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INTRODUCTION AND HYPOTHESIS: We evaluated a pilot multi-component reintegration intervention to improve womens physical and psychosocial quality of life after genital fistula surgery. METHODS: Twelve women undergoing fistula repair at Mulago Specialized Women and Neonatal Hospital (Kampala, Uganda) anticipated in a 2-week multi-component intervention including health education, psychosocial therapy, physiotherapy, and economic investment. We assessed feasibility through recruitment, retention, and adherence, acceptability through intervention satisfaction, and preliminary effectiveness through reintegration, mental health, physical health, and economic status. We collected quantitative data at enrollment, 6 weeks, 3 months, and 6 months. We conducted in-depth interviews with six participants. Quantitative data are presented descriptively, and qualitative data analyzed thematically. RESULTS: Participants had a median age of 34.5 years (25.5-38.0), 50% were married/partnered, 42% were separated, 50$ had completed less than primary education, and 67% were unemployed. Mean number of sessions received was 12 for health education (range 5-15), 8 for counseling (range 8-9), and 6 for physiotherapy (range 4-8). Feasibility was demonstrated by study acceptance among all those eligible (100%); comfort with study measures, data collection frequency and approach; and procedural fidelity. Acceptability was high; all participants reported being very satisfied with the intervention and each of the components. Participant narratives echoed quantitative findings and contributed nuanced perspectives to understanding approach and content. CONCLUSIONS: Our results suggest that the intervention and associated research were both feasible and acceptable, and suggested certain modifications to the intervention protocol to reduce participant burden. Further research to determine the effectiveness of the intervention above and beyond surgery alone with regard to the health and well-being of women with fistulas is warranted.

BACKGROUND: Female genital fistula is a traumatic debilitating injury, frequently caused by prolonged obstructed labor, affecting between 500,000-2 million women in lower-resource settings. Vesicovaginal fistula causes urinary incontinence, and other morbidity may occur during fistula development. Women with fistula are stigmatized, limit social and economic engagement, and experience psychiatric morbidity. Improved surgical access has reduced fistula consequences yet post-repair risks impacting quality of life and well-being include fistula repair breakdown or recurrence and ongoing or changing urine leakage or incontinence. Limited evidence on risk factors contributing to adverse outcomes hinders interventions to mitigate adverse events. This study aims to quantify these adverse risks and inform clinical and counseling interventions to optimize womens health and quality of life following fistula repair through: identifying predictors and characteristics of post-repair fistula breakdown and recurrence (Objective 1) and post-repair incontinence (Objective 2), and to identify feasible and acceptable intervention strategies (Objective 3). METHODS: This mixed-methods study incorporates a prospective cohort of women with successful vesicovaginal fistula repair at approximately 12 fistula repair centers in Uganda (Objectives 1-2) followed by qualitative inquiry among key stakeholders (Objective 3). Cohort participants will have a baseline visit at the time of surgery followed by data collection at 2 weeks, 6 weeks, 3 months and quarterly thereafter for 3 years. Primary predictors to be evaluated include patient-related factors, fistula-related factors, fistula repair-related factors, and post-repair behaviors and exposures, collected via structured questionnaire at all data collection points. Clinical exams will be conducted at baseline, 2 weeks post-surgery, and for outcome confirmation at symptom development. Primary outcomes are fistula repair breakdown or fistula recurrence and post-repair incontinence. In-depth interviews will be conducted with cohort participants (n ~ 40) and other key stakeholders (~ 40 including family, peers, community members and clinical/social service providers) to inform feasibility and acceptability of recommendations. DISCUSSION: Participant recruitment is underway. This study is expected to identify key predictors that can directly improve fistula repair and post-repair programs and womens outcomes, optimizing health and quality of life. Furthermore, our study will create a comprehensive longitudinal dataset capable of supporting broad inquiry into post-fistula repair health. Trial Registration ClinicalTrials.gov Identifier: NCT05437939.

Introduction: We aim to compare the clinical and urodynamic profile of lower urinary tract symptoms (LUTS) in patients undergoing laparoscopic, open transabdominal, and laparoscopic transabdominal vesicovaginal fistulae (VVF) repair at 3 months of repair, that is, in early postoperative period. Materials and Methods: Fifty‐one consecutive patients with endoscopically confirmed VVF were enrolled in our study over 2 years. Malignant fistulae, radiation‐induced, and complex fistulae were excluded after cross‐sectional imaging. All patients underwent a postoperative assessment for the success of the repair. Then at 3 months, they completed the American Urological Association Symptom Score questionnaire and underwent a dual channel pressure‐flow urodynamic study. The results of transvaginal, laparoscopic, and open transabdominal repairs were compared. Results: All patients belonged to the Indian Caucasian race. The mean age was 35.43 ± 6.63 years. Thirty‐two patients had supratrigonal and 19 had trigonal fistulae. Laparoscopic transabdominal repair was done in 15 patients, open transabdominal repair in 22 patients, and transvaginal repair in 14 patients. Forty‐six patients reported some LUTS at a median follow‐up of 5.83 ± 2.37 months postoperatively. Only 18 (35.2%) of these patients had moderate to severe symptoms The postoperative bladder dysfunction rates in open transabdominal, transvaginal and laparoscopic transabdominal groups were 36.4%, 28.6%, and 20%, respectively. Twenty‐seven patients (52.9%) had some urodynamic abnormality, that is, small capacity (5), high voiding pressures (14), genuine stress incontinence (3), and poor compliance (3). Bladder capacity was a significant predictor of bladder dysfunction in our patients. Conclusions: In our study, all three surgical approaches were associated with bladder dysfunction, however, it was the least in the laparoscopic transabdominal approach. Postoperative bladder capacity is a significant predictor of bladder dysfunction. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to share the experiences and outcomes of laparoscopic pneumovesical repair for vesicovaginal fistulas (VVF). Materials and methods: A retrospective review of medical records from a single institution over 10 years was conducted. The focus was on patients who underwent VVF repair using a pneumovesical approach with three 5 mm laparoscopic ports. The study evaluated perioperative parameters, postoperative outcomes, and complication rates to assess the efficacy and safety of this surgical method. Cumulative sum (CUSUM) analysis was used to determine the learning curve based on operative time. Results: Of the 26 patients with VVF, 23 (88.5%) had successful fistula closure after the first surgery. One patient required open surgery conversion due to challenges in maintaining pneumovesicum, and two experienced recurrences, although successful repairs were achieved in subsequent surgeries. The average patient age was 47.4 years, with a mean operative time of 99.9 min. The postoperative hospital stay averaged 9.1 days, and catheterization lasted about 11 days. The CUSUM chart indicated a learning curve, with fluctuations until the 19th case, followed by a consistent upward pattern. Conclusion: Laparoscopic pneumovesical VVF repair is an effective and safe technique, especially suitable for fistulas near the ureteral orifice or deep in the vaginal cavity. The method demonstrates favorable outcomes with minimal complications and allows for easy reoperation if necessary. [ABSTRACT FROM AUTHOR]

