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Shibui Y, Obata S, Hirose R, Nakano R, Setoue T, Miyazaki T, Matsuoka H, Sato T. A case of sacrococcygeal teratoma associated with antenatally acquired urethrovaginal fistula and hydrocolpos. Surg Case Rep 2023; 9:191. [PMID: 37903968 PMCID: PMC10616020 DOI: 10.1186/s40792-023-01772-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/22/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Sacrococcygeal teratomas (SCTs) are known to cause urological complications, but urethrovaginal (UV) fistula as a complication of SCT is rare. We herein report a case of SCT with UV fistula and hydrocolpos. CASE PRESENTATION A 1-day-old female neonate presented to our department with prominent swelling in the sacrococcygeal region. She was born at 37 gestational weeks via spontaneous vaginal delivery from a 39-year-old woman. The weight of the baby was 2965 g, and her Apgar scores were 4/10 (at 1 and 5 min). An MRI examination confirmed an 11 × 11 cm Altman classification typeII SCT associated with hydrocolpos, a dilated urinary bladder, and bilateral hydronephrosis. When she was 5 days, the SCT was excised totally and a coccygectomy was performed. After the operation, as her urinary output appeared unstable, a cystoscopic examination was performed on the third postoperative day. This revealed that the UV fistula was located approximately 1 cm from the urethral opening. In addition, the proximal urethra was unobstructed and connected to the bladder. The cystoscope allowed for the passage of a urinary catheter through the urethra. After 1 month of catheter placement, she was discharged from the hospital at 57 days of age. Follow-up was uneventful, with neither urinary infection nor retention. CONCLUSIONS SCTs are associated with not only trouble with rectal function and lower extremity movement but also urinary complications. The pathogenesis of this UV fistula is thought to be the rapid growth of the SCT that developed in the fetal period, resulting in obstruction of the urethra by the tumor and the pubic bone, which in turn caused urinary retention and the formation of a fistula as an escape route for the pressure. Because SCTs can cause a variety of complications depending on the course of the disease, careful examination and follow-up are necessary.
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Affiliation(s)
- Yuichi Shibui
- Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University, 7-45-1, Nanakuma Jonan-Ku, Fukuoka, Fukuoka, 814-0180, Japan.
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Satoshi Obata
- Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University, 7-45-1, Nanakuma Jonan-Ku, Fukuoka, Fukuoka, 814-0180, Japan
| | - Ryuichiro Hirose
- Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University, 7-45-1, Nanakuma Jonan-Ku, Fukuoka, Fukuoka, 814-0180, Japan
| | - Ryo Nakano
- Division of Neonatology, Center for Maternal, Fetal and Neonatal Medicine, Fukuoka University Hospital, 7-45-1, Nanakuma Jonan-Ku, Fukuoka, Fukuoka, 814-0180, Japan
| | - Takashi Setoue
- Division of Neonatology, Center for Maternal, Fetal and Neonatal Medicine, Fukuoka University Hospital, 7-45-1, Nanakuma Jonan-Ku, Fukuoka, Fukuoka, 814-0180, Japan
| | - Takeshi Miyazaki
- Department of Urology, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma Jonan-Ku, Fukuoka, Fukuoka, 814-0180, Japan
| | - Hirofumi Matsuoka
- Department of Urology, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma Jonan-Ku, Fukuoka, Fukuoka, 814-0180, Japan
| | - Toshihiko Sato
- Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University, 7-45-1, Nanakuma Jonan-Ku, Fukuoka, Fukuoka, 814-0180, Japan
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Serna-Gallegos T, Jeppson PC. Female Pelvic Fistulae. Obstet Gynecol Clin North Am 2021; 48:557-570. [PMID: 34416937 DOI: 10.1016/j.ogc.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Female pelvic fistulae are a pathologic connection between the urinary or gastrointestinal tract and the genital tract. Although this condition has been present for millennia, successful surgical treatments have only been described for the past few hundred years. In developed nations, the most common cause of genitourinary fistulae is benign gynecologic surgery, but worldwide it is obstetric trauma. Fistulae management is rooted in surgical intervention with the highest probability of success associated with the first repair.
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Affiliation(s)
- Tasha Serna-Gallegos
- Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics and Gynecology, MSC 10-5580, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Peter C Jeppson
- Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics and Gynecology, MSC 10-5580, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA.
