Vesicovaginal Fistula Research Articles

Effects of Methimazole vs Propylthiouracil in Newborns: A Comparative Review.

Hyperthyroidism is more common in women and the sensitivity of thyroid function changes during pregnancy. Excess levels of thyroid hormones and thioamides have a major impact on maternal and fetal outcomes. Our aim was to perform an extensive literature review and provide relevant details concerning the analytical and clinical aspects of the potential effects of the two main drugs used (methimazole and propylthiouracil) in newborns. A thorough literature review was conducted using PubMed and Google Scholar databases. In total, 10 relevant studies were identified and data from these studies were extracted and then extrapolated into results after analysis. Three out of four studies that used methimazole and carbimazole, one and two, respectively, showed adverse fetal outcomes requiring surgical management for congenital anomalies like aplasia cutis, patent vitellointestinal duct, and gastroschisis. Out of the three studies that used propylthiouracil, one baby underwent surgery for bilateral pyelectasis, vesicovaginal fistula, anal stenosis, and polydactyly. The findings of the aforementioned studies provide enough evidence to imply that the use of methimazole and carbimazole to treat antenatal hyperthyroidism has worse fetal outcomes than the use of propylthiouracil. Also, given the paucity of data in the existing literature regarding propylthiouracil's effects on newborns, further studies in this demographic are needed.

Perioperative Outcomes of Vesicovaginal Fistula Repair by Surgical Approach.

Data comparing perioperative outcomes between transvaginal, transabdominal, and laparoscopic/robotic vesicovaginal fistula (VVF) repair are limited but are important for surgical planning and patient counseling. This study aimed to assess perioperative morbidity of VVF repair performed via various approaches. The American College of Surgeons National Surgical Quality Improvement Program database was used to identify women who underwent transvaginal, transabdominal, or laparoscopic/robotic VVF repair from 2009 to 2020. Associations of surgical approach with baseline characteristics, blood transfusion, prolonged hospitalization (>4 days), and 30-day outcomes (any major or minor complication or return to the operating room) were evaluated with χ 2 , Fisher exact, and Kruskal-Wallis tests. Multivariable logistic regression models assessed the adjusted association of approach with 30-day complications and prolonged hospitalization. Overall, 449 women underwent VVF repair, including 252 transvaginal (56.1%), 148 transabdominal (33.0%), and 49 laparoscopic/robotic procedures (10.9%). Abdominal repair was associated with a longer length of hospitalization (median, 3 days vs 1 day transvaginal and laparoscopic/robotic; P < 0.001), higher risk of prolonged length of stay (abdominal, 21.1%; transvaginal, 4.0%; laparoscopic/robotic, 2.0%; P < 0.001), major complications (abdominal, 4.7%; transvaginal, 0.8%; laparoscopic/robotic, 0.0%; P = 0.03), and perioperative transfusion (abdominal, 5.0%; transvaginal, 0.0%; laparoscopic/robotic, 2.1%; P = 0.01). On multivariable analysis, the abdominal approach was independently associated with an increased risk of prolonged hospitalization compared with laparoscopic/robotic (odds ratio, 12.3; 95% confidence interval, 1.63-93.21; P = 0.02) and transvaginal (odds ratio, 6.09; 95% confidence interval, 2.87-12.92; P < 0.001) but not with major/minor complications ( P = 0.76). Transvaginal and laparoscopic/robotic approaches to VVF repair are associated with lower rates of prolonged hospitalization, major complications, and readmission compared with a transabdominal approach.

Epidemiological, etiological and evolutionary profile of vesico-vaginal fistulas in Senegal

