Ponad 7000 publikacji medycznych!
Statystyki za 2021 rok:
odsłony: 8 805 378
Artykuły w Czytelni Medycznej o SARS-CoV-2/Covid-19

Poniżej zamieściliśmy fragment artykułu. Informacja nt. dostępu do pełnej treści artykułu tutaj
© Borgis - New Medicine 4/2012, s. 122-124
*Agnieszka Ledniowska1, Grzegorz Ledniowski2, Jarosław Karoń1, Przemysław Karoń1
An evaluation of the efficiency of different surgery techniques in the treatment of vesicovaginal fistulas – own experience
1Gynaecology-Maternity Ward, ZOZ Kędzierzyn-Koźle Public Hospital, Poland
Supervisor: Jarosław Karoń, MD
2Urology Ward, ZOZ Kędzierzyn-Koźle Public Hospital, Poland
Supervisor: Andrzej Trondowski
Summary
Aim. An evaluation of the efficiency of different surgery techniques in the treatment of vesicovaginal fistulas, based on own experience.
Material and methods. In the years 2008-2012, at the Gynaecology-Maternity Ward of the Kędzierzyn-Koźle Public Hospital, 7 patients were operated on due to the development of primary and recurrent vesicovaginal fistulas after abdominal hysterectomy. The patients were operated on vaginally and the operation technique was matched to the location and the size of the fistula.
Results. In 6 patients, the vesicovaginal fistula was closed after only one operation. In 1 patient, a recurrence of the fistula was observed, so the patient needed further corrective surgery.
Conclusions. All of the patients were treated successfully. Both primary and recurrent fistulas can be successfully closed vaginally. Postoperative estrogen therapy in patients operated on vaginally precipitated the healing of postoperative lesions.
INTRODUCTION
Vesicovaginal fistulas are a rare but very discomforting complication. The continuous discharge of urine through the vagina causes irritation of the perineal area and inflammations. It significantly degrades the quality of patients’ lives, at times hindering normal functioning in society. The main cause of the occurrence of fistulas between the urinary and genital tracts is prolonged, complicated birth (1). In developed countries, the majority of vesicovaginal fistulas occur after gynaecological and obstetric surgeries and radiotherapy (2).
Vesicovaginal fistulas occurring after gynaecological surgeries are related in 70% of cases to the removal of the uterus (2, 3). The incidence after uterus removal is 1 in 1800(4).
Radiotherapy, the highly effective method of treatment of genital tract neoplasms carries the risk of complication in the form of postradiation fistula (5, 6). Such fistulas occur due to exceeding the critical dose for the urinary bladder.
Other treatments significantly increasing the risk of occurrence of vesicovaginal fistulas are: restorative surgery of the front vaginal wall, transvaginal hysterectomy.
AIM
The evaluation of effectiveness of various techniques of treatment of vesicovaginal fistulas.
PATIENT AND METHODs
The analysis included 7 patients operated on in the ZOZ Kędzierzyn-Koźle Public Hospital in the period 2008-2012 jointly by doctors of the Gynaecology-Maternity Ward and doctors of the Urology Ward. The patients were operated on for primary and recurrent vesicovaginal fistulas. All of the fistulas had occurred after abdominal hysterectomy. Five of the fistulas were primary. Two were recurrent fistulas, each of them three times closed unsuccessfully through abdominal or vaginal routes. The average age of the patients operated on was 54 years. Before surgery, gynaecological and urological diagnoses were performed on each patient. All patients were subjected to a gynaecological examination with a vaginal speculum, during which methylene blue was administered into the urinary bladder, in order to confirm the diagnosis. In all of the patients cytoscopy was performed before and after the surgery.
All of the patients were operated on via the vaginal route. The average duration of surgery was 110 minutes. The Foley catheter was removed from the bladder on the 14th day after surgery.
The patients were qualified for surgery depending on the diameter of the vaginal orifice of the fistula duct and the location of the vesicovaginal fistula in relation to the external urethral orifice (6). The fistulas were classified as shown below.
Vesicovaginal fistulas are divided into the following, depending on the vaginal orifice diameter:
– simple, with the orifice diameter below 0.5 cm
– complex, with the orifice diameter larger than 2.5 cm
– intermediate, with the orifice diameter between 0.5 cm and 2.5 cm
The Goh classification divides vesicovaginal fistulas into 4 types (7):
Type 1– the vaginal fistula opening is located at more than 3.5 cm from the external urethral orifice
Type 2 – the vaginal fistula opening is located at 2.5-3.5 cm from the external urethral orifice
Type 3 – the vaginal fistula opening is located at 1.5-2.5 cm from the external urethral orifice
Type 4 – the vaginal fistula opening is located at less than 1.5cm from the external urethral orifice
Three operating techniques were used in the treatment.
A surgery using the Sims technique with the Moir modification was performed on one patient. The fistula was classified as primary, simple (< 0.5 cm), Goh type 1. The operating technique involved longitudinal incisions 0.5 cm upward and downward from the fistula. The vaginal wall and the entire cicatricial fibrous tissue are excised downward, so that the excision does not include the mucous membrane of the urinary bladder. The vaginal walls are not separated from the urinary bladder walls. The edges on both sides are pulled together by applying single vertical mattress sutures from top to bottom. The patient was treated successfully.

