Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 601
Filtrar
1.
Chirurgia (Bucur) ; 115(5): 677-680, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33138906

RESUMO

The spread of SARS-CoV-2 in Italy has been rapid, with over 230.000 infections and 33.000 deaths (May 31st, 2020). The full impact of COVID19 on surgery is still unknown, as its effects on healthcare strategy, hospital infrastructure, staff, regional economy and colorectal disease progression, may not be evident before several months. No systematic reports are available about a higher incidence of COVID19 infections in patients with cancer. However, available data indicate that older people are more vulnerable, particularly when there are underlying health conditions such as chemotherapy or active cancer. Herein, we present the case of a patient with rectal cancer treated with pull-through technique low anterior rectal resection and coloanal anastomosis with protective loop ileostomy, complicated with Sars-CoV-2 infection and late (31st post-operative day) colic ischemia with colo-vaginal fistula. Late intestinal ischemia is a rare complication and can be secondary to several traditional factors, but certainly small vessel thrombosis related to Coronavirus disease must be taken into consideration.


Assuntos
Colo/patologia , Infecções por Coronavirus/complicações , Isquemia/cirurgia , Pneumonia Viral/complicações , Fístula Vaginal/cirurgia , Idoso , Betacoronavirus , Colo/cirurgia , Feminino , Humanos , Isquemia/complicações , Itália , Pandemias , Resultado do Tratamento , Fístula Vaginal/complicações
2.
J Nepal Health Res Counc ; 17(4): 560-561, 2020 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-32001869

RESUMO

Obstetric fistula is a hidden tragedy in the developing world, prevention is important and treatment is by surgical repair. However, failure, broken fistula, stress incontinence often demoralizes surgeons and patients. Keywords: Fistula repair; Obstetric fistula; Obstructed delivery.


Assuntos
Fístula Vaginal/patologia , Países em Desenvolvimento , Feminino , Humanos , Nepal , Fístula Vaginal/prevenção & controle , Fístula Vaginal/cirurgia
3.
Curr Urol Rep ; 20(11): 67, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31599353

RESUMO

PURPOSE OF REVIEW: To describe the complexities of diagnosis and management of neobladder-vaginal fistula (NVF) following orthotopic urinary diversion in women. RECENT FINDINGS: Multiple recent single-institution series confirm the variability of outcomes for NVF repairs and caution regarding comorbid stress urinary incontinence which may necessitate further interventions including conversion to alternate diversions. Although both abdominal and transvaginal approaches have been advocated for surgical management of NVF, contemporary series from reconstructive surgeons favor a vaginal approach to decrease overall operative morbidity. Patients should be carefully counseled regarding neobladder and sphincter function following fistula repair along with the risks of secondary urinary diversion.


Assuntos
Estruturas Criadas Cirurgicamente/efeitos adversos , Derivação Urinária/efeitos adversos , Fístula Vaginal/cirurgia , Cistectomia , Feminino , Humanos , Fístula Vaginal/diagnóstico
4.
BMJ Open ; 9(10): e027991, 2019 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-31619418

RESUMO

INTRODUCTION: Female genital fistula is a debilitating traumatic injury, largely birth-associated, globally affecting up to 2 million women, mostly in sub-Saharan Africa. Fistula has significant physical, psychological and economic consequences. Women often face challenges in reintegrating and resuming prior roles despite successful surgery. Synthesising the evidence on services adjunct to fistula surgery and their outcomes is important for developing the evidence base for best practices and identifying research priorities. This scoping review seeks to examine the range of rehabilitation and reintegration services provided as adjunct to genital fistula surgery, map the existing programming and outcomes, and identify areas for additional research. METHODS AND ANALYSIS: Our scoping review is informed by existing methodological frameworks and will be conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses-ScR guidelines. The search strategy will be applied to nine biomedical, public health and social science databases. The initial search was completed on 27 September 2018. Grey literature will be identified through targeted Google searches and from organisational websites identified as relevant by the United Nations Population Fund (UNFPA) Campaign to End Fistula. We will iteratively build our search strategy through term harvesting and review, and search reference lists of reports and articles to identify additional studies. Two reviewers will independently screen titles and abstracts, followed by full-text screening of all potentially relevant articles and standardised data extraction. Articles eligible for inclusion will discuss research or programmatic efforts around service provision in adjunct to surgery among females with genital fistula. Data will be presented in summary tables accompanied by narrative description. ETHICS AND DISSEMINATION: Ethics approval is not required for a scoping review. Our results can be used to inform policy, serve as support for funding and development of reintegration programmes and highlight areas for subsequent research. Results will be disseminated at relevant conferences and published in a peer-reviewed journal.


