Hypothesis / aims of study
A vesico-vaginal fistula (VVaF) is an abnormal communication between the bladder and the vagina, which results in urinary incontinence and repeated urinary tract infections.[1] VVaFs cause significant morbidity and have a severe impact on patients mental health, because of permanent leakage of urine.[2] VVaFs can be treated surgically. The aim of this study is to determine the outcome of surgically treated vesico-vaginal fistulae using a transvaginal approach with a Latzko technique.
Study design, materials and methods
A retrospective chart study was conducted. Surgical approaches to repair VVaF, from 2014 till September 2020, were selected. Patients who underwent a transvaginal approach were included. The primary objective was fistula closure. Secondary objectives were predictive factors for the outcome of the surgical procedure, e.g. patient characteristics, leakage on cystography two weeks postoperative, and surgery time.
Interpretation of results
We analyzed the outcome of vaginal approach of VVaFs. This approach is often chosen because it is a minimally invasive with minimal morbidity. In this study not all recurrent fistulae underwent a second attempt in closing the fistula. If patients who did not yet had a second attempt were taken into account with current success extrapolated, success rates would go up to 79% of the VVaFs successfully closed. Five patients had a cystography that showed leakage and the catheter remained in-situ for an extended period of time to support healing without success. The effect of the catheter remaining in situ therefore seems limited. One can even question the added value of cystography after surgery in this respect. We found that a predicting parameter for success was a previous repair of a VVaF elsewhere, before being admitted to our hospital. This might be coincidental, but at least a previous transvaginal approach elsewhere is not a contra-indication for a second transvaginal attempt.