To evaluate the epidemiological, etiological and evolutionary profile of vesico-vaginal fistulas (VVF) in university hospitals in Senegal. This is a retrospective, descriptive, single-center study, collecting the records of patients followed for VVF between January 2014 and December 2019 at the Urology and Andrology Department of the Centre hospitalier universitaire Aristide Le Dantec, Dakar, Senegal. The following parameters were studied: age, geographical origin, parity, and etiology of VVF. To assess the evolution of the epidemiological and etiological profile of VVF, we compared our results with those of series published by our structure. Forty-five (45) VVFs were identified over a period of 6years. This represents an annual average of 7.5 fistulas. The average age was 40±15.13years with extremes of 13years and 75years; 17 patients (37.8%) were older than 45years. The average parity was 3 with extremes from 0 to 12 children. Multiparous women represented 68.8% of the patients. Obstetric VVF (OVF) was more frequent (48.9%) followed by iatrogenic VVF (33.3%). The mean age was higher in the IVF group compared to the VVF group (32years) (P=0.0004). Thirty patients were from the Dakar region and its suburbs (66.6%). The etiology of VVF did not vary according to the geographical origin of the patients (P=NS). VVF was frequently associated with the management of cervical cancer in 42.2% of cases. Comparison of our current data with previous series shows a reduction in the annual incidence of VVF. VVFs, although they have decreased significantly, are still predominant. There is a constant increase in the number of IVF. There is an evolution of the epidemiological and etiological profile marked by a decrease in the frequency of VVFs and an increase in that of IVFs. It is also worth noting the frequent association between cervical cancer and VVF. Level 4: retrospective study.

KOMUNIKASI, INFORMASI, DAN EDUKASI (KIE) DENGAN MEDIA BUKU SAKU TERHADAP PENINGKATAN PENGETAHUAN DAN SIKAP REMAJA PUTRI TENTANG KESEHATAN REPRODUKSI SEBAGAI UPAYA PREVENTIF PERNIKAHAN DINI

ABSTRACTEarly marriage is a marriage carried out by someone with an age limit between 10-19 years. Central Java is the eighth province with a fairly high early marriage rate of 8.71%. The health impacts that can result from early marriage are bleeding, prolonged labor, distortion, vesico-vaginal and recto-vascinal fistulas, preeclampsia, anemia, and stunting, post partum depression. The purpose of this study was to determine the effect of Communication, Information, and Education (IEC) using pocket books on increasing knowledge and attitudes of young women about reproductive health as a preventive measure for early marriage. The research was conducted at SMA N 1 Petungkriyono, Pekalongan Regency, with the type of pre-experimental research in the form of a One Group Pretest-Posttest Design. The research population is class X-XII students. The sampling technique used Stratified Random Sampling technique as many as 48 female students. The instrument used a questionnaire to measure the knowledge and attitudes of adolescents. The intervention was carried out by providing IEC through the media of a pocket book on reproductive health and early marriage. Statistical test results using the Wilcoxon Signed Rank Test on the knowledge variable obtained a p-value = 0.000 (0.05) meaning that there was a significant effect between before and after being given IEC with pocket book media and there was no effect on the attitude of young women before and after given IEC with pocket book media p-value = 0.095 ( 0.05). The results of this study are expected that female students can increase their knowledge by seeking more extensive and up-to-date information about reproductive health and early marriage and can participate in reducing the number of early marriages, especially in Pekalongan Regency.

Diagnostic Accuracy of Trans Vaginal Sonography in Detecting Vesicovaginal Fistula

Objective: The aim to conduct this study was to establish the diagnostic accuracy of trans vaginal sonography to detect vesicovaginal fistula. Findings are compared with cystogram and surgical results, taking later as gold standard. Settings: The study was conducted in the Department of Radiology, FJMU/Sir Ganga Ram Hospital, Lahore Pakistan. Duration: September 2022 to March 2023. Methods: All patients who were included in study, were married females within age bracket of 32-42 years, who presented in outpatient department with the complaint of urinary incontinence. Trans vaginal ultrasound was performed after verbal consent. Findings were compared with cystogram and surgical results, taking later as gold standard. Patients who suffered stress incontinence during physical movement or activity were excluded from this study. Results: A total of 25 patients were taken. The age range was 32-42years with mean age of 36years. The fistulae were seen by transvaginal ultrasound in all cases with the site, size and number of communicating tracts corresponding with operative results. Trans vaginal sonography reveals 100% sensitivity to detect vesicovaginal fistulae. Conclusion: We recommend transvaginal ultrasound as an accurate imaging modality for detecting vesicovaginal fistula because its findings are correlated well with the surgical results and is non-invasive, safe, non-hazardous and without any risk of radiation exposure.

