Espinosa-García CM, Ramírez-Isarraraz C, Rodríguez-Colorado ES, Gorbea-Chávez V, Granados-Martínez V

Language: Spanish
References: 13
Page: 181-186
PDF size: 349.32 Kb.

ABSTRACT

Background: Obstetric genitourinary fistulas can cause as a complication of uterine artery embolization due to necrosis of the uterus and/or bladder. Vaginal surgical treatment is a less invasive option with success rates of up to 84.12%.
Clinical case: A 40-year-old woman who came with a pregnancy of 35 5/7 weeks and placenta accreta, which was managed with uterine arteries embolization and obstetric hysterectomy after caesarean section. At 3 weeks she had vaginal urine loss; by physical examination and with support of dye test, cystoscopy and retrograde cystography, obstetric vesicovaginal fistula was diagnosed. After the improvement of the inflammatory process, vaginal fistulectomy was performed with modification of the Latzko technique. Its postoperative evolution was satisfactory and without recurrence of the fistula during the follow-up in the outpatient clinic.
Conclusion: This is the fifth case of post-embolization bladder necrosis reported in the literature. The favorable resolution of this case allows us to conclude that vaginal fistulectomy is a viable and safe alternative in the surgical treatment of this type of obstetric fistulas.

REFERENCES

1. De Ridder D. Vesicovaginal fistula: a major healthcare problem. Curr Opin Urol 2009; 19 (4): 358-61. DOI: 10.1097/ MOU.0b013e32832ae1b7.

2. Stanton C, et al. Challenges in measuring obstetric fistula. Int J Gynaecol Obstet 2007; 99 Suppl 1:S4-9. DOI: 10.1016/j. ijgo.2007.06.010.

3. Tayade S, et al. Vesicocervical fistula: a rare complication of lower segment caesarean section. Int J Biomed Res 2012; 3 (4): 221-3. doi: 10.7439/ijbr.v3i4.395.

4. Matsuzaki S, et al. Conservative management of placenta percreta. Int J Gynaecol Obstet 2018; 140 (3): 299-306. DOI: 10.1002/ijgo.12411.

5. Babaei MR, et al. Methotrexate infusion followed by uterine artery embolisation for the management of placental adhesive disorders: a case series. Clin Radiol 2019; 74 (5): 378-83. DOI: 10.1016/j.crad.2019.01.006.

6. Courbiere B, et al. Failure of conservative management in postpartum haemorrhage: uterine necrosis and hysterectomy after angiographic selective embolization with gelfoam. Eur J Obstet Gynecol Reprod Biol 2008; 140 (2): 291-3. DOI: 10.1016/j.ejogrb.2008.03.012.

7. Marín-Sánchez P, et al. Conservative management of vesicovaginal fistula after uterine and partial bladder necrosis due to embolization as a treatment for postpartum hemorrhage. Int Urogynecol J 2015; 26 (5): 773-4. DOI: 10.1007/ s00192-014-2617-1.

8. De Ridder D. An update on surgery for vesicovaginal and urethrovaginal fistulae. Curr Opin Urol 2011; 21 (4): 297- 300. doi: 10.1097/MOU.0b013e3283476ec8.

9. Kumar M, et al. Transvaginal Repair of Vesico Vaginal Fistula: A 10-year experience with analysis of factors affecting outcomes. Urol Int 2019; 103 (2): 218-22. DOI: 10.1159/000499411.

10. Kati B, et al. Which factors affecting the success of iatrogenic obstetric vesical fistulas? Ann Ital Chir 2018; 89: 534-39. DOI: https://doi.org /10.1016/S1569- 9056(18)32614-9.

11. Porcu G, et al. Uterus and bladder necrosis after uterine artery embolization for postpartum haemorrhage. BJOG 2005;112(1):122-3. doi: 10.1111/j.1471- 0528.2005.00306.x.

12. Maassen MS, et al. Complications and failure of uterine artery embolisation for intractable postpartum haemorrhage. BJOG 2009; 116 (1): 55-61. doi: 10.1111/j.1471- 0528.2008.01939.x.

13. Ferrer Puchol MD, et al. Embolización selectiva como tratamiento de la hemorragia obstétrica. Radiologia 2014;56(2):148-53. DOI: 10.1016/j.rx.2012.01.007.