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ABSTRACT
Year : 2016  |  Volume : 8  |  Issue : 6  |  Page : 180-183  

Urology fistulae


Date of Web Publication26-Apr-2016

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How to cite this article:
. Urology fistulae. Urol Ann 2016;8, Suppl S2:180-3

How to cite this URL:
. Urology fistulae. Urol Ann [serial online] 2016 [cited 2020 Jul 12];8, Suppl S2:180-3. Available from: http://www.urologyannals.com/text.asp?2016/8/6/180/181211

Iatrogenic urogenital fistulae in Riyadh Central Hospital

Saleh Al-Mohalhel, Adel Youssef, Abdullah Jasser, Vincent Onoura


Department of Urology, Riyadh Central Hospital, Riyadh, Saudi Arabia

We report 19 cases of Iatrogenic Urogenital fistulae managed in the Department of Urology, Central Hospital, Riyadh in the 5 year period 1985-1989. All the cases resulted from Obstetrics and Gynaecological accidents. The ages ranged from 25 to 50 years. Major symptoms were urinary incontinence through the vagina, menouria, and perineal dermatitis. Ten out of the 19 cases had uretero-vaginal fistulae and 8 of these cases were located on the left side. The fistulae formed after treatment for benign conditions in 80% of our patients and among these 60% were associated with pregnancy. Fistulae complicating cancer surgery were very uncommon. All our patients with ureterovaginal fistulae had preliminary percutaneous nephrostomy which is our policy. On the whole 12 patients underwent reconstruction using either the Boari-Ockerblad flap (5 cases), uretero-neocystostomy (4 cases), or other techniques (3 cases), with excellent results. We feel that preliminary diversion, in association with delayed reconstruction is a treatment option in some cases of urogenital fistulae.

Presented at the: 6 th Saudi Urological Conference

National Guard King Khalid Hospital - Jeddah

27-28 November 1991

Female genito-urinary fistulae

Hassan S. O. Abduljabbar, Hisham A. Mosli,

Hasan M. A. Farsi, Fatma Ali Al Etaibi


Departments of Obstetrics and Gynaecology and Surgery, King Abdulaziz University, College of Medicine, Jeddah, Saudi Arabia

During the period from 1987 until 1989, twenty-eight female patients with genito-urinary fistula were seen at King Abdulaziz University Hospital, 78.6% of which were of obstetrical aetiology. Thirteen patients had small fistulae (less than 2 cm) and fifteen patients had large fistulae (greater than 2 cm), nine of which were considered to be giant fistulae (greater than 5 cm). The patients' age, parity, nationality and duration of their fistulae are presented. Our experience of repairing twenty-four fistulae showed that the cure rate was higher in small fistulae (90.9%) when compared to large fistulae (69.2%). The cure rate was also found to be higher in patients who underwent the abdomino-vaginal approach (71.4%-100%), compared to those who underwent the vaginal approach (66.7%-83.3%).

Presented at the: 6 th Saudi Urological Conference

National Guard King Khalid Hospital - Jeddah

27-28 November 1991

Uretero-vaginal fistulas 15 year experience at St. Boniface Hospital and Health Science Center Winnepeg, Manitoba, Canada

K. Al Otaibi, R. MacMahon


Department of Urology, Aramco Health Service, Dhahran, Saudi Arabia

We reviewed 17 patients with uretero-vaginal fistulas over a 15 year period. Gynecological surgery was the leading cause of the fistula. Of the 17 patients, 8 patients were managed with ureteric stent insertion as an initial therapy. 4 patients (50%) were successfully managed with ureteric stent alone. The remaining 4 patients (50%) had to have an open surgery. A total of 13 patients underwent a successful ureteric reimplantation. Routine cystoscopy revealed 2 of 17 patients (11.8%) with ureterovaginal fistula had concurrent vesico-vaginal fistula. We recommend ureteric stent insertion as primary management for uretero-vaginal fistulas and routine cystoscopy to rule out an association of vesico-vaginal fistula.

Presented at the: 10 th Saudi Urology Conference

King Fahad National Guard Hospital

26-28 November 1996

Uro-alimentary fistula:

A report on 25 cases

I. Khalaf, A. A. El Saad, H. Amr, M. El Kholy, A. Garag


Department of Urology, Faculty of Medicine, Al Azhar University, Cairo, Egypt

Herein we report on 25 patients with uro-alimentary fistulae seen over a 10 year period. These included nephro-colic (8 patients), urethro-rectal (6 patients), poucho-colic (6 patients), vesico-colic (4 patients) and vesico-rectal (1 patient). The pathological types of fistula were mainly iatrogenic in 10 patients, post inflammatory in 9 patients, congenital in 1 patient, neoplastic in 3 patients and post traumatic in 2 patients. Associated metabolic alterations in the form of hyperchloremic acidosis were noticed in cases that followed continent intestinal pouch reconstruction. Our principles of treatment included appropriate urinary and faecal diversion before repair of the fistulae. Well-vascularized healthy tissue was utilized for repair. Closure was accomplished without tension and without overlapping suture lines. When possible, well vascularized non-involved tissue should be interposed between the suture lines to provide an additional buttress. We conclude that uro-alimentary fistulae are a rare entity in urologic practice, which usually requires innovative procedures for optimal treatment. In most of the cases it reveals a serious underlying disease. Preliminary diversion of the faecal or urinary stream is usually needed before definitive repair.

