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Anatomical and functional outcomes of non-obstetric urogenital fistula repair

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Abstract

Introduction and hypothesis

Studies on non-obstetric urogenital fistulas (NOUGFs) provide limited information on predictive outcome factors. This study was aimed at specifying and analyzing the risk factors for long-term anatomical and functional results.

Methods

A cross-sectional study of surgical repair for non-obstetric urogenital fistula was performed. From 2012 to 2020, a total of 479 patients with urogenital fistulas were treated in two tertiary centers. Patients with isolated ureteral fistulas and rectal injuries were excluded. For evaluation of the long-term results, patients with vesicovaginal and urethrovaginal fistulas with at least 12 months of follow-up were identified and contacted by phone and/or examined in the clinic. The anatomical outcome was assessed by resolution of symptoms and/or clinical examination. The Urinary Distress Inventory (UDI-6) was used for the functional outcomes.

Results

Overall, 425 patients were studied (mean age was 49.8; BMI 27.5; mean fistula size 1.4 cm, mean follow-up was 12 months). Vesicovaginal fistula affected 73% of patients. Hysterectomy without radiation was the most common etiology (66.3%), followed by hysterectomy with subsequent radiation (16%) and pelvic radiotherapy (12.2%). The transvaginal approach was used in 54.4%, abdominal in 12.4%, transvesical in 22.4%, and a combined approach in 10.8%. The successful closure rate was 92.9% for primary cases, 71.6% for secondary cases, and 66.7% for radiation fistulas. A high risk for relapse was found for NOUGFs with ureteral involvement (RR 2.5; 95% CI 1.3–4.5; p = 0.003), radiation fistulas (RR 2.1; 95% CI 1.3–3.5, p = 0.003); and combined radiation and hysterectomy cases (RR 2.9; 95% CI 1.8–4.6; p = 0.0001). In multifactorial analysis, fistula size >3.0 cm, pelvic radiation, and previous vaginal surgeries were associated with a higher risk for failure or lower urinary symptoms.

Conclusions

Factors for successful NOUGF closure are fistula size less than 3.0 cm, absence of pelvic radiation, and previous vaginal surgeries.

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Authors and Affiliations

  1. Urology Department, Moscow State University of Medicine and Dentistry, Vuchetich str. 21/2, Moscow, Russian Federation, 127206

    Dmitry Pushkar, George Kasyan & Luydmila Tikhonova

  2. Republican Specialized Center of Scientific and Practical Urology, Tashkent, Uzbekistan

    Rustam Sheripbaev & Shukrat Mukhtarov

Authors
  1. Dmitry Pushkar
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  2. George Kasyan
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  3. Rustam Sheripbaev
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  4. Shukrat Mukhtarov
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  5. Luydmila Tikhonova
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Contributions

Dmitry Pushkar: project development, manuscript editing; George Kasyan: project development, data collection, manuscript writing; Rustam Sheripbaev: data collection; Sukrat Mukhtarov: data collection; Lyudmila Tikhonova: data collection, statistical analysis.

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Correspondence to George Kasyan.

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Pushkar, D., Kasyan, G., Sheripbaev, R. et al. Anatomical and functional outcomes of non-obstetric urogenital fistula repair. Int Urogynecol J 33, 3221–3229 (2022). https://doi.org/10.1007/s00192-021-05073-6

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  • DOI: https://doi.org/10.1007/s00192-021-05073-6

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