Лапароскопическое лечение пузырно-маточного свища (обзор литературы и клиническое наблюдение)

Холтобин Д.П., Набиев А.О., Неклюдов С.А., Кульчавеня Е.В. Лапароскопическое лечение пузырно-маточного свища (обзор литературы и клиническое наблюдение). Гинекология. 2021; 23 (1): 97–101.
DOI: 10.26442/20795696.2021.1.200649

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Kholtobin D.P., Nabiev A.O., Nekludov S.A., Kulchavenya E.V. Laparoscopic treatment of vesicouterine fistula (a literature review and case report). Gynecology. 2021; 23 (1): 97–101. DOI: 10.26442/20795696.2021.1.200649

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Аннотация

Мочеполовые свищи – нередкое осложнение акушерских и гинекологических пособий; в их структуре преобладают пузырно-влагалищные фистулы. С пузырно-маточными свищами врачи встречаются редко, что объясняет затруднения в диагностике и лечении. Проведен обзор отечественной и зарубежной литературы по проблеме; представлено собственное клиническое наблюдение. У пациентки 43 лет через 1 мес после оперативного родоразрешения появилось непроизвольное выделение мочи из влагалища, диагностирован пузырно-маточный свищ. Через 3 мес в МЦ «Авиценна», Новосибирск, выполнено лапароскопическое разобщение и ушивание свища. После удаления уретрального катетера на 7-е сутки у пациентки восстановилось произвольное мочеиспускание, без неконтролируемого истечения мочи из влагалища. При контрольном обследовании через 1, 3 и 6 мес ультразвуковое исследование органов малого таза подтвердило состоятельность рубца на матке. Мочеиспускание оставалось свободным и безболезненным, подтекания мочи пациентка не отмечала. Это клиническое наблюдение показывает возможность лечения пузырно-маточного свища щадящим лапароскопическим доступом с хорошим результатом и возможностью ранней реабилитации пациентки.

Ключевые слова: генитальные свищи, мочеполовые свищи, пузырно-маточный свищ, лапароскопический доступ фистулопластики

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Urogenital fistulas are common complication of obstetric and gynecological surgery; the most common are vesicovaginal fistulas. Vesicouterine fistulas are rare, which explains the difficulties in diagnosis and treatment. The literature review and own clinical case presented in article. A 43-years-old female patient was consulted with complaint of urinary leakage from vagina, which appeared 1 month after the cesarean section and vesicouterine fistula has been diagnosed. Successful laparoscopic treatment of vesicouterine fistula was performed at the Avicenna Medical Center after 3 months. The urethral catheter was removed 7 days after surgery. At control examination after 1, 3 and 6 months, ultrasound examination of the pelvic organs confirmed the consistency of the scar on the uterus. Urination remained free and painless, the patient did not notice urine leakage. This clinical observation shows the possibility of treating a vesicouterine fistula with a laparoscopic approach with a good result and the possibility of early rehabilitation.

Keywords: urinary fistula, vesicouterine fistula, vesicovaginal fistula, laparoscopical treatment of uterovesical fistula