Objective: To investigate long‐term and patient‐reported outcomes, including sexual function, in women undergoing urogenital fistula (UGF) repair, addressing the lack of such data in Western countries, where fistulas often result from iatrogenic causes. Patients and Methods: We conducted a retrospective analysis at a tertiary referral centre (2010–2023), classifying fistulas based on World Health Organisation criteria and evaluating surgical approaches, aetiology, and characteristics. Both objective (fistula closure, reintervention rates) and subjective outcomes (validated questionnaires) were assessed. A scoping review of patient‐reported outcome measures in UGF repair was also performed. Results: The study included 50 patients: 17 (34%) underwent transvaginal and 33 (66%) transabdominal surgery. History of hysterectomy was present in 36 patients (72%). The median (interquartile range [IQR]) operating time was 130 (88–148) min. Fistula closure was achieved in 94% of cases at a median (IQR) follow‐up of 50 (16–91) months and reached 100% after three redo fistula repairs. Seven patients (14%) underwent reinterventions for stress urinary incontinence after transvaginal repair (autologous fascial slings). Patient‐reported outcomes showed median (IQR) scores on the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Modules (ICIQ‐FLUTS) of 5 (3–7) for filling symptoms, 1 (0–2) for voiding symptoms and 4.5 (1–9) for incontinence symptoms. The median (IQR) score on the ICIQ Female Sexual Matters Associated with Lower Urinary Tract Symptoms Module (ICIQ‐FLUTSsex) was 3 (1–5). The median (IQR) ICIQ Satisfaction (ICIQ‐S) outcome score and overall satisfaction with surgery item score was 22 (18.5–23.5) and 10 (8.5–10), respectively. Higher scores indicate higher symptom burden and treatment satisfaction, respectively. Our scoping review included 1784 women, revealing mixed aetiology and methodological and aetiological heterogeneity, thus complicating cross‐study comparisons. Conclusions: Urogenital fistula repair at a specialised centre leads to excellent outcomes and high satisfaction. Patients with urethrovaginal fistulas are at increased risk of stress urinary incontinence, possibly due to the original trauma site of the fistula. [ABSTRACT FROM AUTHOR]

Objective: Laparoscopic repair of vesicovaginal fistula (VVF) is gaining popularity day by day, but we have limited literature on it. This study is to evaluate the safety, feasibility, and outcomes of laparoscopic VVF repair in a tertiary care center in Eastern India. Subjects and Methods: This study is a single-center retrospective study in which 11 patients of supratrigonal VVF were evaluated who underwent laparoscopic repair. Preoperative workup included history, examination, computed tomography urography, cystoscopy, and vaginoscopy. After informed consent, laparoscopic VVF repair was done under general anesthesia. Duration of surgery, the need for conversion to open procedure, intraoperative bowel injury, the need for postoperative blood transfusion, postoperative hospital stay, postoperative urinary leak, and any incontinence after catheter removal were noted. Results: All the patients had primary supratrigonal fistula of approximate size in the range of 1.5–2.0 cm. All the included patients were operated on successfully by laparoscopic technique with a mean duration of surgery of 177.91 ± 6.14 min. The mean duration of postoperative hospital stay was 4.45 ± 0.52 days. There was no incidence of postoperative urine leak in any patient. After urethral catheter removal, all the patients voided well without any incontinence. Conclusions: Laparoscopic VVF repair is a safe and feasible option with satisfactory intraoperative and postoperative outcomes.

Introduction Although uterine perforation is a rare but serious complication, intrauterine devices are globally popular and effective contraceptive methods. Case presentation A 76‐year‐old female patient manifesting symptoms of vaginal leakage and lower abdominal discomfort was admitted to our hospital. Diagnostic imaging identified a vesicovaginal fistula and bladder calculi attributable to perforation of the bladder by an intrauterine device that had been inserted over four decades ago. The patient underwent open surgery for cystolith removal and vesicovaginal fistula repair. Conclusions If a patient with an intrauterine device complains of bladder stones or ongoing lower urinary tract symptoms, bladder perforation caused by the device should be considered in the differential diagnosis.

Abstract Background Complex vesico-vaginal fistulae (VVF) pose unique surgical challenges and necessitate the use of interposition tissue to ensure surgical success. Herein, we describe a case of complex VVF with right uretero-vaginal fistula post radical surgery for locally advanced ovarian cancer and chemotherapy in which the rectus abdominis muscle flap was used as the interposition tissue, as the more routine used options such as omentum and peritoneum were removed in the prior radical surgery. Case presentation We describe a case report of a vesico-vaginal and right uretero-vaginal fistula in a 34-year-old female post ovarian cancer radical surgery managed surgically with the traditional transvesical technique of repair and ureteric reimplantation with a unique interposition with rectus abdominis muscle considering the absence of the more routine options. Conclusion Complex VVFs pose unique surgical challenges and necessitate the use of interposition tissue to ensure surgical success. The inferior pedicle based rectus abdominis muscle flap is an excellent interposition tissue for repairs via the transabdominal approach especially in scenarios where the more routine options are unavailable.

Objective Design Setting Methods Results Conclusions Globally, obstetric fistula is a tragic outcome following obstructed labour. Failure of complex repair and post‐operative incontinence are common. We describe an innovative surgical technique incorporating the rectus abdominus flap at the time of fistula repair.Retrospective case series.Malawi, Fistula Care Centre.Patients were followed for 3 months after discharge to determine continence and healing.Five of six patients were continent at 3 months and one was lost to follow‐up by dry at a one month post‐operative phone call. There were no major complications.The rectus abdominus flap may be a useful adjunct to repair of complex obstetric fistula. [ABSTRACT FROM AUTHOR]

Objective: In Uganda, ∼2% of women have had urogenital fistulae. Given that ureteric involvement makes surgical repair more complex, this research was conducted to identify the risk factors for ureteric involvement when evaluating women who have urogenital fistulae to prepare better for surgical planning and counseling. Materials and Methods: This was a retrospective cohort study of women who underwent urogenital fistula repair at Kitovu Mission Hospital in Masaka, Uganda. Results: Of 546 patients with urogenital fistula, 50 (9.2%) had ureteric involvement. Those with ureteric involvement had statistically significantly higher parity (p < 0.0001) and shorter labor duration, compared with patients without ureteric involvement (p = 0.003); and had undergone prior non-fistula operations, compared to patients without ureteric involvement (p = 0.025). Delivery type distribution was significantly different between groups (p = 0.016) with higher rates of cesarean delivery and cesarean hysterectomy in women with ureteric involvement, compared to women without ureteric involvement (73.9% and 13% versus 61.4% and 5.8%). Goh classification of scarring was statistically significant between the groups (p = 0.013). Conclusions: Potential risk factors for ureteric involvement, include higher parity, shorter duration of labor, and history of cesarean or cesarean hysterectomy. There is also a trend toward Goh classification 1aiii. These factors can be used to stratify patients' risk preoperatively and assist surgical planning, especially in resource-limited settings. (J GYNECOL SURG 20XX:000) [ABSTRACT FROM AUTHOR]

Complex female genital tract malformations account for 1.2% of all female genitourinary malformations. Although exceedingly rare, they can cause severe gynecologic symptoms in young women and lead to fertility problems. We present the case of a 13-year-old girl with primary amenorrhea referred for cyclic abdominal lower pain and menouria. Detailed diagnostics revealed uterus didelphys, transverse vaginal septum, and bilateral vesicovaginal fistulas. Laparoscopic left hemi-hysterectomy and salpingectomy were performed. The vesicovaginal fistula on the right side was excised, and the proximal vagina was anastomosed with the distal dimple. Since the operation, the patient has been pain-free and menstruating regularly from the right uterus. Preservation of the uterus should be considered in any case of complex female genital tract malformation and, as successful laparoscopic treatment advocates, a minimally invasive approach is feasible. [ABSTRACT FROM AUTHOR]

Background: Studies on fertility desires among fistula patients in the Democratic Republic of Congo (DRC) have been conducted on fewer patients. Furthermore, these studies have adopted a univariate descriptive approach. This study aims to examine the determinants of fertility desires among patients with fistula in the DRC. Methods: This cross-sectional study included women aged 15–49 whose fistulas were repaired by the Panzi Hospital mobile team in seven DRC regions between 2013 and 2018. Univariate and bivariate descriptive analyses were performed using the frequency distribution table and the chi-square test. Adjusted odds ratios with their 95 confidence intervals from logistic regression were used to analyze factors associated with fertility desire after fistula repair. All analyses were stratified by parity level for all women aged 15–49 and 20–34 years. Results: Of the 1,646 women aged 15–49 and 808 aged 20–34, 948 (57.6%) and 597 (73.8%), respectively, wanted to have children after fistula repair. Among women aged 15–49 and 20–34 years, the desire to have children was parity-specific. It was negatively associated with age at all parity levels. In women with low parity, the desire for children was significantly negatively associated with a high number of surgeries, abortions, and fistula duration. It tended to decrease with time, but was particularly high in 2014 and 2017. It was high among the Protestant women. Among medium-parity women, it was significantly lower in urban areas and among widows, but higher among women who had more than two abortions. Among high-parity women, it was negatively associated with education level. Conclusion: To help women with fistula achieve or approach their desired number of children, our findings suggest that (1) counseling is needed for women with a high desire for children; (2) the human, material, and financial resources needed to eliminate fistula in the DRC should be made available; and (3) medical and nursing staff should be sufficiently and effectively trained to minimize the number of unsuccessful surgeries performed on women with fistula. [ABSTRACT FROM AUTHOR]

