Urethrovaginal Fistula Research Articles

Reconstructive surgery of difficult urethrocutaneous fistula following gender-affirming surgery.

In Japan, transgender individuals have historically had limited therapeutic options, prompting many to seek gender-affirming surgeries in private or foreign clinics because of restricted access to public hospitals. This has led to challenges for patients undergoing surgery. A transgender man underwent surgery at a private clinic and experienced recurrent complications. Subsequent examination at another clinic and our hospital revealed limited medical records, complicating our understanding of this case. After a detailed investigation, the urethrocutaneous and urethrovaginal fistulas were identified and addressed by joint urologists and plastic surgeons, resulting in no recurrence after 1 year. This case underscores the importance of thorough preoperative assessment with a flexible mindset, emphasizing the need to avoid being misled by inadequate records or appearances in complication management of gender-affirming surgery. Collaborative efforts among healthcare professionals based on comprehensive evaluations lead to safer complication treatments.

Use of Vaginoscopy after Vaginoplasty in Individuals with Congenital Adrenal Hyperplasia

Study ObjectiveTo explore the use of exam under anesthesia with vaginoscopy (EUA-V) following vaginoplasty in patients with congenital adrenal hyperplasia (CAH). DesignRetrospective cohort MethodsAn IRB-approved retrospective chart review was performed of the post-surgical follow-up care of all patients diagnosed with classical CAH who sought care at a tertiary children's hospital from 2000-2017 and had undergone vaginoplasty at that institution. ResultsTwenty-six patients met inclusion criteria. The median age at vaginoplasty was 1.25 years (IQR: 0.67, 9). Median post-surgical follow-up was 5.5 years (IQR: 1.5, 9). Twenty six EUA-Vs were performed, on 22 patients. Four were for complication assessment (rectovaginal fistula (1); urethrovaginal fistula (3)—on the same patient). The remaining 22 EUA-Vs, performed on 20 patients with two each undergoing two EUA-Vs, were planned for routine evaluation of vaginal patency. They were done a median of 0.67 years (IQR: 0.25, 2) following surgery and at a median of 6.67 years of age (IQR: 1.75, 12). Of these, five EUA-Vs identified stenosis in five patients (25%), a median of 0.91 years (IQR: 0.5, 7) after surgery, at a median age of 8.42 years (IQR: 2, 10.92). Of the four who did not undergo EUA-V, one had stenosis on clinical exam with ultrasound-verified hematocolpos. The remaining three were all prepubertal at last follow-up. ConclusionThe majority of CAH patients following vaginoplasty underwent routine EUA-V, roughly a quarter of which detected stenosis. EUA-Vs may play a beneficial role in routine post-op care following vaginoplasty in patients with CAH.

Surgical Approach to Urethral Diverticulum and Urethrovaginal Fistula With Mesh Erosion

Introduction and hypothesisThis video illustrates a rare surgical case involving a urethral diverticulum, urethrovaginal fistula, and mesh erosion.MethodsWe present a 58-year-old patient attending a tertiary care center with a suspected urethrovaginal fistula. Her concerns included stress urinary incontinence (SUI), recurrent urinary tract infection, and vaginal pain. The surgical history was notable for the placement of two different mesh slings during the same procedure to treat SUI. Preoperative evaluation and findings are illustrated in detail. The video uses a high-definition surgical camera to emphasize the initial intraoperative evaluation with localization of the fistula and diverticulum. We then demonstrate the approach to the dissection with the goal of ensuring complete resection of the diverticulum, fistula, and mesh, while preserving healthy tissue for subsequent closure. The utilization of unique and specialized tools for each portion of the procedure is also illustrated. A layered vaginal closure, including a Martius flap, is created to prevent recurrence.ResultsThe surgery was accomplished without complications.ConclusionsTo our knowledge, concomitant findings of a urethral diverticulum, urethrovaginal fistula, and mesh erosion are unique in the literature. We postulate that this triad could have resulted from the mesh burden in this particular patient.

Female non-obstetric urogenital fistula repair: long-term patient-reported outcomes and a scoping literature review.

