Treatment Of Vesicovaginal Fistula Research Articles

Management of Vesicovaginal Fistula in Lower-Resource Settings: A Novel Device for Collection and Drainage of Urine

Abstract Treatment of vesicovaginal fistula (VVF) is currently limited to surgical repair that is costly and sparsely available and requires intervention from trained specialists, preventing patients in lower-resource settings from receiving effective care. As those who remain untreated continue to experience severe vaginal urinary leakage, an affordable, easy-to-use device that discreetly contains and redirects unwanted leakage of fluids would temporarily alleviate the social distress associated with VVF until patients can afford to present for treatment. We present a novel device to mitigate urinary leakage caused by VVF using a vaginal cup, which allows for the funneling and rerouting of urine into an external drainage bag, to be released at a user's convenience. For patients who cannot afford surgery, our device helps manage their symptoms so that they can reintegrate into society and no longer face the harrowing stigma of their family and society. We demonstrate the effectiveness of our device through preliminary benchtop testing, using a non-living vaginal model to verify leak-free retainment of the device under varying pressure conditions. Preliminary results indicate that the device displayed no circumferential leakage, and the internal displacement of the cup was within the allotted range of 5 mm for applied hydrostatic pressures up to 150 cm H2O.

Clinical efficacy of flap transfer coverage in the treatment of vesicovaginal fistula.

Vesicovaginal fistula (VVF) brings severe psychological, physiological, and social stress to patients, which seriously affects the quality of their sexual life. Traditional transvaginal repair surgery can cause vaginal shortening. Transferring the lateral free flap can maintain vaginal length. This study was carried out to investigate the clinical efficacy of the surgery of flap transfer coverage for treating VVF. A retrospective analysis was performed on 37 patients diagnosed with VVF and repaired by flap transfer coverage in the Urogynecology department of the First Affiliated Hospital of Kunming Medical University from January 2018 to June 2021. All patients took a prone split leg position to repair VVF with the flap transfer covering method and a chart review was performed. Among the 37 patients, there were 34 cases of primary complete healing, and the success rate reached 91.89% without recurrence and complications. Three cases recurred with leakage of urine; cystoscopy showed that the fistula was significantly reduced, and all patients were cured after secondary repair by the same surgical method without complications. Flap transfer coverage is a safe and effective surgical method for repairing VVF. The prone split leg position can better increase exposure. The fistula being away from the incision suture is the key to the success of the operation. Transferring the fistula can effectively improve the cure rate of VVF. Transferring the lateral free flap can maintain vaginal length.

Treatment of Vesico-Vaginal Fistula by General Practitioners trained in Fistula Repair owing to a lack of surgeons in rural areas in Burundi.

Our objective was to assess the contribution of general practitioners trained in fistula repair in Burundi. We conducted a retrospective, descriptive study, collecting 70 cases from June 2020 to May 2021 at Gitega Regional Hospital, 47.1% being under 30 years old, 77.1% of whose fistulae were successfully repaired with lasting continence regained within six months. This demonstrates that training of general practitioners in vesico-vaginal fistula repair has filled a gap resulting from the lack of surgeons in Burundi.

Factors Associated with Vesicovaginal Fistula and Their and Treatment Outcome

Vesicovaginal fistulas (VVF) also known as vesicovaginal fistula, have become a growing public health concern especially of developing countries. The most cited reason in literature of VVF is by prolonged and obstructed labor. With improvement in quality care delivery in health around the globe, the etiology of VVF too evolving in the country. Objective: This study was done to find out the factors associated with vesicovaginal fistula and to determine the success rate of operative procedure for treatment of vesicovaginal fistula. Method: This cross sectional study was carried out in Department of Gyneacology and Obstetrics in Liaquat University Hospital, Hyderabad from January 2021 to December 2021 among 60 women at different ages suffering from vesicovaginal fistula due to gynaecological or obstetrical causes or malignancy. Result: Majority of the patients were “young primipara with short stature and malnourished, coming from lower socioeconomic condition of rural areas. Prolonged labor 24 (40%) was the most common cause of vesicovaginal fistula, followed by gynaecological surgeries mainly hysterectomies 18 (30%) and malignancy 4 (6.6%) rare cause. The success rate of repair following first and second attempt was 92% and 8% respectively. Overall success rate was 48 (96%) and functionally failed with a failure in 2(4%) cases. This study showed main cause for developing fistula showing prolonged labor and majority of patient were treated pervaginally. Most of the cases (96%) had successful repair which is very encouraging and correlates well with recently published series. Conclusion: Fistula can be totally preventable by proper antenatal care identification of high risk cases, timely referral, proper intranatal, postnatal care, and proper training. So improvement of health care services and dedication will prevent this type of morbidity. The best results are obtained when repair of vesicovaginal fistulae is carried out under optimal conditions”.

