Aim: Optimization of algorithm of diagnostic of urogenital and intestine-vaginal fistulas
Materials and methods: From 2012 to 2017, we surveyed a group of patients from 31 patients with genital fistulas. Algorithm of examination of patients included 2 stages: outpatient and inpatient. Outpatient examination in the primary appeal of the patient included vaginal examination and cystoscopy in the absence of significant pain syndrome, as well as ultrasound of the kidneys. Outpatient phase of the survey allowed to navigate in the form of fistula, condition of the tissue, plan the amount of patient investigation and timing of surgery. Renal ultrasound has allowed to reveal ureterohydronephrosis transformation aer ureteral fistula and perform drainage of kidney in this group of patients at the preoperative stage. e stationary phase of the survey included physical examination, radiological, endoscopic and functional methods of investigation.
Results: in 26 patients with genital fistula formed as a result of treatment of gynecological cancer pathology, 5 – as a result of treatment of benign gynecological pathology. In 19 of 26 patients with gynecologic cancer pathology fistula formed as a result of treatment for cervical cancer (73% of oncogynecological patients). 15 patients fistula was traumatic etiologies, a 16 – beam. Outpatient examination in 8 patients with uretero-vaginal fistula discovered ureterohydronephrosis transformation, requiring drainage of the kidney on preoperative stage. In 7 patients during cystoscopy and vaginal examination was discovered a foreign body in the urethra, bladder and vagina. In all cases ureterovaginal and combined fistulas use of retrograde and antegrade of pyeloureterography, fistulography and vaginography has helped to clarify the topography of the fistula, the nature and extent of strictures of the ureter. In two patients uretero-vaginal fistula was able to identify only with fistulography, 1 patient – with vaginography. In 5 patients with post-radiation vesico-vaginal fistula, 2 patients with vesicovagino-rectal fistulas, and 1 patient with vesico-vagino-intestinal fistula vaginacology detected reduced urinary bladder capacity less than 100 ml. In 1 patient with vesico-vagino-rectal fistula was discovered rigid spur of the rectum.
Discussion: our experience of examination and treatment of patients with genital fistulae confirms the feasibility of two-step diagnostic algorithm. Outpatient stage of the survey allows you to navigate the topography of the fistula, the condition of the tissue of the vagina in the region of the fistula, plan the preparation of patients and the timing of the operation, to select a group of patients for drainage of the kidney on preoperative stage. At the stationary stage of the survey clarify the topography of the fistula and the condition of the organs and systems involved in the pathological process.
Authors declarelack of the possibleconflicts of interests.