Vesicovaginal fistulas: a gynecological experience in 41 cases at a German pelvic floor center

Reisenauer, Christl

doi:10.1007/s00404-015-3760-8

Cited by 15 publications

(9 citation statements)

References 18 publications

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“…Various vaginal and abdominal surgical procedures are discussed in the literature, whereby vaginal procedures are prioritised. The vaginal interposition of a Martius flap as a defect coverage has proven itself here to be an efficient method with low morbidity 3 , 8 , 9 , 10 , 11 , 12 , 13 . In our investigation, only urethral reconstruction using a double-row, tension-free rows of simple interrupted sutures was performed in the case of smaller defects.…”

Section: Discussionmentioning

confidence: 99%

“…Verschiedene vaginale und abdominale operative Verfahren werden in der Literatur diskutiert, wobei vaginale Verfahren priorisiert werden. Die vaginale Interposition eines Martius-Flaps als Defektdeckung hat sich hier als effiziente Methode mit geringer Morbidität erwiesen 3 , 8 , 9 , 10 , 11 , 12 , 13 . In unserer Untersuchung wurde bei kleineren Defekten ausschließlich die Urethrarekonstruktion mittels zweireihiger spaannungsfreier Nahtreihen von Einzelknopfnähten durchgeführt.…”

Section: Diskussionunclassified

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Management of Urethral Lesions and Urethrovaginal Fistula Formation Following Placement of a Tension-Free Suburethral Sling: Evaluation From a University Continence and Pelvic Floor Centre

Schöller

Brucker

Reisenauer

2018

Geburtshilfe Frauenheilkd

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Introduction The complication of tape erosion in the urethra following placement of a retropubic (TVT) or transobturator (TOT) tension-free suburethral vaginal sling or an accidental iatrogenic transurethral tape position can result in the formation of a urethrovaginal or vesicovaginal fistula. The objective of the investigation is the evaluation of the management of such rare complications. Patients and Methods Retrospective analysis of 14 patients who were treated for a urethral lesion or urethrovaginal fistula formation status post TVT/TOT placement between June 2011 and February 2018 in the Tübingen University Department of Gynaecology. Results As surgical therapy, 57.1% (n = 8) cases underwent vaginal fistula closure using a Martius flap of the labium majus and in 21.4% (n = 3) using a vaginal rotation skin flap. In 21.4% (n = 3), exclusively vaginal suture reconstruction of the urethra following excision of the tape running transurethrally or tape erosion was performed. 50% (n = 7) of the patients had lasting continence postoperatively without any further need for therapy. In 28.6% (n = 4), there was ongoing stress urinary incontinence, in 21.4% (n = 3) mixed urinary incontinence. Six of the 7 patients with persistent incontinence underwent new placement of a tension-free suburethral retropubic sling (TVT) an average of 8.8 months (5 – 13 months) postoperatively which was uncomplicated in all patients and achieved satisfactory continence. The 3 patients with mixed urinary incontinence and persistent urgency components additionally received anticholinergic medication. During the time period investigated, there were no long-term complications, in particular no recurrent fistulas. Conclusion The rare but relevant complications of a urethral erosion, transurethral tape position or urethrovaginal fistula formation status post TVT/TOT placement can be successfully managed via vaginal surgery. Persistent postoperative urinary incontinence with the need for a two-phase repeat TVT placement following sufficient wound healing must be preoperatively clarified.

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Section: Discussionmentioning

confidence: 99%

Section: Diskussionunclassified

Management of Urethral Lesions and Urethrovaginal Fistula Formation Following Placement of a Tension-Free Suburethral Sling: Evaluation From a University Continence and Pelvic Floor Centre

Schöller

Brucker

Reisenauer

2018

Geburtshilfe Frauenheilkd

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“…Como parte de las complicaciones asociadas al tratamiento radioterápico de esta patología encontramos principalmente alteraciones urológicas y gastroenterológicas [3]. De estas complicaciones se ha descrito como graves la aparición de fístulas tanto vesicovaginales como rectovaginales [4], cuya incidencia se ha determinado del 1 al 5 % [5][6], ocupando la mayor cantidad de causas las obstétricas y posquirúrgicas [7][8][9][10].…”

Section: Doi: 1033821/225unclassified

¿Dosis menores de Radioterapia generan mayor riesgo de Fístulas Vaginales en pacientes con Cáncer de Cuello Uterino?

