Selection of procedures for the treatment of female low urovaginal fistulas / 中华泌尿外科杂志

Objective To evaluate the selection and outcome of procedures for the treatment of female patients with low urovaginal fistulas.Methods Between Jan.1999 and Dec.2012,a total of 94 low urovaginal fistula patients with mean age 28(5-58)years and the duration of the condition for mean 4(1-23)years were treated using a variety of procedures.Of the 94 patients,the etiology was trauma in 57 patients,iatrogenic injuries in 34,local inflammation in 2 and congenital in 1.Urethral stricture was associated with urethrovaginal fistulas in 61 patients(Group of urethra)and vesicovaginal fistula in 33 (Group of bladder).Of the group of urethra,it was associated with ileovaginal fistula in 2 patients,rectovaginal fistula in 3 and veginal strictures in 8.Of the group of bladder,the fistula was simple or incipient in 15 cases and complex or recurrent in 18 cases.In group of urethra,pedicle labial skin grafs urethroplasty was used in 30 cases,island flap of vulva urethroplasty in 4 cases,vaginal wall flap urethroplasty in 18 cases,end to end anastomotic urethroplasty in 6 cases,and anterior bladder flap uretbroplasty in 3 cases.At the same time of urethroplasty,bladder neck reconstruction was performed in 6 cases with pre-existing traumatic sphincter incompetence,intestovaginal fistula repair was performed in 5 cases.In the group of vesicovaginal fistula,the fistula repairing was performed by transabdominal approach in 18 cases and by transvaginal approach in 15 cases.Results There were no serious complications postoperatively.Patients were followed up with mean 45(5-140)months.Of the 34 cases underwent pedicle labial or an island flap of vulva urethroplasty,fistulas was recurrent in 3 cases and urethral strictures was happened in one case,3 cases had frequent and stress incontinence,however,all 3 cases achieved urinary continence in 3-8 months postoperatively;of the 18 cases underwent urethroplasty using vaginal flap repairs,all patients achieved anatomical success,and continence in 15 patients and stress incontinence in 3 patients;of the 6 patients underwent urethral end to end anastomosis,all patients achieved urethral anatomical repair success and the continence was achieved in 5 patients,stress incontinence in one patient;and the left 3 patients underwent bladder anterior wall urethroplasty,urethral anatomical repair success was in all 3 patients and continence in one,stress incontinence in one and dysuria in one.Endoscopic resection was performed in the patient with voiding difficulty,after which the patient could void smoothly.In the group of urethra,successful urethral anatomical recovery rate was 91.8％(56/61)and successful functional recovery rate was 83.6％(51/61).In the group of bladder,the fistulas were successfully repaired by one procedure in 29 patients(87.9％)and recurrence in 4 patients.Conclusions The selection of procedures for treatment of female patients with low urovaginal fistulas should be determined by stricture characteristics,including location,length and vaginal condition.It is very important to prevented fistulas reformation during operation by using tissue flaps as a bulk.

Trauspubic access using pedicle labial skin flap urethroplasty for the treatment of female urethral stric-tures associated with urethrovaginal fistulas / 中华泌尿外科杂志

Objective To evaluate the efficacy of transpubie access using pedicle tabularized la-bial urethroplasty for urethral reconstruction in female patients with urethral strictures associated with urethrovaginal fistulas.Methods Eight cases of urethral strictures were treated using pedicle labial skin flaps for urethral reconstructions.All cases were the mid-urethral strictures associated with ure-throvaginal fistulas.A single face pedicle flap was obtained from the labia minus or majus in 5 women,and double face pedicle labial flaps were used in 3 patients.Results There were no serious complica-tions.Two patients complained of dysuria symptoms for 2 weeks and one patient experienced stress incontinence which resolved after 4 weeks.The patients were followed up for 6 to 130 months (mean 52) postoperatively.All patients had normal micturition following catheter removal with urinary peak flow greater than 15 ml/s(17.4-42.0 ml/s).Conclusion Pedicle labial urethroplasty might be a reliable technique for the management of complex urethral strictures associated with urethrovaginal fis-tulas.

