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Contemporary Outcomes of Surgery for Primary and Recurrent Genitourinary Fistulae in a Well-resourced Country
- Source :
- European Urology Open Science, Vol 31, Iss, Pp 41-46 (2021), European Urology Open Science
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- Background Urinary fistula (UF) is a global health problem but less common in well-resourced countries. Over the past decade there has been a trend toward managing UF in dedicated centres. Most of the evidence for surgical treatment is from individual case series, with few publications that involve high numbers. We describe the repair of recurrent and complex UF cases and outcomes in a tertiary referral setting. Objective To describe UF aetiology, repair techniques, and outcomes. Design, setting, and participants This is a retrospective study of a series of patients undergoing UF repair at a specialist unit. Outcome measurements and statistical analysis We describe the aetiology, cure rate, complications, and postoperative urinary incontinence rates for the series of UF cases. Results and limitations A consecutive series of 98 patients was identified, all of whom were tertiary referrals. Of these, 31 (31.6%) had at least one prior attempt at repair at another centre. The median age was 48 yr (interquartile range [IQR] 40–60.25). The median time from occurrence to repair was 12 mo (IQR 6–12). UF occurred most commonly following hysterectomy (48.0%), Caesarean section (9.2%), other gynaecological surgery (7.1%), and anti-incontinence surgery (7.1%). Complex fistulae (eg, repeat cases, radiation, ureteric involvement) comprised 41 of the cases (41.8%). Most patients with vesicovaginal fistula underwent repair via a transabdominal approach (70.4%). Tissue interposition was used in 96 cases (98%). There were no Clavien-Dindo grade >3 complications. Two patients (2%) had a persistent UF postoperatively. Two patients (2%) developed recurrence more than 2 yr after their initial repair, and both were successfully repaired at our centre. Twelve patients (12.3%) developed de novo overactive bladder, 22 (22.5%) developed stress urinary incontinence (13 had subsequent incontinence surgery), and two (2%) developed bladder pain (both had a subsequent cystectomy). Conclusions Despite a high rate of recurrent and complex UF, successful lasting closure was achieved in 96% of our cases. A minority of patients developed other problems such as de novo overactive bladder and stress urinary incontinence that may require further treatment. Patient summary Urinary fistula is an abnormal opening or connection in the urinary tract and is less common in well-resourced countries. As a consequence, management of this condition is more frequently undertaken at specialist units. Even patients with a complex fistula and those who have had multiple attempts at repair can experience a cure. Urinary leakage is a common complication after the operation but can be successfully managed with surgery.<br />Take Home Message Despite a high number of complex and recurrent cases, we achieved a success rate in excess of 95% in the surgical management of genitourinary fistula. It is important that such cases are managed by teams of surgeons who are comfortable in undertaking both vaginal and abdominal approaches to repair.
- Subjects :
- medicine.medical_specialty
business.industry
Urology
medicine.medical_treatment
Fistula
Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Urinary incontinence
medicine.disease
Vesicovaginal fistula
Urogenital fistula
Diseases of the genitourinary system. Urology
Reconstructive urology
Surgery
Cystectomy
Genitourinary Fistula
Overactive bladder
Interquartile range
Urinary Fistula
Genitourinary fistula
Medicine
RC870-923
medicine.symptom
business
RC254-282
Subjects
Details
- ISSN :
- 26661683
- Volume :
- 31
- Database :
- OpenAIRE
- Journal :
- European Urology Open Science
- Accession number :
- edsair.doi.dedup.....6e9e9f70731f2be3c99f359b021186b3