title: Minimally invasive treatment of ureterovaginal fistula: A review and report of a new technique.
abstract: BACKGROUND
  An iatrogenic ureterovaginal fistula (UVF) can be a consequence of difficult pelvic surgery. The patient must endure a long wait before having major surgery to reconstruct the injured ureter. Reports that address the minimally invasive treatment of UVF are limited, and are reviewed here. We introduce the concept of using a Memokath™ 051 stent (PNN A/S, Hornbaek, Denmark) as a promising minimally invasive approach for UVF.
  
  
  METHODS
  We used PubMed, Science Direct, Google and the Cochrane Library to assemble appropriate evidence-based reference reports. The keywords used for the search were: 'Memokath', 'stent'; 'ureterovaginal fistula' and 'ureteral injury'. The review showed 42 relevant articles published up to September 2011.
  
  
  RESULTS
  Ureteric stenting consistently stopped the vaginal leak of urine. The long-term results were not encouraging after removing the JJ stents at 3 months after insertion. Most patients had a recurrence of the vaginal leak of urine. The outcome was different with the Memokath stent, that remained in situ for a duration far exceeding that of the JJ stent. The Memokath stopped the vaginal leak of urine with no episodes of urinary tract infection and no evidence of stent migration.
  
  
  CONCLUSIONS
  Long-term ureteric stenting has two advantages, in that it facilitates urine flow through the ureteric strictured segment down to the bladder, and it stops urine leakage along the fistula. It further promotes the resolution of the ureteric stricture and healing of the fistula. A duration of 3 months was inadequate when a JJ stent was used, whereas longer periods are possible with the Memokath stent. The optimum stenting period required for complete healing of a UVF remains to be defined. Long-term Memokath ureteric stenting can be an effective alternative and minimally invasive approach to conventional surgical repair in selected cases.
authors.affiliation: Department of Urology, King Fahd Hospital, University of Dammam, Saudi Arabia.
authors.forename: Khalid
authors.initials: K
authors.lastname: Al Otaibi
authors.affiliation: Department of Urology, King Fahd Hospital, University of Dammam, Saudi Arabia.
authors.forename: Alaa-Eldin
authors.initials: AE
authors.lastname: Barakat
authors.affiliation: Department of Urology, King Fahd Hospital, University of Dammam, Saudi Arabia.
authors.forename: Hamed
authors.initials: H
authors.lastname: El Darawany
authors.affiliation: Department of Urology, King Fahd Hospital, University of Dammam, Saudi Arabia.
authors.forename: Abulhasan
authors.initials: A
authors.lastname: Sheikh
authors.affiliation: Department of Urology, King Fahd Hospital, University of Dammam, Saudi Arabia.
authors.forename: Kamel
authors.initials: K
authors.lastname: Fadaak
authors.affiliation: Department of Urology, King Fahd Hospital, University of Dammam, Saudi Arabia.
authors.forename: Ossamah
authors.initials: O
authors.lastname: Al Sowayan
authors.affiliation: Department of Urology, King Fahd Hospital, University of Dammam, Saudi Arabia.
authors.forename: Shaheed
authors.initials: S
authors.lastname: Alsuhaibani
authors.affiliation: Department of Urology, King Fahd Hospital, University of Dammam, Saudi Arabia.
authors.forename: Reem
authors.initials: R
authors.lastname: Al Damanhouri
authors.affiliation: Department of Urology, King Fahd Hospital, University of Dammam, Saudi Arabia.
authors.forename: Maha
authors.initials: M
authors.lastname: Madi
authors.affiliation: Department of Urology, King Fahd Hospital, University of Dammam, Saudi Arabia.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Elsadr
keywords: Memokath stent; UVF, ureterovaginal fistula; Ureteric injury; Ureterovaginal fistula