Puente-Vallejo

Silva²,

Gómez³

et al. 2017

Rev. Oncol. Ecu

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ResumenIntroducción: El tratamiento del cáncer de cuello uterino con radiaciones ionizantes y quimioterapia radiosensibilizadora puede tener como complicación la generación de fístulas vaginales. El objetivo del presente estudio fue establecer la prevalencia de fístulas vaginales en un grupo de pacientes que recibieron radioterapia convencional versus radioterapia 3D.Métodos: El presente estudio retrospectivo fue realizado en el Hospital de Solón Espinosa Ayala, SOLCA-Quito. Se registraron las pacientes que recibieron radioterapia externa ya sea en modalidad 2D o 3D más braquiterapia o refuerzo externo de dosis, con quimioterapia concurrente o sin esta última en el período de estudio Enero 2008 a Diciembre 2012. Para el análisis se compararon los tipos de radioterapia y se reporta Odds Ratio.Resultados: Se registraron 315 casos en el grupo de Radioterapia Convencional 2D (R2D) y 299 casos en el grupo de radioterapia Conformacional 3D (R3D). La prevalencia de fístulas en el grupo R2D fue de 10 casos (1.62 %) y en el grupo R3D fue de 8 casos (1.31 %), Odds ratio de 1.19 (IC95 % 0.46 a 3.06) P=0.71. De los 18 casos de fístulas, 9 casos (50 %) fueron con refuerzo externo, 6 casos (33 %) por braquiterapia y 3 casos (17 %) sin refuerzo. El refuerzo externo vs braquiterapia mostro un OR=4.77 IC 95 % (1.66 -13.65) P=0.04. La dosis de radioterapia usada en el tratamiento de Braquiterapia fue de 87.5 ±2.5 Gy vs Refuerzo 68 ±2.5 Gy P<0.001.Conclusión: No existe diferencia entre la prevalencia en los grupos de Radioterapia convencional versus Radioterapia 3D. La radioterapia de refuerzo es un factor de riesgo para fístulas vaginales comparado con la braquiterapia, aun cuando la dosis de radioterapia fue menor en este grupo.

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“…Although rare, VVF in the developed countries is reported as a complication to surgery of benign indication and as part of pelvic malignancy. 3 – 7 It is seen as a complication to hysterectomy of malign indication, the risk being the highest in the treatment of cervical cancer. 3 The VVFs are also seen as a consequence of radiotherapy for pelvic tumors.…”

Section: Introductionmentioning

confidence: 99%

“… 4 , 5 , 8 It is indicated that the success rate might be lower, when looking only at VVF in relation to malignancy. 4 , 6 Complications associated with surgical repair are bleeding, infection, and damage to other structures. 4 Recurrence is seen in 6.4%.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Vesicovaginal Fistulas With Autologous Cell Injections—A Randomized Study in an Animal Model

Jepsen

Sellathurai

Conti

et al. 2017

Technol Cancer Res Treat

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Purpose:To evaluate the effect of autologous satellite cell and smooth muscle cell transplantation on vesicovaginal fistulas in a randomized controlled study by comparing the proportion of fistula closure and tissue composition between the 2 groups.Materials and Methods:Eight pigs underwent surgery to establish an experimental induced fistula. One pig was excluded due to insufficient weight gain. Seven pigs were randomized to receive either an injection of satellite cells and smooth muscle cells or no treatment. Cells were isolated from abdominal skeletal muscle and bladder smooth muscle, cultured in vitro, and marked with bromodeoxyuridine. Cell purity, growth kinetics, and differentiation potential were determined. Cells were injected around the fistula using a cystoscope. Five weeks after the injection of cells, the fistula area was examined macroscopically and histologically.Results:The isolated satellite cell population consisted of 76.6% neural cell adhesion molecule positive cell and the smooth muscle cell population of 88.6% α-smooth muscle actin positive cells. All pigs had a persisting fistula before treatment. One of the 4 vesicovaginal fistulas was closed 5 weeks after injection of satellite cells and smooth muscle cells compared to none in the control group. No histological differences in the tissue composition between the 2 groups were observed and no bromodeoxyuridine-labeled cells were detected around the fistula tissue in the histological examination.Conclusion:We established an animal model with a persisting clinical and histological confirmed vesicovaginal fistula. The study indicated that there might be an effect on vesicovaginal fistula closure using an injection of satellite cells/smooth muscle cells and alginate gel.

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Vesicovaginal fistulas: a gynecological experience in 41 cases at a German pelvic floor center

Abstract: To avoid repeated surgeries, fistula management in specialized centers is advantageous.

Cited by 15 publications

References 18 publications

Management of Urethral Lesions and Urethrovaginal Fistula Formation Following Placement of a Tension-Free Suburethral Sling: Evaluation From a University Continence and Pelvic Floor Centre

Management of Urethral Lesions and Urethrovaginal Fistula Formation Following Placement of a Tension-Free Suburethral Sling: Evaluation From a University Continence and Pelvic Floor Centre

¿Dosis menores de Radioterapia generan mayor riesgo de Fístulas Vaginales en pacientes con Cáncer de Cuello Uterino?

Treatment of Vesicovaginal Fistulas With Autologous Cell Injections—A Randomized Study in an Animal Model

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