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Peng Y, Xiong S, Ding Y, Xie L, Wang Y, Mei Y, Liu W, Deng T. The effect of omentoplasty in various surgical operations: Systematic review and meta-analysis. Int J Surg 2024; 110:01279778-990000000-01157. [PMID: 38446845 PMCID: PMC11175753 DOI: 10.1097/js9.0000000000001240] [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: 12/13/2023] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Omentoplasty is commonly used in various surgeries. However, its effectiveness is unsure due to lack of convincing data and research. To clarify the impact of omentoplasty on postoperative complications of various procedures, this systematic review and meta-analysis was performed. METHODS A systematic review of published literatures from four databases: PubMed, Web of Science, Cochrane Library, and Embase before July 14, 2022. We primarily included publications on five major surgical operations performed in conjunction with omentoplasty: thoracic surgery, esophageal surgery, gastrointestinal surgery, pelvi-perineal surgery, and liver surgery. The protocol was registered in PROSPERO. RESULTS This review included 25 273 patients from 91 studies (n=9 670 underwent omentoplasty). Omentoplasty was associated with a lower risk of overall complications particularly in gastrointestinal (RR 0.53; 95%CI 0.39-0.72) and liver surgery (RR 0.54; 95%CI 0.39-0.74). Omentoplasty reduced the risk of postoperative infection in thoracic (RR 0.38; 95%CI 0.18-0.78) and liver surgery (RR 0.39; 95%CI 0.29-0.52). In patients undergoing esophageal (RR 0.89; 95%CI 0.80-0.99) and gastrointestinal (RR 0.28; 95%CI 0.23-0.34) surgery with a BMI greater than 25, omentoplasty is significantly associated with a reduced risk of overall complications compared to patients with normal BMI. No significant differences were found in pelvi-perineal surgery, except infection in patients whose BMI ranged from 25 kg/m2 to 29.9 kg/m2 (RR 1.25; 95%CI 1.04-1.50) and anastomotic leakage in patients aged over 60 (RR 0.59; 95%CI-0.39-0.91). CONCLUSION Omentoplasty can effectively prevent postoperative infection. It is associated with a lower incidence of multiple postoperative complications in gastrointestinal and liver surgery.
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Affiliation(s)
- Yaqi Peng
- National Clinical Research Center for Metabolic Diseases, Department of Metabolism and Endocrinology
- Key Laboratory of Diabetes Immunology, Ministry of Education, Metabolic Syndrome Research Center
| | - Shan Xiong
- National Clinical Research Center for Metabolic Diseases, Department of Metabolism and Endocrinology
- Key Laboratory of Diabetes Immunology, Ministry of Education, Metabolic Syndrome Research Center
| | - Yujin Ding
- National Clinical Research Center for Metabolic Diseases, Department of Metabolism and Endocrinology
- Key Laboratory of Diabetes Immunology, Ministry of Education, Metabolic Syndrome Research Center
| | - Limin Xie
- National Clinical Research Center for Metabolic Diseases, Department of Metabolism and Endocrinology
- Key Laboratory of Diabetes Immunology, Ministry of Education, Metabolic Syndrome Research Center
| | - Yihang Wang
- National Clinical Research Center for Metabolic Diseases, Department of Metabolism and Endocrinology
- Key Laboratory of Diabetes Immunology, Ministry of Education, Metabolic Syndrome Research Center
| | - Ying Mei
- National Clinical Research Center for Metabolic Diseases, Department of Metabolism and Endocrinology
- Key Laboratory of Diabetes Immunology, Ministry of Education, Metabolic Syndrome Research Center
| | - Wei Liu
- Department of Biliopancreatic Surgery and Bariatric Surgery
| | - Tuo Deng
- National Clinical Research Center for Metabolic Diseases, Department of Metabolism and Endocrinology
- Key Laboratory of Diabetes Immunology, Ministry of Education, Metabolic Syndrome Research Center
- Clinical Immunology Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
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Thompson JC, Halder GE, Jeppson PC, Alas A, Balgobin S, Dieter AA, Houlihan S, Miranne J, Sleemi A, Balk EM, Mama S, Meriwether KV, Antosh DD. Repair of Vesicovaginal Fistulae: A Systematic Review. Obstet Gynecol 2024; 143:229-241. [PMID: 38033311 DOI: 10.1097/aog.0000000000005468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/05/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To assess and compile the current level of evidence regarding successful surgical treatment of vesicovaginal fistulae and how these perioperative interventions affect anatomic, patient-centered, and adverse outcomes. DATA SOURCES PubMed and EMBASE were searched from inception through September 9, 2022. METHODS OF STUDY SELECTION This review included comparative studies (of any sample size) and single-group