Current Trends and Controversies on Female Genitourinary Fistula: A Review Article

Female genitourinary fistula (FGF) is an atypical connection between the female genitourinary system and the urinary tract. The abovementioned issue presents a dire public health concern and significantly affects the affected individuals&amp;rsquo; quality of life. The classification of fistulae arising from the genitourinary tract encompasses a range of types, including vesicovaginal (VVF), rectovaginal (RVF), uterovesical (UVF), and urinary fistula, with the particular manifestation dependent upon the site of perforation.&#x0D; &#x0D; The development of consistent guidelines for FGF care poses a challenge due to the variability of clinical conditions. The selection of an appropriate treatment protocol is contingent upon the surgeon conducting the treatment and the resources at their disposal. In the medical field, it is advisable for surgeons to contemplate implementing conservative treatment methods, particularly in patients thoroughly assessed and deemed suitable for this approach.&#x0D; &#x0D; Delayed repair of FGF results in superior outcomes compared to early repair. The transvaginal repair approach is favored due to its advantageous features. Anticholinergic pharmacotherapeutics may be employed during the postoperative phase to enhance the therapeutic course of the bladder.&#x0D; &#x0D; Healthcare providers can refer their patients to a tertiary care facility with advanced resources and specialized expertise, provided the necessary facilities are available. Surgeons undergoing training and adapting to emerging trends are advised to enhance their proficiency in repairing vesicovaginal fistula (VVF).

Safety and feasibility of right colectomy via a transvaginal approach: early experience from a single center

Objective: To investigate the safety and feasibility of performing right colectomy via a transvaginal approach. Methods: This was a retrospeltive cohort study. Data of 30 patients who had undergone transvaginal laparoscopic right colectomy (transvaginal group) and 23 women who had undergone laparoscopic right colectomy (laparoscopic group) from January 2019 to March 2022 in the Division of Colorectal Surgery, Department of General Surgery, Peking Union Medical College Hospital were collected retrospectively. The inclusion criteria for the transvaginal group were as follows: (1) post-menopausal woman; (2) transverse diameter of the tumor < 6 cm; and (3) diagnosis of benign polyps that were unresectable by endoscopy, mucinous tumors of the appendix, or confirmed right colon cancer not requiring D3 lymphadenectomy. The inclusion criteria for the laparoscopic group were as follows: (1) pathologically confirmed adenocarcinoma or high-grade intraepithelial neoplasia; (2) lesion located from the cecum to the right third of the transverse colon; and (3) clinically stage T1-4NanyM0. The exclusion criteria for the laparoscopic group were as follows: (1) distant metastasis discovered during surgical exploration; (2) multiple organ resection required or R0 resection not possible; or (3) conversion to open surgery required. Safety was evaluated on the basis of intra- and post-operative complications. Feasibility was assessed by postoperative recovery and quality of operative specimen. The body mass index was lower in the transvaginal than the laparoscopic group (22.0±3.1 kg/m2 vs. 24.1±2.6 kg/m2, t=2.617, P=0.012). Results: Among the 30 transvaginal laparoscopic right colectomies, 26 were pure transvaginal surgeries, three required laparoscopic assistance because of difficulties with anastomosis (n=2) or abdominal adhesions (n=1), and one required conversion to laparoscopic surgery because of vascular injury. Compared with the laparoscopic group, the transvaginal group had a longer surgery time (175.0 [147.5, 216.3] minutes vs. 120.0 [100.0, 120.0] minutes, U=63.000, P<0.001) and more blood loss (30.0 [10.0, 50.0] ml vs. 23.0 [10.0, 20.0] ml, U=208.000, P=0.011). The incidence of intraoperative complications (16.7% [5/30) vs. 0, P=0.061] was comparable between the two groups. In the transvaginal group, the sites of intraoperative injuries were bladder (n=3), ileocecal artery (n=1), and right uterine artery (n=1). The incidence of postoperative complications (20.0% [6/30] vs. 17.4% [4/23], χ2<0.001,P>0.999) was also comparable between the two groups. Clavien-Dindo grade III postoperative complications occurred in two patients in the transvaginal group (one patient had a pelvic hematoma that required embolization; the other had a vesico-vaginal fistula that required surgery). Postoperative visual analogue scale scores were significantly lower (P<0.001) in the transvaginal group. Times to first flatus, ambulation, and first intake and duration of postoperative hospital stay were comparable between the two groups (P>0.05). The proportion of specimens of moderate quality was 83.3% (25/30) in the transvaginal group and 100% (23/23) in the laparoscopic group; this difference is not significant (P=0.061). Among patients who underwent D2 lymph node dissection, the number of lymph nodes examined was comparable between the transvaginal (n=23) and laparoscopic groups (n=7) (18 [15, 27] vs. 20 [16, 29], U=69.500, P=0.589). Conclusion: Transvaginal right colon surgery is associated with less postoperative pain than laparoscopic surgery, but is not yet the preferred alternative because of the incidence of surgical complications.

