An estimated 2 million women living in countries with limited resources currently have vesico-vaginal, recto-vaginal, or mixed types of fistulae because of the necrosis that occurs with obstructed labor. We evaluated ...An estimated 2 million women living in countries with limited resources currently have vesico-vaginal, recto-vaginal, or mixed types of fistulae because of the necrosis that occurs with obstructed labor. We evaluated factors readily assessed by the examining practitioner in a consecutive case series of surgical repairs of obstetrical fistulae, for the ability of those factors to stand as a prognostic guide, in a clinical score. Objectives: To identify the predictors of surgical repair outcomes and establish a Score combining these different determinants to facilitate the care of obstetric fistula. Methods: We conducted a multicentric prospective study between 2011 and 2014 in Democratic Republic of the Congo (DRC). Outcomes: We measured 3 months post-surgery in a series of 483 patients with obstetrical fistula repaired by the same surgeon included closure and failure appreciated by dye test. Multivariable generalized estimating equation models were used to generate adjusted odd ratios (OR) and 95% confidence intervals (CIs). The scores ranging from 3 to 14 were established from the outcomes determinants identified. Results: In total, 483 women were enrolled, and 390 cases were at their first surgery and were included in the obstetric fistula (OF) prognosis score and classification. Their mean age was 35 years at the time of the surgery and 25 years at the onset of OF. In 28.6%, the fistula patient was primigravida. Mean duration between onset of the fistula and surgical treatment was 8 years. In 24%, the fistula patients lived separated from their partners. Overall closure rate of the fistulas was 85.7%. Severe vaginal fibrosis (p 0.01), big fistula size (0.01), small distance from fistula to external urethral meatus (0.01) and prior surgery (p 0.48) predicted failed fistula closure. A clinical score ranging from 3 to 14 points is a prognostic score with a range of 1 to 4 for the distance between the fistula and the external meatus and the size, and a scale of 1 to 6 for fibrosis. Conclusions: This study demonstrated that the marked vaginal scarring;large fistula size and distance to urethral meatus are predictors for unsuccessful fistula repair. Due to the lack of a standard classification that is never unanimous among the different surgeons, this prognostic score allows the combination of the different determinants assessing the chances of success and can help the practitioners to orient the patients towards the determined skill scale to take care of the patients.展开更多
Urethrocutaneous fistula （UCF） is a common complication of hypospadias surgery for severe hypospadias. We report our experience in the management of UCF following hypospadias surgery with a prepuce-degloving method ...Urethrocutaneous fistula （UCF） is a common complication of hypospadias surgery for severe hypospadias. We report our experience in the management of UCF following hypospadias surgery with a prepuce-degloving method （PDM）. Our study included 87 patients who developed UCF after hypospadias repair from May 2001 to December 2011. Either simple closure or PDM was performed to repair the fistula. In total, 61 patients underwent a simple closure or Y-V plasty of the fistula, and 26 underwent a PDM repair. The success rate was 78.7% for simple closure or Y-V plasty and 96.2% for PDM repair （P〈0.05）. PDM repair represents a good choice for UCF repair after hypospadias, and our high 96.2% success rate demonstrates its applicability.展开更多
Objective: The aim of our study was to compare the results of tubularized plate urethroplasty with interposing healthy tissue spongioplasty alone and spongioplasty with dorsal dartos flap to assess the role of dartos ...Objective: The aim of our study was to compare the results of tubularized plate urethroplasty with interposing healthy tissue spongioplasty alone and spongioplasty with dorsal dartos flap to assess the role of dartos flap in prevention of fistulae. Patients and Methods: A retrospective study was performed on 80 patients, aged 4 months to 27 years who underwent hypospadias repair using the Snodgrass technique. The patients were assigned to two groups. In group I (40 patients) the neourethra was covered with spongioplasty only, and in group II (40 patients) the neourethra was covered with spongioplasty plus dartos flap. Integrity of the urethral plate was maintained in all the cases. The ventral curvature & torsion was corrected by penile de-gloving, mobilization of the urethral plate and spongiosum and mobilization of the proximal urethra if needed. The results were analysed in view of complication rates. The average period of hospital stay was 7 days & follow-up varied from 8 months to 28 months with a mean of 14 months. Results: In group I, hypospadias were distal penile in 31 (77.5%), mid-penile in 4 (10%) and proximal/peno-scrotal in 5 (12.5%) patients. In group II, hypospadias were distal penile in 17 (42.5%), mid penile in 9 (22.5%) and proximal/peno-scrotal in 14 (35%) patients. Sixty five percent in group I and 80% in group II had ventral curvature but the difference was not statistically significant. Good functional results were achieved in 97.5% patients in group I and in 95% patients in group II?which were statistically similar (p value—0.585). Urethral fistula was encountered in 2.5% in group I & in 2 cases (5%) in group II. Meatal stenosis was noted in 7.5% each in both groups, which responded to urethral dilatation. One patient in group II had complete disruption.?There was no statistically significant difference in early and late complications in both groups (p value—0.812). Conclusions:?Spongioplasty with healthy spongiosal tissue is strong enough and is?effective waterproofing?as an interposition layer. However, more prospective studies in different hands are needed to omit the step of dorsal dartos interposition.展开更多
