Repair of a small and crooked vesicovaginal fistula using electrocauterization

Dear Editor,Vesicovaginal fistula(VVF)is an abnormal opening between the urinary bladder and the vagina.The condition has an immense psychological effect on patients due to the continuous leakage of urine or watery vaginal discharge.The wet feeling and foul smell associated with leakage of urine cause social outcasting of the patients.This leads to immense emotional trauma and makes life miserable for the patient.The most common etiology for VVF in developing countries is obstructed labour[1],and in developed countries,it is abdominal hysterectomy[2].VVF poses a challenging problem to the surgeon.The location and the size of the fistula determine the extent of the patients’symptoms.

Development of vesicovaginal fistula caused by vaginal adenosis: A case report

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.

Vesico-Vaginal and Recto-Vaginal Fistula and Death Caused by a Vaginal Foreign Body in a Body-Packer

Foreign body retained for long duration sometimes causes vesico-vaginal and recto-vaginal fistula. We report a 60-year-old woman with vaginal foreign body causing vesico-vaginal and recto-vaginal fistula;she died after foreign body removal due to septic shock. The patient had vaginal purulent discharge, abdominal pain, and a septic shock. A fragment of stone (limestone) was present in the vagina, which was removed. The patient developed urinary incontinence and fecal incontinence after removal of the foreign body. The examination demonstrated the presence of vesico-vaginal and recto-vaginal fistula. The patient died four days after removal of the foreign body due to septic shock and multi-visceral failure. During the extraction foreign body, bacteria could be disseminated into the systemic circulation and might cause septic shock. Thus, wide-spectrum antibiotic therapy must be used before the procedure, which may decrease the chance of septic shock.

Management of recto-vaginal fistulas after prosthetic reinforcement treatment for pelvic organ prolapse

AIM: To communicate our findings on successful treat-ment of recto-vaginal fistulas (RVFs) after prosthetic reinforcement surgery of pelvic organ prolapse (POP). METHODS: A retrospective single center study between 1998 and 2008 was performed. A total of 80 patients with RVF were identified, of which five patients (6%), with a mean age of 65 years (range: 52-73), had undergone previous surgery for POP with pros-thetic reinforcement. RESULTS: All patients complained about ongoing vaginal infections and febrile episodes. These symptomswere reported after a mean period of 18 mo after POP repair. As a first intervention, three patients underwent ablation of the prosthetic material (PM). As a second intervention, open proctectomy with a primary anas-tomosis, an omental patch, and a protective ileostomy were performed in two patients. One patient required a terminal colostomy due to complete destruction of the anal sphincters. In two other patients, ablation of the PM and proctectomy was performed as a one-step procedure. The postoperative course in all patients was uneventful, with a mean length of hospitalization of 20 d (range: 15-30). Closure of the ileostomy was achieved in all four patients within four months. After a mean period of 35 mo (range: 4-60) of follow-up, no recurrence was observed with normal continence in four patients.CONCLUSION: In our experience, the definitive treat-ment of high RVFs after PM repair for POP necessitates ablation of the PM, proctectomy with a primary colo-rectal anastomosis, an omental patch interposition, and a temporary ileostomy.

Aetiology of Vesico Vaginal Fistula (VVF)—Observation in Patients Managed at CCBRT (Comprehensive Community Based Rehabilitation in Tanzania) Hospital, Dar es Salaam, Tanzania. January to March 2016

In this manuscript the authors have studied the various causes of vesico-vaginal fistula (VVF) and described etiology, clinical characteristics, and surgical outcome of VVF patients managed at CCBRT. They show that out of 155 patients 104 had surgery for VVF, 25 for stress incontinence (SI), 7 for perineal tears, 6 for recto-vaginal fistula (RVF) and 5 for other reasons, such as urethral strictures and bladder stones. They found a rate of 37 (35.58% out of 104 patients) with definitely iatrogenic fistula and therefore support the observation also made by others that there is a shift in etiology of VVF.

A Rare Case of Combined Vesico-Vaginal and Vesico-Cutaneous Fistulae Treated by One-Stage Surgical Repair

Combined vesico-vaginal and vesico-cutaneous fistulae are exceptionally rare. We present a young woman who had combined vesico-vaginal fistula and vesico-cutaneous fistula following prolonged obstructed labour and caesarean section. The patient presented at three months of illness with total urine incontinence from the vagina and lower abdominal skin. One-stage surgical repair of both fistulae was done. The patient had a successful closure of the fistulae, regained full urinary continence, and remained continent at six months follow-up. We opine that one-stage repair of combined vesico-vaginal and vesico-cutaneous fistulae is feasible and preferred. Providers of pelvic surgery in low resource countries should be supervised and retrained accordingly, in order to prevent iatrogenic vesico-cutaneous fistula.

