Vesicovaginal Fistula Research Articles

MP42-18 ROBOT-ASSISTED VESICO-VAGINAL FISTULA REPAIR: COMPARISON OF THE EXTRAVESICAL AND TRANSVESICAL TECHNIQUES

You have accessJournal of UrologyCME1 Apr 2023MP42-18 ROBOT-ASSISTED VESICO-VAGINAL FISTULA REPAIR: COMPARISON OF THE EXTRAVESICAL AND TRANSVESICAL TECHNIQUES Pierre Lecoanet, Thibault Tricard, Anne Mauger De Varennes, Camille Haudebert, Juliette Hascoet, Nicolas Hubert, Imad Bentellis, Branwell Tibi, Christian Saussine, Jacques Hubert, and Benoit Peyronnet Pierre LecoanetPierre Lecoanet More articles by this author , Thibault TricardThibault Tricard More articles by this author , Anne Mauger De VarennesAnne Mauger De Varennes More articles by this author , Camille HaudebertCamille Haudebert More articles by this author , Juliette HascoetJuliette Hascoet More articles by this author , Nicolas HubertNicolas Hubert More articles by this author , Imad BentellisImad Bentellis More articles by this author , Branwell TibiBranwell Tibi More articles by this author , Christian SaussineChristian Saussine More articles by this author , Jacques HubertJacques Hubert More articles by this author , and Benoit PeyronnetBenoit Peyronnet More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003280.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic vesico-vaginal fistula repair (R-VVF) was described in 2004 with the aim to minimize the morbidity of the abdominal VVF repair. Almost two decades later, the literature on r-VVF remains scant. The objective of this study was to evaluate the results of R-VVF repaisr and to report complications. METHODS: The charts of all female patients who underwent a R-VVF from March 2007 to December 2021 at four academic institutions were reviewed retrospectively. All surgeons involved had already a robust robotic surgery experience at the beginning experience (>50 cases) but limited experience with VVF repair. All abdominal VVF repair over the study period were performed using a robotic approach. All centers used a vaginal approach in case of easily accessible vaginal fistulous orifice. The decision to use a vaginal or an abdominal approach was not standardized across centers and left at the surgeons’ discretion. The patients’ characteristics, the surgical technique details (iflap interposition vs. not, transvesical versus extravesical approach, excision of fistulous tract vs not) and peri-operative outcomes were recorded. The success of VVF-R was defined as the absence of clinical recurrence. The outcomes of the extravesical vs transvesical techniques were compared. RESULTS: Twenty-two patients were included over the study period. The median age was 43 years (IQR 38-50). The causes of VVF-R were either post-surgical (77.3%), post-obstetrical (18.2%) or post-trauma (4.5%). Fistulas were supratrigonal and trigonal in 18 and 4 cases respectively. The fistulous tract was systematically excised and an interposition flap was used all but two cases (90.9%%). The transvesical and extravesical techniques were used in 13 and 9 cases respectively. The patient andfistula’s characteristics are presented in Table 1. There were more supratrigonal fistula in the extravesical group (100% vs. 69.2%; p=0.11). One intraoperative complication occurred in the extravesical group: an ureteral injury which was immediately sutured (11.1% vs. 0%; p=0.41). The operative time tended to be shorter in the extravesical group (179 vs. 229 minutes; p=0.13). There were only three postoperative complications, all minor: one gross hematuria in the extravesical group (Clavien grade 1), one hematoma requiring blood transfusion and one pyelonephritis in the transvesical group (both Clavien grade 2) (11.1% vs. 15.4%; p=0.99). The length f hospital stay did not differ significantly between the to groups (5.1 vs. 4.1 dys; p=0.56). None of the patients had vesico-vaginal fistula recurrence after a median follow-up of 14 months (IQR 3-21). CONCLUSIONS: The present series, one of the largest R-VVF reported to date, is consistent with the few series already published with a 100% cure rate and excellent perioperative outcomes. Systematic excision of the fistulous tract and the high rate of flap interposition may explain the high success rate. The transvesical and extravesical approach yielded similar outcomes but the transvesical approach may allow to treat more complex fistulas (e.g. infratrigonal). Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e575 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pierre Lecoanet More articles by this author Thibault Tricard More articles by this author Anne Mauger De Varennes More articles by this author Camille Haudebert More articles by this author Juliette Hascoet More articles by this author Nicolas Hubert More articles by this author Imad Bentellis More articles by this author Branwell Tibi More articles by this author Christian Saussine More articles by this author Jacques Hubert More articles by this author Benoit Peyronnet More articles by this author Expand All Advertisement PDF downloadLoading ...

