Reparación quirúrgica por vía vaginal de fístulas vesicovaginales: una experiencia exitosa / Vaginal surgical repair of vesico-vaginal fistulas: a successful experience

OBJETIVO: Se presenta una serie de casos de reparación por vía vaginal de fístula vesicovaginal (FVV) de nuestro centro. MATERIAL Y MÉTODOS: Estudio observacional descriptivo. Se evaluaron todas las pacientes con reparación quirúrgica de FVV en el Centro de Innovación de Piso Pélvico del Hospital Sótero del Río entre 2016 y 2022. RESULTADOS: Se reportaron 16 casos, de los cuales el 81,3% fueron secundarios a cirugía ginecológica. En todos se realizó la reparación por vía vaginal, con cierre por planos. En el 94% (15/16) se logró una reparación exitosa en un primer intento. El tiempo de seguimiento poscirugía fue de 10 meses (rango: 3-29). No hubo casos de recidiva en el seguimiento. Una paciente presentó fístula de novo, la cual se reparó de manera exitosa en un segundo intento por vía vaginal. Se reportaron satisfechas con la cirugía 15 pacientes, con mejoría significativa de su calidad de vida. Una paciente reportó sentirse igual (6,3%), pero sus síntomas se debían a síndrome de vejiga hiperactiva que la paciente no lograba diferenciar de los síntomas previos a la cirugía. CONCLUSIÓN: Las FVV en los países desarrollados son secundarias a cirugía ginecológica benigna. La cirugía por vía vaginal en nuestra serie demostró una alta tasa de éxito, con mejora significativa en la calidad de vida de las pacientes.

OBJETIVE: We present a case series of vesico-vaginal fistulas (VVF) vaginal repair in our center. MATERIAL AND METHODS: Descriptive observational study. All patients with surgical repair of VVF at the Centro de Innovación en Piso Pélvico of Hospital Sótero del Río were evaluated between September 2016 and September 2022. RESULTS: 16 cases were reported. 81.3% were secondary to gynecological surgery. In all cases, a vaginal repair was performed, with a layered closure. 94% (15/16) had no contrast extravasation at the time of examination, confirming fistula closure. The follow-up time was 10 months (range: 3-29). There were no cases of recurrence during follow-up. 1 patient presented de novo fistula which was successfully repaired in a second attempt vaginally. 15/16 patients reported being satisfied with the surgery, with significant improvement in quality of life. 1 patient reported feeling the same (6.3%), but her symptoms were due to overactive bladder syndrome that the patient could not differentiate from the symptoms prior to surgery. CONCLUSION: VFV in developed countries are mainly secondary to benign gynecological surgery. Vaginal surgery in our series achieved a significant improvement in the quality of life of patients.

Vesico-vaginal fistulae; review of the causes, diagnosis and treatment

To review the causes, diagnosis and treatment of vesico-vaginal fistulae in the department of Gynaecology and Obstetrics, and Urology Department Civil Hospital Quetta. Vesico-vaginal fistula is not life threatening medical disease, but the woman face problems like demoralization, isolation, social boycott and even divorce. The etiology of the condition has been changed over the years and in developed countries obstetrical fistula are rare and they are usually result of gynecological surgeries or radiotherapy. In countries like Pakistan the situation is different, here literacy rate is low, parity rate is high and medical facilities are deficient. People manage delivery at home and usually multi parity. Urogenital fistula surgery doesn't require special or advance technology but needs experienced urogynecologist with trained team and post operative care which can restore health, hope and sense of dignity to women. A retrospective study of 60 patients with different types of vesico-vaginal fistula werereviewed between January 2005 to December 2008. Patients were analyzed with regard to age, parity, cause, diagnosis, mode of treatment and outcome. Patients were also evaluated initially according to prognosis. During the study of four year period 60 patients of vesico-vaginal fistulae were reviewed. Majority of the patients were belonging to middle age group. In 48 patients repair was done through transvaginal route and 12 were operated through transabdominal route. One Ca patient expired and in 4 patients recurrence occurred. Iatrogenic vesico-vaginal fistulae are more common. Difficult and complicated fistulae need experienced surgeon. Establishment of separate fistula surgery unit is suggested to get desired results

