BackgroundA vesicovaginal fistula (VVF) is an abnormal fistulous tract between the bladder and vagina, causing continuous loss of urine via the vagina. VVF is a relatively uncommon condition, but there is a drastically higher prevalence in the developing world. Furthermore, iatrogenic postoperative VVF is most common in developed countries, compared to mainly obstetric trauma in developing countries. In this review we focus on the development of current management techniques for VVF.MethodsMedline was searched to identify articles related to urogenital fistulae, including VVF. Based on these reports we focus on the aetiology, clinical presentation, diagnosis and management of VVF. This in-depth review includes the optimal surgical timing, different surgical approaches (including minimally invasive techniques such as laparoscopic and robotic surgery), recommendations for postoperative care, surgical complications, and the need for further research in the use of robotic surgery to treat this condition.ResultsIn all, 60 articles were identified and included in this review; eight were related to the aetiology, 12 to diagnosis, and 40 to the management of VVF. A thorough evaluation of VVF is imperative for planning the repair. Although the surgeonís experience typically influences the surgical approach, special situations will dictate the best approach.ConclusionThe treatment of genitourinary fistulae with robotic assistance continues to develop, but further research is necessary to fully understand the use of this technology.

Surgical site infection is a significant risk of SNM surgery, although our infection rate is lower than previously reported. Chlorhexidine washing appears to reduce the risk of infection in this population. Because the majority of infections requiring explantation were methicillin-resistant S. aureus positive, prophylactic treatment for this organism should be considered as an additional strategy to reduce infection. Body mass index and immunosuppression appear to be independent risk factors for infection.

Introduction:Interstitial pregnancy is a rare and life-threatening condition. Diagnosis and appropriate management are critical in preventing morbidity and death.Case Description:Four cases of interstitial pregnancy are presented. Diagnostic laparoscopy followed by laparotomy and cornuostomy with removal of products of conception was performed in 1 case. Laparoscopic cornuostomy and removal of products of conception were performed in the subsequent 3 cases with some modifications of the technique. Subsequent successful reproductive outcomes are also presented.Discussion:Progressively conservative surgical measures are being used to treat interstitial pregnancy successfully, with no negative impact on subsequent pregnancies.

Introduction/Hypothesis Opioid use, addiction, and overdose are a growing epidemic in the United States. Our objective was to determine if the amount of opioids prescribed following gynecologic and pelvic reconstructive surgery was insufficient, adequate, or in excess. We hypothesized that we were overprescribing postoperative opioids. Methods Participants who were at least 18 years old and underwent gynecologic and/or pelvic reconstructive surgery from April through August 2016 were eligible to participate. Routine practice for pain management is to prescribe 30 tablets of opioids for major procedures and 10-15 tablets for minor procedures. At the two-week postoperative visit, participants completed a questionnaire that asked about the number of tablets prescribed and used, postoperative pain control experience, and relevant medical history. Fisher’s exact test was used to compare data. Results Sixty-five participants completed questionnaires. Half (49.1%) reported being prescribed more opioids than needed, while 2 (3.5%) felt the amount was less than needed. Though not significant, participants who underwent major surgeries were more likely to report being prescribed more than needed (53.5%) compared with participants who underwent minor surgeries (35.7%; p=0.47). Though not significant, participants with anxiety were less likely to report being prescribed more tablets than needed compared to participants without anxiety (44.4% vs. 57.1%; p=0.38). This was also true of participants with depression compared to those without depression (37.5% vs. 58.3%); p=0.17), and those with chronic pain compared to those without chronic pain (33.3% vs. 60.0%; p=0.10). Conclusions Our current opioid prescription practice for postoperative pain management may exceed what patients need.