Continuous Leakage Of Urine Research Articles

Unmasking of an Ectopic Ureter after Insertion of Tension-Free Vaginal Tape

Ectopic ureters draining into a place other than the posterior-lateral aspect of the trigone is uncommon. Patients may be asymptomatic or present with the classic symptoms of normal voiding associated with continuous urinary leakage. We present a case of an adult female whose ureteric duplication was unmasked after insertion of tension free vaginal tape (TVT).

A comparison of quality of life before and after successful repair of genitourinary fistula: Is there improvement across all the domains of WHOQOL-BREF questionnaire?

ObjectiveTo compare preoperative quality of life (QoL) scores using World Health Organization WHOQOL-BREF quality of life assessment with postoperative QoL scores following successful repair of genitourinary fistula. Patients and methodsThe WHOQOL-BREF questionnaire was used as a tool to evaluate the quality of life before and after surgical repair. All patients, who underwent genitourinary fistula repair between January 2011 and December 2013 were included. Women with complaints of continuous leakage of urine per vagina following obstetric or gynaecological procedures were included in this study. Women with rectovaginal fistula, malignant fistula or radiation induced fistula were excluded from this study. Patients with co-morbidities affecting QoL and those who did not give consent to participate were excluded. Patients whose questionnaire was incomplete were also excluded. ResultsOf the 106 women admitted for treatment of genitourinary fistula during the time period; 101 were included. The preoperative score of physical, psychological, social and environmental health domains were 15.04±2.56, 16.42±4.4, 51.75±11.91 and 34.81±6.89 respectively. The postoperative scores in physical, psychological, social and environmental health domains were 83.61±5.09, 75.79±6.33, 76.17±8.53 and 33.88±6.13 respectively. On comparison between the preoperative and postoperative QoL scores; there was significant improvement in physical, psychological and social health domains in the postoperative period (p<0.01) but the environmental health domain scores remained static. ConclusionThere is marked improvement in the overall quality of life, especially the physical, psychological and social health domains of WHOQOL-BREF questionnaire after successful surgical repair of genitourinary fistula. The environmental health domain remained unchanged even after successful repair.

Single ectopic ureteral orifice with bilateral duplicated renal collecting systems in an adult girl: Diagnosis by magnetic resonance urography.

Renal duplication accompanied by ureteral ectopia is an uncommon urinary congenital abnormality. We report the case of a 21-year-old girl who suffered from lifelong continuous urinary leakage. She was finally diagnosed with bilateral duplicated collecting systems complicated with right ectopic ureteral orifice - an extremely rare case. The patient underwent ureteric re-implantation for the ectopic side, and her urinary incontinence ceased soon thereafter. In this case, traditional imaging failed to show the exact insertion of an ectopic ureter. However, magnetic resonance urography combined with retrograde intubation radiography successfully depicted the point of ureteric insertion, which may make the diagnostic process accurate and efficient.

Prevalence of symptoms of vaginal fistula in 19 sub-Saharan Africa countries: a meta-analysis of national household survey data.

Vaginal fistula is a serious medical disorder characterised by an abnormal opening between the vagina and the bladder or rectum, which results in continuous leakage of urine or stool. The burden of this disorder in sub-Saharan Africa is uncertain. We estimated the lifetime and point prevalence of symptoms of vaginal fistula in this region using national household surveys based on self-report of symptoms. We considered all Demographic and Health Surveys (DHS) and Multiple Indicators Cluster Surveys (MICS) from sub-Saharan Africa and included data for women of reproductive age (15-49 years). We estimated lifetime prevalence and point prevalence of vaginal fistula with use of Bayesian hierarchical meta-analysis. We included 19 surveys in our analysis, including 262,100 respondents. Lifetime prevalence was 3.0 cases (95% credible interval 1.3-5.5) per 1000 women of reproductive age. After imputation of missing data, point prevalence was 1.0 case (0.3-2.4) per 1000 women of reproductive age. Ethiopia had the largest number of women who presently have symptoms of vaginal fistula. This study is the first to estimate the burden of vaginal fistula in 19 sub-Saharan Africa countries using nationally representative survey data. Point prevalence was slightly lower than previously estimated but these earlier estimates are within the prevalence's credible intervals. Although vaginal fistula is relatively rare, it is still too common in sub-Saharan Africa. None.

Good clinical outcomes from a 7-year holistic programme of fistula repair in Guinea.

