Repair Of Urethrovaginal Fistula Research Articles

Urethrovaginal fistula repair with or without concurrent fascial sling placement: A retrospective review.

We sought to review outcomes of urethrovaginal fistula (UVF) repair, with or without concurrent fascial sling placement. All patients diagnosed with UVF at our center from 1988-2017 were included in this study. Patient charts were reviewed from a prospectively kept fistula database, and patient characteristics and surgical outcomes were described. Descriptive statistics were applied to compare complication rates between patients with or without fascial sling placement at the time of UVF repair. A total of 41 cases of UVF were identified, all of which underwent surgical repair. Median age at diagnosis was 49 years (interquartile range [IQR] 35-62). All patients had undergone pelvic surgery. UVF etiology was secondary to stress urinary incontinence (SUI) surgery in 17 patients (41%) and urethral diverticulum repair in seven patients (17%). The most common presenting symptom was continuous incontinence in 19 patients (46%). Nineteen patients had a fascial sling placed at the time of surgery (46%), with no significant difference in complication rates (26% vs. 23%, p=0.79). Two patients had Clavien-Dindo grade I complications (5%) and one had a grade III complication (2%). Four patients had long-term complications (10%), including urinary retention, chronic pain, and urethral stricture. Two patients had UVF recurrence (5%). Median followup after surgery was 21 months (IQR 4-72). UVF should be suspected in patients with continuous incontinence following a surgical procedure. Most UVF surgical repairs are successful and can be done with concurrent placement of a fascial sling.

Primary menouria due to a congenital Urethrovaginal fistulawith vaginal agenesis

Case: A female aged 22 years, suffering from cyclical menouria since age of 12 years presented to our clinic with concerns for future sexuality and fertility. Clinical examination revealed the absence of a vagina, although labia minora and majora were adequately developed. Secondary sexual growth such as axillary and pubic hair, breast development was normal. Micturating cystogram shows abnormal fistulous communication between the posterior urethra and upper vagina with contrast outlining the uterine cavity. Magnetic resonance imaging revealed functioning left kidney along with vaginal agenesis and an abnormal communication between uterus and urethra. The surgical treatment included urethrovaginal fistula repair and pull through vaginoplasty. The patient was asymptomatic till her last visit
 Conclusions: In this case, the diagnosis of congenital urethrovaginal fistula was delayed until adulthood despite menouria. This is a rare case report and to our best of literature search .we could not find any such case report.

16: Urethrovaginal fistula repair and Martius flap dissection

16: Urethrovaginal fistula repair and Martius flap dissection

MP36-10 URETHROVAGINAL FISTULA REPAIR: LONG-TERM OUTCOMES

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) I1 Apr 2017MP36-10 URETHROVAGINAL FISTULA REPAIR: LONG-TERM OUTCOMES Sender Herschorn Sender HerschornSender Herschorn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1121AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urethrovaginal fistula (UVF) is not highly prevalent in urologic practice but merits attention. There are few large published series. This is a review of management of all patients that have been treated over a 30-year period at our institution to assess etiology, operative management, and outcomes. METHODS Between 1986 and 2016, a total of 36 UVFs were repaired. Retrospective review recorded presentation, history, etiology, surgical approach, and results. Long-term lower urinary tract symptoms (LUTS) were noted. All UVFs were closed in 3 or more layers. A variety of flaps were used as needed. A suprapubic or foley catheter was left indwelling for 3-4 weeks and healing was assessed by cystourethrogram. RESULTS Mean patient age was 49.2 (range 21-81). 13 (36%) were long-time smokers. 8 patients had a history of urethral diverticulum and 3 had previously treated pelvic malignancies. All patients had prior pelvic surgery. The most common etiology was an incontinence procedure in 13 patients (36%) with mesh erosion in 6 of these. Other causes were urethral diverticulum repair in 7 (19.4%), forceps delivery in 5 (14%), self-intermittent catheterization in 3 (8%), cystectomy and neobladder in 2 (6%), and other vaginal procedures in 6 (17%). Incontinence was the primary complaint in 33 women and the diagnosis was made on cystoscopy in 34. Thirty-four (94%) were closed via transvaginal approach including 15 with simultaneous rectus fascia pubovaginal slings harvested through an abdominal incision. Two were approached transabdominally, and 1 was closed with a combined abdominal and vaginal approach. Thirteen repairs were done with flaps including Martius in 11 and omentum in 2. Mean hospital stay was 3.9 days (range 0.5-10). The overall repair success rate was 34/36 (94%). Mean follow-up time was 41.2 months (range 0.8-207.33). Long-term LUTS included frequency in 11 patients (31%), urgency in 10 (28%), urgency incontinence in 9 (25%), and stress incontinence in 6 (17%). Foley catheter drainage replaced suprapubic drainage in the past 10 years but did not change outcomes. Two recurrences (1 neobladder and 1 post-ileocystoplasty) occurred immediately and underwent continent diversion. CONCLUSIONS UVFs usually result from a surgical complication. Smoking may be a risk factor. Management techniques that optimized outcomes included multi-layer closure usually with flaps and/or rectus fascial sling, extended catheter drainage, and tailoring the repair to the problem. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e469 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Sender Herschorn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Concomitant repair of stress urinary incontinence with proximal urethrovaginal fistula: Our experience.

