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• W3106636610 abstract "Study Objective The objective of this video is to present the surgical management of a large vesicovaginal fistula with ureters presenting through the fistula with concomitant colpocleisis. Design Surgical Video. Setting The patient was placed in the dorsal lithotomy position for the entirety of the surgery. Patients or Participants We present the case of an 83 year-old female with a history of stage IV prolapse who underwent initial treatment with placement of a pessary. After a year following pessary placement, the patient had the device removed and urine was noted to be in the vaginal vault, highly suspicious for a vesicovaginal fistula. Subsequently, the patient had a cystourethrogram confirming a 0.7 × 1 cm vesicovaginal fistula. For further evaluation and surgical planning, the patient underwent an exam under anesthesia and cystourethroscopy. On vaginal exam, the patient was noted to have stage IV prolapse with a large 5 cm vesicovaginal fistula with the ureters clearly visible, approximately 3 cm from the opening of the fistula. Following evaluation, the patient decided to proceed with definitive surgical management. Interventions Vesicovaginal fistula repair at time of colpocleisis. Measurements and Main Results The patient underwent a vesicovaginal fistula repair with concomitant colpocleisis. The case was performed by Urology and Urogynecology in order to preserve ureteral integrity. At the patient's one month follow up, she had no complaints of prolapse or vaginal leaking. She additionally underwent a cystourogram demonstrating no leakage at the site of repair. Conclusion Neglect of a vaginal pessary can lead to serious complications indicating the importance of patient education and careful follow-up. Surgical planning is a key component in effectively managing a vesicovaginal fistula with ureteral presentation in order to preserve ureteral integrity. Concomitant vesicovaginal repair and colpocleisis can be performed safely with effective cure of a vesicovaginal fistula and stage IV prolapse. The objective of this video is to present the surgical management of a large vesicovaginal fistula with ureters presenting through the fistula with concomitant colpocleisis. Surgical Video. The patient was placed in the dorsal lithotomy position for the entirety of the surgery. We present the case of an 83 year-old female with a history of stage IV prolapse who underwent initial treatment with placement of a pessary. After a year following pessary placement, the patient had the device removed and urine was noted to be in the vaginal vault, highly suspicious for a vesicovaginal fistula. Subsequently, the patient had a cystourethrogram confirming a 0.7 × 1 cm vesicovaginal fistula. For further evaluation and surgical planning, the patient underwent an exam under anesthesia and cystourethroscopy. On vaginal exam, the patient was noted to have stage IV prolapse with a large 5 cm vesicovaginal fistula with the ureters clearly visible, approximately 3 cm from the opening of the fistula. Following evaluation, the patient decided to proceed with definitive surgical management. Vesicovaginal fistula repair at time of colpocleisis. The patient underwent a vesicovaginal fistula repair with concomitant colpocleisis. The case was performed by Urology and Urogynecology in order to preserve ureteral integrity. At the patient's one month follow up, she had no complaints of prolapse or vaginal leaking. She additionally underwent a cystourogram demonstrating no leakage at the site of repair. Neglect of a vaginal pessary can lead to serious complications indicating the importance of patient education and careful follow-up. Surgical planning is a key component in effectively managing a vesicovaginal fistula with ureteral presentation in order to preserve ureteral integrity. Concomitant vesicovaginal repair and colpocleisis can be performed safely with effective cure of a vesicovaginal fistula and stage IV prolapse." @default.
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• W3106636610 date "2020-11-01" @default.
• W3106636610 modified "2023-09-27" @default.
• W3106636610 title "Repair of Vesicovaginal Fistula at Time of Colpocleisis" @default.
• W3106636610 doi "https://doi.org/10.1016/j.jmig.2020.08.339" @default.
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