Vaginal repair of vesico-vaginal fistulas: our experience.

Vesico-vaginal fistula repair is feasible both with abdominal and vaginal approach. We report our experience in vaginal repair of 34 vesico vaginal fistulas. Twenty-eight out of 34 fistulas have been treated by vaginal repair (82.3%) (in 2 cases after an attempt of endoscopic repair), 4/34 (11.8%) by abdominal repair and 4/34 (11.8%) by endoscopic repair with good outcome in 2 cases. In 96% of fistulas treated by vaginal repair (27/28) we obtained a complete recovery; in one patient we observed fistula recurrence after 2 months from the operation. Four patients were treated by abdominal approach: in two complex patients with vesico-uretero-vaginal fistula, the repair was associated with entero-cystoplasty and ureteral reimplantation; in one case of huge fistula following cesarean section (7 cm) a vesical flap was used; in one case we repaired a recurrent fistula in orthotopic ileal neobladder: A good outcome was achieved in all cases. Vaginal approach is less aggressive, well accepted by patients and can lead to lower legal issues. Abdominal surgery is mandatory in complex situations, when the fistula is big (> 4 cm) or when ureteral orifices are involved.

[The use of temporary stents in the treatment of urethral stenosis]. / Considerazioni sull'utilizzo degli stent temporanei nel trattamento delle stenosi uretrali.

The Authors report their past experience in the treatment of urethral strictures by means of temporary stent implants (Urocoil). The results at a long-term follow-up were poor in strictures of the bulbous and penile urethra (2/19 at 36 months) and very good in strictures of bladder neck and prostatic urethra (10/10 at 45 months). They conclude that this treatment has been at present abandoned due to high costs and poor results. It could however be effective in the treatment of postsurgical bladder neck strictures recurring after endoscopic treatment.