Maloney Taylor G, Kavanagh Alex, Khavari Rose
From the *Houston Methodist Hospital, Texas A&M University College of Medicine; and †Department of Urology, Houston Methodist Hospital, Houston, TX.
Female Pelvic Med Reconstr Surg. 2016 Nov/Dec;22(6):501-503. doi: 10.1097/SPV.0000000000000297.
To describe a case presentation and perform a review of the literature on vesicosalpingo fistulas.
An otherwise healthy 32 year-old patient was referred to urology with symptoms of persistent abdominal bloating and urine leakage from the vagina after abdominal conversion of laparoscopic hysterectomy. Two fistula tracts were identified in the bladder during preoperative cystoscopy. The tracts were cannulated with temporary ureteral catheters, and the patient underwent a robotic-assisted laparoscopic repair of a vesicosalpingo and a vesicovaginal fistula.
The patient was discharged on the first postoperative day with an indwelling urinary catheter. A follow-up cystogram performed on the 14th postoperative day demonstrated no evidence of extravasation. There was no evidence of recurrence at a 4-month follow-up visit. This is the first reported robot-assisted laparoscopic repair of a vesicosalpingo fistula and the fifth reported case of a vesicosalpingo fistula in the literature. This is the first reported case of separate vesicosalpingo and vesicovaginal fistulas presenting concurrently in a single patient.
This case presentation with 2 separate fistula tracts emanating from the bladder demonstrates the need to meticulously evaluate each individual fistula tract in order to successfully visualize and address all fistula tracts present in order to mitigate failures and the need for reoperation.
描述一例膀胱输卵管瘘病例并对相关文献进行综述。
一名32岁健康女性患者在腹腔镜子宫切除术后转为开腹手术，出现持续腹胀和阴道漏尿症状，遂转诊至泌尿外科。术前膀胱镜检查发现膀胱内有两条瘘管。通过临时输尿管导管对瘘管进行插管，患者接受了机器人辅助腹腔镜下膀胱输卵管瘘和膀胱阴道瘘修复术。
患者术后第一天留置导尿管出院。术后第14天进行的膀胱造影显示无外渗迹象。4个月随访时无复发迹象。这是文献中首次报道的机器人辅助腹腔镜修复膀胱输卵管瘘，也是第五例膀胱输卵管瘘病例。这是首次报道单一患者同时出现独立的膀胱输卵管瘘和膀胱阴道瘘。
该病例中膀胱出现两条独立瘘管，表明需要仔细评估每条瘘管，以便成功观察并处理所有存在的瘘管，从而减少手术失败和再次手术的必要性。
