RESUMO
ABSTRACT Introduction: The transverse vaginal septum (TVS) with congenital urethra-vaginal fistula (CUVF) is a rare anomaly of the mullerian duct (1, 2). Incomplete channelling of the vaginal plate, or an abnormality in the fusion of the vaginal component of mullerian duct with the urogenital sinus results in TVS (1, 3, 4). High CUVF occurs due to the persistent communication between the urogenital sinus and utero-vaginal primordium at the tubercle sinus, whereas low CUVF is due to excessive apoptosis of the vaginal plate during channelling (5). The principles of management of CUVF with TVS include: 1) TVS resection, 2) Create a neovagina. We present a case of CUVF with TVS managed by robotic assistance. Material and methods: A 24-year-old female, married for 3 years, presented with cyclical hematuria since menarche, dyspareunia and primary infertility. Examination revealed blind ending vagina 4cm from the introitus. Magnetic resonance imaging revealed a fistulous communication between urethra and vagina, and TVS. Cystourethroscopy confirmed a proximal urethra-vaginal fistula. Urethroscopy guided puncture of the TVS was performed, tract dilated and a catheter was placed across it. Robotic assisted transvaginal approach was planned. Air docking of robot was performed. Traction on the catheter was given to identify the incised edges of the septum. Vaginal flaps were raised laterally, fistulous tract was excised. Proximal vagina mucosa was identified and vaginoplasty was performed. Result: Patient's postoperative recovery was uneventful. Urethral catheter was removed after 5 days. She had normal voiding and menstruation. Vaginoscopy performed at 1st month follow-up, revealed an adequate vaginal lumen. Vaginal moulds were advised for 6 weeks during the night, following which she resumed her sexual activity. She conceived 6 months post-surgery, and delivered a child by caesarean section. Conclusion: We successfully managed this case by resection of septum, neovagina creation and thereby achieving normal menstruation and conception. The advantages of robotic approach were magnification, precision and manoeuvrability in a limited space, avoiding a vaginal release incision.
Assuntos
Humanos , Masculino , Feminino , Doenças Vaginais , Fístula Vaginal/cirurgia , Procedimentos Cirúrgicos Robóticos , Uretra/cirurgia , Uretra/diagnóstico por imagem , Vagina/cirurgiaRESUMO
ABSTRACT Introduction: Neobladder vaginal fistula (NVF) is a known complication after cystectomy and orthotopic diversion in women, occurring in 3-5% of women. Possible risk factors for fistula formation include compromised tissue vascularity due to surgical dissection and/or radiotherapy, suture line proximity, local tissue recurrence, and injury to the vaginal wall during dissection. The surgical repair of a NVF can be challenging secondary to vaginal shortening, atrophy, local inflammation from chronic exposure to urinary leakage, and the proximity of the neobladder to the anterior vaginal wall. In this video, we present transvaginal repair of a NVF with Martius flap interposition. Materials and Methods: This is the case of a 47 year old woman with a history of radical cystectomy and creation of a Studer pouch secondary to bladder cancer two years prior who subsequently developed a NVF. Evaluation included an office cystoscopy which demonstrated a 3-4mm left-sided neobladder vaginal fistula at the level of the ileal-urethral anastomosis. No pelvic organ prolapse or evidence of bladder cancer recurrence was appreciated. Results: A vaginal approach for the NVF repair was performed with a Martius flap interposition. A water-tight closure was achieved without any intraoperative or immediate postoperative complications. The urethral Foley was removed at 2 weeks and by 4 weeks the patient did not report any urinary leakage. Conclusions: Neobladder vaginal fistula is a rare complication following cystectomy and orthotopic urinary diversion that can be repaired using a transvaginal approach. A Martius flap interposition is important to augment success of the repair. If a transvaginal approach fails a transabdominal approach or conversion to cutaneous diversion may be necessary.