To investigate long-term and patient-reported outcomes, including sexual function, in women undergoing urogenital fistula (UGF) repair, addressing the lack of such data in Western countries, where fistulas often result from iatrogenic causes. We conducted a retrospective analysis at a tertiary referral centre (2010-2023), classifying fistulas based on World Health Organisation criteria and evaluating surgical approaches, aetiology, and characteristics. Both objective (fistula closure, reintervention rates) and subjective outcomes (validated questionnaires) were assessed. A scoping review of patient-reported outcome measures in UGF repair was also performed. The study included 50 patients: 17 (34%) underwent transvaginal and 33 (66%) transabdominal surgery. History of hysterectomy was present in 36 patients (72%). The median (interquartile range [IQR]) operating time was 130 (88-148) min. Fistula closure was achieved in 94% of cases at a median (IQR) follow-up of 50 (16-91) months and reached 100% after three redo fistula repairs. Seven patients (14%) underwent reinterventions for stress urinary incontinence after transvaginal repair (autologous fascial slings). Patient-reported outcomes showed median (IQR) scores on the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS) of 5 (3-7) for filling symptoms, 1 (0-2) for voiding symptoms and 4.5 (1-9) for incontinence symptoms. The median (IQR) score on the ICIQ Female Sexual Matters Associated with Lower Urinary Tract Symptoms Module (ICIQ-FLUTSsex) was 3 (1-5). The median (IQR) ICIQ Satisfaction (ICIQ-S) outcome score and overall satisfaction with surgery item score was 22 (18.5-23.5) and 10 (8.5-10), respectively. Higher scores indicate higher symptom burden and treatment satisfaction, respectively. Our scoping review included 1784 women, revealing mixed aetiology and methodological and aetiological heterogeneity, thus complicating cross-study comparisons. Urogenital fistula repair at a specialised centre leads to excellent outcomes and high satisfaction. Patients with urethrovaginal fistulas are at increased risk of stress urinary incontinence, possibly due to the original trauma site of the fistula.

129. Urethro-vaginal Fistula in the Setting of a Vaginal Foreign Body - Diagnosis and Treatment

129. Urethro-vaginal Fistula in the Setting of a Vaginal Foreign Body - Diagnosis and Treatment

Genitourinary Fistula: epidemiology, changing trends in etiology and management: A tertiary care institute's perspective.

Urogenital fistula is a physically, socially and psychologically devastating condition for the patient. In developed countries, these fistulae are typically related to gynecological surgery, pelvic pathology like malignancy or post radiation therapy. In contrast, classical teaching is that urogenital fistulae in the developing countries like India are usually associated with prolonged labor and obstetric complications. This retrospective study conducted at a tertiary care health Institute shows a paradigm shift in epidemiology, etiology and management of genitourinary fistulae in India in recent times. This retrospective study included patients undergoing surgical repair for various genitourinary fistulae at our institute from 2016 to 2022. Epidemiology, etiology, site, size and number of fistulae, clinical presentation, and management records of these patients were recorded and reviewed retrospectively. In our study, the mean age of the patients was 38.4 ± 10.2 years. Vesicovaginal Fistula (VVF) was found to be most common fistula in the study population (87.5%) followed by vesicouterine (7.1%) and urethrovaginal fistula (5.4%). The causes of genitourinary fistula were iatrogenic (73.2%), carcinoma of cervix (16.1%), obstructed prolonged labor (7.1%), and genitourinary tuberculosis (3.57%). Among the 48 vesicovaginal fistulas that underwent surgery, 45.8% were treated using a transvaginal approach, 29.2% were managed through a laparoscopic transabdominal repair, and 25% were addressed using a robotic approach. Recurrence occurred in 7.1% of the operated patients. Enhanced healthcare services in the country have contributed to a decrease in the incidence of obstructed labor, subsequently reducing related injuries. Iatrogenic injuries resulting from gynecological surgeries and carcinoma cervix have given rise to more complex fistulas, necessitating the implementation of advanced treatment strategies.

