Rodríguez-Colorado S, Santos-López A, Gorbea-Chávez V, Ramírez-Isarraraz C, Torres-Valdez E, García-Reyes G

Language: Spanish
References: 23
Page: 442-448
PDF size: 241.02 Kb.

ABSTRACT

Background: treatment of a complex genitourinary fistula is a challenge given the multiple difficulties to achieve a successful result, the biological grafting of porcine intestine can be an option in these cases.
Objetive: to describe the diagnosis of genitourinary fistulas and their repair with an innovative interposition of small intestine porcine biological graft.
Materials and Methods: a prospective trial of a series of cases with a diagnosis of vesicovaginal and urethrovaginal fistula in patients of the Instituto Nacional de Perinatología between 2012 to 2014. Description of patient demographics, diagnostic and clinical process, imaging and lab tests; characteristics of the fistula, surgical technique and follow up.
Results: 5 patients with type III or vesicovaginal fistulas located in the trigone were studied, 3 of the fistulas are related to gynecological surgery and 2 with an obstetric event and one type 1 or urethrovaginal in the proximal urethra caused by an instrumented delivery. In the closure of the second layer for placement of the biological graft, we applied the modified Latzko repair technique. One patient had 4 previous repairs, another one had one previous repair and the rest had none. The size varied from 0.5 cm to 3 cm. The postoperative follow-up period did not show recurrence; one patient had stress urinary incontinence one year later. The minimum follow-up was 1 year and the maximum 2 years. No postoperative complications were reported.
Conclusion:: the porcine small intestinal submucosa graft for the repair of complex and recurrent urogenital fistulas was effective in all patients.

REFERENCES

1. Mellano EM, Tarnay CM. Management of genitourinary fistula: Curr Opin Obstet Gynecol. 2014 Oct;26(5):415-23.

2. Angioli R, Penalver M, Muzii L, Mendez L, Mirhashemi R, Bellati F, et al. Guidelines of how to manage vesicovaginal fistula. Crit Rev Oncol Hematol. 2003 Dec;48(3):295-304.

3. Oakley SH, Brown HW, Greer JA, Richardson ML, Adelowo A, Yurteri-Kaplan L, et al. Management of Vesicovaginal Fistulae: A Multicenter Analysis From the Fellows’ Pelvic Research Network. Female Pelvic Med Reconstr Surg. 2014;20(1):7-13.

4. Kim J-H, Smith AL, Raz S. Urinary fistulas: What does the evidence say? Curr Bladder Dysfunct Rep. 2008 Dec;3(4):208-13.

5. Zambon JP, Batezini NSS, Pinto ERS, Skaff M, Girotti ME, Almeida FG. Do we need new surgical techniques to repair vesico-vaginal fistulas? Int Urogynecology J. 2010 Mar;21(3):337-42.

6. Eilber KS, Kavaler E, RodríGuez LV, Rosenblum N, Raz S. Ten-Year Experience With Transvaginal Vesicovaginal Fistula Repair Using Tissue Interposition. J Urol. 2003 Mar;169(3):1033-6.

7. Alagöl B, Gözen AS, Kaya E, Inci O. The use of human dura mater as an interposition graft in the treatment of vesicovaginal fistula. Int Urol Nephrol. 2004;36(1):35-40.

8. Grange P, Giarenis I, Rouse P, Kouriefs C, Robinson D, Cardozo L. Combined Vaginal and Vesicoscopic Collaborative Repair of Complex Vesicovaginal Fistulae. Urology. 2014 Oct;84(4):950-4.

9. Razi A, Mazloomfard MM, Ajami H, Moeini A. Combined vagino-abdominal approach for management of vesicovaginal fistulas: a 10 years’ experience. Arch Gynecol Obstet [Internet]. 2014 Dec 23 [cited 2015 Feb 20]; Available from: http://link.springer.com/10.1007/s00404-014-3589-6

10. Morey AF, Brandes S, Dugi DD, Armstrong JH, Breyer BN, Broghammer JA, et al. Urotrauma: AUA Guideline. J Urol. 2014 Aug;192(2):327-35.

11. Kasyan G, Tupikina N, Pushkar D. Use of Martius flap in the complex female urethral surgery. Cent Eur J Urol. 2014;67(2):202-207.

12. Ecke TH, Hallmann S, Gerullis H, Ruttloff J. Reconstruction of the urethra with a Surgisis onlay patch in urethral reconstructive surgery: two case reports. J Med Case Reports. 2009;3:7232.

13. Rajaian S, Rajadoss MP, Nayak S, Kekre NS. Traumatic rectourethral fistula repair: A potential application of porcine small intestinal submucosa. Indian J Urol IJU J Urol Soc India. 2013 Apr;29(2):148-50.

14. Pye PK, Dada T, Duthie G, Phillips K. Surgisistrade mark mesh: a novel approach to repair of a recurrent rectovaginal fistula. Dis Colon Rectum. 2004 Sep;47(9):1554-6.

15. Schwandner O, Fuerst A, Kunstreich K, Scherer R. Innovative technique for the closure of rectovaginal fistula using Surgisis mesh. Tech Coloproctology. 2009 Jun;13(2):135-40.

16. Moir JC. Personal experiences in the treatment of vesicovaginal fistulas. Am J Obstet Gynecol. 1956 Mar;71(3):476-91.

17. Allona Almagro A, Sanz Migueláñez JL, Pérez Sanz P, Pozo Mengual B, Navío Niño S. [Urinary fistula: update]. Actas Urol Esp. 2002 Dec;26(10):776-95.

18. Meraz Avila D, Vilchis Nava P, Nevarez Bernal RA. [Latzko surgery in recidivant vesicovaginal fistulae. Two case reports and literature review]. Ginecol Obstet México. 2012 Dec;80(12):788-94.

19. Rajamaheswari N, Chhikara AB, Seethalakshmi K, Bail A, Agarwal S. Trans-vaginal repair of gynecological supratri- gonal vesicovaginal fistulae: A worthy option! Urol Ann. 2012 Sep;4(3):154–7.

20. Evans DH, Madjar S, Politano VA, Bejany DE, Lynne CM, Gousse AE. Interposition flaps in transabdominal vesicovaginal fistula repairs: are they really necessary? Urology. 2001 Apr;57(4):670-4.

21. Pshak T, Nikolavsky D, Terlecki R, Flynn BJ. Is tissue interposition always necessary in transvaginal repair of benign, recurrent vesicovaginal fistulae? Urology. 2013 Sep;82(3):707-12.

22. Cook Biotech Incorporated. Biodesing® Tissue Graft -Instructions for Use- [Internet]. ©COOK BIOTECH 2013. USA; 2013. Available from: www.cookmedical.com

23. Goh J, Stanford EJ, Genadry R. Classification of female genito-urinary tract fistula: a comprehensive review. Int Urogynecol J Pelvic Floor Dysfunct. 2009 May;20(5):605-10.