Evaluation and management of obstetric genital fistulas treated at a pelvic floor centre in Germany

Abstract

Background: Obstetric genital fistulas are an uncommon condition in developed countries. We evaluated their causes and management in women treated at a German pelvic floor centre.Methods: Women who had undergone surgery for obstetric genital fistulas between January 2006 and June 2020 were identified and their records were reviewed retrospectively.Results: 11 out of 40 women presented with genitourinary fistulas, and 29 suffered from rectovaginal fistulas. In our cohort the genitourinary fistulas were more common in multiparous (9/11) and the rectovaginal fistulas in primiparaous women (24/29). The majority of the genitourinary fistulas were at a high anterior position in the vagina and all rectovaginal fistulas were at a low posterior position. While all genitourinary fistulas were successfully closed, rectovaginal fistula closure was achieved in 88.65%. Women who suffered from rectovaginal fistulas and were at high risk of recurrence or postoperative functional discomfort and desired another child, we recommended the fistula repair in context of a subsequent delivery. For the first time, pregnancy related changes of the vaginal wall were used to optimize the success rate of a fistula closure.Conclusions: In developed countries, the birth itself can lead to injury-related genital fistulas. As fistula repair lacks evidence-based guidance, their management has to be tailored to the underlying pathology and the surgeonʼs experience. Attention should be directed towards preventive obstetric practice and adequate perinatal and postpartum care. Even if vesicovaginal fistulas occur rarely, in case of urinary incontinence after delivery, attention should be paid to the patient and a vesicovaginal fistula should be ruled out.Trial registration: retrospectively registered, DRKS 00022543, 28.07.2020