Abstract
In this paper our aim is to present a vesicovaginal fistula case that recurred in the 25th postoperative year and emphasize a urogenital fistula which is one of the uncommon complications of the pelvic surgery and assess the diagnostic and management methods.
A-63 year old female, G7P6Y5 had presented with the symptom of continuous urine leak from the vagina to our clinic. She had a history of total abdominal hysterectomy 25 years ago and three re-operations due to development of vesicovaginal fistula in the postoperative period. Though the last 20 years was uneventful, it was inquired that the urinary incontinence repeated in the last year again. Pelvic examination revealed recurrent 1 cm fistula orifice with active urine drainage 1 cm lateral to the center of the vaginal cuff. After methylene blue instillation to the bladder, colored liquid leak was observed from the fistula orifice. Intrabladder orifice of the fistula in the base of the bladder was also visualized in intraoperative cystoscopy. Defect was closed in a helezonic manner using non-absorbable suture material by layered closure method.
Success in genitourinary system fistula depends not only on the appropriate surgical technique and rules but also the careful and correct postoperative wound care.
References
- 1. Ayed M, El Atat R, Haşşine BL, Sfaxi M, Chebil M, Zmerii S. Prognostic factors of recurrence after vesicovaginal fistula repair. Int J Urol 2006;13(4):345-9.
- 2. 'ancer M Observations on prevention and management of vesicovaginal fistula after total hysterectomy. Surg Gynecol Obstet '992;175(6):501-6.
- 3. VVall LL, Arrowsmith SD, Briggs ND, Brown-ng A, Lessey A. The obstetric vesicovaginal fstula in the developing world. Obstet Gynecol Surv 2005;60(7 Suppl 1):S3-S51.
- 4. Margolis T, Mercer LJ. Vesicovaginal fistula. Obstet Gynecol Surv 1994;49(12):840-7.
- 5. Goodwin WE, Scardino PT. Vesicovaginal and ureterovaginal fistulas:a summary of 25 years of experience. J Urol 1980;123(3):370-4.
- 6. Reynolds WS, Gottlieb LJ, Lucioni A, Rapp DE, Song DH, Bales GT. Vesicovaginal fistula repair with rectus abdominus myofascial interposition flap Urology 2008; 71:1119-23.
- 7. Shoukry MS, Hassouna ME, El-Salmy S, Ab-del-Karim AM. Vaginal flap re-inforcement of vesico-vaginal fistula repair. Int Urogynecol J Pelvic Floor Dysfunct. 2010;21:829-33.
- 8. Abdel-Karim AM, Mousa A, Hasouna M, El-salmy S. Laparoscopic transperitoneal ex-travesical repairof vesicovaginal fistula. Int Urogynecol J 2010; 25:1334-7.
- 9. Angioli R, Penalver M, Muzii L, Mendez L, Mirhashemi R, Bellati F, et al. Guidelines of how to manage vesicovaginal fistula. Crit Rev Oncol Hematol 2003;48(3):295-304.
Abstract
Bu yazıda amacımız postoperatif 25. yılda nükseden bir vezikovajinal fistül olgusunu sunmaktır. Ayrıca pelvik cerrahinin nadir komplikasyonlarından biri olan ürogenital fistüllere dikkat çekerek fistüllerin nedenleri, tanı ve tedavi yöntemlerini değerlendirmektir.
Altmış üç yaşında, G7P6Y5 olgu vajenden sürekli idrar gelmesi şikâyetiyle kliniğimize başvurdu. Özgeçmişinden 25 yıl önce total abdominal histerektomi operasyonu yapıldığı; postoperatif dönemde vezikovajinal fistül nedeniyle 3 yıl içinde üç kez öpere edildiği; 20 yıl sorunsuz geçmesine rağmen, son bir yılda idrar kaçırma şikâyetinin tekrarladığı öğrenildi. Pelvik muayenede vajinal kaf orta hattının yaklaşık 1cm lateralinde, 1 mm çapında, aktif idrar drenajı izlenen fistül orifısi görülerek fıstülün nüksettiği görüldü. Mesane içine dilüe metilen mavisi uygulandıktan sonra, fistül orifisinden boyalı sıvı akışı izlendi. İntraoperatif sistoskopide fistülün mesane tabanındaki orifisi de görüldü. Defekt emilmeyen sütür materyali kullanılarak tabakalı kapatma (layered closure) yöntemiyle helezon tarzında kapatıldı.
Genitoüriner sistem fistüllerinin cerrahi tedavisindeki başarı; uygulanan cerrahi teknik ve kuralların yanında postoperatif yara bakımının da dikkatli ve uygun şeklide yapılmasına bağlıdır.
Dr. Serpil AYDOĞMUŞ,
Dr. H. Levent KESKİN,
Dr. Işık ÜSTÜNER,
Dr. Emine ÇELEN,
Dr. Mustafa UZUN,
Dr. Ayşegül ÇİNKAYA,
Dr. Hacer SADIKOĞLU,
Dr. A. Akın SİVASLIOĞLU,
Dr. A. Filiz AVŞAR
References
- 1. Ayed M, El Atat R, Haşşine BL, Sfaxi M, Chebil M, Zmerii S. Prognostic factors of recurrence after vesicovaginal fistula repair. Int J Urol 2006;13(4):345-9.
- 2. 'ancer M Observations on prevention and management of vesicovaginal fistula after total hysterectomy. Surg Gynecol Obstet '992;175(6):501-6.
- 3. VVall LL, Arrowsmith SD, Briggs ND, Brown-ng A, Lessey A. The obstetric vesicovaginal fstula in the developing world. Obstet Gynecol Surv 2005;60(7 Suppl 1):S3-S51.
- 4. Margolis T, Mercer LJ. Vesicovaginal fistula. Obstet Gynecol Surv 1994;49(12):840-7.
- 5. Goodwin WE, Scardino PT. Vesicovaginal and ureterovaginal fistulas:a summary of 25 years of experience. J Urol 1980;123(3):370-4.
- 6. Reynolds WS, Gottlieb LJ, Lucioni A, Rapp DE, Song DH, Bales GT. Vesicovaginal fistula repair with rectus abdominus myofascial interposition flap Urology 2008; 71:1119-23.
- 7. Shoukry MS, Hassouna ME, El-Salmy S, Ab-del-Karim AM. Vaginal flap re-inforcement of vesico-vaginal fistula repair. Int Urogynecol J Pelvic Floor Dysfunct. 2010;21:829-33.
- 8. Abdel-Karim AM, Mousa A, Hasouna M, El-salmy S. Laparoscopic transperitoneal ex-travesical repairof vesicovaginal fistula. Int Urogynecol J 2010; 25:1334-7.
- 9. Angioli R, Penalver M, Muzii L, Mendez L, Mirhashemi R, Bellati F, et al. Guidelines of how to manage vesicovaginal fistula. Crit Rev Oncol Hematol 2003;48(3):295-304.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Obstetrics and Gynaecology |
| Journal Section | Case Reports |
| Authors | |
| Publication Date | November 22, 2010 |
| Published in Issue | Year 2010 Volume: 4 Issue: 3 |
