1/7. diagnosis and management of post-cesarean ureterouterine fistulae.Urinary leakage following obstetric or gynecologic surgery is a dreaded complication, most often caused by a urogenital fistula. Of these, uretero-uterine fistulae are relatively rare and pose a diagnostic and therapeutic dilemma. A 29-year-old woman presented with paradoxical incontinence of urine for 3 months. She had developed vaginal leakage of urine 2 weeks following an uneventful cesarean section. Conservative measures in the form of catheterization and bed rest did not relieve her symptoms. Subsequent examination and investigations revealed that she had a ureterouterine fistula. The case is discussed as well as the diagnostic modalities and treatment options.- - - - - - - - - - ranking = 1keywords = gynecologic (Clic here for more details about this article) |
2/7. Fatal recurrent ureteroarterial fistulas after exenteration for cervical cancer.BACKGROUND: Ureteroarterial fistula (UAF) is a rare occurrence. It can be difficult to diagnose with a high mortality. We report a case of a recurrent UAF. CASE: A 38-year-old women diagnosed with cervical cancer had undergone pelvic exenteration for severe radiation-induced necrosis with a vesicovaginal and rectovaginal fistula after primary radiation therapy. hemorrhage into the urinary tract necessitated surgical intervention and vascular repair with a femoral-femoral bypass. Although these measures were effective, the patient died 6 months later following an acute hemorrhage into her conduit. Arteriogram revealed a second UAF. CONCLUSION: When urinary tract bleeding occurs in patients previously diagnosed with a gynecologic malignancy and treated with radiation therapy and extensive surgery with urinary diversion, UAF should be considered in the differential diagnoses.- - - - - - - - - - ranking = 1keywords = gynecologic (Clic here for more details about this article) |
3/7. Endovascular management of ureteral-iliac artery fistulae with Wallgraft endoprostheses.BACKGROUND: Ureteral-iliac artery fistulae are rare, yet potentially life-threatening, causes of hematuria. Treatment has traditionally been surgical, but advances in endovascular technology have led to a few recent reports of therapy with covered stents. We report two cases of patients diagnosed with ureteral-iliac artery fistulae who were treated with Wallgraft endoprostheses, a new, commercially available covered stent. CASES: We report two patients with gynecologic malignancies who presented with massive hematuria and hypotension and were subsequently proven to have ureteral-iliac arterial fistulae. Both patients had prior pelvic surgery, radiation, and chronic indwelling ureteral stents. Once the diagnosis was established, both patients were managed with endovascular covered stent placement. The patients' conditions stabilized, hematuria ceased, and both were discharged from the hospital without additional transfusion or surgical treatment. CONCLUSION: Endovascular therapy with covered stents is a safe, effective, and readily available method for the treatment of ureteral-iliac artery fistulae.- - - - - - - - - - ranking = 1keywords = gynecologic (Clic here for more details about this article) |
4/7. ureteroscopy: a new asset in the management of postoperative ureterovaginal fistulas.Iatrogenic ureteral injury, an uncommon entity, is primarily caused by complications of gynecologic surgery. This report describes a case of ureterovaginal fistula discovered 13 days after a vaginal hysterectomy. ureteroscopy was performed, with passage of an indwelling ureteral stent for 6 weeks. The patient immediately became continent of urine and the fistula healed, thus avoiding the need for further surgery.- - - - - - - - - - ranking = 1keywords = gynecologic (Clic here for more details about this article) |
5/7. Experiences with a xenograft (acellular bovine collagen matrix) in gynecologic fistula repairs.Urogenital fistulas are significant, though uncommon, complications of gynecologic surgery, and fistula repair can be a challenging surgery for even the most experienced gynecologist. An interposition xenograft (acellular bovine collagen matrix), derived from bovine pericardium, has been used to accomplish successful repairs. We report on five urogenital fistula cases in which an interposition xenograft was used in achieving a successful repair. The use of an interposition xenograft is a successful option in urogenital fistula repair.- - - - - - - - - - ranking = 5keywords = gynecologic (Clic here for more details about this article) |
6/7. Full-thickness Martius grafts to preserve vaginal depth as an adjunct in the repair of large obstetric fistulas.We performed a modified bulbocavernosus full-thickness pedicle graft procedure on four patients with large obstetric fistulas in ghana, West africa. The bulbocavernosus fat pad was harvested in the usual manner, and the full-thickness skin patch was taken from the medial thigh. All grafts showed 100% take by the tenth postoperative day. Adequate vaginal depth and caliber were obtained in all patients. Sexual function resumed in all patients except one, who suffered a recurrent vesicovaginal fistula. This method of vaginoplasty may be useful in patients who have massive vaginal-wall destruction of either gynecologic or obstetric origin.- - - - - - - - - - ranking = 1keywords = gynecologic (Clic here for more details about this article) |
7/7. Use of endoscopy in the management of postoperative ureterovaginal fistula.The aim of the study was to evaluate endourological techniques in the management of iatrogenic ureterovaginal fistula. Seventeen patients referred to us after gynecologic surgery were diagnosed as having iatrogenic ureterovaginal fistula. First, retrograde double-J stenting was tried. If this failed, percutaneous nephrostomy using an antegrade double-J stent was performed. If this also failed, open surgical repair was performed. The retrograde double-J stent bypassed the fistula in 2 patients (11.8%). Percutaneous nephrostomy was performed in the remaining 15. The antegrade double-J stent bypassed the fistula in another 2 of these patients (11.8%). Open surgical repair was performed in the remaining 13 patients (67.5%) (direct ureteroneocystostomy) with nipple valve in 11 patients and Boari flap with psoas hitch in 2 patients). Of all patients, 2 had ureteral stricture, one after antegrade double-J stenting and the other after open repair. It was concluded that early intervention is recommended in the treatment of iatrogenic uretrovaginal fistula, causing minimal morbidity and discomfort, and being less expensive.- - - - - - - - - - ranking = 1keywords = gynecologic (Clic here for more details about this article) |