Distal colpocleisis for actinic vesico-vaginal-rectal fistulas, a simple resolution for a complex problem

Excerpt

The standard treatment for locally advanced cervical cancer is chemotherapy plus radiotherapy. The prevalence of actinic fistulas in stage IV-A curatively treated patients was found to be 22%, with simultaneous involvement of the bladder and rectum occurring in 8.7%, in a series from the Netherlands [1]. The treatment of radiotherapy-induced vesicovaginal fistulas remains a challenge in the field of urogynecology. The closure of these fistulas is impaired owing to low vascularization and intense fibrosis in the surrounding tissue [2]. Thus, the main principles for the treatment of these fistulas are good exposure of the fistulous path, resection of the fibrotic and necrotic tissue, suturing without tension, and interposition of vascularized tissue [3]; however, in some cases, these principles may be impossible to follow, especially when the rectum is involved, and urinary diversion ends up being the most frequently adopted option. Latzko described “proximal colpocleisis,” which is the option of choice for relatively small vesicovaginal fistulas with significant trophic disturbances of the surrounding tissue [4]. Therefore, the treatment should be individualized to establish the solution with the best risk–benefit ratio for particular cases. …