Department of Clinical Urology, Keck School of medicine, University of Southern California, Los Angeles, California.
USC Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.
Neurourol Urodyn. 2018 Apr;37(4):1380-1385. doi: 10.1002/nau.23454. Epub 2017 Nov 15.
The use of orthotropic neobladder (ONB) construction in women has increased in popularity. With increasing numbers so have complications distinct to this procedure. Neobladder vaginal fistula (NVF) is a rare but challenging complication. We present our experience correcting this problem.
An IRB approved database of female patients with an ONB was retrospectively reviewed. Patients with a history of NVF were identified and charts reviewed. Our standard technique of radical cystectomy and orthotopic diversion in female patients includes interposition of omentum between the neobladder and anterior vaginal wall and sacrocolpopexy.
Two hundred and forty-nine female patients underwent cystectomy and ONB construction between 1995 and 2015. Fourteen patients were diagnosed with a NVF (5.6% incidence). The average age and follow-up was 67 years and 33.7 months, respectively. Surgery for fistula closure was attempted in 13 patients. One repair was combined abdominal and transvaginal; the remaining 12 were performed transvaginally. Location of NVF was categorized as at the urethra-neobladder anastomosis (UNA, nine patients) and anterior vaginal wall (AVW, four patients). Eight patients had a successful fistula repair (61.5%) but only five patients ultimately retained their ONB (39%).
Patients with a NVF pose a surgical challenge. Successful fistula repair does not necessarily result in adequate continence due to an incompetent outlet. NVF location at the UNA is the more common location and is more challenging in regard to successful resolution of the NVF as well as possible urinary incontinence post-NVF repair.
女性使用正交膀胱（ONB）构建的方法越来越受欢迎。随着这种方法应用的增加，其特有的并发症也随之增多。新膀胱阴道瘘（NVF）是一种罕见但具有挑战性的并发症。我们介绍了我们纠正这一问题的经验。
回顾性分析了接受 ONB 治疗的女性患者的 IRB 批准数据库。确定了有 NVF 病史的患者，并对病历进行了审查。我们在女性患者中进行根治性膀胱切除术和正交分流的标准技术包括将网膜置于新膀胱和前阴道壁之间，并进行骶骨阴道固定术。
1995 年至 2015 年期间，有 249 名女性患者接受了膀胱切除术和 ONB 构建。14 名患者被诊断为 NVF（发病率为 5.6%）。平均年龄和随访时间分别为 67 岁和 33.7 个月。尝试了 13 名患者进行瘘管闭合手术。其中一次修复为腹部联合经阴道；其余 12 次经阴道进行。NVF 的位置分为尿道-新膀胱吻合口（UNA，9 例）和前阴道壁（AVW，4 例）。8 名患者的瘘管修复成功（61.5%），但只有 5 名患者最终保留了他们的 ONB（39%）。
NVF 患者带来了手术挑战。瘘管修复成功并不一定能保证适当的控尿，因为出口功能不全。UNA 处的 NVF 是更常见的位置，在成功解决 NVF 以及可能的 NVF 修复后尿失禁方面更具挑战性。
