Urovaginal fistulae: 20 years' experience

Area of Science:

• Urology
• Gynecology
• Surgical Pathology

Background:

• Urovaginal fistulae are significant complications, often arising from obstetric trauma.
• Incidence peaks in the third and fourth decades, with rare occurrence after age 50.
• Fistulae present as simple (vesicovaginal, urethrovaginal, ureterovaginal) or complex types.

Purpose of the Study:

• To analyze the incidence, causes, and treatment outcomes of urovaginal fistulae.
• To evaluate the effectiveness of various surgical interventions for different fistula types.

Main Methods:

• Retrospective review of 86 urovaginal fistula patients treated over 20 years.
• Classification of fistulae by location (bladder, urethra, ureter) and complexity.
• Analysis of causative factors, including prolonged labor, cesarean sections, and hysterectomy.
• Documentation of surgical procedures and their success rates.

Main Results:

• Most common causes were difficult labor (28 cases) and cesarean sections (24 cases).
• Vesicovaginal fistulae (54 cases) showed high success rates with various repair methods (simple, flap, cystoplasty).
• Ureterovaginal fistulae (7 cases) were successfully treated with ureteroneocystostomy; urethral fistulae (13 cases) had a 77% success rate.
• Complex fistulae (12 cases) had mixed outcomes, with some requiring diversion or refused operation.

Conclusions:

• Urovaginal fistulae are predominantly linked to obstetric complications in younger women.
• Surgical management, tailored to fistula type, offers good outcomes, particularly for simple fistulae.
• Complex cases present challenges, necessitating individualized treatment strategies and potentially diversion.