Vesicovaginal Fistulas: Anatomical Clinical and Surgical Aspects in the Conakry University Hospital Center

Objective: To analyze the management of VVF in the Service of Urology-Andrology Obstetrics and Gynecology of the University Hospital in Conakry. Materials and Methods: From January 2012 to December 2013, 152 patients with a mean age of 30 years (14 - 80 years) were hospitalized in the Departments of Urology-Andrology and Gynecology-Obstetrics of the Conakry University Hospital Center. Clinically fistulas were divided according to the classification of Benchekroun as single, complex and complicated. The fistulas were diagnosed after a minimum period of three months and the results were assessed with a mean follow-up of 7 months (range 3 to 10 months) according to the following criteria: complete healing, intermediate healing and failure. Results: Fistulas occur mainly in young multiparous women. The obstetric etiology was dominant (98%). Clinically, there were 30% simple fistulas, 46% complex fistulas and 24% of complicated fistulas. From a therapeutic standpoint, the treatment consisted of a single fistulorraphie (Chassar Moir) in 82% of cases and a fistulorraphie with interposition of healthy tissue in 18% of cases. After a mean follow-up of 7 months we obtained a healing in 62% of cases, a failure in 31% of cases and the results were intermediate in 7% of cases. Conclusion: It appears that the VVF represents a public health concern in Guinea and surgical treatment is technical difficult due to the higher frequency of complex fistulas.

Transection Type, Vesico-Vaginal Fistula Surgery

The objective of the study was to report the results of the surgery of the Vesico-vaginal fistula (VVF) transection types at CHU Conakry. Methods: This was a prospective descriptive study that focused on 64 patients operated for VVF transection type at the Urology department of CHU Conakry between January 2013 and December 2015. Four types of transection were defined according to the state of the urethra and vagina, the size of the fistula, the peri-fistulous tissue and associated lesions. The variables studied were the proportion of transection, age, the type of transection, the number of previous cures, the operative technique, the complications and the results after a follow-up of 3 months. Results: Transection accounted for 47.05% of the obstetric fistulas. The average age was 25.18 years old (14-43 years old). This was a Type I transection (11 cases), type II (27 cases), type III (19 cases) and type IV (7 cases). The surgical approach was vaginal in 64 cases. Fistulorraphy with a confection of a new cervix and cervico-urethral anastomosis was conducted in 19 patients, combined with bladder flap urethroplasty (30 patients) or vaginal flap (15 others). We recorded healing in 37 cases. Conclusion: Transection type VVF is a severe VVF. The preferential surgical approach was vaginal. Technical difficulties were related to associate lesions and the continence system affected.

Vulvar Swelling in a 12-Year-Old Girl: An Early Manifestation of Crohn’s Disease

Vulvar Crohn’s disease (VCD) is a rare complication of Crohn’s disease, especially in pediatric population. An early diagnosis can result difficult if the complication does not present in conjunction with the classic gastrointestinal symptoms that characterize this disease. In this study we present the case of a 12-year-old girl whose initial symptom of Crohn’s disease was a symptomatic vulvar swelling promoted by a rectovaginal fistula. We also provide an overview of Crohn’s disease and the vulvar changes found in the course of this disease.

经直肠双平面超声诊断儿童先天性阴道尿道瘘1例

女性患儿,14岁,不自主漏尿10余年、憋尿后明显,近半年症状加重;无特殊家族史。查体及实验室检查均未见明显异常。下腹部纵切面超声:膀胱充盈,双侧输尿管均开口于膀胱三角区,膀胱与阴道、宫颈间未见异常通道;阴道内见5.63cm×1.85cm梭形无回声区。

子宫动静脉瘘致产褥期阴道出血10例分析

目的 探讨子宫动静脉瘘(UAVF)致产褥期阴道出血的临床特点、诊治方法及预后。方法 回顾性分析2016年1月至2022年6月四川锦欣西囡妇女儿童医院、西南交通大学附属医院及西南医科大学附属医院诊治的10例UAVF致产褥期阴道出血的临床资料并总结国内外相关文献。结果 病人年龄范围为21~36岁,平均28.5岁;均有子宫手术操作史,包括人工流产、剖宫产、子宫肌瘤挖除及宫腔镜手术史;此次妊娠7例行剖宫产术;出血量范围为600~2 000 mL,平均1 210 mL;阴道出血距离分娩时间范围为3 h至5周;1例经病理检查确诊,5例经彩色多普勒超声(CDU)确诊,4例经数字减影血管造影(DSA)确诊。6例输注血液制品;1例行全子宫切除术,9例行选择性子宫动脉栓塞术,治疗后阴道出血均停止。随访9例保留子宫病人,均未复发,月经正常来潮,其中2例病人再次妊娠;随访时间0.5~5.7年。结论 UAVF致产褥期阴道出血临床少见,但出血量多,易发展成失血性休克,发病与既往子宫手术操作史相关,诊断依赖于CDU、DSA等影像学检查,治疗以保留生育的选择性子宫动脉栓塞术为主,疗效确切,不影响月经情况及生育功能。