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Список литературы

1. Jóźwik M, Jóźwik M, Lotocki W. Vesicouterine fistula – an analysis of 24 cases from Poland. Int J Gynaecol Obstet 1997; 57 (2): 169–72. DOI: 10.1016/S0020-7292(97)02837-3
2. Machado Junior RA, Machado Junior LC, Lourenço LLE. Vesicouterine Fistula (Youssef Syndrome): Case Report and Literature Review. Rev Bras Ginecol Obstet 2018; 40 (9): 563–9. DOI: 10.1055/s-0038-1666998
3. Пушкарь Д.Ю., Раснер П.И., Гвоздев М.Ю. Мочеполовые свищи. Рус. мед. журн. 2013; 34: 2–8 [Pushkar' D.Iu., Rasner P.I., Gvozdev M.Iu. Mochepolovye svishchi. Rus. med. zhurn. 2013; 34: 2–8 (in Russian)].
4. Буянова С.Н., Юдина Н.В., Барто Р.А. Редкие осложнения кесарева сечения – пузырно-маточные свищи. Рос. вестн. акушера-гинеколога. 2018; 18 (3): 83–7 [Buianova S.N., Iudina N.V., Barto R.A. Redkie oslozhneniia kesareva secheniia – puzyrno-matochnye svishchi. Ros. vestn. akushera-ginekologa. 2018; 18 (3): 83–7 (in Russian)].
5. Berek JS. Berek and Novak's Gynecology. 15th ed. Philadelphia, PA: Lippincott Williams&Wilkins, 2012.
6. Смирнова Т.А., Новодворская О.Д. Генитальные свищи в практике акушера-гинеколога. Медицинский журн. 2016; 2: 145–8 [Smirnova T.A., Novodvorskaia O.D. Genital'nye svishchi v praktike akushera-ginekologa. Meditsinskii zhurn. 2016; 2: 145–8 (in Russian)]
7. Jóźwik M, Jóźwik M. Spontaneous closure of vesicouterine fistula. Account for effective hormonal treatment. Urol Int 1999; 62 (3): 183–7. DOI: 10.1159/000030388
8. Józwik M, Józwik M. Clinical classification of vesicouterine fistula. Int J Gynaecol Obstet 2000; 70 (3): 353–7. DOI: 10.1016/S0020-7292(00)00247-2
9. Yip SK, Leung TY. Vesicouterine fistula: an upd ated review. Int Urogynecol J Pelvic Floor Dysfunct 1998; 9 (5): 252–6. DOI: 10.1007/BF01901500
10. Ali-El-Dein B, El-Tabey N, El-Hefnawy A, et al. Diagnosis, treatment and need for hysterectomy in management of postcaesarean section vesicouterine fistula. Scand J Urol 2014; 48 (5): 460–5. DOI: 10.3109/21681805.2014.903511
11. Ikechebelu JI, Ugboaja JO, Okeke CF. Post-cesarean vesicouterine fistula (Youssef syndrome): report of two cases. J Obstet Gynaecol Res 2011; 37 (7): 912–5.
DOI: 10.1111/j.1447-0756.2010.01428.x
12. Czerwiński F, Pilarczyk K, Kozik W. Vascularization of the posterior wall of the urinary bladder in women after past cesarean section in light of microangiographic studies. Ginekol Pol 1992; 63 (8): 398–403 (in Polish).
13. Hodonou R, Hounnasso PP, Biaou O, Akpo C. Vesicouterine fistula: report on 15 cases at Cotonou University Urology Clinic. Prog Urol 2002; 12 (4): 641–5 (in French).
14. Rao MP, Dwivedi US, Datta B, et al. Post caesarean vesicouterine fistulae – Youssef syndrome: our experience and review of published work. ANZ J Surg 2006; 76 (4): 243–45. DOI: 10.1111/j.1445-2197.2006.03591.x
15. Nouira Y, Feki W, Rhouma SB, et al. Vesicouterine fistula as a complication of forceps delivery: a case report. Int Urogynecol J Pelvic Floor Dysfunct 2005; 16 (6): 512–4. DOI: 10.1007/s00192-005-1288-3
16. Kaaki B, Gyves M, Goldman H. Spontaneous intrapartum vesicouterine fistula. Obstet Gynecol 2006; 107 (2 Pt 2): 449–50. DOI: 10.1097/01.AOG.0000164053.46449.46
17. Majeed SM, Subhani SS. An unusual case of Youssef's syndrome (vesicouterine fistula) and its relationship with placenta percreta. J Coll Physicians Surg Pak 2007; 17 (3): 168–9.
18. Se túbal A, Clode N, Bruno-Paiva JL, et al. Vesicouterine fistula after manual removal of placenta in a woman with previous cesarean section. Eur J Obstet Gynecol Reprod Biol 1999; 84 (1): 75–6. DOI: 10.1016/S0301-2115(98)00305-4
19. Le Mer A. Fistule vésico-utérine après basiotrypsie. Cure chirurgicale. Guérison (à propos d'un cas). J Urol Nephrol (Paris) 1968; 74 (6): 481–3.
