Vol.5, No 1, 1998 pp. 69 - 71
UDC: 616-06;616-089
VESICO-VAGINAL FISTULAS: DIAGNOSTICS AND
TREATMENT
J. Hadži-Djokić, Z. Džamić, C. Tulić, N. Lalić, M. Aćimović
Institute of Urology and Nephrology, Clinic of Urology, Clinical Center
of Serbia, Belgrade, Yugoslavia
Summary. Causes of vesico-vaginal fistulas may vary; most commonly
they develop postoperatively, after radical or classical hysterectomy.
This form of fistula may develop as a consequence of urinary bladder defect
which occurred during or after radiotherapy of cervical carcinoma, as well
as after cesarean section. Such fistulas are very difficult for surgical
management. At the Clinic of Urology we treated 216 female patients due
to vesico-vaginal fistulas in the period 1978-1997. Out of 146 patients
treated in the period 1978-1988, 47 had fistulas which developed after
radical hysterectomy (Wertheim), 84 had fistulas after classic hysterectomy
(Aldrige), while in 15 patients fistula occurred immediately following
cesarean section. In the period 1988-1997 we managed and surgically treated
70 female patients. Seven fistulas developed after Wertheim operation,
36 after classic hysterectomy, 24 after radiotherapy due to Ca PVU, and
3 fistulas developed after delivery. During surgery the transvesical approach
in the majority of cases, 126 (58%) was used. For primary closure of fistula
we applied with insertion of a part of the omentum as well as the vaginal
approach in a much smaller number of cases (31.5%). In cases where lesions
of the urinary bladder, vagina and surrounding structures did not allow
closure of the fistula, we performed ileal conduit or, in a much smaller
percentage, bilateral ureterocutaneostomy. During repeated management in
all cases of fistula recurrence after primary surgical treatment (32 cases
– 20%) we applied transvesical-peritoneal approach by inserting a part
of the peritoneum and omentum with a postoperative success of 97%.
Key words: Vesico-vaginal fistula, diagnosis, treatment
VEZIKO-VAGINALNE FISTULE: DIJAGNOSTIKA
I TRETMAN
Uzroci veziko-vaginalnih fistula mogu biti različiti; najčešće nastaju
postoperativno-posle radikalne ili klasične histerektomije.Ove fistule
mogu nastati i kao posledica oštećenja mokraćne bešike prilikom i nakon
zračne terapije karcinoma grlića materice, kao i posle Sectio Caesarea.Ovako
nastale fistule su veoma teške za operativno zbrinjevanje. Na Urološkoj
klinici u Beogradu, u periodu 1978 god. do 1997 god. lečeno je 216 pacijentkinja
sa veziko-vaginalnim fistulama. Od 146 pacijentkinja koje su tretirane
u periodu 1978 god. do 1988 god., kod 47 fistula je nastala posle radikalne
histerectomije (Wertheim), kod 84 nakon klasične histerektomije (Aldrige),
dok se kod 15 pacijentkinja javila neposredno nakon carskog reza. U periodu
1998 god. do 1997 god. lečeno je i operisano 70 pacijentkinja. Posle Wertheim-ove
operacije nastalo je 7 fistula, posle klasične histerektomije 36, posle
zračne terapije Ca PVU 24 i posle porodjaja 3 fistule. Prilikom operativnog
zatvaranja fistula, u najvećem broju slučajeva 126 (58%) bio je primenjen
transvezikalni pristup.U znatno manjem broju slučajeva korišćeni su kod
primarnog zatvaranja fistula transveziko peritonealni pristup sa umetanjem
dela omentuma ili peritoneuma, kao i vaginalni pristup (31.5%). U slučajevima
kada promene na bešici, vagini i okolnim strukturama nisu dozvoljavale
zatvaranje fistule, učinjen je ilealni konduit ili u još manjem procentu,
obostrana ureterokutaneostomija. U svim slučajevima recidiva fistule nakon
primarnog operativnog zbrinjavanja (32 slučaja-20%) tokom ponovnog operativnog
rešavanja korišćen je transveziko-peritonealni pristup, sa umetanjem dela
peritoneuma i omentuma, i postoperativnim uspehom od 97%.
Ključne reči: Veziko-vaginalne fistule, dijagnoza, tretman