Presented at the: 11 th Saudi Urological Conference

King Fahd Military Medical Complex - Dhahran

24-26 February 1998 (27-29 Shawwal 1418)

Management of female genito-urinary fistulas

A. Tayeb, A. Al Malki, J. Shareef, W. Mainah


Department of Urology, Al Hada Military Hospital, Taif, Saudi Arabia

Nine (9) cases of genito-urinary fistulas reviewed in the period from 1996 to 2000.

The source of our patient is either from our hospital or other local area hospitals.

7 cases were vesico vaginal fistulas

1 case of uretero vaginal fistulas

1 case of vagino uterine fistula.

All patients had IVP, cystogram and vaginal examination, methyline blue tests.

Results:

A. Vesico vaginal fistulas

3 cases with small fistulas (only 6F ureteric catheter can be passed), 2 of them treated successfully by fulguration of the fistulous tract and Foley catheter left for 4 weeks, 1 case have spontaneous closure after leaving the Foley catheter for 3 weeks

4 cases required open surgical procedures O'Conor technique, all cases were successful.

B. 1 case of uretero vaginal fistula treated by ureteral re-implantation and closure of the vaginal defect, successful

C. 1 case of vagino uterine fistula treated also by O'Conor technique successfully.

Conclusion: Conservative and open surgery techniques is successful in all cases that we had reviewed.

Presented at the: 14 th Saudi Urological Conference

King Fahd Military Medical Complex - Dhahran

13-15 February 2001 (19-21 Dhu Al Qa'dah 1421)

Female urogenital fistulae

Mansour Al-Towaity


Department of Urology, Al Thawra Modem General and Teaching Hospital, Sana'a, Republic of Yemen

Introduction and Objectives: Female urogenital fistulae represent a surgical and social problem for many patients in Yemen. We studied the causes of fistulae formation and the appropriate treatment in order to decrease the incidence and increase the success rate of repair.

Patients and Methods: Between June 1996 to November 2003, 66 patients with urogenital fistulae underwent reconstructive surgery in the Urology Department. The age ranged between 16 to 58 (mean 36) years. The fistulae were vesicovaginal in 38, ureterovaginal in 18, vesicoureterine in 2, urethrovaginal in 1 and complicated fistulae in 7 cases. The size of the fistulae was ranged between 7 to 60 mm.

Result: Success was achieved in 60 cases (91%), while failure in 6 cases (9%). Post-operative complication were fever, wound infection, urine incontinence, DVT and massive pulmonary embolism.

Conclusion: Gentle handling of the tissue and well dissection of the vaginal and bladder walls, interposition of a flap with well diversion of urine increase extremely the success rate of fistulae repair. On the other hand, close maternal follow up hospital delivery, and active training for doctors who are in the Gyne and Obstetric postgraduate study program in the Urology Department will decrease the chance of fistulae formation.

Presented at the: 16 th Saudi Urological Conference

King Faisal Specialist Hospital and Research Centre

2-4 March 2004 (11-13 Muharram 1425)

Genitourinary fistulae: Report of 5 cases

Ayman M. Al Bakri, Mohamed A. Gomha, Abdullah N. Al Jasser


Department of Urology, Security Forces Hospital, Riyadh, Saudi Arabia

Objective: We reviewed management and outcome of 5 female patients with genitourinary fistulas who had repair in Security Forces Hospital.

Materials and Methods: Medical records of 5 patients with genitourinary fistula were reviewed. The median age was 38 years (range 37-79). Evaluation included history, pelvic examination, ascending cystogram, intravenous urography and cystoscopy. Retrograde ureteropyelography and computerized tomography were done when clinically indicated. Fistula was vesicovaginal in 2 patients, vesicouterine in 2 and ureterovaginal in 1. All vesicovaginal and vesicouterine fistulas were supratrigonal. Patients with vesicouterine fistula presented with cyclic hematuria (menouria) while other patients presented with incontinence of urine. Cause of the fistula was cesarean section (CS) in patients with vesicouterine fistula, CS with emergency hysterectomy in patient with ureterovaginal fistula, and total abdominal hysterectomy in patients with vesicovaginal fistula. Patients with vesicouterine fistula had all their deliveries by CS (6 times in both patients) and underwent bilateral tubal ligation during last CS. Patients were treated surgically 4-40 months after fistula diagnosis except one who underwent fistula repair 20 years after diagnosis. Patients with vesicovaginal and vesicouterine fistulas were repaired by transperitoneal transvesical approach (O#8217; CONOR technique) with omentum interposition, while ureterovaginal fistula was managed by ureterovesical reimplantation.