Female genital fistula remains a public health concern in developing countries. From January 2007 to September 2013, the Fistula Care project, managed by EngenderHealth in partnership with the Ministry of Health and supported by USAID, integrated fistula repair services in the maternity wards of general hospitals in Guinea. The objective of this article was to present and discuss the clinical outcomes of 7years of work involving 2116 women repaired in three hospitals across the country. This was a retrospective cohort study using data abstracted from medical records for fistula repairs conducted from 2007 to 2013. The study data were reviewed during the period April to August 2014. The majority of the 2116 women who underwent surgical repair had vesicovaginal fistula (n=2045, 97%) and 3% had rectovaginal fistula or a combination of both. Overall 1748 (83%) had a closed fistula and were continent of urine immediately after surgery. At discharge, 1795 women (85%) had a closed fistula and 1680 (79%) were dry, meaning they no longer leaked urine and/or faeces. One hundred and fifteen (5%) remained with residual incontinence despite fistula closure. Follow-up at 3months was completed by 1663 (79%) women of whom 1405 (84.5%) had their fistula closed and 80% were continent. Twenty-one per cent were lost to follow-up. Routine programmatic repair for obstetric fistula in low resources settings can yield good outcomes. However, more efforts are needed to address loss to follow-up, sustain the results and prevent the occurrence and/or recurrence of fistula.

Women and men's awareness of obstetric fistula in facilities in Kisii and Nyamira Counties, Kenya

Background: Obstetric fistula has been defined as an ‘abnormal communication’ between the vagina and the bladder or rectum of a woman which results in continuous leakage of urine and/or faeces. The most common cause of obstetric fistula is obstetric trauma. Obstetric fistula is a highly stigmatising condition; often the women are neglected and or ostracised. Aim: To establish the knowledge and awareness of fistula among men and women living in an area where fistula prevalence is rising. Methods: In this cross-sectional study, women and their partners were recruited purposefully in two counties Kenya: Nyamira and Kisii and interviewed using structured interviews. Data were cleaned and entered into Excel. SPSS was used for descriptive data analysis. Chi2 test was conducted to compare responses according to gender and level of education. Results: Three hundred participants (253 women and 47 men) were interviewed over a 3-month period. Responses from women and men were similar. Few (32%) participants reported having seen a woman with fistula in their community. Just over half (53%) said that they knew what causes fistula, of which 89% said they knew that fistula could be treated. Only 27% said that the health care provider mentioned fistula during health education talks. Participants educated to a level above secondary school were more knowledgeable about fistula. Conclusion: Fistula information is lacking among community members. There is a need to scale up training and community awareness campaigns to help eradicate fistula from Kenya.

Dilatation and curettage of urinary bladder: A rarity

Twenty-eight-year-old female while undergoing a medical termination of pregnancy (MTP) encounter complete urethral loss and massive bladder curettage. After resuscitation, she developed continuous urinary leakage followed by progressive decline in urine output. Case is highlighted here because of the massive vesico-urethral trauma because of MTP, leading to permanent urinary diversion.

A Delayed Type of Ureteric Injury Developed After Transobturator Mesh Procedure for Massive Prolapse

We report on a rare case of delayed presentation of ureteric injury with a transobturator mesh kit for anterior vaginal wall prolapse repair along with conventional vaginal pelvic reconstructive surgery: a case of a 56-year-old multiparous, postmenopausal woman with a body mass index of 22.1 kg/m, who had continuous leakage of urine per vagina 28 days after vaginal hysterectomy, mesh-augmented anterior repair with Avaulta Plus Anterior support system kit (CR Bard Inc, Covington, Ga), and sacrospinous ligament fixation for stage IV pelvic organ prolapse. Pelvic computed tomographic scan with contrast revealed an intact bladder, right hydroureteronephrosis, and right ureterovaginal fistula. Immediate laparotomy performed revealed that the right lower mesh arm was entangled with the distal end of the right ureter, 1.5 cm from the ureteric orifice. Category, time, site classification was 4CaT2S5. Right ureteric reimplantation was performed uneventfully. We herein emphasize that the development of a delayed type of ureteric injury is a possible associated complication of transobturator mesh surgery for the prolapse.

Écoulement urinaire chez la fille : quelle imagerie en 2012 ?

