ABSTRACT
The fistulas, following gynecologic, surgeries are not uncommon. Hysterectomy is one of the most common causes of lower urinary tract fistula in pelvic surgery. Higher incidences are associated with laparoscopic hysterectomy as compared to vaginal or abdominal hysterectomy. Early identification and management of ureterovaginal fistula (UVF) are of utmost importance. The laparoscopic approach in the management of UVF is preferred over open surgery as it reduces pain, hospital stay, and morbidity. However, the laparoscopic approach needs higher surgical dexterity, sound knowledge of pelvic anatomy, and has a higher learning curve. One such approach is discussed here.
ABSTRACT
Ureterovaginal fistula commonly occurs as a result of complication of pelvic surgeries with gynaecologic surgeries accounting for approximately two thirds. It is one of the most feared complications of pelvic surgery. Objectives: This study aims to determine the aetiological factors, role of ultrasound in the confirmation of dignosis and outcome of surgical repair of ureterovaginal fistula at the National Obstetric Fistula Centre, Katsina (NOFIC). Methods: This was a two-year retrospective review of all cases that underwent surgical repair for ureterovaginal fistula at the National Obstetric Fistula Centre Babbar Ruga, Katsina from 1st Jan, 2016 to 31st Dec, 2017. Result: A total of 27 patients had surgery for ureterovaginal fistula during the study period. However only 25 case notes were eligible for data entry and analysis. The mean age of the patients was 29.88 ± 8.53 with a modal parity of one. Eighty-eight percent presented with history of leakage of urine per vagina following emergency caesarean section, caesarean hysterectomy in 8%, prolonged obstructed labour in 8% and gynaecological hysterectomy in 4%. The onset of leakage varied from 2 to 10 days with a mean duration of onset of 5.64 ± 1.70. In addition to the ureterovaginal fistula, 3 had vesicouterine (VUF) fistula and 1 had vesicocervicovaginal (VCVF) fistula. The fistula was bilateral in 2 of the patients. The fistulae involved the left ureter in 13 patients and the right ureter in 10. Abdominal ultrasound was the main means of confirmation of diagnosis. Abdominal reimplantation of the ureter was the most common (88%) treatment approach. Majority 88% (22/25) were healed and continent at discharge. Conclusion: Emergency caesarean section was found to be commonest aetiological factor and the use of abdominopelvic ultrasound was found to be effective in the confirmation of diagnosis and identifying the affected ureter.
ABSTRACT
Female ureterovaginal fistula (UVF)is pathological communication between the ureter and the vagina,which commonly occurs as a complication of ureteral injuries during pelvic operations,especially hysterectomy.Compared with open surgery,the incidence of UVF secondary to laparoscopic surgery was higher.The main clinical symptom of UVF is persistent vaginal leakage.The ureteral injury can be diagnosed promptly and accurately by medical history,clinical symptoms and CTU.The timing of surgical treatment for UVF is still controversial.When stenting failed,early ureteral reimplantation is necessary.The laparoscopic ureteral repimlantation should be recommended because of less invasion and quick recovery.
ABSTRACT
Female ureterovaginal fistula (UVF)is pathological communication between the ureter and the vagina,which commonly occurs as a complication of ureteral injuries during pelvic operations,especially hysterectomy.Compared with open surgery,the incidence of UVF secondary to laparoscopic surgery was higher.The main clinical symptom of UVF is persistent vaginal leakage.The ureteral injury can be diagnosed promptly and accurately by medical history,clinical symptoms and CTU.The timing of surgical treatment for UVF is still controversial.When stenting failed,early ureteral reimplantation is necessary.The laparoscopic ureteral repimlantation should be recommended because of less invasion and quick recovery.
ABSTRACT
During 2007 we were invited at different times to review and manage four women with ureterovaginal fistula following caesarean section performed in different rural hospitals. We describe our experience of a simple technique of diagnosis and management of these indigent patients in a resource-constrained hospital. The condition was diagnosed by the three-swab test in all four patients; and abdominopelvic ultrasound was employed to help find the ureter involved. Transvesical ureteral implantation with a stent was carried out. Stent was removed after 2 weeks. All four patients were dry. Amidst the complexity of and sophistication of modern health care; it is important to remind ourselves of the common occurrence of this distressing condition following caesarean section and the use of a well known simple diagnostic technique and subsequent management in resource-poor communities
Subject(s)
Humans , Hospitals , Vaginal Fistula/therapy , Cesarean Section , Vaginal FistulaABSTRACT
Objective To evaluate the clinical effect of placing double J stent using a ureteroscope in early managing ureterovaginal fistula.Methods Twenty-eight patients cases with ureterovaginal fistula from 2002 to 2008 were treated early with placing double J stent using a ureteroscope and the clinical data were reviewed.Results Twenty-two of 28 cases were treated and double J stent was placed in them by a uretero-scope and 75% (21/28)of cases were cured.Four of 21 cases were treated twice by a ureteroscope and were cured finally.7 cases with failure ureterovaginal treatment underwent ureterocystostomy and were cured.The follow-up from 6 months to 33 months (average 10.1±6.4 months)showed that all of the 28 cases had been cured and had no urinary fistula.Conclusion Placing double J stent using a ureteroscope is the first choice of operative procedure for the early treatment of ureterovaginal fistula.
ABSTRACT
Since vesicovaginal and ureterovaginal fistulas are generally the result of surgical accidents, their incidence is largely a measure of the skill of the surgeon and his use of all available safety measuresComplete urologic visualization of the urinary tract and identification of the lesion will greatly improve the subsequent care of these patients. Adherence to sound principles of surgical repair and wound healing and complete urinary drainage will increase the chance of successful treatment of vesicovaginal and ureterovaginal fistulas.(Summary)
ABSTRACT
Eighteen patients with ureterovaginal fistula were managed at Seoul National University Hospital during the recent 8 years. The operations which led to the formation of the fistula were for cervical cancer in 10 and for the benign pelvic disease in 8. All patients experienced sudden increase of drain amount or incontinence during the postoperative period. Diagnosis was established readily by IVP, cystoscopy and RGP. Six patients were managed primarily by percutaneous nephrostomy, 4 of whom received corrective surgery 6 months later. Four patients received corrective surgery primarily. Two patients were under surve-illence only and 6 patients received nephrectomy. Current trend of management of ureteral injury was discussed.