Use of endoscopy in the management of postoperative ureterovaginal fistula

Abstract

The aim of the study was to evaluate endourological techniques in the management of iatrogenic ureterovaginal fistula. Seventeen patients referred to us after gynecologic surgery were diagnosed as having iatrogenic ureterovaginal fistula. First, retrograde double-J stenting was tried. If this failed, percutaneous nephrostomy using an antegrade double-J stent was performed. If this also failed, open surgical repair was performed. The retrograde double-J stent bypassed the fistula in 2 patients (11.8%). Percutaneous nephrostomy was performed in the remaining 15. The antegrade double-J stent bypassed the fistula in another 2 of these patients (11.8%). Open surgical repair was performed in the remaining 13 patients (67.5%) (direct ureteroneocystostomy) with nipple valve in 11 patients and Boari flap with psoas hitch in 2 patients). Of all patients, 2 had ureteral stricture, one after antegrade double-J stenting and the other after open repair. It was concluded that early intervention is recommended in the treatment of iatrogenic uretrovaginal fistula, causing minimal morbidity and discomfort, and being less expensive.

Immediate and late management of iatrogenic ureteric injuries: 28 years of experience

“…In the last decade, the successful endoscopic placement of a JJ stent via a retrograde or antegrade route allows the ureteric fistula to heal, preserves renal function, and is a reasonable recommendation to avoid major complex open reconstructive surgery in 23.5% of patients [4] .…”

Diagnostik und Therapie vesikovaginaler und ureterovaginaler Fisteln

“…Jedoch erschwert die Stenose möglicherweise die retrograde Anlage eines solchen Stents. Alternativ lässt sich der Harnleiter über einen perkutanen Zugang antegrad schienen [19]. Unabhängig von der gewählten Harnableitung sollte die Drainagemethode nicht länger als 3 Monate in situ verbleiben, um das Risiko für sowohl Infektionen als auch Stent-Inkrustationen und sekundäre Steinbildung zu minimieren [20].…”

Early urinary diversion facilitates stent placement and conservative management of surgical ureteric injuries

“…In such cases, a trial of double J stenting is recommended. [1][2][3] However, in the reported case, the CT scan did not show any communication with the bladder, perhaps because all the urine was draining into the vagina. Therefore we performed a urinary diversion by inserting a per cutaneous nephrostomy tube of 8 Fr under ultrasonography guidance.…”