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Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (4): 675-679. doi: 10.19723/j.issn.1671-167X.2021.04.009

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Prognostic factors for failure of transvaginal repair of vesicovaginal fistula: A nested case-control study

YANG Yang,CHEN Yu-ke,CHE Xin-yan,WU Shi-liang()   

  1. National Urological Cancer Center, Beijing 100034, China
  • Received:2021-03-12 Online:2021-08-18 Published:2021-08-25
  • Contact: Shi-liang WU E-mail:wushiliangjsh@263.net
  • Supported by:
    National Key Research and Deve lopment Program of China(2018YFC2002204)

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Abstract:

Objective: To analyze the prognostic factors affecting the failure of transvaginal repair of vesicovaginal fistula (VVF). Methods: A retrospective nested case-control study was conducted. A total of 15 patients who underwent unsuccessful transvaginal vesicovaginal fistula repair in the Department of Urology, Peking University First Hospital from January 2014 to December 2020 were enrolled as the case group. A total of 60 patients receiving transvaginal vesicovaginal fistula repair by the same surgeon within the same time range, were selected as the control group. The age, body mass index (BMI), etiology of vesicovaginal fistula, associated genitourinary malformation, frequency of repair, characteristics of fistula, surgical procedure, postoperative recovery and other factors were compared between the case group and the control group, and the influencing factors of failure were analyzed. Results: The BMI of the case group was (26.3±3.9) kg/m2, the diameter of vaginal fistula was (1.5±0.8) cm, and the operative time of transvaginal repair was (111.8±19.8) min. The proportion of the patients with genitourinary malformations was 4/15, the proportion of the patients with multiple vaginal repairs was 13/15, the proportion of the patients with concurrent ureteral reimplantation was 6/15, and the proportion of the patients with postoperative fever was 5/15. In the control group, the BMI was (23.9±3.0) kg/m2, the diameter of vaginal fistula was (0.8±0.5) cm, the operative time of transvaginal repair was (99.9±19.7) min, the rate of associated genitourinary malformation was 2/60, the rate of multiple transvaginal repair was 18/60, the rate of concurrent ureteral reimplantation was 5/60, and no postoperative fever was found. Compared with the control group, the case group had higher BMI (P=0.013), bigger vaginal fistula (P=0.002), longer time of operation (P=0.027), higher proportion of genitourinary malformations (P=0.013), higher proportion of repeated transvaginal repair (P<0.001), higher proportion of ureter reimplantation (P=0.006), and higher proportion of postoperative fever (P<0.001). Multivariate analysis showed that fistula diameter ≥1 cm (OR=10.45, 95%CI=1.90-57.56, P=0.007) and repeated transvaginal repair (OR=16.97, 95%CI=3.17-90.91, P=0.001) were independent prognostic factors for VVF failure in transvaginal repair. Conclusion: Fistula diameter ≥1 cm and repeated transvaginal repair are independent prognostic factors of failure in transvaginal repair.

Key words: Vesicovaginal fistula, Transvaginal repair, Nested case-control study

CLC Number: 

  • R694.6

Table 1

Univariate analysis of prognostic factors for failure of transvaginal VVF repair"

Items Case group (n=15) Control group (n= 60) t/χ2 OR (95%CI) P
BMI/(kg/m2), $\bar{x}±s$ 26.3±3.9 23.9±3.0 2.54 0.013
Fistula diameter/cm, $\bar{x}±s$ 1.5±0.8 0.8±0.5 3.55 0.002
Operation time/min, $\bar{x}±s$ 111.8±19.8 99.9±19.7 2.27 0.027
Associated genitourinary malformation, n 4 2 8.88 8.00 (1.62-39.64) 0.013
Repeated transvaginal repair, n 13 18 15.89 2.89 (1.87-4.46) <0.001
Ureter reimplantation, n 6 5 9.62 4.80 (1.69-13.63) 0.006
Absence of fever, n 10 60 21.43 0.67 (0.47-0.95) <0.001
Age/years, $\bar{x}±s$ 49.3±8.1 48.7±7.8 0.26 0.793
Follow-up time/months, $\bar{x}±s$ 36.5±25.3 36.9±22.5 -0.06 0.950
Depth of fistula/cm, $\bar{x}±s$ 6.3±1.4 6.6±1.1 -1.07 0.287
Modified Latzko technique, n 8 39 0.70 0.82 (0.49-1.36) 0.403
With other diseases, n 6 22 0.06 1.09 (0.54-2.20) 0.811
Urine culture positive, n 3 4 2.52 3.00 (0.75-12.00) 0.138
Menopause, n 13 52 0.00 1.00 (0.80-1.25) >0.999

Table 2

Multivariate analysis of prognostic factors for failure of transvaginal VVF repair"

