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.

Prognostic factors for failure of transvaginal repair of vesicovaginal fistula: A nested case-control study / 北京大学学报(医学版)

OBJECTIVE@#To analyze the prognostic factors affecting the failure of transvaginal repair of vesicovaginal fistula (VVF).@*METHODS@#A retrospective nested case-control study was conducted. A total of 15 patients who underwent unsuccessful transvaginal vesicovaginal fistula repair in the Department of Urology, Peking University First Hospital from January 2014 to December 2020 were enrolled as the case group. A total of 60 patients receiving transvaginal vesicovaginal fistula repair by the same surgeon within the same time range, were selected as the control group. The age, body mass index (BMI), etiology of vesicovaginal fistula, associated genitourinary malformation, frequency of repair, characteristics of fistula, surgical procedure, postoperative recovery and other factors were compared between the case group and the control group, and the influencing factors of failure were analyzed.@*RESULTS@#The BMI of the case group was (26.3±3.9) kg/m2, the diameter of vaginal fistula was (1.5±0.8) cm, and the operative time of transvaginal repair was (111.8±19.8) min. The proportion of the patients with genitourinary malformations was 4/15, the proportion of the patients with multiple vaginal repairs was 13/15, the proportion of the patients with concurrent ureteral reimplantation was 6/15, and the proportion of the patients with postoperative fever was 5/15. In the control group, the BMI was (23.9±3.0) kg/m2, the diameter of vaginal fistula was (0.8±0.5) cm, the operative time of transvaginal repair was (99.9±19.7) min, the rate of associated genitourinary malformation was 2/60, the rate of multiple transvaginal repair was 18/60, the rate of concurrent ureteral reimplantation was 5/60, and no postoperative fever was found. Compared with the control group, the case group had higher BMI (P=0.013), bigger vaginal fistula (P=0.002), longer time of operation (P=0.027), higher proportion of genitourinary malformations (P=0.013), higher proportion of repeated transvaginal repair (P < 0.001), higher proportion of ureter reimplantation (P=0.006), and higher proportion of postoperative fever (P < 0.001). Multivariate analysis showed that fistula diameter ≥1 cm (OR=10.45, 95%CI=1.90-57.56, P=0.007) and repeated transvaginal repair (OR=16.97, 95%CI=3.17-90.91, P=0.001) were independent prognostic factors for VVF failure in transvaginal repair.@*CONCLUSION@#Fistula diameter ≥1 cm and repeated transvaginal repair are independent prognostic factors of failure in transvaginal repair.

Guiding opioid-free intravenous antinociception with the Analgesia Nociception Index: a case report / Antinocicepção intravenosa sem opioides orientada pelo Índice de Analgesia/Nocicepção: relato de caso

Abstract Background: Opioid-free anesthesia decreases the incidence of opioid adverse events, but its optimal antinociceptive depth has not been clearly defined. Personalizing intraoperative opioid-free infusions with a nociception monitor may be the solution. Case report: We describe the feasibility and potential limitations of titrating opioid-free antinociception during major abdominal surgery using the Analgesia Nociception Index (Mdoloris, Lille, France) in an obese patient. After stabilizing the patient's nociception-antinociception balance intraoperatively we quickly reversed anesthesia and the patient did not require postoperative opioids. Conclusion: Personalizing opioid-free antinociception with a nociception monitor is feasible. It may optimize intraoperative antinociception and improve postoperative comfort.

Resumo Introdução A anestesia sem opioides diminui a incidência de eventos adversos associados aos opioides, mas a profundidade antinociceptiva ideal dessa abordagem não está claramente definida. Personalizar a infusão intraoperatória sem opioides com o uso de monitor de nocicepção pode ser a solução. Relato de caso Descrevemos a viabilidade e as eventuais limitações da titulação da antinocicepção sem opioides por meio do uso do Índice de Analgesia/Nocicepção (Mdoloris, Lille, França) durante cirurgia abdominal de grande porte em paciente com obesidade. Depois de estabilizar o equilíbrio nocicepção-antinocicepção da paciente no intraoperatório, revertemos rapidamente a anestesia e a paciente não precisou de opioides no pós-operatório. Conclusão A personalização da antinocicepção sem opioides por meio do emprego de monitor de nocicepção é factível. A abordagem pode otimizar a antinocicepção intraoperatória e melhorar o conforto pós-operatório.

