Clinical relevance and treatment outcomes of vesicovaginal fistula (VVF) after obstetric and gynecologic surgery

Lo, Tsia‐Shu; Chua, Sandy; Wijaya, Tomy; Kao, Chuan Chi; Uy-Patrimonio, Ma. Clarissa

doi:10.1016/j.tjog.2018.11.021

Cited by 14 publications

(19 citation statements)

References 18 publications

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“…Out of 10 patients in our study having obstetric fistulas, 3 were having home delivery, 5 were having delivery at some center by untrained personnel, and 2 were having C section. This is in comparison to some of the studies cited above [9,12] . Our 9 patients out of 19 (47.36%) had fistulas due to different gynecological procedures.…”

Section: Discussionsupporting

confidence: 58%

“…Where the vaginal approach has limitation in case of small introitus, complex fistulas, supratrigonal fistulas, and previous failed vaginal repair [12] , their abdominal approach is appreciated. In many underdeveloped countries, vesicovaginal fistulas are mostly due to obstetric causes, but this situation doesn't exist in the western world due to their ideal antenatal and gynecological services [13] .…”

Section: Discussionmentioning

confidence: 99%

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Outcome of Primary Repair of Vesicovaginal Fistula (Vvf)

khalid

Hassan

Asif

et al. 2021

JUMDC

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BACKGROUND & OBJECTIVE: Vesicovaginal fistula is one of the common gynecological problems faced by ladies in developing countries on account of certain significant lacunas in the healthcare delivery system and lack of awareness. The purpose of this study is to highlight our experience of primary vesicovaginal fistula repair. METHODOLOGY: It is a cross-sectional experimental study from February 2019 to February 2020. Nineteen consecutive patients having vesicovaginal fistulas up to 3 cm in size, single in number were included in the study while those having fistulas more than 3 cm, involving urethra, bladder neck, and ureteric orifice were excluded. After a detailed history, physical examination, laboratory workup, and cystoscopic examination under anesthesia, the fistulas were repaired. All information was noted on the pre-planned questionnaire for this purpose. RESULTS: There are around 63% of patients having fistula infratrigonal and the rest percentage on the supratrigonal area of the urinary bladder. The risk factor found hysterectomy in 32% of patients, unsupervised home delivery in 16% of patients, C-Section in 12% of patients, delivery by an untrained person in 26% of patients, induced miscarriages in 5% of patients, and other risk factors found in 12% patients. The 68% of patients managed through transabdominal and the rest 32% patients operated through the transvaginal approach. The surgery, either transabdominal or transvaginal, was successfully done in 84% of patients and failed in the rest of 16% of patients. CONCLUSION: Fistulas due to obstetric trauma were mostly preventable. The success of surgical repair was due to health professionals' expertise, the suitable decision about approach, method of repair, proper preoperative evaluation, and careful postoperative management.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Outcome of Primary Repair of Vesicovaginal Fistula (Vvf)

khalid

Hassan

Asif

et al. 2021

JUMDC

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“…Overall, success of VVF repairs appears to be similar for both abdominal and vaginal routes, including with apical fistulas 28 and supratrigone fistulas 19 . Depending on the methodology and cohort size of available studies, complication rates appear to either be similar between routes or favor the vaginal route because of decreased blood loss, shorter operative time time and hospital stays, lower rates of complications and readmissions, and decreased cost 7,15,20,23,24,26,28 . Our data provide reassurance that 30-day rates of complications are not associated with surgical route when controlling for other factors.…”

Section: Discussionmentioning

confidence: 58%

“…Additional risk factors include endometriosis, diabetes, hypertension, malignancy, and history of pelvic irradiation 5,6 . Spontaneous resolution is uncommon, and most VVFs require surgical repair 5–8 . Common postoperative complications include urinary tract infections (UTIs), surgical site infections (SSIs), blood transfusions, and fistula recurrence 7,9,10 …”

mentioning

confidence: 99%

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

Romanova

Sifri

Gaigbe-Togbe

et al. 2022

Female Pelvic Med Reconstr Surg

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ObjectivesThis 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.MethodsThis 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.ResultsA 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.ConclusionsComplication 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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“…The management of iatrogenic fistula is debatable. Lo et al . report that iatrogenic fistulae are less likely to close spontaneously with bladder decompression, owing to location and size, and advise early transabdominal closure of this type.…”

Section: Bladder Decompression and Timing Of Closurementioning

confidence: 99%

A review of surgical procedures to repair obstetric fistula

Pope

Beddow

2020

Intl J Gynecology & Obste

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Although approximately 2 million women suffer from an obstetric fistula, the surgical literature is sparse. This review examines the evidence published to date. The most relevant surgical evidence is included, highlighting the need for further scientific investigations to contribute to our surgical practice. The most pressing needs relate to antiincontinence techniques and complex obstetric fistula repairs. K E Y W O R D SFistula repair; Global women's health; Obstetric fistula; Vesicovaginal fistula

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Clinical relevance and treatment outcomes of vesicovaginal fistula (VVF) after obstetric and gynecologic surgery

Cited by 14 publications

References 18 publications

Outcome of Primary Repair of Vesicovaginal Fistula (Vvf)

Outcome of Primary Repair of Vesicovaginal Fistula (Vvf)

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

A review of surgical procedures to repair obstetric fistula

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