The choice of surgical approach in the treatment of vesico-vaginal fistulae

Hillary, Christopher; Chapple, Christopher R.

doi:10.1016/j.ajur.2018.01.002

Cited by 27 publications

(21 citation statements)

References 20 publications

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“…The route chosen depends on several factors such as the training, surgical skills and expertise/ experience of the surgeon, patient anatomic factors such as fistula characteristics (size, location, severity) and involvement of other structures. 21,22 In this series, the abdominal and combined abdomino-vaginal routes were applied in the repair of more than half of the patients. This is due to the fact that sixteen (64%) patients, had in addition to fistula closure, other adjunctive procedures such as ureteric re-implantation, abdominal hysterectomy, and construction of continent catheterizable neo-bladder that were done as has been similarly reported by Rutam et al 10 These adjunctive surgical procedures in addition to the fistula closure are better done through the combined abdomino-vaginal route.…”

Section: Discussionmentioning

confidence: 99%

Management of complex genital fistula: experience in a tertiary sub-Saharan hospital

et al. 2020

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Background: Management of complex genital fistulae is challenging due to the cost and technical skill required. This study reports our experience in the management of patients with complex genital fistulae and to highlight the crucial role of the reconstructive urologists.Methods: This was a retrospective review of female patients managed at a tertiary hospital in Nigeria from 2006 to 2017 for complex urinary fistulae. Data were extracted from patient case notes and the data analysed using the SPSS software.Results: Twenty-four female patients mean age 28.9±11.1 years. Fistulae resulted from prolonged obstructed labour 10 (41.6%), caesarean hysterectomy 7 (29.2%), caesarean section and abdominal hysterectomy 2 (8.4%) respectively. The fistulae were vesicovaginal 16 (66.7%), ureterovaginal 3 (12.5%). Others were vesicocutaneous, urethrovaginal and rectovaginal. Prior attempts at repair were done in 7 (29.2%) and the number of attempts ranged from 1 to 4. Surgical procedures included direct closure in 9 (37.5%), closure and uretero-neocystostomy 7 (29.2%), uretero-neocystostomy only 3 (12.5%) closure and abdominal hysterectomy 2 (8.3%), closure and continent catheterizable neo-bladder 2 (8.3%) and 1 (4.2%) closure, abdominal hysterectomy and uretero-neocystostomy. Post-operative complications were noted in 2 (8.3%) and consisted of gynaeatresia and recurrent RVF. Repair was successful in 70.8% of patients while failed repair was recorded in 16.7% and while stress incontinence was present in 12.5%.Conclusions: Complex genital fistulae in our practice are of obstetric origin involving the bladder, ureters and rectum. The reconstructive urologist has a crucial role the management for a favourable outcome.

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Section: Discussionmentioning

confidence: 99%

Management of complex genital fistula: experience in a tertiary sub-Saharan hospital

et al. 2020

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“…The transvaginal approach can be used to manage most of the simple VVFs whereas complex fistulas that include large fistulas (>4 cm), multiple fistulas, those requiring ureteric re-implant (ureteric orifice close to the fistula) or bladder augmentation and post radiotherapy fistulas are best managed by transabdominal route. [8][9][10][11] Although many a times the most important deciding factor is the familiarity and expertise of the surgeon with the said approach and procedure. In our study both transvaginal and transabdominal approaches for VVF repair had an almost equal outcome with success rates of 92.2% and 95.2% respectively.…”

Section: Discussionmentioning

confidence: 99%

Spectrum of urologic complications in obstetrics and gynecology: 13 years’ experience from a tertiary referral center

Kumar

Pandey

Goel

et al. 2019

Turkish Journal of Urology

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Objective:To analyze the patterns of presentation and management for urologic complications of obstetrics and gynecology in the form of genitourinary fistulas at a tertiary referral center and highlight the social issues associated with them. Material and methods:We conducted this retrospective study analyzing 311 patients with genitourinary fistulas after obstetric and gynecologic surgeries between January 2005 and January 2018. We recorded the patients' characteristics and area of residence and then analyzed the etiology, surgical management and success rates by grouping the patients into four types of genitourinary fistulas. The primary end point of success was patient being leak free.Results: Majority of patients (90.4%) were from rural areas. The distribution of genitourinary fistulas in descending order was vesicovaginal (79.7%), ureterovaginal (11.8%), urethrovaginal (10.2%) and vesicouterine fistulas (2.6%). The mean time to presentation was 25.80±48.69 days with a wide range of 10 days to 360 months. The most common etiology was obstructed labour (58.5%) followed by abdominal hysterectomy (32.7%). For vesicovaginal fistulas the route to be used for repair depended on surgeon's preference and both transabdominal and transvaginal routes had almost equal success rates. The success rate of laparoscopic vesicovaginal fistula repair was 89.4% and all (100%) laparoscopic ureteroneocystostomies were successful. Conclusion:Genitourinary fistulas especially due to obstructed labour are still common in developing world showcasing the problem of inequitable distribution of healthcare. The surgical treatment approach depends on the surgeon's familiarity with the said procedure although versatility is required.

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“…The bladder is commonly fibrotic and non-compliant and sometimes requires augmentation [12]. VVFs that develop after RT may manifest months to years after and are associated with endarteritis obliterans and tissue ischaemia [13].…”

Section: Aetiologymentioning

confidence: 99%

Update on vesicovaginal fistula: A systematic review

Elazab

Abolella

Farouk

2019

Arab Journal of Urology

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Objective: To conduct a systematic review of the literature on vesicovaginal fistula (VVF), including reporting on the aetiology, in both developed and underdeveloped countries; diagnosis; intraoperative prevention; and management. Methods: We conducted a systematic review of the literature on VVF through the PubMed and the Cochrane Library according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search was conducted from 1985 to 2018 in English, using the keywords 'fistula' and 'vesicovaginal fistula'. Prospective studies were preferred; however, retrospective studies and case reports were used when no prospective studies were available. All authors' extracted relevant data related to the proposed review of VVF and carefully examined collected articles. Results: In all, 116 relevant articles were identified and 43 articles were included in this systematic review. The outcome of surgical reconstruction was >90%, but the outcome may be suboptimal in radiotherapy (RT)-induced VVFs. Absolute indications for an abdominal approach included: ureteric involvement, the need for concomitant bladder augmentation, severe vaginal stenosis, and an inability to tolerate the dorsal lithotomy position (e.g. due to muscular spasticity). Typically, it was recommended to wait at least 3 months to allow the inflammatory response to subside before definitive surgery. Early fistula repair can be performed in the absence of infection and in patients who have not received pelvic RT. Conclusion: VVF is rare in developed countries. Surgical treatment is the primary method of repair. The outcome of surgical reconstruction exceeds 90%, but the outcome may be suboptimal in RT-induced VVFs.

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The choice of surgical approach in the treatment of vesico-vaginal fistulae

Cited by 27 publications

References 20 publications

Management of complex genital fistula: experience in a tertiary sub-Saharan hospital

Management of complex genital fistula: experience in a tertiary sub-Saharan hospital

Spectrum of urologic complications in obstetrics and gynecology: 13 years’ experience from a tertiary referral center

Update on vesicovaginal fistula: A systematic review

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