Continuous urinary leakage, despite normal deliberate voiding, must suggest the diagnosis of ectopic ureter, more specifically in girls. Ectopic ureter is usually associated with duplex kidney and complete ureteral duplication. The strategy of investigations has changed over the past few years, due to MRI development in the analysis of urinary tract malformations. We report the case of a 4-year-old girl who presented with these symptoms and had a suspicion of left duplex kidney on the prenatal ultrasonography (US). Two US examinations during the first months of life were compatible with a left duplex kidney without any complication. Another US at the age of 4 years was reported as normal. We completed the investigation with MR urography, which revealed a left duplex kidney with a poorly functioning dysplastic upper pole, and the orifice of the ureter of this upper pole inserting in the vagina. The surgical treatment, realized by celioscopy, was partial nephrectomy of the upper pole, removing most of the ectopic ureter. US is the first exam to investigate urinary tract malformations. However, duplex kidney with small dysplastic pole and ectopic insertion of a nondilated ureter may be difficult to see, and a normal US should never end the investigations. Intravenous urography and renal scintigraphy used to be the reference complementary exams, but are now replaced by MR urography. Without using ionizing radiation, MR urography can visualize duplex kidney and ectopic ureteral insertion with high resolution, and evaluates renal function of each kidney and each pole. These morphological and functional data are essential to determine the surgical treatment.

Fístula vesicovaginal continente

ABSTRACTVesicovaginal fistula is an abnormal communication between the bladder and vagina and represents the most frequent type of fistula in the urinary tract. The most common cause in Brazil is iatrogenic fistula, secondary to histerectomia. Classically these women present continuous urinary leakage from the vagina and absence of micturition, with strong negative impact on their quality of life. We present a case of totally continent vesicovaginal fistula, with a follow-up of 11 years with no complications.

Perineal urethrostomy in a cat following prepuce and perineal region injury

A 2- year- old male, intact domestic short hair cat was referred to the Veterinary Clinic of Ferdowsi University of Mashhad with a history of inappetence, vomiting, dysuria,stranguria, depression and continuous urine leakage from the skin injury in perineal region. After physical examinations, temperature, pulse and capillary refill time (CRT) were decreased and pale mucosal membranes and dehydration were observed. Palpation of the abdominal region was painful and kidneys were enlarged.Penis was not present in its normal anatomical position. In biochemical analysis, significant rise in BUN (urea nitrogen) and creatinin were noticed.In abdominal radiographs and ultrasonography evaluations distention of the urinary bladder and blockage in urinary tract were identified. According to these results presence of an obstruction was confirmed in the penile urethra, and consequently, perineal urethrostomy (PU) was performed for correction of obstruction and renewed urine outflow. Normal urination established in our patient after PU surgery and common postsurgery complications did not occurred.

One case of pregnancy and congenital vesicovaginal fistula

To discuss the diagnosis and therapy of congenital vesicovaginal fistula (VVF). We reported 1 case of pregnancy and congenital VVF and summarized the pathogenesis and characters. Congenital VVF is extremely rare and characterised by continuous urinary leakage,cyclical hematuria with severe suprapubic pain. It is always associated with other urinary tract abnormalities, urinary tract infection and stone. The pathogenesis is related with genetic, environment, drugs, radiation and incomplete fusion of mullerian. The diagnosis relies on clinical manifestation and radiological examinations.Surgical resection is the key to treatment. Pregnancy and congenital VVF is extremely rare and always misdiagnosised associated with other urinary tract abnormalities. Early diagnosis and making sure the location, size and relationship with other tissues are important. Reasonable preoperative preparation, surgical and postoperative surgical care are the key for treatment.

1157 HIGH-PRESSURE VAGINOGRAM FOR THE DETECTION AND MANAGEMENT OF VAGINALLY ECTOPIC URETERS WITH SPECIAL EMPHASIS ON THE RARE INVERTED-Y-URETERAL-DUPLICATION

