Causative factors, social and surgical outcomes of vesicovaginal fistulas treated via an abdominal transvesical approach: A single-center experience

Abstract

Objective: To study the demographics, and surgical and social outcomes of patients with fistula repair performed at our hospital.

Methods: This cross-sectional study included 120 patients with fistula repair performed between 2014 and 2019 in the Urology Department of Lady Reading Hospital, Peshawar using an open transvesical repair method without omental interposition. Data were collected on patients' demographics, and social and surgical outcomes. Fistula severity was assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF).

Results: About 80 (66.6%) fistulas were iatrogenic and 40 (33.3%) were ischemic, with 36 (90%) due to obstructed labor. The median age of patients was 36 years (29-40 years). The majority of the patients were multiparous and premenopausal (99; 82.5%). Fifty (56.5%) of the iatrogenic fistulas were due to non-obstetric hysterectomy, and 20 (25%) were due to cesarean hysterectomy. Women had the fistulas for 4-49 weeks before seeking treatment with an average ICIQ score of 18. In all, 73 (73%) of the fistula caused by delivery had involved stillbirths, 4 (3.96%) were early neonatal deaths, and nearly 25 (21%) of patients were divorced. About 114 (95%) of patients were completely cured on discharge.

Conclusion: Vesicovaginal fistula is a devastating condition, with a rising trend in iatrogenic fistulas in low-income countries. In the hands of experienced surgeons, trans-abdominal repair without omental interposition shows a high success rate.

Keywords: iatrogenic fistula; obstructed labor; vesicovaginal fistula.