Herlyn–Werner–Wunderlich (HWW) syndrome is characterized by obstructed hemivagina and ipsilateral renal anomaly, a rare congenital anomaly of the genitourinary tract, resulting from malformations of the renal tract associated with Müllerian duct anomalies. The initial symptoms of HWW frequently present after menarche and may be nonspecific, leading to a delayed diagnosis. We presented a 19-year-old female with 3-year hematuria and abdominal pain. The final diagnosis of HWW syndrome with a rare vesicovaginal fistula was made. The treatment of HWW syndrome typically involves surgical intervention. The primary treatment is resection or removal of the obstructed vaginal septum. The patient underwent excision of vaginal septum and vaginal reconstruction via hysteroscopy, as well as repair of the vesicovaginal fistula. The patient improved well after surgery and fully recovered without sequelae after 3 months. In addition, unilateral renal agenesis is one of congenital abnormalities of the kidney and urinary tract, which are the most frequent cause of chronic kidney disease (CKD) in children. This report describes a patient of HWW syndrome with rarely combined vesicovaginal fistula, and highlights the importance of early recognition and management to prevent associated complications. [ABSTRACT FROM AUTHOR]

Objectives: Vesicovaginal fistulas (VVF) are the most commonly acquired fistulas of the urinary tract. The management of VVF is mainly based on expert opinion and surgeon experience. This study aims to provide the practice patterns and outcomes of vesicovaginal fistula (VVF) management in Indonesia. Methods: This study utilizes the results of a survey among the surgeons who performs VVF repair in referral hospitals throughout Indonesia between June and July of 2021. Data analysis was carried out with SPSS descriptively by displaying the relative frequency of the answers to each question of the questionnaire form. Results: We collected responses from 93 respondents consisting of 68 urologists and 25 gynecologists. The most commonly reported cause of VVF was obstetric (50.5%). Most respondents confirmed the diagnosis of VVF by cystoscopy (81.7%). Waiting time to repair VVF was generally 12 weeks (79.6%), while the transvaginal approach repair was more often performed (77.4%). An additional procedure, such as tissue interposition was performed in 50.5% of cases. Tissue interposition was mostly indicated in recurrent VVF (81%), with omentum being the most selected tissue interposition (71%). When indicated, the most selected method of transabdominal approach was open transvesical (54,84%). A laparoscopic approach was performed only in 7.5% of cases. Overall, the success rate for VVF repair in Indonesia was 70-100% at first attempt. Conclusions: The transvaginal approach is preferred, either with or without an interposition tissue flap. The success rate at the first attempt is satisfactory. [ABSTRACT FROM AUTHOR]

Abstract Vesicovaginal fistula lacks a standard, established animal model, making surgical innovations for this condition challenging. Herein, we aimed to non-surgically establish vesicovaginal fistula using the magnetic compression technique, and the feasibility of this method was explored using eight female Beagle dogs as model animals. In these dogs, cylindrical daughter and parent magnets were implanted into the bladder and vagina, respectively, after anesthesia, and the positions of these magnets were adjusted under X-ray supervision to make them attract each other, thus forming the structure of daughter magnet-bladder wall-vaginal wall-parent magnet. Operation time and collateral damage were recorded. The experimental animals were euthanized 2 weeks postoperatively, and the vesicovaginal fistula gross specimens were obtained. The size of the fistula was measured. Vesicovaginal fistula was observed by naked eye and under a light microscope. Magnet placement was successful in all dogs, and remained in the established position for the reminder of the experiment. The average operation time was 14.38 min ± 1.66 min (range, 12–17 min). The dogs were generally in good condition postoperatively and were voiding normally, with no complications like bleeding and urine retention. The magnets were removed from the vagina after euthanasia. The vesicovaginal fistula was successfully established according to gross observation, and the fistula diameters were 4.50–6.24 mm. Histological observation revealed that the bladder mucosa and vaginal mucosa were in close contact on the internal surface of the fistula. Taken together, magnetic compression technique is a simple and feasible method to establish an animal model of vesicovaginal fistula using Beagle dogs. This model can help clinicians study new surgical techniques and practice innovative approaches for treating vesicovaginal fistula.

Endometriosis is a complex condition causing surgical challenges, sometimes leading to urogynecological complications, the diagnosis and treatment of which are not always obvious. We present a case of a 46-year-old woman with a history of severe endometriosis and adenomyosis who developed an oligosymptomatic vesicovaginal fistula (VVF) as a complication of surgery. The patient’s medical history included multiple surgeries for endometriosis, a cesarean section, and a laparoscopic hysterectomy. After the excision of the full-thickness infiltration of the urinary bladder, she experienced postoperative bowel obstruction treated by laparotomy. Subsequent urinary complications of bladder healing were eventually recognized as oligosymptomatic VVF. Symptoms of VVFs may vary, making a diagnosis challenging, especially when the lesion is narrow. Imaging techniques such as cystoscopy and cystography are helpful for diagnosis. The treatment options for VVFs range from surgical repair to conservative methods, like bladder catheterization, hormonal therapy, and platelet-rich plasma (PRP) injections, depending on the lesions’ size and location. In this case, the patient’s VVF was treated with PRP injections, a low-invasive method in urogynecology. PRP, known for its pleiotropic role, is increasingly used in medicine, including gynecology. The patient’s fistula closed after 6 weeks from the PRP session, highlighting the potential of this conservative treatment modality.

Abstract Background Bladder lithiasis comprises 5% of urological lithiasis. Large bladder stones associated with vesicovaginal fistulas are rare, and the risk factors are not an isolated process. There are metabolic comorbidities associated with this pathology, including diabetes mellitus. Case presentation A 70-year-old Mestizo patient is presented, reporting dysuria, pollakiuria, and abdominal pain of 4 months of evolution, located in the hypogastric region, also with a sensation of a foreign body in the vaginal introitus. In her pathological history, she presented type 2 diabetes mellitus. A computed tomography scan of the abdomen and pelvis was performed, reporting a tumor lesion in the abdominal wall. Therefore, surgical intervention was performed by cystolithotomy, obtaining a giant stone adhered to the vaginal wall with a size of 10 cm × 12 cm. Conclusion Early detection of this pathology should be exhaustive in patients with characteristics and comorbidities associated with stone development to avoid possible complications, such as vesicovaginal fistulas.

