Skip to main content

Advertisement

SpringerLink
Log in

Urogenital fistulae: changing trends and personal experience of 46 cases

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

A retrospective study of 46 patients with different types of urogenital fistulae treated by the author during the period from January 1997 to December 2006 is presented. Twenty-two (48%) cases had a vesicovaginal fistula of which 16 (73%) were repaired vaginally and 6 (27%) were repaired abdominally. The remaining fistulae were as follows: 14 (30%) unilateral ureterovaginal fistulae, 6 (13%) ureterovesicovaginal fistulae (one bilateral), and 4 (9%) vesicouterine fistulae. All were repaired abdominally except for one patient with ureterovesicovaginal fistula needing continent urinary diversion using Mainz type II pouch. All fistulae were iatrogenic except one case (2%) which was due to neglected obstructed labor. The iatrogenic causes were gynecologically related in 26 (57%) patients and obstetrically related in 19 (41%) cases. There were two (9%) failed repairs in the vesicovaginal cases, one in each group, and both were salvaged by a secondary surgery. In view of this selected retrospective study and in association with other reports, it seems that with the improvement in the basic health-care services in Egypt, there is a change in the etiology of urogenital fistulae with the vast majority being physician related and no more related to neglected obstructed labor. Such shortcoming should be addressed in the current gynecological surgery training and residency programs.

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

Similar content being viewed by others

References

  1. Mahfouz N (1957) Urinary fistulae in women. J Obstet Gynaecol Br Emp 64:23–34

    PubMed  CAS  Google Scholar 

  2. Shokeir AA, Hussein MI (1999) The urology of Pharaonic Egypt. Br J Urol 84:755–761

    CAS  Google Scholar 

  3. Falk HC, Tancer ML (1954) Vesicovaginal fistula: an historical survey. Obstet Gynecol 3:337–341

    PubMed  CAS  Google Scholar 

  4. Zacharin RF (2000) A history of obstetric vesicovaginal fistula. ANZ J Surgery 70:851–854

    Article  CAS  Google Scholar 

  5. American College of Obstetricians and Gynecologists (1997) ACOG Educational Bulletin. Lower urinary tract operative injuries. Number 238, July 1997. Int J Gynaecol Obstet 59(1):67–72

    Article  Google Scholar 

  6. Aronson MP, Bose TM (2002) Urinary tract injury in pelvic surgery. Clin Obstet Gynecol 45:428–438

    Article  PubMed  Google Scholar 

  7. Mammen C, Chilaka V, Cust MP (2006) Urological surgical techniques. Best Pract Res Clin Obstet Gynaecol 20:139–156

    Article  PubMed  Google Scholar 

  8. Drake MJ, Noble JG (1998) Ureteric trauma in gynecologic surgery. Int Urogynecol J Pelvic Floor Dysfunct 9:108–117

    Article  PubMed  CAS  Google Scholar 

  9. Thompson JR, Chen AH (1998) Ureteral injuries: a primer. Oper Tech Gynecolog Surg 2:74–83

    Google Scholar 

  10. Donnay F, Weil L (2004) Obstetric fistula: the international response. Lancet 363:71–72

    Article  PubMed  Google Scholar 

  11. Wall LL, Arrowsmith SD, Briggs ND, Browning A, Lassey A (2005) The obstetric vesicovaginal fistula in the developing world. Obstet Gynecol Surv 60(7 Suppl 1):S3–S55

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  13. Hilton P (2003) Vesico-vaginal fistulas in developing countries. Int J Gynecol Obstet 82:285–295

    Article  CAS  Google Scholar 

  14. WHO (2006) Obstetric fistula: guiding principles for clinical management and program development. World Health Organization, Geneva

    Google Scholar 

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

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  17. Flores-Carrerras O, Carbera JR, Galeano PA, Torres FE (2001) Fistulas of the urinary tract in gynecologic and obstetric surgery. Int Urogynecol J Pelvic Floor Dysfunct 12:203–214

    Article  Google Scholar 

  18. Cornella JL, Lee RA (2001) Diagnosis and management of genitourinary fistula. In: Gershenson DM, DeCherney AH, Curry SL, Brubaker L (eds) Operative gynecology, 2nd edn. Saunders, Philadelphia, pp 398–414

    Google Scholar 

  19. Turner-Warwick R, Chapple CR (2002) Gynaeco-urological injuries and fistula repair. In: Turner-Warwick R, Chapple CR (eds) Functional reconstruction of the urinary tract and gynaeco-urology: an exposition of functional principles and surgical procedures. Blackwell, Oxford, pp 591–678

    Google Scholar 

  20. Rovner ES (2007) Urinary tract fistula. In: Wein AJ (ed) Campbell-Walsh Urology, 9th edn. Saunders, Philadelphia, pp 2322–2360

