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Urol Ann 2021 Oct-Dec;13(4):405-411. Epub 2021 Jun 23.

Department of Urology and Transplantation Surgery, Smt. GR Doshi and Smt. K. M. Mehta Institute of Kidney Disease and Research Centre, Dr. H. L. Trivedi Institute of Transplant Sciences, Civil Hospital Campus, Ahmedabad, Gujarat, India.

Introduction: The objective of the study is to evaluate the outcome of robot-assisted laparoscopic repair of injuries to urinary tract following gynecological surgery and obstetric injury.

Methods: This retrospective analysis from prospectively collected data of repair of injuries to bladder and ureter using da Vinci Si robotic platform was carried out. Between April 2014 and May 2019, 27 patients were operated on in a single surgical unit; 25 had hysterectomy and 2 were obstetric cases. Read More

Int J Gynaecol Obstet 2022 May 31;157(2):277-282. Epub 2021 May 31.

Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Objective: To assess function and disability among women in Rwanda and Democratic Republic of Congo living with fistula and identify characteristics associated with higher disability scores.

Methods: Women presenting for fistula care were recruited. Eligible participants underwent a physical examination to classify fistula type and completed the WHO Disability Assessment Schedule 2. Read More

J Endourol 2021 11 13;35(11):1659-1664. Epub 2021 Aug 13.

Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.

To describe our multi-institutional experience with robotic repair of iatrogenic urogynecologic fistulae (UGF), including vesicovaginal fistulae (VVF) and ureterovaginal fistulae (UVF). We performed a retrospective review identifying patients who underwent robotic repair of VVF and UVF between January 2010 and May 2019. All patients failed conservative management with Foley catheter or upper tract drainage (ureteral stent and/or nephrostomy tube), respectively. Read More

Eur J Surg Oncol 2021 08 22;47(8):2125-2133. Epub 2021 Mar 22.

Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China; Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China. Electronic address:

Objective: To compare the oncological outcomes and major complications of laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) for stage IB1 cervical cancer (FIGO 2009) with a tumour size less than 2 cm.

Methods: We retrospectively compared the oncological outcomes and major complications of 1207 stage IB1 cervical cancer patients with a tumour size less than 2 cm who received LRH (n = 546) or ARH (n = 661) in 37 hospitals.

Results: (1) There was no significant difference in 3-year overall survival (OS; 97. Read More

Urologia 2021 Nov 14;88(4):348-354. Epub 2021 Mar 14.

Medical University, Sofia, Bulgaria.

Introduction: This study aimed to establish the urologic complications of radical type C2 hysterectomy in cervical cancer patients with or without ureteral stenting.

Methods: This prospective randomized study included 76 (100%) patients with clinically and pathologically established cervical cancer stages I and II treated with radical type C2 hysterectomy with pelvic lymph node dissection for the last 5 years (2014-2019). Patients were randomized into two groups (2:1 ratio): group II received perioperative ureteral stenting ( = 24, 31. Read More

Int Urogynecol J 2021 Sep 8;32(9):2449-2454. Epub 2020 Sep 8.

Department of Urogynecology, Alexianer St. Hedwig Hospital, Berlin, Germany.

Introduction And Hypothesis: In developed countries urogenital fistulas are rare and usually a complication of surgery or radiation therapy. Surgical repair can be accomplished transvaginally or by laparotomy, laparoscopy, robotic-assisted laparoscopy, or transurethral endoscopy. Closure can be achieved with or without tissue interposition. Read More

Urology 2021 04 24;150:165-169. Epub 2020 Jun 24.

Northwestern Medicine/Feinberg School of Medicine, Chicago, IL.

Objective: To assess the characteristics of women presenting with genitourinary fistula over a 5-year period in Kigali, Rwanda. Genitourinary (GU) fistula is a devastating condition that can result from difficult vaginal deliveries or as a surgical complication. Rwanda has seen notable increases in cesarean section rates as a result of a successful universal health care system. Read More

Gynecol Oncol 2020 07 27;158(1):117-122. Epub 2020 Apr 27.

Department of Preventive Medicine, Konkuk University School of Medicine, 263 Achasan-ro, Gwangjin-gu, Seoul 05030, South Korea. Electronic address:

Objective: This study aimed to assess the risks of intraoperative and postoperative urologic complications between laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH).

