Concomitant repair of stress urinary incontinence with proximal urethrovaginal fistula: Our experience

Abstract

Introduction:Proximal urethrovaginal fistula (UVF) located close to the bladder neck may cause extensive sphincter damage and is usually associated with continuous incontinence, which may mask the associated stress urinary incontinence (SUI). Simultaneous correction of SUI avoids a second surgery for SUI, which needs dissection in ischemic fields and carries a high risk of failure. The aim of this study is to describe our technique of concomitant repair of SUI with proximal UVF and our results.Methods:Between July 2010 and August 2014, 14 patients underwent UVF repair in Jackknife position by the interposition of a Martius flap and simultaneous correction of SUI by modified McGuire pubovaginal autologous fascial sling. The procedure was carried out a minimum of 3 months of presentation and after detailed preoperative evaluation.Results:After a mean follow-up of 28 months, all 14 patients were continent. None of the patients developed recurrence of the UVF. Two patients presented with retention immediately after catheter removal and clean intermittent catheterization training was given to both of them. Two patients became pregnant during the follow-up period and were advised cesarean section near term.Conclusions:Repair of proximal UVF and correction of SUI can be performed in the same session to avoid the operation in an ischemic field.

Urethrovaginal fistula repair with or without concurrent fascial sling placement: A retrospective review

“…21 Whether or not SUI can be treated at the time of UVF repair is controversial, with small cohort studies showing success. 9,10 In our series, 19/41 (46%) patients had a fascial sling placed at the time of surgery, without recurrence of fistula or need for sling removal. We found no significant difference in post-operative complication rates between those who had sling placement, and those who did not.…”