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International Braz J Urol : Official... 2021To evaluate efficacy of urorectal fistula (URF) repair using different approaches and the clinical factor determinant of success, and also the morbidity associated to...
PURPOSE
To evaluate efficacy of urorectal fistula (URF) repair using different approaches and the clinical factor determinant of success, and also the morbidity associated to the procedure and health-related quality of life (HRQoL) in male survivors of pelvic malignancies.
MATERIAL AND METHODS
Retrospective evaluation of 39 patients with URF primarily intervened in three institutions using different surgical approaches. Success was defined as effective fistula closure. Variables evaluated included demographics, previous treatments, surgical approach, ancillary surgeries, complications and HRQoL by using a standardized non-validated specific questionnaire. Median follow-up from surgery to interview was 55 months (interquartile range 49, range 4-112). Factors determinant of success were investigated using logistic regression. Safety of the procedure was evaluated by Clavien-Dindo scale. Deterioration of continence and erectile function and other HRQoL issues were evaluated.
RESULTS
Prostate cancer treatment was the predominant etiology. The success rate for fistula repair was 89.5%. The surgical approach was not related to failed repair (p=0.35) or complications (p=0.29). Factors associated with failure were complications (p=0.025), radiotherapy (p=0.03), fistula location (p=0.04) and fistula size (p=0.007). Multivariate analysis revealed fistula size was the only independent determinant of failure (OR 6.904, 1.01-47.75). Complications occurred in 46.2% and severe complications in 12.8%. The mortality related to the procedure was 2.6%. Urinary incontinence was present before repair in 26.3% and erectile dysfunction in 89.5%. Fistula repair caused de novo urinary incontinence in 7.9% and deterioration of erectile status in 44.7%. Globally 79% were satisfied after repair and only 7.9% rated HRQoL as unhappy. Trans-sphincteric approach was related to less deterioration of erectile function (p=0.003), and higher perceived satisfaction in QoL (p=0.04).
CONCLUSIONS
The surgical approach elected to correct URF is not determinant of success nor of complications. Fistula size appears as independent determinant for failure. Trans-sphincteric approach could be advantageous over other procedures regarding HRQoL issues.
Topics: Humans; Male; Quality of Life; Rectal Fistula; Retrospective Studies; Treatment Outcome; Urinary Fistula; Urinary Incontinence
PubMed: 33284543
DOI: 10.1590/S1677-5538.IBJU.2020.0476 -
BJOG : An International Journal of... Apr 2016To compare primiparous and multiparous women who develop obstetric fistula (OF) and to assess predictors of fistula location.
OBJECTIVE
To compare primiparous and multiparous women who develop obstetric fistula (OF) and to assess predictors of fistula location.
DESIGN
Cross-sectional study.
SETTING
Fistula Care Centre at Bwaila Hospital, Lilongwe, Malawi.
POPULATION
Women with OF who presented between September 2011 and July 2014 with a complete obstetric history were eligible for the study.
METHODS
Women with OF were surveyed for their obstetric history. Women were classified as multiparous if prior vaginal or caesarean delivery was reported. The location of the fistula was determined at operation: OF involving the urethra, bladder neck, and midvagina were classified as low; OF involving the vaginal apex, cervix, uterus, and ureters were classified as high.
MAIN OUTCOME MEASURES
Demographic information was compared between primiparous and multiparous women using chi-squared and Mann-Whitney U-tests. Multivariate logistic regression models were implemented to assess the relationship between variables of interest and fistula location.
RESULTS
During the study period, 533 women presented for repair, of which 452 (84.8%) were included in the analysis. The majority (56.6%) were multiparous when the fistula formed. Multiparous women were more likely to have laboured <1 day (62.4 versus 44.5%, P < 0.001), delivered a live-born infant (26.8 versus 17.9%, P = 0.026), and have a high fistula location (37.5 versus 11.2%, P < 0.001). Multiparity [adjusted odds ratio (aOR) = 4.55, 95% confidence interval (CI) 2.27-9.12)] and history of caesarean delivery (aOR = 4.11, 95% CI 2.45-6.89) were associated with development of a high fistula.
CONCLUSIONS
Multiparity was common in our cohort, and these women were more likely to have a high fistula. Additional research is needed to understand the aetiology of high fistula including potential iatrogenic causes.
TWEETABLE ABSTRACT
Multiparity and caesarean delivery were associated with a high tract fistula in our Malawian cohort.
