FÍSTULAS VESICO-VAGINAIS: UMA VISÃO SOBRE MOÇAMBIQUE | VESICO-VAGINAL FÍSTULAE: MOZAMBIQUE, AN OVERVIEW

Resumo

PT:
Introdução: As fístulas vesico-vaginais são, de todas as fístulas do aparelho urinário, as mais frequentes.
A etiologia deste tipo de fístulas, varia de acordo com a região do globo. Nos países em vias de desenvolvimento, a prin-
cipal causa de fístulas vesico vaginais corresponde a complicações obstétricas. A pressão exercida pelo feto, nas paredes da
vagina, bexiga e uretra proximal leva muitas vezes à necrose dos tecidos. Esta necrose pode levar a um conjunto de compli-
cações que vão desde as fístulas vesico vaginais, estenose vaginal, atresia rectal, infertilidade secundária, ou mesmo à incom-
petência do esfíncter anal e osteíte púbica. Apresentamos 3 casos clínicos de fístulas vesico vaginais de causa obstétrica bem
como uma revisão dos aspectos teóricos e técnicos do diagnóstico e tratamento desta patologia.
Materiais e Métodos: Descrevem-se 3 casos clínicos de fístulas vesico vaginais de causa obstétrica tratadas em 2012. O
primeiro caso foi abordado por via vaginal reparado em três planos, utilizando-se o retalho de Martius. Os outros dois casos
devido à localização e complexidade da fístula foram abordados por via abdominal com interposição de epíploon.
Resultados: No primeiro caso a doente foi seguida noutra instituição, nos outros dois casos não houve recidiva da fístula
num follow up de 6 e 12 meses respectivamente.
Relativamente à correção cirúrgica obedeceu-se aos seguintes princípios: uma boa exposição do trajecto fistuloso, des-
bridamento do tecido desvitalizado e isquémico, utilização de retalhos bem vascularizados e preenchimento do espaço livre.
O encerramento foi realizado em vários planos, sem sobreposição das suturas, sempre sem tensão.
Discussão: As fístulas vesico-vaginais permanecem um enorme desafio do ponto de vista cirúrgico, necessitando de uma
abordagem multidisciplinar, bem como da criação de centros de referência.

Palavras-chave: Fístula vesicovaginal; Complicações do trabalho de parto


EN:
Introduction: The vesico-vaginal fistulae are among all urinary fistulae, the most common.
The etiology of this type of fistula, changes according to the region of the planet. In developing countries, where most of the population
don´t have access to obstetrical care, the main cause of vesico-vaginal fistulae corresponds to prolonged obstructed labor.
The pressure made by the fetus, into the vagina walls, bladder and proximal urethra often leads to tissue necrosis. This necrosis leads to
a set of complications ranging from vesico-vaginal fistula, vaginal stenosis, rectal atresia, secondary infertility, incompetent anal sphincter,
or osteitis pubis.
We present 3 clinical cases of obstetrical vesico-vaginal fistulae and a review of the theoretical and technical aspects of the diagnosis and
treatment of this pathology.
Materials and Methods:We present 3 cases of obstetrical vesico-vaginal fistulae treated in 2012.
In the first case we have used a vaginal approach, and we have repaired in three layers using a Martius flap.
In the other two cases we have used the abdominal approach, because of the location and complexity of the fistula,  with interposition of
epiplon.
Results: In the first case the follow up was made in other institution, the other two cases resolved after single surgery, no relapse was found
in 6 and 12 months follow up respectively.
In all the repairs the basic principles were followed:  adequate exposure of the fistula tract with debridement of devitalized and ischemic
tissue.
Watertight, and multiple-layer closure.
Tension-free, nonoverlapping suture lines.
Use of well-vascularized, healthy tissue flaps for repair.
Discussion: The vesico-vaginal fistulae, are still a huge challenge for the urological surgeons.
That is why, is so important to have a multidisciplinary approach and reference centres.
Keywords: Vesicovaginal fistula; Obstetric labor complicationsIntroduction: The vesico-vaginal fistulae are among all urinary fistulae, the most common.
The etiology of this type of fistula, changes according to the region of the planet. In developing countries, where most of the population
don´t have access to obstetrical care, the main cause of vesico-vaginal fistulae corresponds to prolonged obstructed labor.
The pressure made by the fetus, into the vagina walls, bladder and proximal urethra often leads to tissue necrosis. This necrosis leads to
a set of complications ranging from vesico-vaginal fistula, vaginal stenosis, rectal atresia, secondary infertility, incompetent anal sphincter,
or osteitis pubis.
We present 3 clinical cases of obstetrical vesico-vaginal fistulae and a review of the theoretical and technical aspects of the diagnosis and
treatment of this pathology.
Materials and Methods:We present 3 cases of obstetrical vesico-vaginal fistulae treated in 2012.
In the first case we have used a vaginal approach, and we have repaired in three layers using a Martius flap.
In the other two cases we have used the abdominal approach, because of the location and complexity of the fistula,  with interposition of
epiplon.
Results: In the first case the follow up was made in other institution, the other two cases resolved after single surgery, no relapse was found
in 6 and 12 months follow up respectively.
In all the repairs the basic principles were followed:  adequate exposure of the fistula tract with debridement of devitalized and ischemic
tissue.
Watertight, and multiple-layer closure.
Tension-free, nonoverlapping suture lines.
Use of well-vascularized, healthy tissue flaps for repair.
Discussion: The vesico-vaginal fistulae, are still a huge challenge for the urological surgeons.
That is why, is so important to have a multidisciplinary approach and reference centres.

Keywords: Vesicovaginal fistula; Obstetric labor complications