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.

Analysis of the clinical effect of single J tube of bilateral ureter through the bladder stoma to treat vesicovaginal fistula after radiotherapy of cervical cancer / 中华泌尿外科杂志

This article retrospectively analyzed the clinical data of 8 patients with vesicovaginal fistula after radiotherapy for cervical cancer admitted in our hospital from January 2015 to October 2021. All of them underwent cystostomy under local anesthesia. A single J tube of bilateral ureters was retained under cystoscope, and the single J tube was introduced into the fistula bag through the cystostomy opening. All patients wore diapers for a long time before operation, and used urine pads 0-2 pieces/day after operation. QOL score was 5.3±0.5 points before operation, and 2.5±0.5 points after operation. The patient's body odor basically disappeared. The vesicovaginal fistula can be repaired by surgery, but for patients who cannot be operated or failed repeatedly due to various reasons, a single J tube of bilateral ureters can be drawn out through the cystostomy opening, which can improve the quality of life of patients through minor trauma.

Efficacy of robot-assisted single-port laparoscopic transvaginal surgery in the treatment of vesicovaginal fistula / 现代泌尿外科杂志

【Objective】 To investigate the efficacy of robot-assisted single-port laparoscopic transvaginal vesicovaginal fistula repair. 【Methods】 The clinical data of 3 patients with high vesicovaginal fistula treated during Jun.2020 and Jun.2021 were retrospectively analyzed. 【Results】 All operations were completed successfully, with no conversion to other surgical methods. Operation time: 98 min, 104 min and 115 min; Intraoperative bleeding volume: 15 mL, 20 mL and 22 mL; Postoperative hospital stay was 2 days. The catheter was removed after 1-month follow-up, and the patients had no bleeding, urine leakage, infection or other complications. There was no recurrence of urine leakage at the end of 12-month follow-up. 【Conclusion】 Robot-assisted single-port laparoscopic transvaginal vesicovaginal fistula repair has the advantages of fine suture and minor damage, which can be an effective treatment of vesicovaginal fistula.

Clinical analysis of human acellular allogeneic dermis in the repair of urinary fistula / 现代泌尿外科杂志

【Objective】 To investigate the clinical efficacy of human acellular allogeneic dermis (HADM) in the repair of urinary fistula. 【Methods】 The clinical data of 12 female patients with complex vesicovaginal fistula treated during Jun.2021 and Nov.2022 were retrospectively analyzed. The patients’ average age was 47.3 years, ranging from 38 to 56 years. The body mass index (BMI) ranged from 16.6 to 25.2, with an average of 21.3. HADM was inserted between vagina and bladder wall fistula to repair fistula in all 12 patients. 【Results】 All operations were successful. After the operation, the vaginal urine leakage stopped and the urinary tube was retained for 2 weeks. During the postoperative follow-up of 1 to 16 months, no recurrence or complication were observed. 【Conclusion】 Transvaginal HDMA is an ideal surgical method in the treatment of complex vesicovaginal fistula, which has advantages of small trauma, fast recovery and high success rate.

Transluminal repair of iatrogenic bladder fistula: a report of 7 cases / 现代泌尿外科杂志

【Objective】 To explore the technical methods and clinical efficacy of transvaginal or transrectal repair in the treatment of iatrogenic bladder fistula. 【Methods】 The clinical data of 7 cases of iatrogenic bladder fistula patients treated during 2016 and 2019 were retrospectively analyzed, including 6 cases of vesicovaginal fistula (VVF) and 1 case of vesicorectal fistula (VRF). The operation was conducted 3 to 10 months after the diagnosis of urinary fistula, and the vagina or rectum was fully cleaned before operation. Modified Latzko technique was employed to separate the gap between the bladder wall and vaginal or rectal wall along the fistula, the fistula scar was sharply removed, and the fistula, bladder wall, vaginal or intestinal wall, and vaginal or intestinal mucosa were sutured in layers. The urinary catheter was indwelled for 4 weeks. 【Results】 All 7 cases were successfully repaired at one procedure. No urine leakage was found after the urinary catheter was removed. There was no recurrence after 6 to 12 months of follow-up. 【Conclusion】 Selective application of the modified Latzko technique to repair iatrogenic urinary fistula through the natural lumen is an advantageous treatment scheme, which simplifies the operation and reduces trauma.