Topics: Adult; Cesarean Section; Cross-Sectional Studies; Female; Humans; Logistic Models; Malawi; Multivariate Analysis; Odds Ratio; Parity; Pregnancy; Risk Factors; Urinary Fistula; Uterine Diseases; Vaginal Fistula
PubMed: 26853525
DOI: 10.1111/1471-0528.13901 -
World Journal of Urology Mar 2022Arterio-ureteral fistula (AUF) is an uncommon diagnosis, but potentially lethal. Although the number of reports has increased over the past two decades, the true...
PURPOSE
Arterio-ureteral fistula (AUF) is an uncommon diagnosis, but potentially lethal. Although the number of reports has increased over the past two decades, the true incidence and contemporary urologists' experience and approach in clinical practice remains unknown. This research is conducted to provide insight in the incidence of AUF in The Netherlands, and the applied diagnostic tests and therapeutic approaches in modern practice.
METHODS
A nationwide cross-sectional questionnaire analysis was performed by sending a survey to all registered Dutch urologists. Data collection included information on experience with patients with AUF; and their medical history, diagnostics, treatment, and follow-up, and were captured in a standardized template by two independent reviewers. Descriptive statistics were used.
RESULTS
Response rate was 62% and 56 AUFs in 53 patients were reported between 2003 and 2018. The estimated incidence of AUF in The Netherlands in this time period is 3.5 AUFs per year. Hematuria was observed in all patients; 9% intermittent microhematuria, and 91% presenting with, or building up to massive hematuria. For the final diagnosis, angiography was the most efficient modality, confirming diagnosis in 58%. Treatment comprised predominantly endovascular intervention.
CONCLUSION
The diagnosis AUF should be considered in patients with persistent intermittent or massive hematuria.
Topics: Cross-Sectional Studies; Hematuria; Humans; Stents; Surveys and Questionnaires; Ureteral Diseases; Urinary Fistula; Vascular Fistula
PubMed: 35064800
DOI: 10.1007/s00345-021-03910-3 -
Archivos Espanoles de Urologia May 2019This paper describes our initial experience with laparoscopic ureteroneocystostomy in two patients with distal ureter lesions following gynaecological surgery... (Review)
Review
This paper describes our initial experience with laparoscopic ureteroneocystostomy in two patients with distal ureter lesions following gynaecological surgery (hysterectomy). Furthermore, we review the evidence on the incidence, prevention, and management of urinary tract injuries that occur during laparoscopic gynaecological surgery. METHOD: Two patients with iatrogenic lower ureteral injuries during hysterectomy leading to ureterovaginal fistula underwent laparoscopic ureteroneocystostomy with a psoas hitch. RESULTS: The procedures were successfully performed without any conversion. No intraoperative or postoperative complications were noted. Our minimally invasive approach has yielded successful results, similar to those achieved through open surgical repair. CONCLUSION: Laparoscopic ureteroneocystostomy with a psoas hitch for ureterovaginal fistula secondary to hysterectomy is a safe and feasible option for patients with gynecologic distal ureteral injury, with excellent results and low morbidity.
Topics: Female; Humans; Hysterectomy; Laparoscopy; Ureter; Ureteral Diseases; Urinary Fistula; Vaginal Fistula
PubMed: 31070140
DOI: No ID Found -
Archivio Italiano Di Urologia,... Feb 2023Arterio-ureteralfistula (AUF) is an infrequent but potentially life-threatening condition. The aim of this study was reviewing the literature to build a flow-chart... (Review)
Review
OBJECTIVES
Arterio-ureteralfistula (AUF) is an infrequent but potentially life-threatening condition. The aim of this study was reviewing the literature to build a flow-chart useful for an early and effective diagnosis and treatment of this pathology.
MATERIALS AND METHODS
A literature search in PubMed was conducted. In addition, retrieved articles were cross-referenced. Data parameters included oncologic, vascular and urological history, diagnostics, treatment, and follow up were collected using a standard template by 2 independent reviewers.
RESULTS
A total of 140 cases of AUF out of 172 available in the literature at the time of the review, were considered. All patients presented gross hematuria. Chronic indwelling ureteral catheter (CIUC); history of pelvic surgery (HPS) and history of pelvic radiotherapy (HRT) were present respectively in 81%, 62.1%and 58.6% of the sample. The most predominant location of AUF was at the common iliac artery ureteral crossing. Angiography with provocative measures had the highest diagnostic sensitivity (50%) and endovascular treatment with stent-graft placement across the fistula is the current state of the art treatment choice.
