Urinary Fistula

Contents
Part I: Introduction
Chapter 1: General Considerations
Introduction
Classification
Simple Fistula
Complex Fistula
Diagnosis
Treatment
Conservative Treatment
Timing of Surgical Repair
Surgical Treatment
Laparoscopic Management
Robotic-Assisted Management
Interposition Tissues
Alternative Treatments
Inoperable Fistulae
Postoperative Management
Conclusion
References
Chapter 2: Treatment Decision
Introduction
Definition of Urinary Fistula
Temporizing Management of Incontinence and Improving Quality of Life
Patient Selection for Surgery
Assessment of Urinary Fistulas
Examination Under Anesthesia
Examination of The Rectum and Pelvis
Fistula and Cavity Characteristics
Cavity
Fistula
Selection is the Silent Partner of the Surgeon
Patient Preparation for Surgery
Developing a Surgical Plan for Repair
A Plan in Motion
Urinary Supra-Vesical Diversion vs. Fistula Repair
The Radiated Pelvis
Conclusions and Take-Home Messages
References
Part II: Fistulas in Both Genders
Chapter 3: Pyeloenteric Fistula
Introduction
Definition, Specific Considerations, Classification
Clinical Features, Diagnosis
Treatment Approaches
Conclusions and Recommendations
References
Chapter 4: Nephropleural Fistula
Definition, Specific Considerations, Classification
Clinical Features and Diagnosis
Treatment Approaches
Prevention
Conclusions and Recommendations
References
Chapter 5: Ureterocolonic Fistula
Introduction
Etiology
Diagnosis
Management
Conclusion
References
Chapter 6: Colovesical and Small Bowel Fistulas
Background
Etiology
Diverticulitis
Cancer
Inflammatory Bowel Disease
Complications from Prior Surgery
Radiation
Other
Diagnosis
Clinical Symptoms
Laboratory Evaluation
Imaging
Endoscopy
Cystoscopy
MRI
Other
Management
Role for Antibiotics
Surgical Technique
Malignant Fistula
Small Bowel Enterovesical Fistula
Radiation-Induced Fistula
Peri-Operative Management
Laparoscopic and Robotic Surgery
Endoscopic Closure
Conclusion
References
Chapter 7: Vesicocutaneous Fistula
Introduction
Definition, Etiology and Specific Considerations
Congenital Causes
Prune Belly Syndrome
Persistent Urachus
Acquired Causes
Postoperative
Gynecologic Surgery
Meshplasty
Stones
Radiotherapy
Other Causes
Clinical Features
Diagnosis
Computed Tomography CT Scan
Voiding Cystourethrogram (VCUG)
Fistulography or Fistulogram
Abdominal and Pelvic Ultrasound
Cystoscopy
Methylene Blue Instillation
Determination of Creatinine in Suspicious Drainage
Treatment
Conclusions and Recommendations
References
Chapter 8: Urinary Fistula After Kidney Transplant
Introduction
Risk Factors
Clinical Features and Diagnosis
Treatment Approaches
Prevention (Table 8.2)
Complications
Conclusions and Recommendations
References
Chapter 9: Vascular-Urinary Fistula
Definition, Specific Considerations, Classification
Definition
Specific Considerations
Incidence
Classification
Etiology
Clinical Features, Diagnosis
Treatment Approaches
Outcomes
Conclusions and Recommendations
References
Part III: Fistulas in Females
Chapter 10: Vesicovaginal Fistula: Open Approach
Introduction
Epidemiology
Diagnosis
Presentation and Patient History
Examination
Diagnostic Studies and Procedures
Classification
Timing of Repair
Conservative Management
Indications for Abdominal Approach
Preoperative Care
Surgical Technique
Post-operative Care
Concomitant Procedures
Tissue Interposition
Augmentation Enterocystoplasty
Ureteral Reconstruction
Complications and Outcomes
Peri-Operative Complications
Success of Repair
Urinary Outcomes
Sexual Function Outcomes
Conclusion