studies (1,000 or more participants) of primary or recurrent vesicovaginal fistula (ie, vesicovaginal fistula, urethrovaginal fistula, and bladder neck-vaginal fistula). We evaluated preintervention assessment or management, various techniques for intraoperative management, and postoperative management. Outcomes of interest included anatomic and objective outcomes (such as successful repair, fistula closure, urinary incontinence, recurrent fistula, perioperative complications) and subjective outcomes (such as voiding symptoms and quality of life). Abstracts and full-text articles were screened in duplicate, and study descriptions and findings were extracted into standardized extraction forms. Risk of bias was assessed independently by two investigators and adjudicated by a third. Study quality was summarized with standardized tools. We conducted random-effects model and restricted maximum-likelihood meta-analyses of relative risks when at least three studies compared similar interventions and reported similar outcome measures. TABULATION, INTEGRATION, AND RESULTS Forty-six studies met the inclusion criteria. Studies were categorized into 11 domains: 1) preoperative assessment, 2) preoperative and postoperative physical therapy, 3) route of surgery, 4) incorporation of a flap, 5) trimming, 6) layered closure, 7) intraoperative antibiotics, 8) fibrin glue, 9) fascial sling, 10) postoperative Foley catheter duration, and 11) quality of life. Although the strength of the data is insufficient, preoperative phenazopyridine, physical therapy, layered closure, and intraoperative antibiotics seemed to improve the rate of successful fistula repair. Route of surgery (vaginal vs abdominal laparotomy) was determined primarily by surgeon preference and showed no difference in successful fistula repair. In addition, use of interpositional flaps, trimming fistula edges, fibrin glue, and fascial sling did not show significant improvement in rates of fistula cure. Overall, quality-of-life scores improved postoperatively regardless of route of repair and use of interpositional flaps. CONCLUSION Our findings highlight the limited information available to guide evidence-based treatment of vesicovaginal fistula repair. Overall, high-quality evidence is lacking to provide guidelines; therefore, expert opinion remains the primary influence for fistula repair recommendations. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021214948.
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Affiliation(s)
- Jennifer C Thompson
- Northwest Kaiser Permanente, Portland, Oregon; the University of Texas Medical Branch, Galveston, the University of Texas at San Antonio, San Antonio, UT Southwestern Medical Center, Dallas, and the Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas; the Woman's Center for Advanced Pelvic Surgery, Phoenix, Arizona; MedStar Washington Hospital Center, Washington, DC; the Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; the International Medical Response Foundation, Brooklyn, New York; the Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island; Cooper Medical School of Rowan University, Cooper University Health Care, Camden, New Jersey; and the Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico
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Kurokawa I, Nomura Y, Nakagawa C, Okada Y, Fuji K, Yoshimura Y. Transvaginal vesicovaginal fistula closure: A retrospective study of 28 cases at a single facility in Japan. Int J Urol 2023; 30:586-591. [PMID: 36946367 DOI: 10.1111/iju.15181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/12/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVES We aimed to report the background of patients with vesicovaginal fistulas (VVFs) at our center, which has treated a relatively large number of such patients in Japan, as well as the ingenuity and outcomes of vesicovaginal fistula closure (VVFC). We also investigated the causes of VVFs. METHODS A retrospective review was performed for 28 patients with VVFs treated at our center. Age, body mass index, etiology, site of fistula, and postoperative outcomes were investigated. RESULTS Twenty-one (75%) fistulas occurred following hysterectomy. The overall success rate of VVFC was 85.7%, and the success rate limited to the first attempt was 89.5%. In 68% of cases, no bladder injury suspected as the cause of VVF was noticed during the surgery. Energy devices were used in all 12 patients for whom information on the type of device used for hysterectomy was confirmed. CONCLUSIONS To our knowledge, this is the first report to evaluate a relatively large number of VVFCs in Japan. Although VVF is thought to be caused by bladder injury during hysterectomy, delayed thermal damage might also result in this pathology, even if there is no apparent intraoperative bladder injury.
