| 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. ( info) |
| We report here a case of vesicovaginal fistula, following radiation therapy and intensive local chemotherapy for recurrent endometrial cancer of the vaginal stump, which was ameliorated with fibrin glue. The procedure temporarily postponed urinary diversion until the recurrence of irreparable fistula more than 4 years after the development of the first vesicovaginal fistula. ( info) |
13/120. Compartment syndrome associated with lithotomy position and intermittent compression stockings. BACKGROUND: Compartment syndrome is a condition in which increased tissue pressure within a limited tissue space compromises the circulation and function of the contents of the space. CASE: A 43-year-old black woman, para 3, had repair of a recurrent vesicovaginal fistula. She was placed in a low lithotomy position with thigh length sequential compression sleeves. The procedure lasted more than 5 hours. On postoperative day 1, she complained of pain in her right leg and foot. Compartment syndrome was diagnosed and emergency fasciotomy was done. CONCLUSION: Gynecologists should be aware of the possibility of compartment syndrome during prolonged procedures with patients in the lithotomy position. Concomitant intermittent compression sleeves might further increase the risk. early diagnosis and treatment of compression syndrome are essential to minimize long-term neurovascular morbidity. ( info) |
14/120. Transurethral suture cystorrhaphy for repair of vesicovaginal fistulas: evolution of a technique. Technical difficulties in the initially described transurethral repair of vesicovaginal fistulas have led to several modifications in technique. In an uncontrolled trial, these modifications included the use of a suprapubic tract, along with an arthroscope for visualization of the fistula. A large-caliber port is passed per urethram for transurethral instrumentation access. New-generation laparoscopic needle driver technology markedly improves the ease of transurethral suturing. Three previously unreported vesicovaginal fistula patients have had successful resolution of their fistulas after undergoing transurethral repair. Small-diameter vesicovaginal fistulas in selected patients can be successfully repaired by a minimally invasive transurethral suture technique. ( info) |
15/120. Transpubic repair of vesicourethrovaginal fistula. A patient with recurrent urinary vaginal fistula involving bladder, bladder neck, and urethra was treated by transpubic approach. This afforded excellent exposure for careful repair of the urologic defects. Difficulty with ambulation during the first few weeks postoperatively may be related to removal of larger segment of pubic bone than is usually reported. ( info) |
16/120. Laparoscopic repair of vesicovaginal fistula and right nephrectomy for nonfunctioning kidney in a single session. We report a case of failed vesicovaginal fistula repair and nonfunctioning right kidney, which was managed by laparoscopic nephrectomy and fistula repair with omental interposition in a single session. ( info) |
17/120. rupture of uterine scar with extrusion of twin fetuses into the urinary bladder--a case report. An unusual presentation of a ruptured uterus with extrusion of twin fetuses into the urinary bladder is described. A routine pelvic ultrasound to confirm pelvic collection from a suspended criminally induced abortion revealed a rupture of the anterior wall of the uterus with communication to the urinary bladder and this finding was confirmed at laparatomy. While a high index of suspicion is important in the diagnosis of ruptured uterus, a subtle place for pelvic ultrasound in patients with vaginal bleeding, suprapubic pain and haematuria may be of help. ( info) |
18/120. Postirradiation vesicovaginal fistula completely resolved with conservative treatment. Postirradiation vesicovaginal fistulae (VVF) pose a great challenge for the urologist. The poorly vascularized radiated tissue surrounding the fistula impairs healing and makes operative repair technically demanding. Conservative treatment for postirradiation VVF is considered inappropriate, and to our knowledge has never previously been described. We present a case of a woman with postirradiation VVF that was resolved after transurethral coagulation and 3 weeks of catheterization. ( info) |
19/120. 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. ( info) |
20/120. Repair of vesicovaginal fistulas: simultaneous transvaginal-transvesical approach. The records of 91 patients with vesicovaginal fistulas at the Ochsner Clinic between 1942 and 1974 were reviewed. The fistulas were managed in several ways: spontaneous closure, palliative operation, urinary diversion, transvesical repair, transvaginal repair, and a combined transvaginal-transvesical procedure. The latter had a 100% success rate in the eight patients in whom it was used. The technic of this procedure is described and the indications are expanded to include (1) large fistulas, (2) fistulas near the ureteral orifice, (3) if other abdominal or urologic surgery is being done, (4) if transvesical approach is being used, (5) previous failed attempts at correction, (6) difficulty of access by vaginal approach, and (7) fistulas resulting from transurethral resection of the bladder neck. ( info) |