HEAL Africa score to predict failure of surgical repair of obstetric urethro-vaginal fistula in the Democratic Republic of the Congo

IntroductionObstetric fistula (OF) repair surgery aims to restore the anatomical and functional integrity of the urinary tract, allowing affected women to regain their dignity and quality of life. However, in some cases, this surgical repair may fail. The objective of this study was to develop a predictive score to identify factors associated with the failure of surgical repair of obstetric urethro-vaginal fistula (FSROUVF) in the Democratic Republic of the Congo (DRC).MethodsThis is an analytical cross-sectional study of 358 patients with obstetric urethro-vaginal fistula (OUVF) who received surgical repair. We conducted bivariate and multivariate analyses. Score discrimination was assessed using the receiver operating characteristic (ROC) curve, C-index, and score calibration according to the Hosmer-Lemeshow test.ResultsSurgical repair of OUVF failed in 24.86% of cases (89/358). After logistic modelling, 6 criteria predicted FSROUVF: the use of intravaginal indigenous products (AOR = 3.59; 95% CI: 1.51–8.53), the presence of fibrosis (AOR = 6.37; 95% CI: 1.70–23.82), the presence of 2 or more fistulas in the same patient (AOR = 7.03; 95% CI: 3.14–15.72), the total urethral damage (AOR = 3.29; 95% CI: 1.36–7.95), the fistula size > 3 cm (AOR = 5.65; 95% CI: 2.12–15.01), and the postoperative infection (AOR = 351.10; 95% CI: 51.15–2409.81). A score of 0 to 14 was obtained, with a value ≤5 points indicating a low risk of FSROUVF, a value between 6 and 8 indicating a moderate risk, and a value ≥9 points corresponding to a high risk of FSROUVF. The area under the ROC curve of the score is 0.938 with a sensitivity of 60.67%, a specificity of 96.28%, a positive predictive value of 84.38%, and a negative predictive value of 88.10%.ConclusionWe report a FSROUVF rate in the DRC approaching a quarter of operative patients. Predictors of failure included fibrosis, presence of 2 or more fistulas, total urethral involvement, fistula size greater than 3 cm, postoperative infection, and use of intravaginal indigenous products. These factors are constitutive of the HEAL Africa score, which once validated, may have value in pre-operative counselling of patients. This study could be valuable for policy and strategies to address the problem of OUVF in the DRC and in resource limited settings more generally.

Long-Term Bowel Vaginoplasty With a Single Yang-Monti Tube.

The bowel remains the favored tissue for neo-vaginoplasty (NeoVP) in pediatric patients with vaginal agenesis. In 2001, the first description of NeoVP using the Yang-Monti technique with a sigmoid double tubular flap was published. We present our experience of NeoVP with a single Yang-Monti tube (SYMT) flap and report on the use of different segments of colon. We conducted a retrospective review of patients who underwent NeoVP using a bowel SYMT between 2009 and 2021. The procedure was performed under open abdominal surgery by isolating 8 to 12 cm from the rectosigmoid, cecum, or ascending colon. Subsequently, this segment was detubularized near the mesenteric border, folded, and retubularized transversally, leaving the mesentery in a cephalic position. A channel was dissected in the pelvis to accommodate the NeoVP. Seventeen patients were identified. The median age was 16 years old. The principal diagnosis was Mayer-Rokitansky's syndrome (47.1%). The median follow-up was 50 months. The mean harvested bowel length was 9 cm, and the sigmoid was the preferred site (65%). The cecum-ascending colon was used in 3 (17.6%) patients. Complications were recorded in 6 patients (35%). Of these 6 patients, 4 had introital stenosis. There was 1 case of urethrovaginal fistula and another of left hematometrocolpos. Satisfactory sexual function has been reported in sexually active individuals. We described our experience in NeoVP using a large bowel SYMT as a safe and effective technique. It allows decreased tension on the vascular pedicle and the use of shorter colon segments.

Gender-affirming care in urology: emergency care of the gender-affirming surgical patient-what the primary urologist needs to know.