Transvaginal repair of neobladder vaginal fistula with martius flap

ABSTRACT Introduction: Neobladder vaginal fistula (NVF) is a known complication after cystectomy and orthotopic diversion in women, occurring in 3-5% of women. Possible risk factors for fistula formation include compromised tissue vascularity due to surgical dissection and/or radiotherapy, suture line proximity, local tissue recurrence, and injury to the vaginal wall during dissection. The surgical repair of a NVF can be challenging secondary to vaginal shortening, atrophy, local inflammation from chronic exposure to urinary leakage, and the proximity of the neobladder to the anterior vaginal wall. In this video, we present transvaginal repair of a NVF with Martius flap interposition. Materials and Methods: This is the case of a 47 year old woman with a history of radical cystectomy and creation of a Studer pouch secondary to bladder cancer two years prior who subsequently developed a NVF. Evaluation included an office cystoscopy which demonstrated a 3-4mm left-sided neobladder vaginal fistula at the level of the ileal-urethral anastomosis. No pelvic organ prolapse or evidence of bladder cancer recurrence was appreciated. Results: A vaginal approach for the NVF repair was performed with a Martius flap interposition. A water-tight closure was achieved without any intraoperative or immediate postoperative complications. The urethral Foley was removed at 2 weeks and by 4 weeks the patient did not report any urinary leakage. Conclusions: Neobladder vaginal fistula is a rare complication following cystectomy and orthotopic urinary diversion that can be repaired using a transvaginal approach. A Martius flap interposition is important to augment success of the repair. If a transvaginal approach fails a transabdominal approach or conversion to cutaneous diversion may be necessary.

A martius flap in the treatment of iatrogenic distal urogenital fistula

ABSTRACT Introduction: Distal urogenital fistulas (DUF) are usually iatrogenic and are uncommon in Europe. They occur in the urethra or near the bladder neck, and can be caused by vaginal hysterectomy, para-urethral cyst surgery, or erosion of the bladder or urethra from tension-free slings or meshes. The psychological and physical health consequences of DUF are devastating because most patients consider themselves "healthy" before surgery. Incontinence can appear after successful DUF closure due to previously occult incontinence or urethral incompetence. Additional surgery for incontinence is sometimes necessary to achieve satisfactory outcome. Materials and Methods: A Martius flap was used in 23 patients between 2000 and 2015. Patient age range was 38-75 years (mean, 58.7). DUF was due to gynecologic surgery for benign disease (15 / 23; 65.2%), mesh / sling erosion (2 / 23; 8.7%), and malignancy (6 / 23; 26.1%). The follow-up period was one year. Results: DUF was closed in 22 patients (95.6%). Satisfaction and complete dryness was achieved in 16 patients (69.6%) after the first procedure. Postoperative complications were: postoperative hematoma in 1 (4.4%), primary failure in 1 (4.4%), overactive bladder (OAB) syndrome in 3 (13.2%) and postoperative incontinence in 6 (26.4%) patients. A fascial sling was placed in patients with incontinence. All patients were dry after the secondary surgery. Anticholinergics were used for the treatment of OAB syndrome. Discomfort at the flap harvesting site was of minor importance. Finally, 22 out of 23 patients (95.6%) were satisfied. Conclusion: A Martius flap and additional fascial sling could be successfully used to optimize DUF treatment.

