https://doi.org/10.4081/uij.2022.282
Complex vesicovaginal fistula: Analysis of patient characteristics and functional outcome of surgical reconstruction
Submitted: 29 November 2021
Accepted: 7 February 2022
Published: 2 March 2022
Accepted: 7 February 2022
Abstract Views: 1508
PDF: 386
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Complex vesicovaginal fistulas present a unique challenge to surgeons, and surgical reconstruction outcomes may be suboptimal. The aim is to evaluate the patient’s characteristics as well as the factors influencing the functional outcome of complex vesicovaginal fistula surgical reconstruction. From 2016 to 2020, the medical records of 28 patients with complex fistulas were analyzed retrospectively. Means, ranges, and standard deviations were used in descriptive analysis. For categorical data, the Fisher exact probability test was used. The mean (standard deviation) age at presentation was 44.4 (10.04) years, while 85.7% (24) of patients were below 50 years of age. Hysterectomy was the most common aetiology in 21 (75%) patients, followed by radiotherapy in 3 (10.7%). Surgical repair success was seen in 24 (85.7%) patients. Four (14.2%) patients had an unsuccessful repair, one vaginal and three abdominal approach. All the failed abdominal repairs were radiation-induced fistula (p=0.001). Other factors that significantly influenced repair failure include vaginal mucosal atrophy (3 failures out of 8 patients, p=0.013), severe fibrosis around the fistula (4 failures out of 12 patients, p=0.024), non-placement of suprapubic catheter (2 failures out of 3 patients, p=0.006), and non-placement of interposition tissue flap (p=0.005). Hysterectomy and radiotherapy are the common causes of complex vesicovaginal fistula. The outcome of the repair is hampered by vaginal mucosal atrophy and severe scarring. The use of a suprapubic catheter and an interposition tissue flap improves the outcome. Post-irradiation fistula has a significant impact on repair outcome and necessitates special consideration for a comprehensive management strategy.
El-Azab AS, Abolella HA, Farouk M. Update on vesicovaginal fistula: a systematic review. Arab J Urol 2019;17:61-8.
DOI: https://doi.org/10.1080/2090598X.2019.1590033
Lee D, Zimmern P. Vaginal approach to vesicovaginal fistula. Urologic Clinics 2019;46:123-33.
DOI: https://doi.org/10.1016/j.ucl.2018.08.010
Frajzyngier V, Li G, Larson E, et al. Development and comparison of prognostic scoring systems for surgical closure of genitourinary fistula. Am J Obstet Gynecol 2013;208:112-e1.
DOI: https://doi.org/10.1016/j.ajog.2012.11.040
Rajaian S, Pragatheeswarane M, Panda A. Vesicovaginal fistula: review and recent trends. Indian journal of urology: IJU: journal of the Urological Society of India. 2019;35:250.
DOI: https://doi.org/10.4103/iju.IJU_147_19
Waaldijk K. Surgical classification of obstetric fistulas. Int J Gynecol Obstet 1995;49:161-3.
DOI: https://doi.org/10.1016/0020-7292(95)02350-L
Arrowsmith SD. The classification of obstetric vesico-vaginal fistulas: a call for an evidence-based approach. Int J Gynecol Obstet 2007;99:S25-7.
DOI: https://doi.org/10.1016/j.ijgo.2007.06.018
Stamatakos M, Sargedi C, Stasinou T, et al. Vesicovaginal Fistula: Diagnosis and Management. Indian J Surg 2014;76:131–6.
DOI: https://doi.org/10.1007/s12262-012-0787-y
McKay E, Watts K, Abraham N. Abdominal approach to vesicovaginal fistula. Urologic Clinics 2019;46:135-46.
DOI: https://doi.org/10.1016/j.ucl.2018.08.011
Angioli R, Penalver M, Muzii L, Mendez L, Mirhashemi R, Bellati F, Crocè C, Panici PB. Guidelines of how to manage vesicovaginal fistula. Critical Rev Oncol/Hematol 2003;48:295-304.
