Risk of pelvic organ fistula in patients undergoing hysterectomy

To summarize and describe present knowledge regarding the incidence, cause and risk factors of pelvic organ fistula related to hysterectomy.

The reported incidence of pelvic organ fistula after hysterectomy ranges from 0.1 to 4% in different studies, and a higher incidence is generally reported after radical hysterectomy compared with hysterectomy on benign indications. Iatrogenic injury to the urinary tract or bowels during surgery, and postoperative infections, are probably the main etiologic factors involved in the pathogenesis of fistula formation subsequent to hysterectomy. Evidence from observational studies suggests that hysterectomy increases the risk for pelvic organ fistula disease compared with women with an intact uterus and that risk factors include laparoscopic and total abdominal hysterectomy, increasing age, smoking, diverticulitis and pelvic adhesions.

In industrialized countries, where pelvic organ fistula is rare owing to advances in modern obstetric care, hysterectomy is an important cause of fistula disease. This review demonstrates that hysterectomy is associated with pelvic organ fistula and describes a number of predisposing factors. Although rarely encountered in a general population, pelvic organ fistula disease may have a devastating effect on all aspects of quality of life and should be considered in the surgical decision at the time of hysterectomy.