-
Minerva Urology and Nephrology Aug 2022Colovesical fistulas (CVFs) account for approximately 95% enterovesical fistulas (EVFs). About 2/3 CVF cases are diverticular in origin. It mainly presents with...
INTRODUCTION
Colovesical fistulas (CVFs) account for approximately 95% enterovesical fistulas (EVFs). About 2/3 CVF cases are diverticular in origin. It mainly presents with urological signs such as pneumaturia and fecaluria. Diagnostic investigations aim at confirming the presence of a fistula. Although conservative management can be chosen for selected individuals, most patients are mainly treated through surgical interventions. CVF represents a challenging condition, which records high rates of morbidity and mortality. Our systematic review aimed at achieving deeper knowledge of both indications, in addition to short- and long-term outcomes related to CVF management.
EVIDENCE ACQUISITION
We performed a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. Pubmed/MEDLINE, Embase, Scopus, Cochrane Library and Web of Science databases were used to search all related literature.
EVIDENCE SYNTHESIS
The 22 included articles covered an approximately 37 years-study period (1982-2019), with a total 1365 patient population. CVF etiology was colonic diverticulitis in most cases (87.9%). Pneumaturia (50.1%), fecaluria (40.9%) and urinary tract infections (46.6%) were the most common symptoms. Abdomen computed tomography (CT) scan (80.5%), colonoscopy (74.5%) and cystoscopy (55.9%) were the most frequently performed diagnostic methods. Most CVF patients underwent surgery (97.1%) with open approach (63.3%). Almost all patients had colorectal resection with primary anastomosis with or without ostomy and 53.2% patients underwent primary repair or partial/total cystectomy. Four percent anastomotic leak, 1.8% bladder leak and 3.1% reoperations rates were identified. In an average 5-68-month follow-up, overall morbidity, overall mortality and recurrences rates recorded were 8-49%, 0-63% and 1.2%, respectively.
CONCLUSIONS
CVF mainly affects males and has diverticular origin in almost all cases. Pneumaturia, fecaluria and urinary tract infections are the most characteristic symptoms. Endoscopic tests and imaging are critical tools for diagnostic completion. Management of CVFs depends on the underlying disease. Surgical treatment represents the final approach and consists of resection and reanastomosis of offending intestinal segment, with or without bladder closure. In many cases, a single-stage surgical strategy is selected. Perioperative and long-term outcomes prove good.
Topics: Colon, Sigmoid; Colonoscopy; Diverticulitis, Colonic; Diverticulum; Humans; Intestinal Fistula; Male; Urinary Bladder Fistula
PubMed: 34791866
DOI: 10.23736/S2724-6051.21.04750-9 -
International Journal of Surgery Case... Jul 2022In developing countries, Vesico-vaginal fistula (VVF) results following obstetric trauma or iatrogenic during hysterectomy. Large calculus associated with VVF is...
INTRODUCTION
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. Most bladder stones can be found among patients who are bedridden, indwelling urethral catheter, bladder outlet obstruction, infection, and other similar characteristic. We report a case of VVF with bladder and vaginal stone in 37 years old woman and reviews the evaluation and treatment and highlights the role of the healthcare team in managing patients with this condition.
PRESENTATION OF CASE
A 37-year-old, P2A0, woman with a history of hysterectomy three years ago. Intermittent small amounts of watery vaginal discharge developed 1,5 years after the operation. A physical examination revealed mild tenderness over the suprapubic area and no evidence of uterine prolapse. Cystography computed tomography scan with contrast confirmed a fistula vesicovagina with a connection between posterosuperior wall of vesica urinaria and anterosuperior wall of vagina with vesicolithiasis, size 15 × 26 × 14 mm and two vaginal stone with size of 7 × 12 × 17 mm and 4 × 4 × 5 mm. Cystoscopy revealed a grayish stone identified in supratrigone with size of 30 × 12 mm.
