Abstract
Introduction and hypothesis
In the developed world, urethrovaginal fistulas are most the likely the result of iatrogenic injury. These fistulas are quite rare. Proper surgical repair requires careful dissection and tension-free closure. The objective of this video is to demonstrate the identification and surgical correction of an urethrovaginal fistula.
Methods
The case presented is of a 59-year-old woman with a history of pelvic organ prolapse and symptomatic stress urinary incontinence who underwent vaginal hysterectomy, anterior colporrhaphy, posterior colporrhaphy, and synthetic sling placement. Postoperatively, she developed a mesh extrusion and underwent sling excision. After removal of her synthetic sling, she began to experience continuous urinary incontinence. Physical examination and cystourethroscopy demonstrated an urethrovaginal fistula at the midurethra. Options were discussed and the patient wished to undergo transvaginal fistula repair.
Results
The urethrovaginal fistula was intubated with a Foley catheter. The fistula tract was isolated and removed. The urethra was then closed with multiple tension-free layers. This video demonstrates several techniques for identifying and subsequently repairing an urethrovaginal fistula. Additionally, it demonstrates the importance of tension-free closure.
Conclusions
Urethrovaginal fistulas are rare. They should be repaired with careful dissection and tension-free closure.
References
Stanford EJ, Paraiso MF. A comprehensive review of suburethral sling procedure complications. J Minim Invasive Gynecol. 2008;15:132–45.
Pushkar DY, Dyakov VV, Kosko JW, et al. Management of urethrovaginal fistulas. Eur Urol. 2006;40:1000–5.
Lee UJ, Goldman H, Moore C, et al. Rate of de novo stress urinary incontinence after urethral diverticulum repair. Urology. 2008;71:849–53.
Reisenauer C, Janowitz J, Wallwiener D, et al. Urethrovaginal fistulae associated with tension-free vaginal tape procedures: a clinical challenge. Int Urogynecol J. 2014;25:319–22.
Goh JT, Browning A, Berhan B, et al. Predicting the risk of failure of closure of obstetric fistula and residual urinary incontinence using a classification system. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:1659–62.
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The authors have no conflicts of interest.
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Neither Dr Clifton nor Dr Goldman has any financial disclosures.
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Clifton, M.M., Goldman, H.B. Urethrovaginal fistula closure. Int Urogynecol J 28, 157–158 (2017). https://doi.org/10.1007/s00192-016-3111-8
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DOI: https://doi.org/10.1007/s00192-016-3111-8