https://doi.org/10.4081/uij.2023.313
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
Submitted: 14 June 2023
Accepted: 18 October 2023
Published: 26 October 2023
Accepted: 18 October 2023
Abstract Views: 539
PDF: 260
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
Vesicovaginal fistula (VVF) management is primarily backed by evidence from retrospective studies and expert opinions and therefore lacks standardization. Newer generations of surgeons are more proactive toward changing clinical practices in domains lacking good-quality evidence. This survey-based cross-sectional study aims to elicit consensus on management practices regarding various domains of VVF management and look for any changes in clinical practice trends. A nationwide survey of urologists was conducted, and responses were grouped into 3 categories (overall response, response from young urologists, and response from experienced urologists) and compared. Based on the level of overall consensus, the responses were categorized as highly preferred, preferred, and somewhat preferred. Consensus was noted in conservative and endoscopic management of VVF, timing of VVF repair, definition of simple/complex VVF, approach for surgical repair for trigonal and supratrigonal VVF, use of interposition tissue for repair, and patient positioning in the postoperative period. A lack of consensus was noted in other domains. Changing trends in clinical practices were noted in attempts at conservative and endoscopic management, investigations considered mandatory for evaluation, surgical approach for complex VVF with bladder neck involvement and radiation-induced fistulas, the use of interposition grafts during surgical repair, the use of cystograms during follow-up, and the definition of a successful repair. There is uniformity in practices regarding many domains of VVF management. Those areas, where discordance in opinions is noted, require further research to bring standardization into practice. Regarding certain aspects of VVF management, there appears to be a change in trends among the younger generation of urologists.
Oakley SH, Brown HW, Greer JA, et al. Management of vesicovaginal fistulae: a multicenter analysis from the fellows’ pelvic research network. Female Pelvic Med Reconstr Surg 2014;20:7-13.
DOI: https://doi.org/10.1097/SPV.0000000000000041
Hillary CJ, Osman NI, Hilton P, Chapple CR. 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
Angioli R, Penalver M, Muzii L, et al. Guidelines of how to manage vesicovaginal fistula. Crit Rev Oncol Hematol 2003;48:295-304.
DOI: https://doi.org/10.1016/S1040-8428(03)00123-9
Ahmed S, Holtz SA. Social and economic consequences of obstetric fistula: life changed forever? Int J Gynaecol Obstet 2007;99:S10-5.
DOI: https://doi.org/10.1016/j.ijgo.2007.06.011
Lee JH, Choi JS, Lee KW, et al. immediate laparoscopic nontransvesical repair without omental interposition for vesicovaginal fistula developing after total abdominal hysterectomy. JSLS 2010;14:187-91.
DOI: https://doi.org/10.4293/108680810X12785289143918
Cho GE, Kim SW, Kang SW, Korean Retina Society. Changing trends in surgery for retinal detachment in Korea. Korean J Ophthalmol 2014;28:451-9.
DOI: https://doi.org/10.3341/kjo.2014.28.6.451
Capes T, Stanford EJ, Romanzi L, et al. Comparison of two classification systems for vesicovaginal fistula. Int Urogynecol J 2012;23:1679-85.
DOI: https://doi.org/10.1007/s00192-012-1671-9
WHO. Obstetric fistula : guiding principles for clinical management and programme development; 2006. Available from: https://iris.who.int/bitstream/handle/10665/43343/9241593679_eng.pdf?sequence=1.
Wang Y, Hadley HR. Nondelayed transvaginal repair of high lying vesicovaginal fistula. J Urol 1990;144:34-6.
DOI: https://doi.org/10.1016/S0022-5347(17)39359-X
Obi SN, Ozumba BC, Onyebuchi AK. Decreasing incidence and changing aetiological factors of vesico-vaginal fistula in south-east Nigeria. J Obstet Gynaecol 2008;28:629-31.
DOI: https://doi.org/10.1080/01443610802397686
Stovsky MD, Ignatoff JM, Blum MD, et al. Use of electrocoagulation in the treatment of vesicovaginal fistulas. J Urol 1994;152:1443-4.
DOI: https://doi.org/10.1016/S0022-5347(17)32441-2
Evans LA, Ferguson KH, Foley JP, et al. Fibrin sealant for the management of genitourinary injuries, fistulas and surgical complications. J Urol 2003;169:1360-2.
DOI: https://doi.org/10.1097/01.ju.0000052663.84060.ea
Singh O, Gupta SS, Mathur RK. Urogenital fistulas in women: 5-year experience at a single center. Urol J 2010;7:35-9.
Blaivas JG, Heritz DM, Romanzi LJ. Early versus late repair of vesicovaginal fistulas: vaginal and abdominal approaches. J Urol 1995;153:1110-2;discussion 1112-3.
DOI: https://doi.org/10.1016/S0022-5347(01)67522-0
Pushkar DY, Dyakov VV, Kasyan GR. Management of radiation-induced vesicovaginal fistula. Eur Urol 2009;55:131-7.
DOI: https://doi.org/10.1016/j.eururo.2008.04.044
Redman JF. Female urologic diagnostic techniques. Urol Clin North Am 1990;17:5-8.
DOI: https://doi.org/10.1016/S0094-0143(21)00284-6
Goodwin WE, Scardino PT. Vesicovaginal and ureterovaginal fistulas: a summary of 25 years of experience. J Urol 1980;123:370-4.
DOI: https://doi.org/10.1016/S0022-5347(17)55941-8
Abdel-Karim AM, Moussa A, Elsalmy S. Laparoendoscopic single-site surgery extravesical repair of vesicovaginal fistula: early experience. Urology 2011;78:567-71.