MP68-12 OUR EARLY CLINICAL EXPERIENCE WITH MANTRA TM MULTI ARM SURGICAL ROBOTIC SYSTEM (SS INNOVATIONS GROUP COMPANY) IN MAJOR URO-ONCOLOGICAL SURGERIES

You have accessJournal of UrologyCME1 Apr 2023MP68-12 OUR EARLY CLINICAL EXPERIENCE WITH MANTRATM MULTI ARM SURGICAL ROBOTIC SYSTEM (SS INNOVATIONS GROUP COMPANY) IN MAJOR URO-ONCOLOGICAL SURGERIES Amitabh Singh, Ashish Khanna, Sarbartha Kumar Pratihar, Vivek Vasudev, Nikhil Saurabh, and Sudhir Rawal Amitabh SinghAmitabh Singh More articles by this author , Ashish KhannaAshish Khanna More articles by this author , Sarbartha Kumar PratiharSarbartha Kumar Pratihar More articles by this author , Vivek VasudevVivek Vasudev More articles by this author , Nikhil SaurabhNikhil Saurabh More articles by this author , and Sudhir RawalSudhir Rawal More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003331.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: SSI MantraTM is a new addition to the arsenal of robotics systems in India for clinical usage. Here, we provide the initial outcomes of patients undergoing different types of major uro-oncological procedures. METHODS: A total of 32 patients affected by various urological conditions like prostate cancer, renal cancer, bladder cancer, and vesicovaginal fistula underwent treatment with SSI MantraTM system. Study was approved by institutional board (IRB No- 765/SO/SKR-35). Clinical use of MantraTM was registered with national clinical trial registry (CTRI/2020/11/029053). This system has four independent Arms which are docked. Demography of patient and clinical outcome like docking time, console time, total operative time, complications like bleeding, bowel injury, urinary incontinence, conversion to open, total hospital stay and perioperative outcomes were reported. RESULTS: A total of thirty–two patients were included in this study. This includes radical prostatectomy (n=15), radical cystectomy with ileal conduit (n=6), radical cystectomy with neo-bladder(n=4), radical nephrectomy (n=3), partial nephrectomy (n=2), partial cystectomy (n=1) and vesico-vaginal fistula repair (n=1). Mean age, BMI, ASA, draping time, patients positioning time, arm cart positioning, docking time, surgeon console time, total surgery time, undock time of radical prostatectomy and radical cystectomy patient was 66.1 vs 57.3 yrs , 26.1 vs 22.3, 3.3 vs 2.66, 19.3 vs 13.4 mins, 3.2 vs 5.66 mins, 13.8 vs 12.7 mins 7.2 vs 5.8 mins, 3hrs 12 min vs 5 hrs 20 mins, 5 hrs 6 mins vs 6 hrs 10 min, 10.9 vs 10.2 min respectively. There were total three conversions to open (radical prostatectomy (n=1), radical nephrectomy (n=1) and radical cystectomy with ileal conduit (n=1). CONCLUSIONS: Our experience with SSI MANTRA platform confirms that it is a robust, safe and efficient platform for all major urooncological procedures and it would expand the reach of robotic platform. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e957 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amitabh Singh More articles by this author Ashish Khanna More articles by this author Sarbartha Kumar Pratihar More articles by this author Vivek Vasudev More articles by this author Nikhil Saurabh More articles by this author Sudhir Rawal More articles by this author Expand All Advertisement PDF downloadLoading ...

