2011, Number 4
Diagnosis and management of vesicovaginal fistulas: twenty years of experience
Martínez JÁ, Hernández-Castellanos V, Fernández-Noyola G, Ahumada-Tamayo S, Fulda-Graue S, Pérez-Becerra R, Urdiales-Ortiz A, Santana-Rios Z, Cantellano-Orozco M, Morales-Monto G, Pacheco-Gahbler C
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Language: Spanish
References: 9
Page: 200-206
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ABSTRACT
A vesicovaginal fistula is the abnormal communication between the vaginal epithelium and the bladder epithelium, resulting in continuous urine leakage through the vagina. Its repair can be carried out with vaginal, abdominal, or laparoscopic approach.Methods: A retrospective cross-sectional study was carried out that included case records of patients diagnosed with vesicovaginal fistula that were treated in the urology department of the Hospital General “Dr. Manuel Gea González”, SSA within the time frame of January 1, 1990 to July 31, 2010.
Results: Fifty-four case records of patients diagnosed with vesicovaginal fistula with mean age of 48 years were reviewed. A total of 77.5% of these patients belonged to low socioeconomic class. The number of children varied from one to ten with a mean of four. Active sexual life began at mean 18.8 years of age. All patients had undergone some type of gynecologic and obstetric surgery: five patients underwent cesarean section, twenty-seven underwent total abdominal hysterectomy, two had transobturator suburethral sling placement, four underwent colpoperineoplasty, five had vaginal tear repair, one underwent surgery with Burch technique plus transobturator suburethral sling, seven underwent cesarean section plus hysterectomy, and three underwent hysterectomy plus Burch technique. All patients sought medical attention for total urinary incontinence with transvaginal urine leakage. Localizations were retrotrigonal in thirty patients, intertrigonal in nine patients, bladder floor in three patients, bladder neck in one patient, right parameatal in two patients, left parameatal in one patient, paracervical in one patient, and bladder fundus in seven patients. Fistula diameter varied from 2-35 mm with a mean 7.5 mm and four patients presented with two fistulous orifices in the bladder. The length of time for fistula presentation was from one to sixty days. Transvaginal approach was carried out in sixteen patients, transvesical approach in thirty-four patients, and laparoscopic approach in four patients. Hospital stay for patients with transvaginal approach was eleven days, with transvesical approach nine days, and with laparoscopic approach four days. Only one patient presented with recurrence and was reoperated on at three months. Surgical wound infection presented in three patients.
Conclusions: Vesicovaginal fistula is a pathology that presents in patients with a history of gynecologic and obstetric surgery. In all of the cases reviewed, patients presented with total urinary incontinence with transvaginal urine leakage as primary symptom and clinical diagnosis was supported with imaging studies (excretory urography and cystography) and cystoscopy. The three approaches employed provided good results and the majority of cases were resolved with transvesical approach.
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