abstract
Urinary incontinence (UI) is a common health condition that may interfere with the quality of life. A comprehensive evaluation of female UI helps with effective and safe treatments. Ultrasound has gained popularity to explore UI recently because it can collect crucial information for treatment planning and counseling. Translabial and introital approaches are commonly and reliably applied to ultrasound. The images can be obtained using two-dimensional and three-dimensional ultrasounds. Ultrasound is the only modality capable of confirming the presence or absence of a mid-urethral sling (MUS) and is able to demonstrate bulking agents as well. Although some of the ultrasound findings may only be incidental or supplementary to the patient's symptoms, ultrasound benefits for investigating the pathophysiology of UI and surgical outcomes of MUS procedures. It is anticipated that standardization in terminology, measurement techniques, and reporting can be established in the near future.
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Affiliation(s)
- Jenn-Ming Yang
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Obstetrics and Gynecology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wen-Chen Huang
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
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McArthur M, Patel M. A pictorial review of genitourinary infections and inflammations. Clin Imaging 2023; 104:110013. [PMID: 37918136 DOI: 10.1016/j.clinimag.2023.110013] [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: 08/22/2023] [Revised: 10/03/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023]
Abstract
Various infectious and inflammatory diseases affect the genitourinary system. This paper provides a review of multiple common and uncommon infectious and inflammatory conditions affecting the genitourinary system and some associated complications. These include acute infectious cystitis, emphysematous cystitis, acute pyelonephritis, emphysematous pyelonephritis, renal and perinephric abscesses, pyonephrosis, xanthogranulomatous pyelonephritis, epididymo-orchitis, vasitis, prostatitis, pelvic inflammatory disease, renal hydatid infection, renal tuberculosis, actinomycosis, Erdheim-Chester Disease, IgG4-Related Kidney Disease, urethritis and urethral strictures, ureteritis cystica, and genitourinary fistulas. Radiologists should be aware of these diseases' complications and management. Uncommon conditions must be considered when evaluating the genitourinary system.
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Affiliation(s)
- Mark McArthur
- University of California, Los Angeles, United States.
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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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Han G, Zhao R, Liu K, Wang G, Yang X, Xiao C. Endoscopic Laser Dissection Combined with Laparoscopic Pneumovesical Repair of Vesicovaginal Fistula:A Novel Technique and Case Report. Urology 2023:S0090-4295(23)00206-6. [PMID: 36907470 DOI: 10.1016/j.urology.2023.02.036] [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: 12/19/2022] [Revised: 02/21/2023] [Accepted: 02/28/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE To present a novel technique for the repair of vesicovaginal fistula (VVF) in a transgender patient. METHODS We present a novel technique that combined endoscopic laser dissection and a transvesical laparoscopic approach for VVF repair in a transmasculine patient who received vaginal colpectomy. A literature review of VVF repair was also conducted. RESULTS The patient had an uneventful recovery, and the VVF healed over time. CONCLUSIONS Surgical repair of VVF has been described extensively in the literature. Transvaginal and transabdominal laparoscopic approaches are currently the most common techniques for VVF management. However, for transmasculine patients, neither of these methods is ideal due to either a previous history of vaginal colpectomy or the position of the fistula. This case report demonstrates the feasibility of applying a combined endoscopic laser dissection and transvesical laparoscopic approach for VVF repair. More cases are needed to demonstrate the effectiveness and complication rate of this technique in the future.
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Affiliation(s)
- Gengyu Han
- Department of Urology, Peking University Third Hospital, Beijing, China; Department of Urology, Zhuhai People's Hospital Affiliated with Jinan University, Jinan University, Zhuhai, Guangdong, China
| | - Runlei Zhao
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Ke Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Guoliang Wang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Xin Yang
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Chunlei Xiao
- Department of Urology, Peking University Third Hospital, Beijing, China.