20. Rooney KE, Cholhan HJ. Vesico-uterine fistula after endometrial ablation in a woman with prior cesarean deliveries. Obstet Gynecol 2010; 115 (2 Pt 2): 450–1. DOI: 10.1097/AOG.0b013e3181c846eb
21. Okafor PIS, Orakwe JC, Mbonu OO. Cyclical haematuria sequel to uterine myomectomy: a case report. West Afr J Med 2002; 21 (4): 341–2.
22. Fridman D, Chakraborty S, Khulpateea N. Fistula between degenerated uterine leiomyoma and the bladder: case report. Int Urogynecol J Pelvic Floor Dysfunct 2011; 22 (10): 1329–31. DOI: 10.1007/s00192-011-1414-3
23. Sultana CJ, Goldberg J, Aizenman L, Chon JK. Vesicouterine fistula after uterine artery embolization: a case report. Am J Obstet Gynecol 2002; 187 (6): 1726–7. DOI: 10.1067/mob.2002.128989
24. Price N, Golding S, Slack RA, Jackson SR. Delayed presentation of vesicouterine fistula 12 months after uterine artery embolisation for uterine fibroids. J Obstet Gynaecol 2007; 27 (2): 205–7. DOI: 10.1080/01443610601157273
25. Javali T, Kasaraneni D, Banale K, et al. Vesicouterine fistula and concomitant ureteric necrosis following uterine artery embolization for fibroid uterus. Int Urogynecol J Pelvic Floor Dysfunct 2015; 26 (12): 1877–8. DOI: 10.1007/s00192-015-2764-z
26. Porcaro AB, Zicari M, Antoniolli SZ, et al. Vesicouterine fistulas following cesarean section: report on a case, review and update of the literature. Int Urol Nephrol 2002; 34 (3): 335–44. DOI: 10.1023/A:1024443822378
27. Lesovoy V, Parashchuk Y, Shchukin D, et al. Fettus in the bladder: rare complication of vesicouterine fistula. Case Rep Med 2016; 2016: 5750710.
28. Keskin MZ, Budak S, Can E, İlbey YÖ. Incidentally diagnosed post-cesarean vesicouterine fistula (Youssef's syndrome). Can Urol Assoc J 2015; 9 (11–12): E913-E915. DOI: 10.5489/cuaj.3258
29. Kottász S, Gergely I. Successful pregnancy after surgical repair of vesico-uterine fistula. Int Urol Nephrol 1986; 18 (3): 289–98. DOI: 10.1007/BF02082716
30. Maioli RA, Macedo AR, Garcia AR, et al. Laparoscopic repair for vesicouterine fistulae. Int Braz J Urol 2015; 41 (5): 1030–1.
31. Ramalingam M, Senthil K, Pai M, Renukadevi R. Laparoscopic repair of vesicouterine fistula – a case report. Int Urogynecol J Pelvic Floor Dysfunct 2008; 19 (5): 731–3. DOI: 10.1007/s00192-007-0480-z
32. Das Mahapatra P, Bhattacharyya P. Laparoscopic intraperitoneal repair of high-up urinary bladder fistula: a review of 12 cases. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18 (6): 635–9. DOI: 10.1007/s00192-006-0215-6
33. Jundt K, Gauruder-Burmester A, Wildt B, Tunn R. Vaginal repair of a vesico-uterine fistula type I (Jozwik) after caesarean section. Zentralbl Gynakol 2004; 126 (4): 286–8. DOI: 10.1055/s-2004-822839
34. Alamoudi OJ, AlTheneyan MA, Aldhaam N, Moazin M. Early robotic repair of vesicouterine fistula. A case report and literature review. Urol Case Rep 2017; 11: 76–8. DOI: 10.1016/j.eucr.2017.01.006
35. Perveen K, Gupta R, Al-Badr A, Hemal AK. Robot-assisted laparoscopic repair of rare post-cesarean section vesicocervical and vesicouterine fistula: a case series of a novel technique. Urology 2012; 80 (2): 477–82. DOI: 10.1016/j.urology.2012.04.027
36. Будревич А.Е., Нечипоренко Н.А. Пузырно-влагалищные свищи: проблемы лечения и профилактики. Журн. Гродненского государственного медицинского университета. 2006; 2: 44–7 [Budrevich A.E., Nechiporenko N.A. Puzyrno-vlagalishchnye svishchi: problemy lecheniia i profilaktiki. Zhur. Grodnenskogo gosudarstvennogo meditsinskogo universiteta. 2006; 2: 44–7 (in Russian)].
37. Лоран О.Б., Серегин А.В., Довлатов З.А. Влияние характеристик мочеполового свища на результаты оперативного лечения у женщин. Медицина и образование в Сибири. 2015; 5: 29 [Loran O.B., Seregin A.V., Dovlatov Z.A. Vliianie kharakteristik mochepolovogo svishcha na rezul'taty operativnogo lecheniia u zhenshchin. Meditsina i obrazovanie v Sibiri. 2015; 5: 29 (in Russian)].

