PDF(Pubmed)
Abstract：
OBJECTIVE: This video illustrates a rare surgical case involving a urethral diverticulum, urethrovaginal fistula, and mesh erosion.
METHODS: We present a 58-year-old patient attending a tertiary care center with a suspected urethrovaginal fistula. Her concerns included stress urinary incontinence (SUI), recurrent urinary tract infection, and vaginal pain. The surgical history was notable for the placement of two different mesh slings during the same procedure to treat SUI. Preoperative evaluation and findings are illustrated in detail. The video uses a high-definition surgical camera to emphasize the initial intraoperative evaluation with localization of the fistula and diverticulum. We then demonstrate the approach to the dissection with the goal of ensuring complete resection of the diverticulum, fistula, and mesh, while preserving healthy tissue for subsequent closure. The utilization of unique and specialized tools for each portion of the procedure is also illustrated. A layered vaginal closure, including a Martius flap, is created to prevent recurrence.
RESULTS: The surgery was accomplished without complications.
CONCLUSIONS: To our knowledge, concomitant findings of a urethral diverticulum, urethrovaginal fistula, and mesh erosion are unique in the literature. We postulate that this triad could have resulted from the mesh burden in this particular patient.
METHODS: We present a 58-year-old patient attending a tertiary care center with a suspected urethrovaginal fistula. Her concerns included stress urinary incontinence (SUI), recurrent urinary tract infection, and vaginal pain. The surgical history was notable for the placement of two different mesh slings during the same procedure to treat SUI. Preoperative evaluation and findings are illustrated in detail. The video uses a high-definition surgical camera to emphasize the initial intraoperative evaluation with localization of the fistula and diverticulum. We then demonstrate the approach to the dissection with the goal of ensuring complete resection of the diverticulum, fistula, and mesh, while preserving healthy tissue for subsequent closure. The utilization of unique and specialized tools for each portion of the procedure is also illustrated. A layered vaginal closure, including a Martius flap, is created to prevent recurrence.
RESULTS: The surgery was accomplished without complications.
CONCLUSIONS: To our knowledge, concomitant findings of a urethral diverticulum, urethrovaginal fistula, and mesh erosion are unique in the literature. We postulate that this triad could have resulted from the mesh burden in this particular patient.
摘要：
目的：本视频说明了一个罕见的涉及尿道憩室的手术案例，尿道阴道瘘,和网眼侵蚀。
方法：我们介绍了一名58岁的患者，在三级护理中心就诊，怀疑患有尿道阴道瘘。她的担忧包括压力性尿失禁（SUI），复发性尿路感染,还有阴道疼痛.手术史值得注意的是，在同一手术期间放置了两个不同的网状物吊索来治疗SUI。详细说明了术前评估和发现。该视频使用高清手术摄像机来强调最初的术中评估以及瘘管和憩室的定位。然后，我们演示了解剖的方法，目的是确保完全切除憩室，瘘管,和网格，同时保留健康的组织以供随后闭合。还说明了该过程的每个部分使用独特和专门的工具。分层阴道闭合，包括Martius皮瓣,是为了防止复发而创建的。
结果：手术完成无并发症。
结论：据我们所知，同时发现尿道憩室，尿道阴道瘘,网格侵蚀在文献中是独一无二的。我们推测，该三合会可能是由于该特定患者的网状负担所致。
方法：我们介绍了一名58岁的患者，在三级护理中心就诊，怀疑患有尿道阴道瘘。她的担忧包括压力性尿失禁（SUI），复发性尿路感染,还有阴道疼痛.手术史值得注意的是，在同一手术期间放置了两个不同的网状物吊索来治疗SUI。详细说明了术前评估和发现。该视频使用高清手术摄像机来强调最初的术中评估以及瘘管和憩室的定位。然后，我们演示了解剖的方法，目的是确保完全切除憩室，瘘管,和网格，同时保留健康的组织以供随后闭合。还说明了该过程的每个部分使用独特和专门的工具。分层阴道闭合，包括Martius皮瓣,是为了防止复发而创建的。
结果：手术完成无并发症。
结论：据我们所知，同时发现尿道憩室，尿道阴道瘘,网格侵蚀在文献中是独一无二的。我们推测，该三合会可能是由于该特定患者的网状负担所致。
