Prospective Study of Role of Endoscopic Approach in the Management of Ureterovaginal Fistula

Abstract

Introduction: The causes of iatrogenic post-operative ureterovaginal fistulae (UVF) include ureteral laceration or transection, blunt avulsion, crush injury, partial or complete suture ligation, and ischemia due to operative devitalization of the ureteral blood supply and/or cautery injury. Traditionally, most ureterovaginal fistulas have been repaired by ureteroneocystostomy. In recent years, Endourological management is highly successful in treating ureterovaginal fistulas and ureteral stricture does not appear to be a common complication. Aim: The aim of our study was to evaluate the endourological management of iatrogenic Ureterovaginal fistula.Materials and Methods: A total of 60 patients referred to us after hysterectomy was confirmed of UVF. Once the diagnosis is confirmed, all patients underwent retrograde ureterogram and ureteroscopy with double-J stenting if stenting was not achievable, percutaneous nephrostomy (PCN) was performed, and then after 4 weeks retrograde double-J stenting was attempted. Results: About 58 (96.6%) out of 60 patients were managed successfully with retrograde ureterogram and ureteroscopy with double-J stenting and 2 (3.4%) out of 60 patients required PCN followed by after 4-6 weeks retrograde successful double-J stenting. Conclusion: Ureteroscopy and placement of double-J stent is technically challenging but is still a good option if detected and intervened early, causing minimal morbidity and discomfort. It is more effective, reliable, less invasive, and readily accepted by patients.