Authors: Tomasz Kościński

Rekomendacje dotycz etiologii i klasyfikacji przetok odbytniczo-pochwowych a przede wszystkim zasad postpowania chirurgicznego. W leczeniu przetok zlokalizowanych w dolnej czci odbytnicy zastosowanie znajduj techniki wycicia kanau przetoki i warstwowego zamykania powstaego ubytku, w tym rwnie z rekonstrukcj aparatu zwieraczowego odbytu. Dla wzmocnienia rekonstruowanych tkanek stosuje si matryc kolagenowo-fibrynow TachosilR. W przypadku wysokich przetok odbytniczo-pochwowych wykonuje si usunicie zmienionego chorobowo odcinka jelita wraz z ujciem przetoki z jednoczasowym lub odroczonym odtworzeniem cigoci przewodu pokarmowego.

Topics: Female; Humans; Vaginal Fistula

PubMed: 36805988
DOI: 10.5604/01.3001.0015.9658

Authors: Bin Yang, Haibao Luo, Yixiong Shu...

Topics: Female; Humans; COVID-19; Rectovaginal Fistula; Quadriplegia

PubMed: 37169682
DOI: 10.1016/j.asjsur.2023.04.089

Review

Authors: J-H Lefèvre, Y Parc

Topics: Digestive System Surgical Procedures; Female; Hirschsprung Disease; Humans; Male; Rectovaginal Fistula

PubMed: 21885364
DOI: 10.1016/j.jviscsurg.2011.07.006

Authors: Aurus Dourado Meneses, Adriane Queiroz Oliveira, Daniel Alencar de Araujo...

INTRODUCTION AND OBJECTIVE

Several methods and techniques have been described for the treatment of vesicovaginal fistula (VVF) including abdominal, vaginal and endoscopic approaches. The development of laparoscopic surgery minimizes the morbidity associated with laparotomy, reducing the period of convalescence, being increasingly used in the management of VVF. This aim of this study is to present 42 cases of laparoscopic vesicovaginal fistula repair and to evaluate their results.

MATERIALS AND METHODS

Forty-two patients with a diagnosis of VVF between 1998 and 2016 were included, with precise indications of abdominal surgical approach as recommended by Lee et al. (1) Cystoscopy, Retrograde urethrocystography and excretory urography confirmed the presence of VVF and ruled out ureteral lesions in all patients.

RESULTS

Forty-two patients with VVF, mean age of 40.35 years (19-75 years), were treated. The most frequent cause of VVF was abdominal hysterectomy (80.95%) 34 patients (80.95%) had never been treated, while 7 patients (16.66%) had undergone unsuccessful abdominal surgical treatment. One patient (2.38%) underwent three attempts of correction, one vaginally and two abdominal without success. The average time of hospitalization was 3 days. The average duration of the vesical catheter was 12 days. Complications occurred in 4 patients (9.52%). Only 2 patients (4.76%) had recurrence at 40 and 90 days after their first surgery, both of them were previously submitted to radiotherapy.

CONCLUSION

The laparoscopic approach of VVF is an excellent alternative to the traditional abdominal approach. Therefore, it is a feasible, effective and minimally invasive method that can treat this entity.

Topics: Adult; Aged; Female; Humans; Laparoscopy; Middle Aged; Treatment Outcome; Vesicovaginal Fistula; Young Adult

PubMed: 32022529
DOI: 10.1590/S1677-5538.IBJU.2018.0743

Review

Authors: Krzysztof Pyra, Maciej Szmygin, Hanna Szmygin...

A uretero-vaginal fistula (UVF) describes an abnormal connection between the ureter and vagina causing urinary incontinence, frequent infection, and discomfort. Although UVF might be diagnosed after vaginal delivery, infertility treatment or pelvic radiation therapy, gynecological operations, especially total abdominal hysterectomy, remain the leading cause of ureteral injury and formation of UVF. Traditional ureteroneocystostomy was usually the treatment of choice in patients with UVF. Nevertheless, it is now frequently replaced by less invasive endoscopic and percutaneous procedures which are also highly effective and feasible. That is why, ureteral stenting became the first-line treatment in uncomplicated UVF. The aim of this review is to present clinical presentation of UVF and to assess the current state of knowledge about the diagnosis and management of uretero-vaginal fistula with special interest on minimally-invasive methods.

Topics: Female; Humans; Hysterectomy; Ureter; Ureteral Diseases; Urinary Fistula; Vaginal Fistula

PubMed: 35315024
DOI: 10.5603/GP.a2021.0240

Meta-Analysis Comparative Study Review

Authors: A Venara, H Houlet, E Poupard...

BACKGROUND

The management of obstetric rectovaginal fistula (RVF) is challenging for the surgeon. The best surgical procedure to repair RVFs, specifically after obstetric anal sphincter injury, has not been extensively studied. The objective was to compare the success of the different procedures performed to repair obstetric RVF.

METHODS

The literature search was carried out on PubMed and Web of Science from database inception until 31 December 2022. Selection criteria were: (1) patients with a diagnosis of obstetric-related RVF; (2) patients treated surgically with no restriction concerning the considered surgery; (3) clinical trials or epidemiological studies. Meta-analysis was conducted considering the network meta-analysis framework to allow studying the relative value of each treatment mentioned in the selected articles.

