Urologic Fistulas in Czech Women With Gynaecologic Malignancies - Original Article - Open Access

Sep 23, 2026

Urologic fistulas in developed settings arise mainly from malignancies, radiotherapy, or surgical trauma, and they can markedly impair quality of life while delaying or even preventing adjuvant treatment, affecting both short- and long-term cancer survival. A 10-year retrospective study at University Hospital Hradec Králové assessed fistula and treatment characteristics in women with gynaecologic malignancies. Cervical cancer predominated, most fistulas were complex vesicovaginal fistulas after radiotherapy up to 15 years, with high recurrence after failed complex repairs.

LanguageEnglish

CategoryHealthcare

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Abstract

Introduction

Materials and Methods

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Introduction

Materials and Methods

Cancer Reports ORIGINAL ARTICLE OPEN ACCESS Urologic Fistulas in Czech Women With Gynaecologic Malignancies Jiri Spacek1 | Munachiso Onyedikachi Ndukwe2 | Akaninyene Eseme Bernard Ubom3 | I. Sirak4 | Petr Hoffman5 | Dominik Karasek2 | Jiri Petera4 | Milos Brodak1 | Michal Balik1 | Dominik Habes2 | Jaroslav Pacovsky1 1Department of Urology, University Hospital Hradec Kralove, Hradec Králové, Czech Republic | 2Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, Hradec Králové, Czech Republic | 3Department of Obstetrics, Gynaecology, and Perinatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Ile-Ife, Osun State, Nigeria | 4Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Hradec Králové, Czech Republic | 5Department of Radiology, University Hospital Hradec Kralove, Hradec Králové, Czech Republic Correspondence: Jaroslav Pacovsky ([jaroslav.pacovsky@fnhk.cz](jaroslav.pacovsky@fnhk.cz)) Received: 17 January 2024 | Revised: 16 November 2024 | Accepted: 24 January 2025 Funding: This work was supported by Univerzita Karlova v Praze, Cooperatio 207043. Keywords: cancer | fistula | radiotherapy | surgery ABSTRACT Introduction: 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. Materials and Methods: 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) . Results: 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. Conclusion: 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. 1 | Introduction Urologic fistula is a pathological communication between the urinary tract and surrounding organs [1]. In developing countries, urologic fistulas are mainly of obstetric origin, mostly associated with prolonged or obstructed labour, whereas in developed countries, they are usually related to genitourinary (GU) injuries following pelvic surgery [2] . GU injury is estimated to occur at a rate of 1%–2% for all major gynecologic surgeries, with 75% of these injuries occurring during hysterectomy [3] . The incidence of ureteral injury following hysterectomy is 0.03%–1.5% and for bladder injuries, 0.2%–1.8%[1] . More than 70% of these injuries are not recognised at the time of surgery. Mechanisms of GU fistula formation following gynecologic surgery include unrecognised iatrogenic cystotomy during dissection, poor repair of cystostomy or breakdown This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is pro

FAQs

What factors most commonly cause urologic fistulas in developed countries?

Urologic fistulas arise mainly from malignancies, radiotherapy, or surgical trauma in developed countries. The text also highlights pelvic surgery-related GU injuries as a key source.

What gynaecologic cancer was most frequently associated with urologic fistulas in the study?

Cervical cancer was the most common, associated with urologic fistulas in 36 cases (76.8%).

How long after radiotherapy were fistulas commonly diagnosed?

More than two-thirds of fistulas were diagnosed following radiotherapy, with a time interval from radiotherapy to diagnosis between 3.00 and 14.50 years, and the conclusion notes detection up to 15 years post-radiotherapy.

Sep 23, 2026

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