Skip to main content
SpringerLink
Log in

Vesikovaginale Fisteln

Diagnostik und Therapie

Vesicovaginal fistulas

Diagnostics and treatment

  • Leitthema
  • Published:
Der Urologe, Ausgabe A Aims and scope Submit manuscript

Zusammenfassung

Vesikovaginale Fisteln sind in Entwicklungsländern häufig das Ergebnis von verlängerten Austreibungsphasen während des Geburtsvorgangs. In den westlichen Industrienationen sind die meisten vesikovaginalen Fisteln durch Blasenverletzungen während chirurgischer Eingriffe verursacht. Die Inzidenz geburtshilflicher Fisteln beträgt ca. 3–4/1000 Geburten in Westafrika. Die Inzidenz der chirurgisch bedingten Fisteln ist niedrig, 75% werden durch gynäkologische Eingriffe verursacht. Das Hauptsymptom einer Vesikovaginalfistel ist der permanente Urinverlust. Verschiedene operative Zugangswege zur Korrektur einer Vesikovaginalfistel, die alle ähnlich gute Verschlussraten aufweisen, sind beschrieben worden: transvaginal, transvesikal und transperitoneal.

Unabhängig vom gewählten Zugangsweg sollten folgende Voraussetzungen für einen erfolgreichen Fistelverschluss eingehalten werden: gute chirurgische Exposition der Fistel mit ausgedehnter Mobilisation von Harnblase und Vagina, Fistelexzision, spannungsfreier Verschluss von Harnblase und Vagina sowie, wenn erforderlich, Einbringen eines Interpositionslappens, wie beispielsweise eines Martius-Lappens, des großen Netzes oder des Peritoneums.

Unter Verwendung dieser chirurgischen Prinzipien können 85% der Patientinnen von ihrer Vesikovaginalfistel im Rahmen der Erstoperation geheilt werden.

Abstract

Vesicovaginal fistulas are often the result of obstetric trauma in third world countries or gynaecologic surgery in developed countries. The incidence of obstetric trauma is approximately 3–4/1000 births in West Africa. The incidence of fistulas as a result of surgery has remained relatively unchanged for years; 75% occur during gynaecologic procedures. The main clinical symptom of a vesicovaginal fistula is urine loss.

Different surgical techniques with similar repair results are available: transvaginal approach, transvesical approach and transperitoneal approach. Irrespective of the approach used, requirements for successful repair include adequate surgical exposure, wide mobilization of the bladder and vagina, excision of the fistula tract, tension-free closure of the bladder and vagina, and placement of an interposition flap, i.e. Martius flap, omentum, peritoneum, when indicated.

Using these surgical techniques, around 85% of women can be cured from their vesicovaginal fistula with a single operation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Sim JM (1852) On the treatment of vesico-vaginal fistula. Am J Med Sci 23: 59–82

    Google Scholar 

  2. O’Conor VJJ, Sokol JK, Bulkley GJ, Nanninga JB (1973) Suprapubic closure of vesicovaginal fistula. J Urol 123: 839–840

    Google Scholar 

  3. Trancer ML (1992) Observations on prevention and management of vesicovaginal fistula after total hysterectomy. Surg Gynecol Obstet 175: 501–506

    CAS  PubMed  Google Scholar 

  4. Lee AL, Symmonds RE, Williams TJ (1988) Current status of genitourinary fistulas. Obstet Gynecol 72: 313–319

    Google Scholar 

  5. Kursch ED, Morse RM, Resnik MI, Persky L (1988) Prevention and development of a vesicovaginal fistula. Surg Gynecol Obstet 166: 409–412

    Google Scholar 

  6. Gilmour DT, Dwyer PL, Carey MP (1999) Lower urinary tract injury during gynecologic surgery and ist detection by intraoperative cystoscopy. Obstet Gynecol 94(Suppl): 883–839

    Google Scholar 

  7. Mattingly RF (1978) Acute operative injury to the urinary tract. Clin Obstet Gynecol 5: 123–149

    Google Scholar 

  8. Ba-Thike K, Aye T, Oo N (1992) Tuberculous vesicovaginal fistula. Int J Gynecol Obstet 37: 127–130

    Google Scholar 

  9. Goldstein I, Wise GJ, Trancer ML (1990) A vesicovaginal fistula and intravesical foreign body: a rare case of the neglected pessary. Am J Obstet Gynecol 163: 589–591

    Google Scholar 

  10. Margolis T, Mercer LJ (1994) Vesicovaginal fistula. Obstet Gynecol Surv 49: 840–847

    Google Scholar 

  11. Smith GL, Williams G (1999) Vesicovaginal fistula. BJU Int 83: 564–569

    Google Scholar 

  12. Arrowsmith SD (1994) Genitourinary reconstruction in obstetic fistulas. J Urol 152: 403–406

    Google Scholar 

  13. WOO HH, Rosario DJ, Chapple CR (1996) The treatment of vesicovaginal fistulae. Eur Urol 29: 1–9

    Google Scholar 

  14. Graham JB (1965) Vaginal fistulas following radiotherapy. Surg Gynecol Obstet 120: 1019–1030

    Google Scholar 

  15. Goodwin WE, Scardino PT (1980) Vesicovaginal and ureterovaginal fistulas: a summary of 25 years of experience. J Urol 123: 370–374

