Surgical repair of post-cesarean vesicouterine fistula: A systematic review and a plea for prevention.

Autor: Bonavina G; Department of Obstetrics and Gynecology, IRCCS Humanitas Research Hospital, Milan, Italy., Busnelli A; Department of Obstetrics and Gynecology, IRCCS Humanitas Research Hospital, Milan, Italy.; Department of Biomedical Sciences, Humanitas University, Milan, Italy., Acerboni S; Department of Obstetrics and Gynecology, IRCCS Humanitas Research Hospital, Milan, Italy., Martini A; Department of Urology, Anderson Cancer Center, Houston, Texas, USA., Candiani M; Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, University Vita and Salute, Milan, Italy., Bulfoni A; Department of Obstetrics and Gynecology, IRCCS Humanitas Research Hospital, Milan, Italy.
Jazyk: angličtina
Zdroj: International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics [Int J Gynaecol Obstet] 2024 Jun; Vol. 165 (3), pp. 894-915. Date of Electronic Publication: 2023 Dec 06.
DOI: 10.1002/ijgo.15256
Abstrakt: Background: Vesicouterine fistula (VUF) is a iatrogenic injury in the vast majority of cases. The worldwide increase of cesarean delivery rates is expected to lead to increased complications.
Objectives: To assess current evidence on VUF pathogenesis and surgical management.
Search Strategy: Pubmed and Embase databases were searched from January 2000 to January 2023 using relevant key words.
Selection Criteria: Only original articles including either transabdominal or transvaginal surgical routes for post-cesarean VUF repair, in English language, were included.
Data Collection and Analysis: Two authors independently screened the references for eligibility, data extraction, and assessment of methodologic quality. All available surgical outcomes were recorded.
Main Results: Of the 1160 studies retrieved, 67 were selected for analysis. Most of these were case reports, case series, or observational cohort studies including a total of 284 patients. The majority (78.6%) of patients had more than one cesarean section, and approximately 10% of them experienced an overt bladder injury and/or uterine rupture at the time of cesarean delivery. The supratrigonal part of the bladder was most commonly involved (92.5%). The majority of patients (88.8%) underwent delayed VUF repair through laparotomy. Length of stay and blood loss were significantly less in patients treated via a minimally invasive approach (P < 0.001 and P = 0.02, respectively). Most patients had double-layer bladder repair and single-layer uterine repair. The overall success rate was 100% on first attempt for each independent combination of different surgical approaches and techniques. Live birth following VUF repair was reported in 23 patients.
Conclusions: Paying close attention to surgical details is crucial to reduce the incidence of this complication and recurrence rates. Double-layer bladder closure and delayed timing of repair of VUF are recommended.
(© 2023 International Federation of Gynecology and Obstetrics.)
Databáze: MEDLINE
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