Genitourinary Fistula Research Articles

Iatrogenic Genitourinary Fistula: A Rising Trend

Background:Obstetric fistula (OF) is not very uncommon in our country. But recent issue of increase in iatrogenic fistula (IF) creates a field of interest.
 Objective:To find out the frequency and the cause of iatrogenic genitourinary fistula admitted in National Fistula Centre (NFC), Dhaka.
 Methods:This prospective study was conducted in NFC, Dhaka from January, 2010 to December, 2012. All cases admitted during the study period were included in this study. All patients were evaluated through detailed history, physical examination, relevant investigations and examination under anaesthesia (EUA). Repair was done through abdominal or vaginal route based on the findings. Results of repair were noted and analyzed.
 Results:On an average more than 20% cases of genitourinary fistula (GUF) were due to iatrogenic causes. Among them about 90% cases had history of hysterectomy as an offending procedure. A rising trend of iatrogenic fistula is observed with 19.04% in 2010, 15.68% in 2011 and 30% in 2012.
 Conclusion:This study shows that iatrogenic injuries in women under 40 years of age form major share in the aetiology of GUF. Iatrogenic fistula are increasing day by day. It is the time to check the experience of surgeons doing the gynecological and obstetrical surgeries in a developing country like ours.
 Bangladesh J Obstet Gynaecol, 2017; Vol. 32(1): 10-13

991 - Laparoscopic repair of female genitourinary fistulae: Single-center single-surgeon experience

991 - Laparoscopic repair of female genitourinary fistulae: Single-center single-surgeon experience

Urinary fistula-A continuing problem with changing trends.

Objective:Urinary fistula is a distressing complication after difficult vaginal deliveries, obstetric, and gynecologic surgeries. The present study describes a single center’s experience in the management of urinary fistula at a tertiary care hospital. It was performed to analyze the etiology of genitourinary fistula, to assess the outcome after surgical repair, and to determine the changing trends in the etiology and management of urinary fistula.Material and Methods:This retrospective study was conducted over 5 years in the department of obstetrics and gynecology, All India Institute of Medical Sciences, New Delhi. Twenty patients who underwent surgical repair of urinary fistula were included in the study and analyzed for their etiology, presentation, site, size, previous failed repair, approach of surgical repair, and outcome. The findings of the present study were compared with a previous study at our center to determine the changing trends of urinary fistula.Results:The mean age of the study population was 37.05±8.08 years. The majority (65%) of the fistulae occurred following gynecologic surgeries, whereas 25% were due to obstructed labor, and 10% after cesarean section for other indications. The vaginal approach was used in all except one case of uterovesical fistula, which was repaired abdominally. The outcome was successful in 85% of cases. The success rate was similar in primary versus previous failed repair (p=0.270).Conclusion:The most common cause of urinary fistula in the present study was gynecologic surgery. The vaginal approach can be used even in cases with previous failed repairs with a high success rate.

Residual urinary Incontinence after Successful Repair of Obstetric Fistula

Objective(s): Aim of the study was to identify the risk factors in those women who remain with incontinence after successful fistula repair.Materials & method: The women admitted in Dhaka Medical College Hospital with obstetrical genitourinary fistula were the study population.A observational study was done with all women having successful repair. They were asked to return for a follow-up appointment, 3 months after discharge . Women were examined and questioned at discharge and at follow up appointment. A structured questionnaire were used and information entered into a database.Results: Women who returned for follow-up 3 month postsurgery were included in predictors of closure analyses. Small bladder size (ARR 3.7; 95% CI 1.2–11.8), severe scarring (ARR 1.2; 95% CI 1.1–2.7), urethral involvement (ARR 7.3; 95% CI 3.3–1.46), were predicted failed fistula closure. Women with a closed fistula at 3 month follow-up were included in predictors of residual incontinence analyses .Conclusion:The prognosis for genital fistula closure is related to preoperative bladder size, previous repair, vaginal scarring, and urethral involvement.Bangladesh J Obstet Gynaecol, 2015; Vol. 30(2) : 86-91

Outcome after Surgical Treatment of a Rare Congenital Pouch Colon Variant with Tubularized Coloplasty

Congenital pouch colon (CPC) is an unusual malformation characterized by dilatation of a shortened colon associated with an anorectal malformation (ARM). We report about three patients transferred to our department with the initial diagnosis of an imperforate anus. A rare form of complete congenital pouch colon (CCPC) without a genitourinary fistula was diagnosed during the preoperative diagnostic evaluations at our institute. Definitive surgery was performed by tube coloplasty of the colonic pouch segment and posterior sagittal anorectoplasty (PSARP). Long term follow-up at a range of one to three years was fairly satisfactory in terms of function and without any loco-regional complications.

