A New Dimension in Vesicovaginal Fistula Management: An 8-year Experience at Ramathibodi Hospital

Vesicovaginal fistula is mostly iatrogenic in origin and causes devastating medical, social, psychogenic and hygienic consequences. The aetiology has changed since the nineteenth century, becoming more associated with hysterectomy rather than other obstetric procedures, which were common in the past. We studied the causes, clinical presentations and management of vesicovaginal fistula in our institute during 1998 to 2005. METHODS: From 1998 to 2005, 45 patients were treated in our hospital, of whom 35 were referred from other hospitals after failed surgery. All the medical records were reviewed. Fistulae, clinical presentation, clinical findings, means of treatment and clinical outcome as well as complications were noted. RESULTS: The most common cause of a fistula in our study was post laparoscopic hysterectomy that comprised 28 cases (62.2%). Transabdominal hysterectomy caused fistula in 10 cases (22.2%) and vaginal hysterectomy only four cases (8.8%). Most cases of vesicovaginal fistulae after laparoscopic hysterectomy presented with early urinary leakage, of which 35.7% presented within 1 week and 50% in the second week. Most of the patients after transabdominal hysterectomies (90%) had leakage in the second week. All patients were treated with surgical repair, 19 cases by a transvaginal approach and 26 cases by a transabdominal repair. Seventeen cases in the transvaginal group and 25 cases in the transabdominal group were dry after the first operation. The rest of both groups were dry after the second operation. After 38 months of follow-up, no complication or incontinence was noted. CONCLUSION: Vesicovaginal fistula is still a serious iatrogenic consequence and causes suffering in the physical, emotional and social functioning of patients. The study found that the condition is now more frequently associated with laparoscopic hysterectomy. Successful closure of the fistula requires an accurate and timely repair using procedures that exploit basic surgical principles. With the appropriate surgical expertise, all patients can be cured of this distressing condition

Foreign Bodies in the Female Urinary Bladder: 20-Year Experience in Ramathibodi Hospital

Objective: Foreign bodies in the female urinary bladder may occur by self-insertion or migration from adjacent organs. The most common reason for this is sexual in nature, but hygienic behaviour and attempts to relieve voiding problems have been reported. Only small case series were found in the literature devoted to foreign bodies in the urinary bladder. Therefore, we reviewed our experience regarding foreign bodies in the female urinary bladder in our hospital. Methods: Medical records of female patients who were diagnosed with a foreign body in the urinary bladder during 1985–2005 were reviewed. Demographics, causes, type of object found, clinical presentation, treatment and outcomes were noted. Results: Seventy-eight patients with a mean age of 38 years were identified. The major route for ingress of foreign bodies was via the urethra. The objects found self-inserted were cotton swabs, tampons, paper clips and pen casings. As most of Thailand is an agricultural environment, some small living organisms such as leeches could be found as foreign bodies in the bladder. The majority of the cases presented with haematuria associated with frequency, urgency and pelvic pain. Almost all cases could be managed by endoscopic removal with minimal complications. Four cases were treated by open surgery. Conclusion: Foreign bodies in the urinary bladder represent a urological challenge that requires prompt management. The suspected history and presenting symptoms are crucial and lead to fur-ther investigations. Gentle endoscopic management is the main treatment with a high success rate

Efficacy of Tamsulosin in the Treatment of Lower Urinary Tract Symptoms (LUTS) in Women

We attempted to determine whether tamsulosin is an efficacious therapy for the treatment of lower urinary tract symptoms (LUTS) in women. Methods: A total of 140 women, aged 27-69 years old with LUTS entered a randomized double-blind study comparing tamsulosin (70) versus placebo (70) for 1 month. The outcome variables were mean change from baseline of International Prostate Symptom Score (IPSS), mean change from baseline of mean and maximum urinary flow rate and any adverse effects. Results: Mean change from baseline of IPSS (standard deviation, SD) were −5.6 (6.3) in the tamsulosin group and −2.6 (6.1) in the placebo group. The difference was statistically significant (p = 0.008). Mean change from baseline of mean urinary flow rate (SD) was 0.7 (2.7) mL/second in the tamsulosin group and −0.5 (2.6) mL/second in the placebo group. The difference was also statistically significant (p = 0.013). However, the difference in mean change from baseline of maximum urinary flow rate between the two groups was not statistically significant (p = 0.506). There were two patients in the tamsulosin group who experienced dizziness and asthenia. No other adverse effect was detected. Conclusion: Tamsulosin is more efficacious than placebo in the treatment of LUTS in women

