TAILIEUCHUNG - Vaginal Surgery for Incontinence and Prolapse - part 9

Tắc nghẽn niệu quản thường không tìm thấy trong sự hiện diện của một lỗ rò vesicovaginal phức tạp. Sự vắng mặt của hydronephrosis trong trường hợp này phát sinh từ giải nén tự phát của niệu quản vào các lỗ rò, sản xuất một urogram sai tiêu cực. | 246 Vaginal Surgery for Incontinence and Prolapse opacification arising from urinary pooling or extravasation is noted. Ureteral obstruction often is not found in the presence of a complex vesicovaginal fistula. The absence of hydronephrosis in this case arises from spontaneous decompression of the ureter into the fistula producing a falsely negative urogram. Retrograde pyelography remains the study with highest diagnostic accuracy for diagnosing the site of a ureterovaginal fistula or the possibility of a combined uretero- and vesicovaginal fistula although no direct studies have evaluated this diagnostic technique against other imaging modalities. Voiding cystourethrography VCUG may demonstrate other lower urinary tract abnormalities that may impact upon surgical reconstruction vesicoureteral reflux cystocele urethral diverticulum Figure . Occasionally contrast examination of the vagina vaginography may help demonstrate an irregular fistulous tract. Zimmern et al 44 described the procedure for injecting contrast material through the vagina with a large balloon occluding the vaginal introitus. Occasionally more advanced imaging studies such as computed tomography CT or magnetic resonance imaging MRI scanning are indicated to localize a fistula site and determine regional tissue integrity. These circumstances most commonly arise in the case of fistulas resulting from malignant causes such as uterine or cervical cancer or in patients who have experienced postsurgical complications arising from the initial causative surgical procedure pelvic abscess or urinoma . Hilton 45 evaluated the role of urodynamics in women with lower urinary tract fistulas. In 30 women with fistulas a diverse group of urodynamics diagnoses were established 47 with genuine stress incontinence 44 with detrusor instability and 17 with poor bladder compliance. However none of these findings was predictable on the basis of the patient s symptoms. Urodynamics may be quite difficult to .

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