1/16. Suprapubic-vaginocutaneous fistula 18 years after a bladder-neck suspension.BACKGROUND: Several complications are associated with healing after pelvic reconstructive surgery for stress urinary incontinence. These include infection, hemorrhage, erosion, and fistula formation. CASE: A 67-year-old woman presented with simultaneously draining vaginal and suprapubic sinuses. Examination revealed a vagino-abdominal fistula. Surgical excision found an abscess around synthetic material from a previous bladder-neck suspension. CONCLUSION: Unusual fistulation can occur remotely from anti-incontinence surgery, especially when graft materials are used.- - - - - - - - - - ranking = 1keywords = urinary incontinence, incontinence, urinary (Clic here for more details about this article) |
2/16. Fascial patch technique for repair of complicated urethrovaginal fistula.INTRODUCTION: The operative repair of urethrovaginal fistula due to tension-free vaginal tape (TVT) erosion is a challenging task, and coexisting stress urinary incontinence may complicate the situation even further. We present our technique for the repair of recurrent urethrovaginal fistula combined with stress urinary incontinence, occurring after previous removal of an eroded TVT and failed repair of the fistula. TECHNICAL CONSIDERATIONS: With the patient in the dorsal lithotomy position, an inverted U-shaped incision was cut in the anterior vaginal wall, and a vaginal flap was developed. The Martius flap from the previous repair was identified and separated from the urethra, thereby disclosing a large fistula hole on the left side of the mid-urethra. Because the periurethral tissues were very friable and attenuated, only one-layer closure of the fistula hole with these tissues was feasible. Therefore, we opted to combine a pubovaginal fascial sling with a fascial patch graft, used to reinforce the fistula site. Through a low transverse abdominal incision, a 15 x 2-cm strip of rectus fascia was harvested. A 2 x 2-cm patch of fascia was excised from the strip and transfixed to the periurethral tissues, covering the sutured fistula site. The Martius flap was repositioned over the flap, and a pubovaginal sling procedure was done. The postoperative course was uneventful, the fistula has healed, and the patient regained full continence. CONCLUSIONS: This technique can be used in complicated urethrovaginal fistula repair when the surrounding periurethral tissues have been devastated and can be combined with pubovaginal fascial sling placement.- - - - - - - - - - ranking = 1.812611610991keywords = urinary incontinence, incontinence, urinary (Clic here for more details about this article) |
3/16. A complex ileovaginal fistula with associated obstructive uropathy in a patient with Crohn's disease: technical considerations and review of the literature.A high index of suspicion of an ileogenital fistula should be aroused by a patient with Crohn's disease, weight loss, malnutrition, and a persistent vaginal discharge. Preoperative gastrointestinal and genitourinary evaluation should be used in an attempt to localize the fistulous origin as well as concomitant fistulae. The principles of surgical therapy include preoperative ureteral catheters, resection of the diseased bowel and fistulous segment of bowel, and interposition of healthy tissue (ie, omentum) between the bowel anastomosis and the vaginal cuff.- - - - - - - - - - ranking = 0.0022900507736834keywords = urinary (Clic here for more details about this article) |
4/16. Combined vesicovaginal-ureterovaginal fistulas associated with a vaginal foreign body.A case is presented of vesicovaginal-ureterovaginal fistulas associated with a neglected vaginal foreign body. The patient complained of a foul-smelling vaginal discharge and was found to have a 4-cm hard vaginal mass on examination. Urinary incontinence developed subsequently. Examination under anesthesia was performed, and an aerosol deodorant cap was operatively removed from her posterior vagina/perirectal space. Subsequent work-up demonstrated the presence of both a vesicovaginal fistula and a right ureterovaginal fistula. The patient underwent a combined vaginal repair of the vesicovaginal fistula and abdominal ureteroneocystostomy. The frequency, types, etiology, and treatment of genitourinary fistulas are reviewed with particular attention to those associated with a vaginal foreign body.- - - - - - - - - - ranking = 0.095984245278191keywords = incontinence, urinary (Clic here for more details about this article) |
5/16. Complications of posterior sagittal anorectoplasty.From 1982 to 1985, 23 patients underwent posterior sagittal anorectoplasty procedures: 12 as primary treatment for congenital anorectal malformations, 9 for treatment of fecal incontinence following a prior pull-through procedure, and 2 for treatment of fecal incontinence following trauma. Six patients (26%) developed seven complications specifically related to the procedure. One patient with a cloacal anomaly had partial dehiscence of the sacroperineal incision following total reconstruction. This resulted in retraction of vaginal and anal openings, which, however, have remained separate and patent. Two patients developed temporary femoral nerve palsies, unilateral in one patient lasting one week, and bilateral in one patient lasting four months. Four patients developed leaks from the suture line of the