Research that identifies the different profiles of women who manage to overcome the obstacles and successfully access health care, compared to those who do ..... tion or injury, the early diagnosis is life saving. ..... sequence of cancer treatment by surgery, radiothera- .... vaginal fistula in one of 21 women operated on dur-.
Committee 18
Fistula
Chair Dirk De Ridder (Belgium) Members Obstetrical fistula* Paul Abrams (UK) Catherine De Vries (USA) Suzy Elneil (UK) Alice Emasu (Uganda) Gloria Esegbono (UK/Nigeria) Serigne Gueye (Senegal) Rahmat Mohammad (Nigeria) Sherif Mourad (Egypt) Mulu Muleta (Ethiopia) Non-obstetrical fistula Paul Hilton (UK) Sherif Mourad (Egypt) Robert Pickard (UK) Edward Stanford (USA) Consultant Eric Rovner (USA) *The obstetrical fistula part contains the scientific summary of the ICI meeting held in Marrakech, Marocco 2010. The full text of all obstetrical fistula chapters will be published as a separate volume.
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CONTENTS GENERAL INTRODUCTION
V. DIAGNOSIS OF FISTULA 1. CLINICAL DIAGNOSIS 2. DIAGNOSIS OF GI FISTULA 3. RECOMMENDATIONS
A. Obstetrical fistula I. INTRODUCTION
VI. MANAGEMENT OF VESICO-VAGINAL FISTULA
II. WOMEN, FISTULA SURGEONS, NGOS AND GOVERNMENTS 1. 2. 3. 4.
EPIDEMIOLOGY OF VVF PREVENTION OF VVF UNMET NEEDS IN VVF MANAGEMENT OF NEW AND ESTAB LISHED VVFS 5. CLASSIFICATION OF VVF 6. MANAGEMENT OF THE COMPLICATIONS OF VVF 7. SOCIAL RE-INTEGRATION OF TREATED WOMEN
1. 2. 3. 4.
VII. MANAGEMENT OF GI FISTULA 1. 2. 3. 4.
B. Non-obstetrical fistula I. INTRODUCTION II. EPIDEMIOLOGY 1. 2. 3. 4. 5. 6.
POST-GYNAECOLOGICAL SURGERY ONCOLOGICAL FISTULA CANCER SURGERY RADIATION FISTULA CHEMOTHERAPY COMBINATION THERAPIES
III. URETERIC FISTULA
CONSERVATIVE MANAGEMENT SURGICAL MANAGEMENT POST-OPERATIVE MANAGEMENT MANAGEMENT OF RADIATION FISTULA
LITERATURE REVIEW NON-SURGICAL MANAGEMENT SURGICAL MANAGEMENT RECOMMENDATIONS
VIII. MANAGEMENT OF URETERIC FISTULA 1. 2. 3. 4.
GENERAL PRINCIPLES EVIDENCE QUALITY EVIDENCE SUMMARY RECOMMENDATIONS
IX. MANAGEMENT OF URETHRO-VAGINAL FISTULA 1. 2. 3. 4. 5. 6.
INTRODUCTION AETIOLOGY DIAGNOSIS SURGICAL REPAIR COMPLICATIONS FOLLOW UP
REFERENCES
IV. FISTULA INVOLVING THE GI TRACT
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Fistula Dirk De Ridder Obstetrical
fistula :
Paul Abrams, Catherine De Vries, Suzy Elneil, Alice Emasu,
Gloria Esegbono, Serigne Gueye, Rahmat Mohammad, Sherif Mourad Non-obstetrical fistula: Paul Hilton, Sherif Mourad, Robert Pickard, Edward Stanford Consultant Eric Rovner GENERAL INTRODUCTION In the developing world fistula are often a consequence of poor peri-natal care. The epidemiology, aetiology, diagnosis, treatment and prevention have been described in detail during the recent International Consultations on Incontinence.[1, 2] In contrast to the field of obstetrical fistula where the numbers of patients are high, the prevalence of non-obstetrical fistula seems to be much lower. The published series deal with small numbers, are usually retrospective and have a low level of evidence. The published obstetrical series show impressive numbers and demonstrate the level of skill that many of the fistula surgeons have obtained while working in difficult and isolated situations. In this consultation the main focus has been put on iatrogenic fistula in the developed world. An entirely new chapter was compiled on this subject. Despite the fact that the main focus was to write a chapter on iatrogenif fistula, in this edition the scientific summary of the International Consultation on Vesicovaginal fistula in the developing world, which was held in Marrakech, Marocco in 2010 was added to the text. Both committees are convinced that obstetric fistula surgeons in the developing world and reconstructive pelvic surgeons in the developed countries can learn a lot from each other. Combining the obstetrical and iatrogenic fistula into one chapter will facilitate interaction and exchange of knowledge and ideas in this difficult field of fistula repair.
A. Obstetrical fistula I. INTRODUCTION The First ICUD-SIU Consultation on Vesico-Vaginal Fistula was held at the SIU meeting in Marrakech, Morocco, October 13th – 16th 2010. The recommen-
dations are evidence-based, following a thorough review of the available literature and the opinion of recognised experts serving on the six committees. The individual committee reports were developed and peer-reviewed by open presentation and comment. Review of the literature showed no Level 1 evidence in that there were no randomised controlled trials. All evidence was confined to case series and observational data: Level 3 and 4 evidence. Hence, all recommendations were Grade B and C. The Scientific Committee includes the chairmen of the six committees, who refined the final recommendations. These recommendations published in 2011, will be periodically re-evaluated in the light of clinical experience, technological progress and research. These recommendations are taken from the full versions of the six Consultation chapters, from Epidemiology through to Social Reintegration. These chapters provide the full documentation of the existing scientific literature on the six topic areas.
II. WOMEN, FISTULA SURGEONS, NGOS AND GOVERNMENTS The effect on a woman, in the developing world, of having a VVF resulting from obstructed labour, is disastrous from her point of view, the family perspective and for her society. It is estimated that there are two million women, in developing countries, mainly in sub-Saharan Africa, the Indian sub-continent and South- East Asia, who have either undetected or untreated VVFs. New fistulas are probably occurring at the rate of 82,000 new cases per year, yet only 10,000 operations for fistula closure are being done annually. Hence, this leaves a huge unmet need. VVF, in itself, is bad enough, but it is also inextricably linked with high maternal mortality rate and high infant death rate. Hence the solution to fistula is similar to the solutions that will drive down the maternal mortality rate and the infant death rate. The solutions are not only medical, but also social and political. At present, women in developing countries are often dependent on donations that reach their country
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through non-governmental organisations (NGOs) and charities. The relationship between the NGOs and the fistula surgeons are critical. The fistula surgeons are the experts and those to whom fistula women turn for help. Hence, it is vital that the NGOs allow themselves to be guided by the fistula surgeons as to the priorities within their sphere of work. The vital role of the NGOs is to provide financial and logistical support. Support is also essential to allow the fistula surgeons to write up their work. This is often a considerable problem, as their commitment to the women means that their academic time is restricted. Nevertheless, the data the fistula surgeons generate is their intellectual property, and it is vital that they retain primary authorship of all published material. There are an enormous number of committed and dedicated individuals from both within the developing countries and from developed countries who have committed themselves to the cause of helping women with this dreadful condition. However, the long-term solution must see the responsibilities for women’s and children’s health passing to the governments of the individual countries. Nevertheless, in the meantime, those many dedicated individuals will continue to strive to help as many women as possible return to a life in their own community.
the delivery location. The reason for the woman not receiving help rarely differentiates between the absence of health-seeking behaviour and the lack of services. The only observational study showed no substantial difference between VVF patients and women who delivered without fistula, both in terms of their use of orthodox health care services and more traditional forms of support before childbirth. Recommendations 1. Community-based epidemiological studies using standardised and validated collection tools with acceptable sensitivity and specificity are highly recommended. 2. A validated standardised collection tool should be developed and used in national surveys to facilitate the collection and comparison of data when assessing the regional, continental and global magnitude of VVF and the distribution of fistula world-wide. 3. Prospective longitudinal community-based studies are needed to estimate the incidence of obstetric fistula. 4. Observational studies are needed, utilising advanced epidemiological analyses for: -R isk factors (multivariate analysis controlling potential biases)
1. EPIDEMIOLOGY OF VVF
- Impacts and consequences of VVF
Epidemiological studies on obstetric fistula are inadequate. • They are mainly institutionally-based, retrospective cases series, often written from the perspective of a single fistula surgeon • The geographical coverage of epidemiological reports is uneven • However, better and more relevant information is emerging. The incidence of fistula is expressed per 1,000 deliveries and would appear to be between 0.1% rising to 1.5 per 1,000 pregnancies in rural areas. The major risk factors appear to be age at first marriage, short stature, pregnancy with a male child rather than a female child, failure to attend antenatal care, low socio-economic status, low social class, lack of employment and illiteracy. The consequences of obstetric fistula include divorce (16-92%), social isolation, worsening poverty, malnutrition, sexual dysfunction and mental illness (including anxiety/depression), insomnia, general ill health and thoughts of worthlessness and suicide. There are few detailed reports documenting these women’s obstructed labours. The time of onset of labour is rarely recorded and reports from delivery locations may disregard the fact that the woman has laboured at home for days prior to attending
- Determining health-seeking behaviour 5. Research that identifies the different profiles of women who manage to overcome the obstacles and successfully access health care, compared to those who do not, is recommended. 6. The contribution of other factors, such as ethnic background and malnutrition, needs to be researched and understood. 7. It is recommended that there is long-term follow up of patients following fistula repair to understand their ongoing quality of life and any long-term sequelae and their ongoing needs.
2. PREVENTION OF VVF VVF is a characteristic of abject poverty, a clear marker of failure of political, social and health systems to protect and promote women’s health and their rights. Prevention of VVF is ultimately linked to prevention of maternal and infant mortality and is a requirement of MDG5 of 2000. Prevention, from the medical and public health point of view, mitigates the effect of VVF in the overall burden of pain and suffering the condition imposes, not just on the patient herself, but her family and the entire community. History has shown that improvements in the functioning of local health services dramatically reduce the incidence of maternal death, infant mortality and vesico-vaginal fistula. The following areas of health system improvement and capacity building need to be considered:
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• Enhancing professionalism among health care workers to make the system work better. • Massive infrastructural developments through strengthening existing government health facilities, and advocacy, to maximise the benefits that a political environment sensitive to the needs of these women, is required. • Ensuring that facilities are properly equipped, monitored and supervised with an emphasis on quality as well as quantity of service provision. Systematic improvements are required to address the social and economic inequalities, such as the low status of women, lack of education for girls, early marriages and pregnancy, malnutrition, poverty, inadequate health and transportation infrastructure, and harmful traditional practices, such as female genital mutilation. Health and maternal care are inextricably linked to the availability of financial resources, to the individual in the community and within the country as a whole: as economic conditions improve, the risk of VVF diminishes. Another key stratagem, in preventing VVF, is the empowerment of women and their spouses, to develop birth preparedness plans, within the context of family planning. Family planning in wealthy regions is available according to the choice of the individual, whilst in other developing areas, such as China, it is actively encouraged, or even enforced. Other components of public health care, such as addressing the special nutritional needs of girl children and the requirements of improving their physical health, in order to improve their physical growth and maturity, are also very important. Education of the community is vital so that young women understand what VVF is, are made aware of the need to engage in the ante-natal care process, and plan for their delivery, including making transportation plans for use when they go into labour. Prevention strategies can be considered in public health terms as primary, secondary or tertiary:
• Primary prevention addresses many of the indirect causes which are essential the root causes of fistula. It attempts to reduce or eliminate the risk of the disease and by, amongst other actions, reducing the high levels of illiteracy among women. It also seeks to widen the cadre of care workers by involving, for instance, traditional birth attendants (TBA) • Secondary prevention attempts to limit the severity of the disease by detecting it at its earliest stages. •T ertiary prevention aims to mitigate the effects of the existing disease, for example by effective treatment. The work of Haddon and Maine in the Haddon Matrix and Maine’s Three Delays provide documented approaches to the problems. Maine’s Three Delays: • The first delay: the decision to seek care is influenced by the socio-economic and cultural factors in that woman’s environment. These can include the need to obtain permission from a husband or male family member to seek care, or the community perception that only weak women need assistance with delivery and that strong women can manage delivery on their own. • The second delay is delayed arrival at the health facility. Once the first delay has occurred, the second delay becomes more serious. Road conditions, transportation and communication deficiencies may conspire to delay the woman’s arrival at a hospital or birthing centre. • The third delay is the delayed provision of adequate care at the facility, and may be due to lack of staff, supplies, or electricity. If the lights are out and there is no back-up generator or fuel, a caesarean section cannot be done. If there is no way to reach a doctor or medical officer because there are no telephones, or if equipment hasn’t been sterilised, then timely surgery cannot be performed. These three stages of delay disproportionately affect the world’s poor and, in particular, those women living in rural areas.
Table 1. Categories of Prevention Strategies: The Haddon Matrix
Primary Prevention
Secondary Prevention
Tertiary Prevention
Nutrition Education of girl child and engagement of TBAs Delayed marriage Training of medical staff/midwives Roads, ambulance, functioning health facilities Communication Adequate facilities, equipment and staff Electricity
Transportation Maternity waiting houses Field surveys Partographs Low gynaecological age
Treatment /repairs (surgery) Physical / social / economic rehabilitation and re-integration Media campaigns
Caesarean section (Symphysiotomy) Foley catheter drainage
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Recommendations 1. S trong community support is required to develop solidarity groups which include village volunteers working with trained, skilled and traditional birth attendants, depending on the local customs and resources. 2. The components of the three delays need to be identified and targeted in order to minimise the effect of obstructed labour. By this process there will be other benefits for maternal and child health. 3. There should be provision of adequate health facilities and birthing centres to which women move either as soon as they go into labour, or if labour is delayed. Such facilities must provide emergency obstetric care, including caesarean section. 4. National policies for maternity care should be developed for all countries whether or not VVF is a common complication of childbirth 5. Data collection by local, national and regional bodies should help to define the incidence of birth complications, and factors leading to the “3 Delays”. 6. The components of the “Three Delays” need to be identified and targeted for each community where there is a high prevalence of complications of childbirth. 7. Girls, women and communities should be educated about normal and abnormal labour, and facilities such as waiting houses should be available for pregnant women at risk for complicated deliveries. 8. Solidarity groups including local volunteers and skilled and trained traditional birth attendants should be developed for maternal care. 9. Birthing centres with the capability for caesarean section should be accessible and sufficiently affordable for women to use. 10. Funding should be made available to retain adequate trained staff for waiting houses and birthing centres. 11. Partographs should be employed to track the progress of delivery in order to identify problems and for data collection.
3. UNMET NEEDS IN VVF There is unmet need at every level of the healthcare service in those developing countries where VVF is a significant problem. These needs span from family planning through obstetric care, the availability of emergency obstetric services and the provision for dealing with maternal and infant post-partum problems. Unmet need has not clearly been defined, although the increasing gulf between the prevalence and incidence of fistula and its prevention and treatment is exceedingly worrying. In low resource countries there is a need for stable and enduring collaboration and partnerships
between governments and non-governmental organisations ( NGOs), such as, UNFPA, Engenderhealth, WHO and MSF. These partnerships will go some way to identifying unmet need and ensuring that unmet need is reduced. One of the most important aspects of the unmet needs in fistula surgery training has been the lack of standardization. In order that the recommendations below can even be partially met, there has to be a global strategy in developing training, education, and ancillary support for the surgeons and their associated teams. This will be partially met by the creation of the global competency-based fistula surgical training manual, created by the International Federation for Gynaecology and Obstetrics (FIGO) with International Society of Fistula Surgeons (ISOFS). The purpose of this manual is to enable health care providers to acquire the required knowledge, skill and professionalism to prevent fistula and provide holistic care to fistula patients that includes medical, psychosocial and surgical care. A multi-disciplinary team-based approach is encouraged in the training of each doctor and his/her team nurses, physiotherapists and other health professionals. The course is structured at three levels: standard, advanced and expert levels of fistula training. The manual is made up of several components: - Curriculum Modules Each module has an outline of the course content, that the trainee is expected to be aware of. It needs to be used in conjunction with recommended references, and in some cases with specific Performance Based Assessments (PBAs). There are 7 modules that need to be undertaken. - Logbooks of Competency These are records of the work carried out by each trainee. Each must be signed off by each trainer, who will determine if the trainee has observed a procedure, has assisted with a procedure or is able to work independently. The trainer will determine if the trainee needs further training in a particular area. - Performance Based Assessment (PBA) Each aspect of surgical training will be assessed separately and specifically. The trainees will complete each PBA to a standard, advanced or expert level and ideally need the signature of two or more trainers, from two or more training centres. It is expected that each trainee will undergo a prolonged period of fistula training at one or more centres. There are 15 PBA to be completed before a fistula surgeon would be deemed to be an expert, and will often require the full 24 months of training. However, this is a competency-based training manual and each trainee will require different lengths of time to achieve each level of expertise. This structured approach of the competency-based manual will attempt to standardise and support surgical training in fistula repair. In the process of achieving this aim, it is envisaged that there will eventually
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be an increase in the number of training centres accredited for training and eventually surgeons trained. Recommendations 1. Unmet need has to be defined in each country, and within each country, in each geographical region. 2. The unmet need in ante-natal services needs to be rectified urgently in order to minimise the number of new fistulae occurring. 3. The need for education and training has to be addressed for birth attendants, community nursing and fistula surgeons. 4. Training centres for fistula surgeons need to be identified and new ones established, according to population matrix. Training should be systematic and structured, using assessment tools such as those developed by FIGO with ISFOS. 5. Audit and research must be developed in order to ensure that quality and advances in treatment methods are ensured. 6. National strategies need to be developed to empower individual nations to take charge of the women’s and children’s services in their country.
4. MANAGEMENT OF NEW AND ESTABLISHED VVFS Management of VVF depends on whether the fistula is diagnosed within two or three months of its occurrence or whether the woman presents late with an established fistula. There is evidence that early catheter care will result in the cure of a significant minority of VVFs. Algorithm 1 (Figure 1) describes the management of women who have both early fistulas, defined as those that have occurred within 75
days of presentation, and established fistulas, that is those that are discovered more than 75 days after obstructed labour.
5. CLASSIFICATION OF VVF The Consultation believes that fistula audit research is considerably hampered by the plethora of VVF classification systems, of which we believe there are 32. The Consultation feels that the fistula system that is able to relate its classification to outcome is the classification that should be used in the next few years. The Waaldijk Classification is the only one that has been used to document sufficient numbers of patients from diagnosis to follow-up (Figure 2). Figure 2 shows the Waaldijk Classification which involves precise measurements of the distances between the external urinary meatus and the distal edge of the fistula, together with the widest diameter of the fistula. Fistulas are classified into types 1, 2 and 3. Type 3 fistulas are those fistulas other than vesico-vaginal fistulas and include recto-vaginal fistulas and uretero-vaginal fistulas. The Waaldijk Classification of Types 1 and 2 is illustrated in Figure 3 and described below. If catheter drainage fails, then fistula repair will be necessary. There are certain principles behind fistula repair: • Necrotic tissue must be removed prior to fistula repair. •F istula repair must only be undertaken by a properly trained surgeon. • Adequate post-operative care is essential. • Proper follow-up should be arranged.