Les complications urologiques liées à la chirurgie pelvienne au CHU du Point-G, à propos de 23 cas

Introduction : Les lésions vésicale et urétérale constituent les complications urologiques les plus fréquentes survenant au décours d'une chirurgie pelvienne soit respectivement 1 à 4% et 0,5 à 3% [6,7]. Ces lésions sont rarement reconnues en peropératoire et posent un problème important auquel sont confrontés les urologues, les gynécologues, les chirurgiens généralistes. Objectif : Etudier les facteurs favorisants les complications urologiques consécutives à la chirurgie pelvienne au CHU du Point-G. Patientes et Méthode : Il s'agissait d'une étude rétrospective réalisée au CHU du Point-G entre 2006 et 2015. Elle a concerné 23 patientes présentant toute une lésion urologique au décours d'une chirurgie pelvienne. Ces patientes ont subi un examen clinique et para cliniques (Urographie intra veineuse ; le test au bleu de méthylène) dans le but de confirmer la lésion urologique et d'en déterminer la prise en charge. Résultats : l'âge moyen de nos patientes était de 32,00 ans avec des extrêmes allant de 18 à 40 ans. La fuite d'urine était retrouvée chez 82,6% (19/23). Les interventions pourvoyeuses de lésions urologique étaient : la césarienne 52, 2% (12/23), l'hystérectomie 30, 4% (7/23), une association césarienne et hystérectomie 17,4 % (4/23). Le test au bleu de méthylène a été réalisé chez 19 patientes, il a été positif dans 12 cas soit 52,2 % et l'UIV chez 7 patientes. Les lésions rencontrées étaient : la fistule vésico-vaginale retro trigonale 10 cas, la fistule vésico-vaginale sous trigonale 2 cas, la fistule urétéro-vaginale 7 cas, et la ligature urétérale bilatérale 4 cas. La fistulorraphie a été effectuée dans 52,2 % suivie de la réimplantation urétéro-vésicale directe. Les suites opératoires étaient satisfaisantes dans 100% des cas avec l'obtention d'une bonne étanchéité vésicale. La durée moyenne d'hospitalisation était de 12 jours (+/- 4 jours). Conclusion : La chirurgie pelvienne est pourvoyeuse de lésions urologiques. La césarienne et l'hystérectomie sont des facteurs favorisants. Les fistules vésico-vaginales ou des lésions urétérales sont fréquentes

Robotic repair of vesicovaginal fistula - initial experience

ABSTRACT Objective The most common acquired fistula of the urinary tract is Vesicovaginal fistulae (VVF) (1) posing social stigmata for the patient as well as a surgical challenge for the urologist. Here we present our initial experience with Robotic assisted laparoscopic repair of VVF, its safety and efficacy. Materials and Methods Seven out of eight fistulas were post hysterectomy; five had undergone abdominal while two had laparoscopic hysterectomy while one was due to prolonged labour. Two had associated ureteric injury. All underwent robotic assisted laparoscopic trans abdominal extravesical approach. Three 8 mm ports for robotic arms, one 12 mm port for camera and another 12 mm for assistant were used in a fan shaped manner. All had preoperative ureteric catheter placed. Bladder was closed in two layers and vagina in one layer. Omental flap placed in all cases except two where it was not possible. Drain and per urethral catheter placed in all cases. Double J stents were placed in two cases requiring ureteric implantation additionally. Results The mean age of presentation was 39.25 years (26-47 range) with mean BMI being 26.25 kg/m2 (21-32 range). Mean duration between insult and repair was 9.37 months (3-24 months). Only in single case there was history of previous repair attempt. On cystoscopy four had supratrigonal VVF and four were trigonal with mean size of 13.37 mm (7-20 mm). Mean operative time was 117.5 minutes (90-150). There were no intraoperative/postoperative complications or need for open conversion. Mean haemoglobin drop was 1.4 gm/dL (0.3-2 gm). Drain was removed once 24-48 hours output is negligible. One patient had post-operative urinary leak at 2 weeks which ceased with continuation of catheterisation for another 2 weeks. Catheter was removed after voiding cystourethrogram showed no leak at 2-3 weeks postoperatively. Mean duration of drain was 3.75 days (3-5) and per urethral catheterisation (which was removed after voiding cystourethrography) was 15.75 days (9-28). Mean hospital stay was 6.62 days (4-14). Post-operative bladder capacity was 324.28 cc (280-350) on voiding diary. Follow up ranged from 3-9 months. At 3 months of follow-up, these patients continued to void normally and there was no evidence of recurrence of VVF. Conclusion Robotic repair of VVF is safe and feasible and has additional advantages in the form of precise suturing under 3D vision and certainly a more striking and effective option especially in complex VVF repair associated with ureteric injuries (2).