Assuntos
Humanos , Feminino , Derivação Urinária , Fístula Vaginal/cirurgia , Fístula Vaginal/etiologia , Fístula Vesicovaginal/cirurgia , Retalhos Cirúrgicos , Cistectomia/efeitos adversos , Pessoa de Meia-Idade , Recidiva Local de NeoplasiaRESUMO
Introduction: Neobladder vaginal fistula (NVF) is a known complication after cystectomy and orthotopic diversion in women, occurring in 3-5% of women. Possible risk factors for fistula formation include compromised tissue vascularity due to surgical dissection and/or radiotherapy, suture line proximity, local tissue recurrence, and injury to the vaginal wall during dissection. The surgical repair of a NVF can be challenging secondary to vaginal shortening, atrophy, local inflammation from chronic exposure to urinary leakage, and the proximity of the neobladder to the anterior vaginal wall. In this video, we present transvaginal repair of a NVF with Martius flap interposition. Materials and Methods: This is the case of a 47 year old woman with a history of radical cystectomy and creation of a Studer pouch secondary to bladder cancer two years prior who subsequently developed a NVF. Evaluation included an office cystoscopy which demonstrated a 3-4mm left-sided neobladder vaginal fistula at the level of the ileal-urethral anastomosis. No pelvic organ prolapse or evidence of bladder cancer recurrence was appreciated. Results: A vaginal approach for the NVF repair was performed with a Martius flap interposition. A water-tight closure was achieved without any intraoperative or immediate postoperative complications. The urethral Foley was removed at 2 weeks and by 4 weeks the patient did not report any urinary leakage. Conclusions: Neobladder vaginal fistula is a rare complication following cystectomy and orthotopic urinary diversion that can be repaired using a transvaginal approach. A Martius flap interposition is important to augment success of the repair. If a transvaginal approach fails a transabdominal approach or conversion to cutaneous diversion may be necessary.
Assuntos
Derivação Urinária , Fístula Vaginal , Fístula Vesicovaginal , Cistectomia/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Retalhos Cirúrgicos , Fístula Vaginal/etiologia , Fístula Vaginal/cirurgia , Fístula Vesicovaginal/cirurgiaRESUMO
ABSTRACT Standard radical cystectomy (RC) in women involves removal of the distal ureters, bladder, proximal urethra, uterus, ovaries, and adjacent vagina. Furthermore, pelvic organ-preserving RC to treat selected women has become an accepted technique and may confer better postoperative sexual and urinary functions than standard RC, avoiding complications such as incontinence, prolapse, neobladder-vaginal fistula (NVF), and sexual dysfunction, without compromising oncological outcome. This article reports a different surgical approach: a patient who underwent a cutaneous continent reservoir and neovagina construction using a previous ileal orthotopic neobladder after RC. Patient presented no complications and she has no evidence of recurrent disease and is sexually active, with a satisfactory continent reservoir. This case is the first report of this procedure that was able to treat concomitant dyspareunia caused by short vagina and neobladder-vaginal fistula. In conclusion, standard radical cystectomy with no vaginal preservation can have a negative impact on quality of life. In the present case, we successfully treated neobladder fistula and short vagina by transforming a previous ileal orthotopic neobladder into two parts: a continent reservoir and a neovagina. However, to establish the best approach in such patients, more cases with long-term follow-up are needed.
Assuntos
Humanos , Feminino , Adulto , Vagina/cirurgia , Cistectomia/efeitos adversos , Fístula Vaginal/cirurgia , Coletores de Urina , Neoplasias da Bexiga Urinária/cirurgia , Fístula Vaginal/etiologia , Resultado do TratamentoRESUMO
Standard radical cystectomy (RC) in women involves removal of the distal ureters, bladder, proximal urethra, uterus, ovaries, and adjacent vagina. Furthermore, pelvic organ-preserving RC to treat selected women has become an accepted technique and may confer better postoperative sexual and urinary functions than standard RC, avoiding complications such as incontinence, prolapse, neobladder-vaginal fistula (NVF), and sexual dysfunction, without compromising oncological outcome. This article reports a different surgical approach: a patient who underwent a cutaneous continent reservoir and neovagina construction using a previous ileal orthotopic neobladder after RC. Patient presented no complications and she has no evidence of recurrent disease and is sexually active, with a satisfactory continent reservoir. This case is the first report of this procedure that was able to treat concomitant dyspareunia caused by short vagina and neobladder-vaginal fistula. In conclusion, standard radical cystectomy with no vaginal preservation can have a negative impact on quality of life. In the present case, we successfully treated neobladder fistula and short vagina by transforming a previous ileal orthotopic neobladder into two parts: a continent reservoir and a neovagina. However, to establish the best approach in such patients, more cases with long-term follow-up are needed.