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Milani R, D'Alessandro G, Barba M, Cola A, Volontè S, Frigerio M. Transvaginal primary layered repair of postsurgical urethrovaginal fistula. Int Urogynecol J 2021; 32:1941-1943. [PMID: 33950308 DOI: 10.1007/s00192-021-04819-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 04/18/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Urethrovaginal fistula (UVF) is a rare disorder, which implies the presence of an abnormal communication between the urethra and the vagina. METHODS Surgical repair options include transurethral, transabdominal and transvaginal procedures, either with or without tissue interposition. The vaginal route is considered a safe and effective option to correct UVF. This video is aimed to present a case of direct transvaginal layered repair of urethrovaginal fistula, without the use of tissue interposition. The featured patient is a 66-year-old woman who developed a symptomatic UVF after a complicated laparoscopic hysterectomy for endometrial cancer 3 years before. Cystoscopy demonstrated the presence of a 7 mm urethral orifice a few millimeters caudal from the bladder neck. After proper informed consent, the patient was admitted to transvaginal primary layered repair, according to the technique demonstrated in the video. The featured procedure was completed in 60 min and blood loss was < 100 ml. No surgical complications were observed. RESULTS The procedure was successful in restoring the anatomy and relieving the symptoms. CONCLUSION Transvaginal layered repair without tissue interposition represents a safe and effective procedure for the surgical management of postsurgical urethrovaginal fistula.
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Affiliation(s)
- Rodolfo Milani
- University of Milano-Bicocca, Monza, Italy
- ASST Monza, Ospedale San Gerardo, via G.B. Pergolesi, 33 20900, Monza, Italy
| | - Gloria D'Alessandro
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marta Barba
- University of Milano-Bicocca, Monza, Italy.
- ASST Monza, Ospedale San Gerardo, via G.B. Pergolesi, 33 20900, Monza, Italy.
| | - Alice Cola
- University of Milano-Bicocca, Monza, Italy
| | | | - Matteo Frigerio
- ASST Monza, Ospedale San Gerardo, via G.B. Pergolesi, 33 20900, Monza, Italy
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Noegroho BS, Adi K, Salima S, Paulina, Mustafa A, Bahagianto AF. Giant vaginal stone as a complication of long-term urethrovaginal fistula: A case report. Urol Case Rep 2020; 34:101491. [PMID: 33294377 PMCID: PMC7701185 DOI: 10.1016/j.eucr.2020.101491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 11/25/2022] Open
Abstract
Case presentation A case of a 57 years old woman came with the chief complaint of urinary incontinence since 20 years ago. After labor, she complained of urinary incontinence and left untreated. Physical examination and urethrocystoscopy revealed vaginal stone sized 90 × 70 mm and urethrovaginal fistula. We performed hysterectomy and vaginal stone removal, continued with fistula closure and vaginal repair. Up to 2 months follow up, no sign of urinary leakage and incontinence was found. Conclusion Vaginal stone is a rare Case that might be present in a case of long term urethrovaginal fistula with neglected contraceptive device.
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Affiliation(s)
- Bambang Sasongko Noegroho
- Department of Urology, Faculty of Medicine Padjadjaran University, Hasan Sadikin Hospital Bandung, Indonesia
| | - Kuncoro Adi
- Department of Urology, Faculty of Medicine Padjadjaran University, Hasan Sadikin Hospital Bandung, Indonesia
| | - Siti Salima
- Obstetric and Gynaecology Department, Hasan Sadikin Hospital Bandung, Faculty of Medicine Padjadjaran University, Indonesia
| | - Paulina
- Department of Urology, Faculty of Medicine Padjadjaran University, Hasan Sadikin Hospital Bandung, Indonesia
| | - Akhmad Mustafa
- Department of Urology, Faculty of Medicine Padjadjaran University, Hasan Sadikin Hospital Bandung, Indonesia
| | - Aditya Fajar Bahagianto
- Department of Urology, Faculty of Medicine Padjadjaran University, Hasan Sadikin Hospital Bandung, Indonesia
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Halleran DR, Ahmad H, Ching C, Gorra A, McCracken K, Wood RJ, Levitt MA. Acquired Urethrovaginal Fistula and Urethral Atresia in a Patient with a Sacrococcygeal Teratoma. J Pediatr Surg 2019; 54:612-5. [PMID: 30297116 DOI: 10.1016/j.jpedsurg.2018.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 09/17/2018] [Indexed: 11/22/2022]
Abstract
Acquired urethrovaginal fistulae and urethral atresia are rare findings in pediatric patients, but have been described in adult patients related to trauma or iatrogenic injury. Little exists in the published literature to guide management of such conditions in children, but lessons learned from congenital causes can help. Herein we discuss the preoperative evaluation and management of a child with an acquired urethrovaginal fistula and urethral atresia likely related to in utero compression from an intrapelvic sacrococcygeal teratoma and provide several images detailing the complex anatomy.