DOI: https://doi.org/10.1016/j.urology.2011.05.036
Rizvi SJ, Gupta R, Patel S, et al. Modified laparoscopic abdominal vesico-vaginal fistula repair--"mini-O’Conor" vesicotomy. J Laparoendosc Adv Surg Tech A 2010;20:13-5.
DOI: https://doi.org/10.1089/lap.2009.0176
Pshak T, Nikolavsky D, Terlecki R, Flynn BJ. Is tissue interposition always necessary in transvaginal repair of benign, recurrent vesicovaginal fistulae? Urology 2013;82:707-12.
DOI: https://doi.org/10.1016/j.urology.2013.03.076
Tatar B, Oksay T, Cebe FS, et al. Management of vesicovaginal fistulas after gynecologic surgery. Turk J Obstet Gynecol 2017;14:45-51.
DOI: https://doi.org/10.4274/tjod.46656
Browning A. Lack of value of the martius fibrofatty graft in obstetric fistula repair. Int J Gynaecol Obstet 2006;93:33-7.
DOI: https://doi.org/10.1016/j.ijgo.2006.01.003
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
Reynolds WS, Gottlieb LJ, Lucioni A, et al. Vesicovaginal fistula repair with rectus abdominus myofascial interposition flap. Urology 2008;71:1119-23.
DOI: https://doi.org/10.1016/j.urology.2007.12.057
Gedik A, Deliktas H, Celik N, et al. Which surgical technique should be preferred to repair benign, primary vesicovaginal fistulas? Urol J 2015;12:2422-7.
Nardos R, Menber B, Browning A. Outcome of obstetric fistula repair after 10-day versus 14-day Foley catheterization. Int J Gynaecol Obstet 2012;118:21-3.
DOI: https://doi.org/10.1016/j.ijgo.2012.01.024
Barone MA, Widmer M, Arrowsmith S, et al. Breakdown of simple female genital fistula repair after 7 day versus 14 day postoperative bladder catheterisation: a randomised, controlled, open-label, non-inferiority trial. Lancet 2015;386:56-62.
DOI: https://doi.org/10.1016/S0140-6736(14)62337-0
How to Cite
Choudhary, A., Singh, A., Shetty, S., K.R., S., Wali, M. I., Chawla, A., … Abhishek, G. V. S. (2023). 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, 35(1). https://doi.org/10.4081/uij.2023.313
Copyright (c) 2023 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
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
- Daniele Porru, Valentina Bobbi, Carmelo Di Franco, Alessandra Viglio, Mattia Novario, Carmine Tinelli, Barbara Gardella, Rossella Nappi, Arsenio Spinillo, Marco Paulli, Bruno Rovereto, Time of symptom onset and histologic findings in bladder pain syndrome/interstitial cystitis: new findings on useful correlations , Urogynaecologia International Journal: Vol. 30 No. 1 (2017)
- Karin Glavind, Janus Bo Jespersen, Mikkel Seyer-Hansen, Biomechanical properties of the rectovaginal fascia. Is it really a fascia? , Urogynaecologia International Journal: Vol. 25 No. 1 (2011)
- S.M. RUBINO, P. BARRECA, G. CAMMARATA, LEIOMYOMA IN THE VESICOVAGINAL SPACE: A CASE REPORT , Urogynaecologia International Journal: Vol. 18 No. 2 (2004)
- P. Farnelli, A. Parodi, TRANS OBTURATOR TAPE FOR FEMALE URINARY STRESS INCONTINENCE TREATMENT: A CONTRIBUTION TO ITS EMPLOYMENT IN CLINICAL PRACTICE , Urogynaecologia International Journal: Vol. 22 No. 1 (2008)
- Khaled Refaat, Constanze Fischer-Hammadeh, Mohamad Eid Hammadeh, Overview of pelvic floor failure and associated problems , Urogynaecologia International Journal: Vol. 26 No. 1 (2012)
- Karen De Baets, Ann M. A. De Vylder, Transvaginal urethral diverticulectomy using small intestinal submucosa interposition graft , Urogynaecologia International Journal: Vol. 25 No. 1 (2011)
- Suskhan Djusad, Surahman Hakim, Tyas Priyatini, Fernandi Moegni, Alfa Putri Meutia, Yudhistya Ksyatria, I Gede Manu, Management of stress urinary incontinence using transobturator tape: a case series , Urogynaecologia International Journal: Vol. 36 No. 1 (2024)
- Pau Sarrio-Sanz, Ana Isabel Lopez-Lopez, Laura Martinez-Cayuelas, Luis Gomez-Perez, Manuel Angel Ortiz-Gorraiz, Jesús Romero-Maroto, Is pelvic organ prolapse correction with vaginal mesh suitable with a correct indication and protocolized follow-up? , Urogynaecologia International Journal: Vol. 34 No. 1 (2022)
- Farzana Bashir, Abdul Rouf Khawaja, Yaseer Dar, Tanveer Dar, Javeed Magray, Transobturator-tape outside in (TVT-O) as saviour for female stress urinary incontinence without available cystoscope for gynecologist: A case series , Urogynaecologia International Journal: Vol. 34 No. 1 (2022)
- Barbara Cristina Gentile, Roberto Giulianelli, Luca Albanesi, Gabriella Mirabile, Francesco Pisanti, Transobturator tension-free vaginal tape is the most common procedure in women with stress urinary incontinence: our experience , Urogynaecologia International Journal: Vol. 28 No. 1 (2014)
You may also start an advanced similarity search for this article.