RESUMO
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
OBJECTIVE: To report a case of ureterovaginal fistula secondary to transvaginal oocyte retrieval (TVOR). DESIGN: Case report. SETTING: IVF Center IN a private hospital. PATIENT(S): A 31-year-old woman presented immediately after TVOR with right lower abdominal pain with irradiation to the suprapubic area and vaginal discharge. INTERVENTION(S): Vaginal examination, creatinine dosage in plasma and vaginal discharge, excretory urography. A double-J catheter was inserted under general anesthesia. MAIN OUTCOME MEASURE(S): Clinical follow-up. RESULT(S): Vaginal leakage ceased a few hours after catheter insertion. Transfer of two embryos was performed 3 days after TVOR, but no pregnancy occurred. The double-J catheter was removed 21 days after its placement. Imaging studies done 6 weeks later demonstrated a normal urinary tract morphology. CONCLUSION(S): Given the elective nature of TVOR and IVF, patients should be informed about all potential complications, including ureterovaginal fistula.
Assuntos
Infertilidade/terapia , Recuperação de Oócitos/efeitos adversos , Doenças Ureterais/etiologia , Fístula Urinária/etiologia , Fístula Vaginal/etiologia , Dor Abdominal/etiologia , Adulto , Transferência Embrionária , Feminino , Fertilização in vitro , Humanos , Falha de Tratamento , Doenças Ureterais/diagnóstico por imagem , Fístula Urinária/diagnóstico por imagem , Urografia , Descarga Vaginal/etiologia , Fístula Vaginal/diagnóstico por imagemRESUMO
Se presentan 58 pacientes entre 24 y 65 años, con una edad media de 44,5 años, las que sufrieron lesiones ureterales, en cirugías ginecológicas. Presentaron fístulas ureterovaginales 50 pacientes, lo que significó el 86,2 por ciento. Hubo dos pacientes con fístulas bilaterales, 4 ligaduras de uréteres y 2 fístulas a cavidad. La etiología predominante fue histerectomía simple en casi 69 por ciento e histerectomía ampliada en 24 por ciento. No hubo por causas obstétricas. La soluciones se implementaron inmediatamente de hecho el diagnóstico y sin nefrostomías previas, salvo excepciones, en pacientes en mal estado general, derivadas de otros centros. Se realizó 28 ureteroneocistostomías con técnica de Leadbetter-Politano. A 24 pacientes se les hizo colgajo vesical con técnica de Boari Cassatti y además en un caso fue bilateral. Las otras soluciones fueron cateterismo, anastomosis término terminal y uretero anastomosis con conducto ileal en una paciente irradiada y con cistitis actínica. Los resultados fueron buenos con todas las medidas usadas, excepto la exclusión de un riñón en la Boari Cassatti bilateral y 2 leves ureterectasias, sin síntomas, al año de control, también con la técnica de reimplante con colgajo vesical.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Retalhos Cirúrgicos , Fístula Urinária/etiologia , Fístula Vaginal/etiologia , Histerectomia/efeitos adversos , Ureter/cirurgia , Ureter/lesõesRESUMO
La fístula colovaginal es de ocurrencia excepcional en la práctica clínica, sin embargo, cuando se presenta, la enfermedad diverticular es una de las etiologías más frecuentes. Se presentan tres casos de fístula colovaginal que complican un enfermedad diverticular tratados por autores. Todas las pacientes tenían antecedentes de una histerectomía por vía abdominal, y la primera manifestación clínica de la fístula fue la pérdida de gases y deposiciones por la vagina. Solo en una de ellas existía el antecedente de una diverculitis. Los estudios preoperatorios incluyeron un enema baritado, que demostró la fístula en todos los casos, una colonoscopia en solo una, que fue incompleta por estenosis del sigmoides distal a la fístula y tomografía computada de abdomen en otro paciente que demostró una diverticulitis aguda. Las tres pacientes fueron sometidas a una sigmoidectomía con anastomosis mecánica a nivel del promontorio con buena evolución postoperatoria. Se plantea que la existencia de una fístula colovaginal, sobre todo si existe el antecedente de una histerectomía debe hacer plantear entre otras alternativas, la etiología diverticular. La sigmoidectomía es el tratamiento de elección evitando reparaciones por vía vaginal, que no tratan el origen de la fístula.
Assuntos
Humanos , Feminino , Idoso , Doença Diverticular do Colo/cirurgia , Doença Diverticular do Colo/diagnóstico , Divertículo do Colo/cirurgia , Divertículo do Colo/complicações , Fístula Vaginal/etiologia , Fístula Intestinal/etiologiaRESUMO
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
Evaluation of the characteristics of urogenital fistula with a retrospective study at the clinic of Urology Ginecologica in the Instituto Nacional de Perinatologia between March 1992 to June 1995, information of the location, etiopathogenesis of the disease, urinary tract infection and surgical treatment were obtained form de patients records in the clinic. The etiophatogenesis of the disease was surgical gynecological procedures in 51.1%, and obstetric cause 48.5%; the location were 14 (66.6%) vesicovaginal, 5 (23.5% 0 ureterovaginal and 2 (urethrovaginal). The abdominal approach were in 8 patients and vaginal route in 9, no surgical treatment were 2. Successfully repair fistula were in 80.9%. Urinary tract infections before treatment agreed on the obstetric etiology was 47.6%, and for surgical gynecological procedures 52.2%. There is an increase in the incident of obstetric vesicovaginal fistula, we believe it depends on the patients that we have in de Instituto Nacional de Perinatologia, most of them are obstetric patients.
