Vaginal Wall Bipedicled Flap and Other Techniques in Complicated Urethral Diverticulum and Urethrovaginal Fistula

1995 ◽  
Vol 50 (6) ◽  
pp. 434-435
Author(s):  
Magnus Fall
Keyword(s):  
Urethral Diverticulum ◽  
Vaginal Wall ◽  
Urethrovaginal Fistula

A PAX-8-positive Female Urethra Adenocarcinoma: A Case Report with Diagnostic Challenges in Intestinal- Type Adenocarcinoma

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S60-S61
Author(s):  
M Torrez ◽  
R Allen ◽  
J Zhou
Keyword(s):  
Pulmonary Nodules ◽  
Urethral Diverticulum ◽  
Vaginal Wall ◽  
Intestinal Type ◽  
Primary Adenocarcinoma ◽  
Female Urethra ◽  
Current Case ◽  
Squamous Mucosa ◽  
Uterine Tumors ◽  
Er Positive

Abstract Introduction/Objective Female urethra adenocarcinoma (FUA) in women is extremely rare, representing 0.02% of all women’s cancers and <1% of cancers in the female genitourinary tract. Intestinal-type primary adenocarcinoma of the urethra is even rarer, with only one documented case to our knowledge. Furthermore, PAX-8 immunoexpression in this entity has not been reported. Here we report an intestinal-type primary urethral adenocarcinoma that developed from inflammation-related metaplasia in urethral diverticulum with positive PAX-8 staining. Methods Clinical chart review and microscopic examination on the lung, urethral, and vaginal wall biopsies and immunohistochemistry were performed. Results A 64-year-old female with a 32-pack-year history of tobacco use was found to have multiple pulmonary nodules on imaging. The tumor cells were positive for CK7, CK20, SAT-B2, and PAX-8 and negative for TTF- 1/Napsin and ER. Positive PAX-8 immunoexpression raised the possibility of a gynecologic/Mullerian primary. Subsequent colonoscopy and imaging showed no evidence of colorectal or uterine tumors. The patient began having hematuria with intermittent urinary retention, and cystoscopy showed a 4 x 3 cm mass involving bladder neck circumferentially and invading into the vaginal wall. Urethral and vaginal tumor biopsies were performed. Morphologic examination of the urethral biopsy demonstrated intestinal metaplasia of squamous mucosa with transition from a mature to dysplastic phenotype where the adenocarcinoma originated from. The vaginal wall biopsy showed the same morphology. The urethral and vaginal wall biopsies showed a similar immunophenotype as the pulmonary nodule biopsy. Conclusion FUA is a rare, aggressive tumor that occurs in Skene’s glands. In our current case, however, it appeared to arise from inflammation-related metaplasia in urethral diverticulum. Another important finding of the case is the positive PAX-8 expression. Therefore in PAX-8 positive tumors, primary adenocarcinoma of lower urinary tract should be in the differential, along with gynecologic/Mullerian tumors.

Urogenital Fistulas and Female Urethral Diverticula

2020 ◽  
Author(s):  
Lindsey Cox ◽  
Eric S. Rovner
Keyword(s):  
Urinary Tract ◽  
Surgical Techniques ◽  
Signs And Symptoms ◽  
Urethral Diverticulum ◽  
Vascular Supply ◽  
Organ System ◽  
Fistula Tract ◽  
Urethrovaginal Fistula ◽  
Urogenital Fistula ◽  
Tract Fistula

Urogenital fistulas are a group of conditions in which the urinary tract is apparently connected to another organ system. Causes of fistula range from congenital anomalies, malignancy, trauma, infection or inflammatory conditions, ischemia, parturition, and iatrogenic sources – including surgery and radiation. Signs and symptoms of urinary tract fistula are variable and depend on the organ system involved and the size of the fistula. For patients who are appropriate surgical candidates, elective surgical repair is the mainstay of treatment of urinary tract fistula. Surgical techniques can be complex, but rely on the same key concepts: adequate exposure of the fistula tract; careful dissection and separation of the tissue layers, while minimizing cautery; multi-layer closure; watertight closure of each layer; meticulous hemostasis to prevent hematoma formation, but preserve vascular supply of tissues; use of well-vascularized tissue flaps; tension-free, non-overlapping suture lines; biopsy of tissues concerning for malignancy. This review contains 6 figures, 5 tables, and 82 references. Keywords: urogenital fistula, female bladder, vesical fistula, urinary bladder fistula, vesicovaginal fistula, urethrovaginal fistula, vaginal fistula, urethral diverticulum, urethral diverticulectomy, female urethra

scholarly journals Urethrovaginal fistula repair with or without concurrent fascial sling placement: A retrospective review

