Ureteral stents are commonly used in clinical treatment of ureteral diseases. There were a series of complications, such as biofilms and crusts caused by bacteria after surgery. Therefore, biodegradable with bacteriostatic ureteral scaffolds would be the potential to solve above mentioned problems. In this study, nanosilver (AgNP) was added to the polylactic‐co‐glycolic acid (PLGA) and polycaprolactone (PCL) to prepare biodegradable antibacterial ureteral scaffold samples by 3D printing. The biocompatibility, antibacterial properties, degradability, and mechanical properties of samples were observed. The samples were under a strong inhibitory effect on both Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus), and the higher the concentration of AgNP, the stronger the antibacterial effect. When the concentration of AgNP was 10%, the antibacterial effect was up to 100%. AgNP was released continually with the degradation of samples, which can achieve a continuous antibacterial effect. The breaking strength of the samples without and with AgNP were 6.08 ± 1.16 MPa and 26.02 ± 2.00 MPa. The mechanical properties of samples with AgNP were higher than those without AgNP. It provides a potential way to design ureteral scaffolds based on biodegradable polymers with AgNP in the clinic.

Degradation behavior of polylactic‐co‐glycolic acid and polycaprolactone with nanosilver scaffolds

La destruction de l'uretre feminin, peu courante en Europe, est, en Afrique noire, la complication la plus severe des fistules vesico-vaginales d'origine obstetricale. Nous rapportons notre experience du traitement de ces destructions de l'uretre selon un procede original de reconstruction uretrale a l'aide d'un lambeau cutane pedicule preleve au niveau de la grande levre. Trente-cinq cas de destructions uretrales traitees par uretroplastie labiale pediculee entre janvier 1992 et juin 1996 dans le Service d'Urologie de l'Hopital National de Niamey, au Niger, ont ete analyses. Ces lesions concernaient des femmes de race noire dont l'âge moyen etait de 18 ans avec une mediane de recul de 19 mois. Deux variantes techniques ont ete realisees et sont decrites dans ce travail, la plastie d'allongement (16 cas) et la plastie tubulee de remplacement (19 cas). Le traitement de l'incontinence urinaire a ete assure par un systeme de fronde sous-uretrale realise a l'aide d'un lambeau graisseux preleve au niveau de la grande levre (operation de Martius). Un procede complementaire d'uretro-cervico-suspension vaginale a ete necessaire dans 6 cas. La recuperation d'une miction normale et l'absence de fuite ont ete obtenues dans 24 de ces 35 cas (68,6 %). Il y a eu 6 ameliorations (17,1 %) et 5 echecs (14,2 %). Comparee aux donnees de la litterature, la reconstruction uretrale par lambeau labial pedicule et fronde graisseuse sous-uretrale est un procede qui, avec un taux de succes de pres de 70 %, permet de traiter efficacement tout type de destruction uretrale en rapport avec un traumatisme obstetrical. Il est particulierement adapte a la pratique chirurgicale dans les pays en developpement ou ce type de pathologie se rencontre volontiers. Toutefois, en depit d'une parfaite maitrise technique, la reconstruction d'un appareil de cloture physiologiquement parfait reste actuellement impossible.

Urétroplastie labiale pédiculée : Un procédé original de traitement des lésions urétrales étendues d'origine obstétricale

Summary Background Rectovaginal fistulas represent 5% of all anorectal fistulas. For affected women, this pathology is associated with a reduction in quality of life (QoL) and self-esteem. Most commonly used methods of surgical closure have high recurrence rates or permanent perineal complaints, which in turn lead to negative effects on QoL and self-esteem. A fistula closure, using the “de-epithelialized Singapore flap” (SF), can be a good alternative therapy strategy. Method Our retrospective case series processes the long-term results of seven patients who were operated on for ano-/rectovaginal fistula using the SF. All patients underwent surgery at the University Hospital Graz, between May 2012 and July 2015. The data of the surgical follow-up examinations were collected and an additional telephone survey was carried out. The procedure is presented based on a structured description. All procedures were performed jointly by the Department of General Surgery and the Department of Plastic Surgery. Results The average age of the seven patients was 46.14 years (23–72 a). Five patients had a total of 12 previous operations with frustrating results. Of the seven patients treated, six had a permanent fistula closure (85.7%). The results of the telephone survey ( n = 6) showed a high level of patient satisfaction (100%), and an improvement in QoL (83.3%), through our surgical method. In our cohort, neither urinary nor fecal incontinence occurred. Conclusion The treatment of an ano-/rectovaginal fistula using the “de-epithelialized pudendal thigh flap” (Singapore flap) is a promising treatment alternative. In particular, patients who have had previous proctological interventions show a benefit from this procedure. 

https://link.springer.com/content/pdf/10.1007/s10353-022-00759-7.pdf

Surgical treatment of deep-lying ano-/rectovaginal fistulas using a de-epithelialized “Singapore flap” (pudendal thigh flap)