Nail penetrating trauma： a rare cause of vesicovaginal fistula

Vesicovaginal fistula （VVF） may be caused by prolonged obstructed labor, gynecologic, urologic, or other pelvic surgery, malignancy, radiation, infection and trauma. Here we report a case of VVF caused by nail penetrating trauma in a young woman with genital bleeding after first intercourse. This is a rare etiology of VVF. We also explain the operative technique used to repair the fistula.

腹腔镜辅助阴式子宫切除术泌尿系统损伤5例报告

目的 总结腹腔镜辅助阴式子宫切除术(laparoscopic-assisted vaginal hysterectomy,LAVH)泌尿系统损伤的教训与处理经验.方法 回顾分析我院1995年12月～2006年1月415例LAVH中5例出现泌尿系统损伤的临床资料.结果 术中2例膀胱损伤;术后3例输尿管损伤:2例术后第4天出现腹痛而发现,1例术后30d因无症状阴道大量排液发现.并发症发生率1.2%(5/415).结论 LAVH并发症高危因素有肿瘤直径＞5 cm,肿瘤突向阔韧带及接近宫颈峡部水平,手术修补是主要的治疗方式.

改良经阴道路径膀胱阴道瘘修补术的临床应用和疗效

目的探讨改良经阴道路径膀胱阴道瘘(VVF)修补术的临床应用及疗效。方法回顾性分析2014年1月至2019年12月行经阴道路径VVF修补术36例患者的临床资料。患者中位年龄48.5(33-62)岁,表现为阴道不自觉漏液。32例为妇科手术医源性损伤,4例为外伤;15例为妇科恶性病变者均无盆腔放疗史。14例瘘口位于膀胱三角区以上,17例瘘口位于膀胱三角区,5例瘘口位于膀胱颈部;瘘口中位直径2.0(0.3-4)cm,均为单一瘘口,距输尿管开口>0.5 cm。手术取折刀体位,经阴道置电切镜,以电切环沿瘘口周围切除瘘管黏膜及疤痕组织,沿膀胱阴道间隙切开,分离膀胱、阴道壁,经阴道3-0可吸收缝线分别错位缝合膀胱壁及阴道壁。术后持续留置导尿管2个月以上,行膀胱造影及膀胱镜复查,以阴道漏液消失、膀胱造影剂无渗漏为修补成功标准。修补失败者3个月后以同样方法行修补。结果36例患者均顺利完成手术,中位手术时间50.5(30-80)min,术后平均住院时间(3.0±0.8)d。中位随访时间22(6-30)月。结果显示:31例(86.1%)1次修补成功;5例第1次修补失败,分析显示第1次修补失败病例在既往手术史比率(60.0%vs 6.5%)、中位瘘口直径(3.0 cm vs 2.2 cm)及中位手术时间(60.0 min vs 50.0 min)均高于修补成功患者,差异具有统计学意义(P<0.05);5例修补失败患者3个月后膀胱镜检查皆见瘘口缩小,以同样方法行第2次修补,均获成功。所有患者术后尿控可,无尿潴留。结论VVF修补术创伤小、学习曲线短,且患者住院时间短、术后恢复快,是一种有推广价值的手术方法,适用于瘘口较小、无盆腔放疗史的患者。

腹腔镜子宫切除术后输尿管阴道瘘的围手术期护理

目的:探讨腹腔镜子宫切除术后输尿管阴道瘘病人围手术期的治疗护理要点。方法:回顾性分析21例腹腔镜子宫切除术后输尿管阴道瘘患者的治疗和护理措施及其效果。结果:通过个体化整体护理,所有患者消除了焦虑心理,能积极配合治疗,21例患者有17例一次治愈,一次治愈率80.95%,4例经再次手术治愈,总治愈率100%。结论:输尿管阴道瘘患者应根据具体病情制定个体化的治疗和护理方案,整体护理在输尿管阴道瘘的治疗中能起到积极作用。

