Priyadarshi Vinod, Singh Jitendra Pratap, Bera Malay Kumar, Kundu Anup Kumar, Pal Dilip Kumar
Department of Urology, IPGMER and SSKM Hospital, Kolkata, 700 020 India.
J Obstet Gynaecol India. 2016 Jun;66(3):180-4. doi: 10.1007/s13224-015-0672-2. Epub 2015 Jan 31.
In developing countries, obstetric trauma is the most common cause of genitourinary fistulae. But over the last two decades, health care facilities have been improved and the scenario has been changed.
The aim of the present study is to share our experience with genitourinary fistula in terms of mode of presentation, diagnostic modality, and management with the emphasis on the surgical approach and a parallel review of the available literature.
During a 6-year period from January 2007 to December 2013, 41 cases of genitourinary fistula, who admitted and treated in the urology department of a tertiary care center, were retrospectively analyzed for etiology, site, size and number of fistulae, clinical presentation, diagnostic modalities, and management. The literature search was done using the Medline database.
Mean age of the patient was 27 years (range 16-51). Primary and simple fistulae were common. Obstetric trauma was the most common etiology (56.09 %) followed by iatrogenic (39.03 %). Vesicovaginal fistula was the most common type (78.37 %) and trigone was the most common site involved (51.72 %). 51.35 % of patients were approached successfully by the vaginal route. Ancillary procedures were required in patients for various other associated anomalies at the time of fistula repair. The success rate on follow up was 94.5 %. In the mean follow up of 3 years, 35 patients were sexually active.
Genitourinary fistula is a frustrating entity with potentially devastating psychosocial consequence. Its management poses a tricky challenge to the surgeon. Accurate and timely diagnosis, adhering on basic surgical principle, and repair by an experienced surgeon provide the optimum chance of cure.
在发展中国家，产科创伤是泌尿生殖瘘最常见的病因。但在过去二十年中，医疗保健设施得到了改善，情况已经发生了变化。
本研究的目的是分享我们在泌尿生殖瘘的表现方式、诊断方法和治疗方面的经验，重点是手术方法，并对现有文献进行平行综述。
在2007年1月至2013年12月的6年期间，对在一家三级医疗中心泌尿外科收治并治疗的41例泌尿生殖瘘患者进行回顾性分析，以了解瘘管的病因、部位、大小和数量、临床表现、诊断方法及治疗情况。使用Medline数据库进行文献检索。
患者的平均年龄为27岁（范围16 - 51岁）。原发性和单纯性瘘较为常见。产科创伤是最常见的病因（56.09%），其次是医源性病因（39.03%）。膀胱阴道瘘是最常见的类型（78.37%），三角区是最常受累的部位（51.72%）。51.35%的患者通过阴道途径成功治疗。在瘘管修复时，患者因各种其他相关异常需要辅助手术。随访成功率为94.5%。在平均3年的随访中，35例患者有性生活。
泌尿生殖瘘是一个令人沮丧的疾病，可能会带来毁灭性的心理社会后果。其治疗对外科医生来说是一个棘手的挑战。准确及时的诊断、遵循基本的外科原则以及由经验丰富的外科医生进行修复，可提供最佳的治愈机会。
