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Oct 11, 2024;103 (41): e39881.

Transvaginal double-layer parallel in-situ suturing for early complex vesicovaginal fistula repair: Case report.

Chuanfeng Liu, Shouxia Cao, Haiyan Liu, Qingtan Pang, Zichao Zhao, Fuming Wang, Yongqiang Xia
Author Information
  1. Chuanfeng Liu: Department of Urology, Linyi Maternity and Child Health Care Hospital, Shandong Province, China. ORCID
  2. Shouxia Cao: Clinical Medicine Department, Shandong Medical College, Shandong Province, China.
  3. Haiyan Liu: Department of Anesthesiology, Linyi Maternity and Child Health Care Hospital, Shandong Province, China.
  4. Qingtan Pang: Department of Urology, Linyi Maternity and Child Health Care Hospital, Shandong Province, China.
  5. Zichao Zhao: Department of Urology, Linyi Maternity and Child Health Care Hospital, Shandong Province, China.
  6. Fuming Wang: Department of Urology, Linyi Maternity and Child Health Care Hospital, Shandong Province, China.
  7. Yongqiang Xia: Department of Urology, Linyi Maternity and Child Health Care Hospital, Shandong Province, China. ORCID
PMID: 39465846 DOI: 10.1097/MD.0000000000039881

Abstract

RATIONALE: Complex vesicovaginal fistulas (VVFs) with large defects pose significant surgical challenges. Traditional repair methods often require extensive tissue separation and multilayer suturing, risking local blood supply and healing. This study introduces a novel modified transvaginal repair technique that simplifies the procedure while preserving tissue vascularity. It employs double-layer parallel in situ suturing for early repair of complex VVF.
patient CONCERNS: A 50-year-old woman was admitted with continuous vaginal urine leakage for 4 days following trauma. Speculum examination revealed a 3-cm longitudinal oval laceration at the 11 o'clock position in the dorsal lithotomy site, with continuous fluid leakage through the fistula.
DIAGNOSES: Self-inflicted complex VVF.
INTERVENTIONS: The patient underwent prophylactic placement of bilateral double-J stents and continuous catheterization, followed by surgical repair using a modified transvaginal technique involving double-layer parallel in situ suturing.
OUTCOMES: Postoperative evaluations showed successful healing with no urinary leakage. The vaginal sutures were removed on day 24, and follow-up at 1 year confirmed no recurrence of the fistula or lower urinary tract symptoms, significantly improving the patient's quality of life.
LESSONS: The modified transvaginal repair technique using double-layer parallel in situ suturing is a simple and effective approach for early repair of complex VVF, highlighting its potential for broader clinical application. Future studies with larger cohorts are needed to validate these findings.

