Successful Vesicovaginal Fistula Repair Research Articles

Identifying opportunities for prevention of adverse outcomes following female genital fistula repair: protocol for a mixed-methods study in Uganda

BackgroundFemale genital fistula is a traumatic debilitating injury, frequently caused by prolonged obstructed labor, affecting between 500,000-2 million women in lower-resource settings. Vesicovaginal fistula causes urinary incontinence, and other morbidity may occur during fistula development. Women with fistula are stigmatized, limit social and economic engagement, and experience psychiatric morbidity. Improved surgical access has reduced fistula consequences yet post-repair risks impacting quality of life and well-being include fistula repair breakdown or recurrence and ongoing or changing urine leakage or incontinence. Limited evidence on risk factors contributing to adverse outcomes hinders interventions to mitigate adverse events. This study aims to quantify these adverse risks and inform clinical and counseling interventions to optimize women’s health and quality of life following fistula repair through: identifying predictors and characteristics of post-repair fistula breakdown and recurrence (Objective 1) and post-repair incontinence (Objective 2), and to identify feasible and acceptable intervention strategies (Objective 3).MethodsThis mixed-methods study incorporates a prospective cohort of women with successful vesicovaginal fistula repair at approximately 12 fistula repair centers in Uganda (Objectives 1-2) followed by qualitative inquiry among key stakeholders (Objective 3). Cohort participants will have a baseline visit at the time of surgery followed by data collection at 2 weeks, 6 weeks, 3 months and quarterly thereafter for 3 years. Primary predictors to be evaluated include patient-related factors, fistula-related factors, fistula repair-related factors, and post-repair behaviors and exposures, collected via structured questionnaire at all data collection points. Clinical exams will be conducted at baseline, 2 weeks post-surgery, and for outcome confirmation at symptom development. Primary outcomes are fistula repair breakdown or fistula recurrence and post-repair incontinence. In-depth interviews will be conducted with cohort participants (n ~ 40) and other key stakeholders (~ 40 including family, peers, community members and clinical/social service providers) to inform feasibility and acceptability of recommendations.DiscussionParticipant recruitment is underway. This study is expected to identify key predictors that can directly improve fistula repair and post-repair programs and women’s outcomes, optimizing health and quality of life. Furthermore, our study will create a comprehensive longitudinal dataset capable of supporting broad inquiry into post-fistula repair health.Trial Registration ClinicalTrials.gov Identifier: NCT05437939.

Impact of vesicovaginal fistula repair on urinary and sexual function: patient-reported outcomes over long-term follow-up.

While the anatomical closure rates of vesicovaginal fistula (VVF) following transabdominal (TA) and transvaginal (TV) repairs seem comparable, studies comparing urinary and sexual outcomes following successful repair are lacking. We aimed to report patient-reported outcomes on sexual and urinary functions after long-term follow-up with successful repair. We retrospectively reviewed 81 women who had successful VVF repair at our institute. Pre-, intra- and post-operative details were retrieved from electronic data software. Patient-reported sexual and urinary function outcomes were assessed using the Female Sexual Function Index (FSFI) questionnaire and International Consultation of Incontinence Questionnaire-Short Form (ICIQ-SF), respectively, at last follow-up. We also compared such outcomes among TA and TV repairs. Of 81 women, 28 (34.6%) had TA and 53 (65.4%) had TV repairs. Mean age was 37.5years and mean fistula diameter was 12.9mm. The most common aetiology was hysterectomy. Thirty-three patients (40.7%) had previous failed repairs. At a mean follow-up of 29.8months, 24 (34.3%) women had sexual dysfunction and 15 (18.5%) women experienced urinary dysfunction. The TA and TV groups had comparable mean FSFI scores (28.7 ± 6.1 vs. 30.9 ± 5.2, p = 0.13) and ICIQ-SF scores (0.7 ± 1.7 vs. 0.5 ± 1.4, p = 0.59). In multivariate analysis, fistula size and site were significant predictors of urinary dysfunction whereas multiparity was the most significant predictor of sexual dysfunction. Sexual and urinary dysfunction is found in a considerable number of women after VVF repair. However, our data suggest comparable long-term sexual and continence outcomes between TA and TV repairs.