Figure 1. Algorithm to describe the management of fistula detected early (less than 75 days after obstructed labour) or later
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Table 2 indicates the type of fistula closure that should be used depending on the type of fistula. Bladder / urethra direction of closure Pubocervical fascia / urethral support Ant vagina wall closure Recommendations 1. The comprehensive use of an indwelling catheter with free urinary drainage should be instituted for all patients who have undergone either an emergency caesarean section or a traumatic vaginal delivery after obstructed labour. 2. When fistula surgery is necessary the woman must be assured of the surgeon’s competence to carry out her procedure. 3. It is recommended that further research is needed into the classification of fistula, not only to further validate the Waaldijk Classification, but also if other classifications are proposed for development. 4. There is a need to compare different surgical approaches to fistula within the context of randomized controlled trials, using the Waaldijk Classification to precisely describe the fistulas. 5. Long-term follow up of fistula patients is recommended in order to study the outcome of both conservative and surgical management and, in particular, to determine its effect on quality of life.
Figure 3. The Waaldijk Classification for VesicoVaginal Fistulas
Figure 2. The Waaldijk Classification for Fistula
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6. When reporting the outcome after fistula repair, authors should make a clear distinction between fistula closure rates and post-operative incontinence rates, specifying the time at which followup was carried out.
6. MANAGEMENT OF THE COMPLICATIONS OF VVF The complications of Vesico-vaginal fistula are many but include: • Persistence or recurrence of urinary incontinence • Persistence of lower urinary tract symptoms or occurrence of new lower urinary tract symptoms, including overactive bladder • Urinary tract infections
woman is able to have an elective caesarean section when she goes into labour. 5. In recurrent identifiable fistula make sure of the size and number and this kind of fistula is better repaired by a well experienced fistula surgeon. It is important to use tissue interposition like a Martius flap or fibrin glue. 6. With urinary tract infections or abscess formation, antibiotics must be given before and after the repair, according to culture and sensitivities. 7. Patients complaining of persistent leakage due to urgency incontinence may try antimuscarinics, botulinum toxin injection or even augmentation cystoplasty in small contracted or poorly compliant bladders. 8. Those with a shortened or disrupted urethra, before or after repair, must be treated with urethral reconstruction, autologous slings or injection of bulking agents, delivered trans or peri –urethrally.
• Upper urinary tract symptoms, including loin pain • Dyspareunia and sexual dysfunction • Infertility
9. In cases with unilateral or bilateral ureteric ligation or injury, the early diagnosis is life saving. Patients must be promptly treated by endoscopic ureteral stenting, PCN or ureteric reimplantation.
• Neurological symptoms • Psychological problems and mental illness Recommendations 1. A care programme for failed repairs with persisting incontinence after a successful repair, needs to be in place. 2. It is recommended that surgical treatment of post-operative stress incontinence should only be considered six months after fistula repair.
10. Patients complaining of contracted vagina and dysparunea with sexual dysfunction may use local estrogen, vaginal dilatation or may require the surgical creation of vaginal flaps to augment the vagina.
3. Autologous material should be used when a graft or sling is required and there is no place for synthetic sling material.
11. Patients who develop dropped foot may respond to physiotherapy or require tibialis tendon transfer. Women with neurogenic OAB may benefit from detrusor muscle botulinum injections if antimuscarinic drugs fail.
4. In order to prevent new fistulas in women who become pregnant after a fistula repair, waiting homes should be provided to ensure that each
12. Psychological trauma, social isolation and depression is best treated by counselling and psychological rehabilitation.
Table 2. Surgical Techniques for the Closure of Type l and Type ll VVFs
Bladder / urethra direction of closure
Pubocervical fascia / urethral support
Ant vagina wall closure
Type l
Any according to common sense
No special measure
Approximate vag edges
Type llAa
Transverse
Transverse adaptation
Type llAb
Circumferential end-to-end
Transverse repair (+ fixation) / sling Refixation / sling
Transverse adaptation
Type llBa
Longitudinal (+ transverse) urethra tissue Longitudinal + circumferential non-urethra tissue
Fixation / sling
Flap
Refixation / sling
Flap
Type llBb
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Table 3. Social Re-integration Matrix ELEMENT Physical Improved physical health
LEVEL Facility
Community
Early detection Rehabilitation Skilled surgeon Timely repair
Outreach
Designated space
Follow up
Political Allocate funds for treatment
Health education
Psychological Improved mental health
Psychosocial therapy e.g. stigmatisation
Advocacy and sensitisation Follow up
Socio-economic Increased social connection
Vocational skill training Linkage with Existing programmes
Microcredit or finance Follow up
7. SOCIAL RE-INTEGRATION OF TREATED WOMEN Social integration is defined as appropriate interventions that help women with obstetric fistula overcome physical, psychological and socio-economic challenges, freely identified by themselves, in order to enhance their return to the communities and social networks of their choosing, such that the risk of them presenting with another fistula is minimized. The aim of social re-integration is to break the fistula recurrence/occurrence cycle in which the woman’s physical state is inextricably connected to her mental state and her socio-economic situation. Social re-integration should be seen as happening from the time the leaking of urine becomes manifest, and every subsequent intervention should have the re-integration of the woman, back into her community, as the primary goal. So, social re-integration is the responsibility of everyone who cares for the woman. Social re-integration can be usefully looked at within a matrix, as shown in Table 3 where the three elements of physical, psychological and socio-economic status are looked at in terms of the facility for treating the patient within her community and the political environment. Recommendations 1. Social re-integration is important for all women with obstetric fistula. It is the process by which women are helped to overcome physical, psychological and socioeconomic challenges, freely identifiedby themselves, in order to enhance their level of social functioning in communities and social networks of their choosing, so that the risk of will presenting with another fistula is minimised. 2. Social re-integration should be used for all women. However this series of interventions can be performed by any trained care worker, providing it focuses on making the woman part of her social fabric again, and commences from the time leaking of urine becomes manifest.
Raise awareness on issues of counselling Link u p with ongoing national poverty alleviation programmes
3. S ocial re-integration should be designed to break the fistula recurrence cycle in which the woman’s physical state is inextricably connected to her mental state and her socio-economic situation. 4. Early successful surgical repair or catheter management is highly recommended and is likely to be the only thing needed for social re-integration. Surgery should be performed as soon as possible by a skilled surgeon, and preferably within 3 months of developing the fistula, as this is likely to limit the length of time the woman is seen as abnormal by her family or community and thus perceived as an outcast. 5. S ocial re-integration should start in a designated space where women can recuperate, perhaps within the repair facility or nearby, rather than going home and encountering the risk of behaviours which may make it likely that a recurrence of fistula occurs, due to an exacerbating physical event such as early sexual intercourse or heavy work. Also, peer counselling is more likely to be available in this space. 6.Surgeons and other care workers should consider social re-integration as not just a social tool but also as a means of ensuring that adequate follow-up of the postsurgical improvement in quality of life is done and reported on. At the least, there should be a review of individually defined success of surgery and surgical outcomes, including continence and return to fertility and/or sexual life, as desired by the woman. 7. A ppropriate counselling messages about the risk factors and causes associated with fistula should be targeted at family members (including husbands) and the community, as this can help to overcome the stigma, discrimination and misconceptions surrounding the condition and enhance her community inclusion. It is then an opportunity to make changes so that
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the woman does not present with another fistula in the future.
should have a choice as to whether they wish to be involved in such advocacy activities.
8. C ounselling should be seen as an opportunity for health providers to understand the socioeconomic, psychological and physical experiences that are faced by girls and women living with fistula, before and after surgery, so that they may give meaningful help. This will also help to generate knowledge on social re-integration processes and will help in the planning of a broader range of outcomes for women living with fistula.
15. S ocial re-integration programmes should be monitored and evaluated in order to collect correlates of success and failure and to help understand socio-cultural backgrounds, so that a context specific approach can be used to design and deliver effective, feasible reintegration programmes.
9. S ocial re-integration should include assistance with education and life skills, and encouragement of private initiatives through vocational skills development and microcredit support. If this is freely chosen, it will not keep a woman away from her community unduly, and will help her regain or improve her previous economic status and enhance her self-sufficiency and community inclusion.
Scientific Committees for 1st Consultation on VVF (Chairpersons in bold)
10. S ocial re-integration should include vocational skills training with the aim of providing women with alternative ways to generate income, without jeopardising their recuperation, by teaching them a trade which is economically viable within their community. 11. Institutional re-integration services should be incorporated into existing community activities or programmes directed to empower women (e.g. education, skills training, income generation, self-esteem). 12. Re-integration programmes should develop criteria to determine where support with socioeconomic interventions should be given, as funds may be limited and fistula consequences can vary dramatically by country and region. They should also be careful not to increase the burden of stigma and therefore inadvertently impede re-integration. Of particular concern should be women who are still incontinent, those who are deemed incurable, those who have no children and those who have lived with fistula for a long period of time. 13. Social re-integration programmes need to consider the potential ethical dilemmas in re-integration such as providing targeted financial support or high value goods to women with fistula in poor communities, other than as part of a community approach. 14. Social re-integration should seek to involve women who have been successfully re-integrated into their communities. These women can be termed motivational mobilisers and can contribute to community mobilisation movements for safe motherhood, fistula case mapping and referrals for treatment. Women
Below is set out the committee structure for the Consultation, within whose chapters full details of each committee’s work can be found.
1. Epidemiology
AHMED, aifuddin ARROWSMITH, Steve MULETA, Mulu KISERUD,Torvid
(USA) (USA) (Ethiopia) (Norway)
2. Prevention Strategy
BANGSER, Maggy (Tanzania) COCHRAN, Seth (USA) EMASU, Alice (Uganda) –Co-chair LENGMANG, Sunday (Nigeria) L USI, Lyn (Congo) KIRYA, Fred (Uganda) DE VRIES, Catherine (USA)
3. UnmetNeeds
ELNEIL, Suzy GAME, Xavier PATEL, Naren RUSHWAN, Hamid RUMINJO,Joseph
4. Surgery for Fistula
ABUBAKAR, Kabiru RAASSEN, Tom DE RIDDER, Dirk WAALDIJK, Kees
(UK) (France) (UK) (UK) (USA) (Nigeria) (Kenya) (Belgium) (Nigeria)
5. Complex Fistulae and the Complications after Fistula Surgery HILTON, Paul MOURAD, Sherif MWANJE HARUNA, Moses SHAKER, Hassan VASAN, Sirini
6. Social Integration
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(UK) (Egypt) (Uganda) (Egypt) (India)
AKHTER, Sayeba (Bangladesh) BROWNING, Andrew (Ethiopia) ESEGBONA, Gloria (UK/Nigeria) ISAH, Adamu (Nigeria) KAONGA, Taonga (Malawi) MOHAMMAD, Rahmat (Nigeria) – Co-chair
B. Non-obstetrical fistula I. INTRODUCTION Iatrogenic urogenital fistulae are known complications of pelvic surgery and oncological treatments such as radiotherapy. For example a high quality population-based case-control study from Sweden found that the risk of urogenital fistula was 25 times higher amongst women undergoing hysterectomy (n=180,000) compared to an age matched control population (n=525,826) without hysterectomy. The risk appeared to be highest for laparoscopic hysterectomy and lowest for sub-total hysterectomy but absolute numbers were small with a number needed to harm of 5,700.[3] This section is based on electronic searches of Medline, EMBASE (from 1980 to November 2011), the Cochrane Database of Systematic Reviews, Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Database of Health Technology Assessments, and Database of NHS Economic Evaluations, and the NICE website (all accessed November 2011); references included in identified systematic and non-systematic reviews were evaluated separately. Hand searching of recent (Jan-December 2011) issues of major American, European and British journals in urology, gynaecology and urogynaecology was undertaken, to capture recent publications not yet included in the online databases. ICS, IUGA, AUA, AUGS and SGS conference proceedings for 2011 were also reviewed. It was assumed that studies and trials presented earlier than this would be in press if they were of sufficient quality and maturity to justify inclusion; hence older abstracts have not been considered.Papers offering any relevant data were considered. This included systematic reviews, randomised and quasirandomised trials, non-randomised cohort studies, case controlled studies, longitudinal studies and case series or reports. Those papers considered for inclusion were assessed for quality where relevant, in terms of sequence generation, allocation concealment, blinding, and handling of incomplete data, selective reporting and freedom from other biases. An evidence level [EL] was then assigned to all included studies according to the ICUD modified version of the Oxford Centre for Evidence-based Medicine system. [4) Where quality was considered to be poor – as in most of the studies included in these sections – the evidence level was reduced accordingly. Recommendations (graded A-D) were made on the basis of consistent or ‘majority evidence’ identified.[4]
II. EPIDEMIOLOGY 1. POST-GYNAECOLOGICAL SURGERY Fistulae involving the lower urinary tract can occur following any surgical procedure or traumatic event
to the female reproductive tract, bladder, or rectum. In developing countries, the most common aetiology of fistulae involving the lower urinary tract is clearly obstetric trauma. [5] In most developed countries in which antenatal and intrapartum care is more readily available, obstetrical fistulae are relatively rare and the majority of fistulae are related togynaecological surgery. The ratio of obstetric to gynaecological fistula appears to be consistent at about 10:90 in developed countries. [6] In some developing countries, as gynaecological procedures to treat benign and malignant conditions of the female reproductive tract are more commonly performed, the rate of iatrogenic fistulae is increasing (e.g. Pakistan). [7] The types of fistulae associated with gynaecological procedures may include communication between any reproductive organ (uterus, cervix, Fallopian tube, vagina), intestinal tract (colon, rectum), genitourinary organ (bladder, ureter, urethra), and cutaneous system (abdominal wall, perineum). The combinations, locations, and severity of gynaecological fistulae vary with each patient. In general, vesicovaginal fistulae (VVF) are the most common type. The most common causes of VVF as a consequence of surgery, in developed countries isan injury injury to the urinary tract during hysterectomy for benign conditions (60-75%), followed by hysterectomy for malignant conditions (30%), caesarean section (6%), and obstetric injuries (1%). [8][9] At the ZekaiTahirBurakcentre in Turkey 25,998 gynaecologic and obstetric operations were performed over a 3-year period. The bladder was the most frequently injured organ. Urinary tract injury rates were reported to be 0.49% for the bladder and 0.24% for the ureter in gynaecological operations, and 0.18% for the bladder and 0.01% for the ureter in obstetric operations.[10] Overall, the risk of pelvic organ fistula following hysterectomy has been reported to be between 0.1 and 4%. [11]. It is important to recognize that most urinary tract injuries do not result in a fistula. The prevalence of genitourinary injury and fistulae vary slightly from centre to centre. In one US retrospective study from the Mayo clinic, gynaecologic surgery was responsible for 82% of the fistulas, obstetric procedures for 8%, and various forms of irradiation for 6%, and trauma or fulguration for 4%. The majority of fistulae followed treatment for benign conditions. [12] The relative proportions of the types of urinary fistula have changed with urethral fistulae having increased from 6 to 13%, while ureteral, bladder and/ or urethral fistulae having dropped from 20 to 16 and 11 to 7%. [2] Given the various indications for, and types of hysterectomies, it is important to have an understanding of the type of hysterectomy since genitourinary or colonic fistula is reported with all of these procedures. The overall incidence of hysterectomy complications is estimated to be 95%. Depending upon availability, radiologic studies (cystography, urography, intravenous urography, and CT urography) may be useful. Ultrasonography and colour Doppler have been used by some, although their use
in routine practice remains to be established. [108][109] Urine may extravasate externally or internally. Creatinine levels in the urinte are higher than serum levels. Therefore, in the setting of a suspected fisula, testing the creatinine level in either the extravasated fluid or the accumulated ascites and comparing this value to the the serum creatinine levels will confirm urinary leakage but not the location of the fistula. Likewise, testing potassium levels will show higher levels compared to serum levels. [110] b) Imaging An unstructured review by Narayanan et al. suggested that magnetic resonance imaging, particular with T2 weighting, provided optimal diagnostic information regardingfistula associated with pelvic malignancy, with contrast-enhanced CT with late excretory phase an acceptable alternative.[111] These newer modalities were considered to be superior to other X-ray contrast techniques and ultrasound.
2. DIAGNOSIS OF GI FISTULA Pneumaturia, dysuria and/or recurrent UTI’s are symptoms of a colovesical fistula but may be due to other causes as well.Accepting the limitations of small case series in this regard, a number of studies have investigated the value of a range of investigative techniques in the detection and evaluation of enterovesical or colovesical fistulae.[90, 92, 93, 97, 112-116]Since in each study the authors have presented only results on patients known to have fistulae, sensitivity (true positive/true positive + false negative) may be estimated, however, specificity (true negative/true negative + false positive), positive predictive value, (true positive/true positive + false positive) and negative predictive value (true negative/true negative + false negative) cannot (see Table 3). No test was shown to have consistent reliability; excluding those investigations for which only a single report was identified, CT (53%), cystoscopy (48%), and in the case of colovesical fistula, barium enema (38%) were perhaps the most useful; intravenous urography and sigmoidoscopy or colonoscopy appear to have limited utility in the diagnosis of GI fistula.
Table 2. Data from studies examining the reliability of intra-operative cystoscopy in detecting ureteric injury
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3. RECOMMENDATIONS CT and cystoscopy appear more consistent in the C confirmation and location of possible intestino-vesical fistulae, than other investigations
Table 3: Data from studies examining the sensitivity of various investigations in the diagnosis of intestino-vesical fistulae.
Level 3 evidence indicates that the routine use of C cystoscopy with dye testing at gynaecological surgery has high sensitivity, specificity and negative predictive value in the detection of ureteric injury, although false positive tests do occur. The clinical and cost-effectiveness of routine cystoscopy remains to be established
VI. MANAGEMENT OF VESICO-VAGINAL FISTULA The literature relating to surgical fistula is extensive, but of limited quality. 356 papers of possible relevance were identified, of which only 173 contained any relevant material. Three systematic reviews were identified (albeit one only as a protocol),[117-119] although none contained information of direct relevance. Six randomised trials were identified including one on causation,[120] one on prevention of urinary tract injury at surgery,[121] two on antibiotic prophylaxis at the time of reparative surgery,[122, 123], and two on surgical techniques applied to obstetric fistulae.[124, 125] There was also one quasi-randomised study of relevance.[126] Four non-randomised cohort studies,[127-130] and one cost-effectiveness study,[131] were also identified. All other identified material comprised case series [99] and individual case reports or procedure descriptions [52], and represent level 3or 4 evidence. Three examples of duplicate publication were identified.
