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Ureterovaginal Fistula as a Complication of Radical Pelvic Surgery

Richard J. Calame, MD; James H. Nelson Jr., MD
Arch Surg. 1967;94(6):876-880. doi:10.1001/archsurg.1967.01330120130025.
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URETEROVAGINAL fistula following radical pelvic surgery for the cure of gynecological cancer is a most serious complication. Radical hysterectomy, with its dissection of the entire pelvic course of the ureter, has been the operative procedure most often associated with this fistula. The incidence has been reported from 3%1 to as high as 30%, but in most series it ranges from 8% to 12%.2-4

Trauma to the ureter during the operative procedure and ischemia are the principal causes of ureterovaginal fistula, while antecedent radiation and postoperative infection are contributory factors. The trauma may be in the nature of transection, inadvertent clamping, or excessive stripping of the ureteral sheath. These, of course, would be directly related to surgical technique. Ischemia is the most common etiologic factor, a consequence of the marked compromise of the blood supply to the terminal ureter. In recent years, attention has been focused on methods to


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