Prakash Sankapal, Arjunrao Gite Venkat, Mayank Agrawal, Mudit Maheshwari, Shashank Sharma
Department of Urology, Grant Government Medical College & Sir JJ Hospital, Mumbai, India.
J Reprod Infertil. 2023 Jan-Mar;24(1):63-65. doi: 10.18502/jri.v24i1.11911.
One of the few remaining important issues in urological and gynaecological surgery relates to fistulas between the urinary tract and the vagina. Vesicovaginal fistula (VVF) and ureterovaginal fistulas (UVF) are defined as abnormal connections between the urinary tract, on the one side, and the female genital system, on the other.
This study is about an unreported and undescribed case of 24 year old female who presented with the complaints of continuous urinary incontinence for 18 months following total abdominal hysterectomy. Preoperative cystoscopy and vaginal/speculum findings revealed a papillary frond like mass protruding intravesically from VVF site which was free from the edges of fistulous opening all around. Also, left ureteric orifice was not visualized. On exploration, there was evidence of intravesical herniation of right tubal fimbria through the common opening of VVF and left UVF near left vaginal vault apex mimicking a bladder mass presenting with continuous incontinence for 18 months. Modified O' Conners VVF repair with left ureteric reimplantation was done. The postoperative period was uneventful with patient having no incontinence.
It seems that surgical resection of ovarian cyst with VVF and UVF repair is the definitive treatment and histopathological examination is essential to exclude malignant transformation.
泌尿外科和妇科手术中为数不多的重要遗留问题之一涉及尿路与阴道之间的瘘管。膀胱阴道瘘（VVF）和输尿管阴道瘘（UVF）被定义为一侧尿路与另一侧女性生殖系统之间的异常连接。
本研究涉及一例未报告且未描述过的病例，一名24岁女性在全腹子宫切除术后出现持续尿失禁18个月的症状。术前膀胱镜检查及阴道/窥器检查发现，一个乳头状叶状肿物从膀胱阴道瘘部位向膀胱内突出，肿物四周与瘘口边缘不相连。此外，未见到左侧输尿管口。术中探查发现，右侧输卵管伞端经膀胱阴道瘘和左侧输尿管阴道瘘在左侧阴道穹窿顶端的共同开口处突入膀胱，形似膀胱肿物，导致持续尿失禁18个月。遂行改良奥康纳膀胱阴道瘘修补术并进行左侧输尿管再植术。术后恢复顺利，患者无尿失禁症状。
对于伴有膀胱阴道瘘和输尿管阴道瘘的卵巢囊肿，手术切除囊肿并行瘘管修补似乎是确定性治疗方法，组织病理学检查对于排除恶性转化至关重要。