Methods: Using the database of the National Health Insurance Service (NHIS) and Health Insurance Review & Assessment (HIRA), we identified all Korean women who underwent radical hysterectomy between 2006 and 2018. Intraoperative and postoperative urologic complications were compared between the ARH and LRH groups. Read More

Urology 2020 Jul 23;141:e11-e13. Epub 2020 Apr 23.

Department of Urology, University of Virginia, Charlottesville, VA.

Urogenital fistulas in the setting of foreign body are rare. Isolated vesicovaginal fistula is the most common and has been reported in the setting of retained intraureterine device, neglected pessary and atypical insertions related mostly to sexual activity or underlying psychiatric disorders. Combined vesicovaginal and ureterovaginal fistulas related to foreign body are extremely rare. Read More

BJOG 2020 Jun 19;127(7):897-904. Epub 2020 Feb 19.

Freedom from Fistula, Lilongwe, Malawi.

Objective: To describe and compare baseline renal anatomy and renal function in patients with obstetric fistulas, and to evaluate whether preoperative renal testing and imaging may aid with operative decision making.

Design: A prospective cohort study.

Setting: Fistula Care Centre in Malawi. Read More

Gynecol Oncol 2020 01 2;156(1):115-123. Epub 2019 Dec 2.

Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China. Electronic address:

Objectives: To report the trends in surgical approaches and compare the major surgical complication rates of laparoscopic and abdominal radical hysterectomy for cervical cancer.

Methods: From the major surgical complications of cervical cancer in China (MSCCCC) database, we obtained the demographic, clinical, treatment hospital and complication data of patients with cervical cancer who underwent radical hysterectomy from 2004 to 2015 at 37 hospitals. The patients were assigned to the laparoscopic and abdominal surgery groups. Read More

Arab J Urol 2019 Mar 4;17(1):61-68. Epub 2019 Apr 4.

Department of Urology, Assiut University Urology Hospital, Assiut University, Assiut, Egypt.

: To conduct a systematic review of the literature on vesicovaginal fistula (VVF), including reporting on the aetiology, in both developed and underdeveloped countries; diagnosis; intraoperative prevention; and management. : We conducted a systematic review of the literature on VVF through the PubMed and the Cochrane Library according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search was conducted from 1985 to 2018 in English, using the keywords 'fistula' and 'vesicovaginal fistula'. Read More

Int Urogynecol J 2020 07 29;31(7):1357-1362. Epub 2019 Jun 29.

Section of Female Urology and Laparoscopy, Urology Department, Alexandria University, Alexandria, Egypt.

Introduction And Hypothesis: Laparoscopic repair of different female genitourinary fistulae has been recently reported, including both conventional and laparoendoscopic single-site surgery (LESS). We present our 10-year single-center experience of the laparoscopic repair of different types of female genitourinary fistulae.

Methods: A retrospective analysis of our records over the last 10 years was performed. Read More

Int J Urol 2019 07 17;26(7):717-723. Epub 2019 Jun 17.

Department of Urology, University College London Hospital, London, UK.

Objectives: To report a large series of vesicovaginal fistula, and to assess the incidence of ureteric injury in association with vesicovaginal fistula.

Methods: We retrospectively reviewed a prospective database of patients with vesicovaginal fistula referred to our center between 2004 and 2016. Data on patient demographics, fistula etiology, mode of repair, and any associated ureteric injury and its treatment were noted. Read More

Obstet Gynecol Int 2019 10;2019:6456141. Epub 2019 Feb 10.

Genitourinary/Urogynaecology Unit, Faculty of Clinical Science, UI, Ibadan, Nigeria.

Background: Ureteric injuries leading to ureterovaginal fistula (UVF) is less common than vesicovaginal fistula, as a cause of urinary incontinence. Recently, there is a surge in the number of UVF cases presenting to University College Hospital (UCH) following a caesarean delivery. The urogynaecology unit at UCH is at the forefront of providing surgical repair for women with all forms of genitourinary fistulas. Read More

Female Pelvic Med Reconstr Surg 2019 Mar-Apr;25(2):e7-e11

Northwestern University, Chicago, IL.

