A case of massive transvaginal eversion of urinary bladder through a large vesicovaginal fistula is reported. It has developed by spillage of hyprochloride on prolapse uteri and accompanied with rectovaginal fistula. Satisfactory surgical repair of the fistula was obtained by reduction of bladder and urethral reconstruction using anterior bladder wall.
Fistula ; Prolapse ; Rectovaginal Fistula ; Urinary Bladder* ; Uterus ; Vesicovaginal Fistula

This purpose of this study was to establish a new standard for the surgical management of female genital fistula in Korea. From January 1992 to October 2001, 117 patients with female genital fistula who were admitted to the departments of obstetrics and gynecology, urology and general surgery were analyzed. Nine patients with congenital etiologies and 48 patients who were treated conservatively were excluded. The relationships between surgical outcome and the cause of fistula, the location of fistula, and the various surgical methods were analyzed. In spite of appropriate surgical treatment, fistulas due to cervix cancer management had the worst prognosis. In terms of location, fistula recurrence after surgical repair was most common in the bladder fundus and base. The transvaginal and transrectal approaches are suitable for fistulas located in the lower vagina. The transabdominal approach is appropriate for fistulas located in the functional portions such as the bladder and ureter, for fistulas which are difficult to expose surgically by either the vaginal or rectal approach, or in cases with severe adhesions. In cases of cervix cancer, extra care should be taken during surgical expiration or definitive radiotherapy, especially when the areas involved are the bladder fundus and base. The nature of the surgical approach should be decided by the location of the fistula, the functional importance of the area, and the degree of surgical exposure during the corrective procedures.
Adolescent ; Adult ; Child ; Female ; Human ; Korea ; Middle Age ; Rectovaginal Fistula/surgery ; Treatment Outcome ; Urinary Fistula/surgery ; Vaginal Fistula/*surgery ; Vesicovaginal Fistula/surgery

24 cases of urinary fistulae which were admitted to The Department of Urology, Chonnam University Hospital, during the period from Sept. 1968 to Aug. 1971 were analyzed clinically. 1. 15 cases of all fistulae were in women and 9 in men. 2. The most common age was from 30~35 years with 50%. 3. The most commonly involved site was bladder with 66% and the most common fistula type was vesicovaginal fistula (40%). 4. The most common etiology of vesicovaginal fistula was obstetrical cause 5. 11 cases (44%) of all fistulas occurred after the operation.
Female ; Fistula* ; Humans ; Jeollanam-do ; Male ; Urinary Bladder ; Urinary Fistula ; Urinary Tract* ; Urology ; Vesicovaginal Fistula

OBJECTIVE: We reviewed the frequency and characteristics of urinary-vaginal fistulas after various types of total hysterectomy. METHODS: We analyzed retrospectively 12 women with urinary-vaginal fistulas (10 vesicovaginal, 2 ureterovaginal) after total hysterectomy from January 1994 to December 2003. Hysterectomies included total abdominal hysterectomies (TAH), vaginal hysterectomies (TVH), laparoscopic hysterectomies (TLH), radical hysterectomies (RH), and cesarean hysterectomies (CH). The parameters that were analyzed included age, incidence with respect to the type of hysterectomy, past history, time of onset of the urine leakage and interval between leakage, corrective surgery, location of fistula, type of repair, and results. RESULTS: During the study period, 3,561 hysterectomies were carried out. TAH accounted for 68.9% of procedures, TVH for 14.4%, TLH for 11.6%, RH for 3.3%, and CH for 1.7%. The incidence of vesicovaginal and ureterovaginal fistula was 0.24% and 0% for TAH, 0.48% and 0.48% for TLH, 0.84% and 0% for RH, and 1.67% and 0% for CH, respectively. No fistula was developed after TVH. Urine leakages were developed 5 to 28 days (mean, 14.5 days) after hysterectomies and the intervals between urine leakage and corrective surgery were 7 to 28 days (mean, 16.3 days). The intervals between hysterectomy and corrective surgery were 21 to 54 days (mean, 34.6 days). Corrective surgeries (10 suprapubic transvesical repairs for vesicovaginal fistulas and 2 ureteroneocystostomies for ureterovaginal fistulas) were performed soon after establishment of diagnosis. There was no significant complication and recurrence of fistula after corrective surgery. CONCLUSION: The overall incidence of urinary-vaginal fistula was 0.3%, respectively. The fistulas were more frequently developed after CH than other types of hysterectomy. And the fistulas may be repaired definitively soon after diagnosis of the problem with good results.
Diagnosis ; Female ; Fistula* ; Humans ; Hysterectomy* ; Hysterectomy, Vaginal ; Incidence ; Recurrence ; Retrospective Studies ; Ureter ; Urinary Bladder ; Vagina ; Vesicovaginal Fistula