1. CONSERVATIVE MANAGEMENT a) Immediate management by catheterisation or defunctionalizing Before epithelialisation is complete an abnormal communication between viscera will tend to close spontaneously, provided that the natural outflow is unobstructed. Normal continence mechanisms, however, involve the physiological contraction and intermittent relaxation of urethral and anal sphincters. As a result, although completely spontaneous closure of genital tract fistulae does occur, it is the exception rather than the rule. Bypassing the sphincter mechanisms, or diverting flow around the fistula, for example by urinary catheterisation, percutaneous nephrostomy or defunctionalizing colostomy, may however encourage closure. Bazi reported a non-systematic review of papers including information on the spontaneous fistula closure of vesicovaginal fistulae; whilst the data quality of all was poor, he identified 30 studies from which 12 could be included; these included cases that were almost exclusively of surgical aetiology; it should be noted that in 9 of these 12 studies the sample size was less than 5 patients.[132] Few studies described catheter drainage in large fistulae, although it seemed that
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Table 4. Data from studies including rates of spontaneous closure of surgical vesico-vaginal fistulae. n.b. table includes studies considered by Bazi,(132) but only those of known surgical aetiology.
those of less than 1cm diameter were most likely to heal spontaneously. The time between the insult and institution of drainage in cases of non-surgical closure varied widely, although in most cases this was less than 3 weeks. Similarly, the duration of catheterisation prior to the initiation of conservative treatment was deemed to have been unsuccessful varied considerably, making true estimates of the effectiveness of this approach impossible; generally this varied between 10 days and 3 months.[132] Reported success rates varied between 0% and 100% (although 5 series had a sample size of 1!), although in several series it was difficult to determine how many women had attempted conservative management.[132] In large series of obstetric fistulae where a consistent approach to conservative management has been applied, spontaneous healing has been reported in up to 28% of cases. [133-135] In one series of urogenital fistulae of varying aetiologies, spontaneous closure was seen in 19/238 or 8.0% of surgical cases, 4/38 or 10.5% of obstetric cases, 1/36 or 2.8% of miscellaneous (largely traumatic cases) and 0/34 or 0.0% of radiotherapy related cases.[17] It is likely that in this, and many other reported series, data are an underestimate of the value of this approach to management,[17] nevertheless, combining available data (see Table 4) gives an overall spontaneous closure rate from 348 surgical fistulae treated by initial catheterisation of 13% ± 23%.[8, 17, 21, 136-145]. Patients with ongoing, continuous vaginal leakage despite a functioning indwelling catheter are unlikely to have resolution of the VVF without additional measures such as surgery. Such patients
should be spared prolonged catheter drainage and proceed with more definitive repair as soon as medically appropriate.Small epithelialized fistulas may benefit from minimally invasive cystoscopic electrocoagulation of the fistula tract, followed by prolonged catheter drainage. In patients with fistulae less than 3.5mm in diameter, 11/15 had successful fistula tract ablation with cauterization and catheter drainage in a study by Stovsky et al.[146] In general, conservative measures are successful in small fistulas only, usually less than 2-3mm in diameter. b) Pharmacotherapies to assist fistula closure Several case reports describe successful fistula closure following the induction of amenorrhoea by oestrogen, oestrogen/progesterone combinations, or luteinising hormone releasing hormone analogues,[147] in the management of vesicovaginal,[148] and more frequently, uretero- or vesicouterine fistula following caesarean section.[149-153] The overall closure rate in these studies is 88%±16%. Spontaneous closure of vesico-uterine fistula has also been reported on a number of occasions,[150, 154] with a rate of 41/786 or 5% calculated in one review.[150] Whilst comparison across studies is obviously highly problematic (especially where many are single case reports, with success rates of 0% or 100%), it seems highly likely that the rate of closure following hormone treatment [14/16] is significantly higher than that of spontaneous closure [41/786] (p 6 months) surgical repair when required.[301] Surgery should again adhere to the standard principles of tissue repair and safe anastomosis. Functional and anatomical imaging should be used to follow up patients after repair to guard against late deterioration in function of the affected renal unit. These general aspects of care of patients with trauma to the upper tract and subsequent fistula formation are covered in standard textbooks of urology and guideline documents. [300, 301] This review will concentrate on developments in the past six years.
2. EVIDENCE QUALITY
There is evidence that infliximab is efficacious in the treatment of external fistulae, but only very limited low level evidence of efficacy in urinary B/D fistulae in association with Crohn’s disease A one-stage approach to surgery for intestinovesical fistulae is appropriate in many cases, but should be limited to those patients whose nutritional state is good, and where there is no evidence of additional intra-abdominal pathology (e.g. severe inflammation, radiation injury, advanced malignancy, intestinal obstruction) or major co-morbidity A laparoscopic approach to one-stage management has been shown to be feasible, although there is no high level evidence to allow comparison of outcomes with open surgery
A total of 127 abstracts were screened which were categorised as being not relevant [26], cases reports without useful information [63] and for possible inclusion [38]. After review of full text, 27 were selected for the review and 11 rejected due to duplicate information (n=7) and no relevance (n=4). Four further possible papers were identified from the reference lists of included articles of which two were included in the review. The selected papers [29] included one poor quality randomised trial [302], one poor quality quasi-randomised trial [303], one high-quality population case control study[3], one registry study[76], one systematic review[304], one cost analysis[305], 14 cases series, 8 case reports, and one unstructured review.
B
D
3. EVIDENCE SUMMARY
VIII. MANAGEMENT OF URETERIC FISTULA
a) Management of Specific Fistula 1. Urinary
1. GENERAL PRINCIPLES The relevant clinical principles are related to prevention, diagnosis, management, and after care. [299] Patients at higher risk of ureteric injury such as those undergoing complicated childbirth, radical or repeated pelvic surgery, or surgery following pelvic radiotherapy require experienced surgeons who can identify and protect the ureter and its blood supply to prevent injury and also recognise injury promptly when it occurs. Immediate repair of any intraoperative injury should be performed observing the principles of debridement, adequate blood supply and tension free anastomosis with internal drainage using stents.[300] Delayed presentation of upper tract injury should be suspected in patients whose recovery after relevant abdominal or pelvic surgery is slower than expected, if there is any fluid leak, and if there is any unexpected dilatation of the pelvi-calyceal system. Fluid should be sent for creatinine determination to differentiate serous from urinary leak. Repair of such cases should be undertaken by an experienced team and may consist of conservative management with internal or external drainage, endoluminal management using nephros-
leak after renal preservation surgery
A large case series identified urinary fistula, defined as urinary drainage from a drain site more than 14 days post-operatively, in 4% [45/1118] of patients undergoing partial nephrectomy.[306] This was associated with larger tumours, higher blood loss, and longer ischemia time, but not the mode of surgery (laparoscopic versus open). The majority resolved without intervention but 30% required ureteric stent insertion or percutaneous drainage. A poor quality quasi-randomised study involving 16 patients with persistent leakage after pelvi-calyceal surgery despite stenting found that use of intranasal desmopressin 40 µg daily resulted in a shorter time to resolution of leak compared to control.[303] 2. Urinary
leak after renal transplantation
A case series from Brazil observed a fistula rate of 2.9% [31/1046]presenting at a mean of 28 [1-131] days following transplantation predominantly due to distal ureteric necrosis and with most cases requiring open repair.[307] Fistula occurred more commonly in patients with diabetes and was associated with lower graft survival and two deaths from sepsis. A case se-
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ries from China observed fistula development in 3.5% [43/1223] of patients presenting at a mean (range) of 6 [3-20] days following transplantation again primarily due to necrosis of the distal transplanted ureter. [308] Open intervention with re-implantation of the ureter into the bladder or native ureter was required in 34 patients, with one other patient requiring transplant nephrectomy. The occurrence of a fistula did not appear to prejudice graft or patient survival. Initial implantation of the transplant ureter into the native ureter appeared to result in a lower rate of fistula. A further case series form Serbia found a fistula rate following renal transplantation of 2.2% [5/224] and all required open repair.[309]
past surgical history particularly pelvic cancer surgery (54%) and arterial surgery with graft insertion (31%), and 61% had a ureteric stent in situ. The great majority affected the iliac segment and pre-operative imaging was not always diagnostic. A total of 18 (13%) patients died as a result of the fistula. Many vascular and urologic interventions were used either alone or in combination. Later cases suggested that endovascular repair of the arterial defect gave the best results with lower mortality. Another, more recent case series of 20 patients also showed a high mortality of 10 – 20% but did not find any difference in outcome between open or endovascular graft insertion techniques.[313]
3. Uro-enteral
5. Ureterovaginal
fistula following percutaneous re -
nal surgery
Case reports of ureterocolic fistulae occurring after renal cryotherapy, and gunshot trauma all resolved with insertion of ureteric stent.[310, 311] This is in line with previous accounts of this complication following percutaneous nephrolithotomy.[312] 4. Uretero-arterial
fistula
A systematic literature review found reports of 139 cases of uretero-arterial fistula published between 1899 and 2008.[304] All patients presented with haematuria with 25% also having other urinary symptoms or back pain. Virtually all cases had a relevant
fistula
Ureterovaginal fistula occurring in the early postoperative phase predominantly after hysterectomy is the most frequent presentation to urologists of upper urinary tract fistula. A randomised study involving 3,141 women undergoing open or laparoscopic gynaecological surgery lasting > 30 min found that the incidence of ureteric injury after prophylactic insertion of ureteric stents (1.2 % [19/1583]) was similar to control (1.1% (17/1558]).[302] A previous cost analysis from the United States perspective suggested stenting was only worthwhile if the risk of injury was > 3.2%.[305] If injury does occur, many cases, even those with bilateral injury, can be managed by endoscopic techniques. [314](Figure 9)
Figure 9. Conservative management of bilateral lower ureteric injury. Retrograde ureterogram showing successful cannulation of left ureter by guide wire and successful placement of right ureteric stent.
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The use of ureteric stenting in patients with ureterovaginal fistulae was reported in 11 studies, including 126 patients in total;[315-325] this resulted in closure in 63 cases altogether. Success rates were between 6% and 100%, although the overall closure rate across all series is calculated at 50% ± 18% (see Table 9). Where retrograde stenting proves impossible, percutaneous nephrostomy and antegrade stenting might be considered if there is some degree of pelvicalyceal dilatation. Ureteroscopy may also be helpful,[320, 324] and a technique for combined antegrade and retrograde ureteroscopic cannulation has been reported.[317] In one report all cases of uretero-vaginal fistula were managed by temporary diversion using a percutaneous nephrostomy followed by delayed repair 4-6 weeks later,[156] and a similar approach was taken in the management of one uretero-uterine fistula.[326] If endoluminal techniques fail or result in secondary stricture, the abdominal approach to repair is standard and may require end-to-end anastomosis, re-implantation into the bladder using psoas hitch or Boari flap, or replacement with bowel segments with or without reconfiguration. Recent case series suggest that this standard surgery can be performed safely and with reasonable operative times using laparoscopic or robotic techniques if the relevant skills and facilities are available.[327-329] A recent case report has sug-
gested that open repair through the vagina is possible if abdominal access is problematic.[330] 6. Ureteric
fistula associated the terminal phase
of pelvic malignancy
Urinary leakage is very distressing for people dying of advanced pelvic malignancy but palliation by open diversion may be associated with a high rate of complications. Recent case series have described the technique of occlusion of the distal ureter with coils or other devices using an antegrade approach combined with chronic urinary diversion using nephrostomy tubes.[331-333]Natarajan et al reported successful management of five patients with two requiring repeat embolization but all achieving good palliation until death without adverse effects.[331]Shindel et al reported on 29 patients with bothersome urinary fistula despite chronic nephrostomy drainage, and poor performance status.[332] In all cases palliation of the urinary leakage was achieved. The majority of patients [23/29] died of their underlying cancer at a mean of 8 months after the procedure. Three patients with benign disease subsequently underwent definitive surgical diversion with the remaining 2 lost to follow up. Coil migration was seen in one patient without serious consequence and there were no other complications specific to the embolization. Kim et al used the technique to temporally palliate five women with ureterovaginal fistula prior to delayed definitive repair.[333]
Table 9: Data from studies including rates of closure of uretero-vaginal fistulae with ureteric stenting.
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The algorithm for uretero-vaginal fistula can be found in Figure 10
industrialized countries urethrovaginal fistula in adults mostly have an iatrogenic aetiology. (See Table 10)
Evidence table
In feminizing genital reconstructions in children with ambiguous genitalia and surgical repairs of cloacal malformations, urethrovaginal fistula can occur as early or late complications. [334][335, 336][337, 338] Also in transsexual adults undergoing female to male reconstruction, urethrovaginal fistulae have been reported. [339]
Prophylactic ureteric stent insertion does not reduce risk of ureteric injury during gynaecological surgery The use of desmopressin may hasten resolution of urinary leak after pelvi-calyceal surgery Uretero-arterial fistula is associated with a high mortality rate Antegrade endoluminal distal ureteric occlusion combined with nephrostomy tube diversion often palliates urinary leakage due to malignant fistula in the terminal phase
In the surgical treatment of stress incontinence in women with bulking agents [340, 341] or synthetic slings several cases of urethrovaginal fistula have been reported.[342-345] [119] (see Figure 11) Even conservative treatment of prolapse with pessaries can lead to the formation of fistula, if these pessaries are neglected for an extended period of time, although fistula formation after only 2 weeks of pessary use has been described.[18, 346](see Figure 12).
4. RECOMMENDATIONS
Surgeons undertaking complex pelvic surgery should be competent at identifying, preserving and repairing the ureter Ureteric stents are not required as prophylaxis against injury during routine gynaecological surgery, while their role in more extensive surgery remains to be established
Trauma – including inappropriate catheterisationand foreign bodies are obvious causes of fistula. [347-353]
Ureteric injury or fistula may be suspected in patients following pelvic surgery if a fluid leak or pelvi-calyceal dilatation occurs postoperatively
Urethral diverticula and their surgical repair may also lead to urethrovaginal fistula.[354-356]
Uretero-arterial fistula may be suspected in patients presenting with haematuria with a history of relevant pelvic surgery and indwelling ureteric stent
Urethrovaginal fistula have also been described in some Behçet patients with vasculitis and local necrosis of the urethrovaginal septum. [357, 358]
Elevated levels of creatinine in drainage fluid following pelvic surgery are suggestive of a urinary tract injury Most upper urinary tract fistula should be initially managed by conservative or endoluminal techniques where such expertise and facilities exist
Irradiation complications can also result in the formation of urethrovaginal fistula.[359]
3. DIAGNOSIS Clinical vaginal examination is often sufficient to diagnose the presence of an urethrovaginal fistula. Urethroscopy and cystoscopy can be performed to assess the extent and location of the fistula. In cases of difficult diagnosis, voiding cystourethrography (VCUG) or ultrasound can be useful. [360] Double balloon urethrography is the classic examination to show urethral diverticulum and urethrovaginal fistula, but 3D MRI or CT scan is becoming utilized more widely.. [361-363]
Persistent ureterovaginal fistula should be repaired by an abdominal approach using open, laparoscopic or robotic techniques according to availability and competence For patients with ureteric fistula associated with advanced pelvic cancer and poor performance status, palliation by nephrostomy tudediversion and endoluminal distal ureteric occlusion is an option
4. SURGICAL REPAIR
IX. MANAGEMENT OF URETHRO-VAGINAL FISTULA Urethrovaginal fistulas are a rather rare complication of some surgical and medical conditions or treatments. Most of the literature consists of small retrospective series or case reports. There are no randomized prospective trials.
Several techniques for urethrovaginal fistula closure have been described. A vaginal approach is mostly used. Surgical correction intends to create a continent urethra that permits volitional, painless, and unobstructed passage of urine. Depending on the size, localisation and aetiology of the fistula and the amount of tissue loss urethral reconstruction techniques may be necessary to restore the urethra and to achieve post-operative continence. [347]
2. AETIOLOGY
a) Vaginal approach
Excluding obstetric aetiologies,In the developing world, urethrovaginal fistula may occur as a result of obstructed labor with or without associated VVF. In
Goodwin described in his series that a vaginal approach yielded a success rate of 70% at first attempt and 92% at second attempt, but that an abdominal
1. INTRODUCTION
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Table 10: Etiology of urethrovaginal fistula
Traumatic
Iatrogenic
Medical
Direct trauma
Bulking agents
Beçhet’s disease
Foreign body
Sling surgery Urethral diverticula repair Catheterisation Irradiation
Figure 10. Algorithm for uretero-vaginal fistula
Figure 11. Urethro-vaginal fistula following midurethral tape procedure for SUI.
Figure 12. Fistula in anterior vaginal fornix following use of shelf pessary for utero-vaginal prolapse.
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approach only leads to a successful closure in 58% of cases. A vaginal approach required less operating time, had less blood loss and a shorter hospitalisation time.[364] Most authors describe surgical principles that are identical to those of vesicovaginal fistula repair: identifying the fistula, creation of a dissection plane between vaginal wall and urethra, watertight closure of urethral wall, eventual interposition of tissue, and closure of the vaginal wall. Primary closure rates of 53%-95.4% have been described (see Table 11). Pushkar et al. described a series of 71 women, treated for urethrovaginal fistula. 90.1% of fistula were closed at the first vaginal intervention. Additionally 7.4% were closed during a second vaginal intervention. Despite successful closure, stress incontinence developed in 52%. The stress incontinent patients were treated with synthetic or autologous slings and nearly 60% became dry and an additional 32% improved. Urethral obstruction occurred in 5.6% and was managed by urethral dilation ororurethrotomy.[365] Advancement flaps of vaginal wall can be used to cover the urethral suture line. In some cases more advanced methods are used to close or to protect the urethral closure. In cases of difficult dissection and visualisation, urethral sectioning has been advocated. [366] This technique is also being used in the repair of complex urethral diverticula.[367] Fistulae that are located in the distal third of the urethra may also be marsupialized without compromising the continence mechanism.[368] Distal urethrovaginal fistula may be entirely without symptoms, and in such cases, repair is not mandated. Blaivas advocates that vaginal flaps are usually the best option in dealing with urethral reconstruction, next to the possibility of offering anterior or posterior bladder flaps. Options for vaginal repair of fistula include primary closure, peninsula flaps, bilateral labial pedicle flaps, and labial island flaps. Outcomes are optimised by using exacting surgical principles during repair and careful postoperative management by an experienced reconstructive surgeon. [347]
1. Labial and vaginal flaps and neourethra The simplest flap is a vaginal advancement flap. [369] Labial tissue can be harvested as a pedicled skin flap. This labial skin can be used as a patch to cover the urethral defect, but can also be used to create a tubular neo-urethra. [370, 371] The construction of a neo-urethra has mostly been described in traumatic aetiologies. In some cases a transpubic approach has been used. [372] The numbers of patients reported are small and there are no data on the long-term outcome of fistula closure and continence rates. The underlying bulbocavernosus tissue can be incorporated in the pedicled flap and probably offers a better vascularisation and more bulking to the repair. This could allow a safer placement of a sling afterwards, in those cases where bothersome stress incontinence would occur postoperatively. [373, 374] 2. Martius flap While in obstetrical fistula repair, it was not found to have any benefit in a large retrospective study in 440 women, the labial bulbocavernosus muscle / fat flap by Martius is still considered by some to be an important adjunctive measure in the treatment of genitourinary fistula where additional bulking with well vascularised tissue is needed. [375] Rangnekar et al. report on 12 patients with urethrovaginal fistula, of whom 8 were treated with a Martius flap and 4 with a conventional repair. Only one out of the 8 had a fistula recurrence, while 3out of 4 of the conventional repairs broke down; it should be noted however that these cases were not randomised between surgical techniques.[376] Punekar et al. described 15 patients with complex and recurrent fistula, using the skin island flap modification with excellent results.[377]Radopoulus published a small series of 5 recurrent and complex urethrovaginal fistulas that all healed using a Martius flap.[378]The series of non-obstetrical aetiology are small and all of them are retrospective. There are no prospective data, nor randomized studies.[379, 380] The indications for Martius flap in the repair of all types of fistula remain unclear.