Introduction: Urogenital fistula is a physically, socially and psychologically devastating condition for the patient. In developed countries, these fistulae are typically related to gynecological surgery, pelvic pathology like malignancy or post radiation therapy. In contrast, classical teaching is that urogenital fistulae in the developing countries like India are usually associated with prolonged labor and obstetric complications. This retrospective study conducted at a tertiary care health Institute shows a paradigm shift in epidemiology, etiology and management of genitourinary fistulae in India in recent times. Methods: This retrospective study included patients undergoing surgical repair for various genitourinary fistulae at our institute from 2016 to 2022. Epidemiology, etiology, site, size and number of fistulae, clinical presentation, and management records of these patients were recorded and reviewed retrospectively. Results: In our study, the mean age of the patients was 38.4 ± 10.2 years. Vesicovaginal Fistula (VVF) was found to be most common fistula in the study population (87.5%) followed by vesicouterine (7.1%) and urethrovaginal fistula (5.4%). The causes of genitourinary fistula were iatrogenic (73.2%), carcinoma of cervix (16.1%), obstructed prolonged labor (7.1%), and genitourinary tuberculosis (3.57%). Among the 48 vesicovaginal fistulas that underwent surgery, 45.8% were treated using a transvaginal approach, 29.2% were managed through a laparoscopic transabdominal repair, and 25% were addressed using a robotic approach. Recurrence occurred in 7.1% of the operated patients. Conclusion: Enhanced healthcare services in the country have contributed to a decrease in the incidence of obstructed labor, subsequently reducing related injuries. Iatrogenic injuries resulting from gynecological surgeries and carcinoma cervix have given rise to more complex fistulas, necessitating the implementation of advanced treatment strategies. [ABSTRACT FROM AUTHOR]

Objective: Surgery for obstetric fistula is a highly effective treatment to restore continence and improve quality of life. However, a lack of data on the cost‐effectiveness of this procedure limits prioritization of this essential treatment. This study measures the effectiveness of fistula surgeries using disability‐adjusted life years (DALYs) averted. Methods: In 2021 and 2022, the Fistula Foundation funded 20 179 fistula surgeries and related procedures at 143 hospitals among 27 countries. We calculated DALYs averted specifically for vesicovaginal fistula and rectovaginal fistula procedure types (n = 13 235 surgeries) by using disability weights from the 2019 Global Burden of Disease study. We based cost calculations on direct treatment expenses, including medical supplies, health provider fees, and preoperative and postoperative care. We measured effectiveness using data on the risk of permanent disability, country‐specific average life spans, and treatment outcomes. Results: The total treatment cost was $7.6 million, and a total of 131 433 DALYs were averted. Thus, the cost per DALY averted—the cost to restore 1 year of healthy life—was $58. For this analysis, we took a cautious approach and weighted only surgeries that resulted in a closed fistula with restored continence. We calculated DALYs averted by country. Limitations of the study include data entry errors inherent in patient logs and lack of long‐term outcomes. Conclusion: The current study demonstrates that obstetric fistula surgery, along with having a significant positive impact on maternal health outcomes, is highly cost‐effective in comparison with other interventions. The study therefore highlights the benefits of prioritizing fistula treatment as part of the global agenda for maternal health care. Synopsis: Obstetric fistula treatment is highly cost‐effective. The current study highlights the benefits of prioritizing fistula treatment as part of the global agenda for maternal health care. [ABSTRACT FROM AUTHOR]

Purpose: Traditionally, an omental flap is employed to reduce the risk of recurrence of vesicovaginal fistula (VVF) repair. In this study, we employed a modified surgical technique wherein the vaginal defect was closed using Connell sutures, without incorporation of an omental flap, aiming to mitigate potential complications. Material and method: Between 2010 to 2018, the current randomized clinical trial was conducted on 52 women who were candidates for open fistula repair. The patients were randomly allocated into two groups. In one group, the conventional method of fistula repair was performed involving an omental flap, while in the other group, we used a modified approach with a variation in the vaginal wall closure technique. In-hospital variables, including the length of surgery, hospital stay, and occurrences of ileus, were recorded. Patient follow-up extended for one year, with assessments conducted one, six, and twelve months postoperatively. These evaluations encompassed pad test to ascertain success rates and identify any potential complications. Results: The final analysis comprised 49 patients, with an average age of 46.5 years. Baseline characteristics were comparable between the two groups (P-values > 0.05). The modified technique was associated with significantly reduced surgical duration (P = < 0.001), and shorter hospital stays (P < 0.001). Ileus occurrence was reduced, but it was not significant(P = 0.856). However, the success rate showed no significant difference between the groups, with a success rate of 100% for the modified technique compared to 91.6% for the classic O'Conner method (P = 0.288). Conclusion: Based on the findings of this study, vaginal wall closure using Connell sutures during VVF repair demonstrates a success rate equivalent to the classic approach involving an omental flap. Moreover, this technique presents a reduced incidence of adverse effects, along with decreased surgical duration, hospital stay, and postoperative ileus. [ABSTRACT FROM AUTHOR]

•we report the case of a 36-year-old female patient who presented to our hospital with a diagnosis of cystitis glandularis manifesting as a vesicovaginal fistula. She underwent cystoscopic biopsy at a local hospital, but anti-inflammatory treatment was ineffective, and the patient was experiencing low urination frequency and urgency, as well as pain. The patient underwent laparoscopic repair of a cystoscopy-confirmed vesicovaginal fistula. After surgery, the patient experienced a paroxysm of Crohn's disease with multiple small bowel fistulas and erosion of the external iliac vessels that ruptured to form an external iliac vessel small bowel fistula. The fistula was confirmed by surgical exploration, and the patient eventually died. [ABSTRACT FROM AUTHOR]

Vesicovaginal fistula lacks a standard, established animal model, making surgical innovations for this condition challenging. Herein, we aimed to non-surgically establish vesicovaginal fistula using the magnetic compression technique, and the feasibility of this method was explored using eight female Beagle dogs as model animals. In these dogs, cylindrical daughter and parent magnets were implanted into the bladder and vagina, respectively, after anesthesia, and the positions of these magnets were adjusted under X-ray supervision to make them attract each other, thus forming the structure of daughter magnet-bladder wall-vaginal wall-parent magnet. Operation time and collateral damage were recorded. The experimental animals were euthanized 2 weeks postoperatively, and the vesicovaginal fistula gross specimens were obtained. The size of the fistula was measured. Vesicovaginal fistula was observed by naked eye and under a light microscope. Magnet placement was successful in all dogs, and remained in the established position for the reminder of the experiment. The average operation time was 14.38 min ± 1.66 min (range, 12–17 min). The dogs were generally in good condition postoperatively and were voiding normally, with no complications like bleeding and urine retention. The magnets were removed from the vagina after euthanasia. The vesicovaginal fistula was successfully established according to gross observation, and the fistula diameters were 4.50–6.24 mm. Histological observation revealed that the bladder mucosa and vaginal mucosa were in close contact on the internal surface of the fistula. Taken together, magnetic compression technique is a simple and feasible method to establish an animal model of vesicovaginal fistula using Beagle dogs. This model can help clinicians study new surgical techniques and practice innovative approaches for treating vesicovaginal fistula. [ABSTRACT FROM AUTHOR]

Endometriosis is a complex condition causing surgical challenges, sometimes leading to urogynecological complications, the diagnosis and treatment of which are not always obvious. We present a case of a 46-year-old woman with a history of severe endometriosis and adenomyosis who developed an oligosymptomatic vesicovaginal fistula (VVF) as a complication of surgery. The patient's medical history included multiple surgeries for endometriosis, a cesarean section, and a laparoscopic hysterectomy. After the excision of the full-thickness infiltration of the urinary bladder, she experienced postoperative bowel obstruction treated by laparotomy. Subsequent urinary complications of bladder healing were eventually recognized as oligosymptomatic VVF. Symptoms of VVFs may vary, making a diagnosis challenging, especially when the lesion is narrow. Imaging techniques such as cystoscopy and cystography are helpful for diagnosis. The treatment options for VVFs range from surgical repair to conservative methods, like bladder catheterization, hormonal therapy, and platelet-rich plasma (PRP) injections, depending on the lesions' size and location. In this case, the patient's VVF was treated with PRP injections, a low-invasive method in urogynecology. PRP, known for its pleiotropic role, is increasingly used in medicine, including gynecology. The patient's fistula closed after 6 weeks from the PRP session, highlighting the potential of this conservative treatment modality. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: Genitourinary fistula is a devastating ailment that has an impact on women's physical health, mental health, emotional health, and financial security. The management of genitourinary fistula depends on the type, size, and duration of fistula formation. The purpose of this study is to report the features of genitourinary fistula in Iranian women and our experience in the management of fistula. Methods: Retrospective chart reviews of 283 patients were performed to determine the cause of the fistula, prior repairs, tissue interposition, and the success rate. The operation was considered successful if the patient did not have any urine leakage during the observation time. Results: The mean (SD) age of women was 49.51 (19.39; range: 21–70) years, Of these, 137 (52.9%) had a history of previous genitourinary fistula surgery. The average fistula was 1.53 (0.041) cm in size. The median (interquartile range) operation lasted 70 (15) min. The success rate after fistula repair was 91.5%. The typical follow-up period lasted 13.26 (range: 1–88) months. Forty-three (15.2%) patients had a big fistula (>2.5 cm) and 4 patients (1.4%) had a history of pelvic radiation therapy, among other reasons for failure. After a second repair, all patients' initial failures were resolved. There were no significant complications, as classified by Clavien–Dindo class 2 or greater. Additionally, there were no bowel, ureteral, or nerve injuries. Conclusions: Our patients with genitourinary fistula had a successful outcome following repair techniques, without any significant morbidity or mortality. [ABSTRACT FROM AUTHOR]

