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Vesical Calculi With Unrepaired Vesicovaginal Fistula: A Clinical Appraisal of an Uncommon Association

2003; Lippincott Williams & Wilkins; Volume: 170; Issue: 6 Linguagem: Inglês

10.1097/01.ju.0000095503.76155.30

1527-3792

D. Dalela, Apul Goel, S.N. SHAKHWAR, Krishna M. Singh,

Urological Disorders and Treatments

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Dec 2003Vesical Calculi With Unrepaired Vesicovaginal Fistula: A Clinical Appraisal of an Uncommon Association D. DALELA, APUL GOEL, S.N. SHAKHWAR, and K.M. SINGH D. DALELAD. DALELA , APUL GOELAPUL GOEL , S.N. SHAKHWARS.N. SHAKHWAR , and K.M. SINGHK.M. SINGH View All Author Informationhttps://doi.org/10.1097/01.ju.0000095503.76155.30AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Primary vesical calculi are uncommon in patients with vesicovaginal fistula (VVF). We retrospectively analyzed 19 such cases and present our experience with the management of this condition. Materials and Methods: Between January 1989 and December 2002, 19 patients were treated for this association. All patients provided a history and underwent physical examination, metabolic evaluation for stone disease, urine culture test and cystovaginoscopic examination. They were treated with a staged procedure with the fistula repaired 2 to 3 months after stone removal. Results: VVF was a result of obstructed labor in all cases. The patients presented a mean of 28.8 months after fistula formation. No metabolic abnormality was detected in any patient. Urine culture was positive for Proteus mirabilis in 6 and Escherichia coli in 5, and it yielded mixed growth in 8. All women had some residual urine in the bladder (mean 11 ml). The fistula was located supratrigonally in 13 cases, while it was high trigonal in the remainder. A total of 17 patients were treated endoscopically by cystolitholapexy or fragmentation of the stone by transurethral cystolithotripsy using a Lithoclast (Microvasive Urology, Natick, Massachusetts). Two patients required open suprapubic cystolithotomy. All patients underwent fistula repair 3 months after stone removal with successful results in 16. Conclusions: Primary vesical calculi in patients with VVF are associated with urinary contamination, a high or supratrigonal fistula location, residual urine in the bladder and a long history of disease. Staged management of the problem showed good results. References 1 : Surgery for vaginal fistulae. In: Gynecologic Surgery, Errors, Safeguards and Salvage. Baltimore: Williams & Wilkins Co.1981: 205. Google Scholar 2 : Vesicovaginal fistulas. In: Te Linde's Operative Gynecology. Philadelphia: J. B. Lippincott Co.1985: 637. Google Scholar 3 : Vesical calculi associated with vesicovaginal fistulas: management considerations. J Urol1986; 136: 94. Abstract, Google Scholar 4 : Primary vaginal stones. J Urol1980; 123: 771. Abstract, Google Scholar 5 : Vaginal calculi associated with vesicovaginal fistulae. Ital J Surg Sci1985; 15: 85. Google Scholar 6 : Congenital vesicovaginal fistula associated with vaginal lithiasis. Acta Urol Belg1987; 55: 621. Google Scholar 7 : Primary vaginal lithiasis associated with urethrovaginal fistula. Report of a case and review of the literature. Actas Urol Esp2001; 25: 582. Google Scholar 8 : A case of giant vaginal stone around a foreign body associated with vesicovaginal fistula. Nippon Sanka Fujinka Gakkai Zasshi1996; 48: 359. Google Scholar 9 : Obstetrical vesico-vaginal fistula. Report of 114 cases. Prog Urol2001; 11: 103. Google Scholar 10 : Management of giant vesicovaginal and vesicourethrovaginal fistulas. J Urol1983; 130: 1073. Link, Google Scholar 11 : The O'Conor technique: the gold standard for supratrigonal vesicovaginal fistula repair. J Urol1999; 161: 566. Link, Google Scholar 12 : A method for the repair of vesicovaginal fistulas. Int J Gynaecol Obstet2001; 73: 35. Google Scholar 13 : The challenging vesicovaginal fistula. Eur Urol1983; 9: 157. Google Scholar From the Department of Urology, Chhatrapati Shahuji Maharaj Medical University, (Upgraded K. G. Medical College), Lucknow, India© 2003 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 170Issue 6December 2003Page: 2206-2208 Advertisement Copyright & Permissions© 2003 by American Urological Association, Inc.KeywordsvaginafistulabladdercalculilaborobstetricMetricsAuthor Information D. DALELA More articles by this author APUL GOEL More articles by this author S.N. SHAKHWAR More articles by this author K.M. SINGH More articles by this author Expand All Advertisement PDF DownloadLoading ...