    Google Scholar 

  16. Davits RJAM, Miranda SI (1991) Conservative treatment of vesicovaginal fistulas by bladder drainage alone. Br J Urol 68: 155–156

    Google Scholar 

  17. Zimmern PE, Hadley HR, Staskin D (1985) Genitourinary fistulas: Vaginal approach for repair of vesicovaginal fistulas. Clin Obstet Gynaecol 12: 403–413

    Google Scholar 

  18. Elkins TE (1994) Surgery for the obstetic vesicovaginal fistula: a review of 100 operations in 82 patients. Am J Obstet Gynecol 170: 1108–1120

    Google Scholar 

  19. Barnes R (1977) Transvaginal repair of vesicovaginal fistulas. Urology 10: 258

    Google Scholar 

  20. Sussmann E, Raz S (1999) Vesikovaginale Fisteln. In: Schreiter F (Hrsg) Plastisch-rekonstruktive Chirurgie in der Urologie. Thieme, Stuttgart New York, S 231–236

  21. Blandy JP, Badenoch DF, Fowler CG, Jenkins BJ, Thomas NWM (1991) Early repair of iatrogenic injury to the ureter or bladder after gynaecological surgery. J Urol 146: 761–765

    Google Scholar 

  22. Wang Y, Hadley HR (1980) Nondelayed transvaginal repair of high lying vesicovaginal fistula. J Urol 144: 34–36

    Google Scholar 

  23. Blaivas JG, Heritz DM, Romanzi LI (1995) Early versus late repair of vesicovaginal fistulas: vaginal and abdominal approaches. J Urol 153: 1110–1113

    Google Scholar 

  24. Huang WC, Zinman LN, Bihrle W (2002) Surgical repair of vesicovaginal fistulas. Urol Clin North Am 29: 709–723

    Google Scholar 

  25. Zinman LN, Libertino JA, Smith JJ (1998) Vesico-vaginal fistula.In: Reconstructive urologic surgery, 3. edn. Mosby, St. Louis, pp 259–274

  26. Steg A (1977) Le traitement des fistules vesicovaginales par la technique de Chassar-Moir. Ann Urol 11: 103

    Google Scholar 

  27. Zimmern PE (1985) Genitourinary fistulae. Urol Clin North Am 12: 361

    Google Scholar 

  28. Zimmern PE (1986) Vesicovaginal and urethrovaginal fistulae. Semin Urol 4: 24

    Google Scholar 

  29. Dupont MC, Raz S (1996) Vaginal approach to vesicovaginal fistula repair. Urology 48: 7–9

    Article  CAS  PubMed  Google Scholar 

  30. Carr LK, Webster G (1996) Abdominal repair of vesicovaginal fistula. Urology 48: 10–1

    Article  CAS  Google Scholar 

  31. Nesrallah LJ, Srougi M, Gitte RF (1999) The O’Conor technique: The gold standard for supratrigonal vesicovaginal fistula repair. J Urol 161: 566–568

    Google Scholar 

  32. Nezhat CH, Nezhat F, Nezhat C, Rottenberg H (1994) Laparoscopic repair of a vesicovaginal fistula: a case report. Obstet Gynecol 83: 899–901

    Google Scholar 

  33. Ou CS, Huang UC, Tsuang M, Rowbotham R (2004) Laparoscopic repair of vesicovaginal fistula. J Laparoendosc Adv Surg Tech A 14: 17–21

    Google Scholar 

  34. Von Theobald P, Hamel P, Febbraro W (1998) Laparoscopic repair of a vesicovaginal fistula using an omental J flap. Br J Obstet Gynaecol 105: 1216–1218

    Google Scholar 

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. Urologische Klinik, Universitätsklinikum, Heidelberg

    A. Haferkamp, N. Wagener, S. Buse, A. Reitz, J. Pfitzenmaier & M. Hohenfellner

  2. Abteilung Radiodiagnostik, Radiologische Klinik, Universitätsklinikum, Heidelberg

    P. Hallscheidt

  3. Urologische Klinik, Universitätsklinikum, INF 110, 69120, Heidelberg

    A. Haferkamp

Authors
  1. A. Haferkamp
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. Wagener
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Buse
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Reitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Pfitzenmaier
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. Hallscheidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Hohenfellner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Haferkamp.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Haferkamp, A., Wagener, N., Buse, S. et al. Vesikovaginale Fisteln. Urologe [A] 44, 270–276 (2005). https://doi.org/10.1007/s00120-005-0766-z

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-005-0766-z

Schlüsselwörter

Keywords

Search

Navigation