Faculty Collaboration Database

Neobladder-vaginal fistula after cystectomy and orthotopic neobladder construction. BJU Int 2004 Nov;94(7):1092-5; discussion 1095

Date

11/16/2004

Pubmed ID

15541134

DOI

10.1111/j.1464-410X.2004.0339.x

Scopus ID

2-s2.0-9644260469 (requires institutional sign-in at Scopus site)   35 Citations

Abstract

OBJECTIVE: To determine the potential surgical and clinical factors that contribute to the development of neobladder-vaginal fistula (NVF) after cystectomy and orthotopic neobladder (ONB) construction in women.

PATIENTS AND METHODS: Of 37 patients who had vaginal-sparing cystectomy, the records of four who developed a NVF after radical cystectomy and ONB construction were reviewed. Retrospective clinical and surgical information was collected, including patient demographics, tumour pathology, surgical technique, presenting symptoms, and method and efficacy of surgical repair.

RESULTS: In two of the four patients who developed a NVF a small injury to the anterior vaginal wall was noted during surgery and closed primarily. All patients presented with severe urinary incontinence. The NVF was diagnosed after cystoscopy and/or speculum examination. Three of the four patients had an attempted surgical repair, including one obturator flap interposition, one rectus flap interposition, and one primary two-layer closure. To date, one patient is fistula-free and two were subsequently converted to an ileal conduit or continent cutaneous diversion because the fistula recurred. The fourth patient developed a NVF in association with local tumour recurrence and underwent conversion to an ileal conduit.

CONCLUSION: The development of a NVF is a significant complication after cystectomy. Inadvertent injury to the vaginal wall is an important predisposing factor to subsequent NVF development. The repair of a NVF is often difficult; upon diagnosis, conversion to a continent cutaneous urinary diversion may be considered.

Author List

Rapp DE, O'connor RC, Katz EE, Steinberg GD

Author

Robert Corey O'Connor MD Professor in the Urology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Cystectomy
Female
Follow-Up Studies
Humans
Middle Aged
Urinary Bladder Fistula
Urinary Diversion
Urinary Incontinence
Urinary Reservoirs, Continent
Vagina
Vaginal Fistula