Which factors affecting the success of iatrogenic obstetric vesical fistulas?

Abstract

AIM: In developing countries, surgery, birth traumas, and especially gynecological procedures are the most common cause of vesicovaginal fistulas (VVFs). We retrospectively evaluated our treatment modalities for VVF repair caused by obstetric causes and compared with the current literature.

MATERIALS AND METHODS: We compared the surgical approach preferences and their results with patient characteristics as well as fistula size and location for the management of VVFs. We retrospectively reviewed and prospectively collected data on 63 women who had uterovesical fistulae or VVF surgical repair between October 2004 and November 2017 at our university hospital in southeastern Turkey.

RESULTS: A total of 63 patients with a diagnosis of obstetric fistula were primaries. Most of the patients had a total abdominal hysterectomy in 37 cases. After the cause of VVF, the mean time to the operation was 28±11 (range: 15-96) days. The average fistula tract size was 15.2±7.7 (range: 3-33) mm. Patients were followed up for a mean of 12 (range: 6-20) months. The patient who received antibiotic treatment due to urinary tract infection before surgery was 16 (25.3%). In seven (12.9%) patients whose fistula diameter was greater than 2 cm, a recurrence was observed. The overall success rate was 87.1%. The average operative time was 94,5±24,3 (range: 50-150) minutes for a layered closure, 75 (range: 50-80) minutes for an omental flap and 120 minutes (range: 100-150) for a martius flap. There were no intraoperative complications.

CONCLUSION: Obstetric VVFs are highly successful with surgical repair. Surgical success rates are especially high in fistula tract sizes of less than 20 mm and in patients with no history of urinary infection.