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Affiliation(s)
- Ippei Kurokawa
- Department of Female Pelvic Health Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
- Department of Urology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Yukiko Nomura
- Department of Female Pelvic Health Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
- Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Chie Nakagawa
- Department of Female Pelvic Health Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
- Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Yoshiyuki Okada
- Department of Female Pelvic Health Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
- Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Kohzo Fuji
- Department of Urology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Yasukuni Yoshimura
- Department of Female Pelvic Health Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
- Department of Urology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
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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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Kołodyńska A, Streit-Ciećkiewicz D, Kot A, Kuliniec I, Futyma K. Radiation-Induced Recurrent Vesicovaginal Fistula-Treatment with Adjuvant Platelet-Rich Plasma Injection and Martius Flap Placement-Case Report and Review of Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094867. [PMID: 34063610 PMCID: PMC8124483 DOI: 10.3390/ijerph18094867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/20/2021] [Accepted: 04/29/2021] [Indexed: 11/22/2022]
Abstract
Vesicovaginal fistula is the non-physiological connection between the urinary bladder and vagina. This results in continuous urine leakage. In developed countries, the prevalence of this condition is low and affects (mainly) women with a history of gynaecological procedures or radiotherapy. The aim of this study was to present the therapeutic process of a patient with radiation-induced, recurrent vesicovaginal fistula. The thirty-eight-year-old patient underwent radical hysterectomy with follow-up radiotherapy due to cervical cancer. Five years after the therapy, she was diagnosed with vesicovaginal fistula. After two unsuccessful Latzko procedures and two adjuvant platelet-rich plasma injections, a third Latzko reconstructive surgery was performed with additional transposition of the Martius flap—with successful closure of the fistula.
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Affiliation(s)
- Aleksandra Kołodyńska
- 2nd Department of Gynecology, Medical University in Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (D.S.-C.); (K.F.)
- Correspondence:
| | - Dominika Streit-Ciećkiewicz
- 2nd Department of Gynecology, Medical University in Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (D.S.-C.); (K.F.)
| | - Agata Kot
- Healthcare Centre of St. John of God Independent Public Provincial Hospital in Lublin, Biernackiego 9, 20-400 Lublin, Poland;
- Hospice of the Good Samaritan, Bernardyńska 11a, 20-109 Lublin, Poland
| | - Iga Kuliniec
- Department of Urology and Oncological Urology, Medical University in Lublin, Jaczewskiego 8, 20-954 Lublin, Poland;
| | - Konrad Futyma
- 2nd Department of Gynecology, Medical University in Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (D.S.-C.); (K.F.)
