Vesicovaginal fistulas – retrospective analysis of own surgical experience from 1991 to 2006
Article published in Urologia Polska 2008/61/4.

authors

Teresa Gawlik-Jakubczak1, Kazimierz Krajka2: 1Oddział Urologii 7. Szpitala Marynarki Wojennej w Gdańsku
2Katedra i Klinika Urologii Akademii Medycznej w Gdańsku

keywords

vagina bladder urinary fistula radiotherapy surgery

summary

Introduction.
Vesicovaginal fistulas are rare and serious complications to the pelvis after surgery or radiotherapy. The treatment of

them despite an advance in medicine is still troublesome. For urologists the choice of treatment mode depends on many factors such

as aetiology, localisation of fistula, age and a general status of patient.

The aim of the study.
The aim of this work is an assessment of the main reasons of v-v fistulas in our material. We present the results

of surgical treatment regarding the aetiology and performed surgical technique in our department experience.

Material and method.
Between 1991-2006 in our department we operated on 74 patients for v-v fistulas. We recognised iatrogenic,

postoperative fistulas in 24 cases, the rest were neoplasmatic and postradiation. The primary disease for 14 women was a benign

disease, in the case of 60 patients it was neoplasm, mainly uterine cervix.

Results.
101 operations were performed using 5 main techniques – suture of fistula with vaginal approach, suture from abdominal,

transvesical approach, cystojejunoplasty with transplantation of ureters, urinary diversion, closure with tissue glue or suture by laparoscopy.

In all cases control of urine outflow was achieved. Regrettably in 41 cases we achieved this result performing urinary diversion.

Some patients needed few operations to achieve the same results.

Conclusions.
In the majority of cases is possible to close urinary fistula performing reconstruction surgery or urinary diversion (temporary

or permanent). The risk of fisula recurrence is significantly higher in a group of patients after previous radiotherapy on pelvis .

For selected patients even after RT on pelvis is manageable to suture fistula without urinary diversion.

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