Journal of Reconstructive Urology

.: ORIGINAL RESEARCH
Vezikovajinal Fistül Cerrahisinde Transvezikal Onarım: Tek Merkeze Ait 15 Yıllık Deneyimler: Retrospektif Klinik Çalışma
Transvesical Repair in Vesicovaginal Fistula Surgery: 15-years Experiences of a Single Center: Retrospective Clinical Research
Ömer BAYRAKa, Ömer TURĞUTa, Haluk ŞENa, Sakıp ERTURHANa, İlker SEÇKİNERa
aGaziantep Üniversitesi Tıp Fakültesi, Üroloji ABD, Gaziantep, TÜRKİYE
J Reconstr Urol. 2021;11(2):90-6
doi: 10.5336/urology.2021-81006
Article Language: TR
Full Text
ÖZET
 Amaç: Çalışmamızda, benign patolojiler nedeniyle uygulanan cerrahiler sonrası meydana gelen vezikovajinal fistül (VVF) olgularında, transvezikal onarıma ait tek merkez, uzun dönem sonuçlarımızı sunmayı amaçladık. Gereç ve Yöntemler: 2005-2020 yılları arasında bilgisayar sistemimizden verilerine ulaşılabilen ve en az 6 aylık takipleri olan, transvezikal VVF onarım yapılan 49 hasta retrospektif olarak değerlendirildi. Hastaların yaşı, VVF'ye yol açan patolojisi, ek hastalığı, fistül boyutu, fistül yerleşimi ve takip süreleri kaydedildi. Transvezikal VVF onarımının ilk cerrahiden ne kadar sonra uygulandığı, komplikasyon ve nüks gelişip gelişmediği not edildi. Bulgular: Hastaların ortalama yaşı 45,4±10,3 (18-65) yıl olarak hesaplandı. Hastaların etiyolojisinde; 41'inde (%83,6) benign nedenlerde uygulanan histerektomi, 8'inde (%16,4) sezaryenin rol oynadığı görüldü. Ortalama fistül boyutu 17,6±10,4 (3-50) mm olarak hesaplandı. VVF; 46'sında (%93,8) supratrigonal, 3'ünde (%6,2) trigonal yerleşimliydi. İkisinde (%4,1) ilk yapılan cerrahi sonrası ilk 2 hafta içinde, 47'sinde (%95,9) ilk uygulanan cerrahiden ortanca 4 (3-72) ay sonra VVF onarımı yapıldığı gözlendi. Hiçbir hastada peroperatif komplikasyon gelişmedi, ancak 2'sine (%4,1) postoperatif dönemde kan transfüzyonu yapıldı. Ortalama 79,34±48,05 (8-172) aylık takiplerde, 47'sinde (%95,9) VVF'nin iyileştiği, 2'sinde (%4,1) nüks meydana geldiği saptandı. Nüks gelişimi ve peroperatif sistostomi yerleştirilmesi açısından istatistiksel anlamlı farklılık gözlenmedi (p=0,544). Yine çalışma kapsamında 3'ünde (%6,12) diabetes mellitus saptanmış olup, bu hastaların birinde (%2,04) nüks meydana geldi. Nüks gelişen her 2 hastanın da histerektomi öyküsü olduğu görüldü. Fistül boyutu ile nüks arasında ilişki saptanmadı (p=0,174). Sonuç: Benign nedenlerle uygulanan cerrahiler sonrası meydana gelen, vajen kafı veya mesanede supratrigonal yerleşimli VVF vakalarında, transvezikal VVF onarımı öncelikli tercih edilebilir. Özellikle 15 yıla uzanan süreçte, yüksek başarı oranları ve oldukça düşük nüks oranları bu tercih sebebini desteklemektedir.

Anahtar Kelimeler: Fistül; vezikovajinal; benign patolojiler; transvezikal
ABSTRACT
 Objective: In our study, we aimed to present our singlecenter, long-term results of transvesical vesicovaginal fistule (VVF) repair, occurred after surgeries due to benign pathologies. Material and Methods: Forty-nine patients who underwent transvesical VVF repair between 2005-2020, whose data were available from our database, and had at least 6 months of follow-up, were retrospectively evaluated. The age of the patients, pathology caused VVF, comorbidity, fistule size, fistule location, and follow-up periods were recorded. It was noted how long after the transvesical VVF repair was performed after the first surgery, and whether any complications or recurrence occurred. Results: The mean age of the patients was calculated as 45.4±10.3 (18-65) years. It was observed that hysterectomy performed for benign reasons in 41 (83.6%) patients, and cesarean in 8 (16.4%) patients played a role in the etiology of the patients. The mean fistula size was calculated as 17.6±10.4 (3-50) mm. VVF was supratrigonal in 46 (93.8%) patients, and trigonal in 3 (6.2%) patients. VVF repair was performed in 2 (4.1%) patients within the first 2 weeks after the first surgery, and in 47 (95.9%) patients with a median of 4 (3-72) months after the first surgery. There were no peroperative complications in any of the patients, but 2 (4.1%) patients received blood transfusion in the postoperative period. In an average of 79.34±48.05 (8-172) months of follow-up, it was found that VVF was cured in 47 (95.9%) patients, and recurrence occurred in 2 (4.1%) patients. There was no statistically significant difference in terms of recurrence and peroperative cystostomy placement (p=0.544). In the study, diabetes mellitus was found in 3 (6.12%) patients, and recurrence occurred in one (2.04%) of these patients. It was observed that both patients who had recurrence, accompanied a history of hysterectomy. There was no correlation between fistule size and recurrence (p=0.174). Conclusion: Transvesical VVF repair may be preferred primarily in VVF cases with a supratrigonal location in the bladder or vaginal cuff after surgery performed for benign reasons. High success rates, and very low recurrence rates, especially in a period of up to 15 years, support this preference.

Keywords: Fistule; vesicovaginal; benign pathologies; transvesical
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