CONCLUSIONS
Failure to diagnose can postpone a potentially life-saving targeted therapy and lead to complications. The identifi-cation of the Trifecta hematuria, history of pelvic surgery (HPS) and history of pelvic radiotherapy (HPR) would allow the identity-fication of patients at high risk of AUF, who may benefit from more sensitive early diagnostic investigations such as CT angiography and provocative angiography. The treatment of choice in case of AUF to date consist in endovascular prosthesis placement.
Topics: Humans; Vascular Fistula; Hematuria; Urinary Fistula; Iliac Artery; Ureteral Diseases; Early Diagnosis; Stents
PubMed: 36924382
DOI: 10.4081/aiua.2023.10928 -
Pediatric Surgery International Nov 2019To compare the two major complications, namely postoperative urethrocutaneous fistula and urethral stricture, between the Mathieu and tubularized incised plate (TIP)... (Meta-Analysis)
Meta-Analysis Review
Postoperative outcomes in distal hypospadias: a meta-analysis of the Mathieu and tubularized incised plate repair methods for development of urethrocutaneous fistula and urethral stricture.
PURPOSE
To compare the two major complications, namely postoperative urethrocutaneous fistula and urethral stricture, between the Mathieu and tubularized incised plate (TIP) repair methods for distal hypospadias.
METHODS
In this meta-analysis, electronic databases were searched for comparative studies on the two techniques. The Oxford Centre for Evidence-based Medicine Levels of Evidence was used to evaluate the included studies. The main outcome measure was the frequency of postoperative fistula and urethral stricture. RevMan 5.3 was used for statistical analyses, with P < 0.05 indicating statistical significance.
RESULTS
A total of 17 studies, which included 1572 patients, met the inclusion criteria. The frequency of urethrocutaneous fistula did not differ between the Mathieu [115 (13%)] and TIP [90 (13%)] methods [odds ratio (OR) 1.1, 95% confidence intervals (CI) 0.6-1.9; P = 0.73)]. Urethral stricture was less frequent after the Mathieu [15 (2%)] method than after the TIP [37 (5%)] method (OR 0.5, 95% CI 0.3-0.8; P < 0.01), even after the subgroup analysis of eight randomized controlled trials was included. Overall, the quality of the included studies was determined to be satisfactory. The levels of evidence on which this review was based ranged from 1b to 2b using the CEBM Levels of Evidence.
CONCLUSION
Compared with TIP repair, Mathieu repair for hypospadias had a significantly lower risk for urethral stricture; however, the risk for urethrocutaneous fistula was similar.
Topics: Cutaneous Fistula; Humans; Hypospadias; Male; Postoperative Complications; Urethral Stricture; Urinary Fistula; Urologic Surgical Procedures, Male
PubMed: 31372729
DOI: 10.1007/s00383-019-04523-z -
Einstein (Sao Paulo, Brazil) 2013Vesicovaginal fistula is an abnormal communication between the bladder and vagina and represents the most frequent type of fistula in the urinary tract. The most common...
Vesicovaginal fistula is an abnormal communication between the bladder and vagina and represents the most frequent type of fistula in the urinary tract. The most common cause in Brazil is iatrogenic fistula, secondary to histerectomia. Classically these women present continuous urinary leakage from the vagina and absence of micturition, with strong negative impact on their quality of life. We present a case of totally continent vesicovaginal fistula, with a follow-up of 11 years with no complications.
Topics: Female; Humans; Hysterectomy; Middle Aged; Reoperation; Urination; Vesicovaginal Fistula
PubMed: 23579756
DOI: 10.1590/s1679-45082013000100022 -
BMC Research Notes Sep 2017To explore and summarize the reasons why urethral calculi cause a urethral fistula. (Review)
Review
BACKGROUND
To explore and summarize the reasons why urethral calculi cause a urethral fistula.
CASE PRESENTATION
We retrospectively studied 1 patient in Xiangya hospital and all relevant literature published in English between 1989 and 2015. The patients (including those reported in the literature) were characterized by age, origin, location of calculus, size of calculus, fistulous track, and etiological factors. Most of urethral calculi associated with a urethral fistula were native generated. Urethral calculi can be formed in various locations of the urethra, and the size of the calculus ranged from small (multiple) calculi to giant stones. The fistula external orifice located at the root of the penis was relatively common, and there were various etiological factors, such as urethral strictures, urethral trauma induced by long-term catheterization, lumbar fractures, and congenital anomaly factors. They were managed by the excision of the fistulous tract, retrieval of the urethral stones, and/or debridement and pus drainage operations.