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1. Jóźwik M, Jóźwik M, Lotocki W. Vesicouterine fistula – an analysis of 24 cases from Poland. Int J Gynaecol Obstet 1997; 57 (2): 169–72. DOI: 10.1016/S0020-7292(97)02837-3
2. Machado Junior RA, Machado Junior LC, Lourenço LLE. Vesicouterine Fistula (Youssef Syndrome): Case Report and Literature Review. Rev Bras Ginecol Obstet 2018; 40 (9): 563–9. DOI: 10.1055/s-0038-1666998
3. Пушкарь Д.Ю., Раснер П.И., Гвоздев М.Ю. Мочеполовые свищи. Рус. мед. журн. 2013; 34: 2–8 [Pushkar' D.Iu., Rasner P.I., Gvozdev M.Iu. Mochepolovye svishchi. Rus. med. zhurn. 2013; 34: 2–8 (in Russian)].
4. Буянова С.Н., Юдина Н.В., Барто Р.А. Редкие осложнения кесарева сечения – пузырно-маточные свищи. Рос. вестн. акушера-гинеколога. 2018; 18 (3): 83–7 [Buianova S.N., Iudina N.V., Barto R.A. Redkie oslozhneniia kesareva secheniia – puzyrno-matochnye svishchi. Ros. vestn. akushera-ginekologa. 2018; 18 (3): 83–7 (in Russian)].
5. Berek JS. Berek and Novak's Gynecology. 15th ed. Philadelphia, PA: Lippincott Williams&Wilkins, 2012.
6. Smirnova T.A., Novodvorskaia O.D. Genital'nye svishchi v praktike akushera-ginekologa. Meditsinskii zhurn. 2016; 2: 145–8 (in Russian)
7. Jóźwik M, Jóźwik M. Spontaneous closure of vesicouterine fistula. Account for effective hormonal treatment. Urol Int 1999; 62 (3): 183–7. DOI: 10.1159/000030388
8. Józwik M, Józwik M. Clinical classification of vesicouterine fistula. Int J Gynaecol Obstet 2000; 70 (3): 353–7. DOI: 10.1016/S0020-7292(00)00247-2
9. Yip SK, Leung TY. Vesicouterine fistula: an upd ated review. Int Urogynecol J Pelvic Floor Dysfunct 1998; 9 (5): 252–6. DOI: 10.1007/BF01901500
10. Ali-El-Dein B, El-Tabey N, El-Hefnawy A, et al. Diagnosis, treatment and need for hysterectomy in management of postcaesarean section vesicouterine fistula. Scand J Urol 2014; 48 (5): 460–5. DOI: 10.3109/21681805.2014.903511
11. Ikechebelu JI, Ugboaja JO, Okeke CF. Post-cesarean vesicouterine fistula (Youssef syndrome): report of two cases. J Obstet Gynaecol Res 2011; 37 (7): 912–5.
DOI: 10.1111/j.1447-0756.2010.01428.x
12. Czerwiński F, Pilarczyk K, Kozik W. Vascularization of the posterior wall of the urinary bladder in women after past cesarean section in light of microangiographic studies. Ginekol Pol 1992; 63 (8): 398–403 (in Polish).
13. Hodonou R, Hounnasso PP, Biaou O, Akpo C. Vesicouterine fistula: report on 15 cases at Cotonou University Urology Clinic. Prog Urol 2002; 12 (4): 641–5 (in French).
14. Rao MP, Dwivedi US, Datta B, et al. Post caesarean vesicouterine fistulae – Youssef syndrome: our experience and review of published work. ANZ J Surg 2006; 76 (4): 243–45. DOI: 10.1111/j.1445-2197.2006.03591.x
