Limits...
Vesico-vaginal fistula post cold cup bladder biopsy: mini review.

Mawhinney A, Hameed A, Thwaini A, Mulholland C - Open Access J Urol (2010)

Bottom Line: A case of low grade superficial bladder cancer was treated with multiple resections of bladder tumor and a single installation of mitomycin post initial resection which successfully cleared her bladder cancer, but nevertheless led to a small size and scarred bladder.In addition there was a long history of smoking with its effects on tissue integrity and healing.The rate of successful fistula repair reported in the literature varies between 70% and 100% in nonradiated patients, with similar results when a vaginal or abdominal approach is performed, the mean success rates being 91% and 97%, respectively.

View Article: PubMed Central - PubMed

Affiliation: Belfast City Hospital, Urology Department, Belfast, Northern Ireland, UK.

ABSTRACT

Introduction: We report a case of a vesico-vaginal fistula (VVF) post cold cup biopsy; to our knowledge this is the only reported case. We present the clinical history/presentation, investigation and the outcome of the treatment. VVFs are among the most distressing complications of gynecologic and obstetric procedures. The risk of developing a VVF is more than 1% after radical surgery and radiotherapy for malignancies. Management of these fistulas has been better defined and standardized over the last decade.

Methods and results: A case of low grade superficial bladder cancer was treated with multiple resections of bladder tumor and a single installation of mitomycin post initial resection which successfully cleared her bladder cancer, but nevertheless led to a small size and scarred bladder. In addition there was a long history of smoking with its effects on tissue integrity and healing. VVFs are very rare and are an unpleasant outcome post a cold cup biopsy, adding to the psychological and social effects of the surgical treatment.

Conclusion: Although cold cup biopsy is a normal day procedure performed by both residents and consultants, consensus should exist on how to treat a patient who has a bladder with defective integrity and small capacity. The rate of successful fistula repair reported in the literature varies between 70% and 100% in nonradiated patients, with similar results when a vaginal or abdominal approach is performed, the mean success rates being 91% and 97%, respectively.

No MeSH data available.


Related in: MedlinePlus

Cystoscopy image showing scarring around the right ureteric orifice and discrete fistula to centre of trigone.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3818888&req=5

f1-oaju-2-171: Cystoscopy image showing scarring around the right ureteric orifice and discrete fistula to centre of trigone.

Mentions: The biopsy histopathology results showed mild inflammation only. Three weeks later the patient reported sudden onset continuous leakage of urine. Urine dipstick analysis was normal, and clinical examination failed to show anything of significance apart from continuous vaginal wetting with urine. Cystoscopy was arranged – we did not use methylene blue as the fistula was easily diagnosed clinically, cystoscopically, and radiologically by IVU (intravenous urogram). Cystoscopy showed a well-formed fistulous tract at the site of the recent bladder biopsy, close to the right ureteric orifice (Figure 1). Radiological investigation was carried out as shown below and the fistulous tract was classified as a complex fistula. An IVU revealed normal upper tracts with contrast in the vagina (Figure 2).


Vesico-vaginal fistula post cold cup bladder biopsy: mini review.

Mawhinney A, Hameed A, Thwaini A, Mulholland C - Open Access J Urol (2010)

Cystoscopy image showing scarring around the right ureteric orifice and discrete fistula to centre of trigone.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3818888&req=5

f1-oaju-2-171: Cystoscopy image showing scarring around the right ureteric orifice and discrete fistula to centre of trigone.
Mentions: The biopsy histopathology results showed mild inflammation only. Three weeks later the patient reported sudden onset continuous leakage of urine. Urine dipstick analysis was normal, and clinical examination failed to show anything of significance apart from continuous vaginal wetting with urine. Cystoscopy was arranged – we did not use methylene blue as the fistula was easily diagnosed clinically, cystoscopically, and radiologically by IVU (intravenous urogram). Cystoscopy showed a well-formed fistulous tract at the site of the recent bladder biopsy, close to the right ureteric orifice (Figure 1). Radiological investigation was carried out as shown below and the fistulous tract was classified as a complex fistula. An IVU revealed normal upper tracts with contrast in the vagina (Figure 2).

Bottom Line: A case of low grade superficial bladder cancer was treated with multiple resections of bladder tumor and a single installation of mitomycin post initial resection which successfully cleared her bladder cancer, but nevertheless led to a small size and scarred bladder.In addition there was a long history of smoking with its effects on tissue integrity and healing.The rate of successful fistula repair reported in the literature varies between 70% and 100% in nonradiated patients, with similar results when a vaginal or abdominal approach is performed, the mean success rates being 91% and 97%, respectively.

View Article: PubMed Central - PubMed

Affiliation: Belfast City Hospital, Urology Department, Belfast, Northern Ireland, UK.

ABSTRACT

Introduction: We report a case of a vesico-vaginal fistula (VVF) post cold cup biopsy; to our knowledge this is the only reported case. We present the clinical history/presentation, investigation and the outcome of the treatment. VVFs are among the most distressing complications of gynecologic and obstetric procedures. The risk of developing a VVF is more than 1% after radical surgery and radiotherapy for malignancies. Management of these fistulas has been better defined and standardized over the last decade.

Methods and results: A case of low grade superficial bladder cancer was treated with multiple resections of bladder tumor and a single installation of mitomycin post initial resection which successfully cleared her bladder cancer, but nevertheless led to a small size and scarred bladder. In addition there was a long history of smoking with its effects on tissue integrity and healing. VVFs are very rare and are an unpleasant outcome post a cold cup biopsy, adding to the psychological and social effects of the surgical treatment.

Conclusion: Although cold cup biopsy is a normal day procedure performed by both residents and consultants, consensus should exist on how to treat a patient who has a bladder with defective integrity and small capacity. The rate of successful fistula repair reported in the literature varies between 70% and 100% in nonradiated patients, with similar results when a vaginal or abdominal approach is performed, the mean success rates being 91% and 97%, respectively.

No MeSH data available.


Related in: MedlinePlus