Vesicovaginal Fistulas (VVF): New Dilemmas and Prospectives Review of the Literature

Although they were first described in 2050 BC in Egypt, Vesicovaginal Fistulas (VVF) still remain a challenging entity for both patients and healthcare services. They often result in the continuous, involuntary leakage of urine into the vaginal canal, leading to significant physical discomfort, psychological distress, and social isolation for the affected individuals. Etiology of VVF remains miscellaneous, with the most common etiology being based on obstetric complications during prolonged labor, particularly in developing and low-resource settings. Other causes include pelvic surgery, radiation therapy, trauma, congenital and underlying medical conditions. Effective diagnosis of VVF relies on the combination of clinical assessment, medical history, physical examination, and diagnostic procedures such as cystoscopy, imaging techniques, and dye tests. Proper detection consists crucial concerning successful treatment and can significantly improve the patient's quality of life. Therapeutic mapping approaches for VVF include both surgical and non-surgical interventions. Conservative management may include catheterization, proper nutrition, and the use of vaginal pessaries. However, surgical intervention remains primary treatment option for most cases, aiming the repair of the fistula and restore normal urinary and reproductive function. Surgical techniques range from simple suturing to complex reconstructive procedures, and the choice of approach depends on the size, location, and complexity of the fistula. While surgical repair offers high success rates, comprehensive postoperative care is vital to ensure optimal outcomes. Additionally, supportive care, including counseling, social reintegration, and rehabilitation, plays a crucial role in the overall recovery process. Aim of our study consists assiduous understanding and knowledge of vesicovaginal fistula. The awareness and attention of the scientific society and healthcare providers need to be aroused regarding new prospectives, strategies and methods of detection and management of VVF.

Re-Irradiation with Intensity-Modulated Radiation Therapy for the Treatment of Recurrent Cervical Cancer in the Pelvis: An Analysis of Outcomes and Toxicity.

Background and Objectives: Treatment options for most patients with recurrent cervical cancer within the previously irradiated field are limited. This study aimed to investigate the feasibility and safety of re-irradiation using intensity-modulated radiation therapy (IMRT) for patients with cervical cancer who experienced intrapelvic recurrence. Materials and Methods: We retrospectively analyzed 22 patients with recurrent cervical cancer who were treated with re-irradiation for intrapelvic recurrence using IMRT between July 2006 and July 2020. The irradiation dose and volume were determined based on the range considered safe for the tumor size, location, and previous irradiation dose. Results: The median follow-up period was 15 months (range: 3-120) and the overall response rate was 63.6%. Of the symptomatic patients, 90% experienced symptom relief after treatment. The 1- and 2-year local progression-free survival (LPFS) rates were 36.8% and 30.7%, respectively, whereas the 1- and 2-year overall survival (OS) rates were 68.2% and 25.0%, respectively. Multivariate analysis revealed that the interval between irradiations and gross tumor volume (GTV) were significant prognostic factors for LPFS. The response to re-irradiation showed borderline statistical significance for LPFS. The GTV and response to re-irradiation were also independent prognostic factors for OS. Grade 3 late toxicities were observed in 4 (18.2%) of the 22 patients. Recto- or vesico-vaginal fistula occurred in four patients. The irradiation dose was associated with fistula formation with borderline significance. Conclusions: Re-irradiation using IMRT is a safe and effective treatment strategy for patients with recurrent cervical cancer who previously received RT. Interval between irradiations, tumor size, response to re-irradiation, and radiation dose were the main factors affecting efficacy and safety.

Two Decadal Experiences in Managing Combined Obstetric Vesicovaginal and Rectovaginal Fistulas: A Study From Northern Indian Tertiary Hospital.

