Department of Surgical, Oncological and Gastroenterological Sciences, Urological Unit, University of Padua, Padua, Italy.
Department of Surgical, Oncological and Gastroenterological Sciences, Urological Unit, University of Padua, Padua, Italy.
Eur Urol Focus. 2021 Nov;7(6):1485-1492. doi: 10.1016/j.euf.2020.06.017. Epub 2020 Jul 31.
A vesicovaginal fistula (VVF) is an abnormal communication between bladder and vagina, as a result of traumatic events to the female pelvis. A VVF is a rare event and challenging to cure. Successful treatment can be achieved through an abdominal approach, especially in complex or recurrent cases. This approach has been used in our institution as the procedure of choice for the past 50yr.
To analyze the results of the management of VVFs in our institution and to highlight the key points for success.
DESIGN, SETTING, AND PARTICIPANTS: A total of 138 patients with VVFs have been treated in our institution between 1969 and 2019. Up to now, this is the largest series reported so far on abdominal treatment of VVFs in the developed world.
an abdominal transvesical approach has been performed as the procedure of choice. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: to evaluate the factors influencing the success rate of the abdominal approach at the first closure attempt. Statistical analysis was performed using STATA software.
In total, 124 (90%) patients were submitted to transabdominal repair (89 extraperitoneal; 71.8%), 113 (91.1%) presented with a VVF not associated with another fistula, and 36 (29.0%) had undergone previous unsuccessful treatments elsewhere. Successful closure was obtained in 111/118 (94.1%) patients at the first attempt, excluding external noncontinent urinary diversions. Follow-up was possible in 95 (76.6%) patients; 91 (95.8%) patients were dry. Statistical analysis showed a significant association between fistula size and length, and VVF site in the bladder and extraperitoneal approach. Success rate decreased with the number of previous attempts and did not vary with VVF etiology.
The abdominal approach for the treatment of VVF has a high success rate. Standardization of the technique, identification of surgical key points, and centralization of care in centers with experience are critical.
A vesicovaginal fistula (VVF) is a rare clinical condition, with a high impact on patients' quality of life. We report a large series of VVFs treated in our institution in the past 50yr. Key factors for success include proper surgical technique and centralization of care in centers with high experience.
膀胱阴道瘘（VVF）是一种膀胱和阴道之间的异常沟通，是由于女性骨盆的创伤事件引起的。 VVF 是一种罕见的疾病，难以治愈。成功的治疗可以通过腹部方法实现，尤其是在复杂或复发性病例中。在过去的 50 年中，这种方法一直是我们机构的首选方法。
分析我们机构中 VVF 管理的结果，并强调成功的关键要点。
设计、环境和参与者：自 1969 年至 2019 年，我们机构共治疗了 138 例 VVF 患者。到目前为止，这是迄今为止在发达国家报告的关于腹部治疗 VVF 的最大系列。
作为首选方法，进行了腹部经膀胱入路。
评估影响首次闭合尝试时腹部方法成功率的因素。使用 STATA 软件进行统计分析。
共有 124 例（90％）患者接受了经腹修复（89 例腹膜外； 71.8％），113 例（91.1％）表现为无其他瘘管的 VVF，36 例（29.0％）在其他地方进行了先前不成功的治疗。在首次尝试中，111/118 例（94.1％）患者获得了成功的闭合，不包括外部非控尿转流。95 例（76.6％）患者可进行随访；91 例（95.8％）患者干燥。统计分析显示，瘘管大小和长度以及膀胱和腹膜外部位的 VVF 部位与瘘管之间存在显著相关性。成功率随先前尝试次数的增加而降低，与 VVF 病因无关。
腹部方法治疗 VVF 的成功率很高。技术标准化，确定手术要点以及在有经验的中心集中治疗至关重要。
膀胱阴道瘘（VVF）是一种罕见的临床病症，对患者的生活质量有很大影响。我们报告了过去 50 年来我们机构治疗的 VVF 大量系列。成功的关键因素包括适当的手术技术和在经验丰富的中心集中治疗。
