CODE: 15.3 - Analysis of main causes and evaluation of results of surgical treatment of vesicovaginal fistulas with regard to previous radiotherapy
Article published in Urologia Polska 2006/59/Suplement 1.

authors

Teresa Gawlik-Jakubczak, Kazimierz Krajka

Klinika Urologii AM w Gdańsku

summary

Introduction. Vesicovaginal fistulas are one of the most serious complications after gynecologic surgery or radiotherapy of pelvic cancers. An important factor which influence the choice of way of treatment is previous radiotherapy. Growing number of detected pelvic neoplasms, more aggressive treatment methods and wide use of tele and brachytherapy increase the number of patients which need surgery for vesicovaginal fistulas.

Objectives. The aim of this work is to analyse the most frequent causes of vesicovaginal fistulas and to evaluate the results of surgical treatment of vesicovaginal fistulas in regard to previous irradiation.

Materials and methods. We operated on 66 patients with vesicovaginal fistulas between 1991-2005. Youngest patient was 21, oldest 75 years old. In our group 12 patients had fistula repair operations in other hospitals earlier. 75% of patients had radiotherapy in the past. In most cases we closed fistula during first reconstructive operation or by urinary diversion. Few patients needed several attempts.

Results. 86 operations were performed. Uterine myoma was primary disease in 11 patients and inflammatory process in other 2. Neoplasm was diagnosed in 53 cases, endometrial cancer in 2, bladder cancer in 2, uterine sarcoma in 1. The other patients (48) were treated due to uterine cervix cancer. Postoperative, iatrogenic fistulas were diagnosed in 17 cases. Type of performed operations - suture from vaginal approach was done 8 times, closure by transabdominal, transvesical approach - 26, in 1 case we used tissue glue. Closure of fistula with cystojejunoplasty was done in 16 cases, urinary diversion in 35 cases. 11 patients had to have more than one operation due to recurrence of fistula. One patient was operated 7 times and we sutured fistula without urinary diversion. Next woman needed 3 attempts for closure. 2 patients after few years in good health had the recurrence of vesicovaginal fistula. Their diagnosis was new postradiation fistula. In the group of patients with recurrence of fistula 3 women had no radiotherapy in medical history, 8 had irradiation in the past.

Conclusions. Patients with cancer treated by radiotherapy of pelvis in the past had worse prognosis for good results of fistula repair operations. Radiotherapy is an important factor during selection of type of surgery.