A retrospective study of 28 patients with obstetric combined vesicovaginal fistula (VVF) and rectovaginal fistula (RVF) treated at our centre throughout the last two decades (2002 to 2022) has been conducted. In 12 patients, a preoperative diverting colostomy was performed. Six patients had single-stage surgery (both VVF and RVF repairin the same operation) of which two cases required transabdominal repair and four required transvaginal repair. All single-stage repairs (n=6) were successful in curing urine and faecal incontinence.In 22 patients, VVF was corrected initially via the transvaginal method with Martius flap interposition, followed by RVF repair three months later. In 2/22 patients, there was a leak after RVF repair; therefore, proximal diverting colostomy was performed, and RVF repair was repeated after six months. All cases had effective VVF and RVF repairs, and both urine and faecal incontinence were completely cured. This study suggests the collaborative engagement of aurologist and a surgical gastroenterologist results in an advantageous outcome for the surgical treatment of these intricate obstetric fistulas.

Women’s views on obstetric fistula risk factors and prevention in north-central Nigeria: an interpretive descriptive study

ObjectiveObstetric fistula, also known as vesicovaginal fistula or rectovaginal fistula, is an abnormal opening between the vagina and rectum caused by prolonged obstructed labour that causes substantial long-term harm to...

Urethral fistula repair, including urethral elongation and an anti-incontinence procedure - a case report

Vesicovaginal fistula remains a significant cause of female urinary incontinence and impaired quality of life worldwide. Urethral-vaginal fistulas are less common, and difficult to manage, posing difficulties in terms of diagnostic evaluation, the surgical approach to closure, and how the associated complication of stress urinary incontinence is addressed. In this case report the management of a 34-year-old woman who presented with a urethral fistula following initial surgery for a urethral abscess is presented, including fistula closure; lengthening of the urethra; and addressing the loss of sphincter function. This case highlights the fact that a successful outcome in these patients depends on proper surgical technique, and the experience and skill of the management team.

The etiology of major, acquired female urogenital and rectovaginal lesions in Port Harcourt, Nigeria

Introduction: New and emerging trends in the causation of urogenital and rectovaginal lesions, and changing patterns of behavior of female patients with the diseases were observed. The aim of this study is to determine the risk factors and etiology of these diseases. Methods: This was a cross-sectional observational study of records of consecutive female patients operated on at the University of Port Harcourt Teaching Hospital (UPTH), Nigeria, with major urogenital and rectovaginal lesions from 01/01/2018 to 31/12/2022. Each patient’s records, sociodemographic data, clinical assessment, laboratory investigations, diagnosis, and intraoperative findings were studied and recorded. Data obtained were analyzed with simple statistics, and presented in charts prose, and tables. Results: Twelve major cases were found and studied. Their age statistics (in years) were as follows: mean age, 38.6±11.5; median, 34; and age range of 25 to 68. Ten of them were within the childbearing age (15-45 years). One patient had a uterocutaneous fistula with subcutaneous endometriosis. Another had anorectal carcinoma with rectovesical and rectouterine fistulas. One had uterovesical fistulas with menouria (Youssef’s syndrome), and the fourth had uterovesical fistula with a perineal tear. Four patients had uterovaginal prolapse, and 4 had vesicovaginal fistulas. Obstetric and gynecological trauma and sexual battery accounted for nine of 12 cases. The patients had high-risk pregnancies but had antenatal care and labor managed by either traditional birth attendants or primary healthcare staff at peripheral institutions. Conclusion: Most of the risk and etiological factors of the lesions were found modifiable. Appropriate measures have been suggested for the management and prevention of the lesions.

Robot-assisted vesicovaginal fistula repair: comparison of the extravesical and transvesical techniques.

Almost two decades after the description of robotic vesicovaginal fistula repair (R-VVF), the literature remains limited. The aims of this study are to report the outcomes of R-VVF and to compare the transvesical versus extravesical techniques. We performed an observational, retrospective, multicenter study, including all patients who underwent R-VVF from March 2017 to September 2021 at four academic institutions. All abdominal VVF repair over the study period were performed using a robotic approach. The success of R-VVF was defined as the absence of clinical recurrence. The outcomes of the extravesical versus transvesical techniques were compared. Twenty-two patients were included. The median age was 43 years old (IQR 38-50). Fistulas were supratrigonal and trigonal in 18 and 4 cases respectively. Five patients had undergone previous attempts of fistula repair (22.7%). The fistulous tract was systematically excised, and an interposition flap was used in all but two cases (90.9%). The transvesical and extravesical techniques were used in 13 and 9 cases respectively. There were four postoperative complications, three minor and one major. None of the patients had vesicovaginal fistula recurrence after a median follow-up of 15 months. 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. Systematic excision of the fistulous tract and the high rate of flap interposition may explain the high success rate. The transvesical and extravesical approaches yielded similar outcomes.