Introduction: Surgical repair of obstetric fistula aims to restore the anatomical and functional integrity of the urinary tract, enabling affected women to regain their dignity and quality of life. However, such repairs can end in a failure. The aim of this study is to develop a predictive score to identify factors influencing failure of surgical repair of obstetric vesico-vaginal fistula (FSROVVF) in the Democratic Republic of the Congo. Methods: This was an analytical cross-sectional study of 318 women with obstetric vesico-vaginal fistula (OVVF) who had undergone surgical management. A bivariate and then a multivariate analysis were performed. Score discrimination was assessed using the ROC curve and C-index, and score calibration using the Hosmer–Lemeshow test. Results: Surgical repair of OVVF was unsuccessful in 16.98% of cases (54/318). After logistic modeling, six criteria emerged as predictive factors for FSROVVF: the presence of fibrosis (AOR = 5.01; 95% CI:1.73–14.49), the presence of 2 or more fistulas (AOR = 9.04; 95% CI:3.01–27.13), the association of OVVF with another anatomoclinical entity of fistula (AOR = 3.16; 95% CI:1.09–9.13), the fistula size > 3 cm (AOR = 3.65; 95% CI:1.36–9.76), the peri-operative hemorrhage (AOR = 7.01; 95% CI:2.33–21.03), and the post-operative infection (AOR = 178.89; 95% CI:26.09–1226.64). A score ranging from 0 to 13 points was obtained, of which a value ≤ 5 points defines a low risk of FSROVVF, a value between 6 and 8 points defines a moderate risk and value ≥ 9 points corresponds to a high risk of FSROVVF. The area under the ROC curve of the score is 0.925 with a sensitivity of 61.11%, a specificity of 96.59%, a positive predictive value of 78.57% and a negative predictive value of 92.39%. Conclusion: This study demonstrated that the number of fistulas ≥ 2, fistula size > 3 cm, fibrosis, association of OVVF with other types of fistulas, peri-operative hemorrhage, and post-operative infection are factors predictive of FSROVVF. These six factors are key contributors to the score used to predict FSROVVF. Once validated, this score will inform and enable preoperative counseling regarding the prognosis and the chances of a successful outcome of surgical repair of OVVF. [ABSTRACT FROM AUTHOR]

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Background: Bladder lithiasis comprises 5% of urological lithiasis. Large bladder stones associated with vesicovaginal fistulas are rare, and the risk factors are not an isolated process. There are metabolic comorbidities associated with this pathology, including diabetes mellitus. Case presentation: A 70-year-old Mestizo patient is presented, reporting dysuria, pollakiuria, and abdominal pain of 4 months of evolution, located in the hypogastric region, also with a sensation of a foreign body in the vaginal introitus. In her pathological history, she presented type 2 diabetes mellitus. A computed tomography scan of the abdomen and pelvis was performed, reporting a tumor lesion in the abdominal wall. Therefore, surgical intervention was performed by cystolithotomy, obtaining a giant stone adhered to the vaginal wall with a size of 10 cm × 12 cm. Conclusion: Early detection of this pathology should be exhaustive in patients with characteristics and comorbidities associated with stone development to avoid possible complications, such as vesicovaginal fistulas. [ABSTRACT FROM AUTHOR]

Background: Urinary incontinence (UI) after successful closure of obstetric vesicovaginal fistula (VVF) repair is a widely recognized public health problem. However, there is insufficient research evaluating the factors associated with UI after successful obstetric VVF repair in Ethiopia. Objectives: The main aim of this study was to assess the magnitude and associated factors of UI following the successful closure of obstetric VVF repair at the Yirgalem Hamlin Fistula Center in the Sidama region of southern Ethiopia. Methods: A retrospective cross-sectional analytical study was performed on patients who underwent obstetric VVF repair at the Yirgalem Hamlin Fistula Center between 2016 and 2020. The data were collected from September to October 2021. EPI Data Version 3.1 and SPSS Version 25.0 were used for data entry and analysis. A multivariable binary logistic regression model was used for all variables significant in the bivariate binary logistic analysis to determine the association between the independent variables and outcome variables. The data are presented in tables and figures. Variables with a p-value < 0.05 were considered to be statistically associated with the study outcome. Results: In total, 499 study subjects were included. The magnitude of UI after successful closure of obstetric VVF repair was 23.25%. A Goh type 4 fistula (AOR = 4.289; 95% CI 1.431, 12.852), a fistula size > 3 cm (AOR = 8.855; 95% CI 4.786, 16.382), a partially damaged urethra (AOR = 2.810; 95% CI 1.441, 5.479), and a completely destroyed urethra (AOR = 5.829; 95% CI 2.094, 16.228) were found to be significantly associated factors with the outcome variable. Conclusions: Nearly one in four patients who had successful closure of obstetric VVF repair at the Yirgalem Hamlin fistula center had UI, which is above the WHO recommendations. The presence of a Goh type 4 fistula, large fistula size, and damaged urethral status significantly affect the presence of UI. Therefore, interventions are necessary to prevent and manage UI among patients who underwent obstetric VVF repair and had a closed fistula. [ABSTRACT FROM AUTHOR]

Obstetric fistula is a life transforming event resulting in embodied biographical disruption. Survivors suffer myriad long‐term physical and emotional consequences. This paper is an account of a narrative inquiry, conducted with 15 fistula survivors in North‐central, Nigeria, who described how their identities had been transformed by their condition. A narrative therapeutic approach, using Frank's 'chaos, restitution and quest' typology, was used to map their recovery narratives. 'Chaos', described by Frank as the opposite of restitution, dominated, with women losing hope of recovery. Women's shift towards 'restitution' began with treatment, but inadequate health‐care access often delayed this process. In their quest narratives, women's life and identify changes enabled them to derive meaning from their experience of obstetric fistula within the context of their own lives. The findings highlight socio‐structural factors raising the risk of obstetric fistula, which in turn causes biographical disruption and hampers sufferers' treatment and recovery. Rehabilitation should include income‐generating skills to bring succour to survivors, particularly those whose incontinence persists after repairs. [ABSTRACT FROM AUTHOR]

Genito-urinary fistula describes an abnormal connection between an epithelial surface of the female genital tract and the urological tract. The UK incidence is 100–120 cases per year with the majority caused by iatrogenic injury during pelvic surgery, most commonly involving the bladder. Women describe continuous vaginal leakage of urine. If the bladder fistula is diagnosed within 6 weeks of the index injury conservative treatment with an indwelling catheter on free drainage is recommended. Surgical repair ideally is performed by vaginal approach, with the abdominal approach reserved for ureteric fistula. Surgery is best performed in one of the high volume supra-regional fistula centres. [ABSTRACT FROM AUTHOR]

Objectives: Vesicovaginal fistulas (VVF) are the most commonly acquired fistulas of the urinary tract. The management of VVF is mainly based on expert opinion and surgeon experience. This study aims to provide the practice patterns and outcomes of vesicovaginal fistula (VVF) management in Indonesia. Methods: This study utilizes the results of a survey among the surgeons who performs VVF repair in referral hospitals throughout Indonesia between June and July of 2021. Data analysis was carried out with SPSS descriptively by displaying the relative frequency of the answers to each question of the questionnaire form. Results: We collected responses from 93 respondents consisting of 68 urologists and 25 gynecologists. The most commonly reported cause of VVF was obstetric (50.5%). Most respondents confirmed the diagnosis of VVF by cystoscopy (81.7%). Waiting time to repair VVF was generally 12 weeks (79.6%), while the transvaginal approach repair was more often performed (77.4%). An additional procedure, such as tissue interposition was performed in 50.5% of cases. Tissue interposition was mostly indicated in recurrent VVF (81%), with omentum being the most selected tissue interposition (71%). When indicated, the most selected method of transabdominal approach was open transvesical (54,84%). A laparoscopic approach was performed only in 7.5% of cases. Overall, the success rate for VVF repair in Indonesia was 70-100% at first attempt. Conclusions: The transvaginal approach is preferred, either with or without an interposition tissue flap. The success rate at the first attempt is satisfactory.

