Papers by Patkawat Ramart
Insight UROLOGY, Jun 17, 2022
Frequency-volume chart (FVC) and Bladder diary (BD) are widely accepted as an additional tool to ... more Frequency-volume chart (FVC) and Bladder diary (BD) are widely accepted as an additional tool to evaluate lower urinary tract symptoms. They are simple and inexpensive as well as provide more precise information. However, the guidelines and experts recommend 3-day FVC/BD for evaluation both men and women with lower urinary tract symptoms, it may not be enough for some specific symptoms. To avoid poor compliance and poor reliability, the appropriate duration and instruction are mandatory in each patient. Moreover, there are some limitation and concerns need to be recognized before interpretation. This review would like to demonstrate the appropriate duration of FVC/BD to increase completion rate, compliance and reliability as well as to decrease interpretation errors of FVC/BD.
PubMed, Apr 4, 2023
Objective: This study aimed to demonstrate our management of rectal injury (RI) and rectourinary ... more Objective: This study aimed to demonstrate our management of rectal injury (RI) and rectourinary fistula (RUF) from radical prostatectomy (RP) and identify a possible factor that increased the chance of developing RUF. Materials and methods: Between January 2011 and December 2019, a total of 14 cases of RI were retrospectively reviewed and analyzed, including preoperative, perioperative, and postoperative information. Results: In all 14 cases of RI, the average age at RP was 66.3 years (54-77). During the study period, 8 of 14 cases of RI occurred in our hospital, and the incidence of RI was 0.42%. RI was intraoperative recognition in 8 cases and delayed diagnosis in 6 cases. For immediate recognition, 4 of 8 cases were primarily repaired without developing RUF and did not require diverting colostomy and suprapubic cystostomy. RUF occurred in 10 cases including 4 cases of intraoperative recognition and all cases of delayed diagnosis. In a subgroup analysis of RI that occurred in our hospital, the timing for diagnosis was clinically and statistically significant difference (P = 0.029). Instantly detected RI during RP and intraoperative rectal repair resulted in no postoperative complication. Among all 10 cases of RUF, 5 cases were successfully repaired by modified York-Mason procedure with dartos tissue flap interposition. No major complications were reported. Conclusions: Incidence of RI was 0.42% and intraoperative recognition of RI was a key to prevent the development of RUF. Modified York-Mason procedure with dartos tissue flap interposition was an effective treatment for RUF.
PubMed, Apr 4, 2023
Objective: This study aimed to demonstrate our management of rectal injury (RI) and rectourinary ... more Objective: This study aimed to demonstrate our management of rectal injury (RI) and rectourinary fistula (RUF) from radical prostatectomy (RP) and identify a possible factor that increased the chance of developing RUF. Materials and methods: Between January 2011 and December 2019, a total of 14 cases of RI were retrospectively reviewed and analyzed, including preoperative, perioperative, and postoperative information. Results: In all 14 cases of RI, the average age at RP was 66.3 years (54-77). During the study period, 8 of 14 cases of RI occurred in our hospital, and the incidence of RI was 0.42%. RI was intraoperative recognition in 8 cases and delayed diagnosis in 6 cases. For immediate recognition, 4 of 8 cases were primarily repaired without developing RUF and did not require diverting colostomy and suprapubic cystostomy. RUF occurred in 10 cases including 4 cases of intraoperative recognition and all cases of delayed diagnosis. In a subgroup analysis of RI that occurred in our hospital, the timing for diagnosis was clinically and statistically significant difference (P = 0.029). Instantly detected RI during RP and intraoperative rectal repair resulted in no postoperative complication. Among all 10 cases of RUF, 5 cases were successfully repaired by modified York-Mason procedure with dartos tissue flap interposition. No major complications were reported. Conclusions: Incidence of RI was 0.42% and intraoperative recognition of RI was a key to prevent the development of RUF. Modified York-Mason procedure with dartos tissue flap interposition was an effective treatment for RUF.