Assuntos
Cistectomia/efeitos adversos , Coletores de Urina , Vagina/cirurgia , Fístula Vaginal/cirurgia , Adulto , Feminino , Humanos , Resultado do Tratamento , Neoplasias da Bexiga Urinária/cirurgia , Fístula Vaginal/etiologiaRESUMO
UNLABELLED: The objective of this review was to address the main indications for palliative surgery in the treatment of ovarian cancer. DESIGN: Articles from MEDLINE/PUBMED, EMBASE, and LILACS databases up to May 05, 2012 were included with no bars on foreign languages. The key words used were taken from the Medical Subject Headings and were as follows: ovarian cancer AND palliative surgery, ovarian cancer AND complications, and ovarian cancer AND intestinal obstruction. Subsequently, the references from the original articles were also analyzed. RESULTS: Among the complications developing in the course of malignant neoplasia, intestinal obstruction stands out as the main indication for palliative surgery, which may also be indicated for rectovaginal and enterovaginal fistulas, as well as for genital and lower gastrointestinal hemorrhage. CONCLUSION: Although incurable, the patients with complications due to ovarian cancer may have an extended survival and an improved quality of life with palliative surgery for the following reasons: a) improvement in the nutritional state after treatment for intestinal obstruction due to the possibility of oral nutrition; and b) improvement in clinical conditions, allowing for palliative chemotherapy.
Assuntos
Hemorragia Gastrointestinal/cirurgia , Obstrução Intestinal/cirurgia , Neoplasias Ovarianas/complicações , Cuidados Paliativos , Fístula Retal/cirurgia , Fístula Vaginal/cirurgia , Doenças do Colo/etiologia , Doenças do Colo/cirurgia , Feminino , Humanos , Obstrução Intestinal/etiologia , Doenças Retais/etiologia , Doenças Retais/cirurgia , Fístula Retal/etiologia , Hemorragia Uterina/etiologia , Hemorragia Uterina/cirurgia , Fístula Vaginal/etiologiaRESUMO
We present the laparoscopic management of genitourinary fistulae, mainly five types of fistulae, vesicovaginal, ureterovaginal, vesicouterine, rectourethral and rectovesical fistula. Vesicovaginal fistula (VVF) is mostly secondary to urogynecologic procedures in developed countries, abdominal hysterectomy being the main cause of this condition; they represent 84.9% of the genitourinary fistulae (1).Management has been described for this type of fistula, where low success rate (7-12%) has been reported. Ureterovaginal fistulas may occur following pelvic surgery, particularly gynecological procedures, or as a result of vaginal foreign bodies or stone fragments after shock wave lithotripsy, patients typically present with global and persistent urine leakage through the vagina, this causes patient discomfort, distress, and typically protection is used to stay dry, the initial management is often conservative but typically fails. Vesicouterine fistula is a rare condition that only occurs in 1 to 4% of genitourinary fistulas, the primary cause is low segment cesareansection, and clinically presents in three different forms, which will be described. Treatment of this type of fistulae has been conservative,with hormone therapy and surgery, depending on the presenting symptoms. Recto-urinary (rectovesical and rectourethral) fistulae (RUF) are uncommon and can be difficult to manage clinically. Although they may develop in patients with inflammatory bowel disease and perirectal abscesses, rectourethral fistula frequently result as an iatrogenic complication of extirpative or ablative prostate procedures. Rectovesical fistula usually develops following radical prostatectomy, and occurs along the vesicourethral anastomotic line or along the suture line of a posterior "racquet-handle" closure of the bladder. Conservative management consisting of urinary diversion, broad-spectrum antibiotics and parenteral nutrition is often initially attempted but these measures often fail. Timing of repair is often individualized mainly according to the etiology, delay of diagnosis, size of fistula, the first or subsequent repairs, and the general condition of the patient. Different surgical techniques for the management of RUF have been reported. Encouraged by our experience in minimally invasive surgery we present the laparoscopic approach.