Introduction: Vaginal adenosis is one of the rare diseases of the vagina, and almost all patients are asymptomatic. We report a case of spontaneous vaginal adenosis, which caused vesicovaginal fistula. Case Presentati...Introduction: Vaginal adenosis is one of the rare diseases of the vagina, and almost all patients are asymptomatic. We report a case of spontaneous vaginal adenosis, which caused vesicovaginal fistula. Case Presentation: Our patient was a 25-year-old Japanese woman. She was admitted to our hospital, and her chief complaint was continuous urine flow from the vagina. We found a tumor with a vesicovaginal fistula in her vagina. Subsequent cytological analysis of vaginal smears showed a normal vaginal mucosa. The patient underwent tumor resection and a fistula patch. Pathological diagnosis was adenosis of the vagina, even though the patient had no known history of intrauterine diethylstilbestrol exposure or Müllerian developmental abnormalities. Conclusion: The clinical course of our case was a malignant tumor, which invasively bored a hole in the vaginal wall forming a vesicovaginal fistula, even though it was a benign lesion. Therefore, overzealous treatment should be avoided in this case.展开更多
A left-sided lesion of a coronary cameral fistula (CCF) is extremely rare. Surgical closure of the fistula is indicated when symptoms emerge or as a preventive strategy, while surgical approaches depend on the individ...A left-sided lesion of a coronary cameral fistula (CCF) is extremely rare. Surgical closure of the fistula is indicated when symptoms emerge or as a preventive strategy, while surgical approaches depend on the individual anatomical structures. In particular, a CCF forming a “fistula lake” with multiple inflow vessels is so unique that few studies have focused on the technique to close it. We report the successful management of a CCF originating from multiple coronary arteries and draining into the left ventricle via a “fistula lake” by ligation and clipping of associated communication tracts. On the postoperative coronary computed tomography angiography, the fistula lake and the small vessels entering it had all disappeared.展开更多
患者女,75岁,黑便1周,突发胸背痛伴间断呕血约1000 ml 6 h;4个月前诊断为食管癌伴全身淋巴结转移,未经系统性治疗;既往高血压病史20余年,控制良好。查体:贫血貌,神志清楚,心率95次/分,血压136/87 mmHg。实验室检查:白细胞计数11.64×...患者女,75岁,黑便1周,突发胸背痛伴间断呕血约1000 ml 6 h;4个月前诊断为食管癌伴全身淋巴结转移,未经系统性治疗;既往高血压病史20余年,控制良好。查体:贫血貌,神志清楚,心率95次/分,血压136/87 mmHg。实验室检查:白细胞计数11.64×109/L,红细胞计数2.62×1012/L,血红蛋白77 g/L。胸部平扫CT:食管界限不清,周边见混合密度影,胸主动脉移位并见破裂征象(图1A)。展开更多
文摘An estimated 2 million women living in countries with limited resources currently have vesico-vaginal, recto-vaginal, or mixed types of fistulae because of the necrosis that occurs with obstructed labor. We evaluated factors readily assessed by the examining practitioner in a consecutive case series of surgical repairs of obstetrical fistulae, for the ability of those factors to stand as a prognostic guide, in a clinical score. Objectives: To identify the predictors of surgical repair outcomes and establish a Score combining these different determinants to facilitate the care of obstetric fistula. Methods: We conducted a multicentric prospective study between 2011 and 2014 in Democratic Republic of the Congo (DRC). Outcomes: We measured 3 months post-surgery in a series of 483 patients with obstetrical fistula repaired by the same surgeon included closure and failure appreciated by dye test. Multivariable generalized estimating equation models were used to generate adjusted odd ratios (OR) and 95% confidence intervals (CIs). The scores ranging from 3 to 14 were established from the outcomes determinants identified. Results: In total, 483 women were enrolled, and 390 cases were at their first surgery and were included in the obstetric fistula (OF) prognosis score and classification. Their mean age was 35 years at the time of the surgery and 25 years at the onset of OF. In 28.6%, the fistula patient was primigravida. Mean duration between onset of the fistula and surgical treatment was 8 years. In 24%, the fistula patients lived separated from their partners. Overall closure rate of the fistulas was 85.7%. Severe vaginal fibrosis (p 0.01), big fistula size (0.01), small distance from fistula to external urethral meatus (0.01) and prior surgery (p 0.48) predicted failed fistula closure. A clinical score ranging from 3 to 14 points is a prognostic score with a range of 1 to 4 for the distance between the fistula and the external meatus and the size, and a scale of 1 to 6 for fibrosis. Conclusions: This study demonstrated that the marked vaginal scarring;large fistula size and distance to urethral meatus are predictors for unsuccessful fistula repair. Due to the lack of a standard classification that is never unanimous among the different surgeons, this prognostic score allows the combination of the different determinants assessing the chances of success and can help the practitioners to orient the patients towards the determined skill scale to take care of the patients.