Objective: We describe the management and outcomes of ureterovaginal fistulas over a 13-year period and present a treatment algorithm.

Methods: We performed a review of ureterovaginal fistula cases between January 2005 and December 2017 at our tertiary academic center. Demographics, diagnostic approaches, and treatment outcomes were assessed. Read More

Am J Obstet Gynecol 2019 04 24;220(4):369.e1-369.e7. Epub 2019 Jan 24.

Division of Urogynecology, Department of Obstetrics and Gynecology, Trinity Health of New England, Hartford, CT.

Background: Gynecologists debate the optimal use for intraoperative cystoscopy at the time of benign hysterectomy. Although adding cystoscopy leads to additional up-front cost, it may also enable intraoperative detection of a urinary tract injury that may otherwise go unnoticed. Prompt injury detection and intraoperative repair decreases morbidity and is less costly than postoperative diagnosis and treatment. Read More

Turk J Urol 2019 05 26;45(3):212-217. Epub 2018 Nov 26.

Department of Urology, King George's Medical University, Lucknow, India.

Objective: To analyze the patterns of presentation and management for urologic complications of obstetrics and gynecology in the form of genitourinary fistulas at a tertiary referral center and highlight the social issues associated with them.

Material And Methods: We conducted this retrospective study analyzing 311 patients with genitourinary fistulas after obstetric and gynecologic surgeries between January 2005 and January 2018. We recorded the patients' characteristics and area of residence and then analyzed the etiology, surgical management and success rates by grouping the patients into four types of genitourinary fistulas. Read More

Med Clin North Am 2018 Mar 20;102(2):313-324. Epub 2017 Dec 20.

Department of Urology, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Tarry 16-703, Chicago, IL 60611, USA. Electronic address:

Female voiding dysfunction and incontinence are common in the general population and symptoms have been shown to have a significant negative impact on health-related quality of life. This article highlights the epidemiology, evaluation, diagnosis, pharmacologic therapies, and surgical treatment for overactive bladder, stress urinary incontinence, and urogenital fistulas. Read More

Aktuelle Urol 2018 02 1;49(1):83-91. Epub 2018 Feb 1.

Klinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg.

Background: Vesico- and ureterovaginal fistulas are defined as abnormal connections between the urinary tract, on the one side, and the female genital system, on the other. Despite being highly prevalent as an acquired pathology of the urogenital system, there has as yet been no standardized protocol in place for diagnosing and treating these fistulas. This review analyses the current literature concerning vesico- and ureterovaginal fistulas in order to profile common diagnostic and therapeutic concepts. Read More

Int Urogynecol J 2018 09 11;29(9):1303-1309. Epub 2017 Oct 11.

, Mwanza, Tanzania.

Introduction: Ureteric injuries are among the most serious complications of pelvic surgery. The incidence in low-resource settings is not well documented.

Methods: This retrospective review analyzes a cohort of 365 ureteric injuries with ureterovaginal fistulas in 353 women following obstetric and gynecologic operations in 11 countries in Africa and Asia, all low-resource settings. Read More

Int J Gynaecol Obstet 2017 Sep 28;138(3):293-298. Epub 2017 Jun 28.

Evangel Vesicovaginal Fistula Center, Bingham University Teaching Hospital, Jos, Nigeria.

Objective: To compare outcomes following surgical repair of genital fistula among Nigerian women with or without HIV.

Methods: A retrospective review was conducted of all genital fistula repair surgeries performed at Evangel Vesicovaginal Fistula Center in Jos, Nigeria, between January 1, 2004, and April 30, 2014. Patient characteristics, HIV status, genital fistula characteristics, and postoperative outcomes were assessed for between-group variance. Read More

J Minim Invasive Gynecol 2018 01 3;25(1):17-18. Epub 2017 May 3.

Department of Urology, Laparoscopy Research Center, Center of Excellence for e-Learning, Shiraz University of Medical Sciences, Shiraz, Iran; Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina. Electronic address:

Study Objective: To demonstrate a laparoscopic approach for repair of concomitant vesicovaginal and ureterovaginal fistulas as a troublesome complication of transabdominal hysterectomy (TAH).

Design: Video presentation with narration demonstrating a laparoscopic approach for repair of a vesicovaginal fistula and ureter reimplantation using a bladder (Boari) flap (Canadian Task Force Classification III).

