Effectiveness and initial outcomes of transvesicoscopic bipolar sealing of vesicovaginal fistula

Yıl 2020, , 267 - 270, 01.04.2020

Ali Akkoç , Cemil Aydın

https://doi.org/10.28982/josam.711337

Öz

Aim: Vesicovaginal fistula (VVF) is a social and psychological problem for the female population, causing urinary incontinence and foul-smelling urine. Open, laparoscopic, robotic, and various minimally invasive techniques have been described for the treatment of VVF. In this study, we presented the effectiveness and initial outcomes of transvesicoscopic bipolar sealing of vesicovaginal fistula (TBSF), a novel, minimally invasive technique which we had previously described.
Methods: This surgical case series included 9 patients with VVF of <1 cm located away from ureteral orifices who underwent TBSF from July 2015 to December 2019. The fistula tract was sealed transvesicoscopically with a bipolar vessel sealer. All patients were informed about the modified surgical procedure prior to the operation.
Results: The mean age of the patients was 47.2 (4.6) years. The mean fistula diameter was 6.6 (1.2) mm. The mean operation time was 41 (9.7) minutes. The hospital stay was 1 day in all cases. After catheter removal at 3 weeks, 8 (89 %) patients remained dry while one (11%) patient experienced continuous incontinence.
Conclusion: Transvesicoscopic bipolar sealing of vesicovaginal fistula is a simple and safe procedure to perform for small VVF, has a short learning curve and operative time, and results in reduced blood loss and morbidity, brief hospital stay and improved cosmesis.

Anahtar Kelimeler

Vesicovaginal fistula, Sealing, Bipolar, Transvesicoscopic, Laparoscopic

Vezikovajinal fistülün transvezikoskopik olarak bipolar mühürlenmesinin etkinliği ve ilk sonuçları

Öz

Amaç: Vezikovajinal fistül (VVF), idrar kaçırma ve idrar kokusu nedeniyle, kadınlar için sosyal ve psikolojik bir problemdir. VVF tedavisi için açık, laparoskopik, robotik ve çeşitli minimal invaziv tedavi seçenekleri tanımlanmıştır. Bu çalışmada, daha önce tarif ettiğimiz yeni bir minimal invaziv teknik olan vezikovajinal fistülün transvesikoskopik yolla bipolar mühürlenmesinin etkinliğini ve ilk sonuçlarını sunduk.
Yöntemler: Cerrahi olgu serisi olarak planlanan bu çalışmada, Temmuz 2015-Aralık 2019 tarihleri arasında, üreter orifislerinden uzak yerleşimli ve çapı 1 cm'den küçük vezikovajinal fistülü olan, 9 hastaya transvezikoskopik olarak bipolar damar mühürleme cihazı kullanılarak vezikovajinal fistül mühürleme işlemi gerçekleştirildi. Tüm hastalar ameliyat öncesi modifiye cerrahi prosedür hakkında bilgilendirildi.
Bulgular: Hastaların ortalama yaşı 47,2 (4,6) yıldı. Ortalama fistül çapı 6,6 (1,2) milimetre, ortalama ameliyat süresi 41 (9,7) dakikaydı. Tüm hastalarda hastanede kalış süresi 1 gündü. 3. haftada kateter çıkarıldıktan sonra 8 (%89) hasta kontinan olup, bir (%11) hastada nüks izlendi.
Sonuç: Vezikovajinal fistülün transvesicoskopik yolla bipolar mühürlenmesi; kısa öğrenme eğrisi ve ameliyat süresi, azalmış kan kaybı ve morbidite oranı, kısa hastanede kalış süresi ve iyi kozmetik sonuçları ile küçük fistüller için uygulaması kolay ve güvenli bir prosedürdür.

Anahtar Kelimeler

Vezikovajinal fistül, Mühürleme, Bipolar, Transvezikoskopik, Laparoskopik

Kaynakça

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