15. Nouira Y, Feki W, Rhouma SB, et al. Vesicouterine fistula as a complication of forceps delivery: a case report. Int Urogynecol J Pelvic Floor Dysfunct 2005; 16 (6): 512–4. DOI: 10.1007/s00192-005-1288-3
16. Kaaki B, Gyves M, Goldman H. Spontaneous intrapartum vesicouterine fistula. Obstet Gynecol 2006; 107 (2 Pt 2): 449–50. DOI: 10.1097/01.AOG.0000164053.46449.46
17. Majeed SM, Subhani SS. An unusual case of Youssef's syndrome (vesicouterine fistula) and its relationship with placenta percreta. J Coll Physicians Surg Pak 2007; 17 (3): 168–9.
18. Se túbal A, Clode N, Bruno-Paiva JL, et al. Vesicouterine fistula after manual removal of placenta in a woman with previous cesarean section. Eur J Obstet Gynecol Reprod Biol 1999; 84 (1): 75–6. DOI: 10.1016/S0301-2115(98)00305-4
19. Le Mer A. Fistule vésico-utérine après basiotrypsie. Cure chirurgicale. Guérison (à propos d'un cas). J Urol Nephrol (Paris) 1968; 74 (6): 481–3.
20. Rooney KE, Cholhan HJ. Vesico-uterine fistula after endometrial ablation in a woman with prior cesarean deliveries. Obstet Gynecol 2010; 115 (2 Pt 2): 450–1. DOI: 10.1097/AOG.0b013e3181c846eb
21. Okafor PIS, Orakwe JC, Mbonu OO. Cyclical haematuria sequel to uterine myomectomy: a case report. West Afr J Med 2002; 21 (4): 341–2.
22. Fridman D, Chakraborty S, Khulpateea N. Fistula between degenerated uterine leiomyoma and the bladder: case report. Int Urogynecol J Pelvic Floor Dysfunct 2011; 22 (10): 1329–31. DOI: 10.1007/s00192-011-1414-3
23. Sultana CJ, Goldberg J, Aizenman L, Chon JK. Vesicouterine fistula after uterine artery embolization: a case report. Am J Obstet Gynecol 2002; 187 (6): 1726–7. DOI: 10.1067/mob.2002.128989
24. Price N, Golding S, Slack RA, Jackson SR. Delayed presentation of vesicouterine fistula 12 months after uterine artery embolisation for uterine fibroids. J Obstet Gynaecol 2007; 27 (2): 205–7. DOI: 10.1080/01443610601157273
25. Javali T, Kasaraneni D, Banale K, et al. Vesicouterine fistula and concomitant ureteric necrosis following uterine artery embolization for fibroid uterus. Int Urogynecol J Pelvic Floor Dysfunct 2015; 26 (12): 1877–8. DOI: 10.1007/s00192-015-2764-z
26. Porcaro AB, Zicari M, Antoniolli SZ, et al. Vesicouterine fistulas following cesarean section: report on a case, review and update of the literature. Int Urol Nephrol 2002; 34 (3): 335–44. DOI: 10.1023/A:1024443822378
27. Lesovoy V, Parashchuk Y, Shchukin D, et al. Fettus in the bladder: rare complication of vesicouterine fistula. Case Rep Med 2016; 2016: 5750710.
