Ginsberg D A, Rovner E S, Raz S
Department of Urology, University of California, Los Angeles, School of Medicine, USA.
Urology. 1998 Jul;52(1):61-4; discussion 64-5. doi: 10.1016/s0090-4295(98)00162-9.
Connection between the vaginal cuff and the peritoneal cavity after hysterectomy is a rare event that can mimic urinary incontinence. The appropriate evaluation and treatment of these patients is discussed.
Five patients underwent excision of the vaginal cuff during a 12-month period. All of these patients had a negative workup for urinary incontinence, except for 1 patient who also had stress incontinence and required a vaginal wall sling at the time of cuff excision.
All 5 patients are presently free of excess vaginal drainage or significantly improved, with a mean follow-up of 6 months. One patient developed stress incontinence after cuff excision and later required a vaginal wall sling. There have been no perioperative complications and no evidence of recurrent fistula.
Fistula of the vaginal cuff is a diagnosis of exclusion after urinary incontinence has been ruled out. A high index of suspicion is often required to make the diagnosis because these patients often present with symptoms highly suggestive of urinary leakage. Fistula of the vaginal cuff is successfully treated with excision of the vaginal cuff and the fistulous tract (if identified), with minimal morbidity.
子宫切除术后阴道残端与腹腔相通是一种罕见情况，可类似尿失禁。本文讨论了对这些患者的恰当评估与治疗。
在12个月期间，有5例患者接受了阴道残端切除术。所有这些患者尿失禁检查结果均为阴性，只有1例患者同时合并压力性尿失禁，在切除阴道残端时还需要进行阴道壁悬吊术。
所有5例患者目前均无过多阴道引流情况或有明显改善，平均随访6个月。1例患者在切除阴道残端后出现压力性尿失禁，后来需要进行阴道壁悬吊术。未发生围手术期并发症，也没有复发性瘘管的证据。
阴道残端瘘是在排除尿失禁后作出的排除性诊断。由于这些患者常表现出高度提示尿液渗漏的症状，因此通常需要高度怀疑才能作出诊断。阴道残端瘘通过切除阴道残端和瘘管（如果确定）可成功治疗，且发病率极低。
