[Urinary fistula after radical hysterectomy with lymph node excision]

In 908 radical hysterectomies including dissection of pelvic lymph nodes, 13 (= 1.43%) urogenital fistulas were seen. They occurred postoperatively between the 7th and 15th day. In 12 cases it was a uretero-vaginal and once a vesico-vaginal fistula. The operation report of 7 cases with uretero-vaginal fistula reveals difficulties in separating the ureter in its prevesical part proceeding from tumour spread, endometriosis, scar or bleeding. Since 1985 a percutaneous nephrostomy has been performed (5 cases). 4 fistulas were cured spontaneously, one of them had a percutaneous nephrostomy. In all cases, urography was normal. In 7 cases, ureterocystoneostomy had to be performed. This was done once with fixation of the psoas muscle and 6 times according to Boari. All patients were cured without any complications and with an undisturbed drainage assessed 1 year later by urography. 1 patient, who refused any follow-up, died subsequently. The only vesico-vaginal fistula has been closed by Latzko's procedure. In recent years the problems concerning urogenital fistulas resulting from surgery of cervical cancer have receded. However, if patients adopt an offensive attitude against surgical therapy of stage T2b, the rate of incidence of this complication can be expected to increase.