Surgical outcomes of vesicovaginal fistula in the radiotherapy field
BAUS ePoster online library. Toia B. 06/25/19; 259569; P7-5
Bogdan Toia
Bogdan Toia
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Abstract
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Introduction and Objectives

A debilitating consequence of pelvic radiation therapy is radiation-induced vesicovaginal fistulae (rVVF). Whilst outcomes for vesicovaginal fistula repair after gynaecological or obstetric injury are well documented, the success in radiotherapy cases are only sparsely described in the literature. We examined our cohort of patients requiring rVVF repair.

Patients and Methods

Data on all VVF repairs was collected prospectively. A retrospective review of outcomes in those with rVVF performed between 2009-2018 was performed.

Results

18 women were identified with rVVFs. Mean interval between radiotherapy and fistula repair was 19 (range 0-40) years. Fistulae arose spontaneously in 13 patients, whilst 5 occurred following a further surgical intervention (hysterectomy in 2 women and bladder biopsy, anterior exenteration, clam ileocystoplasty in the others). Closure was attempted vaginally in 7 women and abdominally in one, whilst 10 had primary ileal diversion due to significant bladder contracture and ureteric involvement. Initial closure rate was 4/7 (57%) vaginally and 0/1 abdominally. A failed vaginal closure was successfully achieved abdominally at the second attempt, resulting in an overall closure rate of 5/18 (28%).

Conclusions

Closure of rVVF is a significant challenge with an initial success rate of 22.2% and overall success rate of only 28%. 72% required primary or secondary urinary diversion. Associated bladder dysfunction and ureteric strictures were the deciding factor in 56% Vaginal surgery was utilized in the majority to try avoid a hostile pelvis, but the surgical approach should be tailored to individual circumstance.
Introduction and Objectives

A debilitating consequence of pelvic radiation therapy is radiation-induced vesicovaginal fistulae (rVVF). Whilst outcomes for vesicovaginal fistula repair after gynaecological or obstetric injury are well documented, the success in radiotherapy cases are only sparsely described in the literature. We examined our cohort of patients requiring rVVF repair.

Patients and Methods

Data on all VVF repairs was collected prospectively. A retrospective review of outcomes in those with rVVF performed between 2009-2018 was performed.

Results

18 women were identified with rVVFs. Mean interval between radiotherapy and fistula repair was 19 (range 0-40) years. Fistulae arose spontaneously in 13 patients, whilst 5 occurred following a further surgical intervention (hysterectomy in 2 women and bladder biopsy, anterior exenteration, clam ileocystoplasty in the others). Closure was attempted vaginally in 7 women and abdominally in one, whilst 10 had primary ileal diversion due to significant bladder contracture and ureteric involvement. Initial closure rate was 4/7 (57%) vaginally and 0/1 abdominally. A failed vaginal closure was successfully achieved abdominally at the second attempt, resulting in an overall closure rate of 5/18 (28%).

Conclusions

Closure of rVVF is a significant challenge with an initial success rate of 22.2% and overall success rate of only 28%. 72% required primary or secondary urinary diversion. Associated bladder dysfunction and ureteric strictures were the deciding factor in 56% Vaginal surgery was utilized in the majority to try avoid a hostile pelvis, but the surgical approach should be tailored to individual circumstance.
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