Management of urethrovaginal fistulas

Abstract

Objectives: Despite the apparent similarity, urethrovaginal fistulas (UVFs) are not identical to vesicovaginal defects. Obstetric trauma and vaginal surgery are the causes of a majority of urethrovaginal fistulas.

Methods: Careful preoperative evaluation is essential for identifying small UVFs or associated vesicovaginal fistulas and includes physical examination, cystourethroscopy, intravenous pyelography, ultrasonography, and urinalysis, but sometimes the final surgical plan can only be decided on after the patient is examined under anaesthesia with a metal sound in the urethra. Significant tissue deficit is the main characteristic of UVF repair and the minimal space present often does not allow placing any additional tissue between the urethral and vaginal walls.

Results: Seventy-one women (mean age, 43 yr) with UVFs have been treated in our clinic. Our results have shown successful closure of the fistula in 90.14% of patients after primary surgery and 98.59% after a second operation. Postoperative stress urinary incontinence developed in 37 patients (52.11%). We used both synthetic and autologous slings for their management. Twenty-two patients (59.46%) were cured, 12 (32.43%) were improved, and 3 remained incontinent (8.11%). The long-term results of 21 patients with mean follow-up time of 99.6 mo show no fistula recurrence. Postoperative bladder outlet obstruction (5.63%) was successfully managed by urethral dilation or urethrotomy.

Conclusions: This article gives a detailed description of UVF surgical treatment. An attached DVD demonstrates one case that includes UVF primary repair, recurrent fistula repair, and surgery for continence restoration.