Genitourinary fistulas of obstetric origin

International Urology and Nephrology volume 34, pages489–493(2002)Cite this article

Abstract

Objective: To review the results of management of 42 cases of genitourinary fistulas of obstetric origin.Settings: Department of urology, Nishtar Hospital, Multan. Pakistan.Methods: Forty two cases of genitourinary fistulas (36 vesicovaginal, 2 vesicouterine, one ureterovaginal and 3urethrovaginal) were repaired from 1st December, 1999 to 31st May, 2002). All fistulas were repaired three months or more after formation. Transabdominal and vaginal repair of vesicovaginal fistulas was undertaken in 29 and 7 patients respectively. Two patients had trans-abdominal closure of vesicouterine fistulas. Ureteroneocystostomy with antireflux mechanism was performed for uretereovaginal fistula. For three urethrovaginal fistulas transvaginal layered repair was carried out.Results: Overall success rate for all types of fistula was 85.7% (36 pts).Conclusion: The surgical treatment of genitourinary fistulas will depend upon the type, size and location of fistula. Acceptable results can be achieved by adhering to the surgical principles of fistula repair i.e. optimal tissue conditions, adequate exposure and tension free closure.

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References

  1. 1.

    Symmonds RE. Incontinence: vesical and urethral fistulas. Clin Obstet Gynecol 1984; 27(2): 499–514.

    Google Scholar 

  2. 2.

    Hilton P, Ward A. Epidemiological and surgical aspects of urogenital fistulae: a review of 25 years of experience in southeast Nigeria. Int Urogynecol J 1998; 9(4): 189–194.

    Google Scholar 

  3. 3.

    Rathee S, Nanda S. Vesicovaginal fistulae: a 12-year old study. J Indian Med Assoc (March) 1995; 93(3): 93–94.

    Google Scholar 

  4. 4.

    Rafique M, Riaz A, Rauf A, Arif MH. Surgical repair of vesicovaginal fistulas: review of 45 cases. J Nephrol Urol Trans (April) 2001; 2(2): 52–55.

    Google Scholar 

  5. 5.

    Elkins TE. Surgery for the obstetric vesicovaginal fistula: A review of 100 operations in 82 patients. Am J Obstet Gynecol 1992; 170: 1108–1120.

    Google Scholar 

  6. 6.

    Hilton P. Fistulae. In: Shaw RW, Soutter WP, Stanton SL, eds. Gynecology, 2nd edn. Edinburgh, UK: Chuchill Livingstone, 1997: 779–801.

    Google Scholar 

  7. 7.

    Neilson TC, Hokegard K-H. Cesarean section and intraoperative complications. Acta Obstet Gynecol 1984; 63: 103–108.

    Google Scholar 

  8. 8.

    Rajasekar D, Hall M. Urinary tract injuries during Obstetric intervention. Br J Obstet Gynecol (June) 1997; 104(6): 731–734.

    Google Scholar 

  9. 9.

    Buchholz NP, Daly-Grandeau E, Huber Buchholz MM. Urological complications associated with caesarean section. Eur J Obstet Gynecol Reprod Biol (September) 1994; 56(3): 161–163.

    Google Scholar 

  10. 10.

    Eisenkop SM, Richman R, Platt LD, Paul RH. Urinary tract injury during cesarean section. Obstet Gynecol (November) 1982; 60(5): 591–596.

    Google Scholar 

  11. 11.

    Weinberg SR, Rosenberg JW. Injuries of the ureter. In: Bergman H, ed. The Ureter, 2nd edn. New York: Springer-Verlag, 1981: 427–459.

    Google Scholar 

  12. 12.

    Carley ME, McIntyre D, Carley JM, Schaffer J. Incidence, risk factors and morbidity of unintended bladder or ureter injury during hysterectomy. Int Urogynecol J 2002; 13: 18–21.

    Google Scholar 

  13. 13.

    Health Survey of Pakistan, 1992.

  14. 14.

    Romics I, Kelemen Zs, Fazakas Zs. The diagnosis and management of vesicovaginal fistulae. BJU Int 2002; 89: 764–766.

    Google Scholar 

  15. 15.

    Tancer ML. Observations on prevention and management of vesicovaginal fistula after total hysterectomy. Surgery, Gynecology and Obstetrics 1992; 175: 501–506.

    Google Scholar 

  16. 16.

    Patil U, Waterhouse K, Laungani G. Management of 18 difficult vesicovaginal and urethrovaginal fistulas with modified Ingleman-Sundberg and Martius operations. J Urol 1980; 123: 653–656.

    Google Scholar 

  17. 17.