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15
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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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Serinçay H, Güler HU, Ulubayram K, Mangır N. A scoping review of tissue interposition flaps used in vesicovaginal fistulae repair. Ther Adv Urol 2023; 15:17562872231182217. [PMID: 37434758 PMCID: PMC10331086 DOI: 10.1177/17562872231182217] [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: 07/28/2022] [Accepted: 05/30/2023] [Indexed: 07/13/2023] Open
Abstract
Background Research on the use of tissue interposition flaps (TIFs) in vesicovaginal fistulae (VVF) repair is a broad area where a very wide range of natural and synthetic materials have been used. The occurrence of VVF is also diverse in the social and clinical settings, resulting in a parallel heterogeneity in the published literature on its treatment. The use of synthetic and autologous TIFs in VVF repair is not yet standardized with a lack of the most efficacious type and technique of the TIF. Objectives The aim of this study was to systematically review all synthetic and autologous TIFs used in the surgical repair of VVFs. Data sources and methods In this scoping review, the surgical outcomes of autologous and synthetic interposition flaps used in VVF treatment meeting the inclusion criteria were determined. We searched the literature using Ovid MEDLINE and PubMed databases between 1974 and 2022. Study characteristics were recorded, and data on the change in fistulae size and location, surgical approach, success rate, preoperative patient evaluation and outcome evaluation were extracted from each study independently by two authors. Results A total of 25 articles that met the inclusion criteria were included in the final analysis. A total of 943 and 127 patients who had received autologous and synthetic flaps, respectively, were included in this scoping review. The fistulae characteristics were highly variable with regard to their size, complexity, aetiology, location and radiation. Outcome assessments of fistulae repair in included studies were mostly based on symptom evaluation. Physical examination, cystogram and methylene blue test were the methods in order of preference. Postoperative complications, such as infection, bleeding, donor site, pain, voiding dysfunction and other complications, were reported in patients after fistulae repair in all included studies. Conclusion The use of TIFs in VVF repair was common especially in complex and large fistulae. Autologous TIFs appear to be the standard of care at the moment, and synthetic TIFs were investigated in prospective clinical trials in a limited number of selected cases. Evidence levels of clinical studies evaluating the effectiveness of interposition flaps were overall low.
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Affiliation(s)
- Halime Serinçay
- Bioengineering Division, Graduate School of Science and Engineering, Hacettepe University, Ankara, Turkey
| | - Hayrullah Uğur Güler
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Tadesse S, Ejigu N, Edosa D, Ashegu T, Dulla D. Obstetric fistula repair failure and its associated factors among women underwent repair in Yirgalem Hamlin fistula center, Sidama Regional State, Southern Ethiopia, 2021: a retrospective cross sectional study. BMC Womens Health 2022; 22:288. [PMID: 35811314 PMCID: PMC9272558 DOI: 10.1186/s12905-022-01866-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 07/06/2022] [Indexed: 01/09/2023] Open
Abstract
Background Obstetric fistula repair failure is a combination of unsuccessful fistula closure and/or incontinence following a successful closure. It causes a burden on both the patients and the fistula centers. The aim of this study was to assess the magnitude and associated factors of obstetric fistula repair failure among women who underwent fistula repair at Yirgalem Hamlin fistula center in Southern Ethiopia. Methods A facility-based retrospective cross-sectional study was conducted among women who underwent fistula repair at Yirgalem Hamlin fistula center, Southern Ethiopia, during the period from January 2016 to December 2020. All 562 women who underwent fistula repair in the last 5 years were included in the study. The data were collected using a pre-tested checklist from September 22 to October 22, 2021. The data were then imported into EPI info-data version 3.1, exported to SPSS version 25, and analyzed. Descriptive and logistic regression analyses were performed, and the significant statistical test was assessed at a 95% confidence interval. Variables with a p value of < 0.05 in multivariable logistic regression were regarded to have a statistically significant relationship. Results The magnitude of obstetric fistula repair failure in this study was 28.8%. Obstetric fistula repair failure was found to be associated with labor duration > 48 h (AOR = 2.037; 95% CI 1.268, 3.272), Goh Type 4 fistulas (AOR = 3.939; 95% CI 1.623, 9.560), fistula size > 3 cm (AOR = 6.627; 95% CI 3.802, 11.554), completely destructed urethra (AOR = 3.192; 95% CI 1.234, 8.256), and bladder catheterization > 14 days (AOR = 2.944; 95% CI 1.380, 6.281). Conclusions The magnitude of obstetric fistula repair failure was significantly higher than the World Health Organization standard. Obstetric fistula repair failure had a positive association with a longer duration of labor, Goh Type 4 fistulas, large fistula size, total urethral injury, and a longer period of bladder catheterization. Therefore, the concerned bodies need to implement interventions on factors affecting obstetric fistula repair failure to reduce or prevent the failure of obstetric fistula repair. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01866-z.
