泌尿生殖道瘘的病因及类型

泌尿生殖道瘘指泌尿系统及生殖系统之间存在的异常通道。分娩、手术损伤、先天发育异常、盆腔炎症疾病及肿瘤是出现泌尿生殖道瘘的重要因素。膀胱阴道瘘、输尿管阴道瘘、尿道阴道瘘、膀胱子宫瘘均是泌尿生殖道瘘的常见类型,该文将概括介绍其发病原因、危险因素及诊断方法等。     

Obstetric fistulae: a study of women managed at the Monze Mission Hospital, Zambia

Objective  The objective of this study was to describe and compare characteristics of women with obstetric fistula.
Design  Retrospective cross-sectional study.
Setting  Zambia's primary fistula repair centre, Monze Mission Hospital.
Sample  All women, August 2003 to December 2005.
Method  Review of case notes to obtain data on socio-demographic and obstetric characteristics, causative pregnancy, clinical details, and treatment. Comparison of characteristics with national data was undertaken.
Results  Of 259 women, 239 had socio-demographic and obstetric records and 254 had surgical records. Educational status and height of women were significantly below the national averages, while antenatal care uptake (97.5%) and proportion from the Northern Province were significantly above. Most women (77.9%) weighed ≤50 kg. Median age at marriage was 18 and at development of fistula was 22 years. 15.1% of women were divorced, 49.0% were primiparous, and 27.6% were parity four +. 67.5% of women had spent 2 days or longer in labour. Delays in receiving emergency obstetric care (EmOC) were experienced at home (67.5%) and at clinics (49.4%), usually due to transport difficulties. 89.1% delivered in a health facility, 50.2% of deliveries were by caesarean section, and 78.1% of babies were stillborn. 72.9% of repairs were successful, 17.3% resulted in residual stress incontinence, and 9.8% failed. Failure was significantly associated with previous repair.
Conclusion  More obstetric fistulae occur in areas where early marriage and pregnancy before pelvic maturity is attained is common and where obstetric care is inaccessible. In this study, age at marriage and fistula development was older than usually found, which may indicate that poor access to EmOC contributes more to this problem within Zambia.     

Jejunouterine fistula: a case report

Jejunouterine fistula is a rare type of fistulous communication between the small intestine and the genital tract. This fistula may result from pelvic tumours, obstetric or surgical intervention and inflammatory disease. Cross-sectional imaging modalities, including ultrasonography, magnetic resonance imaging (MRI) and computed tomography (CT), are useful investigations which may demonstrate the site and track of the fistula. Traditional contrast investigations, including hysterosalpingography, are also helpful. Surgical resection of the fistula with primary anastomosis is curative in the majority of cases.     

输尿管瘘与输尿管阴道瘘临床处理

输尿管阴道瘘,指输尿管和阴道之间存在异常通道,尿液自漏孔流出,不受控制。女性输尿管的行程与女性生殖器官有着密切的关系,这就使得盆腔手术中有可能损伤到输尿管。输尿管瘘的处理原则是尽快恢复输尿管的连续性,最大程度地保护肾功能。输尿管瘘与输尿管阴道瘘是妇产科手术的严重并发症,术中应谨记预防损伤输尿管。     

膀胱阴道瘘47例手术治疗临床分析

目的探讨妇科手术并发膀胱阴道瘘的病因、治疗及预防措施。方法回顾分析中国人民解放军总医院2000年1月至2009年12月间收治的47例妇科手术、放疗后等并发膀胱阴道瘘患者的临床资料,经美兰试验和膀胱镜检查确诊。妇科手术引起膀胱阴道瘘42例,4例行双侧输尿管经皮造瘘术,43例行修补术,其中25例(58.1%)经膀胱修补,18例(41.9%)经阴道修补。结果本文43例修补术患者中,37例1次修补成功,3例2次修补后成功。术后随访1～6个月无复发。结论妇科子宫切除手术所致膀胱阴道瘘为最多见,术前充分准备及术后严格管理大大提高手术成功率。     

剖宫产手术子宫瘘的诊治

剖宫产手术子宫瘘主要发生于发展中国家,随着社会经济的发展,其在我国的发病率逐渐降低,但是近年来凶险性前置胎盘的发病率升高,术中损伤增加。因此,剖宫产后的子宫瘘仍需引起大家的重视。文章对剖宫产手术最常见的子宫瘘进行阐述,以期为其诊治提供参考和依据。     