Revisiting Conservative Management of Vesicovaginal Fistula

The incidence of vesicovaginal fistula is the greatest with laparoscopic hysterectomies [ 1 Lee R.A. Symmonds R.E. Williams T.J. Current status of genitourinary fistula. Obstet Gynecol. 1988; 72: 313-319 PubMed Google Scholar ]. A 48-year-old woman underwent a robot-assisted total laparoscopic hysterectomy with benign pathology. One month postoperatively she presented with a 1-cm vesicovaginal fistula (Fig. A,B). Its size was visually estimated on cystoscopy and vaginal exam. This was managed conservatively with bladder drainage. To rule out an associated ureterovaginal fistula, computed tomography urography was done (Fig. C,D) [ 2 Goodwin W.E. Scardino P.T. Vesicovaginal and ureterovaginal fistulas: a summary of 25 years of experience. J Urol. 1980; 123: 370-374 Abstract Full Text PDF PubMed Google Scholar ]. Spontaneous healing was confirmed after 6 weeks of drainage.

Incontinence, Voiding Dysfunction, and Other Urologic Complications After Radiotherapy for Gynecologic Malignancies

Women with newly diagnosed gynecologic cancer will undergo treatment with surgery, radiation, or combination therapy. A considerable proportion of these women will develop urologic complications including urinary incontinence, urinary retention, radiation cystitis, ureteral stricture, or genitourinary fistula. Diagnosis is typically made with a careful history, physical exam, endoscopy, urodynamics, and imaging. Non-surgical and surgical management of urologic complications following radiotherapy is complicated by local tissue damage resulting in inferior success rates when compared to the general population. It is imperative that the patient and physician understand the complexity of treatment and manage expectations accordingly.

Surgical management of simple Vesicovaginal fistulae

Objective: Vesicovaginal fistula is a fairly common occurrence in our country because of poor availability of obstetric care. The purpose of this study is to review our results in the surgical management of VVF.Design: Prospective study. Place and duration of the study: The study was conducted in the department of urology, Federal Government Services Hospital (F.G.S.H.); Islamabad, from February 2002 to January 2004. Patients and Methods: Eleven patients were operated for vesicovaginal fistulae. Transvaginal repair was done in 8 (72.7%) patients while transabdominal repair was adopted in 3 (27.3%) patients only. Inclusion criteria: All patients presented with vesicovaginal fistulae only. Exclusion criteria: All patients presented with genitourinary fistulae other than VVFs. Results: The majority of fistulae (10 (90.9%)) were caused by ischaemic necrosis of bladder and vaginal walls resulting from obstructed labour. One (9.1x) patient developed VVF after hysterectomy due to some gynaecological problem. Surgical repair proved to be successful through transabdominal route in all 3 (100%) cases of VVFs while in 6 (75x) of 8 (100%) cases through transvaginal route. To describe an overall result, 9 (81.8%) vesicovaginal fistulae were successfully repaired at first attempt. Conclusion: Vesicovaginal fistulae can be best managed following basic surgical principles like adequate exposure, identification of structures, wide mobilization, tension free closure, good haemostasis and uninterrupted bladder drainage.