tailored ectatic rectum, which was pulled through to the perineum. In one male patient, the suture line was placed anteriorly, resulting in a rectourethral fistula, which required a repeat posterior sagittal dissection. One male, who had a redo procedure, developed a posterior diverticulum comparable to a large anal crypt. This was repaired prior to closure of the colostomy. One seven-year-old girl developed multiple rectocutaneous fistulae, which closed with conservative management in five months. One male infant developed a single supralevator rectocutaneous fistula, which closed after rediversion of feces with a colostomy and has remained so after colostomy closure. The majority of the complications encountered were probably preventable if careful attention to certain details of technique had been observed: careful padding of the groin areas when patients are prone, especially in older patients.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 0.18738838900902keywords = incontinence (Clic here for more details about this article) |
6/16. Use of full thickness patch graft in urethrovaginal fistula.A full thickness free graft of labium minor was used to repair a large urethrovaginal fistula that could not be bridged otherwise. A successful result was obtained with relief of incontinence and a normal caliber urethra 14 months postoperatively. The question is posed as to the applicability of this technique in vesicovaginal fistulas.- - - - - - - - - - ranking = 0.093694194504508keywords = incontinence (Clic here for more details about this article) |
7/16. Sigmoid exclusion: a new technique in the management of radiation-induced fistula.Colovesical and colovaginal fistulas following irradiation for pelvic malignancy represent a formidable surgical problem. Although complex surgical procedures to close the fistulas and restore continence have been described, often a defunctioning colostomy with an associated urinary conduit is the only feasible option. Three patients who have successfully undergone an original procedure (sigmoid exclusion) are presented. Sigmoid exclusion restores continence but avoids a permanent stoma. The involved sigmoid colon was isolated on its mesentery ensuring that the area incorporating the fistulas was not disrupted. The ends of the isolated sigmoid colon were closed and bowel continuity then restored by a colorectal or colo-anal anastomosis. Following closure of a temporary colostomy the patients were continent with no ill effects or sepsis from the excluded colon. This procedure has the dual advantage of restoring continence yet avoiding both an urinary conduit and a permanent colostomy, and represents a useful advance in the surgical management of radiation induced colonic fistulas.- - - - - - - - - - ranking = 0.0045801015473668keywords = urinary (Clic here for more details about this article) |
8/16. Vesicovaginal and ureterovaginal fistulas: a summary of 25 years of experience.The difficult problem of a vesicovaginal fistula originally was cured surgically by Sims in 1849. During the last 25 years at UCLA and affiliated hospitals 68 patients have been treated by urologic surgeons for fistulas between the vagina and the urinary tract: 21 ureterovaginal and 47 vesicovaginal and urethrovaginal fistulas. The ureterovaginal fistulas often were complex and patients presented the most challenging diagnostic problem. However, they usually were repaired successfully by simple ureteroneocystostomy. Vesicovaginal and urethrovaginal fistulas were repaired transvaginally in 24 cases, with 70% success at the first attempt and 92% success with 2 attempts. Transabdominal or combined approaches were less successful. Only 58% of the cases were closed at first attempt. The transvaginal approach required less operating time, and resulted in less blood loss and shorter hospital stays than the transabdominal approach and will be described in detail.- - - - - - - - - - ranking = 0.0022900507736834keywords = urinary (Clic here for more details about this article) |
9/16. Traumatic avulsion of the lower urinary tract in the female child.We report a rare case of complete avulsion of the proximal urethra from the bladder neck and a urethrovaginal fistula secondary to blunt pelvic injury in a girl. The management consisted of a relatively simple first stage procedure, suprapubic cystostomy, followed 6 months later by transpubic repair of the defect. The child is continent and free of urethral obstruction 10 months postoperatively.- - - - - - - - - - ranking = 0.0091602030947335keywords = urinary (Clic here for more details about this article) |
10/16. Partial vaginal agenesis with a urinary-vaginal fistula.A patient with partial vaginal agenesis and a urinary-vaginal fistula is presented together with a review of the 12 cases reported previously. This unusual anomaly presents with cyclically recurrent hematuria; hypothetically, it results from failure of formation or canalization of the primitive vaginal plate together with partial persistence of the urogenital sinus. Surgical correction, ideally performed after puberty, requires resection of the fistula and mobilization of the apical vaginal segment for its anastomosis to the inferior vaginal pouch.- - - - - - - - - - ranking = 0.011450253868417keywords = urinary (Clic here for more details about this article) |
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