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Use of endoscopy in the management of postoperative ureterovaginal fistula

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Abstract

The aim of the study was to evaluate endourological techniques in the management of iatrogenic ureterovaginal fistula. Seventeen patients referred to us after gynecologic surgery were diagnosed as having iatrogenic ureterovaginal fistula. First, retrograde double-J stenting was tried. If this failed, percutaneous nephrostomy using an antegrade double-J stent was performed. If this also failed, open surgical repair was performed. The retrograde double-J stent bypassed the fistula in 2 patients (11.8%). Percutaneous nephrostomy was performed in the remaining 15. The antegrade double-J stent bypassed the fistula in another 2 of these patients (11.8%). Open surgical repair was performed in the remaining 13 patients (67.5%) (direct ureteroneocystostomy) with nipple valve in 11 patients and Boari flap with psoas hitch in 2 patients). Of all patients, 2 had ureteral stricture, one after antegrade double-J stenting and the other after open repair. It was concluded that early intervention is recommended in the treatment of iatrogenic uretrovaginal fistula, causing minimal morbidity and discomfort, and being less expensive.

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Authors and Affiliations

  1. Tanta University, Tanta, Egypt

    S. Elabd, M. Elsharaby, M. Emran, A. Elgamasy, T. Felfela & A. Elshaer

  2. Tulane University School of Medicine, 1430 Tulane Avenue, SL-42, 70112, New Orleans, LA, USA

    G. Ghoniem (Associate Professor of Urology and Gynecology)

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  1. S. Elabd
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  2. G. Ghoniem
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  3. M. Elsharaby
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  4. M. Emran
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  5. A. Elgamasy
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  6. T. Felfela
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  7. A. Elshaer
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Additional information

EDITORIAL COMMENT: This is an interesting paper that is worthy of mention because of an important concept in the management of an iatrogenic ureterovaginal fistula. The traditional management of these fistulas has been ureteroneocystostomy [1]. However, recent urologic literature suggests that modern endoscopic treatment is highly successful if the passage of an internal stent is possible [2,3]. This is a concept that must be shared with our urogynecologic colleagues.

In this paper, 4 of 14 patients with an iatrogenic fistula underwent placement of an indwelling stent. Of these, two were placed cystoscopically, whereas the other two were placed percutaneously. All four ureterovaginal fistulas healed successfully. However, 1 patient developed a ureteral stricture. It is noteworthy that in the combined series of Selzman [2] and this Tulane group not only were all ureterovaginal fistulas successfully treated with a stent, but only 1 of 11 patients (9%) developed a stricture.

Although the sample size is small, this paper supports the conclusion that successful endoscopic placement of a double-J stent does allow the ureterovaginal fistula to heal spontaneously. Therefore, initial endoscopic management of an iatrogenic ureterovaginal fistula is a reasonable recommendation. However, equally important is the development of a ureteral stricture causing ‘silent hydronephrosis’. After stent removal the patient may develop a distal ureteral stricture with a completely asymptomatic hydronephrosis — ‘silent hydronephrosis’. Although the patient may be clinically asymptomatic, the renal units remain in jeopardy. Therefore, routine periodic follow-up with radiologic studies is warranted after stent removal.

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Elabd, S., Ghoniem, G., Elsharaby, M. et al. Use of endoscopy in the management of postoperative ureterovaginal fistula. Int Urogynecol J 8, 185–190 (1997). https://doi.org/10.1007/BF02765810

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  • DOI: https://doi.org/10.1007/BF02765810

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