Assuntos
Laparoscopia/métodos , Fístula Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Fístula Vesicovaginal/cirurgia , Cistotomia , Feminino , Humanos , Cuidados Pós-Operatórios , Fístula Retovaginal/cirurgia , Doenças Ureterais/cirurgia , Fístula da Bexiga Urinária/cirurgia , Fístula Urinária/diagnóstico , Vagina/cirurgia , Fístula Vaginal/cirurgia , Fístula Vesicovaginal/diagnósticoRESUMO
Describir la técnica quirúrgica en la colecistectomía transvaginal sin cicatriz visible con el uso de instrumental laparoscópico convencional, en el Hospital Dr. Domingo Luciani. Caracas. Se presenta caso de paciente femenina de 52 años de edad, con litiasis vesicular sintomática a quien se le practica colecistectomía transvaginal. Se realizó colecistectomía transvaginal sin complicaciones intraoperatorias. No se administraron analgésicos orales ni parenterales, el alta hospitalaria se dio a las 12 horas del procedimiento. Evolución satisfactoria de la paciente con un seguimiento de 30 días. La cirugía asistida por minilaparoscopia puede considerarse intermedia entre el NOTES, y la cirugía laparoscópica. El siguiente caso demuestra la factibilidad y seguridad del procedimiento realizado por cirujanos generales con entrenamiento laparoscópico y con el uso de instrumental convencional.
Describe the surgical technique in the transvaginal cholecystectomy without a scar using conventional laparoscopic instruments, in the Dr. Domingo Luciani Hospital. Caracas. Presents female patient 52 years old, with sintomatic gallstones who is practicing transvaginal cholecystectomy. Was performed transvaginal cholecystectomy without intraoperative complications. No analgesics were administered oral or parenteral, was discharged at 12 hours of the procedure. There was a satisfactory progress of the patient with a follow upof 30 days. Minilaparoscopy assisted surgery can be considered intermediate between NOTES, and laparoscopic surgery. The following case demonstrates the feasibility and safety of the procedure performed by general surgeons with laparoscopic training and the use of conventional instruments.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Colecistectomia Laparoscópica/métodos , Fístula Vaginal/cirurgia , Fístula Vaginal/terapia , Decúbito Inclinado com Rebaixamento da Cabeça/fisiologia , Umbigo/cirurgia , Cateteres de Demora , Colpotomia/métodos , Instrumentos CirúrgicosRESUMO
A case of poor prognostic choriocarcinoma developing sepsis is described. The patient was treated with vaginal drainage of pelvic abscess metastases, bilateral hypogastric artery ligation to prevent hemorrhage and single-agent chemotherapy.
Assuntos
Coriocarcinoma/patologia , Sepse/diagnóstico , Choque Hemorrágico/diagnóstico , Neoplasias Uterinas/patologia , Fístula Vaginal/diagnóstico , Adulto , Antibacterianos/uso terapêutico , Brasil , Coriocarcinoma/complicações , Coriocarcinoma/diagnóstico por imagem , Coriocarcinoma/cirurgia , Terapia Combinada , Drenagem/métodos , Feminino , Seguimentos , Humanos , Histerectomia/métodos , Gravidez , Medição de Risco , Sepse/complicações , Sepse/tratamento farmacológico , Choque Hemorrágico/complicações , Choque Hemorrágico/terapia , Resultado do Tratamento , Ultrassonografia Doppler , Neoplasias Uterinas/complicações , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/cirurgia , Fístula Vaginal/complicações , Fístula Vaginal/cirurgiaRESUMO
Se presentan dos casos clínicos de pacientes que desarrollaron fístulas tardías entre íleon y la vagina secundario a radioterapia pelviana por tumores cervicouterinos. Se detalla el estudio radiológico y el diagnóstico, además de la resolución quirúrgica y evolución postoperatoria.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Doenças do Íleo/etiologia , Fístula Vaginal/cirurgia , Fístula Vaginal/etiologia , Fístula Intestinal/etiologia , Neoplasias do Colo do ÚteroRESUMO
OBJECTIVES: Ureteral lesions during gynaecologic surgery are a serious problem, affecting morbidity even when they are diagnosed postoperatively. METHODS: 742 gynaecological surgical procedures performed between 1994 and 2000 at the Manuel Fajardo University Hospital where evaluated. Eight operations were complicated with ureteral lesions (1.07%); one patient suffered double lesions, for a total of 9 lesions. RESULTS: 9 ureteral lesions were treated in 8 patients, 7 of them were diagnosed in the postoperative period; 5 bladder reimplantations with submucosal bladder tunnel and 2 ureteral suture repairs (end to end) were performed. Delayed lesions were 2 ureteral-vaginal fistulae treated with nephrectomy and ureteroneocystostomy into a Boary's flap respectively. In both cases diagnosis was established by combination of ultrasound, intravenous pyelogram, cystoscopy, and retrograde catheterization. In all seven patients urinary tract integrity was demonstrated postoperatively. CONCLUSIONS: Lower urinary tract integrity may be damaged during gynaecologic surgery, being bladder ureteral reimplantation with submucosal tunnel the most frequently used repairing procedure. Operations for benign diseases had fewer lesions (0.47%) than malignant (4.8%).