Assuntos
Complicações do Trabalho de Parto/cirurgia , Fístula Vaginal/reabilitação , Fístula Vaginal/cirurgia , Incontinência Fecal/etiologia , Incontinência Fecal/psicologia , Feminino , Humanos , Infertilidade Feminina/etiologia , Infertilidade Feminina/psicologia , Dor/etiologia , Dor/psicologia , Gravidez , Projetos de Pesquisa , Literatura de Revisão como Assunto , Estigma Social , Incontinência Urinária/etiologia , Incontinência Urinária/psicologia , Fístula Vaginal/psicologia
5.
Dis Colon Rectum ; 62(9): 1079-1084, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31318769

RESUMO

BACKGROUND: Diverticular disease is the leading cause of colovaginal fistulas. Surgery is challenging given the inflammatory process that makes dissection difficult. To date, studies are small and include fistula secondary to multiple etiologies. OBJECTIVE: The objectives of this study were to examine surgical outcomes of diverticular colovaginal fistulas and to identify variables associated with successful closure. DESIGN: This was a retrospective study of a prospectively maintained clinical database. SETTINGS: The study was conducted at a single tertiary referral center. PATIENTS: Women with diverticular colovaginal fistulas, who underwent surgical repair with intent to close the fistula, were included. INTERVENTIONS: Repair of colovaginal fistula through minimally invasive or open techniques was involved. MAIN OUTCOME MEASURES: Successful closure of fistula, defined as resolution of symptoms and no stoma, was measured. RESULTS: Fifty-two patients underwent surgical treatment of diverticular colovaginal fistula, 23 (44%) of whom underwent a minimally invasive approach (conversion rate of 22%). Ostomy construction and omental pedicle flaps were used in 28 (54%) and 38 patients (73%). Surgery was successful in 47 patients (90%). Accounting for secondary operations, ultimate success and failure rates were 49 (94.0%) and 3 (5.7%). There was no difference in postoperative morbidity between the 2 groups (5 patients with Clavien-Dindo III/IV complications in the success group versus 2 patients in the failure group; 10.6% vs 40.0%; p = 0.44). Failure to achieve fistula closure was not associated with perioperative variables, age, BMI, diabetes mellitus, ASA grade, steroid use, previous abdominal surgery or hysterectomy, use of omentoplasty, or ostomy. Patients who failed were more likely to be smokers (60.0% vs 12.8%; p = 0.03). LIMITATIONS: Limitations include the retrospective design and lack of power. CONCLUSIONS: Surgery is effective in achieving successful closure of diverticular colovaginal fistula. Smokers should be encouraged to stop before embarking on an elective repair. Although the use of fecal diversion and omental pedicle flaps did not correlate with success, they should be used when clinically appropriate. See Video Abstract at http://links.lww.com/DCR/A983. FÍSTULAS COLOVAGINALES DIVERTICULARES ¿QUÉ FACTORES CONTRIBUYEN AL ÉXITO DEL TRATAMIENTO QUIRÚRGICO?: La enfermedad diverticular es la causa principal de fístulas colovaginales. La cirugía es un reto dado el proceso inflamatorio que dificulta la disección. Hasta la fecha, los estudios son pequeños e incluyen fístulas secundarias a múltiples etiologías. OBJETIVO: 1) Examinar los resultados quirúrgicos de las fístulas colovaginales diverticulares; 2) Identificar variables asociadas a un cierre exitoso. DISEÑO:: Estudio retrospectivo de una base de datos clínicos prospectivamente mantenida. CONFIGURACIÓN:: Centro de referencia superior. PACIENTES: Mujeres con fístulas colovaginales diverticulares, que se sometieron a una reparación quirúrgica con la intención de cerrar la fístula. INTERVENCIONES: Reparación de la fístula colovaginal mediante técnicas mínimamente invasivas o abiertas. MEDIDAS DE RESULTADOS PRINCIPALES: Cierre exitoso de la fístula definida como resolución de los síntomas y sin estoma. RESULTADOS: Cincuenta y dos pacientes se sometieron a tratamiento quirúrgico de la fístula colovaginal diverticular, 23 (44%) de los cuales se sometieron a un acceso mínimamente invasivo (tasa de conversión del 22%). La construcción de la ostomía y los pedículos omentales se utilizaron en 28 (54%) y 38 pacientes (73%), respectivamente. La cirugía fue exitosa en 47 pacientes (90%). Tomando en cuenta las operaciones secundarias, las tasas finales de éxito y fracaso fueron 49 (94.0%) y 3 (5.7%). No hubo diferencias en la morbilidad postoperatoria entre los dos grupos (5 pacientes con complicaciones de Clavien-Dindo III / IV en el grupo de éxito versus a 2 pacientes en el grupo de fracaso, 10.6% versus a 40.0%; p = 0.44). El fracaso para lograr el cierre de la fístula no se asoció con variables perioperatorios, edad, IMC, diabetes, grado ASA, uso de esteroides, cirugía abdominal previa o histerectomía, uso de omentoplastia u ostomía. Los pacientes que fracasaron eran más propensos a ser fumadores (60.0% versus a 12.8%; p = 0.03). LIMITACIONES: Las limitaciones incluyen el diseño retrospectivo y la falta de poder. CONCLUSIONES: La cirugía es efectiva para lograr el cierre exitoso de la fístula colovaginal diverticular. Se debe aconsejar a los fumadores a parar de fumar antes de embarcarse en una reparación electiva. Mientras el uso de desviación fecal y pedículos omentales no se correlacionó con el éxito, deberían utilizarse cuando sea clínicamente apropiado. Consulte el Video del Resumen en http://links.lww.com/DCR/A983.


