title: [Transvaginal repair of neobladder vaginal fistula].
abstract: BACKGROUND
  Neobladder vaginal fistula is a known complication after cystectomy and orthotopic neobladder in women. The exact incidence is still unknown, even if in some of the largest series is reported in about 5% of female patients. We present our personal experience with a case of neobladder vaginal fistula.
  
  
  METHODS
  A fifty-year old woman affected by T2G3 bladder cancer underwent radical cystectomy and orthotopic neobladder in December 2007. Definitive pathological examination revealed pT3aN0G3 urothelial cancer with squamous aspects. Two cycles of neoadjuvant chemotherapy were administered before cystectomy. Three weeks after cystectomy, a retrograde cystography revealed a fistula between vagina and neobladder. At first, the patient was treated conservatively, keeping the urethral catheter for two months. Cystographies, repeated every month, recorded a reduction in size of the fistula but not the complete closure. A surgical correction was planned. Preoperative cystoscopy showed the neobladder opening of the fistula on the posterior wall. Then a transvaginal approach with fistula excision and a two layer cross suture were performed.
  
  
  RESULTS
  At the cystography performed 1 month after surgical repair no fistula was detected, and the patient was completely dry. At 3 months follow-up the patient was completely dry.
  
  
  CONCLUSIONS
  The development of a neobladder-vaginal fistula is a significant, even if infrequent, complication after cystectomy. In our case, we performed a transvaginal approach without tissue interposition, with good results. Such procedure is easy and effective and, in our opinion, can be tempted as first line surgical treatment.
authors.forename: C L A
authors.initials: CL
authors.lastname: Negro
authors.forename: P
authors.initials: P
authors.lastname: De Stefanis
authors.forename: A
authors.initials: A
authors.lastname: Bosio
authors.forename: A
authors.initials: A
authors.lastname: Bisconti
authors.forename: C
authors.initials: C
authors.lastname: De Maria
authors.forename: M
authors.initials: M
authors.lastname: Charchedi
authors.forename: A
authors.initials: A
authors.lastname: Buffardi
authors.forename: L
authors.initials: L
authors.lastname: Rolle
authors.forename: D
authors.initials: D
authors.lastname: Fontana
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy / Q000601:surgery; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D015653:Cystectomy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal; D007077:Ileal Diseases / Q000209:etiology / Q000601:surgery*; D007412:Intestinal Fistula / Q000209:etiology / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D011859:Radiography; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000601:surgery; D014547:Urinary Diversion; D014624:Vaginal Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D002945:Cisplatin; D000093542:Gemcitabine