ABSTRACT
OBJETIVO: Se presenta una serie de casos de reparación por vía vaginal de fístula vesicovaginal (FVV) de nuestro centro. MATERIAL Y MÉTODOS: Estudio observacional descriptivo. Se evaluaron todas las pacientes con reparación quirúrgica de FVV en el Centro de Innovación de Piso Pélvico del Hospital Sótero del Río entre 2016 y 2022. RESULTADOS: Se reportaron 16 casos, de los cuales el 81,3% fueron secundarios a cirugía ginecológica. En todos se realizó la reparación por vía vaginal, con cierre por planos. En el 94% (15/16) se logró una reparación exitosa en un primer intento. El tiempo de seguimiento poscirugía fue de 10 meses (rango: 3-29). No hubo casos de recidiva en el seguimiento. Una paciente presentó fístula de novo, la cual se reparó de manera exitosa en un segundo intento por vía vaginal. Se reportaron satisfechas con la cirugía 15 pacientes, con mejoría significativa de su calidad de vida. Una paciente reportó sentirse igual (6,3%), pero sus síntomas se debían a síndrome de vejiga hiperactiva que la paciente no lograba diferenciar de los síntomas previos a la cirugía. CONCLUSIÓN: Las FVV en los países desarrollados son secundarias a cirugía ginecológica benigna. La cirugía por vía vaginal en nuestra serie demostró una alta tasa de éxito, con mejora significativa en la calidad de vida de las pacientes.
OBJETIVE: We present a case series of vesico-vaginal fistulas (VVF) vaginal repair in our center. MATERIAL AND METHODS: Descriptive observational study. All patients with surgical repair of VVF at the Centro de Innovación en Piso Pélvico of Hospital Sótero del Río were evaluated between September 2016 and September 2022. RESULTS: 16 cases were reported. 81.3% were secondary to gynecological surgery. In all cases, a vaginal repair was performed, with a layered closure. 94% (15/16) had no contrast extravasation at the time of examination, confirming fistula closure. The follow-up time was 10 months (range: 3-29). There were no cases of recurrence during follow-up. 1 patient presented de novo fistula which was successfully repaired in a second attempt vaginally. 15/16 patients reported being satisfied with the surgery, with significant improvement in quality of life. 1 patient reported feeling the same (6.3%), but her symptoms were due to overactive bladder syndrome that the patient could not differentiate from the symptoms prior to surgery. CONCLUSION: VFV in developed countries are mainly secondary to benign gynecological surgery. Vaginal surgery in our series achieved a significant improvement in the quality of life of patients.
Subject(s)
Humans , Female , Middle Aged , Gynecologic Surgical Procedures/methods , Vesicovaginal Fistula/surgery , Surgical Flaps , Urinary Incontinence , Vagina/surgery , Urinary Catheterization , Retrospective Studies , Follow-Up Studies , Vesicovaginal Fistula/diagnosis , Vesicovaginal Fistula/etiology , Treatment OutcomeABSTRACT
Introducción: El tratamiento del cáncer de cuello uterino con radiaciones ionizantes y quimioterapia radiosensibilizadora puede tener como complicación la generación de fístulas vaginales. El objetivo del presente estudio fue establecer la prevalencia de fístulas vaginales en un grupo de pacientes que recibieron radioterapia convencional versus radioterapia 3D. Métodos: El presente estudio retrospectivo fue realizado en el Hospital de Solón Espinosa Ayala, SOLCA- Quito. Se registraron las pacientes que recibieron radioterapia externa ya sea en modalidad 2D o 3D más braquiterapia o refuerzo externo de dosis, con quimioterapia concurrente o sin esta última en el período de estudio Enero 2008 a Diciembre 2012. Para el análisis se compararon los tipos de radioterapia y se reporta Odds Ratio. Resultados: Se registraron 315 casos en el grupo de Radioterapia Convencional 2D (R2D) y 299 casos en el grupo de radioterapia Conformacional 3D (R3D). La prevalencia de fístulas en el grupo R2D fue de 10 casos (1.62 %) y en el grupo R3D fue de 8 casos (1.31 %), Odds ratio de 1.19 (IC95 % 0.46 a 3.06) P =0.71. De los 18 casos de fístulas, 9 casos (50 %) fueron con refuerzo externo, 6 casos (33 %) por braquiterapia y 3 casos (17 %) sin refuerzo. El refuerzo externo vs braquiterapia mostro un OR=4.77 IC 95 % (1.66 13.65) P =0.04. La dosis de radioterapia usada en el tratamiento de Braquiterapia fue de 87.5 ±2.5 Gy vs Refuerzo 68 ±2.5 Gy P <0.001. Conclusión: No existe diferencia entre la prevalencia en los grupos de Radioterapia convencional versus Radioterapia 3D. La radioterapia de refuerzo es un factor de riesgo para fístulas vaginales comparado con la braquiterapia, aun cuando la dosis de radioterapia fue menor en este grupo.
