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Vesico-Vaginal Fistula in Females in 2010–2020: a Systemic Review and Meta-analysis

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Abstract

Introduction

In the Western world today, urogenital fistula, including vesicovaginal fistula (VVF), is rare. However, while it remains significant in developing parts of the world due to prolonged and obstructed labor, in this study, we systematically reviewed the existing literature, discussing VVF occurrence, its etiology, and outcomes.

Material and Methods

We used electronic databases to search relevant articles from 2010–2020. The screening was performed with the help of Covidence. Relevant data from included studies were extracted in excel sheets, and final analysis was done using CMA-3 using proportion with 95% confidence interval (CI).

Results

Fifteen studies reported the VVF among the fistula series. The pooled result showed 76.57% cases of VVF (CI, 65.42–84.96), out of which 27.54% were trigonal, 55.70% supra-trigonal, and the rest with a varied description like circumferential, juxta-cervical, juxta-urethral. Obstetric etiology was commonly reported with 19.29% (CI, 13.26–27.21) with cesarean section and 31.14% (CI, 18.23–47.86) with obstructed labor. Hysterectomy was the commonly reported etiology among gynecological etiology (46.52%, CI; 36.17–57.19). Among different surgical treatments employed for fistula closure, 49.50% were by abdominal approach (CI, 37.23–61.82), and 42.31% by vaginal approach (CI, 31.82–53.54). Successful closure of fistula was reported in 87.09% of the surgeries (CI, 84.39–89.38).

Conclusion

The vesicovaginal fistula is the most common type of genitourinary fistula. Major causes of fistula are gynecological surgery, obstructed labor, and cesarean section. The vaginal approach and abdominal are common modalities of repair of fistula with favorable outcomes in the majority of the patients.

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Abbreviations

AH:

Abdominal hysterectomy

CS:

Cesarean section

LH:

Laparoscopic hysterectomy

LSCS:

Lower segment cesarean section

RVF:

Recto vaginal fistula

TAH:

Total abdominal hysterectomy

UGF:

Urogenital fistula

VH:

Vaginal hysterectomy

VVF:

Vesico-vaginal fistula

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Acknowledgements

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Availability of Data and Materials

The datasets analyzed during the current study are available within manuscripts or supplementary files.

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Authors and Affiliations

  1. Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL, USA

    Dhan Bahadur Shrestha

  2. Department of Internal Medicine, BronxCare Health System, Bronx, NY, USA

    Pravash Budhathoki

  3. Nepalese Army Institute of Health Sciences, Kathmandu, Nepal

    Pearlbiga Karki, Pinky Jha & Gaurab Mainali

  4. Department of Obstetrics and Gynecology, National Academy of Medical Sciences (NAMS), Kathmandu, 44600, Nepal

    Ganesh Dangal

  5. Department of Obstetrics and Gynecology, Nobel Medical College, Biratnagar, Kathmandu University, Dhulikhel, Nepal

    Gehanath Baral & Marisha Shrestha

  6. Manila Central University Hospital, Manila, Philippines

    Pratik Gyawali

  7. SAARC Tuberculosis and HIV/AIDS Center, Bhaktapur, 44800, Nepal

    Pratik Gyawali

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Contributions

DBS, PB, and GD contributed to the concept and design, analysis, and interpretation of data. DBS, PB, PK, PJ, GM, MS, and PG contributed to the literature search, data extraction, review, and initial manuscript drafting. GD and GB interpretation of data, revising the manuscript for important intellectual content, and approval of the final manuscript.

All authors were involved in drafting and revising the manuscript and approved the final version.

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Correspondence to Dhan Bahadur Shrestha.

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Shrestha, D.B., Budhathoki, P., Karki, P. et al. Vesico-Vaginal Fistula in Females in 2010–2020: a Systemic Review and Meta-analysis. Reprod. Sci. 29, 3346–3364 (2022). https://doi.org/10.1007/s43032-021-00832-8

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