To present a narrative review of fundamental information needed to manage postoperative complications in patients who have undergone genital gender-affirming surgery (GAS). A narrative review was performed using the following keywords: 'gender-affirming surgery', 'complications', 'emergency', 'postoperative'. Articles were included after being reviewed by two primary authors for relevance. Four clinicians with significant experience providing both primary and ongoing urological care to patients after GAS were involved in article selection and analysis. The most common feminising genital GAS performed is a vaginoplasty. The main post-surgical complications seen by urologists include wound healing complications, voiding dysfunction, postoperative bleeding, vaginal stenosis, acute vaginal prolapse and graft loss, rectovaginal fistula, and urethrovaginal fistula. The most common masculinising genital GAS options include metoidioplasty and phalloplasty. Complications for these surgeries include urethral strictures, urethral fistulae, and urethral diverticula. Penile implants may also accompany phalloplasties and their complications include infection, erosion, migration, and mechanical failure. Genital GAS is increasing, yet there are still many barriers that individuals face not only in accessing the surgeries, but in receiving follow-up care critical for optimal outcomes. Improved education and training programmes would be helpful to identify and manage postoperative complications. Broader cultural level changes are also important to ensure a safe, gender-inclusive environment for all patients.

A case of sacrococcygeal teratoma associated with antenatally acquired urethrovaginal fistula and hydrocolpos

BackgroundSacrococcygeal teratomas (SCTs) are known to cause urological complications, but urethrovaginal (UV) fistula as a complication of SCT is rare. We herein report a case of SCT with UV fistula and hydrocolpos.Case presentationA 1-day-old female neonate presented to our department with prominent swelling in the sacrococcygeal region. She was born at 37 gestational weeks via spontaneous vaginal delivery from a 39-year-old woman. The weight of the baby was 2965 g, and her Apgar scores were 4/10 (at 1 and 5 min). An MRI examination confirmed an 11 × 11 cm Altman classification typeII SCT associated with hydrocolpos, a dilated urinary bladder, and bilateral hydronephrosis. When she was 5 days, the SCT was excised totally and a coccygectomy was performed. After the operation, as her urinary output appeared unstable, a cystoscopic examination was performed on the third postoperative day. This revealed that the UV fistula was located approximately 1 cm from the urethral opening. In addition, the proximal urethra was unobstructed and connected to the bladder. The cystoscope allowed for the passage of a urinary catheter through the urethra. After 1 month of catheter placement, she was discharged from the hospital at 57 days of age. Follow-up was uneventful, with neither urinary infection nor retention.ConclusionsSCTs are associated with not only trouble with rectal function and lower extremity movement but also urinary complications. The pathogenesis of this UV fistula is thought to be the rapid growth of the SCT that developed in the fetal period, resulting in obstruction of the urethra by the tumor and the pubic bone, which in turn caused urinary retention and the formation of a fistula as an escape route for the pressure. Because SCTs can cause a variety of complications depending on the course of the disease, careful examination and follow-up are necessary.

EP34.05: Multiple intravaginal calcifications in a patient with traumatic vaginal obstruction combined with urethrovaginal fistula

EP34.05: Multiple intravaginal calcifications in a patient with traumatic vaginal obstruction combined with urethrovaginal fistula

Blunt traumatic female urethral and bladder neck injuries: a 15-year single-institution experience.

To describe our experience in the management and outcomes of female patients with urethral or bladder neck (BN) injury at a high-volume Level 1 trauma center. A retrospective chart review of all female patients with urethral or BN injury by blunt trauma mechanism admitted to a Level 1 trauma center between 2005 and 2019 was performed. Ten patients met study criteria with median age 36.5years. All had concomitant pelvic fractures. All injuries were confirmed operatively, with no delayed diagnoses. Two patients were lost to follow up. One patient was not eligible for early repair of urethral injury and had two repairs of a urethrovaginal fistula. Two of seven (29%) patients who underwent early repair of their injury had an early Clavien grade > 2 complication, with none reporting long-term complications at median follow-up of 15.2months. Intraoperative evaluation is critical in the diagnosis of female urethral and BN injury. In our experience, acute surgical complications are not uncommon after the management of such injuries. However, there were no reported long-term complications in those patients who had prompt management of their injury. This aggressive diagnostic and surgical strategy is instrumental in attaining excellent surgical outcomes.