References
Chapter 11: Vesicovaginal Fistula: Minimally Invasive Surgery (MIS) Approaches
Introduction
Classification
Based on Complexity
Anatomically (Based on the Location on Cystoscopy)
Clinical Features, Diagnosis
Treatment Approaches
Conservative Treatment
Surgical Treatment
Step-By-Step Robotic Surgical Technique
Step 1: Patient Preparation
Step 2: Cystoscopy and Catheterization of the Ureters and Fistula
Step 3: Port Placement
Step 4: Creation of an Omental Flap
Step 5: Docking of the Robot
Step 6: Cystotomy and Fistulectomy
Step 7: Vaginal Closure
Step 8: Tissue Interposition
Step 9: Bladder Closure
Step 10: Catheter Placement, Trocar Removal and Skin Closure
Postoperative Management
Conclusion
References
Chapter 12: Vesicouterine Fistula
Introduction
Etiology
Acquired: Cesarean Section
Acquired: Vaginal Delivery
Congenital
Epidemiology
Classification
Youseff’s Syndrome
Updated Classification
Complications
Fertility
Social Impact
Diagnosis
Presentation
Diagnostic Techniques
Therapy
Conservative and Medical Treatment
Surgical Repair
Timing of Repair
Fertility Considerations and the Role of Hysterectomy
Technical and Postoperative Considerations
Vaginal Approach
Abdominal Approaches
Laparoscopic and Robotic Approach
Other Approaches
Conclusions
References
Chapter 13: Ureterovaginal Fistula
Introduction
Clinical Features, Diagnosis
Classification
Treatment Approaches
Conservative Treatment
Surgical Treatment
Step-By-Step Robotic Direct Ureteral Reimplantation Surgical Technique
Step 1: Patient Preparation
Step 2: Patient Positioning
Step 3: Port Placement and Docking of the Robot
Step 4: Ureter Dissection
Step 5: Bladder Mobilization
Step 6: Ureteroneocystostomy
Postoperative Management
Conclusion
References
Chapter 14: Urethrovaginal Fistula
Introduction
Etiologies
Clinical Features and Diagnosis
Presenting Symptoms
Diagnosis and Evaluation
Urethrovaginal and Genitourinary Fistula Classifications
Treatment Approaches
Perioperative Considerations
Surgical Principles of Repair
Positioning and Equipment
Post-Operative Management
Conclusions and Recommendations
References
Chapter 15: Rectovaginal Fistula
Introduction
Etiology
Obstetrical Injury
Infectious Causes
Inflammatory Bowel Disease
Malignancy
Radiation
Iatrogenic
Classification
Evaluation
Symptoms
Physical Exam
Diagnostics
Medical Management
Surgical Management
General Principles
Preoperative Care and Positioning
Diversion
Local Repair
Fistulotomy
Fistula Plug
Mucosal Advancement Flap
Rectal Sleeve Advancement
Transperineal Repairs
Tissue Interposition
Transabdominal Repairs
Resection
Recurrent or Persistent Fistula
Conclusion
References
Chapter 16: Obstetric Fistula
Introduction
Incidence
Types of Obstetric Urinary Tract Fistula
Uretero-Vaginal Fistulae (UTVF)
Aetiology of UTVF
Presenting Symptoms of UTVF
Diagnosis of UTVF
Treatment Options for UTVF and Outcomes
Vesico-Vaginal Fistulae (VVF)
Aetiology of VVF (Table 16.1)
Classification of Obstetric VVF
The Goh Classification [41]
The Waaldijk Classification [42]
Predisposing Factors
Prevention
Pathogenesis
Presenting Symptoms
Diagnosis
Management Options For VVF
Conservative Management
Endoscopic Management
Definitive Repair
Timing of Repair
Antibiotic Usage
Route of Repair
Trans-Vaginal VVF Repair (Fig. 16.8)
Absolute Indications
Relative Indications
Advantages
Trans-Abdominal VVF Repair
Indications for Trans Abdominal VVF Repair (Fig. 16.9)
Absolute Indications
Relative Indications
Advantages
Excision of the Fistula Tract
Tissue Interposition
Who Should Repair VVV and UVF?