Introduction: The treatment of cervical cancer with ionizing radiation and radiosensitizing chemotherapy can have as a complication the generation of vaginal fistulas. The aim of the present study was to establish the prevalence of vaginal fistulas in a group of patients who received conventional radiotherapy versus 3D radiotherapy. Methods: The present retrospective study was carried out at the Solón Espinosa Ayala Hospital, SOLCA-Quito. The patients who received external radiotherapy either in 2D or 3D modality plus brachytherapy or external dose reinforcement, with concurrent chemotherapy or without the latter in the study period January 2008 to December 2012, were registered. For the analysis, radiotherapy types were compared and Odds Ratio is reported. Results: 315 cases were registered in the 2D Conventional Radiotherapy group (R2D) and 299 cases in the Conformacional 3D radiotherapy group (R3D). The prevalence of fistulas in the R2D group was 10 cases (1.62 %) and in the R3D group it was 8 cases (1.31%), Odds ratio 1.19 (95 % CI 0.46 to 3.06) P = 0.71. Of the 18 cases of fistulas, 9 cases (50 %) were externally reinforced, 6 cases (33 %) by brachytherapy and 3 cases (17%) without reinforcement. The external reinforcement vs. brachytherapy showed an OR = 4.77 IC 95 % (1.66 - 13.65) P = 0.04. The dose of radiotherapy used in the Brachytherapy treatment was 87.5 ± 2.5 Gy vs Reinforcement 68 ± 2.5 Gy, P <0.001. Conclusion: There is no difference between the prevalence in the groups of conventional radiotherapy versus 3D radiotherapy. Booster radiotherapy is a risk factor for vaginal fistulas compared to brachytherapy, even when the dose of radiotherapy was lower in this group.
Subject(s)
Humans , Female , Radiotherapy , Uterine Cervical Neoplasms , Dose Fractionation, Radiation , Brachytherapy , Vaginal Fistula , Neoplasm MetastasisABSTRACT
OBJETIVO: As fístulas vesicovaginais e ureterovaginais são complicações incomuns, secundárias a doenças ou a cirurgias pélvicas. O sucesso terapêutico dessas fístulas depende de adequada avaliação pré-operatória para o diagnóstico e visualização do seu trajeto. Este trabalho tem o objetivo de demonstrar o potencial da urorressonância no diagnóstico das fístulas urogenitais e na visualização dos seus trajetos. MATERIAIS E MÉTODOS: Foram analisados, retrospectivamente, os prontuários médicos e as imagens radiológicas e de urorressonância magnética de sete pacientes do sexo feminino com diagnóstico de fístula urogenital. Para a urorressonância foram realizadas seqüências 3D-HASTE com saturação de gordura. RESULTADOS: Seis pacientes apresentavam fístula vesicovaginal e uma paciente tinha diagnóstico de fístula ureterovaginal à direita. Com a utilização da urorressonância magnética, foi possível demonstrar o trajeto da fístula em seis das sete pacientes (85,7 por cento), sem a necessidade de cateterização vesical ou da injeção de contraste. CONCLUSÃO: Este estudo demonstra o potencial e a aplicabilidade da urorressonância na avaliação dessas fístulas.
OBJECTIVE: Vesicovaginal and ureterovaginal fistulas are unusual complications secondary to pelvic surgery or pelvic diseases. The therapeutic success in these cases depends on an appropriate preoperative evaluation for diagnosis and visualization of the fistulous tract. The present study is aimed at demonstrating the potential of magnetic resonance urography for the diagnosis of vesicovaginal and ureterovaginal fistulas as well as for defining the fistulous tracts. MATERIALS AND METHODS: Seven female patients clinically diagnosed with vesicovaginal or ureterovaginal fistulas had their medical records, radiological and magnetic resonance images retrospectively reviewed. Magnetic resonance urography included 3D-HASTE sequences with fat saturation. RESULTS: Six patients presented vesicovaginal fistulas and, in one patient, a right-sided ureterovaginal fistula was diagnosed. Magnetic resonance urography allowed the demonstration of the fistulous tract in six (85.7 percent) of the seven patients evaluated in the present study, without the need of bladder catheterization or contrast injection. CONCLUSION: This study demonstrates both the potential and applicability of magnetic resonance urography in the evaluation of these types of fistulas.