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Long-term functional outcomes following non-radiated urethrovaginal fistula repair

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Abstract

Objective

To review long-term functional outcomes after urethrovaginal fistula (UVF) repair.

Materials and methods

Following IRB approval, women who underwent transvaginal non-irradiated UVF repair with minimum 6-month follow-up were reviewed. Surgical outcomes were assessed by validated questionnaires: UDI-6, IIQ-7, 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, with a mean age of 46 years (range 20–66), BMI 29 (range 21–42) and mean follow-up at 52 months (range 9–142). Overall repair success rate was 95 %. Prior failed UVF repair was recorded in 11 women (61 %). Statistical differences noted for Q4: 1.9 versus 0.8 (p = 0.03) and Q5: 1.3 versus 0 (p = 0.02) and VAS between the two groups, favoring the non-sling group; 1.5 (0.6) versus 5 (4) (p = 0.05). No differences in IIQ-7 were noted between the two groups (p = 0.09). Of the 18 patients, 5 remained sexually active and of those, 2 responded to FSFI (40 %) with low scores. Reoperation rate was 33 % (6 women) with 3 requiring periurethral-bulking agent for recurrent SUI, 2 transurethral laser for residual urethral sling mesh strands and 1 urethral dilation.

Conclusion

This large contemporary series of non-radiated UVF indicates a satisfactory outcome in UVF closure repair at a mean 4- to 5-year long-term follow-up, with the synthetic sling-related group performing worse.

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References

  1. Leach GE (1991) Urethrovaginal fistula repair with Martius labial fat pad graft. Urol Clin North Am 18:409–413

    CAS  PubMed  Google Scholar 

  2. Ou R, Xie XJ, Zimmern PE (2011) Prolapse follow-up at 5 years or more: myth or reality? Urology 78(2):295–299

    Article  PubMed  Google Scholar 

  3. Lemack GE, Zimmern PE (2000) Identifying patients who require urodynamic testing before surgery for stress incontinence based on questionnaire information and surgical history. Urology 55(4):506–511

    Article  CAS  PubMed  Google Scholar 

  4. Blander D, Zimmern PE (2002) Urethral diverticulum and urethrovaginal fistula. In: Stanton SL, Zimmern P (eds) Female pelvic reconstructive surgery, chapter 22. Springer, Berlin, pp 299–311

    Google Scholar 

  5. Lee D, Dillon BE, Zimmern PE (2013) Long-term morbidity of Martius labial fat pad graft in vaginal reconstruction surgery. Urology 82(6):1261–1266

    Article  PubMed  Google Scholar 

  6. Vassallo BJ, Kleeman SD, Segal J, Karram MM (2003) Urethral erosion of a tension-free vaginal tape. Obstet Gynecol 101:1055–1058

    Article  PubMed  Google Scholar 

  7. Lowman J, Moore RD, Miklos JR (2007) Tension-free vaginal tape sling with a porcine interposition graft in an irradiated patient with a past history of a urethrovaginal fistula and urethral mesh erosion: a case report. J Reprod Med 52:560–562

    PubMed  Google Scholar 

  8. Reisenauer C, Wallwiener D, Stenzl A, Solomayer FE, Sievert KD (2007) Urethrovaginal fistula—a rare complication after the placement of a suburethral sling (ivs). Int Urogynecol J Pelvic Floor Dysfunct 18:343–346

    Article  PubMed  Google Scholar 

  9. Clemens JQ, DeLancey JO, Faerber GJ, Westney OL, McGuire EJ (2000) Urinary tract erosions after synthetic pubovaginal slings: diagnosis and management strategy. Urology 56:589–594

    Article  CAS  PubMed  Google Scholar 

  10. Estevez JP, Cosson M, Boukerrou M (2010) An uncommon case of urethrovaginal fistula resulting from tension-free vaginal tape. Int Urogynecol J 21:889–891

    Article  PubMed  Google Scholar 

  11. Siegel AL (2006) Urethral necrosis and proximal urethro-vaginal fistula resulting from tension-free vaginal tape. Int Urogynecol J 17:661–664

    Article  Google Scholar 

  12. Chung C, Kingman T, Tsai L, Bird E (2012) Serious complications from a single-incision midurethral sling placement. Obstet Gynecol 119(2 Pt 2):464–466

    Article  PubMed  Google Scholar 

  13. Deffieux X, Bonnet K, Chevalier N, Gervaise A, Frydman R, Fernandez H (2005) Urinary complications in sub-urethral sling procedures. J Gynecol Obstet Biol Reprod (Paris) 34:745–756

    Article  CAS  Google Scholar 

  14. Blaivas JG, Mekel G (2014) Management of urinary fistulas due to midurethral sling surgery. J Urol. doi:10.1016/j.juro.2014.04.009

    Google Scholar 

  15. Pushkar DY, Dyakov VV, Kosko JW, Kasyan GR (2006) Management of urethrovaginal fistulas. Eur Urol 50(5):1000–1005

    Article  PubMed  Google Scholar 

  16. Leng WW, Davies BJ, Tarin T, Sweeney DD, Chancellor MB (2004) Delayed treatment of bladder outlet obstruction after sling surgery: association with irreversible bladder dysfunction. J Urol 172(4 Pt 1):1379–1381

    Article  PubMed  Google Scholar 

  17. Starkman JS, Duffy JW III, Wolter CE, Kaufman MR, Scarpero HM, Dmochowski RR (2008) The evolution of obstruction induced overactive bladder symptoms following urethrolysis for female bladder outlet obstruction. J Urol 179(3):1018–1023

    Article  PubMed  Google Scholar 

  18. Stav K, Dwyer PL, Rosamilia A, Schierlitz L, Lim YN et al (2010) Repeat synthetic mid-urethral sling procedure for women with recurrent stress urinary incontinence. J Urol 183(1):241–246

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9110, USA

    Dominic Lee & Philippe E. Zimmern

Authors
  1. Dominic Lee
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  2. Philippe E. Zimmern
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Correspondence to Philippe E. Zimmern.

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Lee, D., Zimmern, P.E. Long-term functional outcomes following non-radiated urethrovaginal fistula repair. World J Urol 34, 291–296 (2016). https://doi.org/10.1007/s00345-015-1601-9

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  • DOI: https://doi.org/10.1007/s00345-015-1601-9

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