V03-04 FIRST HUMAN NOTES FOR BLADDER LEIOMYOMA ENUCLEATION AND CYSTORRAPHY

You have accessJournal of UrologyCME1 Apr 2023V03-04 FIRST HUMAN NOTES FOR BLADDER LEIOMYOMA ENUCLEATION AND CYSTORRAPHY Andreia Cardoso, Sara Anacleto, Catarina Laranjo Tinoco, Ricardo Matos Rodrigues, Ana Sofia Araújo, Mariana Capinha, Vera Marques, João Pimentel Torres, Carlos Oliveira, Miguel Mendes, and Emanuel Carvalho-Dias Andreia CardosoAndreia Cardoso More articles by this author , Sara AnacletoSara Anacleto More articles by this author , Catarina Laranjo TinocoCatarina Laranjo Tinoco More articles by this author , Ricardo Matos RodriguesRicardo Matos Rodrigues More articles by this author , Ana Sofia AraújoAna Sofia Araújo More articles by this author , Mariana CapinhaMariana Capinha More articles by this author , Vera MarquesVera Marques More articles by this author , João Pimentel TorresJoão Pimentel Torres More articles by this author , Carlos OliveiraCarlos Oliveira More articles by this author , Miguel MendesMiguel Mendes More articles by this author , and Emanuel Carvalho-DiasEmanuel Carvalho-Dias More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003241.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder leiomyomas (BL) are rare benign tumors, with roughly 250 cases reported worldwide. Surgical excision is the recommended treatment, classically through open partial cystectomy. As alternatives, minimally invasive approaches, such as laparoscopic (lap), robot-assisted and transurethral (TU) resection (TUR), are arising. In parallel, TU cystorraphy has been reported for vesicovaginal fistulas or traumatic perforations. Thus, to the best of our knowledge, we report the 1st Human Natural Orifice Transluminal Endoscopic Surgery (NOTES) with a purely TU approach for BL enucleation and cystorraphy, without transvesical access, gas insufflation, neither extracorporeal knot tying. METHODS: A 68-year-old woman presented an incidental 22mm lesion on the left posterolateral bladder wall on MRI, highly suspicious for BL. After cystocopic confirmation of a submucosal lesion, TUR was proposed. We performed a pioneer NOTES with total TU BL enucleation and cystorraphy using: 30° lens, white light only, saline irrigation, 26Ch resectoscope, operative cystoscope, Collin’s knife and standard resection loop, bipolar energy, 5mm lap needle holder and 3-0 V-Loc 23cm length suture. RESULTS: BL complete enucleation was done with bipolar energy on Collin’s knife and standard resection loop. Then, V-Loc suture was completely placed inside the bladder through the operative cystoscope, and with the lap needle holder inserted through it, a total intravesical cystorraphy with single hand continuous suture was performed. Operative time was 40min. Patient was discharged on the next day, with bladder catheter for 5 days. There were no complications. CONCLUSIONS: TUR has been used for BL, but without cystorraphy, which is a limitation for bigger or more profound infiltrative lesions. Cystorraphy techniques combining TU, transperitoneal and/or transmural bladder access were reported. A purely TU cystorraphy recently reported required extracorporeal sliding knot techniques, so, it was only possible in women. Thus, our approach may be the most minimally invasive possible for the safest treatment of BL. We combined several techniques aiming to reach an ideal one. Using only regular material, a single urethral route, and no gas insufflation, we achieved a quick and safe procedure, with no need for continuous bladder irrigation and short catheterization. Yet, it requires advanced skills such as single hand lap suturing. Our technique seems also feasible in small bladder perforations, fistulas, or other lesions (e.g.: endometriosis). Additionally, with total intravesical suture, it may also be viable in men. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e247 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andreia Cardoso More articles by this author Sara Anacleto More articles by this author Catarina Laranjo Tinoco More articles by this author Ricardo Matos Rodrigues More articles by this author Ana Sofia Araújo More articles by this author Mariana Capinha More articles by this author Vera Marques More articles by this author João Pimentel Torres More articles by this author Carlos Oliveira More articles by this author Miguel Mendes More articles by this author Emanuel Carvalho-Dias More articles by this author Expand All Advertisement PDF downloadLoading ...

HF01-05 UKRAINIAN CONTRIBUTIONS TO UROLOGY: AN IMPORTANT REMINDER

You have accessJournal of UrologyCME1 Apr 2023HF01-05 UKRAINIAN CONTRIBUTIONS TO UROLOGY: AN IMPORTANT REMINDER Daniel Nemirovsky, Maksym Pikul, Zoe Blake, Alexander Kenigsberg, Neil Mendrihatta, Peter Pinto, and Gennady Bratslavsky Daniel NemirovskyDaniel Nemirovsky More articles by this author , Maksym PikulMaksym Pikul More articles by this author , Zoe BlakeZoe Blake More articles by this author , Alexander KenigsbergAlexander Kenigsberg More articles by this author , Neil MendrihattaNeil Mendrihatta More articles by this author , Peter PintoPeter Pinto More articles by this author , and Gennady BratslavskyGennady Bratslavsky More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003243.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Over the past year, the world has witnessed acts of unprovoked violence and aggression in Ukraine. The AUA issued a strong statement standing against the atrocities and inhumanity of war. Many urologists, both with and without ties to Ukraine, have shown support to the country in various ways. In this light, it is imperative to not only support its citizens, but also to remember the contributions Ukraine has had on our understanding of urology. METHODS: Data was obtained with review of both PubMed and non-PubMed indexed literature, as well as through personal interviews with leading urologists in Ukraine. RESULTS: In the field of genitourinary reconstruction, the first ever use of oral mucosa in urethroplasty was pioneered by Kirill Sapezhko in the late 19th century, while working in Kyiv. Interestingly, Dr. Sapezhko was also the first recorded surgeon to describe a two-stage urethroplasty, using a method now known as the Thiersch-Duplay technique. Ludwik Rydygier, as head of the University of Lviv (then Lemberg), developed an early method for transperineal simple prostatectomy, as well as innovating several techniques for repair of vesicovaginal fistulae in the late 1800s. Yurii Voronoy, while working in Kherson during the early 20th century, revolutionized transplantation by conducting the first recorded renal allotransplant, as well as studying the various stages of immunologic rejection. In the mid-to-late 1900s, urologic oncologists in Kharkiv, including Boris Polonsky, Alexey Pereverzev, and Viktor Karpenko, conducted valuable research describing innovative techniques for IVC thrombectomy. More recently, Ukrainian scientists have made enormous strides in our understanding of urologic carcinogenesis, in large part due to the devastating Chernobyl disaster and related chronic ionizing radiation exposure. These studies have led to better insight into the development of kidney and bladder cancers, including the description of ionizing-radiation induced carcinoma in situ, termed “Chernobyl Cystitis”. CONCLUSIONS: Ukrainian urologists have made significant impacts to the field, with important and novel studies spanning across many urologic subspecialties. As urologists, one of the ways that we can support Ukraine is to highlight their many contributions to the field. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e257 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Nemirovsky More articles by this author Maksym Pikul More articles by this author Zoe Blake More articles by this author Alexander Kenigsberg More articles by this author Neil Mendrihatta More articles by this author Peter Pinto More articles by this author Gennady Bratslavsky More articles by this author Expand All Advertisement PDF downloadLoading ...

