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.

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.

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 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.

Review of experiences with vesicovaginal fistula repair in 39 cases / 대한비뇨기과학회지

Vesicovaginal fistula is a distressing complication which may follow total hysterectomy, prolonged labor, chemical cauterization due to uterine prolapse. radiation therapy, and cervix cancer. The management of vesicovaginal fistula still remains controversial in regard to the type of approach and timing of repair. A review of experiences with vesicovaginal fistula repair was done on 39 cases admitted to the Department of Urology, Chonnam University Hospital, during the period from January, 1977 to December. 1991. The most prevalent age group was the forties to fifties (25/39 cases, 64.1%). The most common location of vesicovaginal fistula was the trigone (19/39 cases, 48.7%). The highest range of size of vesicovaginal fistula was that below 1.0 cm (24,39 cases, 61.5%).Of 39 cases. 14 occurred after total hysterectomy (35.9%). 13 chemical cauterization (33.3%). 8 prolonged labor(20.5%). 2 radiation therapy (5.1%). 1 Cesarean section (2.6%), and 1 Dilatation & Curettage (2.6%). The success rate of the initial repair was 88.5% (23,26 cases) by transvaginal repair. 83.3% (5/6 cases) by transperineal transvesical repair. 60.0% (3,5 cases) by suprapubic transvesical repair. 100.0% (1/1 case) by colpotleisis, and l00.0% (1/1 case) by ileal conduit, respectively. The transvaginal repair was most simple, and required the least time of average 96 minutes. Of six cases failed in the initial repair, one case was cured with the second repair and two cases with the third repair, with overall cure rate of 92.3% (36/39 cases).