Spectrum of urologic complications in obstetrics and gynecology: 13 years’ experience from a tertiary referral center

Abstract

Objective:To analyze the patterns of presentation and management for urologic complications of obstetrics and gynecology in the form of genitourinary fistulas at a tertiary referral center and highlight the social issues associated with them. Material and methods:We conducted this retrospective study analyzing 311 patients with genitourinary fistulas after obstetric and gynecologic surgeries between January 2005 and January 2018. We recorded the patients' characteristics and area of residence and then analyzed the etiology, surgical management and success rates by grouping the patients into four types of genitourinary fistulas. The primary end point of success was patient being leak free.Results: Majority of patients (90.4%) were from rural areas. The distribution of genitourinary fistulas in descending order was vesicovaginal (79.7%), ureterovaginal (11.8%), urethrovaginal (10.2%) and vesicouterine fistulas (2.6%). The mean time to presentation was 25.80±48.69 days with a wide range of 10 days to 360 months. The most common etiology was obstructed labour (58.5%) followed by abdominal hysterectomy (32.7%). For vesicovaginal fistulas the route to be used for repair depended on surgeon's preference and both transabdominal and transvaginal routes had almost equal success rates. The success rate of laparoscopic vesicovaginal fistula repair was 89.4% and all (100%) laparoscopic ureteroneocystostomies were successful. Conclusion:Genitourinary fistulas especially due to obstructed labour are still common in developing world showcasing the problem of inequitable distribution of healthcare. The surgical treatment approach depends on the surgeon's familiarity with the said procedure although versatility is required.

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,…”

“…26 Four retrospective nonrandomized comparative studies (N5247) compared abdominal laparotomy and laparoscopic or robotic fistula repair. 27,31,34,57 Although data are limited, endoscopic techniques seem to have similar rates of success as laparotomy (Table 1). However, endoscopic routes have less blood loss and shorter hospitalization.…”

“…However, endoscopic routes have less blood loss and shorter hospitalization. 27,34,57 Kumar et al 31 retrospectively compared three routes of repair: vaginal, abdominal laparotomy, and laparoscopy. Route was determined by surgeon preference, and success rates were similar: vaginal 92.2%, laparotomy 95.5%, and laparoscopy 89.5%.…”

“…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…”