Kumar Saurabh, Jain Amit, Vyas Sameer, Kurmi Narendra, Jain Saurabh, Jani Ajaybhai, Bhatia Skandh
Department of Urology, Gandhi Medical College, Bhopal, IND.
Cureus. 2025 Jun 10;17(6):e85710. doi: 10.7759/cureus.85710. eCollection 2025 Jun.
Most ureterovaginal fistulas (UVFs) are caused by gynecologic, urologic, or colorectal surgeries. Urine leaks, renal failure, and infections lower patients' quality of life. Minimally invasive endoscopic double-J (DJ) stenting has become popular. There is insufficient research on the effects of DJ stenting on fistula size, diagnostic timeliness, and patient comorbidities.
This study examines the efficacy of endoscopic DJ stent implantation in treating UVFs and addresses aspects such as fistula size, diagnosis timing, and comorbidities. This is a five-year retrospective study (2019 to 2024) conducted in Bhopal, India, comprising 31 patients with UVF who received endoscopic DJ stenting as the main treatment. Analyses included patient demographics, clinical presentation, fistula features, treatment outcomes, and complications. Statistical analysis includes chi-square tests for categorical variables and logistic regression for risk factor assessment, with a p-value < 0.05 considered significant.
DJ stenting showed a success rate of 77.4% (24/31 cases), with higher rates for early diagnosis (<4 weeks) and small fistula size (<5 mm) (p=0.038 and 0.032, respectively). Late diagnosis (>4 weeks), large fistula size (>5 mm), diabetes, and elevated creatinine (>1.2 mg/dL) were independent predictors of treatment failure in multivariate analysis. Minor issues included dysuria (16.1%, n=5) and hematuria (9.7%, n=3). One patient (3.2%) needed surgery due to a forgotten DJ stent.
If the UVF is minor and detected early, endoscopic DJ stenting can work. Renal failure, diabetes, larger fistulas, and delayed diagnosis reduce treatment success. Early prognostic identification and patient selection are crucial to maximize results and minimize surgery.
大多数输尿管阴道瘘（UVF）由妇科、泌尿科或结直肠手术引起。尿液渗漏、肾衰竭和感染会降低患者的生活质量。微创内镜双J（DJ）支架置入术已变得流行。关于DJ支架置入术对瘘管大小、诊断及时性和患者合并症的影响的研究不足。
本研究探讨内镜DJ支架置入术治疗UVF的疗效，并涉及瘘管大小、诊断时机和合并症等方面。这是一项在印度博帕尔进行的为期五年的回顾性研究（2019年至2024年），包括31例接受内镜DJ支架置入术作为主要治疗的UVF患者。分析包括患者人口统计学、临床表现、瘘管特征、治疗结果和并发症。统计分析包括分类变量的卡方检验和危险因素评估的逻辑回归，p值<0.05被认为具有统计学意义。
DJ支架置入术的成功率为77.4%（24/31例），早期诊断（<4周）和小瘘管大小（<5mm）的成功率更高（分别为p=0.038和0.032）。多因素分析中，晚期诊断（>4周）、大瘘管大小（>5mm）、糖尿病和肌酐升高（>1.2mg/dL）是治疗失败的独立预测因素。轻微问题包括排尿困难（16.1%，n=5）和血尿（9.7%，n=3）。一名患者（3.2%）因DJ支架遗忘需要手术。
如果UVF较小且早期发现，内镜DJ支架置入术可能有效。肾衰竭、糖尿病、较大的瘘管和延迟诊断会降低治疗成功率。早期预后识别和患者选择对于最大化治疗效果和最小化手术至关重要。
