Department of Obstetrics and Gynecology, University of South Florida, STC Building, 6th Floor, 2 Tampa General Circle, Tampa, FL, 33606, USA.
Female Pelvic Medicine & Reconstructive Surgery, University of South Florida, Tampa, FL, USA.
Int Urogynecol J. 2021 Jul;32(7):1939-1940. doi: 10.1007/s00192-021-04787-x. Epub 2021 Apr 28.
The objectives of this video are to discuss the presentation, evaluation, and surgical management of a patient with a vesicovaginal fistula at the time of colpocleisis.
We present the case of an 83-year-old woman with a history of stage IV prolapse who had had a pessary device removed. Urine had been noted to be in the vaginal vault, leading to suspicion of a vesicovaginal fistula. Following evaluation, the patient decided to proceed with surgical management. The patient underwent a vesicovaginal fistula repair with concomitant colpocleisis. A cystoscopy was performed at the conclusion of the case where the bilateral ureteral stents were removed and a strong efflux was noted at both ureteral orifices.
At the patient's 1-month follow-up, she had no complaints of prolapse or vaginal leaking.
Neglect of a vaginal pessary can lead to serious complications, indicating the importance of patient education and careful follow-up. Surgical planning is a key component in effectively managing a vesicovaginal fistula with ureteral presentation in order to preserve ureteral integrity. Concomitant vesicovaginal repair and colpocleisis can be performed safely with effective cure of a vesicovaginal fistula and stage IV prolapse.
本视频的目的是讨论在阴道闭孔成形术时出现膀胱阴道瘘的患者的表现、评估和手术处理。
我们介绍了一位 83 岁的女性患者，她患有 IV 期脱垂，曾取出过阴道塞。注意到尿液在阴道穹窿中，这导致怀疑是膀胱阴道瘘。经过评估，患者决定进行手术治疗。患者接受了膀胱阴道瘘修补术和阴道闭孔成形术。手术结束时进行了膀胱镜检查，取出双侧输尿管支架，并注意到双侧输尿管口有强烈的尿液流出。
在患者 1 个月的随访中，她没有脱垂或阴道漏的抱怨。
忽视阴道塞可能会导致严重的并发症，这表明患者教育和仔细随访的重要性。手术计划是有效处理伴有输尿管表现的膀胱阴道瘘以保护输尿管完整性的关键组成部分。同时进行膀胱阴道修补术和阴道闭孔成形术可以安全地进行，有效地治愈膀胱阴道瘘和 IV 期脱垂。