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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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Kumar N, Sureka SK, Singh UP, Kapoor R, Rustagi S, Yadav P, Srivastava A, Kapoor R. Vesicovaginal Fistula Repair by Transvaginal Route: Comparison of Resource Utilisation and Outcome with Literature Reported Population Matched Cohort of Patients Operated by Minimally Invasive Route. J Obstet Gynaecol India 2022; 72:414-419. [PMID: 36458065 PMCID: PMC9568645 DOI: 10.1007/s13224-021-01549-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: 03/19/2021] [Accepted: 08/11/2021] [Indexed: 01/09/2023] Open
Abstract
Introduction and Objectives VVF is conventionally repaired by open transvaginal or transabdominal routes. In last few decades, minimally invasive techniques (laparoscopic/robotic) for VVF repair have gained popularity. We have reported our experience of transvaginal vesicovaginal fistula (VVF) repair and compared it with the literature reported population matched cohort of VVF repair done by laparoscopic or robot-assisted techniques. Material and Methods Intraoperative and post-operative parameters including aetiology of fistula, location, operative time, blood loss, major complications, hospital stay and success rate of 202 patients with simple VVF undergoing transvaginal repair at a tertiary care hospital from 1999 to 2019 were recorded. We also compared our transvaginal repair cohort (n = 202) with the literature reported cohort of 260 patients undergoing VVF repair by minimally invasive (laparoscopic and robot assisted) techniques in the systematic review by Miklos et al. Results Most common aetiology of VVF in our series was post hysterectomy in 122 (60.39%) cases followed by trauma during emergency caesareans section in 80 (39.60%) cases. Transvaginal route had higher success rate than minimally invasive approach (99.50 vs. 96.50%, respectively). Mean operative time was lesser in transvaginal group than the minimally invasive group (63 ± 16 min vs. 161.56 ± 41.02 min, p < 0.01) with shorter mean hospital stay in transvaginal group (3 ± 1 days vs. 3.5 ± 1.16 days, respectively, p < 0.01). Mean estimated blood loss was significantly lesser in transvaginal repair (p < 0.01). 62% patients were sexually active at last follow-up. The cost of transvaginal VVF repair is significantly lower compared to repair by minimally invasive approach. Conclusion Transvaginal VVF repair is comparable to minimally invasive approach in terms of post-operative outcomes and morbidity; however, transvaginal repair performs better in terms of cost and resource utilization.
