Skip to main content
SpringerLink
Log in

Vesikovaginale Fisteln: Diagnostik und operatives Management

Vesicovaginal fistulas: diagnosis and surgical management

  • Leitthema
  • Published:
Der Urologe Aims and scope Submit manuscript

Zusammenfassung

Vesikovaginale Fisteln (VVF) bedingen eine enorme psychische, physische und soziale Belastung der Patientinnen. In (hoch)entwickelten Industriestaaten sind sie überwiegend Folge von pelvinen Operationen oder Bestrahlungen, in Entwicklungsländern meist mit langandauernden komplizierten Geburten assoziiert. Der überwiegende Anteil an VVF bedarf einer chirurgischen Therapie. Die Grundlage hierfür bildet eine umfassende Diagnostik. In Abhängigkeit der diagnostischen Charakteristika kann eine Operation transvaginal, transabdominal oder minimalinvasiv erfolgen. Der Zeitpunkt des Eingriffs, die bedarfsgerechte Interposition von vaskularisierten Grafts, das postoperative Management und Kenntnis der operativen Technik sind Voraussetzung für den Therapieerfolg. Diese Übersicht erläutert das diagnostische und therapeutische Management von VVF und beschreibt die unterschiedlichen operativen Techniken.

Abstract

Vesicovaginal fistulas (VVF) represent a detrimental condition causing psychological, physical and social strain on patients. In developed countries they are predominantly the result of pelvic surgery or radiation therapy, whilst obstetric VVF are common in developing countries due to prolonged and complicated births. The majority of VVF require surgical therapy, thus a comprehensive diagnostic workup is needed. Depending on diagnostic characteristics fistula repair can be performed by a transvaginal, transabdominal or minimally invasive approach. Timing of surgery, appropriate interposition of vascularized grafts, optimized postoperative management and surgical expertise are determining factors for successful treatment. This review describes the diagnostic workup and therapeutic management of VVF including various surgical techniques.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7

Literatur

  1. Hillary CJ, Osman NI, Hilton P, Chapple CR (2016) The aetiology, treatment, and outcome of urogenital fistulae managed in well- and low-resourced countries: a systematic review. Eur Urol 70:478–492

    PubMed  Google Scholar 

  2. Malik MA, Sohail M, Malik MT, Khalid N, Akram A (2018) Changing trends in the etiology and management of vesicovaginal fistula. Int J Urol 25(1):25–29

    PubMed  Google Scholar 

  3. Wall LL (2006) Obstetric vesicovaginal fistula as an international public-health problem. Lancet 368(9542):1201–1209

    PubMed  Google Scholar 

  4. Lee RA, Symmonds RE, Williams TJ (1988) Current status of genitourinary fistula. Obstet Gynecol 72:313–319

    CAS  PubMed  Google Scholar 

  5. Tancer ML (1992) Observations on prevention and management of vesicovaginal fistula after total hysterectomy. Surg Gynecol Obstet 175(6):501–506

    CAS  PubMed  Google Scholar 

  6. Garthwaite M, Harris N (2010) Vesicovaginal fistulae. Indian J Urol 26(2):253–256

    PubMed  PubMed Central  Google Scholar 

  7. Arrowsmith SD (1994) Genitourinary reconstruction in obstetric fistulas. J Urol 152(2 Pt 1):403–406

    CAS  PubMed  Google Scholar 

  8. Ghoniem GM, Warda HA (2014) The management of genitourinary fistula in the third millennium. Arab J Urol 2(2):97–105

    Google Scholar 

  9. El-Azab AS, Abolella HA, Farouk M (2019) Update on vesicovaginal fistula: a systematic review. Arab J Urol 17(1):61–68

    PubMed  PubMed Central  Google Scholar 

  10. Zoubek J, McGuire EJ, Noll F, DeLancey JO (1989) The late occurrence of urinary tract damage in patients successfully treated by radiotherapy for cervical carcinoma. J Urol 141:1347–1349

    CAS  PubMed  Google Scholar 

  11. Stamatakos M, Sargedi C, Stasinou T, Kontzoglou K (2014) Vesicovaginal fistula: diagnosis and management. Indian J Surg 76(2):131–136