Results: Follow up duration ranged between 1 and 23 months. Menouria ceased in patients with vesicouterine fistula and all patients were dry at last follow up. One patient was still leaking urine after the fistula repair and further evaluation showed absence of the fistula but there was stress incontinence. This lady was dry after endoscopic Teflon periurethral injection.

Conclusions: Transperitoneal transvesical (O, CONOR) technique for repair of vesicovaginal and vesicouterine fistula has high success rate. Patients who deliver by cesarean section are advised to decrease the number of pregnancies to avoid the possible occurrence of vesicouterine fistula. Thorough evaluation of patients with genitourinary fistula is recommended to detect concomitant stress incontinence.

Presented at the: 16 th Saudi Urological Conference

King Faisal Specialist Hospital and Research Centre

2-4 March 2004 (11-13 Muharram 1425)

Limited experience in the early management of genitourinary tract fistulae

Ahmed M. Shelbaia


Department of Urology, Cairo University, Cairo, Egypt

Objective: To report the results of early management of genitourinary tract fistulae using a retropubic extraperitoneal approach.

Patients and Methods: In our study, 20 women with genitourinary tract fistula, 12 with vesicovaginal, 6 with ureterovaginal and 2 with uterovesical fistulae were discovered, diagnosed and managed within 2 weeks after gynaecologic operations.

Results: All patients reported high quality of life, no urine leak, while 7 cases developed urgency, no urinary tract infections and preservations of upper urinary tract functions were reported.

Conclusion: Early repair of genitourinary tract fistulae has the advantage of high quality of life, few post operative complications and high success rate and preservation of upper urinary tract functions.

Presented at the: 19 th Saudi Urological Conference

King Khalid University Hospital - Riyadh

26 February - 01 March 2007

Colovesical fistula: Diagnosis and management

Hamid Ali, Mohamed A. Gomha, Ibrahim Al-Oraifi, Adel Al-Dayel


Department of Urology, King Fahd Specialist Hospital, Dammam, Saudi Arabia

Introduction: Colovesical fistula is not common. The most common etiology is colonic diverticulitis. We reviewed our experience with colovesical fistula over 3 years.

Methods: We identify four male patients and 1 female patient with colovesical fistula with a median age of 42 years (range: 39-66). Medical records of these patients were reviewed as regards to etiology, presentation, diagnostic procedures, treatment and outcome.

Results: The most common presenting symptoms were recurrent UTI and pneumaturia that were present in all cases. The most useful diagnostic tools were CT and cystoscopy. Cystoscopy with fistulogram was diagnostic in all 4 patients with diverticulitis and also showed the sigmoid tumor infiltrating the bladder with wide opening in the 5 th patient. The patient with sigmoid carcinoma underwent pelvic exenteration. Among the 4 patients with diverticulitis, 2 underwent open one-stage surgery with partial colon resection and bladder closure. The third patient had an abscess cavity filled with fecal matter between bladder and colon, and underwent open surgery with temporary diverting ileostomy. The 4 th patient underwent one stage laparoscopic sigmoid resection and bladder repair. At a median follow up of 9 months, all patients with diverticulitis are asymptomatic but one with mild dysuria with no recurrence of fistula and the patient who underwent pelvic exenteration had no recurrence.

Summary and Conclusion: Diverticulitis is the most common cause of colovesical fistula. The most useful tools for diagnosis are CT and cystoscopy. One stage repair is preferred in clean elective cases but 2 stage repair is appropriate in contaminated and complex situations.

Presented at the: 22 nd Saudi Urological Conference

King Faisal Specialist Hospital and Research Centre

15-18 March 2010

Vesicovaginal fistula repair using abdominal approach with flap

Emad Sabri Rajih, Waleed Al Taweel


Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

Introduction: To report the personal experience at repairing of vesicovaginal fistulae using the transabdominal approach with flap.

Methods: Between January 2004 and August 2007, we treated 22 patients with urogenital fistulae. Preoperative, intraoperative and postoperative data were recorded. The parameters evaluated were patient demographics, including age and the time of fistula repair. Fistula parameters included the number of prior repairs, site and size. Repairs were classified as primary for the first repair or secondary. Outcome measures included bladder capacity, continence, patient follow up and surgical complications.

Results: The etiologies of fistula formation were iatrogenic (7 after hysterectomy and 15 after cesarean section). Our series comprised 16 primary vesicovaginal, 6 repeat vesicovaginal. Four (4) complex with large fistula >4 cm, one with small fibrotic bladder fistula and one with two fistulas, 20 supra-trigonal and 2 inter-trigonal. We have no recurrence of fistula with 100% success, however, stress urinary incontinence in one case.

Summary and Conclusion: Genitourinary fistulae are not life-threatening but are socially debilitating. Surgical repair provides the definitive cure. The abdominal approach with flap has enjoyed reproducible and durable success.

Presented at the: 22 nd Saudi Urological Conference

King Faisal Specialist Hospital and Research Centre

15-18 March 2010




 

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