    Blaivas JG, Hertiz DM, Romanzi LJ. Early versus late repair of vesicovaginal fistulae: vaginal and abdominal approaches. J Urol (April) 1995; 153(4): 1110–1112.

    Google Scholar 

  18. 18.

    Persky L, Herman G, Guerrier K. Non-delay in vesicovaginal fistula repair. Urology 1979; 13: 273–275.

    Google Scholar 

  19. 19.

    Fearl CL, Keizur LWA. Optimum time interval from occurrence to repair of vesicovaginal fistula. Am J Obstet Gynecol 1969; 104: 205–208.

    Google Scholar 

  20. 20.

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

    Google Scholar 

  21. 21.

    Glenn SG, Schoenberg HW. Female urinary tract fistulas. J Urol 1993; 149: 229–236.

    Google Scholar 

  22. 22.

    Woo HH, Rosario DJ, Chapple CR. The treatment of vesico-vaginal fistulae. Eur Urol 1996; 29(1): 1–9.

    Google Scholar 

  23. 23.

    Evans DH, Madjar S, Politano VA et al. Interposition flaps in transabdominal vesicovaginal fistula repair: are they really necessary? Urology (April) 2001; 57(4): 670–674.

    Google Scholar 

  24. 24.

    Bastiaanse MA. The treatment of vesicovaginal fistulas; including the so called radium fistulas. Proc R Soc Med 1954; 47: 610.

    Google Scholar 

  25. 25.

    Raz S, Bregg KJ, Nitti VW, Sussman E. Transvaginal repair of vesicovaginal fistula using a peritoneal flap. J Urol (July) 1993; 150(1): 56–59.

    Google Scholar 

  26. 26.

    Rangnekar NP, Imdad Ali N, Kaul SA, Pathak HR. Role of martius procedure in the management of urinary-vaginal fistulas. J Am Coll Surg (September) 2000; 191(3): 259–263.

    Google Scholar 

  27. 27.

    Birkoff JD, Wechsler M, Romas NA. Urinary fistulas: vaginal repair using a labial fat pad. J Urol (May) 1977; 117(5): 595–597.

    Google Scholar 

  28. 28.

    O'Connor VJ. Review of experience with vesicovaginal fistula repair. J Urol 1980; 123: 367–369.

    Google Scholar 

  29. 29.

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

    Google Scholar 

  30. 30.

    Tancer ML. A report of thirty four instances of urethrovaginal and bladder neck fistulas. Surg Gynecol Obstet 1993; 177(1): 77–80.

    Google Scholar 

  31. 31.

    Naude JH. The hidden vesicostomy. Br J Urol 1982; 54: 686–688.

    Google Scholar 

  32. 32.

    Fisch M, Klinowski U, Wammack R, Hohenfellner R. The sigma rectum pouch (Mainz pouch II) - critical analysis after 3 years of experience. J Urol 1995; 153: 61A.

    Google Scholar 

  33. 33.

    Nezhat CH, Nezhat F, Nezhat C, Rotternberg H. Laparoscopic repair of a vesicovaginal fistula: a case report. Obstet Gynecol 1994; 83: 899–901.

    Google Scholar 

  34. 34.

    Miklos JR, Sobolewski C, Lucente V. Case report: laparoscopic management of recurrent vesicovaginal fistula. Int Urogynecol J 1999; 10(2): 116–117.

    Google Scholar 

  35. 35.

    McKay HA. Transurethral suture Cystorrhaphy for repair of vesicovaginal fistulas: evolution of a technique. Int Urogynecol J Pelvic floor dysfunct 2001; 12(4): 282–287.

    Google Scholar 

  36. 36.

    Dogra PN, Nabi G. Laser welding of vesicovaginal fistula. Int Urogynecol J 2001; 12(1): 69–70.

    Google Scholar 

  37. 37.

    Kanaoka Y, Hirai K, Ishiko O, Ogita S. Vesicovaginal fistula treated with fibrin glue. Int J Gynecol Obstet (May) 2001; 73(2): 147–149.

    Google Scholar 

  38. 38.

    Miklos JR. Laparoscopic treatment of vesicouterine fistula. J Am Assoc Gynecol Laparosc 1999; 6(3): 399–341.

    Google Scholar 

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  1. Nishtar Medical College, Multan, Pakistan

    M. Rafique

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Rafique, M. Genitourinary fistulas of obstetric origin. Int Urol Nephrol 34, 489–493 (2002). https://doi.org/10.1023/A:1025679205541

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  • Genitourinary fistula
  • Ureterovaginal fistula
  • Urethrovaginal fistula
  • Urinary fistula
  • Vesicovaginal fistula