Cirugía laparoscópica de la fístula vesico-vaginal: resultados de una experiencia multi-institucional / Laparoscopic surgery of vesicovaginal fistula: results of a multi institutional experience

Introduction: vesico-vaginal fistula is a rare complication of gynecologic surgery, with a high rate of surgical resolution O'Conor open technique. Aim: to report the results of a multi-institutional experience in laparoscopic repair of vesico-vaginal fistula. Material and Methods: between january 2006 and june 2011, 21 laparoscopic vesico-vaginal fistula were performed. The surgical technique, demographic variables and results are described. Results: the mean age was 45.6 years. The average time between the diagnosis of the fistula and the laparoscopic repair was 15.23 months. The mean total operative time (bladder and laparoscopic) was 153.12 minutes and the average hospital stay was 2.7 days. The average time of bladder catheter was 9.4 days. There was a minimal recurrence of a fistula, repaired by a vaginal approach. Urethrocystography revealed indemnity of the repair in the other 20 cases. The overall success rate was 95.2 percent (20 out of 21 patients) Conclusions: the laparoscopic approach follows all principles for repair of a vesico-vaginal fistulas. It look like a good alternative in the hands of experienced surgeons.

Introducción: la fístula vesico-vaginal es una complicación infrecuente de la cirugía ginecológica, con alta tasa de resolución quirúrgica con la técnica abierta tradicional de O'Conor. Objetivo: comunicar los resultados de una experiencia multi-institucional en la reparación laparoscópica de las fístulas vesico-vaginales. Material y Método: entre enero de 2006 y junio de 2011 se realizaron 21 reparaciones de fístulas vesico-vaginales por vía laparoscópica. Se describe la técnica quirúrgica y se analizan las variables demográficas, quirúrgicas y resultados de la serie. Resultados: la edad media de las pacientes fue de 45,6 años. El tiempo promedio transcurrido entre el diagnóstico de la fistula y su reparación laparoscópica fue de 15,23 meses. El tiempo quirúrgico medio total (vesical y laparoscópico) fue de 153,12 min y el de hospitalización 2,7 días. El tiempo promedio de catéter uretro-vesical fue de 9,4 días. Hubo una mínima recidiva de una fístula, la cual fue reparada por vía vaginal. El control radiológico mediante cistografía reveló indemnidad de la reparación en el resto de los casos. La tasa global de éxito fue de 95,2 por ciento (20 de 21 pacientes) Conclusiones: el abordaje laparoscópico permite cumplir con todos los principios para la reparación de las fístulas vesico-vaginales. La reducción de la morbilidad y la eficacia del procedimiento, lo transforman en una excelente alternativa en manos de cirujanos experimentados.

[Obstetric Vesicovaginal fistulas, about 131 cases]

Vesicovaginal fistulas are the most frequent type of urogenital fistulas. Obstetrical cause remains the dominant etiology. They still represent a public health problem. to study epidemiological aspects of obstetric vesico-vaginal fistulas and their management. a retrospective multicentric study among 19 hospital departments from February 1982 to January 2007. 131 VVF [92% of urogenital fistulas]. The vaginal route for surgical repair was used in 2/3 cases. The mean diameter of the fistula was 11.35mm. In 122 cases [86.5%], the fistula was unique. IVU findings were normal in 83% cases. All patients had normal renal function apart one who had acute renal failure. 177 interventions were performed [1.37 intervention per patient]. Our findings suggest a regression in obstetrical VVF. However many efforts on institutional, socioeconomic and obstetrical levels have to be done in order to eradicate this pathology that is of major handicap for women regarding socioeconomic, functi6nal and psychological effects

