Difficult obstetric vesicovaginal fistula: a report on 12 cases.

In each of the 12 cases presented, the fistula was the result of obstructed labor. Common features to each case were: (a) a large retropubic defect involving the anterior vaginal wall, bladder and urethra, (b) total or partial urethral rupture, and (c) marked vaginal wall scarring with vaginal stenosis. Primary repair was performed by the vaginal route, and two patients were cured by the first operation. Six patients required two or more vaginal procedures for successful closure. Following repeated failure of vaginal closure, two patients had a successful transvesical closure and two require ureterosigmoidostomy.     

Obstetric vesicovaginal fistula: reporting two cases in France

Obstetric vesicovaginal fistula is nowadays rare in developed countries. We are reporting two cases of patients with obstetric vesicovaginal fistula that occurred after operative vaginal deliveries performed in a French hospital. Early postpartum symptoms were vaginal urine leakage and infectious syndrome. The fistula has been cured by vaginal surgery one case and combined (laparotomy and vagina surgery) in the other case. Patients were totally healed a few months following the surgery.     

Sexual trauma--an unusual cause of a vesicovaginal fistula.

A 20-year-old nullipara presented with a post-coital vesicovaginal fistula in the trigone of the bladder. She had normal genital development and no other cause was found. The fistula was repaired by vaginal route.     

Latzko operation for vault vesicovaginal fistula

BACKGROUND: Various surgical procedures are currently performed for the treatment of posthysterectomy vesicovaginal fistula. Most of them are carried out via an abdominal incision. OBJECTIVE: Report of our experience with Latzko's operation, a simple purely transvaginal procedure. METHODS: Retrospective study of vesicovaginal fistulas treated by a Latzko procedure between June 1991 and June 2005. RESULTS: Eleven patients were operated on. Two (18%) had a prior failed attempt of vesicovaginal fistula repair. Mean size of the fistulas was 12+/-11 mm (range: 2-40 mm). Mean operative duration was 62+/-33 min (range: 20-110 min). All fistulas healed. No intraoperative complications were observed. There was only one postoperative complication, a lower urinary tract infection in one patient. Mean hospital stay was 6+/-4 days (range: 2-12 days). CONCLUSIONS: The Latzko procedure is an efficient, safe, and simple technique for the management of vault vesicovaginal fistulas, and can therefore be proposed as the first-line surgical treatment.     

Controversies in the management of vesicovaginal fistula

Achieving 100% closure and continence rate in the management of vesicovaginal fistulas remains a challenge. There is still debate about several aspects of the care including the following:

• •How successful is conservative treatment with catheter drainage, and can it be improved with newer techniques?
• •When is the best time to operate?
• •What is the best surgical approach?
• •Are interpositional flaps helpful?
• •Is there any way to reduce the risk of future stress incontinence during the initial surgery?
• •How long does the bladder need to be drained after surgery?
• •What is the best way to manage radiation-induced fistulas?
• •Where and by whom should the patient be operated?

     

Vaginal prosthesis for control of vesicovaginal fistula

A technique for construction of a vaginal appliance to control urinary incontinence secondary to a vesicovaginal fistula associated with pelvic malignancies and/or radiation therapy is described and illustrated.     

膀胱阴道瘘阴道修补术适应证及手术要点

膀胱阴道瘘经阴道自然腔隙修补术,是具微创意义的手术方式。大多数膀胱阴道瘘均可经阴道修补成功。文章通过复习文献同时结合作者经验,总结了膀胱阴道瘘经阴道修补手术的适应证及手术要点。     

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。