Palliative Management of Inoperable Vesicovaginal Fistula in Cervical Cancer Patient Using Bilateral Single-J Stents and Bladder Stoma: A Pilot Study.

Abstract

Introduction and hypothesis: Vesicovaginal fistula (VVF) is characterized by the formation of an abnormal connection between the bladder and the vagina, leading to continuous, involuntary leakage of urine through the vaginal canal. For patients with inoperable fistulas, individualized urinary diversion becomes necessary to alleviate incontinence and pelvic pain, thereby enhancing the patient's quality of life. This pilot study aims to evaluate the feasibility and clinical benefits of an innovative use of single-J (SJ) stents in conjunction with bladder stomas for palliative management of VVF secondary to cervical cancer treatment. The primary objective of the study is to explore the safety and effectiveness of the urinary diversion in enhancing palliative care for individuals with inoperable VVF.

Methods: This study evaluated 18 cervical cancer patients through purposive sampling. They were diagnosed with VVF at our center between January 2015 and October 2022. The effectiveness of the procedure was measured by comparing preoperative and postoperative data related to incontinence and quality of life, incontinence symptoms were assessed using translated versions of validated questionnaires, namely the Incontinence Quality of Life (I-QOL) questionnaire, Urogenital Distress Inventory-6 (UDI-6), and the Incontinence Impact Questionnaire-7 (IIQ-7). Safety was measured by documenting intraoperative and postoperative complications.

Results: All procedures were successfully completed with minimal blood loss. The mean age was 70.8 ± 12.6 years, and mean fistula diameter was 2.0 ± 0.4 cm. Indications included failed prior repair (n = 10), local tumor recurrence (n = 3), poor surgical candidacy (n = 4), and patient refusal (n = 1). Post-procedurally, QoL scores significantly improved from 43 ± 8 to 72 ± 8. UDI-6 scores decreased from 72 ± 8 to 44 ±7, and IIQ-7 scores decreased from 76 ±6 to 46 ± 7. Daily urine pad usage was reduced to 0-2 pads per 24 h, and outpatient visits for urinary tract infections notably decreased. Complications were mostly grade I (fever, mild hematuria, UTI), with no stent dislodgement or serious adverse events reported during follow-up.

Conclusion: The results suggest that the use of bilateral SJ stents and stoma bags for urinary diversion in patients with inoperable complex fistulas is a safe and effective approach. This method appears to positively impact the quality of life for selected patients with VVF, offering a viable palliative solution in cases where traditional surgical interventions are not feasible.