RESULTS

The quantitative synthesis included 32 studies (18 retrospective and 14 prospective) accounting for 595 patients. The quality of these studies was low because of the lack of prospective randomization. Nineteen procedure types were described and assessed. Most patients (n = 180) underwent endorectal advancement flap (ERAF) followed by excision and layered closure (ELC) (n = 213) and Musset procedure (n = 65). A diverting stoma was performed in 66/132 patients. Only 13 studies reported the functional results of the procedure. In the meta-analysis, the Musset procedure (OR = 4.29; 95% CI: 1.18-16.14), transvaginal ELC (OR = 11.84; 95% CI: 2.18-91.80) and transperineal ELC (OR = 3.56; 95% CI: 1.26-10) significantly improved the anatomical results compared to ERAF.

CONCLUSIONS

A further randomized controlled trial in the literature assessing ERAF and sphincteroplasty to compare the anatomical results, functional results and morbidity of this treatment is needed.

REGISTRATION

PROSPERO CRD42023447875.

Topics: Humans; Female; Rectovaginal Fistula; Anal Canal; Pregnancy; Treatment Outcome; Obstetric Labor Complications; Surgical Flaps; Retrospective Studies

PubMed: 40192869
DOI: 10.1007/s10151-025-03133-3

Authors: R Scott Taylor, Megan Wasson, John V Ashurst...

Topics: Adult; Female; Humans; Hysterectomy; Intraoperative Complications; Urinary Bladder; Urinary Incontinence; Vesicovaginal Fistula

PubMed: 29181523
DOI: 10.7556/jaoa.2017.154

Authors: Minjoon Kim, Nari Park, Hanggoo Yun...

Topics: Female; Genital Diseases, Female; Humans; Postoperative Complications; Recurrence; Retrospective Studies; Treatment Outcome; Urogenital Surgical Procedures; Vesicovaginal Fistula

PubMed: 33221132
DOI: 10.1016/j.asjsur.2020.10.029

Authors: Shanti Laxmi Darga, Mallikarjuna Chiruvella, Taif Mohammed Bedigeri...

INTRODUCTION:

The transverse vaginal septum (TVS) with congenital urethra-vaginal fistula (CUVF) is a rare anomaly of the mullerian duct (1, 2). Incomplete channelling of the vaginal plate, or an abnormality in the fusion of the vaginal component of mullerian duct with the urogenital sinus results in TVS (1, 3, 4). High CUVF occurs due to the persistent communication between the urogenital sinus and utero-vaginal primordium at the tubercle sinus, whereas low CUVF is due to excessive apoptosis of the vaginal plate during channelling (5). The principles of management of CUVF with TVS include: 1) TVS resection, 2) Create a neovagina. We present a case of CUVF with TVS managed by robotic assistance.

MATERIAL AND METHODS:

A 24-year-old female, married for 3 years, presented with cyclical hematuria since menarche, dyspareunia and primary infertility. Examination revealed blind ending vagina 4cm from the introitus. Magnetic resonance imaging revealed a fistulous communication between urethra and vagina, and TVS. Cystourethroscopy confirmed a proximal urethra-vaginal fistula. Urethroscopy guided puncture of the TVS was performed, tract dilated and a catheter was placed across it. Robotic assisted transvaginal approach was planned. Air docking of robot was performed. Traction on the catheter was given to identify the incised edges of the septum. Vaginal flaps were raised laterally, fistulous tract was excised. Proximal vagina mucosa was identified and vaginoplasty was performed.

RESULT:

Patient’s postoperative recovery was uneventful. Urethral catheter was removed after 5 days. She had normal voiding and menstruation. Vaginoscopy performed at 1st month follow-up, revealed an adequate vaginal lumen. Vaginal moulds were advised for 6 weeks during the night, following which she resumed her sexual activity. She conceived 6 months post-surgery, and delivered a child by caesarean section.

CONCLUSION:

We successfully managed this case by resection of septum, neovagina creation and thereby achieving normal menstruation and conception. The advantages of robotic approach were magnification, precision and manoeuvrability in a limited space, avoiding a vaginal release incision.

Topics: Female; Humans; Robotic Surgical Procedures; Urethra; Vagina; Vaginal Diseases; Vaginal Fistula

PubMed: 34735094
DOI: 10.1590/S1677-5538.IBJU.2021.0421

Authors: Jorrit Colenbrander, John Heesakkers, Frank Martens...

INTRODUCTION

The aim of this study is to determine the outcome of surgically treated vesico-vaginal fistulae (VVaFs) using a transvaginal approach with a Latzko technique.

METHODS

A retrospective chart study was conducted at the Department of Urology, Radboud University Medical Centre. Surgical approaches to repair VVaF, from 2014 to September 2020, were selected. Patients who underwent a transvaginal approach were included. The primary objective was fistula closure. Secondary objectives were predictive factors for the outcome of the surgical procedure, for example, patient characteristics, leakage on cystography 2 weeks postoperative, and surgery time.

RESULTS

Thirty-one patients had surgery for VVaF. Twenty-five procedures (81%) were performed transvaginally. Thirteen of these (52%) had successful transvaginal closure after the first attempt. Seven out of 12 had their second attempt at the time of analysis, of which 4 (57%) were successfully closed thereafter. After either 1 or 2 attempts with the transvaginal approach, 17 (68%) of the VVaFs were successfully closed, but 79% if patients who did not yet had a second attempt were taken into account with the current success extrapolated. Only few minor complications were observed.

CONCLUSION

Transvaginal closure of VVaFs with a Latzko technique is successful in about 79% in either 1 or 2 attempts, with few minor complications. A second attempt in closing the fistula with a transvaginal approach is useful, and a previous transvaginal attempt is not a contraindication for a second transvaginal attempt in closing the VVaF surgically.

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Middle Aged; Operative Time; Postoperative Complications; Recurrence; Retrospective Studies; Time Factors; Treatment Outcome; Urologic Surgical Procedures; Vesicovaginal Fistula

PubMed: 34583358
DOI: 10.1159/000519369