Siriraj Medical Journal
Objective: To study the safety and efficacy of retrograde intrarenal surgery (RIRS) in patients w... more Objective: To study the safety and efficacy of retrograde intrarenal surgery (RIRS) in patients with staghorn stones. Materials and Methods: This retrospective observational study was carried out between May 2016 and October 2020, which is when we performed RIRS in staghorn stone patients. Medical records of all patients with this condition in the database of Siriraj Hospital were reviewed. A total of 35 patients were eligible for this study. Descriptive statistics were used to assess the safety and efficacy of RIRS in patients with staghorn stones. Results: In total, 31.43% of patients were stone-free after the first round of RIRS and 59.55% achieved stone-free status after the second procedure. The stone-free rate did not increase after a second round of RIRS. The median size of all staghorn stones was 3.1 cm. Unfortunately, we found two sepsis patients in this study. We also found eight events of minor complications, including fever and minimal ureteric injury in 54 sessions of R...
Insight Urology, 2022
For vaginal reconstructive surgery, the vaginal defect sometimes cannot be closed with primary in... more For vaginal reconstructive surgery, the vaginal defect sometimes cannot be closed with primary intention due to poor tissue quality or loss of the vaginal wall. To cover the defect, plastic surgeons may be consulted with regard to a tissue advancement flap, a very complex procedure, and urologists may not feel familiar with it or comfortable with carrying it out. The rotational labial and inferior pudendal artery based inner thigh flap, devised by Professor Shlomo Raz, is a simple and useful procedure which urologists can perform with a short learning curve. Therefore, this article aims to demonstrate the surgical technique involved in this flap which can be widely used as an adjunct to any vaginal reconstructive procedures.
Siriraj Medical Journal
Objectives: To demonstrate the outcome of transvaginal urethrolysis as a treatment option for wom... more Objectives: To demonstrate the outcome of transvaginal urethrolysis as a treatment option for women with recurrent cystitis, which could be caused from voiding problems. In the case of a failure of non-invasive treatment, the surgical procedure to decrease outlet resistance may have a role. Materials and Methods: Between January 2016 and December 2020, women with recurrent cystitis who underwent urethrolysis at Siriraj Hospital were retrospectively reviewed. Only women who were followed-up for more than 6 months were analyzed. Cure was defined by no clinical symptoms of cystitis, no pyuria on urine analysis, and/or negative urine culture during the follow-up period. Results: In total, 52 women underwent transvaginal urethrolysis. The overall cure rate was observed 53.9% (28 cases) at a median follow-up time of 11.9 (6–59) months. Eighteen of the 44 cases (40.9%) who underwent a video urodynamics study showed bladder outlet obstruction, defined as a Solomon–Greenwell bladder outlet o...
Siriraj Medical Journal, 2023
Urinary tract infection (UTI) referred to microbial invasion of the urinary tract system, typical... more Urinary tract infection (UTI) referred to microbial invasion of the urinary tract system, typically due to bacteria. UTI is more common in women than men, which is thought to be due to differences in lower urinary tract anatomy. Making a diagnosis of UTI begins with the presence of clinical symptoms consistent with either pyelonephritis and cystitis. When pyelonephritis symptoms are present, it is usually associated with bacterial infection, while the symptoms of clinical cystitis may or may not be caused by infection. As both urologic and non-urologic conditions can produce the clinical symptoms of cystitis, diagnosis of UTI requires both pyuria and bacteriuria on urine examination. Complicated UTI is when the infection is associated with either host or bacterial factors that increase the chance of reinfection and decrease treatment efficacy, such as altered organism virulence, immunocompromise, or urinary tract abnormalities. The urologist's primary role in UTI management is to evaluate for such urinary tract abnormalities and, if needed, resolve those conditions to prevent recurrent infection. This review will describe the urologists' evaluation and management of complicated and recurrent UTI and inform physician about the urinary tract abnormalities that can predispose to recurrent UTI.
Journal of the Medical Association of Thailand, Dec 1, 2019
Background: Vesicovaginal fistula (VVF) after a gynecologic procedure is often located at the sup... more Background: Vesicovaginal fistula (VVF) after a gynecologic procedure is often located at the supratrigonal area. This location is difficult to approach via the vagina because of the depth and exposure.
Objective: To demonstrate the outcome of transvaginal closure supratrigonal VVF.
Materials and Methods: The authors retrospectively reviewed non-radiated VVF that was repaired transvaginally between 2015 and 2017. A cure was defined as no clinical urinary incontinence and vaginal discharge.
