The outcomes of urethrovaginal fistula repair
BAUS ePoster online library. Barratt R. Jun 27, 2018; 211397; P10-9
Ms. Rachel Barratt
Ms. Rachel Barratt
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Abstract
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Introduction: Urethrovaginal fistulae (UVF) are rare in the developed world. We report the outcomes of our cohort undergoing UVF repair at a genitourinary fistulae specialist centre.

Patients and Methods: A prospectively acquired database of patients with genitourinary fistulae was analysed. 24 patients had surgical repair of UVF over 11 years (2004-2015). Median age was 53.3 years (range 26-78). All patients had pre-operative cystourethroscopy and video-urodynamics (VUDs), except 2 with concurrent vesicovaginal fistulae (VVF). Post-operative urinary incontinence (UI) was investigated with repeat VUDs.

Results: Aetiology of UVF is outlined in Table 1. 23 (95.8%) patients underwent transvaginal repair of UVF with Martius fat pad interposition. Successful anatomical closure was achieved in 100%. Pre-operative VUDs revealed 13.7% (3/22) had stress UI (SUI) and 13.7% (3/22) had mixed UI (MUI) - all had persistent post-operative UI. Persistent MUI was successfully managed with rectus fascial sling (n=3) and intravesical botulinum toxin (n=2) or sacral neuromodulation (n=1). Persistent SUI was treated successfully with rectus fascial sling (n=2). 1 patient had a TVT-O which failed. Of the remaining transvaginal repair cohort, 2 patients had new-onset post-operative SUI treated successfully with laparoscopic colposuspension. The final patient had a complex urethra-vesico-vaginal fistula and underwent clam ileocystoplasty, bladder neck closure and mitrofanoff channel formation. Continence and channel function are preserved after 13 years.

Conclusion: UVF are rare with varying aetiology including MUT insertion. Vaginal repair of UVF is feasible for the majority of cases. Persistent and new-onset UI occurs in 34.8% and requires surgical treatment with success rates of 87.5%.
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