Valery Sionov Ben, Ben Zvi Masha, Taha Tarek, Sidi Ami, Tsivian Alexander
Department of Urologic Surgery, Edith Wolfson Medical Center, Holon.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Harefuah. 2021 Sep;160(9):583-585.
Vesico-vaginal fistula, is a known complication that can occur following damage to the bladder wall during pelvic surgery or prolonged birth. Prompt and accurate diagnosis and timely repair are essential for a quick solution to the problem, and a reduction in medico-legal claims. Successful treatment requires an accurate assessment of the size and the location of the fistula, determination of timing and the surgical technique. There is an approach that advocates postponing the surgery for several months until "tissue healing" subsides and some advocate immediate repair. In our department, the surgery is performed early, immediately upon diagnosis without delay. The aim of the work is to define the clinical manifestation of fistula after surgery, to analyze the factors, and to summarize the experience of an early intervention.
We reviewed the records of consecutive patients undergoing repair of urogenital fistulas at our institution. Patients with only vesico-vaginal fistulas were included. We recorded demographic characteristics, as well as surgical data, and postoperative complications were also collected. The follow-up period was at least 3 months.
A total of 67 women with urogenital fistulas were identified, of whom 37 were only with vesico-vaginal fistulas. Iatrogenic injury, during hysterectomy was the main cause in 70.3%; 2 women were treated conservatively. A repair in the vaginal approach was performed in 31 women, and in 4 women the repair was performed in the abdominal approach, of them, two underwent urethral re-implantation simultaneously. Complications included sepsis in one case, and vaginal cuff dehiscence in another. The success rate of the repair was 92%. Recurrence occurred in 3 patients, of whom 2 had a history of previous radiation.
A vesico-vaginal fistula can be successfully repaired by early repair, without delay, thus saving the patient considerable distress and discomfort.
膀胱阴道瘘是一种已知的并发症，可在盆腔手术或分娩时间过长导致膀胱壁受损后发生。迅速准确的诊断和及时修复对于快速解决问题以及减少医疗法律索赔至关重要。成功的治疗需要准确评估瘘管的大小和位置，确定手术时机和手术技术。有一种方法主张将手术推迟数月，直到“组织愈合”消退，也有人主张立即修复。在我们科室，一旦诊断明确，立即毫不延迟地尽早进行手术。这项工作的目的是明确手术后瘘管的临床表现，分析相关因素，并总结早期干预的经验。
我们回顾了在我院接受泌尿生殖瘘修复手术的连续患者的记录。仅纳入膀胱阴道瘘患者。我们记录了人口统计学特征以及手术数据，并收集了术后并发症。随访期至少为3个月。
共确定67例泌尿生殖瘘女性患者，其中37例仅为膀胱阴道瘘。子宫切除术中的医源性损伤是主要原因，占70.3%；2例患者接受了保守治疗。31例女性采用阴道入路进行修复，4例女性采用腹部入路进行修复，其中2例同时进行了尿道再植术。并发症包括1例败血症和1例阴道断端裂开。修复成功率为92%。3例患者复发，其中2例有既往放疗史。
膀胱阴道瘘通过尽早修复可成功治愈，无需延迟，从而为患者避免了相当大的痛苦和不适。