Results: Eleven cases were performed transvaginal closure fistula. The average fistula diameter was 5.1 mm. The peritoneal flap and labial fat were used for tissue interposition in five and three cases respectively. Six cases were cured at mean follow-up of 6.8 (1 to 24) months. Five cases recurred and four of them were performed transvaginal closure. The four cases of recurrence were cured at mean follow-up of 7.0 (3 to 10) months. Two cases used peritoneal flap and others used labial fat for tissue interposition. One had recurrence using one pad per day and did not want to repair. The average operative time for 15 repairs was 82.1 (45 to 120) minute. For all 15 repairs, mean length of stay was 4.3 (2 to 11) days and mean catheter time was 19.1 (10 to 54) days.
Conclusion: Supratrigonal VVF could be successfully repaired with transvaginal approach. Overall success rate in first attempt was 54.5%.
Siriraj Medical Journal, 2019
Objective: To evaluate the effects of renin-angiotensin system inhibitors (RASIs) on tumor-recurr... more Objective: To evaluate the effects of renin-angiotensin system inhibitors (RASIs) on tumor-recurrence and diseaseprogression in non-muscle invasive bladder cancer (NMIBC) patients. Methods: From 2006-2015, 348 NMIBC patients at Siriraj Hospital were recruited for this study. Tumor-recurrence was identified after the transurethral resection of bladder cancer (TUR-BT) and pathological confirmation of NMIBC, while stage-progression was defined as muscularis-propria invasion after pathological review or metastases. Cox proportional hazards models were used to assess the recurrence-free survival (RFS) and progression-free survival (PFS) rates. Results: Of the 348 patients, 86 (24.7%) received RASIs at the first TUR-BT. The median age was 68 years, and it was significantly older for the RASI cohort. No differences in the tumor characteristics of the groups were found. The median follow-up periods for tumor-recurrence and stage-progression were 2.3 and 3.7 years, respectively. Forty percent of the patients experienced tumor-recurrence, with the no-RASI cohort experiencing a significantly higher tumor-recurrence rate (46% versus 22%, p<0.001). The 5-year RFS rates were 54% and 78% for the no-RASI and RASI cohorts, respectively (p=0.001). Stage-progression was observed in 6% of the patients. The 5-year PFS rates were 87% and 97% for the no-RASI and RASI cohorts, respectively. On univariate and multivariate analyses, a tumor size ≥3 cm and tumor multifocality were associated with recurrent bladder cancer (p<0.02). On the other hand, the administration of RASIs was associated with a reduced recurrence (p≤0.002). Conclusion: Our study suggests that RASI administration might be a potential factor to prevent bladder cancer recurrence. Further study is needed to evaluate the effects of RASIs.
Journal of the Medical Association of Thailand, 2021
Objective: To report a case series of female paraurethral cysts (FPCs) at a tertiary hospital.
... more Objective: To report a case series of female paraurethral cysts (FPCs) at a tertiary hospital.
Materials and Methods: Sixteen proximal- and distal-FPC cases treated between 2010 and 2019 were retrospectively evaluated. Demographics, clinical presentations, diagnostic methods, treatments, and outcomes were analyzed.
Results: The mean age and BMI of the 11 proximal-FPC patients were significantly higher than those of the five distal-FPC patients [55.6 versus 39.8 years (p=0.008); 27.6 versus 21.5 kg/m² (p=0.036)], respectively. Comorbidity and parity statuses did not differ. The most common presenting symptoms were palpable mass (31.3%) and lower urinary tract symptoms (LUTS) (31.3%). There were palpable masses in four distal-FPC cases (80%), significantly more than in proximal-FPC at one case (9.1%) (p=0.013). Normal urinalyses were found in all five distal-FPC cases, significantly higher than in proximal-FPC at two cases (18.2%) (p=0.005). Diagnosis was confirmed solely by pelvic examination in three distal-FPC cases (60%) with palpable masses at the distal urethra, but in only one proximal-FPC case (9.1%) (p=0.063), otherwise, translabial ultrasound, CT, MRI, or VCUG was used. Patients were managed by transvaginal excision and urethral injury occurred in six (42.9%). While the groups’ operative times, blood losses, and catheter indwelling times were similar, proximal-FPC hospital stays were longer at three versus two days (p=0.019). Disease recurrence, transient stress urinary incontinence (SUI), and urethral stricture occurred in one, two and one of proximal-FPC cases, respectively. One distal FPC developed overactive bladder. The symptom-free success rate was 64.3%. Two proximal-FPC patients had adenocarcinoma.
