Surgical care vesicovaginal fistulas in women with malignant gynecological disease

Abstract

Vesicovaginal fistulae (VVF)represents one of the most frequent complications of various gynecological and obstetric procedures. In presence of a gynecological malignant tumor, fistula could be the outcome of surgical complications, radiotherapy or consequence of the tumor process. Reparation of these fistulae is a very complex problem. Our aim was to analyze the results of surgical care VVF-s occurred in women with malignant gynecological disease which was treated surgically or with radiotherapy. Out of the 48 surgically treated patients with primary VVF, in 28 of them fistula occurred after hysterectomy, and in 20 patients after radiotherapy. In 15 patients (31.25%) transvaginal approach was applied, and in 33 patients (68.75%) abdominal approach was applied, with the interposition of a well vascularized lobe being used in 25 patients. All the VVFs that occurred after radiotherapy were repaired by using the abdominal approach. The efficiency of surgical treatment of VVFs after hysterectomy due to a malignant disease was 78.5%, and after radiotherapy 65%. In patients that have not been subjected to radiotherapy, depending on the characteristics of the fistula, transvaginal or abdominal approach is applicable in VVF reparation, while the abdominal approach remains a golden standard in post-radiation fistula treatment, despite the fact that it has not solved the problem after the first medical treatment in as far as 35% of patients.