In Support of Early Treatment of Postoperative Vesicovaginal Fistulas

Tsivian, Alexander; Uchvatkin, G. V.; Shtricker, Avraham; Yacobi, Yacov; Куренков, А. В.; Sidi, Avner

doi:10.1097/01.spv.0000229897.81163.5e

Cited by 4 publications

(2 citation statements)

References 13 publications

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“…Despite numerous publications on this subject, the management of VVF remains a source of debate. The options of fundamental issues such as the preferred surgical approach and the optimal timing of surgery still vary widely [ 128 ].…”

Section: Discussionmentioning

confidence: 99%

Management of vesicovaginal fistulas (VVFs) in women following benign gynaecologic surgery: A systematic review and meta-analysis

et al. 2017

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BackgroundVesicovaginal fistulas (VVF) are the most commonly acquired fistulas of the urinary tract, but we lack a standardized algorithm for their management. Surgery is the most commonly preferred approach to treat women with primary VVF following benign gynaecologic surgery.ObjectiveTo carry out a systematic review and meta-analysis on the effectiveness of operative techniques or conservative treatment for patients with postsurgical VVF. Our secondary objective was to define the surgical time and determine the types of study designs.MethodsPubMed, Old Medline, Embase and Cochrane Central Register of Controlled Trials were used as data sources. This systematic review was modelled on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, including a registration number (CRD42012002097).ResultsWe reviewed 282 full text articles to identify 124 studies for inclusion. In all, 1379/1430 (96.4%) patients were treated surgically. Overall, the transvaginal approach was performed in the majority of patients (39%), followed by a transabdominal/transvesical route (36%), a laparoscopic/robotic approach (15%) and a combined transabdominal-transvaginal approach in 3% of cases. Success rate of conservative treatment was 92.86% (95%CI: 79.54–99.89), 97.98% in surgical cases (95% CI: 96.13–99.29) and 91.63% (95% CI: 87.68–97.03) in patients with prolonged catheter drainage followed by surgery. 79/124 studies (63.7%) provided information for the length of follow-up, but showed a poor reporting standard regarding prognosis. Complications were studied only selectively. Due to the inconsistency of these data it was impossible to analyse them collectively.ConclusionsAlthough the literature is imprecise and inconsistent, existing studies indicate that operation, mainly through a transvaginal approach, is the most commonly preferred treatment strategy in females with postsurgical VVF. Our data showed no clear odds-on favorite regarding disease management as well as surgical approach and current evidence on the surgical management of VVF does not allow any accurate estimation of success and complication rates. Standardisation of the terminology is required so that VVF can be managed with a proper surgical treatment algorithm based on characteristics of the fistula.

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Section: Discussionmentioning

confidence: 99%

Management of vesicovaginal fistulas (VVFs) in women following benign gynaecologic surgery: A systematic review and meta-analysis

et al. 2017

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“…For patients desiring preservation of fertility, uterine-sparing surgery is to be considered. 9 Our approach to urogenital fistulae is aggressive, 10 and immediate reconstructive surgery is considered. In VCFs, however, our experience suggests that a conservative approach may be considered since one of the four cases resolved with conservative trial.…”

Section: Discussionmentioning

confidence: 99%

Vesico-cervical fistulae: case series

Zvi¹,

Tsivian²,

Neuman³

et al. 2020

MOJWH

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Background: Vesico-cervical fistula (VCF) is an extremely rare complication of cesarean section, and only sporadic cases have been reported. Objectives: We wanted to analyze the incidence, symptomatology, diagnosis and therapeutic aspects of vesico-cervical fistula. Methods: In a six years period we treated four women with vesico-cervical fistula, mean age 34 years, all following a cesarean section. Results: Here we present the diagnosis, management and outcome of women with this complication in our institution. Conclusion: This report should increase awareness of this uncommon complication and aid in prompt and comprehensive evaluation and management.

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