Urethral Diverticula, Urethro-Vaginal Fistulae, Vesico-Vaginal Fistulae
|
|
- Roland Walton
- 5 years ago
- Views:
Transcription
1 EAU Update Series 1 (2003) Urethral Diverticula, Urethro-Vaginal Fistulae, Vesico-Vaginal Fistulae C.R. Chapple * Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Glossop Road, Sheffield S10 2JF, UK Abstract This review considers the management of urethral diverticula, urethro-vaginal fistulae, and vesico-vaginal fistulae. The aim of this is to provide the reader with an overview of the current management of these pathologies, with reference to pertinent literature. # 2003 Elsevier B.V. All rights reserved. Keywords: Trauma; Vesico-vaginal fistulae; Urethro-vaginal fistulae; Urethral diverticula 1. Urethral diverticula Female urethral diverticula are estimated to occur in between 1% and 6% of all adult females and are usually diagnosed after the age of 20, the majority of the cases being in the 4th decade of life. Whilst the majority of urethral diverticula are undiagnosed as they prove to be asymptomatic, they may be complicated by infection, stones or rarely malignancy and by virtue of their size may produce obstruction to the bladder outlet. Diverticula most commonly present with symptoms relating to their size, with discomfort or with episodes of repeated inflammation and infection. If a diverticulum is asymptomatic and causing the patient no concern then there is no indication for its further treatment. The presenting symptoms can be summarised as the three D s, Dysuria, postvoid Dribbling and Dyspareunia. It has been suggested that diverticula are congenital in origin. There is no evidence to support this view as they are rarely found in children but this doesn t preclude the fact that an early diverticulum or weakness might have been present albeit undiagnosed. It is tempting to attribute the development of diverticula to the trauma of childbirth and whilst diverticula often present in women following childbirth it has been shown that urethral diverticula are just as likely to arise in nulliparous patients. A strong possibility is that repeated infection and obstruction of the periurethral glands results in the * Tel. þ ; Fax: þ address: c.r.chapple@sheffield.ac.uk (C.R. Chapple). formation of a cyst which eventually ruptures and drains back into the urethral lumen. Another possibility is that some cases may be due to embryological remnants e.g. Gartner s duct or vestigial Wolfian ducts which may act as a precursor to the diverticulum formation. Urethral diverticula invariably communicate with the urethral lumen and by virtue of their position protrude through and stretch the periurethral smooth muscle (bearing in mind that the favoured hypothesis is that they are based on obstructed periurethral glands). The periurethral glands are tubuloalveolar structures that predominate in the distal two thirds of the urethra and not surprisingly up to 90% of diverticula open into the mid or distal urethra. Occasionally diverticula by virtue of their size extend proximally and extend beneath the bladder neck and trigonal area (Fig. 1). The diagnosis of urethral diverticula used to be based on a combination of clinical observation and urethrography but more recent work in this area had clearly demonstrated that a postvoiding sagittal MRI scan is the most accurate way of finding their size and position (Fig. 2). Urethroscopy whilst often performed usually fails to be helpful particularly if the diverticulum is collapsed as the internal communication between the diverticulum and the urethra is often not visible. Having identified a diverticulum which is asymptomatic then the treatment of choice is the excision of the diverticulum. Simple marsupialisation of a diverticulum is one of the commonest causes of development of a urethro-vaginal fistulae. My standard management of /$ see front matter # 2003 Elsevier B.V. All rights reserved. doi: /s (03)
2 C.R. Chapple / EAU Update Series 1 (2003) Fig. 3. Surgery in the prone position, showing infiltration with lignocaine and adrenaline, raising the anterior vaginal flap and the excellent view and access to the diverticulum seen with this patient positioning. Fig. 1. A diverticulum usually extends through all layers of the urethra, therefore marsupialisation may lead to a fistula. A diverticulum stretches through all layers of the urethra and surgery on it will tend to weaken the urethral sphincter. these patients is to excise the diverticulum via a vaginal approach using the prone position (Fig. 3). The most definitive excision of a diverticulum is to carry out a full excision with a full opening of the urethra but this does carry with it morbidity even in experienced hands and having discussed this with the patient the majority will elect for simple diverticulectomy with insertion of a Martius flap (Fig. 4). Using this approach urethro-vaginal fistula formation is exceedingly rare. All patients however prior to surgery should be warned that there is a risk of incontinence either because it becomes unmasked as a consequence of removing the swollen diverticulum in a patient who already had a tendency to stress incontinence or may result from damage to the urethral sphincter mechanism during removal of the diverticulum. The patients should therefore be aware that a secondary procedure, in particular a sling procedure may be necessary at a later date and certainly this is facilitated by the positioning of the Martius flap at the time of the diverticulectomy. For more information on urethral diverticula and urethro-vaginal fistulae see [1 12]. 2. Urethro-vaginal fistulae and urethral sphincter deficiency Fig. 2. Sagittal MRI scan demonstrating the presence of a diverticulum arising from the posterior aspect of the urethra and extending upwards towards the base of the bladder ( diverticulum with arrows around it). Urethro-vaginal fistulae are happily uncommon but invariably associated with a defect in the posterior section of the urethral sphincter mechanism. Patients presenting with the consequences of a fistula, namely incontinence, in any repair of these fistulae will require