Techniques for Complex Fistulae
Outcomes
Anatomical Closure
Continence Rates
Other Complications
Acute Complications
Long Term Complications
Irreparable Fistula
Vesico-Uterine Fistula
Presentation
Treatment
Urethro-Vaginal Fistula (UVF)
Signs and Symptoms
Diagnosis
Classification
Management
UVF Repair
Rectovaginal Fistula
Future Surgical Developments
Holistic Care
Conclusion
References
Part IV: Fistulas in Males
Chapter 17: Rectovesical Fistula
Introduction
Clinical Features and Diagnosis
Classification
Treatment Approaches
Conservative Treatment
Surgical Treatment
Transabdominal Robotic-Assisted, Laparoscopic Repair Step-by-Step
Patient Preparation
Patient Positioning
Cystoscopy
Port Placement
Omental Harvesting
Dissection of the Fistulous Tract
Rectum Closure
Tissue Interposition
Bladder Closure
Postoperative Care
Surgical Outcomes
Conclusion and Recommendations
References
Chapter 18: Rectourethral Fistula: Transanal, Transperineal, and Posterior Approaches
Introduction
Etiology
Clinical Features
Diagnosis
Management
Transanal Repairs
Endorectal Advancement Flap
Minimally Invasive Transanal Repair
Transperineal Repairs
Gracilis Muscle Interposition Flap
Dartos Musculocutaneous Interposition Flap
Posterior Repairs
Posterior Laterosacral Repair (Kraske)
Posterior Transsphincteric Repair (York Mason)
Recommendations
Conclusion
References
Chapter 19: Transanal, Transperineal, and Combined Abdominoperineal Approaches (Turnbull-Cutait) to Repair of Rectourethral Fistula
Introduction
Evaluation of RUFs for Transanal or Transperineal Repair
Initial Management and Preparation of Patients Prior to Transanal or Transperineal Repair of RUF
Transanal Techniques for Repair of RUFs
Transanal Approach
Latzko: Primary Closure
Park: Rectal Advancement Flap
Transanal Minimally Invasive Surgery (TAMIS)
Transperineal Techniques for Repair of RUFs
Transperineal Approach
Choice of Tissue Apposition
Transacral Techniques
Kraske
York-Mason
Abdominoperineal Techniques
Turnbull-Cutait
References
Chapter 20: Robotic Approach for Rectourethral Fistula
Introduction
Clinical Features and Diagnosis
Signs and Symptoms
Diagnosis
Classification
Malignancy
Treatment Approaches
Conservative treatment
Surgical treatment
Transabdominal Robotic-assisted Laparoscopic Repair Step-by-Step Surgical Technique
Preoperatively
Intraoperatively
Patient Positioning, Port Placement and Cystoscopy
Omental Harvesting
Salvage Prostatectomy
Rectal Defect Closure
Omental Flap Interposition
Vesicourethral Anastomosis (VUA)
Postoperatively
Conclusions and Recommendations
References
Chapter 21: Urethropubic, Urethrocutaneous and Urethroperineal Fistulas
Introduction
Diagnosis and Evaluation
Surgical Tenants
Congenital Fistula
Congenital Anterior Urethrocutaneous Fistula (CAUF)
Congenital Posterior Urethroperineal Fistula (CPUF)
Acquired Fistula
Post-circumcision Urethrocutaneous Fistula
Spinal Cord Injury (SCI), Neurogenic Bladder and Urethrocutaneous Fistula
Urethrocutaneous Fistula Following Hypospadias Repair
Urinary-Pubic Symphysis (Urosymphyseal) Fistula Following Radiotherapy
Urethrocutaneous Fistula Associated with Urethral Calculi
Urethrocutaneous Fistula Secondary To Foreign Body
Urethrocutaneous Fistula Following Penile Fracture
Urethrocutaneous Fistula and Tuberculosis
Urethrocutaneous Fistula and Squamous Cell Carcinoma
Urethrocutaneous Fistula and the Hair-Thread Tourniquet Syndrome
Conclusion
References
Part V: Fistulas After Gender Reassignment Surgery (GRS)
Chapter 22: Neovagina Fistulas
Introduction
Definition, Specific Considerations, Classification
Classification, Clinical Features, Diagnosis
Treatment Approaches
Urethroneovaginal Fistula
Bulbar Urethroneovaginal Fistulas
Membranous Urethroneovaginal Fistula
Prostatic Urethroneovaginal Fistula
Vesiconeovaginal Fistula
Rectoneovaginal Fistula
Conclusions and Recommendations
References
Chapter 23: Neopenis Fistulas
Introduction
Definition, Specific Considerations, Classification
Phalloplasty
Metoidioplasty
Clinical Features and Diagnosis
Phalloplasty & Metoidioplasty: Small Fistulae
Phalloplasty: Large Fistulae
Metoidioplasty: Large Fistulae
Treatment Approaches
Conclusions
Recommendations
References
Part VI: Complications After Fistula Repair
Chapter 24: Complications of Vaginal Fistula Repair
Introduction
Assessment of Fistula
Overactive Bladder After Vaginal Fistula Repair
Contracted Bladder as a Complication of VVF Repair
Urinary Tract Infection
Contracted Vagina, Dyspareunia, and Sexual Dysfunction
Urethral Complications of Vaginal Fistula Repair
Stress Urinary Incontinence Post-Vaginal Fistula Repair
References