Introduction:Proximal urethrovaginal fistula (UVF) located close to the bladder neck may cause extensive sphincter damage and is usually associated with continuous incontinence, which may mask the associated stress urinary incontinence (SUI). Simultaneous correction of SUI avoids a second surgery for SUI, which needs dissection in ischemic fields and carries a high risk of failure. The aim of this study is to describe our technique of concomitant repair of SUI with proximal UVF and our results.Methods:Between July 2010 and August 2014, 14 patients underwent UVF repair in Jackknife position by the interposition of a Martius flap and simultaneous correction of SUI by modified McGuire pubovaginal autologous fascial sling. The procedure was carried out a minimum of 3 months of presentation and after detailed preoperative evaluation.Results:After a mean follow-up of 28 months, all 14 patients were continent. None of the patients developed recurrence of the UVF. Two patients presented with retention immediately after catheter removal and clean intermittent catheterization training was given to both of them. Two patients became pregnant during the follow-up period and were advised cesarean section near term.Conclusions:Repair of proximal UVF and correction of SUI can be performed in the same session to avoid the operation in an ischemic field.

Long-term functional outcomes following non-radiated urethrovaginal fistula repair.

To review long-term functional outcomes after urethrovaginal fistula (UVF) repair. Following IRB approval, women who underwent transvaginal non-irradiated UVF repair with minimum 6-month follow-up were reviewed. Surgical outcomes were assessed by validated questionnaires: UDI-6, IIQ-7, FSFI and visual analogue scale for QoL. Two groups were compared: (1) synthetic sling-related versus (2) non-sling-related UVF. Descriptive statistics were applied with p < 0.05 for significance. From 1996 to 2013, 18 patients underwent UVF repair, with a mean age of 46 years (range 20-66), BMI 29 (range 21-42) and mean follow-up at 52 months (range 9-142). Overall repair success rate was 95%. Prior failed UVF repair was recorded in 11 women (61%). Statistical differences noted for Q4: 1.9 versus 0.8 (p = 0.03) and Q5: 1.3 versus 0 (p = 0.02) and VAS between the two groups, favoring the non-sling group; 1.5 (0.6) versus 5 (4) (p = 0.05). No differences in IIQ-7 were noted between the two groups (p = 0.09). Of the 18 patients, 5 remained sexually active and of those, 2 responded to FSFI (40%) with low scores. Reoperation rate was 33% (6 women) with 3 requiring periurethral-bulking agent for recurrent SUI, 2 transurethral laser for residual urethral sling mesh strands and 1 urethral dilation. This large contemporary series of non-radiated UVF indicates a satisfactory outcome in UVF closure repair at a mean 4- to 5-year long-term follow-up, with the synthetic sling-related group performing worse.