3 180 C.R. Chapple / EAU Update Series 1 (2003) Fig. 4. Plane of dissection for a diverticulum and the advantage of a full opening of the urethra to facilitate complete excision of the diverticulum. definitive repair of the sphincter in order to restore continence. Urethro-vaginal fistulae may result as the consequence of prolonged labour or complicated vaginal delivery where there is damage to the urethra or following surgery, particularly excision of the urethral diverticulum or surgery to the anterior vaginal wall (cf. anterior repair). Urethral damage consequent upon pelvic fracture injuries is extremely rare. Management of a urethro-vaginal fistula therefore requires urethral reconstruction with careful attention to reconstructing the integrity of the urethral sphincter mechanism using a Young Dees urethral tailoring procedure (Fig. 5). Such surgery should be carried out by those familiar with the principles and practice of urethral reconstruction. 3. Vesico-vaginal fistulae Vesico-vaginal fistulae are uncommon in contemporary practice in Europe today. In developing countries where obstetric services are limited then such injury usually follows from prolonged or difficult vaginal delivery whereas in Europe the commonest cause of vesico-vaginal fistulae is gynaecological surgery complicated by damage to the bladder base usually just above the trigone. (See [13 28] for more information on vesico-vaginal fistulae.) The majority of vesico-vaginal fistulae are easy to identify and indeed some bladder fistula may be large enough to feel with a tip of a finger in the vagina. Conversely, when a long established pin hole fistula is present in the base of the bladder it may be difficult to identify. Traditionally the three swab test has been used to identify the cause of a small vesico-vaginal fistula that is difficult to locate (Fig. 6). Cystography is another useful adjunct to diagnosis and will show the presence of leakage from the bladder. Intravenous urography should be carried out to image the upper tracts in all cases presenting with lower urinary tract trauma. Prior to repair however patients should be examined endoscopically using either flexible
4 C.R. Chapple / EAU Update Series 1 (2003) Fig. 5. Principles of Young Dees urethral tailoring (reduction sphincteroplasty). Reducing the diameter of the urethra by tailoring the urethral roof strip, removing the damaged ventral urethra and basing the reconstruction on the intact and anyway more robust dorsal component of the sphincter. or rigid cystoscopes. Where the fistula is very small then a fine ureteric catheter or guideline can be passed through the fistula to clearly demonstrate its position. The use of the cystoscope as a vaginoscope should not be forgotten as this will often allow careful examination of the anterior vaginal wall and can be particularly useful in identifying a fistula which is not immediately apparent on cystoscopy; likewise a guide-wire or ureteric stent can be passed using the cystoscope via this route. The majority of vesico-vaginal fistulae can be closed by an appropriate surgical repair. It is however useful to consider them as being either simple or complex. Simple fistulae result from surgical injuries to the bladder and can usually be closed by a definitive suture approximation of the normal tissue margins using a layered closure with the interposition of vascularised tissue such as omentum or a Martius flap between the vaginal and bladder suture margins. Complex fistulae are associated with greater local tissue destruction
5 182 C.R. Chapple / EAU Update Series 1 (2003) Fig. 6. The three swab test. Tying knots in the strings attached to the swabs helps with subsequent interpretation of the results. Note the false positive with a urethro-vaginal fistula associated with vesico-ureteric reflux. either resulting from infection, infestation, irradiation, extensive trauma or failure of previous surgery repair. In some such cases malignancy is another additional feature which needs to be considered in the overall management of patients. The presence of malignancy is not an exclusion criterion as such but may well dictate the nature of the subsequent reconstruction as many of these patients require exenterative surgery Timing of repair Fistulae should be repaired either within two weeks of their development or after a three month period. Operating in the intervening period increases the complexity of surgery and lessens the likelihood of success as the tissues that are present are rather friable and adequate surgical closure is extremely difficult. There is no clear evidence in the literature to support surgery during this intervening period. patients have had prior gynaecological surgery then an incision via the suprapubic pfannenstiel scar avoids the disfigurement of an additional abdominal incision and is easily achieved by dissecting the skin and fat off the anterior abdominal wall and then carrying out a midline incision. This can be supplemented by an additional incision higher up in the abdomen if necessary though this has rarely proven to be the case in my experience (Fig. 8). When using an abdominal approach the transvesical approach provides the best exposure. The bladder is 3.2. Surgical approach The choice of approach will depend upon the surgeon s training and hence preference but also should be particularly dictated by the position and size of the fistula (Fig. 7). 4. Abdominal approach In cases where the fistula is either large of high up on the bladder then a transabdominal approach provides excellent exposure and access. Since the majority of Fig. 7. Surgical approaches to fistula repair.
6 C.R. Chapple / EAU Update Series 1 (2003) Fig. 8. The mid-line laparotomy via a pfannenstiel incision. split through the mid-line down to the fistulae and bivalved. This facilitates the dissection between bladder and vagina and it is best to develop this plane for 2 3 cm distal to the fistula to allow interposition of vascularised tissue particularly omentum. Other tissues suggested for use include fat patches, peritoneum and striated muscle but in my experience omentum provides the most robust and easily available tissue and provides excellent success rates. It is usually not necessary to develop a full abdomino-perineal tunnel but in complex cases this may prove to be the case and the omentum can be pulled through right to the perineum (Fig. 9). 5. Vaginal approach Many fistulae are amenable to a vaginal repair which I find particularly facilitated by using the prone position. The importance of repair is to achieve adequate separation of the two suture margins i.e. bladder and vagina with interposition of vascularised tissue which is easily achieved by the use of a Martius flap (Fig. 10). Others have suggested the use of other tissues in particular peritoneum with good results. Recent cases of laparoscopic repair have been published but no other significant contributions have appeared in the literature relating to surgical techniques for fistula repair in recent years. Following any fistula repair I leave both a suprapubic and urethral catheter in situ and carry out a cystogram at 10 days to check that the repair is sound. Following these basic principles is simple and the majority of complex fistulae can be dealt with with very high success rate. Certainly approximating to 100%. Fig. 9. Transabdominal transvesical approach to vesico-vaginal fistula repair supported by omental interposition.
