Obstetrik ve jinekolojik operasyonlar sonrasında gelişen vezikovajinal fistüllerin retrospektif değerlendirilmesi

Amaç: Obstetrik ve jinekolojik operasyonlar sonrasında gelişen vezikovajinal fistüllerin cerrahi sonuçları değerlendirildi. Materyal ve Metod: Obstetrik ve Jinekolojik operasyonlar sonrasında veziko vajinal fistül gelişen 37 hastanın retrospektif analizi yapıldı. Hastaların demografik özellikleri, klnik özellikleri, risk faktörleri ve operasyon türleri incelendi. Bulgular: Hastaların ortalama yaşı 43,2±3,7 bulundu. Olguların %50si jinekolojik, %40ı obstetrik, %10u diğer nedenler (radyoterapi, travma) sonrası vezikovajinal fistül oluşmuştur. Her olguya cerrahi tedavi uygulandı. İlk operasyon sonrasında hastaların %59unun , ikinci operasyon sonrası hastaların %89unun, üçüncü operasyon sonrası hastaların %94ünün tedavi edildiği tesbit edildi. Tartışma: Jinekolojik ve obstetrik vakalar sonrasında gelişen fistül onarımında hastalar detaylı şekilde bilgilendirilmeli, fistül yerleşim yeri tam olarak tespit edilmeli ve vezikovajinal fistül onarımı için tekrar cerrahi bir müdahale gerekebileceği hastaya anlatılmalıdır.

To investigate the results of surgical interventions of vesicovaginal fistula secondary to obstetrical and gynecological operations.

Objective: To investigate the results of surgical interventions of vesicovaginal fistula secondary to obstetrical and gynecological operations. Material and methods: This is a retrospective analysis of thirty-seven patients with VVF secondary to obstetrical and gynecological operations. The demographical features, clinical features, risk factors and operation types were analyzed. Results: The mean age of the patients was 43.2±3.7 years. The etiologies of VVF were gynecological interventions in 50% of the patients, obstetrical interventions in the 40% of the patients. Trauma and radiotherapy were determined in 10% of the patients. The treatments of VVF were administered after first operation in 59% of the patients, after second operation in 89% and after third operation in 94% of the patients. Conclusions: Detailed information should be given to the patients undergoing secondary VVF repairment. The fistula localization should be determined before the operation. The possible re-intervention requirement should be explained to the patients.

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1. Symmonds RE. Incontinence: vesical and urethral fistulas. Clin. Obstet. Gynecol 1984; 27:499514.
2. Lee RA, Symmonds RE, Williams TJ. Currentstatus of genito urinary fistula. Obstet Gynecol 1988; 72:313 319.
3. Livengood CH. Colovaginalfistula. Report of a case with failure of transvaginal repair. J ReprodMed 1996; 41:291293.
4. Eilber KS, Kavaler E, Rodriguez LV, et al. Ten-year experience with transvaginal vesicovaginal fistula repair using tissue interposition. J Urol 2003; 169:10331036.
5. Harkki-Siren P, Sjoberg J, Tiitinen A. Urinary tract injuries after hysterectomy. Obstet Gynecol 1998; 92:113118.
6. Hilton P. Surgical fistulae and obstetric fistulae. In: Cardozo LD, Staskin D, editors. Textbook of female urology and uro-gynaecology. 2nd ed. London: Martin Dunitz Ltd; 2001. pp. 691720.
7. Ou CS, Huang UC, Tsuang M, Rowbotham R. Laparoscopic repair of vesicovaginalfistula. J Laparoendosc Adv Surg Tech A 2004;14:17e21.
8. Mathevet P, Valencia P, Cousin C, Mellier G, Dargent D. Operative injuries during vaginal hysterectomy. Eur J Obstet Gynecol Reprod Biol 2001;97:71e5.
9. Armenakas NA, Pareek G, Fracchia JA. Iatrogenic bladder perforations: long term follow up of 65 patients. J AmCollSurg 2004; 198:7882.
10. Likic IS, Kadija S, Ladjevic NG, et al. Analysis of urologic complications after radical hysterectomy. Am J ObstetGynecol 2008; 199:644 e1644 e3.
11. Browning A. Lack of value of theMartiusgraft in obstetricfistularepair. Int J GynaecolObstet 2006;93:337.
12. Hilton P,Ward A. Epidemiological and surgical aspects of urogenital fistulae: a review of 25 years experience in South east Nigeria. Int Urogynecol J Pelvic Floor Dysfunct 1998; 9:189194.
13. Arrowsmith SD. Genitourinary reconstruction in obstetric fistulas. J Urol 1994; 152:403406.
14. Ockrim JL, Greenwell TJ, Foley CL, et al. A tertiary experience of vesicovaginal and urethro-vaginalfistula repair: factor spredicting success. BJU Int 2009; 103:11221126.
15. Haferkamp A, Wagener N, Buse S, Reitz A, Pfitzenmaier J, Hallscheidt P et al (2005) Vesicovaginalfistulas. Urologe A 44(3):270276.
16. Williams G (2007) The AddisAbaba fistula hospital: an holistic approach to the management of patients with vesicovaginalfistulae. Surgeon 5(1):5457.
17. Forsgren C, Lundholm C, Johansson AL, et al. Hysterectomy for benign indications and risk of pelvic organ fistula disease. Obstet Gynecol 2009; 114:594 599.
18. 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; 201:512 e1512 e4.
19. Sharifi-Aghdas F, Ghaderian N, Payvand A.Free bladder mucosal autograft in the treatment of complicated vesico-vaginalfistula. BJU Int. 2002 Mar;89 Suppl1:54-6.
20. Woo HH, Rosario DJ, Chapple SR (1996) The treatment of vesico-vaginalfistulae. EurUrol29:19.
21. Kirschner CV, Yost KJ, Du H, Karshima JA, Arrowsmith SD, Wall LL.Obstetric fistula: the ECWA Evangel VVF Center surgical experience from Jos, Nigeria.Int Urogynecol J. 2010 Dec;21(12):1525-33.
22. Blaivas JG, Heritz DM, Romanzi LJ. Early versus late repair of vesico-vaginalfistulas: vaginal and abdominal approaches. J Urol 1995; 153: 11102.
23. Blandy JP, Badenoch DF, Fowler CG, Jenkins Thomas NW. Early repair of iatrogenic injury to the ureter or bladder after gynecological surgery. J Urol 1991; 146: 7615.
24. Punekar SV, Buch DN, Soni AB, Swami G, Rao SR, Kinne JS et al (1999) Martius labial fat padinter position and its modification in complex lower urinary fistulae. J Postgrad Med 45:6973.
25. OConnor VJ. Review of experience with vesico- vaginalfistula repair. J Urol 1980; 123: 3679.
26. Elkins TE. Surgery for the obstetric vesico- vaginalfistula: a review of 100 operations in patients. Am J Obstet Gynecol 1994; 170: 110820.
27. Collins CG, Pent D, Jones FB. Results from early repair of vesico-vaginalfistulas with preliminary cortisone treatment. Am J Obstet Gynecol 1960; 80: 100512.
28. Kristensen JK, Lose G. Vesico-vaginalfistulas: the transperitoneal repair revisited. Scand J Urol Nephrol 1994; Suppl 157: 1015.
29. Catanzaro F, Pizzoccaro M, Cappellano F, Catanzaro M, Ciotti G, Giollo A (2005) Vaginal repair of vesico- vaginalfistulas: our experience. Arch Ital Urol Androl 77(4):224225.