V09-07 HOW TO USE A MESH SLING SAFELY AFTER THE POST-VESICOVAGINAL FISTULA REPAIR REPAIR PATIENT WITH STRESS URINARY INCONTINENCE

You have accessJournal of UrologyCME1 Apr 2023V09-07 HOW TO USE A MESH SLING SAFELY AFTER THE POST-VESICOVAGINAL FISTULA REPAIR REPAIR PATIENT WITH STRESS URINARY INCONTINENCE Micheal Breen Tamatave, Madagascar, Ly Hoang Roberts, and Larry Sirls Micheal Breen Tamatave, MadagascarMicheal Breen Tamatave, Madagascar More articles by this author , Ly Hoang RobertsLy Hoang Roberts More articles by this author , and Larry SirlsLarry Sirls More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003317.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with complicated obstetric fistulas may have stress urinary incontinence (SUI) after vesicovaginal fistula repair (VVF), especially if the urethra in involved. Various techniques to treat post-VVF SUI have low success rates or is technically challenging due to thin and scarred peri-urethral tissue. We describe a technique to place a midurethral mesh sling outside of the pre-existing vaginal mucosa. METHODS: With the patient in dorsal lithotomy under spinal anesthesia, a foley catheter is placed into the bladder and the labial majora is retracted for adequate exposure. A rectangular area of the same size as the mesh sling (3x1cm) at the midurethra is marked. A number 15 scalpel is used to incise the vaginal mucosa at the marked lines, and Metzenbaum scissors are used to dissect and mobilize the edges. The dissection is then carried out laterally to be behind the inferior pubic bone. This is done on both sides. The island of vaginal mucosa is then superficially scored using low power bovie cauterization to allow for mesh adhesion and tissue ingrowth. The mesh is sutured to the island of skin using a 3-0 Chromic or vicryl suture at the mesh edges in 4 areas. 0- prolen sutures are then placed on each lateral edge of the mesh in a running stitch. The Metzenbaum scissors are then used to enter into the endopelvic fascia behind the pubic bone to develop the retropubic space. Next, a suprapubic incision is made 1cm cranial to the pubic bone down to the rectus fascia. The Stamey needle is passed in a top-down approach approximately 2cm from midline and end delivered into the vaginal incision. To check for bladder perforation, a metal catheter is placed into the bladder and swept laterally to evaluate for any metallic noise indicative of contact. The prolene suture is passed up to the suprapubic incision and the same is done contralaterally. Bladder is backfilled with sterile saline with methylene blue by gravity and foley removed. Sutures are tied together midline with the sling tension adjusted while patient performs a Valsalva. Suprapubic incision is then closed in multiple layers. The vaginal incision is closed with mobilization of the proximal vaginal mucosa and reapproximation to the distal edge. For larger incisions, a Singapore flap can be done for adequate coverage. RESULTS: Successful managment of SUI. CONCLUSIONS: For challenging cases of SUI after a post-VVF repair, this technique can be an option. Further investigation is needed for clinical outcomes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e839 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Micheal Breen Tamatave, Madagascar More articles by this author Ly Hoang Roberts More articles by this author Larry Sirls More articles by this author Expand All Advertisement PDF downloadLoading ...

