Search

INTRODUCTION AND OBJECTIVES:The “Unite the Right” rally in Charlottesville Virginia in 2017, highlighted the controversy of Confederate Memorials. Such statues are felt not to celebrate true “heroe...

INTRODUCTION AND OBJECTIVES:To demonstrate the steps involved in the vaginal repair of a large neobladder to vagina fistula.METHODS:A 56 y old woman underwent a neobladder reconstruction after radi...

INTRODUCTION AND OBJECTIVES:Genitourinary injury and vaginal fistula formation are rare but devastating complications following hysterectomy. The literature regarding this topic is limited and gene...

We investigated a rationale for procedure selection to repair female urethral stricture associated with urethrovaginal fistula. We compared the outcomes of the 5 techniques used.Between January 1999 and October 2011, 44 female patients with urethral stricture associated with urethrovaginal fistula were treated using a total of 5 techniques. The surgical techniques were labial pedicle flap urethroplasty in 24 patients, vulvar flap urethroplasty in 3, anterior vaginal flap urethroplasty in 11, end-to-end anastomosis in 4 and bladder flap urethroplasty in 2. Supplementary procedures were performed in some patients during urethroplasty, including bladder neck reshaping for incontinence in 5, intestinal-vaginal fistula repair in 3, colpoplasty for island vulvar skin flaps in 3, middle vaginal stricture vaginoplasty in 2 and enlargement of the vaginal introitus in 1.Average postoperative followup was 42.3 months (range 6 to 140). Urethrovaginal fistula recurred in 2 patients because of infection, urethral stricture developed in 1 and stress incontinence appeared in 1. The other patients voided normally with an average maximum urine flow greater than 15 ml per second (range 16.7 to 46). The overall anatomical success rate was 93.18% (41 of 44 cases) and the functional success rate was 90.91% (40 of 44).Surgical procedures for treating female urethral strictures with urethrovaginal fistulas should be based on fistula location, stricture length and vaginal anatomy. A transvaginal approach might be optimal if the vagina is wide and easily dilated. Pedicle labial flap urethroplasty was a reliable technique for complex strictures.

Purpose: We reviewed 25 female genitourinary fistula repairs performed at our institution from 1993 to 1997.Materials and Methods: Our series comprised 7 primary vesicovaginal, 6 recurrent vesicovaginal, 7 complex, 1 ureterovaginal and 4 urethrovaginal fistulas. Postoperative followup ranged from 8 months to 5 years.Results: Overall, 92% of the patients were cured (23 of 25). The 2 failures occurred in patients with a history of pelvic malignancy involving adjuvant therapy.Conclusions: Complex irradiated vesicovaginal fistulas require staged repairs, often with pedicle flaps. However, primary repair of uncomplicated vesicovaginal fistulas is highly successful. Limited transvesical repair of these fistulas offers reliable success with minimal morbidity and hospital stay comparable to those of the transvaginal approach.

We present our surgical and functional experience with orthotopic bladder replacement in women.Since 1986, 18 women have undergone lower urinary tract reconstruction with an ileal neobladder. A nerve sparing cystectomy is done, and reservoirs are connected to the proximal urethra or urethrovesical junction. A total of 13 patients was available for complete followup as of March 1995.There were no perioperative deaths and few early complications. The only 2 failures were a neobladder vaginal fistula and these cases, which were converted to a conduit, are excluded from this study. Late complications requiring rehospitalization or reoperation in 2 patients included urethroileal stenosis that had to be dilated without further sequelae and bilateral ureteroileal stenosis that was treated endoscopically. At 3 months postoperatively excellent continence was achieved in 8 patients, while 2 had grade 1 stress incontinence and 3 were hypercontinent. As of March 1995 only 4 patients voided to completion while 9 required intermittent catheterization (continuously in 5 and twice daily for residual urine in 4). We were unable to demonstrate a functional difference of the various resection lines located at the proximal urethra or urethrovesical junction.Urethral support and nerve sparing cystectomy plus the ileal neobladder as a reservoir guarantee excellent continence in all patients. Despite our efforts, we have been unable to demonstrate any advantage of the nerve and urethral support sparing cystectomy technique as far as micturition is concerned. The development of hypercontinence in 70% of the patients with time demonstrates that our current understanding of the functional and anatomical basics of the voiding process is too limited to allow bladder replacement with a perfect functional result in all female patients. Our long-term experience, which is different from initial reports, justifies creation of an ileal neobladder in select female patients as long as they accept a 70% risk of clean intermittent catheterization in the long term. Overall patient satisfaction, including sexual life, is exceptional. However, disappointment is considerable when clean intermittent catheterization is required after periods of successful voiding per urethram.

Reconstruction of bilaterally damaged ureters after pelvic surgery is challenging. We successfully treated such a patient with a uretero-appendicocystostomy on the right side and a psoas hitch on the left side.

We report a rare case of complete avulsion of the proximal urethra from the bladder neck and a urethrovaginal fistula secondary to blunt pelvic injury in a girl. The management consisted of a relatively simple first stage procedure, suprapubic cystostomy, followed 6 months later by transpubic repair of the defect. The child is continent and free of urethral obstruction 10 months postoperatively.

Urethrovaginal fistulas may occur after external or surgical trauma and result commonly in urinary incontinence. Various repair procedures have been suggested. However, it appears that the Martius operation with labial fat pad interposition between the repaired urethra and vagina is as satisfactory as any.

A case of a spontaneous vesicovaginal fistula through an ectopic ureteral stump in an 8-year-old Japanese girl is reported. A simple nephrectomy had been done when she was 3 years old. The genesis of this fistula is discussed and the diagnostic significance of vaginoscopy is emphasized.

The incidence and significance of associated genitourinary abnormalities was reviewed in a series of 484 infants with imperforate anus encountered over a 17-year period. Fourteen percent of the entire series had significant bilateral upper tract urinary abnormalities (either asymmetric or symmetric). Of 67 such patients only 14 had combinations of renal agenesis and hypoplasia-dysplasia representing uncorrectable renal pathology. A high incidence of vesicoureteral reflex and neurovesical dysfunction represent additional important sources of preventable renal deterioration.