7 184 C.R. Chapple / EAU Update Series 1 (2003) Fig. 10. Vaginal approach to vesico-vaginal fistula repair using a Martius flap. Acknowledgements The figures in this paper are from Turner- Warwick and Chapple s. Functional Reconstruction of the Urinary Tract and Gynaecourology. Blackwell, Oxford, The reader is advised to consult this text for a more detailed exposition of the subject. References [1] Anderson MJF. The incidence of diverticula in the female. J Urol 1967;98:96 8. [2] Aspera AM, Rackley RR, Vasavada SP. Contemporary evaluation and management of the female urethral diverticulum. Urol Clin North Am 2002;29(3): [3] Blander DS, Rovner ES, Schnall MD, Ramchandani P, Banner MP, Broderick GA, et al. Endoluminal magnetic resonance imaging in the evaluation of urethral diverticula in women. Urology 2001;57(4): [4] Candiani P, Austoni E, Campiglio GL, Ceresoli A, Zanetti G, Colombo F. Repair of a recurrent urethrovaginal fistula with an island bulbocavernous musculocutaneous flap. Plast Reconstr Surg 1993; 92(7): [5] Davis RS, Linke CA, Kraemer GK. Use of labial tissue in repair of urethrovaginal fistula and injury. Arch Surg 1980;115(5): [6] Debaere C, Rigauts H, Steyaert L, Pattyn G, Ampe J. MR imaging of a diverticulum in a female urethra. J Belge Radiol 1995;78(6): [7] Ganabathi K, Leach GE, Zimmern PE, Dmochowski RR. Experience with the management of urethral diverticula in 63 women. J Urol 1994;152: [8] Khati NJ, Javitt MC, Schwartz AM, Berger BM. MR imaging diagnosis of a urethral diverticulum. Radiographics 1998;18(2): [9] Krogh J, Kay L, Hjortrup A. Treatment of urethrovaginal fistula. Br J Urol 1989;63(5):555. [10] Leach GE, Schmidbauer CP, Hadley HR, Staskin DR, Zimmern P, Raz S. Surgical treatment of female urethral diverticulum. Semin Urol 1986;4(1): [11] Leach GE, Sirls LT, Ganabathi K, Zimmern PE. L N S C3: a proposed classification system for female urethral diverticula. Neurourol Urodyn 1993;12(6):523.
8 C.R. Chapple / EAU Update Series 1 (2003) [12] Woodhouse CR, Flynn JT, Molland EA, Blandy JP. Urethral diverticulum in females. Br J Urol 1980;52(4): [13] Arrowsmith S, Hamlin EC, Wall LL. Obstructed labor injury complex: obstetric fistula formation and the multifaceted morbidity of maternal birth trauma in the developing world. Obstet Gynecol Surv 1996;51(9): [14] Badenoch DF, Tiptaft RC, Thakar DR, Fowler CG, Blandy JP. Early repair of accidental injury to the ureter or bladder following gynaecological surgery. Br J Urol 1987;59(6): [15] Blandy JP, Badenoch DF, Fowler CG, Jenkins BJ, Thomas NW. Early repair of iatrogenic injury to the ureter or bladder after gynecological surgery. J Urol 1991;146(3): [16] Dupont MC, Raz S. Vaginal approach to vesicovaginal fistula repair. Urology 1996;48(1):7 9. [17] Hilton P. Vesico-vaginal fistula: new perspectives. Curr Opin Obstet Gynecol 2001;13(5): [18] Mondet F, Chartier-Kastler EJ, Conort P, Bitker MO, Chatelain C, Richard F. Anatomic and functional results of transperitonealtransvesical vesicovaginal fistula repair. Urology 2001;58(6): [19] Muleta M, Williams G. Postcoital injuries treated at the Addis Ababa Fistula Hospital, Lancet 1999;354(9195): [20] Naude JH. Reconstructive urology in the tropical and developing world: a personal perspective. BJU Int 2002;89(Suppl 1):31 6. [21] Nesrallah LJ, Srougi M, Gittes RF. The O Conor technique: the gold standard for supratrigonal vesicovaginal fistula repair. J Urol 1999;161(2): [22] Romics I, Kelemen Z, Fazakas Z. The diagnosis and management of vesicovaginal fistulae. BJU Int 2002;89(7): [23] Sims JM. On the treatment of vesico-vaginal fistula Int Urogynecol J Pelvic Floor Dysfunct 1998;9(4): [24] Thomas K, Williams G. Medicolegal aspects of vesicovaginal fistulae. BJU Int 2000;86(3): [25] Turner-Warwick R. The use of the omental pedicle graft in urinary tract reconstruction. J Urol 1976;116(3): [26] Turner-Warwick RT, Wynne EJ, Handley-Ashken M. The use of the omental pedicle graft in the repair and reconstruction of the urinary tract. Br J Surg 1967;54(10): [27] Walker RM, Worth PH. Medicolegal aspects of vesicovaginal fistula. BJU Int 2001;87(1):127. [28] Wein AJ, Malloy TR, Carpiniello VL, Greenberg SH, Murphy JJ. Repair of vesicovaginal fistula by a suprapubic transvesical approach. Surg Gynecol Obstet 1980;150(1): CME questions Please visit to answer these CME questions on-line. The CME credits will then be attributed automatically. 1. Urethral diverticula A. are rare occurring in less that 1% of the female population. B. usually present at some stage with symptoms. C. invariably communicate with the urethral lumen. D. protrude through and stretch the surrounding urethral smooth muscle. E. can be usually visualised on urethroscopy. 2. Surgical repair of A. a urethral diverticulum may result in the development of incontinence. B. a urethral diverticulum is usually most appropriately formed by marsupialisation. C. a urethral fistula rarely requires a Martius flap interposition procedure. D. urethral fistula almost never requires a formal urethral tailoring procedure. E. urethral fistula is commonly consequent upon a pelvic fracture injury in the female. 3. Vesico-vaginal fistulae A. are best managed initially by conservative treatment. B. to be repaired easily between 2 6 weeks after injury. C. usually require surgical repair. D. are rarely associated with other injuries to the urinary tract. E. are best managed by an abdominal approach. 4. Diagnosis of a vesico-vaginal fistula is often confirmed by A. a clinical history. B. a two swab test. C. CT scanning. D. 3D MRI scanning. E. ultrasound. 5. Surgical repair of vesico-vaginal fistulae A. is improved by tissue interposition. B. is contraindicated in the presence of malignancy. C. is usually associated with a 20% failure rate. D. should be carried out abdominally via a mid-line skin incision. E. is difficult via the vaginal route with the patient in the prone position.
