OPEN:
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The cystoscopy was accomplished by ureteric catheterisation, to make sure the ureteric blockade and evaluate its level, as seen in the ureterovaginal fistula.
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By performing the general anaesthesia, the patients were diagnosed with ureterovaginal fistula, patients were placed in a supine position and examination was conducted in the lower oblique (Gibson’s incision/muscle cutting incision) approach.
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The ureter proximal was separated and ureteroneocystostomy only or with Boari flap/psoas hitch was performed with a double J stent. The stent was inserted and placed for 6 weeks in all the cases and afterward removed under local anaesthesia.
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The patients need to visit hospital and rechecked within 2 weeks after surgery. Later, the review was maintained with an interval of 3 to 6 months.
LAPAROSCOPIC:
This approach is minimally invasive surgery for treatment of UVF.
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Placement of retrograde ureteral stent is typically attempted when ureter is still continuous. Or else, a percutaneous nephrostomy tube is inserted for temporary management follows by attempts at antegrade stent placement.
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Improvements in ureteroscopes, ureteral stents, guide wires and endourological techniques have been increased the likelihood that a ureteral stent can be effectively placed in the existence of ureterovaginal fistula. An endourological procedure should be the ideal choice in the ureterovaginal fistulae treatment.
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In the patient describes, an IVP discovered obstruction of the duplicated ureterovaginal fistulae. By using a 6.5-French ureteroscope, we may identify the ureteral lumina. Endourological treatment of duplicated ureterovaginal fistulae would be preferred in the initial approach for resolution of the fistulae.
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If endourological treatment is failed, ureteroneocystostomy can be another treatment option. Common sheath reimplantation can give excellent results for duplicated ureterovaginal fistulae in the existence of adequate submucosal tunnel diameter and length.
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To ensure a tension free anastomosis we advocate psoas hitch support.