Table 11: Closure rates of urethrovaginal fistula Author
N patients
Success at first surgery
Success at second surgery
Blaivas[347]
24
79%
Goodwin[364]
24
70%
92%
Lee [12]
50
92%
100%
Keetel[401]
24
87.5%
Pushkar[365]
71
90.1%
Benchekroun[402]
186
53%
98.6%
52% incontinent Mostly obstetrical
Henriksson[403]
6
67%
100%
Kumar[79]
43
95.4%
100%
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3. Rectus muscle flap Rectus abdominis muscle flaps have been described by some authors. [381, 382]Transvaginal urethrovaginalfistula closure was performed followed by a pedicled rectus abdominis muscle flap interposed between the fistula closure and vaginal suture line. The muscle flap was based on the inferior epigastric vessels, and provided additional support to the urethra, bladder neck and bladder base. Urethrovaginalfistula repair with the rectus abdominis muscle flap was successful in all cases without recurrence.. Of the patients 5 (83%) were continent and able to void to completion at a mean follow-up of 23 months (range 2 to 66). 4. Other interposition material A range of non-traditional interposition flaps and grafts have been reported by several authors. All of the publications only report on small patient numbers without long term outcomes or continence data. Golomb et al. reported the use of a fascial patch, while adding a rectus fascia sling to a urethrovaginal fistula repair.[383] Omentum is extensively used in abdominal approaches to VVF, but Janez et al. used it during a vaginal approach in 3 patients with good results.[384] The gracilis muscle can be used as well, although the experience is limited. The graciloplasty was described by Ingelman-Sundberg in 1947 and has been adapted by other surgeons in the treatment of fistula. The number of patients reported is low as is the quality of the evidence. [385-387] Non-autologous material has been used as well. Lowman et al. described the use of porcine dermis interposition and a synthetic sling in an irradiated patient. Other biodegradable materials have been used, although the quality of available data is lowand is insufficient to advocate their use. [388] [389] Non-vascularized tissue grafts should be used with caution in such cases as the aetiology of the initial tissue damage resulting in fistula is often ischemic. b) Posterior approach In cases of high fistula with difficult vaginal access, a perineal pararectal approach has been described. Some variations exist in the incisions and dissection planes. The anterior sagittal transrectal approach (ASTRA technique) and the posterior sagittal pararectal approach only have been reported in small observational series. [390, 391][392-394]
pubic cystostomy, one was totally incontinent, and another had an urethrovaginal fistula. Three had an associated vaginal injury. All five patients underwent construction of a neourethra using a flipped anterior bladder-wall tube (FABWT) and have been followed for 18-80 months (mean 44 months). All patients were continent in the daytime and three were voiding spontaneously without the need for catheterization. Two were managed by clean intermittent catheterization (CIC), one per urethram and other via a continent abdominal stoma (Mitrofanoff). [395] A retropubicretrourethral technique has been described by Koriatim[396] This approach allows a urethrovesical flap tube to be fashioned to form a continent neourethra. Urodynamic studies showed that the proximal vesical and distal urethral components of the neourethra contribute to sphincteric function. For larger fistula an enwrapping technique has been described as well.[397]
5. COMPLICATIONS Little information can be found on complications after urethrovaginal fistula repair. A short report on 4 cases by Tehan et al. describes a disappointing experience in the transvaginal repair of these fistulas. These authors advocate a suprapubic bladder flap or bladder tube technique to achieve a functioning urethra. Complications following surgical repair have been fistula recurrence, urethral shortening and retraction, persistent reflux, bladder calculi, and bladder cancer [398].
6. FOLLOW UP In most series of urogenital fistula repair, follow-up is of very short duration. Dolan et al. investigated urinary and sexual symptoms and quality of life in a group of 31 women 50 months (median) after successful repair of urogenital fistula using the Bristol Female Lower Urinary Tract Symptom questionnaire. [399] All women had undergone urodynamic investigation prior to their repair surgery, and only36% had normal findings. Almost all women reported one or more symptoms, and for 65%, these caused at least ‘a bit of a problem’, although 87% said that their urinary symptoms had little or no impact on their quality of life. Symptoms were similar in urethrovaginal and vesicovaginal fistulae and were not significantly associated with prior functional abnormality.
7. RECOMMENDATIONS
c) Abdominal approach Female urethral injuries may cause serious morbidity with loss of the entire urethra in some cases. Ahmed et al. reported the results of construction of a neourethra by the flipped anterior bladder-tube technique in five girls aged 3-18 years (mean 8 years). All had pelvic fractures. Three patients came with a supra-
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Urethrovaginal fistula are preferably treated by a vaginal approach
C
A variety of autologous tissue interposition techniques have been described, but their value remains uncertain
C
Urethrovaginal fistula repair may be complicated by stress incontinence, urethral stricture and urethral shortening necessitating long-term follow-up
C
hysterectomy performed under the National Health Service in England - patterns of care between 2000 and 2008. 2012:(submitted).
REFERENCES 1.
De Ridder D, Badlani GH, Browing A, Sing P, Sombie I, Wall LL. Fistula in the developing world. In: Abrams P, Cardozo L, Khoury S, Wein A, editors. Incontinence. 4th Edition ed. Paris: Healt Publications Ltd.; 2009. p. 1419-58.
2.
Wall LL, Arrowsmith S, Briggs ND, Browning A, Lassey A. The obstetric vesicovaginal fistula in the developing world. In: Abrams P, Cardozo L, Khoury S, Wein A, editors. Incontinence. Paris: Health Publications; 2005. p. 1403-54.
3.
Forsgren C LC, Johansson AL, Cnattingius S, Altman D. Hysterectomy for benign indications and risk of pelvic organ fistula disease. Obstetrics & Gynecology. 2009;114:594-9.
4.
Abrams P, Khoury S. International Consultation on Urological Diseases: Evidence-based medicine overview of the main steps for developing and grading guideline recommendations. Neurourology and urodynamics. 2010;29(1):116-8. Epub 2009/12/22.
5.
De Ridder D. An update on surgery for vesicovaginal and urethrovaginal fistulae. Curr Opin Urol. 2011;21(4):297300. Epub 2011/05/04.
6.
Fischer W. [Long-term analysis of causes, sites and results of treatment of urogenital fistulas at the Charite Gynecologic Clinic]. Zentralbl Gynakol. 1990;112(12):747-55. Epub 1990/01/01. Langzeitanalyse uber Ursachen, Lokalisation und Behandlungsergebnisse von Urogenitalfisteln an der Charite--Frauenklinik.
7.
Raashid Y, Tmajeed T, Majeed N, Shahzad N. Iatrogenic vesicovaginal fistula. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. 2010;20(7):436-8. Epub 2010/07/21.
8.
Tancer ML. Observations on prevention and management of vesicovaginal fistula after total hysterectomy. Surg Gynecol Obstet. 1992;175(6):501-6. Epub 1992/12/01.
9.
Hadzi-Djokic J, Pejcic TP, Acimovic M. Vesico-vaginal fistula: report of 220 cases. International Urology & Nephrology. 2009;41(2):299-302. Epub 2008/09/24.
10. Ozdemir E, Ozturk U, Celen S, Sucak A, Gunel M, Guney G, et al. Urinary complications of gynecologic surgery: iatrogenic urinary tract system injuries in obstetrics and gynecology operations. Clinical and experimental obstetrics & gynecology. 2011;38(3):217-20. Epub 2011/10/15. 11. Forsgren C, Altman D. Risk of pelvic organ fistula in patients undergoing hysterectomy. Current opinion in obstetrics & gynecology. 2010;22(5):404-7. Epub 2010/08/27. 12. Lee RA, Symmonds RE, Williams TJ. Current status of genitourinary fistula. Obstet Gynecol. 1988;72(3 Pt 1):313-9. Epub 1988/09/01. 13. Song T, Kim TJ, Kang H, Lee YY, Choi CH, Lee JW, et al. A review of the technique and complications from 2,012 cases of laparoscopically assisted vaginal hysterectomy at a single institution. Aust N Z J Obstet Gynaecol. 2011;51(3):239-43. Epub 2011/06/03. 14. Forsgren C, Lundholm C, Johansson AL, Cnattingius S, Altman D. Hysterectomy for benign indications and risk of pelvic organ fistula disease. Obstetrics & Gynecology. 2009;114(3):594-9. Epub 2009/08/25. 15. Harkki-Siren P, Sjoberg J, Tiitinen A. Urinary tract injuries after hysterectomy. Obstet Gynecol. 1998;92(1):113-8. 16. Hospital Episode Statistics [database on the Internet]. Department of Health. 2010 [cited 28/12/10]. Available from: http://www.hesonline.nhs.uk. 17. Hilton P. Urogenital fistula in the UK - a personal case series managed over 25 years. 2011; (early view)]. Available from: http://dx.doi.org/10.1111/j.1464410X.2011.10630.x. 18. Hilton P, Cromwell D. The risk of urogenital fistula after
19. Roberto Martinez P, SE RC, Escobar del Barco L, Ramirez Isarraraz C. Vesicovaginal fistula. Experience at the Instituto Nacional de Perinatologia. Ginecol Obstet Mex. 2007;75(1):31-4. 20. Duong TH, Gellasch TL, Adam RA. Risk factors for the development of vesicovaginal fistula after incidental cystotomy at the time of a benign hysterectomy. Am J Obstet Gynecol. 2009;201(5):512.e1-.e4. 21. Mathevet P, Valencia P, Cousin C, Mellier G, Dargent D. Operative injuries during vaginal hysterectomy. European Journal of Obstetrics, Gynecology & Reproductive Biology. 2001;97(1):71-5. Epub 2001/07/04. 22. Mondet F, Chartier-Kastler EJ, Conort P, Bitker MO, Chatelain C, Richard F. Anatomic and functional results of transperitoneal-transvesical vesicovaginal fistula repair. Urology. 2001;58(6):882-6. Epub 2001/12/18. 23. Chesson RR. Cystoscopy should be a routine procedure in the performance of hysterectomy. J Reprod Med. 2011;56(9-10):371-2. Epub 2011/10/21. 24. Benchekroun A, Lachkar A, Soumana A, Farih MH, Belahnech Z, Marzouk M, et al. [Ureter injuries. Apropos of 42 cases]. Ann Urol (Paris). 1997;31(5):267-72. Epub 1997/01/01. Les traumatismes de l’uretere. A propos de 42 cas. 25. Modarress M, Maghami FQ, Golnavaz M, Behtash N, Mousavi A, Khalili GR. Comparative study of chemoradiation and neoadjuvant chemotherapy effects before radical hysterectomy in stage IB-IIB bulky cervical cancer and with tumor diameter greater than 4 cm. International journal of gynecological cancer : official journal of the International Gynecological Cancer Society. 2005;15(3):483-8. Epub 2005/05/11. 26. Narayanan P, Nobbenhuis M, Reynolds KM, Sahdev A, Reznek RH, Rockall AG. Fistulas in malignant gynecologic disease: etiology, imaging, and management. Radiographics. 2009;29(4):1073-83. Epub 2009/07/17. 27. Baalbergen A, Veenstra Y, Stalpers LL, Ansink AC. Primary surgery versus primary radiation therapy with or without chemotherapy for early adenocarcinoma of the uterine cervix [Systematic Review]. Cochrane Database of Systematic Reviews. 2010;5:5. 28. Denton AS, Clarke N, Maher J. Non-surgical interventions for late radiation cystitis in patients who have received radical radiotherapy to the pelvis [Systematic Review]. Cochrane Database of Systematic Reviews. 2002(Issue 3):Art. No.: CD001773. 29. Marchiole P, Benchaib M, Buenerd A, Lazlo E, Dargent D, Mathevet P. Oncological safety of laparoscopic-assisted vaginal radical trachelectomy (LARVT or Dargent’s operation): a comparative study with laparoscopic-assisted vaginal radical hysterectomy (LARVH). Gynecologic oncology. 2007;106(1):132-41. Epub 2007/05/12. 30. Likic IS, Kadija S, Ladjevic NG, Stefanovic A, Jeremic K, Petkovic S, et al. Analysis of urologic complications after radical hysterectomy. American Journal of Obstetrics & Gynecology. 2008;199(6):644 e1-3. Epub 2008/08/30. 31. Baltzer J, Kaufmann C, Ober KG, Zander J. [Complications in 1,092 radical abdominal hysterectomies with pelvic lymphadenectomies (author’s transl)]. Geburtshilfe Frauenheilkd. 1980;40(1):1-5. Epub 1980/01/01. Komplikationen bei 1092 erweiterten abdominalen Krebsoperationen mit obligatorischer Lymphonodektomie. Ergebnisse einer kooperativen Studie an vier Universitats-Frauenkliniken. 32. Bostofte E, Serup J. Urological complications of Okabayashi’s operation for cervical cancer. Acta Obstet Gynecol Scand. 1981;60(1):39-42. Epub 1981/01/01. 33. Draca P. Wertheim hysterectomy: a ten year experience. Int Surg. 1979;64(5):59-63. Epub 1979/08/01.
1569
34. Genta RM, Ramchandani MK, Gyorkey F, Buzanis CT, Lahart CJ. Enterovesical fistula due to non-Hodgkin lymphoma in AIDS. Journal of Clinical Gastroenterology. 1993;16(4):333-5. 35. Murdoch M, Hilton P. Classical Hodgkin’s lymphoma presenting as vesicovaginal fistula. 2012:(submitted). 36. Averette HE, Nguyen HN, Donato DM, Penalver MA, Sevin BU, Estape R, et al. Radical hysterectomy for invasive cervical cancer. A 25-year prospective experience with the Miami technique. Cancer. 1993;71(4 Suppl):1422-37. Epub 1993/02/15. 37. Hallum IAV, Hatch KD, Nour M, Saucedo M. Comparison of radical abdominal hysterectomy with laparoscopicassisted radical vaginal hysterectomy for treatment of early cervical cancer. Journal of Gynecologic Techniques. 2000;6(1):3-6. 38. Hatch KD, Parham G, Shingleton HM, Orr JW, Jr., Austin JM, Jr. Ureteral strictures and fistulae following radical hysterectomy. Gynecologic oncology. 1984;19(1):17-23. Epub 1984/09/01. 39. Jones CR, Woodhouse CR, Hendry WF. Urological problems following treatment of carcinoma of the cervix. Br J Urol. 1984;56(6):609-13. Epub 1984/12/01. 40. Ralph G, Tamussino K, Lichtenegger W. Urological complications after radical hysterectomy with or without radiotherapy for cervical cancer. Archives of Gynecology & Obstetrics. 1990;248(2):61-5. Epub 1990/01/01. 41. Riss P, Koelbl H, Neunteufel W, Janisch H. Wertheim radical hysterectomy 1921-1986: changes in urologic complications. Archives of Gynecology & Obstetrics. 1988;241(4):249-53. Epub 1988/01/01. 42. Yan X, Li G, Shang H, Wang G, Chen L, Han Y. Complications of laparoscopic radical hysterectomy and pelvic lymphadenectomy--experience of 117 patients. Int J Gynecol Cancer. 2009;19(5):963-7. Epub 2009/07/04. 43. Chen Y, Xu H, Li Y, Wang D, Li J, Yuan J, et al. The outcome of laparoscopic radical hysterectomy and lymphadenectomy for cervical cancer: A prospective analysis of 295 patients. Annals of Surgical Oncology. 2008;15(10):2847-55. 44. Monk BJ, Montz FJ. Invasive cervical cancer complicating intrauterine pregnancy: treatment with radical hysterectomy. Obstetrics & Gynecology. 1992;80(2):199-203. Epub 1992/08/01. 45. Blythe JG, Hodel KA, Wahl TP. A comparison between peritoneal sheathing of the ureters (Ohkawa technique) and retroperitoneal pelvic suction drainage in the prevention of ureteral damage during radical abdominal hysterectomy. Gynecologic oncology. 1988;30(2):222-7. 46. Hopkins MP, Morley GW. Pelvic exenteration for the treatment of vulvar cancer. Cancer. 1992;70(12):2835-8. Epub 1992/12/15. 47. Berek JS, Howe C, Lagasse LD, Hacker NF. Pelvic exenteration for recurrent gynecologic malignancy: survival and morbidity analysis of the 45-year experience at UCLA. Gynecologic oncology. 2005;99(1):153-9. Epub 2005/08/02. 48. Ungar L, Palfalvi L, Novak Z. Primary pelvic exenteration in cervical cancer patients. Gynecologic oncology. 2008;111(2 Suppl):S9-12. Epub 2008/09/09. 49. Langebrekke A, Istre O, Hallqvist AC, Hartgill TW, Onsrud M. Comparison of laparoscopy and laparotomy in patients with endometrial cancer. J Am Assoc Gynecol Laparosc. 2002;9(2):152-7. Epub 2002/04/18. 50. Xu H, Chen Y, Li Y, Zhang Q, Wang D, Liang Z. Complications of laparoscopic radical hysterectomy and lymphadenectomy for invasive cervical cancer: Experience based on 317 procedures. Surgical endoscopy. 2007;21(6):960-4. 51. Kadar N, Reich H. Laparoscopically assisted radical Schauta hysterectomy and bilateral laparoscopic pelvic lymphadenectomy for the treatment of bulky stage
IB carcinoma of the cervix. Gynaecological Endoscopy. 1993;2(3):135-42. 52. Colombel M, Pedron P, Missirlu A, Abbou C, Chopin D. Vesicovaginal fistula after laser vaporization of vaginal condyloma. Journal of Urology. 1995;154(5):1860. 53. Nwabineli NJ, Davis JA. Fistula injury to the bladder at repeat cone biopsy by laser. Eur J Obstet Gynecol Reprod Biol. 1992;43(3):245-6. Epub 1992/02/28. 54. Ahuja A, Safaya R, Prakash G, Kumar L, Shukla NK. Primary mixed mullerian tumor of the vagina--a case report with review of the literature. Pathology, research and practice. 2011;207(4):253-5. Epub 2011/03/08. 55. Kucera H, Skodler W, Weghaupt K. [Complications of postoperative radiotherapy in uterine cancer]. Geburtshilfe Frauenheilkd. 1984;44(8):498-502. Epub 1984/08/01. Komplikationen der postoperativen Strahlentherapie beim Korpuskarzinom. 56. Biewenga P, Mutsaerts MA, Stalpers LJ, Buist MR, Schilthuis MS, van der Velden J. Can we predict vesicovaginal or rectovaginal fistula formation in patients with stage IVA cervical cancer? Int J Gynecol Cancer. 2010;20(3):471-5. Epub 2010/04/09. 57. Pushkar DY, Dyakov VV, Kasyan GR. Management of radiation-induced vesicovaginal fistula. Eur Urol. 2009;55(1):131-7. Epub 2008/05/20. 58. Zoubek J, McGuire EJ, Noll F, DeLancey JO. The late occurrence of urinary tract damage in patients successfully treated by radiotherapy for cervical carcinoma. Journal of Urology. 1989;141(6):1347-9. Epub 1989/06/01. 59. Cochrane JP, Yarnold JR, Slack WW. The surgical treatment of radiation injuries after radiotherapy for uterine carcinoma. The British journal of surgery. 1981;68(1):25-8. Epub 1981/01/01. 60. de Crevoisier R, Sanfilippo N, Gerbaulet A, Morice P, Pomel C, Castaigne D, et al. Exclusive radiotherapy for primary squamous cell carcinoma of the vagina. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2007;85(3):362-70. Epub 2007/10/30. 61. Demanes DJ, Schutz KL, Quackenbush JJ, Ewing T, Rodriguez RR. Low dose rate brachytherapy in vaginal carcinoma: Long-term outcome and morbidity. Journal of Brachytherapy International. 2000;16(1):11-24. 62. Emmert C, Kohler U. Management of genital fistulas in patients with cervical cancer. Archives of Gynecology & Obstetrics. 1996;259(1):19-24. Epub 1996/01/01. 63. Krause S, Hald T, Steven K. Surgery for urologic complications following radiotherapy for gynecologic cancer. Scandinavian Journal of Urology & Nephrology. 1987;21(2):1158. Epub 1987/01/01. 64. Maier U, Ehrenbock PM, Hofbauer J. Late urological complications and malignancies after curative radiotherapy for gynecological carcinomas: a retrospective analysis of 10,709 patients. Journal of Urology. 1997;158(3 Pt 1):8147. Epub 1997/09/01. 65. Monk BJ, Walker JL, Tewari K, Ramsinghani NS, Nisar Syed AM, DiSaia PJ. Open interstitial brachytherapy for the treatment of local-regional recurrences of uterine corpus and cervix cancer after primary surgery. Gynecologic oncology. 1994;52(2):222-8. Epub 1994/02/01. 66. Angioli R, Penalver M, Muzii L, Mendez L, Mirhashemi R, Bellati F, et al. Guidelines of how to manage vesicovaginal fistula. Critical Reviews in Oncology/Hematology. 2003;48(3):295-304. 67. Chassagne D, Sismondi P, Horiot JC, Sinistrero G, Bey P, Zola P, et al. A glossary for reporting complications of treatment in gynecological cancers. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 1993;26(3):195-202. Epub 1993/03/01. 68. Caputo RM, Copeland LJ. Gynecologic effects of tamox-
1570
ifen: case reports and review of the literature. Int Urogynecol J. 1996;7(4):179-84.
