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At least 19 recordsLinked to original sources
PubMed2003

Guidelines of how to manage vesicovaginal fistula.

Vesicovaginal fistulas are among the most distressing complications of gynecologic and obstetric procedures. The risk of developing vesicovaginal fistula is more than 1% after radical surgery and radiotherapy for gynecologic malignancies. Management of these fistulas has been better defined and standardized over the last decade. We describe in this paper the success rate reported in the literature by treatment modality and the guidelines used at our teaching hospitals, University of Rome Campus Biomedico and University of Miami School of Medicine. In general, our preferred approach is a trans-vaginal repair. To the performance of the surgical treatment, we recommend a minimum of a 4-6 week's wait from the onset of the fistula. The vaginal repair techniques can be categorized as to those that are modifications of the Latzko procedure or a layered closure with or without a Martius flap. The most frequently used abdominal approaches are the bivalve technique or the fistula excision. Radiated fistulas usually require a more individualized management and complex surgical procedures. The rate of successful fistula repair reported in the literature varies between 70 and 100% in non-radiated patients, with similar results when a vaginal or abdominal approach is performed, the mean success rates being 91 and 97%, respectively. Fistulas in radiated patients are less frequently repaired and the success rate varies between 40 and 100%. In this setting many institutions prefer to perform a urinary diversion. In conclusion, the vaginal approach of vesicovaginal fistulas repair should be the preferred one. Transvaginal repairs achieve comparable success rates, while minimizing operative complications, hospital stay, blood loss, and post surgical pain. We recommend waiting at least 4-6 weeks prior to attempting repair of a vesicovaginal fistula. It is acceptable to repeat the repair through a vaginal approach even after a first vaginal approach failure. In the more individualized management of fistulas associated with radiation, the vaginal approach should still be considered.

Algorithms↗
PubMed1983

Isolated congenital vesicovaginal fistula.

Vesicovaginal fistula is a recognized complication in patients with antecedent surgical trauma or pelvic organ malignancy and as a sequela to radiation in this area. A review of the literature failed to document a case of isolated congenital vesicovaginal fistula with no other associated organ dysgenesis. We report on a 4-year-old child with incontinence resulting from an idiopathic vesicovaginal fistula.

Child, Preschool↗
PubMed2005

[Vesicovaginal fistulas].

Vesicovaginal fistulas are often the result of obstetric trauma in third world countries or gynaecologic surgery in developed countries. The incidence of obstetric trauma is approximately 3-4/1000 births in West Africa. The incidence of fistulas as a result of surgery has remained relatively unchanged for years; 75% occur during gynaecologic procedures. The main clinical symptom of a vesicovaginal fistula is urine loss. Different surgical techniques with similar repair results are available: transvaginal approach, transvesical approach and transperitoneal approach. Irrespective of the approach used, requirements for successful repair include adequate surgical exposure, wide mobilization of the bladder and vagina, excision of the fistula tract, tension-free closure of the bladder and vagina, and placement of an interposition flap, i.e. Martius flap, omentum, peritoneum, when indicated. Using these surgical techniques, around 85% of women can be cured from their vesicovaginal fistula with a single operation.

Administration, Intravaginal↗
PubMed1999

Laparoscopic management of recurrent vesicovaginal fistula.

Vesicovaginal fistula repair is most commonly undertaken via a transvaginal approach. We report a recurrent case of vesicovaginal fistula which was ultimately repaired using a laparoscopic approach. The fistula followed a hysterectomy and persisted despite two operations using the Latzko partial colpocleisis and prolonged catheterization. The fistulous tract was ultimately repaired by closing the vagina and bladder with an interposing omental flap utilizing a laparoscopic approach.

Adult↗
PubMed2001

Current management of vesicovaginal fistulae.

Vesicovaginal fistula continues to be a distressing problem that results most commonly from urogynecologic surgery. Several surgical techniques for correction of vesicovaginal fistulae have been described. The present review emphasizes those advances in surgical management and recent changes in etiology.

Female↗
PubMed1994

Vesicovaginal fistula.

Vesicovaginal fistulas are often the result of obstetric trauma in third world countries and gynecologic surgery in developed countries. Improvement in obstetric care and the increased use of cesarean section has resulted in a decrease in the incidence of obstetric fistulas in the United States. However, the incidence of fistulas as a result of surgery has remained relatively unchanged for years. Most postoperative fistulas occur under very normal operative circumstances. The keys to prevention of postoperative fistulas are wide dissection of the bladder from the cervix and vagina in the correct plane during surgery and recognition of bladder damage intraoperatively with appropriate repair. More than 90 percent of vesicovaginal fistulas can and should be repaired vaginally. The procedures available for repair are the flap splitting and Latzko techniques. On occasion an abdominal approach is indicated, particularly for vesicouterine fistulas. Requirements for successful repair include adequate surgical exposure, wide mobilization of the vagina, nonexcision of the fistula tract, tension-free closure of the bladder, and grafting when indicated.

