ABSTRACT
Objective To investigate the therapeutic effects of pedicled greater omentum displacement for the repair of complex vesicovaginal fistulas. Methods This series included 67 cases of complex vesicovaginal fistulas.Their mean age was 24 years (range,19-38 years). The disease course ranged from 6 months to 11 years (mean, 3.5 years).All the fistulas resulted from dystocia.The fistula outlet was 2.5-4.5 cm in greatest dimension with a mean of 3.0 cm.The complications included ureter vesicovaginal fistulas in 15 cases (left side in 5,right in 7 and both in 3),ureter orifice stricture in 4 cases (left side in 2,right in 1 and both in 1),hydronephrosis in 17 cases (left side in 7, right in 9 and both in 1),bladder calculi in 9 cases.The pedicled greater omentum displacement was performed to form a kind of protective "tightening screen", which covered the wound repaired between bladder and vesicovaginal fistula. Results The procedure was successfully completed at a single session of repair in 63 patients with a success rate of 94%.Two patients underwent further prolonged indwelling catheterization because of tiny vesicovaginal fistulas of 0.2-0.4 cm after initial operation.The procedure failed in 4 cases (6%).Among the 67 patients,ureterovesicoplasty was performed in 21 cases.After operation,29 patients (46%) had mild incontinence; of them 21 got successful further treatment.The follow-up was 3 months in the 63 cases with successful results.No vesicovaginal fistula occurred. However,8 cases had mild incontinence,and B-ultrasound and IVU showed mild hydronephrosis in 3 cases. Conclusions The operation by “tightening screen” to repair vesicovaginal fistulas through pedicled greater omentum displacement can improve the success rate of operation and allow the appropriate treatment of complications such as ureter orifice stenosis and fistulas.
ABSTRACT
A clinical observation of the vesicovaginal fistulas was made on 15 cases admitted to the Department of Urology, Jeonbug National University Hospital during the last 4 years. The following results were obtained. 1. The causative factors of the vesicovaginal fistula were birth trauma (7 cases), chemical cauterization due to prolapse uteri (6 cases), traffic accident (1 case) and cervical cancer (1 case). 2. Over all success rate of vesicovaginal fistula repair was 80 % at one attempt. 3. More extensive procedure using transperitoneal extravesical approach with interposition of the pedicled omental graft was necessary for the repair of large and complicated fistula and showed excellent result. 4. Waiting for the acute reaction to subside adequately, having no tension in the closure, obtaining adequate exposure, trimming the fistulous edges back to good tissue and adding a temporary urinary diversion turned out to be main factors of the operative success.
Subject(s)
Accidents, Traffic , Cautery , Fistula , Parturition , Prolapse , Transplants , Urinary Diversion , Urology , Uterine Cervical Neoplasms , Uterus , Vesicovaginal FistulaABSTRACT
A clinical observation on the vesicovaginal repair was done on24 cases admitted to the Dep. of Urology, Keimyung University Hospital, during the period from 1971 through 1981. Vesicovaginal fistula can be surgically repaired via vaginal route or transvesical extraperitoneal or transperitoneal technique and the following results were obtained. 1. Overall success rate of vesicovaginal fistula repair was 71% and that of simplified transperitoneal transvesical approach was higher than conventional method (88%). 2. Excision of the fistulas were facilitated by continuing traction on the Foley catheter, vaginal insertion of assistant`s finger and sand bag application below hip. 3. Preoperative infection with scar tissue, short duration, large sized fistula, inadequate exposure and dissection of bladder from vagina turned out to be main factors of the operative failure. 4. Wide exposure with tension free closure of well-vascularized peritoneal flaps and the judicious interposition of pedicled omentum have produced the most encouraging results and supravesical diversion by ileal or colonic conduit can be avoided. 5. Previous attempts for surgical repair seemed to have relation with success rate.