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Affiliation(s)
- Naveen Kumar
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sanjoy Kumar Sureka
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Uday Pratap Singh
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rohit Kapoor
- Department of Urology, DY Patil Medical College, Pune, India
| | - Sanchit Rustagi
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Priyank Yadav
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Aneesh Srivastava
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rakesh Kapoor
- Department of Urology and Renal Transplant, Medanta Hospital, Lucknow, India
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Alvarez de Toledo I, DeLong J. Female Urethral Reconstruction. Urol Clin North Am 2022; 49:393-402. [DOI: 10.1016/j.ucl.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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21
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Vesicovaginal fistula with bladder and vaginal stone. Int J Surg Case Rep 2022; 96:107311. [PMID: 35803097 PMCID: PMC9283988 DOI: 10.1016/j.ijscr.2022.107311] [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: 02/23/2022] [Revised: 06/12/2022] [Accepted: 06/12/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION In developing countries, Vesico-vaginal fistula (VVF) results following obstetric trauma or iatrogenic during hysterectomy. Large calculus associated with VVF is relatively rare, with the risk factor are presence of foreign body, urinary tract infection, and prolonged duration of disease. Most bladder stones can be found among patients who are bedridden, indwelling urethral catheter, bladder outlet obstruction, infection, and other similar characteristic. We report a case of VVF with bladder and vaginal stone in 37 years old woman and reviews the evaluation and treatment and highlights the role of the healthcare team in managing patients with this condition. PRESENTATION OF CASE A 37-year-old, P2A0, woman with a history of hysterectomy three years ago. Intermittent small amounts of watery vaginal discharge developed 1,5 years after the operation. A physical examination revealed mild tenderness over the suprapubic area and no evidence of uterine prolapse. Cystography computed tomography scan with contrast confirmed a fistula vesicovagina with a connection between posterosuperior wall of vesica urinaria and anterosuperior wall of vagina with vesicolithiasis, size 15 × 26 × 14 mm and two vaginal stone with size of 7 × 12 × 17 mm and 4 × 4 × 5 mm. Cystoscopy revealed a grayish stone identified in supratrigone with size of 30 × 12 mm. DISCUSSION A hanging intravesical stone on the dome of urinary bladder is scarce, possibly caused by any synthetic and non-absorbable suture material inside of the bladder were encrusted forming a bladder stone. Important risk factors known, which is specific in developing countries, are poor socioeconomic status, malnourishment, low literacy rate, early marriage and childbearing, and inadequate obstetrical care. CONCLUSION Although the incidence of VVF accompanied by hanging vaginal stone and a large bladder stone is scarce, reports of any case regarding this study can be beneficial to other studies. Due to its harmful effect, the usage of non-absorbable sutures material during surgery isn't suggested. Hence, the absorbable suture material usage with careful dissection is suggested for any gynecological or pelvic surgery.
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22
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Rahmita MM, Rodjani A, Wahyudi I, Widia F. Rare cases of vesicouterine fistula. Low Urin Tract Symptoms 2022; 14:401-404. [PMID: 35343048 DOI: 10.1111/luts.12440] [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: 01/05/2022] [Revised: 02/19/2022] [Accepted: 03/06/2022] [Indexed: 01/09/2023]
Abstract
CASE Vesicouterine fistula (VUF) is the rarest form of genitourinary fistulas. As lower-segment cesarean section becomes a more common mode of delivery, they have become the leading cause of VUF formation. We present four VUF patients with varied symptoms such as menouria, amenorrhea, with or without urinary incontinence. We diagnosed all of our cases through cystoscopy in conjunction with methylene blue dye test or hysteroscopy. OUTCOME We successfully repaired VUF in three open surgery instances and one laparoscopic case. To diagnose VUF, cystoscopy and hysteroscopy are still the gold standard. An expert surgeon's open or laparoscopic repair is effective and safe. The patients no longer experienced incontinence, cyclical hematuria (menouria), discomfort, or sexual dysfunction. CONCLUSION Cystoscopy and hysteroscopy remain the gold standard tool in diagnosing VUF. Open or laparoscopic repair performed by an experienced surgeon is an effective and safe technique with a successful outcome.
