Incidence, type and management of ureteric injury associated with vesicovaginal fistulas: Report of a series from a specialized center

Abstract

Objectives To report a large series of vesicovaginal fistula, and to assess the incidence of ureteric injury in association with vesicovaginal fistula. Methods We retrospectively reviewed a prospective database of patients with vesicovaginal fistula referred to our center between 2004 and 2016. Data on patient demographics, fistula etiology, mode of repair, and any associated ureteric injury and its treatment were noted. Results Overall, 116 patients (median age 49 years, range 23–88 years) were referred for management of vesicovaginal fistula during the study period. Four of these patients (3.4%) had associated ureteric injury, one of whom had bilateral injury. Ureteric obstruction alone was noted in two patients, ureterovaginal fistula alone in one patient, and bilateral ureteric obstruction and ureterovaginal fistula in one patient. All ureteric injuries were managed with simultaneous reimplantation into the bladder at the time of vesicovaginal fistula repair. Five patients had post‐radiotherapy vesicovaginal fistula, and the remainder were post‐surgical. Three patients with post‐radiotherapy vesicovaginal fistula proceeded to primary diversion. Conclusions Ureteric injury is far less common than previously reported, occurring in <5% of patients presenting with vesicovaginal fistula. It can be successfully managed, and it remains the major indication for abdominal repair of vesicovaginal fistula.

Editorial Comment to Incidence, type and management of ureteric injury associated with vesicovaginal fistulas: Report of a series from a specialized center

“…3 However, preoperative diagnosis is essential for the planning of repair surgery. The article by Seth et al 4 presents a large series of 116 patients with VVF, emphasizing the incidence and management of these patients when there is an association of ureteral injury. These authors found just four cases of VVF with concomitant ureteral injury (3.4%), which is a significantly low incidence.…”