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Treatment of Anorectal Malformations
Published in Han C. Kuijpers, Colorectal Physiology: Fecal Incontinence, 2019
The old urogenital sinus (common channel) must be reconstructed to become the new urethra. The most feared complication is the formation of a urethrovaginal fistula (10%).16 In cases of a long gap or total vaginal replacement, use of the small bowel and, sometimes, the colon seems to be the optimal way of replacing the vagina.17,18
Complications of Female Incontinence Surgery
Published in Kevin R. Loughlin, Complications of Urologic Surgery and Practice, 2007
Fistula formation is usually related to an error in surgical technique. During dissection of the vaginal wall, care should be taken to remain superficial to be periurethral fascia and perivesical fascia. Dissection is best performed sharply, without the use of electrocautery. Entry into the correct plane between the vaginal wall and pubocervical fascia usually leads to a relatively bloodless dissection. Hemostasis may be achieved via temporary vaginal packing or accurate suture placement with a 4-0 self-absorbing suture (SAS). The differential diagnosis includes vaginal discharge, severe SUI, and vesicovaginal fistula. Work-up should include history, physical examination, cystoscopy, vaginoscopy, and voiding cystourethrography. Surgical repair of an urethrovaginal fistula is similar to the technique described for urethral diverticulectomy. Interposition of a labial fat graft is often recommended.
Cloaca: Definitive repair and surgical protocol
Published in Alejandra Vilanova-Sánchez, Marc A. Levitt, Pediatric Colorectal and Pelvic Reconstructive Surgery, 2020
Richard J. Wood, Carlos A. Reck-Burneo, Marc A. Levitt
Patients requiring a urogenital separation, as this patient does due to the very short urethra, require more challenging reconstructive techniques. Identifying these patients up front may facilitate referral to high volume centers as required. Except in cases of very long common channels (with all three structures above the PC line), we would advocate starting with a posterior sagittal approach. The incision runs from the coccyx to just posterior to the common channel. Where possible the common channel should be left intact at the perineal level (Figure 6.1). The wound is widely opened and the surgeon's preoperative understanding of whether the rectum and vagina/s lie above or below the levators (PC line) is important at this point in the operation. If present in the posterior sagittal field the rectum should be identified and mobilized as described for the rectal mobilization in any PSARP. The rectal attachment to the vagina/s or common channel needs to be identified, confirming what was seen on preoperative imaging, and divided. If the connection is to the common channel, care must be taken not to injure or narrow the common channel. At this stage, the posterior vagina is opened close to where it joins the common channel (urethrovaginal fistula). Sutures are placed on the edges of the vagina/s and the surgeon is able to look inside and identify the connection between the vagina/s and the common channel and urethra (Figure 6.2). The next stage is to start the separation of the vagina/s from the common channel, urethra, and bladder neck. This is done in the same way as is performed in a male undergoing a PSARP for a rectourethral fistula, with lateral dissection done first, then anterior (Figure 6.3). The lateral dissection is particularly vital as this plane, once the surgen enters the abdomen, is greatly facilitated by having started the dissection posterior sagittaly.
Urethral diverticulum: A systematic review
Published in Arab Journal of Urology, 2019
Alyssa K. Greiman, Jennifer Rolef, Eric S. Rovner
Early common postoperative complications include: UTI (0–39%), de novo SUI (3.8–33%), and de novo urinary retention (0–9%), especially in the setting of concomitant placement of an autologous pubovaginal sling [1,3,18,19]. Delayed complications such as urethral stricture are reported in 0–5.2% of cases [1,18,22]. Urethrovaginal fistula is a devastating complication presenting in 0.9–8.3% of cases [49]. A distal fistula located beyond the sphincteric mechanism can present with split urinary stream or vaginal voiding and may not require repair. However, a fistula located anywhere from the mid-urethra to the bladder neck may result in UI. These patients should undergo repair with consideration of an adjuvant tissue flap, such as a Martius flap, to aid in closure. The timing of the fistula repair is not well defined, with a delay of 3–6 months after the initial repair generally being a good balance between patient discomfort and optimal tissue quality. Rare complications include: distal urethral necrosis, bladder injury, urethral injury, ureteric injury, and vaginal scarring or narrowing with consequent dyspareunia [49]. Attention to surgical technique including: preservation of periurethral fascia, a well-vascularised anterior vaginal wall flap, multi-layered non-overlapping suture lines, adequate haemostasis, and infection prevention, should minimise the potential for postoperative complications.
An update on research and outcomes in surgical management of vaginal mesh complications
Published in Expert Review of Medical Devices, 2019
Dominic Lee, Philippe E. Zimmern
Specific complications following MUS removal include persistent or recurrent incontinence, urethral stricture, persistent pain or dyspareunia, de novo pain, bladder neck injury, urethral injury requiring immediate or delayed repair, urethrovaginal fistula and need for repeat surgery.