Fistula

Fistula
      

Genitourinary Fistulae
 

• Leng WW, Amundsen CL, McGuire EJ [ Univ fo Texas - Houston ]
  Management of Female Genitourinary Fistulas : Transvesical or Transvaginal Approch ?
  J Urol 160 : 1995-1999, 1998
  
  The article points out the flexibility and wide range of skills necessary to successfully tackle these sometimes challenging cases.
  
  The authors highlight the number of important preoperative considerations in these cases, including coexistent urinary incontinence, bladder dysfunction, location of fistula relative to the trigone, vaginal acess,  and complicating factors, such as history of radiation therapy. ‘Optimal’ approach is likely to be decided on an individual basis.
  

Vesico Vaginal Fistulae

• Isellin CE, Aslan P, Webstar GD [ Duke Univ Med CTr. Durham, NC ]
  Transvaginal Repair of Vesicovaginal Fistula After Hysterectomy by Vaginal Cuff Extension
  J Urol 160 : 728-730 , 1998
  
  The authors touch on one of the more controversial issues in fistula repair namely, excision of the fistulas tract. The authors advocate pyramidal excision of the tract and closure in multiple layers. They report excellent success in 20 patients. However, leaving this fistula tract in situ has a number of advantages, including keeping a small fistula small, with the intact ring of fibrous tissue uses overlapping sutures. This can be avoided by using Martius falp.

Urogenital Fistulae

• Hilton P [ Royal Victoria Infirmary, Newcastle upon Tyne, England ]
  Urodynamic Findings in Patients with Urogenital Fistulae
  Br J Urol 81 : 539-542, 1998
  
  Introduction – After the successful repair of an obstetric vesicovaginal fistula, stress incontinence can occur in up to 12% of patients.
  
  Method – 30 patients with diagnosis of a lower urinary genital fistula had dual channel subtracted cystometry before surgery of their fistulas.
  
  Conclusion – In patients with urogenital fistulas, there is a high incidence of abnormal lower urinary tract function. A higher incidence of detrusor instability and genuine stress incontinence was found among patients with urethral or bladder neck fistulas, than fistulas of the vaginal vault.
  
  After successful repair of the fistula, many of these abnormalities appear to resolve although in some women detrusor instability may persist and require further treatment. There findings are relevant and may be of medico legal significance when counseling patients before a repair. 

Ureteral Fistula

• Gibbons M, O’donnel S, Lukens M, et al [ Walter Reed Army Med Ctr. Washington, DC : Univ of the Health Science, Bethesda, Md ]
  Treatment of a Ureteroillac Artery Fistula with an Intraluminal Endovascular Graft 
   J Urol 159 ; 2083-2084, 1998
  
  Introduction : During the last 10 years, ureteroilic artery fistulas have been increasingly reported. They have been associated with Vascular pathological conditions, pelvic irradiation, stenting, and prior pelvic surgery.
  
  Conclusion Because of the intermittent nature of the fistula, diagnosis of this condition can be different. The use of an endovascualr polytetrafluorethylene graft was to avoid the high mortality involved when treating this with direct surgical intervention.