DOI: https://doi.org/10.1016/S1040-8428(03)00123-9
Elkins TE. Surgery for the obstetric vesicovaginal fistula: a review of 100 operations in 82 patients. Am J Obstet Gynecol 1994;170:1108-20.
DOI: https://doi.org/10.1016/S0002-9378(94)70105-9
De Bernis L. Obstetric Fistula: Guiding Principles for Clinical Management and Programme Development. World Health Organization, 2006.
DOI: https://doi.org/10.1016/j.ijgo.2007.06.032
Genadry RR, Creanga AA, Roenneburg ML, Wheeless CR. Complex obstetric fistulas. Int J Gynecol Obstet 2007;99:S51-6.
DOI: https://doi.org/10.1016/j.ijgo.2007.06.026
Wadie BS, Kamal MM. Repair of vesicovaginal fistula: Single-centre experience and analysis of outcome predictors. Arab J Urol 2011;9:135-8.
DOI: https://doi.org/10.1016/j.aju.2011.06.005
Ockrim JL, Greenwell TJ, Foley CL, Wood DN, Shah PJ. A tertiary experience of vesico‐vaginal and urethro‐vaginal fistula repair: factors predicting success. BJU Int 2009;103:1122-6.
DOI: https://doi.org/10.1111/j.1464-410X.2008.08237.x
Breen M, Ingber M. Controversies in the management of vesicovaginal fistula. Best Practice Res Clin Obstet Gynaecol 2019;54:61-72.
DOI: https://doi.org/10.1016/j.bpobgyn.2018.06.005
Bodner-Adler B, Hanzal E, Pablik E, et al. Management of vesicovaginal fistulas (VVFs) in women following benign gynaecologic surgery: a systematic review and meta-analysis. PloS One 2017;12:e0171554.
DOI: https://doi.org/10.1371/journal.pone.0171554
Hillary CJ, Osman NI, Hilton P, et al. The aetiology, treatment, and outcome of urogenital fistulae managed in well- and low-resourced countries: a systematic review. Eur Urol 2016;70:478–92.
DOI: https://doi.org/10.1016/j.eururo.2016.02.015
Hilton P. Urogenital fistula in the UK: A personal case series managed over 25 years. BJU Int 2012;110:102–10.
DOI: https://doi.org/10.1111/j.1464-410X.2011.10630.x
Ayed M, Atat R El, Hassine L Ben, et al. Prognostic factors of recurrence after vesicovaginal fistula repair. Int J Urol 2006;13:345–9.
DOI: https://doi.org/10.1111/j.1442-2042.2006.01308.x
Kumar S, Kekre NS, Gopalakrishnan G. Vesicovaginal fistula: An update. Indian J Urol 2007;23:187–91.
DOI: https://doi.org/10.4103/0970-1591.32073
Evans DH, Madjar S, Politano VA, et al. Interposition flaps in transabdominal vesicovaginal fistula repairs: are they really necessary? Urology 2001;57:670–4.
DOI: https://doi.org/10.1016/S0090-4295(01)00933-5
Eilber KS, Kavaler E, Rodríguez L V, et al. Ten-year experience with transvaginal vesicovaginal fistula repair using tissue interposition. J Urol 2003;169:1033–6.
DOI: https://doi.org/10.1097/01.ju.0000049723.57485.e7
Ruminjo JK, Frajzyngier V, Abdullahi MB, et al. Clinical procedures and practices used in the perioperative treatment of female genital fistula during a prospective cohort study. BMC Pregnancy Childbirth 2014;14:1-3.
DOI: https://doi.org/10.1186/1471-2393-14-220
Nardos R, Menber B, Browning A. Outcome of obstetric fistula repair after 10-day versus 14-day Foley catheterization. Int J Gynecol Obstet 2012;118:21-3.