MP81-15 LONG-TERM OUTCOME OF URETHROVAGINAL FISTULA REPAIR

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology1 Apr 2015MP81-15 LONG-TERM OUTCOME OF URETHROVAGINAL FISTULA REPAIR Dominic Lee and Philippe Zimmern Dominic LeeDominic Lee More articles by this author and Philippe ZimmernPhilippe Zimmern More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2893AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To review long-term functional outcomes after urethro-vaginal fistula (UVF) repair. METHODS Following IRB approval, the charts of women who underwent transvaginal non-irradiated UVF repair with minimum 6 months follow-up were reviewed. Extracted data included demographics, etiology, prior repairs, surgical UVF repair procedure, secondary interventions, and functional outcomes. Surgical outcomes were assessed by validated questionnaires; Urogenital distress inventory (UDI-6), Impact on Incontinence questionnaire (IIQ-7), Female sexual function index (FSFI) and Visual analogue scale for QoL. Two groups were compared: (1) synthetic sling related versus (2) non-sling related UVF. Descriptive statistics were applied with p< 0.05 for significance. RESULTS From 1996 to 2013, 18 patients underwent UVF repair. Mean age was 46 years (range 20-66), with BMI 29 (range 21-42), and mean follow-up at 52 months (range 9 -142). Overall repair success rate was 95%. One recurrence occurred in a renal transplant woman on immunosuppressant who eventually required a cystectomy and ileal conduit. Size of UVF defect was from 1 mm to 2 cm. Prior failed UVF repair was recorded in 11 women (61%). Of the 18 women, one had primary repair without tissue interposition while 17 had Martius fat pad graft (MFPG)(2), autologous pubovaginal sling (PVS) (11), or both (4). As shown in Table 1, there was no statistical difference in UDI-6 outcomes between the 2 groups for Q2 and Q3, but statistical difference noted for Q4: 1.9 vs. 0.8 (p=0.03) and Q5: 1.3 vs. 0 (p=0.02). No differences in IIQ-7 were noted between the 2 groups (p=0.14). Of the 18 patients, 4 remained sexually active and of those, 2 responded to FSFI (50%) with low scores. Reoperation rate was 33% (6 women) with 3 requiring bulking agent for recurrent SUI, 2 transurethral laser for residual urethral sling mesh strands, and 1 urethral dilation. CONCLUSIONS This large contemporary series of non-radiated UVF indicates a satisfactory outcome in UVF closure repair at a mean 4-5 years long-term follow-up, with the synthetic sling related group performing worse. Table 1. Outcomes following Urethrovaginal Fistula (UVF) repair UVF repair Sling (n=9)/SD Non sling (n=9)/SD Total (n=18)/SD p-value Age (mean) 50/13 42/14 46/14 BMI (mean) 28/5.5 34/12 29/7 Gravida 2/1 2/1 2/1.3 Para 2/1 2/1 2/1 Sling type RP* 5 TOT** 2 SISˆ 2 Length of follow up (mean) 50/55 53/45 51/50 Anatomical closure (%) 9 (100) 8 (89) 17 (95) UDI-6 (%) 8 (89) 4 (44) 12 (67) Q1. Frequency 1.4 (1.2) 0.5 (1) 1.1 (1.2) 0.24 Q2. Urge Leak 1.8 (1) 0.8 (1) 1.4 (1) 0.1 Q3. Stress Leak 1.3 (1.3) 0.5 (0.6) 1 (1.1) 0.3 Q4. Small Leak 1.9 (1) 0.8 (0.5) 1.5 (1) 0.03 Q5. Emptying difficulty 1.3(1.2) 0 (0) 0.02 Q6. Pain 0.9 (1.4) 0.3 (0.5) 0.7 (1.1) 0.4 Total 7.4 (5.4) 4.5 (2.1) 6.8 (5) 0.5 IIQ-7 7.7 (11) 1 (1) 5.7 (9.2) 0.14 Visual Analog Scale 4.8 (4) 1.5 (0.6) 3.7 (3.6) 0.05 Sexual Activity No (%) 10 (66) Unknown (%) 4(22) Yes (%) 2 (22) - 4(22) RP*= retropubic, TOT**= transobturator tape, SISˆ= single incision sling © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1034-e1035 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dominic Lee More articles by this author Philippe Zimmern More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Biologic grafted repair of urethrovaginal fistula and concomitant synthetic sling

The utilization of a biologic graft interposition allows for a successful fistula repair and concomitant synthetic sling without an increase in complications.