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Martan A, Svabik K, Zamecnik L, Masata J. Surgical management of recurrent urethrovaginal fistula with a skin island flap. Int Urogynecol J 2019; 30:839-41. [PMID: 30685786 DOI: 10.1007/s00192-019-03868-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS A urethrovaginal fistula is a possible rare complication of tension-free vaginal tape procedures. Surgical management of these fistulas is sometimes complicated, and failure can occur. The operation is difficult when the defect between the urethra and the vagina is larger or scarred, so surgical intervention and the preferred technique are controversial. METHODS The patient was referred to our department, where the first operation was performed to address the urethrovaginal fistula by the transvaginal and transabdominal approach with interposed omentum. This initial repair failed, resulting in a large urethrovaginal fistula with minimal redundant anterior vaginal wall to provide a tension-free closure. This video presentation describes the second operation-transvaginal repair of a large recurrent urethrovaginal fistula using the skin island flap technique. RESULTS The video of the procedure shows how to address a recurrent urethrovaginal fistula by employing a skin flap. An examination during the patient's follow-up visit 3 months later revealed excellent healing and persistent stress urinary incontinence (SUI). Six months after the fistula repair, the patient underwent a bulking agent procedure. CONCLUSIONS The skin island flap procedure allowed the larger defect to heal, though it did not address the SUI, which was later treated by application of a bulking agent.
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Mukwege D, Peters L, Amisi C, Mukwege A, Smith AR, Miller JM. Panzi score as a parsimonious indicator of urogenital fistula severity derived from Goh and Waaldijk classifications. Int J Gynaecol Obstet 2018; 142:187-193. [PMID: 29705989 DOI: 10.1002/ijgo.12514] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 02/13/2018] [Accepted: 04/26/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To derive a comprehensive system that allows a single score to define relative fistula severity. METHODS The present observational study included women with urogenital fistula treated at the Panzi Hospital, Democratic Republic of Congo, or its outreach clinics across the Democratic Republic of Congo between September 1, 2013, and December 31, 2014. Fistula severity was assessed by Goh and Waaldijk classifications and surgical success was ascertained. Logistic regression was used to select fistula characteristics predictive of surgical failure, and to preliminarily verify the newly derived Panzi score. RESULTS Overall, 837 women were included in the analysis. Goh or Waaldijk fistula descriptors associated with a higher probability of poor surgical outcomes in the unadjusted bivariate analysis were circumferential defect (P=0.007), proximity to the external urethral orifice (P=0.001), and size (P=0.001). These fistula characteristics were used to construct the Panzi score, which varied from 3 (most severe) to 0 (minor fistula). For each increase above 0, the odds of surgical failure increase by a factor of 1.65 (P<0.001). CONCLUSION The Panzi score of urogenital fistula provided a data-driven, simple, comprehensive, and parsimonious score. It could be used to report group data, to provide continuous level data for use in higher order statistics, and to resolve issues such as the cut-off point for referring women to hospital in accordance with fistula complexity.
