MP81-15 LONG-TERM OUTCOME OF URETHROVAGINAL FISTULA REPAIR

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology1 Apr 2015MP81-15 LONG-TERM OUTCOME OF URETHROVAGINAL FISTULA REPAIR Dominic Lee and Philippe Zimmern Dominic LeeDominic Lee More articles by this author and Philippe ZimmernPhilippe Zimmern More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2893AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To review long-term functional outcomes after urethro-vaginal fistula (UVF) repair. METHODS Following IRB approval, the charts of women who underwent transvaginal non-irradiated UVF repair with minimum 6 months follow-up were reviewed. Extracted data included demographics, etiology, prior repairs, surgical UVF repair procedure, secondary interventions, and functional outcomes. Surgical outcomes were assessed by validated questionnaires; Urogenital distress inventory (UDI-6), Impact on Incontinence questionnaire (IIQ-7), Female sexual function index (FSFI) and Visual analogue scale for QoL. Two groups were compared: (1) synthetic sling related versus (2) non-sling related UVF. Descriptive statistics were applied with p< 0.05 for significance. RESULTS From 1996 to 2013, 18 patients underwent UVF repair. Mean age was 46 years (range 20-66), with BMI 29 (range 21-42), and mean follow-up at 52 months (range 9 -142). Overall repair success rate was 95%. One recurrence occurred in a renal transplant woman on immunosuppressant who eventually required a cystectomy and ileal conduit. Size of UVF defect was from 1 mm to 2 cm. Prior failed UVF repair was recorded in 11 women (61%). Of the 18 women, one had primary repair without tissue interposition while 17 had Martius fat pad graft (MFPG)(2), autologous pubovaginal sling (PVS) (11), or both (4). As shown in Table 1, there was no statistical difference in UDI-6 outcomes between the 2 groups for Q2 and Q3, but statistical difference noted for Q4: 1.9 vs. 0.8 (p=0.03) and Q5: 1.3 vs. 0 (p=0.02). No differences in IIQ-7 were noted between the 2 groups (p=0.14). Of the 18 patients, 4 remained sexually active and of those, 2 responded to FSFI (50%) with low scores. Reoperation rate was 33% (6 women) with 3 requiring bulking agent for recurrent SUI, 2 transurethral laser for residual urethral sling mesh strands, and 1 urethral dilation. CONCLUSIONS This large contemporary series of non-radiated UVF indicates a satisfactory outcome in UVF closure repair at a mean 4-5 years long-term follow-up, with the synthetic sling related group performing worse. Table 1. Outcomes following Urethrovaginal Fistula (UVF) repair UVF repair Sling (n=9)/SD Non sling (n=9)/SD Total (n=18)/SD p-value Age (mean) 50/13 42/14 46/14 BMI (mean) 28/5.5 34/12 29/7 Gravida 2/1 2/1 2/1.3 Para 2/1 2/1 2/1 Sling type RP* 5 TOT** 2 SISˆ 2 Length of follow up (mean) 50/55 53/45 51/50 Anatomical closure (%) 9 (100) 8 (89) 17 (95) UDI-6 (%) 8 (89) 4 (44) 12 (67) Q1. Frequency 1.4 (1.2) 0.5 (1) 1.1 (1.2) 0.24 Q2. Urge Leak 1.8 (1) 0.8 (1) 1.4 (1) 0.1 Q3. Stress Leak 1.3 (1.3) 0.5 (0.6) 1 (1.1) 0.3 Q4. Small Leak 1.9 (1) 0.8 (0.5) 1.5 (1) 0.03 Q5. Emptying difficulty 1.3(1.2) 0 (0) 0.02 Q6. Pain 0.9 (1.4) 0.3 (0.5) 0.7 (1.1) 0.4 Total 7.4 (5.4) 4.5 (2.1) 6.8 (5) 0.5 IIQ-7 7.7 (11) 1 (1) 5.7 (9.2) 0.14 Visual Analog Scale 4.8 (4) 1.5 (0.6) 3.7 (3.6) 0.05 Sexual Activity No (%) 10 (66) Unknown (%) 4(22) Yes (%) 2 (22) - 4(22) RP*= retropubic, TOT**= transobturator tape, SISˆ= single incision sling © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1034-e1035 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dominic Lee More articles by this author Philippe Zimmern More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...