Bladder substitution by ileal neobladder for women with interstitial cystitis

OBJECTIVE: To report our experience with cystectomy and ileal neobladder for women with interstitial cystitis (IC). MATERIALS AND METHODS: Thirty-five female patients treated during 2000-2005 with the mean age of 45.9 ± 4.4 years were included in this study. All of them had experience suprapubic pain with irritative voiding symptoms and were diagnosed as having IC based on NIDDK criteria for at least 2 years. Conservative treatments had failed to relieve their symptoms; and therefore all of them agreed to undergo a bladder removal. For cystectomy, the urethra was cut 0.5 cm below the bladder neck, proximal to the pubourethral ligament, leaving the endopelvic fascia intact. An ileal segment of 65 cm was used to create the neobladder with the Studer's technique. RESULTS: All patients presented good treatment outcome with regard to both diurnal and nocturnal urinary control without any pain. Quality of life using the SF-36 questionnaire showed significant improvement of both physical health and mental health. Spontaneous voiding with minimal residual urine was found in 33 cases (94.3%), and the remaining 2 cases (5.7%) had spontaneous voiding with residual urine and were placed on clean intermittent catheterization (CIC). Twelve out of 30 cases with sexually active ability had a mild degree of dyspareunia but without disturbance to sexual life. CONCLUSION: Bladder substitution by ileal neobladder for women who suffer from IC can be a satisfactory option after failure of conservative treatment. Resection of the urethra distal to the bladder neck can preserve continence and allow spontaneous voiding in almost all patients

Complications prevention of shoulder balance support device for lateral decubitus position: A randomized controlled trial

Objectives: The authors invented the shoulder balance support device aiming to prevent skin complications and neck pain in surgical patients operated in lateral decubitus position. This study aimed to compare skin complications and neck pain between patients with shoulder balance support device and traditional positioning instruments and to assess surgeons’ and anesthesiologists’ satisfaction in using the device. Methods: A randomized controlled trial, which followed Consolidated Standards of Reporting Trials(CONSORT) statement, was conducted in patients who underwent laparoscopic upper urinary tract surgery in the lateral decubitus position from June 2019 to March 2021. The shoulder balance support device was used in 22 patients and 22 other patients were in the control group. The area of skin erythema, bruising, or abrasion resulting from the pressure effect of the lateral decubitus position was measured and the pain score for the neck and shoulder area after the operation was assessed. Furthermore, the satisfaction of the medical personnel taking care of the patients and using the shoulder balance support device was investigated. Results: A total of 44 patients were included. No patient in the intervention group reported neck pain. Skin erythema was found in six patients in each group and the median area of skin erythema was significantly smaller in the intervention group. Most of the medical personnel reported satisfaction with use of the device. Conclusion: This device is an innovative tool with the aim of ultimate care for surgical patients. Clinical Trial Registration Number: Thai Clinical trials registry ID TCTR 2019060600

Symptom prevalence, bother, and treatment satisfaction in men with lower urinary tract symptoms in Southeast Asia: a multinational, cross-sectional survey

Purpose: The overall objective of the survey was to systematically examine patients’ perspectives on lower urinary tract symptoms (LUTS) and their treatment in Southeast Asia. Methods: A multinational cross-sectional survey involving adult men seeking consultation at urology outpatient clinics because of LUTS in Southeast Asia was conducted using convenience sampling. Self-reported prevalence, bother, treatment and treatment satisfaction of selected LUTS including urgency, nocturia, slow stream, and post-micturition dribble were evaluated. Results: In total, 1535 eligible patients were enrolled in the survey. A majority of respondents were aged 56–75 years, not employed, and had not undergone prostate operation before. Overall, the self-reported prevalence of nocturia was 88% (95% CI 86–90%), slow stream 61% (95% CI 59–63%), post micturition dribble 55% (95% CI 52–58%), and urgency 52% (95% CI 49–55%). There were marked differences in the country specific prevalence of LUTS complaints. Frequently, symptoms coexisted and were combined with nocturia. More than half of patients felt at least some degree of bother from their symptoms: 61% for urgency, 57% for nocturia, 58% for slow stream, and 60% for post-micturition dribble. Before seeing the present urologists, nearly half of patients have received some form of prescribed treatment and more than 80% of patients indicated they would like to receive treatment. Conclusion: Men who sought urologist care for LUTS often presented with multiple symptoms. Nocturia emerged as the most common symptom amongst the four core symptoms studied