Vesicovaginal Fistula Repair Using a Transurethral Pointed Electrode

Abstract

The most common cause of vesicovaginal fistulasis injury to the bladder at the time of surgery. The operation most frequently responsible for vesicovaginal fistula formation is hysterectomy. The first successful transvaginal approach to vesicovaginal fistula repair was reported by Sims in 1838. Although many surgical procedures exist, there is no best approach for all patients with vesicovaginal fistula. However, it is an essential surgical principle that the fistulous tract and scar should be excised completely. Here we report our technique using a transurethral pointed electrode for the treatment of multiple, small vesicovaginal fistulas and its outcome. The most common cause of vesicovaginal fistulas is surgery, and complications by obstetric operations including hysterectomy constitute around 90%. Vesicovaginal fistulas are observed in 0.5% of hysterectomy cases [1].Since Sims [2] in the United States succeeded in operating through the vagina in 1852, discussion on surgical techniques and the operative period for the treatment of vesicovaginal fistulas has continued. However, all fistula surgeries should be conducted under the basic principle that the fistula and scar will be completely excised. The success rate of treatment of a simple vesicovaginal fistula is reported to be 75% to 97%, but that of combined vesicovaginal fistulas is reported to be lower in cases of recurrence, with the existence of tumor, or with a history of radiation treatment.The purpose of this case study was to report a case in which a vesicovaginal fistula after hysterectomy was treated by using a transurethral pointed electrode. CaseThe patient, a 46-year-old female, visited our hospital with postoperative, consistent urinary incontinence. Her medical history included a laparoscopic hysterectomy due to uterine myoma three months before her current visit. Because injury to the urinary bladder was found immediately postoperatively, she had twice undergone restoration of the bladder through the vagina and the abdomen and had an artificial ureter in place for three months as the result of partial injury in the right ureter. The results of blood tests at the time of her current visit showed that her vital signs were within the normal range, her hemoglobin was 13.0 g/dL, and her serum creatinine was 0.80 mg/dL. High magnification of urinalysis exhibited a number of both erythrocytes and leukocytes, and Escherichia coli was cultured in the urine culture test. No abnormal findings were observed in the right ureter in urography after re-