    PubMed  Google Scholar 

  12. Moir JC (1956) Personal experiences in the treatment of vesicovaginal fistulas. Am J Obstet Gynecol 71:476–491

    CAS  PubMed  Google Scholar 

  13. Raghavaiah NV (1974) Double-dye test to diagnose various types of vaginal fistulas. J Urol 112(6):811–812

    CAS  PubMed  Google Scholar 

  14. Hohenfellner R, Fisch M, Stöckle M, Wammack R (1999) Fisteln der unteren Harnwege. In: Hirsch HA, Käser O, Ikle FA, Neeser E (Hrsg) Atlas der gynäkologischen Operationen. Thieme, Stuttgart, S 573–593

    Google Scholar 

  15. Kuhlman JE, Fishman EK (1990) CT evaluation of enterovaginal and vesicovaginal fistulas. J Comput Assist Tomogr 14:390–394

    CAS  PubMed  Google Scholar 

  16. Goodwin WE, Scardino PT (1980) Vesicovaginal and ureterovaginal fistulas: a summary of 25 years of experience. J Urol 123(3):370–374

    CAS  PubMed  Google Scholar 

  17. Capes T, Stanford EJ, Romanzi L, Foma Y, Moshier E (2012) Comparison of two classification systems for vesicovaginal fistula. Int Urogynecol J 23:1679–1685

    CAS  PubMed  Google Scholar 

  18. Beardmore-Gray A, Pakzad M, Hamid R, Ockrim J, Greenwell T (2017) Does the goh classification predict the outcome of vesico-vaginal fistula repair in the developed world? Int Urogynecol J 28:937–940

    PubMed  Google Scholar 

  19. Rajaian S, Pragatheeswarane M, Panda A (2019) Vesicovaginal fistula: review and recent trends. Indian J Urol 35(4):250–258

    PubMed  PubMed Central  Google Scholar 

  20. Angioli R, Penalver M, Muzii L, Mendez L, Mirhashemi R, Bellati F et al (2003) Guidelines of how to manage vesicovaginal fistula. Crit Rev Oncol Hematol 48(3):295–304

    PubMed  Google Scholar 

  21. Fitzpatrick CC, Elkins TE (1993) Plastic surgical techniques in the repair of vesicovaginal fistulas: a review. Int Urogynecol J Pelvic Floor Dysfunct 4:287–295

    Google Scholar 

  22. Bazi T (2007) Spontaneous closure of vesicovaginal fistulas after bladder drainage alone: review of the evidence. Int Urogynecol J Pelvic Floor Dysfunct 18:329–833

    PubMed  Google Scholar 

  23. Waaldijk K (1997) Immediate indwelling bladder catheterisation at postpartum urine leakage—personal experience of 1200 patients. Trop Doct 27:227–228

    CAS  PubMed  Google Scholar 

  24. Zimmern PE, Hadley HR, Staskin D, Raz S (1985) Genitourinary fistulas: vaginal approach for repair of vesicovaginal fistulas. Clin Obstet Gynaecol 12(2):403–413

    CAS  PubMed  Google Scholar 

  25. Breen M, Ingber M (2019) Controversies in the management of vesicovaginal fistula. Best Pract Res Clin Obstet Gynaecol 54:61–72

    PubMed  Google Scholar 

  26. Stovsky MD, Ignatoff JM, Blum MD, Nanninga JB, O’Conor VJ, Kursh ED (1994) Use of electrocoagulation in the treatment of vesicovaginal fistulas. J Urol 152(5 Pt 1):1443–1444

    CAS  PubMed  Google Scholar 

  27. Moses RA, Gormley AE (2017) State of the art for treatment of vesicovaginal fistula. Curr Urol Rep 18(8):60

    PubMed  Google Scholar 

  28. O’Conor VJ, Sokol JK, Bulkley GJ, Nanninga JB (1973) Suprapubic closure of vesicovaginal fistula. J Urol 109(1):51–54

    PubMed  Google Scholar 

  29. Waaldijk K (1994) The immediate surgical management of fresh obstetric fistulas with catheter and/or early closure. Int J Gynaecol Obstet 45:11–16