Assuntos
Colonoscopia/métodos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Divertículo do Colo/complicações , Fístula Intestinal/cirurgia , Fístula Vaginal/cirurgia , Idoso , Divertículo do Colo/diagnóstico , Feminino , Seguimentos , Humanos , Fístula Intestinal/diagnóstico , Fístula Intestinal/etiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Fístula Vaginal/diagnóstico , Fístula Vaginal/etiologia
6.
Arch Esp Urol ; 72(4): 428-435, 2019 May.
Artigo em Espanhol | MEDLINE | ID: mdl-31070140

RESUMO

OBJECTIVE: This paper describes our initial experience with laparoscopic ureteroneocystostomy in two patients with distal ureter lesions following gynaecological surgery (hysterectomy). Furthermore, we review the evidence on the incidence, prevention, and management of urinary tract injuries that occur during laparoscopic gynaecological surgery. METHOD: Two patients with iatrogenic lower ureteral injuries during hysterectomy leading to ureterovaginal fistula underwent laparoscopic ureteroneocystostomy with a psoas hitch. RESULTS: The procedures were successfully performed without any conversion. No intraoperative or postoperative complications were noted. Our minimally invasive approach has yielded successful results, similar to those achieved through open surgical repair. CONCLUSION: Laparoscopic ureteroneocystostomy with a psoas hitch for ureterovaginal fistula secondary to hysterectomy is a safe and feasible option for patients with gynecologic distal ureteral injury, with excellent results and low morbidity.


Assuntos
Laparoscopia , Ureter , Doenças Ureterais , Fístula Urinária , Fístula Vaginal , Feminino , Humanos , Histerectomia , Doenças Ureterais/cirurgia , Fístula Urinária/cirurgia , Fístula Vaginal/cirurgia
7.
Afr J Prim Health Care Fam Med ; 11(1): e1-e9, 2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31038345

