Repair of Vesicovaginal Fistula: Experience of 30 Cases and Analysis of Outcome Predictors

Abstract

Female genital fistula is a serious medical condition in which a perforation develops most commonly between bladder and vagina (VVF). Although the majority of genitourinary fistulas can be closed surgically, the successful closure depends on many factors. In this retrospective study, the records of 30 women with a mean age of 23.8 years were assessed; 13% of the VVF occurred after abdominal hysterectomy, 67% after Caesarean section, and 20% after difficult vaginal delivery. Six (20%) women had previous repair. The median duration of the VVF was 5.9 months. Of the 30 patients of VVF, 24 were high and 6 were low. Twenty seven had single fistula opening and 3 had two fistulous openings. An abdominal approach was used in 24 patients and vaginal approach in 6 patients. At a mean follow up of 24 months, the VVF was cured in 90% patients. In conclusion, surgical correction of the VVF is more successful when done earlier, probably in the first 6 months. Abdominal approach seems to be more successful technique and recurrent VVF being associated with lower success rates than primary repair. High variety also has good result.

Repair of Vesicovaginal Fistulae

“…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.…”

“…The evaluated domains included route of repair and the use of flaps, trimming, layered closure, antibiotics, fascial sling, and fibrin glue (Table 1). 13,14,[16][17][18][20][21][22][23][24][27][28][29][30][31][33][34][35][36][37][40][41][42][44][45][46][48][49][50][51][52][53][56][57][58] Seventeen studies were identified (two prospective nonrandomized comparative studies, 15 retrospective nonrandomized comparative studies) that evaluated vaginal compared with abdominal (through laparotomy) routes of vesicovaginal fistula repair (N51,143). 14,16,18,20,24,29,30,33,35,37,40,41,…”

“…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…”

“…The evaluated domains included route of repair and the use of flaps, trimming, layered closure, antibiotics, fascial sling, and fibrin glue (Table 1). 13,14,16–18,20–24,27–31,33–37,40–42,44–46,48–53,56–58…”

“…Seventeen studies were identified (two prospective nonrandomized comparative studies, 15 retrospective nonrandomized comparative studies) that evaluated vaginal compared with abdominal (through laparotomy) routes of vesicovaginal fistula repair (N=1,143). 14,16,18,20,24,29,30,33,35,37,40,41,48–51,56 The overall study quality was low. Studies varied in definition of success and timing of this assessment.…”