Treatment of vesicovaginal fistula after radiotherapy with gracilis flap: one case report / 中华泌尿外科杂志

The treatment of vesicovaginal fistula after radiotherapy is difficult. Surgical repair is challenging and the success rate is low. The gracilis flap is widely used in the repair surgery of the perineal region, while it is rarely reported for the repair of vesicovaginal fistula domestically. This article reports a case of vesicovaginal fistula after radiotherapy treated with gracilis flap tamponade. The patient was admitted to the hospital because of continuous vaginal leakage of urine for more than 3 years. Digital vaginal examination and urethroscopy showed that a fistula with a diameter of about 3 cm located at the bladder triangle leading to the vagina. The patient had history of cervical cancer surgery and 23 times of postoperative adjuvant radiotherapy. She underwent vesicovaginal fistula repair with gracilis muscle flap. The urethral catheter was removed 3 weeks after the operation. The patient could urinate normally without vaginal leakage. After 10 months of follow-up, there was no vaginal leakage of urine and patient remains continent.

Reparación de fístula vesicovaginal mediante técnica laparoscópica / Repair of vesicovaginal fistula by laparoscopic technique

RESUMEN Objetivos: Describir la experiencia de 43 pacientes con fístula vesicovaginal (FVV) y la reparación con técnica laparoscópica entre 2009 y 2020, analizar su comportamiento y evolución. Métodos: Análisis de 43 pacientes diagnosticadas de FVV supratrigonales secundarias a histerectomías, la mismas que fueron resueltas laparoscópicamente. Resultados: La FVV es una complicación que se presenta en mujeres de edad media a menudo en periodo fértil, y claramen-te demostrado con el antecedente de cirugía o procedimiento ginecológico. Las pacientes fueron diagnosticadas de fístula vesicovaginal, las mismas que fueron intervenidas quirúrgicamente mediante técnica laparoscópica. El tiempo operatorio promedio fue de 172 minutos. Ninguna paciente requirió trans-fusión sanguínea y el tiempo de hospitalización promedio fue de 3,7 días. No se presentaron complicaciones ni recidivas, con un seguimiento promedio de 12 meses. Conclusión: La reparación laparoscópica de la fístula vesicovaginal es una técnica segura, poco invasiva y reproducible en manos entrenadas.Palabras claves: Fístula vesicovaginal, reparación laparoscópica

ABSTRACT Objectives: To describe the experience of 43 patients with Vesicovaginal Fistula (VVF) and laparoscopic repair between 2009 and 2020, and analyze its behavior and evolution. Methods: Analysis of 43 patients diagnosed with supratrigonal VVF secondary to hysterectomies, which were resolved laparoscop-ically. Results: The VVF is a complication that happen in middle-aged women often fertile period, and clearly demonstrated by the history of surgery or gynecological procedure. The patients were diagnosed with vesicovaginal fistula, they were operated on by laparoscopic technique. Mean operative time was 172 minutes. No patient required blood transfusion and the mean hospital stay was 3.7 days. No complications or relapses, with an average follow up of 12 months. Conclusion: Laparoscopic repair of VVF is a safe, minimally invasive and reproducible in trained hands

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.

Fistulectomía vaginal exitosa en un caso de fístula vesicovaginal obstétrica por embolización de arterias uterinas / Successful vaginal fistulectomy in a case of obstetric vesicovaginal fistula due to uterine artery embolization

