Ureteric-vaginal fistula: from etiology to treatment tactics
Introduction. Ureterovaginal fistula fistulas are resulted by an unrecognized injury of the ureter, which mainly occurs during gynecological operations. The introduction of various surgical energy devices in gynecology and oncogynecology has led to the factб that coagulation necrosis has become a common form of ureter injury. The first treatment step for late diagnosed ureter injuries is use of the minimally invasive endourological approach and ureteral stenting.
Materials and methods. The treatment experience of 11 patients with ureterovaginal fistulas in the period from 2016 to 2019 was analyzed.
Results: An attempt to urethroscopy and retrograde stenting of the ureter was made in 8 patients (73% of the total number of patients). In 5 patients (63.5%) it was managed to perform stenting, and in 3 patients (36.5%) the procedure failed. Ureter stenting was effective in 4 patients (50% of the total number of patients in whom stenting was attempted and 80% of the number of patients who had successful stenting). 7 patients (64%) underwent reconstruction of the ureter pelvic part.
Discussion. The question of the ureterovaginal fistula classification for the choice of a differentiated approach to treatment remains open. In order to prevent the fistula persistence in patients with incomplete ureterovaginal fistulas, in whom it is indicated to reconstruct the lower third of the ureter, a transvesical resection of the ureter orifice and the intramutal part of the affected ureter is also required.
Conclusion. The modern possibilities of reconstructive urology and the use of minimally invasive technologies allows to eliminate fistula and restore the urodynamics of the upper urinary tract in most patients. But a change in the etiological structure and clinical picture of the modern ureter injury and its consequences require ureterovaginal fistulas classification optimizations for a differentiated treatment approach and improvement the results.