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Affiliation(s)
- Denis Mukwege
- Department of Obstetrics and Gynecology, Panzi General Referral Hospital Health System/Outreach Clinics, Bukavu, Democratic Republic of Congo.,International Center for Advanced Research and Training in Bukavu, Bukavu, Democratic Republic of Congo
| | - Lisa Peters
- International Center for Advanced Research and Training in Bukavu, Bukavu, Democratic Republic of Congo.,School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Christine Amisi
- Department of Obstetrics and Gynecology, Panzi General Referral Hospital Health System/Outreach Clinics, Bukavu, Democratic Republic of Congo.,International Center for Advanced Research and Training in Bukavu, Bukavu, Democratic Republic of Congo
| | - Alain Mukwege
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | | | - Janis M Miller
- International Center for Advanced Research and Training in Bukavu, Bukavu, Democratic Republic of Congo.,School of Nursing, University of Michigan, Ann Arbor, MI, USA
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Nkwabong E, Fomulu JN. Urethrovaginal fistula following vaginal prolapse of a pedunculated uterine myoma: a case report. J Med Case Rep 2017; 11:292. [PMID: 29058627 PMCID: PMC5651601 DOI: 10.1186/s13256-017-1457-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Urethrovaginal fistulas are usually secondary to a foreign body in the vagina or to vaginal gynecologic surgeries. We present a case of an urethrovaginal fistula secondary to vaginal prolapse of a huge pedunculated submucosal uterine myoma. CASE PRESENTATION A 25-year-old black African woman with a past history of huge uterine fibroids and an uncomplicated vaginal delivery 5 weeks prior to presentation consulted for a difficult micturition that occurred 2 days earlier. A vaginally prolapsed huge uterine myoma was diagnosed. The fibroid was easily twisted off per vagina. Around 9 days after prolapse of the fibroid or 5 days after its removal, she complained of a vaginal leaking of urine during micturition. An urethrovaginal fistula was diagnosed using a blue dye test. The fistula was successfully repaired with polyglactin and she was discharged on day 15. CONCLUSIONS To the best of our knowledge, this is the first case of urethrovaginal fistula secondary to delivered uterine myoma. We recommend close postpartum follow-up of women carrying huge uterine fibroid and urgent management of a vaginally prolapsed uterine fibroid to reduce the risk of urethrovaginal fistula.
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Affiliation(s)
- Elie Nkwabong
- Department of Obstetrics and Gynecology, University Teaching Hospital/Faculty of Medicine and Biomedical Sciences, P.O. Box 1364, Yaoundé, Cameroon.
| | - Joseph Nelson Fomulu
- Department of Obstetrics and Gynecology, University Teaching Hospital, Yaoundé, Cameroon
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Lo TS, Jaili SB, Ibrahim R. A complicated urethrovaginal fistula following an inappropriate urethral diverticulum management. Taiwan J Obstet Gynecol 2017; 56:534-537. [PMID: 28805613 DOI: 10.1016/j.tjog.2016.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2016] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Urethral diverticulum is uncommon, therefore appropriate evaluation, preoperative planning and counseling must be done in order to make correct diagnosis and prevent complications. MATERIALS AND METHODS A case of anterior vaginal wall mass was treated elsewhere by a gynecologist as periurethral cyst abscess; incision and drainage were done but a symptom of pus discharge was observed after 2 weeks. Therefore, exploration, cyst wall excision and primary closure were done though histopathological examination surprisingly confirmed the presence of urethral tissue suggestive of diverticulum. RESULTS Subsequently, she developed persistent urinary leakage along with urethrovaginal fistula for which they again performed pervaginal multilayer closure. Patient was later referred to us with recurrent urethrovaginal fistula. We performed posterior urethral fistulectomy with anterior vaginal wall flap and multilayer closure. Three years follow up reveals complete recovery. CONCLUSION Even urethral diverticulum is a rare condition, should be kept in mind as early diagnosis and management.
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Affiliation(s)
- Tsia-Shu Lo
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, Republic of China; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei Medical Center, Taipei, Taiwan, Republic of China; Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China; Chang Gung University, School of Medicine, Taoyuan, Taiwan, Republic of China.