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence - Evaluation & Therapy1 Apr 20111157 HIGH-PRESSURE VAGINOGRAM FOR THE DETECTION AND MANAGEMENT OF VAGINALLY ECTOPIC URETERS WITH SPECIAL EMPHASIS ON THE RARE INVERTED-Y-URETERAL-DUPLICATION Jyoti Upadhyay, Amanda Burnette, Greg Spana, Margaret Roth, Maryellen Sheridan, and Bijan Shekarriz Jyoti UpadhyayJyoti Upadhyay Norfolk, VA More articles by this author , Amanda BurnetteAmanda Burnette Norfolk, VA More articles by this author , Greg SpanaGreg Spana Syracuse, NY More articles by this author , Margaret RothMargaret Roth Syracuse, NY More articles by this author , Maryellen SheridanMaryellen Sheridan Syracuse, NY More articles by this author , and Bijan ShekarrizBijan Shekarriz Syracuse, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.767AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Magnetic Resonance Urogram (MRU) with exam under anesthesia is advocated to identify ectopic ureters in duplex systems. The best modality for detection/management of inverted-y-ureteral-duplication (IYD) remains uncertain. We describe a novel approach to the identification and treatment of IYD of a single renal unit. METHODS We present prospectively acquired radiographic data with surgical management in a series of five consecutive adolescent females (ages 14–17, mean 15.8) treated from 2001–2009 for continuous urinary incontinence after lengthy negative diagnostic workups. High pressure vaginogram and concomitant minimally-invasive laparoscopic identification and excision of the ectopic segment to the vagina was performed in those with an IYD. RESULTS High pressure vaginogram detected an IYD associated with a single renal unit with ectopia to the vagina in three patients, two of which underwent laparoscopic excision of the ectopic segment. Vaginogram detected ectopic ureter of a duplex system in two patients and had partial nephrectomy. All patients who underwent surgery had complete resolution of incontinence. MRU failed to reveal the anomaly in all cases. CONCLUSIONS We report the first publication of high pressure vaginogram, with a minimally invasive, laparoscopic approach in the management of the rare IYD of single renal units resulting in continuous urinary incontinence. High pressure vaginogram should be in the armamentarium in the evaluation of girls with continuous urinary leakage in whom the diagnosis of an otherwise unrecognized ectopic ureter is in question and not elucidated by MRU. We further advocate that a laparoscopic approach simplifies the treatment of the IYD. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e464 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jyoti Upadhyay Norfolk, VA More articles by this author Amanda Burnette Norfolk, VA More articles by this author Greg Spana Syracuse, NY More articles by this author Margaret Roth Syracuse, NY More articles by this author Maryellen Sheridan Syracuse, NY More articles by this author Bijan Shekarriz Syracuse, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Perception and attitude of obstetric fistula patients about their condition: a report from the Regional Hospital Maroua, Cameroon

Background. Obstetric fistula results in a continuous leakage of urine or feces through the vagina. The social consequences of obstetric fistula are severe, with affected women often ostracized from the community, divorced, abandoned and remaining childless. Objective. The general objective of this study was to analyze the perception and attitude of obstetric fistula patients treated at the Regional Hospital of Maroua, Cameroon. Design and Methods. This is a case series study of 42 obstetric fistula patients at the Regional Hospital of Maroua, Cameroon. After confirmation of the diagnosis of obstetric fistula, the patients were invited to participate to a survey prior to the surgical procedure, from May 2005 to August 2007. Results. Thirty-two percent of patients (13/41) said that they used to isolate themselves. Fifteen percent of patients (6/41) cited suicide as a solution for their fistula problem. Among the 29 patients who had never been operated before, 12 (41%) declared that this was due to a lack of financing means; eight (28%) cited the lack of fistula treatment services; seven (24%) said that this fistula was recent and 2 (7%) declared that they did not consult before. Conclusion. Obstetric fistula patients have a very negative perception about their condition. It is strongly recommended to improve the accessibility to maternal health program in order to prevent and manage the obstetric fistula in Far North Cameroon.

Comparative Analysis of Outcome Between Open and Robotic Surgical Repair of Recurrent Supra-Trigonal Vesico-Vaginal Fistula

Recurrence of fistula is one of the very common complications of fistula repair. The disease has immense psychosomatic effect on the patients due to continuous leakage of urine. Management of recurrent vesico-vaginal fistula (VVF) repair poses a challenge to surgeons. Group I-12 patients with recurrent VVF, having robotic repair from August 2006 to June 2008, were included in the present study. Group II-20 patients matched in all possible parameters with recurrent VVF having open surgical repair in the past were taken as controls. Patients in both the groups were evaluated by assessing relevant clinical details; performing urine routine examination and culture, renal function test, three swab test, ultrasonogram-kidney, ureter, and bladder radiograph, intravenous urogram (to look for upper tract and rule out uretero-vaginal fistula), and urethro-cystoscopy. The details were retrospectively recorded from the case sheets. In group I, 100% were successfully managed as compared with 90% in group II, but it was not statistically significant (p > 0.05). Mean blood loss was significantly less (p < 0.05) in group I compared with group II (mean 88 vs. 170 mL). The mean hospital stay also was significantly less (p < 0.05) in group I in comparison with group II (mean 3.1 vs. 5.6 days). None of the patients had complications in group I compared with group II, but it was not significant. The present study suggests that robotic VVF repair is a better option for recurrent fistulas in view of its reduced morbidity, without compromising the results.