Robotic repair of vesicovaginal fistulae with the transperitoneal-transvaginal approach: A case series

Objective To describe a novel technique of repairing the VVF using the transperitoneal-transvaginal approach. Materials and Methods From June 2011 to October 2013, four patients with symptoms of urine leakage in the vagina underwent robotic repair of VVF with the transperitoneal-transvaginal approach. Cystoscopy revealed the fistula opening on the bladder. A ureteral stent was placed through the fistulous tract. After trocar placement, the omental flap was prepared and mobilized robotically. The vagina was identified and incised. The fistulous tract was excised. Cystorrhaphy was performed in two layers in an interrupted fashion. The vaginal opening was closed with running stitches. The omentum was interposed and anchored between the bladder and vagina. Finally, the ureteral catheters were removed in case they have been placed, and an 18 Fr urethral catheter was removed on the 14th postoperative day. Results The mean age was 46 years (range: 41 to 52 years). The mean fistula diameter was 1.5 cm (range 0.3 to 2 cm). The mean operative time was 117.5 min (range: 100 to 150 min). The estimated blood loss was 100 mL (range: 50 to 150 mL). The mean hospital stay was 1.75 days (range: 1 to 3 days). The mean Foley catheter duration was 15.75 days (range: 10 to 25 days). There was no evidence of recurrence in any of the cases. Conclusions The robot-assisted laparoscopic transperitoneal transvaginal approach for VVF is a feasible procedure when the fistula tract is identified by first intentionally opening the vagina, thereby minimizing the bladder incision and with low morbidity. .

Laparoscopic Treatment of Vesicovaginal Fistula

Introduction Vesicovaginal fistula is a rare disease with great impact for the patients. Laparoscopic repair can be an interesting option in selected cases with goods results but few experience is reported.Objectives Detailed demonstration of our laparoscopic vesicovaginal fistula repair technique. Initial results for ten patients are provided Methods: We treated all cases by the same technique. The surgical steps were: Patient positioning in Lloyd-Davis; Cystoscopy and implant of guide wire on fistula and ureteral catheters (that was removed after procedure); Transperitoneal access and 4 or 5 ports in V or W shape; Opening the bladder wall; Dissection between bladder and vagina for tension free repair; Fistula resection; Vagina repair with Vicryl 3-0; Bladder repair with Vicryl 3-0; Peritoneum/omentum interposition; Positioning 20 Fr urethral catheter.Results Mean age was 50 years. Mean number of fistulas was 1,2. The most common etiology was gynecologic surgery (7). Mean operative time was 2,5 (1,8-3,2) hours. Mean blood loss was 150 (100-200)mL. Complication rate was 10% (one case of urinary infection treated conservatively). Mean hospital stay was 1,2 (1-2) days. Mean return to normal and activities was 20 (15-30) days. For nine patients mean sexual intercourse time was 3 (1-6) months. Success rate after 1 year was 90% (one case of recurrence in patient with previous radiotherapy). Mean follow-up was 36 (12-60) months.Conclusions Laparoscopic repair is feasible, reproducible and present all advantages of minimally invasive surgical procedure. Long term results are similar to conventional open approaches.