Profile and Outcome of Obstetric Fistula Surgeries in a Fistula Care Centre in South-East Nigeria

Prolonged obstructed labour is the main cause of obstetric vesico-vaginal fistula, however there is growing perception that a proportion of cases may be arising from surgical complications and errors. This study intends to evaluate this observation. A retrospective study of 378 eligible cases of obstetric VVF repaired over a five-year period. Requisite information was retrieved from hospital case records. Dataentry and analysis was done using SPSS version 20. Means and SD, Chi square test and the level of significance set at p<0.05 were calculated. The mean age was 33.9±10.1 years, mostly multipara, majority following caesarean sections in 62.3% followed by prolonged obstructed labour in 28.6% of patients. The most common type of VVF was Intra-cervical fistula in 55.8% of patients. At the time of hospital discharge following repair, 76.5% were closed and dry, 18.5% had post-repair incontinence and 5.0% had a failed repair within the studied period. Half of our patients (50.3%) were referred from private hospitals, 40.3% had no referral letter and the remaining were referred from government hospitals. The outcomes of surgeries were not influenced by the type of VVF repaired. Chi square test was 0.38 at 95% CI (p>0.05). There is a worrisome proportion of obstetric VVF from caesarean sections. Our success rates in obstetric VVF repair appears satisfactory; more effort be made in strengthening the referral system and impacting correct surgical skills especially in areas of caesarean section.

Determination of Some Haematological Parameters and Oxidative Stress Markers in Vesico-Vaginal Fistula Patients Attending Maryam Abacha Women and Children Hospital, Sokoto.

Introduction: Vesico-vaginal fistula (VVF) is still a persisting scourge in developing countries with devastating medical and social consequences. The goal of this study was to assess the haematological parameters and oxidative stress markers of VVF patients compared with healthy control female subjects. Material and Methods: This study was carried out at VVF Centre, Maryam Abacha Women and Children Hospital, Sokoto. This is a descriptive study conducted on 50 VVF patients and 50 controls to determine some haematological parameters and oxidative stress markers. Questionnaire was used to obtain sociodemographic information while laboratory investigations were used to obtain haematological and free radical marker results. Results: The values obtained from the control and VVF subjects for PCV, RBC, hemoglobin, platelets, lymphocytes, neutrophils, monocytes and basophils were statistically non-significant (p>0.05) while WBC (5.45 ± 0.31 x 109/L,59 ± 0.27 x 109/L) and eosinophil (2.43 ± 0.33%, 4.83 ± 0.54%) were statistically significant (p<0.05). For the free radical markers, both Malondialdehyde and glutathione levels were statistically non-significant (p>0.05). The correlation of Malondialdehyde and glutathione peroxidase levels with haematological parameters showed that only lymphocyte and monocyte counts were statistically significant respectively. Conclusion: Prolonged obstructed labour, early marriage, ignorance, lack of knowledge are among the factors responsible for the prevalence of VVF in Sokoto State. White blood cell and eosinophil counts should be included as part of the laboratory investigations for VVF patients which may serve as indication for asymptomatic bacteriuria, women should not be given out of marriage before they reach age of maturity and Formal education should be made free and mandatory for girls’ up to tertiary institution.

Urogenital fistulas in the Niger Delta Region of Southern Nigeria: A single center experience

Objectives: To determine the factors that are associated with good prognosis in the management of patients with urogenital fistulas in our tertiary hospital in Port Harcourt, Nigeria. Materials and Methods: We retrospectively identified all patients managed fully for urogenital fistula at the University of Port Harcourt Teaching hospital from January 2018 to December 2022. From the case files, we collected data on age, parity, etiology and type of fistula, investigation findings, management, including perioperative findings and use of drugs, and outcome of treatment. Results: Of the six patients with urogenital fistulas managed, four had vesicovaginal fistulas. Obstetric fistulas were the most common, accounting for five fistulas. Four had surgical repairs, and two were resolved entirely following bladder catheterization. Of those who had a surgical repair, multidisciplinary management involving urologists and gynecologists via the abdominal approach was done in two patients. Two patients had transvaginal fistula repairs performed by only gynecologists (with no urologists). All primary fistula repairs were successful. Conclusion: Most of the urogenital fistulas in this study had obstetric origins. The patients had delayed presentation for treatment. Good patient selection with individualization of patient treatment, adequate history-taking, basic evaluation under anesthesia with three swab testing, experience, and good surgical skills as well as optimal post-treatment care were vital for a good prognosis of fistula repairs

Outcome of Difficult Pelvis Surgeries done by Gynecologist versus General Surgeons

