[Vesicovaginal fistula. Experience at the Instituto Nacional de Perinatología]. / Fístula vesicovaginal. experiencia en el Instituto Nacional de Perinatologia.

BACKGROUND: The damage of the lower urinary tract is originated by complications of obstetric or gynecological surgery, which if not detected timely determines the formation of fistulas. OBJECTIVE: To analyze the experience in diagnosing and treating vesicovaginal fistulas attended at the gynecologic urology clinic of the Instituto Nacional de Perinatologia (INPer). MATERIAL AND METHOD: Retrospective study of 27 files of patients diagnosed with vesicovaginal fistula at the gynecologic urology clinic of the INPer from January 11 1992 trough December 31st 2005. The variables analyzed were age, parity, corporal mass index, surgical history, surgery performed to correct the fistula and postoperative evolution. Averages and standard deviation were calculated to describe data. RESULTS: Average age was 38.2 years. Abdominal hysterectomy (53.3%), followed by obstetric hysterectomy (33.3%), caused the most of complications. The most often used techniques to correct the fistula were Latzko operation, 19 patients (45.23%), and Sims' fistulectomy, 11 patients (26.19%). The most used drainage was Foley probes, with 9.1 days average of use. Urinary tract infection was the most common complication (6.7%). CONCLUSIONS. After our analysis, surgical treatment to patients with vesicovaginal fistula showed good results (71.4% of healing) with a minimum of complications (28.5% of recurrence).

[Urolithiasis and pregnancy]. / Urolitiasis y embarazo.

Urolithiasis disease during pregnancy fortunately is a relatively rare disease; nevertheless many times it complicates the diagnosis and treatment. This paper reviews the safety and efficacy of both and their relationships with mother and fetus and proposes different options for the urologist, gynecologist, and urogynecologist for the attention of pregnant women with suspicion of urolithiasis. The ultrasound seems to be the first-choice method during the pregnancy; it is available in many health centers and does not require too much experience for its interpretation. Intravenous urography, simple X-ray and magnetic resonance image with its limitations aid support to our clinical suspicion; additionally the uretheroscopy is the diagnostic and therapeutic method and can be used safely during the pregnancy; thus first-choice study is the ultrasound with changes in vascular resistance rates. Once diagnosis is established, conservative treatment is applied because the majority of patients has spontaneous elimination of stones (70 to 80%). Surgical intervention can be an option and when is needed, placement of an uretheral catheter JJ, percutaneous nephrostomy and uretheroscopy may be an option to definitive treatment.