Conclusion: The FPC patients had various presentations. Diagnosis of FPC could be made clinically by pelvic examination. Further investigative imaging might be performed in the equivocal cases to confirm the diagnosis. Transvaginal removal was the mainstay treatment.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2011
To evaluate laparoscopic radical prostatectomy (LRP) performed by urological residents trained fr... more To evaluate laparoscopic radical prostatectomy (LRP) performed by urological residents trained from Siriraj Hospital. Twenty-four laparoscopic radical prostatectomies were performed by 12 urological residents between April 2007 and October 2009 (23 intraperitoneal approaches and one extraperitoneal approach). We used five to six ports. Vesico-urethral anastomosis was sutured by interrupted stitches in two cases and continuous technique in 22 cases. Bilateral pelvic lymphadenectomy were performed in all cases. Demographic data, operative outcome, and pathological outcomes were analyzed. Pathological reports were used with TNM stage following AJCC 2002. The peri-operative parameters and follow-up data were studied. Mean age was 71.3 years and mean serum PSA level was 18.34 ng/ml. Eighty seven percent was clinical localized disease. Most Gleason score was 7. Mean operative time was 208.9 minutes and mean blood loss was 295.8 ml. Blood transfusion rate was 16.7%. Mean hospital stay was ...
Asian Pacific Journal of Cancer Prevention, 2014
To determine the accuracy of preoperative urinary symptoms, urinalysis, computed tomography (CT) ... more To determine the accuracy of preoperative urinary symptoms, urinalysis, computed tomography (CT) and cystoscopic findings for the diagnosis of urinary bladder invasion in patients with colorectal cancer. Records of patients with colorectal cancer and a suspicion of bladder invasion, who underwent tumor resection with partial or total cystectomy between 2002 and 2013 at the Faculty of Medicine Siriraj Hospital, were reviewed. Correlations between preoperative urinary symptoms, urinalysis, cystoscopic finding, CT imaging and final pathological reports were analyzed. This study included 90 eligible cases (71% male). The most common site of primary colorectal cancer was the sigmoid colon (44%), followed by the rectum (33%). Final pathological reports showed definite bladder invasion in 53 cases (59%). Significant features for predicting definite tumor invasion were gross hematuria (OR 13.6, sensitivity 39%, specificity 73%), and visible tumor during cystoscopy (OR 5.33, sensitivity 50%,...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2014
To compare urinary continent rate at six and 12-month postoperative period, and perioperative out... more To compare urinary continent rate at six and 12-month postoperative period, and perioperative outcome between robotic-assisted laparoscopic radical prostatectomy (RALP) and laparoscopic radical prostatectomy (LRP) at Siriraj Hospital. All medical records of patients performed RALP and LRP between 2005 and 2010 were reviewed. Data composed of demographic information, perioperative outcome, and oncologic outcome. Moreover, the urinary continence rate was also collected at six and 12-month postoperative period by questionnaires based research design. Between 2005 and 2010, we performed 548 cases of RALP and 613 cases of LRP. Only 486 cases of RALP (88.6%) and 561 cases of LRP (91.5%) had been followed-up more than 12 months. All demographic data including age, biopsy Gleason score, and preoperative PSA level in both groups were comparably. On the other hand, the perioperative outcome in RALP differed from LRP group significantly, including operative time (210 min vs. 255 min), blood lo...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2014
OBJECTIVE To compare urinary continent rate at six and 12-month postoperative period, and periope... more OBJECTIVE To compare urinary continent rate at six and 12-month postoperative period, and perioperative outcome between robotic-assisted laparoscopic radical prostatectomy (RALP) and laparoscopic radical prostatectomy (LRP) at Siriraj Hospital. MATERIAL AND METHOD All medical records of patients performed RALP and LRP between 2005 and 2010 were reviewed. Data composed of demographic information, perioperative outcome, and oncologic outcome. Moreover, the urinary continence rate was also collected at six and 12-month postoperative period by questionnaires based research design. RESULTS Between 2005 and 2010, we performed 548 cases of RALP and 613 cases of LRP. Only 486 cases of RALP (88.6%) and 561 cases of LRP (91.5%) had been followed-up more than 12 months. All demographic data including age, biopsy Gleason score, and preoperative PSA level in both groups were comparably. On the other hand, the perioperative outcome in RALP differed from LRP group significantly, including operativ...