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Affiliation(s)
- Maulidina Medika Rahmita
- Department of Urology, Cipto Mangunkusumo National Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Arry Rodjani
- Department of Urology, Cipto Mangunkusumo National Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Irfan Wahyudi
- Department of Urology, Cipto Mangunkusumo National Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Fina Widia
- Department of Urology, Cipto Mangunkusumo National Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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23
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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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Potluri TK, Holt LM, Tanner JP, Wasingya L, Duffy S, Greene KA. Risk factors for perioperative blood transfusions after urogenital fistula repair in Uganda: a retrospective cohort study. BJOG 2021; 129:120-126. [PMID: 34258859 DOI: 10.1111/1471-0528.16845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To determine the incidence of and risk factors for perioperative blood transfusions after urogenital fistula repairs in Uganda. DESIGN A retrospective cohort study. SETTING A community hospital in Masaka, Uganda. POPULATION Women who underwent fistula repair at the Kitovu Hospital between 2013 and 2019. METHODS Retrospective review of demographics and clinical perioperative characteristics of patients surgically treated for urogenital fistula. Patient characteristics were compared between those who did and those who did not require a blood transfusion. MAIN OUTCOME MEASURES Need for perioperative blood transfusion and risk factors. RESULTS A total of 546 patients treated for urogenital fistulas were included in this study. The median age was 31.1 ± 13.2 years. A vaginal surgical approach was used in the majority of patients (84.6%). Complications occurred in 3.5% of surgical repairs, and the incidence of blood transfusions was 6.2%. In multivariable analyses, for each gram per deciliter (g/dl) increase in preoperative haemoglobin, the odds of blood transfusion decreased by approximately 28% (adjusted OR 0.72, 95% CI 0.59-0.86). Women who had their fistula repaired abdominally were 3.4 times more likely to require transfusions (95% CI 1.40-8.08). CONCLUSIONS The incidence of blood transfusions among urogenital fistula repairs in our population is twice that of developed nations. An abdominal surgical approach to urogenital fistula is a significant risk factor for perioperative blood transfusions. The timing of the repair may warrant further study. TWEETABLE ABSTRACT One of the first studies to look at blood transfusion risk factors after fistula repair in a low-resource setting.
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Affiliation(s)
- T K Potluri
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - L M Holt
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - J P Tanner
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - L Wasingya
- Depratment of Medicine, Kitovu Hospital, Masaka, Uganda
| | - S Duffy
- Kitovu Hospital Fistula Unit, Masaka, Uganda.,Chelsea and Westminster Hospital, London, UK
| | - K A Greene
- Kitovu Hospital Fistula Unit, Masaka, Uganda.,University of South Florida Department of Female Pelvic Medicine and Reconstructive Surgery, Tampa, Florida, USA
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Zhou P, Deng W, Li J, Pan H, Wang Y, Song C, Liu W, Fu B. Transvesical versus extravesical approach to laparoscopic posthysterectomy vesicovaginal fistula repair: A retrospective study from two medical centers. Neurourol Urodyn 2021; 40:1593-1599. [PMID: 34058024 DOI: 10.1002/nau.24724] [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: 02/27/2021] [Revised: 05/18/2021] [Accepted: 05/18/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND The controversy on the best surgical approach for vesicovaginal fistula (VVF) repair remains due to the scarcity of high-level evidences. We aim to analyze the efficacy and safety of the laparoscopic transvesical (LT) and laparoscopic extravesical (LE) approaches to posthysterectomy VVF (PH-VVF). METHODS Data of 64 patients with PH-VVFs who were laparoscopicly treated in the First Affiliated Hospital of Nanchang University and the Hangzhou Third Hospital from January 2011 to November 2019 were retrospectively collected. The operative time (OT), estimated bleeding volume (EBV), postoperative bladder function and complications, hospital stay length (HSL), surgery success rate, and recurrence were compared between the two groups. RESULTS In all, there were no significant differences in baseline characteristics between those two arms. Both approaches were successfully performed without open conversion in either group. The LT group was significantly corrected with a shorter mean OT than the LE group (p < 0.001), regardless of the fistula's position. No significant differences existed in the mean EBV and HSL between the two interventions (p = 0.136 and p = 0.210, respectively). The tendency of postoperative complications and success rates of surgery were also comparable in both groups. The patients in the LT group had similar bladder functions to those in LE group. The recurrence occurred in one patient in each arm during the follow-up periods of 12-36 months. CONCLUSIONS The LT approach is significantly related to a shorter OT than the LE approach without compromising the safety and success rates in repairing PH-VVF.