The Repair of an Urethrovaginal Fistula Using a Biologic Dermis Graft in Female Urologic Surgery

An urethrovaginal fistula is an abnormal connection between the urethra and the anterior vaginal wall. There are many ways to repair a urethrovaginal fistula, the most common being using a patient’s tissue to place between the urethra and the vagina. However, a patient’s tissue may be friable, causing a recurrence of the urethrovaginal fistula. This case report focuses on using a biologic graft dermis to successfully repair the urethrovaginal fistula.

A New Insight Into Ectopic Sebaceous Glands in the Vagina: A Result of Surgery?

Abstract Introduction/Objective Ectopic sebaceous glands with or without hair follicles are well documented in a variety of sites including the vulva, cervix, esophagus, and male genitalia. Ectopic sebaceous glands in the vagina, however, are extremely rare, with only 2 case reports and a third case described in a journal correspondence letter in the English literature. Methods/Case Report We present a 39-year-old patient with Laurence-Moon-Biedl syndrome with pseudotumor cerebri, retinitis pigmentosa/macular degeneration, chronic kidney disease status post renal transplant, obesity, diabetes insipidus, and a urethrovaginal fistula and hypoplastic vagina status post repair and vaginoplasty at age 3 months. High grade squamous intraepithelial lesion on a cervicovaginal Pap test prompted colposcopy, during which a confluent plaque non-staining with Lugol’s solution was noted on the right vaginal sidewall extending from the introitus to 4 cm distal to the cervix. Biopsy of this area revealed hyper- and parakeratosis along with sebaceous glands and hair follicles in the subepithelial stroma. Two theories are proposed in the literature regarding the origin of vaginal ectopic sebaceous glands/cutaneous adnexal structures. The first is a developmental anomaly with aberrant differentiation in-utero, as the lower two thirds of the vagina is normally endodermal in origin and the upper one third is derived from mesoderm, while cutaneous adnexal structures are ectodermal in origin. The second postulates sebaceous glands in the vagina arise from a metaplastic process after prolonged irritation or inflammation. We add a third possibility in this patient, that vaginal plastic surgery performed at 3 months of age involved tissue re- arrangement or grafting which introduced ectodermal structures to the vagina. The patient’s vaginal surgical records were not available for review. Results (if a Case Study enter NA) NA. Conclusion We add a fourth case of ectopic cutaneous adnexal structures in the vagina in a patient with Laurence-Moon-Biedl syndrome to the literature. The origin of these structures may have resulted from vaginal surgery as an infant rather than from a developmental anomaly or metaplasia.

A Rare Case of Herlyn Werner Wunderlich Syndrome (HWWS) with Urethrovaginal Fistula

Herlyn Werner Wunderlich Syndrome (HWW) is a rare congenital malformation of female urogenital tracts. We report our first case of HWWS with urethrovaginal fistula in Lady Aitchison Hospital Lahore. A 27 years old lady presented with hematuria and urinary retention having single opening at vulva with menstrual blood and urine draining through it. Examination under anesthesia showed uretheral opening in anterior wall of lower 1/3 of vagina.MRI showed uterus didelphus with two cervices and vagina (atresia of lower 2/3 on left side) and absent left kidney.Surginal treatment by creating a separate opening of neourethra was made by Urology Department of Mayo Hospital. Keywords: Herlyn Werner Wunderlich syndrome, urethrovaginal fistula, urogenital tract

Urogenital Fistula Patients Profile at a Tertiary Hospital in Surabaya, Indonesia from 2015 to 2021