Risk Factors for De Novo Mixed Urinary Incontinence and Stress Urinary Incontinence Following Surgical Removal of a Urethral Diverticulum
LUTS (2013) 5, 154 158 ORIGINAL ARTICLE Risk Factors for De Novo Mixed Urinary Incontinence and Stress Urinary Incontinence Following Surgical Removal of a Urethral Diverticulum JaeHeonKIM, 1 Kwang Woo
More informationMR of the Urethra 20 th Annual Summer Practicum SCBT-MR Jackson Hole August 11, Evan S. Siegelman MD University of Pennsylvania Medical Center
MR of the Urethra 20 th Annual Summer Practicum SCBT-MR Jackson Hole August 11, 2010 Evan S. Siegelman MD University of Pennsylvania Medical Center MR of the urethra Normal Anatomy Urethral Diverticula
More informationOutcomes of Surgery of Female Urethral Diverticula Classified Using Magnetic Resonance Imaging
european urology 51 (2007) 1664 1670 available at www.sciencedirect.com journal homepage: www.europeanurology.com Female Urology Incontinence Outcomes of Surgery of Female Urethral Diverticula Classified
More informationA New Dimension in Vesicovaginal Fistula Management: An 8-year Experience at Ramathibodi Hospital
Original Article A New Dimension in Vesicovaginal Fistula Management: An 8-year Experience at Ramathibodi Hospital Wachira Kochakarn and Wipaporn Pummangura, 1 Division of Urology, Department of Surgery,
More informationCenter for Reconstructive Urethral Surgery Guido Barbagli Center for Reconstructive Urethral Surgery Arezzo - Italy
Guido Barbagli Arezzo - Italy E-mail: guido@rdn.it Website: www.urethralcenter.it 23 rd ANNUAL EAU CONGRESS Sub-plenary Session on Male urinary incontinence 26 29 March 2008 Milan Italy Incontinence following
More informationSara Schaenzer Grand Rounds January 24 th, 2018
Sara Schaenzer Grand Rounds January 24 th, 2018 Bladder Anatomy Ureter Anatomy Areas of Injury Bladder: Posterior bladder wall above trigone Ureter Crosses beneath uterine vessels At pelvic brim when ligating
More informationPan African Urological Surgeons Association. African Journal of Urology.
African Journal of Urology (2012) 18, 175 179 Pan African Urological Surgeons Association African Journal of Urology www.ees.elsevier.com/afju www.sciencedirect.com Martius flap and anterior vaginal wall
More informationGuido Barbagli. Center for Reconstructive ti Urethral lsurgery
Guido Barbagli Center for Reconstructive ti Urethral lsurgery Arezzo - Italy E-mail: guido@rdn.it Website: www.urethralcenter.it Dedicated to Ruggero Lenzi, teacher and friend. His passing was a great
More informationManagement of Urethrovaginal Fistulas
european urology 50 (2006) 1000 1005 available at www.sciencedirect.com journal homepage: www.europeanurology.com Surgery in Motion Management of Urethrovaginal Fistulas Dmitri Y. Pushkar *, Vladimir V.
More informationRecent advances have improved the
SURGICAL TECHNIQUES BY NEERAJ KOHLI, MD, MBA, and JOHN R. MIKLOS, MD Meeting the challenge of vesicovaginal fistula repair: Conservative and surgical measures A number of simple adjustments to technique
More informationThe circumferential obstetric fistula: characteristics, management and outcomes
DOI: 10.1111/j.1471-0528.2007.01329.x www.blackwellpublishing.com/bjog Short communication The circumferential obstetric fistula: characteristics, management and outcomes A Browning Barhirdar Hamlin Fistula
More information5 DIAGNOSIS. History taking
5 DIAGNOSIS All of the photographs in Chapter 4 were taken in theatre before operation. This chapter deals with how one can recognize the type of fistula by history taking and examination. (Note that the
More informationUse of Martius flap in the complex female urethral surgery
202 Central European Journal of Urology original PAPEr TRAUMA AND RECONSTRUCTIVE UROLOGY Use of Martius flap in the complex female surgery George Kasyan, Nataliya Tupikina, Dmitry Pushkar Urology Department
More informationThe Management of Female Urinary Incontinence. Part 1: Aetiology and Investigations
The Management of Female Urinary Incontinence Part 1: Aetiology and Investigations Dr Oseka Onuma Gynaecologist and Pelvic Reconstructive Surgeon 4 Robe Terrace Medindie SA 5081 Urinary incontinence has
More informationCase Based Urology Learning Program
Case Based Urology Learning Program Resident s Corner: UROLOGY Case Number 19 CBULP 2011 044 Case Based Urology Learning Program Editor: Associate Editors: Manager: Case Contributors: Steven C. Campbell,
More informationSurgical repair of vaginal wall prolapse using mesh
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Interventional procedure consultation document Surgical repair of vaginal wall prolapse using mesh Vaginal wall prolapse happens when the normal support
More informationThis information is intended as an overview only
This information is intended as an overview only Please refer to the INSTRUCTIONS FOR USE included with this device for indications, contraindications, warnings, precautions and other important information
More informationUrethrolysis; When, Why & How. M Karram Professor of Ob/Gyn & Urology University of Cincinnati
Urethrolysis; When, Why & How M Karram Professor of Ob/Gyn & Urology University of Cincinnati Anatomy Urethra may be fixed to the pubic bone with dense scar tissue Goal of urethrolysis is to completely
More informationDaniel K Roberts MD, PhD 2014 Annual Clinical Update
Daniel K Roberts MD, PhD 2014 Annual Clinical Update Kevin E Miller, MD Division of Female Pelvic Medicine and Reconstructive Surgery Dept. of OBGYN University of Kansas School of Medicine- Wichita at
More informationRenal Trauma: Management Options
Renal Trauma: Management Options Immediate surgical repair Nephrectomy Conservative management Alonso RC et al. Kidney in Danger: CT Findings of Blunt and Penetrating Renal Trauma. RadioGraphics 2009;
More informationRECTAL INJURY IN UROLOGIC SURGERY. Inadvertent rectal injury from a urologic procedure is often subtle but has serious postoperative consequences.
