The experience of multi-stage surgical rehabilitation of a patient with a radial vesicovaginal and rectal fistula: a clinical case

Introduction. Genital fistulas remain to be one of the most complicated and not completely resolved problems of urogynecology and pelvic surgery.Despite the fact, that over the past 30 - 40 years the number of «obstetric» fistulas has significantly decreased, the proportion of traumatic «gynecological»and postradiation fistulas has increased. The main challenge for performing reconstructive surgery for fistulas after radiation are tissue circulation dis-turbances, a progressive decrease in the capacity of the bladder with an outcome in microcystis and a narrowing of the rectum at the level of the recto-vaginal fistula due to a scar «spur», which often forms in the region of the posterior rectal wall after exposure to radiation therapy.Case report. The article presents a clinical case of a complex vesico-vaginal-rectal fistula in a 45-year-old patient who required a multi-stage surgicaltreatment.Discussion. Currently, the possibilities of reconstructive surgery allow to restore urination and defecation in many patients with complex and combinedgenital fistulas. But for pelvic surgeons, who are competent in the treatment of this complex category of patients, training is needed.