Prognostic factors of recurrence after vesicovaginal fistula repair

Abstract

Purpose:We evaluate the prognostic factors of recurrence in patients after the surgical repair of vesicovaginal fistula. Materials and methods : From 1985: From to 2002 women with vesicovaginal fistula underwent late (>3 months) surgical repair. A multivariate analysis of the data was performed with the EPI-INFO software. All P-values were two-sided, with odds ratio and 95% confidence intervals. Results: A total number of 73 patients underwent 97 procedures with a mean rate of 1.38 procedures/patient. The overall surgical success rate was 86.7%. Multivariate analysis demonstrated that recurrence was statistically significant for multiple fistulas (single vs two or more), fistula size (>10 mm), fistula type (Type I vs Type II), fistula etiology (obstetrical vs non-obstetrical) and the presence of urinary tract infection before the repair. Recurrence risk was fivefold higher for both the size and the type of the fistula, threefold higher for obstetrical etiology and 4.5-fold higher for multiple fistula. The interposition of flaps was a protective factor for recurrent cases. The surgical approach was not a significant prognostic factor of recurrence. Conclusion: Successful closure of a vesicovaginal fistula requires an accurate and a timely repair using procedures that exploit basic surgical principles. Multiple fistula, size and type of the fistula, and obstetrical etiology were the recurrence risk factors. We recommend in all patients with multiple risk factors for recurrence, the interposition of flaps.

Factors Influencing Repair Outcomes of Vesicovaginal Fistula: A Retrospective Review of 139 Procedures

“…However, a lower proportion of medium/large fistulas were seen in patients with secondary repair (1/21 vs. 28/118). Strong evidence indicated that fistula size was significantly associated with fistula closure [14,16,17,21] . Therefore, smaller fistula size after prior repair may be one explanation of the comparable success rate on second repair.…”

“…Prior studies indicated that fistula repair outcomes were determined by certain fistula characteristics, such as fistula site, fistula size and degree of perifistula scarring [14][15][16][17] . Ayed et al [14] demonstrated that multiple fistula, fistula size and type and obstetrical etiology were associated with recurrent fistulas. Ockrim et al [16] reported that failed repair was significantly more likely in large VVF.…”

Characteristics and Surgical Success of Patients Presenting for Repair of Genitourinary Fistula in VVF Center of a Tertiary Hospital

“…In our series success rate was higher (87.50%) in gynaecological fistula where it was 42.11% in obstetrical cases p = 0.03. Ayed M reported that obstetric fistula has lower success in repair and is a significant prognostic factor; the recurrence risk was threefold higher 20 .…”

Immediate Laparoscopic Nontransvesical Repair without Omental Interposition for Vesicovaginal Fistula Developing after Total Abdominal Hysterectomy

“…20 But, as the rate of relapse is not high in cases of a single VVF <1cm following nonobstetrical reasons, some do not recommend interposition. 12,21,22 In particular, Goyal et al 12 reported that the success rate of the layered closure technique without omental interposition for small (<1 cm) VVFs was 97.5% using a transabdominal or transvaginal approach. Nevertheless, in all reported studies for laparoscopic or robotic repair of VVFs, the omental transposition was performed.…”