Anterior Sagittal Transrectal Approach (ASTRA) for Urethrovaginal Fistula after Total Repair of Persistent Cloaca: 1 Case Report

The authors applied anterior sagittal transrectal apporach (ASTRA) for the repair of urethrovaginal fistula which developed after total repair of persistent cloaca. The patient had been diagnosed to have persistent cloaca, double uterus and double vagina, and received PSARP, excision of right-side uterus and vagina, and left vaginal switch operation at 22 months old. After operation, the patient admitted several times due to frequent urinary tract infection and ectopic stone formation in bladder and neovagina. Urethro-neovaginal fistula was confirmed by cystoscopy and corrected with ASTRA. Postoperative voiding cystourethrogram showed no fistula tract. ASTRA showed improved surgical field, minimized ureterocystic damage, and preserved perirectal nerve due to limited incision of rectum.

Behcet's Disease with Urethrovaginal Fistula and Stress Urinary Incontinence / 대한비뇨기과학회지

Behcet's disease is a polymorphic and systemic disease involving the urinary tract. The principal manifestations in the urinary system are genital ulcerations. Urethrovaginal fistula is an uncommon disorder, which can result from any condition, like Behcet's disease, associated with pressure necrosis or local tissue ischemia. It presents an operative challenge for the surgeon because it tends to be associated with significant scarring and insufficient surrounding tissues to allow for a tension-free closure. For this reason, the interposition of well-vascularized tissue is necessary to facilitate healing. We experienced a 30-year-old woman with Behcet's disease, who had a large urethrovaginal fistula with stress urinary incontinence. For this patient, we tried combining a dermofat graft pubovaginal sling and a vaginal flap urethral reconstruction. This operative method seemed to be safe and effective for complex and refractory urethrovaginal fistula associated with stress urinary incontinence.

Congenital Urethrovaginal Fistula Combined with Uterine Didelphia, Vaginovaginal Fistula and Single Kidney / 대한비뇨기과학회지

Congenital urethrovaginal fistula is a rare disease. And also, combining with other congenital anomalies such as mesonephric duct defect is extremely rare. Mesonephric duct defect occurs in the 4th week of gestational age which leads to solitary kidney and didelphia with obstruction of the ipsilateral horn of uterus and the vagina. The bulbocavernous fat pad or gracillis myocutaneous flap can be used when second-layer closure of the urethrovaginal fistula is difficult to perform because of location, scarring, and lack of sufficient fascia. However, in this case, we used the anterior wall of occult vagina for second-layer closure of the urethrovaginal fistula. We encountered a case of congenital urethrovaginal fistula combined with double vagina, vaginovaginal fistula and single kidney in a 28-year-old female.

Clinical Observation on Vesicovaginal and Urethrovaginal Fistulas / 대한비뇨기과학회지

A clinical observation was made on 10 cases with vesicovaginal fistulas and 5 cases with urethrovaginal fistulas admitted to the Department of Urology, Busan National University Hospital, during the period from January, 1976 to June, 1982. The following results were obtained. 1. The most prevalent age group of vesicovaginal fistula was in its forties to fifties. And that of urethrovaginal fistula was in its thirties to forties and up to twenties. 2. The most common cause of vesicovaginal fistula was total hysterectomy (60%), and that of urethrovaginal fistula was trauma (60%). 3. In 4 of 10 patients with vesicovaginal fistula, the duration between onset and repair of the fistula was 3 to 6 months. In 3 of 5 patients with urethrovaginal fistula, the duration was over 5 years. 4. The most common location of vesicovaginal fistula was the posterior wall of the bladder and that of urethrovaginal fistula was proximal one third of the urethra. 5. The two most common size of vesicovaginal fistula and urethrovaginal fistula were below 1.0 cm and 1.1 to 2.0 cm. 6. The surgical repair was performed in 14 patients. Surgical approaches were as follows; transvaginal in 3, transabdominal in 6 (with vesicovaginal fistula), transvaginal in 5 (with urethrovaginal fistula)patients. 7. The most common duration of catheter drainage in vesicovaginal fistula was 3 wks. And that of urethrovaginal fistula was 2 wks. 8. Vesicovaginal fistula was repaired successfully in 7 out of 9 patients (77.8%), and urethrovaginal fistula was repaired completely in all of 5 patients (100.0%). 9. Postoperative complications of vesicovaginal fistula and urethrovaginal fistula were seen in 3 and 2 patients respectively.

A Case of Congenital Urethrovaginal Fistula / 대한비뇨기과학회지

Congenital urethrovaginal fistula is exceedingly rare disorder of urethra. We report a case of congenital urethrovaginal fistula in a 20 years old female and the relevant literature has been reviewed.

Giant Vaginal Stone due to Prolonged Urethrovaginal fistula: Report of a case / 대한비뇨기과학회지

No abstract available.