Objective: To evaluate the outcomes of difficult pelvis surgeries done by gynecologist versus general surgeons. Study Design: Retrospective study Place and Duration of Study: Department of Surgery, CMH Kharian Medical College, Kharian, Department of Surgery, Wah Medical College POF Hospital, Wah Cantt and Ghulam Muhammad Mahar Medical College, Teaching Hospital, Sukkur from 1st August 2015 to 31st July 2018. Methodology: Fifty professionals (who conducted 500 pelvic surgeries) were included either from the surgery or obstetrics gynecology departments. The study was initiated post-consent of each participant. Surgeons National Surgical Quality Improvement Program (NSQIP) data base software was applied for designing the questionnaire. The NSQIP database collects information from 10 perioperative-variables, as well as preoperative-comorbidities, parity, previous history of pelvic surgery, ureteral obstruction and vesico-vaginal fistula, intraoperative-variables, as well as 30-day mortality and morbidity outcomes including the rate of reoperation and re-admission. Other information regarding ASA classification and malignancy were also collected. Result: There were 341 procedures performed by surgeons while 159 procedures were conducted obstetrics gynecologists’ surgeons. The mean age of the patients was 62.5±11.5 years. The ASA classification presented higher number of surgeries in class 1 and 2 of the ASA class. The apical procedures as Sacrospinous and Sacrocolpopexy were performed highest by obstetrics gynecologists. The 30 days postoperative complication rate was increased significantly in the obstetrics gynecologists group than the surgeons. Conclusion: Prolapse surgery completed by a surgeon is linked with lower odds of 30-day postoperative-complications than the one performed by the obstetrician-gynecologist. Keywords: Outcome, Pelvis surgery, Prolapse surgery, Complication

Transvaginal vesicovaginal fistula closure: A retrospective study of 28 cases at a single facility in Japan.

We aimed to report the background of patients with vesicovaginal fistulas (VVFs) at our center, which has treated a relatively large number of such patients in Japan, as well as the ingenuity and outcomes of vesicovaginal fistula closure (VVFC). We also investigated the causes of VVFs. A retrospective review was performed for 28 patients with VVFs treated at our center. Age, body mass index, etiology, site of fistula, and postoperative outcomes were investigated. Twenty-one (75%) fistulas occurred following hysterectomy. The overall success rate of VVFC was 85.7%, and the success rate limited to the first attempt was 89.5%. In 68% of cases, no bladder injury suspected as the cause of VVF was noticed during the surgery. Energy devices were used in all 12 patients for whom information on the type of device used for hysterectomy was confirmed. To our knowledge, this is the first report to evaluate a relatively large number of VVFCs in Japan. Although VVF is thought to be caused by bladder injury during hysterectomy, delayed thermal damage might also result in this pathology, even if there is no apparent intraoperative bladder injury.

Evaluation of the Anesthetic Management of Patients with Obstetric Fistula at CHU-Point G

Introduction: Our study aimed to evaluate the anesthetic management of women suffering from obstetric vesico-vaginal fistulas at the Point G University Hospital. Patients and Methods: A descriptive retrospective study from 02 January 2018 to 31 December 2018 in the anesthesia-intensive care unit of the University Hospital Center (CHU) of Point G. Results: During the study period, we collected 48 cases of obstetric fistula out of a total of 237 operated during the period, a frequency of 20.25% of all surgical activities. Housewives were the most represented with 72.91% of cases. The most affected age group was 21-30 years with 37.5% of cases. Anesthesia was performed in 87.5% of cases by a medical assistant. The technique used was spinal anesthesia, so all patients received bipuvacaine for their anesthesia. One case of low blood pressure and one case of bradycardia were intraoperative incidents or a total of 2.08% of cases. Conclusion: Resuscitation anesthesia plays an important role in the successful management of obstetric fistula. Regional anesthesia is the most widely used method.

North-central Nigerian women’s experiences of obstetric fistula risk factors and their perceived treatment services: An Interpretive Description