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Osman NI, Mangir N, Reeves FA, Franco A, Ricci E, Inman R, Chapple CR. The Modified Prone Jack-knife Position for the Excision of Female Urethral Diverticula. Eur Urol 2020; 79:290-297. [PMID: 33279306 DOI: 10.1016/j.eururo.2020.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/10/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Female urethral diverticula (UD) are an uncommon and often overlooked aetiology in women presenting with lower urinary tract symptoms, urethral pain, and recurrent urinary tract infection. With increasing awareness, appropriate imaging is more commonly undertaken with consideration given to surgical management. OBJECTIVE The video presented demonstrates the technique for excising large and/or complex UD using a modified prone jack-knife position-a position that offers excellent surgical access and allows the surgeon to operate in a more ergonomic position. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of the data on patients undergoing excision of UD at a tertiary referral unit was performed. SURGICAL PROCEDURE Urethral and suprapubic catheters (±insertion of ureteric stents) were placed in supine position. UD excised in the modified prone jack-knife position (±placement of a Martius flap). MEASUREMENTS Subjective cure rate, recurrence rate, rates of postoperative urinary incontinence, need for secondary incontinence procedure, and postoperative complications were measured. RESULTS AND LIMITATIONS A total of 121 patients were operated on in the study period. The mean follow-up time was 10 mo (range 3-40). The most frequent presenting symptoms included a vaginal mass (n = 76, 63%), followed by dysuria (n = 72, 60%) and pelvic pain (n = 71, 59%). An identifiable aetiological factor was present in 45 patients, including traumatic vaginal delivery (18, 15%), prior periurethral surgery (17, 14%), and urethral dilatation (10, 8%). All patients underwent postvoiding magnetic resonance imaging (MRI) to confirm the diagnosis and plan surgery. UD ranged in maximum diameter from 8 to 48 mm, with a mean of 43 mm (standard deviation 9.24). The most common anatomical location was midurethral (55, 46%), followed by distal (36, 30%), proximal (25, 21%), and full length (5, 4%). Most UDs were single in configuration (74%), followed by multiloculated (15%), saddle shaped (7%), and circumferential (5%). On preoperative videourodynamics, 17 (14%) had stress urinary incontinence. UD excision was undertaken in the modified prone jack-knife position in all cases. A Martius flap was utilised in 36 (30%). The median postoperative postvoiding residual was 26 ml (interquartile range 0-40). In total, 88 (73%) patients were continent postoperatively and 16 (13%) experienced de novo stress urinary incontinence. Of the 37 with pre-existing stress incontinence symptoms, 20 (54%) were continent after operation. A total of 14 patients had subsequent autologous fascial sling at 6 mo. In total, five symptomatic recurrences occurred (4%); of these patients, three elected to undergo surgical excision, all of whom had symptom resolution and were continent after operation. A total of 11 patients (9%) experienced a Clavien-Dindo grade I-II complication within 90 d after operation. Five patients complained of dyspareunia, which resolved by 6 mo. CONCLUSIONS The modified prone jack-knife position facilitates excellent access for excision of both simple and complex UDs. This positioning of the patient is not widely recognised amongst urologists. Using this approach, there were low rates of symptomatic recurrence and de novo stress incontinence at medium-term follow-up. Associated urinary incontinence resolves in over half of patients following UD excision; hence, we advocate deferring any incontinence procedure until after the results of surgery are established. PATIENT SUMMARY Surgical removal of urethral outpouching (diverticula) in women is challenging due to its potential to damage the nearby sphincter muscle, which controls continence, or the urethra tube. Placement of patients on their front, rather than on their back, provides excellent access for the surgical removal of urethral diverticula. With this approach, we achieved excellent rates of cure and low rates of urinary incontinence at an average follow-up of 10 mo.