A baby girl with TBX1 haploinsufficiency who died after elective cardiac repair surgery due to suspected enteroviral meningitis

IntroductionTBX1 haploinsufficiency is an inborn error of immunity with the phenotype of DiGeorge Syndrome. DiGeorge Syndrome has variable immunodeficiency associated with grade of thymic hypoplasia ranging from mild with no infections to severe requiring thymus implant. Enterovirus is an example of an opportunistic infection that can be fatal in these patients. Case PresentationA 1 year old girl with TBX1 haploinsufficiency complicated by Tetralogy of Fallot, pulmonary atresia, high arched palate, and vesicovaginal fistula presented for elective cardiac repair surgery from another country due to failure to thrive and cyanosis. She had no prior infectious history but was on sulfamethoxazole-trimethoprim for prophylaxis. She was asymptomatic with a negative COVID test but no other infectious studies performed. Immediately postoperatively, she was febrile and nasal respiratory viral panel was positive for rhinovirus/enterovirus with increased procalcitonin and leukocytosis with left shift. She decompensated with multi-organ failure and cardiac arrest on postoperative day two. She was cannulated to veno-arterial extracorporeal membrane oxygenation (ECMO). Pre-operatively, she had a normal absolute lymphocyte count. No thymus tissue was observed in surgery. She had profound CD3 lymphopenia to 130 cells/cmm when critically ill. Enteroviral meningitis was suspected as no infectious, cardiac, or other pathology could be identified causing decompensation. Enteroviral serum polymerase chain reaction (PCR) test was negative while lumbar puncture deferred due to clinical status. She was treated with immunoglobulin. Offlabel investigational drug pocapavir was considered but deferred to patient’s irreversible neurological status. The patient was disconnected from ECMO and expired. DiscussionThough we cannot confirm that this patient had enteroviral meningitis, invasive enteroviral infections are associated with elevated transaminases, coagulopathy, and seizures all present in our patient. There has also been reported negative serum enteroviral PCR but positive CSF enteroviral PCR in an immunodeficient patient. Additionally, this case highlights the importance of immunologic evaluation in patients with DiGeorge Syndrome and questions if asymptomatic viral screening for viruses like enterovirus should be considered pre-operatively in patients with inborn errors of immunity. This case highlights potential treatment options for invasive enteroviral infections in patients with inborn errors of immunity: high dose immunoglobulin, fluoxetine, and pocapavir.

LATE UROLOGICAL COMPLICATIONS OF PELVIC RADIOTHERAPY PRESENTING TO A TERTIARY CARE INSTITUTE

Background: The present study aims to assess various presentations of radiotherapy-induced late urological complications and management done in a tertiary care institute. Methods: A prospective study was carried outin two-year which included 30 patients.Patients who received pelvic radiotherapy anytime in the past and presented with complications related to it were included. Their demographic data, primary malignancy, radiotherapy details, presentations, complications and management done were studied. Results: The mean age and interquartile range of patients was 59.76 yr. (57 – 65 yr.). 23 patients (76.66%) were females. Ca cervix was the most common indication for primary radiotherapy (20 patients) followed by ca prostate (six patients). The mean duration of presentation after radiotherapy was 11.96 year with EBRT being the most common modality.The median dose per fraction (IQR) was 2 (2) Gy per fraction. The median number of fractions (IQR) of radiation therapy was 25 (20 – 31.25) and the median total dose (IQR) was 50 Gy (40 – 70.50 Gy). Radiation-induced hemorrhagic cystitis was the most common complication in 15 patients (50%). Other complications include urethral stricture, ureteral stricture and vesicovaginal fistula. The surgical intervention rate was 63.33%. Cystourethroscopy, clot evacuation and electrocoagulation was the most common procedure done in 23.33%. Other operative intervention includes ileal conduit with or without cystectomy, vesicovaginal fistula repair and transureteroureterostomy. Conclusion: Complications of pelvic radiotherapy can manifest very late, are usually irreversible in nature and frequently needs surgical management. Surgery remains the mainstay of treatment modality for many of the complications.

