# Urologic Fistulas in Czech Women With Gynaecologic Malignancies

## TL;DR

This study examines urologic fistulas in Czech women with gynecologic cancers, finding that these fistulas often develop after radiotherapy and are difficult to treat.

## Contribution

The study provides insights into the prevalence, treatment outcomes, and challenges of managing urologic fistulas in gynecologic cancer patients in the Czech Republic.

## Key findings

- Cervical cancer was most commonly associated with urologic fistulas (76.8%).
- Most fistulas were complex vesicovaginal fistulas (VVFs) and diagnosed after radiotherapy.
- Treatment success rates were much higher for simple than complex fistulas.

## Abstract

In developed countries, urologic fistulas arise mainly from malignancies, radiotherapy, or surgical trauma. Hysterectomy and radiation therapy are both critical components of the treatment of women with cancers. Urologic fistulas significantly reduce the quality of life of cancer patients, and may result in delays or even refusal of adjuvant treatment by these patients, thereby negatively impacting both short‐ and long‐term cancer survival.

A 10‐year retrospective study of urologic fistulas associated with gynaecologic malignancies at the University hospital Hradec Kralove, Czech Republic was conducted. Descriptive statistics of the fistula and treatment characteristics of women with malignant fistulas were conducted using the NCSS 22 statistical software program (NCSS, Keysville, Utah).

Cervical cancer was mostly commonly associated with urologic fistulas (36, 76.8%). Most of the malignant fistulas were complex (41, 87.2%) vesicovaginal (23, 48.9%) fistulas (VVFs). More than two‐thirds (33, 70.2%) of the fistulas were diagnosed following radiotherapy, with a time interval from radiotherapy to fistula diagnosis of between 3.00 and 14.50 years. Primary fistuloraphy was performed for all the six cases with simple VVFs and seven (41.2%) of the 17 patients with complex VVFs. Treatment success rate was 83.33% and 14.3% for simple and complex fistulas, respectively. All the failed complex fistula repairs recurred.

Malignant fistulas predominantly follow radiotherapy for cervical cancers, and are usually detected up to 15 years post‐radiotherapy. Most are complex VVFs, which are difficult to treat, with a high rate of recurrence.