Functional: Urinary Fistulae: Difference between revisions
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===== Surgery ===== | ===== Surgery ===== | ||
* '''Pre-operative Counselling''' | * '''<span style="color:#ff0000">Pre-operative Counselling</span>''' | ||
**'''Sexual activity should be documented | **'''<span style="color:#ff0000">Sexual activity should be documented</span>''' | ||
*** '''Some vaginal procedures, including the Latzko procedure, may result in vaginal shortening and postoperative dyspareunia''' | *** '''Some vaginal procedures, including the Latzko procedure, may result in vaginal shortening and postoperative dyspareunia''' | ||
** '''Pre-operative estrogen supplementation may be beneficial in the postmenopausal patient with vaginal atrophy; topical estrogen preparations may improve vascularity and local tissue quality''' | ** '''Pre-operative estrogen supplementation may be beneficial in the postmenopausal patient with vaginal atrophy; topical estrogen preparations may improve vascularity and local tissue quality''' | ||
* '''Approaches (2):''' | * '''<span style="color:#ff0000">Approaches (2):</span>''' | ||
*#'''Transvaginal''' | *#'''<span style="color:#ff0000">Transvaginal</span>''' | ||
*#'''Transabdominal (transvesical) | *#'''<span style="color:#ff0000">Transabdominal (transvesical)</span>''' | ||
*#* '''Success rates are similar between the two approaches''' | *#* '''Success rates are similar between the two approaches''' | ||
*#** The most important factor is the experience of the operating surgeon | *#** The most important factor is the experience of the operating surgeon | ||
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** '''Excision of the fistula tract itself is not always necessary and may even compromise the repair in some patients''' | ** '''Excision of the fistula tract itself is not always necessary and may even compromise the repair in some patients''' | ||
** '''The interposition of a healthy, well-vascularized tissue flap during VVF repair may be beneficial under certain circumstances''' (complex fistulae, such as those that have recurred after a prior attempt at repair, those related to previous radiotherapy, ischemic or obstetric fistulae, large fistulae, and those associated with a difficult or tenuous closure because of poor tissue quality). | ** '''The interposition of a healthy, well-vascularized tissue flap during VVF repair may be beneficial under certain circumstances''' (complex fistulae, such as those that have recurred after a prior attempt at repair, those related to previous radiotherapy, ischemic or obstetric fistulae, large fistulae, and those associated with a difficult or tenuous closure because of poor tissue quality). | ||
*** '''Most commonly used flaps for VVF repaired:''' | *** '''<span style="color:#ff0000">Most commonly used flaps for VVF repaired:</span>''' | ||
**** '''Transvaginal repair: Martius flap or peritoneum''' | **** '''<span style="color:#ff0000">Transvaginal repair: Martius flap or peritoneum</span>''' | ||
**** '''Transabdominal: omentum or peritoneum''' | **** '''<span style="color:#ff0000">Transabdominal: omentum or peritoneum</span>''' | ||
*** '''Other options for a flap include:''' | *** '''Other options for a flap include:''' | ||
**** '''Gracilis muscle''' | **** '''Gracilis muscle''' | ||
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**** '''Seromuscular intestinal flaps''' | **** '''Seromuscular intestinal flaps''' | ||
**** '''Rectum abdominis flaps''' | **** '''Rectum abdominis flaps''' | ||
***** '''Martius flap:''' | ***** '''<span style="color:#ff0000">Martius flap:</span>''' | ||
****** Labial fat pad consisting of adipose tissue and connective tissue | ****** Labial fat pad consisting of adipose tissue and connective tissue | ||
****** '''Blood supply derives from:''' | ****** '''<span style="color:#ff0000">Blood supply derives from:</span>''' | ||
******# '''Superiorly from the external pudendal artery''' | ******# '''<span style="color:#ff0000">Superiorly from the external pudendal artery</span>''' | ||
******# '''Laterally from the obturator artery''' | ******# '''<span style="color:#ff0000">Laterally from the obturator artery</span>''' | ||
******# '''Inferiorly from the posterior labial vessels (branch of the internal pudendal artery)''' | ******# '''<span style="color:#ff0000">Inferiorly from the posterior labial vessels (branch of the internal pudendal artery)</span>''' | ||
****** '''Preferred for low or distal fistulae''' '''involving the trigone, bladder neck, and urethra''' | ****** '''Preferred for low or distal fistulae''' '''involving the trigone, bladder neck, and urethra''' | ||
***** '''Peritoneal flap:''' | ***** '''Peritoneal flap:''' | ||