Resumen ANTECEDENTES: Las fístulas genitourinarias obstétricas se forman como consecuencia de una complicación de la embolización de las arterias uterinas debida a necrosis del útero o de la vejiga. El tratamiento quirúrgico vaginal es una opción menos invasiva, con tasas de éxito que alcanzan 84.12%. CASO CLÍNICO: Paciente de 40 años, con 35.7 semanas de embarazo y acretismo placentario, tratado con embolización de las arterias uterinas e histerectomía obstétrica posterior a la cesárea. A las 3 semanas tuvo pérdida vaginal de orina. En la exploración física, y con apoyo de la prueba de colorantes, cistoscopia y cistografía retrógrada se diagnosticó fístula vesicovaginal obstétrica. Posterior a la disminución del proceso inflamatorio se efectuó la fistulectomía vaginal, con modificación de la técnica de Latzko. La evolución posoperatoria fue satisfactoria, sin recurrencia de la fístula durante el seguimiento en la consulta externa. CONCLUSIÓN: Éste, es el quinto caso de fístula por necrosis vesical postembolización reportado en la bibliografía. La favorable atención del caso permitió concluir que la fistulectomía vaginal es una alternativa viable y segura de tratamiento quirúrgico de este tipo de fístulas obstétricas.

Abstract BACKGROUND: Obstetric genitourinary fistulas can cause as a complication of uterine artery embolization due to necrosis of the uterus and/or bladder. Vaginal surgical treatment is a less invasive option with success rates of up to 84.12%. CLINICAL CASE: A 40-year-old woman who came with a pregnancy of 35 5/7 weeks and placenta accreta, which was managed with uterine arteries embolization and obstetric hysterectomy after caesarean section. At 3 weeks she had vaginal urine loss; by physical examination and with support of dye test, cystoscopy and retrograde cystography, obstetric vesicovaginal fistula was diagnosed. After the improvement of the inflammatory process, vaginal fistulectomy was performed with modification of the Latzko technique. Its postoperative evolution was satisfactory and without recurrence of the fistula during the follow-up in the outpatient clinic. CONCLUSION: This is the fifth case of post-embolization bladder necrosis reported in the literature. The favorable resolution of this case allows us to conclude that vaginal fistulectomy is a viable and safe alternative in the surgical treatment of this type of obstetric fistulas.

A qualitative study on the perceptions of patients with vesicovaginal fistula

Background: Vesicovaginal fistula (VVF) is a grave complication of gynecological surgeries and vaginal deliveries, leading to physical, psychological, and social implications. In India, due to the high patient turnover, it is not uncommon to find such patients in every region. While various works elaborate the surgical aspect of VVF, there is a dearth of literature on qualitative research. Objective: This study was done to better understand the impact of physical, psychological, and social factors on the lives of patient with VVF. Materials and Methods: This study was conducted in the department of urology at a tertiary care hospital. It was a descriptive qualitative study that involved audio recorded in-depth interviews of 18 such patients followed by their transcription and qualitative data analysis. Results: We identified five major categories from the transcripts, namely, understanding of the disease, initial reaction of the patient, reaction of the husband and family, personal and physical discomfort, and social implications. While majority of the perceptions were also reported in the previous studies, we found some unique perceptions in the form of false perception of urine leak from urethra in spite of vagina and blaming, the birth of female child for bad luck was found in our study. Another favorable unique response not noted in other studies was excellent family support in half of the patients. Conclusion: Our study supports the idea that VVF has far deeper implications other than physical discomfort. This study promotes wholesome management of patients, family, and society using a multidisciplinary approach.

Iatrogenic vesicovaginal fistula repair-experience at Prince Hussein Urology and Organ Transplant Center

Background: Despite the advances in technology in urology practice, and the surgical approach in dealing with iatrogenic vesicovaginal fistula repair, the most important is to achieve continent rate with minimum morbidity.Methods: From January 2006 to December 2017, the medical records and operative notes of 52 female (mean age 37 year) who had undergone transabdominal transvesical operative repair of their vesicovaginal fistula (VVF) at this institution were reviewed retrospectively. CT urography and diagnostic cystourethroscopy were the modalities of diagnostic tools. Trans-abdominal, transvesical repair with omental flap interposition were performed within 4-6 months in all cases. Patients were evaluated at two to three weeks initially, then at three months interval and later annually.Results: In present study, the most common presentation of VVF was urine leakage through vagina. In two third of the patients the etiology was due to hysterectomy procedure, regarding the location of the fistula, 94.2% of the fistulas located high in the posterior wall of the urinary bladder (supratrigonal), with the mean size of 2.2cm (range 5-25mm). 49 patients had single fistula (94.2%). The mean operative time was 110 minutes (range 60-130 minutes) and the mean post-operative urethral catheterization was 21 days (range 17-24 days). Almost all patients were continent after a mean of five months.Conclusions: Iatrogenic VVF is one of the distressing complications of gynecological procedure; delayed transabdominal transvesical approach with omental flap interposition is associated with excellent and durable results with minor morbidity. Standardization of the technique is a key success in the outcome of the repair.

