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Review
. 2014 Jun;12(2):97-105.
doi: 10.1016/j.aju.2013.11.006. Epub 2014 Mar 15.

The management of genitourinary fistula in the third millennium

Gamal M Ghoniem  1 , Hussein A Warda  2
Affiliations
Review

The management of genitourinary fistula in the third millennium

Gamal M Ghoniem et al. Arab J Urol. 2014 Jun.

Abstract

Background: A vesicovaginal fistula (VVF) is an abnormal fistulous tract between the bladder and vagina, causing continuous loss of urine via the vagina. VVF is a relatively uncommon condition, but there is a drastically higher prevalence in the developing world. Furthermore, iatrogenic postoperative VVF is most common in developed countries, compared to mainly obstetric trauma in developing countries. In this review we focus on the development of current management techniques for VVF.

Methods: Medline was searched to identify articles related to urogenital fistulae, including VVF. Based on these reports we focus on the aetiology, clinical presentation, diagnosis and management of VVF. This in-depth review includes the optimal surgical timing, different surgical approaches (including minimally invasive techniques such as laparoscopic and robotic surgery), recommendations for postoperative care, surgical complications, and the need for further research in the use of robotic surgery to treat this condition.

Results: In all, 60 articles were identified and included in this review; eight were related to the aetiology, 12 to diagnosis, and 40 to the management of VVF. A thorough evaluation of VVF is imperative for planning the repair. Although the surgeonís experience typically influences the surgical approach, special situations will dictate the best approach.

Conclusion: The treatment of genitourinary fistulae with robotic assistance continues to develop, but further research is necessary to fully understand the use of this technology.

Keywords: Diagnosis; Evaluation; LESS, laparo-endoscopic single-site surgery; Management; Presentation; UVF, ureterovaginal fistula; VVF, vesicovaginal fistula; Vesicovaginal fistula.

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Figures

Figure 1
Figure 1
A high fistula at the vaginal cuff after laparoscopic hysterectomy. Note that the Foley catheter balloon is inflated at the vagina.
Figure 2
Figure 2
Three-dimensional CT urogram showing the fistula in mid-vagina.
Figure 3
Figure 3
A deep VVF at the cuff after hysterectomy. Two silk sutures are placed at the edges for light traction during a Latzko repair.
Figure 4
Figure 4
The interposition of an omental flap.
None
See this image and copyright information in PMC

References

    1. Ghoniem G.M., Khater U.M. Vesicovaginal fistula. Springer-Verlag; London: 2006. (Pelvic floor dysfunction).
    1. Riley V.J. Vesicovaginal fistula. EMed WebMD. 2006 June 25.
    1. Schlunt Eilber K., Kavalier E., Rodriguez L., Rosenblum N., Raz S. Ten-year experience with transvaginal vesicovaginal fistula repair using tissue interposition. J Urol. 2003;169:1033–1036. - PubMed
    1. Cohn J.N. Blood pressure measurement in shock. Mechanism of inaccuracy in ausculatory and palpatory methods. JAMA. 1967;199:118–122. - PubMed
    1. Symmonds R.E. Ureteral injuries associated with gynecologic surgery. Prevention and management. Clin Obstet Gynecol. 1976;19:623–644. - PubMed