Use of Electrocoagulation in the Treatment of Vesicovaginal Fistulas

Stovsky, Mark; Ignatoff, Jeffrey M.; Blum, Michael D.; Nanninga, John B.; O’Conor, Vincent J.; Kursh, Elroy D.

doi:10.1016/s0022-5347(17)32441-2

Cited by 88 publications

(38 citation statements)

References 2 publications

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“…On the other hand, cystoscopic electrocoagulation of the tiny VVF less than 3 mm in size has been found to have successful closure of the fistula in small number of cases. 15 In the present study, about 75% patients received repair of VVF via transabdominal approach, whereas the rest undergone surgery by vaginal route. The later approach is associated with minimal blood loss, less morbidity, early ambulation and shorter hospital stay.…”

Section: Discussionmentioning

confidence: 68%

Vesicovaginal Fistula: Our Experience of 47 Cases in a Tertiary Care Hospital of West Bengal

Datta¹,

Chattopadhyay²,

Mandal³

2016

jemds

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Vesicovaginal Fistula (VVF), an abnormal communication between the urinary bladder and vagina, is one of the most distressing and embarrassing health problem for the ladies. The present observational study was planned to inquire into the demographic and aetiologic pattern of vesicovaginal fistula and the long-term success rate of its surgical management following different techniques of repair in a tertiary care centre of West Bengal, India. MATERIAL AND METHODSA total of 47 patients with vesicovaginal fistula presented at our hospital over a span of nine years, were observed during their course of treatment. The patients were evaluated with clinical history, physical examination, routine laboratory investigations, intravenous urogram and cystoscopy. Then the patients had undergone operation by vaginal or abdominal route. Patients were discharged from the hospital with per urethral catheter. On 21 st post-operative day, routine cystogram was done in every patient before catheter removal to exclude the failure of the operation. RESULTOf the observed 47 patients, 66% were tracked back to their obstetric causes and 34% patients could be linked up to gynaecological aetiology like a complication of hysterectomy or after brachytherapy for carcinoma of cervix. In 23.4% of patients, the repair of fistula was done by vaginal route, whereas in 76.6% cases by abdominal approach. Overall success rate of surgical repair was 87.3%, which is comparable to the success rate mentioned in literature. CONCLUSIONIn spite of a decline in the incidence of vesicovaginal fistula in the western world, it is still highly prevalent in the developing countries. Prolonged obstructive labour was found as the most common aetiology of this devastating condition in our region. Timely intervention with meticulous surgical technique is essential for an acceptable success rate in fistula repair surgery. However, improved obstetric care, institutional delivery, high literacy rate, prevention of early marriage-all are of paramount importance for the prevention of occurrence of this socio-medical problem.

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Section: Discussionmentioning

confidence: 68%

Vesicovaginal Fistula: Our Experience of 47 Cases in a Tertiary Care Hospital of West Bengal

Datta¹,

Chattopadhyay²,

Mandal³

2016

jemds

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“…None of our cases show the healing of fistula after 1 month of catheterization. Some success has been reported with electrocoagulation of the smaller fistula tract (less than 3 mm in diameter), either transvaginally or transurethrally with tiny electrode and minimal coagulation current [1,11]. In this study, electrocoagulation was successfully tried in one case of the small supratrigonal VVF.…”

Section: Discussionmentioning

confidence: 84%

Genitourinary Fistula: An Indian Perspective

Priyadarshi

Singh

Bera

et al. 2015

J Obstet Gynecol India

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Background In developing countries, obstetric trauma is the most common cause of genitourinary fistulae. But over the last two decades, health care facilities have been improved and the scenario has been changed. Purpose The aim of the present study is to share our experience with genitourinary fistula in terms of mode of presentation, diagnostic modality, and management with the emphasis on the surgical approach and a parallel review of the available literature. Materials and Method During a 6-year period from January 2007 to December 2013, 41 cases of genitourinary fistula, who admitted and treated in the urology department of a tertiary care center, were retrospectively analyzed for etiology, site, size and number of fistulae, clinical presentation, diagnostic modalities, and management. The literature search was done using the Medline database. Result Mean age of the patient was 27 years (range 16-51). Primary and simple fistulae were common. Obstetric trauma was the most common etiology (56.09 %) followed by iatrogenic (39.03 %). Vesicovaginal fistula was the most common type (78.37 %) and trigone was the most common site involved (51.72 %). 51.35 % of patients were approached successfully by the vaginal route. Ancillary procedures were required in patients for various other associated anomalies at the time of fistula repair. The success rate on follow up was 94.5 %. In the mean follow up of 3 years, 35 patients were sexually active. Conclusion Genitourinary fistula is a frustrating entity with potentially devastating psychosocial consequence. Its management poses a tricky challenge to the surgeon. Accurate and timely diagnosis, adhering on basic surgical principle, and repair by an experienced surgeon provide the optimum chance of cure.

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“…resolution of small fistula <3cm in over 70% of the subjects in their study group with electrocoagulation followed by 2 weeks catheter drainage (20). An alternative is to destruct the fistulous lining mechanically using the cystoscope.…”

Section: Therapeutic Optionsmentioning

confidence: 98%