Surgical technique of a recurrent post-radiation vesicovaginal fistula with a small intestine graft

Vesicovaginal fistula: Review and recent trends

Vesicovaginal fistula (VVF) is an abnormal communication between the bladder and the vagina. Prompt diagnosis and timely repair are essential for successful management of these cases. As the clinical scenario is variable, it is difficult to frame uniform guidelines for the management of VVF. Hence, the management protocol is dependent on the treating surgeon and the available resources. Conservative methods should be used in carefully selected patients. Delayed repair is better than the early repair of VVF. Transvaginal route for repair is preferred as it has low morbidity, higher success rates, and minimal complications. Anticholinergics should be used in the postoperative period for better chance of bladder healing. When facilities are available, all the patients may be referred to a tertiary care center where expertise and advanced resources are available. Trained surgeons adapting the new trends should refine the art of VVF repair.

Management of radiation-induced rectovesical fistula in a woman using ileum: A case report and review of the literature

BACKGROUND

Radiation-induced rectovesical fistulas (RVFs) require the most demanding treatment. We presented a rare case of postradiation RVF in a woman repaired with ileum.

CASE PRESENTATION

A 49-year-old women was referred to our department for fecaluria and dysuria after radiation for cervical cancer. The voiding cystourethrography demonstrated a large RVF. A segment of ileum was separated into 2 parts for the simultaneous reconstruction of bladder and rectum, which led to a permanently closed fistula. This approach is easily accessible via transabdominal approach, could be applied for large defect, and bladder augmentation could be performed simultaneously.

CONCLUSION

The repair of an RVF using ileum appears feasible and represents an attractive alternative for the management of RVFs.

[Fistulas of the urogenital tract after radiotherapy]

BACKGROUND

Radiotherapy plays a substantial role in the treatment of malignancies. More than 2/3 of all oncologic patients undergo radiotherapy during their specific treatment. Besides manifold side effects of radiotherapy, radiogenic fistulas of the urogenital tract are a potential severe complication. These fistulas might affect the female genital tract and the urinary tract.

THERAPY

Potential manifold variety of radiogenic urogenital fistulas requires a specific therapy. Radiation tissue damage includes severely disturbed local blood supply. Consequently, in some cases extremely complex reconstructive techniques are necessary to restore the functionality of the urinary tract.

CONCLUSION

The treatment of radiogenic urogenital fistulas is challenging. A successful therapy can only be achieved by local improvement of the blood supply in the damaged area.