Management of ureterovaginal fistula

ABSTRACT

To evaluate the outcome of surgical management of uretero-vaginal fistula [UVF]. It was a descriptive study. Setting and Duration of study The study was conducted at the Department of Urology, Chandka Medical College teaching Hospital and Almas Kidney and Lithotripsy Centre Larkana from February 1995 to November 2006. The criterion for selection of the patients and screening workup included complete history, clinical examination and investigations like complete blood count and biochemistry, ultrasound, intravenous urography and retrograde ureteric brash or ureterogram were performed to confirm the level of fistula and also to assess the function of affected kidney. The neo-ureterocystostomy was made with modified Lich Gregoir, Boari Ockeblade flap, Psoas hitch and endoscopic methods as deemed necessary. Our study included 20 cases. The ages of the patients ranged from 22 year to 45 years [average 36 years]. We used modified Lich George method, Boari Ockeblade flap, Psoas hitch method and internal stenting in 09[45%], 05[25%], 04[20%] and 02[10%] of cases respectively. The ureteric catheter or DJ stent were kept postoperatively in 06[30%] and 04[20%] cases respectively. Although all patients had no leakage after surgery; but 06[30%] cases developed transient urgency, frequency, dysuria and persistent pain. These were resolved with conservative treatment. The complications occurred in 4[20%] cases which were wound infection in 01[05%], recurrent urinary tract infection in 02[10%] cases and 01[5%] developed a small bladder capacity. There was no significant difference in outcome of different techniques, rather choice depends upon individual case and preference of surgeon. We conclude that modified Lich surgical procedure is simple, successful and quick method of treatment for repairing the cases of uretero-vaginal fistulae. We suggest bilateral ureteric catheterizations prior to difficult female pelvic and gynecological surgery to prevent such disaster