Items Partial regression coefficient Standard error Wald χ2 OR (95%CI) P
Fistula diameter≥1 cm 2.35 0.87 7.27 10.45 (1.90-57.56) 0.007
Repeated transvaginal VVF repair 2.83 0.86 10.93 16.97 (3.17-90.91) 0.001
Constant term -0.50 0.48 1.12 0.60 0.290
[1] Tancer ML. Observations on prevention and management of vesicovaginal fistula after total hysterectomy [J]. Surg Gynecol Obstet, 1992, 175(6):501-506.
[2] Symmonds RE. Incontinence: Vesical and urethral fistulas [J]. Clin Obstet Gynecol, 1984, 27(2):499-514.
pmid: 6744702
[3] Kieserman-Shmokler C, Sammarco AG, English EM, et al. The Latzko: A high-value, versatile vesicovaginal fistula repair [J]. Am J Obstet Gynecol, 2019, 221(2): 160.e1-160.e4.
doi: 10.1016/j.ajog.2019.05.021
[4] Singh V, Sinha RJ, Sankhwar SN, et al. Transvaginal repair of complex and complicated vesicovaginal fistulae [J]. Int J Gynaecol Obstet, 2011, 114(1):51-55.
doi: 10.1016/j.ijgo.2011.01.015
[5] Luo DY, Shen H. Transvaginal repair of apical vesicovaginal fistula: A modified Latzko technique-outcomes at a high-volume referral center [J]. Eur Urol, 2019, 76(1):84-88.
doi: 10.1016/j.eururo.2019.04.010
[6] 陈宇珂, 杨洋, 虞巍, 等. 经阴道和经腹术式治疗复杂型膀胱阴道瘘的经验总结 [J]. 中华泌尿外科杂志, 2017, 38(10):737-740.
[7] Gerber GS, Schoenberg HW. Female urinary tract fistulas [J]. J Urol, 1993, 149(2):229-236.
doi: 10.1016/S0022-5347(17)36045-7
[8] Chen Y, Yu W, Yang Y, et al. Repair of complex vesicovaginal fistulas by combining a rotational bladder flap and full thick vascular peritoneal interposition [J]. Neurourol Urodyn, 2016, 35(8):934-938.
doi: 10.1002/nau.v35.8
[9] Theofanides MC, Sui W, Sebesta EM, et al. Vesicovaginal fistulas in the developed world: An analysis of disease characteristics, treatments, and complications of surgical repair using the ACS-NSQIP database [J]. Neurourol Urodyn, 2017, 36(6):1622-1628.
doi: 10.1002/nau.v36.6
[10] Zimmern PE, Hadley HR, Staskin DR, et al. Genitourinary fistulae. Vaginal approach for repair of vesicovaginal fistulae [J]. Urol Clin North Am, 1985, 12(2):361-367.
doi: 10.1016/S0094-0143(21)01649-9
[11] 王世军, Oli M, 蒋励, 等. 女性生殖管道发育异常225例临床分析 [J]. 中华妇产科杂志, 2008, 43(07):493-496.
[12] Passos I, Britto RL. Diagnosis and treatment of müllerian malformations [J]. Taiwan J Obstet Gynecol, 2020, 59(2):183-188.
doi: 10.1016/j.tjog.2020.01.003
[13] 洪丽华, 金杭美. 女性生殖道畸形患者发生泌尿系统畸形的临床特点分析 [J]. 中华妇产科杂志, 2004, 39(8):15-18.
[14] Özkaya F, Cinislioğlu AE, Aksoy Y, et al. Vesicovaginal fistula repair experiences in a single center high volume of 33 years and necessity of cystostomy [J]. Turk J Urol, 2021, 47(1):66-72.
[15] El-Azab AS, Abolella HA, Farouk M. Update on vesicovaginal fistula: A systematic review [J]. Arab J Urol, 2019, 17(1):61-68.
doi: 10.1080/2090598X.2019.1590033
[16] Hilton P, Ward A. Epidemiological and surgical aspects of uroge-nital fistulae: A review of 25 years’ experience in southeast Nigeria [J]. Int Urogynecol J Pelvic Floor Dysfunct, 1998, 9(4):189-194.
pmid: 9795822
[17] Capes T, Stanford EJ, Romanzi L, et al. Comparison of two classification systems for vesicovaginal fistula [J]. Int Urogynecol J, 2012, 23(12):1679-1685.
doi: 10.1007/s00192-012-1671-9 pmid: 22273816
[18] Nsambi J, Mukuku O, Kakudji P, et al. Model predicting failure in surgical repair of obstetric vesicovaginal fistula [J]. Pan Afr Med J, 2019, 16(34):91.
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