Transvaginal pedicled omentum pull-through combined transanal colon pull-through for the treatment of vesicorectovaginal fistula / 中华普通外科杂志

Objective To evaluate surgical repair of vesicorectovaginal fistula using transvaginal pedicled omentum pull-through combined transanal colon pull-through.Methods A total of 11 patients with postoperative vesicorectovaginal fistulas complicating female reproductive system malignant tumors undergoing repairement from Aug 2013 to Aug 2018 were retrospectively analyzed.In order to isolate,protect the bladder and eliminate residual vaginal cavity using transvaginal pedicled omentum pull-through,combined transanal colon pull-through to repair vesicorectovaginal fistula.Results All the 11 patients in this group completed the operation successfully,and no air or stool passing from the vaginal after the operation.The fistula disappeared in five patients confirmed by cystography and enterograph.The average operation time was 115 min,the average blood loss was 260 ml.Incision fat liquefaction was found in two.Incision infection occurred in one.Urinary dysfunction in two.Anal stenosis was found in four patients which were healed by anal dilation.Conclusions Transvaginal pedicled omentum pull-through combined transanal colon pull-through can eliminate vesicorectovaginal fistula,improve life quality and avoid colostomy.

Transvaginal pedicled omentum pull-through combined transanal colon pull-through for the treatment of vesicorectovaginal fistula / 中华普通外科杂志

Objective@#To evaluate surgical repair of vesicorectovaginal fistula using transvaginal pedicled omentum pull-through combined transanal colon pull-through.@*Methods@#A total of 11 patients with postoperative vesicorectovaginal fistulas complicating female reproductive system malignant tumors undergoing repairement from Aug 2013 to Aug 2018 were retrospectively analyzed. In order to isolate, protect the bladder and eliminate residual vaginal cavity using transvaginal pedicled omentum pull-through, combined transanal colon pull-through to repair vesicorectovaginal fistula.@*Results@#All the 11 patients in this group completed the operation successfully, and no air or stool passing from the vaginal after the operation. The fistula disappeared in five patients confirmed by cystography and enterograph. The average operation time was 115 min, the average blood loss was 260 ml.Incision fat liquefaction was found in two. Incision infection occurred in one. Urinary dysfunction in two. Anal stenosis was found in four patients which were healed by anal dilation.@*Conclusions@#Transvaginal pedicled omentum pull-through combined transanal colon pull-through can eliminate vesicorectovaginal fistula, improve life quality and avoid colostomy.

Comparative analysis of transvaginal approach and transabdominal approach for vesicovaginal fistula / 中华泌尿外科杂志

Objective To compare the efficacy of transvaginal and transabdominal repair surgery for the treatment of vesicovaginal fistula(VVF).Methods The data of 39 patients undertaken VVF repair in our department between January 2005 and December 2016 was retrospectively reviewed.The patients aged 19 to 69 years (median 45 years),and the median duration of the condition was 22 months (range:1 month to 20 years).The etiologies were all iatrogenic injuries.Thirty-nine patients underwent a total of 43 surgical repairs including 26 transabdominal approach(group 1)and 17 transvaginal approach(group 2).There was no significant difference in terms of the patients' age,fistula size,location and the proportion of patients undergoing repairs previously between the two groups.The operative and outcome data of the two groups was compared.Results The surgical time of group 2 was shorter than that of group 1 (median 85 min vs.178 min,Z =-4.436,P ＜ 0.01).The median blood loss was 20 (5-100) ml in group 2 and 50 (20-800) ml in group 1,and there was statistically significant difference (Z =-3.767,P ＜ 0.01).The postoperative hospital stay of group 2 was also shorter than that of group 1 (median 7 d vs.12 d,Z =-3.076,P ＜ 0.01).The follow-up period was 3 to 120 months (median 26 months).The success rate was 82.4％ (14/17) in group 2 and 80.8％ (21/26) in group 1,and there was no significant difference between the two groups (x2 =0.017,P ＞ 0.05).Conclusion Compared with transabdominal repair,transvaginal repair of VVF is a preferred surgical procedure in respect that it is more simple,less invasive and has similar success rate with transabdominal repair.

