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Santosa KB, Marta SN, Sugianto R, Widia F, Nababan P, Rahardjp HE. Surgeon's point of view in vesico-vaginal fistula management. Arch Ital Urol Androl 2024; 96:12450. [PMID: 38934525 DOI: 10.4081/aiua.2024.12450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/06/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVES Vesicovaginal fistulas (VVF) are the most commonly acquired fistulas of the urinary tract. The management of VVF is mainly based on expert opinion and surgeon experience. This study aims to provide the practice patterns and outcomes of vesicovaginal fistula (VVF) management in Indonesia. METHODS This study utilizes the results of a survey among the surgeons who performs VVF repair in referral hospitals throughout Indonesia between June and July of 2021. Data analysis was carried out with SPSS descriptively by displaying the relative frequency of the answers to each question of the questionnaire form. RESULTS We collected responses from 93 respondents consisting of 68 urologists and 25 gynecologists. The most commonly reported cause of VVF was obstetric (50.5%). Most respondents confirmed the diagnosis of VVF by cystoscopy (81.7%). Waiting time to repair VVF was generally 12 weeks (79.6%), while the transvaginal approach repair was more often performed (77.4%). An additional procedure, such as tissue interposition was performed in 50.5% of cases. Tissue interposition was mostly indicated in recurrent VVF (81%), with omentum being the most selected tissue interposition (71%). When indicated, the most selected method of transabdominal approach was open transvesical (54,84%). A laparoscopic approach was performed only in 7.5% of cases. Overall, the success rate for VVF repair in Indonesia was 70-100% at first attempt. CONCLUSIONS The transvaginal approach is preferred, either with or without an interposition tissue flap. The success rate at the first attempt is satisfactory.
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Affiliation(s)
- Kadek Budi Santosa
- Department of Urology, Faculty of Medicine, Universitas Udayana; Prof. Dr. I.G.N.G Ngoerah General Hospital, Denpasar.
| | - Stacia Novia Marta
- Prof. Dr. I.G.N.G Ngoerah General Hospital, Denpasar; Department of Surgery, Faculty of Medicine, Universitas Udayana.
| | - Ronald Sugianto
- Prof. Dr. I.G.N.G Ngoerah General Hospital, Denpasar; Department of Urology, Faculty of Medicine, Universitas Airlangga.
| | - Fina Widia
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta.
| | - Parsaoran Nababan
- Department of Urology, Bhayangkara Anton Soedjarwo Hospital, Pontianak.
| | - Harrina Erlianti Rahardjp
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta.
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Thompson JC, Halder GE, Jeppson PC, Alas A, Balgobin S, Dieter AA, Houlihan S, Miranne J, Sleemi A, Balk EM, Mama S, Meriwether KV, Antosh DD. Repair of Vesicovaginal Fistulae: A Systematic Review. Obstet Gynecol 2024; 143:229-241. [PMID: 38033311 DOI: 10.1097/aog.0000000000005468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/05/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To assess and compile the current level of evidence regarding successful surgical treatment of vesicovaginal fistulae and how these perioperative interventions affect anatomic, patient-centered, and adverse outcomes. DATA SOURCES PubMed and EMBASE were searched from inception through September 9, 2022. METHODS OF STUDY SELECTION This review included comparative studies (of any sample size) and single-group studies (1,000 or more participants) of primary or recurrent vesicovaginal fistula (ie, vesicovaginal fistula, urethrovaginal fistula, and bladder neck-vaginal fistula). We evaluated preintervention assessment or management, various techniques for intraoperative management, and postoperative management. Outcomes of interest included anatomic and objective outcomes (such as successful repair, fistula closure, urinary incontinence, recurrent fistula, perioperative complications) and subjective outcomes (such as voiding symptoms and quality of life). Abstracts and full-text articles were screened in duplicate, and study descriptions and findings were extracted into standardized extraction forms. Risk of bias was assessed independently by two investigators and adjudicated by a third. Study quality was summarized with standardized tools. We conducted random-effects model and restricted maximum-likelihood meta-analyses of relative risks when at least three studies compared similar interventions and reported similar outcome measures. TABULATION, INTEGRATION, AND RESULTS Forty-six studies met the inclusion criteria. Studies were categorized into 11 domains: 1) preoperative assessment, 2) preoperative and postoperative physical therapy, 3) route of surgery, 4) incorporation of a flap, 5) trimming, 6) layered closure, 7) intraoperative antibiotics, 8) fibrin glue, 9) fascial sling, 10) postoperative Foley catheter duration, and 11) quality of life. Although the strength of the data is insufficient, preoperative phenazopyridine, physical therapy, layered closure, and intraoperative antibiotics seemed to improve the rate of successful fistula repair. Route of surgery (vaginal vs abdominal laparotomy) was determined primarily by surgeon preference and showed no difference in successful fistula repair. In addition, use of interpositional flaps, trimming fistula edges, fibrin glue, and fascial sling did not show significant improvement in rates of fistula cure. Overall, quality-of-life scores improved postoperatively regardless of route of repair and use of interpositional flaps. CONCLUSION Our findings highlight the limited information available to guide evidence-based treatment of vesicovaginal fistula repair. Overall, high-quality evidence is lacking to provide guidelines; therefore, expert opinion remains the primary influence for fistula repair recommendations. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021214948.
