Postradiation genitourinary fistulae: retrospective study

Abstract

Introduction. Radiation therapy of the pelvic organs, used to treat malignant neoplasms, is the main cause of urogenital fistula formation (UGF). The widespread use of radiation therapy in the treatment of malignant neoplasms of the pelvic organs has led to an increase in the number of patients with radiation injuries. The study of the prevalence, characteristics and long-term results of surgical treatment of fistulas are of great interest. Materials and methods. There are 76 patients with postradial fistulae received treatment in our Clinic Department of Urology of A.E. Evdokimov Moscow State University of Medicine and Dentistry for the last 6 years from 2012 – through 2018; 49 patients (64.5%) were operated on. The majority of the patients were suffering from vesicovaginal fistula 48.7% (37 people). Transvaginal approach was used in 35 cases (71.4%); abdominal approach was in 7 cases (14.3%); laparoscopic approach was in 3 cases (6.1%); robotic approach took place in 2 cases (4.1%); combined – one case (2%), percutaneous puncture nephrostomy – 1 case (2%). The various flaps technique took place in 40.8% of cases (20/49). Results. In total, radiation indced fistula closed in 35 out of 49 patients successfully. As a result, overall efficiency was 71%. The presented data has included our experience over the past 6 years, which is limited by the standardization of treatment and the lack of some data. Conclusions. Closing the fistula can be performed in several stages: by reducing the size of the fistula and giving patients more time to recover.