RECTAL INJURY IN 27 UROLOGIC SURGERY Inadvertent rectal injury from a urologic procedure is often subtle but has serious postoperative consequences. With good mechanical bowel preparation plus antibiotic
More informationeuropean urology xxx (2006) xxx xxx
available at www.sciencedirect.com journal homepage: www.europeanurology.com 1 2 3 4 5 Female Urology - Incontinence Supratrigonal VVF Repair by Modified O Connor s Technique- An Experience of 26 Cases
More informationResearch Article Transvesicoscopic Repair of Vesicovaginal Fistula
Diagnostic and Therapeutic Endoscopy Volume 2010, Article ID 760348, 4 pages doi:10.1155/2010/760348 Research Article Transvesicoscopic Repair of Vesicovaginal Fistula R. B. Nerli and Mallikarjun Reddy
More informationInterposition of Omentum, Perivesical Fat, Martious Fat in Management of Lower Urinary Tract Fistula - A Comparative Study
ORIGINAL ARTICLE Interposition of Omentum, Perivesical Fat, Martious Fat in Management of Lower Urinary Tract Fistula - A Comparative Study KHIZAR HAYAT 1, SHAH JAHAN UR REHMAN 2, MUJAHID ALAM 3, SAJJAD
More information11 th Dynasty- Egyptian mummies : Queen Henhenit circa 2050 BC wife of King Mentuhotep II VVF 550 BC- Ancient Egyptian documents (papyri)
February 2019 11 th Dynasty- Egyptian mummies : Queen Henhenit circa 2050 BC wife of King Mentuhotep II VVF 550 BC- Ancient Egyptian documents (papyri) Prescription for a woman whose urine is in an irksome
More informationTHE USE OF DEEPITHELIALIZATION
THE USE OF DEEPITHELIALIZATION IN URETHROPLASTY - Deepithelialization Stratum corneum - Epidermis Papillary dermis Reticular dermis Skin Healing in any reconstructive surgery depends on not only the intact
More information8 A SIMPLE FISTULA REPAIR, STEP BY STEP
8 A SIMPLE FISTULA REPAIR, STEP BY STEP The first step is to suture the labia to the thighs and cover the anus with a swab (Figure 31). Figure 31 The labia are sutured to the thighs and the anus is covered
More informationFIG The inferior and posterior peritoneal reflection is easily
PSOAS HITCH, BOARI FLAP, AND COMBINATION OF PSOAS 7 HITCH AND BOARI FLAP The psoas hitch procedure, Boari flap, and transureteroureterostomy are useful operative procedures for reestablishing continuity
More informationUrethral diverticulum
DOI: 10.1111/tog.12192 The Obstetrician & Gynaecologist http://onlinetog.org 2015;17:125 9 Review Urethral diverticulum Rosemary Archer MB MS, a Jennifer Blackman MRCOG, a Mark Stott FRCS, b Julian Barrington
More informationMorbidity Audit and Logbook Tool SNOMED Board Reporting Terms for SET and IMG Urology ENDOSCOPIC LOWER URINARY TRACT
ENDOSCOPIC LOWER URINARY TRACT Cystolitholapaxy Cystoscopic removal of foreign body from bladder Cystoscopic removal of ureteric stent Cystoscopy and cystodiathermy Cystoscopy and transurethral biopsy
More informationGlossary of Terms Primary Urethral Cancer
Patient Information English Glossary of Terms Primary Urethral Cancer Advanced cancer A tumour that grows into deeper layers of tissue, adjacent organs, or surrounding muscles. Anaesthesia (general, spinal,
More informationA CASE OF DUPLICATION OF PENILE URETHRA. Stoke Mandeville
A CASE OF DUPLICATION OF PENILE URETHRA By J. P. REIDY, F.R.C.S. Stoke Mandeville THIS congenital deformity is of rare occurrence. Gross and Moore (195o) summarised the findings of eighty-three cases.
More informationMIDLAND MEMORIAL HOSPITAL Delineation of Privileges FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY (UROGYNECOLOGY)
MIDLAND MEMORIAL HOSPITAL Delineation of Privileges FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY (UROGYNECOLOGY) Physician Name: Your home for healthcare Female Pelvic Medicine and Reconstructive
More informationhoofdstuk :07 Pagina ix Introduction
hoofdstuk 00 08-03-2001 15:07 Pagina ix Introduction Incontinence at pediatric age is a problem that can harm the psychological and physical development of children. Starting in 1986 we have searched for
More informationPUBOVAGINAL SLING IN THE TREATMENT OF STRESS URINARY INCONTINENCE FOR URETHRAL HYPERMOBILITY AND INTRINSIC SPHINCTERIC DEFICIENCY
Urological Neurology International Braz J Urol Official Journal of the Brazilian Society of Urology PUBOVAGINAL SLING IN SUI Vol. 29 (6): 540-544, November - December, 2003 PUBOVAGINAL SLING IN THE TREATMENT
More informationKey words: Urogenital Abnormalities, Anal Canal, Perineum, Child, Fistula, Urethra.
