Laparoscopic repair of female genitourinary fistulae: 10-year single-center experience.

INTRODUCTION AND HYPOTHESIS: Laparoscopic repair of different female genitourinary fistulae has been recently reported, including both conventional and laparoendoscopic single-site surgery (LESS). We present our 10-year single-center experience of the laparoscopic repair of different types of female genitourinary fistulae. METHODS: A retrospective analysis of our records over the last 10 years was performed. Type of fistula, etiology, laparoscopic approach, operative data, postoperative outcome, and follow-up were recorded. RESULTS: Overall, 46 patients with laparoscopic repair of genitourinary fistulae were reported: 25 had vesicovaginal fistulae (VVF), 14 had vesicouterine fistulae (VUF), and 7 had ureterovaginal fistulae (UVF). Thirty-three patients had conventional laparoscopic repair, whereas 7 VVF and 6 VUF had LESS repair. In all patients with VVF and VUF, extravesical repair was carried out by excising the fistulous tract and closing both the bladder and the vagina or the uterus with interposing tissue in-between. In patients with UVF, extravesical ureteric re-implantation was performed. Mean operative time was 176 ± 25 min. Mean blood loss was 105 ± 25 cc. No intraoperative or postoperative complications occurred. None was converted to open surgery. Mean postoperative hospital stay was 3.2 ± 1.2 days. After a mean follow-up of 6.3 ± 3.1 years, all patients had undergone successful repair, except for one patient with complex VVF. CONCLUSIONS: Laparoscopic repair of VVF, VUF, and UVF is a feasible procedure with a high success rate and low morbidity. LESS repair of VVF and VUF has a comparable success rate to conventional laparoscopy, but with a shorter hospital stay and fewer analgesic requirements.

A prototype non-invasive urodynamic test to estimate voiding reserve in normal adult males.

Objective: To propose a prototype non-invasive test to estimate voiding reserve in normal adult men; identifying its feasibility, limitations, and initial results. Subjects and methods: In all, 30 adult healthy male volunteers aged <40 years were included in the study. Initial free uroflowmetry was done with post-void residual urine volume (PVR) assessment using ultrasonography. The men were later asked to void into a uroflowmeter through a condom catheter attached to the glans penis and connected to an outflow tube with specific vertical heights (10, 20, 30, 40, 50 and 60 cm) on different days. The mean maximum urinary flow rate (Qmax) and PVR at each height were compared with the Qmax and PVR at the initial free uroflowmetry. The maximum height at which the Qmax and PVR remained normal was considered the normal voiding reserve for that age group. Results: All the men completed the study without any complications. At zero level, the mean Qmax was 27.6 mL/s, which then dropped gradually to reach 17.8 mL/s at 60 cm, where still 83% of the men had a normal Qmax. The PVR was nil at zero level and started to exceed the normal range at 50 and 60 cm height (58 and 65.7 mL, respectively). So, the maximum height resistance at which the men could have a normal Qmax and normal PVR was 40 cm. Conclusions: The use of the tube height-resistance test to assess voiding reserve is feasible, non-invasive and has no complications. A 40-cm height resistance can be considered a reference level that a young adult male should be tested against to estimate his voiding reserve. Abbreviations: NPV: negative predictive value; PdetQmax: maximum detrusor pressure at maximum urinary flow; PPV: positive predictive value; PVR: post-void residual urine volume; ROC: receiver operating characteristic.

Factors determining the amount of residual urine in men with bladder outlet obstruction: Could it be a predictor for bladder contractility?

OBJECTIVE: To determine from urodynamic data what causes an increased postvoid residual urine volume (PVR) in men with bladder outlet obstruction (BOO), urethral resistance or bladder failure, and to determine how to predict bladder contractility from the PVR. PATIENTS AND METHODS: We analysed retrospectively the pressure-flow studies (PFS) of 90 men with BOO. Nine patients could not void and the remaining 81 were divided into three groups, i.e. A (30 men, PVR < 100 mL), B (30 men, PVR 100-450 mL) and C (21 men, PVR > 450 mL). The division was made according to a receiver operating characteristic curve, showing that using a threshold PVR of 450 mL had the best sensitivity and specificity for detecting the start of bladder failure. RESULTS: The filling phase showed an increase in bladder capacity with the increase in PVR and a significantly lower incidence of detrusor overactivity in group C. The voiding phase showed a significant decrease in voided volume and maximum urinary flow rate (Q max) as the PVR increased, while the urethral resistance factor (URF) increased from group A to B to C. The detrusor pressure at Q max (PdetQ max) and opening pressure were significantly higher in group B, which had the highest bladder contractility index (BCI) and longest duration of contraction. Group C had the lowest BCI and the lowest PdetQ max. CONCLUSIONS: In men with BOO, PVR results from increasing outlet resistance at the start and up to a PVR of 450 mL, where the bladder reaches its maximum compensation. At volumes of >450 mL, both the outlet resistance and bladder failure are working together, leading to detrusor decompensation.