RESUMO

BACKGROUND: In sub-Saharan African countries, women face a high risk of obstetric fistulas. In Malawi, the prevalence rate is 1 per 1000 women. Studies suggest that several obstacles exist that prevent obstetric fistula patients from getting timely treatment for their condition. AIM: The aim of this article was to find out the factors that delay the timely treatment of obstetric fistula patients at Malawian hospitals. SETTING: The study was conducted at the Queen Elizabeth Central Hospital, a referral hospital, situated in Blantyre, Malawi, and the findings have been generalised to all the hospitals in Malawi. METHODS: An exploratory case study, employing key interview questions, was used to provide insights into why there are delays in providing treatment and care for fistula patients. Purposive sampling technique was used to identify study respondents. Key informant interviews were conducted with 16 health care personnel at a hospital in Malawi. RESULTS: The presence of numerous cases of complicated obstetric fistula cases overwhelms the health care system in Malawi. In addition, the severe shortage of staff, lack of obstetric fistula surgery training, low staff morale, inadequate infrastructure or equipment and water scarcity in the city of Blantyre contribute towards delayed treatment of fistulas at the hospitals. CONCLUSION: The presence of numerous cases of obstetric fistulas is overwhelming health services, and hence there is a need for devising and implementing health policies that will motivate Malawian health personnel to undertake obstetric fistula surgery and care.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Pessoal de Saúde/psicologia , Serviços de Saúde Materna/estatística & dados numéricos , Complicações do Trabalho de Parto/cirurgia , Tempo para o Tratamento/estatística & dados numéricos , Fístula Vaginal/cirurgia , Adulto , Parto Obstétrico/efeitos adversos , Parto Obstétrico/psicologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/estatística & dados numéricos , Humanos , Malaui , Serviços de Saúde Materna/organização & administração , Complicações do Trabalho de Parto/etiologia , Complicações do Trabalho de Parto/psicologia , Gravidez , Pesquisa Qualitativa , Fatores de Tempo , Fístula Vaginal/etiologia , Fístula Vaginal/psicologia
8.
Arch. esp. urol. (Ed. impr.) ; 72(4): 428-435, mayo 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-191759

RESUMO

Objetivo: Presentamos nuestra experiencia inicial mediante ureteroneocistostomía laparoscópica en dos pacientes con lesión del uréter distal tras cirugía ginecológica (histerectomía). A su vez, se lleva a cabo una revisión de la literatura acerca de la incidencia, prevención y manejo de las lesiones urinarias secundarias a cirugía laparoscópica ginecológica. Método: Presentamos dos pacientes con fístula ureterovaginal tras lesión ureteral distal post-histerectomía, que son sometidos a ureteroneocistostomía por vía laparoscópica aplicando la técnica de vejiga psóica. Resultados: Ambos procedimientos se realizaron con éxito sin necesidad de reconversión a cirugía abierta. No se objetivaron complicaciones intra ni postoperatorias. Nuestro enfoque mínimamente invasivo ofrece excelentes resultados, similares a los obtenidos en la reparación quirúrgica por vía abierta. Conclusión: El tratamiento de la fístula ureterovaginal secundaria a lesión ureteral distal post-histerectomía, mediante ureteroneocistostomía laparoscópica aplicando técnica de vejiga psóica, es una técnica factible y segura, con buenos resultados y bajas tasas de morbilidad asociada


Objective: This paper describes our initial experience with laparoscopic ureteroneocystostomy in two patients with distal ureter lesions following gynaecological surgery (hysterectomy). Furthermore, we review the evidence on the incidence, prevention, and management of urinary tract injuries that occur during laparoscopic gynaecological surgery. Method: Two patients with iatrogenic lower ureteral injuries during hysterectomy leading to ureterovaginal fistula underwent laparoscopic ureteroneocystostomy with a psoas hitch.Results: The procedures were successfully performed without any conversion. No intraoperative or postoperative complications were noted. Our minimally invasive approach has yielded successful results, similar to those achieved through open surgical repair. Conclusion: Laparoscopic ureteroneocystostomy with a psoas hitch for ureterovaginal fistula secondary to hysterectomy is a safe and feasible option for patients with gynecologic distal ureteral injury, with excellent results and low morbidity


Assuntos
Humanos , Feminino , Adulto Jovem , Pessoa de Meia-Idade , Doenças Ureterais/cirurgia , Fístula Urinária/cirurgia , Fístula Vaginal/cirurgia , Doenças Ureterais/etiologia , Fístula Urinária/etiologia , Fístula Vaginal/etiologia , Histerectomia/efeitos adversos , Laparoscopia , Cistostomia
9.
Urol Int ; 103(2): 218-222, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30970368

