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Organo Oficial de la Sociedad Mexicana de Urología

2008, Number 1

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Rev Mex Urol 2008; 68 (1)

Bladder fistulas; diagnosis and management. Ten years experience at Centro Medico Nacional '20 de Noviembre'

Priego NA, Cortez BR, Velarde CA, Guzmán HF, Díaz GC, Esqueda MA, Yaber GE, López VCJ, Téllez SM

Language: Spanish
References: 26
Page: 3-13
PDF size: 372.24 Kb.


ABSTRACT

Bladder fistulas (BF) constitute an emotional and social problem, it has been observed through out history BF formation and management since the Egyptians, describing their intimate association with the mechanism of work of childbirth. The etiology is variable (surgery of pelvis, X-ray and tumors). The basic physiopathology process involves the necrosis of bladder tissue, secondarily associated pathologic states are, DM 2, atherosclerosis, tumors, fractures of hip, calculi and endometriosis. The main cause (84%) is necrosis in the childbirth channel, with important injury in the pelvic floor, causing ischemia to the tissue. Up to 10% of the BF is originated by X-ray used in the treatment of carcinoma of the uterine neck. The clinical picture is that of continuous dripping of tinkles through the vagina being associated with UTI, with concomitant irritation of the vulva, vagina and perine, abdominal pain in the flank of the affected side. The fenazopiridine test is patognomonic for BF, the Excretory Urography is a study of important aid to arrive at the diagnosis, revealing the ureteral injury, as well as TAC, ascending pyelography. Its treatment usually is either preservative or surgical, preservative options include a transurethral drilling, the use of cauterization in the site of the fistula, the use of collagen, surgical treatment include the direct closing of the injury before the 3 to 6 months.
Material and method: We made an observational, descriptive and retrospective study, reviewed 54 files from January 1995 to August of 2006, with bladder traumatic injuries, its surgical handling as well as the data were registered in a certificate of data collection.
Results: We reviewed 54 cases in our CMN, with an age average of 50.5 years with an interval more common between 45 and 60 years; we found 7 patients with bladder fistula, with DII 2 6 patients (11.3%), systemic hypertension (8 patients 15%), cervical cancer antecedent (26 women 56%), 26 patients with X-ray antecedent, other 23%.
Conclusions: 70% of the BF, are of gynecological etiology, being the bladder floor injury the most frequent, we found a good results with the SIMS technique for fistula repair.


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