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

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

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

PURPOSE: Numerous techniques have been introduced to reconstruct the perineal area in order to preserve function of both the recipient and the donor site while satisfying aesthetic results. There are several advantages of using the pudendal aretery perforator based flap in that it provides thin coverage of defect area and a relatively excellent circulation through perforators. The perineal region can be divided into two areas : the urogenital triangle and the anal triangle. Since each area differs in structure and function so does its reconstructive plan. The authors of this article report clinical results obtained from pudendal artery perforator based reconstructed cases according to each different triangles. METHODS: A total of 15 patients who underwent perineal reconstruction were enrolled in our study from 2002 to 2006. There were 4 cases of vaginal cancer, 4 cases of extramammary Paget's disease, 1 case of rectovaginal fistula in females and 2 cases of Paget's disease and 4 cases of Fournier's gangrene in male cases. The follow up period was on average 6 month. In female, superficial pudendal artery perforator based local flap were used to reconstruct the urogenital triangle defects, while internal pudendal artery perforator based local flaps were used to reconstruct the anal traingle defects. In males the gracilis myocutaneous flap and internal pudendal artery perforator based local flaps were used in reconstruction of the scrotum and perineal defect. RESULTS: In females, there was 1 case of partial flap necrosis that employed the superficial pudendal artery perforator but secondary repair through the internal pudendal artery perforator based local flap was done. In addition, there were 4 wound dehiscence cases in females and 2 cases in males. CONCLUSION: We believe that a better aesthetic and functional outcome can be achieved in perineal reconstruction if discrete surgical planning is carried out systematically categorizing the choice of flap employed acccording to distinct anatomical regions : the urogenital and the anal triangle.
Arteries ; Female ; Follow-Up Studies ; Fournier Gangrene ; Humans ; Male ; Necrosis ; Paget Disease, Extramammary ; Perforator Flap ; Perineum ; Rectovaginal Fistula ; Scrotum ; Tissue Donors ; Vaginal Neoplasms

OBJECTIVE: The aim of this study was to compare peri-operative morbidity and safety of patients treated by laparoscopically-assisted radical vaginal hysterectomy (LARVH)with laparoscopic pelvic lymphadenectomy (LPL)and radical abdominal hysterectomy (RAH)with pelvic lymph node dissection (PLND) in early stage of cervical cancer. METHODS: Since September 2004,all patients with FIGO stage Ia-IIa cervical cancer undergoing radical surgery by members of our division have been entered into a prospective database. Two surgeons at our center have performed LARVH by Schneider method on all surgically appropriate patients. RESULTS: Between September 2004 and May 2005, 26 patients were performed LARVH with LPL,30 patients were performed RAH with PLND. There were no differences in estimated blood loss, the number of lymph nodes, duration of hospital stay and postoperative complications.But operative time was significantly prolonged in LARVH group. Intraoperative complications in the LARVH with LPL group included: bladder injuries(2), shift to laparotomy due to ureter injury(1). There was one case of vesicovaginal fistula in the RAH group. CONCLUSION: LARVH with LPL in early stage of cervical cancer is a safe and technically effective alternative to RAH. Despite the inherent limitations of LARVH with LPL and its associated learning curve, the procedure conveys many advantages over the open laparotomy technics in terms of postoperative wound pain and recovery. However further study is needed to evaluate long-term recurrence rate and survival rate.
Female ; Humans ; Hysterectomy* ; Hysterectomy, Vaginal* ; Intraoperative Complications ; Laparotomy ; Learning Curve ; Length of Stay ; Lymph Node Excision ; Lymph Nodes ; Operative Time ; Prospective Studies ; Recurrence ; Survival Rate ; Ureter ; Urinary Bladder ; Uterine Cervical Neoplasms* ; Vesicovaginal Fistula ; Wounds and Injuries

Vesicouterine fistula, a fistula between bladder and uterus, is one of the rarest urogenital fistula. Most cases are associated with repeat Cesarean section and with vaginal birth after Cesarean section (VBAC). During Cesarean section, it is important to dissect and move the bladder away from uterus carefully, especially in case of adherent bladder to the anterior vaginal wall or lower segment wall and it is necessary to explain the possibility of vesicouterine fistula development in case of VBAC. Patients usually present with urinary incontinence in the early postoperative period or present months or years later with cyclic hematuria, amenorrhea, vaginal leakage of urine, urinary tract infection and secondary infertility. The diagnosis is made by cystoscopic visualization of the fistula orifice in the bladder and outlining the fistula tract on cystogram, hysterosalpingogram or transvaginal ultrasonogram. There have been varied approaches to the treatment of vesicouterine fistula with conservative therapy or surgical therapy. We experienced two cases of vesicouterine fistulas in women with previous Cesarean section, the one is delivered with repeat Cesarean section after trying VBAC, the other is delivered with vacuum assisted VBAC, and treated with surgical repair.
Amenorrhea ; Cesarean Section* ; Cesarean Section, Repeat ; Diagnosis ; Female ; Fistula* ; Hematuria ; Humans ; Infertility ; Postoperative Period ; Pregnancy ; Ultrasonography ; Urinary Bladder ; Urinary Incontinence ; Urinary Tract Infections ; Uterus ; Vacuum ; Vaginal Birth after Cesarean

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

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

An intravaginal foreign body of long duration can lead to infection and ulceration. Foul-smelling, bloody vaginal discharge, and pelvic pain may indicate the presence of an intravaginal foreign body and symptoms may be referred to the bladder or rectum. But these clinical features are nonspecific and a number of diagnostic modalities may fail to detect the presence of the foreign body. Moreover, long-standing intravaginal foreign body may be difficult to distinguish from an advanced cervical cancer especially in uninformed cases. We present a case of a 41-year-old female who suffered from an aggravating chronic pelvic pain and malodorous dirty vaginal discharge. Initially the advanced cervix cancer complicated with recto-vaginal fistula was suspected. But results of repeated biopsies were benign and symptoms were improved by intravenous antibiotics. Finally the embedded foreign body in the posterior fornix was detected and successfully removed. It was proved as the grip of an umbrella. We concluded that a high index of suspicion is very important for the correct diagnosis of long-standing vaginal foreign body especially in uninformed cases.
Adult ; Anti-Bacterial Agents ; Biopsy ; Diagnosis ; Female ; Fistula ; Foreign Bodies ; Hand Strength ; Humans ; Pelvic Pain ; Rectum ; Ulcer ; Urinary Bladder ; Uterine Cervical Neoplasms* ; Vagina ; Vaginal Discharge