Female non-obstetric urogenital fistula repair: long-term patient-reported outcomes and a scoping literature review

Jakob Klemm; Daniel R Stelzl; Robert J Schulz; Phillip Marks; Shahrokh F Shariat; Margit Fisch; Roland Dahlem; Malte W Vetterlein

doi:10.1111/bju.16395

Female non-obstetric urogenital fistula repair: long-term patient-reported outcomes and a scoping literature review

BJU Int. 2024 May 11. doi: 10.1111/bju.16395. Online ahead of print.

Authors

Jakob Klemm^{1

2}, Daniel R Stelzl^{1

3}, Robert J Schulz^{1

2}, Phillip Marks¹, Shahrokh F Shariat^{2

4

5

6

7

8

9}, Margit Fisch¹, Roland Dahlem¹, Malte W Vetterlein¹

Affiliations

¹ Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
² Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
³ Center for Surgery and Public Health and Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁴ Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
⁵ Division of Urology, Department of Special Surgery, University of Jordan, Amman, Jordan.
⁶ Department of Urology, Weill Cornell Medical College, New York, NY, USA.
⁷ Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
⁸ Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
⁹ Department of Urology, Semmelweis University, Budapest, Hungary.

PMID: 38733321
DOI: 10.1111/bju.16395

Abstract

Objective: To investigate long-term and patient-reported outcomes, including sexual function, in women undergoing urogenital fistula (UGF) repair, addressing the lack of such data in Western countries, where fistulas often result from iatrogenic causes.

Patients and methods: We conducted a retrospective analysis at a tertiary referral centre (2010-2023), classifying fistulas based on World Health Organisation criteria and evaluating surgical approaches, aetiology, and characteristics. Both objective (fistula closure, reintervention rates) and subjective outcomes (validated questionnaires) were assessed. A scoping review of patient-reported outcome measures in UGF repair was also performed.

Results: The study included 50 patients: 17 (34%) underwent transvaginal and 33 (66%) transabdominal surgery. History of hysterectomy was present in 36 patients (72%). The median (interquartile range [IQR]) operating time was 130 (88-148) min. Fistula closure was achieved in 94% of cases at a median (IQR) follow-up of 50 (16-91) months and reached 100% after three redo fistula repairs. Seven patients (14%) underwent reinterventions for stress urinary incontinence after transvaginal repair (autologous fascial slings). Patient-reported outcomes showed median (IQR) scores on the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS) of 5 (3-7) for filling symptoms, 1 (0-2) for voiding symptoms and 4.5 (1-9) for incontinence symptoms. The median (IQR) score on the ICIQ Female Sexual Matters Associated with Lower Urinary Tract Symptoms Module (ICIQ-FLUTSsex) was 3 (1-5). The median (IQR) ICIQ Satisfaction (ICIQ-S) outcome score and overall satisfaction with surgery item score was 22 (18.5-23.5) and 10 (8.5-10), respectively. Higher scores indicate higher symptom burden and treatment satisfaction, respectively. Our scoping review included 1784 women, revealing mixed aetiology and methodological and aetiological heterogeneity, thus complicating cross-study comparisons.

Conclusions: Urogenital fistula repair at a specialised centre leads to excellent outcomes and high satisfaction. Patients with urethrovaginal fistulas are at increased risk of stress urinary incontinence, possibly due to the original trauma site of the fistula.

Keywords: martius flap; patient‐reported outcomes; peritoneal flap; treatment satisfaction; urethrovaginal fistula; urogenital fistula repair; vesicovaginal fistula.