单孔腹腔镜全子宫切除术致膀胱阴道瘘一例

经自然腔道内镜手术(natural orifice transluminal endoscopic surgery,NOTES)是近年出现的新概念和新技术,符合女性对于美的追求[1],在妇科领域广泛应用。在国内,2011年首次报道经脐单孔腹腔镜辅助阴式全子宫切除术[2],2014年张俊吉等[3]报道经脐单孔腹腔镜切除全子宫,并完成腹腔镜下阴道残端的缝合,取得了满意的结果,进一步推动了单孔腹腔镜在全子宫切除中的应用。但是单孔腹腔镜技术完成妇科手术时所带来的并发症也不容忽视。为此本研究回顾性总结在江南大学附属医院(我院)施行单孔腹腔镜全子宫切除术致膀胱阴道瘘1例临床资料,探讨单孔腹腔镜在妇科手术中并发症的处理与预防,现报告如下。

女性初次经阴分娩后远期膀胱尿道及阴道三维解剖的变化

目的:探讨女性初次经阴分娩后远期膀胱尿道及阴道精细解剖结构的变化。方法:选取2013年1月至2016年10月于南方医科大学南方医院妇科就诊的已行MRI检查的53例患者,其中未孕未产者28例,经阴分娩1次者25例。收集患者的静息MRI影像数据,利用Mimics 10.01软件进行三维重建,联合UG软件对膀胱尿道与耻骨联合间的精细解剖参数进行三维测量和分析。结果:患者均可构建盆底器官三维模型,含骨盆、膀胱、尿道、子宫、阴道和直肠。膀胱尿道后角、β角、α角、耻骨后间隙,经阴分娩1次组比未孕未产组增大,但差异均无统计学意义;尿道耻骨角、尿道倾斜角、膀胱颈与耻骨联合下缘连线长度及尿道横纹肌厚度,经阴分娩1次组比未孕未产组减小,但差异均无统计学意义。近中远端尿道阴道间隙、近端和远端阴道前壁宽度,经阴分娩1次组较未孕未产增宽;阴道前壁中线长度,经阴分娩1次组比未孕未产组减小。中段阴道二维形态浅凹型占比,经阴分娩1次组比未孕未产组增加,但差异均无统计学意义。结论:患者经阴道分娩后膀胱尿道及阴道的空间解剖位置和形态发生了变化,表现为膀胱尿道位置向后向下移动,阴道前壁及尿道阴道间隙增宽。两组差异虽无统计学意义,但侧面反映了经阴道分娩后,膀胱尿道及阴道周围支持结构支持功能有所下降。

阴道-膀胱联合径路修补膀胱阴道瘘的临床观察

目的观察经阴道-膀胱联合径路修补膀胱阴道瘘的临床疗效。方法回顾性分析14例膀胱阴道瘘患者的临床资料,其中有7例曾于外院行膀胱阴道瘘修补,均失败。病因包括:子宫肌瘤作子宫全切术4例,宫颈癌作子宫全切术2例,经阴道分娩损伤8例。所有患者均以不同程度阴道漏尿为主诉就诊,术前通过膀胱镜检查和膀胱亚甲蓝试验确诊。我们均采用经阴道-膀胱联合径路进行膀胱阴道瘘修补。结果 14例患者术后随访2~36个月,平均16.2个月,7例初次治疗的患者均治愈(7/7,100%),曾行膀胱阴道瘘修补失败的患者中有6例治愈(6/7,85.7%)。另1例经再次修补后治愈。结论经阴道-膀胱联合径路修补膀胱阴道瘘,因其具有视野暴露清楚、瘘道清除彻底、瘘孔缝合牢固等优势,可获得较高的成功率。

子宫动脉介入栓塞术治疗子宫动静脉瘘的观察及护理

目的讨论子宫动脉介入栓塞术治疗子宫动静脉瘘的护理。方法回顾分析2005年12月～2010年3月我院妇产科6例子宫动静脉瘘患者的临床资料(6例患者全部接受选择性子宫动脉介入栓塞术),包括患者首诊症状、婚育史、确诊依据、手术过程、术前术后护理及随访情况。结果选择性子宫动脉介入栓塞术治疗子宫动静脉瘘,可以保留患者的子宫,优于传统的子宫切除术。结论正确了解子宫静脉瘘并提供及时有效的护理,对促进病人的康复具有重要的临床意义。

肠外瘘早中期确定性外科处理的临床研究

目的探讨肠外瘘早中期确定性处理方法。方法对３１例肠外瘘病人的治疗经验进行分析。在重视综合措施的前提下，对无法确定可否自愈的２８例病人，应经过必要准备后，争取早期手术治疗，并根据术中发现的情况，采用不同手术方法。另３例瘘口较小者采用非手术症法。结果３例非手术治疗者均自愈。可２８例手术治疗者中，治愈２６例（９３６％），死亡２例（６４５％）。平均住院日期３６２２ｄ。结论在大多数肠瘘病人，采取早期手术治疗肠外瘘，可取得缩短病程。