FL. Internal fistulas in diverticular disease. Diseases of the Colon & Rectum. 1988;31(8):591-6.
69. Behtash N, Ghaemmaghami F, Ayatollahi H, Khaledi H, Hanjani P. A case-control study to evaluate urinary tract complications in radical hysterectomy. 2005 [updated 16 Feb; cited 3 12]; Available from: http://dx.doi. org/10.1186/1477-7819-3-12.
86. Glass RE, Ritchie JK, Lennard-Jones JE, Hawley PR, Todd IP. Internal fistulas in Crohn’s disease. Diseases of the Colon & Rectum. 1985;28(8):557-61.
70. Monk BJ, Solh S, Johnson MT, Montz FJ. Radical hysterectomy after pelvic irradiation in patients with high risk cervical cancer or uterine sarcoma: morbidity and outcome. European journal of gynaecological oncology. 1993;14(6):506-11. Epub 1993/01/01. 71. Mitsuhashi N, Takahashi M, Yamakawa M, Nozaki M, Takahashi T, Sakurai H, et al. Results of postoperative radiation therapy for patients with carcinoma of the uterine cervix: evaluation of intravaginal cone boost with an electron beam. Gynecologic oncology. 1995;57(3):321-6. Epub 1995/06/01. 72. Koumantakis E, Haralambakis Z, Koukourakis M, Mazonakis M, Haldeopoulos D, Papageorgiou N, et al. A pilot study on concurrent platinum chemotherapy and intracavitary brachytherapy for locally advanced cancer of the uterine cervix. British Journal of Radiology. 1998;71(MAY):552-7. 73. Matsumura M, Takeshima N, Ota T, Omatsu K, Sakamoto K, Kawamata Y, et al. Neoadjuvant chemotherapy followed by radical hysterectomy plus postoperative chemotherapy but no radiotherapy for Stage IB2-IIB cervical cancer-irinotecan and platinum chemotherapy. Gynecologic oncology. 2010;119(2):212-6. Epub 2010/08/17. 74. Brummer TH JJ, Fraser J, Heikkinen AM, Kauko M, Mäkinen J, Seppälä T, Sjöberg J, Tomás E, Härkki P. FINHYST, a prospective study of 5279 hysterectomies: Complications and their risk factors. Hum Reprod. 2011;26:1741-51.
87. Kyle J. Urinary complications of Crohn’s disease. World J Surg. 1980;4(2):153-60. Epub 1980/01/01. 88. Najjar SF, Jamal MK, Savas JF, Miller TA. The spectrum of colovesical fistula and diagnostic paradigm. Am J Surg. 2004;188(5):617-21. 89. Schofield PF. Colovesical fistulas. Br J Hosp Med (Lond). 1988;39(6):483-7. 90. Pollard SG, Macfarlane R, Greatorex R, Everett WG, Hartfall WG. Colovesical fistula. Annals of the Royal College of Surgeons of England. 1987;69(4):163-5. Epub 1987/07/01. 91. Ferguson GG, Lee EW, Hunt SR, Ridley CH, Brandes SB. Management of the Bladder During Surgical Treatment of Enterovesical Fistulas from Benign Bowel Disease. J Am Coll Surg. 2008;207(4):569-72. Epub 2008/10/18. 92. Garcea G, Majid I, Sutton CD, Pattenden CJ, Thomas WM. Diagnosis and management of colovesical fistulae; six-year experience of 90 consecutive cases. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2006;8(4):347-52. Epub 2006/04/25. 93. McBeath RB, Schiff M, Jr., Allen V, Bottaccini MR, Miller JI, Ehreth JT. A 12-year experience with enterovesical fistulas. Urology. 1994;44(5):661-5. Epub 1994/11/01. 94. Mileski WJ, Joehl RJ, Rege RV, Nahrwold DL. One-stage resection and anastomosis in the management of colovesical fistula. Am J Surg. 1987;153(1):75-9. Epub 1987/01/01.
75. Likic IS KS, Ladjevic NG, Stefanovic A, Jeremic K, Petkovic S, Dzamic Z. . . Analysis of urologic complications after radical hysterectomy. American Journal of Obstetrics & Gynecology. 2008;199:644.e1-3.
95. Pokala N, Delaney CP, Brady KM, Senagore AJ. Elective laparoscopic surgery for benign internal enteric fistulas: a review of 43 cases. Surgical endoscopy. 2005;19(2):222-5. Epub 2004/12/30.
76. Frankman EA WL, Bunker CH, Lowder JL. Lower urinary tract injury in women in the united states, 1979–2006. Am J Obstet Gynecol. 2010;202:495.e1-5.
96. Hsieh JH, Chen WS, Jiang JK, Lin TC, Lin JK, Hsu H. Enterovesical fistula: 10 years experience. Zhonghua yi xue za zhi = Chinese medical journal; Free China ed. 1997;59(5):283-8. Epub 1997/05/01.
77. El-Tabey NA A-E-DB, Shaaban AA, El-Kappany HA, Mokhtar AA, El-Azab M, Kheir AA. Urological trauma after gynecological and obstetric surgeries. Scandinavian Journal of Urology & Nephrology 2011;185:945-50. 78. Sachdev P.S. HN, Abbasi R.M., Das C.M. Genito-urinary fistula: a major morbidity in developing countries. Journal of Ayub Medical College, Abbottabad (JAMC). 2009;21:811. 79. Kumar A, Goyal NK, Das SK, Trivedi S, Dwivedi US, Singh PB. Our experience with genitourinary fistulae. Urol Int. 2009;82(4):404-10. Epub 2009/06/10. 80. Nawaz H. KM, Tareen F.M., Khan S. Retrospective study of 213 cases of female urogenital fistulae at the Department of Urology & Transplantation Civil Hospital Quetta, Pakistan. Journal of the Pakistan Medical Association. 2010;60:28-32. 81. Chadha R, Agarwal K, Choudhury SR, Debnath PR. The colovesical fistula in congenital pouch colon: a histologic study. J Pediatr Surg. 2008;43(11):2048-52. Epub 2008/10/31. 82. Ben-Ami H, Ginesin Y, Behar DM, Fischer D, Edoute Y, Lavy A. Diagnosis and treatment of urinary tract complications in Crohn’s disease: an experience over 15 years. Canadian journal of gastroenterology = Journal canadien de gastroenterologie. 2002;16(4):225-9. Epub 2002/05/01. 83. Greenstein AJ, Sachar DB, Tzakis A, Sher L, Heimann T, Aufses AH, Jr. Course of enterovesical fistulas in Crohn’s disease. Am J Surg. 1984;147(6):788-92.
97. Liu CH, Chuang CK, Chu SH, Chen HW, Chen CS, Chiang YJ, et al. Enterovesical fistula: experiences with 41 cases in 12 years. Chang Gung Medical Journal (Changgeng Yi Xue Za Zhi). 1999;22(4):598-603. 98. Ouyang Q, Xue LY. Inflammatory bowel disease since the 21st Century in China–Turning challenges into opportunities. Journal of Digestive Diseases. 2012:accepted article (online). Available from: http://dx.doi.org/10.1111/j.7512980.012.00579.x. 99. Bahadursingh AM, Longo WE. Colovaginal fistulas. Etiology and management. Journal of Reproductive Medicine. 2003;48(7):489-95. Epub 2003/09/05. 100. Altman D, Forsgren C, Hjern F, Lundholm C, Cnattingius S, Johansson AL. Influence of hysterectomy on fistula formation in women with diverticulitis. The British journal of surgery. 2010;97(2):251-7. Epub 2009/12/26. 101. Ostrzenski A, Ostrzenska KM. Bladder injury during laparoscopic surgery. Obstetrical & gynecological survey. 1998;53(3):175-80. Epub 1998/03/26. 102. Kochakarn W, Pummangura W. A new dimension in vesicovaginal fistula management: an 8-year experience at Ramathibodi hospital. Asian J Surg. 2007;30(4):267-71. Epub 2007/10/27. 103. Kursh ED, Morse RM, Resnick MI, Persky L. Prevention of the development of a vesicovaginal fistula. Surg Gynecol Obstet. 1988;166(5):409-12. Epub 1988/05/01.
84. Margolin ML, Korelitz BI. Management of bladder fistulas in Crohn’s disease. Journal of Clinical Gastroenterology. 1989;11(4):399-402.
104. Ho AM, Roth P, Cowan WD. Gaseous distention of the urinary bag indicating bladder perforation during laparoscopic pelvic procedures. Int J Gynaecol Obstet. 1996;55(3):2978. Epub 1996/12/01.
85. Woods RJ, Lavery IC, Fazio VW, Jagelman DG, Weakley
105. O’Brien WM, Lynch JH. Simplification of double-dye test
1571
to diagnose various types of vaginal fistulas. Urology. 1990;36(5):456. Epub 1990/11/01.
trial. Ethiopian medical journal. 2010;48(3):211-7. Epub 2010/11/16.
106. Indraratna PL, Walsh CA, Moore KH. Intra-operative cystoscopy in gynaecological surgery: A brief overview. Australian and New Zealand Journal of Obstetrics & Gynaecology. 2011;51(3):272-5. Epub 2011/06/03.
123. Tomlinson AJ, Thornton JG. A randomised controlled trial of antibiotic prophylaxis for vesico-vaginal fistula repair. British Journal of Obstetrics & Gynaecology. 1998;105(4):397-9.
107. Gilmour DT, Dwyer PL, Carey MP. Lower urinary tract injury during gynecologic surgery and its detection by intraoperative cystoscopy. Obstetrics & Gynecology. 1999;94(5 pt.2):883-9. Epub 1999/11/05.
124. Safan A, Shaker H, Abdelaal A, Mourad MS, Albaz M. Fibrin glue versus martius flap interpositioning in the repair of complicated obstetric vesicovaginal fistula. A prospective multi-institution randomized trial. Neurourology and urodynamics. 2009;28(5):438-41. Epub 2009/05/29.
108. Sohail S, Siddiqui KJ. Trans-vaginal sonographic evaluation of vesicovaginal fistula. JPMA The Journal of the Pakistan Medical Association. 2005;55(7):292-4. Epub 2005/08/20. 109. Volkmer BG, Kuefer R, Nesslauer T, Loeffler M, Gottfried HW. Colour Doppler ultrasound in vesicovaginal fistulas. Ultrasound in medicine & biology. 2000;26(5):771-5. Epub 2000/08/16. 110. Kruger PS, Whiteside RS. Pseudo-renal failure following the delayed diagnosis of bladder perforation after diagnostic laparoscopy. Anaesthesia and intensive care. 2003;31(2):211-3. Epub 2003/04/26.
125. Shaker H, Saafan A, Yassin M, Idrissa A, Mourad MS. Obstetric vesico-vaginal fistula repair: should we trim the fistula edges? A randomized prospective study. Neurourology and urodynamics. 2011;30(3):302-5. Epub 2011/02/11. 126. Razzaghi MR, Rezaei A, Javanmard B, Lotfi B. Desmopressin as an alternative solution for urinary leakage after ureterocaliceal surgeries. Urology Journal. 2009;6(2):1202. Epub 2009/05/28. 127. Browning A. Lack of value of the Martius fibrofatty graft in obstetric fistula repair. International Journal of Gynecology & Obstetrics. 2006;93(1):33-7. Epub 2006/03/15.
111. Narayanan P NM, Reynolds KM, Sahdev A, Reznek RH, Rockall AG. Fistulas in malignant gynaecologic disease: Etiology, imaging, and management. Radiographics 2009;29:1073-83.
128. Demirel A, Polat O, Bayraktar Y, Gul O, Okyar G. Transvesical and transvaginal reparation in urinary vaginal fistulas. International Urology & Nephrology. 1993;25(5):439-44. Epub 1993/01/01.
112. Amendola MA, Agha FP, Dent TL, Amendola BE, Shirazi KK. Detection of occult colovesical fistula by the Bourne test. American Journal of Roentgenology. 1984;142(4):715-8.
129. Eilber KS, Kavaler E, Rodriguez LV, Rosenblum N, Raz S. Ten-year experience with transvaginal vesicovaginal fistula repair using tissue interposition. Journal of Urology. 2003;169(3):1033-6.
113. Bernstine H, Steinmetz AP, Hardoff R. Urinary diarrhea detected by Tc-99m DTPA scintigraphy in a 3-year-old girl. Clinical nuclear medicine. 2002;27(4):287-9. Epub 2002/03/27.
130. Wang Y, Hadley HR. Nondelayed transvaginal repair of high lying vesicovaginal fistula. Journal of Urology. 1990;144(1):34-6. Epub 1990/07/01.
114. Jarrett TW, Vaughan ED, Jr. Accuracy of computerized tomography in the diagnosis of colovesical fistula secondary to diverticular disease. Journal of Urology. 1995;153(1):446. Epub 1995/01/01. 115. Kavanagh D, Neary P, Dodd JD, Sheahan KM, O’Donoghue D, Hyland JM. Diagnosis and treatment of enterovesical fistulae. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2005;7(3):286-91. Epub 2005/04/30. 116. Kuhlman JE, Fishman EK. CT evaluation of enterovaginal and vesicovaginal fistulas. Journal of computer assisted tomography. 1990;14(3):390-4. Epub 1990/05/01. 117. Guenaga KF, Matos D, Wille-Jorgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database of Systematic Reviews. 2011;9:CD001544. Epub 2011/09/09. 118. Lapitan CM, Rienhardt G. Surgical management of vesicovaginal and/or urethrovaginal fistulae [Protocol]. Cochrane Database of Systematic Reviews. 2010;6:6. 119. Morton HC, Hilton P. Urethral injury associated with minimally invasive mid-urethral sling procedures for the treatment of stress urinary incontinence: A case series and systematic literature search. BJOG: An International Journal of Obstetrics and Gynaecology. 2009;116(8):1120-6. 120. Meeks GR, Sams JOt, Field KW, Fulp KS, Margolis MT. Formation of vesicovaginal fistula: the role of suture placement into the bladder during closure of the vaginal cuff after transabdominal hysterectomy. American Journal of Obstetrics & Gynecology. 1997;177(6):1298-304. Epub 1998/01/10. 121. Horng SG, Huang KG, Lo TS, Soong YK. Bladder Injury after LAVH: A Prospective, Randomized Comparison of Vaginal and Laparoscopic Approaches to Colpotomy during LAVH. The Journal of the American Association of Gynecologic Laparoscopists. 2004;11(1):42-6. Epub 2004/04/24. 122. Muleta M, Tafesse B, Aytenfisu HG. Antibiotic use in ob�stetric fistula repair: single blinded randomized clinical
131. Visco AG, Taber KH, Weidner AC, Barber MD, Myers ER. Cost-effectiveness of universal cystoscopy to identify ureteral injury at hysterectomy. Obstetrics & Gynecology. 2001;97(5 Pt 1):685-92. Epub 2001/05/08. 132. Bazi T. Spontaneous closure of vesicovaginal fistulas after bladder drainage alone: Review of the evidence. International Urogynecology Journal & Pelvic Floor Dysfunction. 2007;18(3):329-33. 133. Waaldijk K. The immediate surgical management of fresh obstetric fistulas with catheter and/or early closure. International Journal of Gynaecology & Obstetrics. 1994;45(1):116. Epub 1994/04/01. 134. Waaldijk K. Immediate indwelling bladder catheterisation at postpartum urine leakage - personal experience of 1200 patients. Tropical Doctor. 1997;27:227-8. 135. Waaldijk K. The immediate management of fresh obstetric fistulas. American Journal of Obstetrics & Gynecology. 2004;191(3):795-9. Epub 2004/10/07. 136. Chittacharoen A, Theppisai U. Urological injury during gynecologic surgical procedures. Journal of the Medical Association of Thailand = Chotmaihet thangphaet. 1993;76 Suppl 1:87-91. Epub 1993/01/01. 137. Davits RJ, Miranda SI. Conservative treatment of vesicovaginal fistulas by bladder drainage alone. Br J Urol. 1991;68(2):155-6. Epub 1991/08/01. 138. Dogra PN, Nabi G. Laser welding of vesicovaginal fistula. International Urogynecology Journal & Pelvic Floor Dysfunction. 2001;12(1):69-70. Epub 2001/04/11. 139. Falk HC, Orkin LA. Nonsurgical closure of vesicovaginal fistulas. Obstetrics & Gynecology. 1957;9(5):538-41. Epub 1957/05/01. 140. Frang D, Jilling A. Techniques for surgical repair of vesicovaginal fistulae. International Urology & Nephrology. 1983;15(2):161-9. Epub 1983/01/01. 141. Gorrea AM, Zuazu FJ, Sanchis MJA, Cruz JJF. Spontaneous healing of uretero-vesico-vaginal fistulas. Eur Urol. 1985;11(5):341-3. Epub 1985/01/01.
1572
142. Latzko W. Postoperative vesicovaginal fistulas: genesis and therapy. Am J Surg. 1942;58:211-8. 143. Lentz SS. Transvaginal repair of the posthysterectomy vesicovaginal fistula using a peritoneal flap: the gold standard. Journal of Reproductive Medicine. 2005;50(1):41-4. Epub 2005/02/26.
162. Hilton P, Ward A. Epidemiological and surgical aspects of urogenital fistulae: a review of 25 years’ experience in southeast Nigeria. Int Urogynecol J. 1998;9(4):189-94. 163. Hilton P. Vesico-vaginal fistulae - new perspectives. Current Opinion in Obstetrics and Gynecology - Clinical Urogynaecology. London: Balliere-Tindall; 2002. p. 513-20.
