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Management of Vesicovaginal Fistulae: A Multicenter Analysis From the Fellows Pelvic Research Network

Oakley, Susan H. MD*; Brown, Heidi W. MD; Greer, Joy A. MD, CDR, MC, USN‡§; Richardson, Monica L. MD, MPH; Adelowo, Amos MD; Yurteri-Kaplan, Ladin MD#; Lindo, Fiona M. MD, MPH**; Greene, Kristie A. MD††; Fok, Cynthia S. MD, MPH‡‡; Book, Nicole M. MD§§; Saiz, Cristina M. MD∥∥; Plowright, Leon N. MD##; Harvie, Heidi S. MD, MSCE; Pauls, Rachel N. MD*

Female Pelvic Medicine & Reconstructive Surgery:
doi: 10.1097/SPV.0000000000000041
Fellows Article
Abstract

Objectives: Vesicovaginal fistulae (VVF) are the most commonly acquired fistulae of the urinary tract, but we lack a standardized algorithm for their management. The purpose of this multicenter study was to describe practice patterns and treatment outcomes of VVF in the United States.

Methods: This institutional review board–approved multicenter review included 12 academic centers. Cases were identified using International Classification of Diseases codes for VVF from July 2006 through June 2011. Data collected included demographics, VVF type (simple or complex), location and size, management, and postoperative outcomes. χ2, Fisher exact, and Student t tests, and odds ratios were used to compare VVF management strategies and treatment outcomes.

Results: Two hundred twenty-six subjects were included. The mean age was 50 (14) years; mean body mass index was 29 (8) kg/m2. Most were postmenopausal (53.0%), nonsmokers (59.5%), and white (71.4%). Benign gynecologic surgery was the cause for most VVF (76.2%). Most of VVF identified were simple (77.0%). Sixty (26.5%) VVF were initially managed conservatively with catheter drainage, of which 11.7% (7/60) resolved. Of the 166 VVF initially managed surgically, 77.5% resolved. In all, 219 subjects underwent surgical treatment and 83.1% of these were cured.

Conclusions: Most of VVF in this series was managed initially with surgery, with a 77.5% success rate. Of those treated conservatively, only 11.7% resolved. Surgery should be considered as the preferred approach to treat primary VVF.

In Brief

Simple primary vesicovaginal fistulae are usually treated with early surgical intervention, with successful outcomes.

Author Information

From the *Division of Urogynecology and Pelvic Reconstructive Surgery, Good Samaritan Hospital, Cincinnati, OH; †Division of Female Pelvic Medicine and Reconstructive Surgery, UC San Diego Health System & Kaiser Permanente, San Diego, CA; ‡Division of Urogynecology and Pelvic Reconstructive Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA; §Naval Medical Center, Portsmouth, VA; ∥Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Ob/Gyn and Urology, Stanford University School of Medicine, Stanford, CA; ¶Division of Urogynecology, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA; #Section of Female Pelvic Medicine and Reconstructive Surgery, Medstar Washington Hospital Center/Georgetown University School of Medicine, Washington, DC; **Female Pelvic Medicine and Reconstructive Surgery, Scott & White Hospital/Texas A&M Health Science Center, Temple, TX; ††Division of Urogynecology, University of South Florida, Tampa, FL; ‡‡Female Pelvic Medicine and Reconstructive Surgery, Loyola University Medical Center, Maywood, IL; §§Center for Female Pelvic Surgery, Riverside Methodist Hospital, Columbus, OH; ∥∥Institute for Female Pelvic Medicine and Reconstructive Surgery, Allentown, PA; and ##Division of Urogynecology and Reconstructive Pelvic Surgery, Cleveland Clinic Florida, Weston, FL.

Reprints: Susan H. Oakley, MD, Cincinnati Urogynecology Associates, Good Samaritan Hospital, 3219 Clifton Ave, Medical Office Building Suite 100, Cincinnati, OH 45220. E-mail: susan_oakley@trihealth.com.

Reprints will not be made available.

The authors have declared they have no conflicts of interest.

Disclaimers: Joy A. Greer, MD, CDR, MC, USN - CDR Greer is a military service member. This work was prepared as part of her official duties. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the US Government.

Presented at the Society of Gynecologic Surgeons’ 39th Annual Scientific Meeting, April 2013, Charleston, SC.

This study was funded by the TriHealth Medical Education Research Fund, Cincinnati, OH, with support from the Fellows’ Pelvic Research Network as part of the Society of Gynecologic Surgeons.

© 2014 by Lippincott Williams & Wilkins