Hypothesis / aims of study
Urethrovaginal fistulae (UVF) are a rare occurrence, particularly given recent improvements in obstetric care. As a result there is a paucity of literature on the management and outcomes for this condition. As a specialist referral centre for Genitourinary fistulae we evaluated our own cohort of patients undergoing UVF repair to report on the management and outcomes of this condition.
Study design, materials and methods
A prospective database was kept of patients with genitourinary fistulae at a single institution. This was interrogated to identify patients undergoing UVF repair over an 11 year period (March 2004-May2015). Data sets collected included: Demographics, aetiology, operative intervention, outcomes and post-operative continence. This analysis identified 24 patients with a median age of 53.3years (range 26-78years). Except for 2 patients with concurrent vesicovaginal fistulae (VVF), all patients underwent pre-operative video-urodynamics and peri-operative cysto-urethroscopy. Any women with post-operative incontinence underwent video-urodynamics to confirm aetiology and plan subsequent treatment.
Interpretation of results
Vaginal repair of UVF is feasible in the majority of cases and gave 100% anatomical closure in our cohort.
In terms of continence outcomes, 6 patients (6/22) who underwent pre-operative video-urodynamics had urinary incontinence – 3 had pure urodynamic stress urinary incontinence (USUI) and 3 had mixed urinary incontinence (MUI). All patients with pre-operative urinary incontinence persisted post-operatively.
For the patients with USUI, 2 patients achieved continence after insertion of a rectus fascial sling. 1 patient underwent a TVT-O which, unfortunately, failed with ongoing incontinence. In the patients with MUI the stress component was treated with a rectus fascial sling (n=3) and the urge component treated with sacral neuromodulation (n=1) and intravesical botulinum toxin (n=2). All patients in this group are continent.
De novo USUI occurred in 2 patients (8.3%) and was treated successfully in both cases with colposuspension.