144. Milicic D, Sprem M, Bagovic D. A method for the repair of vesicovaginal fistulas. International Journal of Gynaecology & Obstetrics. 2001;73(1):35-9. Epub 2001/05/05.
164. Hilton P. Vesico-vaginal fistulas in developing countries. International Journal of Gynaecology & Obstetrics. 2003;82(3):285-95.
145. Soong Y, Lim PH. Urological injuries in gynaecological practice--when is the optimal time for repair? Singapore medical journal. 1997;38(11):475-8. Epub 1998/04/29.
165. Miller S, Lester F, Webster M, Cowan B. Obstetric fistula: a preventable tragedy. Journal of Midwifery & Women’s Health. 2005;50(4):286-94. Epub 2005/06/24.
146. Stovsky MD, Ignatoff JM, Blum MD, Nanninga JB, O’Conor VJ, Kursh ED. Use of electrocoagulation in the treatment of vesicovaginal fistulas. J Urol. 1994;152(5 Pt 1):1443-4. Epub 1994/11/01.
166. Onolemhemhen DO, Ekwempu CC. An investigation of sociomedical risk factors associated with vaginal fistula in northern Nigeria. 0363-0242. 1999;28(3):103-16.
147. Yokoyama M, Arisawa C, Ando M. Successful management of vesicouterine fistula by luteinizing hormone-releasing hormone analog. International Journal of Urology. 2006;13(4):457-9. Epub 2006/06/01. 148. Goh JT, Howat P, de Costa C. Oestrogen therapy in the management of vesicovaginal fistula. The Australian & New Zealand journal of obstetrics & gynaecology. 2001;41(3):333-4. Epub 2001/10/11. 149. Hemal AK, Wadhwa SN, Kriplani A, Hemal U. Youssef’s syndrome: An appraisal of hormonal treatment. Urol Int. 1994;52(1):55-7. Epub 1994/01/01. 150. Jozwik M, Jozwik M. Spontaneous closure of vesicouterine fistula. Account for effective hormonal treatment. Urol Int. 1999;62(3):183-7. Epub 1999/10/26. 151. Kumar A, Vaidyanathan S, Sharma SK, Sharma AK, Goswami AK. Management of vesico-uterine fistulae: a report of six cases. International Journal of Gynaecology & Obstetrics. 1988;26(3):453-7. Epub 1988/06/01.
167. Tahzib F. Epidemiological determinants of vesicovaginal fistulas. British Journal of Obstetrics and Gynaecology. 1983;90:387-91. 168. Tahzib F. Vesicovaginal fistula in Nigerian children. Lancet. 1985;2:1291-3. 169. Game X, Malavaud B, Alric L, Mouzin M, Sarramon JP, Rischmann P. Infliximab treatment of Crohn disease ileovesical fistula. Scandinavian journal of gastroenterology. 2003;38(10):1097-8. Epub 2003/11/19. 170. Sato S, Sasaki I, Naito H, Funayama Y, Fukushima K, Shibata C, et al. Management of urinary complications in Crohn’s disease. Surgery today. 1999;29(8):713-7. Epub 1999/09/14. 171. Serizawa H, Hibi T, Ohishi T, Watanabe N, Hamada Y, Watanabe M, et al. Laparoscopically assisted ileocecal re�section for Crohn’s disease associated with intestinal stenosis and ileovesical fistula. Journal of gastroenterology. 1996;31(3):425-30. Epub 1996/06/01.
152. Rubino SM. Vesico-uterine fistula treated by amenorrhoea induced with contraceptive steroids. Two case reports. Bjog. 1980;87(4):343-4. Epub 1980/04/01.
172. Shackley DC, Brew CJ, Bryden AA, Anderson ID, Carlson GL, Scott NA, et al. The staged management of complex entero-urinary fistulae. BJU International. 2000;86(6):6249. Epub 2000/11/09.
153. Tarhan F, Erbay E, Penbegul N, Kuyumcuoglu U. Minimal invasive treatment of vesicouterine fistula: A case report. International Urology & Nephrology. 2007;39(3):791-3. Epub 2006/09/29.
173. Tsai MS, Liang JT. Surgery is justified in patients with bowel obstruction due to radiation therapy. Journal of Gastrointestinal Surgery. 2006;10(4):575-82.
154. Novi JM, Rose M, Shaunik A, Ramchandani P, Morgan MA. Conservative management of vesicouterine fistula after uterine rupture. International Urogynecology Journal & Pelvic Floor Dysfunction. 2004;15(6):434-5. Epub 2004/11/19. 155. Garrido-Ruiz MC, Rosales B, Luis Rodriguez-Peralto J. Vulvar pseudoverrucous papules and nodules secondary to a urethral--vaginal fistula. American Journal of Dermatopathology. 2011;33(4):410-2. Epub 2011/02/03. 156. Onuora VC, al-Mohalhal S, Youssef AM, Patil M. Iatrogenic urogenital fistulae. Br J Urol. 1993;71(2):176-8. 157. Gruen A, Musik T, Kohler C, Fuller J, Wendt T, Stromberger C, et al. Adjuvant chemoradiation after laparoscopically assisted radical vaginal hysterectomy (LARVH) in patients with cervical cancer: Oncologic outcome and morbidity. Strahlentherapie und Onkologie. 2011;187(6):344-9. 158. Nashiro T, Yagi C, Hirakawa M, Inamine M, Nagai Y, Sakumoto K, et al. Concurrent chemoradiation for locally ad�vanced squamous cell carcinoma of the vagina: Case series and literature review. International Journal of Clinical Oncology. 2008;13(4):335-9. 159. Arias BE, Ridgeway B, Barber MD. Complications of neglected vaginal pessaries: case presentation and literature review. International Urogynecology Journal & Pelvic Floor Dysfunction. 2008;19(8):1173-738. Epub 2008/02/28. 160. Carr LK, Webster GD. Abdominal repair of vesicovaginal fistula. Urology. 1996;48(1):10-1. Epub 1996/07/01. 161. Aimakhu VE. Reproductive functions after the repair of obstetric vesicovaginal fistulae. Fertility & Sterility. 1974;25(7):586-91. Epub 1974/07/01.
174. Eyre RC, Rosenthal JT, Libertino JA, Zinman LM. Management of urinary and bowel complications after ileal conduit diversion. Journal of Urology. 1982;128(6):117780. Epub 1982/12/01. 175. Penalver MA, Angioli R, Mirhashemi R, Malik R. Management of early and late complications of ileocolonic continent urinary reservoir (Miami pouch). Gynecologic oncology. 1998;69(3):185-91. 176. Waaldijk K, Elkins T. The obstetric fistula and peroneal nerve injury: an analysis of 947 consecutive patients. International Urogynecological Journal. 1994;5:12-4. 177. Hilton P. Vesico-vaginal fistulas in developing countries. International Journal of Gynecology & Obstetrics. 2003;82(3):285-95. 178. Tomlinson AJ, Thornton JG. A randomised controlled trial of antibiotic prophylaxis for vesico- vaginal fistula repair. British Journal of Obstetrics and Gynaecology. 1998;105:397-9. 179. Arrowsmith SD, Ruminjo J, Landry EG. Current practices in treatment of female genital fistula: a cross sectional study. BMC pregnancy and childbirth. 2010;10(73):73. Epub 2010/11/12. 180. Niel-Weise BS, van den Broek PJ. Antibiotic policies for short-term catheter bladder drainage in adults. Cochrane Database of Systematic Reviews. 2005;2005(3):CD005428. Epub 2005/07/22. 181. Ojengbede OA, Morhason-Bello IO, Shittu O. Onestage repair for combined fistulas: myth or reality? International Journal of Gynaecology & Obstetrics. 2007;99(1).
1573
182. Browning A, Fentahun W, Goh JT. The impact of surgical treatment on the mental health of women with obstetric fistula. BJOG: an International Journal of Obstetrics & Gynaecology. 2007;114(11):1439-41. Epub 2007/10/02. 183. Goh JT, Sloane KM, Krause HG, Browning A, Akhter S. Mental health screening in women with genital tract fistulae. BJOG: an International Journal of Obstetrics & Gynaecology. 2005;112(9):1328-30. 184. Hilton P. Debate: ‘Post-operative urinary fistulae should be managed by gynaecologists in specialist centres’. Brit J Urol. 1997;80, suppl 1:35-42. Epub 1997/07/01. 185. Hilton P. Urethrovaginal fistula associated with ‘sterile abscess’ formation following periurethral injection of dextranomer/hyaluronic acid co-polymer (Zuidex (TM)) for the treatment of stress urinary incontinence-a case report. BJOG. 2009;116(11):1527-30. 186. Gortchev G, Tomov S, Tantchev L, Velkova A, Radionova Z. Da Vinci S robotic surgery in the treatment of benign and malignant gynecologic tumors. Gynecological Surgery. 2009;7(2):153-7. 187. Lee JH, Choi JS, Lee KW, Han JS, Choi PC, Hoh JK. Immediate laparoscopic nontransvesical repair without omental interposition for vesicovaginal fistula developing after total abdominal hysterectomy. JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons. 2010;14(2):187-91. Epub 2010/10/12. 188. Shelbaia AM, Hashish NM. Limited Experience in Early Management of Genitourinary Tract Fistulas. Urology. 2007;69(3):572-4. Epub 2007/03/27. 189. Badenoch DF, Tiptaft RC, Thakar DR, Fowler CG, Blandy JP. Early repair of accidental injury to the ureter or bladder following gynaecological surgery. Br J Urol. 1987;59(6):516-8. Epub 1987/06/01. 190. Blandy JP, Badenoch DF, Fowler CG, Jenkins BJ, Thomas NW. Early repair of iatrogenic injury to the ureter or bladder after gynecological surgery. Journal of Urology. 1991;146(3):761-5. Epub 1991/09/01. 191. Kam MH, Tan YH, Wong MY. A 12-year experience in the surgical management of vesicovaginal fistulae. Singapore medical journal. 2003;44(4):181-4. Epub 2003/09/04. 192. Moriel EZ, Meirow D, Zilberman M, Farkas A. Experience with the immediate treatment of iatrogenic bladder injuries and the repair of complex vesico-vaginal fistulae by the transvesical approach. Archives of Gynecology & Obstetrics. 1993;253(3):127-30. Epub 1993/01/01. 193. Radoja I, Sudarevic B, Perkovic J, Rakin I, Cosic I, Pavlovic O, et al. Our experience with vesicovaginal fistula repair surgery. European Urology, Supplements. 2010;9 (6):637. 194. Dolan LM, Dixon WE, Hilton P. Urinary symptoms and quality of life following urogenital fistula repair: a long-term follow-up study. BJOG. 2008;115(12):1570-4. 195. Browning A, Menber B. Women with obstetric fistula in Ethiopia: a 6-month follow up after surgical treatment. BJOG: an International Journal of Obstetrics & Gynaecology. 2008;115(12):1564-9. Epub 2008/11/28. 196. Sims J. On the treatment of vesico-vaginal fistula. American Journal of the Medical Sciences. 1852;XXIII:59-82. 197. Wall LL. Dr. George Hayward (1791-1863): a forgotten pioneer of reconstructive pelvic surgery. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16(5):330-3. Epub 2005/06/25. 198. Lawson J. Vesical fistulae into the vaginal vault. Br J Urol. 1972;44:623-31. 199. Moir JC. The vesico-vaginal fistula and its treatment. J R Coll Surg Edinb. 1962;7:268-74. Epub 1962/07/01. 200. Hamlin R, Nicholson E. Reconstruction of urethra totally destroyed in labour. Br Med J. 1969;2:147-50. 201. Ayed M, El Atat R, Hassine LB, Sfaxi M, Chebil M, Zmerli S. Prognostic factors of recurrence after vesicovaginal fistula
repair. International Journal of Urology. 2006;13(4):345-9. Epub 2006/06/01. 202. Catanzaro F, Pizzoccaro M, Cappellano F, Catanzaro M, Ciotti G, Giollo A. Vaginal repair of vesico-vaginal fistulas: our experience. Archivio italiano di Urologia, Andrologia. 2005;77(4):224-5. Epub 2006/02/01. 203. Langkilde NC, Pless TK, Lundbeck F, Nerstrom B. Surgical repair of vesicovaginal fistulae--a ten-year retrospective study. Scandinavian Journal of Urology & Nephrology. 1999;33(2):100-3. Epub 1999/06/09. 204. 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(8):1122-6. Epub 2009/01/22. 205. Ou CS, Huang UC, Tsuang M, Rowbotham R. Laparoscopic Repair of Vesicovaginal Fistula. Journal of Laparoendoscopic and Advanced Surgical Techniques. 2004;14(1):1721. Epub 2004/03/24. 206. Hilton P, Ward A. Epidemiological and surgical aspects of urogenital fistulae: a review of 25 years experience in south-east Nigeria. International Urogynecology Journal & Pelvic Floor Dysfunction. 1998;9:189-94. 207. Nezhat CH, Nezhat F, Nezhat C, Rottenberg H. Laparoscopic repair of a vesicovaginal fistula: A case report. Obstet Gynecol. 1994;83(5 II):899-901. 208. Abdel-Karim AM, Mousa A, Hasouna M, Elsalmy S. Laparoscopic transperitoneal extravesical repair of vesicovaginal fistula. International Urogynecology Journal & Pelvic Floor Dysfunction. 2011;22(6):693-7. Epub 2010/11/26. 209. Abdel-Karim AM, Moussa A, Elsalmy S. Laparoendoscopic single-site surgery extravesical repair of vesicovaginal fistula: early experience. Urology. 2011;78(3):567-71. Epub 2011/07/26. 210. Chibber PJ, Shah HN, Jain P. Laparoscopic O’Conor’s repair for vesico-vaginal and vesico-uterine fistulae. BJU International. 2005;96(1):183-6. Epub 2005/06/21. 211. Das Mahapatra P, Bhattacharyya P. Laparoscopic intraperitoneal repair of high-up urinary bladder fistula: a review of 12 cases. International Urogynecology Journal & Pelvic Floor Dysfunction. 2007;18(6):635-9. Epub 2006/10/13. 212. Gozen AS, Teber D, Canda AE, Rassweiler J. Transperitoneal laparoscopic repair of iatrogenic vesicovaginal fistulas: Heilbronn experience and review of the literature. Journal of Endourology. 2009;23(3):475-9. Epub 2009/02/17. 213. Miklos JR, Sobolewski C, Lucente V. Laparoscopic management of recurrent vesicovaginal fistula. International Urogynecology Journal & Pelvic Floor Dysfunction. 1999;10(2):116-7. Epub 1999/06/29. 214. Otsuka RAP, Amaro JL, Tanaka MT, Epacagnan E, Mendes Jr JB, Kawano PR, et al. Laparoscopic repair of vesicovaginal fistula. Journal of Endourology. 2008;22(3):525-7. Epub 2008/03/22. 215. Phipps J. Laparoscopic repair of posthysterectomy vesicovaginal fistula: Two case reports. Gynaecological Endoscopy. 1996;5(2):123-4. 216. Porpiglia F, Fiori C, Morra I, Ragni F, Vaccino D, Scarpa RM. Laparoscopic vesico-vaginal fistula repair: our experience and review of the literature. [Review] [25 refs]. Surgical laparoscopy, endoscopy & percutaneous techniques. 2009;19(5):410-4. Epub 2009/10/24. 217. Rizvi SJ, Gupta R, Patel S, Trivedi A, Trivedi P, Modi P. Modified laparoscopic abdominal vesico-vaginal fistula repair-’Mini- o’Conor’ vesicotomy. Journal of Laparoendoscopic and Advanced Surgical Techniques. 2010;20(1):135. Epub 2010/01/12. 218. Shah SJ. Laparoscopic transabdominal transvesical vesicovaginal fistula repair. Journal of Endourology. 2009;23(7):1135-7. Epub 2009/07/09. 219. Sotelo R, Mariano MB, Garcia-Segui A, Dubois R, Spaliviero M, Keklikian W, et al. Laparoscopic repair of vesicovaginal fistula. Journal of Urology. 2005;173(5):1615-8. Epub 2005/04/12.
1574
220. Wong C, Lam PN, Lucente VR. Laparoscopic transabdominal transvesical vesicovaginal fistula repair. Journal of Endourology. 2006;20(4):240-3. Epub 2006/05/02.
238. Lazarou G, Grigorescu B, Powers K, Mikhail MS. Transvaginal injection of fibrin sealant for closure of vesicovaginal fistula. Journal of Pelvic Medicine & Surgery. 2006;12(6):335-7.
221. Melamud O, Eichel L, Turbow B, Shanberg A. Laparoscopic vesicovaginal fistula repair with robotic reconstruction. Urology. 2005;65(1):163-6. Epub 2005/01/26.
239. Sharma SK, Perry KT, Turk TMT. Endoscopic injection of fibrin glue for the treatment of urinary-tract pathology. Journal of Endourology. 2005;19(3):419-23. Epub 2005/05/04.
222. Hemal AK, Kolla SB, Wadhwa P. Robotic Reconstruction for Recurrent Supratrigonal Vesicovaginal Fistulas. Journal of Urology. 2008;180(3):981-5.
240. McKay HA. Vesicovaginal and vesicocutaneous fistulas: transurethral suture cystorrhaphy as a new closure technique. Journal of Urology. 1997;158(4):1513-6. Epub 1997/09/25.
223. Kurz M, Horstmann M, John H. Robot-assisted laparoscopic repair of high vesicovaginal fistulae with peritoneal flap inlay. Eur Urol. 2012;61(1):229-30. Epub 2011/10/11. 224. Schimpf MO, Morgenstern JH, Tulikangas PK, Wagner JR. Vesicovaginal fistula repair without intentional cystotomy using the laparoscopic robotic approach: a case report. JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons. 2007;11(3):378-80. Epub 2007/10/13. 225. Sundaram BM, Kalidasan G, Hemal AK. Robotic repair of vesicovaginal fistula: Case series of five patients. Urology. 2006;67(5):970-3. 226. Shekarriz B, Stoller ML. The use of fibrin sealant in urology. Journal of Urology. 2002;167(3):1218-25. Epub 2002/02/08. 227. Grumbt H, Kurz W, Knoth HJ. [Closure of a vesico-perineal fistula with fibrin glue]. Zentralblatt fur Chirurgie. 1984;109(5):364-5. Epub 1984/01/01. Verschluss einer Blasen-Damm-Fistel durch Fibrinkleber. 228. Morita T, Tachikawa N, Tokue A. Successful closure of neovesicocutaneous fistula with fibrin glue. Urol Int. 1998;61(2):130-1. Epub 1999/01/05 21:58. 229. Morita T, Tokue A. Successful endoscopic closure of radiation induced vesicovaginal fistula with fibrin glue and bovine collagen. Journal of Urology. 1999;162(5):1689. Epub 1999/10/19. 230. Rossi D, Bladou F, Berthet B, Coulange C, Serment G. [A simple alternative for the treatment of urinary fistulas: fibrin glue]. Progres en Urologie. 1991;1(3):445-8. Epub 1991/06/01. Une alternative simple dans le traitement des fistules urinaires: la colle de fibrine. 231. Schneider JA, Patel VJ, Hertel E. [Closure of vesicovaginal fistulas from the urologic viewpoint with reference to endoscopic fibrin glue technique]. Zentralbl Gynakol. 1992;114(2):70-3. Epub 1992/01/01. Der Verschluss von Blasenscheidenfisteln aus urologischer Sicht unter Berucksichtigung der endoskopischen Fibrinklebung. 232. Tostain J. [Conservative treatment of urogenital fistula following gynecological surgery: the value of fibrin glue]. Acta Urol Belg. 1992;60(3):27-33. Epub 1992/01/01. Traitement conservateur des fistules urogenitales apres chirurgie gynecologique: interet de la colle de fibrine. 233. Welp T, Bauer O, Diedrich K. [Use of fibrin glue in vesicovaginal fistulas after gynecologic treatment]. Zentralbl Gynakol. 1996;118(7):430-2. Epub 1996/01/01. Fibrinkleber im Einsatz bei Blasen-Scheiden-Fisteln nach gynakologischer Behandlung. 234. Yashi M, Muraishi O, Yuzawa M, Tokue A. [A case of colovesico-vaginal fistula caused by sigmoid colon diverticulitis]. Hinyokika Kiyo. 1998;44(7):513-5. Epub 1998/09/30. 235. D’Arcy FT, Jaffry S. The treatment of vesicovaginal fistula by endoscopic injection of fibrin glue. The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland. 2010;8(3):174-6. Epub 2010/04/20. 236. Daley SM, Lallas CD, Swanson SK, Novicki DE, Itano NB. Fibrin Sealant Closure of a Persistent Vesicovaginal Fistula After Failed Transabdominal Closure. Journal of Pelvic Medicine & Surgery. 2006;12(4):229-30. 237. Evans LA, Ferguson KH, Foley JP, Rozanski TA, Morey AF. Fibrin sealant for the management of genitourinary injuries, fistulas and surgical complications. Journal of Urology. 2003;169(4):1360-2. Epub 2003/03/12.
