Introduction and Objectives
Post irradiation vesicovaginal fistulas (piVVF), with histological changes including fibrosing of exposed tissues and vasculitis (telangiectasies). Reconstructive surgery on devitalizing tissue is very complexes. Extend of surgical reconstruction depends on changes of piVVF and its localization.
Material and Methods
In five years period (since 1999–2005) we treated surgically 39 pts with piVVF. Mean age are 47 years (36–68 years) Preoperative diagnosis including anamnesis, cystoscopycally findings, intravenous urography, retrograde uereteropyelography, CT urography etc. Small trigonally and subtrigonally fistulas we treated conservatively with urethral catheter. Large, extensive retrotrigonal fistulas we treated immediately with transabdominal approach (TAA), because we have good expossure of anatomical structure involved in pathological postirradiation changes. TAA is good for reconstruction like ureteric reimplantation, omental interpostion with omental wrap. In the situation with excessive fibrotic changes on surround tissues we have possibilities for pelvis exenteration and one of the methods of supravesical derivations.
Results
Fistulas excision with omenatal interposition in 25 pts (65%). Bilateral ureterocystostomy in 6 pts (15%) Ureterocutaneostomy in 2 pts (5%). Cystectomy with Brucker derivation, like method of choice in 4 pts (10%). Uretreosigmoidostomy in 1 pts (2%). Dysuric symptoms persist postoperatively in 60% of pts. (postirradiation cystitis), conservative treatments. Postoperative recidivs in 5% (pts with simple excisions).
Conclusions
Transabdominal approach with wide opening of bladder, good exposure of surround anatomical structure involved in piVVF, possibilities for reconstructive surgery made this approach superiorly than transvaginaly approach (smaller operating field and limited possibility for reconstructive surgery).
Article info
Identification
Copyright
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.