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Affiliation(s)
- Nadir I Osman
- Department of Urology, Royal Hallamshire Hospital, Sheffield, UK.
| | - Naside Mangir
- Department of Urology, Hacettepe University School of Medicine, Sıhhiye, Ankara, Turkey
| | - Felicity A Reeves
- Functional, Female and Restorative urology (Fellow), University College Hospital, London, UK
| | | | - Ester Ricci
- Department of Maternal, Infantile and Urological Sciences, University of Naples Frederico II, Naples, Italy
| | - Richard Inman
- Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
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Tewary SK, Das RK, Choudhary A, Basu S, Dey RK. Modified Technique of Doubly Folded Peritoneal Flap Interposition in Transabdominal Vesicovaginal Fistula Repair: Our Experience of 36 Cases. Urol Int 2020; 104:928-932. [PMID: 32898844 DOI: 10.1159/000509446] [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: 04/07/2020] [Accepted: 06/13/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE Correction of vesicovaginal fistula (VVF) using interpositional flaps is an established procedure. In open repair, omental flap gives good results. However, its availability in all the cases is questionable. We utilized our technique of doubly folded peritoneal flap and assessed the outcome of the repair. METHODS Retrospective observational study included 36 cases of open VVF repair, performed during 2010-2019. Preoperative clinical examination, cystoscopy, and imaging were performed routinely. Open transvesical repair as described by O'Conor was performed and doubly folded peritoneal flap was utilized. Intra- and postoperative parameters were recorded. The outcome was assessed after 21 days of catheter removal. A minimum of 6 months of follow-up was done. RESULTS Mean age was 44 ± 18 years, and 97.2% of VVF were iatrogenic, mainly after hysterectomy (75.0%) and caesarean section (22.2%). Fistula size ranged from 0.6 to 5.5 cm. Five cases had multiple fistulas and 3 cases were recurrent. Mean flap length and width were 8.0 ± 2.4 and 5.1 ± 1.1 cm, respectively. Mean operative time and estimated blood loss were 94 ± 15 min and 155 ± 45 mL, respectively. Fourteen of 36 patients developed complications of Clavien-Dindo grade I/II. Thirty-five out of 36 cases (97.2%) were cured and remained dry for 6 months after surgery. Three cases reported de-novo urgency and were treated medically. Satisfaction level was good in 91.2% of cases. CONCLUSION Transvesical repair using doubly folded peritoneal flap provides an excellent and durable outcome. It is a suitable alternative to the omental interpositional flap.
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Affiliation(s)
- Shashi Kant Tewary
- Department of Urology, RG Kar Medical College and Hospital, Kolkata, India
| | - Ranjit Kumar Das
- Department of Urology, RG Kar Medical College and Hospital, Kolkata, India
| | - Arpan Choudhary
- Department of Urology, Super Speciality Hospital, NSCB Medical College, Jabalpur, India,
| | - Supriyo Basu
- Department of Urology, RG Kar Medical College and Hospital, Kolkata, India
| | - Ranjan Kumar Dey
- Department of Urology, RG Kar Medical College and Hospital, Kolkata, India
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Lask A, Rappaport YH, Neheman A, Zisman A, Beberashvili I, Stav K. Transvaginal surgical repair of large urethral diverticula with bipedicle double-opposing flaps of the periurethral fascia. Int Urogynecol J 2020; 32:2969-2973. [PMID: 32797263 DOI: 10.1007/s00192-020-04486-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 07/30/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The aims of this study were to describe a novel technique for transvaginal repair of large (> 4 cm) female urethral diverticulum (UD) using bipedicle double-opposing flaps of the periurethral fascia and to evaluate long-term follow-up. METHODS The medical records of 29 women who underwent transvaginal excision of UD at our institution were reviewed retrospectively. Seventeen cases with UD > 4 cm were included in the study. Cystourethroscopy was performed at the beginning of the surgery, and in 60% of cases the orifice of the diverticulum was identified. An inverted-U incision was performed at the vaginal anterior wall. The periurethral fascia was incised longitudinal at the midline and parallel to the urethra. The diverticular sac was dissected and resected. The neck of the diverticulum was closed with 4/0 vicryl suture. The periurethral fascia was sutured using bipedicle double-opposing flaps with interrupted 3/0 vircyl suture. The vaginal mucosa was sutured with 2/0 vicryl continuous suture. RESULTS All 17 women with large UD were operated on using bipedicle double-opposing flaps of the periurethral fascia. Follow-up of 5 ± 2.4 years yielded no recurrence and no other late complications. CONCLUSION Using bipedicle double-opposing flaps of the periurethral fascia during transvaginal excision of large UD is safe and effective.
