Authors: J Shaw E TunitskyBitton M D Barber J E Jelovsek
Publish Date: 2013/12/18
Volume: 25, Issue: 5, Pages: 615-621
Abstract
Nineteen ureterovaginal fistulas were identified during the 7year study period One fistula followed a repeat cesarean section and 18 fistulas followed a hysterectomy 9 total abdominal 6 total laparoscopic 3 vaginal hysterectomies Ureteral injuries were not recognized in any of the patients at the time of index surgery Computed tomography CT urography was the most commonly utilized diagnostic modality 58 Primary nonsurgical management with ureteral stents was attempted and successful in 5 out of 7 cases 71 There were 14 total surgical repairs including 2 cases in which stents were successfully placed but the fistula persisted and 6 additional cases where attempted stent placement failed Surgical repair consisted of 10 ureteroneocystostomies performed via laparotomy and 4 performed laparoscopically 3 of which were robotically assistedDespite being uncommon ureterovaginal fistula should remain in the differential diagnosis of new postoperative urinary incontinence after gynecological surgery Conservative management with ureteral stent appears to be the best initial approach in selected patients with a success rate of 71 Minimally invasive approaches to performing ureteroneocystostomy have high success rates comparable to those of open surgical repair
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