Urosymphyseal fistula after pelvic radiotherapy in a tertial referral centre – a rare entity with significant comorbidity requiring multidisciplinary management

To report population-based clinical presentation and outcomes in patients with urosymphyseal fistula (USF) after pelvic radiotherapy (RT). A retrospective chart review was performed in 33 consecutive patients diagnosed with suspicion of USF in a tertial referral center from 2014-2022 to ascertain information about diagnostic delay, clinical presentation, precipitating causes, treatments received and outcomes during the median 22 months follow-up. Out of 33 consecutive patients with suspicion of USF, one female with vesicovaginal fistula, one patient developing RT-associated bladder angiosarcoma, four patients with short follow-up (<3 months), and three patients that during chart review not were considered to have a USF were excluded. In all, 24 males with a median age of 77 years were diagnosed with USF. Local pain was the predominating symptom in 17/24 (71%) patients. Endourologic manipulations preceded the diagnosis of USF in 16 patients. Five patients had a diagnostic delay of more than 3 months. At diagnosis, 20/24 patients had radiological signs of osteomyelitis, and five had a concomitant rectourethral fistula. Due to comorbidity, five patients were not amenable to any other interventions than urinary catheter or suprapubic tube in conjunction with long-term antibiotics, of which three died from infections related to the USF. Out of the remaining 19 patients receiving some form of urinary diversion, five had recurrent osteomyelitis, of which four did not undergo cystectomy in conjunction with surgery for the USF. Urethral endourologic interventions in patients previously subjected to pelvic RT should be performed cautiously.

Surgical needles with handles

Having given examples of hand-held surgical needles and of needle holders of various types, we can consider a few needles that are mounted on handles. Greco-Roman and Arabic sources described ornately handled eyeless needles for displacing cataracts for use in the technique of couching. Also of historical origin are the various types of acupuncture needle. In 1564, Ambroise Paré illustrated a robust handled needle, which had an eye part way along the needle, through which were passed gold or lead ligatures, used during hernia repair. Handled needles have sharp or blunt tips, the latter for passing ligatures around structures to be tied off, such as pedicles or individual blood vessels. Hand-held needles have proximal eyes, whereas handled needles have distally placed eyes. This allows ligatures to be applied at some depth by one of two methods: passing ligature-loaded needles through tissues to be ligated or, passing the ‘empty’ needle through tissues and then loading the needle by feeding the ligature into a closed or open eye manually by an assistant or, rarely, by using a mounted ligature holder. The needle then is carefully withdrawn and the ligature tied on each side of the pedicle. These now rather historical instruments were frequently used in pelvic surgery by gynaecologists or urological surgeons. The longer reaching needle is clearly useful when working in other rather inaccessible areas, for example, when repairing vesicovaginal fistulas or cleft palates.

Quality of life, voiding & sexual dysfunction following robot-assisted vesicovaginal fistula repair: a tertiary care centre experience.

Robot-assisted VVF (RA-VVF) repair has the advantage of small cystotomy, precise dissection and minimal surrounding tissue trauma. Translation of this to better functional outcomes is not studied so far. This study aims to evaluate the quality of life, voiding, and sexual dysfunction following robot-assisted VVF repair. Women with successful RA-VVF repair were screened using UDI-6, IIQ-7, FSFI, and WHOQOL-BREF questionnaires. The preoperative assessment was done in the prospective cohort only. Of the 75 women who underwent RA-VVF repair, 47 were enrolled, 33 in retrospective, and 14 in a prospective cohort. Overall, 28 (60%) women had urinary complaints with a median UDI-6 total score of 4 (0-100) and IIQ-7 score(0-23) in 5 (10%) women. However, UDS (15 women) showed no DO with cystometric capacity (352 ± 98.12) ml and normal compliance in 14 (93%) women. Mean BOOI and DCI were 11.90 ± 7.01 and 44.25 ± 8.60 respectively, with PdetQmax ranging from 17 to 44. None had difficulty in voiding (Qmax 13.85 ± 4.90). Twenty (43%) women were sexually active, and 2 had sexual dysfunction (FSFI score < 26.55). Quality of life was "good" to "very good" in all domains (score > 90) except for the social domain. The prospective cohort showed significant improvement in UDI-6 score (p < 0.05), IIQ-7 score (p < 0.05), and quality of life (p < 0.05) postoperatively. RA-VVF repair results in minimal voiding dysfunction and significant improvement in overall quality of life. For sexual dysfunction assessment, a longer follow-up is required.

