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Complex circumferential obstetric fistula-a urologist's worst nightmare.
Int Urogynecol J. 2020 Jun 23 [Online ahead of print]IU

Abstract

INTRODUCTION AND HYPOTHESIS

Circumferential vesicourethrovaginal fistula is a severe form of obstetric injury that is challenging to repair and carries a poor prognosis related to eventual continence. Here, we report the successful repair of a circumferential vesicovaginal fistula associated with near total loss of the urethra. The use the anterior bladder flap technique along with an autologous rectus sheath sling resulted in the creation of an effective continence unit.

METHODS

A 31-year-old woman had a history of obstructed labor resulting in intrauterine death followed by trans-abdominal hysterectomy for postpartum hemorrhage. Since then she had had total urinary incontinence. She had an attempted repair through the vaginal route, which had failed. Physical examination and endoscopic evaluation revealed a large vesicourethrovaginal fistula with near total loss of the urethra leaving only the meatus. Intraoperatively, we found that it was a large circumferential defect in the infratrigonal region with no anterior bladder wall left at the site of the fistula.

RESULTS

We performed an anterior bladder flap procedure as described by Tanagho along with an autologous rectus sheath sling for additional support. Postoperatively, the patient was completely continent.

CONCLUSIONS

The anterior bladder onlay flap technique, which has been used extensively for female urethral reconstruction in developed countries, along with an autologous rectus sheath sling is an effective technique for management of circumferential fistulas allowing good continence. Incorporation of this technique into the armamentarium of surgeons managing fistulas in developing countries will go a long way toward helping this unfortunate group of women with this morbid complication of obstructed labor.

Authors+Show Affiliations

Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Prashantigram, Puttaparthi, Andhra Pradesh, 515134, India. ashwindoc1@yahoo.com.Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Prashantigram, Puttaparthi, Andhra Pradesh, 515134, India.Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Prashantigram, Puttaparthi, Andhra Pradesh, 515134, India.Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Prashantigram, Puttaparthi, Andhra Pradesh, 515134, India.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32577790

Citation

Ashwin Shekar, P, et al. "Complex Circumferential Obstetric Fistula-a Urologist's Worst Nightmare." International Urogynecology Journal, 2020.
Ashwin Shekar P, Dumra A, Pal BC, et al. Complex circumferential obstetric fistula-a urologist's worst nightmare. Int Urogynecol J. 2020.
Ashwin Shekar, P., Dumra, A., Pal, B. C., & Gopalakrishnan, G. (2020). Complex circumferential obstetric fistula-a urologist's worst nightmare. International Urogynecology Journal. https://doi.org/10.1007/s00192-020-04398-y
Ashwin Shekar P, et al. Complex Circumferential Obstetric Fistula-a Urologist's Worst Nightmare. Int Urogynecol J. 2020 Jun 23; PubMed PMID: 32577790.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Complex circumferential obstetric fistula-a urologist's worst nightmare. AU - Ashwin Shekar,P, AU - Dumra,Anuj, AU - Pal,Bipin Chandra, AU - Gopalakrishnan,Ganesh, Y1 - 2020/06/23/ PY - 2020/04/15/received PY - 2020/06/12/accepted PY - 2020/6/25/entrez KW - Bladder flap KW - Circumferential fistula KW - Obstetric KW - Reconstruction KW - Surgery KW - Vesicovaginal JF - International urogynecology journal JO - Int Urogynecol J N2 - INTRODUCTION AND HYPOTHESIS: Circumferential vesicourethrovaginal fistula is a severe form of obstetric injury that is challenging to repair and carries a poor prognosis related to eventual continence. Here, we report the successful repair of a circumferential vesicovaginal fistula associated with near total loss of the urethra. The use the anterior bladder flap technique along with an autologous rectus sheath sling resulted in the creation of an effective continence unit. METHODS: A 31-year-old woman had a history of obstructed labor resulting in intrauterine death followed by trans-abdominal hysterectomy for postpartum hemorrhage. Since then she had had total urinary incontinence. She had an attempted repair through the vaginal route, which had failed. Physical examination and endoscopic evaluation revealed a large vesicourethrovaginal fistula with near total loss of the urethra leaving only the meatus. Intraoperatively, we found that it was a large circumferential defect in the infratrigonal region with no anterior bladder wall left at the site of the fistula. RESULTS: We performed an anterior bladder flap procedure as described by Tanagho along with an autologous rectus sheath sling for additional support. Postoperatively, the patient was completely continent. CONCLUSIONS: The anterior bladder onlay flap technique, which has been used extensively for female urethral reconstruction in developed countries, along with an autologous rectus sheath sling is an effective technique for management of circumferential fistulas allowing good continence. Incorporation of this technique into the armamentarium of surgeons managing fistulas in developing countries will go a long way toward helping this unfortunate group of women with this morbid complication of obstructed labor. SN - 1433-3023 UR - https://www.unboundmedicine.com/medline/citation/32577790/Complex_circumferential_obstetric_fistula-a_urologist's_worst_nightmare L2 - https://dx.doi.org/10.1007/s00192-020-04398-y DB - PRIME DP - Unbound Medicine ER -
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