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

Correção laparoscópica de fístula vesicovaginal: relato de caso / Laparoscopic repair of vesicovaginal fistula: a case report

Apesar de constituírem complicação incomum, as fístulas vesicovaginais apresentam expressivo impacto na qualidade de vida dos pacientes. As abordagens minimamente invasivas têm ganhado mais espaço no tratamento de doenças geniturinárias. Ainda são poucos os relatos do acesso laparoscópico para correção das fístulas vesicovaginais. Relata-se aqui um caso de fístula pós-histerectomia tratada totalmente de forma laparoscópica com ótimo resultado. As vantagens do acesso laparoscópico, assim como alguns detalhes técnicos, são discutidos...

Despite being an uncommon complication, vesicovaginal fistulas have significant impact on patient quality of life. Minimally invasive approaches have gained more space in the treatment of genitourinary diseases. There are few reports on laparoscopic approaches for correction of vesicovaginal fistulas. This is a case report of a post-hysterectomy fistulatreated exclusively through laparoscopy with excellent results. The advantages of the laparoscopic approach, as well as some technical details, are discussed...

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.

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.

Reparación laparoscópica de fístula vesicovaginal mediante técnica retrovesical: una serie de 6 pacientes / Laparoscopic repair of vesicovaginal fistula: a serie of 6 patients

Antecedentes: La fístula vesicovaginal (FVV) es una enfermedad frecuente en países no desarrollados y afecta la calidad de vida de mujeres en edad media, siendo la causa más habitual la histerectomía previa. Las técnicas quirúrgicas disponibles para su reparación presentan resultados variables. Objetivos: Presentar nuestra experiencia en la reparación de FVV por vía laparoscópica con abordaje retrovesical, en una serie consecutiva de 6 pacientes. Método: análisis prospectivo descriptivo de 6 pacientes sometidos a reparación laparoscópica retrovesical de FVV supratrigonales secundarias a histerectomías. Resultados: El tiempo operatorio promedio fue de 191 minutos. Ningún paciente requirió transfusiones y el tiempo de hospitalización promedio fue de 2,5 días. No se presentaron complicaciones ni recidivas, con un seguimiento promedio de 15 meses. Conclusión: La reparación laparoscópica de FVV mediante técnica retrovesical es una técnica segura, poco invasiva y reproducible en manos entrenadas, que podría convertirse en la técnica de elección a futuro. De acuerdo a nuestra revisión, esta comunicación es la primera serie de reparación laparoscópica de FVV publicada en Chile.

Background: Vesicovaginal fistula (VVF) is a fairly common condition in underdeveloped countries affecting mainly young women. Its most prevalent cause is prior hysterectomy. Surgical techniques for repairing VVF have widespread results. Objective: To present our results with a retrovesical laparoscopical repair of VVF in a 6 consecutive patient case series. Method: It is a descriptive prospective analysis of 6 consecutive patients with a retrovesical laparoscopical repair of supratrigonal VVF after hysterectomy. Results: Average surgical time was 191 minutes. No blood transfusion was required. Average hospital stay was 2.5 days. None of them had postoperatory complications nor relapse whatsoever, after a minimum of 15 months follow-up. Conclusion: Retrovesical laparoscopic repair of VVF is a feasible, simple, reproducible and less invasive technique. In trained hands it is the election technique for this condition. To the best of our knowledge this is the first publication of laparoscopic management for VVF in Chile.

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.

Flap de martius: técnica quirúrgica / Martius flap: surgical technique

La tasa de éxito en la reparación de fístulas vésico-vaginales, mejora notablemente con la interposición de tejido. El flap de Martius produce resultados alentadores. Nosotros describimos la técnica de interposición de tejido para la reparación transvaginal de fístulas vésico-vaginales.

The success rate of vesicovaginal fistula repair is improved by tissue interposition. The Martius flap produces reliable results. We describe the technique of tissue interposition for transvaginal repair of vesicovaginal fistulas.

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.