Transabdominal repair of vesicovaginal fistula: an experience of 27 cases

To review the causes of vesicovaginal fistula and outcome of its repair through transabdominal approach. This is a descriptive cross sectional study which was conducted in Surgical "D" unit, Khyber Teaching Hospital Peshawar from January 2004 to December 2009. The record of all cases of vesicovaginal fistula that had undergone transabdominal repair was reviewed. Complex vesicovaginal fistula cases were excluded. Operative findings and procedure's details were obtained from operation notes. Post-operative follow up findings after one week, three weeks, forty days and three months were noted for every case. A total of 27 cases had undergone transabdominal repair for vesicovaginal fistula with age ranging from 26 to 63 years. Twenty two cases developed vesicovaginal fistula as a result of obstructed labour and five as a result of Gynaecological surgery [post-hysterectomy]. Mean post-operative hospital stay was seven days. Failure of repair was seen in one case only. Five cases were lost during follow up. Eight [29.63%] cases developed urinary tract infection, and two [7.40%] cases developed transient urinary stress incontinence. This study suggests that obstetrical trauma is the commonest cause for developing vesicovaginal fistula and the transabdominal approach gives satisfactory results in its repair

Management of female uro-genital fistulas: framing certain guidelines

The study was carried out to discuss the pathogenesis and management protocol of seven different varieties of female uro-genital fistulas [FUGFs]. During 2000-2007, total of 15 FUGFs were operated, which belonged to seven different varieties requiring different routes and surgical procedures for their repair. Different fistulas with different pathophysiological factors required specific examinations and investigations preoperatively. The results of the repaired FUGFs, following the general surgical principles, were acceptable with formation of only one residual fistula. Successful correction of FUGFs is a surgical challenge. Detailed history, through examination and planning, atraumatic tissue handling, routine use of the interposition or onlay reinforcement flaps and vigilant postoperative care were found the key factors in successful outcome of the repaired fistulas

Fístula vesico vaginal: modificación de técnica quirúrgica / Vesicovaginal fistula: modification of the surgical technique

Las fístulas vesicovaginales se conocen desde la antigüedad. Mahfouz describió una en una momia egipcia, actualmente la causa más frecuente es la histerectomía, el éxito de la reparación de la fístula, depende de: tiempo de establecida la fístula, etiología, localización, estudio de la paciente y la fístula, técnica quirúrgica y experiencia del urólogo. Se realizó un estudio descriptivo longitudinal para de mostrar las ventajas de la modificación en la técnica quirúrgica, entre los años 2001 y 2008 en el servicio de Urología del Hospital Docente Iluminado Rodríguez de Jagüey Grande, Matanzas, se operaron 21 pacientes, las edades comprendidas entre 21 y 50 años y el motivo de ingreso, incontinencia de orina y antecedente de una operación quirúrgica ginecológica. Se utilizaron los archivos del hospital para obtener los datos recogidos de las historias clínicas. La distribución etárea fue del 76 por ciento de los casos entre los 31 y 45 años, que denota su gran frecuencia entre mujeres en edad fértil y de mayor desarrollo socio-económico, resultaron estadísticamente significativas las histerectomías abdominales en la génesis de la fístula con más del 85.7 por ciento. Se comprobó que la vía de abordaje quirúrgico más utilizada en la reparación fue la abdominal y por lo general de localización retrotrigonal. Se logra recuperación de la función urinaria fisiológica y ahorro de $ 750.00, en cada caso y la regresión a la tranquilidad familiar, la vida laboral y social de todas las pacientes.

Vesicovaginal fistulas are known from the ancient times. Mahfouz described one in an Egyptian mummy. Nowadays the most frequent cause is the hysterectomy. The success in repairing a fistula depends on: time of fistula's formation, aetiology, location, study of the patient and the fistula, surgical technique and urologist's experience. We carried out a longitudinal descriptive study to state the advantages of the modification of the surgical techniques, in the years from 2001 and 2008 at the Urology Service of the Teaching Hospital Iluminado Rodríguez of Jagüey Grande, Matanzas. 21 21-to-50 years-old patients were operated. The causes of entering the hospital were urine incontinence and antecedents of gynaecologic surgical intervention. The hospital records were used to obtain the data collected in the patients' clinical records. 76 per cent of the cases were between 31 and 45 years old, denoting its great frequency among women in fertile age and of the higher socio-economic status, being statistically significant abdominal hysterectomies in the fistula genesis with more than 85.7 per cent. We proved that the most used surgical treatment use was the abdominal one, and generally the location was retrotrigonal. It was achieved the recovering of the physiologic urinary function and $ 750.00 were saved in each case. All the patients recovered the familiar peace, and returned to social and laboral life.

