Vesicovaginal fistulas in the developed world: An analysis of disease characteristics, treatments, and complications of surgical repair using the ACS‐NSQIP database

Theofanides, Marissa C.; Sui, Wilson; Sebesta, Elisabeth M.; Onyeji, Ifeanyi; Matulay, Justin T.; Chung, Doreen E.

doi:10.1002/nau.23167

Cited by 15 publications

(21 citation statements)

References 8 publications

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“…8,9 Previous studies have demonstrated higher rate of complications associated with an abdominal approach, including urinary tract infections, sepsis, blood transfusions, and hospital readmissions. 6,7 Results from our study are consistent with published data advocating for vaginal approach in regards to risk of perioperative blood transfusion as well. However, there are circumstances in which an abdominal approach may be indicated, such as for ureteric involvement, limited vaginal access, significant associated scarring or failed prior repairs.…”

Section: Discussionsupporting

confidence: 91%

“…A rare complication of fistula surgery is hemorrhaging, accounting for 3% of all complications. 6 However, this can be serious and life-threating as access to safe blood for women in low-resource settings can be challenging. Therefore, it is important to understand potential risk factors for perioperative transfusions to allow for proper planning and risk mitigation among high-risk women.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Risk factors for perioperative blood transfusions after urogenital fistula repair in Uganda: a retrospective cohort study

Potluri

Holt

Tanner

et al. 2021

Preprint

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Objective: To determine the incidence of and risk factors for perioperative blood transfusions after urogenital fistula repairs in Uganda. Design: A retrospective cohort study. Setting: A community hospital in Masaka, Uganda. Population: Women who underwent fistula repair at the Kitovu Hospital between 2013 and 2019. Methods: Retrospective review of demographics, and clinical perioperative characteristics of patients surgically treated for urogenital fistula. Patient characteristics were compared between those who did and did not require a blood transfusion. Main Outcome Measures: need for perioperative blood transfusion, risk factors Results: 546 patients treated for urogenital fistulas were included in this study. The median age was 31.1 ± 13.2. A vaginal surgical approach was used in the majority of patients (84.6%). Complications occurred in 3.5% of surgical repairs, and the incidence of blood transfusions was 6.2%. In multivariable analyses, women with fistula repairs approached abdominally were 4.3 (95% CI: 1.85–10.00) times more likely to require transfusions than vaginal operations. A borderline association was observed between timing of repair and perioperative transfusions such that patients who underwent repair after three months from the time of developing the fistula were at lower risk of perioperative transfusions (aOR: 0.48, 95% CI: 0.22–1.04). Conclusions: The incidence of blood transfusions among urogenital fistula repairs in our population is twice that of developed nations. An abdominal surgical approach to urogenital fistula is a significant risk factor for perioperative blood transfusions. Timing of repair may warrant further study.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Risk factors for perioperative blood transfusions after urogenital fistula repair in Uganda: a retrospective cohort study

Potluri

Holt

Tanner

et al. 2021

Preprint

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“…It is not clear if the cost to society, and a national healthcare system such as that in the UK, would be different for each of the techniques. However, the increased length of stay and morbidity associated with an open abdominal approach as reported elsewhere would suggest that the societal cost of a successful abdominal repair might be likely to be greater than that of a vaginal repair [12].…”

Section: Success Ratementioning

confidence: 87%

“…In a bid to provide assistance in making this decision, our series demonstrates an evolution in practice for a single surgeon from a predominantly abdominal approach to a predominantly vaginal approach. This progression was made in a bid to reduce the exposure of patients to the greater morbidity seen with an abdominal approach, as identified by previous studies [12].…”

Section: Surgical Approachmentioning

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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“…The most common cause of VVF in developed countries is pelvic surgery e.g. hysterectomy while in developing countries prolonged obstructed labour is the leading cause 11 . Contrary to various studies from Pakistan, we found hysterectomy as the most common cause.…”

Section: Discussionmentioning

confidence: 99%

O’conor (Transabdominal) Repair: Is It Always Necessary to Interpose a Flap in Simple Vesico-Vaginal Fistula? A Comparative Study

Rizwan

Zia

Khurshid

et al. 2021

PAFMJ

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Objective: To assess morbidity and success of transabdominal (O’Conor) repair of vesicovaginal fistula with orwithout interposition of flap between vagina and urinary bladder. Study Design: Prospective comparative study. Place and Duration of Study: Armed Forces Institute of Urology, Rawalpindi, from Mar 2016 to Jan 2019. Methodology: Fifty five patients were randomized into group A & B by lottery method. An inclusion criterionwas single fistulous opening of ≤3cm. Complex and recurrent fistulae were excluded. Patients in group A underwent O’Conor repair without interpositional flap while in group B vesicovaginal fistulae were repaired with flap interposition. Results: Twenty two patients were randomized in group A while 27 in group B. Mean age of patients was 41.65± 11.93 years. Gynecological and obstetrical surgery was the main cause of fistula. Mean duration of surgerywas 162.7 ± 18.49 minutes. Per-operative ureteric catheterization was done in 9 (16.8%) patients. Seventeen(30.6%) patients had paralytic ileus. There was transient fever in 4 (7.6%) of cases and wound infection was seenin 3 (5.8%) of patients. Mean hospital stay was 3.4 ± 2.3 days. Cystogram was done in 35 (64.5%) of patients before the removal of per-urethral catheter. The overall success rate was 92.9%. Ten (18.2%) of patients developed denovo urgency which was managed conservatively. There was no statistical difference in both groups in terms of morbidity and success. Conclusion: In simple Vesico-vaginal fistulae repair, interposition of flap can be omitted and it does not affect the outcomes in terms of success and morbidity.

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Vesicovaginal fistulas in the developed world: An analysis of disease characteristics, treatments, and complications of surgical repair using the ACS‐NSQIP database

Abstract: In the US VVF remains a rare entity. Over half of VVFs were repaired vaginally. The occurrence of serious complications is low. A vaginal approach appears to be associated with fewer complications.

Cited by 15 publications

References 8 publications

Risk factors for perioperative blood transfusions after urogenital fistula repair in Uganda: a retrospective cohort study

Risk factors for perioperative blood transfusions after urogenital fistula repair in Uganda: a retrospective cohort study

The cost effectiveness of vaginal versus abdominal repair of vesicovaginal fistulae

O’conor (Transabdominal) Repair: Is It Always Necessary to Interpose a Flap in Simple Vesico-Vaginal Fistula? A Comparative Study

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