JOURNAL OF CASE REPORTS 2014;4(1):164-168 Repair of Urogenital Anomaly with Anterior Displacement of Anus using a Posterior Sagittal Approach- Operative Steps Patne Pravin B, Nerli Rajendra B, Hiremath
More informationThe number following the procedure code is the TRICARE payment group. KIDNEY
TRICARE/CHAMPUS POLICY MANUAL 6010.47-M JUNE 25, 1999 S POLICY CHAPTER 13 SECTION 9.1 ADDENDUM 1, SECTION 8 TRICARE-APPROVED AMBULATORY SURGERY S - URINARY SYSTEM The number following the procedure code
More informationLaparoscopic extravesical vesicovaginal fistula repair: our technique and 15-year experience
DOI 10.1007/s00192-014-2458-y ORIGINAL ARTICLE Laparoscopic extravesical vesicovaginal fistula repair: our technique and 15-year experience John R. Miklos & Robert D. Moore Received: 26 March 2014 /Accepted:
More informationGlossary of terms Urinary Incontinence
Patient Information English Glossary of terms Urinary Incontinence Anaesthesia (general, spinal, or local) Before a procedure you will get medication to make sure that you don t feel pain. Under general
More informationSciFed Journal of Public Health. Endoscopic Management of Obstetrical Uretero-Uterine Fistula. Case Report and Review of Literature
SciFed Journal of Public Health Case Report Open Access Endoscopic Management of Obstetrical Uretero-Uterine Fistula. Case Report and Review of Literature * Yasin Idweini * Chairperson of Urology Department
More informationInterventional procedures guidance Published: 12 October 2016 nice.org.uk/guidance/ipg566
Single-incision short sling mesh insertion for stress urinary incontinence in women Interventional procedures guidance Published: 12 October 2016 nice.org.uk/guidance/ipg566 Your responsibility This guidance
More informationFemale Epispadias Repair
hoofdstuk 07 08-03-2001 15:25 Pagina 89 Female Epispadias Repair Female epispadias repair: a new 1-stage technique CHAPTER 7 Tom P.V.M de Jong, Pieter Dik and Aart J. Klijn Journal of Urology 2000, 164,
More informationTHE operation of reimplantation of the ureter into the bladder has undergone
REIMPLANTATION OF THE URETER INTO THE BLADDER J. G. WARDEN, M.D., and C. C. HIGGINS, M.D. Department of Urology THE operation of reimplantation of the ureter into the bladder has undergone a stormy course
More informationDr. Aso Urinary Symptoms
Haematuria The presence of blood in the urine (haematuria) is always abnormal and may be the only indication of pathology in the urinary tract. False positive stick tests and the discolored urine caused
More informationSymptomatic Male Urethral Diverticula- Presentation, Diagnosis and Management
Original article Symptomatic Male Urethral Diverticula- Presentation, Diagnosis and Management Ratkal JM 1, Elias Sharma 2 1Associate Professor, Department of Urology, KIMS, Hubli 2Asst Professor, Department
More informationA Simplified Urinary Incontinence Score for the Evaluation of Treatment Outcomes
Neurourology and Urodynamics 19:127 135 (2000) A Simplified Urinary Incontinence Score for the Evaluation of Treatment Outcomes Asnat Groutz, Jerry G. Blaivas,* and Jarrod E. Rosenthal Weill Medical College,
More informationTraditional Anterior, Posterior, and Apical Compartment Repairs A Technique Based Review
Traditional Anterior, Posterior, and Apical Compartment Repairs A Technique Based Review Sandip Vasavada, MD Center for Female Urology and Pelvic Reconstructive Surgery The Glickman Urological and Kidney
More informationBladder Trauma Data Collection Sheet
Bladder Trauma Data Collection Sheet If there was no traumatic injury with PENETRATION of the bladder DO NOT proceed Date of injury: / / Time of injury: Date of hospital arrival: / / Time of hospital arrival:
More informationCase MDCT 3D reconstructed features of posterior urethral valve
Case 12688 MDCT 3D reconstructed features of posterior urethral valve Hidayatullah Hamidi Third year Resident of Radiology French medical institute for children Radiology Department; Kabul, Afghanistan;
More informationPelvic Floor Ultrasound Imaging. Prof HP Dietz (Sydney) A/Prof KL Shek (Sydney) Dr R Guzman Rojas (Santiago de Chile) Dr Kamil Svabik (Prague)
Pelvic Floor Ultrasound Imaging Workshop IUGA 2015 Nice Faculty: Prof HP Dietz (Sydney) A/Prof KL Shek (Sydney) Dr R Guzman Rojas (Santiago de Chile) Dr Kamil Svabik (Prague) The use of translabial ultrasound
More informationApproach to the Repair of Chronic Perineal Lacerations and Rectovaginal Fistula (RVF)
Approach to the Repair of Chronic Perineal Lacerations and Rectovaginal Fistula (RVF) Blair B. Washington MD, MHA Urogynecology & Reconstructive Pelvic Surgery Virginia Mason Medical Center Disclosures
More informationSurgery of urogenital trauma in condition of war or precarity
Surgery of urogenital trauma in condition of war or precarity C. H. Rochat Multi-disciplinary Center for Robotic Surgery, Geneva (www.beaulieu.ch) Geneva Foundation for Medical Education and Research (www.gfmer.ch)
More informationFemale Pelvic Medicine & Reconstructive Surgery
Female Pelvic Medicine & Reconstructive Surgery APPLICATION FOR NEW FELLOWSHIP Name of Institution: McGill University Location: Royal Victoria Hospital (Glen Site), St Mary s Hospital Centre Type of Fellowship:
More informationAppendix 1. Canadian Classification of Health Intervention Codes Used to Identify
1 2 3 Appendix 1. Canadian Classification of Health Intervention Codes Used to Identify any Vaginal Mesh (Synthetic) Implantation Procedure(s) for Pelvic Organ Prolapse 4 Canadian Classification of health
More informationBy:Dr:ISHRAQ MOHAMMED
By:Dr:ISHRAQ MOHAMMED Protrusion of an organ or structure beyond its normal confines. Prolapses are classified according to their location and the organs contained within them. 1-Anterior vaginal wall
More informationJapanese Neurogenic Bladder Society Meeting. Kofu - Japan. September 29th - October 1st, 2010
Japanese Neurogenic Bladder Society Meeting Kofu - Japan September 29th - October 1st, 2010 Reconstruction of penile and bulbar urethra Evaluation of anterior urethral stricture Urethrography Retrograde
More informationRepair of Bulbar Urethra Using the Barbagli Technique
22 Repair of Bulbar Urethra Using the Barbagli Technique G. Barbagli, M. Lazzeri 22.1 Introduction and Historical Background 182 22.2 Anatomical Remarks 182 22.3 Step-by-Step Surgical Details 183 22.3.1
More information6 THE OPERATIONS BASIC PRINCIPLES
6 THE OPERATIONS BASIC PRINCIPLES Basic principles are described here; strategies for specific situations are discussed in later sections. The basic principles in the repair of a fistula are: adequate
More informationBard: Continence Therapy. Stress Urinary Incontinence. Regaining Control. Restoring Your Lifestyle.
Bard: Continence Therapy Stress Urinary Incontinence Regaining Control. Restoring Your Lifestyle. Stress Urinary Incontinence Urinary incontinence is a common problem and one that can be resolved by working
More informationUrethral Stricture Management. AUA Guidelines. Michael Coburn, MD Scott Department of Urology Baylor College of Medicine Houston, Texas
Urethral Stricture Management AUA Guidelines Michael Coburn, MD Scott Department of Urology Baylor College of Medicine Houston, Texas Urethral Stricture Guidelines Systematic peer-reviewed literature review
More informationWe welcome comments and corrections which will be used to improve the system annually.
