Sarr A, Sow Y, Thiam A, Ngom I, Fall B, Diao B, Fall P A, Ndoye A K, Ba M, Diagne B A
Service d'urologie-andrologie, CHU Aristide-Le-Dantec, avenue Pasteur, BP 35354, Dakar, Sénégal.
Prog Urol. 2013 Sep;23(10):884-9. doi: 10.1016/j.purol.2013.03.013. Epub 2013 Apr 30.
Describe the epidemiology, diagnosis and treatment of vesicovaginal fistula (VVF).
We conducted a retrospective descriptive study of all cases of VVF secondary to hysterectomy. The following parameters were studied: age, parity, indication for hysterectomy, risk factors, the consultation period, the anatomical type of VVF, the paraclinical, the surgical approach and results of the cure.
Fourteen cases were identified over 10 years. All hysterectomies were performed by laparotomia. The average age of patients was 54.3±13 years. Hysterectomy was performed in view of a uterine leiomyoma in eight cases, a cancer of the cervix in four cases, a menometrorrhagia in one case and a choriocarcinoma in one case. Four patients had received neoadjuvant radiotherapy. The mean time from injury was 13.5±18 months. Examination under valve was allowed to find 11 VVF type 1 and three type 2 VVF. IVU was normal in seven patients and allowed to find an ureterohydronephrose stage III in one patient. VVF was addressed by high in ten cases including 5 by transperitoneovaginale and 5 by transvesical pure. The postoperative course was uneventful in 11 patients (78%) but marked by vesicocutaneous fistula, parietal suppuration and one failure.
In this short series of post-hysterectomy VVF treated by laparotomia, we observed a rate of cure satisfying in spite of an important psychosocial morbidity.
描述膀胱阴道瘘（VVF）的流行病学、诊断及治疗方法。
我们对所有子宫切除术后继发膀胱阴道瘘的病例进行了回顾性描述性研究。研究了以下参数：年龄、产次、子宫切除的指征、危险因素、会诊时间、膀胱阴道瘘的解剖类型、辅助检查、手术方式及治愈结果。
10年间共确诊14例。所有子宫切除术均通过剖腹手术进行。患者的平均年龄为54.3±13岁。8例因子宫平滑肌瘤行子宫切除术，4例因宫颈癌，1例因月经过多，1例因绒毛膜癌。4例患者接受了新辅助放疗。从受伤到确诊的平均时间为13.5±18个月。经阴道检查发现11例1型膀胱阴道瘘和3例2型膀胱阴道瘘。7例患者静脉肾盂造影正常，1例患者静脉肾盂造影显示输尿管肾盂积水Ⅲ期。10例膀胱阴道瘘采用高位手术治疗，其中5例经腹阴道联合手术，5例单纯经膀胱手术。11例患者（78%）术后恢复顺利，但有1例出现膀胱皮肤瘘、腹壁化脓及手术失败。
在这一小系列经剖腹手术治疗的子宫切除术后膀胱阴道瘘病例中，尽管存在严重的社会心理问题，但我们观察到治愈率令人满意。