BackgroundAn obstetric fistula also known as vesico vaginal fistula (VVF), or recto-vaginal fistula (RVF) is an abnormal opening between the urogenital tract and intestinal tract caused by prolonged obstructed labour; when the head of the baby presses on the soft tissues in the pelvis leading to loss of blood flow to the women’s bladder, vagina, and rectum. This can cause necrosis of the soft tissues resulting in debilitating fistula formations. AimThis study aimed to uncover North-central Nigerian women’s experiences of obstetric fistula and their perceived treatment services. DesignQualitative, interpretive descriptive methodology underpinned by symbolic interactionism involving face-to-face semi-structured interviews was used to explore North-central Nigerian women’s experiences of obstetric fistula and their perceived treatment services. SampleA purposive sample of 15 women who had experienced obstetric fistula at a repair Centre in North-central Nigeria were eligible. ResultsFour themes emerged from North-central Nigerian women’s experiences of obstetric fistula and their perceived treatment services i) I was left alone in the room ii) Waiting for the one vehicle in the village iii) I never knew about labour until that very day iv) and We kept following the native doctors and sorcerers. ConclusionThe findings from this study highlighted the depth of women’s experiences from the devastating complication of childbirth injury in North-central Nigeria. Analysis of insights from women’s voices directly affected by obstetric fistula demonstrated that in their views and experiences the themes identified were majorly responsible for their fistula status. Thus women need to raise their collective voices to resist oppressive harmful traditions and demand empowerment opportunities that will improve their social status. Government should improve primary healthcare facilities, train more midwives and subsidise maternal care for antenatal education and birth services spending for childbirth women may result in improved childbirth experiences for women in rural and urban communities. Tweetable AbstractReproductive women call for increased accessibility to healthcare services and the provision of more midwives to mitigate obstetric fistula in North-central Nigerian communities.

Removal of retained pessary and repair of vesicovaginal fistula with colpocleisis

Removal of retained pessary and repair of vesicovaginal fistula with colpocleisis

Vaginal-Laparoscopic Repair (VLR) of Primary and Persistent Vesico-Vaginal Fistula: Description of a New Technique and Surgical Outcomes

The main aim of our study was to describe the surgical technique and evaluate the feasibility, efficacy and safety of a vaginal-laparoscopic repair (VLR) of iatrogenic vesico-vaginal fistulae (VVF). Between April-2009 and November-2017, we retrospectively reviewed all clinical, radiological and surgical details of surgery for benign or malignant disease and ended up with VVF. All patients were diagnosed by CT urogram, cystogram and clinical test. The surgical technique was standardised and is described here. Eighteen patients developed VVF after hysterectomy, three after caesarean section and three after hysterectomy and pelvic lymphadenectomy. Twenty-two patients had an average 3 (range 1-5) attempts at fistula repair in other hospitals. In one patient, five attempts were made. The mean size of the fistula was 2.4 cm (range 0.7-3.1 cm). A median 8 weeks (6-16) conservative management with Foley catheter failed in all patients. No conversion to laparotomy and no complication occurred at VLR. Median hospitalisation was 1.4 days (range 1-3). The latter confirmed all patients were dry and tested negative at a repeated filling test. At 36 months follow-up, all patients remained dry. In conclusion, VLR successfully repaired VVF in all patients with primary and persistent VVF. The technique was safe and effective.

Transurethral Incision of the Bladder Neck with or without Additional Procedure Resumes Spontaneous Voiding in Female Voiding Dysfunction-A Long-Term Retrospective Follow-Up.

This study evaluated the long-term effectiveness of transurethral incision of the bladder neck (TUI-BN) with or without an additional procedure for female voiding dysfunction. Women with voiding difficulty who underwent TUI-BN in the last 12 years were included. All patients underwent a videourodynamics study (VUDS) at baseline and after TUI-BN. A successful outcome was defined as having a voiding efficiency (VE) increase by ≥50% after treatment. Patients with insufficient improvement were chosen for repeated TUI-BN, urethral onabotulinumtoxinA injection, or transurethral external sphincter incision (TUI-ES). The current voiding status, surgical complications, and additional surgeries were evaluated. A total of 102 women with VUDS evidence of a narrow bladder neck during voiding were enrolled. The long-term success rate of the first TUI-BN was 29.4% (30/102) and increased to 66.7% (34/51) after combining TUI-BN and an additional procedure. The overall long-term success rates were 74.6% in women with detrusor underactivity (DU), 52.0% in detrusor overactivity and low contractility, 50.0% in bladder neck obstruction, 20.0% in hypersensitive bladder, and 75% in stable bladder (p = 0.022). Patients with a lower maximum flow rate (Qmax), (p = 0.002), lower voided volume (p < 0.001), lower corrected Qmax (p < 0.001), lower ladder contractility index (p = 0.003), lower voiding efficiency (p < 0.001), but larger post-void residual volume (p < 0.001) had a satisfactory surgical outcome. Spontaneous voiding was achieved in 66 (64.7%) patients, de novo urinary incontinence in 21 (20.6%), and vesicovaginal fistula in 4 (3.9%), all were repaired. TUI-BN alone or in combination with an additional procedure was safe, effective, and durable in patients with DU to resume spontaneous voiding.

Predictors and outcomes of surgical repair of obstetric fistula at Mekelle Hamlin Fistula Center, Northern Ethiopia.