    Google Scholar 

  21. Meeks GR, Roth TM (2003) Vesicovaginal and urethrovaginal fistulas. In: Rock JA, Jones HW III (eds) Te Linde’s operative gynecology, 9th edn. Williams & Wilkins, Philadelphia, pp 1099–1120

    Google Scholar 

  22. Margolis T, Mercer LJ (1994) Vesicovaginal fistula. Obstet Gynecol Surv 49:840–847

    Article  PubMed  CAS  Google Scholar 

  23. Woo HH, Rosario DJ, Chapple CR (1996) The treatment of vesicovaginal fistulae. Eur Urology 29:1–9

    CAS  Google Scholar 

  24. Hadley HR (2002) Vesicovaginal fistula. Curr Urol Rep 3:401–407

    Article  PubMed  Google Scholar 

  25. Kumar S, Kekre NS, Gopalakrishnan G (2007) Vesicovaginal fistula: an update. Ind J Urol 23:187–191

    Google Scholar 

  26. Dupont MC, Raz S (1996) Vaginal approach to vesicovaginal fistula repair. Urology 48:7–9

    Article  PubMed  CAS  Google Scholar 

  27. Romanzi LJ, Heritz DM, Blaivas JG (1996) Surgery for vesicovaginal fistula: timing and approach. Contemp Ob/Gyn 41:65–76

    Google Scholar 

  28. Zacharin RF (1980) Grafting as a principle in the surgical management of vesicovaginal and rectovaginal fistulae. Aust N Z J Obstet Gynaecol 20:10–17

    PubMed  CAS  Google Scholar 

  29. Given FT, Acosta AA (1989) The Martius procedure- Bulbocavernosus fat flap: a review. Obstet Gynecol Surv 44:34–40

    Google Scholar 

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

    Article  Google Scholar 

  31. Mayer AR, Rodriguez RL (1994) Flap techniques as an adjunct in vaginal fistulectomy. Int Urogynecol J Pelvic Floor Dysfunct 5:175–182

    Article  Google Scholar 

  32. O’Connor VJ Jr (1980) Review of experience with vesicovaginal fistula repair. J Urol 123:367–369

    Google Scholar 

  33. Turner-Warwick R (1972) The use of pedicle grafts in the repair of urinary tract fistulae. Br J Urol 44:644–656

    Article  PubMed  CAS  Google Scholar 

  34. Turner-Warwick R, Chapple CR (2002) The value and the principles of omentoplasty and omental interposition. In: Turner-Warwick R, Chapple CR (eds) Fuctional reconstruction of the urinary tract and gynaeco-urology: an exposition of functional principles and surgical procedures. Blackwell, Oxford, pp 155–186

    Google Scholar 

  35. Fisch M, D’Elia G, Hohenfellner R, Thüroff JW (2004) Ureterosigmoidostomy: Mainz pouch II. In: Graham SD Jr (ed) Glenn’s Urologic surgery, 6th edn. Williams & Wilkins, Philadelphia, pp 689–696

    Google Scholar 

  36. Fisch M, Hohenfellner R (2005) Ureterosigmoidostomy and the rectosigmoid pouch (Mainz pouch II). In: Krane RJ, Siroky MB, Fitzpatrick JM (eds) Operative urology surgical skills. Churchill Livingstone, New York, pp 121–125

    Google Scholar 

  37. El-Mekresh MM, Hafez AT, Abol-Enein H, Ghoneim MA (1997) Double folded rectosigmoid bladder with a new ureterocolic antireflux technique. J Urol 157:2085–2089

    Article  PubMed  CAS  Google Scholar 

  38. El-Lamie IK (2001) Preliminary experience with Mainz type II pouch in gynecologic oncology patients. Eur J Gynaecol Oncol 22:77–80

    PubMed  CAS  Google Scholar 

  39. Rice LW (1998) Ureterovaginal fistula. Oper Tech Gynecolog Surg 2:141–149

    Google Scholar 

  40. Koo HP, Bloom DA (1999) Lower ureteral reconstruction. Urol Clin North Am 26:167–173

    Article  PubMed  CAS  Google Scholar 

  41. Stief CG, Jonas U, Petry K-U, Sohn C, Bektas H, Klempnauer J, Chavan A, Galanski M, Montorsi F (2003) Ureteric reconstruction. Br J Urol 91:138–142

    CAS  Google Scholar 

  42. Borer JG, Diamond DA (2005) Ureteral reimplantation. In: Krane RJ, Siroky MB, Fitzpatrick JM (eds) Operative urology surgical skills. Churchill Livingstone, New York, pp 99–106