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Affiliation(s)
- Jennifer C Thompson
- Northwest Kaiser Permanente, Portland, Oregon; the University of Texas Medical Branch, Galveston, the University of Texas at San Antonio, San Antonio, UT Southwestern Medical Center, Dallas, and the Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas; the Woman's Center for Advanced Pelvic Surgery, Phoenix, Arizona; MedStar Washington Hospital Center, Washington, DC; the Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; the International Medical Response Foundation, Brooklyn, New York; the Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island; Cooper Medical School of Rowan University, Cooper University Health Care, Camden, New Jersey; and the Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico
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Wang X, Gao Z, Li L, Tian D, Zhou H, Shen J. Clinical efficacy of flap transfer coverage in the treatment of vesicovaginal fistula. Int Urogynecol J 2023; 34:1797-1802. [PMID: 36738313 PMCID: PMC10415502 DOI: 10.1007/s00192-023-05465-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/31/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Vesicovaginal fistula (VVF) brings severe psychological, physiological, and social stress to patients, which seriously affects the quality of their sexual life. Traditional transvaginal repair surgery can cause vaginal shortening. Transferring the lateral free flap can maintain vaginal length. This study was carried out to investigate the clinical efficacy of the surgery of flap transfer coverage for treating VVF. METHODS A retrospective analysis was performed on 37 patients diagnosed with VVF and repaired by flap transfer coverage in the Urogynecology department of the First Affiliated Hospital of Kunming Medical University from January 2018 to June 2021. All patients took a prone split leg position to repair VVF with the flap transfer covering method and a chart review was performed. RESULTS Among the 37 patients, there were 34 cases of primary complete healing, and the success rate reached 91.89% without recurrence and complications. Three cases recurred with leakage of urine; cystoscopy showed that the fistula was significantly reduced, and all patients were cured after secondary repair by the same surgical method without complications. CONCLUSIONS Flap transfer coverage is a safe and effective surgical method for repairing VVF. The prone split leg position can better increase exposure. The fistula being away from the incision suture is the key to the success of the operation. Transferring the fistula can effectively improve the cure rate of VVF. Transferring the lateral free flap can maintain vaginal length.
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Affiliation(s)
- Xingqi Wang
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
- Yunnan Province Clinical Research Center for Chronic Kidney Disease, Kunming, 650032, China
| | - Zhenhua Gao
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
- Yunnan Province Clinical Research Center for Chronic Kidney Disease, Kunming, 650032, China
| | - Ling Li
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
- Yunnan Province Clinical Research Center for Chronic Kidney Disease, Kunming, 650032, China
| | - Daoming Tian
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
- Yunnan Province Clinical Research Center for Chronic Kidney Disease, Kunming, 650032, China
| | - Hang Zhou
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
- Yunnan Province Clinical Research Center for Chronic Kidney Disease, Kunming, 650032, China
| | - Jihong Shen
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China.
- Yunnan Province Clinical Research Center for Chronic Kidney Disease, Kunming, 650032, China.