PD44-04 DIAGNOSIS AND MANAGEMENT OF PUBIC OSTEOMYELITIS ASSOCIATED WITH GENITOURINARY FISTULA

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III1 Apr 2016PD44-04 DIAGNOSIS AND MANAGEMENT OF PUBIC OSTEOMYELITIS ASSOCIATED WITH GENITOURINARY FISTULA John Lacy, Hakan Ilaslan, Kenneth Angermeier, and Hadley Wood John LacyJohn Lacy More articles by this author , Hakan IlaslanHakan Ilaslan More articles by this author , Kenneth AngermeierKenneth Angermeier More articles by this author , and Hadley WoodHadley Wood More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1796AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We sought to evaluate the clinical diagnosis and management of patients with pubic osteomyelitis and genitourinary (GU) fistula at a single institution. Although associated with significant patient morbidity, there is a dearth of literature on this rare disease process. METHODS Patients with a diagnosis of pubic osteomyelitis and GU fistula were identified by retrospectively reviewing surgical logs and clinic visits of 2 surgeons at a single institution between 2009 and 2015. All imaging studies were evaluated blindly by a single radiology staff member. RESULTS 13 patients met inclusion criteria during the study period with a mean follow up of 17.5 months after definitive intervention. Diagnostic criteria evolved over the time period and are summarized in the table below. The majority of patients (9/13) required ileal conduit urinary diversion with local debridement, excision of fistula and flap coverage. The remaining patients underwent more conservative management or fistula excision and GU reconstruction. 10/12 patients reported improvement or complete resolution of their initial symptoms after intervention and 1 patient is being followed expectantly with suppressive antibiotics. 7/13 patients experienced Clavien grade 3 or 4 complications. CONCLUSIONS Pubic osteomyelitis associated with genitourinary fistula is challenging to diagnose and to treat. There are a variety of etiologies and contributing factors that may often overlap and are frequently related to prostate cancer therapy. Sensitivity of imaging and lab studies vary, but magnetic resonance imaging (MRI) and C-reactive protein (CRP) are the diagnostic tests of choice. Treatment options are typically limited and invasive, and excellent success rates are paired with relatively high complication rates. Goals of therapy and patient expectations should be defined prior to surgical intervention. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e999 Advertisement Copyright & Permissions© 2016MetricsAuthor Information John Lacy More articles by this author Hakan Ilaslan More articles by this author Kenneth Angermeier More articles by this author Hadley Wood More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

V2-10 VAGINAL APPROACH TO VESICOUTERINE FISTULA

You have accessJournal of UrologyFemale Voiding Dysfunction1 Apr 2016V2-10 VAGINAL APPROACH TO VESICOUTERINE FISTULA Eder Brazão, Lucas Gon, Raphael Pioli, Cassio Riccetto, and Paulo Palma Eder BrazãoEder Brazão More articles by this author , Lucas GonLucas Gon More articles by this author , Raphael PioliRaphael Pioli More articles by this author , Cassio RiccettoCassio Riccetto More articles by this author , and Paulo PalmaPaulo Palma More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2664AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Vesicouterine fistula is a rare cause of genitourinary fistulas. Close relation between bladder and uterus predisposes to this lesion during many gynecological and obstetric procedures. This kind of complication is increasing due to the widespread of cesarian deliveries. The aim of this video is to highlight the technique of vesicouterine fistula repair using vaginal approach. METHODS A 38-year-old female was admitted to hospital with ciclic hematuria, amenorrhea and no incontinence. She had three previous cesarian deliveries, last one with bladder trauma 3 months before admission. Magnetic Resonance has shown a vesicouterine fistula above cervix. Patient intended to have future pregnancies so a vaginal correction of the vesicouterine fistula without hysterectomy was performed. The patient was prepared and draped in a modified dorsal lithotomy position. Initially, cystoscopy was done with identification of the fistula tract at anterior bladder wall. Uterine cavity was inspected though fistula tract. Next, ureteral catheters were introduced for safety during the procedure. Methylene blue was injected into the bladder to demonstrate the localisation of the fistula in the vaginal wall. A Pozzi clamp was applied to the uterine cervix for good exposure. Next, a supracervical incision was made and dissection was carried out until fistulous tract was identified. A T-clamp was applied to the vaginal wall and the inked fistulous tract was identified and dissected. An Hegar bougie was introduced into the cervical canal facilitating the procedure. Then the bladder wall was dissected in order to allow a tension-free closure of the bladder defect. Both ureters were identified before the vaginal wall was closed. After the closure of the bladder, uterus was closed with interrupted sutures over the Hegar bougie. Finally, vaginal wall was closed and ureteral catheters are removed. RESULTS Patient was discharged home 1 day after surgery. Urethral catheter was maintained for 14 days. After four months, patient keeps without hematuria, neither incontinence and recovered her normal menstrual cycle. CONCLUSIONS Vesicouterine fistula is a dreaded complication after cesarian deliveries. Its correction is usually performed through abdominal approach, however, vaginal approach is feasible, safe and less invasive. It may always be considered, mainly if procedure is made early after delivery, when uterus is still movable. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e182-e183 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Eder Brazão More articles by this author Lucas Gon More articles by this author Raphael Pioli More articles by this author Cassio Riccetto More articles by this author Paulo Palma More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

59: Genitourinary fistula: A prospective study of transabdominal approach for 67 complicated cases at a tertiary care hospital, Khartoum-Sudan