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Affiliation(s)
- Peng Zhou
- Department of Urology, Third Hospital of Hangzhou, Zhejiang, China
| | - Wen Deng
- Department of Urology, Nanchang University, Nanchang, Jiangxi, China
| | - Junhua Li
- Department of Urology, Third Hospital of Hangzhou, Zhejiang, China
| | - Huixian Pan
- Department of Urology, Third Hospital of Hangzhou, Zhejiang, China
| | - Yanbin Wang
- Department of Urology, Third Hospital of Hangzhou, Zhejiang, China
| | - Chen Song
- Department of Urology, Third Hospital of Hangzhou, Zhejiang, China
| | - Weipeng Liu
- Department of Urology, Nanchang University, Nanchang, Jiangxi, China
| | - Bin Fu
- Department of Urology, Nanchang University, Nanchang, Jiangxi, China
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Factors affecting surgical treatment and outcomes of vesico-vaginal fistula: A retrospective study. Asian J Surg 2020; 44:427-428. [PMID: 33221132 DOI: 10.1016/j.asjsur.2020.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 01/09/2023] Open
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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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Platelet-Rich Plasma as Adjuvant Therapy for Recurrent Vesicovaginal Fistula: A Prospective Case Series. J Clin Med 2019; 8:jcm8122122. [PMID: 31810344 PMCID: PMC6947156 DOI: 10.3390/jcm8122122] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 01/09/2023] Open
Abstract
Vesicovaginal fistula (VVF) is the nonphysiological communication between the bladder and vagina, and surgical closure is the gold treatment standard. Despite that successful closure occurs in around 85% of patients after the first repair, recurrence remains a highly distressing complication for patients and surgeons. The aim of our study was to evaluate the efficacy of a platelet-rich plasma (PRP) injection as a supportive treatment in the surgical repair of recurrent VVF. Between January 2018 and July 2019, 16 patients with recurrent VVF were injected with PRP in a tertiary gynecological department. Subsequently, a surgical Latzko procedure for VVF closure was scheduled 6–8 weeks after the PRP injection allowing proper neovascularization and remodeling of surrounding tissues. Patients were considered cured if no leakage was observed after surgery and negative dye test results were indicated at follow-up. All patients who were examined therein remained dry. To the best of our knowledge, this is the first study aiming to assess PRP injections as a supporting treatment prior to surgical procedure for recurrent VVF. Preliminary results are encouraging, and we incorporated this method in our clinical practice. Further reports on a larger group will follow.
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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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Xie M, Zheng D, Yao H, Wang Z. Vesicovaginal fistula repair through combined transurethral and transvaginal approaches: A case series study. J Gynecol Obstet Hum Reprod 2018; 47:487-490. [PMID: 29783034 DOI: 10.1016/j.jogoh.2018.05.004] [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: 02/25/2018] [Revised: 05/14/2018] [Accepted: 05/17/2018] [Indexed: 01/09/2023]
Abstract
We report a case series study on five patients who underwent combined transurethral and transvaginal approaches to repair their vesicovaginal fistulas. All of them had failed the previous surgical treatments for their fistulas. Combined transurethral and transvaginal approaches successfully repaired their vesicovaginal fistulas, with minimal intraoperative bleeding and rapid postoperative recoveries. All the clinical symptoms had resolved. Bladder saline infusion tests and cystogram examinations confirmed the successful closure of their fistulas. Follow-up examinations up to one and a half years showed no return of clinical symptoms. Combined transurethral and transvaginal approaches could be successfully applied to patients who failed previous surgical treatments for the vesicovaginal fistula, when the fistula was smaller than 3cm and was located more than 0.5cm from the ureteral orifice.
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Affiliation(s)
- M Xie
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200025, China
| | - D Zheng
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200025, China
| | - H Yao
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200025, China.
| | - Z Wang
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200025, China.
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