Abstract Background Female genital fistula is a traumatic debilitating injury, frequently caused by prolonged obstructed labor, affecting between 500,000-2 million women in lower-resource settings. Vesicovaginal fistula causes urinary incontinence, and other morbidity may occur during fistula development. Women with fistula are stigmatized, limit social and economic engagement, and experience psychiatric morbidity. Improved surgical access has reduced fistula consequences yet post-repair risks impacting quality of life and well-being include fistula repair breakdown or recurrence and ongoing or changing urine leakage or incontinence. Limited evidence on risk factors contributing to adverse outcomes hinders interventions to mitigate adverse events. This study aims to quantify these adverse risks and inform clinical and counseling interventions to optimize women’s health and quality of life following fistula repair through: identifying predictors and characteristics of post-repair fistula breakdown and recurrence (Objective 1) and post-repair incontinence (Objective 2), and to identify feasible and acceptable intervention strategies (Objective 3). Methods This mixed-methods study incorporates a prospective cohort of women with successful vesicovaginal fistula repair at approximately 12 fistula repair centers in Uganda (Objectives 1-2) followed by qualitative inquiry among key stakeholders (Objective 3). Cohort participants will have a baseline visit at the time of surgery followed by data collection at 2 weeks, 6 weeks, 3 months and quarterly thereafter for 3 years. Primary predictors to be evaluated include patient-related factors, fistula-related factors, fistula repair-related factors, and post-repair behaviors and exposures, collected via structured questionnaire at all data collection points. Clinical exams will be conducted at baseline, 2 weeks post-surgery, and for outcome confirmation at symptom development. Primary outcomes are fistula repair breakdown or fistula recurrence and post-repair incontinence. In-depth interviews will be conducted with cohort participants (n ~ 40) and other key stakeholders (~ 40 including family, peers, community members and clinical/social service providers) to inform feasibility and acceptability of recommendations. Discussion Participant recruitment is underway. This study is expected to identify key predictors that can directly improve fistula repair and post-repair programs and women’s outcomes, optimizing health and quality of life. Furthermore, our study will create a comprehensive longitudinal dataset capable of supporting broad inquiry into post-fistula repair health. Trial Registration ClinicalTrials.gov Identifier: NCT05437939.

Objectives: To evaluate success of vesicovaginal fistula repair by vaginal approach with secondary objective to assess the limitations of repair by vaginal route. Study Design: Retrospective & Descriptive study. Setting: Department of Urology and Renal Transplantation, Faisalabad Medical University, Faisalabad. Period: January 2017 to December 2020. Material & Methods: In which 42 patients were included in the study. All patients were submitted for VVF repair by vaginal approach. Procedure was done under spinal anesthesia in all patients. Operation was done in lithotomy position. Circumferential incision was made around the fistula. Vagina and bladder were separated. Urinary bladder was repaired in two layers and vagina by perpendicular stitching technique. Foley catheter was passed. Urinary leakage was seen by instillation of normal saline and Gentian Violet. Vaginal packing was done at the end of the procedure which was removed after 1 day of surgery and patient post operative data was noted. Results: 42 patients were included. There mean age was 27 years. 45.23% patients came with history of prolonged labor, 30.95% patients presented after transabdominal hysterectomy, 21.42% after lower segment secession section and 2.38% patients came after operation for cystocele. Infra-trigonal VVF was present in 59.53% patients and supra-trigonal in 40.47% cases. Our success rate was 85.71% and we faced failure in 14.28% of patients. Lower urinary tracts symptoms were seen in 30.95%, hematuria in 9.25%, stress incontinence in 11.9%, symptoms like over active bladder in 7.14% and urinary tract infection in 14.28%. Conclusion: VVF repair by vaginal approach is safe and successful with less morbidity than abdominal approach. [ABSTRACT FROM AUTHOR]

Key Clinical Message: This case highlights the need for further research to explore a potential link between systemic sclerosis and fistula development, and the importance of raising awareness among clinicians about this possibility for timely appropriate management. The primary diagnosis in this case is systemic sclerosis (scleroderma) in a 47‐year‐old female patient with various clinical manifestations, including vesicovaginal and vesicorectal fistulas. The medical interventions and diagnostic workup involved an electrocardiogram, cardiac echocardiogram, pulmonary function tests, beta blockers, aspirin, inhaled corticosteroids, albuterol, endoscopy, biopsy, treatment for Helicobacter pylori infection, fluconazole for candida esophagitis, endoscopic dilation for achalasia, anticholinergic therapy for mixed urinary incontinence, gabapentin for neuropathic symptoms, analgesia for knee pain, and psychiatric treatment with selective serotonin reuptake inhibitors. The outcomes described in the case report include the diagnosis of systemic sclerosis, the identification of vesicovaginal and vesicorectal fistulas, the patient's medical history and symptoms over the years, and various treatments and management strategies. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess and compile the current level of evidence regarding successful surgical treatment of vesicovaginal fistulae and how these perioperative interventions affect anatomic, patient-centered, and adverse outcomes. DATA SOURCES: PubMed and EMBASE were searched from inception through September 9, 2022. METHODS OF STUDY SELECTION: This review included comparative studies (of any sample size) and single-group studies (1,000 or more participants) of primary or recurrent vesicovaginal fistula (ie, vesicovaginal fistula, urethrovaginal fistula, and bladder neck-vaginal fistula). We evaluated preintervention assessment or management, various techniques for intraoperative management, and postoperative management. Outcomes of interest included anatomic and objective outcomes (such as successful repair, fistula closure, urinary incontinence, recurrent fistula, perioperative complications) and subjective outcomes (such as voiding symptoms and quality of life). Abstracts and full-text articles were screened in duplicate, and study descriptions and findings were extracted into standardized extraction forms. Risk of bias was assessed independently by two investigators and adjudicated by a third. Study quality was summarized with standardized tools. We conducted random-effects model and restricted maximum-likelihood meta-analy-ses of relative risks when at least three studies compared similar interventions and reported similar outcome measures. TABULATION, INTEGRATION, AND RESULTS: Forty-six studies met the inclusion criteria. Studies were categorized into 11 domains: 1) preoperative assessment, 2) preoperative and postoperative physical therapy, 3) route of surgery, 4) incorporation of a flap, 5) trimming, 6) layered closure, 7) intraoperative antibiotics, 8) fibrin glue, 9) fascial sling, 10) postoperative Foley catheter duration, and 11) quality of life. Although the strength of the data is insufficient, preoperative phenazopyridine, physical therapy, layered closure, and intraoperative antibiotics seemed to improve the rate of successful fistula repair. Route of surgery (vaginal vs abdominal laparotomy) was determined primarily by surgeon preference and showed no difference in successful fistula repair. In addition, use of interpositional flaps, trimming fistula edges, fibrin glue, and fascial sling did not show significant improvement in rates of fistula cure. Overall, quality-of-life scores improved postoperatively regardless of route of repair and use of interpositional flaps. CONCLUSION: Our findings highlight the limited information available to guide evidence-based treatment of vesicovaginal fistula repair. Overall, high-quality evidence is lacking to provide guidelines; therefore, expert opinion remains the primary influence for fistula repair recommendations. [ABSTRACT FROM AUTHOR]

