Repair of non-obstetrical vesicovaginal fistula: a 13-year experience of single Irish institution

The objective of this study was to review our clinical experience in the surgical management of non obstetrical vesicovaginal fistulae (VVF) over the past 13 years, to determine common causes of fistulae in a modern hospital setting and outcomes based on different surgical approaches and timing of repair. A retrospective review of patients with VVF at the Adelaide Meath Hospital, Dublin, was undertaken from January 1997 to June 2010. 35 patients with mean age of 32 years (range 17 to 53 years) with vesicovaginal fistulae underwent surgical repair. A percentage of 68.5 fistulae occurred post hysterectomy, 20% were due to pelvic malignancy and the remainder from other causes. With regards to the timings of surgery, 57% were repaired within 3 months, 11% within 6 months and 32% after 6 months. 57% of patients underwent abdominal repair of fistulae and 26% had vaginal repair. 6 patients were not suitable for any type of repair and hence had urinary diversion. There were 3 failures, all after abdominal repair for complex fistulae. Timing of surgery has no apparent impact on the final outcome of the fistula. The type of approach depends on the preference and experience of the surgeon, with different approaches offering equally good results at our institution. Urinary diversion is still an option for a select group of patients.