The efficacy of double percutaneous nephrostomy combined with ureter occlusion stent in treating cervicalcancercomplicatedwithvesicovaginalfistulaafterradiotherapy / 中华放射学杂志

Objective To evaluate the efficacy of double percutaneous nephrostomy combined with ureter occlusion stent in treating cervical cancer complicated with vesicovaginal fistula after radiotherapy. Method A prospective analysis was taken for 12 patients with cervical cancer complicated with vesicovaginal fistula after radiotherapy who were diagnosed by gynecological examination, imaging and cystoscopy. All patients received concurrent double percutaneous nephrostomy and ureter occlusion stent implantation.The improvement of symptoms and postoperative complications were observed.The number of white blood cells in urine,renal function,number of diapers in daily use(pieces),daily vaginal and urethral exudate, pain score,physical status (ECOG) score and quality of life score (KPS) before and 7 d after the procedure were compare by the paired Student's t test. Results Twelve patients were successfully implanted 24 ureter occlusion stents after successful nephrostomy. Postoperatively, urinary fistula immediately disappeared in all patients.One week after operation,bilateral hydronephrosis disappeared in 4 patients, renal insufficiency and renal function returned to normal in 4 patients. There were significant differences in the number of white blood cells in urine,the number of diapers in daily use,the daily vaginal and urethral exudate,pain score,KPS and ECOG score compared with before and 7 d after the procedure(all P<0.05).There was no significant difference in the creatinine and urea nitrogen (all P>0.05). No serious complications occurred after the operation.Conclusion Double percutaneous nephrostomy combined with ureter occlusion stent can effectively and safely treat cervical cancer complicated with vesicovaginal fistula after radiotherapy.

Reparación de fístula urogenital con interposición de injerto biológico de submucosa intestinal / Urogenital fistula repair with intestinal submucosa biological graft interposition

Resumen ANTECEDENTE: el tratamiento de una fístula genitourinaria compleja es un reto por las múltiples dificultades para conseguir un resultado exitoso; el injerto biológico de intestino porcino puede ser una opción en estos casos. OBJETIVO: describir el diagnóstico de las fístulas genito-urinarias y su reparación con una innovadora interposición de injerto biológico de intestino delgado porcino. MATERIALES Y MÉTODOS: estudio prospectivo de serie de casos con diagnóstico de fístula vésico-vaginal y uretro-vaginal de pacientes atendidas en el Instituto Nacional de Perinatología entre los años 2012 a 2014. Descripción de los datos demográficos de cada paciente, proceso diagnóstico-clínico y estudios de gabinete y laboratorio; características de la fístula, técnica quirúrgica y seguimiento. RESULTADOS: se estudiaron 5 pacientes con fístulas tipo III o vésico-vaginales localizadas en el trígono, 3 de ellas relacionadas con cirugía ginecológica y 2 con un evento obstétrico, y una tipo I o uretrovaginal en la uretra proximal, relacionada con parto instrumentado. En el cierre del segundo plano, para la colocación del injerto biológico, se aplicó la técnica de reparación de Latzko modificada. Una paciente tuvo 4 reparaciones previas, otra una reparación previa y el resto ninguna. El tamaño varió de 0.5 cm a 3 cm. El seguimiento posoperatorio no evidenció recurrencia; una paciente tuvo incontinencia urinaria de esfuerzo un año después. El seguimiento mínimo fue de 1 y el máximo de 2 años. No se registraron complicaciones posoperatorias. CONCLUSIÓN: el injerto de mucosa de intestino delgado porcino para la reparación de fístulas urogenitales complejas y recurrentes fue efectivo en todas las pacientes.