MP42-17 INCONTINENCE AFTER SUCCESSFUL ANATOMICAL CLOSURE OF VESICO-VAGINAL FISTULA; INCIDENCE AND MANAGEMENT

You have accessJournal of UrologyCME1 Apr 2023MP42-17 INCONTINENCE AFTER SUCCESSFUL ANATOMICAL CLOSURE OF VESICO-VAGINAL FISTULA; INCIDENCE AND MANAGEMENT Amaani Ahmad, Helena Gresty, Anthony Noah, Richard Nobrega, Mahreen Pakzad, Jeremy Ockrim, and Tamsin Greenwell Amaani AhmadAmaani Ahmad More articles by this author , Helena GrestyHelena Gresty More articles by this author , Anthony NoahAnthony Noah More articles by this author , Richard NobregaRichard Nobrega More articles by this author , Mahreen PakzadMahreen Pakzad More articles by this author , Jeremy OckrimJeremy Ockrim More articles by this author , and Tamsin GreenwellTamsin Greenwell More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003280.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Vesicovaginal fistula (VVF) is a rare condition in high resource settings. Significant urinary incontinence (UI) rates have been reported following VVF closure in low resource setting. We have reviewed our VVF series for anatomical closure and post closure UI rates. METHODS: Retrospective review of 132 patients having 1st surgical management of their VVF between 2004-2022. Median age was 51 (16-88) with a median follow-up of 14 months (2-150). Data was collated on demographics, fistula aetiology and characteristics, previous surgery, outcome in terms of anatomical closure and urinary continence, and any requirement for further surgery. Statistical analysis was carried out using chi-squared test, fisher test or students t-test as appropriate. RESULTS: Of the 132 patients identified, 127 (96.2%) had surgery to close their VVF whilst 5 (3.8%) had a primary ileal conduit. Successful anatomical closure was achieved in 118 (93.9%) at 1st attempt. Of the 9 failures, 6 had a 2nd VVF closure attempt, 2 had ileal conduit formation and 1 had recurrent carcinoma and did not proceed to further surgery. Vaginal closure was successful in 95% (97/102) after 1st attempt whilst abdominal closure was successful in 88% (22/25). Of the 6 failures having a 2nd attempt at VVF closure, 3 had an abdominal and 3 had a vaginal approach, with 100% successfully closed. Anatomical closure was confirmed in all patients by cystogram and/or cystoscopy. Of those with successful VVF closure 19 (15.2%) (16 vaginal and 3 abdominal approach) had bothersome post repair UI. This was pre-existing stress urinary incontinence (SUI) in 5 (4%), new onset SUI in 8 (6.4%), pre-existing urgency urinary incontinence (UUI) in 1 (0.8%), new onset UUI in 3 (2.4%) and new onset mixed urinary incontinence (MUI) in 2 (1.6%). 5 (26.3%) (4 with pre-existing SUI) required surgical intervention for management of their SUI (2 colposuspensions and 3 rectus fascial slings) whilst the patient with pre-existing UUI progressed to sacral neuromodulation, with resolution or significant improvement. The remaining 13 (68%) patients experienced resolution or significant improvement of their UI with conservative measures. CONCLUSIONS: Successful anatomical closure of VVF in high resource health care settings can be achieved in 92.9% after 1st repair and 100% after 2nd repair. Post closure bothersome urinary incontinence occurs in 15.2% and resolves with conservative measures in 68%. Surgical interventions for SUI or UUI post closure in 4.8%, with excellent results. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e574 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amaani Ahmad More articles by this author Helena Gresty More articles by this author Anthony Noah More articles by this author Richard Nobrega More articles by this author Mahreen Pakzad More articles by this author Jeremy Ockrim More articles by this author Tamsin Greenwell More articles by this author Expand All Advertisement PDF downloadLoading ...