Of flukes and fistulae
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文摘
Between January 1989 and December 2002, 19 patients were treated for this association. All patients provided a history and underwent physical examination, metabolic evaluation for stone disease, urine culture test and cystovaginoscopic examination. They were treated with a staged procedure with the fistula repaired 2 to 3 months after stone removal.

Results

VVF was a result of obstructed labor in all cases. The patients presented a mean of 28.8 months after fistula formation. No metabolic abnormality was detected in any patient. Urine culture was positive for Proteus mirabilis in 6 and Escherichia coli in 5, and it yielded mixed growth in 8. All women had some residual urine in the bladder (mean 11 ml). The fistula was located supratrigonally in 13 cases, while it was high trigonal in the remainder. A total of 17 patients were treated endoscopically by cystolitholapexy or fragmentation of the stone by transurethral cystolithotripsy using a Lithoclast (Microvasive Urology, Natick, Massachusetts). Two patients required open suprapubic cystolithotomy. All patients underwent fistula repair 3 months after stone removal with successful results in 16.

Conclusions

Primary vesical calculi in patients with VVF are associated with urinary contamination, a high or supratrigonal fistula location, residual urine in the bladder and a long history of disease. Staged management of the problem showed good results.


m/science?_ob=MImg&_imagekey=B7XMT-4HG54R9-C-1&_cdi=29679&_user=10&_orig=article&_coverDate=12 % 2F31 % 2F2003&_sk=998299993.7998&view=c&wchp=dGLbVlb-zSkWz&md5=d21db60139ab94d2b1833b3e8605dc86&ie=/sdarticle.pdf"">mg name=""pdf"" style=""vertical-align:absmiddle;"" border=""0"" src=""http://www.sciencedirect.com/scidirimg/icon_pdf.gif"" alt=""""> Purchase PDF (302 K)
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mg src=""/scidirimg/bullet_square.gif"" alt="""">mt=high&_coverDate=01 % 2F31 % 2F2004&_rdoc=1&_orig=article&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=0188136b6b8bf7e5d9f5d73619d9fa07"" onMouseOver=""InfoBubble.show('infobubble_2','mlktLink_2')"" onMouseOut=""InfoBubble.timeout()"">Large Post-Hysterectomy and Post-Radiation Vesicovagina...
The Journal of Urology
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mg border=0 src=""/scidirimg/jrn_nsub.gif"" alt=""You are not entitled to access the full text of this document"" title=""You are not entitled to access the full text of this document"" width=12 height=14""> m/science?_ob=ArticleURL&_udi=B7XMT-4HG54PV-27&_user=10&_coverDate=01 % 2F31 % 2F2004&_rdoc=1&_fmt=high&_orig=article&_cdi=29679&_sort=v&_docanchor=&view=c&_ct=71&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=8385572e7bb0de4c2fbc5a1a81bad1a8"">Large Post-Hysterectomy and Post-Radiation Vesicovaginal Fistulas:: Repair by Ileocystoplasty
The Journal of Urology, Volume 171, Issue 1, January 2004, Pages 272-274
I.D. TABAKOV, B.N. SLAVCHEV

Abstract
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ABSTRACT

Purpose

We devised a technique for simultaneous closure of large post-hysterectomy and post-radiation vesicovaginal fistulas, and augmentation of the concomitant shrunken bladder by ileocystoplasty as a 1-step procedure.

Materials and Methods

Between 1989 and 2000, 4 patients with large vesicovaginal fistulas after radical hysterectomy and radiotherapy for spinocellular cancer of the uterine cervix underwent fistula repair according to the technique described. The premise of utmost importance in the proposed technique is a healthy and not radiation damaged distal ileum.

Results

Fistula closure was achieved in 3 patients, while in 1 a 3 mm residual fistula was repaired 5 years later by a Martius skin flap. In all patients the augmented bladder allowed good quality of life with spontaneous voiding, and daytime and nighttime continence.

Conclusions

The technique described seems to have certain advantages. Wide dissection of the bladder from the vagina and pelvic walls is avoided. The bladder defect is closed with a well vascularized ileal segment. Bladder capacity is enlarged simultaneously with good functional results. The procedure can be adapted to cases with concomitant damaged distal ureters.


m/science?_ob=MImg&_imagekey=B7XMT-4HG54PV-27-1&_cdi=29679&_user=10&_orig=article&_coverDate=01 % 2F31 % 2F2004&_sk=998289998&view=c&wchp=dGLbVlb-zSkWz&md5=4a494d9b2bfb3a4295e3fe302270e602&ie=/sdarticle.pdf"">mg name=""pdf"" style=""vertical-align:absmiddle;"" border=""0"" src=""http://www.sciencedirect.com/scidirimg/icon_pdf.gif"" alt=""""> Purchase PDF (99 K)
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mg src=""/scidirimg/bullet_square.gif"" alt="""">mt=high&_coverDate=05 % 2F31 % 2F2006&_rdoc=1&_orig=article&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=b8fda407acb89297da556abad789d484"" onMouseOver=""InfoBubble.show('infobubble_3','mlktLink_3')"" onMouseOut=""InfoBubble.timeout()"">Robotic repair of vesicovaginal fistula: Case series of...
Urology
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mg border=0 src=""/scidirimg/jrn_nsub.gif"" alt=""You are not entitled to access the full text of this document"" title=""You are not entitled to access the full text of this document"" width=12 height=14""> m/science?_ob=ArticleURL&_udi=B6VJW-4JXY9PX-F&_user=10&_coverDate=05 % 2F31 % 2F2006&_rdoc=1&_fmt=high&_orig=article&_cdi=6105&_sort=v&_docanchor=&view=c&_ct=71&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=79bcdebf5bace3515e4b03b31de94115"">Robotic repair of vesicovaginal fistula: Case series of five patients
Urology, Volume 67, Issue 5, May 2006, Pages 970-973
Bala M. Sundaram, Guru Kalidasan, Ashok K. Hemal

Abstract
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Objectives

To describe a technique of robotic repair of vesicovaginal fistula (VVF) and present our experience with 5 such patients.

Methods

A total of 5 patients were diagnosed with posthysterectomy (n = 4) or postmyomectomy (n = 1) VVF. All patients were first treated conservatively with continuous drainage using a Foley catheter without any success. After 12 weeks, these patients underwent robotic repair of the VVF. The steps of the technique of robotic repair are (a) vaginoscopy, (b) cystoscopy, (c) bilateral ureteral catheterization, (d) placement of ports for robotic repair, (e) peritoneoscopy, (f) lysis of adhesions, (g) incision of the bladder and cystotomy in reverse tennis racquet fashion encircling the fistula, (h) excision and freshening of the fistulous margins after complete separation of the bladder from the vagina, (i) closure of the vaginal opening horizontally and bladder opening vertically with interrupted Vicryl sutures, and, finally, (j) interposition of the omentum between these suture lines.

Results

Fistula repair was successful in all cases, with a mean operative time (from cystoscopy to the end of the procedure) of 233 minutes (range 150 to 330) and estimated blood loss of less than 70 mL. The length of hospital stay was a mean of 5 days (range 4 to 7). The Foley catheter was removed on the 10th postoperative day after voiding cystourethrography. At 6 months of follow-up, these patients continued to void normally without any recurrence of VVF.

Conclusions

These data suggest that robot-assisted VVF repair is feasible and results in lower morbidity, a shorter hospital stay, and a quicker recovery. The minimally invasive approach of robot-assisted VVF repair may be a more attractive option for patients with VVF.


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Case Report

Of flukes and fistulae

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