Evaluation of different techniques to create chronic urinary incontinence in the rat

To evaluate models for chronic urinary incontinence (UI) in the rat. Two models were fully evaluated: one of repeated dilatation of the vagina, simulating birth trauma, the vaginal dilatation (VD) group; the other, with surgical transposition of the urethra to a vertical position, the urethral transposition (UT) group. The VD rats were evaluated by the sneeze test. When negative, vaginal dilatation was repeated in a similar way. The UT group was evaluated by observation of continuous urine leakage. The leak-point pressure (LPP) was measured at study end in all the rats. All the VD rats had occasional negative sneeze tests and all had to be dilated again. This resulted in persistent UI on sneeze testing for the entire period. In the UT group, 12 rats leaked continuously during the whole study period; in the other four UI became less at 4, 5, 6, and 7 weeks, respectively. The LPP in the rats with UI was significantly lower than in the respective control groups. These models permit study of chronic stress UI and continuous UI in the rat. Spontaneous recovery of continence was seen mostly in the VD group.

Epidemiology of vesico-vaginal fistula: No longer a calamity of teenagers

Vesico-vaginal fistula (VVF), an abnormal communication between the vagina and the urinary bladder, leads to continuous leakage of urine that is not just a severe medical problem but a great social...

Congenital vaginal fistula from a single system ectopic ureter: A case report

Vaginal fistulae particularly vesico-vagina fistula, is a common urogynaecologic problem in Sub-Saharan Africa. Majority of these cases are acquired and congenital fistulas are rare. We here report a case of congenital vaginal fistula secondary to an ectopic ureter in 15 year old Nigerian female. The case records of a 15 year old female who presented to the obstetrics and gynaecological unit of the Federal Medical centre Azare and a Review of literature on the subject was used. A 15-old-girl presented with continuous leakage of urine from the vaginal since birth despite the establishment of normal voiding habit. Examination revealed urine leaking from a pinhole fistula in the vestibule. Intravenous urography showed delayed excretion of the right kidney with a normal single ureter (single system) and normal left kidney. Ureteric implantation into the bladder was performed with good postoperative outcome. In an environment with scarce resources, managing ectopic ureter in the female is quiet challenging. Multidisciplinary approach involving the urologist, paediatric surgeon, radiologist and the gynaecologist will yield the best outcome.

Vesicovaginal Fistula Due to an Unreported Foreign Body in an Adolescent

Background In the United States, vesico-vaginal fistula formation is most commonly associated with prior gynecologic surgery, and only rarely with severe pressure necrosis. Case A 16-year-old girl presented with continuous urinary leakage and malodorous discharge. Examination revealed an incarcerated plastic cup in the vagina with a 5cm vesico-vaginal fistula at the bladder neck. After trans-vaginal repair, the patient underwent full recovery with an intact continence mechanism. Conclusion Evaluation of unusual urinary symptoms in an adolescent should include pelvic examination and/or imaging. An undisclosed vaginal foreign body is a rare, but well described entity, contributing to vesico-vaginal fistula formation.

L6‐S1 spinal nerve stimulation reduces micturition frequency in anaesthetized rats with cyclophosphamide‐induced cystitis

To further investigate the rationale for using spinal nerve stimulation (SNS) for treating bladder overactivity associated with cystitis in a rat model of cyclophosphamide-induced cystitis, as several studies suggested that symptoms associated with chronic cystitis could be treated using stimulation of sacral spinal nerves, but the mechanisms by which it works are unknown. Cystitis was induced by i.p. injection of cyclophosphamide 48 h before the experiments in anaesthetized male rats. Neurograms were taken by placing a recording electrode onto the pelvic nerve and a stimulating electrode on either the L6 or S1 ipsilateral spinal nerves. Two selected intensities were then evaluated for SNS in control and cyclophosphamide-treated rats during cystometry. Cyclophosphamide resulted in significant bladder overactivity. There was no apparent difference in the neurograms generated in response to SNS of the S1 and L6 spinal nerves, and between cyclophosphamide and control rats. Intensities of 200 microA (Adelta-fibre-specific) and 2 mA (Adelta+ C-fibres) were chosen for SNS. Continuous SNS at 200 microA significantly reduced the frequency of voiding and non-voiding contractions in cyclophosphamide-treated rats. SNS at 2 mA resulted in the abolition of voiding contractions, accompanied by continuous leakage of urine. SNS recruiting only Adelta-fibre produced fewer voiding contractions in cyclophosphamide-treated rats, to a level similar to that from the control rats. These results support the ability of SNS to decrease bladder overactivity in a pathophysiological model of chemical irritation of the bladder.