241. McKay HA. Transurethral suture cystorrhaphy for repair of vesicovaginal fistulas: Evolution of a technique. International Urogynecology Journal & Pelvic Floor Dysfunction. 2001;12(4):282-7. Epub 2001/09/25. 242. Okamura K, Kanai S, Kurokawa T, Kondo A. Endoscopic transvesico-transurethral approach for repair of vesicovaginal fistula: Initial case report. Journal of Endourology. 1997;11(3):203-5. Epub 1997/06/01. 243. Rangnekar NP, Imdad Ali N, Kaul SA, Pathak HR. Role of the martius procedure in the management of urinaryvaginal fistulas. J Am Coll Surg. 2000;191(3):259-63. Epub 2000/09/16. 244. Zimmern P, Schmidbauer CP, Leach GE, Staskin DR, Hadley HR, Raz S. Vesicovaginal and urethrovaginal fistulae. Semin Urol. 1986;4(1):24-9. Epub 1986/02/01. 245. Turner-Warwick R. The use of the omental pedicle graft in urinary tract reconstruction. Journal of Urology. 1976;116:341-7. 246. Wein AJ, Malloy TR, Carpiniello VL, Greenberg SH, Murphy JJ. Repair of vesicovaginal fistula by a suprapubic transvesical approach. Surg Gynecol Obstet. 1980;150(1):5760. Epub 1980/01/01. 247. Evans DH, Madjar S, Politano VA, Bejany DE, Lynne CM, Gousse AE. Interposition flaps in transabdominal vesicov� aginal fistula repairs: are they really necessary? Urology. 2001;57(4):670-4. Epub 2001/04/18. 248. Izes J, Smith J, Zinman L. The gracilis muscle iin repair of complex lower urinary tract fistulae (15 year experience). . J Urol. 1992;147 (suppl):281A. 249. Symmonds RE, Hill LM. Loss of the urethra: a report on 50 patients. Am J Obstet Gynecol. 1978;130(2):130-8. Epub 1978/01/15. 250. Mraz JP, Sutory M. An alternative in surgical treatment of post-irradiation vesicovaginal and rectovaginal fistulas: the seromuscular intestinal graft (patch). J Urol. 1994;151(2):357-9. Epub 1994/02/01. 251. Menchaca A, Akhyat M, Gleicher N, Gottlieb L, Bernstein J. The rectus abdominis muscle flap in a combined abdominovaginal repair of difficult vesicovaginal fistulae. A report of three cases. J Reprod Med. 1990;35(5):565-8. Epub 1990/05/01. 252. Viennas LK, Alonso AM, Salama V. Repair of radiationinduced vesicovaginal fistula with a rectus abdominis myocutaneous flap. Plastic & Reconstructive Surgery. 1995;96(6):1435-7. 253. Brandt FT, Lorenzato FR, Albuquerque CD. Treatment of vesicovaginal fistula by bladder mucosa autograft technique. J Am Coll Surg. 1998;186(6):645-8. Epub 1998/06/19. 254. Ostad M, Uzzo RG, Coleman J, Young GP. Use of a free bladder mucosal graft for simple repair of vesicovaginal fistulae. Urology. 1998;52(1):123-6. Epub 1998/07/22. 255. Sharifi-Aghdas F, Ghaderian N, Payvand A. Free bladder mucosal autograft in the treatment of complicated vesicovaginal fistula. BJU Int. 2002;89 Suppl 1:54-6. Epub 2002/03/06. 256. Nardos R, Browning A, Member B. Duration of bladder catheterization after surgery for obstetric fistula. International Journal of Gynaecology & Obstetrics. 2008;103(1):30-2.
1575
257. Hedlund H, Lindstedt E. Urovaginal fistulas: 20 years of experience with 45 cases. Journal of Urology. 1987;137(5):926-8. Epub 1987/05/01.
M, Bizic M, et al. [Repair of vesicovaginal fistula caused by radiation therapy with labia maiora skin flap]. Srp Arh Celok Lek. 2010;138(5-6):356-61. Epub 2010/07/09.
258. Jovanovic MD, Milovic N, Aleksic P, Bancevic V, Kosevic B, Campara Z, et al. Efficiency of urinary fistulas surgical treatment. European Urology, Supplements. 2010;9 (6):572.
277. Tran KT, Kuijpers HC, van Nieuwenhoven EJ, van Goor H, Spauwen PH. Transposition of the rectus abdominis muscle for complicated pouch and rectal fistulas. Diseases of the Colon & Rectum. 1999;42(4):486-9. Epub 1999/04/24.
259. Madjar S, Gousse A. Postirradiation vesicovaginal fistula completely resolved with conservative treatment. International Urogynecology Journal & Pelvic Floor Dysfunction. 2001;12(6):405-6. Epub 2002/01/25.
278. Amsellem-Ouazana D, Cornud F, Conquy S, Beuzeboc P, Massault PP, Vieillefond A, et al. Management of a malignant urinary fistula by ureteral embolization with coils. Urology. 2006;68(2):427.e1-.e3.
260. Vanni AJ, Buckley JC, Zinman LN. Management of surgical and radiation induced rectourethral fistulas with an interposition muscle flap and selective buccal mucosal onlay graft. Journal of Urology. 2010;184(6):2400-4. Epub 2010/10/19.
279. Gaylord GM, Johnsrude IS. Transrenal ureteral occlusion with Gianturco coils and gelatin sponge. Radiology. 1047;172(3 Pt 2):1047-8.
261. Kisner CD, Kesner KM. Use of the transverse colon conduit for vesicovaginal fistula in late-stage carcinoma of the cervix. Br J Urol. 1987;59(3):234-8. 262. Ravi R, Dewan AK, Pandey KK. Transverse colon conduit urinary diversion in patients treated with very high dose pelvic irradiation. Br J Urol. 1994;73(1):51-4. Epub 1994/01/01. 263. Schmidt JD, Hawtrey CE, Buchsbaum HJ. Transverse colon conduit: a preferred method of urinary diversion for radiation-treated pelvic malignancies. Journal of Urology. 1975;113(3):308-13. Epub 1975/03/01. 264. Hampson SJ, Morris SB, Gordon EM, Shearer RJ. Management of inoperable pelvic carcinomas with complex fistulas: a new approach. Annals of the Royal College of Surgeons of England. 1994;76(3):188-9. Epub 1994/05/01. 265. Leissner J, Black P, Filipas D, Fisch M, Hohenfellner R. Vaginal reconstruction using the bladder and/or rectal walls in patients with radiation-induced fistulas. Gynecologic oncology. 2000;78(3 Pt 1):356-60. Epub 2000/09/14. 266. Hsu TH, Rackley RR, Abdelmalak JB, Madjar S, Vasavada SP. Novel technique for combined repair of postirradiation vesicovaginal fistula and augmentation ileocystoplasty. Urology. 2002;59(4):597-9. Epub 2002/04/03. 267. Tabakov ID, Slavchev BN. Large post-hysterectomy and post-radiation vesicovaginal fistulas: repair by ileocystoplasty. Journal of Urology. 2004;171(1):272-4. Epub 2003/12/11. 268. Kulkarni JN, Gulla RI. 1-Stage repair of radiation induced colovesical fistula by resection and colocystoplasty. Journal of Urology. 1998;160(6 Pt 1):2149-50. Epub 1998/11/17. 269. Verbaeys C, Hoebeke P, Oosterlinck W. Complicated postirradiation vesicovaginal fistula in young women: keep off or try reconstruction? Eur Urol. 2007;51(1):243-6; discussion 6. Epub 2006/07/11. 270. Hilton P. Fistula repair. In: Smith R, del Priore G, Curtin J, Monaghan J, editors. An Atlas of Gynaecological Oncology. 3rd ed. London: Taylor & Francis Medical Books; 2011. p. 236-50.
280. Farrell TA, Wallace M, Hicks ME. Long-term results of transrenal ureteral occlusion with use of Gianturco coils and gelatin sponge pledgets. Journal of Vascular & Interventional Radiology. 1997;8(3):449-52. 281. Farrell T, Yamaguchi T, Barnhart W, Lang E. Percutaneous ureteral clipping: long-term results and complications. Journal of Vascular & Interventional Radiology. 1997;8(3):453-6. 282. Kinn AC, Ohlsen H, Brehmer-Andersson E, Brundin J. Therapeutic ureteral occlusion in advanced pelvic malignant tumors. Journal of Urology. 1986;135(1):29-32. Epub 1986/01/01. 283. Schild HH, Gunther R, Thelen M. Transrenal ureteral occlusion: results and problems. Journal of Vascular & Interventional Radiology. 1994;5(2):321-5. 284. Papanicolaou N, Pfister RC, Yoder IC. Percutaneous occlusion of ureteral leaks and fistulae using nondetachable balloons. Urol Radiol. 1985;7(1):28-31. 285. Sanchez R, Quinn SF, Morrisseau PM, Roberts W, Kavanagh J, Clark RA. Urinary diversion by using a percutaneous ureteral occlusion device. American Journal of Roentgenology. 1988;150(5):1069-70. Epub 1988/05/01. 286. Horenblas S, Kroger R, Van Boven E, Meinhardt W, Newling DWW. Use of balloon catheters for ureteral occlusion in urinary leakage. Eur Urol. 2000;38(5):613-7. 287. Avritscher R, Madoff DC, Ramirez PT, Wallace MJ, Ahrar K, Morello FA, Jr., et al. Fistulas of the lower urinary tract: percutaneous approaches for the management of a difficult clinical entity. Radiographics. 2004;24(suppl 1):S217S36. Epub 2004/10/16. 288. Levy C, Tremaine WJ. Management of internal fistulas in Crohn’s disease. Inflammatory bowel diseases. 2002;8(2):106-11. Epub 2002/02/21. 289. Present DH, Rutgeerts P, Targan S, Hanauer SB, Mayer L, van Hogezand RA, et al. Infliximab for the treatment of fistulas in patients with Crohn’s disease. New England Journal of Medicine. 1999;340(18):1398-405. Epub 1999/05/06.
271. Aitken RJ, Elliot MS. Sigmoid exclusion: a new technique in the management of radiation-induced fistula. The British journal of surgery. 1985;72(9):731-2. Epub 1985/09/01.
290. Sonnenberg A, Gavin MW. Timing of surgery for enterovesical fistula in Crohn’s disease: decision analysis using a time-dependent compartment model. Inflammatory bowel diseases. 2000;6(4):280-5. Epub 2001/01/10.
272. Levenback C, Gershenson DM, McGehee R, Eifel PJ, Morris M, Burke TW. Enterovesical fistula following radiotherapy for gynecologic cancer. Gynecologic oncology. 1994;52(3):296-300. Epub 1994/03/01.
291. Amin M, Nallinger R, Polk HC, Jr. Conservative treatment of selected patients with colovesical fistula due to diverticulitis. Surg Gynecol Obstet. 1984;159(5):442-4. Epub 1984/11/01.
273. Kiricuta I, Goldstein AM. The repair of extensive vesicovaginal fistulas with pedicled omentum: a review of 27 cases. Journal of Urology. 1972;108(5):724-7. Epub 1972/11/01.
292. Lewis SL, Abercrombie GF. Conservative surgery for vesicocolic fistula. Journal of the Royal Society of Medicine. 1984;77(2):102-4. Epub 1984/02/01.
274. Bizic M, Kojovic V, Majstorovic M, Djordjevic M. A versatile labia minora skin flap in severe vesicovaginal fistula repair. European Urology, Supplements. 2010;9 (6):572.
293. McNamara MJ, Fazio VW, Lavery IC, Weakley FL, Farmer RG. Surgical treatment of enterovesical fistulas in Crohn’s disease. Diseases of the Colon & Rectum. 1990;33(4):2716. Epub 1990/04/01.
275. Lai YL, Chang CJ. Vulvovaginal reconstruction following radical tumor resection: report of 12 cases. Chang Gung Medical Journal. 1999;22(2):253-8. 276. Stanojevic D, Djordjevic M, Martins F, Rudic J, Stanojevic
294. Pontari MA, McMillen MA, Garvey RH, Ballantyne GH. Diagnosis and treatment of enterovesical fistulae. The American surgeon. 1992;58(4):258-63. Epub 1992/04/01.
1576
295. McConnell DB, Sasaki TM, Vetto RM. Experience with colovesical fistula. Am J Surg. 1980;140(1):80-4. Epub 1980/07/01. 296. Balaguera CJ, Camunas Segovia J, Pena Gamarra L, Oliart Delgado de Torres S, Martin Garcia-Almenta M, Viso Ciudad S, et al. Colovesical fistula complicating diverticular disease: one-stage resection. Int Surg. 2006;91(1):17-23. 297. Menenakos E, Hahnloser D, Nassiopoulos K, Chanson C, Sinclair V, Petropoulos P. Laparoscopic surgery for fistulas that complicate diverticular disease. Langenbeck’s archives of surgery / Deutsche Gesellschaft fur Chirurgie. 2003;388(3):189-93. Epub 2003/07/02. 298. Tsivian A, Kyzer S, Shtricker A, Benjamin S, Sidi AA. Laparoscopic treatment of colovesical fistulas: technique and review of the literature. International Journal of Urology. 2006;13(5):664-7. Epub 2006/06/15. 299. Dobrowolski Z KJ, Drewniak T, Habrat W, Lipczynski W, Jakubik P, Weglarz W. Renal and ureteric trauma: Diagnosis and management in Poland. BJU international 2002;89:748-51. 300. Djakovic N PE, Martínez-Piñeiro L, Lynch T, Mor Y, Santucci RA, Serafetinidis E, Turkeri LN, Hohenfellner M. European Association of Urology Guidelines on Urological Trauma 2009. http://wwwuroweborg/gls/pdf/20_Urological_Trauma%202009pdf. 2009.
The management of bilateral ureteric injury following radical hysterectomy. Adv Urol. 2008;524919. 315. Andriole GL, Bettmann MA, Garnick MB, Richie JP. Indwelling double-J ureteral stents for temporary and permanent urinary drainage: experience with 87 patients. Journal of Urology. 1984;131(2):239-41. Epub 1984/02/01. 316. Barton DP, Morse SS, Fiorica JV, Hoffman MS, Roberts WS, Cavanagh D. Percutaneous nephrostomy and ureteral stenting in gynecologic malignancies. Obstetrics & Gynecology. 1992;80(5):805-11. Epub 1992/11/01. 317. Beaghler MA, Taylor FC, McLaughlin KP. A combined antegrade and retrograde technique for reestablishing ureteral continuity. Tech Urol. 1997;3(1):44-8. Epub 1997/04/01. 318. Campbell SC, Streem SB, Zelch M, Hodge E, Novick AC. Percutaneous management of transplant ureteral fistulas: patient selection and long-term results. Journal of Urology. 1993;150(4):1115-7. Epub 1993/10/01. 319. Dowling RA, Corriere JN, Jr., Sandler CM. Iatrogenic ureteral injury. Journal of Urology. 1986;135(5):912-5. Epub 1986/05/01. 320. Koonings PP, Huffman JL, Schlaerth JB. Ureteroscopy: A new asset in the management of postoperative ureterovaginal fistulas. Obstetrics & Gynecology. 1992;80(3 Pt 2):548-9. Epub 1992/09/01.
301. Brandes S CM, Armenakas N, McAninch J. Diagnosis and management of ureteric injury: An evidence-based analysis. BJU International 2004;95:277-89.
321. Lang EK. Antegrade ureteral stenting for dehiscence, strictures, and fistulae. American Journal of Roentgenology. 1984;143(4):795-801. Epub 1984/10/01.
302. Chou MT WC, Lien RC. Prophylactic ureteral catheterization in gynecologic surgery: a 12-year randomized trial in a community hospital. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20:689-93.
322. Lingeman JE, Wong MYC, Newmark JR. Endoscopic management of total ureteral occlusion and ureterovaginal fistula. Journal of Endourology. 1995;9(5):391-6. Epub 1995/10/01.
303. Razzaghi MR RA, Javanmard B, Lotfi B. Desmopressin as an alternative solution for urinary leakage after ureterocaliceal surgeries. Urology Journal 2009;6:120-2.
323. Mandal AK, Sharma SK, Vaidyanathan S, Goswami AK. Ureterovaginal fistula: Summary of 18 years’ experience. Br J Urol. 1990;65(5):453-6. Epub 1990/05/01.
304. Van den Bergh RN MF, De Vries JP, Lock TM. Arterioureteral fistulas: Unusual suspects-systematic review of 139 cases. Urology. 2009;74:251-5.
324. Narang V, Sinha T, Karan SC, Sandhu AS, Sethi GS, Srivastava A, et al. Ureteroscopy: savior to the gynecologist? Ureteroscopic management of post laparoscopic-assisted vaginal hysterectomy ureterovaginal fistulas. Journal of Minimally Invasive Gynecology. 2007;14(3):345-7. Epub 2007/05/05.
