Management of ureterovaginal fistula: a retrospective study
Abstract:Background: Ureterovaginal fistulae are a rare but extremely serious complication of gynaecologic surgery. The objective of this study is to evaluate the feasibility and outcome of endourology in the management of ureterovaginal fistulae. Methods: Retrospective study from August 2018 to April 2022 comprising 18 consecutive cases. Patients ranged from 25-45 years, most common preceding gynaecological intervention was total abdominal hysterectomy, most common presenting complaint was urinary leak. All patients in which the imaging studies showed the ureter communicating with the urinary bladder were taken up for primary stenting. Rest of the cases were subjected to a urinary diversion by percutaneous nephrostomy. Results: 12 cases had fistula on right and 6 on left side. Imaging studies showed communication in 12 cases in which primary retrograde stenting was attempted. We were successful in 8 cases. In remaining 10 cases percutaneous nephrostomy was done. In the 10 cases of urinary diversion, antegrade stenting could be done in 3 cases. 2 out of these did not show any ureteric communication in the initial imaging studies. Overall, 11/18 cases (61.1%) could be stented, rest 7 cases were managed by ureteric reimplantation. Conclusions: Primary retrograde stenting should be considered the primary mode of intervention in all cases of ureterovaginal fistula where imaging studies show a ureteric communication with the bladder. When it is not possible or when imaging studies fail to demonstrate a communication, achieve a urinary diversion by nephrostomy and reassess after 2 weeks. All cases managed by endoscopic approach must be followed up after stent removal.
Keywords: diversion / ureterovaginal fistula / strong / retrospective / percutaneous / gynaecologic / ureteric / extremely
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