Assuntos
Procedimentos Cirúrgicos em Ginecologia , Complicações Intraoperatórias/etiologia , Ureter/lesões , Abscesso/cirurgia , Cistostomia , Doenças das Tubas Uterinas/cirurgia , Feminino , Neoplasias dos Genitais Femininos/cirurgia , Humanos , Histerectomia , Incidência , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/cirurgia , Nefrectomia , Estudos Retrospectivos , Retalhos Cirúrgicos , Técnicas de Sutura , Ureter/cirurgia , Doenças Ureterais/etiologia , Doenças Ureterais/cirurgia , Bexiga Urinária/cirurgia , Fístula Urinária/etiologia , Fístula Urinária/cirurgia , Fístula Vaginal/etiologia , Fístula Vaginal/cirurgiaRESUMO
PURPOSE: The aim of this paper is to present the results obtained in five cases with a stoma created by the laparoscopic approach. PATIENTS AND METHOD: Analysis of five patients who required a stoma as treatment for their diseases or as a complementary management of another medical problem from March 1999 to May 1999. There were three women and two men. Mean age was 43 years (range 20-59 years). Two women had a rectovaginal fistula secondary to radiation proctitis, another woman presented an infected sacral wound, one man suffered a sphincteric lesion that required sphincteroplasty, and the other man had Fournier's gangrene. Surgical technique included the use of two ports, one at the umbilicus for the camera and the other at the site previously chosen for the stoma. RESULTS: Mean surgical time was 30 min (range 20-40 min), transoperative bleeding was meaningless; all stomas began to function during the first 24 h after the procedure. One patient began oral intake on the first day, three patients on the second day, and one patient was intubated in the intensive care unit and for this reason was unable to eat. All stomas achieved the objective sought and there were no complications related to the procedure. CONCLUSIONS: Stoma creation by the laparoscopic approach may offer advantages over the open-surgery technique.
Assuntos
Colostomia/métodos , Ileostomia/métodos , Laparoscopia , Adulto , Canal Anal/lesões , Canal Anal/cirurgia , Feminino , Gangrena de Fournier/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Paraplegia/complicações , Úlcera por Pressão/cirurgia , Lesões por Radiação/cirurgia , Fístula Retal/etiologia , Fístula Retal/cirurgia , Região Sacrococcígea , Resultado do Tratamento , Fístula Vaginal/etiologia , Fístula Vaginal/cirurgiaRESUMO
Antecedentes: La cirugía laparoscópica colónica es un procedimiento novedoso, cuyos primeros resultados aún no permiten sacar conclusiones respecto de su verdadera utilidad. Objetivo: Análisis clínico retrospectivo de pacientes intervenidos por esta vía. Lugar de aplicación: Práctica hospitalaria y privada. Diseño: Estudio observacional retrospectivo basado en criterios clínicos. Población: Selección de 30 pacientes (1,5 por ciento) intervenidos por afecciones colorrectales, sobre un total de 1950; entre 1992 y 1996. Métodos: Exclusión de pacientes con grandes eventraciones, tumores adheridos a pared u otros órganos, ostomías, obstrucción o perforación. Resultados: Mortalidad: 3,3 por ciento, complicaciones: 16,7 por ciento. Conversión, 25,9 por ciento. Promedio de ganglios resecados, 15. No hubo diferencias en la conversión respecto de afecciones benignas o malignas, segmento operado, aunque en el recto medio fueron todos convertidos (3/3). El intervalo de confianza esperado para el éxito laparoscópico fue del 53,3-88,9 por ciento. Conclusiones: La cirugía laparoscópica colorrectal puede ser realizada con igual amplitud que la cirugía a cielo abierto. El índice de conversión es alto, aunque con un mayor entrenamiento y una mejor selección de casos puede ser disminuído