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Affiliation(s)
- Avigal Lask
- Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), 7030000, Zerifin, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yishai Hode Rappaport
- Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), 7030000, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Neheman
- Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), 7030000, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amnon Zisman
- Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), 7030000, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilia Beberashvili
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology, Shamir Medical Center (Assaf Harofeh Campus), Zerifin, 7030000, Israel
| | - Kobi Stav
- Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), 7030000, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Mancini M, Righetto M, Modonutti D, Morlacco A, Dal Moro F, Zattoni F. Successful Treatment of Vesicovaginal Fistulas via an Abdominal Transvesical Approach: A Single-center 50-yr Experience. Eur Urol Focus 2020; 7:1485-1492. [PMID: 32747296 DOI: 10.1016/j.euf.2020.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/14/2020] [Accepted: 06/25/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND A vesicovaginal fistula (VVF) is an abnormal communication between bladder and vagina, as a result of traumatic events to the female pelvis. A VVF is a rare event and challenging to cure. Successful treatment can be achieved through an abdominal approach, especially in complex or recurrent cases. This approach has been used in our institution as the procedure of choice for the past 50yr. OBJECTIVE To analyze the results of the management of VVFs in our institution and to highlight the key points for success. DESIGN, SETTING, AND PARTICIPANTS A total of 138 patients with VVFs have been treated in our institution between 1969 and 2019. Up to now, this is the largest series reported so far on abdominal treatment of VVFs in the developed world. INTERVENTION an abdominal transvesical approach has been performed as the procedure of choice. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: to evaluate the factors influencing the success rate of the abdominal approach at the first closure attempt. Statistical analysis was performed using STATA software. RESULTS AND LIMITATIONS In total, 124 (90%) patients were submitted to transabdominal repair (89 extraperitoneal; 71.8%), 113 (91.1%) presented with a VVF not associated with another fistula, and 36 (29.0%) had undergone previous unsuccessful treatments elsewhere. Successful closure was obtained in 111/118 (94.1%) patients at the first attempt, excluding external noncontinent urinary diversions. Follow-up was possible in 95 (76.6%) patients; 91 (95.8%) patients were dry. Statistical analysis showed a significant association between fistula size and length, and VVF site in the bladder and extraperitoneal approach. Success rate decreased with the number of previous attempts and did not vary with VVF etiology. CONCLUSIONS The abdominal approach for the treatment of VVF has a high success rate. Standardization of the technique, identification of surgical key points, and centralization of care in centers with experience are critical. PATIENT SUMMARY A vesicovaginal fistula (VVF) is a rare clinical condition, with a high impact on patients' quality of life. We report a large series of VVFs treated in our institution in the past 50yr. Key factors for success include proper surgical technique and centralization of care in centers with high experience.
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Affiliation(s)
- Mariangela Mancini
- Department of Surgical, Oncological and Gastroenterological Sciences, Urological Unit, University of Padua, Padua, Italy.
| | - Marialaura Righetto
- Department of Surgical, Oncological and Gastroenterological Sciences, Urological Unit, University of Padua, Padua, Italy
| | - Daniele Modonutti
- Department of Surgical, Oncological and Gastroenterological Sciences, Urological Unit, University of Padua, Padua, Italy
| | - Alessandro Morlacco
- Department of Surgical, Oncological and Gastroenterological Sciences, Urological Unit, University of Padua, Padua, Italy
| | - Fabrizio Dal Moro
- Department of Surgical, Oncological and Gastroenterological Sciences, Urological Unit, University of Padua, Padua, Italy
| | - Filiberto Zattoni
- Department of Surgical, Oncological and Gastroenterological Sciences, Urological Unit, University of Padua, Padua, Italy
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