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The urinary bladder
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
To repair a ureterovaginal fistula, an extraperitoneal approach to the ureter via the previous Pfannenstiel incision is made. Considerable adhesions will be encountered, but the ureter can usually be found above the level of the injury and followed down. Reimplantation into the bladder is often required. Depending on the amount of ureter lost, it may be possible to achieve reimplantation with a psoas hitch procedure. If the gap is too large a Boari flap of anterior bladder wall should be cut and brought over to meet the ureter and a reimplant performed. The most important principle of ureteric reimplantation is that there should be no tension on the repair.
Urology
Published in Janesh K Gupta, Core Clinical Cases in Surgery and Surgical Specialties, 2014
A1: What is the likely differential diagnosis? Vesicovaginal fistula/ureterovaginal fistulaUrethral incontinence
Update on vesicovaginal fistula: A systematic review
Published in Arab Journal of Urology, 2019
Ahmed S. El-Azab, Hassan A. Abolella, Mahmoud Farouk
The physician should become suspicious of the presence of a VVF when the patient complains of a leakage of urine after a pelvic operation. Occasionally these postoperative VVFs may not develop until a few weeks or even few months after an operation or RT. On pelvic examination, the vagina should be carefully inspected using a speculum; under anaesthesia, if required. Ghoniem and Warda [14] in their review stated that acute VVFs are usually not palpated but by inspection with the speculum, the mucosa surrounding the VVF may appear erythematous and inflamed. However, in mature VVFs an opening is usually seen or palpated in the vagina. A phenazopyridine test can be performed by giving the patient oral phenazopyridine (pyridium). A vaginal pack or a tampon is inserted into the vagina before taking the phenazopyridine. After careful removal, if the pack reveals the presence of orange stain, there is a high likelihood that a VVF exists. The authors have been using a methylene blue test for many years, with very good sensitivity. The test is carried out by installing 100 mL methylene blue solution into the bladder through the urethra using a catheter. After removing the catheter, three cotton swabs are placed into the vagina. After 2 h the swabs are inspected and if stained blue this indicates a VVF; whilst an orange stain indicates a ureterovaginal fistula (UVF) [14].
Urological approach for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in a clinical care center
Published in Acta Chirurgica Belgica, 2018
Carlos Gustavo Trujillo, Cristina Domínguez, Daniela Robledo, Juan Ignacio Caicedo, Alejandra Bravo-Balado, Juan Guillermo Cataño, Natalia Cortés, Lina Parra, Wilson Riaño, Eduardo Londoño-Schimmer, Jorge Otero, Gabriel Herrera, Fernando Arias, Mauricio Plata
Four (3.9%) patients developed urinary fistulae: two were ureterocutaneous fistulae managed with nephrostomy tubes and double-J stenting; one was a ureterovaginal fistula treated with double-J stenting exclusively, and one case presented with vesicovaginal plus a vesicoperitoneal fistula that required percutaneous drainage and ureteral catheter replacement. Fistulae were diagnosed in a median time of 29.5 days (range 19–36). These patients had been treated with multiple chemotherapeutic schemes, had a previous history of multiple surgical interventions including a nephrectomy, and required extensive pelvic dissection at the CRS-HIPEC procedure.
Recurrent postcoital vesicovaginal fistula: outcome of consensual sex in an adult female
Published in Journal of Obstetrics and Gynaecology, 2018
Aruna Nigam, Arifa A. Elahi, Swaraj Batra
A 35-year-old, para six female presented with continuous dribbling of urine for last 15 years. She was married 15 years back and complained of urinary incontinence since her first coitus. At that time she was diagnosed as a case of large vesicovaginal fistula of 4 cm. The fistula could not be repaired immediately as she became pregnant and continued with the pregnancy. This fistula was repaired vaginally 3 months after delivery. Her uretheral catheter was removed on the 14th post-operative day and suprapubic catheter on the 21st day. She was continent at the time of discharge but she had a failure of repair on 22nd postoperative day because of repeat coital injury despite advice for abstinence. She was not brought to the hospital for medical attention or for repair, and had 5 more vaginal deliveries at home, last childbirth being 3 years back. She did not consult any doctor for this complaint during this period as her husband thought of completing the family first. She was socially ostracised for all these years because of the incontinence and the smell. She avoided going to the family functions and religious rituals in temple. Examination revealed an anxious-looking female who smelt of urine. Local examination revealed excoriated vulva and thighs. Speculum examination revealed urine leaking from vagina. A single large fistula of 5 × 5 cm was seen in the anterior vaginal wall. Tissue around the opening showed puckering with bladder mucosa protruding through the fistula. Cervix was normal. Vaginal examination confirmed the findings. Uterus and adnexa were normal. Rectal examination was unremarkable. Routine investigations were within normal limits. Intravenous pyelography revealed normal calibre of ureter with no other fistula or ureterovaginal fistula. Cystoscopic examination (Figure 1) revealed a large fistula of 5 × 5 cm in the supratrigonal region with right ureter 0.5 cm from fistula and left ureter 1.5 cm away from the margin.