Regular Low-Dose Oral Metronidazole Is Associated With Fewer Vesicovaginal and Rectovaginal Fistulae in Recurrent Cervical Cancer: Results From a 10-Year Retrospective Cohort.

PURPOSE: Anaerobic necrosis in cervical cancer can lead to malodor, fistulae, and treatment abandonment. In this retrospective cohort study, we examined the association between maintenance metronidazole and the incidence of malignant fistulae in recurrent cervical cancer. METHODS: We screened all cervical cancer records registered between 2007 and 2016 in the local palliative care database at Christian Medical College, Vellore, India. There were 208 eligible patients with post-treatment residual/recurrent pelvic disease. Among them, 76 had received oral maintenance metronidazole 200 mg once per day for 2 to 86 weeks (interquartile range, 4-16 weeks). RESULTS: Seventy-two patients developed at least one fistula. Forty-nine had vesicovaginal fistulae, 10 had rectovaginal fistuale, and 13 developed both types of fistulae. Patients on maintenance metronidazole had fewer fistulae (22.4% v 41.7%; P = .005), a longer median fistula-free survival (42.9 months v 14.1 months; P < .001), and a postrecurrence survival of 11.5 months versus 8.7 months (P = .112). We performed Cox multivariable proportional hazards regression analysis on the data from the subset of 146 patients observed until death. Bladder/rectal infiltration had a higher risk of fistula (HR, 5.24; P = .011), whereas distant metastases (HR, 2.46; P = .012) and Eastern Cooperative Oncology Group performance status greater than 1 (HR, 1.64; P = .008) were associated with a higher risk of death. Maintenance metronidazole was associated with a lower risk of fistula (hazard ratio [HR], 0.33; 95% CI, 0.16 to 0.67; P = .002) and a lower risk of death (HR, 0.56; 95% CI, 0.39 to 0.81; P = .002). CONCLUSION: Our data indicate that there is a significant inverse association between oral maintenance metronidazole and malignant fistulae in locally recurrent cervical cancer. The impact of this simple intervention on pelvic symptoms, fistulae, and survival should be evaluated in prospective studies.

The treatment of vesicovaginal fistula by endoscopic injection of fibrin glue.

Creation of a vesicovaginal fistula (VVF) is a complication seen in a variety of patients from prolonged labour and elective hysterectomies to advanced gynaecological malignancies. Causing distressing symptoms such as a loss of continence and vulval excoriation, conventional teaching has always advocated an open surgical approach as described by Sims in 1852. This however may not be feasible in cases of advanced malignancy or attractive to the post-operative patient. In this article the case of a 46-year-old lady with a VVF following elective hysterectomy is discussed. She was successfully managed with endoscopic closure of her fistula with fibrin glue.

[Hormonal dependence of vesicouterine fistulas]. / Zaleznosc hormonalna przetok pecherzowo-macicznych.

Vesicouterine fistulas are more and more frequently reported. This paper reviews available data suggesting the role of the endometrium in the fistula's formation. At least a proportion of these fistulas fulfil the criteria of external endometriosis. Conservative management by means of hormonal treatment should be considered before surgical repair. We also present a new clinical classification of this disorder, based on the routes of menstrual flow: type I--with menouria, type II--with dual flow via both the bladder and vagina, and type III--with normal vaginal menses.

[Vesicovaginal fistulas with special reference to therapeutic possibilities and time]. / Vesikovaginale fistler specielt med henblik på behandlingsmuligheder og -tidspunkt.

We report our own results of minimally invasive treatment in eight women with vesicovaginal fistula after gynecologic surgery. Minimally invasive or non-operative measures include fulguration of the fistula area and bladder drainage. In addition to our own results, the paper gives a review of the treatment of vesicovaginal fistulae. With respect to the literature we compare and discuss the possible procedures, surgical as opposed to conservative of minimally invasive. We also focus on the results of non-delay in the treatment of vesicovaginal fistulae. The results of non-delay and minimally invasive therapy are interesting, and it seems that these possibilities could be offered to some patients prior to or instead of surgery.

Experiencia personal en el uso del lipiodol ultrafluido en las fístulas urogenitales iatrogénicas: nueva modalidad de tratamiento / Personal experience in the use of ultrafluid lipiodol in iatrogenic genitourinary fistulas: a new treatment modality

Apoyados en la propiedad que tiene el lipiodol de estimular la granulación de los tejidos, se utiliza con resultados exitosos en el tratamiento de las fístulas urogenitales, secuelas de accidentes quirúrgicos y obstétricos, lo cual queda corroborado por los casos curados mediante la instilación vesical del mismo. Con este nuevo procedimiento, se evita realizar una nueva intervención quirúrgica a estas pacientes con pocas posibilidades de curación mediante la cirugía

Fístula vesicouterina: complicación infrecuente de la operación cesárea; caso clínico / Vesico-uterine fistula: unusual complication of cesarean section; clinical case

Se presenta un caso clínico de fístula vesicouterina, complicación poco frecuente de la operación cesárea, de la que existen escasas referencias en la literatura nacional. En relación al caso, se actualizan su sintomatología y diagnóstico, así como los elementos por considerar en su tratamiento