Obstetric Fistula

Background: Obstetric Fistula (OF) is a breach of the birth canal due to obstructed labor. It is a major public health problem in developing countries. Objective: Study the epidemiology and treatment of obstetric fistulas at the Departmental University Hospital Centre of Borgou and Alibori (CHUD-B/A) in Parakou, Benin. Study Method: This was a descriptive and analytical cross-sectional study with prospective data collection on women treated during OF care missions from February 2020 to April 2021 in CHUD-B/A in Parakou, Benin. The data concerned their socio-demographic characteristics, obstetric history, the clinic and therapeutic characteristics of their obstetric fistulas. Results: In total 97 patients with OF were treated during the 14-month period. The average age of the patients was 36.42 ± 11.75 years old. The patients were married (51.54%), without professional occupation (54.64%) and had no formal education (73.20%). The vesico-vaginal variety was predominating (54.64%). The fistulas were of Type I (46.39%), Type II (20.62%) and Type III (32.99%) according to the classification of Waaldjik Kees. The patients were operated on under spinal anesthesia (94.79%), and vaginally (55.67%) according to the principle of Chassar Moir (68, 60%). The associated procedures were lengthening urethroplasty (17.53%), and interposition of the Martius flap (1.03%). The overall success rate without Stress Urinary Incontinence was 71.13%. The factors associated with the failure of the fistula repair were: the nutritional status of the patients (p = 0.004), the previous repair failure (p = 0.001), the high size of the fistula (p = 0.007), the fistula severity (p and a urethral reconstruction (p Conclusion: OF is a relatively frequent pathology in Benin. Vesico-vaginal fistula is the most common form. The success rate of the surgical treatment is satisfactory, but depends on some factors. 

/pdf/epidemiological-and-therapeutic-aspects-of-obstetric-fistula-6zcxjyf3.pdf

Epidemiological and Therapeutic Aspects of Obstetric Fistula in 2021: A Review of 97 Cases at the Departmental University Hospital Centre of Borgou and Alibori in Benin

Resume Objectif Decrire les caracteristiques epidemiologiques, anatomiques et cliniques des fistules urogenitales et recto-vaginales ainsi que l’issue de leur prise en charge chirurgicale au Togo. Materiel et methodes Une etude retrospective a collige tous les cas operes sur une periode de cinq ans dans le centre national de prise en charge des fistules obstetricales. Les parametres etudies etaient les donnees sociodemographiques des patientes, les caracteristiques cliniques et l’issue de la reparation chirurgicale. Resultats Le nombre de patientes traitees etait de 197, pour un nombre total de 217 interventions chirurgicales. L’âge moyen des patientes etait de 40,7 ans avec des extremes de 18 et 70 ans. Les causes obstetricales predominaient (95 %) et 3,5 % etaient causees par une chirurgie. Sur le plan anatomo-clinique, la fistule vesico-vaginale (FVV) etait la forme la plus frequente representant 87,3 % tandis que la fistule vesico-uterine n’occupait que 4,1 %. La multiparite etait un facteur de risque de survenue de fistule obstetricale et une cesarienne a ete necessaire dans 70 % marquee par une forte mortalite du fœtus (88,2 %). La prise en charge chirurgicale a ete tardive dans la majorite des cas, avec un delai d’environ 10 ans entre la survenue de la fistule et sa reparation. Le taux de guerison etait de 78,1 %. Conclusion Les fistules urogenitales sont principalement d’origine obstetricale au Togo avec comme facteur de risque la multiparite. La prise en charge est tardive mais permet un bon taux de guerison. Leur prevention passe par la lutte contre la dystocie. Niveau de preuve IV.

Profil épidémiologique, anatomoclinique et thérapeutique des fistules urogénitales et rectovaginales au Togo

The purpose of this study is to describe a simple, non-expensive, accessible and effective technique of ureterovaginal fistula diagnosis, and to assess the results of surgical management in a resource-constrained hospital. During a campaign of obstetric fistulas repair, we diagnosed ureterovaginal fistulas by vaginal exam with the blue methylene test associated to abdominal ultrasonography, two simple and non-expensive explorations which permitted to identify ureterovaginal fistula and to do differential diagnosis with vesicovaginal fistula. The management was surgery, by ureterovesical reimplantation. Four ureterovaginal fistulas have been diagnosed in 32 women presented with obstetrical fistula. The mean age of those fistulas was 4.85 years; it was located on the left ureter in three cases, on the right in one case. The ureteral lesion was consecutive to a caesarean section in all patients and sited on the pelvic segment of ureter. In three patients, diagnosis was performed by the negativity of the blue test and unilateral dilation of ureter and kidney while the discovery was done during the treatment of vesicovaginal and rectovaginal fistulas associated in the last patient. After effects of surgery were simple, characterized by disappearance of urine leakage and dilation of ureter kidney. In resources-constrained context, techniques such as blue test and ultrasonography are enough to perform diagnosis of ureterovaginal fistula. Ureterovesical reimplantation is an effective therapeutic method for diagnosing ureterovaginal fistula.

[Ureterovaginal fistula after caesarean: Diagnosis and management in a resource-constrained hospital in Togo].

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Profil épidémiologique, anatomoclinique et thérapeutique des fistules urogénitales et rectovaginales au Togo

[Ureterovaginal fistula after caesarean: Diagnosis and management in a resource-constrained hospital in Togo].