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2025, Vol. 7, Issue 2, Part C
Radiation’s hidden toll: A rare case of vesicovaginal and ureterovaginal fistulas in advanced cervical cancer
Author(s): Shilpee Agrawal, Kishan Raj K and Prashanth Adiga
Abstract:
Background: Carcinoma of the cervix is a common malignancy of the female genital tract, managed primarily through radiotherapy, chemotherapy, and surgery. Radiation-induced fistulas (RIF) are a rare but serious complication in cervical cancer treatment, and synchronous occurrence of vesico vaginal (1-8%) and ureterovaginal fistulas due to radiation is exceedingly rare. The presence of HBsAg positivity in a patient doubles surgical risks and complicates the treatment. In cases of extensive tissue destruction, repair may be impossible, and urinary diversion such as an ileal conduit becomes necessary.
Case Report: A 46-year-old woman with stage IV-A cervical cancer, known case of HBsAg+, received chemotherapy and radiation. Despite aggressive treatment, residual cancer persisted, leading to extra-fascial hysterectomy with bilateral salpingo-oophorectomy, left pelvic lymph node dissection, and bladder repair. One month after surgery, the patient developed continuous urinary incontinence. CT pelvis confirmed the presence of left ureterovaginal and vesicovaginal fistulas and identified left pyelonephritis. Cystoscopy and Nephrogram revealed contrast filling vagina but not the bladder, confirming the diagnosis. Patient underwent percutaneous nephrostomy (PCN). After multiple attempts at conservative management, an ileal conduit was performed. A stoma was created, and a Foley’s catheter was placed. Postoperatively, the patient improved, and the stoma was draining urine.
Conclusion: This case highlights the rare occurrence of synchronous vesicovaginal and ureterovaginal fistulas following radiation treatment for cervical cancer. The rarity of such cases, combined with the complexity of treatment, makes it particularly noteworthy. This case serves as a reminder of potential long-term complications of radiation therapy for cervical cancer, emphasizing the importance of vigilant monitoring and personalized care, which takes into account both physical and psychosocial impact on the patient.
DOI: 10.22271/27081494.2025.v7.i2c.212
Pages: 136-138 | Views: 76 | Downloads: 33
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How to cite this article:
Shilpee Agrawal, Kishan Raj K, Prashanth Adiga. Radiation’s hidden toll: A rare case of vesicovaginal and ureterovaginal fistulas in advanced cervical cancer. Int J Case Rep Surg 2025;7(2):136-138. DOI: 10.22271/27081494.2025.v7.i2c.212
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