文摘Urethrocutaneous fistula （UCF） is a common complication of hypospadias surgery for severe hypospadias. We report our experience in the management of UCF following hypospadias surgery with a prepuce-degloving method （PDM）. Our study included 87 patients who developed UCF after hypospadias repair from May 2001 to December 2011. Either simple closure or PDM was performed to repair the fistula. In total, 61 patients underwent a simple closure or Y-V plasty of the fistula, and 26 underwent a PDM repair. The success rate was 78.7% for simple closure or Y-V plasty and 96.2% for PDM repair （P〈0.05）. PDM repair represents a good choice for UCF repair after hypospadias, and our high 96.2% success rate demonstrates its applicability.
文摘Objective: The aim of our study was to compare the results of tubularized plate urethroplasty with interposing healthy tissue spongioplasty alone and spongioplasty with dorsal dartos flap to assess the role of dartos flap in prevention of fistulae. Patients and Methods: A retrospective study was performed on 80 patients, aged 4 months to 27 years who underwent hypospadias repair using the Snodgrass technique. The patients were assigned to two groups. In group I (40 patients) the neourethra was covered with spongioplasty only, and in group II (40 patients) the neourethra was covered with spongioplasty plus dartos flap. Integrity of the urethral plate was maintained in all the cases. The ventral curvature & torsion was corrected by penile de-gloving, mobilization of the urethral plate and spongiosum and mobilization of the proximal urethra if needed. The results were analysed in view of complication rates. The average period of hospital stay was 7 days & follow-up varied from 8 months to 28 months with a mean of 14 months. Results: In group I, hypospadias were distal penile in 31 (77.5%), mid-penile in 4 (10%) and proximal/peno-scrotal in 5 (12.5%) patients. In group II, hypospadias were distal penile in 17 (42.5%), mid penile in 9 (22.5%) and proximal/peno-scrotal in 14 (35%) patients. Sixty five percent in group I and 80% in group II had ventral curvature but the difference was not statistically significant. Good functional results were achieved in 97.5% patients in group I and in 95% patients in group II?which were statistically similar (p value—0.585). Urethral fistula was encountered in 2.5% in group I & in 2 cases (5%) in group II. Meatal stenosis was noted in 7.5% each in both groups, which responded to urethral dilatation. One patient in group II had complete disruption.?There was no statistically significant difference in early and late complications in both groups (p value—0.812). Conclusions:?Spongioplasty with healthy spongiosal tissue is strong enough and is?effective waterproofing?as an interposition layer. However, more prospective studies in different hands are needed to omit the step of dorsal dartos interposition.
文摘Introduction: Vaginal adenosis is one of the rare diseases of the vagina, and almost all patients are asymptomatic. We report a case of spontaneous vaginal adenosis, which caused vesicovaginal fistula. Case Presentation: Our patient was a 25-year-old Japanese woman. She was admitted to our hospital, and her chief complaint was continuous urine flow from the vagina. We found a tumor with a vesicovaginal fistula in her vagina. Subsequent cytological analysis of vaginal smears showed a normal vaginal mucosa. The patient underwent tumor resection and a fistula patch. Pathological diagnosis was adenosis of the vagina, even though the patient had no known history of intrauterine diethylstilbestrol exposure or Müllerian developmental abnormalities. Conclusion: The clinical course of our case was a malignant tumor, which invasively bored a hole in the vaginal wall forming a vesicovaginal fistula, even though it was a benign lesion. Therefore, overzealous treatment should be avoided in this case.
文摘A left-sided lesion of a coronary cameral fistula (CCF) is extremely rare. Surgical closure of the fistula is indicated when symptoms emerge or as a preventive strategy, while surgical approaches depend on the individual anatomical structures. In particular, a CCF forming a “fistula lake” with multiple inflow vessels is so unique that few studies have focused on the technique to close it. We report the successful management of a CCF originating from multiple coronary arteries and draining into the left ventricle via a “fistula lake” by ligation and clipping of associated communication tracts. On the postoperative coronary computed tomography angiography, the fistula lake and the small vessels entering it had all disappeared.
