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Commonalities of Cerclage-Related Genitourinary Fistulas

Massengill, Jason C. MD, Maj, USAF, MC*; Baker, Tieneka M. DO, CPT, USA, MC*; Von Pechmann, Walter S. MD; Horbach, Nicolette S. MD; Hurtado, Eric A. MD

Female Pelvic Medicine & Reconstructive Surgery: November/December 2012 - Volume 18 - Issue 6 - p 362–365
doi: 10.1097/SPV.0b013e318270aa7c
Case Series

Objectives: The purpose of this review was to identify common features of cerclage-related genitourinary fistulas.

Methods: A retrospective case series of cerclage-related fistulas was performed. The results were then pooled with available published case reports to identify common factors in these cases. Fistula location, surgical technique, and previous surgical and obstetrical histories were examined.

Results: From 2008 to 2011, 5 women were referred with vesicovaginal fistulas after cerclage. Within this series, 4 had prior cervical procedures, 3 had previous cesarean deliveries, and 4 had a McDonald cerclage in the antecedent pregnancy. When pooled with available data in 7 published case reports on cerclage-related fistulas, all 12 fistulas occurred in patients with prior histories of cervical procedures or cesarean deliveries. Specifically, of the 12 patients, 8 [66.7%; 95% confidence interval (CI), 0.39–0.86] had at least 1 prior cerclage and 10 (83.3%; 95% CI, 0.54–0.97) had at least 1 prior cervical surgery. When reported, 81.8% (95% CI, 0.51–0.96) had the McDonald technique used for placement of the current cerclage.

Conclusions: The isolated and pooled findings suggest previous cerclage, any previous cervical procedures, and use of the McDonald technique are common factors in cases of cerclage-related genitourinary fistulas. This information may be useful when evaluating and counseling patients.

Previous cerclage, any previous cervical procedures, and use of the McDonald technique are common factors in cases of cerclage-related genitourinary fistulas.

From the *Walter Reed National Military Medical Center, Department of Obstetrics and Gynecology, Bethesda, MD; and †Inova Fairfax Hospital, Department of Obstetrics and Gynecology, Falls Church, VA.

Reprints: Jason Carlisle Massengill, MD, Maj, MC, USAF, Walter Reed National Military Medical Center, Department of Obstetrics and Gynecology, 8901 Wisconsin Ave, Bethesda, MD 20889. E-mail: Jason.massengill@gmail.com.

The authors have declared that there are no conflicts of interest.

Presented at the 38th Annual Meeting of the Society of Gynecologic Surgeon’s Scientific Meeting, April 13-15, 2012, Baltimore, MD (abstract only).

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Departments of the Army, Navy, Air Force, or the Department of Defense.

© 2012 by Wolters Kluwer Health | Lippincott Williams & Wilkins