Vezikovajinal fistülün transvajinal ve abdominal teknik ile onarımı: Pamukkale Üniversitesi Üroloji Kliniği sonuçları

Öz

Amaç: Vezikovajinal fistül (VVF), mesane ve vajina arasındaki bir trakttan idrar kaçırmaya sebep olan, yaşam kalitesini, sosyal hayatı ve hasta sağlığını olumsuz etkileyen patolojik bir durumdur. VVF onarımında tercih edilen yöntem hastanın, fistülün özelliklerine göre ve cerrahın deneyimine göre yapılmaktadır. Vajinal ve abdominal VVF onarımı tercihinde kesinleşmiş kılavuz bilgileri bulunmamaktadır. Bu çalışmada, kliniğimizde opere edilen VVF vakaları retrospektif olarak değerlendirilerek hasta özelliklerinin ve sonuçlarının literatür ile karşılaştırılarak yorumlanması amaçlanmaktadır. Gereç ve yöntem: Bu çalışmada kliniğimizde vajinal ve abdominal VVF onarımı yapılan 35 hastanın verileri retrospektif olarak değerlendirildi. Bulgular: Hastaların 12’sinde (%34,3) abdominal yöntem tercih edilirken 23 (%65,7) hastada transvajinal yöntem tercih edildi. Kliniğimizde uygulanan VVF cerrahisinin başarı oranı %88,6 olarak tespit edilmiştir. Vajinal onarımda %91,4, abdominal onarımda ise %83,4 olarak birbirine yakın başarı oranları görüldü. Transvajinal teknik tercih edilen 23 hastanın 2’sinde (%8,6) ve abdominal teknik tercih edilen 12 hastanın ise 2’sinde (%16,6) nüks izlendi. Sonuç: Vezikovajinal fistül cerrahisinde hastanın ve fistülün özellikleri tercih edilecek cerrahiye yön gösterse de özellikle cerrahın deneyimi büyük rol oynamaktadır. Vajinal ve abdominal VVF cerrahisi birbirine benzer ve yüksek başarı oranları ile uygulanmaktadır.

Anahtar Kelimeler

• Vezikovajinal fistül
• vajinal vezikovajinal fistül onarımı
• abdominal vezikovajinal fistül onarımı

Repair of vesicovaginal fistula with transvaginal and abdominal technique: Pamukkale University Urology Clinic results

Öz

Purpose: Vesicovaginal fistula (VVF) is a pathological condition that causes urinary incontinence from a tract between the bladder and the vagina, negatively affecting the quality of life, social life, and patient health. The preferred method for VVF repair depends on the patient's characteristics, the features of the fistula, and the surgeon's experience. There is no definitive guideline for choosing between vaginal and abdominal VVF repair. This study aims to retrospectively evaluate VVF cases operated on in our clinic, comparing and interpreting patient characteristics and outcomes with the literature. Materials and methods: The data of 35 patients who underwent vaginal and abdominal VVF repair in our clinic were evaluated retrospectively. Results: Transvaginal repair was preferred in 23 (65.7%) of the patients and abdominal repair was preferred in 12 (34.3%). The success rate of VVF surgery performed in our clinic was determined to be 88.6%. Success rates were similar; 91.4% in vaginal repair and 83.4% in abdominal repair. Recurrence was observed in 2 of 23 patients (8.6%) who underwent transvaginal repair and in 2 of 12 patients (16.6%) who underwent abdominal repair. Conclusion: In vesicovaginal fistula surgery, patient characteristics and fistula characteristics guide the preferred surgery. However, the surgeon's experience also plays a big role. Vaginal and abdominal VVF surgeries are performed with similar high success rates.

