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Functional outcomes of primary and secondary repairs of vesicovaginal fistulae via vaginal cuff scar excision

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Abstract

Hospital and office charts of patients who underwent vaginal cuff scar excision for vesicovaginal fistula (VVF) repair from February 1998 to December 2002 at our institution were reviewed. Preoperative demographics and fistula characteristics were gathered. Intraoperative data included use of tissue flaps, blood loss, OR time and anesthetic type. Postoperative review included time to discharge, successful repair and postoperative urinary or sexual dysfunction. Forty fistula repairs were identified. Ninety-three percent occurred after a hysterectomy and no subjects had a history of radiation. Forty-two percent had failed at least one surgical repair of their fistula and 12% had failed two or more attempted repairs. Twenty percent of the fistulae measured 1 cm or more in diameter and the remaining 80% were 5 mm or less. Peritoneal flaps and martius flaps were performed in 32% and 5%, respectively. Postoperatively, 100% of subjects were evaluated at 3 weeks when the suprapubic catheter was removed and 93% were evaluated at 3 months or later. All subjects were cured of their fistulae at last contact. At 3 months postoperatively, 94% percent denied any urinary dysfunction and 85% had resumed sexual intercourse. Two sexually active subjects reported mild deep dyspareunia. Transvaginal cuff scar excision is an effective method for the primary and secondary repair of vesicovaginal fistulae and does not appear to cause postoperative irritative voiding symptoms or dyspareunia.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA

    Michael K. Flynn & Cindy L. Amundsen

  2. Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC, USA

    Andrew C. Peterson, Cindy L. Amundsen & George D. Webster

Authors
  1. Michael K. Flynn
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  2. Andrew C. Peterson
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  3. Cindy L. Amundsen
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  4. George D. Webster
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Corresponding author

Correspondence to Michael K. Flynn.

Additional information

Disclaimer: The views expressed in this article are those of the authors and do not reflect the official policy or position of the United States Army, Department of Defense or the United States government

This article was presented at the 24th annual meeting of the American Urogynecologic Society, September 11–13, 2003. Hollywood, FL, USA

Editorial Comment: Vesicovaginal fistula (VVF) is a most distressing problem for both the patient and surgeon alike. The most expeditious, safest, and least morbid repair with the greatest likelihood of success should be employed. These authors have previously described this approach for VVF repair and, now, in this article have published on functional outcomes. There is very little in the literature on long-term functional outcomes following VVF repair and therefore this represents an important contribution. Although the use of anonymous, complete validated questionnaires as an outcome measure would have been ideal, especially as regards urinary and sexual function, these authors report that functional outcomes following vaginal cuff excision repair of VVF are satisfactory. It is important to remember that the vast majority of patients presenting with VVF were healthy, presumably without significant urinary or sexual dysfunction, and underwent an elective surgery which created the problem. This paper suggests that these patients can be restored to a satisfactory level of urinary and sexual function following repair.

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Flynn, M.K., Peterson, A.C., Amundsen, C.L. et al. Functional outcomes of primary and secondary repairs of vesicovaginal fistulae via vaginal cuff scar excision. Int Urogynecol J 15, 394–398 (2004). https://doi.org/10.1007/s00192-004-1188-y

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  • DOI: https://doi.org/10.1007/s00192-004-1188-y

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