Frequency of Success in Surgery of Vesicovaginal Fistula by Layered Closure with Graft Repair

Introduction: Vesicovaginal fistulae is abnormal communication between bladder and vagina that cause continous dribling of urine. It is physically, mentally and socially distressing condition. There are various approaches for surgeries of these urogenital fistulae with different success-rate that depend upon the experience of surgeon and surgical procedures. This study can help us to estimate the success rate of layered repair with graft in vaginal route to make stragedy to adopted in severe patient. Objective: To determine frequency of success in surgery on vesic-ovaginal fistulae by layered closured with graft repair procedures among patients admitted in Isra University. Setting: Obstetrics & Gynecology department in Isra university hospital Duration: 6 months from 10.2.2014 to 10.8.2014 Study Design: Case series Subject and methods: A total of 100 patients after having surgery for vesicovaginal fistula by layered closure with graft repair was included in this study. History and examination of all subjects were taken. The follow up visit was planned after 3 weeks of surgery. All women was questioned for recurrence of continuous urinary leakage and that without such symptoms proved by absence of leakage on methylene blue dye test was labeled as ‘success’. Results: - Frequency of success in surgery on vesic-ovaginal fistulae by layered closured with graft repair procedures was observed in 88% cases. Conclusion: The success rate of VVF repair by layered closured with graft repair procedures is high. It is concluded that obstetric urogenital fistula is a preventable condition. Keywords: Vesicovaginal fistulae, Layered closured, Graft repair, urogenital fistula

The Role of Regenerative Medicine in Wound Healing in Cases of Vesicovaginal Fistulae

Background: Post-surgical wound healing in cases of vesicovaginal fistulae is a challenge because it is related to infection prevention and the long-term well-being of women. Aim: The aim of this research was to critically review the application of regenerative medicine in wound healing. The next aim was to look in depth to see whether regenerative medicine strategies have a place in the future of wound healing in a clinical setting. More specifically, to see if these strategies would apply for vesico vaginal fistulae case in the field of urogynecology. Method: A narrative literature review examines several previous research published at the last 5 years, containing keywords, namely vesicovaginal fistulae, regenerative medicine, wound healing. We used databases from Google Scholar, PubMed and Scopus Database. Results: A vesicovaginal fistula is an abnormal communication between the bladder and the vagina. There are currently no precise guidelines for the postoperative management of patients after fistula repair. Transvaginal surgical procedures are a common solution for vesicovaginal fistulas. In wound healing, more attention is needed because of the risk of infection especially wound healing in the area of ​​​​the reproductive organs. It should also be noted that stress urinary incontinence is a common complication. Several studies have initiated the trial process of regenerative medicine for using in urogynecological cases. Conclusion: In the management of vesico vaginal fistula cases, regenerative medicine can be a solution in postoperative care but still needs further development and standardization. Keywords: placenta, urogynecology, regenerative medicine

O’CONOR (TRANSABDOMINAL) REPAIR: IS IT ALWAYS NECESSARY TO INTERPOSE A FLAP IN SIMPLE VESICO-VAGINAL FISTULA? A COMPARATIVE STUDY

Objective: To assess morbidity and success of transabdominal (O’Conor) repair of vesicovaginal fistula with orwithout interposition of flap between vagina and urinary bladder. Study Design: Prospective comparative study. Place and Duration of Study: Armed Forces Institute of Urology, Rawalpindi, from Mar 2016 to Jan 2019. Methodology: Fifty five patients were randomized into group A & B by lottery method. An inclusion criterionwas single fistulous opening of ≤3cm. Complex and recurrent fistulae were excluded. Patients in group A underwent O’Conor repair without interpositional flap while in group B vesicovaginal fistulae were repaired with flap interposition. Results: Twenty two patients were randomized in group A while 27 in group B. Mean age of patients was 41.65± 11.93 years. Gynecological and obstetrical surgery was the main cause of fistula. Mean duration of surgerywas 162.7 ± 18.49 minutes. Per-operative ureteric catheterization was done in 9 (16.8%) patients. Seventeen(30.6%) patients had paralytic ileus. There was transient fever in 4 (7.6%) of cases and wound infection was seenin 3 (5.8%) of patients. Mean hospital stay was 3.4 ± 2.3 days. Cystogram was done in 35 (64.5%) of patients before the removal of per-urethral catheter. The overall success rate was 92.9%. Ten (18.2%) of patients developed denovo urgency which was managed conservatively. There was no statistical difference in both groups in terms of morbidity and success. Conclusion: In simple Vesico-vaginal fistulae repair, interposition of flap can be omitted and it does not affect the outcomes in terms of success and morbidity.

Urology

This chapter covers various issues to do with urology in women. It begins by listing different investigation methods and what conditions they are best prepared to show. It then goes through various urological problems that may be encountered, such as ureteric stenting, haematuria, urinary tract infections and non-bacterial cystitis, and bladder pain syndrome. Urethral conditions and injuries to the urinary tract are both covered, including mechanism of injury and repair. Catheters, vesicovaginal fistulae, and urinary diversion are also described and given techniques for management.

Ureteric reimplantation via vaginal route: a new surgical technique

Vesicovaginal fistulae (VVF) and ureteric reimplantation are two rare complications of obstetric surgery. VVF can be repaired via a vaginal approach utilizing Martius fat pad interposition to minimize urethral complications and improve surgical outcomes, while ureteric reimplantation into the bladder classically necessitates an abdominal or laparoscopic approach. We present a new technique of ureteric reimplantation via vaginal approach with concomitant repair of a 5-cm VVF in a 25-year-old woman after an emergency caesarean section with bladder injury and ureteric transection. Good drainage was confirmed on MAG3 and successful vaginal birth (albeit preterm) was subsequently achieved.