Obstetric fistula is a medical condition that involves an opening between vagina and bladder or vagina and rectum. From 2010 to 2013, on average, around 2000 women each year had surgery for obstetric fistula in Ethiopia. The success and failure rate of obstetric fistula repair varies from center to center and is determined by many factors. Thus, this study aimed to assess the predictors and outcomes of surgical repair of obstetric fistula at Mekelle Hamlin Fistula Center (MHFC). A retrospective reviewed medical records of 328 patients with obstetric fistula were carried out at MHFC. Multivariable logistics regression analysis was conducted, a significant association was declared when the p-value was less than 0.05, and the strength of the association was determined by computing the odds ratio at 95% CI. The analysis was done using SPSS version 24. Obstetrics fistula patients who had formal education were 13% more likely to be successfully repaired than obstetrics fistula patients who had no formal education. Additionally, obstetrics fistula patients who had a live birth were 32.325 (exp (β) = 32.325) times more likely to have had a successful repair than those who had a stillbirth. Fistula closure was achieved in 89.3% of cases. The success rate for VVF (vesico-vaginal fistula) and RVF (recto-vaginal fistula) surgical repair was 86.9% and 100% respectively, which is higher than the WHO target. Body mass index between 18.5-24.9kg/m2, formal education, antibiotic use, live birth, large fistula size, and home and cesarean delivery were predictors of successful closure of obstetric fistula.

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.

Invited Commentary: From Unacceptable to Intolerable

Invited Commentary: From Unacceptable to Intolerable

Vesicovaginal fistula: an uncommon complication of a perineal burn in a 12-year-old girl

Perineal burns are a rare finding in children that may cause severe complications. Vesicovaginal fistulas are an uncommon complication of a perineal burn that can be a tragedy for girls suffering from them. Fistula and/or its treatment are a socially debilitating problem with significant medicolegal implications. We present a rare case of a girl with a history of traumatic perineal burns who was diagnosed with a vesicovaginal fistula and repaired through a transvaginal approach.

Assessment of Obstetrics and Gynaecological referred Cases and their Outcomes to Isra Tertiary Care Hospital

Objective: To assess, the type of obstetrics and gynaecological cases referred to tertiary care hospitals.Study Design: Descriptive cross-sectional study.Place and Duration of Study: The study was carried out at the Department of Obstetrics and Gynecology Unit 2 of Isra University Hospital Hyderabad, Pakistan from May 2022 to July 2022.Materials and Methods: The patients who were referred to the Department of Obstetrics and GynaecologyUnit 2 at Isra University Hospital during the study duration from various primary, secondary, tertiary, andprivate hospitals for any obstetric or gynaecological emergency were the primary source of data. Theconfidentiality of each patient was carefully respected. This study evaluated the prevalence of various obstetricand gynaecological conditions for which patients were usually referred to Isra University Hospital within thestudy duration as well as the management options provided to these patients.Results: The bulk of referrals (71%) were for gynaecological cases, according to the results of our study. Patients under 20 years of age comprised 31% of the total. The majority of patients (20%) were multipara and in their third trimester (18%). Vesicovaginal fistula (VVF) was the most common gynaecological reason for referral(27%) and the least were ectopic pregnancy and UV prolapse 9% each. Placenta previa (13%), was the mostcommon obstetric referral in our study and at least 2% were placental abruption, preterm labour, and preeclampsia. Furthermore, 24% of VVF patients were successfully managed transvaginal while only 4% weremanaged transabdominal. All gynaecological malignancies were treated with total abdominal hysterectomywith bilateral salpingo-oophorectomy and omentectomy. Laparotomies were done for ectopic pregnanciesand 5 patients of UV Prolapse underwent vaginal hysterectomy whereas only 1 had pessary insertion. Amongstobstetric cases 7% cases of placenta previa/accreta had Cesarean section, 4% had Cesarean section along withbladder repair and 2% of cases necessitated myometrial excision. Compression sutures were the mostfrequently used form of treatment (5%) for postpartum hemorrhage patients, followed by hysterectomy (4%)and medical management (2%). Preterm labour was monitored, whereas placental abruption and preeclampsiarequired caesarean procedures.Conclusion: The majority of patients both gynaecological and obstetric referred to Isra Tertiary Care Hospitalthroughout a 3 months period had either an urgent need for treatment or a serious condition that necessitateda specialist's expertise and the availability of the appropriate resources. Therefore, it can be concluded thatthere is a critical need to upgrade our health system infrastructure, particularly in the area of maternal and child health care, in order to make it simple to provide timely and appropriate management to a variety of health conditions and lower the likelihood of any mishaps involving the mother or the fetus. Additionally, this will also benefit patients by avoiding unnecessary travel from distant regions and helps reduce the burden on tertiary care health system.&#x0D; &#x0D; &#x0D;