Surgical outcomes of vesicovaginal fistulae in patients with previous pelvic radiotherapy.

Abstract

INTRODUCTION AND HYPOTHESIS:

Vesicovaginal fistulae (VVF) repair success rates for simple surgical fistulae are high, but constitute a significantly greater challenge when occurring in a radiotherapy field. We aim to evaluate the causes, assessment, closure rates and functional outcomes of VVF surgery in patients with previous radiotherapy.

METHODS:

Data on all VVF repairs were collected prospectively. A retrospective review of outcomes in those with VVF performed between 2009 and 2018 was carried out. Details including time from radiotherapy, pre-operative assessments, approach to surgery and functional outcome were analysed.

RESULTS:

Twenty women with VVFs were identified. The mean age was 59 (range 25-88) years. Primary malignancy was cervical in 16 women, with the remaining 4 women having ovarian, urethral, endometrial and rectal cancer respectively. All women had external beam radiotherapy with 6 (30%) undergoing boosted brachytherapy. Mean interval between radiotherapy and fistula repair was 19 (range 0-40) years. Fistulae arose spontaneously in 14 patients, whereas 6 occurred following a further surgical intervention.Closure was attempted vaginally in 7 women and abdominally in 1, whereas 12 had a primary diversion owing to significant bladder contracture and ureteric involvement. The closure rate in those attempted was 62.5%, 40% in those with spontaneous fistulae compared with 100% for post-surgical fistulae, but only 20% for the total cohort.

CONCLUSIONS:

Closure of VVF is a significant challenge, with an initial success rate of 20% and an overall success rate of only 25%. Seventy percent required primary or secondary urinary diversion. Vaginal surgery was utilised in the majority to try to avoid a hostile pelvis, but the surgical approach should be tailored to individual circumstances.

• Authors: Bogdan Toia, Mahreen Pakzad, Rizwan Hamid, Tamsin Greenwell, Jeremy Ockrim
• Journal: International urogynecology journal (Int Urogynecol J) Vol. 31 Issue 7 Pg. 1381-1385 (07 2020) ISSN: 1433-3023 [Electronic] England
• PMID: 31989199 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Female
• Humans
• Middle Aged
• Pelvis
• Retrospective Studies
• Treatment Outcome
• Urinary Diversion
• Vesicovaginal Fistula (etiology, surgery)