Anahtar Kelimeler

• Vesicovaginal fistula
• vaginal vesicovaginal fistula repair
• abdominal vesicovaginal fistula repair

Kaynakça

1. 1. Malik MA, Sohail M, Malik MT, Khalid N, Akram A. Changing trends in the etiology and management of vesicovaginal fistula. International Journal of Urology 2018;25:25-29. https://doi.org/10.1111/iju.13419
2. 2. De Ridder D. Vesicovaginal fistula: a major healthcare problem. Current Opinion in Urology 2009;19:358-361. https://doi.org/10.1097/MOU.0b013e32832ae1b7
3. 3. Shrestha DB, Budhathoki P, Karki P, et al. Vesico-vaginal fistula in females in 2010–2020: a systemic review and meta-analysis. Reproductive Sciences 2022;29:3346-3364. https://doi.org/10.1007/s43032-021-00832-8
4. 4. Medlen H, Barbier H. Vesicovaginal Fistula. StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.
5. 5. Angioli R, Penalver M, Muzii L, et al. Guidelines of how to manage vesicovaginal fistula. Critical Reviews in Oncology/Hematology 2003;48:295-304. https://doi.org/10.1016/s1040-8428(03)00123-9
6. 6. Kumar S, Kekre NS, Gopalakrishnan G. Vesicovaginal fistula: an update. IJU 2007;23:187-191. https://doi.org/10.4103/0970-1591.32073
7. 7. El Azab AS, Abolella HA, Farouk M. Update on vesicovaginal fistula: a systematic review. Arab Journal of Urology 2019;17:61-68. https://doi.org/10.1080/2090598X.2019.1590033
8. 8. Tancer ML. Observations on prevention and management of vesicovaginal fistula after total hysterectomy. Surg Gynecol Obstet 1992;175:501-506.

9. 9. Zumrutbas AE, Ozlulerden Y, Alkis O, Baser A, Aybek Z. Optic-guided vaginal repair of vesicovaginal fistula. Journal of Endourology 2014;28:275-279. https://doi.org/10.1089/end.2013.0435
10. 10. Hillary CJ, Osman NI, Hilton P, Chapple CR. The aetiology, treatment, and outcome of urogenital fistulae managed in well-and low-resourced countries: a systematic review. European Urology 2016;70:478-492. https://doi.org/10.1016/j.eururo.2016.02.015
11. 11. Kaplan Ö, Güney M. Obstetrik ve jinekolojik operasyonlar sonrasında gelişen vezikovajinal fistüllerin retrospektif değerlendirilmesi. SDÜ Tıp Fak Derg 2014;21:72-77.
12. 12. Ayed M, Atat RE, Hassine LB, Sfaxi M, Chebil M, Zmerli S. Prognostic factors of recurrence after vesicovaginal fistula repair. International Journal of Urology 2006;13:345-349. https://doi.org/10.1111/j.1442-2042.2006.01308.x
13. 13. Blaivas JG, Heritz DM, Romanzi LJ. Early versus late repair of vesicovaginal fistulas: vaginal and abdominal approaches. J Urol 1995;153:1110-1113.
14. 14. McKay E, Watts K, Abraham N. Abdominal approach to vesicovaginal fistula. Urol Clin N Am 2019;46:135-146. https://doi.org/10.1016/j.ucl.2018.08.011
15. 15. Ockrim JL, Greenwell TJ, Foley CL, Wood DN, Shah PJR. A tertiary experience of vesico‐vaginal and urethro‐vaginal fistula repair: factors predicting success. BJU International 2009;103:1122-1126. https://doi.org/10.1111/j.1464-410X.2008.08237.x
16. 16. Kapoor R, Ansari M, Singh P, et al. Management of vesicovaginal fistula: an experience of 52 cases with a rationalized algorithm for choosing the transvaginal or transabdominal approach. Indian J Urol 2007;23:372-376. https://doi.org/10.4103/0970-1591.36709
17. 17. Pushkar DY, Dyakov VV, Kasyan GR. Management of radiation-induced vesicovaginal fistula. European Urology 2009;55:131-138. https://doi.org/10.1016/j.eururo.2008.04.044
18. 18. Langkilde NC, Pless TK, Lundbeck F, Nerstrøm B. Surgical repair of vesicovaginal fistulae: a ten-year retrospective study. Scand J Urol Nephrol 1999;33:100-103. https://doi.org/10.1080/003655999750016069
19. 19. Tenggardjaja CF, Goldman HB. Advances in minimally invasive repair of vesicovaginal fistulas. Curr Urol Rep 2013;14:253-261. https://doi.org/10.1007/s11934-013-0316-y