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Neoplasias Colorretais/cirurgia , Laparoscopia/estatística & dados numéricos , Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Cirurgia Colorretal/instrumentação , Cirurgia Colorretal/métodos , Colectomia , Colectomia/instrumentação , Colectomia/tendências , Doença Diverticular do Colo/cirurgia , Fístula Intestinal/cirurgia , Fístula Vaginal/cirurgia , Laparoscopia/normas , Prolapso Retal/cirurgia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Antecedentes: La cirugía laparoscópica colónica es un procedimiento novedoso, cuyos primeros resultados aún no permiten sacar conclusiones respecto de su verdadera utilidad. Objetivo: Análisis clínico retrospectivo de pacientes intervenidos por esta vía. Lugar de aplicación: Práctica hospitalaria y privada. Diseño: Estudio observacional retrospectivo basado en criterios clínicos. Población: Selección de 30 pacientes (1,5 por ciento) intervenidos por afecciones colorrectales, sobre un total de 1950; entre 1992 y 1996. Métodos: Exclusión de pacientes con grandes eventraciones, tumores adheridos a pared u otros órganos, ostomías, obstrucción o perforación. Resultados: Mortalidad: 3,3 por ciento, complicaciones: 16,7 por ciento. Conversión, 25,9 por ciento. Promedio de ganglios resecados, 15. No hubo diferencias en la conversión respecto de afecciones benignas o malignas, segmento operado, aunque en el recto medio fueron todos convertidos (3/3). El intervalo de confianza esperado para el éxito laparoscópico fue del 53,3-88,9 por ciento. Conclusiones: La cirugía laparoscópica colorrectal puede ser realizada con igual amplitud que la cirugía a cielo abierto. El índice de conversión es alto, aunque con un mayor entrenamiento y una mejor selección de casos puede ser disminuído (AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Neoplasias Colorretais/cirurgia , Laparoscopia/estatística & dados numéricos , Resultado do Tratamento , Prolapso Retal/cirurgia , Doença Diverticular do Colo/cirurgia , Fístula Vaginal/cirurgia , Fístula Intestinal/cirurgia , Cirurgia Colorretal/instrumentação , Cirurgia Colorretal/métodos , Estudos Retrospectivos , Colectomia/métodos , Colectomia/instrumentação , Colectomia/tendências , Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Laparoscopia/normasRESUMO
OBJECTIVES: To report our experience in the surgical treatment of urinary fistulas. METHOD: The clinical records of the patients seen during the period 1988-1991 were reviewed. RESULTS: Sixteen cases of urinary fistulas were found; most of these had been caused during a gynecological procedure. All cases were treated by surgery, which achieved a satisfactory result in 100% of the cases. CONCLUSIONS: Abdominal hysterectomy was the most frequent cause of urinary fistula. The most common was vesico-vaginal fistula, predominantly located in the upper portion of the trigone. The surgical technique most commonly utilized was transvesical fistulectomy.
Assuntos
Fístula Urinária/cirurgia , Fístula Vaginal/cirurgia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
We are reporting the institutional experience of March 1992 to May 1993. Eleven patients were studied with a diagnostic of urogenital fistula, one of them was vesico-uterine, two uretero-vaginal and eight vesico-vaginal. Only to eight of the patients surgery correction was realized, one of them was aboarded by vaginal tract and seven by abdominal tract. Of the patients with abdominal aboarded, two cases were ureteroneocystostomies. The failure of the surgery was presented in two cases, both with abdominal aboarded. These data clears up that the urogenital fistula is a frequent complication in patients that are submitted to surgical gynecological procedures. The surgical success probably depends more of the surgical technique rather than aboarded tract.
Assuntos
Doenças Ureterais/diagnóstico , Fístula da Bexiga Urinária/diagnóstico , Fístula Urinária/diagnóstico , Doenças Uterinas/diagnóstico , Fístula Vaginal/diagnóstico , Fístula Vesicovaginal/diagnóstico , Feminino , Humanos , México , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Doenças Ureterais/cirurgia , Fístula da Bexiga Urinária/cirurgia , Fístula Urinária/cirurgia , Doenças Uterinas/cirurgia , Fístula Vaginal/cirurgia , Fístula Vesicovaginal/cirurgiaRESUMO
Las fístulas uretrovaginales adquiridas son una condición rara en la edad pediátrica y requieren tratamiento quirúrgico diferente al empleado en mujeres adultas, ya que la mayoría de éstas presentan introitos amplios y tejidos perineales fláccidos que permiten la correción transvaginal. Proponemos el acceso sagital posterior trans-rectovaginal para identificar las fístulas uretrovaginales adquiridas durante la infancia, y su tratamiento racional