Author(s): Juliusz Kobierski, Hanna Olszewska, Karolina Agnieszka Go?ka, Janusz Emerich
Introduction. Genitourinary fistulas result most commonly from pelvic surgery and might constitute a problem in patients treated radically for cervical cancer. The most frequently observed are vesicovaginal fistula (VVF) and ureterovaginal fistula. Nowadays various surgical techniques aimed to repair VVF as well as methods providing adequate post – operative bladder drainage are used. Aim. The aim of the study is an evaluation of our own modified surgical technique in VVF repair. Material and methods. The retrospective study of three patients with postsurgical VVF previously treated for cervical cancer with radical hysterectomy alone was presented. The own modification of surgical technique of the fistula closure used in the Department of Gynecology, Medical University of Gdansk was shown. Results. Three patients with FIGO IB2 cervical cancer were treated by Wertheim – Meigs procedure. After 5 – 6 weeks’ time each of these women developed VVF, which was closed by standard transvaginal layered repair. The primary fistula closure procedure failed in all of the patients with symptoms of vaginal urine discharge presenting on the 16, 21 and 25th day following the operation. The next modified surgical procedure was performed. During that operation the ureters were catheterized and the catheters were connected together with the Foley catheter extended by the urethra. The margin of the fistula was circumcised. The VVF was repaired with absorbable sutures in 3 layers closure in each of these patients. These three recurrences were all successfully repaired in a second operation. There were no post – operative complications and no evidence of recurrent fistula. Conclusion. The own modification of surgery in VVF repair is the valuable procedure and might stand the worthy supplement of the vaginal surgical techniques.