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At least 19 recordsLinked to original sources
PubMed1977

The closure of urinary-vaginal fistulas.

Reported series of urinary-vaginal fistulas repaired by a vaginal approach show at least 85% primary closure. However, many patients have had several unsuccessful operations elsewhere prior to the final repair. This means that regularly successful closure is possible, but it demands a certain "know-how" and engagement. In search for the general principles leading to such successful primary closure, different published techniques have been studied. It appears that the essential features are the establishment of a proper distance between the inner vesical and the outer vaginal epithelium and the creation of broad raw surfaces to be ajoined. The operation should not involve any risk of enlarging the existing fistula, and the transfer of normal tissue to the site of the repair and the interposition of tissue between the cavities to be separated are sound reconstructive procedures. A personal technique based on these principles is presented. The gynecologists of to-day most often refer urinary-vaginal fistulas to the urologists, who almost without exception prefer a suprapubic transvesical approach. It is strongly recommended that the large majority of urinary-vaginal fistulas should be repaired by the vaginal approach which is a minor intervention. The plastic surgeon should be engaged in the management of urinary-vaginal fistulas.

Female↗
PubMed1976

Uretero-vaginal fistula.

Six cases of uretero-vaginal fistula are presented. Five patients developed this complication after gynaecological surgery and one after Caesarian section. Constant urinary incontinence combined with normal voiding is typical of this lesion. Excretory urography revealed a stricture in the distal part of the ureter in 5 cases, while in one patient the urographic findings were normal. Accumulation of contrast medium in the vagina was seen on urography in 2 patients. Surgical correction is the treatment of choice, and all patients were successfully treated by resection of the distal part of the ureter with reimplantation of the ureter into the bladder.

Adult↗
PubMed1979

[Operative treatment of vesico-vaginal fistulae in the University Hospital, Lomé (Togo, West Africa) (author's transl)].

This publication draws attention to the importance of knowing about the existence of vesico-vaginal fistulae with or without disturbance of normal sphincteric control of the bladder. The repair procedure and avoidance of urinary incontinence after successful anatomical closure of the fistulae depends on the preoperative assessment of sphincteric function. A classification is presented in schematic form of the various types of vesico-vaginal fistulae with the appropriate surgical method of choice, according to our experience in this field, to obtain optimum functional results. In particular, our own operative procedure for substitution of absent sphincteric bladder control is detailed and discussed. Finally, attention is drawn to the balloon catheter test and the possibility of obtaining improvement in the surgical management of vesico-vaginal fistulae by a combination and modification of established operative procedures.

Female↗
PubMed1976

Urinary tract changes in obstetric vesico-vaginal fistulae: a report of 216 cases studied by intravenous urography.

Intravenous urographies carried out routinely on 216 cases of vesico-vaginal fistulae were reviewed. All the patients had suffered from urinary incontinence following obstructed labour for periods varying from immediate post-partum period to as long as 35 years with the majority (48%) presenting in the first year of the disease. One hundred and eleven patients (51-4%) showed no urinary tract abnormality. Calyceal abnormality was graded from 1-5 in ascending order of severity. The most frequent abnormality was Grade 1 (or minimal calyceal blunting) found in 75 (71%) of 105 cases showing lesions. Ten patients had non-functioning kidneys. There was no correlation of severity of calyceal grading with duration of the disease. Other notable changes were hydroureter in 75 (34%), medial deviation of the terminal ureters in 21 (9-7%) and bladder calculi in four. The study reveals a high risk of morbidity to the kidneys in patients with vesico-vaginal fistulae and the predominant role of fibrous itssue in tis genesis is postulated.

Adolescent↗
PubMed1977

Urinary fistulas: vaginal repair using a labial fat pad.

A technique is recommended to repair urinary fistulas vaginally using a pedicle of labial fat to separate the urothelial and vaginal layers. The technique was used in 6 patients with vesicovaginal and 4 patients with urethrovaginal fistulas. Anatomic results were successful in all cases and stress incontinence was cured in all patients who had this coexistent condition.

Adipose Tissue↗
PubMed1978

Reproductive performance after the repair of obstetric vesico-vaginal fistulae.

Between 1966 and 1976, 148 out of 162 patients with obstetrically acquired vesico-vaginal fistulae were successfully repaired in Lagos University Teaching Hospital. The reproductive performance of these patients after repair has been reviewed with special regard to menstruation, satisfactory coitus and childbearing. Before the repair of the fistulae 66 patients (40.6%) had secondary amenorrhoea ranging from 4 months to 15 years. There were 3 cases each of oligomenorrhoea and cryptomenorrhoea. After repair menstruation returned within 6 months in 58 patients. Secondary amenorrhoea is thought to be due to a combination of severe malnutrition, anaemia, endometritis, psychological upsets and occasionally endocrine malfunction due to focal anterior pituitary necrosis. Repair of the fistulae worsened gynatresia in 17 cases. Twelve patients had dyspareunia and 3 others had apareunia. Thirty-one patients achieved 38 pregnancies after repair. Thirty-two infants were delivered by lower segment Caesarean section. There were 5 vaginal deliveries and one abortion. The average birth weight was 2.96 kg. The corrected perinatal mortality was nil. Five cases had a recurrence of the fistulae after delivery and 2 others had stress incontinence. Electric lower segment Caesarean section is the ideal method of delivery.

Cesarean Section↗