Bronchobiliary fistula (BBF) is a rare condition in which there is a nonnatural communication between the biliary tract and the bronchial trees. It is usually aroused by the complications of hepatic hydatidosis, hepatic amebic, biliary obstruction, trauma, neoplasm and hepatic abscess formation. In this paper, we described a patient suffering from BBF that is secondary to trauma or surgery. Especially, BBF was detected in the left lung. Finally, we managed this case successfully without an open surgery.
Biliary Fistula ; Bronchial Fistula ; Drainage ; Humans

PURPOSE: Urologic injuries occur frequently during surgery in the pelvic cavity. Inadequate diagnosis and treatment may lead to severe complications and side effects. This investigation examined the clinical features of urologic complications following obstetric and gynecologic surgery. MATERIALS AND METHODS: We accumulated 47,318 obstetric and gynecologic surgery cases from 2007 to 2011. Ninety-seven patients with urological complications were enrolled. This study assessed the causative disease and surgical approach, type, and treatment method of the urologic injury. RESULTS: Of these 97 patients, 69 had bladder injury, 23 had ureteral injury, 2 had vesicovaginal fistula, 2 had ureterovaginal fistula, and 1 had renal injury. With respect to injury rate by specific surgery, laparoscopic-assisted radical vaginal hysterectomy was the highest with 3 of 98 cases, followed by radical abdominal hysterectomy with 15 of 539 cases. All 69 cases of bladder injury underwent primary suturing during surgery without complications. Of 14 cases with an early diagnosis of ureteral injury, 7 had a ureteral catheter inserted, 5 underwent ureteroureterostomy, and 2 underwent ureteroneocystostomy. Of nine cases with a delayed diagnosis of ureteral injury, ureteral catheter insertion was carried out in three cases, four cases underwent ureteroureterostomy, and two cases underwent ureteroneocystostomy. CONCLUSIONS: Bladder injury was the most common urological injury during obstetric and gynecologic surgery, followed by ureteral injury. The variety of injured states, difficulty of diagnosis, and time to complete cure were much greater among patients with ureteral injuries. Early diagnosis and urologic intervention is important for better outcomes.
Delayed Diagnosis ; Early Diagnosis ; Female ; Fistula ; Gynecologic Surgical Procedures ; Humans ; Hysterectomy ; Hysterectomy, Vaginal ; Iatrogenic Disease ; Ureter ; Urinary Bladder ; Urinary Catheters ; Urinary Tract ; Vesicovaginal Fistula

Isolated congenital urethrocutaneous fistula of the anterior urethra is an extremely rare anomaly in which, along with a normal urethra and meatus, a fistula is present. These cases usually present in the pediatric age group. To date, only one such case has been described in the adult population. We describe one such case in an adult and discuss the management of this uncommon anomaly.
Adult ; Cutaneous Fistula ; Fistula ; Humans ; Urethra ; Urinary Fistula

A clinical observation was made on 20 cases of vesicovaginal fistula admitted to the Department of Urology, presbyterian Medical Center during the period from Aug., 1970 through July. 1977 and the following results were obtained. 1. Among 36 cases of urinary tract fistula, the most commonly involved site was bladder(22cases) and the most common fistula type was vesicovaginal fistula (20cases). 2. Among 20 cases of vesicovaginal fistula, the most common age was between 30 and 50 years. 3. The most common etiology of vesicovaginal fistula was gynecological cause(9 cases). 4. The most common location of vesicovaginal fistula was trigone(13 cases) mainly. 5. On I.V.P. finding of vesicovaginal fistula, 11 cases were normal and 8 cases abnormal. 6. On cystoscopic findings of vesicovaginal fistula, 7 cases were normal, 11 cases abnormal, 3 cases combined with bladder stone and 1 case with vaginal stone. 7. On treatment of vesicovaginal fistula, suprapubic transvesical approach was performed in 9 cases, transvesical transperitoneal approach 4 cases, Foley catheter drainage 3 cases and ileal conduit 1 case. 8. Success rate of repair was 76.9%, suprapubic transvesical 66.7 % and transperitoneal transvesical 100%.
Catheters ; Drainage ; Fistula ; Protestantism ; Urinary Bladder Calculi ; Urinary Diversion ; Urinary Tract ; Urology ; Vesicovaginal Fistula*