Objective: To evaluate the efficacy of bupivacaine instillation at the renal bed in reduction of ... more Objective: To evaluate the efficacy of bupivacaine instillation at the renal bed in reduction of postoperative pain and analgesic drugs. Material and Methods: Twenty patients who underwent laparoscopic live donor nephrectomy from March 2013 to August 2013 at Siriraj Hospital were randomly divided into two groups, the normal saline and bupivacaine groups. At the end of the operation, an agent was introduced at the renal bed. Each patient was given 20 ml of normal saline or 0.5% bupivacaine, according to the group. The numeric rating scale was used to assess the patients’ pain score. The patients were given the analgesic drugs according to their pain scores. Data were compared between the groups and statistically analyzed. Results: There was no difference in the characteristics between the groups. The patients in the normal saline group required more total morphine at postoperative 12 hours (3 mg VS 1.5 mg) ), but this finding failed to reach statistical significance (p=0.912). In the...
Objective: To describe an objective method for evaluating kidney stone radiopacity for use in the... more Objective: To describe an objective method for evaluating kidney stone radiopacity for use in the selection of cases suitable for extracorporeal shock wave lithotripsy (ESWL). Materials and Methods: We recruited 55 adult patients with a solitary 0.5-2 cm renal pelvic stone or proximal ureteral stone. All patients underwent routine plain KUB, and an aluminum step wedge was adapted before x-ray exposure. This plain KUB was digitized using Fuji computed radiography. Fuji computed radiography can evaluate the gray level of the stone and each of the 11 steps of the Al step wedge. This allows radiographic stone density to be expressed in mm aluminum equivalent (mm Al Eq). Results: Stone density on plain KUB was 3 to 26.7 mm aluminum equivalent. The 16 patients in whom ESWL failed were found to have stones of a significantly higher density than the stones found in patients with complete stone fragmentation (mean ± SD 16.69 ± 5.46 vs 10.65 ± 5.28 mm aluminum equivalent, p-value<0.001). T...
Objective: To evaluate the effect of urethral dilation on lower urinary tract symptoms in women. ... more Objective: To evaluate the effect of urethral dilation on lower urinary tract symptoms in women. Material and Methods: Forty-five women with non-neurogenic lower urinary tract symptoms (LUTS) without genital prolapsed underwent urethral dilation. Clinical and uroflowmetry were followed up and recorded at 1 and 3 months. Any significant change in clinical and uroflowmetry were evaluated. Results: Within 1 month of dilation, 88% (40/45) of the women reported a clinical improvement. Clinical improvement in LUTS was associated with a lower IPSS score (p<0.05). At 3 months, 80% (36/45) of the women also reported a clinical improvement. No significant change in uroflowmetry before and after dilation was reported. Conclusion: The study demonstrated that urethral dilation was effective in aged women with LUTS in the short term (1 and 3 months) However, other studies are reguired in order to determine the long-term effects. ผลของการขยายทอปสสาวะในผหญงวยกลางคน ทมกลมอาการทางเดนปสสาวะสวนลาง เ...
Comparison of 1 Year Recurrent Rate in High-Risk of Recurrent Non-Muscle Invasive Bladder Cancer ... more Comparison of 1 Year Recurrent Rate in High-Risk of Recurrent Non-Muscle Invasive Bladder Cancer Who Had Received Induction Course of Intravesical BCG after TUR-BT Between Combination with Immediate Intravesical Mitomycin C and Induction Course of Intravesical BCG Alone Objective: To compare a recurrent rate within the first year after TUR-BT between immediate intravesical Mitomycin C with induction course of intravesical BCG and induction course of intravesical BCG alone in high risk group of non-muscle invasive bladder cancer. Materials and methods: A retrospective study between January 2007 and December 2010, 138 patients who underwent complete induction course of intravesical BCG and followed surveillance cystoscopy every 3 months at least 1 year after TUR-BT were identified and divided in two groups, immediate intravesical Mitomycin C plus induction course of intravesical BCG (group 1) and induction course of intravesical BCG alone (group 2). The 1 year recurrent rate of tumor ...