V263 ROTATIONAL LABIAL AND INFERIOR PUDENDIAL ARTERY BASED INNER THIGH FLAPS IN VAGINAL RECONSTRUCTION

You have accessJournal of UrologyFemale Voiding Dysfunction (Pelvic Reconstruction & Incontinence)1 Apr 2013V263 ROTATIONAL LABIAL AND INFERIOR PUDENDIAL ARTERY BASED INNER THIGH FLAPS IN VAGINAL RECONSTRUCTION Forrest Jellison, Gladys Ng, Lisa Rogo-Gupta, Leah Nakamura, Denise Chow, Ja-Hong Kim, Larissa Rodriguez, and Shlomo Raz Forrest JellisonForrest Jellison Los Angeles, CA More articles by this author , Gladys NgGladys Ng Los Angeles, CA More articles by this author , Lisa Rogo-GuptaLisa Rogo-Gupta Los Angeles, CA More articles by this author , Leah NakamuraLeah Nakamura Los Angeles, CA More articles by this author , Denise ChowDenise Chow Los Angeles, CA More articles by this author , Ja-Hong KimJa-Hong Kim Los Angeles, CA More articles by this author , Larissa RodriguezLarissa Rodriguez Los Angeles, CA More articles by this author , and Shlomo RazShlomo Raz Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1646AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The rotational inner thigh flap is well vascularized, maintains sensation, and provides reliable cosmetic and functional results for complex vaginal reconstruction. The purpose of this video is to describe the technique with the rotational flap. METHODS All women, from 2002–2012, requiring vaginal reconstruction were retrospectively reviewed. Patients who had a rotational inner thigh flaps performed were included in this analysis. Demographics, pre-operative and operative findings, postoperative sexual function and validated body image perception questionnaire, recurrence of vaginal fistula, or vaginal stenosis were analyzed. RESULTS A total of 486 women underwent vaginal reconstructive procedures of which 30 patients required rotational inner thigh flaps. Indications were vaginal defects that were difficult to access and or required large amount of coverage. The flap was utilized for (7) recurrent vesicovaginal fistula (VVF) repair or (6) rectovaginal fistula (RVF), (14) vaginal stenosis, (6) complex posterior vaginal wall defects, and (13) prior radiation. The median number of prior surgeries was 3. The operative times (mean 173 minutes + 59), EBL (193 + 92 mL), median LOS (3 days), and perioperative complication (6%- superficial soft tissue infection (1), blood transfusion (1) were observed. Graft survival was 100% and all had good cosmesis with no dehiscence. Successful repair of VVF or RVF occurred in 13 (100%) with 8 (62%) requiring 1 surgery, and 5 (38%) two operations. Those that failed primary repair with recurrent VVF (1) and RVF (4) had a history of radiation in 3 (60%) and bowel diversion was not performed in 3 out of the 4 RVF (75%). Complex posterior defects were successfully repaired in all patients (6) with one patient developing vaginal stenosis. Vaginal depth and width were adequate in 82% overall, with 93% (13) patients with vaginal stenosis successfully repaired. Sexual function was maintained in all except 2 patients. Post-operatively patients completed the body image disturbance questionnaires (BIDQ) which examines negative body image. Patient post-operative body image was maintained with a low (BIDQ) score of 1.96 +.92 which is comparable to the non-surgical general population with a 30% response rate. CONCLUSIONS The rotational inner thigh flap is a versatile option for complex vaginal reconstruction. Reliable functional and cosmetic results are achieved while maintaining body image with minimal morbidity. Not performing fecal diversion and a history of radiation were associated with risk of recurrence of fistula. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e108 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Forrest Jellison Los Angeles, CA More articles by this author Gladys Ng Los Angeles, CA More articles by this author Lisa Rogo-Gupta Los Angeles, CA More articles by this author Leah Nakamura Los Angeles, CA More articles by this author Denise Chow Los Angeles, CA More articles by this author Ja-Hong Kim Los Angeles, CA More articles by this author Larissa Rodriguez Los Angeles, CA More articles by this author Shlomo Raz Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Obstetric fistula: the use of urethral plugs for the management of persistent urinary incontinence following successful repair