Highlights: Vesicovaginal fistula is the most common urogenital fistula. The transvaginal approach is preferred in treating urogenital fistula. Abstract: A fistula is an extra-anatomical channel between two or more hollow organs, or between an organ and the body surface. WHO estimated there were two million patients with untreated urogenital fistula, with 130,000 new cases every year. The ideal approach for urogenital fistula depends on surgeon preference and individual clinical characteristics. Accordingly, we aimed to determine the profile of patients with a urogenital fistula at a tertiary hospital of Dr. Soetomo General Academic Hospital in Surabaya, Indonesia, from 2015 to 2021. A retrospective study with a descriptive design was carried out by medical records data retrieval of patients with urogenital fistula. It included age, etiology, anatomical location, surgical management, and recurrence rate. The study population consisted of 55 patients. The majority of the patients were among the 41-50 y.o. age groups (41.17%), while the least were in the <20 years group (1.96%). History of obstructed labor was the most common etiology (70.59%). Fistulas in the study population were also associated with a history of trauma (15.68%) and malignancy (11.76%). The vesicovaginal fistula was the most common type of fistula (88.23%). Other types found include urethrovaginal, ureterovaginal, rectovesical, rectovaginal, and vesicocolon fistulas. The transvaginal approach was preferred in almost all study populations. A total of two cases of vesicovaginal fistula recurred (3.39%). In general, patients with urogenital fistula are prevalent in the 4th decade age group, with the most common etiology being a history of obstructed labor. Transvaginal surgery is the treatment of choice with good results and low recurrence rates.

Complications of Suburethral Sling in the form of Mini Vaginal Tape (MVT): A Case Report

Synthetic mid-urethral sling has become the most widely used technique for the surgical treatment of stress urinary incontinence. Despite its higher success rate significant complications have been reported including- migration, encrustation, and vesico-urethral fistula formation by a mid-urethral sling (MUS). Following the mid-urethral sling procedure, periurethral stone and urethrovaginal fistula formation are very uncommon. After an online search, we could not find any reported case of migration, encrustation and vesico-urethral fistula formation by mid-urethral sling (MUS). In this case a 55 years female presented with lower abdominal pain and incontinence, 10 years after mid-urethral sling procedure in the form of mini vaginal tape (MVT). We successfully removed the stone formed by encrustation of the displaced sling and repaired the fistula. Following the sling procedure, patients need long term follow up. Although rare, a high degree of suspicion is mandatory for diagnosis and management of complications. Bangladesh J. Urol. 2021; 24(2): 232-234

“Labia Majora Fasciocutaneous Flap Reconstruction in Complex Urogynecological Fistulas With Vaginal Deficit - A Versatile Approach”

ObjectiveTo appraise the pivotal points of different modifications of labia majora fasciocutaneous flap in combating the challenges of complex urogynecological fistula repair in the form of 7 cases. MethodsSeven patients with complex urogynecological fistulas with vaginal deficit were treated over last 3 years. The challenges associated with them were non-capacious rigid vagina, irradiated and inflamed surrounding tissues, inelasticity, long-standing fistula with radiation-induced vesicovaginal fistula(VVF), an iatrogenic urethrovaginal fistula with anterior vaginal wall loss with vaginal stenosis, and a case of vesicolabial fistula with a history of forceps delivery and transvaginal VVF repair. Transvaginal repair with labia majora fasciocutaneous flap along with fat pad with relevant technical modifications was contemplated in all. ResultsAll radiation-induced VVF patients demonstrated no leak in the postoperative period barring one who became dry after transvaginal colpocleisis later. The patient with urethrovaginal fistula and vaginal stenosis was continent, had capacious vagina, and without any leak with regular menstrual periods. The female with vesicolabial fistula remained dry at the end of 6-month follow-up. ConclusionTransvaginal repair using the labia majora fasciocutaneous flap and the demonstrated technical modifications can be a feasible option in repairing complex urogynaecological fistulas associated with vaginal wall deficit.

V06-06 ROBOTIC ARTIFICIAL URINARY SPHINCTER EXPLANTATION AND CONCOMITANT FASCIAL SING INSERTION IN CASE OF BLADDER NECK CUFF EXTRUSION FOR FEMALE PATIENTS

