Indications de l’abord vaginal en chirurgie urologique: à propos de 30 cas

Abstract

ObjectivesTo report the epidemiological features of patients operated by vaginal route, the patients’ pathologies and management. Patients and methodsFrom November 2005 to November 2010 in the department of Urology of the regional hospital center of Louga, all the patients who have been operated by vaginal route for genito-urinary disease were included in this study. All data were obtained by review of medical records and registers. ResultsThe study included 30 patients; one patient had two operations. The mean age was 42.17 years (range 20–70 years), SD 15.06. The mean parity was 4.06 (range 1–10). We noted 22 cases of external genito-urinary prolapse, 6 cases of vesico-vaginal fistula, one case of peri-urethral metastasis of gestational trophoblastic disease, one case of urethral diverticulum with calculi. The different constituents of genito-urinary prolapse were: cystoceles (21 cases, 11 of which were isolated), hysteroceles (11 cases) and rectoceles (3 cases). Three cases of genito-urinary prolapse were associated with stress urinary incontinence. All patients were treated without prosthesis placement. The procedures were: triple perineum operation with total hysterectomy (11 cases, 7 of which had annexectomy), repair of cystocele with posterior colpoperineorraphy (11 cases). Stress urinary incontinences (3 cases) was treated by Marion–Kelly technique. The vesico-vaginal fistulas were treated by splitting in two and closure the vesico-vaginal wall with interposition of Martius flap in five cases. The diverticulectomy was done for the urethral diverticulum. The peri-urethral metastasis of gestational trophoblastic disease was resected and the loss of substance repaired by using a Martius flap. Five patients who had triple perineum operation with total hysterectomy were transfused. A vesical injury observed was managed by vesical drainage. No mortality was noted. The satisfaction rate was 86.66%. We noted one failure and two patients were not seen during the follow period. ConclusionThe urological surgery by vaginal route is mainly practiced for genito-urinary prolapses in our institution. This surgery has many advantages concerning the cost, the morbidity and the convalescence. The question about using prosthesis reinforcement in certain cases, in certain countries makes that, the urological surgery without prosthesis will continue for many years.