Use of a Biologic Allograft to Treat Vesicovaginal Fistula in a Patient with Cervical Cancer.

Abstract

<h3>Study Objective</h3> To demonstrate the robotic treatment of a vesicovaginal fistula that occurred after chemotherapy and radiation for cervical cancer with the help of a biologic allograft. <h3>Design</h3> Video demonstration. <h3>Setting</h3> Tertiary care center. <h3>Patients or Participants</h3> Forty-five-year-old post-menopausal female para three with a history of stage 3b squamous cell carcinoma of the cervix diagnosed in 2020 status-post treatment with cisplatin, pelvic external beam radiotherapy, and left nephrostomy tube placement for hydronephrosis. She subsequently developed a vesicovaginal fistula in early 2021, which was treated with total abdominal hysterectomy, bilateral salpingectomy, vesicovaginal fistula repair and bilateral ureteral stent placement. She was discharged with a foley catheter and the left nephrostomy tube still in place. She was subsequently seen at the Urogynecology office for leakage of urine. On exam, a two-three-centimeter persistent vesicovaginal fistula was noted. <h3>Interventions</h3> She underwent re-operation with robotic lysis of adhesions, vesicovaginal fistula repair, and placement of a biologic allograft. <h3>Measurements and Main Results</h3> Her post-operative course was uncomplicated. She was seen at three weeks post-operatively, and had intermittent leakage of urine, but was otherwise healing well. <h3>Conclusion</h3> Vesicovaginal fistula in the setting of gynecologic malignancy, especially following radiation, can be more complicated to treat and more prone to failure than other etiologies. Biologic allografts may be a viable alternative to autografts in these complicated cases given their favorable biochemical properties. Controlled trials should be performed to assess the benefit of using biologic allografts to enhance complicated vesicovaginal fistula repair, and possibly reduce the need for re-operation.