The Latzko: A high-value, versatile vesicovaginal fistula repair

Clinical efficacy of flap transfer coverage in the treatment of vesicovaginal fistula

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.

Complications After Vesicovaginal Fistula Repair Based on Surgeon Specialty in the United States: Analysis of a National Database

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.

[Prognostic factors for failure of transvaginal repair of vesicovaginal fistula: A nested case-control study]

OBJECTIVE

To analyze the prognostic factors affecting the failure of transvaginal repair of vesicovaginal fistula (VVF).

METHODS

A retrospective nested case-control study was conducted. A total of 15 patients who underwent unsuccessful transvaginal vesicovaginal fistula repair in the Department of Urology, Peking University First Hospital from January 2014 to December 2020 were enrolled as the case group. A total of 60 patients receiving transvaginal vesicovaginal fistula repair by the same surgeon within the same time range, were selected as the control group. The age, body mass index (BMI), etiology of vesicovaginal fistula, associated genitourinary malformation, frequency of repair, characteristics of fistula, surgical procedure, postoperative recovery and other factors were compared between the case group and the control group, and the influencing factors of failure were analyzed.

RESULTS

The BMI of the case group was (26.3±3.9) kg/m², the diameter of vaginal fistula was (1.5±0.8) cm, and the operative time of transvaginal repair was (111.8±19.8) min. The proportion of the patients with genitourinary malformations was 4/15, the proportion of the patients with multiple vaginal repairs was 13/15, the proportion of the patients with concurrent ureteral reimplantation was 6/15, and the proportion of the patients with postoperative fever was 5/15. In the control group, the BMI was (23.9±3.0) kg/m², the diameter of vaginal fistula was (0.8±0.5) cm, the operative time of transvaginal repair was (99.9±19.7) min, the rate of associated genitourinary malformation was 2/60, the rate of multiple transvaginal repair was 18/60, the rate of concurrent ureteral reimplantation was 5/60, and no postoperative fever was found. Compared with the control group, the case group had higher BMI (P=0.013), bigger vaginal fistula (P=0.002), longer time of operation (P=0.027), higher proportion of genitourinary malformations (P=0.013), higher proportion of repeated transvaginal repair (P < 0.001), higher proportion of ureter reimplantation (P=0.006), and higher proportion of postoperative fever (P < 0.001). Multivariate analysis showed that fistula diameter ≥1 cm (OR=10.45, 95%CI=1.90-57.56, P=0.007) and repeated transvaginal repair (OR=16.97, 95%CI=3.17-90.91, P=0.001) were independent prognostic factors for VVF failure in transvaginal repair.

CONCLUSION

Fistula diameter ≥1 cm and repeated transvaginal repair are independent prognostic factors of failure in transvaginal repair.