Martius flap and anterior vaginal wall sling for correction of urethrovaginal fistula (UVF) associated with stress urinary incontinence (SUI) after vaginal delivery

To determine the efficacy, safety and urodynamic effects of the Martius flap and the anterior vaginal wall sling in treating post-birth trauma in the form of urethra-vaginal fistula (UVF) associated with stress urinary incontinence (SUI). Between July 2006 and August 2011, 19 patients underwent repair of UVF by interposition of a Martius flap and correction of associated SUI by a modified anterior vaginal wall sling. The procedure was carried out 3–17 (mean 7) months after post-birth trauma. Pre-operative evaluation consisted of history, voiding diary, physical examination, routine laboratory work-up, abdominopelvic ultrasonography, intravenous urography (IVU), and cystourethrography. The patients were followed up for a mean of 34 months. Follow-up included history, physical examination, urine analysis and pelvic ultrasonography for the assessment of residual urine. Urodynamic evaluation was performed at 3 months post-operatively. None of the patients developed recurrence of UVF. SUI was corrected in 16 patients (84%). In the post-operative period, 3 patients (16%) complained of an overactive bladder (OAB) with urodynamic detrusor overactivity (DO) and an obstructed flow. These problems were managed successfully using anticholinergics and urethral dilation. Three patients (16%) complained of mild SUI, but refused further management. Within 3 years following the intervention, 3 patients complained of a recurrence of SUI which was managed successfully by a rectus sheath sling. Patients with a post-birth trauma in the form of UVF should be examined intra-operatively for the presence of associated SUI following correction of UVF. The use of the Martius flap and anterior vaginal wall sling in treating such patients is safe, efficient and reproducible. An anterior vaginal wall sling should be avoided in distal UVF to avoid recurrence of SUI.

Retrospective cohort study on patterns of care and outcomes of surgical treatment for lower urinary–genital tract fistula among English National Health Service hospitals between 2000 and 2009

To examine patterns of care among women with urogenital fistula treated in the English National Health Service (NHS) between 2000 and 2009. To assess whether failure of repair was associated with hospital or surgeon workload. We conducted a retrospective cohort study using data from Hospital Episode Statistics on women undergoing vesicovaginal or urethrovaginal fistula repair between January 2000 and December 2009 in English NHS hospitals. The main outcome measure was the number of fistula repairs and the incidence of re-repair; re-repair rates were stratified by age, NHS trust and consultant team volume. Between 2000 and 2009, 1194 women underwent surgical repair (n = 905) or ileal conduit (n = 289) for urogenital fistula under the care of 490 consultant teams. A total of 281 teams performed only a single index procedure, and only three consultant teams performed a mean of >3 per year. The rate of unsuccessful repair was 11.9% (108/905). The rate of re-operation at NHS trusts who performed over 30 procedures over the 10-year study period was 7.4% compared with 13.2% at those undertaking fewer (P = 0.02). A similar difference in re-operations between consultant teams performing > or <30 procedures did not reach significance (8.4% v 12.7%, P = 0.13). One in nine women required re-operation after surgical repair of a urogenital fistula. Our results lend weight to the argument for a 'minimum workload' for fistula management; given the number of fistulae occurring in England currently, this would best be provided by a network of supra-regional centres.

Biologic Grafted Repair of Urethrovaginal Fistula and Concomitant Synthetic Sling

Biologic Grafted Repair of Urethrovaginal Fistula and Concomitant Synthetic Sling

Primary vaginal calculus secondary to urethrovaginal fistula with imperforate hymen in a 6-year-old girl

Primary vaginal stones are extremely rare in children and may be mistaken for bladder calculi on plain radiography. We present a case of a large vaginal calculus in a 6-year-old girl who had an imperforate hymen and urethrovaginal fistula. Hymenotomy and urethrovaginal fistula repair were performed, and the vaginal stone was extracted. It was postulated that the vaginal calculus originated from stasis of urine through the urethrovaginal fistula in the obstructed vagina. This is a unique case of a vaginal calculus with a congenital urethrovaginal fistula associated with an imperforate hymen.

