Sexual function after vaginal and abdominal fistula repair

Mohr, Stefan; Brandner, Sonja; Mueller, Michael D.; Dreher, E.; Kühn, Annette

doi:10.1016/j.ajog.2014.02.011

Cited by 25 publications

(17 citation statements)

References 30 publications

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“…It has previously been established that vaginal approaches lead to a shorter hospital stay and quicker recovery times [4,5]. Current evidence suggests that where both routes are an appropriate surgical option, there might be similar success (radiologically confirmed closure) [6], quality of life and sexual function [7]. In this paper, we have analysed a singlesurgeon series of VVF repairs to consider the cost implications for healthcare providers of an open transabdominal versus a transvaginal approach.…”

Section: Introductionmentioning

confidence: 99%

The cost effectiveness of vaginal versus abdominal repair of vesicovaginal fistulae

et al. 2019

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Introduction and hypothesis The objective was to assess the comparative provider costs of vaginal and open abdominal repair of vesicovaginal fistula (VVF) and to determine the most cost-effective means of managing VVF. Methods A prospectively acquired database of all women undergoing VVF repair by a single surgeon between 2007 and 2015 was retrospectively reviewed to determine operating time, perioperative complications, inpatient stay and 30-day readmissions. The success and cost of the VVF repair were identified. Statistical analysis was by unpaired t test, Chi-squared test and Mann-Whitney U test. Results Forty-seven consecutive women of mean age 51 years (range 21-88) undergoing a first attempt at VVF repair at our institution were included; 32(68%) had vaginal repair with Martius fat pad interposition and 15 (32%) had open abdominal repair with omental interposition. There were no perioperative complications or 30-day readmissions in either group. Mean operative time was longer for open abdominal (223.4 min) than vaginal repair (196.9 min). Median inpatient stay was longer for an open abdominal (8 days) than for a vaginal approach (4 days). Successful anatomical closure was achieved in 91% of vaginal and 86% of open abdominal repairs at first attempt, and in 100% after second repair, where required. Mean/median costs for an abdominal repair were significantly higher, at £4,608.69/£4,169.20 than for vaginal repair at £3,381.50/£3,009.24 (P < 0.05). Conclusions Vesicovaginal fistulae were successfully repaired in 89% of cases at first attempt. The success rate did not differ between approaches. Vaginal repair is significantly more cost-effective than abdominal repair owing to the shorter operative time and length of stay.

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Section: Introductionmentioning

confidence: 99%

The cost effectiveness of vaginal versus abdominal repair of vesicovaginal fistulae

et al. 2019

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“…The diagnosis of OF is done clinically through a pelvic exam verified by a dye test or cystoscopy and the treatment is mainly surgical through transvaginal or transabdominal techniques [10]. Surgical closure rates are reported to be as high as 90 % but vary from one repair hospital to another [2, 11, 12].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with the failure of obstetric fistula repair in Guinea: implications for practice

et al. 2016

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BackgroundThe prevention and treatment of obstetric fistula still remains a concern and a challenge in low income countries.The objective of this study was to estimate the overall proportions of failure of fistula closure and incontinence among women undergoing repair for obstetric fistula in Guinea and identify its associated factors.MethodsThis was a retrospective cohort study using data extracted from medical records of fistula repairs between 1 January 2012 and 30 September 2013. The outcome was the failure of fistula closure and incontinence at hospital discharge evaluated by a dye test. A sub-sample of women with vesicovaginal fistula was used to identify the factors associated with these outcomes.ResultsOverall, 109 women out of 754 (14.5 %; 95 % CI:11.9–17.0) unsuccessful repaired fistula at discharge and 132 (17.5 %; 95 % CI:14.8–20.2) were not continent.Failure of fistula closure was associated with vaginal delivery (AOR: 1.9; 95 % CI: 1.0–3.6), partially (AOR: 2.0; 95 % CI: 1.1–5.6) or totally damaged urethra (AOR: 5.9; 95 % CI: 2.9–12.3) and surgical repair at Jean Paul II Hospital (AOR: 2.5; 95 % CI: 1.2–4.9).Women who had a partially damaged urethra (AOR: 2.5; 95 % CI: 1.5–4.4) or a totally damaged urethra (AOR: 6.3; 95 % CI: 3.0–13.0) were more likely to experience post-repair urinary incontinence than women who had their urethra intact.ConclusionAt programmatic level in Guinea, caution should be paid to the repair of women who present with a damaged urethra and those who delivered vaginally as they carry greater risks of experiencing a failure of fistula closure and incontinence.

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“…Interestingly, while GOG 240 reported an increased rate of fistula in the CHT+BEV group, the quality of life was not decreased in this group. Other reports show that fistula formation leads to a substantial reduction in quality of life [ 23 ]. Therefore, patient-reported outcomes, as used in GOG 240, might not be appropriate to determine the detrimental effect of fistula formation on quality of life.…”

Section: Discussionmentioning

confidence: 99%

Increased genitourinary fistula rate after bevacizumab in recurrent cervical cancer patients initially treated with definitive radiochemotherapy and image-guided adaptive brachytherapy

et al. 2017

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Background and purposePatients with recurrent cervical cancer (RecCC) who received definitive radiochemotherapy including image-guided adaptive brachytherapy (IGABT) as primary treatment are currently treated in our institution with palliative intent by chemotherapy (CHT) combined with bevacizumab (BEV). We aim to evaluate the risk of gastrointestinal (GI)/genitourinary (GU) fistula formation in these patients.Materials and methodsData of 35 consecutive patients with RecCC treated initially with radiochemotherapy and IGABT were collected. Known and presumed risk factors associated with fistula formation were evaluated. Fistula rate was compared between patients receiving CHT or CHT+BEV.ResultsOf the 35 patients, 25 received CHT and 10 patients received CHT+BEV. Clinical characteristics were comparable. Fistulae were reported in 6 patients: two fistulae (8%) in the CHT group, four (40%) in the CHT+BEV group. GU fistula occurred in the CHT+BEV group only (3/4). Of these 6 patients with fistulae, 5 (83%) had undergone previous invasive procedures after the diagnosis of RecCC and 1 patient had undergone pelvic re-irradiation; 3/6 patients had developed a local recurrence. No other risk factors for fistula formation were identified.ConclusionIn patients with RecCC after definitive radiochemotherapy including IGABT, the addition of BEV to CHT may increase the risk for GU fistula formation, particularly after invasive pelvic procedures. Future clinical studies are required to identify predictors for fistula formation to subsequently improve patient selection for the addition of BEV in the RecCC setting.

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Sexual function after vaginal and abdominal fistula repair

Cited by 25 publications

References 30 publications

The cost effectiveness of vaginal versus abdominal repair of vesicovaginal fistulae

The cost effectiveness of vaginal versus abdominal repair of vesicovaginal fistulae

Factors associated with the failure of obstetric fistula repair in Guinea: implications for practice

Increased genitourinary fistula rate after bevacizumab in recurrent cervical cancer patients initially treated with definitive radiochemotherapy and image-guided adaptive brachytherapy

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