Large post-hysterectomy and post-radiation vesicovaginal fistulas: repair by ileocystoplasty.
OBJECTIVE
We devised a technique for simultaneous closure of large post-hysterectomy and post-radiation vesicovaginal fistulas, and augmentation of the concomitant shrunken bladder by ileocystoplasty as a 1-step procedure.


METHODS
Between 1989 and 2000, 4 patients with large vesicovaginal fistulas after radical hysterectomy and radiotherapy for spinocellular cancer of the uterine cervix underwent fistula repair according to the technique described. The premise of utmost importance in the proposed technique is a healthy and not radiation damaged distal ileum.


RESULTS
Fistula closure was achieved in 3 patients, while in 1 a 3 mm residual fistula was repaired 5 years later by a Martius skin flap. In all patients the augmented bladder allowed good quality of life with spontaneous voiding, and daytime and nighttime continence.


CONCLUSIONS
The technique described seems to have certain advantages. Wide dissection of the bladder from the vagina and pelvic walls is avoided. The bladder defect is closed with a well vascularized ileal segment. Bladder capacity is enlarged simultaneously with good functional results. The procedure can be adapted to cases with concomitant damaged distal ureters.
Tabakov
I D
ID
Department of Urology, District Hospital St Ann, Sofia, Bulgaria.
Slavchev
B N
BN
D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D007082:Ileum / Q000637:transplantation; D008875:Middle Aged; D011832:Radiation Injuries / Q000601:surgery*; D013524:Surgical Flaps; D001743:Urinary Bladder / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000379:methods; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy / Q000601:surgery; D014719:Vesicovaginal Fistula / Q000209:etiology / Q000601:surgery*