    CAS  PubMed  Google Scholar 

  30. Blandy JP, Badenoch DF, Fowler CG, Jenkins BJ, Thomas NW (1991) Early repair of iatrogenic injury to the ureter or bladder after gynecological surgery. J Urol 146(3):761–765

    CAS  PubMed  Google Scholar 

  31. Pushkar DY, Dyakov VV, Kasyan GR (2009) Management of radiation-induced vesicovaginal fistula. Eur Urol 55:131–137

    PubMed  Google Scholar 

  32. Hillary CJ, Chapple CR (2018) The choice of surgical approach in the treatment of vesico-vaginal fistulae. Asian J Urol 5:155–159

    PubMed  PubMed Central  Google Scholar 

  33. Dalela D, Ranjan P, Sankhwar PL, Sankhwar SN, Naja V, Goel A (2006) Supratrigonal VVF repair by modified O’Connor’s technique, an experience of 26 cases. Eur Urol 49:551–556

    PubMed  Google Scholar 

  34. Raz S, Bregg KJ, Nitti VW, Sussman E (1993) Transvaginal repair of vesicovaginal fistula using a peritoneal flap. J Urol 150:56–59

    CAS  PubMed  Google Scholar 

  35. Evans DH, Madjar S, Politano VA, Bejany DE, Lynne CM, Gousse AE (2001) Interposition flaps in transabdominal vesicovaginal fistula repairs: are they really necessary? Urology 57:670–674

    CAS  PubMed  Google Scholar 

  36. Ockrim JL, Greenwell TJ, Foley CL, Wood DN, Shah PJR (2009) A tertiary experience of vesico-vaginal and urethro-vaginal fistula repair: factors predicting success. BJU Int 103:1122–1126

    PubMed  Google Scholar 

  37. Mayo C (1916) Repair of small vesicovaginal fistula. Ann Surg 63:106–107

    CAS  PubMed  PubMed Central  Google Scholar 

  38. Sims JM (1852) On the treatment of vesicovaginal fistula. Am J Med Sci 23:59

    Google Scholar 

  39. Simon G (1856) Fälle von Operationen bei Urinfisteln am Weibe. Beobachtung einer Harnleiter-Scheidenfistel. Dtsch Klin 8:311

    Google Scholar 

  40. Latzko W (1942) Postoperative vesicovaginal fistulas. Genesis and therapy. Am J Surg 48:211

    Google Scholar 

  41. Ueda T, Iwatsubo E, Osada Y, Hirano H, Iwakawa A (1978) Closure of a vesicovaginal fistula using a vaginal flap. J Urol 119(6):742–743

    CAS  PubMed  Google Scholar 

  42. Nezhat CH, Nezhat F, Nezhat C, Rottenberg H (1994) Laparoscopic repair of a vesicovaginal fistula: a case report. Obstet Gynecol 83:899–901

    CAS  PubMed  Google Scholar 

  43. Melamud O, Eicheel B, Turbow B, Shanberg A (2005) Laparoscopic vesicovaginal fistula repair with robotic reconstruction. Urology 65:163–166

    CAS  PubMed  Google Scholar 

  44. Miklos JR, Moore RD, Chinthakanan O (2015) Laparoscopic and robotic-assisted vesicovaginal fistula repair: a systematic review of the literature. J Minim Invasive Gynecol 22(5):727–736

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Deutschland

    P. Marks FEBU, I. J. Lang & M. Fisch

  2. Klinik für Urologie, Universitätsklinikum Frankfurt, Frankfurt a.M., Deutschland

    L. A. Kluth

Authors
  1. P. Marks FEBU
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. A. Kluth
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. I. J. Lang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Fisch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Marks FEBU.

Ethics declarations

Interessenkonflikt

P. Marks, L. A. Kluth, I. J. Lang und M. Fisch geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Marks, P., Kluth, L.A., Lang, I.J. et al. Vesikovaginale Fisteln: Diagnostik und operatives Management. Urologe 59, 432–441 (2020). https://doi.org/10.1007/s00120-020-01155-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-020-01155-3

Schlüsselwörter

Keywords

Search

Navigation