[25] Urinary bladder repair after vesico-uterine fistulectomy and hysterectomy using ‘omentum wrap’: A novel technique

Objective: To present a case of urinary bladder repair after vesico-uterine fistulectomy and hysterectomy using ‘omentum wrap’, as vesical fistulae, irrespective of their distal component, are a challenge for urologists and uro-gynaecologists alike. The complex nature of these fistulae and their rep...

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Autores principales:	Said Yaiesh, Tariq Al-Shaiji
Formato:	article
Lenguaje:	EN
Publicado:	Taylor & Francis Group 2018
Materias:	Diseases of the genitourinary system. Urology RC870-923
Acceso en línea:	https://doaj.org/article/6a1e2816cad249babf5720a7b0e4c6d7
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spelling	oai:doaj.org-article:6a1e2816cad249babf5720a7b0e4c6d72021-12-02T10:11:39Z[25] Urinary bladder repair after vesico-uterine fistulectomy and hysterectomy using ‘omentum wrap’: A novel technique2090-598X10.1016/j.aju.2018.10.072https://doaj.org/article/6a1e2816cad249babf5720a7b0e4c6d72018-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2090598X18301669https://doaj.org/toc/2090-598XObjective: To present a case of urinary bladder repair after vesico-uterine fistulectomy and hysterectomy using ‘omentum wrap’, as vesical fistulae, irrespective of their distal component, are a challenge for urologists and uro-gynaecologists alike. The complex nature of these fistulae and their repair has affected outcomes of the documented treatment modalities. In general, higher fistula origin and insertion, and prolonged presentation are indices of poorer outcomes of treatment. Methods: We present the case of a 54-year-old multiparous woman who presented to our clinic with total urinary incontinence (UI). She has had a history of use of vaginal pessaries and misdiagnosis with stress UI that had led to the performance of trans-obturator tape (TOT) insertion, unnecessarily. Post-TOT the patient’s UI worsened from occasional to total. Investigations initially showed vesico-vaginal fistula, but examination under anaesthesia by cystoscopy and hysteroscopy showed a large vesico-uterine fistula. Lower midline fistula repair was complicated by a chronically inflamed friable bladder on cystostomy and total abdominal hysterectomy after uterine transection due to adherent uterine and anterior vaginal walls to the bladder. Bladder repair was augmented with omental flap interposition posteriorly to cover the fistula site, and omental flap wrapping superiorly, laterally and anteriorly to enhance its recovery. The patient had an uneventful postoperative recovery and follow-up cystography showed a small capacity bladder but no leakage. Results: To our knowledge this is the first attempt of its kind to utilise an omental flap to support bladder repair in a wrapped fashion. The omentum is known for its extraordinary support mechanisms, mechanical and anti-inflammatory, and has been incorporated into many forms of repairs as a flap and graft. In what looked like a poor outcome bladder repair due to extremely inflamed tissue, the bladder healed completely in a short time. Conclusion: Vesical fistulae are difficult entities to diagnose and treat. Incorporation of innovative surgical principles of repair from other experiences can improve outcomes of traditional procedures.Said YaieshTariq Al-ShaijiTaylor & Francis GrouparticleDiseases of the genitourinary system. UrologyRC870-923ENArab Journal of Urology, Vol 16, Iss , Pp S12-S13 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the genitourinary system. Urology RC870-923
spellingShingle	Diseases of the genitourinary system. Urology RC870-923 Said Yaiesh Tariq Al-Shaiji [25] Urinary bladder repair after vesico-uterine fistulectomy and hysterectomy using ‘omentum wrap’: A novel technique
description	Objective: To present a case of urinary bladder repair after vesico-uterine fistulectomy and hysterectomy using ‘omentum wrap’, as vesical fistulae, irrespective of their distal component, are a challenge for urologists and uro-gynaecologists alike. The complex nature of these fistulae and their repair has affected outcomes of the documented treatment modalities. In general, higher fistula origin and insertion, and prolonged presentation are indices of poorer outcomes of treatment. Methods: We present the case of a 54-year-old multiparous woman who presented to our clinic with total urinary incontinence (UI). She has had a history of use of vaginal pessaries and misdiagnosis with stress UI that had led to the performance of trans-obturator tape (TOT) insertion, unnecessarily. Post-TOT the patient’s UI worsened from occasional to total. Investigations initially showed vesico-vaginal fistula, but examination under anaesthesia by cystoscopy and hysteroscopy showed a large vesico-uterine fistula. Lower midline fistula repair was complicated by a chronically inflamed friable bladder on cystostomy and total abdominal hysterectomy after uterine transection due to adherent uterine and anterior vaginal walls to the bladder. Bladder repair was augmented with omental flap interposition posteriorly to cover the fistula site, and omental flap wrapping superiorly, laterally and anteriorly to enhance its recovery. The patient had an uneventful postoperative recovery and follow-up cystography showed a small capacity bladder but no leakage. Results: To our knowledge this is the first attempt of its kind to utilise an omental flap to support bladder repair in a wrapped fashion. The omentum is known for its extraordinary support mechanisms, mechanical and anti-inflammatory, and has been incorporated into many forms of repairs as a flap and graft. In what looked like a poor outcome bladder repair due to extremely inflamed tissue, the bladder healed completely in a short time. Conclusion: Vesical fistulae are difficult entities to diagnose and treat. Incorporation of innovative surgical principles of repair from other experiences can improve outcomes of traditional procedures.
format	article
author	Said Yaiesh Tariq Al-Shaiji
author_facet	Said Yaiesh Tariq Al-Shaiji
author_sort	Said Yaiesh
title	[25] Urinary bladder repair after vesico-uterine fistulectomy and hysterectomy using ‘omentum wrap’: A novel technique
title_short	[25] Urinary bladder repair after vesico-uterine fistulectomy and hysterectomy using ‘omentum wrap’: A novel technique
title_full	[25] Urinary bladder repair after vesico-uterine fistulectomy and hysterectomy using ‘omentum wrap’: A novel technique
title_fullStr	[25] Urinary bladder repair after vesico-uterine fistulectomy and hysterectomy using ‘omentum wrap’: A novel technique
title_full_unstemmed	[25] Urinary bladder repair after vesico-uterine fistulectomy and hysterectomy using ‘omentum wrap’: A novel technique
title_sort	[25] urinary bladder repair after vesico-uterine fistulectomy and hysterectomy using ‘omentum wrap’: a novel technique
publisher	Taylor & Francis Group
publishDate	2018
url	https://doaj.org/article/6a1e2816cad249babf5720a7b0e4c6d7
work_keys_str_mv	AT saidyaiesh 25urinarybladderrepairaftervesicouterinefistulectomyandhysterectomyusingomentumwrapanoveltechnique AT tariqalshaiji 25urinarybladderrepairaftervesicouterinefistulectomyandhysterectomyusingomentumwrapanoveltechnique
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[25] Urinary bladder repair after vesico-uterine fistulectomy and hysterectomy using ‘omentum wrap’: A novel technique

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