A vesicovaginal fistula is a distressing complication which may follow hysterectomy and other extensive pelvic operation. Maligntncies of the uterin cervix or bladder may predispose to erosion and vesicovaginal fistula or such fistulas may occur as a result of extensive radiation therapy. Childbirth, particularly involving prolonged labor with potential necrosis of the vesico vaginal septum or complicated delivery with trauma may also induce a vesicovaginal fistula. In this experience the most common cause of vesicovaginal fistula resulting from surgery was total abdominal hysterectomy. Diagnosis of vesicovaginal fistula is usually made when appearance of methylene blue in the vagina after instillation of the dye into the bladder and further confirmed the presence and definitive localization of the fistula with cystoscopic examination. The operative procedures, the authors utilized were suprapubic transvesical closure in 8 cases, vaginal closure in two cases, and transabdominal approach in one case. The bladder was opened at the dome and then stay sutures were made at 1.0cm from the fistula margin. Then, the fistulous tract was excised making a lateral margin wide enough to leave viable tissue for subsequent closure. Vaginal wall and bladder wall closure were carried out in whole layer using interrupted 2 zero chromic suture. In one case of large fistula with high opening, the patient was underwent transabdominal method interposing a peritoneal flap between vagina and bladder wall. A urethral catheter was placed for 10 to 12 days postoperatively. In 5 cases of ureterovaginal fistula, one patient required the nephrectomy because of pyonephrosis, 2 patients refused further medication, one had ureteral reimplantation and another patient had psoas hitch and Boari operation. The following conclusions were obtained. 1. The most common cause of vesicovaginal fistula was the complication of total hysterectomy. 2. The diameter of fistulous tract was ranging from 1 to 10 mm. 3. For the repair of vesicovaginal fistula transvesical approach were 8 out of in 13 case, vaginal route in 2 cases, intraabdominal approach using a peritonal flap in one case. 4. Urethral catheter had been placed postoperatively was removed on the 12th postoperative day in most cases. Ureteral splint catheter was also placed for 8 to 10 days postoperatively. 5. 12 out of 14 cases, urinary vaginal fistulas were successfully closed on the first surgical attempt and one case healed on the second attempt. One case failed because of infection at the area of closure.
Catheters ; Cervix Uteri ; Diagnosis ; Female ; Fistula ; Humans ; Hysterectomy ; Methylene Blue ; Necrosis ; Nephrectomy ; Parturition ; Pyonephrosis ; Replantation ; Splints ; Surgical Procedures, Operative ; Sutures ; Ureter ; Urinary Bladder ; Urinary Catheters ; Vagina ; Vaginal Fistula* ; Vesicovaginal Fistula

Pelvic fistulas may result from obstetric complications, inflammatory bowel disease, pelvic malignancy, pelvic radiation therapy, pelvic surgery, or other traumatic causes, and their symptoms may be distressing. In our experience, various types of pelvic fistulas are identified after pelvic disease or pelvic surgery. Because of its close proximity, the majority of such fistulas occur in the pelvic cavity and include the vesicovaginal, vesicouterine, vesicoenteric, ureterovaginal, ureteroenteric and enterovaginal type. The purpose of this article is to illustrate the spectrum of imaging features of pelvic fistulas.
Bladder Fistula/diagnosis/etiology ; Female ; Fistula/*diagnosis/*etiology ; Human ; Intestinal Fistula/diagnosis/etiology ; *Pelvis ; Ureteral Diseases/diagnosis/etiology ; Urinary Fistula/diagnosis/etiology ; Uterine Diseases/diagnosis/etiology ; Vaginal Fistula/diagnosis/etiology