A tertiary experience of vesico–vaginal and urethro–vaginal fistula repair: factors predicting success

A tertiary experience of vesico–vaginal and urethro–vaginal fistula repair: factors predicting success

Fascial patch technique for repair of complicated urethrovaginal fistula

Introduction The operative repair of urethrovaginal fistula due to tension-free vaginal tape (TVT) erosion is a challenging task, and coexisting stress urinary incontinence may complicate the situation even further. We present our technique for the repair of recurrent urethrovaginal fistula combined with stress urinary incontinence, occurring after previous removal of an eroded TVT and failed repair of the fistula. Technical Considerations With the patient in the dorsal lithotomy position, an inverted U-shaped incision was cut in the anterior vaginal wall, and a vaginal flap was developed. The Martius flap from the previous repair was identified and separated from the urethra, thereby disclosing a large fistula hole on the left side of the mid-urethra. Because the periurethral tissues were very friable and attenuated, only one-layer closure of the fistula hole with these tissues was feasible. Therefore, we opted to combine a pubovaginal fascial sling with a fascial patch graft, used to reinforce the fistula site. Through a low transverse abdominal incision, a 15 × 2-cm strip of rectus fascia was harvested. A 2 × 2-cm patch of fascia was excised from the strip and transfixed to the periurethral tissues, covering the sutured fistula site. The Martius flap was repositioned over the flap, and a pubovaginal sling procedure was done. The postoperative course was uneventful, the fistula has healed, and the patient regained full continence. Conclusions This technique can be used in complicated urethrovaginal fistula repair when the surrounding periurethral tissues have been devastated and can be combined with pubovaginal fascial sling placement.

The management of old urethral injury in young girls: analysis of 44 cases

Background/purpose: Traumatic urethral injury in girls is rare, and there is no consensus on its management. The authors report their 22-year experience. Methods: Forty girls presented with urethrovaginal fistula. Twenty-six girls presented with cystostomy tube in place, whereas 17 girls presented with complete urinary incontinence. Incision and dilatation of the obliterated urethra was carried out in 7 patients. Vaginal repair of urethrovaginal fistula was performed in 4 patients. Transpubic reconstruction of the urethra using a modified Young-Dees-Leadbetter procedure with simultaneous repair of the urethrovaginal fistula was performed in 35 patients (once in 27, twice in 5, and 3 times in 3 patients). Results: Follow-up in 40 girls averaged 3.5 years. Twenty-nine patients have regained normal urinary control, and 11 patients have mild stress urinary incontinence. Four patients were lost to follow-up. Conclusions: Simple dilation of the obliterated urethra can reestablish satisfactory urethral patency if the obliterated segment is short. The vaginal approach to urethrovaginal fistula may be successful in patients without concomitant urethral stricture or in those with stricture amenable to simple dilation. The transpubic approach remains the method of choice for repairing complete urethral disruption and severe urethral stricture, especially when associated with urethrovaginal fistula.

Complications associated with surgical repair of urethrovaginal fistula

We present 4 patients seen in the last five years with urethrovaginal fistulas involving the mid or proximal urethra. Our experience in the transvaginal repair of these fistulas has been disappointing. The best chance for the development of a functioning continent urethra is by suprapubic bladder flap technique or bladder tube replacement with suprapubic urinary diversion. We suggest that no urethral catheter be placed. Complications following surgical repair have been fistula recurrence, urethral shortening and retraction, persistent reflux, bladder calculi, and bladder cancer.

Pregnancy In An Untreated Case of Tranverse Vaginal Septum with Urethrovaginal Fistula: A Case Report and Review of the Literature

A 17 years old married woman presented at 24 weeks pregnancy with absent foetal movement for 12 days. She was found to have transverse vaginal septum in the lower third of her vagina with urethro-vaginal fistula (UVF) and a dead foetus of approximately 24 weeks gestation. She underwent hysterotomy for the delivery of the dead foetus. Two and half months later the transverse vaginal septum was removed with repair of urethro-vaginal fistula. Bangladesh J Obstet Gynaecol, 2009; Vol. 24(2) : 71-74 DOI: http://dx.doi.org/10.3329/bjog.v24i2.8532