Gynaecological oncology: radiation fistula: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Gynaecological oncology: radiation fistula

Sample item

A woman 8 months after pelvic radiotherapy for cervical cancer develops continuous urinary leakage, and cystoscopy shows a vesicovaginal fistula with indurated tissue. Biopsy excludes recurrence. What principle guides repair?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Use well-vascularised tissue such as a Martius or omental flap, as irradiated tissue heals poorly

Radiation-induced fistulae occur in ischaemic, fibrotic tissue, so simple closure fails often. Repair is delayed until inflammation settles and recurrence is excluded, and is done with interposition of well-perfused tissue such as a Martius labial fat pad or omentum. Urinary diversion may be needed for complex cases.

Option by option

  • A. Use well-vascularised tissue such as a Martius or omental flap, as irradiated tissue heals poorly (correct)

    Correct. Healthy vascularised tissue interposition improves success.

  • B. Radiotherapy to the fistula

    More radiation would worsen the tissue damage.

  • C. Repair immediately with simple closure alone

    Simple closure in irradiated tissue often breaks down.

  • D. Treat with long-term catheter drainage and cure is expected

    Catheter drainage alone rarely heals radiation fistulae.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is A, Use well-vascularised tissue such as a Martius or omental flap, as irradiated tissue heals poorly. Radiation-induced fistulae occur in ischaemic, fibrotic tissue, so simple closure fails often.

Why is "Radiotherapy to the fistula" not the answer?

More radiation would worsen the tissue damage.

Why is "Repair immediately with simple closure alone" not the answer?

Simple closure in irradiated tissue often breaks down.

Why is "Treat with long-term catheter drainage and cure is expected" not the answer?

Catheter drainage alone rarely heals radiation fistulae.

What concept does this question test?

It tests Gynaecological oncology: radiation fistula in OBG. Repair is delayed until inflammation settles and recurrence is excluded, and is done with interposition of well-perfused tissue such as a Martius labial fat pad or omentum. Urinary diversion may be needed for complex cases.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gynaecological oncology: radiation fistula?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.