| | - Sukanda Bin Jaili
- Department of Obstetrics and Gynaecology, Hospital Umum, Sarawak, Malaysia; Fellow of the Division of Urogynecology, Department of Obstetrics &Gynaecology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan, Republic of China
| | - Rami Ibrahim
- Fellow of the Division of Urogynecology, Department of Obstetrics &Gynaecology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan, Republic of China; Department of Obstetrics and Gynecology, Al-Bashir Hospital, Amman, Jordan
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Zilberlicht A, Lavy Y, Auslender R, Abramov Y. Transvaginal repair of a urethrovaginal fistula using the Latzko technique with a bulbocavernosus (Martius) flap. Int Urogynecol J 2016; 27:1925-1927. [PMID: 27423455 DOI: 10.1007/s00192-016-3085-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 06/22/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Urethrovaginal fistula is a rare disorder that may occur following sling procedures for stress urinary incontinence, excision of a urethral diverticulum, anterior vaginal wall repair, radiation therapy, and prolonged indwelling urethral catheter. The most common clinical manifestation is continuous urinary leakage through the vagina, aggravated by an increase in the intra-abdominal pressure. Appropriate management, including timing of the surgical intervention and the preferred technique, remains controversial. METHODS This video presentation describes the transvaginal repair of a urethrovaginal fistula using the Latzko technique and a bulbocavernosus (Martius) flap. RESULTS The patient's postoperative course was uneventful. At her follow-up visit 2 months later, she was free of urinary leakage, and a pelvic examination revealed excellent healing, with complete closure of the fistula. CONCLUSIONS Transvaginal repair using the Latzko technique with a vascular bulbocavernosus (Martius) flap is an effective and safe mode of treatment.
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Affiliation(s)
- Ariel Zilberlicht
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carmel Medical Center, Rappaport Faculty of Medicine, Technion University, 7 Michal Street, Haifa, Israel, 31048.
| | - Yuval Lavy
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ron Auslender
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carmel Medical Center, Rappaport Faculty of Medicine, Technion University, 7 Michal Street, Haifa, Israel, 31048
| | - Yoram Abramov
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carmel Medical Center, Rappaport Faculty of Medicine, Technion University, 7 Michal Street, Haifa, Israel, 31048
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Lee D, Zimmern PE. Long-term functional outcomes following non-radiated urethrovaginal fistula repair. World J Urol 2016; 34:291-6. [PMID: 26049863 DOI: 10.1007/s00345-015-1601-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 05/18/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To review long-term functional outcomes after urethrovaginal fistula (UVF) repair. MATERIALS AND METHODS Following IRB approval, women who underwent transvaginal non-irradiated UVF repair with minimum 6-month follow-up were reviewed. Surgical outcomes were assessed by validated questionnaires: UDI-6, IIQ-7, FSFI and visual analogue scale for QoL. Two groups were compared: (1) synthetic sling-related versus (2) non-sling-related UVF. Descriptive statistics were applied with p < 0.05 for significance. RESULTS From 1996 to 2013, 18 patients underwent UVF repair, with a mean age of 46 years (range 20-66), BMI 29 (range 21-42) and mean follow-up at 52 months (range 9-142). Overall repair success rate was 95%. Prior failed UVF repair was recorded in 11 women (61%). Statistical differences noted for Q4: 1.9 versus 0.8 (p = 0.03) and Q5: 1.3 versus 0 (p = 0.02) and VAS between the two groups, favoring the non-sling group; 1.5 (0.6) versus 5 (4) (p = 0.05). No differences in IIQ-7 were noted between the two groups (p = 0.09). Of the 18 patients, 5 remained sexually active and of those, 2 responded to FSFI (40%) with low scores. Reoperation rate was 33% (6 women) with 3 requiring periurethral-bulking agent for recurrent SUI, 2 transurethral laser for residual urethral sling mesh strands and 1 urethral dilation. CONCLUSION This large contemporary series of non-radiated UVF indicates a satisfactory outcome in UVF closure repair at a mean 4- to 5-year long-term follow-up, with the synthetic sling-related group performing worse.
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Abstract
We present a case of iatrogenic urethrovaginal fistula with transverse vaginal septum. The patient presented with cyclical hematuria and infertility. The vagina was blind-ending. The magnetic resonance imaging (MRI) showed normal uterus with transverse vaginal septum. The cystoscopic examination during cyclical hematuria revealed bloody efflux through a small fistula below the internal urethral sphincter. Vaginoplasty and repair of the urethrovaginal fistula was done. The vagina was reconstructed using an amniotic mould. The report emphasizes the importance of MRI and cystoscopy in diagnosing such rare and complex anomalies.
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Affiliation(s)
- Abha Singh
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College and SSK Hospital, New Delhi, India
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