La fistule urétérovaginale après césariennes : diagnostic et traitement dans un hôpital à ressources limitées au Togo

Abstract

The purpose of this study is to describe a simple, non-expensive, accessible and effective technique of ureterovaginal fistula diagnosis, and to assess the results of surgical management in a resource-constrained hospital. During a campaign of obstetric fistulas repair, we diagnosed ureterovaginal fistulas by vaginal exam with the blue methylene test associated to abdominal ultrasonography, two simple and non-expensive explorations which permitted to identify ureterovaginal fistula and to do differential diagnosis with vesicovaginal fistula. The management was surgery, by ureterovesical reimplantation. Four ureterovaginal fistulas have been diagnosed in 32 women presented with obstetrical fistula. The mean age of those fistulas was 4.85 years; it was located on the left ureter in three cases, on the right in one case. The ureteral lesion was consecutive to a caesarean section in all patients and sited on the pelvic segment of ureter. In three patients, diagnosis was performed by the negativity of the blue test and unilateral dilation of ureter and kidney while the discovery was done during the treatment of vesicovaginal and rectovaginal fistulas associated in the last patient. After effects of surgery were simple, characterized by disappearance of urine leakage and dilation of ureter kidney. In resources-constrained context, techniques such as blue test and ultrasonography are enough to perform diagnosis of ureterovaginal fistula. Ureterovesical reimplantation is an effective therapeutic method for diagnosing ureterovaginal fistula.

Degradation behavior of polylactic‐co‐glycolic acid and polycaprolactone with nanosilver scaffolds

“…[1][2][3][4][5][6] However, the use of ureteral scaffolds is often accompanied by some complications, such as scaffold displacement, biofilm, crusting, and vesicoureteral reflux. [7][8][9] These complications greatly affect the treatment effect and postoperative quality of life of patients. 10 Biofilms and crusts can easily allow bacteria to multiply, which can result in urinary tract infections.…”

“…The implantation of ureteral scaffolds is a common clinical solution 1–6 . However, the use of ureteral scaffolds is often accompanied by some complications, such as scaffold displacement, biofilm, crusting, and vesicoureteral reflux 7–9 . These complications greatly affect the treatment effect and postoperative quality of life of patients 10 .…”