Powyżej zamieściliśmy fragment artykułu, do którego możesz uzyskać pełny dostęp.
Mam kod dostępu
  • Aby uzyskać płatny dostęp do pełnej treści powyższego artykułu albo wszystkich artykułów (w zależności od wybranej opcji), należy wprowadzić kod.
  • Wprowadzając kod, akceptują Państwo treść Regulaminu oraz potwierdzają zapoznanie się z nim.
  • Aby kupić kod proszę skorzystać z jednej z poniższych opcji.

Opcja #1

19

Wybieram
  • dostęp do tego artykułu
  • dostęp na 7 dni

uzyskany kod musi być wprowadzony na stronie artykułu, do którego został wykupiony

Opcja #2

49

Wybieram
  • dostęp do tego i pozostałych ponad 7000 artykułów
  • dostęp na 30 dni
  • najpopularniejsza opcja

Opcja #3

119

Wybieram
  • dostęp do tego i pozostałych ponad 7000 artykułów
  • dostęp na 90 dni
  • oszczędzasz 28 zł
Piśmiennictwo
1. Gołka KA, Klasa-Mazurkiewicz D, Milczek T et al.: Przetoka cewkowo-pochwowa jako powikłanie przedłużonego porodu. Ginekol Pol 2008; 79: 56-59. 2. Lee RA, Symmonds RE, Williams TJ: Current status of genitourinary fistula. Obstet Gynecol 1988; 72(3 Pt 1): 313-319. 3. Leach G, Trockman B: Surgery for vesicovaginal fistula and uretrovaginal fistula and urethral diverticulum. En: Walsh P et al.: Campbell’s urology, 7ed. Vol. 1 Philadelphia, Saunders 1998; 1135-1153.-7. 4. Angioli R, Penalver M, Muzii L et al.: Guidelines of how to manage vesicovaginal fistula. Crit Rev in Oncol Hematol 2003; 48(3): 295-304a. 5. Van Nagell J, Parker J, Marujama Y et al.: Bladder or rectal injury following radiation therapy for cervical cancer. Am J Obstet Gynecol 1974; 6: 727-732. 6. Boronow R, Rutledge F: Vesicovaginal fistula, radiation and gynecologic cancer. Am J Obstet Gynecol 1971; 111(1): 85-90. 7. Goh JA: A new classification of female genital tract fistula. Aust N Z J Obstet Gynecol 2004; 44(6): 502-504. 8. Miller EA, Webster GD: Current management of vesico-vaginal fistulae. Curr Opin Urol 2001; 11(4): 417-421. 9. Woo H, Rosario D, Chapple C: The treatment of vesicovaginal fistulae. Eur Urol 1996; 29: 1-9. 10. Mior Ch: Personal Experience in the treatment of vesicovaginal fistulas. Am J Obstet Gynecol 1956; 71(3): 476-491. 11. Jarecki P, Szkarłat P, Sasim K: Przypadek kobiety chorej na przetokę pęcherzowo-pochwową, leczonej laparoskopowo. Polish Urology 2006; 59/3. 12. Tancer M: Observations on prevention and management of vesicovaginal fistula after total hysterectomy. Surg Gynecol Obstet 1992; 175(6): 501-506a. 13. Raashid Y, Tmajeed T, Majeed N et al.: Iatrogenic vesicovaginal fistula. J Coll Physicians Surg Pak 2010; 20(7): 436-438. 14. Jatoi N, Jatoi NM, Shaikh F et al.: Key to successful vesico-vaginal fistula repair – an experience of urogenital fistula surgeries et outcome at gynaecological syrgical camp-2005. J Ayub Med Coll Abbottabad 2008; 20(2): 125-127. 15. Zambon JP, Batezini NS, Pinto ER: Do we need new surgical techniques to repair vesico-vaginal fistulas? Int Urogynecol J Pelvic Floor Dysfunct 2010; 21(3): 337-342. 16. Rechberger T, Postawski K, Romanek K et al.: Przetoki pęcherzowo-pochwowe-aktualna strategia postępowania. Ginekol Pol 2010; 81(6): 452-456.
otrzymano: 2012-11-13
zaakceptowano do druku: 2012-11-30

Adres do korespondencji:
*Agnieszka Ledniowska
Gynaecology-Maternity Ward ZOZ Kędzierzyn-Koźle Public Hospital
24 Kwietnia St. 5, 47-200 Kędzierzyn-Koźle
tel.: +48 517-056-831
e-mail: a.ledniowska@interia.pl

New Medicine 4/2012
Strona internetowa czasopisma New Medicine