Vesicovaginal fistula is a cause of deterioration in the quality of life. It is a communication between the bladder and vagina resulting in the uncontrollable leakage of urine through the vagina. Recently, regenerative methods have been used more frequently, and platelet-rich plasma is one of these methods. The functional properties of platelet-rich plasma are based on the synthesis and secretion of multiple growth factors released after platelet activation. The aim of this study was to investigate how platelet-rich plasma influences the condition of the tissue and the healing ability of the urothelium, vaginal epithelium and tissues surrounding the fistulous canal. The study included eight patients who had undergone the Latzko procedure aimed at closing the vesicovaginal fistula. Samples were collected during primary surgery without platelet-rich plasma and after failed surgery, during a second attempt. The specimens were subjected to histological and immunohistochemical evaluation. The histology demonstrated that in platelet-rich plasma patients, greater vascularization and wider subepithelial mucosa layering was observed. Inflammatory infiltration in the subepithelial layer was increased in platelet-rich plasma patients. No localization differences in growth factor proteins were found in either group, but in platelet-rich plasma-patients, the reactions were stronger. It can be concluded that the use of platelet-rich plasma improves the morphological structure of the injected tissues. [ABSTRACT FROM AUTHOR]

This article presents a case study of a 57-year-old female patient with a history of cervical cancer and urothelial cancer who developed a radiation-induced vesicovaginal fistula. Despite multiple rounds of chemotherapy, the patient's cancer persisted, leading to the initiation of palliative radiation therapy for symptom relief. The article describes a radiological intervention using embolization to treat the fistula, which resulted in a significant improvement in urinary symptoms. However, the patient's cancer continued to progress, highlighting the complex and dynamic nature of her disease and the importance of innovative management in the face of treatment-related side effects and ongoing disease progression. [Extracted from the article]

To describe the long-term outcomes of patients with stage IVA cervical cancer, a rare and deadly disease for which long-term toxicity data are scarce, to guide clinician counseling and survivorship support. In a retrospective review of a prospectively maintained database, we identified 76 patients with stage IVA cervical cancer with biopsy- or MRI-proven bladder mucosal involvement who received definitive radiotherapy (external beam radiotherapy [EBRT] alone or EBRT plus brachytherapy) with or without chemotherapy at our institution between 2000 and 2020. We used Kaplan-Meier modeling to estimate recurrence-free survival (RFS) and overall survival (OS) and used proportional hazard modeling to identify clinical variables associated with recurrence or survival. We performed actuarial competing risk modeling for severe late toxicity (grades 3 to 5, occurring >6 months of follow-up) and vesicovaginal fistulae (VVF), censoring for pelvic recurrence and death, and made comparisons between potential predictors using Gray's test and binary logistic regression. The median follow-up time was 76 months (interquartile range 58–91). The median OS duration was 35 months (range, 18-not reached), and the 2- and 5-year OS rates were 53.6% and 40.9%, respectively. OS and RFS did not differ significantly between patients who received EBRT alone (N = 18) or EBRT plus brachytherapy (N = 49). Current smoking was a strong predictor of severe late toxicity, whose incidence was 14% at 2 years and 17% at 10 years. The VVF incidence was 24% at 2 years and 32% at 10 years. Patients with stage IVA cervical cancer, even those who receive EBRT alone, can have long-term survival. These patients should be followed closely for late radiation-related toxicity. • Patients ineligible for brachytherapy should be encouraged to complete treatment with EBRT. • In this cohort, patients treated with EBRT alone had comparable survival to patients treated with EBRT and brachytherapy. • Patients remain at high risk for late radiation-related toxicity, up to 15 years after treatment completion. • Prolonged surveillance is recommended to monitor for late toxicities that can lead to severe morbidity. [ABSTRACT FROM AUTHOR]

Objectives: To determine the effectiveness of early operative management of patients with Vesicovaginal fistula (VVF) secondary to benign gynecological surgeries. Material and methods: It is a descriptive case series of 70 patients selected from August 2018 to Oct 2022. All patients meeting inclusion criteria had routine lab investigations, imaging, cystoscopy, and vaginoscopy. The suprapubic approach described by O'Conor et al; was used. All surgeries were performed between the 4th and 6th weeks after the onset of the fistula to allow some time for tissue healing. All patients were followed after 2 weeks; a cystogram was performed to document fistula closure followed by removal of Foleys catheter. A second follow-up was at 3 months, patients were assessed with patient global impression of improvement score (PGI-I) for improvement in symptoms. Results: The mean age of the patients was 40.6 ± 10.2 years. 14(19.7%) patients were primipara while 56 (78.9%) patients were multipara. The mean fistula size was 11.5 ± 4.5mm. Supra-trigonal fistulas were more common than trigonal fistulas 43(60.6%) vs 27(38%). Hysterectomy (including cesarean hysterectomy and simple hysterectomy) was the commonest cause of VVF followed by cesarean section and difficult labor 33(46.5% vs 21(29.6) vs 12(16.9%). The overall mean operative time was 125.3 ± 10.7 minutes. The mean hospital stay was 3.8 ± 0.8 days. The fistula was successfully closed in 64 (90.1%) patients while 6 (9.9%) patients had failed surgery. The small-size fistulas (5-10mm) had a higher success rate of closure than larger fistulas (11-20mm) with statistical significance (p=0.02). Over 63 (90 %) patients responded PGI score below 3 with much improvement in symptoms. Conclusion: Our results show that early operative management of VVF secondary to benign gynecological and obstetric surgeries is feasible and effective. It also improves the symptoms of patients with PGI-I score. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to conduct a comparative analysis of various intraoperative parameters and postoperative outcomes between the laparoscopic extravesical repair versus the laparoscopic O'Connor repair techniques in management of supratrigonal vesicovaginal fistula. Methods: A prospective nonrandomized study was conducted from January 2018 to January 2023, in which 36 patients who met inclusion criteria like primary or recurrent, single, simple, supratrigonal vesicovaginal fistula were included. Among these patients 18 patients were operated with laparoscopic O'Connor repair, while 18 were operated with laparoscopic transperitoneal extravesical vesicovaginal fistula repair. Intraoperative and postoperative parameters of these 2 techniques were compared. Results: Laparoscopic O'Connor repair had longer operative time of 140 minutes, while laparoscopic extravesical VVF repair had an operative time of 117 minutes (P = .026). Mean blood loss was also significantly higher in laparoscopic O'Connor (210 mL versus 95 mL) (P = .004). Postoperative complications and analgesics requirement were less with laparoscopic extravesical repair. Hence, laparoscopic extravesical repair reduced mean hospital stay (3.2 days versus 3.9 days) (P = .003). A success rate of 83.33% for laparoscopic O'Connor and 94.45% for laparoscopic extravesical repair (P = .153) was recorded. Conclusion: Laparoscopic extravesical approach appears to be a convenient and effective method in selective supratrigonal vesicovaginal fistula repair. [ABSTRACT FROM AUTHOR]

This article discusses the psychosocial conditions of patients with vesicovaginal fistula (VVF) at a referral hospital in Surabaya, Indonesia. VVF is an abnormal opening between the bladder and vagina that causes urinary incontinence. The study aims to describe the psychosocial state of VVF patients and highlights the importance of prevention and awareness in the gynecological community. The prevention of fistulas should prioritize education, improving women's social status and nutrition, and ensuring accessible healthcare services. The study also highlights the link between fistulas and depression, with patients experiencing physical problems and a sense of depression. The document emphasizes the importance of education in reducing the risk of depression and the need for healthcare workers to provide education and support to prevent and manage fistulas. [Extracted from the article]

Background: Vesicovaginal fistula (VVF) is an abnormal opening between the bladder and vagina that causes persistent urinary incontinence. Management in this case tends to be difficult and has the potential to experience recurrence. Aim: This study aims to describe the psychosocial condition of vesicovaginal fistula patients at Dr. Soetomo Hospital Surabaya Indonesia. Method: This research is a cross sectional study with descriptive analysis. The data used is the medical record data Dr. Soetomo in 2017. The Psychosocial Condition is Measured by Measuring Depression Using the Beck Depression Index (BDI). Patients interview by telephone. The Data Obtained were analysed descriptively. Results: 14 Patients out of 20 people were successfully interviewed. More than half of the respondents were aged 46-55 years. Most respondent had finished senior high school education. Most respondent were ethnic Javanese and did not work. Nearly half of the respondents experienced depression. Only 2 patients did not undergo surgery. Nearly half of the respondents were referral patients. There were 2 patients who had moderate depression. Most of the causes of fistulas experienced were gynaecological operations. Based on the results of the interviews, it was found that the most common complaints were sleep disturbances, weight loss, decreased appetite, and interest in sexual function. Conclusion: Doctors and health workers need to carry out management and prevention of depression in patients with vesicovaginal fistula in the hospital.

