VESICOVAGINALS FISTULAS: THE EXPERIENCE OF OUR CLINIC ON SURGICAL TREATMENT AND RESULTS

A. Sima,1,B. Braticevici, 1,F.Benguș,1,R.Petca1,V. Jinga1

1The Clinical Urology Hospital "Theodor Burghele" Bucharest

Corresponding author: Andrei Sima 
Phone no. 0040740251570
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Abstract

Vesicovaginals fistulas are the most common type of urogenital fistulas resulting after radical hysterectomy with or without radiotherapy. In most cases, surgery is necessary for healing. The present study was conducted over a period of 5 years. In all cases, the diagnosis was made on medical history, a complete clinical examination, intravenous pyelography and cystoscopy. Surgical closing technique of fistula tract could be applied in 28 cases (68.29%), out of which in 9 (22%) patients the exicision of the fistula tract and separate suture of the bladder and the vagina were performed while in 19 ( 46.3%) patients a flap was interposed too. All 25 patients who presented fistula after radical hysterectomy were feasible to surgical treatment of demolition of fistula and only 3 of 16 (18.75%) of the cases of hysterectomy and radiotherapy had indication for surgical closing technique of fistula tract. In 4 cases (9.7%) an external urinary diversion as the only therapeutic solution was performed. In 3 cases (7.3%) a percutaneous nephrostomy was inserted. Two patients (4.8%) presented vesicovaginal fistula and rectovaginal fistula as well. 24 (85.71%) of the 28 cases that have benefited from surgery remained continent, without loss of urine vaginally after the removal of urethro-bladder catheter. In 13 (31.7%) cases the success could not be obtained due to radiotherapy associated with hysterectomy. In the 25 cases where radiotherapy was not enforced, the success rate of surgery was 92%, while in patients who have benefited from radiotherapy too it goes down drastically (33%).The surgical closing technique of the vesicovaginal fistula has a very high success rate. The success of the operation can be obtained from the first surgery. The associated radiotherapy has a big influence in the approach of this pathology surgery.

Keywords: vesicovaginalis fistula, radiotherapy, urethro-bladder catheter

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