[Subtotal cystectomy and ileal substitution cystoplasty for complicated vesicovaginal fistula: a case report].
A 68-year old female underwent laparoscopic vaginal hysterectomy for uterine wall perforation, following the removal of an intrauterine contraceptive device (IUD). The patient entered our hospital complaining of persistent genital bleeding, lower abdominal pain and urinary incontinence. She was diagnosed with a vesicovaginal fistula. The diameter of the fistula was over 3 cm and extended from the trigone to the internal urethral orifice, complicating the right distal ureteral obstruction. Therefore, curative surgery required a subtotal cystectomy and substitution cystoplasty due to severe urothelial changes, hydronephrosis and poor bladder compliance. An ileal neobladder (modified Studer's method) was successfully created and the postopertive course was uneventful. Although minor urinary incontinence persists, she can void through the urethra which has improved her quality of life.
Fukumoto
Ryo
R
Division of Urology, Shinko Hospital.
Imanishi
Osamu
O
Tunemori
Hiroyuki
H
Hinata
Nobuyuki
N
Oba
Takeshi
T
Yuen
Keiji
K
Yamanaka
Nozomu
N
D000368:Aged; D015653:Cystectomy; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal; D011183:Postoperative Complications / Q000601:surgery*; D011788:Quality of Life; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000601:surgery; D014547:Urinary Diversion / Q000379:methods; D014719:Vesicovaginal Fistula / Q000601:surgery*