ACGME Case Log Instructions: Female Pelvic Medicine and Reconstructive Surgery (FPMRS) Review Committees for Obstetrics and Gynecology, and Urology Updated July 2013 BACKGROUND The ACGME Case Log System
More informationBladder exstrophy and epispadias
Great Ormond Street Hospital for Children NHS Foundation Trust: Information for Families Bladder exstrophy and epispadias This leaflet explains about bladder exstrophy and epispadias and what to expect
More informationQuality care in vesico-vaginal obstetric fistula: case series report from the regional hospital of Maroua-Cameroon
Provisional PDF Published 27 April 2010 Case report, Volume 5, issue 6, 2010 Quality care in vesico-vaginal obstetric fistula: case series report from the regional hospital of Maroua-Cameroon Pierre Marie
More informationUrinary and faecal incontinence following delayed primary repair of obstetric genital fistula
BJOG: an International Journal of Obstetrics and Gynaecology July 2002, Vol. 109, pp. 828 832 Urinary and faecal incontinence following delayed primary repair of obstetric genital fistula Christine Murray,
More informationLec-8 جراحة بولية د.نعمان
4th stage Lec-8 جراحة بولية د.نعمان 11/10/2015 بسم هللا الرحمن الرحيم Ureteric, Vesical, & urethral stones Ureteric Calculus Epidemiology like renal stones Etiology like renal stones Risk factors like
More informationUrogynecology ICD-9 to ICD-10 Crosswalks
1100 Wayne Ave, Suite 825 Silver Spring, MD 20910 301.273.0570 Fax 301.273.0778 info@augs.org www.augs.org Urogynecology ICD-9 to ICD-10 Crosswalks ICD 9 ICD 9 Description ICD 10 Code ICD 10 Description
More informationClinical aspects in urogenital injuries
Clinical aspects in urogenital injuries Rolf Wahlqvist Oslo Urological University Clinic Aker University Hospital Nordic Rad.2008 1 Urogenital injuries in trauma patients Renal injury Ureteral injury (infrequent/iatrogenic)
More informationSURGICAL PROCEDURES OPERATIONS ON THE UROGENITAL SYSTEM
KIDNEYS AND PERINEPHRUM 1. No additional claim should be made for nephroscopy when done at the time of pyelolithotomy or nephrolithotomy. 2. In a routine surgical approach to the kidney and related procedures,
More informationA Laparoscopic-Assisted Extraperitoneal Bladder Neck Suspension: An Initial Experience
Journal Of Laparoendoscopic Surgery Volume 4, Number 5, 1994 Mary Ann Liebert, Inc., Publishers A Laparoscopic-Assisted Extraperitoneal Bladder Neck Suspension: An Initial Experience E.D. RIZA, M.D.(1)
More informationRetrospective study of 213 cases of female urogenital fistulae at the Department of Urology & Transplantation Civil Hospital Quetta, Pakistan
Original Article Retrospective study of 213 cases of female urogenital fistulae at the Department of Urology & Transplantation Civil Hospital Quetta, Pakistan Haq Nawaz, Masha Khan, Faiz Muhammed Tareen,
More informationInformation for Patients
Information for Patients Congenital Malformation in the Urinary Tract: Ureteral Duplication, Ureterocele, and Ectopic Ureter English Table of contents Ureteral Duplication... 3 Symptoms and Diagnosis...
More informationAppendix B Protocol for management of obstetric anal sphincter injury THE MANAGEMENT OF THIRD- AND FOURTH-DEGREE PERINEAL TEARS
Appendix B Protocol for management of obstetric anal sphincter injury Document Type: THE MANAGEMENT OF THIRD- AND FOURTH-DEGREE PERINEAL TEARS PURPOSE & SCOPE To provide a guideline that will assist in
More informationCONGENITAL ANTERIOR URETHRAL DIVERTICULUM
CONGENITAL ANTERIOR URETHRAL DIVERTICULUM W Y Cheong, H K Cheng, K P Tan SYNOPSIS We report the first documented case in Singapore of a congenital saccular anterior urethral diverticulum causing bladder
More informationFind Medical Solutions to Your Problems HYDRONEPHROSIS. (Distension of Renal Calyces & Pelvis)
HYDRONEPHROSIS (Distension of Renal Calyces & Pelvis) Hydronephrosis is the distension of the renal calyces and pelvis due to accumulation of the urine as a result of the obstruction to the outflow of
More informationHow I Do It - Evaluation of the Urethra
How I Do It - Evaluation of the Urethra Parvati Ramchandani, MD Professor, Radiology and Surgery University of Pennsylvania Medical Center Philadelphia, PA, USA Disclosure of Commercial Interest Neither
More informationWest Yorkshire Major Trauma Network Clinical Guidelines 2015
WYMTN: Pelvic fracture with urogenital trauma KEY RECOMMENDATIONS 1. During the initial exploratory survey / secondary survey, a. The external urethral meatus and the transurethral bladder catheter (if
More informationSWISS SOCIETY OF NEONATOLOGY. A paraurethral cyst or the mandatory peek into the diapers of newborn girls
SWISS SOCIETY OF NEONATOLOGY A paraurethral cyst or the mandatory peek into the diapers of newborn girls November 2008 2 Minocchieri S, Kaczala GW, Messer AM, Dingeldein I, Nelle MN, Department of Pediatrics,
More informationPostoperative Care for Pelvic Fistulae. Peter Jeppson, MD October 3, 2017
Postoperative Care for Pelvic Fistulae Peter Jeppson, MD October 3, 2017 No Disclosures Rational for Postoperative Care Intraoperative injury may be managed by: Identification Closure Continuous post-operative
More informationUrethroplasty for Long Anterior Urethral Strictures Report of Long-term Results
Reconstructive Surgery Urethroplasty for Long Anterior Urethral Strictures Report of Long-term Results Mahmoudreza Moradi, As ad Moradi Introduction: We reviewed the long-term outcome of substitution urethroplasty
More informationPROFESSIONAL SKILLS 1 3RD YEAR SEMESTER 6 RADIOGRAPHY. THE URINARY SYSTEM Uz. Fatema shmus aldeen Tel
