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

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

Placenta previa presents a highest risk to pregnancy, and placenta accreta is the most serious. Placenta accreta requires cesarean delivery and often results in massive obstetric hemorrhage and higher maternal morbidity. Challenges associated with cesarean delivery techniques may contribute to increased maternal blood loss and morbidity rates. Several recent obstetric studies reported the usefulness of transverse uterine fundal incision for managing placenta accreta. We present a case of placenta percreta that was treated by a transverse fundal incision. We successfully avoided cutting through the placenta and helped decrease maternal blood loss. After delivery, the patient underwent a cesarean hysterectomy. Postoperative day 48, she experienced watery discharge and was diagnosed with vaginal fistula. We present our case and review the literature.
Hemorrhage ; Humans ; Hysterectomy* ; Placenta ; Placenta Accreta* ; Placenta Previa ; Pregnancy ; Vaginal Fistula*

Colouterine fistula is an extremely rare condition because the uterus is a thick, muscular organ. Here, we present a case of a colouterine fistula secondary to colonic diverticulitis. An 81-year-old woman was referred to the emergency department with abdominal pain and vaginal discharge. Computed tomography showed a myometrial abscess cavity in the uterus adherent to the thick sigmoid wall. Upon contrast injection via the cervical os for fistulography, we observed spillage of the contrast into the sigmoid colon via the uterine fundus. Inflammatory adhesion of the distal sigmoid colon to the posterior wall of the uterus was found during surgery. The colon was dissected off the uterus. Resection of the sigmoid colon, primary anastomosis, and repair of the fistula tract of the uterus were performed. The postoperative course was uneventful. This case represents an unusual type of diverticulitis complication and illustrates diagnostic procedures and surgical management for a colouterine fistula.
Abdominal Pain ; Abscess ; Colon ; Colon, Sigmoid ; Diverticulitis ; Diverticulitis, Colonic ; Emergencies ; Female ; Fistula ; Humans ; Uterus ; Vaginal Discharge

Ureteral injury is usually iatrogenic in origin, in particular as a result of laparoscopic or gynecological surgery. Ureterouterine fistula constitute a rare subset of iatrogenic genitourinary fistulas. The most common presentation of ureterouterine fistula is in women who have had a cesarean section. The management options include conservative therapy (spontaneous healing), endourologic (stented repair) or open surgical operation (ureteroneocystostomy or ureteroureterostomy). Herein, we report on a case of ureterouterine fistula in a 33-year-old woman who underwent a cesarean section. The 17th day after the operation, she complained watery vaginal discharge. Clinical and urographic assessments revealed an iatrogenic ureterouterine fistula and an ureteroneocystostomy was performed after 3 months.
Adult ; Cesarean Section ; Female ; Fistula ; Gynecologic Surgical Procedures ; Humans ; Pregnancy ; Ureter ; Vaginal Discharge

We report the vesicouterine fistula due to migration of intrauterine device in 35-year-old woman, who had suffered from dysuria and watery vaginal discharge for 4 months. The vesicouterine fistula was confirmed by ultrasonography, cystoscopy and fistulography, and treated with laparoscopic fistulectomy.
Adult ; Cystoscopy ; Dysuria ; Female ; Fistula* ; Humans ; Intrauterine Devices* ; Ultrasonography ; Vaginal Discharge

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

A colo-uterine fistula is a rare complication of diverticular disease, due to the resistance of the uterine tissue. Only 18 cases have been reported in the world literature. Here, a case of an 82-year-old woman, with a colo-uterine fistula secondary to diverticulitis, is described. She presented with a malodorous vaginal discharge. A barium enema revealed colonic diverticulosis with a fistula tract to the body of uterus. The clinical symptoms were not specific, with the exception of the purulent material and stools from the vagina. A Sigmoidectomy, with fistula tract removal, and simple closure of the uterus was performed curatively.
Aged, 80 and over ; Barium ; Colon, Sigmoid* ; Diverticulitis* ; Diverticulosis, Colonic ; Enema ; Female ; Fistula* ; Humans ; Uterus ; Vagina ; Vaginal Discharge

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

PURPOSE: Rectovaginal fistulas (RVFs) are relatively uncommon diseases which account for only 5% of anorectal fistulas. The treatment of RVFs is difficult and the results are often unsatisfactory. For proper treatment, many factors must be considered, such as causes, size, location and the general condition of the patients. Generally obstetric injury has been the most common cause, but recently the incidence of RVFs associated with malignant diseases or radiotherapy has been increasing. The purpose of this study was to evaluate the clinical features of RVFs according to causes. METHODS: Thirth-two patients with RVF were managed at the Gospel Hospital, Kosin University between Jan. 1989 and Dec. 2000 were retrospectively reviewed. RESULTS: Among RVF associated malignant diseases (26 cases), there were 5 cases due to direct invasion of malignant tumors, all of which were incurable. However, of the 18 cases of radiation induced RVFs (cervical cancer in 13, rectal cancer in 4, vaginal cancer in 1), 2 who received radiotherapy due to cervical cancer and had no residual malignancy were cured with low anterior resection with coloanal anastomosis. All 3 cases of RVFs due to operative complication of malignant diseases were also curable. In RVFs associated with non-malignant diseases (6 cases), there were 2 cases of RVFs due to obstetric injuries, 1 due to trauma, and 3 due to operative complication of non- malignant diseases such as uterine myoma, hemorrhoids, and uterine prolapse. All 6 cases were curable, but only 3 were treated with single-stage operation, 3 required multiple-stage operation. Other cases frequently featured recurrence. CONCLUSION: Among many factors, the cause was the most important factor related to treatment in RVFs. Although the cases due to direct invasion of malignant tumors were incurable, the 2 who received radiotherapy due to cervical cancer were treated successfully, and their prognosis remains hopeful. All 6 cases associated with non-malignant disease were also curable. However, because of the high recurrence rate in such those cases, more careful preoperative assessment is required for patients with RVFs.
Fistula ; Hemorrhoids ; Hope ; Humans ; Incidence ; Leiomyoma ; Prognosis ; Radiotherapy ; Rectal Neoplasms ; Rectovaginal Fistula* ; Recurrence ; Retrospective Studies ; Uterine Cervical Neoplasms ; Uterine Prolapse ; Vaginal Neoplasms