Abstract BACKGROUND: treatment of a complex genitourinary fistula is a challenge given the multiple difficulties to achieve a successful result, the biological grafting of porcine intestine can be an option in these cases. OBJECTIVE: to describe the diagnosis of genitourinary fistulas and their repair with an innovative interposition of small intestine porcine biological graft. MATERIALS AND METHODS: a prospective trial of a series of cases with a diagnosis of vesicovaginal and urethrovaginal fistula in patients of the Instituto Nacional de Perinatología between 2012 to 2014. Description of patient demographics, diagnostic and clinical process, imaging and lab tests; characteristics of the fistula, surgical technique and follow up. RESULTS: 5 patients with type III or vesicovaginal fistulas located in the trigone were studied, 3 of the fistulas are related to gynecological surgery and 2 with an obstetric event and one type 1 or urethrovaginal in the proximal urethra caused by an instrumented delivery. In the closure of the second layer for placement of the biological graft, we applied the modified Latzko repair technique. One patient had 4 previous repairs, another one had one previous repair and the rest had none. The size varied from 0.5 cm to 3 cm. The postoperative follow-up period did not show recurrence; one patient had stress urinary incontinence one year later. The minimum follow-up was 1 year and the maximum 2 years. No postoperative complications were reported. CONCLUSION: the porcine small intestinal submucosa graft for the repair of complex and recurrent urogenital fistulas was effective in all patients.

Transvaginal repair for vesicovaginal fistulas / 中国医师杂志

Vesicovaginal fistulas are the common complications of gynecologic and obstetric procedure,which could be repaired through vaginal approach (Laztko procedure) or abdominal approach (O'Conor procedure).However,the vaginal approach of vesicovaginal fistulas repair should be the preferred one,because the transvaginal repairs is mini-invasive and achieve comparable success rates compared to abdominal repairs.In addition,surgeon could transvaginal repair recurrent fistula easily.Now,most vesicovaginal fistulas are iatrogenic with sever scar tissue surrounding fistulous tract.Therefore,based on the previous experience of transvaginal operation,we recommend usingShen Modification of Laztko's Procedure to improve the success rate of first transvaginal repair.

Comparison and discussion of different surgical methods used to treat vesicovaginal fistulas / 北京大学学报(医学版)

Objective:To compare the feasibility and prognosis of different surgical methods used for vesicovaginal fistulas and to explore the value of electrocoagulation treating small ones.Methods:The medical data of 19 patients who had undertaken transvaginal VVF repairs in Peking University People's Hospital between October 2008 and November 2016 were retrospectively collected.The follow-ups were performed.The patients' age ranged from 31 to 55 years with the median age of 48 years and the history length ranged from 1 month to 24 months with the median length of 3 months.Their fistula situation,surgical methods and prognosis were analyzed and the differences and similarities were compared.Results:Three patients (15.79％) was performed by electrocoagulation,4 (21.05％) by transvaginal repair,5 (21.32％) by laparoscopic repair and 7(36.84％) by open operation.Except one patient who rejected urinary catheter and D-J catheters,the rest of the patients discharged with catheters.Twelve patients (63.2％) got full satisfaction with one operation.One of the 3 patients who undertook electrocoagulation repeated the operation for twice and got completely cured within 1 month while the other two undertook the operation once and got dry within 1 month.Three patients who undertook transvaginal repair got dry within 1 month.Two of the 5 patients who undertook laparoscopic repair had readmission for a second operation and the other 3 got dry after operation.Five of the 7 open repair patients got dry while the other 2 attempted other center for treatment.Conclusion:Transvaginal repair has been the main surgery procedure for VVF,but it is limited by the location of fistula and the condition of vaginal.For patients not suitable for transvaginal repair,laparoscopic repair and open surgery are feasible.However both laparoscopic repair and open surgery are more invasive.Based on that,electrocoagnlation becomes a better choice.In our research,patients with small and high location fistula treated by electrocoagulation got a higher cure rate and bear less surgical trauma.Electrocoagulation used in the treatment of VVF showed advantages of less trauma,less bleeding and better satisfaction.Fistulas with low location were more suitable for transvaginal repair.Complex VVF,especially with narrow ureteral open and ureteral fistulas,were more suitable for open and laparoscopic repair.As for single and small fistula,the electrocoagulation can be the first choice.