Female↗
PubMed2006

Laparoscopic repair of vesicovaginal fistula.

Vesicovaginal fistula (VVF) may be a complication of prolonged repair or urogynecologic surgery. Failing conservative management, it may be repaired using an abdominal or vaginal approach. We herein report laparoscopic repair of VVF following vaginal hysterectomy and detail the operative steps.

Adult↗
PubMed2005

Laparoscopic repair of vesicovaginal fistula.

PURPOSE: Vesicovaginal fistula may be a complication of urogynecologic surgery. We describe the technique of laparoscopic repair of vesicovaginal fistula as performed at our 2 institutions. MATERIALS AND METHODS: Since August 1998 laparoscopic repair of vesicovaginal fistula was performed in 15 select patients who had clear indications to undergo surgical treatment through an abdominal approach. Hysterectomy had previously been performed in 14 patients (93%). Conservative treatment was initially attempted for more than 2 months in all cases. Four patients had undergone a previous surgical fistula closure attempt with unsuccessful results. Our technique involved cystoscopy, catheterization of the vesicovaginal fistula, laparoscopic cystotomy, opening and excision of the fistulous tract, dissection of the bladder from the vagina, cystotomy closure and colpotomy with interposition of a flap of healthy tissue. Demographic as well as perioperative and outcome data were recorded. RESULTS: Average patient age was 38 years. None of the cases required open conversion. Mean operative time was 170 minutes (range 140 to 240). Mean hospital stay was 3 days (range 2 to 5). The mean duration of bladder catheterization was 10.4 days (range 9 to 15) At a mean followup of 26.2 months (range 3 to 60) 14 patients (93%) were cured. CONCLUSIONS: We believe that laparoscopic repair of vesicovaginal fistula is a feasible and efficacious minimally invasive approach for the management of this entity.

Adult↗
PubMed1985

[A case of congenital vesicovaginal fistula].

Congenital vesicovaginal fistula is very rare and only five cases have been reported so far. This is a report on a case of congenital vesicovaginal fistula in a three-year-old girl. Vesicovaginal fistula was confirmed by cystoscopy and colposcopy. Roentgen examinations, including IVP, CG and CT revealed a left hypoplastic kidney, left ectopic ureteric orifice and left vesicoureteral reflux. Under general anesthesia, the fistula was resected and closed transvesically, and ureterocystoneostomy was performed. Five out of the six cases of congenital vesicovaginal fistula reported worldwide had other congenital complications of the genitourinary system, but the etiology of this anomaly is still unknown.

Child, Preschool↗
PubMed2003

A 12-year experience in the surgical management of vesicovaginal fistulae.

INTRODUCTION: Vesicovaginal fistulae are largely iatrogenic and represent therapeutic dilemmas in surgical approach and timing of repairs. AIM: We have reviewed our surgical management of vesicovaginal fistulae over a 12-year period to determine whether the outcome is dependent on surgical approach and timing of repair. PATIENTS AND METHODS: From January 1990 to September 2001, 23 patients were referred to our department of whom 20 have retrievable records. Fourteen of these 20 patients had gynaecological operations as the primary cause for their fistulas whilst the remaining six had varied causes ranging from forceps delivery to recurrent pelvic malignancies. RESULTS: Of 20 patients, four underwent transvaginal repair, seven transvesical repair, eight supravesical repair and one required an ileal conduit diversion. There was an 85% success after first repair with only three fistula recurrences, two of whom underwent a successful second repair and one was treated conservatively and successfully with urethral catheterisation. There were no further recurrences at mean follow-up of 23 months for our cohort. Earlier repair seemed to be associated with a higher recurrence rate (33% of six patients within six weeks) compared with delayed operations (7% of remaining 14 operated after six weeks). CONCLUSION: Vesicovaginal fistulae can be successfully managed surgically. Although the type of approach did not affect outcome, the timing of the repair may affect the success of the operation.

Adult↗
PubMed2000

Congenital vesicovaginal fistula.

Congenital vesicovaginal fistula is a very rare entity, the etiology of which has not been clearly elucidated because pathologic features have not been mentioned in previous reports. The case of a 4-year-old girl having incontinence resulting from a congenital vesicovaginal fistula joining with the left ectopic ureter from the hypoplastic kidney is described. This is thought to be the first presentation of congenital vesicovaginal fistula joining with ectopic ureter. A microscopic examination revealed the fistula consisting of transitional cell epithelium, suggesting an abnormal fusion of the ureteral bud and caudal end of the müllerian duct with the urogenital sinus.

Child, Preschool↗
PubMed2002

Fitsari 'dan Duniya. An African (Hausa) praise song about vesicovaginal fistulas.

