UroToday.com - Vesicovaginal fistula has been a medical and social problem and remains a surgical challenge,weider x factor plus, especially when it requires re-operation, presents large size, involves the ureter and is associated with radiotherapy. In this paper, we describe our experience with complex urogenital fistulas. We retrospectively evaluated patients with complex vesico vaginal fistulas, including those with fistula size greater than 2 cm, previous history of radiotherapy, infectious or laceration at the fistula site and vesicovaginal fistula associated with ureteral fistula. The vaginal approach was the first choice for all patients, except for those patients with concomitant ureteral fistula requiring ureteral reimplantation or bladder augmentation. The vaginal approach was carried out as described by Raz S. and abdominal approach was carried out as described by O'Connor. Out of 23 patients, 16 were treated by vaginal approach and 6 by abdominal approach. Hysterectomy was the major etiology (72.7%) and 9 patients had at least 1 previous abdominal surgery. The vaginal approach allowed early hospital discharge. There were no major intraoperative or early postoperative complications, such as bleeding, blood transfusion or infection. The main reason for the longest hospitalization in those patients with abdominal approach was related to recovering from paralyzed ileum and pain,x factor workout. Dyspareunia occurred after 3 months only in women who submitted to the vaginal approach. All patients had some sort of tissue interposition (peritoneum, omentum or Martius flap). Complex vesicovaginal fistulas are a big challenge for the urologist and there is not a gold standard surgical approach. Surgeons' experience with surgical technique and anatomy seems to be the main factor for treatment success,trx suspension trainer. The evaluation of fistulas must be done with care to prevent recurrence. The majority of complex vaginal fistula can be successfully managed by vaginal repair. However, some situations may require abdominal or even combined intervention,trx bands for sale. As the vaginal approach is a minimally invasive procedure,trx suspension trainer pro pack, with low costs, easy learning curve and high cure rates, new approaches such as laparoscopic or robotic surgery must be carefully evaluated before being suggested as an alternative. Written by João Paulo Zambon, MD, Nelson S. S. Batezini, MD, Eduardo R. S. Pinto, MD, Milton Skaff, MD, Marcia E. Girotti, MD and Fernando G. Almeida, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations, etc., of their research by referencing the published abstract. UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice. To access the latest urology news releases from UroToday, go to: www.urotoday.com Copyright 2010 - UroToday Sessions At APA Annual Meeting To Highlight DSM-5 Developmen Statehealthfacts.org Updates Women's Health Data