Objective: To measure the correlation of the bony pelvis parameters and the difficulty of RALP in... more Objective: To measure the correlation of the bony pelvis parameters and the difficulty of RALP in operative time and estimated blood loss (EBL). Material and Methods: In a retrospective descriptive analytic study from January 2007 to December 2012, 154 cases of prostate cancer patients who underwent RALP by a single surgeon were reviewed, after the exclusion of the first 50 cases. Preoperative data and imaging studies were collected. Bony pelvis measurements, operative time, and EBL were analyzed in order to determine if there is any correlation between them. Results: There was no significant correlation between pelvic parameters, operative time and EBL. After we analyzed prostate volume and tumor stage, it was determined that they were not correlated. BMI came close to showing a significant correlation with operative time (p-value = 0.009) but not EBL. The nerve-sparing procedure was the only independent parameter that impacted operative time and EBL statistically; however, this fi...
Objective: To evaluate the incidence of urinary incontinence and erectile dysfunction (ED) at 12 ... more Objective: To evaluate the incidence of urinary incontinence and erectile dysfunction (ED) at 12 month post robotic-assisted laparoscopic radical prostatectomy (RALP) in Siriraj hospital. To evaluate the risk factor (age, pre-operative PSA, Gleason score, T-staging, Margin, status post-operative PSA, Nerve sparing, Case number) for incontinence and ED at 12 months post RALP in Siriraj hospital Materials and Methods: Between February 2007 to December 2009, the continence and erectile function of 318 patients that underwent RALP were evaluated by questionnaire-base research design. Incontinence was defined as the use of more than one safety pad per day. Erectile function was assessed by IIEF-5 scores which less than 22 was dysfunction. Direct questions of the ability to have erection and ability to have sexual intercourse were also used to assess erectile function. Results: The rate of urinary incontinence post RALP at 1 year was 26.7%. The rate of erectile dysfunction post RALP at 1 ...
Uploads
Papers by Patkawat Ramart
Objective: To demonstrate the outcome of transvaginal closure supratrigonal VVF.
Materials and Methods: The authors retrospectively reviewed non-radiated VVF that was repaired transvaginally between 2015 and 2017. A cure was defined as no clinical urinary incontinence and vaginal discharge.
Results: Eleven cases were performed transvaginal closure fistula. The average fistula diameter was 5.1 mm. The peritoneal flap and labial fat were used for tissue interposition in five and three cases respectively. Six cases were cured at mean follow-up of 6.8 (1 to 24) months. Five cases recurred and four of them were performed transvaginal closure. The four cases of recurrence were cured at mean follow-up of 7.0 (3 to 10) months. Two cases used peritoneal flap and others used labial fat for tissue interposition. One had recurrence using one pad per day and did not want to repair. The average operative time for 15 repairs was 82.1 (45 to 120) minute. For all 15 repairs, mean length of stay was 4.3 (2 to 11) days and mean catheter time was 19.1 (10 to 54) days.
Conclusion: Supratrigonal VVF could be successfully repaired with transvaginal approach. Overall success rate in first attempt was 54.5%.
Materials and Methods: Sixteen proximal- and distal-FPC cases treated between 2010 and 2019 were retrospectively evaluated. Demographics, clinical presentations, diagnostic methods, treatments, and outcomes were analyzed.
