CODE: 15.3 - Vesicovaginointestinal fistulas as the therapeutic problem - analysis of patients treated between 1991-2005
Article published in Urologia Polska 2006/59/Suplement 1.

authors

Teresa Gawlik-Jakubczak, Kazimierz Krajka

Klinika Urologii AM w Gdańsku

summary

Introduction. Vesicovaginointestinal fistulas are serious disease which concern women in various age. The main reason of them are extensive neoplasmatic disease or inflammatory process in pelvis and increased number of complications after oncological therapy. It depends on growing number of detected neoplasms, inclusion of therapy even in advanced disease and widespread use of irradiation as therapeutic method.

Objectives. The aim of this work is to analyse the causes of treated fistulas and results of per-formed type of operations.

Materials and methods. There were 27 patients with 29 vesicovaginointestinal fistulas treated in our department between 1991-2005. We collected data regarding main disease, kind of therapy in the past, surgical and oncological treatment and radiotherapy scheme. We monitor total survival time after fistula surgery.

Results. The causes of fistula were: in 1 case perforation of inflamed intestinal diverticulum, in 2 cases advanced colon cancer, in 2 endometrial cancer, 22 uterine cervix cancer. All patients with uterine cervix cancer had irradiation in the past. 3 patients with different diseases had no radiotherapy. In 7 cases we sutured fistula without urinary diversion. 3 patients had sutured fistula by laparotomy with creation of preternatural anus, 2 patients had cystoje-junoplasty and preternatural anus. 2 women were operated twice and both methods were used to close urinary fistula. Anus was created during first operation. For 20 patients urinary fistula was closed by forming urinary diversion - Brickers method. Anus preternatural was formed in 25 cases, only 2 patients had still natural anus. After first operation we closed both fistulas in 17 cases, 2 patients were operated twice due to vesicovaginointestinal fistulas which appeared after a few years of good health - these are detected as new, distinct postradiation fistulas. 8 patients were operated twice due to early recurrence of urinary fistula-vesicovaginal type. In analysed group of patients 1 woman is waiting for next - third operation of vesicovaginal fistula.

Conclusions. Vesicovaginointestinal fistulas are serious complication for patients.Treatment of them is associated with mutilating operations. Any attempts to cure more sparingly are connected with high risk of failure, so than we expose patients to next operations.