Moses Rachel A, Ann Gormley E
Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
Curr Urol Rep. 2017 Aug;18(8):60. doi: 10.1007/s11934-017-0708-5.
Vesico-vaginal fistulae (VVF) remain the most prevalent genitourinary fistula detrimentally impacting quality of life.
The purpose of this review is to examine relevant literature on management of VVF.
Obstructed labor is the leading cause of VVF in the developing world with most repairs performed via the transvaginal approach. Conversely, the predominate etiology in industrialized nations is iatrogenic injury with an increasing trend towards abdominal repair via a minimally invasive (laparoscopic and robotic) approach. No studies have compared transvaginal repair to minimally invasive transabdominal approaches. Further, an increasing number of authors have developed algorithms to determine optimum surgical approaches and risk factors for persistent incontinence. As surgeons become more facile with laparoscopic and robotic skills, there is a growing trend for minimally invasive surgical management of VVF in developed countries, perhaps widening the disparity gap between developing nations where transvaginal approaches predominate with good success. Further studies are needed to compare transvaginal to minimally invasive transabdominal approaches.
膀胱阴道瘘（VVF）仍然是最常见的泌尿生殖瘘，对生活质量有不利影响。
本综述的目的是研究有关膀胱阴道瘘管理的相关文献。
在发展中国家，产程梗阻是膀胱阴道瘘的主要原因，大多数修复手术通过经阴道途径进行。相反，在工业化国家，主要病因是医源性损伤，通过微创（腹腔镜和机器人）途径进行腹部修复的趋势日益增加。尚无研究比较经阴道修复与微创经腹途径。此外，越来越多的作者已经开发出算法来确定最佳手术方法和持续性尿失禁的危险因素。随着外科医生对腹腔镜和机器人技术越来越熟练，在发达国家，膀胱阴道瘘的微创外科治疗趋势日益增加，这可能会扩大发展中国家与发达国家之间的差距，在发展中国家，经阴道途径占主导地位且成功率较高。需要进一步研究来比较经阴道与微创经腹途径。