Vesico-vaginal fistula: interposition flap, a key to success

Vesico-vaginal Fistula [VVF] is an abnormal communication between bladder and vagina that causes continuous discharge of urine into vaginal vault. The objective of this study is to describe current trends of aetiology and repair of Vesico-vaginal Fistulae. This is a Descriptive Study, conducted at Armed Forces Institute of Urology, Rawalpindi and Combined Military Hospital, Kharian between May 2001 and May 2007. All patients diagnosed as cases of vesico-vaginal fistulae were included in the study. Their demographic profile and repair success was determined. A total of 86 patients were included in the study. The mean age of the patients was 35.5 years [range 25-46]. Total abdominal hysterectomy was the most common cause [53% of the cases] followed by obstetric causes [43.92% of the cases]. Success rate of the surgery in the study was 97.5%. The common causes of vesico-vaginal fistula in this study were total abdominal hysterectomy and obstetric causes. The success rate was high, yet the attempt should be made to prevent this socially distressing condition

Reparación laparoscópica de fístulas genitourinarias / Laparoscopic management of genitourinary fistula

Objetivo: Las fístulas del tracto genitourinario comúnmente ocurren como una complicación de cirugía pélvica y en especial de procedimientos ginecológicos. Su reparación constituye un desafío para los urólogos. El objetivo de esta presentación es describir la técnica para reparación laparoscópica de fístulas vesicovaginales y ureterovaginales, presentando la experiencia y resultados con dichas técnicas. Material y Método: Entre enero de 2007 y febrero de 2009, 8 pacientes sometidas a cirugía ginecológica presentaron como complicación una fístula genitourinaria. Cuatro pacientes presentaron fístulas ureterovaginales (FUV) y 4 pacientes presentaron fístulas vesicovaginales (FVV). Todas ellas se repararon por vía laparoscópica. Resultados: La reparación laparoscópica fue realizada sin complicaciones en todos los casos. Se realizaron 4 neoimplantes con flap de Boari por vía laparoscópica. El tiempo promedio de cirugía fue 202,5 min (Rango: 180-240 min). La estadía hospitalaria promedio fue de 6 días (Rango: 4-7 días). El seguimiento promedio es de 16 meses (Rango: 9-28 meses). En todas las pacientes se demuestra indemnidad de la vía urinaria. En el caso de las FVV, el tiempo promedio de cirugía fue 161,3 min (Rango: 135-180 min), El tiempo promedio de hospitalización fue 4 días (Rango: 3-5 días). Seguimiento promedio 8 meses (Rango: 4-10 meses). Todas las pacientes evolucionaron en forma satisfactoria. Conclusiones: El manejo de las fístulas genitourinarias secundarias a cirugía ginecológica es posible de realizar por vía laparoscópica respetando los conceptos de la cirugía clásica.

Objective: The genitourinary tract fistulas commonly occur as a complication of pelvic surgery, especially gynecologic procedures. Repair is a challenge for urologists. The aim of this presentation is to describe the technique for laparoscopic repair of vesicovaginal fistula and ureterovaginal, presenting the experience and results with these techniques. Material and Methods: Between January 2007 and February 2009, 8 patients undergoing gynecological surgery had genitourinary fistula as a complication. 4 patients had ureterovaginal fistulas (FUV) and 4 patients had vesicovaginal fistulas (FVV). All of them were repaired by laparoscopic surgery. Results: The laparoscopic repair was performed without complications in all cases. 4laparoscopic ureteroneocystostomy with boari flap was performed. The average time of surgery was 202.5 min (range: 180-240 min), the average hospital stay was 6 days (range: 4-7 days).The average follow-up was 16 months (range: 9-28 months). All patients demonstrated indemnity of the urinary tract. In the case of the FVV, the average time of surgery was 161.3min (range: 135-180 min), the length of hospital stay was 4 days (range: 3-5 days). The average of 8 months (range: 4-10 months). All patients evolved in a satisfactory manner. Conclusions: The management of genitourinary fistula secondary to gynecological surgery is possible to perform laparoscopic respecting the classical concepts of surgery.