Пузырно-влагалищные свищи: современные концепции диагностики и лечения.

Introduction. Vesicovaginal fistula (VVF) is a pathological communication between the urinary bladder and the vagina. The lack of common approaches to the treatment choice, its timing and postoperative management of patients makes this disorder one of the challenges of modern urogynecology. Materials and methods. Relevant publications were searched using the PubMed database, the Google Scholar search system, and the scientific electronic library eLibrary.ru. Results. VVF is the most common form of urogenital fistulas. In developed countries, the formation of VVF mainly are the result of surgical trauma or radiation therapy, but in developing ones the majority of VVF have an obstetric etiology. There are different classifications of VVF; however, there is no overall accepted one that is suitable for predicting treatment efficacy and long-term outcomes regardless of etiology of VVF. Treatment of VVF with long-term bladder drainage should be performed only for small, benign and unformed VVF. Surgical closure of VVF is the primary method of treatment. Surgery can be performed using abdominal and vaginal access. Regardless of the access, a positive result (closure of the fistula) on average is achieved in 90,8% of cases. The treatment of post-radiation fistulas is more challenged and associated with a high failure rate. Conclusion. Despite of the variety of VVF treatment options, unfortunately, there is no the perfect one yet due to the variability of VVF ethiology, the lack of unified curative approaches and the shortage of studies comparing different therapies.

Impact of the surgical approach, considering Goh classification, on long-term results in patients with vesicovaginal fistula repair

BackgroundThis study aims to present long-term results, preoperative classification, and surgical approach in the therapy of vesicovaginal fistulas (VVF) and neovesicovaginal fistulas (NVVF). Unlike developing countries, where fistulas are mainly the result of delivery trauma, in the modern world, the main causes are urogynecological surgery and irradiation therapy.MethodsData of 36 woman who underwent surgical treatment of VVF and NVVF were collected retrospectively. After clinical assessment, fistulas were categorized by the Goh classification system, which led to the choice of surgical approach: transvaginal or transabdominal. Follow-up period was 60 to 108 months.ResultsOut of 36 patients evaluated, 23 were operated transabdominal, and 13 were operated transvaginal. Patients selected for the transabdominal approach were mainly categorized as Goh 1 and 2, including patients after radiotherapy and patients with large fistulas. Patients selected for the transvaginal approach were mainly Goh 3 and 4. There were no statistical differences between groups regarding the success of the operation (83.3%) and complication rate. Complications included fistula recurrence (16.6%), stress urinary incontinence (22.2%), urinary tract infections (11.1%), overactive bladder (13.9%), and urosepsis (2.8%). There was a statistical difference in the duration of the hospital stay in favor of the transvaginal approach (12.00 ± 5.8 vs 16.27 ± 4.65).ConclusionsSuccess in the surgical treatment of VVF and NVVF can be achieved by careful preoperative classification, selection of surgical approach, assessment of local tissue status, taking into consideration the characteristics of the fistulas, and adhering to the basic surgical principles. Regardless of the surgical approach, conducting such a preoperative stratification can achieve similar long-term outcomes. Most fistula recurrence (83.3%) appeared within 6 months after the surgery.

Морфологический анализ структуры парасвищевых тканей у пациенток с пузырно-влагалищными свищами при местном внутритканевом применении аутоплазмы, обогащенной тромбоцитами