RESUMO

OBJECTIVES: To highlight the transvaginal route as an excellent approach for repair of a simple trigonal, supra-trigonal vesico-vaginal and urethrovaginal fistulae without compromising on the successful patient outcomes. We also determine factors affecting outcomes in such patients. MATERIALS AND METHODS: A retrospective analysis was carried out on 58 patients with simple trigonal, supra trigonal and urethrovaginal fistula who underwent transvaginal repair in the last 10 years. Simple fistulas were defined as fistula less than 3 cm in size or recurrent fistulae less than 1.5-2 cm in size and located either supra-trigonally (above the bar of mercier) or sub-trigonally (below the bar of mercier) as determined by cystoscopy. RESULTS: Obstetric cause, due to obstructed labour, was the most common cause of fistula formation (68.96%), while remaining (29.31%) were attributed to hysterectomy. Primary fistulae were found in 68.9% of patients and recurrent fiistulae in 31.1% patients. The mean age of patients was 33.4 years. Average fistula size was 1.5 cm. The success rate of primary operation was 84.12% (50/58). On using a multivariate regression model, the underlying aetiology (OR 2.2), fistula location (OR 2.5) and history of previous repair (OR 2.4) were found to be significant factors affecting outcome. CONCLUSION: The transvaginal approach is less invasive and achieves comparable success rates as compared to other methods of vesico-vaginal fistula repair. This surgery with Foley catheter has a high success rate with reduced morbidity. We postulate that vaginal approach should be preferred over abdominal approach for repair of all vaginally accessible vesico vaginal fistulae, both of obstetrical and gynaecological origin.


Assuntos
Doenças Uretrais/cirurgia , Fístula Urinária/cirurgia , Fístula Vaginal/cirurgia , Fístula Vesicovaginal/cirurgia , Adulto , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos/métodos , Vagina
10.
Int Urogynecol J ; 30(5): 839-841, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30685786

RESUMO

INTRODUCTION AND HYPOTHESIS: A urethrovaginal fistula is a possible rare complication of tension-free vaginal tape procedures. Surgical management of these fistulas is sometimes complicated, and failure can occur. The operation is difficult when the defect between the urethra and the vagina is larger or scarred, so surgical intervention and the preferred technique are controversial. METHODS: The patient was referred to our department, where the first operation was performed to address the urethrovaginal fistula by the transvaginal and transabdominal approach with interposed omentum. This initial repair failed, resulting in a large urethrovaginal fistula with minimal redundant anterior vaginal wall to provide a tension-free closure. This video presentation describes the second operation-transvaginal repair of a large recurrent urethrovaginal fistula using the skin island flap technique. RESULTS: The video of the procedure shows how to address a recurrent urethrovaginal fistula by employing a skin flap. An examination during the patient's follow-up visit 3 months later revealed excellent healing and persistent stress urinary incontinence (SUI). Six months after the fistula repair, the patient underwent a bulking agent procedure. CONCLUSIONS: The skin island flap procedure allowed the larger defect to heal, though it did not address the SUI, which was later treated by application of a bulking agent.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Slings Suburetrais/efeitos adversos , Fístula Urinária/cirurgia , Fístula Vaginal/cirurgia , Idoso , Feminino , Humanos , Recidiva , Fístula Urinária/patologia , Incontinência Urinária por Estresse/cirurgia , Fístula Vaginal/patologia
11.
Dis Colon Rectum ; 62(5): 595-599, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30614849