2020 ◽  
Vol 15 (5) ◽  
Author(s):  
Sarah Neu ◽  
Jennifer Locke ◽  
Mitchell Goldenberg ◽  
Sender Herschorn
Keyword(s):  
Patient Characteristics ◽  
Urethral Diverticulum ◽  
Pelvic Surgery ◽  
Study Patient ◽  
Complication Rates ◽  
Urethrovaginal Fistula ◽  
Fascial Sling ◽  
Significant Difference ◽  
Sling Placement

Introduction: We sought to review outcomes of urethrovaginal fistula (UVF) repair, with or without concurrent fascial sling placement. Methods: All patients diagnosed with UVF at our center from 1988–2017 were included in this study. Patient charts were reviewed from a prospectively kept fistula database, and patient characteristics and surgical outcomes were described. Descriptive statistics were applied to compare complication rates between patients with or without fascial sling placement at the time of UVF repair. Results: A total of 41 cases of UVF were identified, all of which underwent surgical repair. Median age at diagnosis was 49 years (interquartile range [IQR] 35–62). All patients had undergone pelvic surgery. UVF etiology was secondary to stress urinary incontinence (SUI) surgery in 17 patients (41%) and urethral diverticulum repair in seven patients (17%). The most common presenting symptom was continuous incontinence in 19 patients (46%). Nineteen patients had a fascial sling placed at the time of surgery (46%), with no significant difference in complication rates (26% vs. 23%, p=0.79). Two patients had Clavien-Dindo grade I complications (5%) and one had a grade III complication (2%). Four patients had long-term complications (10%), including urinary retention, chronic pain, and urethral stricture. Two patients had UVF recurrence (5%). Median followup after surgery was 21 months (IQR 4–72). Conclusions: UVF should be suspected in patients with continuous incontinence following a surgical procedure. Most UVF surgical repairs are successful and can be done with concurrent placement of a fascial sling.

Urethral diverticulum presenting as anterior vaginal wall cyst

2002 ◽  
Vol 22 (6) ◽  
pp. 700-700
Author(s):  
A. S. Parveen ◽  
R. Gonsalves ◽  
J. V. M. Mariasiluvai
Keyword(s):  
Urethral Diverticulum ◽  
Vaginal Wall ◽  
Anterior Vaginal Wall

scholarly journals AN OPERATIVE POSITION SUITABLE FOR TRANSVAGINAL EXCISION OF URETHRAL DIVERTICULUM OR CLOSURE OF URETHROVAGINAL FISTULA

2006 ◽  
Vol 97 (5) ◽  
pp. 757-760
Author(s):  
Fumiaki Hoshiyama ◽  
Kiyohide Fujimoto ◽  
Chie Matsushita ◽  
Akihide Hirayama ◽  
Masaki Haramoto ◽  
...  
Keyword(s):  
Urethral Diverticulum ◽  
Urethrovaginal Fistula

Urethral Diverticulum Mimicking Anterior Vaginal Wall Prolapse: Case Report

2010 ◽  
Vol 17 (3) ◽  
pp. 390-392 ◽  
Author(s):  
Jitendra Jadhav ◽  
Ourania Koukoura ◽  
Rita Joarder ◽  
Simon Edmonds
Keyword(s):  
Case Report ◽  
Urethral Diverticulum ◽  
Vaginal Wall ◽  
Anterior Vaginal Wall ◽  
Anterior Vaginal Wall Prolapse

scholarly journals Atypical vaginal location of endometriosis following repeated urogynaecological surgery

2021 ◽  
Vol 14 (8) ◽  
pp. e244186
Author(s):  
Anna Elisabet Christensen ◽  
Jens Jorgen Kjer ◽  
Dorthe Hartwell ◽  
Signe Perlman
Keyword(s):  
Vaginal Surgery ◽  
Surgical Excision ◽  
Scar Tissue ◽  
Pelvic Organ ◽  
Urethral Diverticulum ◽  
Vaginal Wall ◽  
Anterior Vaginal Wall ◽  
Urinary Flow ◽  
Prolapse Symptoms ◽  
One Year

