1/91. Recurrent posttraumatic urethro-vaginal 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 a 16-year-old girl with recurrent urethro-vaginal fistula. The young girl had a posttraumatic urethro-vaginal fistula. It recurred after 4 operations by a direct vaginal approach before definitive correction with the ASTRA. Three years after the operation the patient has remained well with complete healing and no fistula recurrence confirmed by a voiding cystourethrogram and urodynamic and rectal manometric tests. This report suggests that ASTRA is a useful method of treating acquired or developmental anomalies of the perineal region. ( info) |
2/91. Ureterovaginal fistula following laparoscopic-assisted vaginal hysterectomy--a case report with review of literature. The authors present a case of ureterovaginal fistula following laparoscopy-assisted vaginal hysterectomy, which was successfully managed by ureteroneocystostomy with bladder psoas hitch. ( info) |
3/91. Transvaginal repair of postcystectomy peritoneovaginal fistulae. To our knowledge, peritoneovaginal fistula is a complication of cystectomy that has not been reported before. We describe 2 patients in whom a transvaginal approach using a Martius flap was utilized to repair persistent vaginal leakage after cystectomy. At a mean follow-up of 20 months, both patients are free from vaginal leakage and have no evidence of recurrent fistula. This approach offers a safe and effective way to repair a peritoneovaginal fistula in a cystectomy patient. ( info) |
4/91. Ureterovaginal fistulas complicating laparoscopic hysterectomy: a report of two cases. Three ureterovaginal fistulas occurred following laparoscopic hysterectomy in two patients. Inadvertent burn of the distal ureter by a unipolar electrocautery was thought to be the cause. Avoidance of unipolar cautery to achieve hemostasis of uterine arteries would have prevented these urologic complications. ( info) |
5/91. Ileosigmoid anastomosis with exclusion of transected ileal loop for intestinal fistula following total cystectomy of bladder cancer. Report of a case. We report in this article a new technique of surgical treatment of enterocutaneous or enterovaginal fistula after total cystectomy for three cases of bladder cancer. The surgical outcome was successful in these patients, showing good performance status after this operation. It would seem that this technique is a good indication for enteric fistulas in the bottom of the pelvic cavity, which were difficult to be managed even under the control of total parenteral nutrition. ( info) |
6/91. Cervico-vaginal fistula from induced abortions causing subsequent spontaneous midtrimester abortions in Nigerians: case report. A report of three cases of cervico-vaginal fistula (CVF) from induced abortions causing subsequent spontaneous mid-trimester abortions and a literature review is presented. Restrictive abortion laws, low contraceptive usage and increased sexual activity consequent upon adverse socio-economic conditions have led to an increase in the prevalence of illegal abortions in nigeria over the previous two decades. CVF appears to be an emerging complication of such abortions. Cervical cerclage is preferred to trachelorrhaphy in the management of such cases. However, where vaginally performed cerclage does not succeed, the abdominal route should be used as a last resort. After a previous induced abortion, clinicians managing the subsequent pregnancy need to search carefully for cervico-vaginal fistula, which may compromise that particular pregnancy. Appropriate contraceptive use and safe abortions using modern methods in cases of contraceptive failure will prevent such horrendous complications of induced abortions in nigeria and other developing countries. ( info) |
7/91. Hip-vagina fistula after acetabular revision. A case of a fistula between the hip and the vagina in a 46-year-old woman after acetabular revision for a failed total hip arthroplasty (THA) is presented. This patient had undergone multiple revision procedures complicated by infection after a primary THA failed because of chronic recurrent dislocation. The patient 18 months after reconstruction of a pelvic discontinuity using an antiprotrusio cage. The chief complaint was weight-bearing groin pain and persistent atypical vaginal discharge. Plain radiographs showed a fracture of the antiprotrusio cage with medial and superior migration of the acetabular cage into the pelvis. An arthrogram showed a fistula between the hip joint and the vagina. To our knowledge, a hip-vaginal fistula has not been reported previously as a complication of THA. ( info) |
8/91. Two cases of unusual urethral complications after resection of sacrococcygeal teratoma. This report describes 2 rare complications of a sacrococcygeal teratoma leading to urethral obstruction in 1 case and midurethral necrosis in the other. The anomalies appear to be based on pressure necrosis of the urethra by mechanical compression between the symphysis pubis and the teratoma. ( info) |
9/91. Late sequelae of hysterectomy and diverticulosis: colovaginal fistulae. Three cases of colovaginal fistulae were recently diagnosed and treated. Colovaginal fistulae are not commonly reported and their diagnosis may be difficult to make. Our cases presented with a complaint of vaginal discharge, history of hysterectomy, and diagnosis of diverticulosis. The diagnosis and treatment of colovaginal fistulae are discussed. ( info) |
10/91. 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. ( info) |