305. Schimpf M GE, Wagner J. Universal ureteral stent placement at hysterectomy to identify ureteral injury: a decision analysis. Bjog. 2008;115:1151-8. 306. Kundu SD TR, Kallingal GJ, Cambareri G, Russo P. Urinary fistulae after partial nephrectomy. BJU International. 2010;106:1042-4. 307. Mazzucchi E SG, Hisano M, Antonopoulos IM, Piovesan AC, Nahas WC, Lucon AM, Srougi M. Primary reconstruction is a good option in the treatment of urinary fistula after kidney transplantation. International Braz J Urol 2006;32:398-403. 308. Nie ZL ZK, Li QS, Jin FS, Zhu FQ, Huo WQ. Treatment of urinary fistula after kidney transplantation. Transplantation Proceedings. 2009;41:1624-6. 309. Basic D DJ, Milutinovic D, Dzamic Z, Topuzovic C, Pejcic T. Ureteral fistulae after kidney transplantation: Experience with 224 cases. Acta Chir Iugosl. 2011;58:89-94. 310. Vanderbrink BA RA, Caplin D, Ost MC, Lobko I, Lee BR. Successful conservative management of colorenal fistula after percutaneous cryoablation of renal-cell carcinoma. Journal of Endourology. 2007;21:26-9. 311. Ould Ismail T HF, Janane A, Dekkak Y, Sossa J, Chafiki J, Lahrech Y, Qarro A, Jira H, Ghadouane M, Ameur A, Abbar M. Renocolic fistula following abdominal trauma: a case study. Progres en Urologie 2010;20:230-2. 312. El-Nahas AR SA, El-Assmy AM, Shoma AM, Eraky I, ElKenawy MR, El-Kappany HA. Colonic perforation during percutaneous nephrolithotomy. Urology. 2006;67:937–41. 313. Fox JA KA, McPhail AF, Lightner D. Ureteroarterial fistula treatment with open surgery versus Endovascular Management: Long-Term Outcomes. Journal of Urology. 2009;185:945-50. 314. Shaw MB TM, Rix DA, Dorkin TJ, Murthy LN, Pickard RS
325. Ustunsoz B, Ugurel S, Duru NK, Ozgok Y, Ustunsoz A. Percutaneous management of ureteral injuries that are diagnosed late after cesarean section. Korean journal of radiology : official journal of the Korean Radiological Society. 2008;9(4):348-53. Epub 2008/08/07. 326. Wang AC, Hung CF. Endourologic diagnosis and treatment of ureterouterine fistula. International Urogynecology Journal & Pelvic Floor Dysfunction. 1997;8(3):164-7. Epub 1997/01/01. 327. Puntambekar S PR, Gurjar AM, Sathe RM, Talaulikar AG, Agarwal GA, Kashyap M. Laparoscopic ureteroneocystostomy with psoas hitch. Journal of Minimally Invasive Gynecology. 2006;13:302-5. 328. Modi P GR, Rizvi SJ. Laparoscopic ureteroneocystostomy and psoas hitch for post-hysterectomy ureterovaginal fistula. Journal of Urology. 2008;180:615-7. 329. Laungani R PN, Krane LS, Hemal AK, Raja S, Bhandari M, Menon M. Robotic-assisted ureterovaginal fistula repair: Report of efficacy and feasibility. Journal of Laparoendoscopic and Advanced Surgical Techniques. 2008;18: 731-4. 330. Chen SS YS-H, Yang J-M, Huang W-C. Transvaginal repair of ureterovaginal fistula by Latzko technique. Int Urogynecol Journal 2007;18:1381-3. 331. Natarajan V BN, Meiring P, Spencer P, Parys BT, Oakley NE. Ureteric embolization: An alternative treatment strategy for urinary fistulae complicating advanced pelvic malignancy. BJU International. 2007;99:147-9. 332. Shindel AW ZH, Hovsepian DM, Brandes SB. Ureteric embolization with stainless-steel coils for managing refractory lower urinary tract fistula: a 12-year experience. BJU International. 2007;99:364-8.
1577
333. Kim SK LY, Kyung MS, Choi JS. Transrenal ureteral occlusion with the use of microcoils in five patients with ureterovaginal fistulas. Abdom Imaging 2008;33:615–20. 334. Park S, Ha SH, Kim KS. Long-term follow-up after feminizing genital reconstruction in patients with ambiguous genitalia and high vaginal confluence. J Korean Med Sci. 2011;26(3):399-403. Epub 2011/03/12.
351. Kobayashi K, Otoshi T, Madono K, Momohara C, Imamura R, Takada S, et al. [A case of urethrovaginal fistula caused by a foreign body in the vagina]. Hinyokika Kiyo. 2010;56(7):389-91. Epub 2010/08/21. 352. Thrumurthy SG, Hill SR, Islam S. Iatrogenic urethrovaginal fistula from catheterization in labour. Br J Hosp Med (Lond). 2010;71(7):414. Epub 2010/07/16.
335. Dhabalia JV, Nelivigi GG, Satia MN, Kakkattil S, Kumar V. Congenital urethrovaginal fistula with imperforate hymen: a first case report. J Obstet Gynaecol Can. 2009;31(7):6523. Epub 2009/09/19.
353. Cameron AP, Atiemo HO. Unusual presentation of an obstetrical urethrovaginal fistula secondary to improper catheter placement. Can Urol Assoc J. 2009;3(4):E21E2. Epub 2009/08/13.
336. Oguzkurt P, Ince E, Ezer SS, Temiz A, Demir S, Hicsonmez A. Primary vaginal calculus secondary to urethrovaginal fistula with imperforate hymen in a 6-year-old girl. J Pediatr Surg. 2009;44(7):e11-3. Epub 2009/07/04.
354. Ben Amna M, Hajri M, Moualli SB, Mehrez R, Chebil M, Ayed M. [The female urethral diverticula: apropos of 21 cases]. Ann Urol (Paris). 2002;36(4):272-6. Epub 2002/08/07. Le diverticule de l’uretre feminin, a propos de 21 observations.
337. Levitt MA, Bischoff A, Pena A. Pitfalls and challenges of cloaca repair: how to reduce the need for reoperations. J Pediatr Surg. 2011;46(6):1250-5. Epub 2011/06/21. 338. Levitt MA, Pena A. Cloacal malformations: lessons learned from 490 cases. Semin Pediatr Surg. 2010;19(2):128-38. Epub 2010/03/24. 339. Hage JJ, Bouman FG, Bloem JJ. Construction of the fixed part of the neourethra in female-to-male transsexuals: experience in 53 patients. Plast Reconstr Surg. 1993;91(5):904-10; discussion 11-3. Epub 1993/04/01. 340. Hilton P. Urethrovaginal fistula associated with ‘sterile abscess’ formation following periurethral injection of dextranomer/hyaluronic acid co-polymer (Zuidex) for the treatment of stress urinary incontinence--a case report. Bjog. 2009;116(11):1527-30. Epub 2009/08/18. 341. Carlin BI, Klutke CG. Development of urethrovaginal fistula following periurethral collagen injection. J Urol. 2000;164(1):124. Epub 2000/06/07. 342. Estevez JP, Colin P, Lucot JP, Collinet P, Cosson M, Boukerrou M. [Urethrovaginal fistulae resulting from sub-urethral slings for stress urinary incontinence treatment. A report of two cases and review of the literature]. J Gynecol Obstet Biol Reprod (Paris). 2010;39(2):151-5. Epub 2010/01/23. Fistules uretrovaginales apres cure d’incontinence urinaire d’effort par bandelettes sous-uretrales. A propos de deux cas et revue de la litterature. 343. Estevez JP, Cosson M, Boukerrou M. An uncommon case of urethrovaginal fistula resulting from tensionfree vaginal tape. Int Urogynecol J. 2010;21(7):889-91. Epub 2010/01/07. 344. Reisenauer C, Wallwiener D, Stenzl A, Solomayer FE, Sievert KD. Urethrovaginal fistula--a rare complication after the placement of a suburethral sling (IVS). Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(3):343-6. Epub 2006/05/05. 345. Glavind K, Larsen EH. Results and complications of tension-free vaginal tape (TVT) for surgical treatment of female stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(6):370-2. Epub 2002/01/25.
355. Porpiglia F, Destefanis P, Fiori C, Fontana D. Preoperative risk factors for surgery female urethral diverticula. Our experience. Urol Int. 2002;69(1):7-11. Epub 2002/07/18. 356. Ganabathi K, Leach GE, Zimmern PE, Dmochowski R. Experience with the management of urethral diverticulum in 63 women. J Urol. 1994;152(5 Pt 1):1445-52. Epub 1994/11/01. 357. Chung HJ, Goo BC, Lee JH, Bang D, Lee KH, Lee ES, et al. Behcet’s disease combined with various types of fistula. Yonsei Med J. 2005;46(5):625-8. Epub 2005/11/01. 358. Waidelich RM, Brunschweiger SM, Schmeller NT. [Urethrovaginal fistula in Behcet disease]. Urologe A. 1994;33(2):163-6. Epub 1994/03/01. Urethrovaginale Fistel bei Morbus Behcet. 359. Flottorp J, Inversen S. [Vesicovaginal and urethrovaginal fistulas treated at the Norwegian Radium Hospital 1940-1952 and in the gynecological department of the Rikshospitalet 1953-1959]. Tidsskr Nor Laegeforen. 1960;80:597-9. Epub 1960/06/15. 360. Ying T, Li Q, Shao C, Zhu Z, Feng L, Hu B. Value of transrectal ultrasonography in female traumatic urethral injuries. Urology. 2010;76(2):319-22. Epub 2010/02/17. 361. Abet L, Richter J, Lenk S, Kotalla H, Hegenscheid F. [Double-balloon urethrography in the female]. Z Urol Nephrol. 1983;76(1):19-28. Epub 1983/01/01. Die Doppelballonurethrographie der Frau. 362. Quiroz LH, Shobeiri SA, Nihira MA. Three-dimension�al ultrasound imaging for diagnosis of urethrovaginal fistula. Int Urogynecol J. 2010;21(8):1031-3. Epub 2010/01/14. 363. Schoellnast H, Lindbichler F, Riccabona M. Sonographic diagnosis of urethral anomalies in infants: value of perineal sonography. J Ultrasound Med. 2004;23(6):76976. Epub 2004/07/13. 364. Goodwin WE, Scardino PT. Vesicovaginal and ureterovaginal fistulas: a summary of 25 years of experience. J Urol. 1980;123(3):370-4. Epub 1980/03/01.
346. Walker KF, Dasgupta J, Cust MP. A neglected shelf pessary resulting in a urethrovaginal fistula. Int Urogynecol J. 2011;22(10):1333-4. Epub 2011/04/07.
365. Pushkar DY, Dyakov VV, Kosko JW, Kasyan GR. Management of urethrovaginal fistulas. Eur Urol. 2006;50(5):1000-5. Epub 2006/09/02.
347. Blaivas JG, Purohit RS. Post-traumatic female urethral reconstruction. Curr Urol Rep. 2008;9(5):397-404. Epub 2008/08/16.
366. Parks J. Section of the urethral wall for correction of urethrovaginal fistulae and urethral diverticula. Am J Obstet Gynecol. 1965;93(5):683-92. Epub 1965/11/01.
348. Liu GC, Xia HM, Wen YQ, Zhang LY, Li ZM. Considerations before repair of acquired rectourethral and urethrovaginal fistulas in children. World J Pediatr. 2008;4(1):53-7. Epub 2008/04/12.
367. Rovner ES, Wein AJ. Diagnosis and reconstruction of the dorsal or circumferential urethral diverticulum. J Urol. 2003;170(1):82-6; discussion 6. Epub 2003/06/11.
349. Holland AJ, Cohen RC, McKertich KM, Cass DT. Urethral trauma in children. Pediatr Surg Int. 2001;17(1):5861. Epub 2001/04/11. 350. Parkhurst JD, Coker JE, Halverstadt DB. Traumatic avulsion of the lower urinary tract in the female child. J Urol. 1981;126(2):265-7. Epub 1981/08/01.
368. Lamensdorf H, Compere DE, Begley GF. Simple surgical correction of urethrovaginal fistula. Urology. 1977;10(2):152-3. Epub 1977/08/01. 369. Fall M. Vaginal wall bipedicled flap and other techniques in complicated urethral diverticulum and urethrovaginal fistula. J Am Coll Surg. 1995;180(2):150-6. Epub 1995/02/01.
1578
370. Xu YM, Sa YL, Fu Q, Zhang J, Xie H, Jin SB. Transpubic access using pedicle tubularized labial urethroplasty for the treatment of female urethral strictures associated with urethrovaginal fistulas secondary to pelvic fracture. Eur Urol. 2009;56(1):193-200. Epub 2008/05/13. 371. Pushkar D. Editorial comment on: Transpubic access using pedicle tubularized labial urethroplasty for the treatment of female urethral strictures associated with urethrovaginal fistulas secondary to pelvic fracture. Eur Urol. 2009;56(1):200. Epub 2008/05/13. 372. Huang CR, Sun N, Wei p, Xie HW, Hwang AH, Hardy BE. The management of old urethral injury in young girls: analysis of 44 cases. J Pediatr Surg. 2003;38(9):132932. Epub 2003/10/03. 373. Candiani P, Austoni E, Campiglio GL, Ceresoli A, Zanetti G, Colombo F. Repair of a recurrent urethrovaginal fistula with an island bulbocavernous musculocutaneous flap. Plast Reconstr Surg. 1993;92(7):1393-6. Epub 1993/12/01. 374. McKinney DE. Use of full thickness patch graft in urethrovaginal fistula. J Urol. 1979;122(3):416. Epub 1979/09/01. 375. Browning A. Lack of value of the Martius fibrofatty graft in obstetric fistula repair. Int J Gynaecol Obstet. 2006;93(1):33-7. Epub 2006/03/15.
tally destroyed in labour. Br Med J. 1969;2(5650):14750. Epub 1969/04/19. 388. Lowman J, Moore RD, Miklos JR. Tension-free vaginal tape sling with a porcine interposition graft in an irradiated patient with a past history of a urethrovaginal fistula and urethral mesh erosion: a case report. J Reprod Med. 2007;52(6):560-2. Epub 2007/08/19. 389. Scott R, Gorham SD, Aitcheson M, Bramwell SP, Speakman MJ, Meddings RN. First clinical report of a new biodegradable membrane for use in urological surgery. Br J Urol. 1991;68(4):421-4. Epub 1991/10/01. 390. Mauermann J, Gonzalez R, Franc-Guimond J, Filipas D. The anterior sagittal transrectal approach for traumatic urethrovaginal fistula closure. J Urol. 2004;171(4):16501. Epub 2004/03/17. 391. Rossi F, De Castro R, Ceccarelli PL, Domini R. Anterior sagittal transanorectal approach to the posterior urethra in the pediatric age group. J Urol. 1998;160(3 Pt 2):1173-7. Epub 1998/08/27. 392. Domini M, Aquino A, Rossi F, Lima M, Ruggeri G, Domini R. Recurrent posttraumatic urethrovaginal fistula: a new application for ASTRA. J Pediatr Surg. 2000;35(3):5225. Epub 2000/03/22.
376. Rangnekar NP, Imdad Ali N, Kaul SA, Pathak HR. Role of the Martius procedure in the management of urinaryvaginal fistulas. J Am Coll Surg. 2000;191(3):259-63.
393. Nikolaev VV, Bizhanova DA. High posttraumatic vaginal stricture combined with urethrovaginal fistula and urethral stricture in girls: reconstruction using a posterior sagittal pararectal approach. J Urol. 1998;160(6 Pt 1):2194-6. Epub 1998/11/17.
377. Punekar SV, Buch DN, Soni AB, Swami G, Rao SR, Kinne JS, et al. Martius’ labial fat pad interposition and its modification in complex lower urinary fistulae. J Postgrad Med. 1999;45(3):69-73. Epub 2000/03/29.
394. Pena A. The surgical management of persistent cloaca: results in 54 patients treated with a posterior sagittal approach. J Pediatr Surg. 1989;24(6):590-8. Epub 1989/06/01.
378. Radopoulos DK, Dimitriadis GP, Vakalopoulos IK, Ioannidis SS, Tzakas KA, Vasilakakis IE. Our experience with salvage genitourinary fistulae repair: technique and outcomes. Int Urol Nephrol. 2008;40(1):57-63. Epub 2007/07/05.
395. Ahmed S, Kardar AH. Construction of a neourethra in girls: follow-up results. Pediatr Surg Int. 2000;16(8):5845. Epub 2001/01/10.
379. Baskin D, Tatlidede S, Karsidag SH. Martius repair in urethrovaginal defects. J Pediatr Surg. 2005;40(9):148991. Epub 2005/09/10. 380. Birkhoff JD, Wechsler M, Romas NA. Urinary fistulas: vaginal repair using a labial fat pad. J Urol. 1977;117(5):595-7. Epub 1977/05/01. 381. Atan A, Tuncel A, Aslan Y. Treatment of refractory urethrovaginal fistula using rectus abdominis muscle flap in a six-year-old girl. Urology. 2007;69(2):384 e11-3. Epub 2007/02/27.
396. Koraitim M. A new retropubic retrourethral approach for large vesico-urethrovaginal fistulas. J Urol. 1985;134(6):1122-3. Epub 1985/12/01. 397. Massoudnia N. [G. Doderlein’s «enwrapping plasty» for the surgical treatment of large bladder- and urethrovaginal fistulas]. Zentralbl Gynakol. 1974;96(20):624-9. Epub 1974/05/17. Ein Beitrag zur «Einrollplastik» nach G. Doderlein zur operativen Behandlung grosser Blasen- und Harnrohren-Scheidenfisteln. 398. Tehan TJ, Nardi JA, Baker R. Complications associated with surgical repair of urethrovaginal fistula. Urology. 1980;15(1):31-5. Epub 1980/01/01.
382. Bruce RG, El-Galley RE, Galloway NT. Use of rectus abdominis muscle flap for the treatment of complex and refractory urethrovaginal fistulas. J Urol. 2000;163(4):1212-5. Epub 2000/03/29.
399. Dolan LM, Dixon WE, Hilton P. Urinary symptoms and quality of life in women following urogenital fistula repair: a long-term follow-up study. Bjog. 2008;115(12):1570-4. Epub 2008/11/28.
383. Golomb J, Leibovitch I, Mor Y, Nadu A, Ramon J. Fascial patch technique for repair of complicated urethrovaginal fistula. Urology. 2006;68(5):1115-8. Epub 2006/11/11.
400. de Bernis L. Obstetric fistula: guiding principles for clinical management and programme development, a new WHO guideline. Int J Gynaecol Obstet. 2007;99 Suppl 1:S117-21.
384. Janez J. [Use of the great epiploon in the treatment of complex vesico- and urethro-vaginal fistulae]. Ann Urol (Paris). 1985;19(4):267-8. Epub 1985/01/01. Utilisation du grand epiploon dans le traitement des fistules vesico- et uretro-vaginales complexes. 385. Ingelman-Sundberg A. An extravaginal technic in the operation for urethro-vaginal and vesico-vaginal fistulas. Gynaecologia. 1947;123(6):380-5. Epub 1947/06/01. 386. Patil U, Waterhouse K, Laungani G. Management of 18 difficult vesicovaginal and urethrovaginal fistulas with modified Ingelman-Sundberg and Martius operations. J Urol. 1980;123(5):653-6. Epub 1980/05/01. 387. Hamlin RH, Nicholson EC. Reconstruction of urethra to-
401. Keettel WC, Sehring FG, deProsse CA, Scott JR. Surgical management of urethrovaginal and vesicovaginal fistulas. Am J Obstet Gynecol. 1978;131(4):425-31. Epub 1978/06/15. 402. Benchekroun A, Lakrissa A, Essakalli HN, Faik M, Abakka T, Hachimi M, et al. [Vesicovaginal fistula. Apropos of 600 cases]. J Urol (Paris). 1987;93(3):151-8. Epub 1987/01/01. Les fistules vesico-vaginales. A propos de 600 cas. 403. Henriksson C, Kihl B, Pettersson S. Urethrovaginal and vesicovaginal fistula. A review of 29 patients. Acta Obstet Gynecol Scand. 1982;61(2):143-8. Epub 1982/01/01.
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