    Google Scholar 

  43. Razdan S (2005) Bladder flap procedures. In: Krane RJ, Siroky MB, Fitzpatrick JM (eds) Operative urology surgical skills. Churchill Livingstone, New York, pp 107–110

    Google Scholar 

  44. Politano VA, Leadbetter WF (1958) An operative technique for the correction of vesicoureteral reflux. J Urol 79:932–941

    PubMed  CAS  Google Scholar 

  45. Youssef AF (1957) Menouria following lower segment cesarean section: a syndrome. Am J Obstet Gynecol 73:759–762

    PubMed  CAS  Google Scholar 

  46. Tancer ML (1986) Vesicouterine fistula-a review. Obstet Gynecol Surv 41:743–753

    Article  PubMed  CAS  Google Scholar 

  47. Furbetta A, Fagioli A, Cristini C, Michetti PM, Trucchi A, Signori S, Vahedi M (1994) Vesicouterine fistulae as complications of cesarean section. Int Urogynecol J Pelvic Floor Dysfunct 5:240–246

    Article  Google Scholar 

  48. Yip S-K, Leung T-Y (1998) Vesicouterine fistula: a review. Int Urogynecol J Pelvic Floor Dysfunct 9:252–256

    Article  PubMed  CAS  Google Scholar 

  49. Jóźwik M, Jóźwik M (2000) Clinical classification of vesicouterine fistula. Int Gynecol Obstet 70:353–357

    Article  Google Scholar 

  50. DiMarco CS, DiMarco DS, Klingele CJ, Gebhart JB (2006) Vesicouterine fistula: a review of eight cases. Int Urogynecol J Pelvic Floor Dysfunct 17:395–399

    Article  PubMed  Google Scholar 

  51. Fichtner J, Voges G, Steinbach F, Hohenfellner R (1993) Ureterovesicovaginal fistulas. Surg Gynecol Obstet 176:571–574

    PubMed  CAS  Google Scholar 

  52. Kamat N (2005) Vesico-vaginal fistula (letter). Br J Urol 96:192

    Google Scholar 

  53. Béland G (1977) Early treatment of ureteral injuries found after gynecological surgery. J Urol 118:25–27

    PubMed  Google Scholar 

  54. Persky L, Herman G, Guerrier K (1979) Nondelay in vesicovaginal fistula repair. Urology 13:273–279

    Article  PubMed  CAS  Google Scholar 

  55. Wang Y, Hadley HR (1990) Nondelayed transvaginal repair of high lying vesicovaginal fistula. J Urol 144:34–36

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  57. Blaivas JG, Heritz DM, Romanzi LJ (1995) Early versus late repair of vesicovaginal fistulas: vaginal and abdominal approaches. J Urol 153:1110–1113

    Article  PubMed  CAS  Google Scholar 

  58. Selvaggi, FP, Battaglia M, Traficante A, Pace G, Martino P (1991) Obstetric and gynecologic lesions of the ureter: experience with 88 injuries. Int Urogynecol J Pelvic Floor Dysfunct 2:81–84

    Article  Google Scholar 

  59. Tarkington MA, Dejter SW Jr, Bresette JF (1991) Early surgical management of extensive gynecologic ureteral injuries. Surg Gynecol Obstet 173:17–21

    PubMed  CAS  Google Scholar 

  60. El-Tabey NA, Ali-El-Dein B, Shaaban AA, El-Kappany HA, Mokhtar AA, El-Azab M, Kheir AA (2006) Urological trauma after gynecological and obstetric surgeries: an 18-year single-center experience. Scand J Urol Nephrol 40:225–231

    Article  PubMed  Google Scholar 

  61. Mahfouz N (1929) Urinary and recto-vaginal fistulae in women. J Obstet Gynaecol Br Emp 36:581–589

    Google Scholar 

  62. Mahfouz N (1938) Urinary and fecal fistulae. J Obstet Gynaecol Br Emp 45:405–424

    Google Scholar 

  63. Foda MS (1959) Evaluation of methods of treatment of urinary fistulae in women. J Obstet Gynaecol Br Emp 66:372–381

    PubMed  CAS  Google Scholar 

  64. Aronson MP, DeLancey JOL, Lee RA (1999) Prevention and immediate management of urinary tract injury (Panel Discussion). J Pelvic Med Surg 5:282–292

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics & Gynecology, Ain Shams University, Cairo, Egypt

    Ismail K. El-Lamie

Authors
  1. Ismail K. El-Lamie
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ismail K. El-Lamie.

Rights and permissions

Reprints and permissions

About this article

Cite this article

El-Lamie, I.K. Urogenital fistulae: changing trends and personal experience of 46 cases. Int Urogynecol J 19, 267–272 (2008). https://doi.org/10.1007/s00192-007-0426-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-007-0426-5

Keywords

Search

Navigation