References

  1. Malik MA, Sohail M, Malik MT, Khalid N, Akram A. Changing trends in the etiology and management of vesicovaginal fistula. Int J Urol. 2018;25:25���9.
  2. Wang X, Gao Z, Li L, Tian D, Zhou H, Shen J. Clinical efficacy of flap transfer coverage in the treatment of vesicovaginal fistula. Int Urogynecol J. 2023;34:1797���802.
  3. Grewal M, Pakzad MH, Hamid R, Ockrim JL, Greenwell TJ. The medium- to long-term functional outcomes of women who have had successful anatomical closure of vesicovaginal fistulae. Urol Ann. 2019;11:247���51.
  4. Bodner-Adler B, Hanzal E, Pablik E, Koelbl H, Bodner K. Management of vesicovaginal fistulas (VVFs) in women following benign gynaecologic surgery: a systematic review and meta-analysis. PLoS One. 2017;12:e0171554.
  5. Latzko W. Postoperative vesicovaginal fistulas: genesis and therapy. Am J Surg. 1942;58:211���28.
  6. Medlen H, Barbier H. Vesicovaginal Fistula. In: StatPearls. Treasure Island (FL): StatPearls Publishing Copyright �� 2023, StatPearls Publishing LLC.; 2023.
  7. Lo TS, Chua S, Wijaya T, Kao CC, Uy-Patrimonio MC. Clinical relevance and treatment outcomes of vesicovaginal fistula (VVF) after obstetric and gynecologic surgery. Taiwan J Obstet Gynecol. 2019;58:111���6.
  8. Shirvan MK, Alamdari DH, Ghoreifi A. A novel method for iatrogenic vesicovaginal fistula treatment: autologous platelet rich plasma injection and platelet rich fibrin glue interposition. J Urol. 2013;189:2125���9.
  9. Akko�� A, Aydin C, U��ar M, ��ent��rk AB, Top��uo��lu M, Metin A. Transvesicoscopic bipolar sealing of vesicovaginal fistula. J Endourol Case Rep. 2018;4:94���6.
  10. El-Azab AS, Abolella HA, Farouk M. Update on vesicovaginal fistula: a systematic review. Arab J Urol. 2019;17:61���8.
  11. Kumar N, Sureka SK, Singh UP, et al. Vesicovaginal fistula repair by transvaginal route: comparison of resource utilisation and outcome with literature reported population matched cohort of patients operated by minimally invasive route. J Obstet Gynaecol India. 2022;72:414���9.
  12. Tang M, Li P, Wang C, Zhang Q, Meng X. Clinical application of single-layer annular vaginal flap in transvaginal repair for vesicovaginal fistula. World J Urol. 2023;41:249���55.
  13. Stamatakos M, Sargedi C, Stasinou T, Kontzoglou K. Vesicovaginal fistula: diagnosis and management. Indian J Surg. 2014;76:131���6.
  14. Cardenas-Trowers O, Heusinkveld J, Hatch K. Simple and effective: transvaginal vesico-vaginal fistula repair with a modified Latzko technique. Int Urogynecol J. 2018;29:767���9.
  15. Sayegh AS, Medina LG, Sotelo R. Vesicovaginal Fistula: Minimally Invasive Surgery (MIS) Approaches. In: Sotelo R, Polotti CF, Arriaga J, eds. Urinary Fistula. Cham: Springer International Publishing; 2022:125���138.
  16. Kieserman-Shmokler C, Sammarco AG, English EM, Swenson CW, DeLancey JO. The Latzko: a high-value, versatile vesicovaginal fistula repair. Am J Obstet Gynecol. 2019;221:160.e1���4.
  17. Lee D, Zimmern P. Vaginal approach to vesicovaginal fistula. Urol Clin North Am. 2019;46:123���33.
  18. Kurokawa I, Nomura Y, Nakagawa C, Okada Y, Fuji K, Yoshimura Y. Transvaginal vesicovaginal fistula closure: a retrospective study of 28 cases at a single facility in Japan. Int J Urol. 2023;30:586���91.
  19. Matei DV, Zanagnolo V, Vartolomei MD, et al. Robot-assisted vesico-vaginal fistula repair: our technique and review of the literature. Urol Int. 2017;99:137���42.
  20. Serna-Gallegos T, Jeppson PC. Female pelvic fistulae. Obstet Gynecol Clin North Am. 2021;48:557���70.
  21. Cohen BL, Gousse AE. Current techniques for vesicovaginal fistula repair: Surgical pearls to optimize cure rate. Curr Urol Rep. 2007;8:413���8.
  22. Meeks G, GHafar M. Vesicovaginal and urethrovaginal fistulas. Glob Libr Women���s Med. 2012;2. doi:10.3843/GLOWM.10064. [DOI: 10.3843/GLOWM.10064]
  23. Rajaian S, Pragatheeswarane M, Panda A. Vesicovaginal fistula: review and recent trends. Indian J Urol. 2019;35:250���8.

MeSH Term

Female
Humans
Vesicovaginal Fistula
Middle Aged
Suture Techniques
Vagina
Journal Article Case Reports

Word Cloud

Created with Highcharts 10.0.0repairsuturingdouble-layerparallelcomplexmodifiedtransvaginaltechniquesituearlyVVFcontinuousleakagefistulavesicovaginalsurgicaltissuehealingvaginalusingurinaryRATIONALE:ComplexfistulasVVFslargedefectsposesignificantchallengesTraditionalmethodsoftenrequireextensiveseparationmultilayerriskinglocalbloodsupplystudyintroducesnovelsimplifiesprocedurepreservingvascularityemploysPATIENTCONCERNS:50-year-oldwomanadmittedurine4daysfollowingtraumaSpeculumexaminationrevealed3-cmlongitudinalovallaceration11o'clockpositiondorsallithotomysitefluidDIAGNOSES:Self-inflictedINTERVENTIONS:patientunderwentprophylacticplacementbilateraldouble-JstentscatheterizationfollowedinvolvingOUTCOMES:Postoperativeevaluationsshowedsuccessfulsuturesremovedday24follow-up1yearconfirmedrecurrencelowertractsymptomssignificantlyimprovingpatient'squalitylifeLESSONS:simpleeffectiveapproachhighlightingpotentialbroaderclinicalapplicationFuturestudieslargercohortsneededvalidatefindingsTransvaginalin-siturepair:Casereport

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