Transvaginal neobladder vaginal fistula repair after radical cystectomy with orthotopic urinary diversion in women

Carmel, Maude; Goldman, Howard B.; Moore, Courtenay; Rackley, Raymond R.; Vasavada, Sandip P.

doi:10.1002/nau.22687

Cited by 19 publications

(19 citation statements)

References 24 publications

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“…Others benefits of POPRC have also been described, such as decreased fistula rate and improved continence ( 11 ). NVF is an uncommon but devastating complication that occurs in 3.6% – 10% of women who have undergone RC ( 4 , 12 , 13 ). Its predisposing factors are poor tissue vascularity and damage in the AVW, proximity of suture lines, pelvic radiation, local recurrence, bulking agents used in incontinent patients ( 4 , 5 , 14 ), and local cancer recurrence ( 13 , 14 ).…”

Section: Discussion and Future Perspectivesmentioning

confidence: 99%

“…NVF is an uncommon but devastating complication that occurs in 3.6% – 10% of women who have undergone RC ( 4 , 12 , 13 ). Its predisposing factors are poor tissue vascularity and damage in the AVW, proximity of suture lines, pelvic radiation, local recurrence, bulking agents used in incontinent patients ( 4 , 5 , 14 ), and local cancer recurrence ( 13 , 14 ). Several technical modifications have been described that can be used to treat NVF: preservation of the AVW, double vaginal cuff closure, interposition of a well-vascularized omentum flap between the neobladder and vagina, avoidance of overlapping suture lines, and preservation of the clitoral vasculature ( 2 , 11 ).…”

Section: Discussion and Future Perspectivesmentioning

confidence: 99%

“…No consensus exists regarding the optimal approach or technique to repair naive or recurrent NVF ( 5 , 13 ). In the present case, we innovated an ileal-based reservoir technique that used part of a previous neobladder with a continent, catheterizable stoma ( 10 ).…”

Section: Discussion and Future Perspectivesmentioning

confidence: 99%

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Neovagina construction and continent cutaneous urinary reservoir using a previous orthotopic ileal neobladder

et al. 2018

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Standard radical cystectomy (RC) in women involves removal of the distal ureters, bladder, proximal urethra, uterus, ovaries, and adjacent vagina. Furthermore, pelvic organ-preserving RC to treat selected women has become an accepted technique and may confer better postoperative sexual and urinary functions than standard RC, avoiding complications such as incontinence, prolapse, neobladder-vaginal fistula (NVF), and sexual dysfunction, without compromising oncological outcome.This article reports a different surgical approach: a patient who underwent a cutaneous continent reservoir and neovagina construction using a previous ileal orthotopic neobladder after RC. Patient presented no complications and she has no evidence of recurrent disease and is sexually active, with a satisfactory continent reservoir. This case is the first report of this procedure that was able to treat concomitant dyspareunia caused by short vagina and neobladder-vaginal fistula.In conclusion, standard radical cystectomy with no vaginal preservation can have a negative impact on quality of life. In the present case, we successfully treated neobladder fistula and short vagina by transforming a previous ileal orthotopic neobladder into two parts: a continent reservoir and a neovagina. However, to establish the best approach in such patients, more cases with long-term follow-up are needed.

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Section: Discussion and Future Perspectivesmentioning

confidence: 99%

Section: Discussion and Future Perspectivesmentioning

confidence: 99%

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Neovagina construction and continent cutaneous urinary reservoir using a previous orthotopic ileal neobladder

et al. 2018

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“…Transvaginal repair of the particularly challenging neobladder-vaginal fistula after radical cystectomy and orthotopic diversion (18,19);…”

Section: Usesmentioning

confidence: 99%

How and why to take a Martius labial interposition flap in female urology

Wilson¹,

Pillay²,

Greenwell³

2017

Transl. Androl. Urol.

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The Martius modified labial fat pad flap at nearly 90 years old is still very much part of the modern vaginal surgeon’s armamentarium. Here we describe this straightforward and adaptable technique, the avoidance of pitfalls, its advantages and uses in vaginal surgery, and outcomes both short and long term. Specifically patient reported outcomes related to scar perception and sexual function are explored.

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“…Distinct complications associated with this diversion have been described including hypercontinence/urinary retention requiring clean intermittent catheterization, pouch calculus formation, prolapse, persistent urinary incontinence and neobladder—vaginal fistula (NVF) formation . NVF is an uncommon complication that occurs in 3.6‐10% of women following ONB reconstruction . Predisposing factors for NVF are poor tissue vascularity of the anterior vaginal wall (AVW), damage to the AVW during surgery, suture line proximity, pelvic radiation, local recurrence, and bulking agent use in incontinent patients .…”

Section: Introductionmentioning

confidence: 99%