Ureteral Stent Migration Through Colovesical and Vesicovaginal Fistulas in a Patient with Stage IV Cervical Cancer Treated with Pelvic Radiation
Citrus Memorial Hospital
Cervical cancer, Pelvic radiation, Radiationinduced ureteral stricture, Ureteral stent, Vesicovaginal fistula
Internal Medicine | Neoplasms | Oncology
Introduction: Pelvic radiation is often used as radical treatment or additional therapy in patients with gynecologic malignancies. Irradiation damages deoxyribonucleic acid (DNA) of tumor cells by an inflammatory process with several inciting factors. The inflammatory process continues well after the treatment has been given and its effects can present decades after initial treatment. Complications of radiation are related to tissue damage due to parenchymal and vascular endothelial cell death as well as fibrosis resulting from innate immune response. Fibrosis is a late complication of radiation therapy and can present as stenosis or fistulas. Fistulas have an annual incidence rate of up to 5% and can develop anywhere in the irradiated field.
Case Report: This case describes a patient with vesicovaginal fistula secondary to stage IV cervical cancer treated with pelvic radiation. The patient had ureteral stent placement for radiation-induced ureteral stricture which exited the body through the anus through the vesicovaginal fistula and a colovesical fistula which developed over the course of 10 years after initial treatment with radiation therapy.
Conclusion: As cancer survivorship rates increase with improved treatments, it is important to anticipate continuing radiation damage in patients who have received radiation therapy.
Publisher or Conference
Journal of Case Reports and Images in Oncology
Klein J, Gandhi S. Ureteral stent migration through colovesical and vesicovaginal fistulas in a patient with stage IV cervical cancer treated with pelvic radiation. J Case Rep Images Oncology. 2021;7(2):100093Z10JK2021. doi: 10.5348/100093Z10JK2021CR