1/108. Bladder injuries during total laparoscopic hysterectomy: diagnosis, management, and prevention.Based on a series of 150 total hysterectomies carried out via laparoscopy between January 1993 and December 1994, we observed 2 bladder complications: 1 bladder injury and 1 vesicovaginal fistula. These two accidents form the basis of discussion on the risk factors for these complications, their diagnosis, treatment, and prevention.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
2/108. Laparoscopic management of recurrent vesicovaginal fistula.vesicovaginal fistula repair is most commonly undertaken via a transvaginal approach. We report a recurrent case of vesicovaginal fistula which was ultimately repaired using a laparoscopic approach. The fistula followed a hysterectomy and persisted despite two operations using the Latzko partial colpocleisis and prolonged catheterization. The fistulous tract was ultimately repaired by closing the vagina and bladder with an interposing omental flap utilizing a laparoscopic approach.- - - - - - - - - - ranking = 7keywords = fistula (Clic here for more details about this article) |
3/108. The Mitrofanoff urinary diversion for complex vesicovaginal fistulae: experience from uganda.OBJECTIVE: To evaluate the results of Mitrofanoff continent urinary diversion in a group of women with persistent severe incontinence after vesicovaginal fistula (VVF) secondary to obstructed labour. patients AND methods: Seven women with severe incontinence following a VVF were offered the Mitrofanoff procedure after all other attempts had failed to restore continence. In three patients a caecocystoplasty formed the urinary reservoir and in four the bladder was used. In all seven patients the appendix was used as the conduit for self-catheterization. The mean (range) follow-up was 10 (3-14) months. RESULTS: One patient died postoperatively from hepatic failure, which could not be attributed to the particular procedure. One patient required re-operation at 10 days to adjust the conduit, but of the six patients who recovered, all are fully continent and self-catheterizing with no difficulty. CONCLUSION: The Mitrofanoff procedure appears to be a valuable technique to restore continence in this difficult group of patients.- - - - - - - - - - ranking = 5keywords = fistula (Clic here for more details about this article) |
4/108. Intravesical foreign body and vesicovaginal fistula: a rare complication of a neglected pessary.A silicone Gellhorn pessary, 3 inches in diameter, neglected for several years in an elderly woman, eroded through the anterior vaginal wall, ultimately to lie entirely within the bladder. General anesthesia and bilateral deep full-length Schuchardt's incisions were required to remove it. A Latzko procedure was done at a later date to close the large vesicovaginal fistula; similar Schuhardt's incisions were again used.- - - - - - - - - - ranking = 5keywords = fistula (Clic here for more details about this article) |
5/108. Recurrent posttraumatic urethrovaginal fistula: a new application for ASTRA.The authors describe the results of an application of the surgical technique called ASTRA (anterior sagittal transrectal approach) in the case of a 16-year-old girl with a posttraumatic urethrovaginal fistula. The young girl with a posttraumatic urethrovaginal fistula had recurrence after 4 surgical attempts at closure performed by the vaginal approach before it was definitively corrected with the ASTRA. Two years after the ASTRA operation the patient is well with a complete restitution of function confirmed by a voiding cystourethrogram and urodynamic and rectal manometric tests. The successful recovery confirmed that ASTRA may be an excellent method of treating the developmental or acquired anomalies of the perineal region.- - - - - - - - - - ranking = 6keywords = fistula (Clic here for more details about this article) |
6/108. Congenital vesicovaginal fistula.Congenital vesicovaginal fistula is a very rare entity, the etiology of which has not been clearly elucidated because pathologic features have not been mentioned in previous reports. The case of a 4-year-old girl having incontinence resulting from a congenital vesicovaginal fistula joining with the left ectopic ureter from the hypoplastic kidney is described. This is thought to be the first presentation of congenital vesicovaginal fistula joining with ectopic ureter. A microscopic examination revealed the fistula consisting of transitional cell epithelium, suggesting an abnormal fusion of the ureteral bud and caudal end of the mullerian duct with the urogenital sinus.- - - - - - - - - - ranking = 8keywords = fistula (Clic here for more details about this article) |
7/108. New onset vesicovaginal fistula after transurethral collagen injection in women who underwent cystectomy and orthotopic neobladder creation: presentation and definitive treatment.PURPOSE: We present our experience with collagen injection for treating urinary incontinence after cystectomy and orthotopic bladder substitution in women. We discuss the efficacy of collagen injection, specific complications and subsequent definitive therapy. MATERIALS AND methods: We performed cystectomy and orthotopic bladder substitution in 2 women for muscle invasive transitional cell carcinoma of the bladder. In each case new onset stress urinary incontinence developed after surgery that was refractory to conservative therapy. Intrinsic sphincter deficiency was diagnosed in each patient by video urodynamic studies. Initial treatment involved transurethral collagen injections but subsequent intervention was required due to resultant complications and primary therapy inefficacy. RESULTS: collagen (3.5 cc per session) was injected in 1 case at 2 treatment sessions and in the other at 3. Incontinence symptoms did not significantly improve in either patient and a new onset vesicovaginal fistula developed 2 days and 1 month after collagen injection, respectively. Subsequently in each case 1-stage transvaginal primary fistula repair was done in multiple layers with a pubovaginal sling procedure. Six months after repair there has been no recurrent fistula and the women remain hypercontinent, requiring intermittent self-catheterization. They are satisfied with their eventual lower tract function and overall outcome. CONCLUSIONS: collagen injection for type 3 stress urinary incontinence after cystectomy and orthotopic bladder replacement in women may not be as effective and innocuous as in patients with a native bladder. Initial treatment with a pubovaginal sling procedure should be considered.- - - - - - - - - - ranking = 7keywords = fistula (Clic here for more details about this article) |
8/108. Complex obstetric fistulae--two case reports.Two cases of complex obstetric fistulae are reported. Poor assessment and mismanagement of labour were revealed. The resulting fistulae were vesico-urethro-rectovaginal and vesico-cervico-vaginal. Plastic repair using a modified Martius graft was used in case 1. Considering the young age of the patient, transplantation of the ureters into the rectum or colon was deemed undesirable. The patient's endurance over a period of ten years, with seventeen attempts at repair ultimately was rewarded by achieving both vesical and rectal continence. Repair using the transvaginal route was successful at the first attempt in case 2.- - - - - - - - - - ranking = 6keywords = fistula (Clic here for more details about this article) |
9/108. Vaginal pedicled flap for closure of vesicovaginal fistula.A 22-year-old woman presented with chronic urinary tract infections and was found to have an ectopic ureter. Repair involved ligation of the distal ectopic ureter via a vaginal approach. She developed an iatrogenic vesicovaginal fistula which was repaired with a vaginal pedicled flap.- - - - - - - - - - ranking = 5keywords = fistula (Clic here for more details about this article) |
10/108. Laser welding of vesicovaginal fistula.The management of vesicovaginal fistula remains a source of debate, despite extensive literature on the subject. It is difficult to prove the superiority of one surgical technique over another by randomized trials, given the variabilities of fistula etiology, the location and clinician expertise. Small epithelized fistulae following conservative treatment and residual or recurrent cases following transabdominal or transvaginal repair pose a therapeutic challenge. A case of a small vesicovaginal fistula following abdominal hysterectomy is presented, in which a successful outcome was achieved using endoscopic Nd-YAG laser fulguration.- - - - - - - - - - ranking = 8keywords = fistula (Clic here for more details about this article) |
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