RESUMO

BACKGROUND: Pouch-vaginal fistula is a debilitating condition with no single best surgical treatment described. Closure of these fistulas can be incredibly difficult, and transanal, transabdominal, and transvaginal approaches have been reported with varying success rates. Recurrence is a major problem and could eventually result in repeat redo pouch or permanent diversion. OBJECTIVE: The aim of our study was to investigate healing rates for procedures done for pouch-vaginal fistula closure. DESIGN: This is a retrospective analysis of a prospectively maintained database complemented by chart review. SETTINGS: This study reports data of a tertiary referral center. PATIENTS: Patients who underwent surgery for pouch-vaginal fistula from 2010 to 2017 were identified. Patients who underwent surgery with intent to close the fistula were included, and patients who had inadequate follow-up to verify fistula status were excluded. INTERVENTIONS: Patients included underwent surgery to close pouch-vaginal fistula. MAIN OUTCOME MEASURES: Success of the surgery was the main outcome measure. Success was defined as procedures with no reported recurrence of fistula on last follow-up. RESULTS: A total of 70 patients underwent surgery with an intent to close the pouch-vaginal fistula, 65 of whom had undergone index IPAA for ulcerative colitis, but 13 of these patients later had the diagnosis changed to Crohn's disease. Thirty-nine patients (56%) had a fistula originating from anal transition zone to dentate line to the vagina (not at the pouch anastomosis). In the total group of 70 patients, our successful closure rate was 39 (56%) of 70. Procedures with the highest success rates were perineal ileal pouch advancement flap and redo IPAA (61% and 69%). LIMITATIONS: The retrospective nature and small number of cases are the limitations of the study. CONCLUSIONS: Although numerous procedures may be used in an attempt to close pouch-vaginal fistula, pouch advancement and redo pouch were the most successful in closing the fistula. See Video Abstract at http://links.lww.com/DCR/A841.


Assuntos
Colite Ulcerativa/cirurgia , Bolsas Cólicas , Doença de Crohn/cirurgia , Fístula Intestinal/cirurgia , Complicações Pós-Operatórias/cirurgia , Proctocolectomia Restauradora , Fístula Vaginal/cirurgia , Polipose Adenomatosa do Colo/cirurgia , Adulto , Anastomose Cirúrgica , Bases de Dados Factuais , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reoperação , Estudos Retrospectivos , Retalhos Cirúrgicos , Resultado do Tratamento , Adulto Jovem
12.
Tech Coloproctol ; 23(1): 43-52, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30604248

RESUMO

BACKGROUND: The aim of this study was to evaluate the effectiveness of gracilis muscle transposition (GMT) to treat recurrent anovaginal, rectovaginal, rectourethral, and pouch-vaginal fistulas in patients with inflammatory bowel disease (IBD). METHODS: A retrospective study was conducted in patients with IBD who had GMT performed by a single surgeon between 2000 and 2018. Follow-up data regarding healing rate, complications, additional procedures, and stoma closure rate was collected. RESULTS: A total of 30 women and 2 men had GMT. In all patients fistula was associated with Crohn's disease. In 1 female patient, contralateral gracilis transposition was required after a failed attempt at repair. The primary healing rate was 47% (15/32) and the definitive healing rate (healed by the time of data collection and after secondary procedures) was 71% (23/32). Additional surgical procedures due to fistula persistence or recurrence were performed on 17 patients (53%).At least 7 patients (21%) suffered complications including one wound infection with ischemia of the gracilis muscle. Stoma closure was successful in 18 of 31 cases of patients with stoma (58% of the patients). CONCLUSIONS: GMT for the treatment of recurrent and complex anorectal fistulas in patients with IBD patient is eventually successful in almost 2/3 of patients.


Assuntos
Doença de Crohn/complicações , Fístula/cirurgia , Músculo Grácil/transplante , Fístula Urinária/cirurgia , Fístula Vaginal/cirurgia , Adulto , Feminino , Fístula/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fístula Retal/etiologia , Fístula Retal/cirurgia , Fístula Retovaginal/etiologia , Fístula Retovaginal/cirurgia , Recidiva , Estudos Retrospectivos , Retalhos Cirúrgicos , Resultado do Tratamento , Doenças Uretrais/etiologia , Doenças Uretrais/cirurgia , Fístula Urinária/etiologia , Fístula Vaginal/etiologia
13.
J Ayub Med Coll Abbottabad ; 31(Suppl 1)(4): S678-S679, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31965775

RESUMO

We report a case of urethrovaginal fistula following impacted foreign body in vagina. Fistula was suspected on the basis of history and examination and was later on confirmed by voiding cystourethrogram. Cystourethroscopy was done and the fistula was repaired transvaginally in layers. We are reporting this case because of its rarity.