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Kaundal P, Mavuduru RS, Bora GS, Mete UK, Singh SK. Quality of life, voiding & sexual dysfunction following robot-assisted vesicovaginal fistula repair: a tertiary care centre experience. J Robot Surg 2023:10.1007/s11701-023-01599-7. [PMID: 37055673 DOI: 10.1007/s11701-023-01599-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/09/2023] [Indexed: 04/15/2023]
Abstract
Robot-assisted VVF (RA-VVF) repair has the advantage of small cystotomy, precise dissection and minimal surrounding tissue trauma. Translation of this to better functional outcomes is not studied so far. This study aims to evaluate the quality of life, voiding, and sexual dysfunction following robot-assisted VVF repair. Women with successful RA-VVF repair were screened using UDI-6, IIQ-7, FSFI, and WHOQOL-BREF questionnaires. The preoperative assessment was done in the prospective cohort only. Of the 75 women who underwent RA-VVF repair, 47 were enrolled, 33 in retrospective, and 14 in a prospective cohort. Overall, 28 (60%) women had urinary complaints with a median UDI-6 total score of 4 (0-100) and IIQ-7 score (0-23) in 5 (10%) women. However, UDS (15 women) showed no DO with cystometric capacity (352 ± 98.12) ml and normal compliance in 14 (93%) women. Mean BOOI and DCI were 11.90 ± 7.01 and 44.25 ± 8.60 respectively, with PdetQmax ranging from 17 to 44. None had difficulty in voiding (Qmax 13.85 ± 4.90). Twenty (43%) women were sexually active, and 2 had sexual dysfunction (FSFI score < 26.55). Quality of life was "good" to "very good" in all domains (score > 90) except for the social domain. The prospective cohort showed significant improvement in UDI-6 score (p < 0.05), IIQ-7 score (p < 0.05), and quality of life (p < 0.05) postoperatively. RA-VVF repair results in minimal voiding dysfunction and significant improvement in overall quality of life. For sexual dysfunction assessment, a longer follow-up is required.
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Affiliation(s)
- P Kaundal
- Department of Urology, Indira Gandhi Medical College, Shimla, India
| | - R S Mavuduru
- Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - G S Bora
- Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
| | - U K Mete
- Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - S K Singh
- Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Serinçay H, Güler HU, Ulubayram K, Mangır N. A scoping review of tissue interposition flaps used in vesicovaginal fistulae repair. Ther Adv Urol 2023; 15:17562872231182217. [PMID: 37434758 PMCID: PMC10331086 DOI: 10.1177/17562872231182217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 05/30/2023] [Indexed: 07/13/2023] Open
Abstract
Background Research on the use of tissue interposition flaps (TIFs) in vesicovaginal fistulae (VVF) repair is a broad area where a very wide range of natural and synthetic materials have been used. The occurrence of VVF is also diverse in the social and clinical settings, resulting in a parallel heterogeneity in the published literature on its treatment. The use of synthetic and autologous TIFs in VVF repair is not yet standardized with a lack of the most efficacious type and technique of the TIF. Objectives The aim of this study was to systematically review all synthetic and autologous TIFs used in the surgical repair of VVFs. Data sources and methods In this scoping review, the surgical outcomes of autologous and synthetic interposition flaps used in VVF treatment meeting the inclusion criteria were determined. We searched the literature using Ovid MEDLINE and PubMed databases between 1974 and 2022. Study characteristics were recorded, and data on the change in fistulae size and location, surgical approach, success rate, preoperative patient evaluation and outcome evaluation were extracted from each study independently by two authors. Results A total of 25 articles that met the inclusion criteria were included in the final analysis. A total of 943 and 127 patients who had received autologous and synthetic flaps, respectively, were included in this scoping review. The fistulae characteristics were highly variable with regard to their size, complexity, aetiology, location and radiation. Outcome assessments of fistulae repair in included studies were mostly based on symptom evaluation. Physical examination, cystogram and methylene blue test were the methods in order of preference. Postoperative complications, such as infection, bleeding, donor site, pain, voiding dysfunction and other complications, were reported in patients after fistulae repair in all included studies. Conclusion The use of TIFs in VVF repair was common especially in complex and large fistulae. Autologous TIFs appear to be the standard of care at the moment, and synthetic TIFs were investigated in prospective clinical trials in a limited number of selected cases. Evidence levels of clinical studies evaluating the effectiveness of interposition flaps were overall low.