CONCLUSION
Some elements, such as trauma, recurrent urinary tract infections, abscess formation induced by long-term catheterization, and urethral calculus, may be the risk factors for a urethral fistula.
Topics: Humans; Male; Middle Aged; Tomography, X-Ray Computed; Urethral Diseases; Urinary Calculi; Urinary Fistula
PubMed: 28874183
DOI: 10.1186/s13104-017-2798-z -
Revista Brasileira de Ginecologia E... Sep 2018To describe a case of vesicouterine fistula and to review the literature related to this condition. (Review)
Review
OBJECTIVE
To describe a case of vesicouterine fistula and to review the literature related to this condition.
METHODS
For the review, we accessed the MEDLINE, BIREME and LILACS databases; the references of the searched articles were also reviewed.
RESULTS
A 38-year-old woman, in the 1st day after her 3rd cesarean, presented heavy hematuria, which was considered secondary to a difficult dissection of the bladder. A total of 6 months after delivery, she failed to resume her regular menstrual cycles and presented cyclic menouria and amenorrhea. At this time, she had two episodes of urethral obstruction by blood clots. She remained without a correct diagnosis until about two years postdelivery, when a vesicouterine fistula was confirmed through cystoscopy. A surgical correction through open abdominal route, coupled with hysterectomy, was performed. After the surgery, the symptoms disappeared. The review showed a tendency of change in the relative frequency of the different types of genitourinary fistulae. Vesicovaginal fistulae, usually caused by inadequate care during labor, are becoming less frequent than those secondary to medical procedures, such as vesicouterine fistulae. The most common cause of this latter kind of fistula is cesarean section, especially repeated cesarean sections. The diagnosis is confirmed through one or more imaging exams, or through cystoscopy. The most common treatment is surgical, and the routes are: open abdominal, laparoscopic, vaginal or robotic. There are some reports of success with the conservative treatment.
CONCLUSION
Vesicouterine fistulae are becoming more common because of the increase in the performance of cesarean sections, and the condition must be considered a possible complication thereof.
Topics: Adult; Cesarean Section; Female; Fistula; Humans; Postoperative Complications; Syndrome; Urinary Bladder Fistula; Uterine Diseases
PubMed: 30231295
DOI: 10.1055/s-0038-1666998 -
Journal of Gynecologic Oncology Mar 2023This study aimed to identify the risk factors for genitourinary fistulas and delayed fistula recognition after radical hysterectomy for cervical cancer.
OBJECTIVE
This study aimed to identify the risk factors for genitourinary fistulas and delayed fistula recognition after radical hysterectomy for cervical cancer.
METHODS
This study was a retrospective analysis of data collected in the Major Surgical complications of Cervical Cancer in China (MSCCCC) database from 2004-2016. Data on sociodemographic characteristics, clinical characteristics, and hospital characteristics were extracted. Differences in the odds of genitourinary fistula development were investigated with multivariate logistic regression analyses, and differences in the time to recognition of genitourinary fistula were assessed by Kruskal-Wallis test.
RESULTS
In this study, 23,404 patients met the inclusion criteria. Surgery in a cancer center, a women's and children's hospital, a facility in a first-tier city, or southwest region, stage IIA, type C1 hysterectomy, laparoscopic surgery and ureteral injury were associated with a higher risk of ureterovaginal fistula (UVF) (p<0.050). Surgery in southwest region, bladder injury and laparoscopic surgery were associated with greater odds of vesicovaginal fistula (VVF) (p<0.050). Surgery at cancer centers and high-volume hospitals was associated with an increase in the median time to UVF recognition (p=0.016; p=0.005). International Federation of Gynecology and Obstetrics (FIGO) stage IIA1-IIB was associated with delayed recognition of VVF (p=0.040).
CONCLUSION
Intraoperative urinary tract injury and surgical approach were associated with differences in the development of UVFs and VVFs. Patients who underwent surgery in cancer centers and high-volume hospitals were more likely to experience delayed recognition of UVF. Patients with FIGO stage IIA1-IIB disease were more likely to experience delayed recognition of VVF.
Topics: Child; Humans; Female; Uterine Cervical Neoplasms; Retrospective Studies; Urinary Fistula; Hysterectomy; Risk Factors; Laparoscopy
PubMed: 36603848
DOI: 10.3802/jgo.2023.34.e20