Yu.P. Seryak, O.I. Litvinov, Yu.V. Gonzov, A.I. Sagalevich, O.S. Frolov, R.V. Ischuk
A case from practice. Cystectomy with the formation of an orthotopic ileal bladder by studer method in a patient with vesico-vaginal fistula after combined treatment for Ca collі uterі T3N0M0 St II, cl. gr. II
Introduction: cervical cancer occupies one of the leading positions in the structure of female cancer morbidity and mortality in developing countries, is also an important medical and social problem in all economically developed countries. Radiation therapy (RT) in patients with cervical cancer of locally advanced forms is the only method of treatment and is used in 40-47% of patients. Unfortunately, in 20-30% of patients after radiation therapy, due to various causes, radiation damage to the rectum and bladder is formed, which can lead to fistula.
Case description: the patient D. born in 1967, appealed to the Kiev Regional Clinical Hospital in March 2017 with complaints of leakage of urine through the vagina, the presence of cystostomic drainage, nephrostomy on both sides. Treatment: 28.09.17 уear - surgery - cystectomy, resection of vesico-vaginal fistula, suturing of the vagina. Ileocystoplasty by Studer method (surgeon professor Sernyak Y.). After the operation, the patient was in the intensive care unit (1 day) - under monitoring. In the p/o period was carried out a/b, infusion and symptomatic therapy, dressings. The wound healed by primary tension without inflammation, the drainage of the small pelvis was removed for 5 days, the sutures were removed for 7-10 days. Ureteral catheters were removed on the 19th day. The patient in satisfactory condition on the twenty-sixth day was discharged from the hospital under the supervision of a urologist, gynecologist, oncologist at the place of residence.
Conclusions: the widespread introduction of modern methods of planning and carrying out radiation therapy in clinical practice will lead in the future to a decrease in the frequency of radiation injuries and, as a consequence, to a decrease in the number of patients with postradiation fistulas who seek surgical care. Treatment of patients with postradiation urogenital fistulas is a complex and unsolved problem. In all studies on this topic it was noted that each case of a fistula is unique and requires an individual approach, and therefore it is extremely difficult to develop a standard approach to the treatment of this complication of radiotherapy. The high frequency of relapse dictates the need for continuing research aimed at optimizing approaches to managing patients in this category.