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Affiliation(s)
- Halime Serinçay
- Bioengineering Division, Graduate School of Science and Engineering, Hacettepe University, Ankara, Turkey
| | - Hayrullah Uğur Güler
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Kumar N, Sureka SK, Singh UP, Kapoor R, Rustagi S, Yadav P, Srivastava A, Kapoor R. Vesicovaginal Fistula Repair by Transvaginal Route: Comparison of Resource Utilisation and Outcome with Literature Reported Population Matched Cohort of Patients Operated by Minimally Invasive Route. J Obstet Gynaecol India 2022; 72:414-419. [PMID: 36458065 PMCID: PMC9568645 DOI: 10.1007/s13224-021-01549-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/11/2021] [Indexed: 01/09/2023] Open
Abstract
Introduction and Objectives VVF is conventionally repaired by open transvaginal or transabdominal routes. In last few decades, minimally invasive techniques (laparoscopic/robotic) for VVF repair have gained popularity. We have reported our experience of transvaginal vesicovaginal fistula (VVF) repair and compared it with the literature reported population matched cohort of VVF repair done by laparoscopic or robot-assisted techniques. Material and Methods Intraoperative and post-operative parameters including aetiology of fistula, location, operative time, blood loss, major complications, hospital stay and success rate of 202 patients with simple VVF undergoing transvaginal repair at a tertiary care hospital from 1999 to 2019 were recorded. We also compared our transvaginal repair cohort (n = 202) with the literature reported cohort of 260 patients undergoing VVF repair by minimally invasive (laparoscopic and robot assisted) techniques in the systematic review by Miklos et al. Results Most common aetiology of VVF in our series was post hysterectomy in 122 (60.39%) cases followed by trauma during emergency caesareans section in 80 (39.60%) cases. Transvaginal route had higher success rate than minimally invasive approach (99.50 vs. 96.50%, respectively). Mean operative time was lesser in transvaginal group than the minimally invasive group (63 ± 16 min vs. 161.56 ± 41.02 min, p < 0.01) with shorter mean hospital stay in transvaginal group (3 ± 1 days vs. 3.5 ± 1.16 days, respectively, p < 0.01). Mean estimated blood loss was significantly lesser in transvaginal repair (p < 0.01). 62% patients were sexually active at last follow-up. The cost of transvaginal VVF repair is significantly lower compared to repair by minimally invasive approach. Conclusion Transvaginal VVF repair is comparable to minimally invasive approach in terms of post-operative outcomes and morbidity; however, transvaginal repair performs better in terms of cost and resource utilization.
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Affiliation(s)
- Naveen Kumar
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sanjoy Kumar Sureka
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Uday Pratap Singh
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rohit Kapoor
- Department of Urology, DY Patil Medical College, Pune, India
| | - Sanchit Rustagi
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Priyank Yadav
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Aneesh Srivastava
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rakesh Kapoor
- Department of Urology and Renal Transplant, Medanta Hospital, Lucknow, India
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Complications After Vesicovaginal Fistula Repair Based on Surgeon Specialty in the United States: Analysis of a National Database. Female Pelvic Med Reconstr Surg 2022; 28:e120-e126. [PMID: 35272345 DOI: 10.1097/spv.0000000000001161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aimed to compare the rates of major and minor complications for vesicovaginal fistula (VVF) repair based on surgeon specialty and to identify risk factors for adverse outcomes. METHODS This was a retrospective cohort analysis of the American College of Surgeons National Surgical Quality Improvement Program between the years 2014 and 2019. Cases were identified using Current Procedural Terminology codes for VVF repair. Minor and major complication rates for VVF repair were compared between 2 cohorts defined by surgeon specialty: gynecology versus urology. Additional outcomes included readmissions and reoperations. Multivariable logistic regression analysis was performed to investigate risk factors for complications. RESULTS A total of 319 VVF repairs were included in the analysis, of which 115 (36.1%) were performed by gynecologists and 204 (63.9%) by urologists. There were no significant differences in the demographic or medical characteristics between the gynecology and urology cohorts except for race. Gynecologists performed more concomitant hysterectomies (10.4% vs 1.0%, P < 0.001) and apical suspension procedures (6.1% vs 0%, P < 0.001). There were no differences in minor (7.8% vs 6.4%, P = 0.623) or major (2.6% vs 3.4%, P = 1.000) complications between the cohorts. The overall readmission rate was 4.7%, and the reoperation rate was 2.2% with no differences between specialties. On multivariable logistic regression analysis, body mass index and concurrent hysterectomy were risk factors for major or minor complications with no increased risk associated with surgeon specialty or route of surgery. CONCLUSIONS Complication rates did not differ for VVF repairs performed by gynecologists compared with urologists. Readmission and reoperation rates were low for both groups.
