VESICOUTERINE FISTULA 20 YEARS FOLLOWING BRACHYTHERAPY FOR CERVICAL-CANCER

This report concerns an extremely rare type of fistula, a vesicouterin e fistula. in a 59-year-old female occurring twenty years following br achytherapy for cervical cancer. The patient presented with a history of recurrent urinary tract infections, sensation of incompletely empty ing the bladder, nocturia and constant leakage of urine for several mo nths. Cystoscopy revealed a fistulous opening and an exophytic lesion on the posterior bladder wall. Contrast computerized tomography demons trated a fistulous tract between the posterior bladder wall and the an terior aspect of the uterine cavity. She underwent a hysterectomy, exc ision of the bladder fistula and interposition of a vascularized rectu s muscle graft. Histology of the cervix and bladder only revealed infl ammatory changes with no evidence of malignancy. The diagnosis and inv estigation of this extremely rare condition are discussed, and the man agement strategies outlined.