The objectives of this study are to analyse the effect of a urethral plug as a means of controlling persistent urinary incontinence following successful repair of an obstetric vesicovaginal fistula (VVF) and to identify factors which might influence potential success or failure. Data from Physiotherapy Department records of a series of 181 women referred for urethral plug assessment following successful repair of VVF were studied retrospectively. Outcome in terms of continence status with the plug was considered in relation to estimated bladder size, urethral length and diameter, and vaginal scarring. A total of 137 women (75.7 %) reported being dry whilst using a urethral plug and 18 (9.9 %) half dry. There were 26 women (14.4 %) who remained wet, 17 of whom had a new or wide urethra. A total of 101 women (55.8 %) had a smaller than normal estimated bladder size (linear measurement from urethral meatus to the deepest point of the bladder = <7.5 cm) and were more likely to remain wet although this was not found to be statistically significant. Adverse incidents included rupture of the urethral plug (two) and migration of a plug into the bladder, requiring cystoscopic removal (six) A urethral plug appears to be an effective means of restoring or improving continence in women with persistent urinary incontinence following successful repair of obstetric VVF although data on long-term outcome were not available for analysis. Success rates may be lower if women have a significantly reduced bladder capacity or a new or wide urethra.

Quality of life following successful repair of vesicovaginal fistula in Nigeria

The impact of obstetric vesicovaginal fistula (VVF), which continues to occur among women in developing countries, can severely affect the health of the women while the condition persists. This study was designed to discover the effect of successful VVF repair on affected women's quality of life. A comparison of the quality of life of a cross-section of women who had VVF was carried out before and 6 months after successful repair. Quality of life was assessed using the WHO Quality of Life (WHOQOL)-BREF Questionnaire. Of the 150 women studied, only 20% felt satisfied with their general state of health and quality of life before the repair, while this increased to 90% following successful repair (highly statistically significant at p<0.000). In the physical health domain, the mean quality of life score was 67.9 ± 4.4 before and 69.3 ± 3.4 after successful repair (p<0.01). In the mental health domain, the mean quality of life score was 32.4 ± 8.7 before and 74.7 ± 3.2 after successful repair (p<0.005). In the social health domain, the mean score was 20.2 ± 2.7 before and 69.7 ± 2.3 after successful repair (p<0.001). In the environment domain, the mean score of quality of life was 60.3 ± 4.3 before repair and 59.7 ± 2.7 after successful repair (comparable at p<0.2). Successful repair of VVF is associated with significant improvement in the multidimensional quality of life among affected women.

Pregnancy and delivery after successful repair of vesicovaginal fistula

Pregnant women (110) with successfully repaired vesicovaginal fistula, supervised at the Ahmadu Bello University Teaching Hospital in Zaria, Nigeria, formed the study population. The obstetric complications, mode of delivery and fetal outcome are reviewed. The obstetric complications and fetal outcome were compared with a matched hospital control group. There was a higher complication rate among the women with vesicovaginal fistulae, and the commonest complication was urinary tract infection. Perinatal mortality rate was 17.2% in the cases compared to 10.2% in the controls.

Combined vaginal and transvesical approach in successful repair of vesicovaginal fistula.

The distressing problem of urinary leakage through a vesicovaginal fistula has been much discussed and numerous techniques have been presented for surgical repair. Unfortunately, many of these methods and special tricks, ranging from Sims' introduction of silver wire sutures to the more recent partial colpocleisis (Latzko), are subject to failure and only lead to greater difficulties at attempted secondary repair. The gynecologist has uniformly attacked closure of the fistula by the vaginal route and has shied away from the transvesical approach, while the urologist has reversed this and has tried to cure this abnormal opening only through a suprapubic opening. Moir states: Don't attempt a transvesical or transabdominal operation unless for a very special reason. Similarly, Falk writes: Suprapubic, extraperitoneal and transvesical and transabdominal procedures are now seldom performed by gynecologists. Also (ibid.), These transvesical methods of repair are still the ones most frequently used by urologists. The separate specialist