DOI: https://doi.org/10.1016/j.ijgo.2012.01.024
How to Cite
Shetty, S. ., Chawla, A., Choudhary, A., Sitaram, M., Jayadeva Reddy, S., & Sourabh Reddy, B. (2022). Complex vesicovaginal fistula: Analysis of patient characteristics and functional outcome of surgical reconstruction. Urogynaecologia International Journal, 34(1). https://doi.org/10.4081/uij.2022.282
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
An Open Access Publication is one that meets the following two conditions:
- the author(s) and copyright holder(s) grant(s) to all users a free, irrevocable, worldwide, perpetual right of access to, and a license to copy, use, distribute, transmit and display the work publicly and to make and distribute derivative works, in any digital medium for any responsible purpose, subject to proper attribution of authorship, as well as the right to make small numbers of printed copies for their personal use.
- a complete version of the work and all supplemental materials, including a copy of the permission as stated above, in a suitable standard electronic format is deposited immediately upon initial publication in at least one online repository that is supported by an academic institution, scholarly society, government agency, or other well-established organization that seeks to enable open access, unrestricted distribution, interoperability, and long-term archiving.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
Similar Articles
- Pierre Marie Tebeu, Charles-Henry Rochat, Jean Marie Kasia, Thérèse Delvaux, Perception and attitude of obstetric fistula patients about their condition: a report from the Regional Hospital Maroua, Cameroon , Urogynaecologia International Journal: Vol. 24 No. 2-3 (2010)
- Ileogben Sunday-Adeoye, Patrick Okonta, Ogbonnaya Lawrence Ulu, Prevalence, profile and obstetric experience of fistula patients in Abakaliki, Southeast Nigeria , Urogynaecologia International Journal: Vol. 25 No. 1 (2011)
- Etim I. Ekanem, Mabel I. Ekott, John E. Ekabua, Thomas U. Agan, Atta Inyang-Otu, Outcome of management of obstetric genito-urinary fistulae in the general hospital, Ikot Ekpene, Akwa Ibom state, Nigeria , Urogynaecologia International Journal: Vol. 24 No. 2-3 (2010)
- Aniefiok J. Umoiyoho, Emmanuel C. Inyang-Etoh, Obstetric fistula repair: a guide to patient selection , Urogynaecologia International Journal: Vol. 25 No. 1 (2011)
- Aniefiok J. Umoiyoho, Aniekan M. Abasiattai, Okon E. Akaiso, Review of obstetric fistulas in a rural hospital in South-South Nigeria , Urogynaecologia International Journal: Vol. 25 No. 1 (2011)
- Jawad ul Islam, Ronald Grainger, Ted McDermott, Robert Flynn, John Thornhill, Repair of non-obstetrical vesicovaginal fistula: a 13-year experience of single Irish institution , Urogynaecologia International Journal: Vol. 27 No. 1 (2013)
- Nisarath Soontrapa, Sukree Soontrapa, Srinaree Kaewrudee, Woraluk Somboonporn, Chuanchom Sakondhavat, Urogenital symptoms in postmenopausal women: a hospital-based prevalence study , Urogynaecologia International Journal: Vol. 25 No. 1 (2011)
- Leonard Juul, Gerhard B. Theron, Risk factors for third- and fourth-degree perineal tears during vaginal delivery , Urogynaecologia International Journal: Vol. 25 No. 1 (2011)
- Sonika Mann, Pushpa Dahiya, Amit Mann, Shikha Madan, Uterovesicovaginal fistula following placenta percreta: case review and management options , Urogynaecologia International Journal: Vol. 27 No. 1 (2013)
- Anupam Choudhary, Anshuman Singh, Suyog Shetty, Surag K.R., Manjunath Irappa Wali, Arun Chawla, Padmaraj Hegde, Bommireddy V. Reddy, Goli Venkata Sai Abhishek, Prevalent practices and changing trends in the management of vesicovaginal fistula: a cross-sectional study from a nationwide questionnaire-based survey of urologists from a developing country , Urogynaecologia International Journal: Vol. 35 No. 1 (2023)
You may also start an advanced similarity search for this article.