You have accessJournal of UrologyCME1 May 2022V06-06 ROBOTIC ARTIFICIAL URINARY SPHINCTER EXPLANTATION AND CONCOMITANT FASCIAL SING INSERTION IN CASE OF BLADDER NECK CUFF EXTRUSION FOR FEMALE PATIENTS Camille Haudebert, Juliette Hascoet, Lucas Freton, Claire Richard, Karim Bensalah, Gregory Verhoest, Zine Eddine Khene, Romain Mathieu, Andrea Manunta, and Benoit Peyronnet Camille HaudebertCamille Haudebert More articles by this author , Juliette HascoetJuliette Hascoet More articles by this author , Lucas FretonLucas Freton More articles by this author , Claire RichardClaire Richard More articles by this author , Karim BensalahKarim Bensalah More articles by this author , Gregory VerhoestGregory Verhoest More articles by this author , Zine Eddine KheneZine Eddine Khene More articles by this author , Romain MathieuRomain Mathieu More articles by this author , Andrea ManuntaAndrea Manunta More articles by this author , and Benoit PeyronnetBenoit Peyronnet More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002586.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Female stress urinary incontinence (SUI) is highly prevalent. Artificial urinary sphincter is an option for severe or complex female SUI cases. In case of bladder neck cuff extrusion, AUS explantation is required and further SUI treatment can be challenging. In the present video, we report and describe a new surgical technique aiming both to treat AUS bladder neck extrusion and to prevent recurrence of SUI. METHODS: We present the case of a 43-year-old female patient with a history of urethrovaginal fistula. After the repair with a Martius flap interposition she reported severe SUI. She reported SUI with 350 g on 24h pad weigh test, massive leakage on cough stress test with a fixed urethra. She underwent robotic AUS implantation with complete resolution of SUI. Six months after, she had a recurrence of the SUI and urethral pain. Bladder neck extrusion of the AUS cuff was diagnosed on cystoscopy. A robotic AUS explantation was planned. We offered to place a fascial sling at the bladder neck during the explantation to minimize the risk of SUI and urethrovaginal fistula recurrence. RESULTS: Five ports are placed. The bladder is dropped down from the abdominal wall. Opening the fibrotic tissue surrounding the bladder neck, the cuff is found, dissected and opened. The anterior aspect of the bladder is opened longitudinally to repair the bladder neck defect transvesically. The edges of the bladder incision are sutured on each side to the abdominal wall to improve the transvesical bladder neck exposure. The inflammatory/necrotic tissues surrounding the extrusion orifice are excised. The orifice is then closed transversally in two layers (detrusor and mucosa individually) using interrupted 4/0 Vicryl suturesWe harvest a 10x1.5 cm rectus fascial sling. The fascial sling is inserted in the abdomen and placed around the bladder neck. The sling is pulled towards the rectus fascia using two permanent 2/0 monofilament stitches inserted into the abdomen with a Reverdun needle and placed at each end of the sling. We tightened the sling above the rectus fascia moderately. The operative time was 280 minutes. There was no postoperative complications. The urethral catheter was removed at day 15 and the patient resumed spontaneous voiding. CONCLUSIONS: Robotic artificial urinary sphincter explantation and concomitant fascial sing insertion in case of bladder neck cuff extrusion appears feasible and may be an interesting salvage option to prevent SUI recurrence and avoid further anti-incontinence surgical procedures likely to be highly challenging. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e566 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Camille Haudebert More articles by this author Juliette Hascoet More articles by this author Lucas Freton More articles by this author Claire Richard More articles by this author Karim Bensalah More articles by this author Gregory Verhoest More articles by this author Zine Eddine Khene More articles by this author Romain Mathieu More articles by this author Andrea Manunta More articles by this author Benoit Peyronnet More articles by this author Expand All Advertisement PDF DownloadLoading ...

Complications of the suburethral sling in the form of Mini Vaginal Tape (MVT): A case report.

Synthetic sub-urethral sling has become the most widely used technique for the surgical management of stress urinary incontinence. Despite a higher success rate, complications like migration, encrustation, and stone formation have been reported by a mid-urethral sling (MUS). Among mid-urethral sling procedures, mini vaginal tape (MVT) is very popular. As periurethral stone formation and urethrovaginal fistula are very uncommon after MVT, case report on this issue is sparse. The current case report features a 55-year female presented with lower abdominal pain and continuous urinary incontinence, 10 years after the MVT. She was diagnosed as a case of periurethral stone with urinary incontinence due to urethro-vaginal fistula. Our surgical team successfully removed the stone formed by the encrustation of the displaced tape and repaired the fistula. Following the MVT, a high degree of suspicion and long-term follow-up is mandatory for the diagnosis and management of these rare complications.