Vesicovaginal and Urethrovaginal Fistulas

Successful repair of large vesicovaginal fistulas poses a significant challenge in surgically unfit older women with pelvic organ prolapse. Two women, at ages of 85 and 93, referred for involuntary urine loss were found to have neglected pessaries resulting in large vesicovaginal fistulas. After the removal of the pessary, fistula repair and LeFort colpocleisis were done with success. At 12 months postoperatively, the patients were free of leakage and prolapse. For frail, elderly women with large vesicovaginal fistula and pelvic organ prolapse, addition of LeFort colpocleisis to the repair provides an effective treatment for both.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Large vesicovaginal fistula in women with pelvic organ prolapse: the role of colpocleisis revisited

Esin

Harmanli

2008

“…Though various surgeons have opined differently, we advocate excision of the scarred fistula tract as it ensures tissue viability which in turn promotes wound healing and obviates the need for interpositional flaps or grafts. We repaired the VVF by the flap splitting technique [11]. This is because the second musculofascial layer reinforces the interrupted Lembert sutures of the submucosal layer and reduces tension, thereby helping immensely in healing and successful fistula closure.…”

Section: Discussionmentioning

confidence: 99%

Corrosive-induced vesicovaginal fistula with procidentia: a rare occurrence

Basak

Bag

2008

Vesicovaginal fistula (VVF) has huge physical, psychological and, above all, social implications in a woman's life. It has always been a challenge for the urogynaecologic surgeons to manage VVF. VVF can be caused by unrelieved obstructed labour, pelvic surgery, malignancies, radiation therapy, infection and trauma. Here we report a case of VVF caused by the application of a mixture of chemicals in a female with longstanding pelvic organ prolapse. This occurrence is unique by virtue of aetiology and to the best of our knowledge is only the second of its kind reported till date. We have also explained the operative technique used to combine both the prolapse and the fistula repair into a single operation that achieved excellent functional results.

“…The surgical approach to vesical fistulae depended on the type with pure vesicovaginal ones being tackled either vaginally or abdominally [15][16][17][18][19][20][21][22][23][24][25]. All other types with ureteric or uterine involvement were repaired abdominally.…”

Section: Methodsmentioning

confidence: 99%

“…Vaginal repair was preferred due to better cosmesis and lesser morbidity, blood loss, and postoperative discomfort [26,27]. Abdominal repair was chosen when pelvic and vaginal anatomy precluded achievement of adequate exposure, proximity of the fistula to the ureteric orifices and possibility of their inclusion while suturing even if indwelling stents are used, insufficient hip or knee flexibility for the exaggerated lithotomy position, severe vaginal scarring and induration, as well as concerns about foreshortening of the vagina leading to dyspareunia in patients with limited vaginal capacity [15][16][17][18][19][20][21][22][23][24][25].…”

Section: Methodsmentioning

confidence: 99%

Urogenital fistulae: changing trends and personal experience of 46 cases

El-Lamie

2007

A retrospective study of 46 patients with different types of urogenital fistulae treated by the author during the period from January 1997 to December 2006 is presented. Twenty-two (48%) cases had a vesicovaginal fistula of which 16 (73%) were repaired vaginally and 6 (27%) were repaired abdominally. The remaining fistulae were as follows: 14 (30%) unilateral ureterovaginal fistulae, 6 (13%) ureterovesicovaginal fistulae (one bilateral), and 4 (9%) vesicouterine fistulae. All were repaired abdominally except for one patient with ureterovesicovaginal fistula needing continent urinary diversion using Mainz type II pouch. All fistulae were iatrogenic except one case (2%) which was due to neglected obstructed labor. The iatrogenic causes were gynecologically related in 26 (57%) patients and obstetrically related in 19 (41%) cases. There were two (9%) failed repairs in the vesicovaginal cases, one in each group, and both were salvaged by a secondary surgery. In view of this selected retrospective study and in association with other reports, it seems that with the improvement in the basic health-care services in Egypt, there is a change in the etiology of urogenital fistulae with the vast majority being physician related and no more related to neglected obstructed labor. Such shortcoming should be addressed in the current gynecological surgery training and residency programs.