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Dr Farah Yousaf
Prof of Urology/Principle
Abstract
Objectives; To find out optimal procedure of repair of uretervaginal fistula and
there outcome in gynaecology and obstetric practice.
Conclusion; Always try to treat the patients conservatively in ureteric injury, with
stenting if possible, patients with conservative management, along with ureteric
implantation group have good results, while in those with adjuvant maneuver
like Boari flap have fair success rate, in experienced hands.
Treatment modalities and outcome for Ureterovaginal fistula
inflicted in obstetrical and gynaecological practice
Introduction;
The close anatomical relationship between the urinary tract and internal genital
organs predisposes the distal ureter to iatrogenic injury during pelvic and
gynaecological surgery. The incidence of ureteric injury during hysterectomy for
benign disease is 1:500 cases, which rises to 1% in cases of malignancy. The
risk of ureteric injury is higher during abdominal compared to vaginal
hysterectomies. Repeat caesarean sections and postpartum hysterectomies are
also associated with increased risk of injury to the lower urinary tract. Most of the
uterine injuries occur at the lower one third of the ureter5.
All the patients were admitted. A detailed history of the patients regarding
mode of gynecological or obstetrical procedure was obtained. History of surgery,
cause, type of injury was taken. Duration between the infliction of injury and
development of symptoms was recorded. This was followed by thorough clinical
examination including general physical examination, systemic and pelvic
examination. In the pelvic examination both per vaginal examination and
speculum examination were performed and the findings were recorded. In
addition to routine investigations, ultrasonography and intravenous urography
was done to evaluate the upper tract, status of bladder, ureter and any leakage.
In patients where intravenous urography was inadequate to demonstrates
ureteral anatomy then retrograde pyelography was performed.
Patients with ureterovaginal fistulae double J stent was tried to pass at the
initial stage. Where we were unable to pass the ureteric stent, the distance
between the ureteric orifice and the site of injury were noted. On the basis of
these findings the decision, regarding mode of procedure was made, where the
distance was 2-3 cm we go for ureteric reimplantation with double J stent, Boari
flap with Psoas hitch and double J stent was performed for distance more than 4-
5 cm. For suturing vicryl 4/0 was used for end to end ureteric anastomosis over
JJ stent. JJ stent was removed on 6th post operative week. Patients were
assessed for outcome.
Results
Discussion
Conclusion;
References
3. Nawaz FA, Khan ZE, Rizvi J: Urinary tract injuries during obstetrics and
gynaecological surgical procedures at the Agha khan university hospital
Karachi, Pakistan: a 20 year review;Urol int.2007;78(2):106-11.
564-70.