医源性尿瘘预防与新的尿瘘治疗方法

分娩损伤及妇科手术损伤是医源性尿瘘的主要病因,针对病因的预防措施是降低医源性尿瘘的根本所在。随着现代医学的进步和科学技术的日新月异,机器人辅助内镜手术将成为未来治疗的趋势。     

The obstetric vesicovaginal fistula: characteristics of 899 patients from Jos, Nigeria

OBJECTIVE: The purpose of this study was to describe the characteristics of women with obstetric vesicovaginal fistulas at a hospital in north central Nigeria. STUDY DESIGN: A retrospective record review was conducted of all women who were seen with vesicovaginal fistulas at Evangel Hospital in Jos, Plateau State, Nigeria, between January 1992 and June 1999. RESULTS: A total of 932 fistula cases were identified, of which 899 cases (96.5%) were associated temporally with labor and delivery. The "typical patient" was small and short (44 kg and <150 cm); had been married early (15.5 years) but was now divorced or separated; was uneducated, poor, and from a rural area; had developed her fistula as a primigravida during a labor that lasted at least 2 days and which resulted in a stillborn fetus. CONCLUSION: Obstetric vesicovaginal fistula is extremely common in north central Nigeria. A complex interaction that involves multiple biologic and socioeconomic factors appears to predispose young women to this devastating childbirth injury.     

Vesico–vaginal fistula in Jordan

In order to study the aetiology of vesico-vaginal fistula in Jordan, and assess the outcome of surgical treatment, 132 cases of acquired vesico-vaginal fistulae treated at Al-Bashir Hospital, and Jordan University Hospital, Amman, Jordan, during the period between 1972 and 1996 were reviewed. Forty-five cases (30%) had one or more previous failed repair outside these hospitals. Successful repair of 108 cases was achieved (82%), 60 cases of them from the first attempt (45%) and, 48 other cases after repeated attempts (36%). In 24 cases, a total of 72 repeated operations failed. Obstetric fistulae in Jordan are decreasing due to improvement and expansion of maternity care. Although a patient with neglected fistula is a social problem, this is not the case in Jordan because of the strong family ties. Nevertheless, they present a great challenge to the gynaecologist. Referral to a centre experienced in this type of surgery certainly improves the success rate, and diminish the suffering of these patients.     

Eliminating obstetric fistula: progress in partnerships.

Obstetric fistula persists in the developing world due to poor access to obstetric care. It has been overlooked in the past, as the women suffering from fistula often live on the fringe of society due to their poverty and the stigma surrounding the condition. A global Campaign to End Fistula is bringing a variety of actors together to raise awareness and support to prevent fistula and provide comprehensive treatment for women living with fistula. This paper describes the strategies and progress of the campaign since it began in 2003.     

Vesicovaginal Fistula Following Loop Electrosurgical Excision Procedure: A Case Report

Background

The loop electrosurgical excision procedure (LEEP) is commonly used to treat cervical dysplasia and has few procedural risks. We report a rare complication: vesicovaginal fistula (VFF).

A retrovesical approach for the laparoscopic repair of vesicouterine fistulas

Objective

To report the initial experience with laparoscopic repair of vesicouterine fistulas (VUFs) at Shiraz University of Medical Sciences, Shiraz, Iran.

Methods

Between June 2012 and February 2013, 2 patients with a history of multiple cesarean deliveries had a diagnosis of VUF confirmed by cystography and cystoscopy. The fistulas were repaired laparoscopically via a retrovesical approach to minimize manipulation of the bladder.

Results

The operative times were 160 minutes and 180 minutes. Excellent laparoscopic visualization and magnification together with the presence of a catheter in the fistula tract allowed meticulous dissection in the retrovesical space between the bladder and the uterus, and resection of the fistula tract with minimal manipulation of the bladder, obviating the need for a large cystotomy. A postoperative cystogram at 4 weeks showed complete resolution of the VUF in both patients. There was no recurrence of the fistula and the patients remained symptom-free during the follow-up period.

Conclusion

Laparoscopic VUF repair with a retrovesical approach is an effective technique with successful outcome. This approach provides excellent exposure to a poorly accessible area in the retrovesical space. Longer follow-up periods are needed to evaluate the likelihood of VUF recurrence with this technique.     