Results: The mean age and BMI of the 11 proximal-FPC patients were significantly higher than those of the five distal-FPC patients [55.6 versus 39.8 years (p=0.008); 27.6 versus 21.5 kg/m² (p=0.036)], respectively. Comorbidity and parity statuses did not differ. The most common presenting symptoms were palpable mass (31.3%) and lower urinary tract symptoms (LUTS) (31.3%). There were palpable masses in four distal-FPC cases (80%), significantly more than in proximal-FPC at one case (9.1%) (p=0.013). Normal urinalyses were found in all five distal-FPC cases, significantly higher than in proximal-FPC at two cases (18.2%) (p=0.005). Diagnosis was confirmed solely by pelvic examination in three distal-FPC cases (60%) with palpable masses at the distal urethra, but in only one proximal-FPC case (9.1%) (p=0.063), otherwise, translabial ultrasound, CT, MRI, or VCUG was used. Patients were managed by transvaginal excision and urethral injury occurred in six (42.9%). While the groups’ operative times, blood losses, and catheter indwelling times were similar, proximal-FPC hospital stays were longer at three versus two days (p=0.019). Disease recurrence, transient stress urinary incontinence (SUI), and urethral stricture occurred in one, two and one of proximal-FPC cases, respectively. One distal FPC developed overactive bladder. The symptom-free success rate was 64.3%. Two proximal-FPC patients had adenocarcinoma.
Conclusion: The FPC patients had various presentations. Diagnosis of FPC could be made clinically by pelvic examination. Further investigative imaging might be performed in the equivocal cases to confirm the diagnosis. Transvaginal removal was the mainstay treatment.
Objective: To demonstrate the outcome of transvaginal closure supratrigonal VVF.
Materials and Methods: The authors retrospectively reviewed non-radiated VVF that was repaired transvaginally between 2015 and 2017. A cure was defined as no clinical urinary incontinence and vaginal discharge.
Results: Eleven cases were performed transvaginal closure fistula. The average fistula diameter was 5.1 mm. The peritoneal flap and labial fat were used for tissue interposition in five and three cases respectively. Six cases were cured at mean follow-up of 6.8 (1 to 24) months. Five cases recurred and four of them were performed transvaginal closure. The four cases of recurrence were cured at mean follow-up of 7.0 (3 to 10) months. Two cases used peritoneal flap and others used labial fat for tissue interposition. One had recurrence using one pad per day and did not want to repair. The average operative time for 15 repairs was 82.1 (45 to 120) minute. For all 15 repairs, mean length of stay was 4.3 (2 to 11) days and mean catheter time was 19.1 (10 to 54) days.
Conclusion: Supratrigonal VVF could be successfully repaired with transvaginal approach. Overall success rate in first attempt was 54.5%.
Materials and Methods: Sixteen proximal- and distal-FPC cases treated between 2010 and 2019 were retrospectively evaluated. Demographics, clinical presentations, diagnostic methods, treatments, and outcomes were analyzed.
Results: The mean age and BMI of the 11 proximal-FPC patients were significantly higher than those of the five distal-FPC patients [55.6 versus 39.8 years (p=0.008); 27.6 versus 21.5 kg/m² (p=0.036)], respectively. Comorbidity and parity statuses did not differ. The most common presenting symptoms were palpable mass (31.3%) and lower urinary tract symptoms (LUTS) (31.3%). There were palpable masses in four distal-FPC cases (80%), significantly more than in proximal-FPC at one case (9.1%) (p=0.013). Normal urinalyses were found in all five distal-FPC cases, significantly higher than in proximal-FPC at two cases (18.2%) (p=0.005). Diagnosis was confirmed solely by pelvic examination in three distal-FPC cases (60%) with palpable masses at the distal urethra, but in only one proximal-FPC case (9.1%) (p=0.063), otherwise, translabial ultrasound, CT, MRI, or VCUG was used. Patients were managed by transvaginal excision and urethral injury occurred in six (42.9%). While the groups’ operative times, blood losses, and catheter indwelling times were similar, proximal-FPC hospital stays were longer at three versus two days (p=0.019). Disease recurrence, transient stress urinary incontinence (SUI), and urethral stricture occurred in one, two and one of proximal-FPC cases, respectively. One distal FPC developed overactive bladder. The symptom-free success rate was 64.3%. Two proximal-FPC patients had adenocarcinoma.
Conclusion: The FPC patients had various presentations. Diagnosis of FPC could be made clinically by pelvic examination. Further investigative imaging might be performed in the equivocal cases to confirm the diagnosis. Transvaginal removal was the mainstay treatment.