The issue of complications of fistuloplasty of vesicovaginal fistulas (VVF) remains extremely relevant both for modern surgeons and for patients. Optimization of morphological characteristics by local interstitial application of Platelet-Rich Plasma (PRP) can positively affect the results of surgical treatment of VVF. PURPOSE OF THE STUDY to conduct a comparative assessment of the morphological parameters of parafistulous tissues before and after local interstitial application of PRP. MATERIALS AND METHODS Study included 52 patients who underwent fistuloplasty. Group I included 30 women who were treated according to the standard method. Group II included 22 patients who underwent PRP therapy prior to surgery. All patients underwent an excisional biopsy of the VVF edges. After performing an excisional biopsy, Group II patients received 9-10 parafistulic injections of activated PRP with a frequency of one every seven days for five weeks before fistuloplasty. Repeated biopsy of the VVF edges was performed in Group II patients immediately before fistuloplasty. For histological study, tissue sections were stained with hematoxylin and eosin according to standard technology. RESULTS Primary biopsy revealed keratinization disorders in eight (37 percent) patients from Group II, and after PRP therapy in four (18 percent) patients (p>0.05). In all patients of Group II, after PRP therapy, the epithelial layer had a normal histological structure (p<0.05). Erosive and ulcerative lesions of the integumentary epithelium were initially detected in 14 patients (64 percent) from Group II. No erosions were detected during control biopsy (p<0.05). The thickness of fibrous tissue in Group II before the therapy was 886.3+/-113.5 M, and 830.1+/-119.9 M (p=0.66) after. Lymphoid infiltration was initially present in 20 patients from Group II, in eight of them (40 percent) it decreased (p<0.05) after the therapy. Cell density decreased after PRP therapy in 11 patients (50 percent), but in four (18 percent) patients it increased from low to moderate (p<0.05). Microvascular density before therapy was 29+/-3,3, and 19.9+/-1.9 after. The difference has statistical validity at the trend level (p=0.078). CONCLUSION Taking into account a statistically significant decrease in the activity of the inflammatory process, complete relief of erosive and ulcerative lesions, and decrease in the thickness of fibrosis in the stromal layer in fistula tissues, application of PRP therapy in the surgical treatment of VVF should be considered appropriate and justified.

A short note on the article by prof. Dm. Ott: "The volume of operative treatment of vesicovaginal fistulas complicated by the destruction of the urethra"

In the Journal "Obstetrics and Women's Diseases" for June this year, an article by prof. Dm. Otta: "About the operative treatment of vesicovaginal fistulas, complicated by the destruction of the urethra." In this article, prof. Ott proposes, in cases of significant destruction of the urethra, where and after successful plasty of the vesicovaginal wall, all the same, the patient is not able to keep urine, an operative problem, consisting in lengthening the urethra up to the lip of the anterior side of the labrum.

On the surgical treatment of vesicovaginal fistulas complicated by the destruction of the urethra

One of the most thankless tasks in the work of a gynecologist is the fight against such forms of violation of the integrity of the urinary bladder, which are complicated by the destruction of the entire urethra or most of it. There are often cases when even a completely successful plastic surgery in the area of the disturbed vesicovaginal septum does not bring relief to patients due to defects in the area of the urinary canal.

Treatment of Vesico-vaginal Fistula by a Robot Assisted Laparoscopy : Results of a Multicentric Series (FFVLARO)

Treatment of Vesico-vaginal Fistula by a Robot Assisted Laparoscopy : Results of a Multicentric Series (FFVLARO)

Awareness Regarding Vesicovaginal Fistula among Women Residing in A Municipality of Kapilvastu

Introduction: Vesicovaginal fistula (VVF) is one of the most distressing maternal morbidities. It is a physically and socially disabling obstetric complication that affects many women annually. It has a devastating social, economic and psychological effect on the health and well-being of the affected women. The aim of the study was to find out awareness regarding vesicovaginal fistula among women.&#x0D; Material and Method: Descriptive study design was used for the study to find out awareness regarding vesicovaginal fistula. Hundred women were selected as the study sample by non purposive and snow ball sampling technique. Pretested semi structured interview schedule was used for data collection and analyzed by using descriptive and inferential statistics.&#x0D; Results: The findings of the study revealed that 81% and 100% of women knew that delivery by non skilled and wetting under garments is risk factor and symptom of VVF. 82% and 73% of women knew that VVF is preventable and curable respectively. 58% of women had knowledge that women can become pregnant in case of VVF and 47 % knew that VVF can be reoccurred. Out of 73 women, 23% knew that surgery as the treatment of VVF. Forty nine percentage of women had answered regarding family and social misbehave and depression (5%) being social consequences of VVF. Seventy percentage of women answered that cervicitis is complication of VVF. &#x0D; Conclusion: Based on the findings of the study half of the women had low knowledge regarding VVF. So, it is recommended to organize continue awareness program to the women regarding VVF.