28. Keskin MZ, Budak S, Can E, İlbey YÖ. Incidentally diagnosed post-cesarean vesicouterine fistula (Youssef's syndrome). Can Urol Assoc J 2015; 9 (11–12): E913-E915. DOI: 10.5489/cuaj.3258
29. Kottász S, Gergely I. Successful pregnancy after surgical repair of vesico-uterine fistula. Int Urol Nephrol 1986; 18 (3): 289–98. DOI: 10.1007/BF02082716
30. Maioli RA, Macedo AR, Garcia AR, et al. Laparoscopic repair for vesicouterine fistulae. Int Braz J Urol 2015; 41 (5): 1030–1.
31. Ramalingam M, Senthil K, Pai M, Renukadevi R. Laparoscopic repair of vesicouterine fistula – a case report. Int Urogynecol J Pelvic Floor Dysfunct 2008; 19 (5): 731–3. DOI: 10.1007/s00192-007-0480-z
32. Das Mahapatra P, Bhattacharyya P. Laparoscopic intraperitoneal repair of high-up urinary bladder fistula: a review of 12 cases. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18 (6): 635–9. DOI: 10.1007/s00192-006-0215-6
33. Jundt K, Gauruder-Burmester A, Wildt B, Tunn R. Vaginal repair of a vesico-uterine fistula type I (Jozwik) after caesarean section. Zentralbl Gynakol 2004; 126 (4): 286–8. DOI: 10.1055/s-2004-822839
34. Alamoudi OJ, AlTheneyan MA, Aldhaam N, Moazin M. Early robotic repair of vesicouterine fistula. A case report and literature review. Urol Case Rep 2017; 11: 76–8. DOI: 10.1016/j.eucr.2017.01.006
35. Perveen K, Gupta R, Al-Badr A, Hemal AK. Robot-assisted laparoscopic repair of rare post-cesarean section vesicocervical and vesicouterine fistula: a case series of a novel technique. Urology 2012; 80 (2): 477–82. DOI: 10.1016/j.urology.2012.04.027
36. Budrevich A.E., Nechiporenko N.A. Puzyrno-vlagalishchnye svishchi: problemy lecheniia i profilaktiki. Zhur. Grodnenskogo gosudarstvennogo meditsinskogo universiteta. 2006; 2: 44–7 (in Russian)
37. Loran O.B., Seregin A.V., Dovlatov Z.A. Vliianie kharakteristik mochepolovogo svishcha na rezul'taty operativnogo lecheniia u zhenshchin. Meditsina i obrazovanie v Sibiri. 2015; 5: 29 (in Russian)

Авторы

Д.П. Холтобин*1,2, А.О. Набиев1, С.А. Неклюдов1, Е.В. Кульчавеня1–3

1 Медицинский центр «Авиценна», Новосибирск, Россия;
2 ФГБУ «Новосибирский научно-исследовательский институт туберкулеза» Минздрава России, Новосибирск, Россия;
3 ФГБОУ ВО «Новосибирский государственный медицинский университет» Минздрава России, Новосибирск, Россия
*urology-avicenna@mail.ru

________________________________________________

Denis P. Kholtobin*1,2, Aziz O. Nabiev1, Sergei A. Nekludov1, Ekaterina V. Kulchavenya1–3

1 Medical Center “Avicenna”, Novosibirsk, Russia;
2 Novosibirsk Research Institute of Tuberculosis, Novosibirsk, Russia;
3 Novosibirsk State Medical University, Novosibirsk, Russia
*urology-avicenna@mail.ru

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