Assuntos
Corpos Estranhos , Fístula Urinária , Fístula Vaginal , Adolescente , Feminino , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico , Corpos Estranhos/cirurgia , Humanos , Paquistão , Fístula Urinária/diagnóstico , Fístula Urinária/etiologia , Fístula Urinária/cirurgia , Vagina/diagnóstico por imagem , Vagina/cirurgia , Fístula Vaginal/diagnóstico , Fístula Vaginal/etiologia , Fístula Vaginal/cirurgia
15.
J Gastrointest Surg ; 23(5): 1015-1021, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30251070

RESUMO

BACKGROUND: The purpose of this study was to review our experience with laparoscopic colectomy and fistula resection, evaluate the frequency of conversion to open, and to compare the perioperative courses of the complete laparoscopic and conversion groups. METHODS: This study is a retrospective analysis of 111 consecutive adult patients with diverticular fistulae diagnosed clinically or radiographically over 11 years at a single institution. Five patients were excluded for preoperative comorbidities. The remaining 106 consecutive patients underwent minimally invasive sigmoid colectomy with primary anastomosis. Preoperative, intraoperative, and postoperative variables were collected from the colorectal surgery service database. A retrospective cohort analysis was performed between laparoscopic and converted groups. RESULTS: Within the group, 47% had colovesical fistulas, followed by colovaginal, coloenteric, colocutaneous, and colocolonic fistulas. The overall conversion rate to laparotomy was 34.7% (n = 37). The most common reason for conversion was dense fibrosis. Mean operative time was similar between groups. Combined postoperative complications occurred in 26.4% of patients (21.4% laparoscopic and 37.8% converted, p = 0.075). Length of stay was significantly shorter in the laparoscopic group (5.8 vs 8.1 days, p = 0.014). There were two anastomotic leaks, both in the open group. There were no 30-day mortalities. CONCLUSIONS: Laparoscopic sigmoid colectomy for diverticular fistula is safe, with complication rates comparable to open sigmoid resection. We identify a conversion rate which allows the majority of patients to benefit from minimally invasive procedures.


Assuntos
Colectomia/métodos , Colo Sigmoide/cirurgia , Doença Diverticular do Colo/cirurgia , Fístula/cirurgia , Laparoscopia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/etiologia , Colectomia/efeitos adversos , Conversão para Cirurgia Aberta/efeitos adversos , Fístula Cutânea/etiologia , Fístula Cutânea/cirurgia , Doença Diverticular do Colo/complicações , Feminino , Fístula/etiologia , Humanos , Fístula Intestinal/etiologia , Fístula Intestinal/cirurgia , Laparoscopia/efeitos adversos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Fístula da Bexiga Urinária/etiologia , Fístula da Bexiga Urinária/cirurgia , Fístula Vaginal/etiologia , Fístula Vaginal/cirurgia
16.
Trop Med Int Health ; 24(1): 53-64, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30372572

RESUMO

OBJECTIVES: To explore trajectories of physical and psychosocial health, and their interrelationship, among women completing fistula repair in Uganda for 1 year post-surgery. METHODS: We recruited a 60-woman longitudinal cohort at surgical hospitalisation from Mulago Hospital in Kampala Uganda (Dec 2014-June 2015) and followed them for 1 year. We collected survey data on physical and psychosocial health at surgery and at 3, 6, 9 and 12 months via mobile phone. Fistula characteristics were abstracted from medical records. All participants provided written informed consent. We present univariate analysis and linear regression results. RESULTS: Across post-surgical follow-up, most women reported improvements in physical and psychosocial health, largely within the first 6 months. By 12 months, urinary incontinence had declined from 98% to 33% and general weakness from 33% to 17%, while excellent to good general health rose from 0% to 60%. Reintegration, self-esteem and quality of life all increased through 6 months and remained stable thereafter. Reported stigma reduced, yet some negative self-perception remained at 12 months (mean 17.8). Psychosocial health was significantly impacted by the report of physical symptoms; at 12 months, physical symptoms were associated with a 21.9 lower mean reintegration score (95% CI -30.1, -12.4). CONCLUSIONS: Our longitudinal cohort experienced dramatic improvements in physical and psychosocial health after surgery. Continuing fistula-related symptoms and the substantial differences in psychosocial health by physical symptoms support additional intervention to support women's recovery or more targeted psychosocial support and reintegration services to ensure that those coping with physical or psychosocial challenges are appropriately supported.