Contributing factors of Vesico-Vaginal Fistula (VVF) among Fistula Patients in Dr.Abbo's National Fistula et Urogynecology Centre - Khartoum 2008

"Background: Vesico-vaginal Fistula (VVF) is defined as an abnormal communicating tract extending between the bladder (vesico-) and the vagina resulting in continuous involuntary discharge of urine into the vaginal vault. Vesico-vaginal fistula is still a persisting scourge in the developing countries; including Sudan in which new cases of obstetric fistula were estimated to occur every year"" #he ob$ectives of this work were to study the contributing factors of vesico-vaginal fistula in Sudanese patients"" Methods: the design was descriptive; cross-sectional; community-based study"" A total of 2 patients with vesicovaginal fistula presented to the Fistula (entre in )Khartoum Teaching hospital from July to August 2 ;; were investigated using an administrated; semi-structured questionnaire"" Results: The study revealed that 44""2of patients were 1;-24 years old; "";were teenagers when married (1; yrs old)"" While 7of the patients were illiterates; 62"";were married to illiterate husbands"" (; "";) were poor; (4 ""4) were from western regions of Sudan"" The study showed that labor was responsible for 9 ""4of VVF of whom 9""6were primiparous; 42""6delivered at home"" It was found that 4 ""4of the total deliveries were by forceps as long as 27""7were emergency caesarian sections"" (3""2) of the deliveries were attended by traditional birth attendants and ""3of cases stayed in labor for more than 24 hours; as long as 3""2were not in regular antenatal care"" Conclusion:The vesico-vaginal fistula in Sudan resulted mainly from obstructed labor"" the victim was mostly a young woman; a primigravida; who was poor; illiterate; not on regular antenatal care et being in labor more than 24 hours"" Most deliveries were carried at home; attended by traditional Birth Attendants in most cases"" the deliveries were mostly assisted by forceps; or conducted as emergency caesarian sections"" To prevent VVF; the study suggested raising awareness of women at bearing age; improve transportation; besides inclusion of the issue in the curricula of schools and universities"""

Obstetric trauma is the commonest cause of urogenital fistulae

To determine incidence of different types of urogenital fistulae, their frequency and success rate of different methods of repair. This descriptive study was conducted at Armed Forces Institute of Urology and Department of Obstetrics and Gynecology, Military Hospital Rawalpindi from January 1997 to January 1998. A total of 44 patients were included in the study. Diagnosis was made by taking comprehensive history, detailed examination and appropriate investigations. Data regarding aetiological and risk factors was gathered. The incidence was 0.26%. Obstetric trauma, mostly prolonged and obstructed labour, was responsible for 53.3% cases and 40% were result of surgical trauma and miscellaneous causes. Forty percent of fistulae were vesico vaginal and same number was simple in type. Nearly 55% were repaired by abdominal route and 75% were successful in 1[st] attempt. Obstetric trauma was the commonest cause of urogenital fistulae. Majority were repaired by abdominal route and 75% were successful in first attempt. Improvement in maternity care in rural areas, easy approach to specialist care and better training of staff in instrumental deliveries may help to decrease the incidence of these fistule

Key to successful vesico-vaginal fistula repair-an experience of urogenital fistula surgeries and outcome at gynaecological surgical CAMP-2005

Vesico-vaginal fistula is not life threatening medical problem, but the woman face demoralization, social boycott and even divorce and separation. The aetiology of the condition has been changed over the years and in developed countries obstetrical fistula are rare and they are usually result of gynaecological surgeries or radiotherapy. Urogenital fistula surgery doesn't require special or advance technology but needs experienced urogynaecologist with trained team and post operative care which can restore health, hope and sense of dignity to women. This prospective study was carried out to analyze the success rate in patients attending the referral hospital and sent from free gynaecological surgery camps held at interior of Sindh, and included pre-operative evaluation for route of surgery, operative techniques and postoperative care. Total 70 patients were admitted from the patients attending the camp. Out of these, 29 patients had uro-genital fistula. Surgical repair of the fistula was done through vaginal route on 27 patients while 2 required abdominal approach. Out of 29 surgical repairs performed, 27 proved successful. Difficult and complicated fistulae need experienced surgeon. Establishment of separate fistula surgery unit along with appropriate care and expertise accounts for the desired results