J. Marion Sims and the Vesicovaginal Fistula: Historical Understanding, Medical Ethics, and Modern Political Sensibilities.

To review the historical background surrounding the early work of Dr. J. Marion Sims, who developed the first consistently successful surgical technique for the repair of obstetric vesicovaginal fistulas by operating on a group of young, enslaved, African American women who had this condition between 1846 and 1849. Review of primary source documents on Sims and his operations, early 19th century clinical literature on the treatment of vesicovaginal fistula, the introduction of ether and chloroform anesthesia into surgical practice, and the literature on the early 19th century medical ethics pertaining to surgical innovation. The goals are to understand Sims's operations within the clinical context of the 1840s and to avoid the problems of "presentism," in which beliefs, attitudes, and practices of the 21st century are anachronistically projected backward into the early 19th century. The object is to judge Sims within the context of his time, not to hold him accountable to standards of practice which were not developed until a century after his death. A narrative of what Sims did is presented within the context of the therapeutic options available to those with fistula in the early 19th century. Review of the available material demonstrates that Sims' first fistula operations were legal, that they were carried out with express therapeutic intent for the purpose of repairing these women's injuries, that they conformed to the ethical requirements of his time, and that they were performed with the patients' knowledge, cooperation, assent, and assistance.

Laparoscopic repair of vesicovaginal fistulae with a transperitoneal approach at Universitas Gadjah Mada Urological Institute: a case report

BackgroundA vesicovaginal fistula is an abnormal fistulous tract extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault. In addition, the sequelae from these fistulae have a profound effect on the patients in view of their physical, psychological, and social dimensions. The treatment of vesicovaginal fistula is surgical in most cases and the choice of the repair technique is controversial. We evaluated the benefits of a laparoscopic approach in a patient with vesicovaginal fistulae. Here, we present our first experience using a simplified laparoscopic approach technique to repair vesicovaginal fistulae in our country.Case presentationA 46-year-old Javanese woman presented with urinary incontinence following an abdominal hysterectomy 3 months earlier and received laparoscopic repair. A cystoscopy was performed to confirm the fistula orifice and a stent was inserted into the fistula tract from her bladder to her vagina. A tamponade was inserted into her vagina up to the vaginal apex, to be able to identify the vagina. She had adhesions; therefore, adhesiolysis was performed using a combination of sharp and blunt dissection to expose the vaginal stump and the superior aspect of her bladder. A simple cystotomy was performed and extended to include the fistulae site, and then the defect was repaired by using a running stitch. A second layer of closure was performed in an imbricating fashion with the same suture. The vagina defect was not closed separately but covered with an omental flap. This procedure takes approximately 2.5 hours; estimated blood loss was minimal and there were no intraoperative complications. She had no recurrent symptoms 6 months after surgery.ConclusionOur case report concludes that the simplified laparoscopic approach to vesicovaginal fistulae is a viable option for successful repair and that it reduces the size of bladder opening, causes minimal bleeding, and gives successful relief.

Comparative analysis of transvaginal approach and transabdominal approach for vesicovaginal fistula

Objective To compare the efficacy of transvaginal and transabdominal repair surgery for the treatment of vesicovaginal fistula(VVF). Methods The data of 39 patients undertaken VVF repair in our department between January 2005 and December 2016 was retrospectively reviewed. The patients aged 19 to 69 years (median 45 years) , and the median duration of the condition was 22 months (range: 1 month to 20 years). The etiologies were all iatrogenic injuries. Thirty-nine patients underwent a total of 43 surgical repairs including 26 transabdominal approach(group 1)and 17 transvaginal approach(group 2). There was no significant difference in terms of the patients′ age, fistula size, location and the proportion of patients undergoing repairs previously between the two groups. The operative and outcome data of the two groups was compared. Results The surgical time of group 2 was shorter than that of group 1 (median 85 min vs. 178 min, Z=-4.436, P 0.05). Conclusion Compared with transabdominal repair, transvaginal repair of VVF is a preferred surgical procedure in respect that it is more simple, less invasive and has similar success rate with transabdominal repair. Key words: Vesicovaginal fistula; Transvaginal repair; Transabdominal repair; Treatment outcome

Laparoscopic Transperitoneal Vesicovaginal Fistula Repair

Abstract Objective: The goal of this research was to determine the efficacy and safety of laparoscopic treatment of vesicovaginal fistula (VVF). Materials and Methods: This was a descriptive, retro...

