Urinary tract fistulas in radical surgery for cervical cancer: The importance of early diagnosis

Abstract

BackgroundUrinary fistulas are a well-recognised complication of radical gynaecological oncology surgery for cervical cancer. Reported incidence varies between 0.6 and 5.1%. MethodsA retrospective case-note review of vesical and ureteric fistulas diagnosed in cases that underwent radical surgery for the new diagnosis of early stage cervical cancer between January 2000 and June 2010. ResultsA total of 323 radical procedures for cervical cancer were performed during the study period. There were nine urinary tract fistulas found in eight women undergoing radical surgery for stage 1b1 cervical cancer, giving an incidence of 2.7%. Haemorrhage was the commonest associated factor and the commonest presenting symptom for fistula was leaking of urine per vagina. The fistulas were managed conservatively or surgically depending on their nature and severity. The longer the delay in confirming the diagnosis and initiating treatment the more severe were the long-term symptoms and morbidity. ConclusionIdentification of predisposing factors, high index of suspicion, early investigations and multidisciplinary team management of urinary tract fistula are necessary to reduce post-operative morbidity and minimise renal loss.