PROFESSIONAL SKILLS 1 3RD YEAR SEMESTER 6 RADIOGRAPHY THE URINARY SYSTEM Uz. Fatema shmus aldeen Tel. 0925111552 Professional skills-2 THE URINARY SYSTEM The urinary system (review anatomy and physiology)
More informationUrethral Injuries: Realignment vs. Delayed Reconstruction
Urethral Injuries: Realignment vs. Delayed Reconstruction E. Charles Osterberg, MD Assistant Professor of Surgery (Urology) Dell Medical School Chief of Urology and Genitourinary Reconstruction None Disclosures
More informationGynecology Dr. Sallama Lecture 3 Genital Prolapse
Gynecology Dr. Sallama Lecture 3 Genital Prolapse Genital(utero-vaginal )prolapse is extremely common, with an estimated 11% of women undergoing at least one operation for this condition. Definition: A
More information3. Urinary Catheters. Indications. Methods of Bladder Catheterization. Hashim Hashim
3. Urinary Catheters Hashim Hashim Indications Urinary catheters are used to drain urine from the bladder. The main indications are: A. Diagnostic Measure post-void residual in the absence of ultrasound
More informationUrogynaecology. Colm McAlinden
Urogynaecology Colm McAlinden Definitions Urinary incontinence compliant of any involuntary leakage of urine with many different causes Two main types: Stress Urge Definitions Nocturia: More than a single
More informationGuido Barbagli. Center for Reconstructive ti Urethral lsurgery
Guido Barbagli Center for Reconstructive ti Urethral lsurgery Arezzo - Italy E-mail: guido@rdn.it Website: www.urethralcenter.it Portuguese Andrological Association National Meeting June 21-23, 2008 Oporto
More informationThird & Fourth Degree Tears guideline (GL926)
Third & Fourth Degree Tears guideline (GL926) Approval Approval Group Job Title, Chair of Committee Date Maternity & Children s Services Clinical Governance Committee Chair, Maternity Clinical Governance
More informationPost-Traumatic Female Urethral Reconstruction
Post-Traumatic Female Urethral Reconstruction Jerry G. Blaivas, MD, and Rajveer S. Purohit, MD, MPH Corresponding author Jerry G. Blaivas, MD The New York Presbyterian Hospital, Weill Cornell Medical Center,
More informationFISTULA CAMPAIGNS ARE THEY OF ANY BENEFIT?
ORIGINAL ARTICLE FISTULA CAMPAIGNS ARE THEY OF ANY BENEFIT? Cetin Cam 1, Ates Karateke 2, Arman Ozdemir 3, Candemir Gunes 4, Cem Celik 5 *, Buhara Guney 1, Dogan Vatansever 1 Departments of Pelvic 1 Reconstructive
More informationInjection of Urethral Bulking Agents
Injection of Urethral Bulking Agents Department of Gynaecology Patient Information What are urethral bulking agents? Urethral bulking agents are substances that are injected to support the bladder neck.
More informationREPAIR OF LARGE CYSTOCELE
REPAIR OF LARGE CYSTOCELE WITH RAZ SUSPENSION 17 VAGINAL INCISION AND DISSECTION Premarin cream application to the anterior vagina daily for 1 month before cystocele repair enriches the vasculature and
More informationUniversity of Alberta Reconstructive Urology Fellowship
FACULTY OF MEDICINE AND DENTISTRY DEPARTMENT OF SURGERY DIVISION OF UROLOGY Keith Rourke, MD, FRCSC Reconstructive Urology Professor Chair of Academic Urology Reconstructive Urology Fellowship Director
More informationIntroduction/Learning Objectives. Incontinence: Natural History. Course Outline 10/14/2016. Urinary Incontinence: Conservative Measures
Management of Urinary Complications after Prostatectomy Course Faculty: Introduction/Learning Objectives Jaspreet S. Sandhu, MD Associate Attending Urologist Department of Surgery/Urology Memorial Sloan
More informationNational Defense Medical Center, Taipei, Taiwan.
CONGENITAL SEMINAL VESICLE CYST ASSOCIATED WITH IPSILATERAL RENAL AGENESIS MIMICKING BLADDER OUTLET OBSTRUCTION: A CASE REPORT AND REVIEW OF THE LITERATURE Chien-Chang Kao, 1 Ching-Jiunn Wu, 2 Guang-Huan
More informationVideo-urodynamics. P J R Shah Institute of Urology and UCH
Video-urodynamics P J R Shah Institute of Urology and UCH Bladder Function Storage Capacity and Pressure Emptying Pressure/flow/emptying URODYNAMIC INVESTIGATIONS Free urine flow rate Urethral pressure
More informationGuide to Pelvic Floor Multicompartment Scanning
Guide to Pelvic Floor Multicompartment Scanning These guidelines have been prepared by Giulio A. Santoro, MD, PhD, Head Pelvic Floor Unit, Section of Anal Physiology and Ultrasound, Coloproctology Service,
More informationBen Herbert Alex Wojtowicz
Ben Herbert Alex Wojtowicz 54 year old female presenting with: Dragging sensation Urinary incontinence Some faecal incontinence HPC Since May 14 had noticed a mass protruding from the vagina when going
More informationCase: Spontaneous bladder rupture presenting as sudden-onset abdominal pain in a child after many years in remission from bladder rhabdomyosarcoma
Case: Spontaneous bladder rupture presenting as sudden-onset abdominal pain in a child after many years in remission from bladder rhabdomyosarcoma Cyrus Chehroudi; Kourosh Afshar, MD University of British
More informationClinical Curriculum: Urogynecology
Updated July 201 Clinical Curriculum: Urogynecology GOAL: The primary goal of the Urogynecology rotation at the University of Alabama at Birmingham (UAB) is to train physicians to have a broad knowledge
More informationUroradiology For Medical Students
Uroradiology For Medical Students Lesson 4: Cystography & Urethrography - Part 2 American Urological Association Review Cystography is useful in evaluating the bladder, the urethra and the competence of
More information