OPTIMIZATION OF SURGICAL TREATMENT OF VESICOVAGINAL FISTULAS

Currently, urogenital fistulas are one of the most actual and socially significant problems of medicine. A common type of urogenital fistula is the vesicovaginal fistula. The most difficult for surgery treatment is postradiation vesicovaginal fistula, which appear after uncontrolled radiation exposure on the pelvic. This is due to decrease of tissue vascularization, the prevalence of fibrosis in the lamina, muscle tissue in the vaginal and bladder mucosa, chronic lymphocytic inflammation and hyperkeratosis which destroy epithelium. Conservative therapy of vesicovaginal is not usually effective and in rare case leads to fistula closure. Thus, surgical approach remains the accepted strategy for the treatment of vesicovaginal fistulas. This article contains the most actual literary data with optimal strategy for the treatment of vesicovaginal fistula.

904 Successful treatment of vesico-vaginal fistula: A single-centre 35 years experience on 106 consecutive cases

904 Successful treatment of vesico-vaginal fistula: A single-centre 35 years experience on 106 consecutive cases

C108: Treatment of vesicovaginal fistulas: Our clinical experience of surgical repair and outcome

C108: Treatment of vesicovaginal fistulas: Our clinical experience of surgical repair and outcome

Fistules vésicovaginales posthystérectomie

Describe the epidemiology, diagnosis and treatment of vesicovaginal fistula (VVF). We conducted a retrospective descriptive study of all cases of VVF secondary to hysterectomy. The following parameters were studied: age, parity, indication for hysterectomy, risk factors, the consultation period, the anatomical type of VVF, the paraclinical, the surgical approach and results of the cure. Fourteen cases were identified over 10 years. All hysterectomies were performed by laparotomia. The average age of patients was 54.3±13 years. Hysterectomy was performed in view of a uterine leiomyoma in eight cases, a cancer of the cervix in four cases, a menometrorrhagia in one case and a choriocarcinoma in one case. Four patients had received neoadjuvant radiotherapy. The mean time from injury was 13.5±18 months. Examination under valve was allowed to find 11 VVF type 1 and three type 2 VVF. IVU was normal in seven patients and allowed to find an ureterohydronephrose stage III in one patient. VVF was addressed by high in ten cases including 5 by transperitoneovaginale and 5 by transvesical pure. The postoperative course was uneventful in 11 patients (78%) but marked by vesicocutaneous fistula, parietal suppuration and one failure. In this short series of post-hysterectomy VVF treated by laparotomia, we observed a rate of cure satisfying in spite of an important psychosocial morbidity.

Community misconception about the aetiopathogenesis and treatment of vesicovaginal fistula in northern Nigeria

Background : The increasing incidence of obstetric vesicovaginal fistula (OVVF) in Nigeria has justified the need for continued exploration of ways to prevent the occurrence of this debilitating maternal morbidity. Aim : The study set out to gain insight into the rural people’s perception about the cause and treatment of obstetric fistula using focus-group discussions. Materials and Methods : A series of focusgroup discussion sessions were held with the local people of obstetric fistulaprevalent areas of northern Nigeria during a medical outreach. Results : Most (74.9%) of the participants had no formal education, while the majority (62.0%) of them were married at the time of the study. Most of the healthy females and a few male participants believed OVVF was a punishment from the gods to affected women for their infidelity. The majority of the men believed VVF resulted from unforeseen natural forces during childbirth. The majority of the women with obstetric fistula believed their condition either resulted from the effect of a poison from the skull bone of the dead macerated fetus that they were delivered of or from the manipulation of the Traditional Birth Attendants (TBA) while trying to deliver the dead fetus from their birth canal. On the possible treatment for VVF, the majority of the men in the study population and a few healthy women believed VVF had no cure. All the women awaiting repair of their VVF believed the condition could be corrected in the hospital. A few of the healthy women posited that OVVF could be treated with herbal products by experienced TBAs. Conclusion : There is a high level of misconception about the aetiopathogenesis of OVVF in rural areas of northern Nigeria. This calls for continued enlightenment of the populace on the cause and treatment of obstetric vesicovaginal fistula. Keywords : Vesicovaginal fistula, cause, treatment, misconception, Nigeria.