59: Genitourinary fistula: A prospective study of transabdominal approach for 67 complicated cases at a tertiary care hospital, Khartoum-Sudan

Laparoscopic Repair of Vesicouterine Fistula: A Case Report and Mini-Review of the Literature

Vesicouterine fistula (VUF) is the rarest form of genitourinary fistulas. Despite the advantages of laparoscopy, there are few case reports showing its feasibility in the management of this rare entity. A 40-year-old woman presented to our department with urinary incontinence associated to cyclic hematuria and amenorrhea. After diagnosis of cervicovesical fistula, the laparoscopic approach was chosen. Catheterization of the fistula tract during cystoscopy at the time of laparoscopy was beneficial to localize the fistula tract and allowed meticulous dissection in the retrovesical space between the bladder and the uterus. Operating time was approximately 165 min. The woman had no signs of recurrence after 12 months of follow-up. Laparoscopic VUF repair is an effective and safe technique with successful outcome. J Curr Surg. 2016;6(3-4):75-77 doi: https://doi.org/10.14740/jcs309w

Incidentally diagnosed post-cesarean vesicouterine fistula (Youssef's syndrome).

Vesicouterine fistula (VUF) is a very rare occurrence and is estimated to occur in only 1-4% of all genitourinary fistulas; 90% of cases are Youssef syndrome, which is accompanied by amenorrhea and cyclic hematuria (menouria). In this article, a renal transplant donor who was incidentally diagnosed with Youssef syndrome 20 years after a second cesarean delivery.

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.

Ultrasound-Guided Percutaneous Transperineal Anorectoplasty of Low Imperforate Anus Without Fistula

Background: Primary anoplasty of low imperforate anus depends on precise identification of the midpoint of the sphincter complex. Despite the use of the Peña muscle stimulator, the location of the deep sphincter anatomy can be challenging. We hypothesized that the addition of ultrasound guidance and endoscopy (when a colostomy is present) would enhance the localization of the sphincter complex and thus allow for a less invasive, percutaneous transperineal anorectoplasty. Methods and Results: Four neonates (three boys and one girl) presented following term and uncomplicated pregnancies with a low imperforate anus without associated genitourinary fistula or other congenital anomalies. All patients had a well-developed perineal musculature on physical examination and on ultrasound appeared to have a rectal pouch within 10 mm of the skin, for which they underwent an ultrasound-guided percutaneous transperineal anorectoplasty as follows (video run time 4 minutes, 24 seconds). In the operating room, under general anesthesia and in a lithotomy position, aided by muscle stimulation, an ultrasound examination identified the superficial and deep sphincter complex as well as the levator muscles. With a Seldinger technique, a needle followed by a guidewire was advanced under ultrasound guidance to the sphincter midpoint. The tract was dilated using sequential over-the-wire dilators of a gastrostomy kit, and the resulting mucosal edges were sutured across the dilated defect to the perianal skin with interrupted absorbable sutures. One of the four patients in our cohort, presented to us at 11 weeks of age with a history of neonatal colonic perforation from the imperforate anus that resulted in a diverting colostomy. We sought to enhance our technique with the addition of endoscopy. In the operating room, a flexible endoscope was advanced through the distal stoma, demonstrating rectal concentric rings that transitioned to anoderm at the dentate line, with converging folds of mucosa pointing to a central focal point. Aided by transillumination, muscle stimulation, and ultrasound guidance, a similar percutaneous transperineal anorectoplasty was effectively performed. All patients underwent planned serial anal dilations and have demonstrated satisfactory outcomes with good bowel function and continence at follow-up intervals that ranged from 1 to 6 years. Specifically, none of the patients has required cecostomy/appendicostomy, enemas, or other corrective procedures. Conclusions: Ultrasound-guided percutaneous transperineal anorectoplasty can be advantageous in a select group of healthy term newborns, with low imperforate anus, who lack associated fistula or other major congenital anomalies. Ultrasound guidance enhances the Peña muscle stimulation, and when a colostomy is present, endoscopy through the distal limb with transillumination can further localize the midpoint of the distal rectum. The blind end of the atretic rectum contains the anoderm that can be preserved by this percutaneous minimally invasive approach. No competing financial interests exist. Runtime of video: 4 mins 24 secs

Management of genitourinary fistula, 5-year retrospective review from single centre

Management of genitourinary fistula, 5-year retrospective review from single centre