Fístula vesicovaginal: nuestra experiencia / Bladder-vaginal fistula: our experience

Entre enero de 1992 y diciembre de 2006 se operaron 26 pacientes con el diagnóstico de fístula vesicovaginal. El 88.4 por ciento de las fístulas fueron producidas por histerectomía transabdominal, 92,3 por ciento eran de localización retrotrigonal, 80,8 por cientoo de las pacientes se operaron por vía transvesical extraperitoneal. De las 26 pacientes operadas sólo 3 (11.6 por ciento) recidivaron y resolvieron con una segunda operación. Se analizan los parámetros y esquemas de estudio y tratamiento utilizados para solucionar esta entidad en el primer intento quirúrgico.

From January 1992 to December 2006, 26 patients with vesico-vaginal fistula were surgically operated. 88.4% of the fistulas were produced by trans-abdominal hysterectomy. 92.3% of the cases had retrotrigonal fistulas. 80.8% of the patients were operated by extraperitoneal transvesical way. 3 (11.6%) out of the 26 patients surgically operated showed recurrence, thus, they were subjected to a second operation. The parameters, study charts and treatment previously followed were analyzed in order to resolve this medical entity with only one surgical treatment.

Mayer Rokitansky Kuster Hauser syndrome with urogenital sinus anomaly

Mayer Rokitansky Kuster Hauser [MRKH] syndrome is a rare disorder, characterized by the congenital absence of uterus and associated renal tract anomalies. The case presented with primary amenorrhea and primary infertility, despite development of normal female secondary sexual characteristics. CT scan revealed absent uterus, a solitary left sided pelvic kidney and a vesicovaginal communication that, on cystoscopy, revealed urogenital sinus anomaly manifesting as a common channel formed due to absent anterior wall of vagina and posterior wall of urethra. The urogenital sinus anomaly in MRKH syndrome has not been reported earlier

study of vesicovaginal fistulae repair at gynaecological surgical camp at peoples medical college hospital Nawabshah

To evaluate the predisposing factors for vesicovaginal fistulae [VVF], route of fistula repair and outcome of surgery. Total 21 patients of VVF were admitted. 15 - 24 October 2002 Department of Obstetrics of Obstetrics and Gynaecology at PMCH Nawabshah, Sindh Out of 2I VVF, 14 of them were due to obstetrical trauma, 5 occurred due to gynaecological surgery and 2 were congenital. 18 cases were repaired vaginally and 2 were repaired with abdominal approach. One case was not repaired due to impacted bladder stone. Success repair was in 18 cases and 2 were failed. The success rate was 90%. The key for success was adequate tissue mobilization, division of scar tissue and good postoperative care

Vesico-vaginal fistula experience of surgical repair at Larkana

To assess the causes of Vesico-vaginal fistula and evaluate the results of surgical repair ot'Vesico-vaginal fistula A retrospective study was conducted in Ch and ka Medical College Hospital and Larkan Medical Centre from March 1999 to February 2005. Forty patients of Vesico-vaginal fistula resulting from causes other than malignancies and radiations were included in the study. Majority of the patients had fistula secondary to an obstetrical cause. Of the total 32 patients were repaired trans-vaginally. Prolonged labour was the major cause of Vesico-vaginal fistula [80%]. Thirty two [80%] patients were operated trans vaginally and 8 trans-abdominally. Success rate was 85.8% for the transvaginal approach in the first instance. Stress urinary incontinence was noted in 2 patients while 1 patient with transabdominal approach developed recurrence. In developing countries the major cause of Vesico-vaginal fistula is obstructed labour which can be repaired trans. vaginally in majority of cases under skilled surgeon

Fístulas urinarias en la práctica urológica / Urinary fistulas in the urological practice

Purpose: to analyze the different aspects of urinary fistulas. Design: retrospective observational clinical study. Methods: we evaluated 50 cases comparing different aspectis as etiology, incidence, diagnosis, treatment and success rate... This study demonstrates the high rate of successful closure of the urinary fistula, but highlight the knowledge that we should have of the incidence, etiology, diagnosis and treatment of this urological problem