Impact of vesicovaginal fistula repair on urinary and sexual function: patient-reported outcomes over long-term follow-up

Panaiyadiyan, Sridhar; Nayyar, Bharti Uppal; Nayyar, Rishi; Kumar, Neeraj; Seth, Amlesh; Kumar, Rajeev; Singh, Prabhjot; Nayak, Brusabhanu; Kumar, Manoj

doi:10.1007/s00192-020-04648-z

Cited by 11 publications

(4 citation statements)

References 18 publications

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“…13,21,36,46,47,[53][54][55] All retrospective nonrandomized comparative studies (30 studies) and prospective nonrandomized comparative studies (5 studies) were considered high risk of bias because these studies evaluated interventions designated by surgeon preference, varied in their follow-up, provided limited information on evaluation of cure, and did not control for confounding factors. 14,[16][17][18][19][20][22][23][24][25][26][27][28][29][30][31][32][33][34][35]37,[39][40][41][42][43][44][45]48,49,51,52,[56][57][58] One comparative study, by Geisler et al, 25 reported preoperative assessment of the fistula for surgical planning. This prospective nonrandomized comparative study (N553) describes the use of phenazopyridine given preoperatively to identify fistula tracts.…”

Section: Resultsmentioning

confidence: 99%

“…Two retrospective nonrandomized comparative studies (N5117) reported quality-of-life outcomes comparing abdominal and vaginal routes of repair. 26,43 Panaiyadiyan et al 43 (N581) assessed urinary and sexual function after successful vesicovaginal fistula repair, comparing vaginal and abdominal routes. Route of repair was determined by fistula characteristics influenced largely by surgeon preference.…”

Section: Resultsmentioning

confidence: 99%

“…13,21,36,46,47,53–55 All retrospective nonrandomized comparative studies (30 studies) and prospective nonrandomized comparative studies (5 studies) were considered high risk of bias because these studies evaluated interventions designated by surgeon preference, varied in their follow-up, provided limited information on evaluation of cure, and did not control for confounding factors. 14,16–20,22–35,37,39–45,48,49,51,52,56–58…”

Section: Resultsmentioning

confidence: 99%

“…Surgical repair shows improvement in quality-of-life scores, including overall satisfaction, psychological health domains, and bladder and sexual function, and helps women regain a place within their communities. 26,43,60,61 Although the old tenets of surgical repair yield high success rates, surgeons still have a responsibility to identify what is best practice. Beyond surgical repair, rehabilitation and reintegration programs are critical.…”

Section: Discussionmentioning

confidence: 99%

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Repair of Vesicovaginal Fistulae

Thompson,

Halder,

Jeppson

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: To assess and compile the current level of evidence regarding successful surgical treatment of vesicovaginal fistulae and how these perioperative interventions affect anatomic, patient-centered, and adverse outcomes. DATA SOURCES: PubMed and EMBASE were searched from inception through September 9, 2022. METHODS OF STUDY SELECTION: This review included comparative studies (of any sample size) and single-group studies (1,000 or more participants) of primary or recurrent vesicovaginal fistula (ie, vesicovaginal fistula, urethrovaginal fistula, and bladder neck–vaginal fistula). We evaluated preintervention assessment or management, various techniques for intraoperative management, and postoperative management. Outcomes of interest included anatomic and objective outcomes (such as successful repair, fistula closure, urinary incontinence, recurrent fistula, perioperative complications) and subjective outcomes (such as voiding symptoms and quality of life). Abstracts and full-text articles were screened in duplicate, and study descriptions and findings were extracted into standardized extraction forms. Risk of bias was assessed independently by two investigators and adjudicated by a third. Study quality was summarized with standardized tools. We conducted random-effects model and restricted maximum-likelihood meta-analyses of relative risks when at least three studies compared similar interventions and reported similar outcome measures. TABULATION, INTEGRATION, AND RESULTS: Forty-six studies met the inclusion criteria. Studies were categorized into 11 domains: 1) preoperative assessment, 2) preoperative and postoperative physical therapy, 3) route of surgery, 4) incorporation of a flap, 5) trimming, 6) layered closure, 7) intraoperative antibiotics, 8) fibrin glue, 9) fascial sling, 10) postoperative Foley catheter duration, and 11) quality of life. Although the strength of the data is insufficient, preoperative phenazopyridine, physical therapy, layered closure, and intraoperative antibiotics seemed to improve the rate of successful fistula repair. Route of surgery (vaginal vs abdominal laparotomy) was determined primarily by surgeon preference and showed no difference in successful fistula repair. In addition, use of interpositional flaps, trimming fistula edges, fibrin glue, and fascial sling did not show significant improvement in rates of fistula cure. Overall, quality-of-life scores improved postoperatively regardless of route of repair and use of interpositional flaps. CONCLUSION: Our findings highlight the limited information available to guide evidence-based treatment of vesicovaginal fistula repair. Overall, high-quality evidence is lacking to provide guidelines; therefore, expert opinion remains the primary influence for fistula repair recommendations. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42021214948.

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