Setting: Mothers and Children Hospital, Shiraz University of Medical Sciences. Read More

Am J Obstet Gynecol 2017 05 9;216(5):502.e1-502.e11. Epub 2017 Jan 9.

Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI.

Background: Healthcare teams that frequently follow a bundle of evidence-based processes provide care with lower rates of morbidity. Few process bundles to improve surgical outcomes in hysterectomy have been identified.

Objective: The purpose of this study was to investigate whether a bundle of 4 perioperative care processes is associated with fewer postoperative complications and readmissions for hysterectomies in the Michigan Surgical Quality Collaborative. Read More

Bull Soc Pathol Exot 2016 Dec 14;109(5):329-333. Epub 2016 Jun 14.

CHU Sylvanus-Olympio, BP 57, Lomé, Togo.

The purpose of this study is to describe a simple, non-expensive, accessible and effective technique of ureterovaginal fistula diagnosis, and to assess the results of surgical management in a resource-constrained hospital. During a campaign of obstetric fistulas repair, we diagnosed ureterovaginal fistulas by vaginal exam with the blue methylene test associated to abdominal ultrasonography, two simple and non-expensive explorations which permitted to identify ureterovaginal fistula and to do differential diagnosis with vesicovaginal fistula. The management was surgery, by ureterovesical reimplantation. Read More

J Obstet Gynaecol India 2016 Jun 31;66(3):180-4. Epub 2015 Jan 31.

Department of Urology, IPGMER and SSKM Hospital, Kolkata, 700 020 India.

Background: In developing countries, obstetric trauma is the most common cause of genitourinary fistulae. But over the last two decades, health care facilities have been improved and the scenario has been changed.

Purpose: The aim of the present study is to share our experience with genitourinary fistula in terms of mode of presentation, diagnostic modality, and management with the emphasis on the surgical approach and a parallel review of the available literature. Read More

Urol Ann 2016 Jan-Mar;8(1):26-30

Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India.

Introduction: Urinary tract injuries are a known complication of obstetrical and gynecological surgeries because of their anatomical proximity. Delayed diagnosis and improper management leads to high morbidity and even mortality. This is our three year's experience of urological complications after obstetric and gynecological surgery, their treatment and follows up. Read More

Int Urogynecol J 2016 Jun 7;27(6):831-7. Epub 2016 Jan 7.

Newcastle University, Newcastle upon Tyne, UK.

It has long been held as conventional wisdom that urogenital fistulae in low-income and middle-income countries are almost exclusively of obstetric aetiology, related to prolonged neglected obstructed labour, whereas those seen in high-income countries are largely iatrogenic in nature. There is, however, a growing perception amongst those working in the field that an increasing proportion of urogenital fistulae in low-income and middle-income countries may be iatrogenic, resulting from caesarean section. Recent studies suggest that adverse patterns of care may also be emerging in high-income countries; an increase in the risk of both vesicovaginal and ureterovaginal fistulae following hysterectomy has been reported, concurrently with the reduction in overall use of the procedure. Read More

Arab J Urol 2014 Jun 15;12(2):97-105. Epub 2014 Mar 15.

Hurley Medical Center, Michigan State University, Flint, MI, USA.

Background: A vesicovaginal fistula (VVF) is an abnormal fistulous tract between the bladder and vagina, causing continuous loss of urine via the vagina. VVF is a relatively uncommon condition, but there is a drastically higher prevalence in the developing world. Furthermore, iatrogenic postoperative VVF is most common in developed countries, compared to mainly obstetric trauma in developing countries. Read More

Urologe A 2015 Mar;54(3):349-58

Urologische Klinik und Poliklinik, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland,

Background: Vesicovaginal fistulae are much more common in developing countries along the equatorial fistula belt than in industrialized countries. However, although the classical obstetric fistula caused by lack of medical support through pregnancy and delivery in adolescent primiparae has almost vanished in Germany, we are now facing new and predominantly iatrogenic variants. Increasing frequency of gynecological surgery as well as pelvic radiation, forgotten vaginal foreign bodies, or uninhibited cancer growth are the modern causes for vesicovaginal fistula in elderly patients. Read More