Cases reported "Vesicovaginal Fistula"

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1/27. 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.
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ranking = 1
keywords = operative
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2/27. 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.
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keywords = operative
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3/27. 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.
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keywords = operative
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4/27. 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.
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keywords = operative
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5/27. Combined spinal epidural anaesthesia for vesico-vaginal fistula repair in an achondroplastic dwarf.

    A 33-year-old achondroplastic female was scheduled to undergo vesico-vaginal fistula repair by the abdominoperineal route. Preoperative examination suggested a difficult airway so a combined spinal epidural technique was used. Subarachnoid block (sensory loss to T6) was established using 0.5% hyperbaric bupivacaine 1 ml. Anaesthesia was prolonged with incremental doses of epidural bupivacaine 0.5% (total 10 ml) and postoperative analgesia was provided with epidural morphine boluses.
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ranking = 2
keywords = operative
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6/27. Bilateral pedicled myocutaneous vertical rectus abdominus muscle flaps to close vesicovaginal and pouch-vaginal fistulas with simultaneous vaginal and perineal reconstruction in irradiated pelvic wounds.

    Chronic postoperative pouch-vaginal and vesicovaginal fistulas after hysterectomy and irradiation to treat advanced cervical cancer do not respond to conventional treatment because of the low vascularity in the irradiated area. We present the successful repair of these complications in a female patient, in whom several vaginal and abdominal approaches had been tried and had resulted not only in failure but also in tissue loss and fibrosis and persisting fistulas. First, a synchronous vaginoabdominal approach using a vertical myocutaneous distally based rectus abdominis myocutaneous flap was used successfully to close a pouch-vaginal fistula and simultaneously reconstruct the posterior vaginal wall. In a second approach, the persisting vesicovaginal fistula was closed by a right rectus abdominis myocutaneous flap while simultaneously reconstructing the anterior vaginal wall, closing the enterocutaneous stoma and performing an appendicovesicostomy as a continence channel for catheterization. Despite unfavorable local wound situations, including an enterocutaneous stoma through the rectus abdominis and various previous incision lines, the transfer of axially well-vascularized tissue can solve these problem wounds. Consecutive bilateral use of the rectus abdominis flap may be necessary to deal with extensive pelvic wounds. This technique should be considered as one repair modality in irradiated pelvic wounds with fistulas. Previous enterostomy is not a contraindication to the use of this flap.
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ranking = 1
keywords = operative
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7/27. Urogenital sinus, rectovaginal fistula, and an anterior stenosed anus--another cloacal variant.

    The persistent cloaca is one of the most complex and challenging developmental malformations. It is a rare anomaly occurring only in the female newborn and is represented by the association of urogenital sinus with an anorectal malformation (arm). Each case is probably unique. We report here one such case of cloaca with the VATER association-tracheoesophageal fistula (TOF) with a urogenital sinus, rectovaginal fistula, and an anteposed stenosed anus, along with preaxial syndactyly of the right hand. The spine, renal, and cardiac systems were normal. Interim management was directed towards repair of the TOF and a right transverse defunctioning colostomy. Despite thorough radioendoscopic preoperative investigations, the complexity of the cloacal anomaly was not delineated until surgery. This case is a rather rare combination of an intermediate form of the cloacal-arm spectrum. Such patients present with many diagnostic and therapeutic problems. Interval surgery should be directed towards decompression of the affected organ systems, and definitive surgery must be carefully planned and, whenever possible, done in a single stage with simultaneous multisystem repair to correct all significant malformations related to the cloacal complex.
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ranking = 1
keywords = operative
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8/27. vesicovaginal fistula after Irving sterilization: a case report.

    BACKGROUND: patients scheduled for gynecologic surgery must be informed about the development of urogenital fistulae as a possible complication. CASE: A 49-year-old woman underwent Irving sterilization with subsequent abdominal hysterectomy due to intraabdominal abscess formation. Inadvertent damage complication to the bladder during hysterectomy led to development of a vesicovaginal fistula despite intraoperative management. The fistula was repaired at once in a second session. As a sequela of bladder injury, the patient had recurrent vesical diverticula and urolithiasis with repeated removal of the diverticula and stones. A subsequent intervention performed laparoscopically led to development of a second vesicovaginal fistula. In addition, an anesthesia-induced complication resulted in cerebral hypoxia with postoperative development of Parkinson's disease. CONCLUSION: Retrospectively, there is doubt whether the proper surgical procedures were employed in this case. The fact that the patient had type 1 diabetes mellitus gives rise to the question of why no conservative method of contraception was chosen. The type of operative approach in elective surgery should always be planned on the basis of the individual patient's overall condition and in relation to the anatomic situation.
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ranking = 3
keywords = operative
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9/27. Laparoscopic vesicovaginal fistula repair with robotic reconstruction.

    INTRODUCTION: To describe, to our knowledge, the first case report of robotic-assisted laparoscopic repair of a vesicovaginal fistula. A 44-year-old woman presented with a vesicovaginal fistula after vaginal hysterectomy. She had been noted to have a bladder injury that was repaired at that time. A vesicovaginal fistula developed several weeks later, and she was referred for repair. The location of the fistula was deemed amenable to repair using a robot-assisted laparoscopic approach. TECHNICAL CONSIDERATIONS: The total operative time was 280 minutes, including placement of ureteral catheters and repositioning. The estimated blood loss was 50 mL. The fistula was repaired using robot-assisted laparoscopic techniques without complications, and the patient went home on the second postoperative day. The Foley catheter was removed 2 weeks postoperatively. The patient continued to void normally without recurrence at 16 weeks of follow-up. CONCLUSIONS: Laparoscopic repair of vesicovaginal fistulas has not gained widespread acceptance owing to its technical difficulty. We describe a minimally invasive laparoscopic approach using the DaVinci robotic system to repair a vesicovaginal fistula.
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ranking = 3
keywords = operative
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10/27. Long-term chronic complications from Stamey endoscopic bladder neck suspension: a case series.

    Purpose/objective Long-term complications from anti-incontinence surgical procedures are rarely reported. We report on delayed presentation of complications relating to the synthetic bolster placed for the Stamey bladder neck suspension. MATERIALS AND methods: patients undergoing re-operative surgery following prior Stamey endoscopic bladder neck suspension were selected from a surgical database. Four women with lower urinary tract and/or vaginal symptoms following prior Stamey endoscopic bladder neck suspension were identified. All patients had undergone removal of the bolster material by a single surgeon (ESR) at re-operation. Preoperative, operative, and postoperative inpatient and outpatient records were reviewed. RESULTS: patients presented with a variety of symptoms including urinary incontinence, recurrent cystitis, vaginitis, and urinary frequency at 9, 11, 11, and 12 years after Stamey bladder neck suspension. In addition, two patients presented with recurrent, intermittent bloody vaginal discharge and two patients complained of recurrent urinary tract infections and irritative voiding symptoms. All patients underwent transvaginal excision of the Dacron bolster. Three patients also underwent placement of an autologous pubovaginal sling for symptomatic recurrent stress urinary incontinence. At a mean follow-up of 30 months all four patients were improved. There was no recurrence of vaginal discharge or urinary tract infections. Irritative voiding symptoms resolved. CONCLUSIONS: Delayed complications from surgically implanted synthetic materials can present many years after initial implantation. The clinical findings are often subtle and require a high degree of suspicion. vaginal discharge and irritative urinary symptoms in patients with even a remote history of Stamey bladder neck suspension should prompt a thorough vaginal exam and cystoscopy. Excision of the bolsters can be performed and is usually followed by symptomatic improvement.
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ranking = 4
keywords = operative
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