Herlyn–Werner–Wunderlich (HWW) syndrome is characterized by obstructed hemivagina and ipsilateral renal anomaly, a rare congenital anomaly of the genitourinary tract, resulting from malformations of the renal tract associated with Müllerian duct anomalies. The initial symptoms of HWW frequently present after menarche and may be nonspecific, leading to a delayed diagnosis. We presented a 19-year-old female with 3-year hematuria and abdominal pain. The final diagnosis of HWW syndrome with a rare vesicovaginal fistula was made. The treatment of HWW syndrome typically involves surgical intervention. The primary treatment is resection or removal of the obstructed vaginal septum. The patient underwent excision of vaginal septum and vaginal reconstruction via hysteroscopy, as well as repair of the vesicovaginal fistula. The patient improved well after surgery and fully recovered without sequelae after 3 months. In addition, unilateral renal agenesis is one of congenital abnormalities of the kidney and urinary tract, which are the most frequent cause of chronic kidney disease (CKD) in children. This report describes a patient of HWW syndrome with rarely combined vesicovaginal fistula, and highlights the importance of early recognition and management to prevent associated complications.

The optimal surgical method of vesicovaginal fistula (VVF) remains uncertain. Minimally invasive surgical approaches have become highly popular in line with technological advancements, namely, laparoscopic, robotic, and transvaginal techniques. However, these techniques still require invasiveness. This is the first case report that described a novel “zero-incision” technique for natural orifice transvaginal single-port laparoscopy used to repair a recurrent and high-position VVF. The patient underwent transvaginal single-port laparoscopic repair of a VVF. Methylene blue was used to locate the VVF, and a needle electrode was used to thoroughly remove the scar tissue of the VVF. In addition, this technique for transvaginal single-port laparoscopy provides more working space to expose and repair fistulas conveniently and adequately. One year after surgery, the patient remained asymptomatic and had no fistula recurrence. Minimally invasive transvaginal single-port laparoscopy provides a clear surgical field, is safe and feasible. This novel technique has promising as an additional personalized treatment option for VVF repair.

This study aimed to investigate the efficacy and safety of three-dimensional printing noncoplanar template (3D-PNCT) assisted computer tomography (CT) guided high-dose-rate interstitial brachytherapy (HDR-ISBT) for the irradiation of pelvic recurrence of cervical carcinoma after external beam radiotherapy (EBRT). From January 2019 to August 2023, 48 eligible patients were enrolled in the prospective cohort. All patients received 3D-PNCT assisted CT-guided HDR-ISBT with a prescribed dose of 4-7Gy/fraction to high-risk clinical target volume (HR-CTV), 3-8 fractions, 1-2 fractions per week. The primary endpoints were the local progression-free survival (LPFS) and tumor response rate (TRR). The secondary outcome measures included overall survival (OS) and toxicities. Cox proportional hazards modeling was used in uni- and multivariate analyses to analyze the prognostic factors. 48 patients received a total of 283 fractions of 3D-PNCT assisted ISBT. The mean (SD) HR-CTV D90 (EQD 2) for reirradiation was 41.38 (13.36) Gy and the mean D 2cc (EQD 2) of rectum and bladder for reirradiation was 24.52 (9.27) Gy and 28.06 (11.35) Gy, respectively. The TRR was 70.8% at the time of 3 months after reirradiation. Median follow-up time was 35.4 months. The 1-, 3-year, and 5-year LPFS were 34.8%, 23.2%, and 23.2%, respectively. The median OS was 23.2 months (95% CI 15.7 - NA). The 1-, 3- and 5-year OS were 75.4%, 45.5%, and 34.1%, respectively. 4 (8.3%) patients suffered from grade≥3 acute toxicity, which was vesicovaginal fistula, dermatitis, and mucositis in 1, 1, and 2 patients, respectively. The incidence of grade≥3 late toxicity was 12.5%, consisting of fistula, dermatitis, and mucositis. No grade≥3 operation-related or hematology side effects were observed. In multivariate analysis, LPFS was associated with recurrence-free interval (RFI) (≥12 mon vs. <12 mon, HR 0.43, p = 0.036), diameter (≥5 cm vs. 3 cm≤d<5 cm, HR 3.26, p = 0.025), peripheral recurrence (vs. central recurrence, HR 3.79, p = 0.002) and HR-CTV D 90 for reirradiation ≥45Gy (EQD 2) (HR 0.36, p = 0.042). RFI (≥12 mon vs. <12 mon, HR 0.35, p = 0.024), and diameter (<3 cm vs. 3 cm≤d<5 cm, HR 0.20, p = 0.005, and ≥5 cm vs 3 cm≤d<5 cm, HR 5.64, p = 0.002) were independent prognostic factors for OS. 3D-PNCT assisted CT-guided HDR-ISBT is a promising alternative for salvage treatment in pelvic recurrent cervical cancer. Identification of prognostic factors could help to differentiate patients who are likely to benefit from HDR-ISBT reirradiation. [ABSTRACT FROM AUTHOR]

In developing countries, Vesico-vaginal fistula (VVF) results following obstetric trauma or iatrogenic during hysterectomy. Large calculus associated with VVF is relatively rare, with the risk factor are presence of foreign body, urinary tract infection, and prolonged duration of disease. The diagnosis is often delayed, and mortality sometimes occurs with delayed diagnosis and treatment. Radiology has an important role for vaginal and bladder stone evaluation and diagnosis used in VVF are abdominal plain x-ray, ultrasonography (USG), intravenous urography (IVU) and Multi-slice computed tomography (MSCT). In our Hospital We reported a case of VVF with vaginal and bladder stone in 37 years old woman and reviewed the evaluation and treatment and highlighted the role of the radiology team in managing patients with this condition. Through a combination of radiological modalities like USG, CT, Xray, and additional cystoscopy as well as vaginoscopy, diagnosis and the definitive management was done on time. Although the incidence of VVF accompanied by a large vaginal and bladder stone is rare, early detection with a multi modality approach in Radiology with a team of clinicians and technologists coupled with an interdisciplinary collaboration will be beneficial to the patients and case documentation also. [ABSTRACT FROM AUTHOR]

The title "Father of Modern Gynecology" is often attributed to Dr James Marion Sims, a pioneering American physician whose contributions to gynecology have profoundly influenced modern medical practice. Born in 1813, Sims developed several innovative surgical techniques and instruments that revolutionized the treatment of gynecological conditions. Among his most notable contributions is the Sims speculum, which remains a fundamental tool in gynecological examinations today. Sims is also credited with pioneering surgical techniques for repairing VVFs, previously deemed untreatable. His work, primarily conducted in the mid-19th century, laid the foundation for modern gynecological surgery and significantly advanced women's healthcare. However, Sims' legacy is also marked by ethical controversy. His early research involved experimental surgeries on enslaved African-American women, conducted without the use of anesthesia. These practices have sparked critical discussions regarding medical ethics, informed consent, and the historical exploitation of marginalized groups under the guise of scientific progress. This review article explores the dual facets of James Marion Sims' legacy, acknowledging his crucial role in shaping modern gynecology while critically examining the ethical implications of his methods. Such a discussion is vital for understanding the evolution of medical practices and the ongoing need for stringent ethical standards in clinical research and patient care., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Shende et al.)