Dahman Ahmad, McClelland Daniel, Zaslau Stanley, Turner Valerie Galvan, Duenas Omar, Shapiro Robert
West Virginia University School of Medicine, Morgantown, WV 26506, USA.
Department of Urology, West Virginia University School of Medicine, Morgantown, WV 26506, USA.
Case Rep Urol. 2021 May 5;2021:8865146. doi: 10.1155/2021/8865146. eCollection 2021.
Vesicovaginal fistula is a rare and distressing urological condition. It is especially prevalent in developing countries with the predominant etiology secondary to obstructed labor. Radiation therapy in female patients with cervical cancer is a risk factor for vesicovaginal fistula formation in the United States. . A 53-year-old woman with a history of cervical cancer and radiation presented with continuous urinary incontinence. Following diagnostic vaginoscopy, a 1 cm vesicovaginal fistula was diagnosed at the vaginal apex. The patient elected for surgical repair. She subsequently underwent successful transvaginal fistula closure using colpocleisis to optimally address the systemic factors of poor wound healing associated with irradiated tissue. Because of the adjacent tissue having been compromised by pelvic radiation, we opted to use a biologic graft made of human cadaveric pericardial tissue (CPT) instead of a native tissue flap to provide additional support for the fistula repair.
A transvaginal approach for surgical repair of vesicovaginal fistula can be successful in patients with a prior history of pelvic radiation. Transvaginal colpocleisis is a viable option to augment vesicovaginal fistula repair for patients with significant comorbidities when sexual intercourse is no longer desired.
膀胱阴道瘘是一种罕见且令人痛苦的泌尿系统疾病。它在发展中国家尤为普遍，主要病因是产程梗阻。在美国，宫颈癌女性患者接受放射治疗是膀胱阴道瘘形成的一个危险因素。一名有宫颈癌和放疗史的53岁女性出现持续性尿失禁。诊断性阴道镜检查后，在阴道顶端诊断出一个1厘米的膀胱阴道瘘。患者选择手术修复。她随后成功接受了经阴道瘘管闭合术，采用阴道封闭术以最佳方式解决与放疗组织相关的伤口愈合不良的全身因素。由于邻近组织已因盆腔放疗而受损，我们选择使用由人尸体心包组织（CPT）制成的生物移植物，而不是自体组织皮瓣，为瘘管修复提供额外支持。
对于有盆腔放疗史的患者，经阴道手术修复膀胱阴道瘘可能成功。对于不再有性交需求且有严重合并症的患者，经阴道阴道封闭术是增强膀胱阴道瘘修复的可行选择。