The surgical treatment for complex vesicovaginal fistula / 中华泌尿外科杂志

Objective To discuss the outcomes of transvaginal repair and transabdominal repair for complex vesicovaginal fistula (VVF).Methods The data of complex VVF patients undergoing surgical repair in Peking University First Hospital were retrospectively collected between January 2009 and December 2016.The surgical modalities for complex VVF included transvaginal repair with layered closure and transabdominal repair with full thick vascular peritoneal interposition.The subtype distribution of complex VVF in transabdominal repair group and transvaginal repair group were recorded.The present study included 63 complex VVF patients with the median age of 46 years (range 26-60 years).There were 32 cases undergoing transvaginal repair with layered closure and 31 cases undergoing transabdominal repair with full thick vascular peritoneal interposition.The proportion of cases having failed previous repairs was significantly higher in transvagical repair group (30/32 vs.23/31,P =0.034).Compared with patients with transvaginal repair,patients with transabdominal repair tended to have multiple VVF without statistic significance (18.8％ vs.29.0％,P =0.338).Patients with transabdominal repair had larger VVF than patients with transvaginal repair (median:1.0cm vs.0.5cm,P ＜ 0.001).Results There were 2 cases suffering from fat liquefaction of surgical incision and 1 case suffering from adhesive intestinal obstruction in patients undergoing transabdominal repair.In the median follow-up duration of 24 months (range 8-102 months)and 29 months (range 8-78 months),the successful rates of transvaginal repair and transabdominal repair were 75％ (24/32) and 93.5％ (29/31).Severe lower urinary tract symptoms occurred in one patient who had urine leakage after transabdomnal repair.The bladder volume of patients in transabdominal group recovered at postoperative 3-6 months.Conclusions In consideration of surgical invasion and fistula condition,transvaginal repair with layered closure and transabdominal repair with full thick vascular peritoneal interposition should be performed individually for complex VVF.Meanwhile,the surgeons need pay attention to other perioperative management.

The surgical treatment for complex vesicovaginal fistula / 中华泌尿外科杂志

Objective To discuss the outcomes of transvaginal repair and transabdominal repair for complex vesicovaginal fistula (VVF).Methods The data of complex VVF patients undergoing surgical repair in Peking University First Hospital were retrospectively collected between January 2009 and December 2016.The surgical modalities for complex VVF included transvaginal repair with layered closure and transabdominal repair with full thick vascular peritoneal interposition.The subtype distribution of complex VVF in transabdominal repair group and transvaginal repair group were recorded.The present study included 63 complex VVF patients with the median age of 46 years (range 26-60 years).There were 32 cases undergoing transvaginal repair with layered closure and 31 cases undergoing transabdominal repair with full thick vascular peritoneal interposition.The proportion of cases having failed previous repairs was significantly higher in transvagical repair group (30/32 vs.23/31,P =0.034).Compared with patients with transvaginal repair,patients with transabdominal repair tended to have multiple VVF without statistic significance (18.8％ vs.29.0％,P =0.338).Patients with transabdominal repair had larger VVF than patients with transvaginal repair (median:1.0cm vs.0.5cm,P ＜ 0.001).Results There were 2 cases suffering from fat liquefaction of surgical incision and 1 case suffering from adhesive intestinal obstruction in patients undergoing transabdominal repair.In the median follow-up duration of 24 months (range 8-102 months)and 29 months (range 8-78 months),the successful rates of transvaginal repair and transabdominal repair were 75％ (24/32) and 93.5％ (29/31).Severe lower urinary tract symptoms occurred in one patient who had urine leakage after transabdomnal repair.The bladder volume of patients in transabdominal group recovered at postoperative 3-6 months.Conclusions In consideration of surgical invasion and fistula condition,transvaginal repair with layered closure and transabdominal repair with full thick vascular peritoneal interposition should be performed individually for complex VVF.Meanwhile,the surgeons need pay attention to other perioperative management.