title: Pelvic radiation is associated with urinary fistulae repair failure and need for permanent urinary diversion.
abstract: OBJECTIVE
  To review our experience with nonmuscle flap repairs of enterourinary fistulae (EUF) and urinary cutaneous fistulae (UCF). EUF and UCF can be treated either with temporary urinary diversion allowing for healing by secondary intention or primary closure of the defect using an interposing omental, sliding, or muscle flap. Even after successful fistula repair, permanent urinary diversion can be required because of persistent urinary incontinence.
  
  
  METHODS
  We reviewed 86 patients who underwent treatment of EUF or UCF at Washington University between the years 1998 and 2013. Of these, 39 patients underwent fistula repair, whereas 47 patients underwent either surgical or nonsurgical urinary diversion. Outcomes measured included postoperative fistula closure, need for permanent urinary diversion, and urinary incontinence.
  
  
  RESULTS
  The mean age in our series was 59 years (21-87 years) at the time of surgery, with median follow-up of 20 months (1-137 months). Among patients who underwent surgical repair, radiation was associated with higher rates of repair failure (P = .0002), postsurgical incontinence (P <.0001), and the need for permanent urinary diversion (P = .0076). At the time of final follow-up, 32 of the 44 radiated patients had required permanent diversion (72%) compared with 3 of the 42 nonradiated patients (7%; P <.0001).
  
  
  CONCLUSIONS
  Patients who undergo pelvic radiation before EUF and UCF repairs are at higher risk for developing repair failure and postsurgical incontinence. Many patients eventually require permanent urinary diversion. Therefore, EUF and UCF repairs in radiated patients should be undertaken with caution, and patients should be counseled about the possibility of urinary diversion as primary therapy.
authors: Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Electronic address: jeswara@partners.org.
authors: Jairam R
authors: JR
authors: Eswara
authors: Division of Urologic Surgery, Department of Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO.
authors: Valary T
authors: VT
authors: Raup
authors: Division of Urologic Surgery, Department of Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO.
authors: Avory M
authors: AM
authors: Heningburg
authors: Division of Urologic Surgery, Department of Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO.
authors: Steven B
authors: SB
authors: Brandes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000209:etiology; D017577:Cutaneous Fistula / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009852:Omentum / Q000637:transplantation; D011832:Radiation Injuries / Q000209:etiology*; D011878:Radiotherapy / Q000009:adverse effects*; D013524:Surgical Flaps; D017211:Treatment Failure; D014547:Urinary Diversion; D014548:Urinary Fistula / Q000209:etiology / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology; D055815:Young Adult