We outline a case of vaginal endometriosis in scar tissue located in the distal part of the anterior vaginal wall close to the urethra following repeated urogynaecological surgery. Our case presents a 45-year-old woman diagnosed with pelvic endometriosis in her youth. She underwent several vaginal surgeries due to pelvic organ prolapse, symptoms of stress incontinence and decreased urinary flow. One year after her most recent vaginal surgery, she developed a tender lump in the lower part of the anterior vaginal wall. A urethral diverticulum was suspected, but a diagnostic puncture and biopsy unexpectedly showed histologically verified endometriosis. As the cyst recurred, surgical excision of all visible endometriosis tissue was performed. After 3 years of follow-up, the patient remained without recurrence. This case illustrates the risk of atypical implantation of endometriosis related to repeated urogynaecological surgery and that treatment requires surgery with thorough removal of all visible tissues.

scholarly journals Pathophysiology and Management of Long-term Complications After Transvaginal Urethral Diverticulectomy

2021 ◽  
Vol 25 (3) ◽  
pp. 202-209
Author(s):  
Hyeon Woo Kim ◽  
Jeong Zoo Lee ◽  
Dong Gil Shin
Keyword(s):  
De Novo ◽  
Urethral Diverticulum ◽  
Pubovaginal Sling ◽  
Urethrovaginal Fistula ◽  
Benign Condition ◽  
Martius Flap ◽  
Urethral Bulking ◽  
Tract Infections ◽  
Female Urethral Diverticulum

Female urethral diverticulum (UD) is a rare and benign condition that presents as an epithelium-lined outpouching of the urethra. It has various symptoms, of which incontinence in the form of postmicturition dribble is the most common. The gold standard for the diagnosis of UD is magnetic resonance imaging, and the treatment of choice is transvaginal diverticulectomy. Despite the high success rate of transvaginal diverticulectomy, postoperative complications such as de novo stress urinary incontinence (SUI), recurrence, urethrovaginal fistula, recurrent urinary tract infections, newly-onset urgency, and urethral stricture can occur. De novo SUI is thought to result from weakening of the anatomical support of the urethra and bladder neck or damage to the urethral sphincter mechanism during diverticulectomy. It can be managed conservatively or may require surgical treatment such as a pubovaginal sling, Burch colposuspension, or urethral bulking agent injection. Concomitant SUI can be managed by concurrent or staged anti-incontinence surgery. Recurrent UD may be a newly formed diverticulum or the result of a remnant diverticulum from the previous diverticulectomy. In cases of recurrent UD requiring surgical repair, placing a rectus fascia pubovaginal sling may be an effective method to improve the surgical outcome. Urethrovaginal fistula is a rare, but devastating complication after urethral diverticulectomy; applying a Martius flap during fistula repair may improve the likelihood of a successful result. Malignancies in UD are rarely reported, and anterior pelvic exenteration is the recommended management in such cases.

scholarly journals Müllerian Cyst of the Vagina Masquerading as a Cystocele

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Emrah Töz ◽  
Muzaffer Sancı ◽  
Süheyla Cumurcu ◽  
Aykut Özcan
Keyword(s):  
Lower Urinary Tract ◽  
Squamous Epithelium ◽  
Lesion Size ◽  
Urethral Diverticulum ◽  
Vaginal Wall ◽  
Pelvic Examination ◽  
Complete Excision ◽  
Perineal Ultrasonography ◽  
Empty Bladder ◽  
Lower Urinary

Müllerian cysts are usually small, ranging from 0.1 to 2 cm in diameter. Rarely, they may be enlarged and mistaken for other structures, such as a cystocele or urethral diverticulum. We report on a female with symptomatic vaginal wall prolapse, diagnosed as a vaginal Müllerian cyst, which was originally misdiagnosed as a cystocele. The mass was soft and could be compressed manually without difficulty. Perineal ultrasonography and cystoscopy revealed no relationship between the cyst and the lower urinary tract, suggesting independence of the lesion. We performed surgical treatment with complete excision of the mass via a vaginal approach under spinal anaesthesia. The pathology result confirmed a benign Müllerian cyst lined with mucinous and squamous epithelium. When evaluating an anterior vaginal cyst, assessment of the lesion via history taking and pelvic examination is important to confirm both lesion size and location. Perineal ultrasonography performed with an empty bladder is useful to differentiate such vaginal cysts and to define their communication, if any, with adjacent organs.

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