Do we need new surgical techniques to repair vesico-vaginal fistulas?

Do we need new surgical techniques to repair vesico-vaginal fistulas?

Autor Zambon, Joao Paulo Autor UNIFESP Google Scholar
Batezini, Nelson S. S. Autor UNIFESP Google Scholar
Pinto, Eduardo R. S. Autor UNIFESP Google Scholar
Skaff, Milton Autor UNIFESP Google Scholar
Girotti, Marcia E. Autor UNIFESP Google Scholar
Almeida, Fernando G. Autor UNIFESP Google Scholar
Instituição Universidade Federal de São Paulo (UNIFESP)
Resumo The urogenital fistula is a devastating condition for women. Despite advances in medical care, the vesicovaginal fistula continues to be a distressful problem. Complex vesicovaginal fistulae repair may need tissue interposition. It can be achieved by vaginal or abdominal approach and depends on the surgeon's experience and local factors like size, location, and previous radiotherapy. the aim of this study was to demonstrate that using traditional approaches is possible and reasonable to treat any sort of vesicovaginal fistula.Between January 2004 and August 2007, we treated 23 patients with complex urogenital fistulae. of those with concomitant ureteral fistula requiring re-implantation or bladder augmentation, the vaginal approach was the first choice in 17 and abdominal approach in six. Patients were clinically evaluated at 1, 4, and 12 weeks postoperatively, then every 3 months in the first year.Seventeen women were treated by vaginal approach and six patients were treated by abdominal approach. Hysterectomy was the major etiology (73.9%). Ten patients (43.5%) had at least one previous abdominal surgery for fistulae repair without success before. in those patients with abdominal approach, the hospitalization was longer than vaginal approach (80.5+/-6 h versus 48+/-3 h). in both, there were no major intraoperative or postoperative complications; 13% developed urgency and 4% developed stress urinary incontinence. No patients have recurrence of fistulae (success rate 100%).Complex vesicovaginal fistulas are a big challenge for the urologist, and there is no gold standard surgical approach. the majority of complex vaginal fistula can be successfully managed by vaginal repair. As the vaginal approach is a minimally invasive procedure with low costs, easy learning curve, and high cure rates, new approaches must be carefully evaluated before being suggested as an alternative.
Palavra-chave Vesicovaginal fistula
Vaginal approach
O' Connor technique
Idioma Inglês
Data de publicação 2010-03-01
Publicado em International Urogynecology Journal. Artington: Springer London Ltd, v. 21, n. 3, p. 337-342, 2010.
ISSN 0937-3462 (Sherpa/Romeo, fator de impacto)
Publicador Springer
Extensão 337-342
Fonte http://dx.doi.org/10.1007/s00192-009-1040-5
Direito de acesso Acesso restrito
Tipo Artigo
Web of Science WOS:000274251500013
Endereço permanente http://repositorio.unifesp.br/handle/11600/32317

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