Abstract

This study is aimed at evaluation of the results of surgical treatment carried out in 1991–2003 at Urology Department of Medical University in Gdańsk and focused on elimination of fistulas vesico-vaginal, vesico-vagino-intestinal, uretero-vaginal and urethro-vaginal. The group of 89 patients who had 110 operations was analyzed.
An average age of the patients was 52 years 11 months.

The fistulas etiology was different. There were recognized iatrogenic – after surgical procedures, radiation induced and neoplasmatic. The most often basic diseases were uterine cervix cancer 61, then uterine myoma 12, inflammation changes in pelvis minor 5, endometrial cancer 4 and another neoplasm of pelvis 6. Vesico-vaginal fistula were diagnosed in 55 cases, vesico-vagino-intestinal in 23 cases, vagino-ureteral in 13 cases, vagino-urethral in 4 cases. Six patients had two different fistulas in that period. 55 patients had passed radiotherapy. All of them in the course of uterine cancer.

The operations were performed in five principal surgical techniques.
I – closure (suture) from vaginal approach – 10
II – closure by transabdominal, transvesical approach – 31
III – closure of fistulae with cystojejunoplasty – 17
IV – urinary diversion – 41
V – reimplantation of ureteral orifice – 10

15 patients had to have more than one operation. Recurrence of fistulas was diagnosed with 10 patients what stands for 11.23%. Operations failures occurred while the techniques of I, II and III group were applied. Closure of fistula or drying by urinary diversion was achieved with 79 patients as a results first operations – 88.76 % after second success was achieved with 87 patients – 97.7%. Four patients suffered diagnosed and treated a subsequent radiation induced fistula in the analyzed period. The obtained results of surgical treatment having consider a high percentage of radiation induced fistulas were very good. The statistic data were compared applying chi-square test and Fischer’s test for groups of low numerical force. Fistula recurrence depended on applied surgical techniques. Most often recurrence was found after performance from vaginal approach. A dependence between previously performed operations – uterine excision and the type of fistula was confirmed. A dependence between a type of fistula and passed radiotherapy was confirmed as well, however no relations were between recurrence of fistula and main diseases were found. Thus, a selection proper surgical techniques considering radiotherapy passed previously contribute to achievement of good results of surgery.

Adres: dr Teresa Gawlik-Jakubczak
Klinika Urologii AMG
ul. Kliniczna 1a, 80–402 Gdańsk
e-mail: ta@koti.com.pl