Re-operative surgery for genitourinary fistulae to the colorectum

Re-operative surgery for genitourinary fistulas to the colorectum is very distressing condition for the patients. These fistulas are extremely complex and at times may require a staged, multidisciplinary approach in order to correct them. Post-operative and recurrent genitourinary fistula to the colorectum can occur as a consequence of pelvic disorders, including trauma, iatrogenic injury, inflammatory bowel disease, pelvic neoplasm, and infection. Basic surgical principles, such as gentle handling of the tissues, curetting of the fistula tract, adequate debridement of unhealthy tissue, and adequate mobilization of tissue to allow tension-free tissue approximation, are essential for a successful outcome. Surgical therapy for these fistulas remains largely based on the surgeons׳ preference and is influenced by many retrospective reports. Currently, there is no specific treatment algorithm available for these post-operative and recurrent genitourinary fistulas to the colorectum. Through this article, we will highlight the various treatment options available and have attempted to formulate a treatment algorithm for post-operative and recurrent rectourethral, rectovaginal, and ileal pouch vaginal fistulas.

Intravesical mini-laparoscopic repair of vesicovaginal fistulas

Vesicovaginal fistulas (VVF) constitute the most common type of genitourinary fistulas. In developed countries, VVF are almost always iatrogenic and frequently a secondary result of gynecological surgery. Some minimally invasive techniques have been introduced to decrease the morbidity related to standard open procedures for the treatment of VVF. One such procedure is the intravesical mini-laparoscopic approach. The aim of this study was to present our initial clinical experience using this technique for transvesical VVF repair. In 2013 and 2014, we carried out mini-laparoscopic repair of VVF in two women who did not respond to conservative treatment with a Foley catheter. The procedure was performed transvesically with a 3-mm instrument and a 5-mm, 30° scope. The fistulous tract was dissected and partially excised. The bladder and vaginal wall defects were closed in two layers with two separated continuous barbed, resorbable 3-0 sutures (V-Loc 90 Absorbable Wound Closure Device; Covidien, Norwalk, CT, USA). The median operative time for the two patients was approximately 100 min, and the blood loss was not clinically significant. The patients were released from the hospital 24 h after surgery. A Foley catheter was left in place for 14 days. Imaging examinations performed 6 weeks postoperatively revealed no VVF. In patients with simple fistulas, this technique provides a minimally invasive, easily reproducible approach with few associated complications. Nevertheless, further experience and observations are necessary.

Étude comparative du résultat de la cure des fistules vésico-vaginales avec et sans interposition du lambeau de Martius : une expérience camerounaise

This study aimed to investigate whether Martius' graft has an effect on the outcome of the surgical management of genitourinary fistula. This was a retrospective comparative study of all cases of genitourinary fistula that underwent curative surgery in two Cameroonian hospitals. Patients were all operated between January 2005 and July 2011 in the gynecology unit of the Maroua Regional Hospital and the University Hospital Centre of Yaoundé by a well-trained surgeon. The characteristics of women with fistulas operated without graft of Martius were compared with those of women operated with graft of Martius. Among the 81 genitourinary fistulas operated, 28 (34.6%) had benefited from graft of Martius. Depending on the characteristics of obstetric fistula, the two groups (that of patients who had a cure with, and that of patients who had a cure without interposition of graft of Martius) were similar: there was no difference in the proportion of rigid edges (89.3% vs. 73.6%, P=0.0989); in the proportion of vaginal flanges (78.6% vs. 60.4%, P=0.0986), in the proportion of cervical localization (42.9% vs. 28.3%, P=0.3762), in the proportion of fistulas with a size greater than 2 cm (64.3% vs. 39.6%, P=0.0702), nor in the proportion of recurrent fistulas (28.6% vs. 41.5%, P=0.2523) between the two groups. Similarly, both groups were comparable according to the results of surgery: there was no difference in the overall closure rate (85.7% vs. 79.2%, P=0.347) nor in the closure of fistula with continence (60.7% vs. 67.9%, P=0.260) between the two groups. The use of graft of Martius had no effect on the overall closure of genitourinary fistula in our series [OR: 1.57; 95% CI: 0.4 to 6.6; P=0.680]. The Martius graft does not seem to affect the outcome of the surgical management of genitourinary fistula. These results need to be confirmed by studies on a larger population.

Bladder Catheterization After Genitourinary Fistula Repair: How Many Days Are Enough?

In developing countries, where genitourinary (GU) fistulas are common, 90% result from prolonged labor. Conversely, in developed countries, 90% of GU