DISCUSSION
A hanging intravesical stone on the dome of urinary bladder is scarce, possibly caused by any synthetic and non-absorbable suture material inside of the bladder were encrusted forming a bladder stone. Important risk factors known, which is specific in developing countries, are poor socioeconomic status, malnourishment, low literacy rate, early marriage and childbearing, and inadequate obstetrical care.
CONCLUSION
Although the incidence of VVF accompanied by hanging vaginal stone and a large bladder stone is scarce, reports of any case regarding this study can be beneficial to other studies. Due to its harmful effect, the usage of non-absorbable sutures material during surgery isn't suggested. Hence, the absorbable suture material usage with careful dissection is suggested for any gynecological or pelvic surgery.
PubMed: 35803097
DOI: 10.1016/j.ijscr.2022.107311 -
BMJ Case Reports May 2022Bladder stone is a known complication in a neurogenic bladder that can very rarely cause vesicovaginal fistula (VVF). We are presenting the case of a woman in her late...
Bladder stone is a known complication in a neurogenic bladder that can very rarely cause vesicovaginal fistula (VVF). We are presenting the case of a woman in her late 70s, bed bound with progressive multiple sclerosis (MS), who was referred to urology for consideration of suprapubic catheter due to difficulty in managing her indwelling urethral catheter. The ultrasonogram (USG) identified a 4.7 cm bladder stone with right-sided hydronephrosis (HN) and left atrophic kidney. A CT scan later showed that a 5 cm bladder stone has migrated through a VVF into her vagina. She had a cystoscopy and transvaginal retrieval of the stone. Given her performance status and intraoperative finding of a small contracted bladder, it was agreed to manage her VVF conservatively.To the best of our knowledge, this is the first case of a primary bladder stone migrating into the vagina through a VVF.
Topics: Cystoscopy; Female; Humans; Male; Urinary Bladder; Urinary Bladder Calculi; Vagina; Vesicovaginal Fistula
PubMed: 35534044
DOI: 10.1136/bcr-2022-249463 -
Medicina (Kaunas, Lithuania) Nov 2023Vesicovaginal fistulas (VVFs) are an abnormal communication between the vagina and bladder and the most common type of acquired genital fistulas. This review will... (Review)
Review
Vesicovaginal fistulas (VVFs) are an abnormal communication between the vagina and bladder and the most common type of acquired genital fistulas. This review will address the prevalence, impact, and management challenges of VVFs. Epidemiologic studies examining VVFs are considered. In addition, publications addressing the treatment of VVFs are reviewed. VVFs in developing countries are often caused by obstructed labor, while most VVFs in developed countries have iatrogenic causes, such as hysterectomy, radiation therapy, and infection. The reported prevalence of VVFs is approximately 1 in 1000 post-hysterectomy patients and 1 in 1000 deliveries. VVFs affect every aspect of quality of life, including physical, mental, social, and sexual aspects. Prevention of VVFs is essential. Early diagnosis is necessary to reduce morbidity. Nutrition, infection control, and malignancy detection are important considerations during evaluation and treatment. Conservative and surgical treatment options are available; however, these approaches should be customized to the individual patient. The success rate of combined conservative and surgical treatments exceeds 90%. VVFs are considered debilitating and devastating. However, they are preventable and treatable; key factors include the avoidance of prolonged labor, careful performance of gynecologic surgery, and early detection.
Topics: Humans; Female; Vesicovaginal Fistula; Prevalence; Quality of Life; Urinary Bladder; Gynecologic Surgical Procedures
PubMed: 38003996
DOI: 10.3390/medicina59111947 -
The Journal of the American Osteopathic... Dec 2017
Topics: Adult; Female; Humans; Hysterectomy; Intraoperative Complications; Urinary Bladder; Urinary Incontinence; Vesicovaginal Fistula
PubMed: 29181523
DOI: 10.7556/jaoa.2017.154 -
International Urogynecology Journal Nov 2022A representative, large animal model of vesicovaginal fistulas is needed for the training of surgeons and for the development of new surgical techniques and materials...