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Contemporary Outcomes of Surgery for Primary and Recurrent Genitourinary Fistulae in a Well-resourced Country. EUR UROL SUPPL 2021; 31:41-46. [PMID: 34467239 PMCID: PMC8385280 DOI: 10.1016/j.euros.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 11/21/2022] Open
Abstract
Background Urinary fistula (UF) is a global health problem but less common in well-resourced countries. Over the past decade there has been a trend toward managing UF in dedicated centres. Most of the evidence for surgical treatment is from individual case series, with few publications that involve high numbers. We describe the repair of recurrent and complex UF cases and outcomes in a tertiary referral setting. Objective To describe UF aetiology, repair techniques, and outcomes. Design setting and participants This is a retrospective study of a series of patients undergoing UF repair at a specialist unit. Outcome measurements and statistical analysis We describe the aetiology, cure rate, complications, and postoperative urinary incontinence rates for the series of UF cases. Results and limitations A consecutive series of 98 patients was identified, all of whom were tertiary referrals. Of these, 31 (31.6%) had at least one prior attempt at repair at another centre. The median age was 48 yr (interquartile range [IQR] 40-60.25). The median time from occurrence to repair was 12 mo (IQR 6-12). UF occurred most commonly following hysterectomy (48.0%), Caesarean section (9.2%), other gynaecological surgery (7.1%), and anti-incontinence surgery (7.1%). Complex fistulae (eg, repeat cases, radiation, ureteric involvement) comprised 41 of the cases (41.8%). Most patients with vesicovaginal fistula underwent repair via a transabdominal approach (70.4%). Tissue interposition was used in 96 cases (98%). There were no Clavien-Dindo grade >3 complications. Two patients (2%) had a persistent UF postoperatively. Two patients (2%) developed recurrence more than 2 yr after their initial repair, and both were successfully repaired at our centre. Twelve patients (12.3%) developed de novo overactive bladder, 22 (22.5%) developed stress urinary incontinence (13 had subsequent incontinence surgery), and two (2%) developed bladder pain (both had a subsequent cystectomy). Conclusions Despite a high rate of recurrent and complex UF, successful lasting closure was achieved in 96% of our cases. A minority of patients developed other problems such as de novo overactive bladder and stress urinary incontinence that may require further treatment. Patient summary Urinary fistula is an abnormal opening or connection in the urinary tract and is less common in well-resourced countries. As a consequence, management of this condition is more frequently undertaken at specialist units. Even patients with a complex fistula and those who have had multiple attempts at repair can experience a cure. Urinary leakage is a common complication after the operation but can be successfully managed with surgery.
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Panaiyadiyan S, Nayyar BU, Nayyar R, Kumar N, Seth A, Kumar R, Singh P, Nayak B, Kumar M. Impact of vesicovaginal fistula repair on urinary and sexual function: patient-reported outcomes over long-term follow-up. Int Urogynecol J 2021; 32:2521-2528. [PMID: 33420796 DOI: 10.1007/s00192-020-04648-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND HYPOTHESIS While the anatomical closure rates of vesicovaginal fistula (VVF) following transabdominal (TA) and transvaginal (TV) repairs seem comparable, studies comparing urinary and sexual outcomes following successful repair are lacking. We aimed to report patient-reported outcomes on sexual and urinary functions after long-term follow-up with successful repair. METHODS We retrospectively reviewed 81 women who had successful VVF repair at our institute. Pre-, intra- and post-operative details were retrieved from electronic data software. Patient-reported sexual and urinary function outcomes were assessed using the Female Sexual Function Index (FSFI) questionnaire and International Consultation of Incontinence Questionnaire-Short Form (ICIQ-SF), respectively, at last follow-up. We also compared such outcomes among TA and TV repairs. RESULTS Of 81 women, 28 (34.6%) had TA and 53 (65.4%) had TV repairs. Mean age was 37.5 years and mean fistula diameter was 12.9 mm. The most common aetiology was hysterectomy. Thirty-three patients (40.7%) had previous failed repairs. At a mean follow-up of 29.8 months, 24 (34.3%) women had sexual dysfunction and 15 (18.5%) women experienced urinary dysfunction. The TA and TV groups had comparable mean FSFI scores (28.7 ± 6.1 vs. 30.9 ± 5.2, p = 0.13) and ICIQ-SF scores (0.7 ± 1.7 vs. 0.5 ± 1.4, p = 0.59). In multivariate analysis, fistula size and site were significant predictors of urinary dysfunction whereas multiparity was the most significant predictor of sexual dysfunction. CONCLUSIONS Sexual and urinary dysfunction is found in a considerable number of women after VVF repair. However, our data suggest comparable long-term sexual and continence outcomes between TA and TV repairs.
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Affiliation(s)
- Sridhar Panaiyadiyan
- Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Bharti Uppal Nayyar
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rishi Nayyar
- Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - Neeraj Kumar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Amlesh Seth
- Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Prabhjot Singh
- Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Brusabhanu Nayak
- Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Manoj Kumar
- Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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Robot-assisted Repair of Complex Vesicovaginal Fistulae: Feasibility and Outcomes. Urology 2020; 144:92-98. [DOI: 10.1016/j.urology.2020.07.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/09/2020] [Accepted: 07/15/2020] [Indexed: 11/17/2022]
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