Minimally Invasive Management of Concomitant Vesicovaginal and Ureterovaginal Fistulas After Transabdominal Hysterectomy: Laparoscopic Vesicovaginal Fistula Repair With Ureteroneocystostomy Using a Boari Flap

Study Objective

To demonstrate a laparoscopic approach for repair of concomitant vesicovaginal and ureterovaginal fistulas as a troublesome complication of transabdominal hysterectomy (TAH).

Urological complications following gynaecological surgery

Iatrogenic urological injuries during gynaecological surgery can have devastating consequences and significant long-term sequelae. Timely recognition of injury and appropriate investigation and treatment, whether in the acute or delayed setting, are vital in reducing the potential impact of subsequent complications to both patient and doctor. In this review, we will describe the aetiology, diagnosis and management of ureteric, bladder and urethral injuries in both the acute and delayed setting, with a special focus on urogenital fistulas in women in order to facilitate a better understanding of what can be done to minimize iatrogenic injury to the urinary tract and the optimal management of these complications when they do occur.     

妇科手术中泌尿系损伤的预防

泌尿系损伤是一种少见但后果却可能极为严重的盆腹腔手术并发症,其中50%医源性泌尿系损伤由妇科手术操作所致。开腹、腹腔镜、阴式手术3种术式中泌尿系损伤原因和特点各异,了解盆腔手术不同手术路径的特点,选择合适的手术方式,进行良好的术前评估,熟悉手术区域解剖,正确使用各种电器械,熟练掌握手术操作技巧,术中时刻警惕泌尿系损伤的发生,能有效地预防妇科手术导致的泌尿系损伤。     

Early surgical repair of iatrogenic ureterovaginal fistula secondary to gynecologic surgery

Objective

To describe the early surgical repair of iatrogenic ureterovaginal fistula (UVF) secondary to gynecologic surgery, and evaluate the efficacy and feasibility of early surgical intervention.

Methods

Data were retrospectively reviewed for 52 patients with iatrogenic UVF who underwent early surgical repair between January 1996 and January 2011 at the Sir Run Run Shaw Hospital, Hangzhou, China. Preoperative patient characteristics and postoperative endpoints, including type of index procedure, repair technique, operative time, perioperative complications, and postoperative follow-up data were assessed.

Results

All early surgical repairs were uneventful. The mean time from diagnosis to surgery was 15.7 days (range, 14–21 days). The mean operative time was 73.4 min (range, 51–110 min) for ureteroneocystostomy, and 104 min (range, 91.5–153 min) for Boari flap procedure. The mean estimated blood loss was 57.8 mL (range, 35–80 mL). No major intraoperative complications occurred, although 5 patients had postoperative surgical site infections. Forty-three patients were followed for a mean of 18.4 months (range, 10.5–24.0 months). Ureteral stricture with asymptomatic hydronephrosis occurred in 2 (4.7%) patients. Ipsilateral renal function was preserved in all patients.

Conclusion

Early surgical repair of UVF secondary to gynecologic surgery was safe and effective, and preserved ipsilateral renal function.     

Fertility desires and the feasibility of contraception counseling among genital fistula patients in eastern Democratic Republic of the Congo

Objective

To determine the fertility and contraceptive desires of genital fistula patients in eastern Democratic Republic of the Congo (DRC) and to evaluate the impact of contraceptive counseling and its effect on contraceptive knowledge and use.

Methods

Group contraceptive counseling was offered to fistula patients at HEAL Africa Hospital between February and May 2010. Fertility desires and contraceptive knowledge were assessed via verbally administered questionnaires before and after counseling, and use of modern contraceptive methods was tracked.

Results

Of the 61 participants, 22/34 (64.7%) of those who desired children wanted to wait at least 1 year after repair before attempting pregnancy. Overall, 31/58 (53.4%) women had heard of birth control, although only 15 (24.6%) knew any specific methods, and none had ever used contraception. After counseling, all participants could recall 1 or more methods. Of the 25 participants discharged over the subsequent 3 months, 5 (20.0%) and 3 additional fistula patients selected a modern method of contraception.

Conclusion

Desire for contraception and birth spacing among women with fistula is significant. Basic group contraception counseling and access are feasible and lead to increased contraceptive knowledge and use.