Vesico-vaginal fistula post cold cup bladder biopsy: mini review

Abstract

IntroductionWe report a case of a vesico-vaginal fistula (VVF) post cold cup biopsy; to our knowledge this is the only reported case. We present the clinical history/presentation, investigation and the outcome of the treatment. VVFs are among the most distressing complications of gynecologic and obstetric procedures. The risk of developing a VVF is more than 1% after radical surgery and radiotherapy for malignancies. Management of these fistulas has been better defined and standardized over the last decade.Methods and resultsA case of low grade superficial bladder cancer was treated with multiple resections of bladder tumor and a single installation of mitomycin post initial resection which successfully cleared her bladder cancer, but nevertheless led to a small size and scarred bladder. In addition there was a long history of smoking with its effects on tissue integrity and healing. VVFs are very rare and are an unpleasant outcome post a cold cup biopsy, adding to the psychological and social effects of the surgical treatment.ConclusionAlthough cold cup biopsy is a normal day procedure performed by both residents and consultants, consensus should exist on how to treat a patient who has a bladder with defective integrity and small capacity. The rate of successful fistula repair reported in the literature varies between 70% and 100% in nonradiated patients, with similar results when a vaginal or abdominal approach is performed, the mean success rates being 91% and 97%, respectively.

Current Trends and Controversies on Female Genitourinary Fistula: A Review Article

“…Tuberculosis, actinomycosis, schistosomiasis, and endometriosis (Lovatsis & Drutz, 2003;Dennis et al, 2009) have been detected in the biopsy specimens retrieved from the fistulous tract. Notwithstanding the anecdotal nature of these reports, performing routine biopsies is not advised, and a customized approach should be adopted to prevent unnecessary complications that may result from the biopsy process (Mawhinney et al, 2010) To obtain vital staging information for locally advanced genitourinary malignancies affecting the urinary bladder, and when there exists a history of such malignancies, a biopsy is recommended as the entire management plan hinges on the accuracy of the local staging (Kim, Jeong, &Cho, 2022). In cases where transvaginal repairs are conducted, removing the fistula tract may reduce the vaginal space.…”

Vesicovaginal fistula: Review and recent trends

“…However, these reports are anecdotal and routine biopsy is not recommended and an individually tailored approach would be helpful to avoid undue complications secondary to the biopsy. [72] Biopsy is recommended when: (1) there is a previous history of genitourinary malignancies and (2) staging information is required for locally advanced malignancies involving the urinary bladder as the entire management plan would be dependent on local staging. [30] Excising the fistula tract may compromise the vaginal space when a transvaginal repair is being performed.…”