The vesicovaginal fistula from prolonged obstructed labor is a condition that is no longer seen in the affluent, industrialized world, yet it continues to exist in epidemic proportions in sub-Saharan Africa, where several million women are estimated to suffer from this condition. The unremitting urinary incontinence that is produced by a fistula causes these women to become social outcasts. The problem is particularly acute in Nigeria, where the Federal Ministry of Women's Affairs estimates that there may be as many as 800,000 unrepaired fistula cases. Because of the social stigma attached to their condition, fistula victims have often been subjected to major psychosocial trauma. Finding ways to help such patients reintegrate into social networks is an important part of their treatment. When fistula patients meet one another, they realize that they are not alone in their suffering. This article describes the use of a "praise song" by a group of Nigerian fistula patients as a vehicle for building group identity as part of a "sisterhood of suffering." A transcription and translation of a Hausa praise song about vesicovaginal fistulas is presented, along with a commentary on the text that sheds new light on a problem that is unfamiliar to most Western obstetrician-gynecologists.

Adolescent↗
PubMed1988

Vesicovaginal fistula revisited.

Vesicovaginal fistulas remain common and serious problems for women in West Africa. Thirty-six surgical repairs done during visiting professorships by American gynecologists between the years 1978-1987 are documented. The overall success rate was 70%. The management of large (greater than 4 cm) obstetric fistulas was especially difficult until the Latzko technique was abandoned for the technique of wide mobilization of vaginal flaps over the fistula site. This technique reduced the failure rate from 75% through 1986 to approximately 25% in 1987. Ongoing controversies and basic principles of surgical techniques in fistula repair are reviewed.

Africa, Western↗
PubMedDate not supplied

Pedicled omental graft in repair of large, difficult vesicovaginal fistulae.

Large vesicovaginal fistulae, particularly those associated with urethral loss, present formidable repair problems. Omentum, recognized for its role in resolving abdominal infection, is successfully used for pedicle grafts in these complex situations. The authors present their experience in 25 cases, describing modifications of an earlier procedure.

Adolescent↗
PubMed1989

New surgical approach for treatment of complex vesicovaginal fistula.

Complex vesicovaginal fistulas still represent a management problem, since most of the cases have been operated on previously and because of the lack of a completely successful surgical technique. A new procedure for vesical autoplasty is presented. A flap is obtained from the posterosuperior bladder wall that slides down to cover large lesions, even in low capacity reservoirs. The technique has shown excellent long-term results in 42 consecutive complicated cases.

Adult↗
PubMed1988

Prevention of the development of a vesicovaginal fistula.

The cause of vesicovaginal fistulas after hysterectomy is not clearly understood. In an attempt to determine its cause, the records of 12 patients who had vesicovaginal fistula develop (after total abdominal hysterectomy) were compared with 12 consecutive patients who underwent total abdominal hysterectomy without fistula formation. Most of the patients who had vesicovaginal fistulas develop had excessive postoperative abdominal pain, distension or paralytic ileus, or both. Hematuria and symptoms of irritability of the bladder were also noted in the fistula group and prolonged postoperative fever and increased white blood cell count occurred more often. In contrast, the postoperative course was uncomplicated in the nonfistula group. The clinical course observed in many of the patients with vesicovaginal fistulas suggests that the patients had an unrecognized injury to the bladder resulting in urinary extravasation. It is postulated that the fistula develops when the urinoma drains into the vaginal cuff which is dependent and usually not closed. It may be possible to abort the development of many vesicovaginal fistulas by early recognition and treatment of an unsuspected bladder injury. It is suggested that patients with severe abdominal pain, distension, paralytic ileus, hematuria or symptoms of severe irritability of the bladder after abdominal hysterectomy be investigated early for a possible bladder injury.

Adult↗
PubMed1985

Genitourinary fistulae. Vaginal approach for repair of vesicovaginal fistulae.

Controversy still remains concerning the timing of repair, the type of approach, and the technical guidelines most likely to prevent recurrence of both radiated and nonradiated vesicovaginal fistulae. The authors advocate the transvaginal approach because it avoids a cystotomy and involves minimal blood loss and consequently is followed by less postoperative discomfort and a shorter hospital stay. Included in this discussion are the techniques and results of the transvaginal approach for simple vesicovaginal fistulae as well as for complex cases and radiation fistulae.

Catheters, Indwelling↗
PubMed1983

Epidemiological determinants of vesicovaginal fistulas.

Between 1969 and 1980 1443 patients with vesicovaginal fistulas were operated on in Ahmadu Bello University Hospital in Northern Nigeria. They have been studied in relation to their obstetric, social and environmental background. The preventable nature of the lesion was explored particularly with respect to age, parity and obstructed labour, and to traditional practices including 'gishiri cutting', which alone accounts for 13% of all the fistulas. Vesicovaginal fistulas are still a major cause for concern in many developing countries; measures for prevention include universal education and improved status of women in society as well as improved and accessible medical services.

Adolescent↗