INTRODUCTION AND HYPOTHESIS
A representative, large animal model of vesicovaginal fistulas is needed for the training of surgeons and for the development of new surgical techniques and materials for obstetric fistula repair.
METHODS
The safety, feasibility, and reproducibility of vesicovaginal fistula creation were studied in 4 adult female sheep. A 1-cm fistula was created between the vagina and the bladder through a transvaginal approach. The defect was allowed to heal for 8 weeks and the animals were then euthanized. The primary outcome was the fistula patency. Secondary outcomes were fistula size, urogenital dimensions, urodynamic evaluation, histology (inflammation, vascularization, collagen deposition) and biomechanical characteristics of the fistula edge (stress at break, maximum elongation, and stiffness).
RESULTS
The transvaginal creation of a vesicovaginal fistula was safe. All animals survived the surgical procedure and follow-up period, without complications. Three of the four animals demonstrated a patent vesicovaginal fistula after 8 weeks. Baseline data are provided of the urogenital dimensions and the urodynamic, histological, and biomechanical characteristics of the model.
CONCLUSIONS
The ewe is a safe, feasible, and reproducible model for vesicovaginal fistulas. The model can help to study new techniques and materials to boost surgical innovation for vesicovaginal fistula repair.
Topics: Animals; Female; Humans; Pregnancy; Reproducibility of Results; Sheep; Urinary Bladder; Vagina; Vesicovaginal Fistula
PubMed: 36121458
DOI: 10.1007/s00192-022-05342-y -
Annals of Surgery Nov 1964
Topics: Appendectomy; Appendicitis; Appendix; Cystitis; Female; Fistula; Humans; Intestinal Fistula; Parovarian Cyst; Radiography; Surgical Procedures, Operative; Urinary Bladder Calculi; Urinary Bladder Fistula; Urography
PubMed: 14236598
DOI: 10.1097/00000658-196411000-00004 -
BMC Pregnancy and Childbirth Dec 2013Obstetric fistula is a severe condition which has devastating consequences for a woman's life. The estimation of the burden of fistula at the population level has been... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Obstetric fistula is a severe condition which has devastating consequences for a woman's life. The estimation of the burden of fistula at the population level has been impaired by the rarity of diagnosis and the lack of rigorous studies. This study was conducted to determine the prevalence and incidence of fistula in low and middle income countries.
METHODS
Six databases were searched, involving two separate searches: one on fistula specifically and one on broader maternal and reproductive morbidities. Studies including estimates of incidence and prevalence of fistula at the population level were included. We conducted meta-analyses of prevalence of fistula among women of reproductive age and the incidence of fistula among recently pregnant women.
RESULTS
Nineteen studies were included in this review. The pooled prevalence in population-based studies was 0.29 (95% CI 0.00, 1.07) fistula per 1000 women of reproductive age in all regions. Separated by region we found 1.57 (95% CI 1.16, 2.06) in sub Saharan Africa and South Asia, 1.60 (95% CI 1.16, 2.10) per 1000 women of reproductive age in sub Saharan Africa and 1.20 (95% CI 0.10, 3.54) per 1000 in South Asia. The pooled incidence was 0.09 (95% CI 0.01, 0.25) per 1000 recently pregnant women.
CONCLUSIONS
Our study is the most comprehensive study of the burden of fistula to date. Our findings suggest that the prevalence of fistula is lower than previously reported. The low burden of fistula should not detract from their public health importance, however, given the preventability of the condition, and the devastating consequences of fistula.
Topics: Africa South of the Sahara; Bangladesh; Developing Countries; Female; Humans; India; Obstetric Labor Complications; Pregnancy; Prevalence; Rectovaginal Fistula; Vesicovaginal Fistula
PubMed: 24373152
DOI: 10.1186/1471-2393-13-246 -
Proceedings of the Royal Society of... Dec 1958
Topics: Fistula; Humans; Intestinal Fistula; Intestines; Urinary Bladder; Urinary Bladder Fistula
PubMed: 13623829
DOI: No ID Found