CHARLESTON, S.C. – Most simple vesicovaginal fistulae are initially managed by surgery, which is successful in the majority of cases, according to a multicenter review from the Fellows’ Pelvic Research Network.
Conversely, most of those initially managed conservatively by catheter drainage fail to resolve.
Of 226 patients with vesicovaginal fistulae (VVF) included in the review, 166 were managed surgically at the outset, and 77.5% of these resolved with one surgery. Of 37 who did not resolve after initial surgery, 32 underwent a second surgery; 56% of these resolved, Dr. Susan H. Oakley reported at the annual meeting of the Society of Gynecologic Surgeons.
Of the 60 patients who were managed conservatively, only 12% resolved during a median duration of catheterization of 35 days. The 53 who did not resolve went on to have surgery; the majority of these patients resolved. The overall success rate in the study was 83% in the 219 who underwent surgery, said Dr. Oakley of Good Samaritan Hospital, Cincinnati.
The patients (mean age, 49.5 years) were treated for VVF at 1 of 12 participating academic medical centers between July 2006 and June 2011. Most patients were postmenopausal (53%), nonsmokers (59.5%) and white (71%).
Of those initially managed surgically, 41% underwent vaginal repair, 23% underwent abdominal repair, and the remaining patients underwent other types of repair such as electrocautery. Of those initially managed conservatively who underwent subsequent surgery, 41% underwent vaginal repair, 53% underwent abdominal repair, and the remaining patients underwent other types of repair.
"VVF are the most common acquired fistulae of the urinary tract, and in the United States, gynecologic surgery is often the cause. Regardless of the etiology, the physical and emotional effects on patients are profound," Dr. Oakley said, adding that because a standardized algorithm for the management of VVS is lacking, the purpose of this study was to describe practice patterns and treatment outcomes for VVF.
While conservative management is often suggested as first-line therapy, it has been unclear how often this strategy is successful, she said at the meeting, jointly sponsored by the American College of Surgeons.
Although limited by its retrospective nature and by missing data that prevented complete analysis of all of the variables of interest, the study does have several strengths, including the multicenter design and a large number of cases. The findings thus support a recommendation that early surgical management should be considered as the preferred approach to treating simple VVF, Dr. Oakley concluded.
She reported having no relevant financial disclosures.