Repair of vesico-vaginal fistula near ureteral opening after McDonald’s cervical cerclage

<p>The authors repaired a vesico-vaginal fistula located between the bilateral ureteral openings after McDonald’s cervical cerclage in a pregnant woman whose vaginal portion of the cervix had almost disappeared due to uterine vaginal conical resection.</p><p>Our concerns regarding this procedure were damage to the ureteral opening and the need for a ureterovesicostomy; delicate procedures are required in such cases. Specifically, the following made it possible to have a successful outcome: (1) Ureteral stents were placed and cystoscopic observation was repeated during the operation, and (2) the bladder surface was first exposed widely in a healthy area—sufficiently away from the fistula. The separation of the bladder wall and the vaginal wall was positioned toward the fistula margin. This step clarified the boundary between the healthy parts and the scared parts of the bladder wall, minimizing the resection range of the bladder. In this paper, we introduce the details of this surgical procedure and the author's thoughts on avoiding ureterovesicostomies. Due to the recent increase in cervical cancer of younger women along with an increase in later-in-life marriages, opportunities to perform cervical cerclage for pregnant women (whose vaginal portion of the cervix has been largely resected by conical resection) are on the rise. In these cases, the higher chances of developing a vesico-vaginal fistula are inevitable. Therefore, it is our hope that the techniques and ideas introduced here will be of practical help to urogynecologic surgeons.</p>