Commonalities of cerclage-related genitourinary fistulas

The purpose of this review was to identify common features of cerclage-related genitourinary fistulas.

A retrospective case series of cerclage-related fistulas was performed. The results were then pooled with available published case reports to identify common factors in these cases. Fistula location, surgical technique, and previous surgical and obstetrical histories were examined.

From 2008 to 2011, 5 women were referred with vesicovaginal fistulas after cerclage. Within this series, 4 had prior cervical procedures, 3 had previous cesarean deliveries, and 4 had a McDonald cerclage in the antecedent pregnancy. When pooled with available data in 7 published case reports on cerclage-related fistulas, all 12 fistulas occurred in patients with prior histories of cervical procedures or cesarean deliveries. Specifically, of the 12 patients, 8 [66.7%; 95% confidence interval (CI), 0.39-0.86] had at least 1 prior cerclage and 10 (83.3%; 95% CI, 0.54-0.97) had at least 1 prior cervical surgery. When reported, 81.8% (95% CI, 0.51-0.96) had the McDonald technique used for placement of the current cerclage.

The isolated and pooled findings suggest previous cerclage, any previous cervical procedures, and use of the McDonald technique are common factors in cases of cerclage-related genitourinary fistulas. This information may be useful when evaluating and counseling patients.