Assuntos
Fístula Urinária , Fístula Vaginal , Feminino , Humanos , Estudos Retrospectivos , Fístula Urinária/etiologia , Fístula Urinária/terapia , Fístula Vaginal/etiologia , Fístula Vaginal/terapiaRESUMO
Informamos la frecuencia de la lesión urológica en la cirugía ginecológica y urogenicológica en el INstituto Nacional de Perinatología de la Ciudad de México, de marzo de 1993 a febrero de 1995. En este período se ralizaron 3,452 cirugía en total, 2.971 fueron ginecológicas y 481 uroginecológicas. Se encontraron 20 pacientes con lesión del tracto urinario inferior. El tipo de lesión más frecuente fue punzante y roma en ocho casos respectiva y cortante en cuatro. En 17 pacientes el diagnóstico de la lesión se hizo en el transoperatorio y en tres pasó inadvertida. La complicación tardía de la lesión fue fístula uretrovaginal en dos, vesicovaginal en una y ureterovaginal una, formación de litos una y retención de sonda transuretral una. El órgano más afectado fue la vejiga en 18 casos, uretero uno y uretra un caso. La lesión del aparato urinario inferior representa 4.15 por ciento de las complicaciones de la cirugía uroginecológica y 0.67 por ciento de la ginecológica. El aspecto fundamental en el pronóstico de la lesión del aparato urinario inferior, es el diagnóstico opotuno de la lesión durante el procedimiento quirúrgico
Assuntos
Humanos , Feminino , Fístula Vaginal/diagnóstico , Fístula Vaginal/etiologia , Fístula Vesicovaginal/diagnóstico , Fístula Vesicovaginal/etiologia , Histerectomia Vaginal/efeitos adversos , Doença Iatrogênica , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Fístula da Bexiga Urinária/diagnóstico , Fístula da Bexiga Urinária/etiologia , Bexiga Urinária/lesões , Sistema Urogenital/lesõesRESUMO
Se estudiaron 114 pacientes con cancer de cuello uterino entre 1988 y 1991, los cuales fueron tratados en el servicio de Oncologia del Hospital Provincial Docente Clinicoquirurgico de Santa Clara mediante tratamiento radiante con cobalto-60 en forma de teleterapia y braquiterapia. El grupo mas afectado se encontro entre los 50-59 anos, la variedad histica mas frecuente correspondio al carcinoma epidermoide, y la etapa clinica mas comun fue la II. En la mayoria de los casos se aplicaron dosis de 2001 a 3000 cGy con teleterapia externa en los puntos A y B, previo a la braquiterapia; despues se completo los puntos B con teleterapia. La mayoria de los pacientes recibieron 80 Gy en el punto A y mas de 60 en el B. Las complicaciones inmediatas mas frecuentes fueron la proctitis y la enterocolitis, y entre las tardias, las fistulas y la estenosis vaginal
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Braquiterapia/efeitos adversos , Enterocolite/etiologia , Fístula Vaginal/etiologia , Proctite/etiologia , Radioisótopos de Cobalto/efeitos adversos , Radioisótopos de Cobalto/uso terapêutico , Teleterapia por Radioisótopo/efeitos adversos , Neoplasias do Colo do Útero/radioterapia , Carcinoma de Células Escamosas/radioterapiaAssuntos
Humanos , Feminino , Fístula Urinária/diagnóstico , Fístula Vaginal/diagnóstico , Fístula Vesicovaginal/diagnóstico , Fístula Urinária/cirurgia , Fístula Urinária/etiologia , Fístula Vaginal/cirurgia , Fístula Vaginal/etiologia , Fístula Vesicovaginal/cirurgia , Fístula Vesicovaginal/etiologia , Complicações Pós-OperatóriasAssuntos
Humanos , Feminino , Adulto , Fístula Urinária , Fístula Vaginal , Varicocele , Países em Desenvolvimento , Fístula Urinária/cirurgia , Fístula Urinária/epidemiologia , Fístula Urinária/etiologia , Fístula Vaginal/cirurgia , Fístula Vaginal/epidemiologia , Fístula Vaginal/etiologia , Resultado do Tratamento , Varicocele/epidemiologia , Varicocele/etiologia , Varicocele/cirurgiaRESUMO
Una mujer de 44 años fue admitida en el Departamento de Ginecología del Hospital Gíneco-Obstétrico Isidro Ayora, presentando cuadro de Leiomioma abortivo pediculado. La paciente fue sometida a una histerectomía abdominal extrafacial total. Después de 22 días de la cirugía presentó una fístula uretero-vaginal derecha, la cual fue reparada más tarde por la técnica de Boary-Ockerbland, 8 semanas después de extirpado el útero; se obtuvo excelentes resultados