Assuntos
Qualidade de Vida/psicologia , Autoimagem , Estigma Social , Fístula Vaginal/psicologia , Saúde da Mulher , Adaptação Psicológica , Feminino , Humanos , Estudos Longitudinais , Fístula Retovaginal/psicologia , Uganda , Fístula Vaginal/cirurgia , Fístula Vesicovaginal/psicologia
17.
J Pediatr Surg ; 54(3): 612-615, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30297116

RESUMO

Acquired urethrovaginal fistulae and urethral atresia are rare findings in pediatric patients, but have been described in adult patients related to trauma or iatrogenic injury. Little exists in the published literature to guide management of such conditions in children, but lessons learned from congenital causes can help. Herein we discuss the preoperative evaluation and management of a child with an acquired urethrovaginal fistula and urethral atresia likely related to in utero compression from an intrapelvic sacrococcygeal teratoma and provide several images detailing the complex anatomy.


Assuntos
Região Sacrococcígea/patologia , Teratoma/complicações , Doenças Uretrais/cirurgia , Fístula Urinária/cirurgia , Fístula Vaginal/cirurgia , Endoscopia/métodos , Feminino , Humanos , Lactente , Cuidados Pré-Operatórios/métodos , Região Sacrococcígea/cirurgia , Teratoma/cirurgia , Doenças Uretrais/complicações , Fístula Urinária/complicações , Anormalidades Urogenitais/diagnóstico , Anormalidades Urogenitais/cirurgia , Fístula Vaginal/complicações
19.
BMC Urol ; 18(1): 96, 2018 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-30373586

RESUMO

OBJECTIVE: To evaluate the procedure of endoscopic surgery for ureterovaginal fistula (UVF) and its clinical efficacy. MATERIALS AND METHODS: A retrospective analysis of 46 patients needing treatment for UVF with endourology technology was conducted (all patients had unilateral ureteric injury, 27 left and 19 right). Transurethral retrograde ureteric stenting or realignment retrograde/antegrade approach stenting was used to treat the fistula, and the relation between treatment and prognosis was analyzed. RESULTS: One case failed, the patient undergoing percutaneous nephrostomy instead. Success was achieved in 45 cases, and urinary leakage was stopped 48 h after surgery. Of the 45 patients operated on, 16 had their double-J stents removed after 3-6 months, and 29 needed replacement every 6-12 months. In a postoperative follow-up of 6-36 months, 10 patients had recurrent stenosis needing ureteroscopic endoureterotomy or reexpansion with a balloon. No other complications occurred. CONCLUSIONS: Endoscopic surgery is an effective technology in the treatment of UVF, with the advantages of being effective, reliable, less invasive, and readily accepted by patients.


Assuntos
Histeroscopia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Fístula Urinária/cirurgia , Fístula Vaginal/cirurgia , Adulto , Endoscopia/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Nefrostomia Percutânea/métodos , Estudos Retrospectivos , Fístula Urinária/diagnóstico por imagem , Fístula Vaginal/diagnóstico por imagem
20.
BMJ Case Rep ; 20182018 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-30097549

RESUMO

A 22-year-old woman met with road traffic accident 6 months back following which she underwent exploratory laparotomy with intraperitoneal bladder rupture repair. She presented with urethrovaginal fistula due to a fragment of fractured pubic bone impinging into the anterior vaginal wall. The findings were confirmed on CT scan and cystoscopy. The patient was managed with removal of the bony spicule and transvaginal repair of urethrovaginal fistula with Martius fat pad interposition.


Assuntos
Traumatismos Abdominais/diagnóstico , Fraturas Ósseas/diagnóstico , Osso Púbico/lesões , Doenças Uretrais/diagnóstico , Fístula Vaginal/diagnóstico , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/cirurgia , Acidentes de Trânsito , Diagnóstico Diferencial , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Tomografia Computadorizada por Raios X , Doenças Uretrais/diagnóstico por imagem , Doenças Uretrais/cirurgia , Fístula Vaginal/diagnóstico por imagem , Fístula Vaginal/cirurgia , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...